打一場(chǎng)精神療法的持久戰(zhàn)(共6頁)

1、打一場(chǎng)(y chn)精神療法的持久戰(zhàn) HYPERLINK /i/2048118688/ o Ashie Ashie發(fā)表(fbio)于 2010-12-21 14:27（文/Jonah Lehrer）每個(gè)時(shí)代都有自己的特征，而我們正生活在抑郁癥的時(shí)期。普通(ptng)精神病學(xué)文獻(xiàn)集上發(fā)表的一項(xiàng)新研究顯示，1998年到2007年之間，美國人接受抗抑郁治療的上升率超過了20%，并且，其它研究中估算出美國成年人患有或曾經(jīng)患有抑郁癥的比例在20%到40%之間。顯然，引起這種比例上升的原因多得讓人眼花。一部分是診斷的原因，就像Alan Horwitz和Jerome Wakefield所主張的那樣，由于心理

2、障礙診斷與統(tǒng)計(jì)手冊(cè)的修改，我們用醫(yī)學(xué)方法處理悲傷，將痛苦轉(zhuǎn)化為臨床疾病。但抑郁癥的增加在多大程度上是由診斷標(biāo)準(zhǔn)變化所引起的呢？我認(rèn)為即使診斷標(biāo)準(zhǔn)沒變，抑郁癥比例仍有可能增加。換句話說，我們現(xiàn)在的生活，是不是存在那些(nxi)讓我們悲慟的原因呢？這些極端負(fù)面的情緒是社會(huì)問題的反映嗎？這是個(gè)難題，無法用三言兩語說清，因此在這篇文章中，我會(huì)將重點(diǎn)放在這個(gè)新研究的其中一項(xiàng)數(shù)據(jù)上，也就是抑郁癥患者中，利用精神療法的比例在1998到2007年之間戲劇性地從53.6%降到了43.1%（與此同時(shí)，大部分被調(diào)查者卻表示自己更喜歡談話療法）。不用多說，藥片代替了心理醫(yī)生，超過75%的抑郁癥患者會(huì)用抗抑郁藥物進(jìn)行治

3、療，這也導(dǎo)致了這方面醫(yī)療開銷神奇(shnq)地增加了。同年間，醫(yī)療保險(xiǎn)中有關(guān)抑郁癥的支出從5.2億美元上升到了22.5億美元。抗抑郁藥奏效時(shí)，它們簡直就是藍(lán)色小奇跡。但同時(shí)也會(huì)經(jīng)常失靈，至少藥效沒比安慰劑好多少（而且，它們常常會(huì)有不討人喜歡的副作用，這會(huì)讓一半以上的患者(hunzh)在最嚴(yán)重的癥狀消失之后就停止用藥。之后他們的抑郁癥會(huì)復(fù)發(fā)，這也解釋了為什么使用選擇性5-羥色胺再攝取抑制劑的患者有75%的復(fù)發(fā)率）。這也是我對(duì)談話療法比例下降感到憂慮的原因，畢竟許多研究表明治療抑郁癥最好的方法是藥物療法與談話療法結(jié)合。此外，除了談話療法，許多其他種類的精神療法也很有效。例如，在同一期普通精神病學(xué)文

4、獻(xiàn)集中還有一項(xiàng)有關(guān)抗抑郁藥物與“正念療法”在防止抑郁癥復(fù)發(fā)方面的比較研究。若有時(shí)間保證，正念療法是個(gè)簡單而直接的療法，它由每周兩小時(shí)一共八周的小組討論組成，外加一次全天靜修和選修的一小時(shí)冥想課程。參與者學(xué)會(huì)了如何用“非評(píng)價(jià)的感悟”和“自我同情”來考慮自己的情緒，并將這些新學(xué)會(huì)的“正念技能”用于日常生活的煩雜中。實(shí)驗(yàn)結(jié)果一目了然，如你所料，患者(hunzh)使用抗抑郁藥物逃脫了抑郁狀態(tài)，但停止用藥之后大約有70%的復(fù)發(fā)率?；瘜W(xué)物質(zhì)的推動(dòng)力只是暫時(shí)的，然而，在18個(gè)月的跟蹤調(diào)查中，接受正念療法的患者里，只有28%回到了原先的精神病狀態(tài)。我們總是會(huì)忘記這個(gè)事實(shí)，精神療法也會(huì)像藥物一樣從化學(xué)層面改變大

5、腦。把談話療法看成空話，認(rèn)為語言不過是虛幻，這很容易，而且坐在沙發(fā)上這種治療形式看起來的確像是老古董。但正確的談話可以修復(fù)破碎的心靈，幫助我們逃脫壓力和負(fù)面情緒的惡性循環(huán)，防止我們陷入抑郁。改變想法從來不是件容易的事，在極端情況下幾乎不可能。我們的生活如此繁忙，而精神療法卻需要以小時(shí)計(jì)的努力(n l)和不斷的練習(xí)，更不用說我們的大腦皮層還如此頑固不化。但數(shù)據(jù)說明了一切，如果我們需要一種長效的抑郁癥解藥，那么精神療法才是最有用的。 HYPERLINK /category/science-blogs/frontalcortex/ Frontal CortexIn Defense Of Therap

6、yEvery period has its signature disorder. We live in the age of depression. Consider a brand new HYPERLINK /cgi/content/abstract/67/12/1265 surveypublished in theArchives of General Psychiatry:Between 1998 and 2007, the percentage of Americans being treated for depression increased by more than 20 p

7、ercent. Other studies estimate that somewhere between 20 and 40 percent of American adults will suffer from depression at some point in their life.Obviously, theres a dizzying array of forces that are causing this rise. Part of the problem is diagnosis, as people like Alan Horwitz and Jerome Wakefie

8、ld have HYPERLINK /Loss-Sadness-Psychiatry-Transformed-Depressive/dp/0195313046 argued. Thanks to changes in the DSM, Horwitz and Wakefield insist that weve medicalized sadness, transforming anguish and its synonyms into a clinical condition.But it remains unknown how much of the rise in depression

9、is accounted for by changes in diagnosis. And I think its extremely important to not dismiss the likely possibility that, even if our diagnostic standards had remained constant, there would still be a rise in depression. In other words, is there something about the way we live now thats making us ex

10、tremely sad? Are these intensely negative feelings symptoms of a larger societal problem?Hard questions, no easy answers. In this blog post, Id like to focus instead on one of the troubling data points in this most recent medical survey, which is that the percentage of depressed subjects seeking psy

11、chotherapy for treatment declined dramatically between 1998 and 2007, from 53.6 percent to 43.1 percent. (This drop has come despite the fact that a majority of subjects say talk therapy is their preferred method of treatment.) Needless to say, pills have taken the place of therapists, as more than

12、75 percent of depressed patients are now treated with anti-depressants, which has led to a dramatic increase in medical spending on the disorder. Between 1998 and 2007, Medicare expenditures for depression increased from $0.52 billion (1998) to $2.25 billion (2007).When anti-depressants work, they a

13、re little blue miracles. But they often dont work, at least not at rates higher significantly higher than HYPERLINK /irving-kirsch-phd/antidepressants-the-emper_b_442205.html placebo. (Plus, they often have unpleasant side-effects, which leads more than HYPERLINK /cgi/content/abstract/58/4/395?ijkey

14、=8adc047906eb23689021b7757e5326a251fff292&keytype2=tf_ipsecsha halfof patients to stop taking the drugs shortly after the worst symptoms disappear. And then they relapse, which helps explain why patients treated with SSRIs have HYPERLINK /pubmed/15809409 relapse ratesabove 75 percent.) And thats why

15、 Im troubled by the drop in talk therapy, as most studies demonstrate that the most effective treatment for depression is pharmaceuticals coupled with a good therapist. Furthermore, many different kinds of therapy can be effective. For instance, the same December 2010 issue of theArchives of General

16、 Psychiatryalso contains an interesting comparative HYPERLINK /cgi/content/abstract/67/12/1256 studyof anti-depressants and mindfulness therapy in preventing relapse following an extended depressive episode. The mindfulness therapy itself was straightforward stuff, if time intensive. There were eigh

17、t weekly group sessions of two hours each, plus a full day retreat and optional one-hour meditation classes. The subjects learned how to reflect upon their feelings with “non-judgmental awareness” and “self-compassion.” They were urged toapply their new mindfulness skills to everyday life challenges

18、.The results were stark. Not surprisingly, patients who escaped depression with the help of anti-depressants, and then stopped taking the drugs, relapsed about 70 percent of the time. The chemical boost was temporary. However, during the 18 month follow-up period, only 28 percent of patients in mindfulness therapy slipped back into the mental illness.What we often forget is that therapy alters the chemical brain, just like a pill. Its easy to dismiss words as airy nothings and talk therapy as mere talk. Sitting on a couch can seem like such an antiquated form of treatment. Bu