Welcome to Huberman Lab Essentials,

where we revisit past episodes for the

most potent and actionable science-based

tools for mental health, physical

health, and performance.

I'm Andrew Huberman and I'm a professor

of neurobiology and opthalmology at

Stanford School of Medicine. Today we

are talking about obsessivempulsive

disorder or OCD. First of all, as the

name suggests, OCD includes thoughts or

obsessions and compulsions which are

actions. The obsessions and the

compulsions are often linked. In fact,

most of the time the obsessions and the

compulsions are linked such that the

compulsion, the behavior is designed to

relieve the obsession. However, one of

the hallmark themes of

obsessivecompulsive disorder is that the

obsessions are intrusive. People don't

want to have them. They don't enjoy

having them. They just seem to pop into

people's minds and they seem to pop into

their mind recurrently. And the

compulsions unlike other sorts of

behaviors provide brief relief to the

obsession but then very quickly

reinforce or strengthen the obsession.

OCD is extremely common. In fact,

current estimates are that anywhere from

2.5% to as high as three or even 4% of

people suffer from true OCD. That is an

astonishingly high number. Another thing

to point out is that OCD is currently

listed as number seven in terms of the

most debilitating illnesses. Not just

mental illnesses or disorders, but all

types of illnesses, including things

like asthma and cancer, etc. So, you can

imagine with that standing at number

seven that it is both extremely common

and extremely debilitating. And as a

consequence, it's now realized that many

hours, days, weeks, months, or even

years of work performance or showing up

at work of relational interactions

really suffer as a consequence of people

having OCD. With recurrent intrusive

thoughts happening at very high

frequency or even at moderate frequency,

people are spending a lot of time

thinking about this stuff and they're

thinking about the behaviors they need

to engage in and then engaging in the

behaviors which, as I mentioned before,

just serve to strengthen the

compulsions. And so they're not actually

doing the other things that make us

functional human beings like commuting

to work or doing homework or doing work

or listening when people are talking or

interacting or sports or working out.

All the things that make for a rich

quality life are taken over by OCD in

many cases. Another thing you'll soon

learn is that sadly a lot of the

obsessions and compulsions in OCD often

relate to taboo topics. And that's

because the general categories of OCD

fall into three different bins. checking

obsessions and compulsions, repetition

obsessions and compulsions, and order

obsessions and compulsions. The checking

ones are somewhat obvious, checking the

stove or checking the locks. Repetition

obsessions and compulsions obviously can

dovetail with the the checking ones, but

those tend to be things like counting

off of a certain number of numbers like

1 2 3 4 5 6 7 6 5 4 3 2 1. People

perform that repeatedly, repeatedly

repeatedly or feel that they have to. So

we have checking, we have repetition,

and then there's order. Order often

times is thought of as putting

cleanliness or making sure everything is

aligned and perfect and orderly. And

often times that is the case. But there

are other forms of order that people

with OCD can focus on in a obsessive and

compulsive way. Things like

incompleteness, the idea that one can't

walk away from something or stop doing

something because something's not right

or complete in that picture. It could be

the way the table is set. It could be

the way that something's written on a

page. It could be an email. It can also

be in terms of symmetry that everything

be aligned and symmetric in some way.

This could be uh seen perhaps in young

kids. This is one example that I read in

the literature of children that need to

arrange their stuffed animals in exact

same order every day and in a particular

order uh to the point where if you were

to move the little stuffed frog over

next to the stuffed rabbit that the

child will have a an anxiety reaction to

that and feel literally compelled driven

to fix that maybe even multiple times

over and over again. And then the other

aspect of order which is a little bit

less than intuitive is this notion of

disgust. This idea that something is

contaminated. So we often think about

OCD and handwashing behavior in response

to people feeling that something is

contaminated, a space, a towel, etc. or

even simply somebody else's hand and so

they're unwilling to shake somebody's

hand. You can imagine how these

different bins of obsessions and

compulsions, checking, repetition, and

order could be extremely debilitating

depending on how severe they are and how

many different domains of life they show

up in. And I know I've said it multiple

times now, but I'm going to say it many

times throughout this episode in a

somewhat obsessive, but I believe

justified way that every time that one

engages in the compulsion related to the

obsession, the obsession simply becomes

stronger. So you can imagine what a what

a powerful and debilitating loop that

really is. So let's drill a little bit

deeper into how the obsessions and

compulsions relate to one another. If we

were to draw a line between the

obsessions and the compulsions, that

line could be described as anxiety. Now,

we need to define what anxiety is. And

to be quite honest, most of psychology

and science can't agree on exactly what

anxiety is. Typically the way we think

about fear is that it's a heightened

state of autonomic arousal. So increased

heart rate, increased breathing,

sweating etc. in response to an

immediate and present threat or

perceived threat. Whereas anxiety

generally speaking in the scientific

literature relates to the same sorts of

thought patterns and somatic bodily

responses, heart rate, breathing, etc.

But without a clear and present danger

being in the environment or right there.

So that's the way that we're going to

talk about anxiety. Now, and anxiety is

really what binds the obsessions and

compulsions such that someone will have

an intrusive thought. Some people are

probably wondering if there's a genetic

component to OCD. And indeed, there is.

Although the nature of it isn't exactly

clear, based on twin studies where

researchers have examined identical

twins, fraternal twins, even identical

twins that share the same sack in

uterero, the what we call monocorionic,

so sitting in the same little bag during

pregnancy or in different little bags,

you can see different levels of what's

called genetic concordance. But if we

were to just sort of cut a cut a broad

swath through all of the genetic data,

it's fair to say that about 40 to 50% of

OCD cases are have some genetic

component, some mutation or some

inherited aspect that's genetic and that

one could point to if they got their

genome mapped. Now, while that's

interesting, I don't think it's terribly

useful for most people. First of all,

you can't really control your genes. It

can't pick who your parents were, as

they say. So, just know that there is a

genetic component in about half of

people with OCD, but not always. Now, as

is typical for this podcast, I want to

focus on some of the neural mechanisms

and chemical systems in the brain and

body that generate obsessivempulsive

disorder. So, let's take a step back and

look at the neural circuitry. What's

going on in the brain and body of people

with OCD? Why the intrusive recurrent

thoughts? Many studies, we can fairly

say dozens, if not hundreds of studies

have now identified a particular circuit

or loop of brain areas that are

interconnected and very active in

obsessivempulsive disorder.

That loop includes the cortex which is

kind of the outer shell of the the human

brain, the lumpy stuff as it sometimes

appears if the skull is removed. And it

involves an area called the stryatum

which is involved in action selection

and holding back action. The cortex and

the strriatam are in this intricate back

and forth talk. It's really loops of

connection. There's a third element in

this cortico strriatal loop as it's

called and that's the phalamus. Now, the

thealamus is not a structure I've talked

a lot about before on this podcast, but

it's one of my favorite structures to

think about and teach about in neuro

anatomy, which I teach uh back at

Stanford and have taught for many years

elsewhere. Because the phalamus is this

incredible egg-like structure in the

center of your brain that has different

channels through it. Channels for

relaying visual information or auditory

information or touch information from

your environment up into your cortex and

as a consequence making certain things

that are happening to you and around you

apparent to you, making you aware of

them, making you perceive them and

suppressing others. At the same time,

your phalamus is surrounded by a kind of

a shell, something called the theamic

reticular nucleus. Again, you don't have

to remember the names, but the theamic

reticular nucleus, as I'm going to call

it, serves as a sort of gate as to which

information is allowed to pass through

up to your conscious experience and

which is not. So, let's zoom out and

take a look at the circuit that we've

got and that we now know based on

neuroiming studies is intimately

involved in generating obsessions and

compulsions in OCD. We have a cortex or

neoortex which is involved in perception

and understanding of what's happening.

We have the strriatam and basil ganglia

which are involved in generating

behaviors go and suppressing behaviors

no go. And we have the phalamus which

collects all of our sensory experience

in parallel hearing touch smell etc. Not

so much smell through the phalamus I

should mention but the other sensor

senses that is and then that phalamus is

encased by the phalamic reticular

nucleus which serves as a kind of a a

guard saying you can pass through and

you can pass through but you you you

can't pass through up to conscious

understanding and perception. So that

loop this corticostriothamic

loop corticostriolamic loop is the

circuit thought to underly OCD and

dysfunction in that circuit is what's

thought to underly OCD. How do we know

that this circuit is involved in OCD?

Well, there we can look to some really

interesting studies that involve

bringing human subjects into the

laboratory and generating their

obsessions and compulsions and then

imaging their brain using any variety of

techniques that we talked about before.

So, what they do typically is bring

subjects into the laboratory who have a

obsession about germs and contamination

and a compulsion to hand wash. And they

give these people, believe it or not, a

sweaty towel that contains the sweat and

the odor and the liquid basically from

somebody else's hands. In fact, they'll

sometimes have someone wipe their own

sweat off the back of their neck and put

it on the towel and then they'll put it

in front of the person, which as you can

imagine for someone with OCD is

incredibly anxietyprovoking

and almost always evokes these

obsessions about, oh, this is really uh

this is really bad. This is really bad.

I need to I need to clean. I need to

clean. I need to clean. Now, they're

doing all this while someone is in a

brain scanner or while they're being

imaged for posetronom tomography. And

then they can also look at the patterns

of activation in the brain while the

person is doing hand washing. Although

sometimes the apparati associated with

these imaging studies make it hard to do

a lot of movement. They can do these

sorts of studies. They have done these

sorts of studies in many subjects using

different variations of what I just

described. And lo and behold, what

lights up? And when I say lights up,

what what sorts of brain regions are

more metabolically active, more blood

flow, more neural activity? Well, it's

this particular corticostrial phalamic

loop. In addition to that, some of the

drug treatments that are effective in

some, and I want to emphasize some

individuals at suppressing obsessions

and/or compulsions, such as the

selective serotonin reuptake inhibitors

or SSRIs, which we'll talk about in a

little bit. When people take those

drugs, they see not just a suppression

of the obsession and compulsion, but

also a suppression of these particular

neural circuits. They become less

active. Now, I want to emphasize and

telegraph a little bit of what's coming

later. These drugs like SSRIs do not

work for everybody with OCD. And as many

of you know, they carry other certain

problems and side effects for many but

not all individuals. That collection of

studies of data, fMRI, PET scanning in

humans, the treatment with SSRIs really

points squarely to the fact that the

cortical stridthalamic loop is likely to

be the basis of OCD. Now, of course,

other circuits could also be involved,

but the cortical stridthalamic circuit

seems to be the main circuit generating

OCD- like behavior. But as you'll next

learn when thinking about the various

behavioral treatments and drug

treatments and holistic treatments for

OCD, what you'll notice is that each one

taps into a different component of this

corticostrial theamic loop. By

understanding the underlying mechanism,

why certain drugs and behavioral

treatments work and don't work will

become immediately apparent. And in

thinking about that, in knowing that,

you'll be able to make excellent

choices, I believe, in terms of what

sorts of treatments you pursue, what

sorts of treatments you abandon, and

most importantly, the order, the

sequence that you pursue and apply those

treatments. Before we go any further,

I'd like to give people a little bit of

a window into what a diagnosis for OCD

would look like. give you a sense of the

sorts of questions that a clinician

would ask to determine whether or not

somebody has OCD or not. The most

commonly used test of OCD or for OCD I

should say is called the Yale Brown

obsessivempulsive scale and this is uh

you know scientists love acronyms as do

the military and it's the Y box the Y-bs

the Y box. Before the clinician would

proceed with any kind of direct

questions, they would very clearly

define what obsessions and compulsions

are. And here I'm actually reading from

the Ybox. So, quote, "Obsessions are

unwelcome and distressing ideas,

thoughts, images, or impulses that

repeatedly enter your mind. They may

seem to occur against your will. They

may be repugnant to you. You may

recognize them as senseless, and they

may not fit your personality."

Then there are compulsions. Quote,

"Compulsions, on the other hand, are

behaviors or acts that you feel driven

to perform, although you may recognize

them as senseless or excessive. At

times, you may try to resist doing them,

but this may prove difficult. You may

experience anxiety that does not

diminish until the behavior is

completed. Now, there are tremendous

number of questions on the Y box. So,

I'm just going to highlight a few of the

general categories.

Typically, the person will fill out a

checklist. So they will designate

whether or not currently or in the past

they have for instance aggressive

obsessions. Fear that one might harm

themselves. Fear that one might harm

others. Fear that they'll steal things.

Fear that they will act on unwanted

impulses currently or in the past or

both. That's one category. The other one

are contamination obsessions. So

concerned with dirt or germs, bothered

by sticky substances or residues, etc.,

etc. So a bunch of different categories

that include for instance sexual

obsessions, what are called saving

obsessions, even moral obsessions,

right? Excess concern with right or

wrong or morality, concerned with

sacrilege and blasphemy, obsession with

need for symmetry and exactness. Again,

all of these questions being answered as

either present in the past or not

present in the past, present currently

or not present currently. And then the

the test generally

transitions over to questions about

target symptoms. They really try and get

people to identify if they have

obsessions. What are their exact

obsessions? Now, this turns out to be

really important because as we talk

about some of the therapies that really

work, I'll just give away a little bit

of why they work best in certain cases

and why they don't work as well in other

cases. It turns out that it becomes very

important for the clinician and the

patient to not just identify the

obsessions and the compulsions generally

in a kind of a generic or top contour

way but to really encourage or even

force the patient to define very

precisely what the biggest most

catastrophic fear is. what the obsession

really relates to that turns out to be

very important in disrupting this

corticostrialamic

loop and getting relief from symptoms

one way or the other. So the Yale Brown

obsessivempulsive scale, this Y box

again is very extensive. It goes on for

dozens of pages actually and has all

these different categories. not so much

designed to just pinpoint what people

obsess about or what they feel compelled

to do, but to also try and identify what

is the fear that's driving all this.

Right? In the way that we've set this up

thus far, we've been talking about

obsessions and compulsions as kind of

existing in a vacuum. You're obsessed

about germs and you're compelled to wash

your hands. Obsessed about germs,

compelled to wash your hands. Or

obsessed about symmetry, compelled to

put right angles on everything. Or

obsessed about counting and therefore

counting, etc. The deeper layer to all

that is what is the fear exactly if one

were to not perform the compulsion

meaning what is the fear that's driving

the obsession. So that brings us to a

very powerful category of treatments

that I should say does not work in

everybody with OCD but works in many

people with OCD and really speaks to the

underlying neural circuitry that

generates OCD and how to interrupt it.

and that is the treatment of cognitive

behavioral therapy and in particular

exposurebased cognitive behavioral

therapy. Cognitive behavioral therapy

and exposure therapy in the context of

OCD most often involves trying to get

people to tolerate not relieve their

anxiety. This is extremely important and

I realize there's variation to this

depending on the style of cognitive

behavioral therapy, the style of

exposure therapy, but almost across the

board. The goal again is to get people

to feel the anxiety that normally they

are able to at least partially relieve

however briefly by engaging in the

compulsion. So if we think back to that

circuit of corticostrial falamic, what's

going on here? Where is CBT intervening?

Well, as you recall, the cortex is

involved in conscious perception. The

phalamus and that the phalamic reticular

nucleus are involved in the passage of

certain types of experience up to our

conscious perception, not others. And

the stridum is involved in this go no-go

type behavior. When OCD is really

expressing itself in its fullness,

people feel an anxiety around a

particular thought and they either have

a go, for instance, wash hands or a

no-go, do not turn left type reaction.

By having people progressively in a kind

of hierarchical way reveal their precise

source of anxiety, their utmost fear in

this context,

what happens is they feel enormous

amounts of autonomic arousal. Now in the

context of anxiety treatment or other

types of treatments, the goal would be

to teach people to dampen to lessen

their anxiety through breathing

techniques or through visualization

techniques or through self-t talk or

through social support. any of the

number of things that are well known to

help people self-regulate their own

anxiety. Here, it's the opposite. What

they're trying to get the patient to do

is to really feel the anxiety at its

maximum, but then do the exact opposite

of whatever the normal compulsion is.

So, if normally the compulsion is to

wash one's hands, then the idea is to

suppress handashing while being in the

experience of the utmost anxiety. Now, I

want to be very clear. This is not the

sort of thing you want to do on your

own. This is not the sort of thing you

want to do for a friend. This is done by

trained licensed psychologists and

psychiatrists because the goal again is

to bring the person right up close to

the thing that they fear the most and

then to interrupt the circuit. What's

happening is the person is feeling

compelled to act act to relieve the

anxiety and through a progressive type

of exposure, right? You don't throw

people in the deep end in this kind of

therapy right off the bat. you gradually

ratchet them toward or move them toward

the discussion of exactly what they fear

the most and then eventually move them

toward the interruption of the

compulsion as they're feeling this

extremely elevated anxiety. Of course,

within the context of a supportive

clinical setting, but in doing that,

what you are teaching people is that the

anxiety can exist without the need to

engage in the compulsion. So, I'd like

to just briefly summarize the key

elements of cognitive behavioral therapy

and exposure therapy and how they can be

combined with drug treatments that are

very effective. Much of what I'm going

to talk about next relates to the data

and indeed the practice of an incredible

research scientist and clinician. So,

this is Helen Blair Simpson or I should

say Dr. Dr. Helen Blair Simpson because

she is indeed an MD medical doctor and a

PhD research scientist at Columbia

University School of Medicine and one of

the world's foremost experts if not the

expert I would put her in a category of

maybe just one to three people who is

most knowledgeable about the mechanisms

of OCD is actively researching OCD in

humans trying to find new treatments

trying to unveil new mechanisms and

expand on our current understanding. and

who also treats OCD quite actively in

her own clinic. She describes that the

key procedures are exposures of course

done in person and with the actual thing

that evokes the obsessions and

compulsions. And the goal of course then

is to gradually and progressively

increase the level of anxiety but then

to intervene in so-called ritual

prevention to prevent the person from

engaging in the compulsion. Typically,

this is done through two planning

sessions with the patient. So,

describing to the patient what will

happen and when it will happen and how

long it will happen so that they're not

just thrown into this out of the blue.

And then 15 exposure sessions done twice

a week or more. So, the one thing to

really understand about cognitive

behavioral therapy is that it can take

some period of time, several or more

weeks, as many as 10 or 12 weeks. In

addition, Dr. Dr. Blair Simpson and

others have explored what are the best

treatments for patients with OCD by

comparing cognitive behavioral therapy

alone, placebo, so essentially no

intervention or something that takes an

equivalent amount of time but is not

thought to be effective in treatment as

well as

selective serotonin reuptake inhibitors.

Placebo did not reduce the obsessions or

compulsions to any significant degree.

However, cognitive behavioral therapy

had a dramatic effect in reducing the

obsessions and compulsions such that by

four weeks that score that in this case

ranged from 8 to 28 dropped all the way

from 25 down to about 11. So there's a

huge drop in the severity of the

symptoms. Now what's really interesting

is that when you look at the effects of

SSRIs in the treatment of OCD symptoms,

they had a significant effect in

reducing the symptoms of OCD, but the

severity of their symptoms was still

much greater than those receiving

cognitive behavioral therapy alone. So

what happens when you combine them?

Well, they explored that as well. and

the combination of cognitive behavioral

therapy and the SSRIs together did not

lead to any further decrease in OCD

symptoms. This points to the idea that

cognitive behavioral therapy is the most

effective treatment. And again, when I

say cognitive behavioral therapy now,

I'm still referring to cognitive

behavioral/exposure

therapy done in the way that I detailed

before, twice a week for 12 weeks or

more. So for those of you that have

sought treatment and you're taking a

SSRI or if you're thinking about

treatment and you're prescribed an SSRI,

the ideal scenario really would be to

combine the drug treatment with

cognitive behavioral therapy or in some

cases maybe cognitive behavioral therapy

alone. Although that's a decision that

you really have to make with the close

advice and oversight of of a licensed uh

physician because of course these are

prescription drugs and anytime you're

going to add or remove a prescription

drug or change dosage, you really want

to do that in close discussion with and

on the advice of your physician. I don't

just say that to protect me. I say that

to protect you and because it's just the

right thing to do. So, what I'm about to

tell you next is most certainly going to

come as a big surprise, which is that

despite the fact that the selective

serotonin reuptake inhibitors can be

effective in reducing the symptoms of

OCD, at least somewhat, and certainly

more than placebo, there is very little,

if any, evidence that the serotonin

system is disrupted in OCD. And I have

to point out that this is a somewhat

consistent theme in the field of

psychiatry. that is a given drug can be

very effective or even partially

effective in reducing symptoms or in

changing the overall landscape of a

psychiatric disorder or illness and yet

there is very little if any evidence

that that particular system is what's

causal for OCD or anxiety or depression

etc. Now earlier we were talking about

not reducing anxiety but learning

anxiety tolerance in order to deal with

and treat OCD in the context of

cognitive behavioral therapies. That

doesn't necessarily rule out cannabis as

a candidate for the treatment of OCD.

And in fact this has been explored. A

study from Dr. Blair Simpson herself

looked at this. This was a fairly

smallcale study. So first of all I'll

give you the title and again we'll

provide a link. This is entitled acute

effects of canabonoids on symptoms of

obsessivempulsive disorder a human

laboratory study. I'm just reading from

their conclusions here. The data

suggests that smoked cannabis whether

containing primarily THC or CBD has

little acute impact meaning immediate

impact on OCD symptoms

and yield smaller reductions in anxiety

compared to placebo. So they did not see

a a when I say a positive effect I mean

a um a meerative effect an effect in

reducing symptoms of OCD from cannabis

or or CBD. Another treatment that's

becoming somewhat common or at least

people are commonly excited about is

transcranial magnetic stimulation. So

this is the use of a magnetic coil. This

is completely non-invasive placed on one

portion of the skull and one can direct

magnetic

energy toward particular areas of the

brain to either suppress or nowadays you

can also activate particular brain

regions. There are some interesting data

showing that if TMS is applied to areas

of the brain involved in the generation

of motor action, so the so-called motor

areas or supplementary motor areas as

they're called, while people think about

or have intrusive thoughts, we know that

the TMS coil can interrupt the motor

behaviors, the compulsive behaviors, and

at least in a small cohort of studies

and a small number of patients within

those studies, this has been shown to be

effective. Not just while the coil is on

the head, of course, but act after the

study has been performed or the

treatment's been performed in reducing

OCD symptoms by disrupting the tendency

for the compulsive behavior to be so

automatic. Right now, I don't think it's

fair to say that TMS is a magic bullet

either. I think there's a lot of

excitement about TMS. And in particular,

I really want to nail this point home.

In particular, there's excitement about

the combination of TMS with drug

treatments or the combination of TMS

with cognitive behavioral therapy. I

realize that a number of listeners of

this podcast are probably interested in

the non-typical or holistic treatments

for OCD. Dr. Blair Simpson's lab has at

least one study exploring the role of

mindfulness meditation for the treatment

of OCD. there the data are a little bit

um complicated and I should mention that

good things are happening at least in

the United States probably elsewhere as

well but good things are happening in

terms of the exploration of things like

meditation and other let's call them

non-traditional or holistic forms of of

treatment for psychiatric disorders

because of the division of complimentary

health that's now been launched by the

national institutes of health. So

whereas before people would think about

uh meditation or yoga nidra or even CBD

supplementation for that matter as kind

of fringe maybe or kind of woo or

non-traditional at the very least the

national institutes of health in the

United States has now devoted an entire

division right an entire institute

purely for the exploration of things

like breathing practices meditation etc.

So there's a cancer institute, there's a

hearing and deafness institute, there's

a vision institute and now there's this

complimentary health institute which I

think is a wonderful addition to the

more traditional aspects of medicine. I

think uh no possible useful treatment

should be overlooked or unressearched in

my opinion provided that can be done

safely. Turns out that mindfulness

meditation can be useful in the

treatment of OCD, but mainly by way of

how it impacts the focus on and the

ability to engage in cognitive

behavioral therapies. So, it's very

unlikely, at least by my read of the

data, to be a direct effect of

meditation on relieving the symptoms.

Rather, it seems that meditation is

increasing focus on things like

cognitive behavioral therapy homework

and to not focus on other things and

therefore indirectly improving the

symptoms of OCD. Now, somewhat

surprisingly, at least to me, there have

also been a fairly large number of

studies exploring how neutrauticals, as

they're sometimes called, supplements

that are available over the counter can

impact the treatment of

obsessivempulsive disorder. One compound

that I like to focus on is inositol. And

here I'm referring specifically to

myoininoitol because it comes in several

forms. And it does appear that 900

milligrams of inositol can improve sleep

and can reduce anxiety perhaps when

taken at that dosage or higher dosages.

So I think there's a great future for

these neutrauticals meaning I think more

systematic exploration in particular of

lower dosages in the context of of OCD

treatment and as we saw before for the

SSRIs and other prescription drug

treatments. I think there really needs

to be an exploration of these

neutrauticals in combination with

behavioral therapies and who knows maybe

with brain machine interface like

cranial magnetic stimulation as well.

What I've tried to provide is an

opportunity to really drill deep into

the neural circuitry and an

understanding of where OCD comes from

and also to give you a sense of how the

individual behavioral and drug

treatments work and perhaps don't work

so that you can really make the best

informed choices. again highlighting the

fact that OCD is an extremely common

extremely common and yet extremely

debilitating condition and one that I

hope that if any of you have or that you

know people that have it that you'll

both gain sympathy and understanding for

what they're dealing with perhaps as a

consequence of some of the information

presented today and maybe help them

direct their treatment find better

treatment and of course apply those

treatments for some relief. In closing,

I'd like to thank you for this in-depth

discussion about the mechanisms and

various treatments for obsessivempulsive

disorder and some of the related

disorders. And as always, thank you for

your interest in science.