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焦虑障碍、接受、慈悲和智慧--Wisdom and Compassion in Psychotherapy17

蓝蓝2016-1-20 11:26
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第十七章:讲师:李孟潮,致谢

 

 

Lizabeth Roemer

Susan M. Orsillo


注意到李老师对本章观点

1,没有必要在临床中执着一种疗法,应当针对具体病症灵活选择适合,有实证支持的疗法,心理教育不但在认知行为疗法中适用,在心理动力学治疗中使用也如虎添翼,焦虑障碍首选CBT,无效再转动力学疗法。本土治疗师应当发展更具本国文化特色的正念练习方法。


2,更加自由出入评价和不评价是更具平等舍心的正念,不用排斥评价态度,当出现的时候以不评价态度对待评价,即便贪嗔痴也有很多作用。


3,对ABBT的评价是:疗法经验太短,不太了解,建议学习的疗法最好是三十年以上,创始人终身在发展此疗法,有稳定的发展和疗效,本法没有看见有明确的疗效研究,如果已有现存疗法可用,优先首选该疗法,若要自己整合一些疗法,必须明确,持何种哲学观、整合方法又针对何种困难,以及判断整合兼容性。

比如ABBT疗法的三大基础:ACT最有效对象精神病人,正念认知疗法预防慢性抑郁复发,DBT针对边缘和自杀干预,所以对认知行为第三波的这三个主要技术,是否需要复方一统用于新的病人身上,技术中是否又有创新性都是需要考虑的。

又例如前面章节对内在家庭关系的疗法,本来我以为和内在小孩疗法区别不大,兴趣不浓,但是朱一峰老师找了很多文献,我发现这个疗法对类风湿性关节炎很有效,就引起了我的兴趣,所以我们对疗法评估师也需要时间检验,对ABBT看时间和疗效检验了。

 

关于文本简要介绍

 

本章是介绍一种发展了十年的专门用于工作焦虑障碍的疗法:ABBT。这一疗法基于认知行为疗法,吸收了接收与承诺疗法、正念认知疗法、辩证行为疗法整合而成。主要内容概要如下:


一、焦虑行为模型:(障碍产生源于与内在体验有问题的关系产生惊恐担心,回避内在体验,限制行为投入强化了对内在焦虑的恐惧感)

 

二:治疗经验:

1,去中心慈悲

和内在体验发展一种去中心的慈悲的关系(心理教育、自我监控、正念练习、治疗关系)

心理教育中向来访者演示焦虑障碍模型,并会大量教育患者意识到情绪的正向作用和意义,了解情绪本身不是问题,对情绪的反应和试图回避才造成问题,学习接纳情绪。

这里提到情绪分两类:清澈情绪和混浊情绪,情绪变得浑浊是因为自我关怀不足,(缺乏睡眠饮食不节);对过去情境的剩余反应;预期未来的威胁;对清晰情绪进行评价和反应,与情绪融合;努力回避情绪

自我监督:行为治疗方式

正念练习:治疗中常规合并推荐,诗歌在培养正念态度的训练中具有相当地位:

Rumis poem  The Guest House

这里有一个练习:邀请困难,通过身体对之工作。

另,中国的诗人王维也非常有空灵感和禅意

mbsr中有瑜伽,如发展身体运动禅修,可以使用八段锦、太极

去中心化的想象可以是想象自己的念头如溪流中的叶子一样飘走等等,也可以如“山禅”方法(卡巴金的《正念》或另一译名《此刻是一枝花》雷淑云译

扩展到生活的正式练习:三分钟呼吸减压,正念行走,或微冥想,正念刷牙、洗碗、沐浴等

 

 

治疗关系:治疗师确认来访者体验,无论患者表达何种反应都当作人类共性一部分,还要策略性地自我暴露.


 

2,具有灵活性的和体验相处的态度,过一种值得过的生活

 

经验性接纳,强调和情绪共处,接纳,对不愿浸泡在痛苦中的患者,可以用ACT的比喻,我们在通往一座美丽的山的路上,现在有一个沼泽,如果在路边,可以绕行,如果在路中心,就必须跳进去渡过,继续前行,但我们可以穿上靴子或者用一块模板,减少和淤泥的接触,有时也会跌入泥潭,我们可以用慈悲将自己扶起,继续前行。

    澄清对来访者什么是重要的,并如何选择重要的生活,使得价值和行为一致起来。这里有一个在关系中澄清价值的练习。

 

在本次微课开始和结束前,李老师分别带了该技术中的2个练习(具体文本在此:我觉得写作练习可以再续一个步骤就更好,把写下的东西封起来隔一天来看,隔一周来看隔三个月来看,分别再去体会。另外在这些天做冥想练习会有一些发现:冥想训练能够有效地抑制分心的倾向,强化专注力,乃至提高记忆力。昨天和伙伴在聚焦中也发现,正念的状态其实反而是一种有序有控制感的,而平日生活中自动化的反应和思维反而是没有控制感的,所以会造成无序,而序可以说是事物运行的规律,无序的状态一切都会变得混乱亦会大幅增加焦虑信号产生,导致各种情绪混乱、冲突和躯体不适。这是我当下发现的正念好处,感恩之。),

 

邀请困难,通过身体对之工作。

 

INVITING A DIFFICULTY IN AND WORKING WITH ITTHROUGH THE BODY

 

l         Before you begin this exercise, think of a difficulty youre experiencing right now. It doesnt have to be a significant difficulty, but choose something that you find unpleasant, something that is unresolved. It may be something you are worried about, an argument or misunderstanding youve had, or about which something you feel angry, resentful, guilty, or frustrated. If nothing is going on right now, think of some time in the recent past when you felt scared, worried,frustrated, resentful, angry, or guilty, and use that.

l         Notice the way you are sitting in the chair or on the floor. Notice where yourbody is touching the chair or floor. Bring your attention to your breath for a moment. Notice the in-breath . . . and the out-breath. . . . Now gently widen your awareness, take in the body as a whole. Notice any sensations that arise,breathing with your whole body.

l         When you are ready, bring to mind whatever situation has been stirring up difficult emotions for you. Bring your attention to the specific emotions that arise and any reactions you have to those emotions. And as you are focusing on this troubling situation and your emotional reaction, allow yourself to tune in to any physical sensations in the body that you notice are arising . . .becoming aware of those physical sensations . . . and then deliberately but gently directing your focus of attention to the region of the body where the sensations are the strongest in the gesture of an embrace, a welcoming . . . noticing that this is how it is right now . . . and breathing into that part of the body on the in-breath and breathing out from that region on the out-breath,exploring the sensations, watching their intensity shift up and down from one moment to the next.

 

l         Now, see if you can bring to this attention an even deeper attitude of compassion and openness to whatever sensations, thoughts, or emotions you are experiencing, however unpleasant, by saying to yourself from time to time, Its OK. Whatever it is, its already here. Let me open to it.

 

l         Stay with the awareness of these internal sensations, breathing with them,accepting them, letting them be, and allowing them to be just as they are. Say to yourself again, if you find it helpful, Its here right now. Whatever it is,its already here. Let me be open to it. Soften and open to the sensation you become aware of, letting go of any tensing and bracing. If you like, you can also experiment with holding in awareness both the sensations of the body and the feeling of the breath moving in and out as you breathe with the sensations moment by moment.

 

l         And when you notice that the bodily sensations are no longer pulling your attention to the same degree, simply return 100% to the breath and continue with that focus as the primary object of attention.

 

l         And then gently bring your awareness to the way you are sitting in the chair,your breath, and, when you are ready, open your eyes.

 

 

在关系中澄清价值练习

CLARIFYING VALUES IN RELATIONSHIPS

 

l         Please set aside 20 minutes during which you can privately and comfortably do this writing assignment. In your writing we want you to really let go and explore your very deepest emotions and thoughts about the topic. You may want to take several minutes to practice mindfulness before you start, so that you can approach this task with openhearted awareness.

(正念写作练习)

l         As you write, try to allow yourself to experience your thoughts and feelings as completely as you can. Pushing these disturbing thoughts away can actually make them worse, so try to really let yourself go. Bring your mindfulness practice to the exercise so that you can accept and allow any reactions you have and continue to clarify what matters to you most. If you cannot think of what to write next, repeat the same thing over and over until something new comes to you. Be sure to write for the entire 20 minutes. Dont be concerned with spelling, punctuation, or grammar; just write whatever comes to mind.

(写作前正念,无需评价和顾虑)

l         You may notice that you often have thoughts about why you cannot be the way you would like to be in your relationships. This is natural and we will explore these obstacles at other times. So, for this particular exercise, see if you can notice these thoughts as they arise and gently turn your attention back to how you would like to be, if you were not experiencing the obstacle, so that you can really explore what matters to you.

(写作内容)

l         Choose two or three relationships that are important to you. You can either pick actual relationships (e.g., my relationship with my brother) or relationships you would like to have (e.g., I would like to be part of a couple, I would like to make more friends). Briefly write about how you would like to be in those relationships. Think about how you would like to communicate with others (e.g., how open vs. private you would like to be, how direct vs. passive you would like to be in asking for what you need and in giving feedback to others). Think about what sort of support you would like from other people and what sort of support you can give without sacrificing your self-care. Write about anything else that matters to you in your relationships with others.









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