演講MP3+雙語文稿:抑郁、焦慮和上癮等心理問題可以用這種方法來治療？

聽力課堂TED音頻欄目主要包括TED演講的音頻MP3及中英雙語文稿，供各位英語愛好者學(xué)習(xí)使用。本文主要內(nèi)容為演講MP3+雙語文稿:抑郁、焦慮和上癮等心理問題可以用這種方法來治療？，希望你會喜歡！

【演講人】Rick Doblin

【演講主題】迷幻劑竟能治療抑郁、焦慮和上癮等心理問題？

【演講文稿-中英文】

翻譯者 Leila Ataei 校對：Hajar Almasi

準(zhǔn)備此次演講比準(zhǔn)備LSD治療還讓我害怕。

Preparing for this talk has been scarier for me than preparing for LSD therapy.

（笑聲）

(Laughter)

“迷幻劑之于心智，就像顯微鏡之于生物學(xué)，望遠(yuǎn)鏡之于天文學(xué)?！边@些話是斯坦尼斯拉夫·格羅夫博士說的。他是世界上首屈一指的迷幻劑研究者之一，他也是我的導(dǎo)師。今天，我想和你們分享當(dāng)明智的使用迷幻劑時，是如何擁有潛力幫助治愈我們，幫助激發(fā)我們，并且甚至幫助拯救我們的。

"Psychedelics are to the study of the mind what the microscope is to biology and the telescope is to astronomy." Dr. Stanislav Grof spoke those words. He's one of the leading psychedelic researchers in the world, and he's also been my mentor. Today, I'd like to share with you how psychedelics, when used wisely, have the potential to help heal us, help inspire us, and perhaps even to help save us.

在1950和1960年代，迷幻劑研究在全球各地都很熱門，并在精神病學(xué)，心理學(xué)和心理療法，神經(jīng)科學(xué)和神秘體驗的研究中均顯示了巨大的潛力。但迷幻劑從研究環(huán)境中泄露出來并被反主流文化，以及反越戰(zhàn)運動使用。存在一些不明智的使用。因此引起了強烈的反對。在1970年，美國政府將所有對迷幻劑的使用定為犯罪，并且開始終止所有的迷幻劑研究。這一禁令在全球擴(kuò)散并持續(xù)了幾十年。這真是個悲劇，迷幻劑實際上只是個工具，不管它們的結(jié)果是好還是壞，取決于它們怎么被使用。

In the 1950s and 60s, psychedelic research flourished all over the world and showed great promise for the fields of psychiatry, psychology and psychotherapy, neuroscience and the study of mystical experiences. But psychedelics leaked out of the research settings and began to be used by the counterculture, and by the anti-Vietnam War movement. And there was unwise use. And so there was a backlash. And in 1970, the US government criminalized all uses of psychedelics, and they began shutting down all psychedelic research. And this ban spread all over the world and lasted for decades. and it was tragic, since psychedelics are really just tools, and whether their outcomes are beneficial or harmful depends on how they're used.

迷幻意思是“心靈顯現(xiàn)”，它與LSD、裸蓋菇素、美斯卡林，依波加等藥物有關(guān)。在18歲時，我是個大學(xué)新生，我體驗了LSD和墨斯卡靈，這些體驗讓我接觸到自己的情感。它們幫助我建立了一種精神聯(lián)系，不幸的是，我的成年禮并沒有產(chǎn)生這種聯(lián)系。

Psychedelic means "mind-manifesting," and it relates to drugs like LSD, psilocybin, mescaline, iboga and other drugs. When I was 18 years old, I was a college freshman, I was experimenting with LSD and mescaline, and these experiences brought me in touch with my emotions. And they helped me have a spiritual connection that unfortunately, my bar mitzvah did not produce.

（笑聲）

(Laughter)

當(dāng)我想戲弄我父母時，我會跟他們說是他們把我推向了迷幻劑，因為我的成年禮并沒有把我變成男人。

When I wanted to tease my parents, I would tell them that they drove me to psychedelics because my bar mitzvah had failed to turn me into a man.

（笑聲）

(Laughter)

但最重要的是，迷幻劑給了我一種我們共同的人性，我們與所有生命的統(tǒng)一的感覺。其他人也報告有同樣的感受。我覺得這些體驗具有潛力成為部落主義、 原教旨主義、種族滅絕和環(huán)境破壞的解藥。于是我決定把我的人生致力于改變法律以及成為一名合法迷幻劑心理治療師上。

But most importantly, psychedelics gave me this feeling of our shared humanity, of our unity with all life. And other people reported that same thing as well. And I felt that these experiences had the potential to help be an antidote to tribalism, to fundamentalism, to genocide and environmental destruction. And so I decided to focus my life on changing the laws and becoming a legal psychedelic psychotherapist.

（鼓掌）

(Applause)

如今，在禁止過了半個世紀(jì)后，我們正處于迷幻劑研究的全球復(fù)興之中。迷幻劑治療法在治療創(chuàng)傷后應(yīng)激障礙(PTSD)，抑郁，社交焦慮，藥物濫用和酗酒和自殺等方面顯示了巨大的潛力。迷幻劑心理治療試圖追擊問題的根源，只需相對較少的管理，相比之下，今天使用的大多數(shù)精神藥物,主要是減輕癥狀， 并意味著需要每天服用。

Now, half a century after the ban, we're in the midst of a global renaissance of psychedelic research. Psychedelic psychotherapy is showing great promise for the treatment of post-traumatic stress disorder, or PTSD, depression, social anxiety, substance abuse and alcoholism and suicide. Psychedelic psychotherapy is an attempt to go after the root causes of the problems, with just relatively few administrations, as contrasted to most of the psychiatric drugs used today that are mostly just reducing symptoms and are meant to be taken on a daily basis.

迷幻劑今天也被用作神經(jīng)科學(xué)工具來研究大腦功能，和用來研究人類意識的永恒之謎。人們正在探索迷幻劑和它們產(chǎn)生的神秘體驗,與冥想和正念之間的聯(lián)系，包括最近發(fā)表的一篇,關(guān)于終身禪修者在禪修中服用裸蓋菇素后顯示出了,其長期效果,還有大腦變化的論文。

Psychedelics are now also being used as tools for neuroscience to study brain function and to study the enduring mystery of human consciousness. And psychedelics and the mystical experiences they produce are being explored for their connections between meditation and mindfulness, including a paper just recently published about lifelong zen meditators taking psilocybin in the midst of a meditation retreat and showing long-term benefits and brain changes.

這些藥物是怎么作用的？現(xiàn)代神經(jīng)科學(xué)研究已經(jīng)證明,迷幻劑減少了我們所周知的大腦默認(rèn)模式網(wǎng)絡(luò)的活動。這是我們創(chuàng)造自我意識的地方。這是我們的自我，它會根據(jù)我們的個人需求和優(yōu)先事項過濾所有進(jìn)入的信息。當(dāng)默認(rèn)模式網(wǎng)絡(luò)的活動減少時，我們的自我就從前臺轉(zhuǎn)移至后臺，我們意識到,這只是一個更大的意識領(lǐng)域的一部分。這跟哥白尼和伽利略用望遠(yuǎn)鏡向人類展示地球不再是宇宙的中心，而實際上是繞著太陽轉(zhuǎn)類似，有比自身更大的東西。對有些人來說，這個意識的轉(zhuǎn)變,是他們最重要和人生中最重要的體驗。他們感到與比自己更大的世界的親密性。他們利他的感覺更強，并且他們對死亡也不那么恐懼。

Now, how do these drugs work? Modern neuroscience research has demonstrated that psychedelics reduce activity in what's known as the brain's default mode network. This is where we create our sense of self. It's our equivalent to the ego, and it filters all incoming information according to our personal needs and priorities. When activity is reduced in the default mode network, our ego shifts from the foreground to the background, and we see that it's just part of a larger field of awareness. It's similar to the shift that Copernicus and Galileo were able to produce in humanity using the telescope to show that the earth was no longer the center of the universe, but was actually something that revolved around the sun, something bigger than itself. For some people, this shift in awareness is the most important and among the most important experiences of their lives. They feel more connected to the world bigger than themselves. They feel more altruistic, and they lose some of their fear of death.

不是所有的藥物都這樣起作用。MDMA/搖頭丸，也稱為嗨飛，或莫利，作用原理就就有著本質(zhì)不同。我可以和你分享馬塞拉的故事，她因暴力性侵犯而患有PTSD。馬塞拉和我是1984年介紹認(rèn)識的，當(dāng)時MDMA仍然非法，但它也開始從治療圈中泄露出來。瑪塞拉曾在娛樂場所嘗試過MDMA，在這期間，她過去的創(chuàng)傷意識淹沒了她，強化了她自殺的想法。在我們第一次交談時，我分享說當(dāng)MDMA用于治療時，它可以減輕對消極情緒的恐懼，并且可以幫助她走出創(chuàng)傷。我請求她如果我們開始合作，希望她答應(yīng)我不要自殺。她同意了并且做了承諾。

Not all drugs work this way. MDMA, also known as Ecstasy, or Molly, works fundamentally different. And I'll be able to share with you the story of Marcela, who suffered from post-traumatic stress disorder from a violent sexual assault. Marcela and I were introduced in 1984, when MDMA was still legal, but it was beginning also to leak out of therapeutic circles. Marcela had tried MDMA in a recreational setting, and during that, her past trauma flooded her awareness and it intensified her suicidal feelings. During our first conversation, I shared that when MDMA is taken therapeutically, it can reduce the fear of difficult emotions, and she could help move forward past her trauma. I asked her to promise not to commit suicide if we were to work together. She agreed and made that promise.

在她的治療環(huán)節(jié)，瑪塞拉能夠更流暢，更容易地面對她的創(chuàng)傷。并且，她能夠說出,強奸犯告訴過她，如果她把事情說出去，他就殺了她。她意識到囚禁她的是她自己的思想。所以能夠分享遭遇、經(jīng)歷、感覺和頭腦中的想法解放了她，并且她也能夠決定,她想要她的生活繼續(xù)。在那一刻，我意識到MDMA對治療PTSD可能非常有效。如今，在瑪塞拉接受治療的35年后，她成為了一名治療師，培訓(xùn)其他治療師，幫助人們用MDMA克服PTSD。

During her therapeutic sessions, Marcela was able to process her trauma more fluidly, more easily. And yet, she was able to tell that the rapist had told her that if she ever shared her story, he would kill her. And she realized that that was keeping her a prisoner in her own mind. So being able to share the story and experience the feelings and the thoughts in her mind freed her, and she was able to decide that she wanted to move forward with her life. And in that moment, I realized that MDMA could be very effective for treating PTSD. Now, 35 years later, after Marcela's treatment, she's actually a therapist, training other therapists to help people overcome PTSD with MDMA.

那么，MDMA是如何作用的？MDMA是如何幫到瑪塞拉的？患有PTSD的人與沒有的人大腦不一樣。他們的杏仁核很活躍，這是處理恐懼的地方。他們的前額皮質(zhì)的活動有所減少，這是負(fù)責(zé)邏輯思維的地方。他們的海馬體的活動減少了，這是我們儲存長期記憶的地方。而MDMA會把大腦朝相反的方向改變。MDMA減少了杏仁核的活動，增加了前額皮質(zhì)的活動，并且增加了杏仁核和海馬體之間的連接，將創(chuàng)傷記憶轉(zhuǎn)移到長期存儲中。最近，約翰·霍普金斯大學(xué)的研究人員在《自然》雜志上發(fā)表了一篇論文，他們證明MDMA能釋放催產(chǎn)素，愛和養(yǎng)育的荷爾蒙。同樣的研究人員也對章魚進(jìn)行了研究，章魚通常是獨來獨往的，除非在交配季節(jié)。但給了它們MDMA之后，它們變得親社會了。

Now, how does MDMA work? How did MDMA help Marcela? People who have PTSD have brains that are different from those of us who don't have PTSD. They have a hyperactive amygdala, where we process fear. They have reduced activity in the prefrontal cortex, where we think logically. And they have reduced activity in the hippocampus, where we store memories into long-term storage. MDMA changes the brain in the opposite way. MDMA reduces activity in the amygdala, increases activity in the prefrontal cortex and increases connectivity between the amygdala and the hippocampus to remit traumatic memories to move into long-term storage. Recently, researchers at Johns Hopkins published a paper in "Nature," in which they demonstrated that MDMA releases oxytocin, the hormone of love and nurturing. The same researchers also did studies in octopuses, who are normally asocial, unless it's mating season. But lo and behold, you give them MDMA, and they become prosocial.

（笑聲）

(Laughter)

在瑪塞拉和我治療幾個月后，美國緝毒局開始將使用搖頭丸定為犯罪，對其治療作用則一無所知。所以我來到華盛頓，我來到緝毒局的總部，并且提起訴訟，要求舉辦一場聽證會，這樣精神病學(xué)家和精神治療師，將能夠提供有關(guān)MDMA治療用途的信息，來讓它變得合法。在聽證會中間，緝毒局抓狂了，宣布進(jìn)入緊急狀態(tài)，并將所有使用MDMA的行為定為犯罪。于是我看到的剩下的唯一讓它回歸的方式，是通過科學(xué)，醫(yī)學(xué)，并通過FDA藥物開發(fā)流程。

Several months after Marcela and I worked together, the Drug Enforcement Administration moved to criminalize Ecstasy, having no knowledge of its therapeutic use. So I went to Washington, and I went into the headquarters of the Drug Enforcement Administration, and I filed a lawsuit demanding a hearing, at which psychiatrists and psychotherapists would be able to present information about therapeutic use of MDMA to try to keep it legal. And in the middle of the hearing, the DEA freaked out, declared an emergency and criminalized all uses of MDMA. And so the only way that I could see to bring it back was through science, through medicine and through the FDA drug development process.

所以在1986年，我成立了MAPS，這家非盈利的迷幻藥制藥公司。它花了我們30年的時間，直到2016年，我們才得到了所需提交給FDA的數(shù)據(jù)，以申請進(jìn)入大規(guī)模第三階段研究的許可，在獲得處方使用的批準(zhǔn)之前，這是個需要證明其安全性和有效性的許可。

So in 1986, I started MAPS as a nonprofit psychedelic pharmaceutical company. It took us 30 years, till 2016, to develop the data that we needed to present to FDA to request permission to move into the large-scale Phase 3 studies that are required to prove safety and efficacy before you get approval for prescription use.

托尼是我們一項試點研究中的一個老兵。根據(jù)退伍軍人管理局的數(shù)據(jù)，現(xiàn)在有超過一百萬的退伍軍人患有PTSD。每天至少有20個老兵自殺，其中很多是因為PTSD。托尼所接受的治療有3個半月長。但在那期間，他只接受了三次MDMA治療，中間分為12次90分鐘的非藥物心理療程，3次在第一次MDMA療程前作為準(zhǔn)備環(huán)節(jié)，3次在每次MDMA療程后進(jìn)行整合。我們把我們的治療方法稱為“內(nèi)在導(dǎo)向治療”，在這個過程中，我們支持病人去體驗他們大腦或身體里出現(xiàn)的一切。即便有MDMA，這個工作也不容易。我們的很多研究對象都說過，“我不知道他們?yōu)槭裁窗堰@叫嗨飛?！?/p>

Tony was a veteran in one of our pilot studies. According to the Veterans Administration, there's over a million veterans now disabled with PTSD. And at least 20 veterans a day are committing suicide, many of them from PTSD. The treatment that Tony was to receive was three and a half months long. But during that period of time, he would only get MDMA on three occasions, separated by 12, 90-minute non-drug psychotherapy sessions, three before the first MDMA session for preparation and three after each MDMA session for integration. We call our treatment approach "inner-directed therapy," in that we support the patient to experience whatever's emerging within their minds or their bodies. Even with MDMA, this is hard work. And a lot of our subjects have said, "I don't know why they call this Ecstasy."

（笑聲）

(Laughter)

在托尼的首次MDMA療程中，他躺在沙發(fā)上，戴著眼罩，聽著音樂，他可以和治療師交談，后者是一組男女聯(lián)合治療小組，隨時在他需要時響應(yīng)。在幾個小時后，在一個平靜和清晰的時刻，托尼分享了他意識到的，他的PTSD是他和朋友聯(lián)系的一種方式。這是紀(jì)念他死去的朋友的一種方式。但他能夠通過死去的朋友的眼睛看到自己。他意識到他們不希望他受苦，揮霍他的生命。他們希望他活得充實，而這是他們無法做到的。于是他意識到，有新的方法來紀(jì)念他的朋友們，那就是盡可能充實地活著。他還意識到，他是在給自己洗腦，說他服用鴉片是為了止痛。但事實上，他意識到，他是用它們來逃避。于是他決定再也不需要鴉片了，他再也不需要MDMA了，于是他退出了研究。現(xiàn)在已經(jīng)7年了。托尼沒有再受PTSD折磨，他也沒復(fù)吸鴉片，并且正在柬埔寨幫助那些 沒有他那么幸運的人。

During Tony's first MDMA session, he lay on the couch, he had eyeshades on, he listened to music, and he would speak to the therapists, who were a male-female co-therapy team, whenever he felt that he needed to. After several hours, in a moment of calmness and clarity, Tony shared that he had realized his PTSD was a way of connecting him to his friends. It was a way of honoring the memory of his friends who had died. But he was able to shift and see himself through the eyes of his dead friends. And he realized that they would not want him to suffer, to squander his life. They would want him to live more fully, which they were unable to do. And so he realized that there was a new way to honor their memory, which was to live as fully as possible. He also realized that he was telling himself a story that he was taking opiates for pain. But actually, he realized, he was taking them for escape. So he decided he didn't need the opiates anymore, he didn't need the MDMA anymore, and he was dropping out of the study. That was seven years ago. Tony is still free of PTSD, has never returned to opiates and is helping others less fortunate than himself in Cambodia.

（鼓掌）

(Applause)

我們向FDA展示的數(shù)據(jù)來自我們試驗研究的107個人，包括托尼，數(shù)據(jù)顯示23%未接受積極MDMA治療的人在治療結(jié)束時不再患有PTSD。這對于這些病人群體真是個好消息。然而，當(dāng)你加入MDMA時，結(jié)果翻倍，56%的人擺脫了PTSD。

The data that we presented to FDA from 107 people in our pilot studies, including Tony, showed that 23 percent of the people that received therapy without active MDMA no longer had PTSD at the end of treatment. This is really pretty good for this patient population. However, when you add MDMA, the results more than double, to 56 percent no longer having PTSD.

（鼓掌）

(Applause)

但更重要的是，一旦人們意識到他們不需要壓制他們的創(chuàng)傷，而是可以應(yīng)付，他們就自行恢復(fù)了。所以在最后一個療程結(jié)束一年后，為期12個月的后續(xù)跟蹤中，2/3的人不再患有PTSD。并且在1/3沒有好轉(zhuǎn)的人中，許多人的癥狀在臨床上有顯著的減輕。

But most importantly, once people learn that if they don't need to suppress their trauma, but they can process it, they keep getting better on their own. So at the 12-month follow-up one year after the last treatment session, two-thirds no longer have PTSD. And of the one-third that do, many have clinically significant reductions in symptoms.

（鼓掌）

(Applause)

根據(jù)這些數(shù)據(jù)，F(xiàn)DA宣布PTSD的MDMA輔助心理治療為突破性治療。FDA還宣布裸蓋菇素對難治性抑郁癥是一種突破性的療法，并且最近剛剛批準(zhǔn)用埃斯氯胺酮治療抑郁癥。

On the basis of this data, the FDA has declared MDMA-assisted psychotherapy for PTSD a breakthrough therapy. FDA has also declared psilocybin a breakthrough therapy for treatment-resistant depression and just recently approved esketamine for depression.

我很自豪地說，我們現(xiàn)在已經(jīng)開始我們第三階段的研究。假如結(jié)果不負(fù)所望，并且他們跟第二階段研究類似，到2021年底，F(xiàn)DA將會批準(zhǔn)PTSD的MDMA輔助心理治療。如果得到批準(zhǔn)，唯一能直接給病人治療的治療師將會是通過我們培訓(xùn)項目的治療師，并且他們只能在臨床環(huán)境的直接監(jiān)督下實施MDMA。我們預(yù)計未來幾十年內(nèi)，將會出現(xiàn)數(shù)千個致幻劑診所，在這些地方，治療師將能夠使用MDMA，裸蓋菇素、氯胺酮等致幻劑治療潛在的數(shù)百萬病人。這些診所也可以發(fā)展成治療中心，人們可以來這里進(jìn)行迷幻心理治療，以實現(xiàn)個人成長、夫妻治療或精神、神秘體驗。

I'm proud to say that we have now initiated our Phase 3 studies. And if the results are as we hope, and if they're similar to the Phase 2 studies, by the end of 2021, FDA will approve MDMA-assisted psychotherapy for PTSD. If approved, the only therapists who will be able to directly administer it to patients are going to be therapists that have been through our training program, and they will only be able to administer MDMA under direct supervision in clinic settings. We anticipate that over the next several decades, there will be thousands of psychedelic clinics established, at which, therapists will be able to administer MDMA, psilocybin, ketamine and other psychedelics to potentially millions of patients. These clinics can also evolve into centers where people can come for psychedelic psychotherapy for personal growth, for couples therapy or for spiritual, mystical experiences.

人類現(xiàn)在正在災(zāi)難和意識之間舉棋不定。迷幻劑復(fù)興可以幫助意識勝利。現(xiàn)在，如果你們都看一下座位下面…開個玩笑！

Humanity now is in a race between catastrophe and consciousness. The psychedelic renaissance is here to help consciousness triumph. And now, if you all just look under your seats ... Just joking!

（笑聲）

(Laughter)

謝謝。

Thank you.

（鼓掌）

(Applause)

（笑聲）

(Laughter)

（鼓掌）

(Applause)

謝謝

Thank you.

（鼓掌）

(Applause)

科里·哈吉姆：你得在這里多呆一分鐘。非常感謝，瑞克。我猜這群觀眾們都很支持你。

Corey Hajim: You've got to stay up here for a minute. Thank you so much, Rick. I guess it's a supportive audience.

里克·多布林：是的，非常支持。他們很多人也去過火人節(jié)。

Rick Doblin: Yes, very. Many of them have also been to Burning Man.

（笑聲）

(Laughter)

科里·哈吉姆：有共鳴。

CH: There's some synergy.

里克·多布林：(笑聲)

RD: (Laughs)

科里·哈吉姆：在演講中，你談到可以使用這些藥物來解決一些非常嚴(yán)重的創(chuàng)傷。那么像焦慮和抑郁這些更常見的精神疾病，這些微劑量療法也有用武之地嗎？

CH: So, in your talk, you talked about using these drugs to address some pretty serious traumas. So what about some more common mental illnesses like anxiety and depression, and is that where microdosing comes in?

里克·多布林： 微劑量確實對于抑郁有幫助，我確實知道有人在使用它。但總體上而言，要達(dá)到治療目的，我們更喜歡宏觀劑量而不是微觀劑量，目的是為了真正幫助人們應(yīng)對問題根源。微劑量更多的是為了提升創(chuàng)造力，藝術(shù)靈感，為了讓患者集中注意力…它也會帶來情緒的提升。但我認(rèn)為對于嚴(yán)重的疾病，我們不想讓人們認(rèn)為他們每天都需要藥物，但要做更深入、更細(xì)致的工作。

RD: Well, microdosing can be helpful for depression, I do know someone that has been using it. But in general, for therapeutic purposes, we prefer macro-dosing rather than microdosing, in order to really help people deal with the root causes. Microdosing is more for creativity, for artistic inspiration, for focus ... And it also does have a mood-elevation lift. But I think for serious illnesses, we'd rather not get people thinking that they need a daily drug, but do more deeper, intense work.

科里·哈吉姆：在美國和北美之外這方面的研究做得怎樣？

CH: And what about outside the United States and North America, is this research being done there?

里克·多布林：是的，我們在全球化。我們第三階段的研究其實是在以色列，加拿大和美國進(jìn)行的。所以一旦獲得FDA批準(zhǔn)，它也會被以色列和加拿大批準(zhǔn)。我們剛剛在歐洲開始研究。我們其實正要培訓(xùn)一些來自中國的治療師。

RD: Oh yeah, we're globalizing. Our Phase 3 studies are actually being done in Israel, Canada and the United States. So once we get approval in FDA, it will also become approved in Israel and in Canada. We're just starting research in Europe. And we're actually going to be training some therapists from China.

科里·哈吉姆：太棒了。我們要來個觀眾投票，看大家是否認(rèn)為推進(jìn)這個研究是個好主意，但我感覺我知道答案了，那么… 非常感謝，里克。

CH: That's great. We were going to do an audience vote to see if people felt like this was a good idea to move forward with this research or not, but I have a feeling I know the answer to that, so ... Thank you so much, Rick.

里克·多布林：謝謝，謝謝大家。

RD: Thank you. Thank you all.

（鼓掌）

(Applause)