504：你身处其中的时刻，比你所记得的时刻更重要

欢迎收听《感觉良好》播客。

Welcome to the Feeling Good podcast.

你有没有想过，为什么你明明在努力改变，却还是总感觉老样子？

Have you ever wondered why you keep feeling the same way even when you're trying to change?

焦虑、习惯、人际关系的困扰。

Anxiety, habits, relationship struggles.

有时候你会觉得，怎么努力都留不住变化。

Sometimes it can feel like nothing really sticks.

我是心理咨询师凯文·科尼利厄斯，每周我都会和戴维·伯恩斯博士对谈。

I'm therapist Kevin Cornelius, and each week I sit down with Doctor.

戴维·伯恩斯是认知行为疗法领域最权威的专家之一，也是TEAM CBT的创始人。

David Burns, one of the world's greatest authorities on cognitive behavioral therapy and the creator of TEAM CBT.

这个播客专注于真正管用的实用方法。

This podcast is all about practical tools that actually work.

教你清晰可操作的技巧，摆脱焦虑和抑郁，改善人际关系，建立真正的自信。

Clear techniques you can use to overcome anxiety and depression, improve your relationships, and build real confidence.

没有废话，没有空洞的建议，只有真正管用的方法，帮你改变想法、感受和生活方式。

No fluff, no vague advice, just effective tools that can help you change the way you think, the way you feel, and the way you live.

我们开始吧。

Let's get started.

今天我们要探讨一个问题，这个问题已经影响了心理治疗超过一百年。

Today, we're tackling a question that's shaped therapy for more than a century.

你必须了解过去，才能痊愈吗？

Do you have to understand your past to heal?

很多人觉得，抑郁、焦虑和创伤都源于童年经历，真正的康复就是要深入挖掘那些旧伤。

Many of us assume that depression, anxiety, and trauma are rooted in childhood experiences and that real recovery means digging deep into old wounds.

但伯恩斯医生对此提出了强烈的质疑。

But doctor Burns challenges that idea in a big way.

他最近在PsychologyToday.com上发表了一篇文章，标题是《你当下的时刻，比你记得的过去更重要》。

He recently published an article on psychologytoday.com titled, The Moment You're In Matters More Than the One You Remember.

在他职业生涯早期，一位病人请他深入探索自己的过去，以解释自己为何抑郁。

Early in his career, a patient asked doctor Burns to explore his past to explain his depression.

但伯恩斯医生提出了一个出人意料的建议。

Instead, doctor Burns made an unusual proposal.

咱们先把抑郁治好。

Let's cure the depression first.

如果你之后还想回顾过去，我们再一起做。

Then if you still want to explore your history, we will.

接下来发生的事，彻底改变了伯恩斯医生的职业方向。

What happened next changed the course of doctor Burns' career.

他结合数十年的临床经验，以及一项大规模手机应用研究的新数据，指出：只要了解一个人当下的感受，他们过去的情绪经历对预测康复几乎没什么帮助。

Drawing on decades of clinical experience and new data from a large app based study, he argues that once you account for how someone feels right now, their emotional history may add almost nothing to predicting recovery.

换句话说，治愈的关键或许不在于回溯过去，而在于改变当下。

In other words, the key to healing might not lie in revisiting the past, but in transforming the present.

这场对话将探讨治疗、创伤、实证，以及一个极具希望的观点——情绪痛苦可能比我们想象的更容易改变。

This is a conversation about therapy, trauma, evidence, and a radically hopeful idea that emotional suffering may be far more changeable than we've been led to believe.

我们开始吧。

Let's dive in.

大卫，很高兴再次和你聊天。

David, it's great to talk to you again.

我也是。

Likewise.

谢谢你。

Oh, thank you.

我特别喜欢读你的文章，想先问你一个问题。

I really enjoyed reading your article, and I have a question for you to begin.

你能不能给我们讲讲这个抑郁症病人的故事？就是他当时想深入挖掘自己的过去，好弄明白自己为什么抑郁。

I'm wondering if you'd be alright with just telling us the story, kind of set the scene for us of this client who was depressed, who asked you to delve into his past in order for him to understand his depression.

当然可以。

Oh, yes.

对。

Yeah.

太好了。

Oh, great.

谢谢你提醒我这件事，凯文。

Thank you for reminding me about that, Kevin.

那时我刚起步做临床工作，刚开始学习认知疗法，特别着迷。

I was just starting out my clinical practice and I was just beginning to learn cognitive therapy and got very excited about it.

我之前是精神科住院医师。

And I had been a psychiatric resident.

我先在斯坦福读医学院，后来在奥克兰的高地医院和费城的宾夕法尼亚大学完成住院培训。

I was a medical student at Stanford and then I did my residency at Highland Hospital up in Oakland and at the University of Pennsylvania in Philadelphia.

当时接受的训练就是静静地听病人说。

And the training I got was just listen to patients.

但我一直对这种方式感到不满意。

And I was always unhappy with that.

我总觉得特别别扭，明明可以教他们一些方法，或者更自然地跟他们互动。

I felt so terribly awkward not to give them techniques to use or to interact with them in a more natural way.

说实话，我从来没见谁光靠听就能好起来，我的导师们都是权威人物。

I'd never seen anybody get better, to be honest, from just my supervisors were presidents.

有一年，我觉得是费城某家精神分析协会的主席在指导我。

One year I think I had the president of one of the Philadelphia Psychoanalytic Associations supervising me.

真的吗。

Wow.

我从来没见哪个病人真正好转过，更别说改善了。

I never once saw a patient recover, much less improve.

后来我从贝克那里了解到，其实我们可以教患者一些方法，帮助他们快速摆脱抑郁。

And so when I learned from Beck that there are methods we can teach patients to get over your depression and maybe fairly rapidly.

我简直太兴奋了。

I was just overjoyed.

所以我决定把我的职业生涯和整个人生都投入到这件事上。

And that's why what I decided to devote my career and my life to.

但我记得，我早期的一个病人是费城宾大的一名学生。

But I remember one of my early patients was a student from Penn in Philadelphia.

我记不清具体是什么问题了，但他可能有完美主义倾向，人际关系上也有些不安全感，整体情绪很低落。

And I don't remember exactly what was wrong, but he had some probably perfectionism going on and maybe some insecurity in his relationships, but he was quite depressed.

他之前也接受过不少没什么效果的治疗。

And he'd had a lot of ineffective treatment as well.

于是我告诉他，我们会布置一些作业，采取一种非常主动的方式，教他如何改变自己的想法和感受。

And so I told him how we'd be doing homework assignments, a very active approach to teaching him how to change the way he thinks and feels.

他回答说：‘哦，可是医生……’

And he said, Oh, well, yeah, but Doctor.

伯恩斯，我们难道不该先花点时间，去梳理一下我的过去，找找那些导致我如今问题的模式吗？

Burns, aren't we gonna take some time before we do that to explore my past, to find some patterns there that would explain why I'm having the problems I'm having.

我有点意外，因为我刚经历过好几年这样的治疗，或者至少是试图这么做，可从来没看到任何人因此真正好转。

And I was a little bit taken aback because I had just gotten over several years of doing that or trying to do that with no benefits ever that I noticed for anybody.

所以我有点防御心理，感觉被逼到墙角，于是脱口而出对他说：‘吉姆，这样吧，如果你真想花时间回顾过去，那我请你先给我两三次，或者四五次机会，用这些新方法先帮你把抑郁治好。’

So I felt a little defensive and my back was up against the wall and then I kind of blurted out to him, Jim, I tell you what, if you wanna spend some time exploring your past, I would like to ask you if you would give me two or three or four or five sessions to cure your depression first with these new techniques.

等你康复了，那时候如果你想，我们再花多少时间去探索过去都行。

And then once you're cured, then if you like, we can take all the time you want exploring your past.

他同意了，我也松了口气，因为我根本不知道该怎么去探索他的过去，更不确定那样对他能有什么帮助。

So he was okay, and I was kind of relieved too because I didn't want to explore his past because I didn't have any idea of what I was gonna do that could possibly be helpful to him.

他反应特别快。

And so he was a very rapid responder.

三到五次咨询后，他的症状就完全消失了，整个人开心得不得了。

And after three, four, five sessions, his symptoms went to zero and he was happy as can be.

我说：太好了。

And I said, Hey, great.

好消息是，我们可以安排时间，慢慢探索你的过去，想花一个月、两个月，甚至一两年都行。

Now the good news is we can take some time and schedule to explore your past and we can do it for a month or two or even a year or two if you like.

我当时想，这真是太好了。

And I was thinking, this is great.

这能让我诊所的生意稳下来。

This will stabilize my practice.

我刚开了新诊所。

I have a new practice.

我手上有很多空档时间，这样正好能把它们都填满。

I have a lot of empty slots and this will fill up my slots and that type of thing.

然后他说：‘医生，’

And then he says, oh, Doctor.

伯恩斯，我不需要再探索我的过去了。

Burns, don't need that anymore to explore my past.

就这样结束了。

That was it.

接着我想起另一位早期的病人，情况完全不一样。

And then I remember another early patient I had very different.

但有个同事问我，能不能在斯坦福医院见见她，叫安。

But a colleague asked if I would see her in the Stanford Hospital, Anne.

她是咱们医院里特别受人爱戴的行政人员。

And she was a beloved administrator at our hospital.

她四十多岁，住在宾夕法尼亚州的上达比，家里挺大的。

And she was in her 40s and she lived in Upper Darby, Pennsylvania and had a big house there.

她一直在照顾好几位有残疾的家人。

And she was helping to care for several relatives with disabilities.

她一直没结婚。

And she had never married.

她去妇科做例行的半年检查。

And she went to her OBGYN for a routine six month evaluation.

医生说，我注意到你骨盆里有点异常，你得住院做个活检，弄清楚那到底是什么。

And he said, I've noticed something in your pelvis there and I want you to go into the hospital so we can do a biopsy and find out what it was.

结果发现她得了晚期卵巢癌。

And then they found out she had terminal ovarian cancer.

天哪。

Oh, no.

我不知道现在有没有治愈的方法，但那时候肯定没有。

And I don't know if there's any cure for it today, but there certainly wasn't in those days.

医生告诉她，最多还能活两年。

And told her that she had two years to live.

这对她来说是个巨大的打击。

And this was a trauma.

说到治疗创伤，

Talk about treating trauma.

每个人遇到的创伤都不一样，但这件事让她陷入了严重的抑郁。

Well, all have different things that are traumatic for us, but this threw her into a severe depression.

同事们问，这种新的认知疗法会不会对她有帮助？

Colleagues said, Would this new cognitive therapy maybe have any help for her?

那位同事问我，能不能抽空去她病床前和她聊一聊？

And the colleague said, Would I be willing to stop by and at least talk to her by her bedside?

我说，我很乐意去。

And I said, I'd be glad to do that.

我去和她聊了聊，我们俩很快就聊得来。

And I went and spoke with her and we kind of hit it off.

她以前并没有长期抑郁，所以我用不着去梳理很长的病史。

And she hadn't spent a life being depressed, so I didn't have a big history to take.

但我还是给了她贝克抑郁量表，那是我当时常用的工具。

But I gave her the Beck Depression Inventory, which was the one I was using in those days.

她当时严重抑郁。

And she was severely depressed.

于是我问了她，那时候我对现在你这么熟悉的这种现代目标设定技巧其实了解不多，凯文。

And then I just asked her, and I didn't know that much about the agenda setting techniques that we've developed in this modern era that you're so familiar with, Kevin.

我就问她，我知道不能保证什么，但如果你愿意，我能不能帮你缓解一下抑郁？

But I asked her, you know, I can't promise anything but would you want some help with your depression if I could offer that to you?

她回答：当然愿意。

And she said, Oh, absolutely.

我又问：那你需要吗？

And I said, well, would you need it?

你今天就需要吗？

Would you want it today?

今天？

Today?

比如现在就行吗？

Like how about right now?

她说：‘我准备好了。’

And she says, yes, I'm ready.

我当时才认识她大约十五分钟。

And I'd only known her for about fifteen minutes.

于是我直接按常规的认知疗法问她：你在想什么？

And so I just went into the normal cognitive therapy thing as what are you thinking?

你心里在想些什么？

What are your thoughts?

因为这永远是改变的关键。

Because that's always the key to change.

当然，也是理解的关键。

And as well as, of course, the key to understanding.

她当时大概有三四个想法。

And she had, I think, three or four thoughts.

让我想想。

Let's see.

第一，我觉得我让家人失望了。

One, I'm letting my family down.

那是她的一个想法。

That was one of her thoughts.

她对此深信不疑。

She believed it 100%.

希望我没说太久。

I hope I'm not talking too long.

估计是说多了。

Probably am.

哎呀，我都这把年纪了，也不在乎了。

Oh, well, I'm so old I don't care anymore.

你讲得非常好。

You're doing great.

我很喜欢这个故事，真的很有帮助。

I love this story and this is super helpful.

是的

Yeah.

没有我，他们根本活不下去。

Then they can't survive without me.

所以我把这些都写下来。

So I'm writing these down.

你们在听的，如果想的话也可以记下来。

You folks who are listening can write them down too if you want.

他们一旦

They can't survive when they

那也是百分之百吗？

Was that a 100% too?

对，没错。

Oh, yeah.

三个都是百分之百。

All three were a 100.

第三点是，我觉得得癌症是我自己的错。

The third is, it's my fault that I got cancer.

然后我想，她真是个心地善良的女人。

And then I thought, well, she's a really good hearted woman.

她总是帮居民们做研究项目。

She would help the residents with their research projects.

她就是那种愿意付出的人，特别温柔、有爱心。

She was just a person who gave, a giving person, a very loving, gentle person.

我感觉她应该挺信教的。

And I had a feeling she was pretty religious also.

所以我就在想，用一种反向的成本收益法，或者叫矛盾的双重标准法，会不会对她有帮助。

And so I just thought, I wonder if a paradoxical cost benefit or a paradoxical double standard technique would be helpful to her.

这跟通常的双重标准正好相反。

And that's kind of a reverse of the normal double standard.

通常的双重标准是：你会这样跟别人说话吗？

Normal double standard is, would you talk this way to another person?

如果不是这样，你会对处在同样情况下的别人说些什么呢？

And if not, what would you say to someone else in the same circumstances?

而我是反过来用的。

And I used it in the opposite way.

我说，安，你想象一下，有个女人住在宾夕法尼亚医院，单人病房，跟你一样也有个室友，她跟你一模一样。

I said, Anne, imagine that there's a woman and she had a single room there in the Penn Hospital, matching you have a roommate and she's just like you.

她四十多岁，突然得了卵巢癌，医生说只剩两年寿命。

She's in her 40s and she unexpectedly got cancer of the ovaries and she's got two years to live.

她家在上达比有一栋大房子，还照顾过好几个有残疾的亲戚。

And she has a big house in our Upper Darby and she's taken care of several relatives who have disabilities.

现在，我想让你转过身去，对她说：你知道吗？你让家人失望了。

And I want you to turn to her right now and say to her, know, you're letting your family down.

她一下子愣住了。

And she was like stunned.

她沉默了十五到二十秒，然后说：医生。

And she said nothing for fifteen, twenty seconds and said, Doctor.

伯恩斯，我没法这么说。

Burns, I can't say that.

我没法对另一个和我处境相同的女人说出这种话。

I couldn't say that to another woman who was in the same circumstances as I'm in.

于是我问她：‘那为什么不行呢，安？’

And I said, Well, why not, Anne?

你对自己说话就是这样的。

You're talking to yourself that way.

那你为什么不对别的女人这么说呢？

Why wouldn't you talk to another woman that way?

她回答：‘那样做太残忍了。’

And she said, well, it would be it would be cruel.

我对她说：‘是啊。’

And I and I said to her, yeah.

没错。

Yes.

但是，安，你相信说真话吗？

But, Anne, do do you believe in telling the truth?

你是那种说实话的女人，还是那种会撒谎的女人？

Are you the kind of woman who tells the truth or the kind of woman who lies?

她说：哦，我一向都说真话。

And she says, oh, I always tell the truth.

这属于精神层面的，你知道的，我非常非常虔诚。

That that's that that's that's a spiritual you know, I'm very very religious.

我说：好吧。

And I said, okay.

圣经里说，真理必叫你们得以自由。

It says in the bible, the truth shall set you free.

按你自己的说法，我正在让家人失望。

By your own admission, I'm letting my family down.

你说过，这百分之百是真的。

You said that's a 100% true.

所以，如果这对你是真的，那对那个跟你一模一样的女人来说也是一样的。

And so if it's true of you, it would be true of this other woman who's like identical to you.

那你现在就去告诉她，你正在让家人失望，因为这才是符合信仰的做法。

So go ahead and tell her you're letting your family down because that's the religious thing to do.

她又沉默了，然后说：不，不，伯恩斯医生，我还是没法对那个女人说这话。

And she got quiet again and she said, no, no, doctor Burns, I still can't say that to this other woman.

我说：那为什么不能说呢？

I said, well, why why not?

她回答：因为那不是真的。

And she she said, because it's not true.

我说：你什么意思，那不是真的？

And I said, well, what what do you mean it's not true?

她说：我的家人爱我，他们一直很感激我这些年为他们所做的一切。

And and she says, well, my family loves me, and they appreciate what I've done for them for years.

他们得知我的病情，知道我两年后就要离世，都难过极了。

And they're extremely sad about my diagnosis and the fact that I'm gonna be dying two years from now.

但他们从来没有流露出一丝一毫觉得我拖了他们的后腿。

But none of them ever gave any hint that they think that I'm letting them down.

这太荒谬了。

That's absurd.

我就问她，你现在多大程度上相信这个想法呢？

And I said, well, how much do you believe that thought right now?

她回答：零。

And she said, zero.

这根本不是真的想法。

That's not a true thought.

接着我们用同样的方式分析了另外几个想法：没有我他们活不下去，是我害自己得癌症。

And then we went through the same process with, They can't survive without me, and it's my fault I got cancer.

她意识到，首先，这些想法也完全不真实。

And she saw, first of all, that those thoughts also were absolutely untrue.

而且，它们还特别残忍。

And also, they were just cruel.

这正是抑郁症的关键所在。

And that's the whole key to depression.

当你抑郁的时候，你一直在苛责自己，却根本没意识到。

When you're depressed, you're beating up on yourself, but you don't realize it.

那时候，她很容易就能反驳这三个想法。

It was then It was relatively easy for her to talk back to all three thoughts.

她对这三个想法的相信程度都降到了零。

And her belief in all three of them went down to zero.

整个过程只花了大约十五分钟。

That took about fifteen minutes.

我问她：‘你现在感觉怎么样？’

And I said, How are you feeling now?

她说：‘好多了。’

She said, A lot better.

我又问：‘要不要再填一遍抑郁量表？’

And I said, Well, you wanna take this back depression inventory again?

所以我们看到，她的得分已经降到了零。

So we could see, and her score had gone down to zero.

真惊人。

Wow.

她的抑郁情绪完全消失了。

And her depression just had entirely vanished.

而这一切，都是通过聚焦她生活中当前的问题实现的。

And it was by focusing on a present problem in her life.

可惜的是，我后来又见到她，因为我当时在精神科工作，所以碰巧遇到了。

And sadly, I saw her because I was in the department of psychiatry, so our paths crossed.

但她的抑郁再也没有回来过。

But her depression never returned.

她感受到了被爱。

She felt loved.

她觉得自己有价值。

She felt worthwhile.

可惜两年后，她准时去世了，再次入院时已是全身多处转移并伴有心力衰竭。

And she sadly died two years later, right on schedule, was rehospitalized with massive metastases and heart failure.

她离世确实让人难过。

And it was sad that she died.

但她的治疗过程出奇地顺利。

But she had been so easy to treat.

我一直在想，她是个创伤患者，而我学过的都说这类病人很难治。

And I asked myself, she's a trauma patient, and I've been taught that they're very difficult to treat.

为什么她的治疗这么容易呢？

Why is she so easy to treat?

说实话，这个问题我琢磨了整整三十年都没想明白。

And and I couldn't figure it out for about thirty years, to be honest with you.

我猜，也许是因为她没有长期的抑郁史。

And I thought, well, maybe because she didn't have a long history of depression.

她并没有在固守自己的抑郁情绪。

She she wasn't trying to defend her depression.

她只想在剩下的日子里，带着喜悦和释然度过。

She she wanted to spend her remaining time with joy and and loss and like that.

但最近我突然想到，这么说可能有点自大，也许我有点夸大了。

But then just recently, it occurred to me, you you know, and this is gonna sound arrogant and I I maybe am overstating it.

我接触过很多创伤患者。

But I've had many, many trauma patients.

我曾在全美和加拿大各地举办过两天的创伤治疗工作坊，每场都当着观众的面，现场治疗一名志愿者，持续两个小时。

I did a trauma workshop all around The US and Canada two day workshop, and I treated a live volunteer from the audience at every workshop right in front of the audience for a two hour live demo.

我还治疗了那些来参加工作坊的创伤患者。

And I treated volunteer trauma patients who attended the workshop.

他们全都像她一样，在一次治疗中就康复了。

And they all recovered like she did in a single session.

后来我在斯坦福办了一场针对精神科住院医师的创伤治疗研讨会，就是想让他们见识一下，TEAM认知行为疗法真的能在两小时内带来显著改变。

And then I did a trauma conference at Stanford for the psychiatric residents because I wanted them to learn TEAM CBT and see it's possible to get dramatic changes in patients in a single two hour session.

于是我们几位讲师推荐了大约五到十位病情严重、长期无效的创伤患者。

And so we the faculty referred about five or 10 presumably, you know, very severe trauma patients, refractory.

我每次在居民面前为其中一位患者做治疗，那是个白天进行的两小时研讨会。

I treated one of them in front of the residents at each of our It was a daytime, a two hour seminar.

结果在那两小时里，他们的症状几乎全都消失了。

And they all pretty much went to zero in that two hours.

与此同时，我根本没跟上创伤领域的文献进展，什么都没看。

And in the meanwhile, I hadn't been keeping up with the trauma literature or anything.

我只是发现，创伤患者其实是最好治的一类人。

I just noticed trauma patients are by far the easiest to treat.

这一直都是我的亲身经验。

And it's just always been my experience.

所以我一直觉得这再正常不过了。

So I just took it for granted.

我从来没想过这背后意味着什么。

I never thought about what it might mean.

后来我才开始听说，有些人自称是创伤治疗专家——虽然他们不这么叫自己，但专攻创伤治疗，用的都是EMDR、ACT，还有各种别的方法。

And then I started hearing about these people who call themselves trauma shrinks, or that's not what they call themselves, but they specialize in the treatment of trauma and they use EMDR and ACT and this and that, the other thing.

他们强调治疗可能需要长期进行，很多患有创伤后应激障碍的退伍军人接受长达五年的暴露疗法，却毫无起色。

They emphasize that the treatment can be very long term and that with the depressed veterans with PTSD, they're often treated with prolonged exposure for five years with no improvement.

于是我开始问自己，为什么我的经验会这么不一样？

And I began asking myself, why is my experience so different?

但我还是想不明白。

And I still couldn't figure it out.

我觉得可能有人会对这个感兴趣。

And I thought people might be interested.

后来有一次星期天去徒步，这回答可够啰嗦的，你以后别问我问题了。

And then on a Sunday hike, this is a long winded answer, you'll learn not to ask me questions.

每期播客都得终结在这儿，因为我根本停不下来。

It'll be the end of every podcast because I can't shut up.

我还经常做大量的数据统计建模。

And then I do a lot of statistical modeling of data.

我手头有好几百名患者的数据，他们都是用我们的‘ Feeling Great ’应用接受治疗的。

And I had data from several 100 patients who we've been treated with my app, the Feeling Great App.

其实最早的版本叫《感觉良好》应用。

Well, was actually the prototype, the Feeling Good App.

他们的改善速度非常快。

And they had very, very rapid improvements.

我建立了一个数学模型，现在终于要提交给《医疗互联网研究杂志》了，看看能不能发表。

But I developed a mathematical model and we're just sending it now finally to the journal JMRI, the Journal for Medical Internet Research, to see if we can get it published there.

《今日心理学》那篇文章是通俗版的，我觉得挺好，普通人也能看懂。

The Psychology Today was a pop psychology version of it, which I think is good so the lay person can understand.

我建立了一个数学模型，能根据患者初次评估时的情绪状态，预测并分析他们使用《感觉良好》应用后快速康复的情况——比如你现在七种情绪分别怎么样。

But I developed a mathematical model and was able to predict and analyze the rapid recovery in the patients using the Feeling Good App based on how they were feeling at the intake evaluation, how do you feel right now in seven different emotions?

你有多抑郁？

How depressed are you?

你有多焦虑？

How anxious are you?

你有多绝望？

How hopeless are you?

你有多生气？

How angry are you?

就是这类问题。

That type of thing.

然后我在初评时还加入了一个变量，了解他们过去两年的整体情绪状态，好判断我们面对的是怎样的人群。

Then I had this variable from the intake evaluation, how you've been feeling over the past two years to see what kind of patient population we had.

因为所有参与者都是自愿来试用这款应用的。

Because they were all volunteering to try the app.

结果发现，他们过去两年的主要抑郁水平异常高，几乎和住院患者相当。

And it turned out that their main depression level in the previous two years was exceptionally high, almost like hospitalized patients.

于是我想到，得把这个变量也加进模型里，因为它很可能提升模型的解释力——毕竟我们的用户大多数在使用应用的头三天就明显好转，甚至完全康复了。

And then I said, well, I've got to put this variable into the model because it'll probably add additional explanatory power because our patients, most of them pretty much recovered or got dramatic changes in the first three days using the app.

我推测，那些过去两年情绪特别严重的患者，改善幅度可能没那么大。

And I said, well, those who have been really severe in the previous two years probably don't improve as much.

如果能把这个数学变量纳入模型，或许能挖掘出更多有用的信息。

And maybe by bringing this mathematical variable into my model, I can learn more things.

所以我把它加进了模型里。

And so I brought it into the model.

我用的是结构方程建模，它不会直接跟你说话，但又像是在跟你对话，只不过用的是数学语言。

I use something called structural equation modeling and it doesn't exactly talk to you, but it talks to you, but it does it in, you know, kind of a mathematical language.

结果它给出的答复让我大吃一惊。

And it said And it just shocked the hell out of me.

它说：大卫，你得把这个新变量从模型里删掉，它对我一点用都没有。

It said, David, I want you to get that new variable out of the model because it doesn't do me a damn bit of good.

它没有带来任何我之前不知道的新信息。

It adds not one thread of new information that I didn't already have.

对理解变化毫无帮助，也完全无法预测谁会改变、会改变多少。

And then nothing to the understanding of change and nothing to the prediction of who's gonna change and by how much.

这个变量根本就是多余的。

It's a totally useless variable.

那天下周日我去徒步，心里想：天哪，我从来没遇见过哪个变量是模型主动要求我把它删掉的。

And I was hiking on a Sunday hike and I said, My God, I've never had a variable that the model told me, I don't want that in my model.

我已经得到了完整的答案。

I've already got the complete answer.

但我当时并不明白那意味着什么。

And I didn't understand what it meant.

后来有天半夜，我突然想通了，就像醒来的那一刻，我明白了：原来这就是它的意思。

And then it suddenly came to me in the middle of the night, kind of like I woke up and said, Oh, here's what that means.

真正的原因是，过去四十年来我的患者进步这么快，是因为我始终聚焦于当下，除非有人经历过特定的创伤，伴有反复侵入性的幻想，我才会用暴露技术，比如记忆重写。

What it means, the reason my patients have been getting better so fast for the past forty years is because I'm always focusing on the here and now, and I don't dwell on the past unless someone's had a specific trauma that with intrusive fantasies, that I might focus on an exposure technique like memory rescripting.

但这种情况其实很少见。

But that's pretty rare.

但大多数时候，我发现只要帮人们改变今天的情绪状态，

But most of the time, I have found that when I help people change the way they feel today.

当

When

我治疗创伤患者时，从不纠结于你二十年前的创伤。

I treat trauma patients, I don't treat your trauma from twenty years ago.

我处理的是你今天面临的问题。

I treat a problem in your life today.

我发现，你所有的困扰都浓缩在你情绪波动的那一刻。

And what I found is that all of your problems are encapsulated in any one moment when you're upset.

所以，只要弄清楚你今天为什么难过，你的认知偏差和自我挫败的信念是什么，就能解开你所有的痛苦，包括过去的创伤。

And so once we found out why you're upset today, what are your distortions, what are your self defeating beliefs, That's through all of your suffering, even the trauma that you had.

把它改过来。

Change it.

当我们今天治愈了它，实际上就是最彻底的治愈。

And when we heal it today, we're actually healing the best.

这就是我为《今日心理学》写那篇文章的原因。

And that's why I wrote that article for Psychology Today.

最近我有点生气，脾气也变得暴躁，因为我很不满，世界上似乎没人重视我那些发现。

And I'm hoping the world I've been kind of in an angry, elderly, irritable phase lately because I'm pissed off that the world seems to be ignoring a lot of the discoveries that that I've made.

我真的不喜欢这样。

And and I don't like it.

我觉得他们应该认真对待这个问题。

I think they should attempt to attend to it.

我治疗创伤取得的惊人效果，这一点非常重要，也很有意义。

And I think the fact that I've had such spectacular results in the treatment of trauma is important and meaningful.

那篇文章说的就是这个，而且背后其实有个简单的解释。

And that's what that article was all about and that there's a simple explanation for it.

但那些一辈子钻研过去疗法的人，恐怕不会喜欢，因为他们的饭碗可能受到威胁。

But the people who have devoted their careers to doing all these techniques focusing on the past, they're not gonna like it because their livelihood is threatened perhaps.

当然。

Sure.

没错。

Of course.

否则你就得学一套全新的治疗方法。

Or you'd have to learn a whole new way of treating people.

明白。

Yeah.

大卫，你提到愿意在《今日心理学》上发表这篇文章，我特别欣赏这一点，因为普通读者也能看懂你在说什么。

David, I love what you said when you said you were happy to publish this in Psychology Today because the layperson could understand what it is that you're talking about.

我读这篇文章的时候，最喜欢的就是这一点——这确实是让你的理念传达到更多人手中的好方式。

And that's what I loved about that article when I read it, because it's a great way for you to get this word out to people.

事实上，现在正有听众在听我们对话，而他们此刻正承受着痛苦。

And in fact, now, there are people listening to us as we're having this conversation who are suffering right now.

他们正被抑郁困扰，偶然找到这个播客，是希望从中找到让自己好起来的方法。

They're they're struggling with depression and they found this podcast in hopes that they could help themselves feel better.

你刚才说的这些，真的给了这样的人莫大的希望，让我特别触动。

And I'm just struck by how much hope you give people in that situation with everything that you just said.

我想试着总结几点，用更通俗的方式讲出来，毕竟我的思维没你那么学术。

And I'm gonna try to summarize a couple of things to bring it down to my not as intellectual as you level.

一个人只要看清自己当下的感受，就能开始摆脱抑郁，不管已经抑郁多久了。

A person just needs to look at how they're feeling right now today in order to overcome their depression no matter how long they've been feeling depressed.

因为只要活在当下，观察自己的情绪，再回溯那些引发情绪的想法，你就能立刻明白该如何让自己好起来。

Because in the present moment, when you look at feelings and then look at the thoughts that caused those feelings, you can see everything that you need to know about helping yourself feel better right now today.

因为一旦一个人意识到那些想法并不真实，他就会从这些想法带来的抑郁中解脱出来。

Because as soon as a person proves that those thoughts aren't true, they get a relief from the depression that those thoughts were causing.

这其实是一种美好又近乎简单的方法，对吧？

And it's such a beautiful and almost simple thing, isn't it?

是的。

Yeah.

只要问问自己：我现在在对自己说什么？这话真的对吗？

To just look at what am I telling myself right now and is that true?

我特别喜欢你讲的安妮的故事，那种矛盾的双重标准技巧——她怎么也不肯对别人说那些她对自己说过的话，而那个人其实和她一模一样。

And I loved that story that you told about Anne and that paradoxical double standard technique when she just couldn't say the words to another person who was exactly like her that she had been saying to herself.

还有那个特别棒的问题：真相对你重要吗？因为你所说的，难道不是真的吗？

And that beautiful question, is the truth important to you because isn't what you're saying true?

她不得不承认，其实那些话并不真实。

And she had to disagree and say it actually isn't true.

就在那一刻，她从抑郁中走出来了。

And that was the moment that she recovered from depression.

我特别喜欢你教给治疗师和患者的东西，其实只需要这一步就够了。

And what I love so much about what you teach therapists and patients is that's all we need.

我们只需要证明给自己看，那些让我们痛苦的想法并不真实。

We just need to prove to ourselves that what we're telling ourselves that causes our suffering isn't true.

就在那一刻，我们就能完全摆脱这些问题。

And in that instant, we fully recover from our problems.

你在网站上特别慷慨，把很多工具免费提供给听你播客的人，他们可以直接下载使用，也可以用你的App。

And you're very generous on your website where you share with people who are listening to your podcast tools that they could even just download and use right there on the website, plus they could use your app too.

你的每日情绪记录表也可以用。

And your daily mood log is available.

就在你的网站上，随时都能找到。

It's right there on your website.

现在就有一个人，完全可以马上开始填写。

Someone right now could just start filling it out.

他们可以问自己：我现在有什么感受？是什么想法导致了这些感受？

They could ask themselves, what am I feeling right now and what thoughts are causing my feelings?

你的网站上有关于如何操作的说明，你所有的书里也都有详细指导。

And there are some instructions on your website for how to do that and certainly in all of your books.

我提到这些，是因为对正在听这个节目的人，我想说的是：你现在就能让自己感觉好很多，完全有可能摆脱抑郁。

And I'm mentioning all this because for the person who's listening to this, I just encourage you to realize that you can help yourself to feel tremendously better right now and you could overcome your depression.

就在今天，当你在听这个播客的时候，不妨暂停一下，立刻帮自己一把。

Even today, while you're listening to this podcast, put it on pause and help yourself.

对吧？

Right?

你传达的这个理念真的很棒，跟其他心理疗法给人们的建议完全不同。

And that is such a beautiful message that you're right is very different than what other approaches to therapy are telling people.

每当我想到人们被灌输‘你得深挖过去，得花好几年时间’，还有人说CBT只是表面功夫，我就特别生气。

And I get pissed off too when I think about how people are given this message that you have to go deep into your past and it's gonna take you years and things like CBT are just surface level change.

大卫，我想问你的是，我猜有些听众会想：他们刚才在你面前，一打破那些想法，确实感觉好多了。

And what I wanna ask you about, David, is I'm imagining that some people who are listening are asking a question like, well, they felt better in that moment with you when they've crushed their belief on their thoughts.

但那些想法不会又回来吗？

Aren't those thoughts gonna come back?

负面情绪以后还会再回来吗？

Aren't negative feelings gonna come back again in the future?

那岂不是说他们的康复只是暂时的？

And doesn't that mean that their recovery is temporary?

不会。

No.

它们再也不会回来了。

They they never do.

这是一次解决，彻底了结。

It's a one and done.

我提供的是终身无限的愉悦感，达不到这个效果，全额退款。

What I offer is unlimited euphoria for the rest of your life and money back guarantee if you don't get that result.

但你说得特别重要，因为生活对每个人来说都不容易。

But it's so important what you said because life is hard for all of us.

当一个人经历了最初的突破并康复之后——我所说的康复，不只是指抑郁感减轻了。

And after someone has had that initial breakthrough and has recovered, and by recovery, I don't mean just feeling less depressed.

我的意思是，追求快乐，去发现那些全是胡说八道的东西。

I mean, getting to joy, getting to see what malarkey.

我不是在贬低谁，但当你抑郁的时候，你对自己说的那些话，不仅刻薄，根本就是一堆废话。

And I don't mean this in an insulting way, but when you are depressed, you're telling yourself things not only that are cruel, but they're just a lot of horse shit.

比如安妮觉得自己得卵巢癌是自己的错，这简直是荒谬到极点，因为那时候根本没人知道卵巢癌的病因。

Like when Anne was telling herself, It's my fault I got ovarian cancer, it was just like horse shit in the extreme because the cause of ovarian cancer wasn't known in those days.

就算你拼命想，也不可能让自己得癌症。

So you couldn't give yourself cancer if you tried.

但她却一直在狠狠责怪自己。

It would have been impossible, but she's beating up on herself like that.

而这恰恰就是她抑郁的根源。

And is the cause of her depression.

但这也恰恰是她最动人的地方，因为她一生都在帮助他人，对受苦的人充满爱意。

But it's also one of the most beautiful things about her because her life was devoted to helping other people and her love for others who were suffering.

这才是真正的承担责任。

And that's taking responsibility.

她的抑郁，其实就是责任感太强了，有点过头了。

Her own depression was just a little bit of too much of a good thing, a little too much responsibility.

但只要你搞清楚了自己的思维模式——那些认知扭曲，比如非黑即白、过度概括、自责、情绪化推理、‘应该’思维——不管你是哪一种，康复之后，这些念头还是会回来。

But once you know what your pattern is, what are the cognitive distortions, the all or nothing thinking or the overgeneralization or the self blame or the emotional reasoning or the should statements, whatever you get into, after you've recovered, those thoughts will come back.

这几乎是必然的。

And that's a guarantee.

不过在安妮的情况里，我觉得那些念头没再出现，但她只活了两年。

Now, in Anne's case, I don't think they did, but she only lived for two years.

但对我们大多数人来说，这些负面想法可能会每周都冒出来。

But for most of us, those negative thoughts can come back you know, every week.

我最近几周也掉进地狱了，因为丢了电脑，所有数据都没了。

I've been in hell myself the last couple weeks since I've lost my computer and all my data.

那可是我四十年的心血啊。

And that was forty years of my life.

天哪。

Oh my goodness.