systematic desensitization: 系统脱敏法
classical conditioning: 经典条件反射
counterconditioning: 对抗性条件作用
neutral stimulus: 无关刺激
unconditioned stimulus: 非条件刺激
conditioned stimulus: 条件刺激
unconditioned response: 非条件反应
conditioned response: 条件反应
motivational conflict: 动机冲突
reciprocal inhibition: 交互抑制作用
graduated exposure therapy: 渐进式暴露疗法
negative reinforcement: 负强化,消极强化
operant conditioning:操作性条件反射
Do you feel too uneasy about spiders or snakes or closed-in places to carry out daily life? I guess most of us would say "NO". Then, congratulation! However, some people would actually do. We call that symptom as phobia. A person with a phobia suffers from a persistent and irrational fear of a specific object, activity, or situation that is excessive and unreasonable given the reality of the threat. It causes tremendous anxiety and interfere with normal day-to-day life. Luckily, phobias can be managed and cured. Today we are going to introduce something about systematic desensitization which is a treatment for phobias and other anxiety, it also can help us to cope with fears and emotion issues in daily life. Let's start from its origin -- classical conditioning and counterconditioning.
你是否对蜘蛛、蛇或是密闭空间感到非常地不安,以致影响到你的日常生活?我想大多数人都还没有到那个程度,但的确有许多人会。我们将这种现象称为恐惧症。恐惧症患者会持续地和非理性地害怕某一特定物体、活动或者情境,这种恐惧相对于实际的威胁来说是夸大和非理性的。恐惧症会给患者的日常生活造成巨大的焦虑和干扰。幸好,恐惧症可以控制和治愈。今天我们就是要介绍一种治疗恐惧症的方法--系统脱敏法,它也可以帮助我们应付日常生活中的害怕和情绪问题。让我们从系统脱敏法的起源开始吧。
Ivan Pavlov -- Classical Conditioning & Counterconditioning
In the early 1900's, Russian physiologist Ivan Pavlov used dogs in studying the concept of classical conditioning. Pavlov knew that a dog salivates when eating. In his experimentation, Pavlov began to present a neutral stimulus, such as signal light or bell, before feeding the dogs. Obviously, the signal had no noticeable effect on the dogs’ salivation. But Pavlov kept the signal on when the dogs were being fed (and actively salivating), and, over the course of time, Pavlov found that the signal alone, even without his offering food, gradually caused the dogs to salivate.
20世纪初期,俄罗斯生理学家伊万·巴甫洛夫用狗来研究经典条件反射理论。巴甫洛夫注意到狗在嚼吃食物时会淌口水,或者说分泌大量的唾液。在他的实验里,巴甫洛夫在给狗喂食之前,先发出一个中性刺激,比如信号灯、铃声等;很显然,这种信号对狗的唾液分泌没有效果,是一个无关刺激。然而,在喂食狗的时候(狗在嚼吃食物时进行主动的唾液分泌),巴甫洛夫继续发出先前的信号。经过一段时间后,巴甫洛夫发现:即使没有进行喂食,仅仅只是信号本身也逐渐地开始使狗分泌唾液。【这就是我们初中学的条件反射啊。。。】
So, in classical conditioning, an unconditioned stimulus (food) leads to an unconditioned response (salivation), a conditioned stimulus (light or bell), when paired consistently with the unconditioned stimulus (food) leads to a conditioned response (salivation) similar to the unconditioned response (salivation). Interestingly enough, there’s a reverse side to classical conditioning, and it's called counterconditioning. This amounts to reducing the intensity of a conditioned response (anxiety, for example) by establishing an incompatible response (relaxation) to the conditioned stimulus (a snake, for example).
Joseph Wolpe -- Counterconditioning & Systematic Desensitization
Why someone would think that counterconditioning could be used for helping human coping with fear? It's a long story. Let's just see how Wolpe did that. Wolpe's inspiration came from experiments by a researcher named Masserman . Masserman made cats "neurotic" by giving them electric shocks in a certain box. Soon the cats acted anxious whenever they were put in the box. Masserman observed that the cats lost their "neurosis" if they were fed in the box. He interpreted this in psychodynamic terms, as "breaking through the motivational conflict." Wolpe saw the same events in terms of conditioning. Wolpe replicated Masserman's work and showed that cats could be induced to show gradually less and less fear, by being fed first at a distance, then closer to the box where previously they were shocked.
为什么会有人想到用对抗性条件作用来帮助人们克服害怕呢?说来话长,还是让我们看看沃尔帕是怎么开始的吧。沃尔帕的灵感来自于马瑟曼的实验。马瑟曼通过电击使得猫对待在某个箱子里变得“神经质”。不久,这些猫--不论什么时候被置于那个箱子里--都表现得很焦虑。马瑟曼观察到:如果在那个箱子里给猫喂食的话,它们就不会如此焦虑。他以精神动力学的概念将这一现象解释为“突破动机冲突”。沃尔帕在条件反射中也看到过相同现象。于是沃尔帕重复了马瑟曼的实验,并且指出:通过将进食位置越来越移近那个猫被电击时所在的箱子,猫渐渐地不再表现出害怕和恐惧。
Wolpe called this counter-conditioning, literally using one association (between the box and feeding) to run counter to another association (between the box and shocks). Wolpe also termed the process reciprocal inhibition because he felt the responses of anxiety and eating inhibited or prevented each other. By encouraging animals to have a response incompatible with anxiety, while exposing them to the stimulus that previously caused anxiety, he found that he could weaken and eliminate the conditional response of anxiety caused by being put in the box.
沃尔帕将这称为对抗性条件作用,即用一种联系(箱子和喂食)去对抗另一种联系(箱子和电击)。沃尔帕也把这一过程称为交互抑制作用,因为他认为焦虑和进食的反应是互相抑制的。当暴露于之前令动物们产生焦虑的刺激环境中时,通过激发动物们的一种与焦虑不兼容的反应,沃尔帕发现他可以弱化和消除动物们由于置于箱子中所产生的条件反应--焦虑。
In the late 1950s, Joseph Wolpe developed a treatment program for anxiety that was based on the principles of counterconditioning. Wolpe found that anxiety symptoms could be reduced (or inhibited) when the stimuli to the anxiety were presented in a graded order and systematically paired with a relaxation response. Hence this process of reciprocal inhibition came to be called systematic desensitization.
在20世纪50年代末,沃尔帕发展了一种基于对抗性条件作用原理的焦虑治疗方法。沃尔帕发现:当焦虑刺激按一定等级序列发生,并通过放松反应来系统地对抗相应刺激时,焦虑症状会减少(或抑制)。因此,这个交互抑制的过程被称为系统脱敏法。
类似系统脱敏法的心理治疗方法在中国古代也有运用。据《儒门事亲》载:卫德新的妻子旅途中,在旅舍的楼上住宿,夜逢盗贼烧房子,因受惊而堕下床来。自此以后,每听到声响,便会受惊昏倒不省人事。家人也只得蹑足而行,不敢冒然弄出声响,逾年不愈。医师张从正(号戴人)诊断后既让二侍女执其两手,按于高椅之上,在面前放一张小桌几。张从正说:“娘子,请看这木头!”便猛击桌,其妇大惊。张从正说:“我用木头击桌,有何可惊呢?”妇人吓后稍显安定,张从正又击桌,惊已显然减缓。又过一会儿,连击三五次,又用木杖击门,又暗中令人击背后的窗子。妇人慢慢从惊恐中平定下来。晚上又叫击其卧房的门窗,接连数日,从天黑直到天亮,一、二月后,虽听雷鸣也不惊恐了。
Systematic Desensitization (SD or Desensitization) is defined by Wikipedia as a type of behavioral therapy used in the field of psychology to help effectively overcome fears, phobias, and other anxiety disorders. More specifically, it is a type of Pavlovian therapy developed by a South African psychiatrist, Joseph Wolpe.
根据Wikipedia资料,系统脱敏法(SD)是心理学领域中一种用以治疗害怕、恐惧症以及其他焦虑症的行为治疗法。更为具体地说,它是由南非心理学家沃尔帕在巴甫洛夫治疗法上发展起来的。
Developed in the 1950s by behavior therapy pioneer Joseph Wolpe, systematic desensitization is based on the principles of “classical conditioning.” The idea is that when humans learn something, they are being ‘conditioned,’ so if someone with anxiety can be ‘unconditioned’ then the fears they have come to learn to be afraid of can therefore also be removed by reversing the learning…a kind of self brainwashing in a way.
自我洗脑。【理解这个“去条件化”,多参考之前的巴甫洛夫实验以及对抗性条件作用。。。】
Before we simply list the basic procedures of systematic desensitization, let's have a rough understanding about the reasons why they are important.
在简单列出系统脱敏疗法的基本步骤之前,让我们粗略地了解一下这些步骤之所以重要的原因:即从认知角度说明为什么要暴露于恐惧情境中(减少负强化的影响),为什么要学习放松,为什么要建立恐惧等级序列。
Specific phobias are one class of mental illness often treated through cognitive-behavioral therapy and the process of Systematic Desensitization (SD). When individuals possess irrational fears of an object, they tend to avoid it. Since escaping from the phobic object reduces their anxiety, patients’ behavior to reduce fear is reinforced through negative reinforcement, a concept defined in operant conditioning. The goal of Systematic Desensitization is to overcome this avoidance pattern by gradually exposing patients to the phobic object until it can be tolerated.
特殊恐怖症是一类通常以认知行为疗法和系统脱敏法来治疗的精神疾病。当对某一对象产生非理性的恐惧时,人们总是会本能地逃避它。因为避开令人恐惧的对象就可以减少焦虑,患者的这种逃避行为通过负强化不断得到加强(负强化的概念来自于操作性条件反射)。系统脱敏疗法旨在逐步让患者暴露在令其恐惧的情境中直至耐受性增加,从而达到克服逃避模式的目的。
Prior to exposure, the therapist teaches the patient cognitive strategies to cope with anxiety. This is necessary because it provides the patient with a means of controlling their fear, rather than letting it build until it becomes unbearable. Relaxation training, such as meditation, is one type of coping strategy. Patients might be taught to focus on their breathing or to think about happy situations. Another means of relaxation is cognitive reappraisal of imagined outcomes. The psychotherapist might encourage subjects to examine what they imagine happening when exposed to the phobic object, allowing them to recognize their catastrophic visions and contrast them with the actual outcome. For example, a patient with a snake phobia might realize that they imagine any snake they encounter would coil itself around their neck and strangle them, when this would not actually occur.
暴露于恐惧情境之前,治疗师有必要教患者一些克服焦虑的认知策略。这将会帮助患者在暴露过程中控制他们的恐惧,而不至于让这份恐惧变得无法忍受。放松训练,比如冥想,就是此策略之一。患者将学习如何专注于自己的呼吸,或者回想起快乐的情形。另一种放松方式是对想象性结局的认知重评。治疗师可能鼓励患者进行如下思考以便让患者识别自己想象的惨况并与实际情形相对比:当暴露于恐惧情境中,他们觉得会发生什么?想象的情形是什么样的?比如,一个对蛇有恐惧症的患者可能会意识到:对任何遇到的蛇,他们都会想象其缠绕在自己脖子上而扼杀他们的情形,而实际上这并不会发生。
The second component of systematic desensitization is gradual exposure to the feared object. Continuing with the snake example, the therapist would begin by asking their patient to develop a fear hierarchy, listing the relative unpleasantness of various types of exposure. For example, seeing a picture of a snake in a newspaper might be rated 5 of 100, while having several live snakes crawling on one’s neck would be the most fearful experience possible. Once the patient had practiced their relaxation technique, the therapist would then present them with the photograph, and help them calm down. They would then present increasingly unpleasant situations: a poster of a snake, a small snake in a box in the other room, a snake in a clear box in view, touching the snake, etc. At each step in the progression, the patient is desensitized to the phobia through the use of the coping technique. They realize that nothing bad happens to them, and the fear gradually extinguishes.
系统脱敏法的第二个元素就是逐步暴露于恐惧情境中。继续以蛇为例,治疗师首先要做的就是,通过询问患者来建立一个列明了对应各种暴露情形的恐惧层次的等级序列。比如,看见报纸上的蛇的图片,恐惧层次可能在5(最高为100),而活蛇绕颈可能就是最恐怖的层次。一旦患者掌握了放松技巧,治疗师就可以给他们看一些照片,并帮助他们保持平静。接下来,治疗师会展示一些越来越令人不舒服的情形:一张蛇的海报,另一房间的小盒里的一条小蛇,透明可见的盒子里的蛇,触摸蛇等等。在进展的每个阶段,患者通过使用之前的应对策略逐渐地增加对恐惧情形的忍受力。他们意识到并没有什么不好的事情发生,恐惧也就渐渐消退。
All in all, Joseph Wolpe(1958) described a three-part systematic desensitization procedure:
总而言之,沃尔帕(1958)陈述了系统脱敏疗法的三个步骤:
1. The client is trained in deep relaxation. Wolpe received the idea of relaxation from Jacobson who studied muscle relaxation. He modified Jacobson relaxation techniques so that they took less time. Wolpe’s rationale was that you cannot be both relaxed and anxious at the same time. Some techniques that may be helpful include deep breathing, progressive muscle relaxation, visualization and meditation.
训练患者掌握深度放松技巧。沃尔帕采纳了研究肌肉放松的专家雅格布森那里的放松概念,并改进了放松技巧,从而使得可以花较少时间以获得放松。沃尔帕的基本原理是:人不能同时既放松又焦虑(也就是说,放松和焦虑是交互抑制的,通过放松可以抑制焦虑。)一些有用的放松技巧包括:深呼吸,渐进式肌肉放松,想象,冥想。放松训练,一般需要6—10次练习,每次历时半小时,每天1至2次,以达到全身肌肉能够迅速进入松弛状态为合格。