What's normal anxiety -- and what's an anxiety disorder? | Body Stuff with Dr. Jen Gunter | TED

We live in a culture that doesn't take mental health

譯者: 童寧 張 審譯者: Thomas Tam

我們生活在一個

不重視心理健康

issues seriously.

There's a lot of stigma.

還有許多誤解的社會裡

有些人只會叫你撐下去

Some people tell you to just suck it up, or get it together, or to stop worrying,

振作起來，不要太擔心

or that it's all in your head.

或說只是你在胡思亂想

But I'm here to tell you that anxiety disorders,

但我想告訴你

they're as real as diabetes.

焦慮症和糖尿病一樣真實

(Music) [Body Stuff with dr.

（音樂）

[與珍醫師了解你身體]

哈囉

Jen Gunter] Hi again.

我是珍醫師

It's Dr. Jen, and I've noticed something

我發現我的病患有個共同問題

with my patients.

They often describe to me some classic symptoms

他們時常向我描述

一些典型的焦慮症症狀

of an anxiety disorder.

Constant worry, trouble sleeping, tense muscles and struggle

持續性擔憂和睡眠障礙

肌肉緊繃以及無法專注

with concentrating.

But they aren't getting treatment.

但他們卻沒有任何治療

There's a lot of issues with mental-health care in this country.

我們國家的心理保健有許多問題

Some people don't have insurance that would cover it.

有些人因為沒有保險而無法負擔醫藥費

Some have been dismissed or minimized in the past,

有些人曾被人小看或打發

and don't think seeking help will do any good.

因此不認為尋求幫助是有效的

有些人顧慮別人的眼光

Some worry about the stigma and whether it could affect

怕會影響工作和人際關係

future jobs or relationships.

But severe anxiety isn't a moral or personal failing.

但嚴重的焦慮不是道德或個人的失敗

It's a health problem, just like strep throat or diabetes.

它是健康問題

就像咽喉炎或糖尿病一樣

It needs to be treated with the same kind of seriousness.

它必須被同等嚴肅看待

Before we can talk about anxiety disorders,

在我們談論焦慮症之前

我們先談談焦慮本身

let's talk about anxiety itself.

Anxiety is the very real and normal emotion

當我們處於有壓力的情況時

we feel in a stressful situation.

焦慮是很真實和正常的情緒

It's related to fear.

它和恐懼有關

But while fear is a response to an immediate threat

但恐懼是對即刻威脅的反映

that quickly subsides, anxiety is a response

很快就能平息

而焦慮反映的是更加不明確的威脅

to more uncertain threats that tends to last much longer.

持續的時間更長

It's all part of the threat detection system,

這是威脅偵測系統的一部分

which all animals have to some degree, to help protect us from predators.

所有動物或多或少都有

它能幫助我們遠離危險

焦慮源自大腦中的杏仁核

Anxiety starts in the brain's amygdala, a pair of almond-sized nerve bundles

一對杏仁大小的神經束

that alert other areas of the brain to be ready for defensive action.

它警告大腦中的其他區域做好防禦準備

Next, the hypothalamus relays the signal, setting off what we call

接著，下視丘會傳遞這個訊號

我們的身體就開始出現壓力反應

the stress response in our body.

Our muscles tense, our breathing and heart rate increase

肌肉變得緊繃

呼吸和心跳加速

and our blood pressure rises.

血壓升高

Areas in the brain stem kick in and put you in a state of high alertness.

腦幹中部分區域開始作用

讓你處於高度警覺狀態

This is the fight-or-flight response.

這就是「戰鬥或逃走」反應

There are ways the fight-or-flight response

有些方法能使這些反應

is kept somewhat in check, with an area of higher-level thinking

維持於控制範圍內

哪就是能提供更高階思考的 腹內側前額葉皮質

called the ventromedial prefrontal cortex.

It works like this.

它是這樣運作的

If a person sees something they think is dangerous, like a tiger,

如果人類處於危險的情況， 比如看見老虎

that sends a signal to the amygdala, saying "it's time to run."

杏仁核就會收到應該逃跑的訊號

The ventromedial prefrontal cortex can say to the amygdala,

腹內側前額葉皮質會通知杏仁核

"Hey, look.

看！老虎被關在籠子裡

The tiger's in a cage.

You know what a cage is?

你知道籠子是什麼？ 牠們無法從籠子逃走

They can't escape from a cage.

所以你可以冷靜下來了

It's OK to calm down."

It's a feedback loop that can help keep the response in check.

這是一個讓反應可控的反饋迴路

The hippocampus is also involved.

海馬體也在此反應中運作

It provides context, saying things like, "Hey, we've seen tigers in cages before.

它能提供一些情境，像是：

「嘿，你曾看過老虎在籠子裡

We're in a zoo.

在動物園裡是非常安全的。」

You are extra safe."

With anxiety, these threat-detection systems

當焦慮產生時

這些威脅偵測系統與機制會被抑制

and mechanisms that reduce or inhibit them are functioning incorrectly

並且錯誤地運作

使我們對自身安危感到擔心

and cause us to worry about the future and our safety in it.

But for many people, it goes into overdrive.

但對某部分人來說它運作過度

They experience persistent pervasive anxiety

他們的焦慮症狀持續不斷

that disrupts work, school, and relationships

並干擾到工作、課業與人際關係

and leads them to avoid situations that may trigger symptoms.

使他們避開所有會觸發焦慮症狀的情境

Anxiety disorders are not at all uncommon.

焦慮症一點也不少見

Based on data from the World Mental Health Survey,

根據世界精神衛生調查的數據顯示

researchers estimate that about 16% of individuals

約有百分之十六的人

currently have or have had an anxiety disorder.

患有或曾患有焦慮症

These include social anxiety disorder, panic disorder, agoraphobia and phobias.

包含社交恐懼症

恐慌症、廣場恐懼症及特殊恐懼症

Studies have shown that people with anxiety disorders

研究顯示患有焦慮症者

don't just have a different way of reacting to stress.

不只是對於壓力的反應與常人有異

There may be actual differences in how their brain is working.

他們的大腦運作也可能與常人不同

One model describes possible mix-ups in the connections between the amygdala

這個模型說明大腦產生混亂的原因

杏仁核與大腦其他部分連結

and other parts of the brain.

The pathways that signal anxiety become stronger.

傳送焦慮的路徑會逐漸增強

And the more anxiety you have, the stronger the pathways become,

且越是焦慮，連結越強

and it becomes a vicious cycle.

然後成為惡性循環

The good news is there's treatment for anxiety,

值得慶幸的是焦慮是可以治療的

and that you don't have to suffer.

不需要一直受其所苦

Remember, this isn't about weakness.

記住，焦慮並不是你的軟弱

It's about changing brain patterns, and research shows that our brains

只是你要改變大腦運作模式

研究顯示

have the ability to reorganize and form new connections

我們的大腦有能力構成新的連結方式

all throughout our lives.

且一生都有機會轉變

A good first step is to do the basics.

第一步要維持基本的良好生活習慣

Eat a balanced diet, exercise regularly

均衡飲食

規律運動

and get plenty of sleep, as your mind is part of your body.

保持睡眠充足

畢竟腦部也是身體的一部分

It might also help to try meditation.

冥想可能也會有所幫助

Instead of our heart rate rising and our body tensing,

放鬆肌肉並使心跳平穩

with mindfulness and breathing, we can slow down

保持正念和平穩呼吸

我們可以減緩戰鬥或逃走反應

the fight-or-flight response and improve how we feel in the moment.

好好感受當下

Cognitive behavioral therapy, a form of talk therapy,

「認知行為治療」是其中一種的談話療法

can also be fantastic.

效果也很不錯

In it, you learn to identify upsetting thoughts

在治療中你學識哪些使你心煩的想法

and determine whether they're realistic.

並判斷它們是否切實

Over time, cognitive behavioral therapy can rebuild those neural pathways

認知行為治療可以慢慢重建神經路徑

that tamp down the anxiety response.

並抑制焦慮反應

短期或長期服藥

Medication can also give relief, in both the short-term and the long-term.

也可以使症狀獲得緩解

In the short-term, anti-anxiety drugs can down-regulate

短期服用抗焦慮藥物

可以抑制威脅偵測機制

the threat-detection mechanisms that are going into overdrive.

避免它過度運作

Studies have shown that both long-term medications

而研究顯示長期用藥

and cognitive behavioral therapy can reduce that overreactivity

以及認知行為治療

可以降低杏仁核的活躍程度

of the amygdala we see an anxiety disorders.

也就是我們所說的焦慮症

High blood pressure and diabetes, they can be treated or managed over time.

就像高血壓與糖尿病

可以受控制或被治癒

焦慮症也一樣可以

And the same is true for an anxiety disorder too.