December 6, 2021 • 2hr 10min

Erasing Fears & Traumas Based on the Modern Neuroscience of Fear

Huberman Lab

In this episode, Dr. Andrew Huberman discusses the neuroscience of fear and trauma, including the neural circuits involved in the "threat reflex" and how specific experiences and memories come to activate that system. He explains the logic of fear mechanisms and how "top-down" processing from brain areas that assign meaning to our feelings is involved in both generating and erasing fears and traumas. Huberman reviews what successful fear and trauma treatment must include and evaluates various treatments like EMDR, cognitive behavioral therapy, ketamine, and MDMA-assisted therapies. He also discusses new research on how brief daily stress exposure can reduce fear and depression, and examines the role of social connection in modulating fear responses.

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Key Takeaways

Fear involves activation of the "threat reflex" circuit in the brain, which includes the amygdala and leads to physiological responses like increased heart rate and alertness
Trauma occurs when fearful experiences get deeply embedded in the nervous system and are reactivated inappropriately
Effective fear/trauma treatment must include:
- Extinction of the original fear response
- Relearning a new positive narrative/association
- Attaching that new positive experience to the original fearful event
Top-down control from the prefrontal cortex allows us to override and reframe our fear responses through narrative and cognitive processing
Social connection and support is critical for reducing fear/trauma by activating oxytocin and suppressing fear-enhancing molecules like tachykinin
Brief, self-imposed stress (5 min/day) may help recalibrate the fear system and reduce anxiety/depression
Emerging therapies like ketamine and MDMA-assisted psychotherapy show promise for PTSD by allowing rapid reprocessing of traumatic memories
Foundational lifestyle factors like quality sleep, nutrition, and social connection are essential indirect supports for overcoming fear and trauma

Introduction

In this episode, Dr. Andrew Huberman discusses the neuroscience of fear and trauma, including the neural circuits involved in the "threat reflex" and how specific experiences and memories come to activate that system. He explains the logic of fear mechanisms and how "top-down" processing from brain areas that assign meaning to our feelings is involved in both generating and erasing fears and traumas.

Huberman reviews what successful fear and trauma treatment must include and evaluates various treatments like EMDR, cognitive behavioral therapy, ketamine, and MDMA-assisted therapies. He also discusses new research on how brief daily stress exposure can reduce fear and depression, and examines the role of social connection in modulating fear responses.

Topics Discussed

The Biology and Circuitry of Fear (6:49)

Fear is an emotion involving both physiological and cognitive responses
The "threat reflex" circuit includes the amygdala and leads to activation of stress responses
The HPA (hypothalamic-pituitary-adrenal) axis is key for triggering stress hormones like cortisol
Fear learning can occur through classical conditioning, often with just one intense experience

Top-Down Control of Fear (28:24)

The prefrontal cortex provides top-down control to override fear reflexes
We can attach new narratives and meaning to fear responses
This allows cognitive reframing of fearful experiences

How Fear Learning Occurs (41:45)

Long-term potentiation strengthens neural connections associated with fear
NMDA receptors are key for encoding new fear memories
Gene expression changes can embed fear responses long-term

Extinguishing Fears (46:10)

Extinction involves weakening of fear-associated neural connections
Must replace old fear with new positive experience/memory
Can't just erase fear - need to overwrite it with new associations

Cognitive Therapies for Fear (50:25)

Prolonged exposure, cognitive processing therapy, and CBT are effective
Involve detailed recounting of traumatic events to reduce physiological fear response
Repeated retelling turns "terrible story" into "boring bad story"
Must then attach new positive narrative to old fearful event

EMDR for Trauma Treatment (1:05:28)

Eye movements may help suppress amygdala activation
Allows recounting of trauma with reduced physiological fear response
Most effective for single-event traumas
May not fully incorporate relearning of new positive narrative

Social Connection and Isolation (1:14:00)

Social isolation increases fear-enhancing tachykinin
Social connection activates oxytocin and suppresses fear circuits
Critical to maintain social support when working through trauma

Transgenerational Trauma (1:18:23)

Trauma in parents can lead to increased stress sensitivity in offspring
Involves epigenetic changes to stress response genes
Creates predisposition, not guaranteed trauma in children

PTSD Treatments: Ketamine and MDMA (1:25:00)

Ketamine creates dissociative state allowing trauma reprocessing
MDMA increases oxytocin, dopamine, serotonin
Allows rapid relearning of new associations to traumatic memories
Still in clinical trials but showing promise

Assessing Trauma (1:39:25)

Consider balance of interoception (internal sensations) vs exteroception (external focus)
Insula calibrates internal responses to external events
Trauma can lead to miscalibration and overreaction

Brief Stress to Erase Fears (1:46:16)

New research shows 5 min/day of intense stress can reduce depression/anxiety
Self-directed entry into stress state is key
May help recalibrate threat detection system

Lifestyle Factors (1:59:42)

Quality sleep, nutrition, and social connection are foundational
Support overall mental health and fear circuit function
Essential indirect supports for overcoming trauma

Supplements for Anxiety/Fear (2:02:30)

Saffron (30mg) shown to reduce anxiety
Inositol (12-18g) comparable to some antidepressants
Kava increases GABA and dopamine, may help anxiety
Use caution and consult doctor before trying supplements

Conclusion

Understanding the neurobiology of fear and trauma provides insight into more effective treatment approaches. Key elements include extinguishing the original fear response, relearning new positive associations, and attaching those to the fearful memory. Top-down cognitive control, social support, and recalibrating the threat detection system (potentially through brief stress exposure) are important components.

While traditional therapies like CBT remain effective, emerging treatments like ketamine and MDMA-assisted psychotherapy show promise for rapid reprocessing of trauma. Lifestyle factors like sleep, nutrition, and social connection provide an essential foundation. Overall, a multi-faceted approach addressing both the neurobiology and cognitive/narrative aspects of fear offers the best path forward for overcoming trauma and anxiety.