18. The Real OCD Chemical Imbalance: Glutamate, GABA, & Becoming An OCD Neuroscientist with Dr. Ana Maria De Souza

(upbeat music) - Hello and welcome to a chat with Uma, with me, your host, Uma R. Chatterjee. On this podcast, I bring together all of my roles as a neuroscientist, researcher, board certified mental health peer specialist, mental health advocate, community builder, and a survivor with lived experience to bring you honest and unfiltered conversations, exploring our true human experiences in their fullest form. Every week, I'm bringing you conversations bridging the gap on all things neuroscience, psychology, mental health, lived experience, advocacy, psychedelics, and more. This is a space for raw unfiltered truth, to truly explore ourselves for who we are and how we are. I cannot wait to connect with you, answer all of your questions and co-create this with you. Welcome to a chat with Uma. Hello, my beautiful friends, and welcome to another week of a chat with Uma. I am so beyond thrilled and ecstatic to share this episode with you for so many reasons, but first, let me get into who this is, and then I'll just ramble to you about why I am so just beyond excited and honored to have this conversation. So today's episode is with the amazing Dr. Annamaria Desuza, also known as OCD_Science on Instagram. You might be familiar with her if you were in the OCD world, though this episode for all the tens and purposes is not just for people with OCD or researchers studying OCD. This really is just an amazing conversation for anybody interested in neuroscience, cognitive neuroscience, psychology, mental health, and really the state of research and the intersection of lived experience and research. So Dr. Annamaria Desuza is a Brazilian cognitive neuroscientist who is passionate about bridging the gap between researchers, clinicians, and the public. She has completed an undergraduate degree at a masters in psychology in Brazil, and moved to the UK to pursue a PhD at the University of Cambridge with some of the most renowned OCD researchers in the world. She has committed to translating brain research into publicly available treatments for OCD, and empowering individuals to make fully informed choices. And my goodness, can I tell you that she delivers on those fronts in such powerful ways, not only through this episode, of course, but through her own work in her own science communication and advocacy and hearing her bio and hearing about her, I think number one, just reinforces and instills in me our shared mission and our shared values and how much we align. And that really, really shows in this conversation. And I am in just so much respect and awe for the way she shares so honestly and openly, and you're definitely going to hear it as I don't want to give spoilers and give it all away. But she is just someone who really inspires me as a human as a scientist in the way she shows up in this very oftentimes rough and binary and sacred ties world. And it's just in service of so many people, of course, with her work as a researcher, but also with her advocacy and with her science communication and the way she really wants to bridge the gap just like me. And so I was so honored to have her on the show to talk through her very extensive experience as a psychologist, as a neuroscientist, how her training evolved to get her to start studying OCD and all of the misconceptions that most people in the field face when coming into this diagnosis and understanding and really learning about her background, her lived experience that informed her empathy and her understanding and her interest in psychiatry and mental illness to begin with. And then talking through just such exciting new research being done on the neuroscience front for OCD, talking about one of the amazing papers that just came out about glutamate and GABA and balances, which you'll hear all about, as well as hearing about a lot of unpublished or soon to be published data that you're going to hear here first, which gives me so much joy and lights me up as a researcher. And just this really awesome conversation about the importance of science communication and consuming research responsibly and disseminating research responsibly and just everything that aligns with my values and drives me as a human. And so thank you so much, Dr. Dussuzza, for coming on the show. And without further ado, let's get into this amazing episode with Dr. Adam Ria Desuzza, aka OCD_Science. (upbeat music) Dr. Dussuzza, it's so exciting and such an honor to have you on the show today for so many reasons, mostly because I mean, hello, scientist, scientist, and your work and not only just your work as a scientist, but what you do for science communication and creating a space to disseminate research and just create a space for empowering people with OCD, people in the community is just so beautiful. It's something that really inspires me and I mean, that's how and why I reached out to you to be on the show because I would love to talk about so many things about your work and about OCD and about the amazing, super cool papers I'm very excited about, but also just how you came to be who you are and how you show up in the world and the work you do. So first of all, welcome to the show and thank you so much for being here and giving us your time. - Thank you, it's a pleasure to be here. - I really want to start with your story and whatever you feel called a share because I truly, I mean, I believe as scientists as people who do this work, there's generally a reason why we do the work. And specifically, I feel when studying OCD, I feel like I'm just as a topic and as a subject that can oftentimes in the research world be not as understood or stigmatized because of the misunderstanding around OCD, I usually find that there's a very compelling reason that someone came to this work. So yeah, I'd love to know what inspired you to start on your academic path as a human and how you got to being the cognitive neuroscientist you are today. - So that's so, it's yeah, difficult one because there are so many reasons. First of all, I think I always wanted to study the brain but not just the brain. So why do people react to certain situations differently? How do we make choices? And I was someone that since I was a little kid I've struggled with anxiety. So especially, generalizing anxiety disorder but especially performance related so God forbid I had a 9.9-year school. I would be reminishing over that 0.1 that I didn't get. Just always being a good student in performing well. So that was something that I wanted to not to understand myself of course, but I wanted to understand how people act differently. And for that reason, when I started deciding which course I was going to undertake, I was in doubt if I wanted to do psychology, neurology, psychiatry or biology because I had this idea of I want to study brain and behavior. And in researching that, I realized, no, it's actually psychologists don't have to be all on their clinical side as sometimes people think. We can go to research and I thought it would be more empowered actually by studying psychology that would give me a deep understanding into the mind. And I do appreciate the clinical side for that as well because a lot of research is that we see sometimes see their participants as just brains and forget that there's someone underneath that brain that has feelings. And I find that having this a little bit of clinical experience also helps me as a researcher just to understand my participants and that's one of the things that motivates me with the page as well. It's not, yeah, I'm not just taking formation from you. I want you to know why I'm doing that because the reason is with that, for our participants and for people who with the most different conditions. Yeah, no story short, that's how I got to psychology, but I always knew it would be something more related to academia and neuropsychology. Wow, I love the way you shared that because first of all, thank you for sharing about your own experience growing up and how that just developed this extra level of interest and empathy and just understanding humans in the ways they struggle. And I think you touched on something so important that I think people not in research might not realize, like just the vast number of disciplines that exist and oftentimes they're very siloed. And like, you know, there's clinical psychology looking at things from a very specific lens and then there's, you know, neuroscience and all the different forms of neuroscience that are looking at people from different lenses. And then I feel like so much of the future is bringing those disciplines together to come at a human being and the experience from different angles and work together to you. bridge all of our work, rather than like, I'm looking at it this way, you're looking at it that way, we're going to progress separately, like coming together and be, and not only that, but you being a person who has so many disciplines under your belt. So I'd love to know more about, so you mentioned clinical psychology. Or did you get your doctorate in clinical psychology to like, in theory, be able to practice, but also do the research or how did that play out? So that's a good question. Maybe people have guests from my accent, but I'm Brazilian, and in Brazil, psychology is actually five years, so it's a very long course, and since your third year, if I'm not mistaken, yes, since year three, we do clinical internship. So actually when we finish the course, we're already able to see patients. So I'm not now that I'm living in the UK, I didn't do a doctorate in clinical psychology, so I can't see patients here for, yeah, clinical treatment, but I did have my office for two years, my private practice, sorry, for two years in Brazil with a psychiatrist, and I have done internships at hospitals, and especially focusing on cognitive behavioural therapy. So still have, sorry, I had at the time some experience, treating patients. Wow, that's okay. And then so how did you transition from that to then working, I guess, in my perception in a lab and doing the research and kind of like gathering the data? Like how did that transpire? Same, as I've mentioned with the whole anxiety for grades, I was always a very proactive student, let's put it this way, which means that also different from the UK or the US, I believe, I'm not too sure. We can work as research assistants as undergrad, I know here in the UK at least, it is very careful so that students are not committing too much time to other activities other than their studies, but I used to, the Department of Psychology, which I would actually joke, sorry, let's mark there, would actually joke that I was in there for a very lives Christmas party because I volunteered for so many of them, so I've worked with professional counselling, for example, so professional orientation, I mean, diagnosis, development of questionnaires and like, psychometrics lab, neuropsychology and ambulatory anxiety disorders at the Department of Psychiatry. So that's how I always had one foot say more of the clinic and one in research because I knew that I wanted to do neuroscience and psychiatric disorders for sure and this interlink with measures of neuroscience and brain related measures. Okay, and then where in this did you, and maybe I'm jumping ahead, so you tell me in chronological order how you want to talk about this, but where did you start studying or, you know, finding an interest in OCD in particular or also anxiety disorders, but particularly OCD and then also moving into the neuroscience side because that's a whole other world of skills and that's, I mean, that's why part of what you do is so amazing, the amount of skills that you have. Thank you. Yeah, actually just little bits of skill here and there, but I wanted to explore as much as I could. So one thing that I did from the very beginning was I got associated to the Department of Psychiatry at the University and it was the childhood anxiety program. And there at the time, so this is pre DSM five, OCD was still characterized as an anxiety disorder, so we would still get OCD cases. Of course, I was an undergraduate student, I wasn't treating them, but I was listening to the psychiatrist and just collecting questionnaire data and things like that. But always anxiety general because of my own generalizing anxiety disorder. As well, so it was something that I always like how I could communicate with people that had anxiety disorders because they would tell me, you see, syndrome if I was doing the clinical interview when I would do that, like, yes, yes, I know. And then if you're exactly like that and the person is, how do you know I was like, yeah, because I actually get the same. So that was, oh, you've taken this medication. Me too. How does that work for you? And the faces of people like they just eliminate by seeing that look, that person that is researching me or interviewing me actually feels the same. So it's not that, yeah, you are the words that I hate the most, crazy or anything like that. It's just I was lucky enough to have the appropriate treatment and hopefully we'll get there for you as well. So I was a little bit more on anxiety until I got to my masters at which point everyone in the department of psychology was thinking, who is she going to go with now since she has tried every single lab in this university. And then I decided to go for a very different one, which is a biosignal lab with my, say, my master supervisor was the head of this lab, which was focusing more on skin govani, response, heart rate, variability, and electron cephalogram, which is my expertise, the EEG person. And that was my first attempt actually at with the EEG. So I did my masters in combination with this psychiatry laboratory on anxiety disorders and EEG in psychology. And then for the PhDs, but still not specific to your CD. For the PhD, I wanted to come to the UK. There's also personal story to it, but my husband is Australian. So we needed to find some common ground between Brazil and Australia. That was there was a difficult one, so we decided the UK. And just by reading the biography of several professors, I just fell in love with Professor Trouble Roberts. It's a very big name, but a big, big person as well. And the universe aligned, I think, all the stars that I got a position with him. And that was my first actually deep, say my start in the OCD world. It was because of his expertise, but I just loved the interplay between the name of his institute is behavior and clinical neuroscience, which in me was everything that I could possibly want. So end the whole life is more focused on OCD, which in the end couldn't have been more of a perfect fit for me than it was. I hope I use that. Oh, you absolutely did. And I have like 15 questions. I'm like, where do I even begin? I'm also like you and your husband. That's a whole other story. But so I'm so curious. You came in with your background. First, actually, let me say this with the empathy that you were able to share with the people you were working with throughout your work previously in the clinical setting. I just want to highlight and uplift that and also thank you for being so open and so brave to do so because I think so many people know in this field, especially as someone who has OCD and who's been on the patient side and who also does the research side that especially in academic settings, there's so much stigma in terms of disclosure and to be for you to be able to create that space for, you know, the people you're working with to relate to them and help them understand that you're also a human being and you happen to have a job and have a skill set, but you're also a human being who understands. I don't necessarily think like the person doing the work needs to like that's a requisite. But when that is part of the experience, it's so it's such an opportunity for connection and for normalization. So I just want to thank you on behalf of the people that you worked with and I know that you made a difference in their lives. So I just wanted to say that. And then in terms of you going to the UK and then joining your lab that in that study, OCD, I'm so curious to know what was your perception of OCD when you first like read about the lab description like, did you like, what did you think OCD was and has that changed since working in the lab and starting to do this work? Definitely. So that is one thing that I hear a lot. So everyone actually says the same thing. Of course, I don't blame the university when we study, don't have much time for every single condition. But even as a psychologist, you don't talk that much about OCD at school. And I embarrassed with my eyes. but I thought as a psychologist student I didn't have that much interest in OCD because you're just here. Oh yes, the organized. Why are you doing that? It's really horrible to say and I'm only saying that and I hope people understand that now like I don't possibly know of course this is you talking about the stigma and the lack of understanding that exists in the field across the world and you were you're understanding was a byproduct of the lack of understanding not because you were an ignorant person so I that is the intention of asking this question so please continue if I just know you're not being judged at all. But yeah exactly because we don't talk that much of course the teachers try not to show any prejudice but if they just read the diagnostic criteria sometimes it didn't feel as much suffering as the other disorders when you're hearing about it so someone talks about depression everyone identifies that or has someone in the family has depression it's like I imagine feeling like that and then your heart just goes with that person of extreme anxiety which I would just to feel and then I understand it's schizophrenia but OCD is like okay what if I may must be not knowing and difficult for you to have to do all these things but we're not sad or anxious it was a very difficult to relate and we don't have as many cases when you also because of this stigma so it was just when I started studying OCD that now I've become the most like you have no idea if someone tells me I'm a little bit OCD one day or no you find out that I mean jail because I will have lost it with someone that said that I'm in it I'm disclosing it for the future if I'm never in jail it will be because of that because it's absolutely not not the case in the suffering the things I've seen especially now working at the highly specialized service is yeah it's just not fair the way we learn it absolutely not fair. You're so right though in that it's not it's not fair and it's just when I think OCD carries this unique stigma that not only is it not understood but it also has this misconception of being a quirk of being used in the vernacular so flippantly as you know oftentimes a positive adjective like I'm so OCD about cleaning so I'm really good at it and I love it and look at how perfect I am like it just even does more of a disservice to just not only is it an uphill battle to actually justify it as a disorder but like what it actually is and how people are so fondly associated to it so I just really applaud you for your honesty in the perception of the way you switched and the way you had to you know that you even came into the space as someone to my knowledge without the lived experience and still found that empathy and understanding and or such a such advocate for it now and so I'm very curious when you came into interfacing with your lab and you saw that as part as the specialty what on the surface level like inspired you to be to then gain an interest like was it that you really like the PI and you and because of that description you understood OCD was something else or was it like part by learning about the lab you understood OCD more like how did that shift for you to get you to dedicate your career to studying this. That's yeah great question and this one I have to say was not academically it was an academic change it was by seeing patients as I saw a little bit of myself of course I don't have OCD I wouldn't dare to to compare but this strength because people know they have they are caring they are daily routines all they have to do plus the weight of the obsessions and compulsions and they still say no but it's okay I just have to do it and and they just keep going with their lives and how patients are also so interested in helping with research so we don't see I don't have that much experience of course but some other conditions people are not as in enthusiastic and I saw like that desire of helping now we need to participate because I've even heard people say it's not going to be more my lifetime but for the next people it also gets me going I'm gonna do that to find some way but it's just that the persons are ready on 150% of the energy levels and they're still there and giving while others are saying why are you tired you don't do anything all day like I mean you don't think that obsessing all days exhausting right like anyone would prefer to be at work caring rate of necessary then being at home feeling like that so I think it was it was really seen the this strength and resilience of people like dealing with all of that that just flipped for me and now just so not in love of course because it's a terrible condition but you love with the people yeah conversations like this I think really restore my faith in humanity and I'm sure it's for people who are listening to because I think especially just coming fresh off of the International OCD Foundation conference and being just among so many people doing this work as well as the people who live with it of which I am both I think there's this feeling sometimes of like it takes someone so special to in my opinion at least to actually dedicate their life to this disorder to this debilitation to be this committed to supporting people especially when they don't have the lived experience because again of the uphill battle of you know how does one get invested in this disorder that has such a uniquely uncomfortable stigma around it to even be considered like legitimate enough for interesting enough or the people like recognizing people's debilitation if I think especially in clinical settings there's more of a normalization of people with lived experience than becoming clinicians and starting to do this work to support people because they understand what it's like or having a you know loved one or something but I don't know to me the people who come into it you know purely from yes empathy but also from a you know professional perspective and then get almost hooked in because of understanding how important it is to support people with this with OCD I don't know I just really really really respect people and I know that I'm not the only one so thank you for sharing so much of that and I am now I would love to know in your words what you would conceptualize to be OCD and a lot of the misconceptions that you oftentimes face when discussing your work and you know just the way that you conceptualize from your own perspective and I know everyone has their own perspective but from yours of what obsessions and compulsions are and kind of that cycle because I think that framework will be really helpful to then discuss your work and everything from your lab after so first of all every time I say I work with OCD so in your person in fairbly if they don't say oh I'm a little bit OCD and they'll say they know some other days or OCD is that one of people are cleaning things and I don't know walking without stepping on the lines I think so like that and nowadays just say like no it's just it's much more than that and I usually people are only stopping attention to me when I mention with this most severe cases that I've seen and people like I didn't think it could get that bad and then like their faces just change because they think it's funny that the person just yet cannot eat if the food has touched this surface and it seems like why don't you just stop it and then you give an example of why don't you stop your diabetes and then you're like ah yes yes you're correct so just like it is very very frustrating to discuss and then you also have a lot of people that feel they know how to how to cure it so I'm especially I get specially frustrated with same health services because when patients get to the highly specialized clinic where we are now they have had so many bad experiences that it just it breaks your heart I think here things like have you tried gardening like oh my god that's the Nobel Prize right there the person just found the cure for OCD and I've been trying not the way gardening that's it and then of course gardening didn't work or or a hobby you just have to do more things and people are still there so the way we conceptualize OCD in terms of from the evidence that we have behavioral neuroimaging there's one of the theories proposed at least but our lab or our science mode this one is because of an imbalance there is an imbalance between go direction habitual systems in the brain. So we could think of us ideas, something evolutionarily adaptive. The behaviors are usually there to protect you. You should check if you turned off the stove, if you close the door, or if the food's not contaminated. But at some point, these actions become more habitual. And then in my work with electric cephalogram, I have actually found that there are potentials, multiple potentials in the brains of people with LCD. There are stronger than in people without LCD. So the habitual areas are a little bit more active. So you've already checked, for example, but as with habits, they are automatic. And everything automatic escapes our attention a little bit more. So there's also the component that they will happen involuntarily. And it's easy for us to say, "Have I done that?" If I ask you, "Well, ma'am, when you took a shower today, did you wash your left foot?" Probably, like, "Yeah, probably, by your shore." But I mentioned so because we all have a routine of how to take a shower. If you notice, everyone will start by the same side and finish by the same sign. So you think you have because it's part of the routine. But the memory sometimes gets foggy because you're just not paying attention to it, not because of actual memory issues in people with LCD. So those habits are so involuntary that they take over to the points that they are not adaptive anymore. But you still have that sign there. So I usually say that people with LCD and with anxiety disorders have some sort of broken alarm in their mind. It's like, "Danger, danger, danger, there's something that you need to check." Right? And we know which brain area responsible for that. And then your motor areas start trying to fix that in some sort of way. But it's just broken. So actually, ideally, we would just ignore the alarm, but that's much easier said than done. So we do work with. I know it sounds horrible to just reduce to that, but in terms of brain imbalance between go-directed and habitual areas. No, no. That's not. That's honestly one of the best descriptions I've heard. And I'll tell you why. And this is hugely why I'm a neuroscientist or why I'm in the process of continuing and training that way. Because there's so often times when it's so important to describe this symptomology and the themes and the different ways OCD can present. But in describing it as such, especially from advocate standpoints where they're disclosing their lived experience, if we're hearing just one perspective or one patient's experience with their themes, it's very easy for someone who's not familiar with OCD to become just entrenched in that. For example, one of the biggest ones is contamination. If someone has indeed superseded the typical stigma of OCD being a quirk and they do realize it might be a disorder, then most people end up thinking that it's this for cleaning, excessively cleaning or excessively checking the stove or whatever has been perpetuated in the media as typical OCD. But I think descriptions like yours really take it back and describe the underlying general physiology and the cycle of what OCD entails to where then it kind of describes how it can latch on to quite literally anything. If there is a salient cue, if there's something in OCD or in someone with OCD who there's any level of doubt or any level of hypervigilance about something, it can become an obsession. And then that habitual behavior in order to cope with said uncertainty or said distress or whatever, like, can become a compulsion. So your description is exactly why one of the many reasons why I have you on the podcast because that is such an important vantage point. And that leads me to, you know, we can go so many ways different different directions of getting into all the things I want to talk about. I guess I'll start with since you already just started talking about the brain areas involved. And EEG, I'd love to know your, I guess, journey in starting to work with more of the neuroscience, you know, bridging into the neuroscience of OCD and kind of the different, the way you conceptualize the, you know, I guess the anatomy of OCD or like the different parts of the pathophysiology and kind of what vantage point you interact with that work as. So, yeah, as you said, it is important, of course, to recognize that there are different dimensions, but again, as you said, one of the problems of, yeah, relationship OCD and then contamination or harm or aggression is that then they all become different disorders. And it's very difficult even to have studies that address them and treatments. So we always try to go to the root because of course I understand the suffering is unique, but we do believe the root of all the dimensions is the same, right? They are all there because of doubt and that's actually a point that I didn't mention before, but intolerance of uncertainty is something that we always measure in any of our studies because it does seem to have a major impact on this hypervigilance and then of course this will produce anxiety. So I for one subscribe to the idea and people get sometimes a little bit angry, I'm gonna say that, but I think that OCD and anxiety are dissociated, meaning anxiety is OCD, I don't, I'm not taking anxiety from OCD, but I don't think you have to, that they could start the same way. I think, yeah, you can have OCD and then anxiety will be a part of OCD, but you don't just get, you know, central OCD when you're anxious, for example. But in terms of brain, what it was interesting because we know areas that are implicated in OCD, they are quite famous, or with a front of cortex, and so a later inventory media with a front of cortex, then what my supervisor would joke that's my favorite area, which is the interior secret cortex, which is this one of error monitoring and conflict, the the alarm one. And I like that because of anxiety as well, but it's a point when I just when I arrived in Cambridge, I spent the first few months just reading and we read things in the literature of OCD as patients don't like making errors, because they are threatening, so you try to do everything perfectly and the most efficient way. But then we also see that, okay, you're doing that, but now your actions are not go oriented anymore, they're actually a bit short, they are not adaptive anymore, so why are you perseverating? That's me thinking. So I wouldn't understand perseveration, you don't like making errors where you're perseverating, there's something there. And you're getting the external feedback, that you're wrong, and we used to do the term nisic and probabilistic voicilloning tasks, people know their own, and then you could even ask in the end, did you understand the roles of the task and the patient? Was it was it clear for you or you're making mistakes because you did understand? I don't know, I knew that the cycle gave me more money than this square, so why did you keep going for the square? Because I felt I had to and there was, there's something there, and I could be simplistic and say, oh people, they just don't like money or they're not paying attention to the task. But then I started reading a little bit more about motor literature and there's just right feeling for example, and just the idea that external feedback doesn't seem, and we still have fights over that in our lab, but I insist that external feedback doesn't seem to be as relevant for people with also the as-in turner one. So even if the environment is saying you're making it a wrong decision like adapt and disbraineries, screaming they are adept, your internal feedback has to be how you're proceeding the action. And sometimes it's just right feeling comes from a number of times that you have to do a certain action, and then I shift it, it's like why is no one looking at motor areas? Could it be that there's a relationship, but for some reason and I'm not comparing so please, but I read a little bit about the literature on Parkinson's just by coincidence, and then came to my attention, we're not checking motor areas, right? Maybe the person is aware cognitively and it is the case most of the times, but motor areas and much more to neurons are much faster, so they will tell you to do an action even if they're not seriously called screaming. So I used to joke it's like yeah the The hand is going to press on me to do the. the inter-singular chord is saying no no no no no no no go but that's go signal is stronger and you still go so you get both of the both the motor signal and the danger alarm at the same time and that's when I started focusing a little bit more on the supplementary motor area and all these things if habits are habits is because there is a motor component there they're selling them to go without your awareness and that's why it's so difficult like why don't you just stop it not because like that can't my brain is telling me to to the doctor so now my new favorite area is the motor motor area oh my gosh I I love your brain I love your brain I love that you are so not only interdisciplinary but you're coming into these scenarios and like you said you have debates in your lab endlessly but you through perceiving human action it's that translation of human action human psyche like why can't people stop in that leading you to looking at the you know correlates in the brain in terms of the areas perhaps even deeper like the connectivity and the function and structure and all those things and I have a quick question before we move on because I'm curious for your perspective in terms of mental compulsions do you think the physiology or you know the mechanisms driving those are in your opinion I know you don't know the answer per se but do you think they're equivalent to physical compulsions in terms of the motor areas action in them I have debated this one a lot and I might retract myself one day because of course I don't know the answer for sure but I think if we see imagery studies for example we do know that just thinking imagining yourself performing a motor action will engage those same areas so we do have we do have evidence even that inhibition of thoughts engages motor areas as much as inhibition of actions so there is definitely something there it might not be the only explanation but motor areas will be placated in the sense of agency all of those those things aside from performing the compulsions self I love your answer and when you said you might retract your statement later well that's why you just come back on the podcast and also that's the nature of research which you're definitely going to get into in terms of like how much research is changing and how you know as much as people with OCD I'm just kind of joking but kind of not want certainty and want rigidity like that's the opposite of research so we'll get into that after but I love that you said that and that I think that your answer just makes a lot of sense to me and it's kind of validating in a way of with mental compulsions I know oftentimes people in their experience their their physical compulsions are less difficult in treatment to start you know not doing and with with ERP but mental compulsions oftentimes I know for me especially feel like well it's just thinking like how do I stop thinking like I'm a human so like how can I stop doing mental compulsions it feels so automatic but I know that in the way it's treated and just like the psycho education of it all like at the end of the day having a thought is you know kind of automatic but engaging with set thought is an action and so in your framework of even in hip trying to inhibit a thought or to engage with a thought and that being related correlatively at least to the motor area that makes a lot of sense and helps reconcile that kind of feeling like it's just automatic but it's kind of not so thank you for saying that and I I I definitely oh my gosh I'm so excited there's the paper that just came out that's so exciting but before we get into the paper I kind of want to just lay it a framework for the audience especially in terms of different you know modalities of studying the brain and neuroscience and cognitive neuroscience and imaging and EEG and all of that and I just kind of if you can share with us the general scope of what your lab does and then what you do in your lab and kind of maybe some of the key findings and assumptions and hypotheses that your lab is like looking at and works with. So yeah this paper that you mentioned was actually led by a colleague Dr. Margin Birian so she I'm the EEG lady she's the spectroscopy lady but basically what we're trying to do isn't the standard CD as a whole right which is very difficult of course it's very complex disorder but we were our participants like I need to thank them so much because I used to bribe them in a good way with chocolate and pull right photos of them you've read the EEG so two sessions four hours each do very long days but we tried to squeeze as much information as we could from them because otherwise it just so that's why I think people get frustrated with research and I understand but just have like portraits of what's happening right now so we need to try to get information without burdening participants too much so what we're trying to do there was see neurochemicals are in the brain with clinical questionnaires self-reported questionnaire behavioral tasks of habits and cognitive flexibility for example and inhibition and I was doing that with EEG so I was actually seeing all these motor areas how people are able to stop their actions the whole inhibitory control with the EEG we're trying them to get to a framework of us we can see so we're not discriminating by I want to subgroup of checkers or subgroup of people with contamination sessions no our participants had OCD that was the the main inclusion criteria say and we're really trying to understand as much as we could so it was quite interesting for me then this is not published yet because I tested participants in Cambridge and in this NHS facility where I'm working as a as opposed to now I end up with two different neuro profiles of OCD patients by not by accident but by a lucky surprise say because the patients are becoming to Cambridge although everyone had OCD they were somewhat less impacted by the disorder they were presenting higher degrees of they were more functional in a way so we would have medical students that had OCD or people that had the disorder for maybe last time so it wasn't as as the stressing as these others that went to the NHS and there was a clinical trial so you have that different profile those going for research and those going for treatment as well and interestingly we see we were able to see that yeah there's more severe patients and NHS had different brain responses to my EEG tasks than the ones in in Cambridge and this could only be achieved of course because I had a simple side of more than 70 participants I would test them twice or three times so we're really really trying to get OCD and models of compulsivity so I don't work with that my supervisor also has animal models also animal labs the monkeys and rats and then models of compulsivity because we just need to understand what compulsivity is and then be able to apply that to people. I have like 50 questions where do I start? Well I just want to highlight what you said at the end as well just for people because I know so many people are interested in becoming a researcher and like don't even know where to start in terms of different parts of OCD or just in general different parts of a disorder or experience and I love that your lab to my from what I gather is bench to bedside it's like very much from the most like very nitty gritty cellular and animal models developing like the most ways to manipulate and test very specific hypotheses and do things that we can't do in humans in terms at this point at least in terms of manipulating different circuits and cells all the way to looking at the actual human being and using the technology we do have which is hugely what you're doing and not only you know assessing them as a person and talking to them and gathering their data and their self-report but also looking at their brains and looking at as much as we can like the connectivity and the responses and so that's super cool and just for anyone listening like there are many different ways you can engage in research and sometimes you have a supervisor or lab that kind of does all of it and you get to contribute to a certain part of it that then comes together to create a fuller picture so that's what I'm hoping to do with my PhD and part of the labs that I'm rotating into but that's a total aside. I I don't know if I'm allowed to ask you this, so you tell me if you want to wait till it's published. No, we can talk about it, but the two different profiles that you're finding in two different patients. So first of all, in terms of assessing functionality versus the more dysfunctional, what, I guess, what criteria determines who's more functional? And I think you mentioned, for example, like med students being more functional versus is it that maybe they are not able to, I guess, like provide them for themselves or engage in careers or like how is that associated? And then, like, what are your preliminary thoughts on what could be driving that difference in populations? That's a high question. But we used in terms of functionality, we didn't use a specific measure. We do have the quality of life measures, so not quality of life, sorry, disability measures. So how much do you think your symptoms are impacting social life, professional studies, and family, friends? So we do have that, but then of course, from clinical interviews, we'd know, for example, I've seen people that would only live the house to come to the clinic for this tribe. They would say, like, I had to drop out of school. I cannot live by myself, or I don't live the house, like very, very severe cases where many people, yeah, they couldn't work anymore, which is something that, when I was in university, I didn't even think that you wouldn't be able to work. And I would see how common that is, unfortunately, the people are just like at home all day, very, very debilitated. And you have these other profiles that for some reason has been protected by other factors, they still don't know what they are, but the symptoms are there where the person can still go to university and do things. And then I really don't know what started first. If maybe going to university, protected them in a way that the symptoms didn't get that bad, or if it's the other way around, but they develop more resources. And one of these findings that's not published yet, I was very surprised at it. So I studied this component called the error-related negativity, which is basically this alarm that we were talking about in the interior secret cortex. It's very a simple component. You measure that from fraction time tasks. So you have a task, you have to respond to the error. If the error points to the right, it press right, if the error points to the left to press left. If the error is red, though, it means don't press anything. But they're so fast, people make mistakes, it's normal. And the computer is actually rigged in a way. It will adapt to your responding to make it more difficult for each person. And then you go there and press the red arrow. And we all have that same reaction. It's normal, everyone does that little jump. Which is good. That's your brain saying, hey, you've made a mistake, adapt. Good, everyone has that, everyone should have it. Absolutely great. But you know, it's like, hey, you made a mistake, adapt! And it's just so strong that the person gets like, okay, and that disrupts everything. So errors become much more immersive. We, the literature is not completely convinced, but there was some sort of common sense, even with papers that said otherwise, that we do know this error-related negativity is a biomarker for anxiety and OCD. So these are heightened, yeah, error monitoring system. But it was thought that maybe would correlate with symptoms of erity. So having that more, you feel the person is more severe. But what I found actually was that this subgroup of the less disabled patients had this component higher, meaning the screen was louder. Yeah, exactly from, yeah, from our face. You see, that so I thought, that is the opposite. But then we've been like analyzing the remaining of the date and study. We do notice that this component is kind of screaming. Say you're in a battle, you're going to lose the battle and then the general screen for reinforcements, so bring more soldiers and then the cavalry arrives because you're actually a screen louder. So that's what it's doing and saying prefrontal cortex, please, we need some more cognitive control here. We're making mistakes. So sent resources to us. Whereas the group that was more disabled, they still have that this component, so this little wave, let's say, a higher than people without a city, but it was like, hey, reinforcement, please, in a way of almost hopelessness, like, yes, we're screaming for help, but help is not coming because cognitive control is not helping anymore. So there seems to be something about recruiting cognitive control and this wave trying to compensate for errors, which is exhausting. That's why a lot of high functioning people will see the idea of the day might be three times more tired than others because you need more cognitive control because you're fighting two battles at the same time, like the task at hand and all this monitoring on the side. But by asking for this cognitive control, you are actually being able to perform your tasks where a disorder group was not recruiting this compensatory mechanism as well. So I hope I made myself clear. So clear. I'm just saw my face. I'm like a holy crap. Like that's okay. I have curiosity and thoughts on what you just talked about. And this is just shooting this shit with you because I, so when you talked about kind of the, in terms of assessing functionality and being, they're being people who are by quality of life terms and by disability terms are disabled and they're not able to function. So debilitating overtly and then there are people who have OCD oftentimes severely, but they, you know, by standards of functionality of, you know, being able to exist in the world seem to be more functional for whatever reason. I, what came to mind is that I have been both of those people. I have been the person that, you know, I had a 1.83 GPA. I had undiagnosed severe OCD and other things. And I literally like, could it go to a store like I would be there for eight to ten hours a day? And I, I couldn't move. I had to leave school and I didn't know this at the time because like I couldn't even participate in class probably because of the number of compulsions I had to do to even exist and be able to take an information. And it was just, that's the tip of the iceberg, but that I was so, I used to sit in the dark. I couldn't even turn the lights on because I had, you know, obsessions about what if I spend all my money and I go broke and it was just, it was really, it was like by very, very typical standards, extremely debilitating. I couldn't function. I couldn't do anything. And, of course, I, at the time, I would imagine I would score extreme because when I did finally go into treatment in terms of the Y-box, I was at extreme and I'd still become more functional by standards and still I was at extreme. And then through treatment and where I am now, and I'm very open about this. So this is not new for anyone listening to the podcast. I score moderate to severe. Oftentimes, more in the severe range because I have definitely recovered largely and have done ERP for a lot of my physical compulsions and for the things that really kept me debilitated in the sense of disabling me in terms of functioning in the world and like taking care of myself and existing and doing things. But even to this day, I still, and largely because of the PTSD comorbidity and lots of other things, I'm still in the process of even working on becoming more functional and not scoring to moderate to severe on the Y-box. And so I now kind of fall in the category of what you're talking about, like on the service level and, you know, by standards of what looks like on the outside, I'm, you know, just graduated with my master's after having a 1.83 GPA and not being able to function. I'm about to start a PhD program. I've worked in labs. I've, you know, presented. I have things I'm doing and it's I'm functional and yet I still have severe compulsions and oftentimes they're mental. And so what came to mind for me in terms of like, again, this is just an end of one and this is just like putting myself in the perspective of what you're talking about, I wonder how much of the difference in the populations you're looking at might be, and this is going to be hard to say because I know if people don't listen to the whole thing, they're going to come at me. But in terms of compulsions and what they look like in terms of the net over way they interface with the world in terms of does it actually in certain, I would never think compulsions are ever actually helpful and act, they're debilitating and, you know, we don't want to do them. However, the content of the compulsion and sometimes to a certain degree what happens from the compulsion in terms of what it does for the work you're doing or the thing you're doing. For example, like, you know, oftentimes this, and this is why it's so hard to say, people think like people who check things all the time, they just happen to like have better outcomes in terms of doing things more perfectly and doing things whatever and at the end, into the day, like we don't want to be someone who has a disabling amount of checking compulsions. And there's obviously a cost-benefit analysis and diminishing returns. However, there's probably a part of checking where like because there is checking at least in the beginning, like you are checking for accuracy, it just then becomes compulsive and becomes like, you know, completely useless and there's no point doing it and you're just abilitating yourself in a way of like needing treatment. What I'm trying to say, I guess, is that the group of people that seem to be more functional and I wonder if that's where perhaps themes or maybe even just the compulsions that they are doing happen to be something that is definitely disabling in their human experience and they take up too much of their time and leaves them exhausted. At the same time though, their compulsions don't necessarily impede their way that they get to like participate in the world because there's some like perceived benefit at least at the beginning of doing them versus other people's compulsions for whatever theme that's stuck with them has resulted in them literally, you know, being locked in their house and not being able to engage with a job. And so I guess I don't know, that's just my outward rant in terms of like what perhaps is contributing to this difference. And then there's also what you said after in terms of like the increased amount of helplessness in the less functional group and the higher alarm. But anyway, I don't know if any of that made sense but I'm so curious on your thoughts. Yeah, to be fair, I don't really know how to because when we are analyzing by themes or dimensions of a CD, we'd need a much larger simple size. So I wouldn't have the power to analyze for that. One of my hypothesis though is, not a hypothesis, it's a full part of the data, this group that was more disabled had higher levels of depression, clean could depression. So significantly more depressed. So if you're more depressed, it's more difficult to ask for help. It's almost as, yeah, it's that we help, but you just don't even expect that anymore. Whereas the other group, if you see a little bit more anxious, you're still fighting with more strength, let's say. So I think depression did mediate those results. In this subgroup, we didn't find this difference in terms of statistical differences. But the longer you've had the disorder and untreated the worse it is, more depleted your results. So a lot of these participants that came to Cambridge work younger ones that had just been diagnosed, for example, so you're still in that phase where you're more actively fighting bad. It would be very, I had thought of doing study by dimensions, but it's just so difficult. And also they seem to change, which is why we have this idea of one common route, because people can have multiple themes throughout their life. So sometimes it's easy if we could find one thing that works for everyone, but this would be, yeah, very interesting hypothesis. People with mental compulsions, for example, although they are horrible and very distressing, they're easier to hide, and that's what my participants would say. So unless you're so distressed and physically distressed by them, they can still do their compulsions outside. So that's just the sabling in this sense. Oh, it's so disabling. And it's almost not that OCD is OCD is OCD, but having mental compulsions and then being able to hide it. And then number one, just like not being seen in your suffering by people around you to even validate that you have the disorder and your in treatment. And then also being in treatment, and unless you're with a super trained, almost like my and reader OCD therapist who knows about mental compulsions, how easy it is to get away with doing them and mitigating your suffering in sessions. So it looks like you're getting better. That was my experience. And I also just from what you said in terms of the data showing that the longer one is have the disorder and especially untreated the more, you know, the correlation to the severity of the illness, I think that's just such, I mean, that's like the icing on the cake of why this advocacy and awareness is so important. It's not just raising awareness of the disorder so that people know. I mean, that's so important. But also how much suffering is unnecessary. I mean, I guess we can't control that we, you know, we have OCD or we get OCD or whatever. But to it's even more unnecessary suffering when the disorder gets worse and people suffer longer and have a worst case oftentimes because of how unnecessarily long it takes to get the diagnosis and treatment. So thank you for saying that. I'm so just unfortunately, I guess excited about the data in a sense like validating that necessity. So it's, it's a weird thing to be in research. I'm so excited for this result in this, you know, project and it's like about something that's so debilitating, but it's because we want that data to be able to help people. So I completely get it. And especially when you said earlier. And so wow, you are sharing so much exciting information to me as a researcher about stuff that hasn't even been published. And I'm so excited to hear about that. And that I guess also feeds into well, the paper that just came out. And I, I mean, I'm going to let you sum it up and you tell me just like what the findings were and how that came about and the significance because it's so hugely significant to developing treatments and further understanding the pathophysiology and the way that this disorder works. So please, please take it away and tell us all about the new nature paper that came out. Thank you. And yeah, well, something to look forward is that in this paper, of course, Dr. Birrier mentions her results with spectroscopy, but all these patients had the EEG as well. So we can actually compare the results of spectroscopy with EEG and they had FMRI as well. So I'm saying that these participants were the most amazing people. So we have a good understanding of EEG, but basically what she did was we recruited 31 participants without EEG, 30 participants with EEG, matched by age, gender. And they were asked to go into this scanner, which I was a pilot for so many times. It feels just like the normal magnetic resonance scanner, but this one has a much stronger magnetic field. So it's a seven-task light. And that's why this study also is much more impactful. It's because in the UK, I believe we only have seven of those scanners. One of them is in Cambridge. So the magnetic field is really, really strong. And that allows us to actually differentiate the metabolites in the brain. These usually studies on substance that will be more of a patch scanners, but then they have the whole radiation, which makes them a little bit more difficult. And ENOSID, especially so Dr. Bure has a chapter on spectroscopy and ENOSID summarizing findings, which was written before this study. Most studies are worth anything. This is the first study, if I'm not mistaken, but don't think I am with seven Tesla. So all the others have three Tesla, which is yet not nearly as strong for us to be able to differentiate glutamate and GABA and glutamine as well. And now I've seen even comments. Curiously, yesterday I saw that there was. It wasn't Facebook and there was a press release of this paper. And there were a lot of. I'd say, not so enthusiastic comments underneath the paper. Oh, great news. I came to go in balances again. Oh, what did you find? Like, this is not news, anything's like that. And I understand because we've been talking about chemical imbalances for a long time. But we didn't know exactly where they were and what they were. And that's what makes difference. So what she found was that in this interesting little cortex, which I mentioned before is this alarm area, there's higher concentration of glutamate, which is the excitatory neurotransmitter. So the one that activates the synapses and lower levels of GABA. And the same was found for the supplementary motor area, which is this one that I've been measuring as well with the EEG. So we actually have a correlation there between her findings and mine, showing that these areas are so overactive. And just by knowing where it is now in which metabolite is actually excessive, then we can develop drugs that will target these areas specifically. And this metabolites are specifically. Whereas before we talk about Capricorn Balance, we're going to talk about Capricorn Balance. So what does that mean? And this is something that I wanted to emphasize in what you hear, if I may, is she and I, because of the page, I've received a lot of messages from people with OCD that of course I'm interested in treatment and that's how it should be, right? It's such an ability to get in disorder. But what we found is still basic research. So I can't tell anyone to take. So people are asking me, so should I take Gabba or should I try to mediate glutamate with this and that? It's like absolutely not. Do what your doctor tells you to do, follow the guidelines. What we found now is a way to develop new drugs, but we still don't know. Because even if Gabba is inhibitory, for example, it means inhibits and pain, it means inhibits transmission, what say, that's already inhibitory, so he actually excites it. So we really need to study this pathways and I know it's frustrating, there are controns like things to treatment him ultimately, but yeah, just do not start taking Gabba or glutamate because of that. But we are one step closer to getting the treatments. That is so, so important and thank you so much for sharing that and I'm not surprised that you're receiving those messages honestly because I, you know, any time I talk about literally anything about OCD or anything at all, like in terms of like dopamine or like D2 receptors or whatever, it's like, oh, so like, therefore I should take this thing and I should do this thing. It's like, it's so interesting, like being in research and the more you get into research and are a researcher, it's like basically an exercise of learning like, how much you don't know, like the more, you just become more aware of like how much you don't know and how much there is to know versus people are like, you know, who are not in research, which is like, I mean, they don't have the education or awareness for good reason to know what it is that like where the findings are in perspective of like the grand scheme of existence and like, you know, papers are amazing and especially a nature paper is huge and that might even feel like if people have heard, wow, nature is this like, you know, it must be like the answer if it's in nature, like no, it's just a publication that happens to have a lot of, of a reputation for groundbreaking papers. But at the end of the day, like the way I try to describe it to people is like, if you think of a puzzle, like a very, very, very extremely complex puzzle, like usually findings are chipping away at building into this puzzle that we don't even know as researchers how big the puzzle is or what it looks like, we're just chipping away at a puzzle and sometimes there's a paper or a finding like you had that your, you know, your group had that is yes, a small piece of the puzzle, but it's a piece that kind of orients us to like, I don't know, I don't know why a picture of a horse is coming up right now and then it's like, you kind of see like, it's a picture of its face so you're like, oh, well, I guess I can tell that right now we're in the face part and that's easier to tell versus like being in all the, the for, I don't know if this is making any sense, but I guess it's sometimes findings are so interesting because it gives us perspective to build upon and it's, you know, hugely informative to the direction of the field and something that we're validating. But at the end of the day, it's still just a result. And like you said, you know, even drugs in terms of even if people are going to develop drugs from what you just said, you're looking at specifically in different areas, what the different transmission levels look like and the different interactions of chemical, you know, activity, but those are specific areas and then drugs to this, you know, at this point are generally globally interactive with the whole brain and the whole system. So like, what's the net effective? This, you know, therapeutic or that therapeutic or the supplement, like that's what trials are for and this is just to inform more targeted approaches to then develop something that might, you know, there's just so much there. So I just wanted to bounce off of what you said because it's so, so important and that's why conversations like this need to happen from people who are doing the work, who have the understanding of where their work lies within the grand scheme of things to the people who really want to understand because I'm so acutely aware as someone with OCD who, you know, was not a researcher and now I'm a researcher to know that like we feel so like siloed off and feel like we just were so frustrated. Like why aren't there things that are helping us and making us get better? And like it once it helps us to empower ourselves with knowledge and also because OCD particularly is so discriminated against, it oftentimes feels like if we can arm ourselves with knowledge and research like this broad term research says that OCD is this and research says that OCD can be treated this way. It almost like as an advocate as or as a person with OCD validates that, oh, this is a real disorder in research is studying it and research is fighting that it's a brain disorder and it does this, this and this and it's very easy to latch on to like findings as absolute fact and findings as this end all be all to be able to for, you know, and I'm saying this again to like understand why people are doing this with compassion and I've been there too. It just helps us feel like this is real and you know, let me just talk about this over and over and over and talk about how this is fact but the reality is that's just not research. So I just wanted you to have more space in this conversation to just talk about, you know, why this this process of research matters, why it's important for the layman's person to understand and why we need to communicate our results and just like understanding the nuance of research because you do such an amazing job with your page and with the way you you're talking here. So yeah, any thoughts on that at all? Thank you. So yeah, I've become more and more an advocate of empowering people with knowledge and because I know research is sometimes like staying in their bottle and using difficult words and it's something like when I started with the page I would ask people that were reading it like it might be too childish because I don't want to be perceived as a serogant or like I'm drawing it for you but people say no, no, it's it's good because you just need to be able now when they teach students I say the same thing like if I'm not understanding a paper and I'm someone that has knowledge on it, how can anyone else understand it? Why are you doing research if it's not for people to understand you and a lot of researchers will go and see just a brain in front of them and that's it but I feel like no, you have to know why I'm doing that. So I was doing the eG for patients who had the same story 12 times but I would explain look this is the component of when you're doing that we think that this causes that same term doesn't make sense to you and I generated so many hypotheses from there as well and just by learning from from people in this this moment but I really think that strongly even its schools we should have some sort of research mind training be able to interpret research because we have been seeing so much of these like fake news now and information and I wish it didn't take days and everyone is an expert on whatever it is without without studying or even people they're really trying hard but they're going to read a paper and it's difficult to to understand sometimes. So I do think the research especially need to explain to people why are they doing that also from a selfish point of view it gets us better data as well because if the person is not understanding what they are doing most of the tasks that we use those behavioral tasks people like why am I pressing arrows to the left and the right like is this person just spanning my time here and like why can she learn from that right and then it just seems like a joke whereas no actually this task measures this specific thing of course sometimes we can't say what we're measuring because that would bias the results but people need to know that they are part of something and that science is taking long to find something it is part of the process so there was something that I wanted to to emphasize as well is the why basic research is so important so for this paper now it has gotten a lot of attention but if we were there when we were recruiting for this study it wasn't easy to get the 30 participants and we were offering like with pay your expenses which a lot of labs don't have this resources so that was like Cambridge is a nice town would pay for your hotel everything come with a family take the day out but give you tourist tips if you want because basic research doesn't seem as interesting but now we are conducting the and I know it's an area you just said I'm part of the Salos I've been trying with Imperial College London and for that the number of people that have registered is huge because it's treatment already which I understand right you want treatment but we only get to that point once we check the brain and say like oh maybe Salos I've been looking at to these areas yeah or what it's doing and why like what is Salos I been interacting with in the brain of someone with OCD that is creating different results perhaps that other drugs are not that's to your point exactly and when I describe like what is what it is I actually want to do as a neuroscientist and I out people's eyes often glaze over because it's like oh you don't want to like do the trial and like just see what happens. like with the drug, like you want to go in the brain and like cut up an animal's brain and see like what the like what the cells are how boring It's like no, that's literally the point like to be able to understand like on a deep level Which is like what why it takes so long to do like what exactly is going on and it's just so important and I also think to your point of disseminating and communicating research like It's amazing that there's now access to like pub bed and research and the you know oftentimes there's even Not a paywall for seeing papers and that's so Important for people to have access to but to your point of training, you know the research brain or the research mind for people I know most people just look at a paper and they read the abstract and then there's a conclusion at the end of It's not even generally very certain but people interpret it as certain or if if they're really interested They'll go through the paper read the intro read the conclusion completely skip over the methods materials limitations And go straight to the end because you know who knows who has the time and I guess like like It doesn't seem like it registers that the rest of the paper is important to get to the actual point But for people like you and me like it we know like through journal clubs and through like the work we do the middle is kind of the most important Because they're in it illustrates all of the limitations because no research is perfect no research is definite no research is certain and there's always You know many different Deportations or caveats or considerations. So I that's just so important and what you're doing to have nuanced Conversations and coming on the show and talking with me and like being able to share your work and the Cauchy's interpretation through your platform. It's just so so so important and so in keeping with that theme I'm curious if you have any thoughts on and I know this this is what you do in your lab all day long But like to do it publicly as an example like what would you say are different limitations or questions or Different interpretations from from y'all's recent paper that are kind of in form a future directions to further clarify what you found So of course for now which we focused on these two brain areas That doesn't mean that we don't have to look at other So we actually one of the PhD students in in our lab is not looking at the putainment so try to use To follow up from dr. Birrier study But in this area there's more related to habitual responding so we need to see how this goes and And then understand there okay there are just different different chemical concentrations How can we solve them now? So that's the the next point is it through drugs? But as a side drugs that we act specifically in the pathways that we want them to act can be a little bit difficult so potentially Transcreen and magnetic simulation is something that is a little bit more focused. It could help Fixed as in balance. So now we need to of course first Yeah replicate the findings would be be very important There is always a some chance of Error in whatever we do my is in research is about retracting ourselves As I said and then try to solve this this imbalance and Potentially are they are very important for a compulsivity, but it might not solve the whole the whole CD framework and Could be that are there areas or as if I found in this study in my study first I thought that I should definitely reduce their relating activity because that is giving the alarm and anxiety And now I'm finding whoopsy that's actually protective so We just need to keep manipulating those to see what's the best outcome and Most importantly now try to work with a more precision medicine approach so We understand basic Inbalances but whatever works for one person may not work for the other one So even ERP on CBT and SSR just a ghost standard will still have 50% Dropouts from your view ERP is very difficult so okay, it's great if you can do it You most likely to improve but some people will not be able to tolerate the treatment Right, so we can't just say oh you didn't tolerate too bad. That's what works now We need to find ways to get that person to the level where they can so Maybe habit reversal treatment works for some people to diminish the anxiety in the beginning and then they can get to your P How do we do to so that everyone can have treatment despite The limitations and difficulties Yeah, and to your point it's the fact that it's a harrowing statistic that up to one in three people do not respond The treatment at all and up to 50% of people drop out like it's so it's equally valid that we're so We want to advocate for ERP because we don't know about it And it is so a factual in people and give so many people their life back and we need so much more for the people who it doesn't fully help or Doesn't help at all and it does it's not a knock on that treatment It's that people are bio individual have different circumstances and we just need a bigger toolkit of Resources for people at the end of the day to just mitigate their suffering and so this you know having you to just be able to Hear I think people get a window into the researcher brain through this episode is just the most Beautiful thing and I'm so so grateful that you came on I didn't even get to ask you like half the questions that I want to so I'm definitely gonna be bothering you again to come back But before we Close out. I have some questions some rapid fire questions for you Just as some to bring it back to the human who's been sharing all of your work. So my first question is Who is the person behind all that you do and the ways you show up in the world? How would you describe yourself as a human? I know oftentimes we say like I'm a this I'm a that I have this role I have this education. I have this whatever but behind that how would you describe the human doing all those things? Wow, that's a difficult one Well, I guess as part of the anxiety I do have Quite a significant imposter syndrome as well. So as I'm talking to you I'm already thinking if I didn't say anything wrong going appropriate if all the facts were correct But I think I'm just looking with the I Really I can't of course I can't say a few what What participants feel but I I just see people as people and not for data So I think that just makes so much difference in research It's okay if you're not feeling right. I don't worry about my research worry about yourself We can do this together and So it's the empathy really of my guy's been there and I am still there in several things It's not uncommon that I cry I'm doing something participants tell me something and I start crying Because it's just this you know how difficult it is because I have colleagues that I Once had a colleague that stroke me a Very harsh she looked at a person she said She doesn't look like she has a CD What someone with a CD look like I then did so one participant was rude to us and then I was a little bit upset It's just said oh, but don't be upset because like she has a CD like yes She has a CD doesn't have the right to be rude It's not like it It is it is a condition but people or people and I think that's That's all really I'm just trying to be as honest as possible People and say yeah, but I don't know this we're doing that hopefully it works That just shines through it shines through your humanity and your care and the reason that you're here doing this work And you picked a certain avenue and a certain suite of skills that's to be able to help Understand this and further the field but it comes from this person who cares so deeply about people suffering about empathy about People's lived experience across different walks of life and I just feel that so deeply and I know everyone listening does too So thank you for being who you are. We're so lucky to have you doing this research and making a difference and having your humanity Be part of what's infused into the research and My final question is what is one thing you wish everyone knew or could hear it could be about anything Say like You're not alone like you're definitely not alone And not just yet through I know there's so many groups of support but research is hearing you We we are there We'll get through this We'll go through this together. That's absolutely certainty for me and I know so it is all about certainty so Saying that Yeah, I will not rest not to avoid it, but I will dedicate my life to this Because yeah, I know how important it is I will take that certainty. I will take that certainty so I know other people will. And Dr. Jussuza, thank you so much for your time for sharing about your work, about how you came to it, letting us see the human behind the research and also just talking through this really, really important research being done for people like me, people who are listening, and just also advocating for OCD to so many people listening who don't know what it is and who are also living in that stigma and the lack of awareness. And your work is so important. And I hope everybody goes and follows OCD underscore science on, I'm sorry, just OCD science on Instagram. I'll have everything in the show notes. And also just, you know, reads your papers and reads the middle of it too, not just the beginning and end. And I can't wait to have you back on the show and talk so much more because there's so much more to talk through and ask. And you're just someone that really inspires me to continue for it than I just feel such community with you for all that you do. So just thank you, thank you, thank you. I really appreciate you. - Oh, thank you. It's my pleasure, really. I think it's been great being here. And look forward to coming back. (upbeat music) - Y'all, I think you can tell why I was so, beod-hyped and thrilled to share this episode with you. It was just so powerful, so cross-disciplinary, so just full of humanity amongst all of the research, all of the work being done by Dr. D'Souza. And just, I'm so grateful for her sharing herself in such a vulnerable and open ways. And just educating us on so much of the incredible seminal research being done from her and her lab. Thank you so, so much for being on the show. And for just creating this episode and as a resource for people to give them hope and information and empower them with really responsible knowledge. And for all of the dialogue about the nuances of science communication and experiencing and taking in research. And I'm just so excited to have Dr. D'Souza back on for so many more conversations in the future. So make sure to follow her at OCD_Science on Instagram to learn about all of the work that she's doing and to just have a resource to take in really responsibly shared information about OCD neurobiology and psychology and all of the ways that the brain and the body and the mind and the environment intersect in relation to OCD and beyond. Also, make sure to check out the Orchard Registry, which is this amazing resource for people with OCD to submit themselves to this platform, to then be matched to research studies that are studying OCD so that people with OCD can be of service and people who are studying OCD can be back of service to patients. Research is the future and is how we move forward. So I really encourage you to check it out and to sign up if you feel calls to in Europe, I believe. And all of this will be linked in the show notes and make sure to check it out. And of course, if you love this episode, please first take five seconds to subscribe to the podcast wherever you're listening to it. That way you'll be the first to receive messages about when the podcast is out and you can stay updated with all of these amazing episodes with these beautiful people who are coming on the show. There's so much more to come. I'm so, so excited. Also, if you could leave me a five star rating and review, that would support the show so much because that would empower this community to grow, so feel safe when they find this show and to tune in and join us in this journey of exploration and understanding. It would really, really support me and being able to continue this show. So thank you so much for subscribing and rating and reviewing. And lastly, make sure to share this episode with anyone who you think would be interested from any standpoint, anyone who would resonate with this conversation, make sure to just take this link and send it to people over text or to share on social media, my posts about the episode or take a screenshot. I would love that so much and would love to share that with the community too. So thank you so much for supporting the show. Thank you so much for being here. I can't wait to see you next week for another chock full episode as always and sending you so much love, so much care and just so grateful to co-create this space for you. Have a beautiful week friends and see you next week for another episode of a chat with Uma.