Psychiatry
心理治疗
Therapist-free therapy
无需治疗师的治疗
Cognitive-bias modification may put the psychiatrist's couch out of business
认知偏差矫正可能会让心理治疗师的沙发失去用处
Mar 3rd 2011 | from the print edition
THE treatment, in the early 1880s, of an Austrian hysteric called Anna O is generally regarded as the beginning of talking-it-through as a form of therapy. But psychoanalysis, as this version of talk therapy became known, is an expensive procedure. Anna's doctor, Josef Breuer, is estimated to have spent over 1,000 hours with her.
通常认为心理治疗采用谈话方式治疗心理疾病始于十九世纪八十年代，治疗患有歇斯底里症的奥地利人安娜・欧。这种谈话治疗法后来被称为精神分析治疗，这是一项价格昂贵的治疗程序，据估计，约瑟夫・布洛伊尔医生在安娜・欧身上花了一千个小时以上的时间。
Since then, things have improved. A typical course of a modern talk therapy, such as cognitive behavioural therapy, consists of 12-16 hour-long sessions and is a reasonably efficient way of treating conditions like depression and anxiety (hysteria is no longer a recognised diagnosis). Medication, too, can bring rapid change. Nevertheless, treating disorders of the psyche is still a hit-and-miss affair, and not everyone wishes to bare his soul or take mind-altering drugs to deal with his problems. A new kind of treatment may, though, mean he does not have to. Cognitive-bias modification (CBM) appears to be effective after only a few 15-minute sessions, and involves neither drugs nor the discussion of feelings. It does not even need a therapist. All it requires is sitting in front of a computer and using a program that subtly alters harmful thought patterns.
从那以后，治疗方法有了进步，典型的像认知行为治疗等现代的谈话治疗方式包括12到16小时时长的治疗，而且对于治疗忧郁症、焦虑症等比较有效（已经不认可歇斯底里症为病症名称）。药物治疗也能快速产生效果。但是，尽管如此，心理失常仍然难治，有些人不愿意吐露自己最隐私的心理活动、也不愿意接受药物治疗。那么，最新一项治疗方法表示他们也许可以不需要采取这两种方法。认知偏差矫正（CBM），只需经过几次时长15分钟治疗，不需服药，也不用谈论内心的感受，就能取得较好的效果。采用CBM治疗方法甚至都不需要治疗师，只要坐在一台电脑前，使用一个能够巧妙地改进有害的思考方式的这样一种程序，就可达到治疗效果。
This simple approach has already been shown to work for anxiety and addictions, and is now being tested for alcohol abuse, post-traumatic-stress disorder and several other disturbances of the mind. It is causing great excitement among researchers. As Yair Bar-Haim, a psychologist at Tel Aviv University who has been experimenting with it on patients as diverse as children and soldiers, puts it, "It's not often that a new evidence-based treatment for a major psychopathology comes around."
这项简单的方法已经在治疗焦虑证和各种成瘾病症上取得了效果，现在正测试用于治疗酒瘾、重大创伤后遗症及其它几项心理疾病，在心理学研究者当中掀起了很大的热情。特拉维夫大学心理学家Yair Bar-Haim，在治疗儿童、军人等不同病人时，实验过使用这一方法，他讲，"出现一项新的基于有证据证实的重要心理治疗方法，可是一件稀罕的事情。"
CBM is based on the idea that many psychological problems are caused by automatic, unconscious biases in thinking. People suffering from anxiety, for instance, may have what is known as an attentional bias towards threats: they are drawn irresistibly to things they perceive to be dangerous. Similar biases may affect memory and the interpretation of events. For example, if an acquaintance walks past without saying hello, it might mean either that he has ignored you or that he has not seen you. The anxious, according to the theory behind CBM, have a bias towards assuming the former and reacting accordingly.
CBM治疗方法基于这样的理念，即许多心理疾病都是由于自动产生的、无意识的思考方式的偏见。比如，患有焦虑症的人可能有种倾向，就是人们常讲"过度地关注威胁"倾向，他们不能控制住不去想危险的事情。另外，对某些事件的记忆和解读有可能受相似的倾向影响。比如，如果有个认识的人经过你没打招呼，有可能他是故意忽视了你，也有可能就是没看到你，那么，根据CBM治疗方法所赖以支撑的理论，有焦虑症倾向的人可能会认为是故意为之，并做出相应的应。
The goal of CBM is to alter such biases, and doing so has proved surprisingly easy. A common way of debiasing attention is to show someone two words or pictures―one neutral and the other threatening―on a computer screen. In the case of social anxiety these might be a neutral face and a disgusted face. Presented with this choice, an anxious person instinctively focuses on the disgusted visage. The program, however, prods him to complete tasks involving the neutral picture, such as identifying letters that appear in its place on the screen. Repeating the procedure around a thousand times, over a total of two hours, changes the user's tendency to focus on the anxious face. That change is then carried into the wider world.
CBM治疗方法的目标在于改变这类偏见，而且据证明，这改变还蛮简单。消除注意力偏见有一个被广泛使用的方法就是在显示器上给某人展示两个单词或两张图片，一个中立的，另一个有威胁性的。有焦虑倾向的人本能地注意有威胁性的意象。那么这个系统，就会要求他完成一些与中立图片相关的任务，比如辨认中立图片里的字符。就这样一个过程，在两个小时的时间里会重复大约一千次，从而改变用户集中于威胁性图片的倾向。这样的改变渐渐地被带到日常生活里。
Emily Holmes of Oxford University, who studies the use of CBM for depression, describes the process as like administering a cognitive vaccine. When challenged by reality in the form of, say, the unobservant friend, the recipient of the vaccine finds he is inoculated against inappropriate anxiety.
牛津大学的艾米莉・霍尔姆斯（Emily Holmes）研究CBM在忧郁症治疗上的运用，她讲这一过程像打认知疫苗。经过这一治疗的焦虑症患者，再碰到朋友没注意到他的情形，会发现他像打了预防针一样，不再产生不该有的焦虑了。
In a recent study of social anxiety by Norman Schmidt of Florida State University and his colleagues, which involved 36 volunteers who had been diagnosed with anxiety, half underwent eight short sessions of CBM and the rest were put in a control group and had no treatment. At the end of the study, a majority of the CBM volunteers no longer seemed anxious, whereas in the control group only 11% had shed their anxiety. Although it was only a small trial, these results compare favourably with those of existing treatments. An examination of standard talk therapy carried out in 2004, for instance, found that half of patients had a clinically significant reduction in symptoms. Trials of medications have similar success rates.
不久前，佛罗里达州立大学的诺曼・施密特（Norman Schmidt）和同事合作进行了一项针对社交焦虑的研究试验， 36名被诊断有焦虑症的人志愿参与这一试验，其中一半人经过了八小时的CBM治疗，另一半归于控制组，没接受任何治疗。最后，接受CBM治疗的那组大多数都不再焦虑了，而控制组的只有11%不再焦虑。尽管这只是个小试验，但显示出其效果明显好于其它治疗方法。例如，2004年有项检查标准谈话治疗效果的实验，结果显示一半的病人明显地减轻了症状。针对药物治疗的试验显示其效果也在一半左右。
The latest research, which is on a larger scale and is due to be published this month in Psychological Science, tackles alcohol addiction. Past work has shown that many addicts have an approach bias for alcohol―in other words, they experience a physical pull towards it. (Arachnophobia, a form of this bias that is familiar to many people, works in the opposite way: if they encounter a spider, they recoil.)
最近有项规模较前者大、针对酒瘾的研究，将发表于本月的《心理科学》杂志上，过去的工作显示许多有酒瘾的人对酒精有种趋近的倾向，换言之，似乎酒精能伸手拉住他们。（而另一种广为人知的趋近倾向（approach bias），蜘蛛恐惧症，其表现却刚好相反，有蜘蛛恐惧症的人遇见蜘蛛会本能地回缩。）
This study, conducted by Reinout Wiers of the University of Amsterdam and his colleagues, attempted to correct the approach bias to alcohol with CBM. The 214 participants received either a standard addiction treatment―a form of talk therapy―or the standard treatment plus four 15-minute sessions of CBM. In the first group, 41% of participants were abstinent a year later; in the second, 54%. That is not a cure for alcoholism, but it is a significant improvement on talk therapy alone.
这项研究由阿姆斯特丹大学的Reinout Wiers及其同事完成，旨在使用CBM纠正对酒精的趋近倾向。214名参与者，分为两组，一组接受标准的酒瘾治疗方式――一种谈话方式，第二组接受标准的谈话治疗方法，外加4个15分钟时长的CBM治疗方式，一年后，第一组有41%的人戒酒，第二组54%。可能CBM并非治疗酒瘾的方法，但比起单靠谈话治疗方法，还是有明显的改进。
Many other researchers are now exploring CBM. A team at Harvard, led by Richard McNally, is seeking volunteers for a month-long programme that will use smart-phones to assess the technique's effect on anxiety. And Dr Bar-Haim and his team are examining possible connections between cognitive biases and post-traumatic-stress disorder in the American and Israeli armies.
还有许多其他研究者在发掘CBM的用处，理查德・麦克纳利（ Richard McNally）领导的哈佛大学团队，正在寻找志愿者参与一项一个月长的项目，使用智能手机评估这一技术对焦虑的影响。而特拉维夫大学Bar-Haim博士的团队现在正研究美国和以色列部队里，认知偏见与重大创伤后遗症的联系。
Not all disorders are amenable to CBM. One study, by Hannah Reese (also at Harvard) and her colleagues, showed that it is ineffective in countering arachnophobia (perhaps not surprising, since this may be an evolved response, rather than an acquired one). Moreover, Dr Wiers found that the approach bias towards alcohol is present in only about half of the drinkers he studies. He hypothesises that for the others, drinking is less about automatic impulses and more about making a conscious decision. In such cases CBM is unlikely to work.
CBM并不能治疗所有的心理疾病。哈佛大学另一名专家汉娜・瑞西及其同事的研究显示CBM在治疗蜘蛛恐惧症上没有效果，也许这不值得奇怪，因为蜘蛛恐惧症似乎是随进化得来的病症，而不是后天得的。另外，Wiers博士发现，饮酒者中只有一半人对酒精有趋近倾向。他提出假说，对另一半没有趋近倾向饮酒者，喝酒并非自发的冲动，而是有意识的选择，所以，CBM不可能有效治疗这类酒瘾。
Colin MacLeod of the University of Western Australia, one of the pioneers of the technique, thinks CBM is not quite ready for general use. He would like to see it go through some large, long-term, randomised clinical trials of the sort that would be needed if it were a drug, rather than a behavioural therapy. Nevertheless, CBM does look extremely promising, if only because it offers a way out for those whose answer to the question, "Do you want to talk about it?" is a resounding "No".
西澳大利亚大学的柯林・麦可劳得是这项技术的先驱之一，他认为CBM技术还未发展到广泛运用阶段。他希望这项技术，也像药物一样，而非像行为治疗方法一样，在运用前，经受一些较大的、长期的、随机的临床试验，检验其效果。尽管如此，CBM确实是非常有用，至少，给那些非常不愿与治疗师谈论内心感受的人提供了另一种治疗方式。
心理治疗
Therapist-free therapy
无需治疗师的治疗
Cognitive-bias modification may put the psychiatrist's couch out of business
认知偏差矫正可能会让心理治疗师的沙发失去用处
Mar 3rd 2011 | from the print edition
THE treatment, in the early 1880s, of an Austrian hysteric called Anna O is generally regarded as the beginning of talking-it-through as a form of therapy. But psychoanalysis, as this version of talk therapy became known, is an expensive procedure. Anna's doctor, Josef Breuer, is estimated to have spent over 1,000 hours with her.
通常认为心理治疗采用谈话方式治疗心理疾病始于十九世纪八十年代，治疗患有歇斯底里症的奥地利人安娜・欧。这种谈话治疗法后来被称为精神分析治疗，这是一项价格昂贵的治疗程序，据估计，约瑟夫・布洛伊尔医生在安娜・欧身上花了一千个小时以上的时间。
Since then, things have improved. A typical course of a modern talk therapy, such as cognitive behavioural therapy, consists of 12-16 hour-long sessions and is a reasonably efficient way of treating conditions like depression and anxiety (hysteria is no longer a recognised diagnosis). Medication, too, can bring rapid change. Nevertheless, treating disorders of the psyche is still a hit-and-miss affair, and not everyone wishes to bare his soul or take mind-altering drugs to deal with his problems. A new kind of treatment may, though, mean he does not have to. Cognitive-bias modification (CBM) appears to be effective after only a few 15-minute sessions, and involves neither drugs nor the discussion of feelings. It does not even need a therapist. All it requires is sitting in front of a computer and using a program that subtly alters harmful thought patterns.
从那以后，治疗方法有了进步，典型的像认知行为治疗等现代的谈话治疗方式包括12到16小时时长的治疗，而且对于治疗忧郁症、焦虑症等比较有效（已经不认可歇斯底里症为病症名称）。药物治疗也能快速产生效果。但是，尽管如此，心理失常仍然难治，有些人不愿意吐露自己最隐私的心理活动、也不愿意接受药物治疗。那么，最新一项治疗方法表示他们也许可以不需要采取这两种方法。认知偏差矫正（CBM），只需经过几次时长15分钟治疗，不需服药，也不用谈论内心的感受，就能取得较好的效果。采用CBM治疗方法甚至都不需要治疗师，只要坐在一台电脑前，使用一个能够巧妙地改进有害的思考方式的这样一种程序，就可达到治疗效果。
This simple approach has already been shown to work for anxiety and addictions, and is now being tested for alcohol abuse, post-traumatic-stress disorder and several other disturbances of the mind. It is causing great excitement among researchers. As Yair Bar-Haim, a psychologist at Tel Aviv University who has been experimenting with it on patients as diverse as children and soldiers, puts it, "It's not often that a new evidence-based treatment for a major psychopathology comes around."
这项简单的方法已经在治疗焦虑证和各种成瘾病症上取得了效果，现在正测试用于治疗酒瘾、重大创伤后遗症及其它几项心理疾病，在心理学研究者当中掀起了很大的热情。特拉维夫大学心理学家Yair Bar-Haim，在治疗儿童、军人等不同病人时，实验过使用这一方法，他讲，"出现一项新的基于有证据证实的重要心理治疗方法，可是一件稀罕的事情。"
CBM is based on the idea that many psychological problems are caused by automatic, unconscious biases in thinking. People suffering from anxiety, for instance, may have what is known as an attentional bias towards threats: they are drawn irresistibly to things they perceive to be dangerous. Similar biases may affect memory and the interpretation of events. For example, if an acquaintance walks past without saying hello, it might mean either that he has ignored you or that he has not seen you. The anxious, according to the theory behind CBM, have a bias towards assuming the former and reacting accordingly.
CBM治疗方法基于这样的理念，即许多心理疾病都是由于自动产生的、无意识的思考方式的偏见。比如，患有焦虑症的人可能有种倾向，就是人们常讲"过度地关注威胁"倾向，他们不能控制住不去想危险的事情。另外，对某些事件的记忆和解读有可能受相似的倾向影响。比如，如果有个认识的人经过你没打招呼，有可能他是故意忽视了你，也有可能就是没看到你，那么，根据CBM治疗方法所赖以支撑的理论，有焦虑症倾向的人可能会认为是故意为之，并做出相应的应。
The goal of CBM is to alter such biases, and doing so has proved surprisingly easy. A common way of debiasing attention is to show someone two words or pictures―one neutral and the other threatening―on a computer screen. In the case of social anxiety these might be a neutral face and a disgusted face. Presented with this choice, an anxious person instinctively focuses on the disgusted visage. The program, however, prods him to complete tasks involving the neutral picture, such as identifying letters that appear in its place on the screen. Repeating the procedure around a thousand times, over a total of two hours, changes the user's tendency to focus on the anxious face. That change is then carried into the wider world.
CBM治疗方法的目标在于改变这类偏见，而且据证明，这改变还蛮简单。消除注意力偏见有一个被广泛使用的方法就是在显示器上给某人展示两个单词或两张图片，一个中立的，另一个有威胁性的。有焦虑倾向的人本能地注意有威胁性的意象。那么这个系统，就会要求他完成一些与中立图片相关的任务，比如辨认中立图片里的字符。就这样一个过程，在两个小时的时间里会重复大约一千次，从而改变用户集中于威胁性图片的倾向。这样的改变渐渐地被带到日常生活里。
Emily Holmes of Oxford University, who studies the use of CBM for depression, describes the process as like administering a cognitive vaccine. When challenged by reality in the form of, say, the unobservant friend, the recipient of the vaccine finds he is inoculated against inappropriate anxiety.
牛津大学的艾米莉・霍尔姆斯（Emily Holmes）研究CBM在忧郁症治疗上的运用，她讲这一过程像打认知疫苗。经过这一治疗的焦虑症患者，再碰到朋友没注意到他的情形，会发现他像打了预防针一样，不再产生不该有的焦虑了。
In a recent study of social anxiety by Norman Schmidt of Florida State University and his colleagues, which involved 36 volunteers who had been diagnosed with anxiety, half underwent eight short sessions of CBM and the rest were put in a control group and had no treatment. At the end of the study, a majority of the CBM volunteers no longer seemed anxious, whereas in the control group only 11% had shed their anxiety. Although it was only a small trial, these results compare favourably with those of existing treatments. An examination of standard talk therapy carried out in 2004, for instance, found that half of patients had a clinically significant reduction in symptoms. Trials of medications have similar success rates.
不久前，佛罗里达州立大学的诺曼・施密特（Norman Schmidt）和同事合作进行了一项针对社交焦虑的研究试验， 36名被诊断有焦虑症的人志愿参与这一试验，其中一半人经过了八小时的CBM治疗，另一半归于控制组，没接受任何治疗。最后，接受CBM治疗的那组大多数都不再焦虑了，而控制组的只有11%不再焦虑。尽管这只是个小试验，但显示出其效果明显好于其它治疗方法。例如，2004年有项检查标准谈话治疗效果的实验，结果显示一半的病人明显地减轻了症状。针对药物治疗的试验显示其效果也在一半左右。
The latest research, which is on a larger scale and is due to be published this month in Psychological Science, tackles alcohol addiction. Past work has shown that many addicts have an approach bias for alcohol―in other words, they experience a physical pull towards it. (Arachnophobia, a form of this bias that is familiar to many people, works in the opposite way: if they encounter a spider, they recoil.)
最近有项规模较前者大、针对酒瘾的研究，将发表于本月的《心理科学》杂志上，过去的工作显示许多有酒瘾的人对酒精有种趋近的倾向，换言之，似乎酒精能伸手拉住他们。（而另一种广为人知的趋近倾向（approach bias），蜘蛛恐惧症，其表现却刚好相反，有蜘蛛恐惧症的人遇见蜘蛛会本能地回缩。）
This study, conducted by Reinout Wiers of the University of Amsterdam and his colleagues, attempted to correct the approach bias to alcohol with CBM. The 214 participants received either a standard addiction treatment―a form of talk therapy―or the standard treatment plus four 15-minute sessions of CBM. In the first group, 41% of participants were abstinent a year later; in the second, 54%. That is not a cure for alcoholism, but it is a significant improvement on talk therapy alone.
这项研究由阿姆斯特丹大学的Reinout Wiers及其同事完成，旨在使用CBM纠正对酒精的趋近倾向。214名参与者，分为两组，一组接受标准的酒瘾治疗方式――一种谈话方式，第二组接受标准的谈话治疗方法，外加4个15分钟时长的CBM治疗方式，一年后，第一组有41%的人戒酒，第二组54%。可能CBM并非治疗酒瘾的方法，但比起单靠谈话治疗方法，还是有明显的改进。
Many other researchers are now exploring CBM. A team at Harvard, led by Richard McNally, is seeking volunteers for a month-long programme that will use smart-phones to assess the technique's effect on anxiety. And Dr Bar-Haim and his team are examining possible connections between cognitive biases and post-traumatic-stress disorder in the American and Israeli armies.
还有许多其他研究者在发掘CBM的用处，理查德・麦克纳利（ Richard McNally）领导的哈佛大学团队，正在寻找志愿者参与一项一个月长的项目，使用智能手机评估这一技术对焦虑的影响。而特拉维夫大学Bar-Haim博士的团队现在正研究美国和以色列部队里，认知偏见与重大创伤后遗症的联系。
Not all disorders are amenable to CBM. One study, by Hannah Reese (also at Harvard) and her colleagues, showed that it is ineffective in countering arachnophobia (perhaps not surprising, since this may be an evolved response, rather than an acquired one). Moreover, Dr Wiers found that the approach bias towards alcohol is present in only about half of the drinkers he studies. He hypothesises that for the others, drinking is less about automatic impulses and more about making a conscious decision. In such cases CBM is unlikely to work.
CBM并不能治疗所有的心理疾病。哈佛大学另一名专家汉娜・瑞西及其同事的研究显示CBM在治疗蜘蛛恐惧症上没有效果，也许这不值得奇怪，因为蜘蛛恐惧症似乎是随进化得来的病症，而不是后天得的。另外，Wiers博士发现，饮酒者中只有一半人对酒精有趋近倾向。他提出假说，对另一半没有趋近倾向饮酒者，喝酒并非自发的冲动，而是有意识的选择，所以，CBM不可能有效治疗这类酒瘾。
Colin MacLeod of the University of Western Australia, one of the pioneers of the technique, thinks CBM is not quite ready for general use. He would like to see it go through some large, long-term, randomised clinical trials of the sort that would be needed if it were a drug, rather than a behavioural therapy. Nevertheless, CBM does look extremely promising, if only because it offers a way out for those whose answer to the question, "Do you want to talk about it?" is a resounding "No".
西澳大利亚大学的柯林・麦可劳得是这项技术的先驱之一，他认为CBM技术还未发展到广泛运用阶段。他希望这项技术，也像药物一样，而非像行为治疗方法一样，在运用前，经受一些较大的、长期的、随机的临床试验，检验其效果。尽管如此，CBM确实是非常有用，至少，给那些非常不愿与治疗师谈论内心感受的人提供了另一种治疗方式。
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