The future of psychedelic-assisted psychotherapy | Rick Doblin

翻译人员: psjmz mz 校对人员: Yolanda Zhang

Preparing for this talk has been scarier for me

准备此次演讲

than preparing for LSD therapy.

比准备LSD治疗还让我害怕。

(Laughter)

（笑声）

"Psychedelics are to the study of the mind

“迷幻剂之于心智，

what the microscope is to biology

就像显微镜之于生物学，

and the telescope is to astronomy."

望远镜之于天文学。”

Dr. Stanislav Grof spoke those words.

这些话是斯坦尼斯拉夫·格罗夫博士说的。

He's one of the leading psychedelic researchers in the world,

他是世界上首屈一指的 迷幻剂研究者之一，

and he's also been my mentor.

他也是我的导师。

Today, I'd like to share with you how psychedelics, when used wisely,

今天，我想和你们分享 当明智的使用迷幻剂时，

have the potential to help heal us,

是如何拥有潜力帮助治愈我们，

help inspire us,

帮助激发我们，

and perhaps even to help save us.

并且甚至帮助拯救我们的。

In the 1950s and 60s,

在1950和1960年代，

psychedelic research flourished all over the world

迷幻剂研究在全球各地都很热门，

and showed great promise for the fields of psychiatry,

并在精神病学，心理学和心理疗法，

psychology and psychotherapy,

神经科学和神秘体验的研究中

neuroscience and the study of mystical experiences.

均显示了巨大的潜力。

But psychedelics leaked out of the research settings

但迷幻剂从研究环境中泄露出来

and began to be used by the counterculture,

并被反主流文化，

and by the anti-Vietnam War movement.

以及反越战运动使用。

And there was unwise use.

存在一些不明智的使用。

And so there was a backlash.

因此引起了强烈的反对。

And in 1970, the US government criminalized all uses of psychedelics,

在1970年，美国政府将所有 对迷幻剂的使用定为犯罪，

and they began shutting down all psychedelic research.

并且开始终止所有的迷幻剂研究。

And this ban spread all over the world and lasted for decades.

这一禁令在全球扩散并持续了几十年。

and it was tragic,

这真是个悲剧，

since psychedelics are really just tools,

迷幻剂实际上只是个工具，

and whether their outcomes are beneficial or harmful

不管它们的结果是好还是坏，

depends on how they're used.

取决于它们怎么被使用。

Psychedelic means "mind-manifesting,"

迷幻意思是“心灵显现”，

and it relates to drugs like LSD, psilocybin, mescaline,

它与LSD、裸盖菇素、美斯卡林，

iboga and other drugs.

依波加等药物有关。

When I was 18 years old,

在18岁时，

I was a college freshman,

我是个大学新生，

I was experimenting with LSD and mescaline,

我体验了LSD和墨斯卡灵，

and these experiences brought me in touch with my emotions.

这些体验让我接触到自己的情感。

And they helped me have a spiritual connection

它们帮助我建立了一种精神联系，

that unfortunately, my bar mitzvah did not produce.

不幸的是，我的成年礼 并没有产生这种联系。

(Laughter)

（笑声）

When I wanted to tease my parents,

当我想戏弄我父母时，

I would tell them that they drove me to psychedelics

我会跟他们说是他们 把我推向了迷幻剂，

because my bar mitzvah had failed to turn me into a man.

因为我的成年礼并没有 把我变成男人。

(Laughter)

（笑声）

But most importantly,

但最重要的是，

psychedelics gave me this feeling of our shared humanity,

迷幻剂给了我一种 我们共同的人性，

of our unity with all life.

我们与所有生命的统一的感觉。

And other people reported that same thing as well.

其他人也报告有同样的感受。

And I felt that these experiences had the potential

我觉得这些体验具有潜力

to help be an antidote

成为部落主义、

to tribalism, to fundamentalism, to genocide and environmental destruction.

原教旨主义、种族灭绝和 环境破坏的解药。

And so I decided to focus my life

于是我决定把我的人生致力于

on changing the laws

改变法律

and becoming a legal psychedelic psychotherapist.

以及成为一名合法迷幻剂 心理治疗师上。

(Applause)

（鼓掌）

Now, half a century after the ban,

如今，在禁止过了半个世纪后，

we're in the midst of a global renaissance of psychedelic research.

我们正处于迷幻剂研究的 全球复兴之中。

Psychedelic psychotherapy is showing great promise

迷幻剂治疗法在治疗

for the treatment of post-traumatic stress disorder, or PTSD,

创伤后应激障碍(PTSD)，抑郁，

depression, social anxiety, substance abuse and alcoholism

社交焦虑，药物滥用 和酗酒和自杀等方面

and suicide.

显示了巨大的潜力。

Psychedelic psychotherapy is an attempt to go after the root causes

迷幻剂心理治疗试图追击

of the problems,

问题的根源，

with just relatively few administrations,

只需相对较少的管理，

as contrasted to most of the psychiatric drugs used today

相比之下，今天使用的 大多数精神药物

that are mostly just reducing symptoms

主要是减轻症状，

and are meant to be taken on a daily basis.

并意味着需要每天服用。

Psychedelics are now also being used as tools for neuroscience

迷幻剂今天也被用作神经科学工具

to study brain function

来研究大脑功能，

and to study the enduring mystery of human consciousness.

和用来研究人类意识的永恒之谜。

And psychedelics and the mystical experiences they produce

人们正在探索迷幻剂 和它们产生的神秘体验

are being explored for their connections between meditation and mindfulness,

与冥想和正念之间的联系，

including a paper just recently published

包括最近发表的一篇

about lifelong zen meditators taking psilocybin

关于终身禅修者在禅修中

in the midst of a meditation retreat

服用裸盖菇素后显示出了

and showing long-term benefits and brain changes.

其长期效果还有大脑变化的论文。

Now, how do these drugs work?

这些药物是怎么作用的？

Modern neuroscience research has demonstrated

现代神经科学研究已经证明

that psychedelics reduce activity

迷幻剂减少了我们所周知的

in what's known as the brain's default mode network.

大脑默认模式网络的活动。

This is where we create our sense of self.

这是我们创造自我意识的地方。

It's our equivalent to the ego,

这是我们的自我，

and it filters all incoming information

它会根据我们的个人需求和优先事项

according to our personal needs and priorities.

过滤所有进入的信息。

When activity is reduced in the default mode network,

当默认模式网络的活动减少时，

our ego shifts from the foreground to the background,

我们的自我就从前台转移至后台，

and we see that it's just part of a larger field of awareness.

我们意识到这只是一个更大 的意识领域的一部分。

It's similar to the shift

这跟

that Copernicus and Galileo were able to produce in humanity

哥白尼和伽利略用望远镜

using the telescope

向人类展示

to show that the earth was no longer the center of the universe,

地球不再是宇宙的中心，

but was actually something that revolved around the sun,

而实际上是绕着太阳转类似，

something bigger than itself.

有比自身更大的东西。

For some people, this shift in awareness

对有些人来说，这个意识的转变

is the most important

是他们最重要

and among the most important experiences of their lives.

和人生中最重要的体验。

They feel more connected to the world bigger than themselves.

他们感到与比自己更大 的世界的亲密性。

They feel more altruistic,

他们利他的感觉更强，

and they lose some of their fear of death.

并且他们对死亡也不那么恐惧。

Not all drugs work this way.

不是所有的药物都这样起作用。

MDMA, also known as Ecstasy, or Molly,

MDMA/摇头丸，也称为嗨飞，或莫利，

works fundamentally different.

作用原理就就有着本质不同。

And I'll be able to share with you the story of Marcela,

我可以和你分享马塞拉的故事，

who suffered from post-traumatic stress disorder

她因暴力性侵犯而患有

from a violent sexual assault.

PTSD。

Marcela and I were introduced in 1984,

马塞拉和我是1984年介绍认识的，

when MDMA was still legal,

当时MDMA仍然非法，

but it was beginning also to leak out of therapeutic circles.

但它也开始从治疗圈中泄露出来。

Marcela had tried MDMA in a recreational setting,

玛塞拉曾在娱乐场所尝试过MDMA，

and during that, her past trauma flooded her awareness

在这期间，她过去的 创伤意识淹没了她，

and it intensified her suicidal feelings.

强化了她自杀的想法。

During our first conversation,

在我们第一次交谈时，

I shared that when MDMA is taken therapeutically,

我分享说当MDMA用于治疗时，

it can reduce the fear of difficult emotions,

它可以减轻对消极情绪的恐惧，

and she could help move forward past her trauma.

并且可以帮助她走出创伤。

I asked her to promise not to commit suicide

我请求她如果我们开始合作，

if we were to work together.

希望她答应我不要自杀。

She agreed and made that promise.

她同意了并且做了承诺。

During her therapeutic sessions,

在她的治疗环节，

Marcela was able to process her trauma more fluidly, more easily.

玛塞拉能够更流畅， 更容易地面对她的创伤。

And yet, she was able to tell

并且，她能够说出

that the rapist had told her that if she ever shared her story,

强奸犯告诉过她， 如果她把事情说出去，

he would kill her.

他就杀了她。

And she realized that that was keeping her a prisoner in her own mind.

她意识到囚禁她的是她自己的思想。

So being able to share the story

所以能够分享遭遇、

and experience the feelings and the thoughts in her mind

经历、感觉和头脑中的想法

freed her,

解放了她，

and she was able to decide

并且她也能够决定

that she wanted to move forward with her life.

她想要她的生活继续。

And in that moment,

在那一刻，

I realized that MDMA could be very effective for treating PTSD.

我意识到MDMA对治疗 PTSD可能非常有效。

Now, 35 years later, after Marcela's treatment,

如今，在玛塞拉接受治疗的35年后，

she's actually a therapist,

她成为了一名治疗师，

training other therapists to help people overcome PTSD with MDMA.

培训其他治疗师，帮助人们 用MDMA克服PTSD。

Now, how does MDMA work?

那么，MDMA是如何作用的？

How did MDMA help Marcela?

MDMA是如何帮到玛塞拉的？

People who have PTSD have brains that are different

患有PTSD的人

from those of us who don't have PTSD.

与没有的人大脑不一样。

They have a hyperactive amygdala, where we process fear.

他们的杏仁核很活跃， 这是处理恐惧的地方。

They have reduced activity in the prefrontal cortex,

他们的前额皮质的活动有所减少，

where we think logically.

这是负责逻辑思维的地方。

And they have reduced activity in the hippocampus,

他们的海马体的活动减少了，

where we store memories into long-term storage.

这是我们储存长期记忆的地方。

MDMA changes the brain in the opposite way.

而MDMA会把大脑 朝相反的方向改变。

MDMA reduces activity in the amygdala,

MDMA减少了杏仁核的活动，

increases activity in the prefrontal cortex

增加了前额皮质的活动，

and increases connectivity between the amygdala and the hippocampus

并且增加了杏仁核和 海马体之间的连接，

to remit traumatic memories to move into long-term storage.

将创伤记忆转移到长期存储中。

Recently, researchers at Johns Hopkins published a paper in "Nature,"

最近，约翰·霍普金斯大学的研究人员 在《自然》杂志上发表了一篇论文，

in which they demonstrated that MDMA releases oxytocin,

他们证明MDMA能释放催产素，

the hormone of love and nurturing.

爱和养育的荷尔蒙。

The same researchers also did studies in octopuses,

同样的研究人员 也对章鱼进行了研究，

who are normally asocial, unless it's mating season.

章鱼通常是独来独往的， 除非在交配季节。

But lo and behold, you give them MDMA,

但给了它们MDMA之后，

and they become prosocial.

它们变得亲社会了。

(Laughter)

（笑声）

Several months after Marcela and I worked together,

在玛塞拉和我治疗几个月后，

the Drug Enforcement Administration moved to criminalize Ecstasy,

美国缉毒局开始将使用 摇头丸定为犯罪，

having no knowledge of its therapeutic use.

对其治疗作用则一无所知。

So I went to Washington,

所以我来到华盛顿，

and I went into the headquarters of the Drug Enforcement Administration,

我来到缉毒局的总部，

and I filed a lawsuit demanding a hearing,

并且提起诉讼，要求举办一场听证会，

at which psychiatrists and psychotherapists

这样精神病学家和精神治疗师

would be able to present information about therapeutic use of MDMA

将能够提供有关 MDMA治疗用途的信息，

to try to keep it legal.

来让它变得合法。

And in the middle of the hearing, the DEA freaked out,

在听证会中间，缉毒局抓狂了，

declared an emergency

宣布进入紧急状态，

and criminalized all uses of MDMA.

并将所有使用MDMA 的行为定为犯罪。

And so the only way that I could see to bring it back

于是我看到的剩下的 唯一让它回归的方式

was through science, through medicine

是通过科学，医学，

and through the FDA drug development process.

并通过FDA药物开发流程。

So in 1986, I started MAPS

所以在1986年，我成立了MAPS

as a nonprofit psychedelic pharmaceutical company.

这家非盈利的迷幻药制药公司。

It took us 30 years, till 2016,

它花了我们30年的时间， 直到2016年，

to develop the data that we needed to present to FDA

我们才得到了所需 提交给FDA的数据，

to request permission to move into the large-scale Phase 3 studies

以申请进入大规模 第三阶段研究的许可，

that are required to prove safety and efficacy

在获得处方使用的批准之前，

before you get approval for prescription use.

这是个需要证明其安全性 和有效性的许可。

Tony was a veteran in one of our pilot studies.

托尼是我们一项试点研究中 的一个老兵。

According to the Veterans Administration,

根据退伍军人管理局的数据，

现在有超过一百万的 退伍军人患有PTSD。

there's over a million veterans now disabled with PTSD.

And at least 20 veterans a day are committing suicide,

每天至少有20个老兵自杀，

many of them from PTSD.

其中很多是因为PTSD。

The treatment that Tony was to receive was three and a half months long.

托尼所接受的治疗有3个半月长。

But during that period of time,

但在那期间，

he would only get MDMA on three occasions,

他只接受了三次MDMA治疗，

separated by 12, 90-minute non-drug psychotherapy sessions,

中间分为12次90分钟 的非药物心理疗程，

three before the first MDMA session for preparation

3次在第一次MDMA 疗程前作为准备环节，

and three after each MDMA session for integration.

3次在每次MDMA疗程后进行整合。

We call our treatment approach "inner-directed therapy,"

我们把我们的治疗方法 称为“内在导向治疗”，

in that we support the patient to experience whatever's emerging

在这个过程中，我们支持病人去体验

within their minds or their bodies.

他们大脑或身体里出现的一切。

Even with MDMA, this is hard work.

即便有MDMA，这个工作也不容易。

And a lot of our subjects have said,

我们的很多研究对象都说过，

"I don't know why they call this Ecstasy."

“我不知道他们为什么把这叫嗨飞。”

(Laughter)

（笑声）

During Tony's first MDMA session,

在托尼的首次MDMA疗程中，

he lay on the couch, he had eyeshades on,

他躺在沙发上，戴着眼罩，

he listened to music,

听着音乐，

and he would speak to the therapists,

他可以和治疗师交谈，

who were a male-female co-therapy team,

后者是一组男女联合治疗小组，

whenever he felt that he needed to.

随时在他需要时响应。

After several hours,

在几个小时后，

in a moment of calmness and clarity,

在一个平静和清晰的时刻，

Tony shared that he had realized

托尼分享了他意识到的

his PTSD was a way of connecting him to his friends.

他的PTSD是他 和朋友联系的一种方式。

It was a way of honoring the memory of his friends who had died.

这是纪念他死去的朋友的一种方式。

But he was able to shift and see himself through the eyes of his dead friends.

但他能够通过死去的朋友 的眼睛看到自己。

And he realized that they would not want him to suffer,

他意识到他们不希望他受苦，

to squander his life.

挥霍他的生命。

They would want him to live more fully,

他们希望他活得充实，

which they were unable to do.

而这是他们无法做到的。

And so he realized that there was a new way to honor their memory,

于是他意识到有新的方法 来纪念他的朋友们，

which was to live as fully as possible.

那就是尽可能充实地活着。

He also realized that he was telling himself a story

他还意识到，他是在给自己洗脑，

that he was taking opiates for pain.

说他服用鸦片是为了止痛。

But actually, he realized, he was taking them for escape.

但事实上，他意识到 他是用它们来逃避。

So he decided he didn't need the opiates anymore,

于是他决定再也不需要鸦片了，

he didn't need the MDMA anymore,

他再也不需要MDMA了，

and he was dropping out of the study.

于是他退出了研究。

That was seven years ago.

现在已经7年了。

Tony is still free of PTSD,

托尼没有再受PTSD折磨，

has never returned to opiates

他也没复吸鸦片，

and is helping others less fortunate than himself in Cambodia.

并且正在柬埔寨帮助那些 没有他那么幸运的人。

(Applause)

（鼓掌）

The data that we presented to FDA

我们向FDA展示的数据

from 107 people in our pilot studies, including Tony,

来自我们试验研究的 107个人，包括托尼，

showed that 23 percent of the people that received therapy without active MDMA

数据显示23%未接受 积极MDMA治疗的人

no longer had PTSD at the end of treatment.

在治疗结束时不再患有PTSD。

This is really pretty good for this patient population.

这对于这些病人群体真是个好消息。

However, when you add MDMA,

然而，当你加入MDMA时，

the results more than double, to 56 percent no longer having PTSD.

结果翻倍，56%的人摆脱了PTSD。

(Applause)

（鼓掌）

But most importantly,

但更重要的是，

once people learn that if they don't need to suppress their trauma,

一旦人们意识到他们不需要 压制他们的创伤，

but they can process it,

而是可以应付，

they keep getting better on their own.

他们就自行恢复了。

So at the 12-month follow-up one year after the last treatment session,

所以在最后一个疗程结束一年后 为期12个月的后续跟踪中，

two-thirds no longer have PTSD.

2/3的人不再患有PTSD。

And of the one-third that do,

并且在1/3没有好转的人中，

many have clinically significant reductions in symptoms.

许多人的症状在临床上 有显著的减轻。

(Applause)

（鼓掌）

On the basis of this data,

根据这些数据，

the FDA has declared MDMA-assisted psychotherapy for PTSD

FDA宣布PTSD的 MDMA辅助心理治疗

a breakthrough therapy.

为突破性治疗。

FDA has also declared psilocybin a breakthrough therapy

FDA还宣布裸盖菇素对 难治性抑郁症

for treatment-resistant depression

是一种突破性的疗法，

and just recently approved esketamine for depression.

并且最近刚刚批准用 埃斯氯胺酮治疗抑郁症。

I'm proud to say that we have now initiated our Phase 3 studies.

我很自豪地说我们现在已经 开始我们第三阶段的研究。

And if the results are as we hope,

假如结果不负所望，

and if they're similar to the Phase 2 studies,

并且他们跟第二阶段研究类似，

by the end of 2021, FDA will approve MDMA-assisted psychotherapy for PTSD.

到2021年底，FDA将会批准PTSD 的MDMA辅助心理治疗。

If approved,

如果得到批准，

the only therapists who will be able to directly administer it to patients

唯一能直接给病人治疗的治疗师

are going to be therapists that have been through our training program,

将会是通过我们培训项目的治疗师，

and they will only be able to administer MDMA

并且他们只能在临床环境

under direct supervision in clinic settings.

的直接监督下实施MDMA。

We anticipate that over the next several decades,

我们预计未来几十年内，

there will be thousands of psychedelic clinics established,

将会出现数千个致幻剂诊所，

at which, therapists will be able to administer MDMA,

在这些地方，治疗师 将能够使用MDMA，

psilocybin, ketamine and other psychedelics

裸盖菇素、氯胺酮等致幻剂

to potentially millions of patients.

治疗潜在的数百万病人。

These clinics can also evolve into centers where people can come

这些诊所也可以发展成 治疗中心，人们可以来这里

for psychedelic psychotherapy for personal growth,

进行迷幻心理治疗，以实现个人成长、

for couples therapy

夫妻治疗

or for spiritual, mystical experiences.

或精神、神秘体验。

Humanity now is in a race between catastrophe and consciousness.

人类现在正在灾难 和意识之间举棋不定。

The psychedelic renaissance is here to help consciousness triumph.

迷幻剂复兴可以帮助意识胜利。

And now, if you all just look under your seats ...

现在，如果你们都看一下座位下面…

Just joking!

开个玩笑！

(Laughter)

（笑声）

Thank you.

谢谢。

(Applause)

（鼓掌）

(Laughter)

（笑声）

(Applause)

（鼓掌）

Thank you.

谢谢。

(Applause)

（鼓掌）

Corey Hajim: You've got to stay up here for a minute.

科里·哈吉姆： 你得在这里多呆一分钟。

Thank you so much, Rick.

非常感谢，瑞克。

I guess it's a supportive audience.

我猜这群观众们都很支持你。

Rick Doblin: Yes, very.

里克·多布林： 是的，非常支持。

Many of them have also been to Burning Man.

他们很多人也去过火人节。

(Laughter)

（笑声）

CH: There's some synergy.

科里·哈吉姆：有共鸣。

RD: (Laughs)

里克·多布林：(笑声)

CH: So, in your talk, you talked about using these drugs

科里·哈吉姆：在演讲中， 你谈到可以使用这些药物

to address some pretty serious traumas.

来解决一些非常严重的创伤。

So what about some more common mental illnesses

那么像焦虑和抑郁这些更常见

like anxiety and depression,

的精神疾病，

and is that where microdosing comes in?

这些微剂量疗法也有用武之地吗？

RD: Well, microdosing can be helpful for depression,

里克·多布林： 微剂量确实对于抑郁有帮助，

I do know someone that has been using it.

我确实知道有人在使用它。

But in general, for therapeutic purposes,

但总体上而言，要达到治疗目的，

we prefer macro-dosing rather than microdosing,

我们更喜欢宏观剂量 而不是微观剂量，

in order to really help people deal with the root causes.

目的是为了真正帮助人们 应对问题根源。

Microdosing is more for creativity,

微剂量更多的是为了提升创造力，

for artistic inspiration,

艺术灵感，

for focus ...

为了让患者集中注意力…

And it also does have a mood-elevation lift.

它也会带来情绪的提升。

But I think for serious illnesses,

但我认为对于严重的疾病，

we'd rather not get people thinking that they need a daily drug,

我们不想让人们认为 他们每天都需要药物，

but do more deeper, intense work.

但要做更深入、更细致的工作。

CH: And what about outside the United States and North America,

科里·哈吉姆： 在美国和北美之外这方面的研究

is this research being done there?

做得怎样？

RD: Oh yeah, we're globalizing.

里克·多布林： 是的，我们在全球化。

Our Phase 3 studies are actually being done

我们第三阶段的研究其实是在

in Israel, Canada and the United States.

以色列，加拿大和美国进行的。

So once we get approval in FDA,

所以一旦获得FDA批准，

it will also become approved in Israel and in Canada.

它也会被以色列和加拿大批准。

We're just starting research in Europe.

我们刚刚在欧洲开始研究。

And we're actually going to be training some therapists from China.

我们其实正要培训一些 来自中国的治疗师。

CH: That's great.

科里·哈吉姆：太棒了。

我们要来个观众投票，

We were going to do an audience vote

看大家是否认为推进这个研究

to see if people felt like this was a good idea

to move forward with this research or not,

是个好主意，

but I have a feeling I know the answer to that, so ...

但我感觉我知道答案了，那么…

Thank you so much, Rick.

非常感谢，里克。

RD: Thank you. Thank you all.

里克·多布林： 谢谢，谢谢大家。

(Applause)

（鼓掌）