必备知识：强迫症（OCD）的科学与治疗

欢迎来到休伯曼实验室精华版，这里我们会回顾往期内容，为你提炼出最有效、最实用的科学工具，帮助改善心理健康、身体健康和表现表现。

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.

我是安德鲁·休伯曼，斯坦福大学医学院神经生物学和眼科学的教授。

I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine.

今天我们要聊的是强迫症，也就是OCD。

Today, are talking about obsessive compulsive disorder or OCD.

首先，从名字就能看出来，强迫症包含两种东西：强迫性思维和强迫行为。

First of all, as the name suggests, OCD includes thoughts or obsessions and compulsions, which are actions.

这些思维和行为通常是相互关联的。

The obsessions and the compulsions are often linked.

实际上，大多数情况下，强迫行为就是为了缓解强迫性思维带来的焦虑而产生的。

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.

但强迫症的一个典型特征是，这些想法会不由自主地冒出来。

However, one of the hallmark themes of obsessive compulsive disorder is that the obsessions are intrusive.

人们并不想有这样的想法。

People don't want to have them.

他们并不享受这种感觉。

They don't enjoy having them.

这些念头总是莫名其妙地冒出来，而且反复出现。

They just seem to pop into people's minds and they seem to pop into their mind recurrently.

强迫行为和其他行为不同，它只能短暂缓解焦虑，但很快反而会强化这些念头。

And the compulsions, unlike other sorts of behaviors, provide brief relief to the obsession, but then very quickly reinforce or strengthen the obsession.

强迫症非常普遍。

OCD is extremely common.

据目前估计，有2.5%到3%甚至4%的人真正患有强迫症。

In fact, current estimates are that anywhere from two point five percent to as high as three or even four percent of people suffer from true OCD.

这个数字高得惊人。

That is an astonishingly high number.

另外值得注意的是，强迫症在所有疾病中致残程度排名第七，不只是精神疾病，而是包括哮喘、癌症在内的所有疾病。

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, etcetera.

你可以想象，既然排名第七，那它不仅极其普遍，而且破坏力极强，因此人们的工作表现、出勤率，以及人际关系，往往因为强迫症而受到严重影响，可能持续数小时、数天、数周，甚至数月或数年。

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.

当反复出现的侵入性想法频繁发生，哪怕只是中等频率，人们也会花大量时间琢磨这些念头，想着该做什么行为，然后真的去做，而这些行为正如我之前说的，只会让强迫症越来越强。

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.

结果就是，他们没法做那些让生活正常运转的事了——通勤、写作业、上班、认真听人说话、社交、运动，所有让生活丰富多彩的活动，很多时候都被强迫症完全占满了。

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.

你很快还会了解到，令人遗憾的是，强迫症中的很多强迫念头和行为往往都涉及一些禁忌话题。

Another thing you'll soon learn is that sadly, a lot of the obsessions and compulsions in OCD often relate to taboo topics.

这是因为强迫症大致可以分为三类：检查型、重复型和秩序型。

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.

检查型的比较好理解，比如反复检查炉子有没有关，门有没有锁好。

The checking ones are somewhat obvious, checking the stove or checking the locks.

重复型的强迫症常常和检查型重叠，但更多表现为数数，比如从一数到七，再从七数回一，一遍又一遍。

Repetition obsessions and compulsions obviously can dovetail with the checking ones, but those tend to be things like counting off of a certain number of numbers like one, two, three, four, five, six, seven, seven, six, five, four, three, two, one.

他们会一遍又一遍地做，或者觉得必须这么做，根本停不下来。

People will perform that repeatedly, repeatedly, repeatedly, or feel that they have to.

所以，总的来说，就是检查、重复，还有秩序这三种类型。

So we have checking, we have repetition, and then there's order.

秩序通常被理解为保持整洁，确保一切摆放整齐、完美有序。

Order oftentimes is thought of as putting cleanliness or making sure everything is aligned and perfect and orderly.

很多时候确实如此，但强迫症患者还可能在其他方面以强迫的方式执着于秩序。

And oftentimes that is the case, but there are other forms of order that people with OCD can focus on in a obsessive and compulsive way.

比如一种不完整感，总觉得不能离开某件事或停止某个行为，因为事情看起来不对劲、不完整。

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.

可能是餐桌的摆设方式。

It could be the way the table is set.

可能是页面上文字的书写形式。

It could be the way that something's written on a page.

也可能是一封邮件的格式。

It could be an email.

还有一种是对称性，要求所有东西在某种方式上完全对称。这在小孩子身上尤其明显，我读到过一个例子：有些孩子每天必须把毛绒玩具按固定顺序摆好，如果有人把那只小青蛙挪到兔子旁边，孩子就会焦虑不安，感到非得把它挪回去不可，甚至反复调整好多次。

It can also be in terms symmetry that everything be aligned and symmetric in some way, this could be 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 to the point where if you were to move the little stuffed frog over next to the stuffed rabbit, that the child would have an anxiety reaction to that and feel literally compelled, driven to fix that, maybe even multiple times over and over again.

秩序的另一个方面没那么直观，那就是厌恶感，觉得某样东西被污染了。

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.

我们通常一提到强迫症，就会想到洗手，因为患者觉得什么东西被污染了——比如一个地方、一条毛巾，甚至只是别人的手，所以他们连握手都不愿意。

So we often think about OCD and handwashing behavior in response to people feeling that something is contaminated, a space, a towel, etcetera, or even simply somebody else's hand and so they're unwilling to shake somebody's hand.

你可以想象，这些不同的强迫思维和行为模式——比如反复检查、重复动作、追求秩序——如果严重起来，影响到生活的方方面面，会有多大的破坏力。

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.

我知道我已经说过好多遍了，但接下来这期节目里，我还会反复提到这一点，虽然听起来有点强迫，但我认为完全有道理：每次你去执行那个强迫行为来应对焦虑，那个强迫念头就会变得更强烈。

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.

所以你能想象，这种循环有多强大、多让人陷入困境。

So you can imagine what a powerful and debilitating loop that really is.

我们先短暂休息一下，感谢赞助商AG1。

I'd like to take a quick break and acknowledge our sponsor AG1.

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AG1 is a vitamin mineral probiotic drink that also includes prebiotics and adaptogens.

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I discovered AG1 way back in 2012, long before I ever had a podcast, and I've been taking it every day since.

我当初开始喝AG1，现在还坚持每天喝，是因为据我所知，它是目前市面上质量最高、成分最全面的基础营养补充品。

The reason I started taking AG1 and the reason I still take it every day is because AG1 is to my knowledge, the highest quality and most comprehensive of the foundational nutritional supplements on the.

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AG1 is designed to support things like gut health, immune health, and overall energy.

它通过弥补你日常饮食中可能存在的营养缺口来实现这一点。

And it does so by helping to fill any gaps that you might have in your daily nutrition.

我经常被人问，如果只能选一种补充剂，该选哪一种？

I get asked pretty much all the time, if I could only take one supplement, what should that supplement be?

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And my answer is always AG1.

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It has just been so helpful for supporting all aspects of physical health, mental health, and performance.

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Omega-three and Coenzyme Q10 are known to support cardiovascular health, cellular health and energy generally, brain health, and much more.

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I personally take them both every day.

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接下来我们深入探讨一下强迫思维和强迫行为之间的关系。

So let's drill a little bit deeper into how the obsessions and compulsions relate to one another.

如果我们画一条线把强迫思维和强迫行为连起来，这条线其实就是焦虑。

If we were to draw a line between the obsessions and the compulsions, that line could be described as anxiety.

现在我们需要明确什么是焦虑，老实说，心理学和科学界对焦虑的定义至今还没有统一的看法。

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.

通常我们理解恐惧，是身体在面对即时或感知到的威胁时，出现的自主神经高度激活状态，比如心率加快、呼吸急促、出汗等等。

Typically the way we think about fear is that it's a heightened state of autonomic arousal, so increased heart rate, increased breathing, sweating, etcetera, in response to an immediate and present threat or perceived threat.

而焦虑，从科学文献的角度来看，虽然也有类似的思维模式和身体反应，比如心率、呼吸的变化，但环境中并不存在明确而直接的危险。

Whereas anxiety, generally speaking in the scientific literature, relates to the same sorts of thought patterns and somatic bodily responses, heart rate, breathing, etcetera, but without a clear and present danger being in the environment or right there.

所以接下来我们就按照这个方式来讨论焦虑。

So that's the way that we're going to talk about anxiety now.

而焦虑正是将强迫思维和强迫行为联系在一起的关键因素，让人产生侵入性的想法。

And anxiety is really what binds the obsessions and compulsions such that someone will have an intrusive thought.

有些人可能在想，强迫症有没有遗传因素？确实有，但具体机制还不太明确。研究者通过对比同卵双胞胎、异卵双胞胎，甚至同在子宫内一个羊膜囊里的同卵双胞胎——也就是单绒毛膜双胎，和分别在不同羊膜囊里的双胞胎——发现它们的遗传一致性存在差异。

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 sac in utero, what we call monochorionic, 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.

但如果从所有遗传数据来看一个大致趋势，大约百分之四十到五十的强迫症病例确实存在某种遗传成分，可能是某种基因突变或遗传特质，如果你做基因测序，是有可能找出来的。

But if we were to just sort of cut a broad swath through all of the genetic data, it's fair to say that about forty to fifty percent of OCD cases 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.

不过，虽然这听起来挺有意思，但对大多数人来说其实用处不大。

Now, while that's interesting, I don't think it's terribly useful for most people.

首先，你没法控制自己的基因，也没法选择自己的父母，这话说得没错。

First of all, you can't really control your genes, can't pick who your parents were as they say.

所以你只需要知道，大约一半的强迫症患者有遗传因素，但也不是绝对的。

So just know that there is a genetic component in about half of people with OCD, but not always.

和往常一样，这期节目我想重点聊聊大脑和身体里那些导致强迫症的神经机制和化学系统。

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 obsessive compulsive disorder.

所以，我们先退一步，看看相关的神经回路。

So let's take a step back and look at the neural circuitry.

强迫症患者的大脑和身体里到底发生了什么？

What's going on in the brain and body of people with OCD?

为什么会有那些挥之不去的 intrusive 思绪？

Why the intrusive recurrent thoughts?

大量研究——我们可以说有几十项，虽然还没到上百项——已经锁定了一组特定的大脑回路，这些区域相互连接，在强迫症患者身上异常活跃。

Many studies, we can fairly say dozens, not hundreds of studies have now identified a particular circuit or loop of brain areas that are interconnected and very active in obsessive compulsive disorder.

这个回路包括大脑皮层，也就是人脑最外层的那部分，有时候把头骨打开后看起来像一堆皱巴巴的组织；同时还涉及一个叫纹状体的区域，它负责选择行动，也负责抑制行动。

That loop includes the cortex, which is kind of the outer shell of the human brain, the lumpy stuff as it sometimes appears if the skull is removed, and it involves an area called the striatum, which is involved in action selection and holding back action.

皮层和纹状体之间不断来回沟通，其实是一圈圈紧密连接的神经回路。

The cortex and the striatum are in this intricate back and forth talk, it's really loops of connections.

这个皮质-纹状体回路里还有第三个关键部分，那就是丘脑。

There's a third element in this corticostriatal loop as it's called, and that's the thalamus.

丘脑这个结构我以前在这档播客里没怎么提过，但它却是我最钟爱的神经解剖结构之一，我在斯坦福，还有以前在其他地方教神经解剖课时，经常讲到它。丘脑位于大脑正中央，形状像颗鸡蛋，内部有不同通道，负责把视觉、听觉、触觉等来自外界的信息传递到皮层，让你意识到周围正在发生的事，感知到它们，同时过滤掉其他不重要的信息。

Now the thalamus 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 neuroanatomy, which I teach back at Stanford and have taught for many years elsewhere, because the thalamus 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.

与此同时，丘脑周围还包裹着一层结构，叫做丘脑网状核。

At the same time, your thalamus is surrounded by a kind of a shell, something called the thalamic reticular nucleus.

你不用记这些名字，但所谓的丘脑网状核，它的作用就像一个闸门，决定哪些信息能传到你的意识层面，哪些被拦下来。

Again, you don't have to remember the names, but the thalamic 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.

让我们退一步，看看这个回路——根据神经影像研究，它和强迫症中的强迫思维与重复行为密切相关。

So let's zoom out and take a look at the circuit that we've got and that we now know based on neuroimaging studies is intimately involved in generating obsessions and compulsions in OCD.

我们有大脑皮层，或者叫新皮层，负责感知和理解周围发生的事。

We have a cortex or neocortex, which is involved in perception and understanding of what's happening.

还有纹状体和基底节，它们负责启动行为，或者抑制行为，也就是‘做’和‘不做’。

We have the striatum and basal ganglia, which are involved in generating behaviors, go, and suppressing behaviors, no go.

还有丘脑，它同时接收所有感官信息——听觉、触觉、嗅觉等等，不过嗅觉其实不经过丘脑，其他感官信息都经过它，然后这些信息被丘脑网状核把关，像守门人一样，决定哪些能传到意识层面，哪些被挡在外面。

And we have the thalamus, which collects all of our sensory experience in parallel, hearing, touch, smell, etcetera, not so much smell through the thalamus I should mention, but the other senses that is, and then that thalamus is encased by the thalamic reticular nucleus, which serves as a kind of 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.

这个皮质-纹状体-丘脑回路，就是被认为导致强迫症的神经通路，而这个回路的功能异常，正是强迫症的根源。

So that loop, this Corticosteroidothalamic Loop, Corticosteroidothalamic Loop is the circuit thought to underlie OCD and dysfunction in that circuit is what's thought to underlie OCD.

我们怎么知道这个回路和强迫症有关呢？

How do we know that this circuit is involved in OCD?

我们可以看看一些很有趣的研究，让受试者进入实验室，诱发他们的强迫思维和行为，再用之前提到的各种成像技术来扫描他们的大脑。

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.

他们通常会找一些有洁癖、害怕污染、总想洗手的受试者到实验室里。

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.

然后，你可能想不到，他们会递给这些人一条汗湿的毛巾，上面沾着别人手上的汗液、气味和体液。

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.

有时候，他们甚至会把别人后颈擦下来的汗抹在毛巾上，再拿给受试者看——你可以想象，这对强迫症患者来说有多令人焦虑，几乎立刻就会触发他们的念头：‘这太脏了，太脏了，我得洗，我得洗，我得洗。’

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 anxiety provoking and almost always evokes these obsessions about, oh, this is really bad, this is really bad, I need to clean, I need to clean, I need to clean.

在这个过程中，受试者正躺在脑部扫描仪里，或者接受正电子发射断层扫描，研究人员就能观察他们在洗手时大脑的活动模式。

Now they're doing all this while someone is in a brain scanner or while they're being imaged for positron emission tomography, and then they can also look at the patterns of activation in the brain while the person is doing hand washing.

虽然这些成像设备限制了身体活动，但这类研究还是能顺利进行。

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.

他们已经对大量受试者重复了类似实验，用了各种变体，结果你猜怎么着？什么区域被激活了？

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?

我说的‘激活’，是指哪些脑区代谢更活跃、血流更多、神经活动更强？

And when I say lights up, what sorts of brain regions are more metabolically active, more blood flow, more neural activity?

答案就是这个特定的皮质-纹状体-丘脑回路。

Well, it's this particular corticostriatal thalamic loop.

除此之外，有些药物对部分人有效，能减轻强迫观念或强迫行为，比如选择性血清素再摄取抑制剂，也就是SSRIs，我们稍后会详细讲。

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.

当人们服用这些药物时，不仅强迫观念和行为得到缓解，这些特定的脑回路活动也会减弱，变得不那么活跃。

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.

我要特别强调一下，后面会提到，像SSRIs这样的药物并不是对所有强迫症患者都有效。

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.

正如很多人知道的，这些药物对不少人来说会有其他问题和副作用，但不是每个人都会遇到。

And as many of you know, they carry other certain problems and side effects for many, but not all individuals.

这些基于人类fMRI和PET扫描的研究，加上SSRI治疗的结果，都明确指向一个结论：皮质-纹状体-丘脑回路很可能是强迫症的根本原因。

That collection of studies of data, fMRI, PET scanning in humans, the treatment with SSRIs really points squarely to the fact that the corticostriatal thalamic loop is likely to be the basis of OCD.

当然，也可能有其他脑回路参与其中，但皮质-纹状体-丘脑回路似乎是引发强迫症行为的主要通路。

Now, of course, other circuits could also be involved, but the corticostriatal thalamic circuit seems to be the main circuit generating OCD like behavior.

但接下来你们会看到，在考虑各种行为治疗、药物治疗和综合疗法时，会发现每一种方法都作用于这个皮质-纹状体-丘脑回路的不同环节。

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 corticostriatal thalamic loop.

一旦理解了背后的机制，就能立刻明白为什么某些药物或行为疗法有效，而另一些却无效。

By understanding the underlying mechanism, why certain drugs behavioral treatments work and don't work will become immediately apparent.

明白了这一点，你就能更好地决定该选择哪些治疗方式，该放弃哪些，最重要的是，合理安排它们的先后顺序。

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.

接下来我先休息一下，感谢我们的赞助商Eight Sleep。

I'd like to take a quick break and acknowledge our sponsor Eight Sleep.

Eight Sleep生产智能床垫罩，具备制冷、加热和睡眠监测功能。

Eight Sleep makes smart mattress covers with cooling, heating, and sleep tracking capacity.

想要睡个好觉，最关键的一点是让卧室的温度保持在合适范围。

One of the best ways to ensure you get a great night's sleep is to make sure that the temperature of your sleeping environment is correct.

因为要入睡并保持深度睡眠，你的体温需要下降大约一到三摄氏度。

And that's because in order to fall asleep and stay deeply asleep, your body temperature actually has to drop by about one to three degrees.

而要醒来后感觉神清气爽，你的体温又得上升大约一到三摄氏度。

And in order to wake up feeling refreshed and energized, your body temperature actually has to increase by about one to three degrees.

Eight Sleep会根据你的个人需求，整夜自动调节床垫温度。

Eight Sleep automatically regulates the temperature of your bed throughout the night according to your unique needs.

我用了快五年Eight Sleep的床垫罩，睡眠质量得到了彻底改善。

I've been sleeping on an Eight Sleep mattress cover for nearly five years now, and it has completely transformed and improved the quality of my sleep.

最新的Eight Sleep产品是Pod five。

The latest Eight Sleep model is the Pod five.

我现在用的就是这个，真的特别喜欢。

This is what I'm now sleeping on, and I absolutely love it.

它拥有太多令人惊叹的功能了。

It has so many incredible features.

比如，Pod five有个叫自动巡航的功能，是一个AI系统，能学习你的睡眠模式，并在不同睡眠阶段自动调节床铺温度。

For instance, the Pod five has a feature called autopilot, which is an AI engine that learns your sleep patterns and then adjust the temperature of your sleeping environment across different sleep stages.

如果你打鼾，它还会帮你抬高头部，还会做其他调整来优化睡眠质量。

It'll even elevate your head if you're snoring, and it makes other shifts to optimize your sleep.

如果你想试试Eight Sleep，去8sleep.com/huberman，可以享受最多350美元的优惠。

If you'd like to try Eight Sleep, go to 8sleep.com/huberman to get up to $350 off the new Pod five.

Eight Sleep支持全球许多国家配送，包括墨西哥和阿联酋。

Eight Sleep ships to many countries worldwide, including Mexico and The UAE.

再说一遍，网址是eightsleep.com/huberman，能省下最多350美元。在继续之前，我想先给大家简单介绍一下强迫症的诊断是什么样的。

Again, that's eightsleep.com/huberman to save up to $350 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.

让你了解一下医生通常会问哪些问题，来判断一个人是否患有强迫症。

Give you a sense of the sorts of questions that a clinician would ask to determine whether or not somebody has OCD or not.

目前最常用的强迫症评估工具叫耶鲁-布朗强迫量表。

The most commonly used test of OCD or for OCD, I should say, is called the Yale-Brown Obsessive Compulsive Scale.

科学家和军队都喜欢用缩写，这个量表的缩写是Y-BOCS。

And this is, you know, scientists love acronyms as do the military, and it's the Y BOCS, the -BOCS.

就是Y-BOCS。

The Y Y BOCS.

在直接提问之前，医生会先清楚地解释什么是强迫思维和强迫行为。

Before the clinician would proceed with any kind of direct questions, they would very clearly define what obsessions and compulsions are.

我现在念的这段话，就来自Y-BOCS的原文。

And here I'm actually reading from the Y BOCS.

强迫思维是指那些反复出现、令人困扰的想法、念头、画面或冲动，你并不想有这些想法。

So quote, Obsessions are unwelcome and distressing ideas, thoughts, images, or impulses that repeatedly enter your mind.

它们好像不受你控制似的。

They may seem to occur against your will.

这些想法可能让你感到厌恶。

They may be repugnant to you.

你明明知道它们毫无道理，也不符合你的性格。

You may recognize them as senseless and they may not fit your personality.

接下来是强迫行为。

Then there are compulsions.

强迫行为则是你感到必须去做的动作或行为，即使你清楚它们毫无意义或过于夸张。

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.

有时候你会试图抗拒，但往往很难做到。

At times you may try to resist doing them, but this may prove difficult.

你会感到焦虑，只有做完这个行为，焦虑才会消失。

You may experience anxiety that does not diminish until the behavior is completed.

YBOCS的问题非常多，我这里只挑几个主要类别简单说说。

Now, are a tremendous number of questions on the Y box, so I'm just going to highlight a few of the general categories.

通常患者会填一份清单，标记自己目前或过去是否出现过某些情况，比如：攻击性的想法、害怕伤害自己、害怕伤害他人、害怕偷东西，或者害怕自己会做出无法控制的冲动行为——这些都属于同一类。

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.

另一种是污染型强迫思维，特别担心脏污或细菌，对黏腻的物质或残留物感到困扰，等等。

The other one are contamination obsessions, So concerned with dirt or germs, bothered by sticky substances or residues, etcetera, etcetera.

还有好几类，比如性方面的强迫思维、所谓的囤积型强迫思维，甚至道德型强迫思维，对吧？

So a bunch of different categories that include, for instance, sexual obsessions, what are called saving obsessions, even moral obsessions, right?

过分在意对错或道德，担心亵渎或冒犯神明，或者对对称性和精确性有强烈执念。

Excess concern with right or wrong or morality, concerned with sacrilege and blasphemy, obsession with need for symmetry and exactness.

所有这些问题的回答，都是判断这些症状过去有没有、现在有没有。

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.

接着，测试会转到针对具体症状的问题上。

And then the test generally transitions over to questions about target symptoms.

他们会努力帮患者明确，到底有哪些具体的强迫思维。

They really try and get people to identify if they have obsessions, what are their exact obsessions?

这一点其实非常关键，因为当我们聊到一些真正有效的疗法时，我先透露一点：为什么这些疗法在某些情况下效果特别好，而在其他情况下就不那么有效——关键在于，临床医生和患者不能只笼统地识别出强迫思维和行为，而必须引导甚至迫使患者精确地说出，最让他们恐惧的、最灾难性的想法到底是什么，强迫思维的核心到底指向什么。

Now, 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.

这一点对于打破皮质-纹状体-丘脑回路、缓解症状至关重要。

That turns out to be very important in disrupting this corticostriatal thalamic loop and getting relief from symptoms one way or the other.

所以耶鲁-布朗强迫症量表，也就是Y-BOCS，内容非常全面。

So the Yale-Brown Obsessive Compulsive Scale, this Y-BOCS, again, is very extensive.

它长达几十页，涵盖了很多不同类别，目的不只是找出人们 obsess 的内容或强迫行为，更重要的是想弄清楚背后到底在怕什么。

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 right?

到目前为止，我们一直把强迫和强迫行为当成孤立的现象来讨论。

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.

比如你害怕细菌，所以不停洗手；担心对称，就非要让所有东西都摆成直角；或者总在数数，于是不停地数下去，等等。

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, etcetera.

但更深层的问题是：如果不做这些强迫行为，你最害怕的是什么？

The deeper layer to all that is what is the fear exactly if one were to not perform the compulsion?

也就是说，到底是什么样的恐惧在驱动着这些强迫念头？

Meaning what is the fear that's driving the obsession?

这就引出了一个非常有效的治疗类别——我要说明的是，它不是对所有强迫症患者都有效，但对很多人确实管用，而且直接触及了强迫症背后的神经回路以及如何打断它。

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.

这种疗法就是认知行为疗法，特别是基于暴露的认知行为疗法。

And that is the treatment of Cognitive Behavioral Therapy and in particular exposure based Cognitive Behavioral Therapy.

在强迫症的背景下，认知行为疗法和暴露疗法通常旨在帮助人们学会忍受焦虑，而不是去缓解它。

Cognitive Behavioral Therapy and Exposure Therapy in the context of OCD most often involves trying to get people to tolerate, not relieve their anxiety.

这一点非常关键，我知道不同流派的认知行为疗法和暴露疗法会有差异，但总体来说，目标都是让人去体验那种原本通过强迫行为能暂时缓解的焦虑感。

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.

如果我们回过头来看一下皮质-纹状体-丘脑回路，那这里到底发生了什么？

So if we think back to that circuit of corticostriatal thalamic, what's going on here?

认知行为疗法是在哪个环节起作用的？

Where is CBT intervening?

正如你记得的，大脑皮层负责有意识的感知，丘脑和丘脑网状核则控制哪些体验能进入我们的意识，哪些被过滤掉，而纹状体则参与‘行动’或‘抑制’这类行为决策。

Well, as you recall, the cortex is involved in conscious perception, the thalamus and that thalamic reticular nucleus are involved in the passage of certain types of experience up to our conscious perception, not others, and the striatum is involved in this go, no go type behavior.

当强迫症完全发作时，人们会因为某个想法感到焦虑，要么产生‘行动’的冲动，比如洗手，要么产生‘禁止’的反应，比如不能向左转。

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.

通过逐步、有层次地引导人们直面他们最深层的恐惧，他们会经历强烈的自主神经反应。

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.

在焦虑治疗或其他类型的治疗中，通常的目标是教人通过呼吸练习、想象技巧、自我对话或社会支持等方式来减轻焦虑，这些方法都被广泛认为有助于自我调节情绪。

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 talk or through social support, any of the number of things that are well known to help people self regulate their own anxiety.

但在这里，情况恰恰相反。

Here, it's the opposite.

他们希望患者真正感受到焦虑达到顶峰，同时却做出与平时强迫行为完全相反的举动。

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.

比如，平时的强迫行为是洗手，那么这里的目标就是在经历极度焦虑时，刻意抑制洗手的冲动。

So if normally the compulsion is to wash one's hands, then the idea is to suppress hand washing while being in the experience of the utmost anxiety.

我要特别说明一点，这绝不是你自己或帮朋友能随便尝试的事，必须由受过专业训练、持有执照的心理学家或精神科医生来操作。因为目标是让患者直面最恐惧的事物，同时打断那个循环。

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.

患者此时感到强烈的冲动，必须立刻行动来缓解焦虑，而这种疗法是通过逐步暴露来实现的，对吧？

What's happening is the person is feeling compelled to act, act, act to relieve the anxiety and through a progressive type of exposure, right?

你不会在一开始就直接把人扔进深水区。

You don't throw people in the deep end in this kind of therapy right off the bat.

你会慢慢引导他们，一步步接近他们最害怕的话题，最终在他们经历极度焦虑时，打断他们的强迫行为——当然，这一切都在一个支持性的临床环境中进行。

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.

但通过这种方式，你是在教会人们：焦虑可以存在，而你并不需要靠强迫行为来消除它。

But in doing that, what you are teaching people is that the anxiety can exist without the need to engage in the compulsion.

我想简单总结一下认知行为疗法和暴露疗法的核心要点，以及它们如何与效果显著的药物治疗相结合。

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.

接下来我要讲的很多内容，都基于一位杰出的研究科学家和临床医生的数据与实践。

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.

这位是海伦·布莱尔·辛普森，或者更准确地说，辛普森医生。

So this is Helen Blair Simpson, or I should say Doctor.

海伦·布莱尔·辛普森，她确实拥有医学博士和哲学博士双学位，是哥伦比亚大学医学院的研究科学家。

Helen Blair Simpson, because she is indeed an MD, medical doctor and a PhD, research scientist at Columbia University School of Medicine.

她是全球最顶尖的强迫症专家之一，甚至可以说是顶尖的那几位之一，只有寥寥一到三人能与她比肩。她不仅深入研究强迫症在人体中的机制，积极寻找新疗法、探索新机制、拓展我们现有的理解，还在自己的诊所里actively治疗强迫症患者。

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.

她指出，关键的治疗手段是暴露疗法，当然必须面对面进行，直接接触那些引发强迫思维和行为的实际情境。

She describes that the key procedures are exposures, of course, done in person and with the actual thing that evokes the obsessions and compulsions.

目标是逐步、循序渐进地提升患者的焦虑水平，同时实施仪式行为阻止，防止患者执行强迫行为。

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.

通常，这需要先和患者进行两次规划会谈。

Typically this is done through two planning sessions with the patient.

所以要提前告诉患者接下来会发生什么、什么时候发生、持续多久，不能让他们毫无准备地直接进入状态。

So describing to the patient what will happen and when it will happen and how long it will happen so they're not just thrown into this out of the blue.

然后进行15次暴露治疗，每周两次或更频繁。

And then 15 exposure sessions done twice a week or more.

要明白一点，认知行为疗法需要一段时间，通常要几周甚至更久，可能长达十到十二周。

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 ten or twelve weeks.

另外，医生。

In addition, Doctor.

布莱尔·辛普森和其他研究者通过对比多种疗法，来找出治疗强迫症最有效的方法：单独使用认知行为疗法、安慰剂（也就是没有实际干预，或进行同等时间但无效的活动），以及选择性血清素再摄取抑制剂。

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.

安慰剂对减少强迫思维或行为几乎没有明显效果。

Placebo did not reduce the obsessions or compulsions to any significant degree.

但认知行为疗法的效果非常显著，能在四周内将症状评分从25分大幅降至约11分，而这个评分原本范围是8到28分。

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 range from eight to 28 dropped all the way from twenty five down to about eleven.

也就是说，症状的严重程度出现了大幅下降。

So it's a huge drop in the severity of the symptoms.

也许最被低估却最有效的提升心理健康、身体表现和认知能力的工具，就是每天保证充足的饮水。

Perhaps one of the most underestimated but powerful tools to improve your mental health, your physical performance, and your cognitive performance is ensuring you get enough hydration every day.

但现实并不乐观，自来水里常常含有对健康有害的污染物。

The unfortunate reality, however, is that tap water often contains contaminants that negatively impact our health.

我们本想通过喝水来改善健康，结果反而可能带来严重问题。

So while we're trying to get great hydration, that can cause serious problems.

事实上，2020年环境工作组的一项研究估计，超过两亿美国人通过饮用自来水接触到PFAS化学物，也就是所谓的‘永久性化学物’。

In fact, a 2020 study by the Environmental Working Group estimated that more than two hundred million Americans are exposed to PFAS chemicals, also known as forever chemicals through drinking tap water.

这些永久性化学物与多种健康风险相关，比如荷尔蒙紊乱、肠道菌群失衡、生育问题，还有很多其他健康隐患，有些甚至才刚刚被发现。

These forever chemicals are linked to serious health issues, such as hormone disruption, gut microbiome disruption, fertility issues, and many other health problems, some of which are just now coming to light.

正因为这些原因，当我发现Rorra净水器时，简直欣喜若狂，现在它也成为本播客的赞助商。

For all these reasons, I was thrilled when I came across Rorra Water Filters, and now they're a sponsor of this podcast.

我认为Rorra生产的净水器是市面上最好的。

Rorra makes what I believe are the best water filters on the market.

我差不多用了一年时间，一直在用Rorra的台式净水系统。

I've been using the Rorra countertop system for almost a year now.

Rorra的过滤技术能去除有害物质，比如内分泌干扰物和消毒副产物，同时保留镁和钙等有益矿物质。

Rorra's filtration technology removes harmful substances, including endocrine disruptors and disinfection byproducts, while preserving beneficial minerals like magnesium and calcium.

它不需要安装或改造水管，特别方便。

It requires no installation or plumbing, it's extremely convenient.

采用医用级不锈钢材质，放在台面上既美观又实用。

It's built from medical grade stainless steel, and it fits beautifully on your countertop.

这种东西，你肯定会想放在厨房里。

It's something that you would want to have in your kitchen.

如果你想试试Rorra，可以去roora.com/huberman，享受专属折扣。

If you'd like to try Rorra, you can go to roora.com/huberman and get an exclusive discount.

再次提醒，是rorra.com/huberman。

Again, that's Rorra, rorra.com/huberman.

有意思的是，研究发现SSRI类药物在治疗强迫症症状上确实有效，但患者症状的严重程度，依然比只接受认知行为疗法的人高很多。

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.

那如果把两者结合起来会怎样呢？

So what happens when you combine them?

他们也研究过这一点。

Well, they explored that as well.

结果发现，把认知行为疗法和抗抑郁药结合起来，并没有进一步减轻强迫症状。

And the combination of cognitive behavioral therapy and the SSRIs together did not lead to any further decrease in OCD symptoms.

这说明认知行为疗法才是最有效的治疗方法。

This points to the idea that Cognitive Behavioral Therapy is the most effective treatment.

再说一遍，我指的是前面详细讲过的那种认知行为暴露疗法，每周两次，持续十二周或更久。

And again, when I say Cognitive BehavioralExposure Therapy done in the way that I detailed before, twice a week for 12 or more.

所以，如果你已经接受治疗并在服用SSRI，或者正在考虑治疗并被开了SSRI，理想的做法是把药物治疗和认知行为疗法结合起来，或者在某些情况下，单独使用认知行为疗法。但这个决定一定要在专业医生的密切指导和监督下做出，毕竟这些是处方药。

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, cognitive behavioral therapy alone, although that's a decision that you really have to make with the close advice and oversight of a licensed physician, because of course these are prescription drugs.

无论你要加药、停药，还是调整剂量，都一定要和医生充分沟通，听从他们的建议。

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.

我这么说不是为了自保，而是为了你的安全，因为这本来就是该做的事。

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.

接下来我要说的，你肯定想不到：尽管选择性血清素再摄取抑制剂确实能在一定程度上缓解强迫症状，而且效果明显优于安慰剂，但几乎没有证据表明强迫症患者的血清素系统真的出了问题。

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.

我得指出，这在精神病学领域是一个比较常见的现象。

And I have to point out that this is a somewhat consistent theme in the field of psychiatry.

也就是说，某种药物可能在减轻症状或改变精神疾病整体状况方面非常有效，甚至部分有效，但几乎没有证据表明，正是那个特定的系统导致了强迫症、焦虑症或抑郁症等。

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, etcetera.

之前我们谈到，在认知行为治疗的框架下，治疗强迫症的关键不是消除焦虑，而是学会耐受焦虑。

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.

但这并不一定排除大麻作为强迫症治疗候选方案的可能性。

That doesn't necessarily rule out cannabis as a candidate for the treatment of OCD.

事实上，这一点已经被研究过了。

And in fact, this has been explored.

布莱尔·辛普森博士的一项研究。

A study from Doctor.

布莱尔·辛普森博士本人对此进行了考察。

Blair Simpson herself looked at this.

这是一项规模相对较小的研究。

This was a fairly small scale study.

首先，我先念一下标题。

So first of all, I'll give you the title.

我们也会提供相关链接。

And again, we'll provide a link.

这项研究的标题是《大麻素对强迫症症状的急性影响：一项人体实验室研究》。

This is entitled Acute Effects of Cannabinoids on Symptoms of Obsessive Compulsive Disorder, a human laboratory study.

我这里只是直接引用他们的结论。

I'm just reading from their conclusions here.

数据显示，无论是以THC为主还是以CBD为主的大麻烟，对强迫症症状的即时影响都很小，而且相比安慰剂，缓解焦虑的效果更弱。

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.

也就是说，他们并没有发现大麻或CBD对减轻强迫症症状有积极效果。

So they did not see a, when I say a positive effect, mean a ameliorative effect, an effect in reducing symptoms of OCD from cannabis or CBD.

另一个越来越常见、也备受关注的治疗方法是经颅磁刺激。

Another treatment that's becoming somewhat common or at least people are commonly excited about is Transcranial Magnetic Stimulation.

这种方法是用一个磁线圈，完全无创，放在头骨的某个位置，可以将磁能定向投送到大脑特定区域，用来抑制或如今也可以激活这些区域。

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.

有一些有趣的数据表明，如果将经颅磁刺激应用于大脑中负责产生运动行为的区域，也就是所谓的运动区或辅助运动区，当人们思考或出现侵入性想法时，TMS线圈能够打断这些运动行为，也就是强迫行为。至少在少数研究的小样本患者中，这被证明是有效的，不仅是在线圈贴在头上时有效，而且在治疗结束后，通过打破强迫行为自动化的倾向，也能减少强迫症症状。

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, in a small number of patients within those studies, this has been shown to be effective, not just while the coil is on the head, course, but 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.

目前来说，我认为说TMS是万能药并不公平。

Right now, I don't think it's fair to say that TMS is a magic bullet either.

我觉得大家对TMS非常兴奋，尤其是我想特别强调这一点，大家特别兴奋于TMS与药物治疗或TMS与认知行为疗法的结合。

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.

我意识到，这个播客的一些听众可能对非典型或整体疗法治疗强迫症很感兴趣。

I realize that a number of listeners of this podcast are probably interested in the non typical or holistic treatments for OCD.

那位医生，

Doctor.

布莱尔·辛普森的研究团队至少做过一项研究，探讨正念冥想在强迫症治疗中的作用。

Blair Simpson's lab has at least one study exploring the role of mindfulness meditation for the treatment of OCD.

这方面的研究数据比较复杂，我得提一下，至少在美国已经有不少积极的进展了，其他国家应该也是如此。美国国立卫生研究院新成立了一个补充健康部门，所以现在冥想这类治疗方式的研究得到了推动，这些疗法可以被称为非传统或整体式精神疾病治疗方案。

There, the data are a little bit 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 nontraditional or holistic forms of treatment for psychiatric disorders because of the division of complementary health that's now been launched by the National Institutes of Health.

要是在以前，人们可能会觉得冥想、瑜伽睡眠，甚至是之前提到的CBD补充剂都多少有点边缘，或者说有点玄乎，至少是不入主流的另类方法。但现在美国国立卫生研究院专门成立了一整个部门，哦不对，是一整个研究院，就专门研究呼吸训练、冥想这类疗法的效果。

So whereas before people would think about 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, etcetera.

现在有了癌症研究所、听力与耳聋研究所、视力研究所，还新设立了补充健康研究所，我觉得这是对传统医学很好的补充。

So there's a Cancer Institute, there's a Hearing and Deafness Institute, there's a Vision Institute, and now there's this Complementary Health Institute, which I think is a wonderful addition to the more traditional aspects of medicine.

在我看来，只要能安全地进行研究，任何可能有效的治疗方法都不该被忽视。

I think no possible useful treatment should be overlooked or unresearched in my opinion, provided that can be done safely.

正念冥想在治疗强迫症方面确实有帮助，但主要是通过提升患者对认知行为疗法的专注力和参与度来实现的。

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.

根据我对现有数据的理解，冥想不太可能直接缓解强迫症的症状。

So it's very unlikely, at least by my read of the data, to be a direct effect of meditation on relieving the symptoms.

更可能的情况是，冥想帮助人们更专注于认知行为疗法的课后练习，减少对其他念头的纠结，从而间接改善强迫症症状。

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.

令人惊讶的是，至少对我来说，已经有不少研究探讨了营养补充剂——也就是那些非处方药——对强迫症治疗的影响。

Now, surprisingly, at least to me, there have also been a fairly large number of studies exploring how nutraceuticals, as they're sometimes called supplements, that are available over the counter can impact the treatment of obsessive compulsive disorder.

我想特别提到一种物质，叫肌醇，这里我指的是肌醇的一种具体形式——肌醇（myo-inositol），因为它有好几种类型。

One compound that I like to focus on is inositol, and here I'm referring specifically to myo inositol because it comes in several forms.

研究显示，每天服用900毫克肌醇，可能有助于改善睡眠，减轻焦虑，尤其是在这个剂量或更高剂量的情况下。

And it does appear that nine hundred milligrams of inositol can improve sleep and can reduce anxiety perhaps when taken at that dosage or higher dosages.

我觉得这些营养补充剂前景很好，尤其是值得系统地研究更低剂量在强迫症治疗中的应用。

So I think there's a great future for these nutraceuticals, meaning I think more systematic exploration in particular of lower dosages in the context of OCD treatment.

就像我们之前看到的SSRI和其他处方药一样，我觉得这些营养补充剂也应该和行为疗法结合起来研究，说不定还能和经颅磁刺激这类脑机接口技术一起用。

And as we saw before for the SSRIs and other prescription drug treatments, I think there really needs to be an exploration of these nutraceuticals in combination with behavioral therapies and who knows, maybe with brain machine interface like Transcranial Magnetic Stimulation as well.

我努力做的，是带大家深入理解强迫症背后的神经回路，搞清楚它到底从哪儿来。

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.

同时也想让大家明白，各种行为疗法和药物治疗是如何起作用的，或者为什么不起作用，这样你们才能做出更明智的选择。

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.

再次强调，强迫症非常普遍，而且极其影响生活质量。我希望，无论你们自己或身边的人是否患有这种病，都能通过今天分享的信息，多一些理解与同情，帮助他们找到更合适的治疗方式，获得真正的缓解。

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.

最后，感谢大家参与这次关于强迫症及其相关疾病机制与治疗的深入探讨。

In closing, I'd like to thank you for this in-depth discussion about the mechanisms and various treatments for obsessive compulsive disorder and some of the related disorders.

一如既往，感谢你们对科学的关注。

And as always, thank you for your interest in science.