系统脱敏法 Systematic Desensitization
作者: 转载 / 8890次阅读 时间: 2017年1月15日
来源: 沪江英语
www.psychspace.com心理学空间网

  phobia: 恐惧症
  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。

Background

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).

所以,在经典条件反射中,一个非条件刺激(食物)引起非条件反应(唾液分泌);一个与非条件刺激(食物)紧密结合的条件刺激(灯光或铃声)也会引起等同于非条件反应(唾液分泌)的条件反应(唾液分泌)。说也有趣,经典条件反射有其反面,我们称之为对抗性条件作用。通过建立一个不兼容的反应(放松)来应对条件刺激(比如蛇),对抗性条件作用相当于降低条件反应(比如焦虑)的强度。【不禁让人想起此类之言:用一个好习惯去代替一个坏习惯,从而逐渐消除坏习惯,不是同样的道理么?这就是系统脱敏法的基本原理的通俗表现哦。 】

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。

Definition

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.

由行为疗法先锋沃尔帕在20世纪50年代发展起来的系统脱敏法,其基本原理是经典性条件反射。思路如下:人类的学习过程就是“条件化”的过程,所以,如果有焦虑的人们可以“去条件化”,那么他们先前习得的恐惧就会通过反向学习而消除。。。某种程度上,类似自我洗脑。【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。。。】

Clinical Procedure 

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。   


Deep Breathing 腹式呼吸法

Progressive Muscle Relaxation 渐进式放松训练 & How to Practice Progressive Muscle Relaxation

Meditation 冥想

学学最经典的三种放松训练

2. The client and therapist construct a list of anxiety-eliciting stimuli, the so-called fear hierarchy, ordered from least to most distressing. During this process, the client and therapist need to find out all the things that could trigger the client's fear or anxious, and then make correspondent fear hierarchy base on these things.

患者和治疗师一起建立一个从最小痛苦到最大程度痛苦的引发焦虑的刺激列表,也就是所说的恐惧等次序列。在这个过程中,患者和治疗师要找出所有使患者感到恐怖或焦虑的事件,然后将这些事件按等级程度由小到大的顺序排列。
    
  3. Starting with the least anxiety-arousing image, the feared stimuli are paired with relaxation, until eventually the most feared stimulus is tolerated calmly.

从引发最小焦虑的图像开始,用放松来应对引发恐惧的刺激,直到最终可以冷静地接受最恐怖的刺激。

In the years after Wolpe publicized his original procedure, researchers tried out dozens of variations, looking for more efficient procedures. For example, researchers found that drugs or carbon dioxide/oxygen mixtures could provide rapid relaxation, making time-consuming relaxation training unnecessary. No matter what, Wolpe's Systematic Desensitization program, as a practical application of his theories, proved to be highly successful in the treatment of neurotic anxiety.

在沃尔帕发表他的最初的步骤设计的多年后,研究人员尝试了数十个方法,以寻找更有效的疗程。比如,研究人员发现药物或二氧化碳/氧气混合物可以让人快速放松,从而使得耗时的放松训练不再必要。不管怎样,作为其理论的实务应用,沃尔帕的系统脱敏法在神经性焦虑治疗中获得了巨大成功。

点击查看大图案例---克服“考试怯场”的案例。将你每次应试的真实感受按时间顺序逐一记录下来。比如:开始复习时、复习期间、 考试前一天、临进考场时、进入考场时、未做试题前、开始做题时等等,记述当时的周围环境和内心体验,按紧张程度不同分成由弱到强的顺序。然后开始运用“脱敏”训练:在充分的自我放松后,读你的第一次记录上的描述,尽量详细逼真地想象当时的情景,感到有紧张反应时,可用言语暗示“停止紧张”和深呼吸、肌肉放松术等方法压制或减弱紧张,直至镇定自若;再接下去进行第二份记录,依次逐渐训练。最后达到在你回想起初最紧张的情景时也能够完全或接近完全般轻松自如。

Try Systematic Desensitization on Yourself

系统脱敏法的关键是确定引起过激反应的事件或物体。但有时较容易看到的过激反应事件并不一定是真正引发心理障碍的原因,所以应找到真正的致病原因,结合“认知调整法”标本兼治。如有的人的异性交往恐惧只是一个表面现象,当起先不理解致病的真正原因时,系统脱敏的效果并不理想。当找到了真正的致病原因——身体缺陷导致自卑、逃避、幻想、心理失衡时,对自身采用系统脱敏和认知调整法相结合的方法进行治疗就会取得良好的效果。

在了解了系统脱敏法的三步骤以及关键后,我们大家自己也可以针对某些害怕、紧张情绪等采用系统脱敏的方法,步骤如下:

How To perform Systematic Desensitization on Yourself

•The most important step when starting to work on a program to cure your mind of fears is to gather data. So, make a list of all the situations and things that scare you. Once you have the list, start working with the point of least resistance: the situation you fear the LEAST. This way, you'll have a better chance of succeeding with minimal effort and a success is going to reinforce positive beliefs about your capabilities.

使用系统脱敏法治疗害怕的最先最重要的一步是收集数据。所以,请列出所有使你感到害怕的情形和事件。有了这样一个列表后,先从列表中你最不抗拒的那个情形--也就是你不那么害怕的情形--开始练习。通过这种序列,你比较有机会以最小的努力来获得成效,而这个成效又将进一步增强你对自己能力的自信。

•Reserve an hour in the day for the exercise, preferably a quiet time in the day. I would suggest you avoid doing it at bedtime. The reason is that you don't want to do something radically proactive at night: it may interfere with sleep.

一天中保留一个小时来做练习,最好是一天中比较安静的时间。我建议您不要在睡前做练习。因为夜间你并不想做一些活动性的练习,而且它可能会干扰睡眠

•Find and dedicate a quiet, peaceful corner for the practice.

确定一个安静的、平和的角落作为练习的场所。

•Sit or lay yourself down and relax as much as possible. Take a few deep breaths. Deep breathing takes you into a relaxed state so that you are more likely to focus your mind.

坐下或躺下,尽可能地放松。做几个深呼吸。深呼吸会带你进入放松的状态,使你尽可能地集中思绪。

•Now imagine the least dreaded situation. Visualize it. Let's say, for instance, that you are scared of enclosed spaces. And you want to get over the fear of subways and tunnels and cars and elevators. Now out of these situations, pick the one which is relatively less frightening. And visualize yourself there.

现在想象最不害怕的情形。生动地想象它。以害怕密闭空间为例,您想克服对地铁、隧道、汽车和电梯这四个密闭空间的恐惧。先从中选一个您相对不那么害怕的空间,然后想象您自己正在里面。

•Out of the above situations in the example, let's suppose sitting in the car is the least bothersome. So what you do is visualize a calm, relaxed and normal "you" sitting in the car.

在上述例子的情形中,我们假设,坐在汽车里是最不那么害怕的,那么您所要做的就是想象一个平静的、放松的和正常的“自己”坐在汽车里。

•Divide the situation into scenes for maximum benefit. Visualize yourself getting out into the garage, and imagine that you are totally relaxed doing that. Now try relaxing your muscles and calming yourself down while visualizing yourself in the garage.... Repeat the exercise till you are fairly in control and relaxed imagining the situation. Take your time. Remember it might take a few days of practice to get the hang of it.

为了取得最好的成效,将最不害怕的情形(密闭空间的例子里是指“坐在汽车里的情形”)划分为几个场景。先想象自己完全放松地走入车库;接着想象自己在车库里时,努力地放松肌肉,让自己平静下来...重复此练习直到在想象的情形中您可以控制自己并放松。别着急,慢慢来。这可能需要几天时间的练习来掌握。

•Now go to the next scene. Play it like a movie in your head. You now open the door of the car and climb in. Calmly. Visualize yourself totally relaxed and cool about the journey. Relax yourself with the vision. Relax your muscles. Keep your breathing steady. Now repeat this a few times.

现在进入下一个场景。这就好像是在头脑里放电影一样。现在,您打开了车门,并坐了进去。平静地,想象您自己在这个旅程中完全放松和舒适。通过这些想象的画面来放松自己,放松肌肉;并保持平稳的呼吸。重复练习几次。

•Keep visualizing each step of the situation and visualize a successful culmination of the task. Every time you do it, imagine that you are actually doing what you fear, without being fearful.

依次想象序列中的每个情形,并感受任务成功完成后的成就感。每次想象的时候,想象您自己正在做您自己害怕的事情,而这些事情本身并不恐怖?

•Once you have learned the art of visualization and also practiced relaxing yourself for a couple of weeks, try doing the dreaded thing for real. You'll find that you are much less tense while actually doing it. The idea is rehearsal for the show. You teach yourself to face the fear by facing it in small increments over time and in your head.

一旦您学会了想象的方法,并几个星期地练习放松技巧,就可以尝试在现实中面对恐惧的事物。您会发现当您在现实中面对它的时候,您并没有那么地害怕了。原因就在于您已经事先预演过了。您通过在头脑中长期地、一小部分一小部分地面对恐惧教会了自己如何面对恐惧。

•Keep working on your technique. Refine it. Modify it to suit your specific needs. Be creative. But... Don't quit it. Even if you stumble a bit on the way.

不断练习您的技巧并精练化。您也可以根据自己的特定需要对某些部分做出修改。要稍微灵活些。但...不要松懈,即使您在某个方面被绊住。

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