--:-- Andrew Huberman: 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.
--:-- Andrew Huberman: Today, we're going to talk about the neuroscience of fear. We are also going to talk about trauma and post-traumatic stress disorders. I think it's fair to say that in the last 10 years, The field of neuroscience has shed light on not just the neural circuits, meaning the areas of the brain that control the fear response and the ways that it does it, but some important ways to extinguish fears using behavioral therapies, drug therapies, and what we call brain-machine interfaces.
--:-- Andrew Huberman: Today, we are going to talk about all of those, and you are going to come away with both an understanding of the biology of fear and trauma, as well as many practical tools to confront fear and trauma. To give you a sense of where we are going, I'll just lay out the framework for today's podcast.
--:-- Andrew Huberman: First, I'm going to teach you about the biology of fear and trauma, literally the cells and circuits and connections in the body and chemicals in the body that give rise to the so-called fear response and why sometimes, but not always, fear can turn into trauma.
--:-- Andrew Huberman: I will also describe the biology of how fear is unlearned or what we call extinguished. You're going to learn, for instance, that we can't just eliminate fears, we actually have to replace fears with a new positive event.
--:-- Andrew Huberman: So what is fear? Well, fear falls into a category of nervous system phenomenon that we can reliably call an emotion. I think it's fair to say that emotions include responses within our body, quickening of heart rate, changes in blood flow, things that we experience as a warming or a cooling of our skin, but that there's also a cognitive component.
--:-- Andrew Huberman: There are thoughts, there are memories. There's all sorts of stuff that goes on in our mind and in our body that together we call an emotion. So let's talk first about what fear isn't. Most people are familiar with stress, both as a concept and as an experience.
--:-- Andrew Huberman: Stress is a physiological response And it is fair to say that we cannot have fear without having several, if not all of the elements of the stress response. However, we can have stress without having fear.
--:-- Andrew Huberman: Likewise, people are familiar with the phrase or the word rather anxiety. Anxiety tends to be stress about some future event, although it can mean other things as well.
--:-- Andrew Huberman: We can't really have fear without seeing or observing or experiencing some of the elements of anxiety, but we can have anxiety without having fear. So what you're starting to realize is that fear is built up from certain basic elements that include stress and anxiety.
--:-- Andrew Huberman: And then there is trauma. The operational definition of trauma is that some fear took place, which of course includes stress and anxiety, and that fear somehow gets embedded or activated in our nervous system such that it shows up at times when it's maladaptive, meaning that fear doesn't serve us well and it gets reactivated at various times.
--:-- Andrew Huberman: The reason I'm putting all this word soup around fear out onto the table is not to complicate the issue. Rather, it is to simplify the issue because now that we acknowledge that there are many different phrases to describe this thing that we call fear and then related phenomenon, we can start to just focus on two of these issues, fear and trauma as it relates to specific biological processes, specific cognitive processes, and we can start to dissect how fears are formed, how fears are unformed, and how new memories can come to replace previously fearful experiences.
--:-- Andrew Huberman: We've known for a long time that there are things that we can do to improve our sleep, and that includes things that we can take, things like magnesium threonate, theanine, chamomile extract, and glycine, along with lesser known things like saffron and valerian root.
--:-- Andrew Huberman: These are all clinically supported ingredients that can help you fall asleep, stay asleep, and wake up feeling more refreshed. I'm excited to share that our longtime sponsor, AG1, just created a new product called AGZ, a nightly drink designed to help you get better sleep and have you wake up feeling super refreshed.
--:-- Andrew Huberman: Over the past few years, I've worked with the team at AG1 to help create this new AGZ formula. It has the best sleep supporting compounds in exactly the right ratios in one easy to drink mix. This removes all the complexity of trying to forge the vast landscape of supplements focused on sleep and figuring out the right dosages and which ones to take for you.
--:-- Andrew Huberman: AGZ is to my knowledge, the most comprehensive sleep supplement on the market. I take it 30 to 60 minutes before sleep. It's delicious by the way. And it dramatically increases both the quality and the depth of my sleep.
--:-- Andrew Huberman: I know that both from my subjective experience of my sleep and because I track my sleep. I'm excited for everyone to try this new AGZ formulation and to enjoy the benefits of better sleep.
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--:-- Andrew Huberman: If you'd like to try AGZ, go to drinkagz.com slash Huberman to get a special offer. Again, that's drinkagz.com slash Huberman.
--:-- Andrew Huberman: So in this effort to establish a common language around fear and trauma, I want to point out autonomic arousal. Autonomic arousal relates to this aspect of our nervous system that we call the autonomic nervous system.
--:-- Andrew Huberman: It basically has two branches to it, two branches meaning two different systems. One is the so-called sympathetic autonomic nervous system. It has nothing to do with sympathy. It has everything to do with increasing alertness.
--:-- Andrew Huberman: The other branch of the autonomic nervous system is the so-called parasympathetic branch of the autonomic nervous system. I know that's a mouthful.
--:-- Andrew Huberman: The parasympathetic branch of the autonomic nervous system are the cells and neurons and chemicals and other aspects of your brain and body that are involved in the calming nervous system.
--:-- Andrew Huberman: So sympathetic is alerting, parasympathetic is calming, and it acts as sort of a seesaw to adjust your overall level of alertness.
--:-- Andrew Huberman: There are many different aspects to the autonomic nervous system, but one of the main aspects is an aspect that's going to come up again and again and again today.
--:-- Andrew Huberman: It's called the HPA axis. The HPA axis stands for hypothalamic pituitary adrenal axis. The hypothalamus is a collection of neurons. It's an area of your brain, real estate, that's deep in the brain, at the base of the brain, that contains many, many different areas that control things like temperature and desire to have sex, desire to eat, thirst.
--:-- Andrew Huberman: It also controls the desire to not mate, have sex, not eat, not drink more water or any other type of fluid. So it has accelerators and brakes in there as well.
--:-- Andrew Huberman: The hypothalamus connects to the so-called pituitary. The pituitary lives close to the roof of your mouth. It releases hormones into your bloodstream.
--:-- Andrew Huberman: And so the hypothalamus has this ability to trigger the release or prevent the release of particular hormones like cortisol or the hormones that go stimulate adrenals to produce adrenaline.
--:-- Andrew Huberman: And speaking of the adrenals, that A in the HPA are the adrenals. You have two glands that sit above your kidneys in your lower back.
--:-- Andrew Huberman: They release different hormones and other types of chemicals into the body. And the two main ones that you need to know about today are adrenaline, also called epinephrine, and cortisol.
--:-- Andrew Huberman: Both of those are so-called stress hormones, but they're not always involved in stress. They're also involved in waking up in the morning when you rise from sleep.
--:-- Andrew Huberman: And so this HPA axis should be thought of in the following way. The HPA axis includes a piece of the brain the hypothalamus, the pituitary, and the adrenal.
--:-- Andrew Huberman: So it's a beautiful three-part system that can use your brain to alert or wake up your body and prepare it for action.
--:-- Andrew Huberman: And it can do that in the short term by triggering the release of hormones and chemicals that make you alert and ready to go right away.
--:-- Andrew Huberman: And by triggering the release of neurotransmitters and hormones and other chemicals that give that alertness a very long tail, a very long latency before it shuts off.
--:-- Andrew Huberman: And that's important because one of the hallmarks of fear and one of the hallmarks of trauma is that they involve fear responses that are long lasting.
--:-- Andrew Huberman: Even if those fearful events, the events in the world that trigger the HPA axis can be very brief, the fear response can reverberate through your system because the chemicals that are involved in this HPA axis have a fast component and a longer lasting component.
--:-- Andrew Huberman: And the longer lasting component can actually feed back to the brain and literally control gene expression, which can take many days and build out new circuits and new chemicals that can embed fear in our brain and body.
--:-- Andrew Huberman: We can't really have a discussion about fear without discussing the famous amygdala. Famous because I think most people by now have heard of the amygdala.
--:-- Andrew Huberman: Amygdala means almond. It's an almond-shaped structure on both sides of the brain. The amygdala is part of what we can call the threat reflex.
--:-- Andrew Huberman: And this is very important to conceptualize fear as including a reflex. And that reflex involves things like quickening of your heart rate, hypervigilance, your attentional systems pop on increased ability to access energy stores for movement and thought and so forth
--:-- Andrew Huberman: The amygdala is part of the threat reflex so much so that we can really say that it's the final common pathway through which the threat reflex flows.
--:-- Andrew Huberman: In other words, the amygdala is essential for the threat response. So while the amygdala might look like an almond, it's actually part of a much bigger complex or collection of neurons called the amygdaloid complex.
--:-- Andrew Huberman: That complex has anywhere from 12 to 14 areas, depending on which neuroanatomist is naming things and carving it up.
--:-- Andrew Huberman: Why is that important to us? Well, it turns out that the amygdala is not just a area for threat. It's an area for generating threat reflexes that integrates lots of different types of information.
--:-- Andrew Huberman: Information from our memory systems, like the hippocampus, and from our sensory systems, our eyes, our ears, our nose, our mouth, et cetera.
--:-- Andrew Huberman: So taste information, vision, auditory information, touch, et cetera, flow into the so-called lateral portion of the amygdala or the amygdaloid complex.
--:-- Andrew Huberman: And then there are multiple outputs from the amygdala. And this is where things get particularly interesting because the outputs of the amygdala have a lot of different areas, but there are two main pathways.
--:-- Andrew Huberman: One involves the hypothalamus and it also feeds out to our adrenals to create a sense of alertness and action.
--:-- Andrew Huberman: The other pathway out of the amygdala is to a very interesting area that typically is associated with reward and even addiction.
--:-- Andrew Huberman: The amygdaloid complex actually projects to areas of the dopamine system, the so-called nucleus accumbens, the mesolimbic reward pathway.
--:-- Andrew Huberman: For those of you that want to look that up or that remember from the dopamine episodes, we have pathways in our brain that are associated with pursuit, motivation, and reward, and the neuromodulator dopamine is largely responsible for that feeling of craving, pursuit, and reward.
--:-- Andrew Huberman: And this threat center is actually able to communicate with and activate the dopamine system.
--:-- Andrew Huberman: And later you will realize why that is very important and why you can leverage the dopamine system in order to wire in new memories to replace fearful ones.
--:-- Andrew Huberman: There's a fourth component, and I promise this is the last component that we need to put into this picture of the neural circuits for fear.
--:-- Andrew Huberman: And this is a circuit that involves an area of the brain called the prefrontal cortex. and some of it subdivision, so literally in the front.
--:-- Andrew Huberman: And it's involved in what we call top-down processing. Top-down processing is the way that your prefrontal cortex and other areas of the brain can control or suppress a reflex.
--:-- Andrew Huberman: You tell yourself, I want to do this, or I should do this, or even though I don't want to, I'm going to do it anyway.
--:-- Andrew Huberman: So this fourth component of fear is really our ability to attach narrative, to attach meaning, and to attach purpose to what is, by all accounts and purposes, a generic response.
--:-- Andrew Huberman: There's no negotiating what fear feels like. There's only negotiating what it means. There's only negotiating whether or not you persist, whether or not you pause, or whether or not you retreat.
--:-- Andrew Huberman: So this is usually the point in the podcast where I think people start asking, okay, well, there's the biology, there's the mechanism, there's the logic, how do I eliminate fear?
--:-- Andrew Huberman: Well, it's not quite that simple, although by understanding the logic and the mechanisms by which these circuits are built, we can eventually get to that place.
--:-- Andrew Huberman: I do want to plant a flag around a particular type of tool or a logical framework around a particular set of tools, rather, that we are going to build out through this episode.
--:-- Andrew Huberman: And based on what you now know, that the threat reflex gets input and it has outputs, and it's subject to these top-down processing events, these narratives, you should be asking yourself, what sort of narrative should I apply to eliminate fear?
--:-- Andrew Huberman: Well, first let's take a step back and just acknowledge the reality, which is that fear is in some cases an adaptive response.
--:-- Andrew Huberman: We don't want people eliminating fears that can get them injured or killed, right? The reason that the fear threat response and reflex exists at all is to help us from dying, to help us from making really bad decisions.
--:-- Andrew Huberman: So it's not just about a readiness for things that might injure us or kill us in the immediate circumstance, but also protecting us for the future because of our important need and ability to anticipate.
--:-- Andrew Huberman: Some memories, even if they evoke a sense of fear in us, are protective. They protect us from making bad mistakes that could get us injured or killed or put us into really horrible circumstances.
--:-- Andrew Huberman: Other memories are dangerous because they create a sense in us of discomfort and they tend to limit our behavior in ways that are maladaptive, that prevent us from having healthy relationships to others, healthy job relationships, healthy relationship to ourselves, frankly.
--:-- Andrew Huberman: So this language of memories as protective or memories as dangerous, it's an important aspect of fear because much of the fear system is a memory system.
--:-- Andrew Huberman: It's designed to embed a memory of certain previous experiences in us such that the threat reflex is activated in anticipation of what might happen, okay?
--:-- Andrew Huberman: So let's talk for a second about how certain memories get attached to this fear system.
--:-- Andrew Huberman: And this brings us to a beautiful and indeed Nobel Prize winning aspect of biology and physiology, which is Pavlovian conditioning.
--:-- Andrew Huberman: Many of you are probably familiar with Pavlov's dogs and the famous Pavlovian conditioning experiments.
--:-- Andrew Huberman: They go something like this, ring a bell. A dog doesn't do much in response to a bell. It might attend to it, but it doesn't salivate typically in response to the bell.
--:-- Andrew Huberman: However, if you pair the ringing of a bell with a presentation of food enough times, the dog will salivate in response to the food.
--:-- Andrew Huberman: Eventually you take away the food, you just ring the bell and the dog will salivate in response to the bell.
--:-- Andrew Huberman: So in the context of so-called Pavlovian conditioning, these things have names like conditioned stimulus and unconditional stimulus and responses.
--:-- Andrew Huberman: The unconditioned stimulus is the thing that evokes a response unconditionally. So food is the unconditioned stimulus in the example I just gave.
--:-- Andrew Huberman: The bell in the previous example is what we call the conditioned stimulus or the conditioning stimulus.
--:-- Andrew Huberman: The conditioned stimulus is paired with the thing that naturally creates a response.
--:-- Andrew Huberman: And then eventually the conditioned stimulus creates the response itself.
--:-- Andrew Huberman: You might think, well, that just seems, you know, endlessly boring and simple, but this is actually the way that our fear systems work.
--:-- Andrew Huberman: Except unlike Pavlov's dogs, you don't need many, many pairings of a bell with some unconditioned stimulus in order to get a response.
--:-- Andrew Huberman: You can get what's called one trial learning. And in this circuit that involves the amygdala, the threat reflex, and all this other, you know, stuff that I was talking about earlier, the system is set up for learning.
--:-- Andrew Huberman: It's set up to create memories and to anticipate problems. It's a very good system because it was designed to keep us safe.
--:-- Andrew Huberman: So now you should understand how classical conditioning, as it's called, occurs.
--:-- Andrew Huberman: You go to give a piano recital as a kid, you sit down and you freeze up, and it's horribly embarrassing.
--:-- Andrew Huberman: And even if you just freeze up for a few seconds, the heart rate increase and the perspiring, the sweating and the shame that you feel leads you to want to avoid playing instruments or public displays of performances for a long period of time, unless you do something to overcome it.
--:-- Andrew Huberman: Some people, it tends to be more an accumulation of experiences.
--:-- Andrew Huberman: There's a key, what we call temporal component. There's a component of the fear system being able to batch many events in time and create one specific fear or take one very specific isolated incident that happened very briefly and create one very large general sense of fears.
--:-- Andrew Huberman: And I'll give an example of the latter just to kind of flesh this out a little bit.
--:-- Andrew Huberman: I had a friend come visit me in San Francisco some years ago and their car got broken into, unfortunately a frequent occurrence in San Francisco and in the middle of the day, never leave anything in your car in San Francisco.
--:-- Andrew Huberman: They'll break in in the middle of the day, doesn't matter. Police can be having coffee right there in front of them. They'll still do it.
--:-- Andrew Huberman: They got their belongings taken and they decided they were never coming back to San Francisco.
--:-- Andrew Huberman: This was an isolated incident that forever colored their view of the city, which I, you know, frankly, understanding the fear system, I can understand.
--:-- Andrew Huberman: We can have isolated incidents that wick out to broad decisions about entire places, or we can have many experiences that funnel into very specific isolated fears about particular circumstances, places, and things.
--:-- Andrew Huberman: I'd like to take a quick break and acknowledge one of our sponsors, Element.
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--:-- Andrew Huberman: To make sure that I'm getting proper amounts of hydration and electrolytes, I dissolve one packet of element in about 16 to 32 ounces of water when I first wake up in the morning, and I drink that basically first thing in the morning.
--:-- Andrew Huberman: I also drink element dissolved in water during any kind of physical exercise that I doing especially on hot days when I sweating a lot and losing water and electrolytes
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--:-- Andrew Huberman: Again, that's drinkelement.com slash Huberman to claim a free sample pack.
--:-- Andrew Huberman: So I like to think that by now you have a pretty good understanding of the circuits that underlie the threat reflex, the fear response, and how we have top-down control, meaning we can attach a narrative to the fear response, and that the fear response can be learned in association with particular events, okay?
--:-- Andrew Huberman: So now I'd like to talk about therapies that are carried out in humans that allow fears to be undone, that allow traumas to be reversed.
--:-- Andrew Huberman: Contrary to popular belief, it is not going to work to simply extinguish a fear.
--:-- Andrew Huberman: One needs to extinguish a fear and or trauma and replace that fearful or traumatic memory or idea or response with a positive response.
--:-- Andrew Huberman: And this is something that's rarely discussed both in the scientific literature, but certainly in the general discussion around fear and trauma.
--:-- Andrew Huberman: And so that brings us to which treatments are directly related to the fear circuitry and the circuitry related to trauma.
--:-- Andrew Huberman: And the primary one to begin with is the so-called behavioral therapies.
--:-- Andrew Huberman: There are three forms of therapy that purely through the use of language have been shown to have very strong positive impact, meaning reduce fears and traumas.
--:-- Andrew Huberman: And those three are prolonged exposure therapy, cognitive processing or CPT, and cognitive behavioral therapy.
--:-- Andrew Huberman: It's very clear because it's been measured that if you look at the amount of anxiety, the pure physiological anxiety response of quickening of heart rate, flushing of the skin, sometimes quaking of the hands, the experience of fear, over time when people recount or retell their trauma, that the first time they do that, especially when it's recounted in a lot of detail, there's a tremendous anxiety response, sometimes even as great or greater than the actual exposure to the fearful event or trauma.
--:-- Andrew Huberman: And obviously this is something that is done with a clinician present because it is very traumatic to the person.
--:-- Andrew Huberman: They're literally reliving the trauma in full rich detail and they are encouraged to provide full rich detail.
--:-- Andrew Huberman: They're often encouraged to speak in complete sentences, to flesh out details about how they felt inside, to flesh out details about their memories going into this traumatic or fearful event, going through it, and after really digging into all the nuance and contours of these horrible experiences.
--:-- Andrew Huberman: But what's remarkable is that in the second and the third and the fourth retelling of these traumatic or fearful events, that anxiety response and the amount of the physiological response, I should say that the amplitude of the physiological response, becomes progressively diminished with each retelling.
--:-- Andrew Huberman: Every clinician I spoke to in anticipation of this episode said the exact same thing, which is that a detailed recounting of the traumatic and fearful events is absolutely essential in order to get the positive effects of prolonged exposure, cognitive processing, and cognitive behavioral therapy.
--:-- Andrew Huberman: So the thing to embed in your mind is that recognition of the early traumatic or fearful event in detail over and over is key to forming a new non-traumatic association with that event or person.
--:-- Andrew Huberman: So that's part one. You need to diminish the old experience.
--:-- Andrew Huberman: And when I say diminish, I mean reduce the amplitude of the physiological response.
--:-- Andrew Huberman: But even after that's occurred, there's an essential need to relearn a new narrative.
--:-- Andrew Huberman: Why is there essential need to relearn a new narrative or create a new association?
--:-- Andrew Huberman: Well, that has to do with that fear reflex circuitry.
--:-- Andrew Huberman: As you recall, there are outputs to areas of the brain that are associated with dopamine release and reinforcement.
--:-- Andrew Huberman: And that we now know offers the capacity for these fear circuits and these circuits that underlie trauma to be mapped onto new experiences that are of positive association.
--:-- Andrew Huberman: That is all through narrative. It's all through cognition.
--:-- Andrew Huberman: And I think this is a very important point.
--:-- Andrew Huberman: Oftentimes, I think we tend to undervalue the importance of rationalization and of story and of narrative.
--:-- Andrew Huberman: But the prefrontal cortex is this amazing capacity of our brain real estate to create meaning, to attach meaning and purpose to things that otherwise are just reflexive.
--:-- Andrew Huberman: Now, I mentioned prolonged exposure therapy, cognitive processing, and cognitive behavioral therapy.
--:-- Andrew Huberman: For those of you that are seeking relief from fear and traumatic events.
--:-- Andrew Huberman: You can look up licensed clinicians that can carry out those one or several of those types of therapies.
--:-- Andrew Huberman: There are many people, however, that don't have access to that or who are working through stuff.
--:-- Andrew Huberman: They have things in their past that are very uncomfortable to them.
--:-- Andrew Huberman: And I'm aware that many people are working through those things through journaling, through talking to a friend, through any number of different sort of non-traditional
--:-- Andrew Huberman: One thing that really pertains to everybody who's working through fear and trauma of any kind is the importance of social connection as it relates to the chemical systems and the neural circuits associated with fear and trauma.
--:-- Andrew Huberman: And it's really important to understand that regular social connection, trusting social connection of any kind is going to be very beneficial for that process.
--:-- Andrew Huberman: In a few minutes, we are going to discuss some of the behavioral treatments, including some really new exciting protocols for dealing with fear and trauma.
--:-- Andrew Huberman: But for a few minutes, I'd like to discuss some of the drug treatments that are starting to emerge as potential therapeutics, in particular for PTSD.
--:-- Andrew Huberman: The two drug treatments I'd like to focus on are ketamine-assisted psychotherapy and MDMA-assisted psychotherapy.
--:-- Andrew Huberman: Ketamine is a dissociative anesthetic.
--:-- Andrew Huberman: You know, dissociation in its essence is really about viewing what's happening from a different perspective than what normally one would view that experience from.
--:-- Andrew Huberman: What seems to be the case is that it somehow allows the patient, the individual, to recount their trauma while feeling either none or a very different set of emotional experiences that they experienced in the actual trauma or fearful experience.
--:-- Andrew Huberman: So it's a remapping of new onto old, new meaning new feelings onto old feelings while staying in the exact same narrative.
--:-- Andrew Huberman: And so in that way, we can sort of view, or we can try and view ketamine assisted psychotherapy for the treatment of trauma as bringing together the three elements that we talked about before.
--:-- Andrew Huberman: You want to diminish the intensity, the potency of the old original trauma experience or fear experience.
--:-- Andrew Huberman: So that seems to be accomplished through this dissociation that leads to the extinction of the trauma and the fear.
--:-- Andrew Huberman: But then there also seems to be an automatic or kind of built in relearning of a new narrative and new set of experiences, which is the next step that we described earlier.
--:-- Andrew Huberman: So it's an intriguing therapy.
--:-- Andrew Huberman: It's one that's really catching on and there are many, many clinics around the US that are now doing it.
--:-- Andrew Huberman: Whether or not it turns out to be the ultimate treatment for trauma and for fear isn't clear.
--:-- Andrew Huberman: My colleagues in psychiatry tell me that that's unlikely, although it does seem to be beneficial for a number of people, especially people that are experiencing trauma or have existing traumas and fear that are coupled with depressive symptoms because the data on ketamine and depression seems to be quite strong.
--:-- Andrew Huberman: I'd like to take a quick break and acknowledge one of our sponsors, Function.
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--:-- Andrew Huberman: There so many things related to your mental and physical health that can only be detected in a blood test
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--:-- Andrew Huberman: As a consequence, I decided to join their scientific advisory board, and I'm thrilled that they're sponsoring the podcast.
--:-- Andrew Huberman: If you'd like to try Function, you can go to functionhealth.com slash Huberman.
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--:-- Andrew Huberman: So now let's talk about MDMA.
--:-- Andrew Huberman: MDMA, also sometimes called ecstasy or molly in its recreational form, is a powerful synthetic drug that at least as far as we know, creates a state in the brain and body that is unlike any other chemical state in the brain and body that's normally experienced.
--:-- Andrew Huberman: What do I mean by that? Well, we have several neuromodulator systems in our body.
--:-- Andrew Huberman: Good examples of neuromodulators are dopamine, serotonin, acetylcholine, norepinephrine.
--:-- Andrew Huberman: And there is a little bit of a seesaw type phenomenon with dopamine and serotonin.
--:-- Andrew Huberman: Dopamine most commonly associated with activating neural circuits related to motivation, craving, and reward.
--:-- Andrew Huberman: And serotonin more typically activated in response to situations or conditions in which we are very happy and content with what we have.
--:-- Andrew Huberman: So dopamine is more about pursuing and seeking.
--:-- Andrew Huberman: Serotonin is more about kind of pleasure and satisfaction with resources that we have in our immediate sphere.
--:-- Andrew Huberman: MDMA is a unique compound in that it leads to very large increases in the amount of both dopamine and serotonin in the brain and body simultaneously.
--:-- Andrew Huberman: And that's a unique circumstance that is just simply not seen under normal conditions.
--:-- Andrew Huberman: From a subjective standpoint, people under the influence of MDMA in the therapeutic setting tend to report immense feelings of connection or resonance with people or even things, with music, with objects.
--:-- Andrew Huberman: Why would this state of mind and body be potentially useful for the treatment of trauma?
--:-- Andrew Huberman: What it seems to allow is a very fast relearning or new associations to be tacked on to the previously traumatic experience.
--:-- Andrew Huberman: So again, it brings us back to the same model of how people extinguish fears and traumas and replace them with new experiences when there is no drug treatment involved.
--:-- Andrew Huberman: There needs to be a diminishing of the old experience, meaning an extinction, and then a relearning of a new narrative.
--:-- Andrew Huberman: This whole business of fear and trauma relates to taking external experiences and funneling those experiences into this thing that I'm calling a threat reflex or the fear circuitry.
--:-- Andrew Huberman: We have a system that can generate threat responses.
--:-- Andrew Huberman: And in the case of trauma, PTSD, and extreme stress, chronic stress, that system gets ramped up so that it takes very little, maybe even just a memory or maybe even an association that we're not even aware of.
--:-- Andrew Huberman: How do we recalibrate the system?
--:-- Andrew Huberman: Well, most of the approaches that are out there involving drug treatments, Typical drug treatments would involve suppressing the level of internal arousal, just trying to bring that down.
--:-- Andrew Huberman: So what we've been doing in human subjects is having them do breathing protocols called cyclic hyperventilation, which is somewhat stressful.
--:-- Andrew Huberman: It's five minutes a day of stress and involves basically doing this, what I'll do in a moment, for five minutes, which is hyperventilating, which is... but not continuously for the five minutes because many people would pass out or feel extremely uncomfortable.
--:-- Andrew Huberman: It involves inhale, exhale, inhale, exhale, very deep, inhale through the nose, exhale through the mouth, and then every 25 or 30 breaths or so, doing a full exhale and holding one's breath, lungs empty for about 25, maybe 30, maybe even 60 seconds, and then continuing until five minutes is up.
--:-- Andrew Huberman: Subjects report and our data indicate that people feel a heightened level of autonomic arousal.
--:-- Andrew Huberman: In fact, I can feel it right now, even from that very brief cyclic hyperventilation bout I just did, you feel a heating up, you feel a, some people will perspire, some people get wide-eyed, some people feel agitated, that's adrenaline being released into your system.
--:-- Andrew Huberman: It's stressful, in air quotes.
--:-- Andrew Huberman: You can imagine a very brief five minutes a day, two weeks intervention in which people, with the support of a clinician, we would hope, would deliberately induce a physiological state that's very stressful, right?
--:-- Andrew Huberman: Not shying away from the stress response, but increasing their own stress response deliberately, and maybe in conjunction with recounting the traumatic or fearful circumstance.
--:-- Andrew Huberman: This is far and away different than the kind of state of mind and body that would come about in a ketamine-assisted, trauma-induced psychotherapy session, or a MDMA-assisted trauma psychotherapy session, or in a purely narrative-based psychotherapy session aimed at alleviating fear or trauma.
--:-- Andrew Huberman: The reason I like these sorts of interventions is that A, they are very low cost or even zero cost, right?
--:-- Andrew Huberman: One could, you could imagine doing this while journaling or while recounting a particular experience.
--:-- Andrew Huberman: I do think that deliberate self-directed entry into these short bouts of stress is a very promising approach.
--:-- Andrew Huberman: And it's one that if people are going to experiment, I just again, want to caution people with anxiety or panic disorders, be very cautious, probably don't do it.
--:-- Andrew Huberman: Ideally, you would do this in conjunction with support from a clinician.
--:-- Andrew Huberman: But I'm also aware that there are a lot of people out there that are dealing with trauma and dealing with post-traumatic stress of various kinds and that they're desperate for various self-directed intervention approaches.
--:-- Andrew Huberman: So just very briefly, I want to touch on some of the lifestyle and supplementation factors that can impact things like fear and trauma and getting over fear and trauma.
--:-- Andrew Huberman: To make a long story short, there are many things that we all can and should do to support our overall mental and physical health.
--:-- Andrew Huberman: And these are the foundational elements of quality nutrition, what that means to you, quality sleep on a regular basis, ample sleep on a regular basis.
--:-- Andrew Huberman: I just want to briefly mention a few
