Translator: Sarah Gillis
Reviewer: Pari Szi [Facing the challenge] [Voyage to the center of the brain:
Understanding and outwitting anxiety] Good evening all. I am sure that some of you know
what these two characters have in common. On one side we have Monk,
the detective who solves mysteries with the help of his nurse,
and on the other, we have Howard Hughes, whose life inspired the film Aviator
with Leonardo DiCaprio. Indeed, these two characters have OCD, obsessive-compulsive disorder. And while, in fiction, OCD can be seen as something harmless,
even a little glamorous at times, actually, in real life, it is an illness
that can be very disabling. Imagine having frightening thoughts
all day long, that repeat in your head
and that compel you to do certain behaviors,
certain things, repeatedly, even though you find this
completely absurd. This is Monk, who, because he is afraid of germs and viruses, is going to bust his wipes budget,
going to wash his hands frantically. This is Howard Hughes,
who finds himself compelled to repeat certain words or gestures, or else he will experience
a surge of intense anxiety. Understanding what happens in the brains of people with OCD is something
that I am very interested in as a psychologist
and doctor of neuroscience. And especially, trying to see
how we can try to apply this knowledge
about the brain to enhance therapy techniques
that are already working in people with OCD
and other anxiety disorders. And among these therapies, we have behavior therapy, or how to be able to manage
their psychological difficulties by changing their behavior. And then, we put this theory
into practice in 2020. Think back to the start of that year, a grim account of a virus
that came from China, that turned into a pandemic,
that reached France, and that brought with it
the daily fear of being infected. I was scared, too. What if, at the start,
I was able to take a little distance, even joke about this fear
by telling myself, “Yes, it’s nice, it’s kind of like a ‘walk in my shoes’
for patients with OCD.” But after a few weeks,
I laughed a lot less. I began to have trouble sleeping, to become more irritable, to avoid touching things outside, to wash my groceries, and finally, to not want
to leave my house, for fear of passing someone
on the other side of the street, on the opposite sidewalk. And there, I told myself:
“Stop, take a break. What is happening? Can you not try to do
what you do with your patients, as if you became your own psych?” I know very well that when one faces
the challenge of anxiety, we have a tendency to put things
into place a bit instinctively, and that this does not always work. And that facing this failure, one might
tell oneself that the problem is me, a psychological weakness,
maybe a lack of willpower. But no. What I tell my patients is that it’s your brain
that is malfunctioning. So be aware, it’s not broken, or crazy, it’s malfunctioning. Imagine that your brain
is like a giant symphonic orchestra with millions, billions of musicians. And when everyone plays
together harmoniously, it’s beautiful. Your brain is working well. And then, at a certain moment,
we don’t know why; there is a group of musicians who got the wrong line on the sheet music and they decided, I don’t know why,
to change the tempo, but in any case, what comes out
isn’t harmonious anymore. Your brain is malfunctioning. So, we know that when we are confronted
with this malfunctioning of the brain, and with this fear that we feel,
the fear of being contaminated, that we have a set of structures
that manage the emotions, which we call the limbic system,
that are going to be activated. But there isn’t only
the fear of being infected. There are also thoughts
going around in my head, with negative assumptions... What if the thing that I just touched, someone else had touched it before, in exactly the same spot
and this person was infected? Indeed, all their capacities
for thought, for reasoning, are possible due to the activity
of our prefrontal cortex. That’s a structure in our brain
that distinguishes us the most from non-human primates,
which is monkeys. It’s true that I have this anxiety,
all these negative thoughts that come, and as it’s very unpleasant, I want to get rid of them
as quickly as possible. So I can simply avoid facing them. I’m not going to go out, I’m going
to stay home where I can do things like washing my groceries
or using wipes like Monk. But look. When I do these behaviors,
I have a sharp decrease in anxiety, and this decrease
is interpreted by my brain as a reward. And we have a set of structures
at the center of our brain called the basal ganglia,
which are involved in this reward mechanism
and also in creating habits: the automation of behaviors,
through repetition. The concern is that it’s going to produce, in my brain and in my life
for that matter, a real vicious cycle. The more I’m anxious,
the more I try to quickly get rid of this anxiety. But by doing that, I prevent my brain from acclimating to that anxiety. It’s as if I made it
more and more allergic to the slightest anxiety. So, what do we do
to break this vicious cycle? This vicious cycle, we find it
in illnesses other than anxiety, like excessive fear of being embarrassed
when we speak publicly. That, I don’t have. It might also be phobias: phobia of rats, phobia of spiders. To break this vicious cycle, unfortunately, psychologists
don’t have a magic wand. However, I can give you on of the techniques
of our orchestra chief to restore harmony
in our behavior and in our brain. And this technique,
the heart of behavioral therapy, is exposure. You are going to have to accept
putting yourself in situations where you know that the anxiety
is going to come. You might tell yourself:
“The psych is crazy for sure this time, she’s asking me to lick
the subway handrail.” But no, be assured,
we are not going to put you in a situation where
the anxiety is significant, or this situation might even be dangerous. We are going to begin
with a small dose of anxiety. I, who never wanted to go out at all, I’m going to tell myself:“Go, Anne-Hélène, You’re leaving,
you’re going out five minutes. Just five minutes. Then you do it multiple times per day,
multiple days in a row.” And after a moment, the anxiety will be greatly reduced,
maybe even nonexistent. And then I’ll be able
to spend fifteen minutes and I’m going to
repeat it again, and so on. It’s kind of like
I’m desensitizing my neurons To this anxiety. You might say to yourself
“If the psych knows all that, why didn’t she do it sooner?” Indeed, I say to myself: “Why didn’t you do that sooner?” Simply, because my brain,
your brain tricks you. It influences you. It has a tendency to push you
with more force, more motivation, towards something
that is going to give you an immediate reward, now, right away, even if we know that it isn’t
what’s best in the end. This was demonstrated in an experiment. We are in cognitive psychology, where
we were able to conduct an experiment and we saw that you would rather
receive €100 now, right away, than €120 in a month. So we agree, the cashflow
isn’t beneficial at all. But what really motivated me to act, because it wounded my pride,
was when I remembered that we don’t only see this in humans, but also in other species,
particularly pigeons. I told myself, “It’s not possible,
you have to do something. You know that this anxiety, your brain will push you
to get rid of it immediately and by doing that,
instead of eliminating or decreasing it, you will only strengthen it
in the long term and you can change that by tackling and changing your behavior
consistently and gradually.” So I also remembered,
which motivated me even more, that by changing my behavior,
I could also manage to change the activity in my brain. This was demonstrated in an experiment. I have a group of patients
with OCD, real ones this time, where we have seen cerebral disfunction
that we could observe in their brain, it decreased significantly starting six weeks after beginning
a therapy that included these exposure sessions,
and it was visible long-term then measured up to six months
after the end of the therapy. So, even if I hope that
that today you haven’t reached Monk’s wipes budget, or Howard Hughes’
social disability, remember, when you are in a situation where you feel anxious and you consider this anxiety
excessive, too much, that you have the power
to tame this anxiety by changing your behavior, by exposing yourself
consistently and gradually. You have the power
to reprogram your brain. Thank you. (Applause)
