AMA #5: Intrusive Thoughts, CGMs, Behavioral Change, Naps & NSDR

ANDREW HUBERMAN: Welcome to the Huberman Lab podcast

where we discuss science and science-based tools

for everyday life.

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I'm Andrew Huberman, and I'm a professor

of neurobiology and ophthalmology

at Stanford School of Medicine.

Today is an Ask Me Anything episode or AMA.

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And now without further ado, I will answer your questions.

And as always, I will strive to be

as thorough as possible, as clear as possible,

and as concise as possible.

Our first question is about abstaining from thoughts.

And in answering this question, we're

going to skirt right up against a topic

that I've covered before on the podcast which

is obsessive compulsive disorder, which

is a very serious disorder.

I mean, it can have a range of severity,

but people with true OCD suffer a lot

from obsessions, these are intrusive thoughts,

and compulsions, which are the behaviors typically associated

with those thoughts.

I think it's really important that we define

OCD really clearly so that we can make sure

that we're talking about intrusive thoughts

and the desire to abstain from thoughts versus OCD

and where there might be some overlap there.

The functional definition of OCD that really pertains

to the disorder, obsessive compulsive disorder,

OCD as opposed to we call people neurotic,

or we say you have OCD, or I'm so

OCD about this, or OCD about that,

that's become a common use of the acronym OCD.

But true OCD is a situation in which

engaging in a particular compulsive behavior

does not serve to reduce the intensity or the frequency

of the obsessions.

In fact, it makes it worse.

So the typical thing that we hear these days

is oh, you're so OCD, or he's so OCD, or she's so OCD,

or I'm so OCD.

Now if someone is OCD in that sense, OK, so not

the clinical disorder but OCD in the sense

that they're really clean, they're really fastidious,

they need everything perfect.

However, that person can achieve some level of calm and comfort

that's fairly long lasting if everything's

clean and perfect, well, then that's not

obsessive compulsive disorder.

This is really important to understand

as we venture into answering the question

about intrusive thoughts and the desire

to abstain from certain thoughts.

A person with true OCD will keep cleaning and cleaning,

or washing their hands, or arranging things

at perfect right angles, but the more they

do it, the more their anxiety goes up.

A person who has more typical, gosh, we don't really even

have a language for this nowadays unfortunately,

but the sort of person that's extremely particular, they need

things a certain way, and they're very driven to resolve

things and do things to make sure that things are done

in a certain way, or handled in a certain way,

well, if that person can experience relief

from engaging in let's say, exercise, or from cleaning,

you'd say you're so OCD about exercise.

Well, but if exercising for an hour or even two hours

in the morning make somebody really calm the rest of the day

and they don't need to exercise well,

then they're not necessarily true OCD.

They don't necessarily have a disorder related to exercise.

However, if they're exercising for two hours in the morning

and then they find they can't concentrate

on other things and their desire to exercise just increases

and increases and becomes intrusive for them disrupting

their quality of life throughout the day,

well, then that's falling under the umbrella of what

we would call a true disorder.

So we want to highlight that because the question is

about a desire to abstain from thoughts,

and the question is, in your discussion

with Dr. Anna Lembke-- and I should just

mention Dr. Anna Lembke is the director of our Dual Diagnosis

Addiction Clinic at Stanford University School of Medicine.

She's the author of this incredible book Dopamine Nation

that I think everybody should read.

I do believe everyone should read that book.

So important for the addict and nonaddict

alike because it deals with basically the state of our life

nowadays.

We're living in this dopamine rich world

where we can quickly become dopamine depleted, which

is terrible, leads to depression in addition to things

like addiction in some folks, et cetera.

Anna was a guest on the podcast.

You can find her episode at hubermanlab.com.

Just put Anna.

I think she's the only guest we've

had thus far whose name is Anna, so it'll just pop up there.

The entire website is searchable.

But if you want to listen to that episode

or watch that episode, you can access it hubermanlab.com.

The question is in your discussion

with Dr. Anna Lembke you were talking about abstaining

from people's drug of choice for 30 days

to reset the dopamine reward pathway.

And indeed that is the prescriptive that Dr. Anna

Lembke gives for most all addictions

and for people that are suffering from milder even

severe depression related to dopamine

seeking behaviors, social media, video games, sex, food,

et cetera.

However, of course, in the instance of food

or in some other addictions, you can't abstain for 30 days.

That would be terrible to abstain for food for 30 days.

I'm sure people have done it, but it is not healthy to do.

Certain things like alcohol and drugs people

can abstain for 30 days in efforts

to never go back to them again.

There are cases of severe alcohol or opiate

dependence where people can't go cold turkey or they risk dying,

so there they need to really work with a physician.

But the 30-day reset of the dopamine system

is something that's very real and that

pertains to most people.

That is it's going to be very effective for most

people struggling with either behavioral,

or what are sometimes called process addictions,

or other types of addictions including substance abuse

issues.

The question continues.

You said you were going to ask Ana

how to abstain if your drug of choice

is a thought or narrative as opposed

to a substance or a behavior.

The question continues, as far as I can tell,

your discussion with Ana moved on

before you asked her the question.

Would you be able to discuss strategies

for abstaining from addictive thoughts and narratives?

OK.

So let's talk about intrusive thoughts,

and let's start off by asking ourselves, what is a thought?

In the realm of neurobiology, we have

sensations which are the processes by which our neurons,

nerve cells convert light, photons, sound waves, touch,

mechanical pressure, et cetera into electrical signals

and chemical signals that head into our nervous system,

including our brain.

And then our brain, at least we think, make sense of them,

and help us navigate the world that we're in.

So the sensation part is a pure transformation

of mechanical information, or in some cases,

chemical information like smell.

Literally, volatile chemicals floating around in the world

are brought in through your nose and your neurons

and your olfactory bulb convert those

into electrical and chemical signals

that your brain can understand.

Perceptions are your idea of what those signals out

in the world are.

Either because you're paying attention

to them, or for some other reason you decide

that stop sign in front of you is red,

and that the sign behind it is white,

and that the sky is blue or cloudy, those are perceptions.

So we have sensations and perceptions.

Then we have emotions which are these things that

include the mind and body that are related

to neuromodulators like dopamine, serotonin, et cetera,

although, those chemicals do other things as well.

And then, of course, we have behaviors, actions.

Everything from me moving my pen on a piece of paper

to walking, running, et cetera.

Thoughts are a fifth category of neural

functioning that we really need to define,

but that doesn't have as strict a definition

as sensations, perceptions, or feeling, or action.

But thoughts are real.

We all know this.

Thoughts are real, and one way that we can define thoughts

is that thoughts are perceptions that include data

from the past, present, or future, or combinations

of past and present, or present and future, or future and past.

I'm not trying to give an overly complicated definition here,

but if we are going to answer a question about how

to abstain from thoughts in a really

direct and actionable way, we really

need to address what our thoughts.

So thoughts are perceptions that are generated internally.

We don't need any external sensation

in order to have a thought.

We can close our eyes.

We could be in sensory isolation for that matter.

We could even be floating with no gravity,

and we can have a thought.

Thoughts tend to run pretty much automatically in the background

all the time.

Some people refer to this as chatter

in the back of our minds in a very unstructured way.

And then if we force our thoughts

to be structured because we decide they need to be,

or if something in our environment

captures our perception, then our thoughts

tend to be structured.

Let me give you an example.

If I'm just walking around, if there

were a way in which we could broadcast

my thoughts onto a screen, I hope we wouldn't do that.

But those thoughts would be a mixture

of semi-complete sentences and gibberish.

However if somebody stops me, and says, hi.

Good to see you.

What are you doing today?

And I start answering, well, then my thoughts

are suddenly being driven by an external stimulus,

their question, and some internal ideas, memory

of who I am and what I'm doing that day so

past and present, and so on.

And so thoughts become structured.

So when we have a question about how to abstain from thoughts,

we need to be additionally specific

and really pinpoint that what we're trying to do

is to abstain from thoughts we don't want presumably, either

because they are too repetitive and distracting,

or because what's contained in those thoughts is disturbing.

This is important because it gives us two answers

to the questions that are highly divergent.

One answer to the question of how

to abstain from intrusive thoughts, thoughts that

were addicted to, is if those thoughts are merely

on loop all the time and we can't stop them,

but the thoughts themselves aren't particularly disturbing.

So think about a song you can't get out of your head,

or you keep recounting some event,

but the event itself isn't very disturbing.

It's just intrusive because it's there.

Well, in that case, the data really

point to trying to anchor your thoughts

to some external stimulus.

So getting into action, getting into activities

that really draw your attention away from that thought.

Now you may still hear it scrolling in the background,

so you might be sitting in class still hearing that loop

of thoughts in the background.

That's something that over time ought to wane,

it ought to disappear if we try and bring

more and more attention to whatever it

is that's in our environment, whatever

it is that we happen to be learning or doing physically,

et cetera.

Things like mindful meditation.

Doing a 10 or even just 5 minute a day

practice of sitting with eyes closed,

or lying down with eyes closed and really focusing

on one's breath, focusing one's attention on sometimes

called the third eye center, but in science we'd

say just the region right behind the forehead,

you're directing your attention there,

has been shown to increase focus for singular topics

and can improve memory and do a bunch of other things as well.

Those are data from Dr. Wendy Suzuki's lab at New York

University.

She was a guest on the podcast as well.

My laboratory has run studies on mindful meditation as well.

So what you're really trying to do

is learn how to focus better on one thing,

and by focusing on that one thing,

you focus off these repetitive thoughts.

Now, I have a feeling that this question was asked

and that many people upvoted this question

because the issue isn't just thoughts that

are intrusive because they're there and on repeat,

but because the thoughts themselves are actually

troubling.

This could be recounting a trauma, someone harmed you,

you observed something that was disturbing, you felt wronged,

you felt someone else was wronged,

you can't seem to get your mind off of something,

and your emotions tend to follow,

and so it's uncomfortable.

I have a feeling this is the root of the question.

In that case, the approach is very different.

What we know from essentially all of the quality

scientific and clinical studies is

that those sorts of intrusive thoughts

are very much like a trauma.

Now we have to be clear in defining what trauma is.

I'll use the definition that Dr. Paul

Conti, another incredible guest that was on our podcast.

A Stanford-Harvard trained psychiatrist.

I think one of the world's foremost leaders

on the issue of trauma and psychiatry and psychology

generally.

He defines trauma as an event or something that fundamentally

changes the way that your nervous system works such

that you function less adaptively going forward

from that event.

So not every bad occurrence in your life is a trauma.

That's good news.

The bad news is many people have traumas,

and traumas change the way that our nervous system

works so that we don't function as well as we could.

So in that sense, intrusive thoughts that are disturbing

are in many ways traumas and are reinforcing that trauma.

Now, we know that almost counterintuitively

in order to deal with trauma, you

have to get very close to that trauma.

You don't have to reexpose, and I

would hope you would not reexpose yourself

to the very same trauma.

But we know that one of the best ways to deal with traumas

is to get very clear about the narrative around those traumas.

Now this can be done with a therapist ideally,

but not everyone has access to therapy or can afford therapy.

There's a range of quality of therapists for that matter,

so we're always referring to the desire for people

to do great therapy with really great,

meaning excellently trained people.

But it turns out that if you want to extinguish an intrusive

thought, one of the best ways to do that

is to journal about that particular thought extensively.

So rather than the earlier strategy for intrusive thoughts

where they're just on loop, and intrusive

because they're on loop and present,

but their content isn't disturbing,

when that thought is disturbing and intrusive,

we know that it's very useful to script out

as much detail about that particular thought

and the things around it as possible.

Now obviously, you want to do this in a way that

is fairly structured.

So you ideally would use complete sentences.

So the reason for doing that is that thoughts,

as I mentioned earlier, can often be fragmentary.

So they pop up in our mind almost

we seemingly spontaneously.

They're inhibiting our ability to focus,

or be present at work, or family, or other things,

or sleep.

Writing things down in a lot of detail

does seem to have this quality of both reducing

the emotional load of whatever it is that thought is about,

as well as diminishing the frequency of those intrusive

thoughts over time.

So this is far and away different than the strategy

I mentioned for the other types of intrusive thoughts.

And really it's far and away different

from the 30-day abstinence approach

that Dr. Anna Lembke was talking about for substance

or behavioral addictions.

Now, of course, this process of abstaining from thoughts

or removing the addictive nature of certain thoughts

can definitely take some time.

So a good example there would be superstitions.

I'll come clean here, and I've talked

about this before on a few podcasts

that when I was in college, I developed

a knock on wood superstition.

Any time I'd say something that I didn't want to happen or did

want to happen, I'd say, knock on wood, and I'd knock on wood.

And then I started suppressing the behavior mostly

because it was a little embarrassing.

And then I started just telling myself in my head,

knock on wood, knock on wood, knock on wood.

And it was clearly a little bit of an OCD type thing,

but again, OCD in air quotes here.

I think it qualified as OCD in the sense

that the more I did it, the more I wanted to do it.

So I needed to go cold turkey on the thinking,

but how can you go cold turkey on a thought?

You couldn't.

What I was told to do and what worked very well for me

was to just write down the worst possible outcome

that I was concerned about.

So to really get close to the nature or the underlying basis

of that intrusive thought.

And I raise this because a lot of times

the intrusive thought is not, OK, I'm

thinking about a car accident, or I'm

thinking about a breakup, or I'm thinking about an exam

that I have.

That can be intrusive, but a lot of times

it's some kind of nebulous, abstract,

set of words, or ideas, or images around something

that happened that we saw or heard or experienced.

And by putting a lot of clear structure

to what the thought is exactly and to putting some thought

and structure onto paper about what that pattern of not

healthy thinking relates to, people often

achieve tremendous relief in a fairly short amount of time.

Sometimes just in one session of writing it down,

sometimes they need to write it down multiple times.

What you're essentially trying to do with a intrusive thought

or a trauma of any kind is you're

trying to turn a disturbing story, that is a story that

evokes a lot of emotion and captures,

it hijacks your nervous system, into what is essentially

a known but repetitive and old, boring story

where the emotional load has been depleted.

And there are, of course, I have to highlight the fact

that getting sufficient rapid eye movement sleep we also know

is very important for removing the emotional load

of traumatic experiences and intrusive thoughts.

So you really want to strive to get the best possible sleep you

can.

That includes sufficient rapid eye movement sleep.

And we have multiple zero-cost resources

for that at hubermanlab.com.

We have the episode on mastery or sleep.

We have the episode on perfecting your sleep.

We have the toolkit for sleep.

All of which are time stamped and all of which

can be accessed to completely zero cost to try and get

your sleep as good as possible, including lots

of rapid eye movement sleep.

So in order to remove intrusive and addictive thoughts,

ask yourself, is this OCD of the classic sense?

If it is, you should see a psychiatrist.

They won't necessarily prescribe medication,

but there are tools for true OCD that are

very effective in many cases.

And we did the episode on OCD which I invite

you to listen to as well.

You want to ask yourself, are the thoughts

disturbing or merely intrusive and repetitive?

If they're merely intrusive and repetitive, well,

then learning to focus your attention on other things

and getting better at focusing on single things

through an exercise like mindfulness,

meditation can really help.

And indeed perhaps the best use of mindfulness meditation

is to improve your level of focus.

It does have other benefits as well,

but that's going to be the major one that one will experience

even with these very short 5 or 10-minute day meditations.

Great data on that from the scientific literature.

And then if those intrusive thoughts are not only intrusive

but they're also disturbing, in that case,

you really want to put as much structure and thought,

believe it or not, into what those thoughts are

really about.

Write them out on paper in complete sentences

and maybe do that multiple times until the underlying

emotions related to those thoughts

really start to diminish.

And by doing that, you're essentially

doing your own form of trauma therapy,

for lack of a better way to put it.

And again, the data really point to the fact

that getting close to the specific details

around those intrusive thoughts is

going to be the best way to extinguish them.

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