Could Psychedelics Help Patients in Therapy? | Benjamin Lewis | TED

翻译人员: Nora Fang 校对人员: XU Gloria

Many of the mental health struggles that we see in our world

在这个世界上， 我们所能看到的许多心理健康问题

come from a loss of connection,

都源于联结感缺失，

the loss of connection to ourselves,

源于与自己、与他人、 与我们的社区、甚至与地球失去联结感。

to each other,

to our communities, to the Earth.

This loss of connection is so profound

这种情况甚至严重到

that the United States Surgeon General has called it a public health crisis.

美国卫生局局长 都称之为公共卫生危机。

Thich Nhat Hanh said, we are all connected.

著名越南佛教僧侣释一行说，

我们都是相互关联的。

When you touch one thing, you are touching everything.

所有事物冥冥之中都有联系。

Whatever we do has an effect on others.

无论我们做什么，都会对他人造成影响。

Therefore, we must learn to live mindfully,

因此，我们必须学会谨慎地生活，

to touch the peace inside each of us.

实现内心的和平。

Psilocybin, the active ingredient in so-called "magic mushrooms,"

赛洛西宾， 所谓的 “神奇蘑菇”中的活性成分，

is an emerging treatment that is about reconnection.

也是一种重新建立联结感的新兴疗法。

As a psychiatrist at the Huntsman Mental Health Institute,

作为亨斯迈 心理健康研究所的精神科医生，

I have been running clinical trials with psilocybin-assisted therapy,

我一直在进行 赛洛西宾辅助疗法的临床试验。

working specifically with two groups:

这个实验专门研究两组人员：

patients dealing with symptoms of depression

出现与癌症诊断相关的抑郁症患者；

associated with a cancer diagnosis;

and frontline health-care workers experiencing burnout and depression

还有患有与新型冠状病毒 相关的倦怠和抑郁症的一线医护人员。

related to the COVID-19 pandemic.

These two groups appear very different on the surface,

乍一看，这两个群体截然不同，

but their suffering is related to a loss of connection.

但他们的痛苦都与失去联结感有关。

Each person dealing with a cancer diagnosis is unique.

每个接受癌症诊断的人都是独一无二的。

However, patients face some common challenges:

但是，患者会遇到一些共同的困难：

the uncertainty,

疾病的不确定性、漫长的疗程 与对家人和朋友的影响。

the treatments, the impact on family and friends.

This can result in symptoms of loss, grief, depression, anger,

这些困难可能会让患者感到 失落、悲伤、抑郁、或是愤怒、

feelings of hopelessness and isolation.

同时也会让患者感到绝望和孤立。

The COVID-19 pandemic has heightened burnout

新型冠状病毒的疫情加剧了 一线医疗工作者的职业倦怠，

in frontline health care providers

who feel disconnected from their work,

他们感到与工作脱节，

disconnected from their patients and their suffering.

与患者脱节， 无法对他们的痛苦感到同情。

They feel overwhelmed and inadequate.

他们感到不知所措又无能为力。

There are clear distinctions between these two groups,

这两个群体之间有着明显的区别，

but there is overlap in this sense of disconnection.

但从这种脱节的意义上来说， 他们也有相同之处。

Psilocybin is considered a classic psychedelic,

赛洛西宾是一种典型的精神促动药物，

one of a group of chemicals that acts on the serotonin system in the brain.

它是作用于 大脑血清素系统的化学物质。

The term "psychedelic" comes from the combination

“赛洛西宾” 一词源于“迷幻的”。

而它的前后两部分来源于希腊语。

of the Greek words psyche, or mind,

前半部分是源于 “psyche”（心灵）

and delos, to reveal or make manifest.

后半部分则是 ”delos“ （揭示或表现出来）。

So mind manifesting.

所以”迷幻的“一词意为 使心灵显现出来。

Or expressing this idea

换句话说：这些化学物质 可以揭示我们原本无法接触到的心灵，

that these chemicals can reveal aspects of the mind

that we otherwise don't have access to.

These chemicals cause significant changes to consciousness,

这些化学物质会造成意识上的重大变化，

including experiences that are referred to as mystical or spiritual in nature,

其中包括一些在自然中 被视为神秘的或精神上的体验。

experiences characterized by a deep sense of connection to one's self, to others,

以及与自我，他人，和世界产生深刻联系 为特征的体验。

and to the world.

And in recent years, there has been a renewed interest

近年来，专家们对于

将这些化学物质用于治疗 重新产生了兴趣。

in the study of these compounds for therapeutic purposes.

Using psilocybin in the context of a clinical trial

在临床试验中使用赛洛西宾 与其他情况有很大不同，

looks quite different than it does in other settings,

such as recreational use.

例如娱乐用途。

For one thing,

首先，尽管从医学的角度来看，

while classic psychedelics are remarkably safe

常规的赛洛西宾非常安全，

from a medical standpoint

and don't have the same potential for abuse as other substances,

并且不像其他药物那样 容易被滥用。

they nonetheless cause powerful changes to consciousness

但它们仍然会导致意识发生强烈的变化，

从而带来风险。

that can present risk.

In particular, for people with a risk of psychosis or mania.

特别是对于有着精神疾病或躁狂病的人。

This is not a treatment for everyone.

这并不是适合所有人的治疗方法。

Our studies employ a rigorous screening process to ensure that this is safe,

我们的研究采用了严格的筛查程序，

以确保其在医学和精神病学上的安全。

both medically and psychiatrically.

We also embed the dosing session within a therapeutic protocol

我们还将给药环节嵌入到了治疗方案中，

with preparation

包括准备工作和所谓的整合疗程。

and what we call integration sessions following.

There are two qualities to this form of therapy

关于这种疗法，我想强调两个特征。

that I'd like to emphasize

that distinguish this intervention from anything else in psychiatry.

这些特征 是精神病学中的其他任何干预措施

都不具有的。

The first is the importance of the experience itself.

首先是治疗体验本身的重要性。

A reliable finding across multiple studies with psilocybin

在多项关于赛洛西宾的研究中发现，

is that specific kinds of changes to consciousness,

单次疗程中特定类型的意识变化

often with a single session,

appear to be important for therapeutic changes.

对治愈至关重要。

Patients report a sense of connection, or the interconnectedness of all things;

患者体验到了联结感， 也就是所有事物的相互关联性，

a sense of preciousness or sacredness to the experience;

他们感到了这个联系是神圣且宝贵的，

and a deep sense that this reveals something true or fundamental

他们深刻地感到这揭示了现实本质。

about the nature of reality.

The second quality is the combination

第二个特征是药物管理 与治疗方案的结合。

of a drug administration with a therapeutic protocol.

This is not simply about taking a pill and expecting a result.

这不仅仅是服用药物， 然后等待治疗结果，

This is a form of assisted psychotherapy with specific preparation,

这是一种辅助心理治疗，

需要特定的准备工作， 为该疗程提供全程的支持，

support through the session itself

以及随后的整合环节。

and integration following.

One's intentions matter.

患者的想法很重要，

A patient's mental preparation going into a session

患者在疗程中的心理准备 可以深刻影响治疗效果。

can profoundly shape the impact of the experience.

How these tools are employed is central to their effect.

这些治疗手段怎么用 对于它们的疗效至关重要。

One current model for understanding brain changes with psychedelic drugs

目前，一个用于了解精神促动药物 对大脑的影响的模型，

examines changes in connectivity between different brain regions.

观察了大脑各个部分之间联系的变化。

With administration of psilocybin,

使用塞西罗宾后，

the brain temporarily enters a state of global increase in integration

大脑会暂时进入一个特别的状态：

即不同神经网络间的整合 与互联在整体上有所增加，

and interconnection

across different neural networks that are normally compartmentalized.

而这些神经网络在正常情况下 是相互分隔的。

Simply put,

简而言之，通常不互相联系的大脑区域

brain regions that normally don't talk to each other

are now conversing.

将会开始建立联系。

Of course, this doesn't last,

当然，这种情况不会一直持续，

but as the brain cools from this experience,

但是随着大脑从这种经历中慢慢恢复，

previously rigid patterns of neural connectivity

之前抑郁症之类的病症 导致的僵化的神经连接模式将会被软化，

related to the beliefs characteristic of, say, depression,

如此，这个僵化就有了一定的回旋余地。

are softened, given some wiggle room,

some flexibility is introduced into the system.

Current models of psilocybin-assisted therapy in clinical trials

当前临床试验中 赛洛西宾辅助治疗模式，

involve two therapists per person

要求每位患者都配备两名治疗师，

through a process that is generally 20 or more hours.

治疗的疗程通常会持续 20 小时或更长时间。

Our research group at the University of Utah

我们在犹他大学的研究小组 提出了一个问题：

has naturally asked the question,

can we do this in groups

为了提高这个疗程的效率，

to expand the scale on which these promising treatments can be delivered?

能不能让它以小组的形式实行？

Now, in a way, this is nothing new.

从某种意义上说， 这并不是什么新鲜事。

Psychedelics have been used in group context

几千年来，

土著人民都在以群组的形式 使用精神促动药物。

for millennia by Indigenous groups.

This includes ceremonial use of psilocybe mushrooms,

包括在仪式上使用迷幻蘑菇、 圣佩德罗仙人掌、

San Pedro cactus

and ayahuasca, the dimethyltryptamine

和死藤水，它是一种含有 二甲基色胺的中南美洲的饮品。

containing South and Central American brew.

But when we look at modern studies,

但是现代研究则更侧重于 个人和个人疗程。

these have focused on individuals and individual sessions.

But going deeper,

但是，从更深层的角度来讲， 小组流程是关于连接和共同经历的。

group process is about connection and shared experience.

If these forms of suffering we're looking at in our studies,

如果我们正在研究的那些

depression associated with cancer,

与癌症相关的抑郁症， 还有前线医护人员的倦怠

health care provider burnout,

are characterized in part by a loss of connection,

都与失去联结感有关。

exploring these tools in supported shared experiences makes sense,

那么，在受支持的共享体验中 探索这些疗法是很有意义的，

potentially enhancing therapeutic aspects of group process that are already there.

这样做有可能增强已有的 群体疗程的疗效。

Last year, our research group completed the HOPE trial.

去年，研究小组完成了HOPE试验，

This was a pilot study of group psilocybin-assisted therapy

这项是一项先导试验，它对 12 名 患有与癌症诊断相关的抑郁症患者

for 12 patients dealing with symptoms of depression

进行赛洛西宾辅助治疗。

associated with a cancer diagnosis.

We ran groups of four participants at a time.

实验中的每一组 都由 4 名参与者组成，

Patients with cancer are a well-studied population with psilocybin

关于癌症患者使用赛洛西宾治疗的 相关的研究已经非常成熟了，

in individual formats.

These previous studies have shown

这些研究表明了 赛洛西宾显著而持久的治疗效果，

significant and enduring therapeutic effects

that have been sustained for years following even a single dosing session.

即使是只有一次给药 也让这种效果持续了多年。

Our study is the first modern trial to employ a full group format.

我们的研究是第一个 采用小组形式的现代试验。

All three of our preparatory sessions,

我们的工作都是以小组形式进行， 比如三次预备环节、

our single eight-hour dosing session

单次八小时的给药疗程、

and our three integration sessions were run as groups.

和三次整合环节。

This was a small study designed to look at safety and feasibility,

这是一项 旨在研究安全性和可行性的小型研究，

but we found a clear signal that the group format may amplify

但我们有了一个明显的结论，

即小组形式会增强联结感，

the sense of connection that we know is important

这对治疗抑郁症至关重要。

in treating depressive symptoms.

The group format requires thoughtful preparation.

以小组形式进行试验 需要深思熟虑的准备。

The neighbor on your right may be giggling uncontrollably

你右边的同伴在无法控制地傻笑时，

while the neighbor on your left is sobbing.

你左边的同伴可能正在抽泣。

One mantra we use through this process is,

我们在这个过程中恪守的是：

all is welcome.

我们欢迎一切，

All is welcome.

我们接受一切。

We learned this mantra from Mary Cosimano,

这是从我们在约翰·霍普金斯大学的导师 玛丽·科西马诺那里学来的口头禅。

a mentor of ours at Johns Hopkins.

This mantra is about saying, "Yes!"

这个格言关于对一切表示接受，

It is about opening up to whatever is coming up for you personally,

对你所有的感受表示理解，

but also what is coming up in the whole room.

也对所有发生的事表示理解。

All is welcome.

我们欢迎一切。

The processes of others around you are not a distraction.

周围其他人的治疗进程不会影响你，

They are there for you, and you for them.

他们陪伴着你，而你也陪伴着他们。

In this spirit, our study used a communal music playlist

本着这种精神，

在我们的研究中， 为了强调并增强集体感，

played over speakers rather than individual headphones,

to emphasize and add to this collective experience.

音乐是通过扬声器 而不是个人耳机播放的。

I wonder what this would be like

我想知道大家现在的感受，

for all of you right now

to fully welcome everything coming up in this space.

大家在演讲厅中听到这些事情的感受，

Excitement for this event,

对这个活动的热情，

social dynamics of a large crowd,

对人山人海的社交活动的热情，

your private joys and sorrows,

对自己的喜悦和悲伤的体会，

your connection with a person on this stage.

对你与演讲者的思想交流，

Maybe even your anxiety,

甚至可能是你内心的焦虑，

"They might screw it up."

“他们有可能要搞砸了。”

(Laughter)

（笑声）

All is welcome.

我们欢迎一切。

Our study showed that this treatment can be safely

我们的研究表明，

and effectively administered in a group format.

这种治疗可以安全并有效地 以小组形式开展。

Our participants demonstrated significant improvement in depressive symptoms

在为期六个月的治疗里，

that was sustained to our final endpoint at six months.

参与者的抑郁症状有了显著的改善，

Furthermore, participants felt strongly

此外，参与者们非常同意

that the group format was a critical component of their process.

小组形式是他们疗程中非常重要的部分。

We are still in the early stages of understanding

我们在探索如何将赛洛西宾辅助疗法作为 心理健康治疗手段中，仍是初级阶段。

how to use psilocybin-assisted therapy as a tool in mental health care.

The HOPE trial is a small step

HOPE试验是该领域一小步，

in the ongoing development of this field

towards understanding how to harness and sustain

试验的目的是了解如何利用和维持 患者的各种联系，

the kinds of connectedness that patients experience,

and towards expanding access

并试图帮助更多患者。

for people suffering with difficult-to-treat conditions.

What if, instead of trying to fit

如果我们不再试图 将赛洛西宾辅助疗法纳入精神病治疗中，

psychedelic-assisted therapy into psychiatry,

we asked,

而是问道：

how can we make psychiatry more psychedelic?

“我们怎样才能让精神病治疗

变得更迷幻？”

Thank you very much.

非常感谢您的聆听。

(Applause)

（掌声）