注意力缺陷多动障碍以及任何人都能提升专注力的方法

这些都属于药代动力学的范畴，动力学指的是不同化合物在血液和大脑中的移动方式，这些因素会实实在在地影响一个人服用这些药物后是感觉良好，还是过于焦虑、嗜睡等等。

These are some of the pharmacokinetics, kinetics meaning movement of the different compounds within the bloodstream and brain that could, you could imagine in a very real way would impact whether or not someone would feel really good on one of these drugs or whether or not they would feel too anxious or too sleepy and so on.

让我们稍微退一步，先问一个问题：这些药物到底是什么？

Let's take a step back for a second and just ask, what are these drugs?

我们知道它们会增加多巴胺，但它们究竟是什么？

We know they increase dopamine, but what are they really?

利他林，也叫哌甲酯，与安非他命（俗称“快药”）非常相似。

Well, Ritalin also called methylphenidate is very similar to amphetamine speed, or what's typically called speed in the street drug nomenclature.

阿德拉，它还有其他各种名称，对吧？

Adderall, which goes by various other names, okay?

比如阿德拉、阿德拉XR、美达辛之类的药物。

So Adderall, Adderall XR, my diasis, things like that.

阿德拉本质上是安非他命和右旋安非他命的混合物。

Adderall is basically a combination of amphetamine and dextroamphetamine.

现在，你们中的一些人可能已经意识到，阿德拉就是安非他命，但我猜仍有不少人——甚至包括家长和孩子——并不知道这些药物像可卡因、安非他命、甲基苯丙胺一样，极其危险、极易成瘾，且滥用潜力极高。

Now, some of you probably realize this, that Adderall is amphetamine, but I'm guessing that there are a good number of you out there, perhaps even parents and kids that don't realize that these drugs like cocaine and amphetamine, methamphetamine, which incredibly dangerous and incredibly habit forming and have high potential for abuse.

这些药物的制药版本正是用于治疗注意力缺陷多动障碍（ADHD）的。

Well, the pharmaceutical versions of those are exactly what are used to treat ADHD.

它们虽然不像可卡因或甲基苯丙胺那样完全相同，但在结构和化学上非常相似。

And they're not exactly like cocaine or methamphetamine, but they are structurally and chemically very similar.

它们在大脑和身体中的总体作用基本相同，主要是增加多巴胺，同时也提高一种名为去甲肾上腺素或肾上腺素的神经调质水平——这些名称其实指的是同一种物质。

And their net effect in the brain and body is essentially the same, which is to increase dopamine primarily, but also to increase levels of a neuromodulator called epinephrine or norepinephrine also called noradrenaline and adrenaline, those names are the same.

在一定程度上，它们也会略微提升大脑和血液中的血清素水平，但血清素的作用并不明显。

And to some extent to increase levels of serotonin in the brain and blood, but not so much serotonin.

这种影响只是微乎其微。

That's just kind of a small smidgen of effect.

好的，所以多巴胺大幅上升，去甲肾上腺素和肾上腺素也大幅上升。

Okay, so dopamine way up, norepinephrine and adrenaline way up.

这会带来动力、驱动力、专注力和能量。

So that's motivation, drive, focus, and energy.

同时，血清素也会略有增加，而血清素主要让人感到平静和放松。

And to some extent, a little bit of serotonin, which is really more about feeling calm and relaxed.

你可以想象，为什么这种效应能对多巴胺和去甲肾上腺素起到良好的平衡作用。

And you can imagine why that would be a good balancing effect for dopamine and norepinephrine.

所以，我本质上想说的是，用于治疗ADHD的药物都是兴奋剂，它们与我们常听说的那些所谓危险的街头兴奋剂在外观上非常相似，几乎完全相同。

So what I'm essentially saying is that the drugs that are used to treat ADHD are stimulants and they look very much like, in fact, nearly identical to some of the so called street drug stimulants that we all hear are so terrible.

然而，我想强调的是，在适当剂量下，并由合格的精神科医生、神经科医生或家庭医生（必须是持证的医学博士）开具处方时，这些药物是有效的。

However, I do want to emphasize that at the appropriate dosages and working with a quality psychiatrist or neurologist or family physician does have to be a board certified MD that prescribes these things.

许多ADHD患者通过这些药物获得了显著的缓解，虽然并非所有人都有效，但很多人确实受益，尤其是如果在生命早期就开始治疗的话。

Many people with ADHD achieve excellent relief with these drugs, not all of them, but many of them do, especially if these treatments are started early in life.

现在既然了解了这些药物的性质，我想提出一个问题：为什么要开这些药？

So now knowing what these drugs are, I want to raise the question of why prescribe these drugs?

我的意思是，每个人都要自己或为孩子决定是否要服用这些药物。

I mean, everyone has to make a decision for themselves or for their child as to whether or not they're going to take these things or not.

我也想承认，有很多人——非常多的人——在没有被临床诊断为ADHD的情况下也在服用这些药物。

I also want to acknowledge that many people out there, many, many people out there are taking these drugs, even though they have not been clinically diagnosed with ADHD.

当我提到这些药物时，我特指的是利他林、阿得拉和莫达非尼，但更常见的是阿得拉，明白吗？

When I say these drugs, I'm specifically referring to Ritalin and Adderall and Modafinil, but more typically it's Adderall, okay?

人们使用可卡因和安非他命进行娱乐性服用，那是完全不同的东西，确实是一种危险行为，我强烈反对。

People using cocaine and amphetamine for recreational purposes, that's a completely different beast and it is indeed a beast and it's something that I strongly discourage.

然而，我知道高达百分之二十五的大学生，以及可能多达百分之三十五的17至30岁人群，会定期或间歇性地服用阿得拉，以帮助工作、学习和提升日常生活的专注力，即使他们并未被诊断为ADHD。

However, I'm aware that up to twenty five percent of college students and perhaps as many as thirty five percent of all individuals between the ages of 17 and 30 are taking Adderall on a regular or semi regular basis in order to work, in order to study and in order to function and focus in their daily life, even though they have not been diagnosed with ADHD.

这背后有一个完整的黑市。

There's a whole black market for this.

他们从有处方的人那里获取这些药物。

They're getting it from people with prescriptions.

我并不是来评判这些行为的。

I'm not here to pass judgment.

我只是想强调这些药物是如何起作用的。

I just want to emphasize how these drugs work.

它们在某些人身上能提升认知和专注力，对大脑有益，但在其他人身上却可能造成严重损害。

Some of the things that they do to enhance cognition and focus that actually serve the brain well in certain individuals and how they can be very detrimental in other individuals.

我刚才直接略过了这一点，但事实上，高达百分之二十五的年轻人在没有临床ADHD诊断的情况下服用阿得拉这类药物，这个数字高得离谱。

I sort of blew right past it, but the fact that in upwards of twenty five percent of young people are taking things like Adderall despite not having a clinical diagnosis of ADHD, well, that's ridiculously high number.

几年前，据估计，在没有被诊断为注意力缺陷多动障碍的情况下使用阿德拉和利他林的人数，仅次于大麻使用率。

A few years ago, it was estimated that Adderall use and Ritalin use without diagnosis of ADHD was second in incident only to cannabis.

但如今，在这个年龄段中，无处方使用阿德拉的人数已经超过了大麻的使用人数。

But actually now the consumption of Adderall without prescription is higher than the consumption of cannabis in that age group.

这意味着该年龄段中存在大量的兴奋剂使用现象。

So what that means is that there's a lot of stimulant use in that age group.

同时，也有许多成年人在使用并滥用兴奋剂以提升专注力。

And there are a lot of adults also using and abusing stimulants in order to gain focus.

我们完全可以展开一场讨论，探讨生活是否正变得越来越具有挑战性，以及对专注力的需求是否过度了。

And we could have a whole discussion about whether or not life is becoming more demanding, whether or not the need for focus is excessive.

而这正是人们这样做的原因。

And that's why people are doing that.

坦白说，这是一个有趣的讨论，但它并不会带给我们任何明确的答案。

Frankly, it's an interesting discussion, but it's not one that would deliver us to any answers.

相反，我更想聚焦于人们如今以及历来是如何通过自我用药来提升专注力的，对吧？

Rather I'd like to focus on the ways that people now and people have always been self medicating to increase focus, right?

咖啡因，我偶尔会使用，它长期以来一直被用作兴奋剂，以增加多巴胺、去甲肾上腺素，提升专注力和能量。

Caffeine, which I indulge some, don't think to access has long been used as a stimulant to increase dopamine, increase norepinephrine, increase focus and energy.

此外，它还通过所谓的环磷酸腺苷磷酸二酯酶通路发挥作用。

And in addition to that, it works through the so called cyclic AMP phosphodiesterase pathway.

记住，但凡你听到或看到‘ASE’，那通常是指一种酶；磷酸二酯酶参与将环磷酸腺苷等物质转化为细胞所需的能量。

Remember anytime you see, you hear an ASE, that's an enzyme phosphodiesterase is involved in the conversion of things like cyclic AMP into energy for cells and so forth.

简而言之，咖啡能给你能量。

Basically coffee gives you energy.

它让你感觉良好。

It makes you feel good.

它通过激活大脑中的特定神经回路来增强专注力。

And it increases focus because of the circuits that it engages in the brain.

人们长期以来一直在摄入咖啡因，并且至今仍在继续。

People have been taking caffeine and continue to take caffeine for ages.

过去人们还通过吸烟摄入尼古丁来提升专注力。

People also used to smoke cigarettes, nicotine in order to gain focus.

如今，由于对吸烟导致肺癌的合理担忧，这种情况已经不那么常见了，但市面上有很多电子烟。

Nowadays, that's less common because of the concerns, quite valid concerns about lung cancer from smoking, but there's a lot of vaping out there.

现在有很多人摄入尼古丁，这是香烟和大多数尼古丁电子烟中的活性成分，它能刺激大脑，使人更专注、更警觉。

There are a lot of people now consuming nicotine, which is the active substance in cigarettes and in most nicotine vapes that stimulates the brain to be more focused and more alert.

因此，通过服用或吸食刺激物来提高警觉性，并不是一个新想法。

So the idea of taking stimulants of consuming things or smoking things in order to increase alertness is not a new idea.

但在注意力缺陷多动障碍（ADHD）中，这些物质居然有效，这很令人惊讶，对吧？

It's just that in ADHD, it's surprising that these things would work, right?

我的意思是，如果问题在于注意力缺陷多动障碍，我们实际上讨论的是，那些被开具兴奋剂药物的儿童，按理说这些药物应该让他们更加多动、亢奋。

I mean, if the problem is attention deficit hyperactivity disorder, what we're really talking about here or children that are prescribed a drug that ought to be a stimulant, ought to make them hyper hyperactive.

但事实并非如此，这些药物反而能让他们稍微平静下来，或者至少帮助他们集中注意力。

And rather than doing that, it actually somehow serves to calm them a bit or at least allow them to focus.

原因如下。

Here's the reason.

儿童的大脑具有高度可塑性，意味着相比成人，他们的大脑能根据经验非常迅速地重塑和改变。

Children have a brain that's very plastic, meaning it can remodel itself and change in response to experience very, very quickly compared to adults.

作为儿童服用兴奋剂，如果你被诊断为注意力缺陷多动障碍，这能让前额叶的任务相关网络在适当的时候启动并活跃起来。

Taking stimulants as a child, if you are a child diagnosed with ADHD, allows that forebrain task related network to come online, to be active at the appropriate times.

由于这些孩子还年轻，这使他们能够学习什么是专注，并逐渐进入专注的状态。

And because those children are young, it allows those children to learn what focus is and to sort of follow or enter that tunnel of focus.

现在，通过服药，是在人为地创造专注状态。

Now, by taking a drug, it's creating focus artificially.

这种专注并不是因为他们对某件事特别感兴趣，而是通过化学手段诱导出一种专注的状态。

It's not creating focus because they're super interested in something, it's chemically inducing a state of focus.

坦白说，童年、学业以及成长为一个有功能的成年人，很大程度上在于学会即使不想做某事也能集中注意力。

And let's face it, a lot of childhood and school and becoming a functional adult is about learning how to focus even though you don't want to do something.

事实上，我在大学时有个小技巧，可能对你们中的一些人有用：如果我无法专注于正在学习的内容，我会骗自己，假装那是世界上最有趣的事情。

In fact, when I was in college, I had this little trick that may or may not work for some of you, which is if I couldn't focus on the material I was trying to learn, I would delude myself into thinking that it was the most interesting thing in the world.

我会对自己撒个谎，告诉自己：好吧，这个——我就不点明具体科目了。

I would just kind of lie to myself and tell myself, okay, this, I won't mention the subjects.

我 absolutely 爱这个。

I absolutely love this.

我只是告诉自己，我真的很喜欢它。

I would just, I would tell myself that I loved it.

我注意到，只要我有意识地调动那种渴望了解的神经回路——无论那在大脑中具体是什么机制，毫无疑问涉及多巴胺——就能让我集中注意力并记住信息，而且令人惊讶的是（或许也不算意外），我常常会对这些信息产生爱恋。

And I noticed that just that selective or deliberate engagement of that desire to know circuit, whatever that is in my brain, no doubt involves dopamine, allowed me to focus and remember the information and somewhat surprisingly, or perhaps not surprisingly, I would often fall in love with the information.

我发现，那就是我最喜爱的课程，也是我最想学习的内容。

I find that that was my favorite class or it was what I wanted to learn the most.

所以，这是一种人为的方式，但患有多动症的孩子却做不到，对吧？

So that's one way you can do it artificially, but kids with ADHD, they can't do that, right?

他们被要求坐好，结果却站起来十一次。

They're told to sit still and they end up getting up 11 times.

他们被告诉不能在课堂上随意发言，或者必须在座位上坐满十分钟，但尽管他们竭尽全力，就是做不到。

You know, they're told that they can't speak out in class or that they have to remain in their seats for ten minutes and they just, despite their best effort, they simply cannot do it.

他们极易分心。

They're highly distractible.

那么，我们该如何理解这个整体图景呢？我们需要更多的多巴胺，但这些患有多动症的孩子，却是通过药物获得多巴胺的，而这种药物本质上就是安非他命，对吧？

So what are we to make of this whole picture that we need more dopamine, but these kids with ADHD, they're getting their dopamine by way of a drug, which is for all the world amphetamines, right?

那就是兴奋剂。

It's speed.

这其实就是本质。

That's really what it is.

长期后果是什么？

What are the long term consequences?

短期后果是什么？

What are the short term consequences?

我们应该如何看待那些没有临床需求却服用这些药物的人？

And what should we make of people taking these drugs without a clinical need?

那会有什么后果？

What are the consequences there?

为了找到一些答案，我咨询了我的一位同事。

Well, in order to get to some of those answers, I went to one of my colleagues.

这位同事我其实认识很久了。

This is a colleague that I've actually known for a very long time.

我当他们本科生时是他们的助教。

I was their teaching assistant when they were an undergraduate.

他们后来获得了医学博士学位，并成为了一名儿科神经科医生，专门治疗从三岁到二十一岁各年龄段儿童的癫痫和注意力缺陷多动障碍（ADHD）。

They went on to get an MD, a medical degree, as well as a PhD and have become a pediatric neurologist that specializes in the treatment of epilepsy and ADHD in kids of all ages, from age three to 21.

这个年龄段范围很广，他们在这方面拥有丰富的知识。

That's the age range, pretty broad age range and has extensive knowledge in this.

而他们在这个讨论中特别值得关注的原因是，他们有一个年幼的儿子，现在正表现出ADHD的迹象，他们正处在是否要给孩子开阿得拉或类似药物的决策边缘。

And what makes them particularly interesting for sake of this discussion is that they have a child, a young boy, who's now showing signs of ADHD and they are on the threshold of trying to decide whether or not they will prescribe Adderall or something similar.

因此，我们就这个问题进行了讨论，在得知他们的孩子可能患有ADHD之前，我问了以下问题。

So we had a discussion about this and prior to learning that their child may have ADHD, I asked the following questions.

首先，我问：你对给小孩子使用安非他明有什么看法？

First of all, I asked, what do you think about giving young kids amphetamine?

他们的回答是：表面上看，这似乎很疯狂，但只要使用尽可能低的剂量，并随着孩子成长和注意力发展不断调整剂量，他们的观察是，受益的孩子比未受益的更多。

And their answer was, you know, on the face of it, it seems crazy, but provided that the lowest possible dose is used and that that dosage is modulated as they grow older and develop those powers of attention, their observation was that they've seen more kids benefit than not benefit from that.

当然，我并不是在建议人们该怎么做。

Now, I'm certainly not saying what people should do.

你当然得去看医生，因为我一直说，我不是医生。

You obviously have to go to a doctor because as I always say, I'm not a doctor.

我不会开任何药。

I don't prescribe anything.

我是一名教授，所以我教授知识。

I'm a professor, so I profess things.

在这里我要强调的是，如果你正在考虑给孩子服用利他林、阿得拉或任何类型的兴奋剂，当然，还有什么比孩子的健康更重要的呢？

And here I'm professing that you talk to your doctor if you're considering giving Ritalin or Adderall or any type of stimulant to your child, of course, what could be more important than the health of your child?

但这个回答非常有趣，因为通常我们听到的都是‘用药’或‘不要用药’。

But it was a very interesting answer because typically we hear yes medicate or don't medicate.

我们很少听到这种观点：药物剂量应该随着人的一生而调整，并且以某种特定方式调整。

Rarely do we hear that the medication should be adjusted across the lifespan and in any particular kind of way.

现在，这位我现在的朋友兼同事，对大脑运作机制有如此深入的专业知识，却正在考虑让孩子服用这类药物。

Now, the fact that this person, this now friend of mine and colleague of mine has so much expertise in the way that the brain works and is considering putting their child on such medication.

我说，你知道吗，你为什么不等孩子进入青春期再做决定呢？

I said, you know, why wouldn't you wait until your kid reaches puberty?

我的意思是，我们知道在男孩和女孩身上，青春期会带来睾酮和雌激素的增加，这不仅会显著改变身体的外观，也会极大地改变大脑的功能。

I mean, we know that in boys and in girls, are increases in testosterone and estrogen during puberty that dramatically change the way that the body appears, but also that dramatically change the way that the brain functions.

特别是，我们知道青春期会激活所谓的额颞叶任务相关执行功能。

In particular, we know this, that puberty triggers the activation of so called frontotemporal task related executive functioning.

这只是专业术语，意思是能够集中注意力、引导自己的注意力、控制自己的冲动。

That's just fancy science speak for being able to focus, being able to direct your attention, being able to control your impulses.

看看一个小孩子或者一只小狗，再看看一个大一点的孩子或者一只成年狗，它们自发行为的水平和模式截然不同。

Look at a small child or look at a puppy and then look at an older child or look at a dog, very different levels, patterns of spontaneous behavior.

小孩子会不停地动来动去。

Young children move around a lot.

我不想说他们‘坐立不安’，因为这个词听起来像是他们在干坏事，虽然他们可能真的在干坏事，但也不一定。

I don't want to say shifty because that makes it sound like they're up to something bad, which they might be, but they don't have to be up to something bad.

他们经常坐不住，爱扭动。

They fidget a lot.

小狗也是这样，一切事物都是刺激源。

So do puppies, everything's a stimulus.

随着动物和人类年龄增长，他们会学会控制自己的行为，即使不想，也能安静坐着、倾听和集中注意力。

As animals and humans get older, they learn how to control their behavior and sit still, listen, and focus, even if they don't want to.

因此，人们认为，通过药物帮助孩子尽早获得这种静止能力，将有助于他们在未来保持这种能力。

So giving a drug that allows a child to access that stillness early on, it's thought will allow them to maintain that ability as time goes on.

但我决定再深入一步。

But I decided to push a little bit further.

我说：为什么不在青春期前或青春期后做，而要在现在做呢？

I said, well, why would you do it now as opposed to during puberty or after puberty?

他们的回答非常具体，我认为非常重要。

And their answer was very specific and I think very important.

他们说：你看，神经可塑性在儿童时期最强，大约25岁后逐渐减弱，但从3岁到12或13岁期间，神经可塑性极高。

What they said was, look, neuroplasticity is greatest in childhood and tapers off after about age 25, but neuroplasticity from age three until age 12 or 13 is exceedingly high.

他们说得对。

And they're right.

当你回过头来看关于神经可塑性的文献时，你会说儿童期和年轻成年期的可塑性远高于成年期，但早期儿童期的可塑性才是大脑能够以最快速度重塑的最关键阶段。

When you sit back and you look at the literature on neuroplasticity, you'd say childhood plastic ity and young adult plasticity is much greater than adult plasticity, but that early childhood plasticity is far and away the period in which you can reshape the brain at an accelerated rate.

因此，这与临床文献高度一致，毫不意外，他们作为临床医生认为早期治疗至关重要。

So this lines up really well with the clinical literature, not surprisingly, they're a clinician that early treatment is key.

如果你有机会与一位优秀的医生合作，尽早治疗这些问题，这些药物可以帮助前额叶回路、这些与任务相关的回路达到应有的功能水平，让孩子们学会在各种情境下集中注意力。

If you have the opportunity to work with a quality physician and treat these things early, these drugs can allow these frontal circuits, these task related circuits to achieve their appropriate levels of functioning and for kids to learn how to focus in a variety of different contexts.

那么，这是他们应该做的唯一事情吗？

Now, is that the only thing that they should be doing?

当然不是。

Of course not.

所以我接下来问的问题是，我们该如何看待所有这些与饮食相关的内容呢？

So the next question I asked was, what should we make of all this diet related stuff, right?

我以前听说过，所谓的消除饮食法——即不摄入糖、乳制品或麸质——据说都能改善多动症的症状。

I've heard before that the so called elimination diet or ingesting no sugars or no dairy or no gluten, that all of these things have been purported to improve symptoms of ADHD.

许多家长和患有ADHD的人会不遗余力地寻找导致问题的具体食物，以及孩子可以安全食用的食物，试图正确地塑造他们的大脑，避免终身患ADHD。

And people and parents with ADHD go to fanatic lengths to try and find the exact foods that are causing problems and the exact foods that the kids can eat in order to try and get their brain wired up right and correctly, and to avoid lifelong ADHD.

他们的回答非常有趣。

Their answer was really interesting.

但在告诉你们他们的答案之前，我想先和你们分享一些关于饮食及其所避免或摄入的各类食物是否与我们的注意力水平有关的研究和数据。

But before I tell you their answer, I want to tell you the studies and the data related to this question of whether or not food and the constellation of foods that one avoids and will eat has anything to do with our levels of attention.

特别是，这些因素是否能作为治疗ADHD的干预手段。

And in particular, whether or not that can be used as a leverage point to treat ADHD.

你可以想象，在任何研究中探讨饮食和营养的作用都存在挑战，尤其是在ADHD研究中，为什么呢？

So you can imagine the challenges of exploring the role of diet and nutrition in any study, but especially in a study on ADHD, why?

正如我之前提到的，患有多动症的儿童，以及成年ADHD患者，往往会倾向于选择含糖食物，或任何能提升其多巴胺水平的食物。

Well, because as I mentioned before, children with ADHD and it turns out adults with ADHD tend to pursue sugary foods or any types of food that increase their levels of dopamine.

无论他们是否意识到这一点，他们似乎本能地被这些食物吸引，试图以此缓解注意力不集中和冲动行为。

They are naturally drawn to those foods, whether or not they realize it or not, presumably as a way to try and treat their lack of focus and impulsivity.

因此，在我即将与你们分享的这项研究中，并未使用任何药物治疗。

So in this study that I'm about to share with you, there was no drug treatment.

这是一项仅通过调整饮食进行的实验，共涉及100名儿童，其中50名被分配到所谓的排除饮食组——即剔除某些特定食物的特殊饮食，另外50名则属于对照组。

It was just a study manipulating diet and involved a 100 children, 50 in the so called elimination diet group, the special diet where certain foods were eliminated and 50 in the so called control group.

然而，作为一项设计严谨的随机对照试验，本研究还采用了交叉设计，即在研究的某个阶段，孩子们会作为自己的对照组。

However, being a well designed randomized controlled trial, this study also included a crossover meaning where the kids would serve as their own control or control group at a certain portion of the studies.

他们会进入一个组，剔除某些食物。

They would be in one group where they eliminated certain foods.

在研究的某个阶段后，他们会调换到另一个组。

And then after a period of time in the study, they would swap to the other group.

这种研究设计方式非常有力，原因你可以想象，因为它能减少因个体差异带来的干扰和影响。

This is a powerful way to design a study for reasons that you can imagine, because you start to eliminate changes and effects due to individual differences.

总之，总共100名儿童，任何时间段内每组各50人。

In any case, a 100 children total, 50 in each group at any one period in time.

他们观察到的效果极其显著。

And the effects that they observed were extremely dramatic.

在统计学和科学数据分析中，我们谈论p值，即概率值。

In the world of statistics and analysis of scientific data, we talk about P values, probability values.

某件事偶然发生的可能性有多大。

What's the likelihood that something could happen according to chance.

通常，显著性阈值会设定为p值小于0.05。

And typically the cutoff would be something like P less than 0.05.

这基本上意味着这些效应由偶然引起的概率小于0.05。

That's less than 0.05 chance essentially of the effect being due to chance.

然而，在这项研究中，每一个效应的P值都小于0.0001，表明观察到的效应由偶然引起的概率极低。

However, in this study, every single one of the effects is P less than 0.0001, very, very infinitesimally small probability that the effects observed could be due to chance.

那么这些效应是什么呢？

So what were these effects?

这些效应包括专注力增强、冲动减少，甚至在试图静坐时也更少地乱动。

These effects were enhanced ability to focus, less impulsivity, even less tendency to move when trying to sit still.

因此，从心理专注力到身体控制能力，所有方面在进行排除饮食组时都得到了改善。

So everything from mental focus to the ability to control their bodies improved when they were in the elimination diet group.

被排除了哪些食物？

What was eliminated?

这项研究中的排除饮食是一种所谓的低抗原饮食。

Well, the elimination diet in this particular study was a so called oligoantigenic diet.

这种饮食要求每个孩子接受检测，以确定他们对哪些食物存在抗体，也就是说，他们对这些食物有轻微过敏。

It was a diet in which each kid took a test to determine which foods they had antibodies for, meaning that they were mildly allergic to.

在这项研究中，孩子们不能对任何食物有严重过敏，因为正如我之前提到的，他们在研究的某个阶段实际上作为对照组，食用了包括那些他们轻度过敏的食物在内的各种食物。

Now in this study, it was very important that the kids not be extremely allergic to any food, because as I mentioned before, they actually served as a control at one point in the study where they were eating all sorts of foods, including foods that they had mild allergies to.

所以这项研究的基本结论是，消除儿童过敏的食物可以显著改善他们的多动症症状。

So basically what the study said was that eliminating foods to which children have allergies can dramatically improve their symptoms of ADHD.

这项研究并不令人意外，因为它发表在《柳叶刀》等高质量期刊上，且受试者数量庞大，因此在全世界引起了轰动。

And this study, not surprisingly, because it was published in such a high quality journal, Lancet, etcetera, large number of subjects set the world on fire.

人们对此结果感到非常兴奋，因为在没有任何药物治疗的情况下，观察到了多动症症状的显著改善。

People were extremely excited about these results because here in the absence of any drug treatment, there was a significant improvement in ADHD symptoms observed.

随后，批评声出现了。

And then came the criticisms.

在这项研究之后，发表了大量专门重新分析这些数据的论文。

So many papers were published after this specifically dealing with reanalysis of these data.

我想公平地说，论文中的数据看起来不错，但这项研究的整体设计结构存在一些批评意见。

And I want to be fair in saying that the data in the paper look good, but there are criticisms of the overall structural design in the study.

我不会深入所有细节，因为关于统计方法和如何分析这类数据的问题非常复杂，但确实存在质疑。在科学中，质疑是健康的，尤其是在决定是否让儿童食用某种食物或给予某种药物时。

Don't I want to go into all the details exactly because it gets really nuanced about some of the statistics and the way that one examines these types of data, but there was skepticism and in science skepticism is healthy, especially when making decisions about whether or not to treat or feed children one food or another or give them one drug or another.

现在我想回到我一位儿科神经科医生朋友的故事，他治疗ADHD患儿，自己的孩子也正处在可能开始服用药物治疗ADHD的边缘。

Now I want to return to the story of my friend who is a pediatric neurologist and treats ADHD and has a child who is on the precipice of perhaps starting to take drugs for the treatment of ADHD.

我问了一个简单的问题：你有没有看到有效的饮食方式？

I asked the simple question, do you see an effective diet?

我的意思是，当父母控制孩子的饮食时，是否会对孩子对利他林、阿得拉等ADHD药物的反应产生正面、负面或无影响，或者能否帮助孩子完全避免使用这些药物。

Meaning when parents control the diet of their children, does it make a positive or negative or no difference in terms of the way that the kids respond to ADHD drugs like Ritalin and Adderall, or whether or not it can help them avoid treating with those drugs entirely.

她的回答非常直接。

And her response was very straight forward.

她说，消除简单糖分会产生显著而积极的效果。

She said, elimination of simple sugars has a dramatic and positive effect.

她已经在数十名，甚至数百名患者身上反复观察到这一现象。

She's observed that over and over and over again in many dozens, if not hundreds of patients.

好吧，这并不是一项经过同行评审的研究。

Okay, now that's not a peer reviewed study.

这是我向你们传达的一个轶事性陈述，但它基于非常丰富的经验。

That's a statement that I'm conveying to you anecdotally, but it's highly informed one.

我说，那这些排除饮食呢？

I said, what about these elimination diets?

她说，我也找到了其他支持这一观点的资料，这些低抗原饮食是有争议的。

She said, and I found other sources to support this, that these oligoantigenic diets are controversial.

有很多人非常相信，要找出你过敏的所有物质，并确保你和你的孩子避免食用这些食物。

There are many people who really believe in identifying all the things that you're allergic to and making sure that you and especially your kids avoid those foods.

然而，在同行评审的科学文献中，正逐渐出现另一种观点，表明当孩子不接触某些食物，特别是坚果之类的食品时，反而会对其产生过敏。

However, there's another camp that's starting to emerge in the peer reviewed scientific literature showing that when kids are not exposed to certain foods, in particular nuts and things of that sort, they develop allergies to those foods.

等到后来再接触这些食物时，就会引发严重问题。

And then when exposed to them later, they cause real problems.

因此，关于儿童过敏以及低抗原饮食是否合适，存在着大量讨论、争议甚至激烈的对抗。

So there's a whole galaxy of discussion and controversy and outright fighting about allergies in kids and whether or not the oligoantigenic diet is the appropriate one.

不过，在我为本节目采访的四位神经科医生和精神科医生中，每一位都表示，患有多动症的孩子应尽可能避免摄入高糖和精制糖类食物。

However, out of the four neurologists and psychiatrists that I spoke to about ADHD in preparation for this, every single one said children with ADHD as much as possible should be encouraged to avoid high sugar and simple sugar foods of most kinds.

如果能发现某些特定食物会加重他们的症状，那么显然剔除这些食物是有益的。

And if they can find particular foods that exacerbate their symptoms, obviously eliminating those foods is beneficial.

而加剧他们症状的食物会随时间变化。

And the foods that exacerbate their symptoms change over time.

所以我不喜欢给出一个复杂的答案，但我也讨厌给出一个不完整的答案。

So I don't like giving a complicated answer, but I also don't like giving an incomplete answer.

这告诉我，患有注意力缺陷多动障碍的儿童，尤其是年幼的孩子，应该尽量少吃糖，特别是简单糖类。

What this tells me is that children, and especially young children who have ADHD should probably not eat much sugar in particular, simple sugars.

此外，探索他们是否对已食用的食物存在过敏反应可能是个好主意。

In addition to that, exploring whether or not they have existing allergies to foods they already consume might be a good idea.

至少这篇由Pelser等人发表在《柳叶刀》上的论文似乎支持这一点。

At least that's what this paper, the Pelser et al Lancet paper seems to speak to.

我应该提一下，这篇论文发表于2011年。

And I should mention that that paper was published in 2011.

自那以来，已有数十项研究探讨了同一问题，以及对所有这些数据的荟萃分析。

Since then, there have been many dozens of studies exploring the same thing, as well as meta analysis of all those data.

研究确实表明，饮食在消除或至少减轻注意力缺陷多动障碍症状方面可能发挥非常重要的作用，以至于一些儿童完全不需要服药，或者在成年后逐渐停药。

And it does appear that diet can have a highly significant role in eliminating or at least reducing the symptoms of ADHD so much so that some of the children are able to not take medication at all or eventually wean themselves off medication as young adults and as adults.

一个有趣的问题是，成年人是否应该调整饮食，以提高自己的专注力，即使他们目前的专注力已经正常，但希望进一步提升，或减轻已有的成人注意力缺陷多动障碍。

One interesting question is whether or not adults should modify their diet in order to increase their levels of focus if they're already having normal levels of focus, but would like more or would like to reduce existing adult ADHD.

这是一个有趣且更具争议性的话题。

That's an interesting and even more controversial topic.

这把我们直接带入了所谓的欧米伽-3脂肪酸的领域。

It brings us right into the realm of what are called omega-three fatty acids.

我在这档播客中多次谈到欧米伽-3脂肪酸的已知益处，特别是每天摄入一克（1000毫克）甚至高达两千毫克的欧米伽-3中的EPA成分，已被证实具有抗抑郁、改善情绪的作用，并对心血管系统有重要保护作用。

I've talked many times on this podcast about the known benefits of omega-three fatty acids in particular, getting one gram, one thousand milligrams or more, even as much as two thousand milligrams each day of the so called EPA component of omega-three fatty acids known to have antidepressant effects, mood elevating effects known to have important effects protecting the cardiovascular system.

现在看来，免疫系统同样受益于欧米伽-3脂肪酸，尤其是含有至少一克EPA的欧米伽-3，它们非常有益。

I think it's now clear that the immune system also benefits that omega-three fatty acids that include a gram or more of EPAs, they are very beneficial.

通常这是通过鱼油实现的，液态鱼油最具成本效益，但也有胶囊形式。

Typically that's done through fish oil, liquid fish oil is going to be the most cost efficient, but there are capsule forms.

对于不喜欢鱼油的人，你也可以通过其他方式摄取，比如某些藻类或磷虾等。

For those of you that don't like fish oil, you can ingest this through other means you can get from certain algaes or krill, etcetera.

你需要根据自己的特定饮食习惯来选择，无论你是素食者、纯素食者还是杂食者等等。

You have to make it compatible with your particular diet, whether or not you're vegan or vegetarian or omnivore, etcetera.

Omega-3已被证明具有所有这些健康益处。

Omega-three have been shown to have all these positive health benefits.

它们对专注力和注意力有正面影响吗？

Do they have positive effects on focus and attention?

答案是，你可以找到支持这一说法的研究，且效果显著，但效果是适度的。

And the answer is you can find studies that support that statement and the effects are significant, but the effects are modest.

你也可以找到显示无效果的研究。

You can also find studies that show no effect.

然而，就像Omega-3与抗抑郁药一样，每天摄入一克或更多EPA的Omega-3脂肪酸，能让重度抑郁症患者减少抗抑郁药的剂量；同样，成人每日摄入含一千毫克或更多EPA的Omega-3脂肪酸，似乎也能让患有注意力缺陷多动障碍或轻度注意力问题的成人减少药物剂量，极少数情况下甚至完全停药。

However, much like with omega-3s and antidepressants, whereby ingestion of omega-three fatty acids of a gram or more of EPA per day allows people with major depression to get away with taking lower doses of antidepressant medication, it does seem that ingestion of omega-three fatty acids in adults that include EPAs of a thousand milligrams or more can allow adults with ADHD or mild attention deficit issues to function well on lower doses of medication and in rare cases to eliminate medication entirely.

因此，这再次表明Omega-3脂肪酸是有益的。

So what this says is once again, that the omega-three fatty acids are beneficial.

它们能治愈或消除注意力缺陷多动障碍吗？

Will they cure or eliminate ADHD?

我认为可以安全地说：不能。

I think it's safe to say no.

它们扮演着支持性或我们所说的调节性角色。

They are playing a supportive or what we call a modulatory role.

就像良好的睡眠对几乎所有方面——你的免疫系统、思考能力、情绪调节能力——都起到支持和调节作用一样，它也在调节这一过程。

Just like good sleep plays a supportive and modulatory role for essentially everything, your immune system, your ability to think, your ability to regulate your emotion, it's modulating that process.

这一点调节作用非常重要，需要特别强调。

This component of modulation is extremely important to highlight.

我想花一点时间来谈谈这个，因为这在ADHD以及当前大量相关信息的背景下尤其重要。

And I think I want to spend a moment on it because this is especially important in the context of ADHD and all the information that's out there.

有一些生物过程是由特定化合物如多巴胺所介导的。

There are biological processes that are mediated by particular compounds like dopamine.

例如，感到动力和集中注意力的能力是由大脑中释放多巴胺的神经回路所介导的。

So for instance, the ability to feel motivated and to attend to focus is mediated by the circuits in the brain that release dopamine.

然而，注意力也受到你休息状态的调节。

However, attention is also modulated by how rested you are.

如果你想彻底丧失思考能力，就连续两天不睡觉，对吧？

If you want to eliminate your ability to think well at all, just stay up for two nights and don't sleep at all, right?

如果你这样做，你就会改变大脑中对各种刺激作出反应的神经回路，变得极易分心。

If you do that, you will have modulated the circuits in your brain that respond to various things, and you will be highly distractible.

你会情绪波动剧烈。

You will be highly emotional.

你会觉得自己糟透了，但这并不意味着睡眠直接控制注意力和专注力。

You will feel like garbage, but that doesn't mean that sleep mediates focus and attention.

它只是间接地调节这些功能。

It modulates it indirectly.

同样，我认为这些Omega-3脂肪酸，特别是EPA，对情绪非常有益，似乎对注意力也有帮助，但它们并不直接调控注意力和情绪。

Likewise, I think these omega-three fatty acids in particular the EPAs, are so beneficial for mood and apparently also for attention, they don't directly mediate attention and mood.

它们的作用是调节相关的神经回路。

What they do is they modulate those circuits.

它们让多巴胺更容易被获取。

They make dopamine more available.

它们让现有可用的多巴胺更有可能与神经元上的各种受体结合。

They make whatever dopamine is available, more likely to bind to the various receptors that are present on neurons and so forth.

我认为这一点非常重要，因为同样地，任何关于营养的讨论都必须包含这样一个框架：这种饮食、排除饮食，或者其他任何饮食，比如生酮饮食，是在调节还是直接介导某个过程？

And I think this is very important because likewise diet and any discussion about nutrition has to include this framework of is the diet, the elimination diet, or whether or not it's some other diet or esoteric diet, ketogenic diet, is it modulating or mediating a process?

在ADHD的背景下，它很可能是在调节这一过程。

And most likely in the context of ADHD, it's modulating that process.

因此，如果ADHD症状较轻，或发现得足够早，或与药物治疗相结合，那么饮食可能有助于帮助儿童或成人更好地集中注意力，但它不会是那个彻底改变一切的开关。

So if the ADHD is mild or if it's caught early enough, or if it's in conjunction with pharmacology, with a prescription treatment, well, then it might help guide the child or adult to a better place of being able to focus, but it's not going to be the switch that flips everything.

但这并不意味着摄入错误的食物、含糖食物或你过敏的食物是好的做法，它们仍然会有害。

Now that does not mean that consuming the wrong foods, sugary foods, or foods that you happen to be allergic to is a good idea, it will still be detrimental.

我希望这个概念框架能有所帮助，因为如果你上网搜索，无论你是否患有ADHD，都会被各种ADHD饮食、寡抗原饮食、排除饮食、补充剂、EPA等信息淹没。

So I hope that conceptual framework helps because if you go online, if you're somebody with ADHD or not, you are going to be bombarded with the ADHD diet, oligoantigenic diet, the elimination this, the supplement, that EPA.

我认为理解你所讨论的是在直接介导一个过程，还是在调节一个过程，非常重要。

And I think it's very important to understand whether or not you're talking about something mediating a process or modulating a process.

像利他林、阿得拉这样的药物，是直接作用于介导注意力和专注力的神经回路和神经化学机制。

Now drugs like Ritalin, drugs like Adderall, they are tapping into the circuitries and the neurochemistries that mediate attention and focus.

它们并不是治疗这些神经回路或增强专注力相关回路的唯一选择或唯一途径。

They are not the only alternatives or the only choices rather for treatment of these circuits and enhancement of the circuits for focus.

我将在几分钟内介绍一些不太为人所知但非常有效的其他替代方法和行为干预手段。

I'm going talk about other alternatives and some behavioral alternatives that are not very well known, but are very, very effective in a few minutes.

但我真的想明确区分‘调节’和‘介导’，因为这对任何试图调节或干预自身大脑过程的人来说都至关重要。

But I really want to make this clear distinction between modulation and mediation because it's vital for anyone that's trying to modulate or mediate anything within their own brain.

如果你们中有人对寡抗原饮食与ADHD的关系感兴趣，并想了解除了2011年那篇颇具争议的《柳叶刀》研究之外的更近期研究，

If any of you are interested in this oligoantigenic diet, as it relates to ADHD, and you want to explore a more recent study besides that classic 2011 Lancet study, that's rather controversial.

去年（2020年）有一篇论文发表在《精神病学前沿》上。

There's a paper that was published in Frontiers in Psychiatry just last year, 2020.

这篇论文的标题是《寡抗原饮食能可靠地改善儿童ADHD评分量表得分，辅以视频评估》。

The title of the paper is Oligoantigenic Diet Improves Children's ADHD Rating Scale Scores Reliably in Added Video Rating.

所谓‘视频评估’，是指他们采用了额外的注意力与专注力测量方法。

The added video rating is just that they're using an additional measure of focus and attention.

再次强调，这是2020年《精神病学前沿》的研究。

Again, that's Frontiers in Psychiatry 2020.

我会在字幕中附上这篇论文的链接。

I'll put a link to it in the caption.

这是一篇更近期的研究，供你参考。

And that's a more recent study for you to peruse.

我们已经讨论了专注的神经回路和专注的化学机制，但还没有探讨什么能让我们更好地专注，以及真正意义上的更好专注是什么。

So we've talked about the neural circuits of focus and the chemistry of focus, but we haven't talked yet about what would make us better at focusing and what focusing better really is.

让我们退一步，思考一下我们是如何专注的，以及如何提升专注能力。

So let's take a step back and think about how we focus and how to get better at focus.

我将与你们分享一种工具，有大量研究数据支持，它能在单次练习中永久性地提升你的专注能力。

And I'm going to share with you a tool for which there are terrific research data that will allow you in a single session to enhance your ability to focus in theory forever.

接下来我要读给你们的内容来自一本优秀的书籍，如果你们对神经科学、冥想、默认模式网络等相关话题感兴趣，我强烈推荐这本书。

What I'm about to read you is from an excellent book that I recommend if any of you are interested in neuroscience and things like meditation and default mode networks and things of that sort.

这本书名为《改变的特质》。

The book is called Altered Traits.

科学揭示了冥想如何改变你的心灵、大脑和身体。

Science reveals how meditation changes your mind, brain, and body.

不，我并不会试图说服你们去冥想。

And no, I'm not going to try and convince you to meditate.

我将与你们分享书中的一段小内容，其中涉及一些与专注力相关的非常重要研究数据。

I'm going to share with you a small passage in the book that relates some research data related to focus that are very important.

如果你想冥想，那是你的选择，这是另一回事。

If you want to meditate, that's your choice, that's a separate matter.

这本书由丹尼尔·戈尔曼和理查德·戴维森合著。

This is a book by Daniel Goleman and Richard Davidson.

我应该提一下，戈尔曼是一位知名作家。

And I should just mention that Goleman is a well known author.

他写过关于情绪智力等方面的书籍。

He's written books on emotional intelligence and so forth.

理查德·戴维森也拥有博士学位。

Richard Davidson is also a PhD.

他是心理学和精神病学教授，任职于威斯康星大学麦迪逊分校。

He's a professor of psychology and psychiatry, and he is at a University of Wisconsin Madison.

他在大脑状态及其调控方面做了出色的研究。

He's done terrific work on brain states and modulation of brain states and so forth.

我们即将讨论的是注意力何时有效，何时失效。

What we're about to talk about is when attention works and when attention falters.

我们将具体讨论所谓的注意瞬脱，这不是真正的眼睑眨动。

And what we are specifically going to talk about are what are called attentional blinks, not actual eye blinks.

我们稍后会谈到注意瞬脱，但现在先讨论这个概念。

We're going to talk about that in a few minutes, but we're going to talk about attentional blinks.

我这里是在转述，因为戈尔曼和戴维森对此的表述非常优美。

I'm paraphrasing here because Goldman and Davidson wrote about this so beautifully.

我宁愿转述他们的原话，也不愿自己杜撰一个更乏味或更差的表达方式，但我必须注明他们的贡献。

I'd rather paraphrase from them than try and just make up a new way to say it that is less interesting or less good, but I want to credit them.

如果你想象一个‘寻找瓦尔多’的任务，注意瞬脱就很容易理解。

Attentional blinks are really easy to understand if you think about a where's Waldo task.

‘寻找瓦尔多’这个任务中，画面里有许多人物、物体和各种元素，而瓦尔多戴着条纹帽、戴着眼镜，是个瘦瘦的人，你需要在其中找到他。

This task, where's Waldo, where there are a bunch of people and objects and things in a picture and somewhere in there is Waldo with the striped hat and the glasses and kind of a skinny dude, and you have to find Waldo.

这是一项视觉搜索任务，目标是寻找具有明显特征的物体，但这个物体被淹没在大量可能被误认为是瓦尔多的其他元素之中。

And so it's a visual search and it's visual search for an object that has distinct features, but is embedded in this ocean of other things that could easily be confused as Waldo.

所以你会不停地看、看、看、看、看、看、看，然后终于找到了瓦尔多。

So you tend to look, look, look, look, look, look, look, and then you find Waldo.

孩子们能做这个，他们喜欢做；成年人可能喜欢也可能不喜欢，但他们也能做到。

Kids can do this, they enjoy doing this, adults may or may not enjoy it, but they can do it too.

他们找到了瓦尔多。

They find Waldo.

当你找到瓦尔多，或者在其他视觉搜索任务中找到目标时，那一刻你的神经系统会稍微庆祝一下，通过释放让你感觉良好的神经化学物质来庆祝。

When you find Waldo or when you search for a target in some other visual search task, at that moment, your nervous system celebrates a little bit and it celebrates through the release of neurochemicals that make you feel good.

你找到了，于是停了下来。

You found it and you pause.

这个停顿很有趣，因为根据大量实验，就在你停顿并轻微庆祝的那一刻——无论多么轻微——你都无法看到紧挨着它的另一个瓦尔多。

Now, the pause is interesting because when you pause, what we know from many experiments is that in that moment of pause and mild celebration, however mild, you are not able to see another Waldo sitting right next to it.

这意味着，当你专注于某物、进行搜索并识别出视觉目标时，你的注意力就‘闪烁’了一下，短暂地关闭了。

So what this means is in attending to something, in searching and in identifying a visual target, your attention blinked, it shut off for a second.

我们还有更正式、更实验室化的方式来研究这种现象。

And there's a more formal and more laboratory type way that we look at this.

更典型的做法是给人一组字母或一串数字。

The more typical way to do this is to give someone a string of letters or a string of numbers.

在此之前，你会告诉他们：留意字母R和Z。

And beforehand you tell them, be on the lookout for the letters R and Z.

明白吗？

Okay?

你只需要看着这串数字过去，里面会出现字母R和字母Z，试着把它们都找出来。

You're just going to watch this string of numbers go by and there will be a letter R in there and there will be a letter Z in there and try and spot them both.

你会发现，当你呈现这串数字后，当他们看到R时，会意识到它并有意识地捕捉到，但却往往会错过Z，就像在找Waldo的例子中一样。

And what you find is when you present that string of numbers and then they see the R, they see the R, they register it consciously and they tend to miss the Z, just like in the Waldo type example.

当然，这些数字是快速滚动的，但他们还是能发现R。

Now, of course the numbers are going by pretty quickly, but they can spot the R.

如果你事先告诉他们只找Z，他们也能发现Z。

They could also spot the Z if you told them beforehand, just spot the Z.

在这两种情况下，数字的滚动速度都是一样的。

And the numbers are moving through at the same rate in both conditions.

这意味着，在每种情况下，你都能看到R或Z，但当你试图同时看到两者时，看到第一个就会让你错过第二个。

So what that means is that in every case you are capable of seeing the R or the Z, it's when you try and see both that seeing the first one prevents you from seeing the second one.

这就是我们所说的注意瞬脱。

It's what we call an attentional blink.

我们经常遇到这种情况，而患有注意力缺陷多动障碍的人比普通人经历更多的注意瞬脱。

We do this all the time and people with ADHD tend to have many more attentional blinks than people that don't.

这一点对儿童和成人都适用。

And this is true for children and for adults.

这是一个重要的观点。

This is an important point.

重要到我想强调两遍，以防你故意眨了眼。

So important that I want to emphasize it twice in case you intentionally blinked.

如果你看到了你正在寻找的东西，或者对某件事非常感兴趣，你肯定会错过其他信息，部分原因是你过度专注于某一点。

If you see something that you're looking for, or you're very interested in something, you are definitely missing other information in part because you're over focusing on something.

这引出了一个关于注意力缺陷多动障碍成因的有趣假设：我们一直认为他们无法集中注意力，但我们知道他们完全可以专注于自己非常在意的事情。

And this leads to a very interesting hypothesis about what might go wrong in ADHD, where we've always thought that they cannot focus and yet we know they can focus on things they care very much about.

也许，仅仅是也许，他们经历的注意力盲点比没有ADHD的人更多。

Well, maybe, just maybe, they are experiencing more attentional blinks than people who do not have ADHD.

事实上，现在已有数据支持这种可能性，即实际情况确实如此。

And indeed there are data now to support the possibility that that's actually what's happening.

这对任何患有ADHD的人来说都应该是令人振奋的。

And that should be exciting to anyone that has ADHD.

对任何希望提升专注力和注意力的人来说，这也应该令人振奋。

It should also be exciting to anyone that cares about increasing their focus and their ability to attend.

这表明，支撑我们专注力、注意力以及消除分心能力的这些神经回路，并非只是无法集中注意力。

What this is saying is that these circuits that underlie focus in our ability to attend and our ability to eliminate distraction, they aren't just failing to focus.

那只是对结果的一种语义性描述。

That's just a semantic way of describing the outcome.

它们实际上是过度专注于某些事物，因而忽略了其他事物。

They are over focusing on certain things and thereby missing other things.

因此，我们或ADHD患者的分心现象，可能是因为过度专注于某些元素，从而错过了本应关注的其他元素。

And so our distractibility or the distractibility of somebody with ADHD could exist because they are over focusing on certain elements and they are therefore missing other elements that they should be attending to.

所以他们真正需要的是我们称之为开放监控的这种特性。

So what they really need is this property that we call open monitoring.

开放监控在刚才提到的那本书中有描述，通常与那些进行过大量冥想的人有关，比如所谓的内观冥想，或者花了很多时间学习如何进行开放凝视视觉分析和开放凝视思考。

Now open monitoring is something that's described in the book that I just referred to, and that typically is associated with people who have done a lot of meditation, so called Vipassana meditation, or have spent a lot of time learning how to do what's called open gaze visual analysis and open gaze thinking.

但有一种更简单的方法可以绕过所有这些复杂过程。

But there's a simpler version of this that allows us to bypass all that.

首先，你的视觉系统有两种处理模式。

First of all, your visual system has two modes of processing.

它可以高度聚焦，像吸管一样的视野。

It can be highly focused, a soda straw view.

比如在刚才提到的数字串中寻找字母R，或者当你对某件事非常兴奋时，你就处于这种吸管式的视野中，因而忽略了其他事物，明白吗？

So looking for the R in this string of numbers in the example that I just gave, or if you're very excited about something, you're that soda straw view of the world and you're missing other things, okay?

这是高度专注的状态。

That's high levels of attention.

然而，你的视觉系统还具备一种特性，能让你扩展视线，进入所谓的全景视野。

However, there's also a property of your visual system that allows you to dilate your gaze to be in so called panoramic vision.

全景视觉是你现在就可以做到的，无论你身在何处，我现在就可以做到。

Panoramic vision is something you can do right now, no matter where you are, and I can do it right now.

你可能不会察觉到我在做这件事，但即使我仍然直视着你，我也有意识地扩大了我的视野，以便看到周围的天花板、地板和墙壁。

You won't know that I'm doing it, but even though I'm still looking directly at you, I'm consciously dilating my gaze so that I can see the ceiling, the floor and the walls all around me.

这种全景视觉实际上是由一组独立的神经通路或回路介导的，这些通路从眼睛延伸到大脑。

That panoramic vision is actually mediated by a separate stream or set of neural circuits going from the eye into the brain.

这组通路不仅仅是广角视野。

And it's a stream or set of circuits that isn't just wide angle view.

它在时间处理上也更出色。

It also is better at processing things in time.

它的帧率更高。

Its frame rate is higher.

你看过慢动作视频，也看过普通视频。

You've seen slow motion video and you've seen standard video.

慢动作视频之所以呈现慢动作效果，是因为它的帧率更高，它在时间上进行了更精细的切片，明白吗？

Slow motion video gives you that slow motion look because it's a higher frame rate, your thin slicing time, okay?

你可以利用全景视觉来进入我们称之为开放监控的状态。

You can use panoramic vision to access the state that we call open monitoring.

当人们这样做时，他们能够关注并识别这一串数字中的多个目标。

When people do that, they are able to attend to and recognize multiple targets within this string of numbers.

他们能看到R，也能看到Z，还能看到其他东西。

They can see the R and they can see the Z and they can see additional things.

因此，这是一种可以训练的能力，无论是否患有注意力缺陷多动障碍，人们都可以练习。

So this is something that can be trained up and people can practice whether or not they have ADHD or not.

这涉及学习如何有意识地扩展你的视线。

What it involves is learning how to dilate your gaze consciously.

对大多数人来说，这其实很简单，无论你是否佩戴矫正镜片或隐形眼镜，你都可以有意识地进入开放凝视状态，然后也可以收缩你的视野。

That's actually quite easy for most people, whether or not you wear corrective lenses or contacts or not, you can consciously go into open gaze and then you can contract your field of view as well.

也有研究显示，人们在极短的时间内被教导以特定方式思考，这永久性地改变了他们限制或减少注意力眨眼次数的能力。

There have also been studies done where people were taught to think in a particular way for a very short period of time and that forever changed their ability to limit or reduce the number of these attentional blinks.

现在文献中已有相关报道，描述了一种简单的练习：受试者只需安静坐着，闭上眼睛，进行一种类似于冥想的活动，但不将思维导向任何特定状态或方向，而是仅仅关注呼吸，专注于所谓的内感受——即身体的感受，如果思绪飘走，就把它带回来。

There are now published accounts in the literature of a simple practice done for about fifteen minutes where subjects were asked to just sit quietly, eyes closed and do what is sort of akin to meditation, but to not direct their mind into any particular state or place, but simply to think about their breathing and to focus on their so called interoception, focus on how their body feels, if their mind drifted to bring it back.

好的，这基本上就是大约十五分钟的冥想。

Okay, so it's basically meditation for about fifteen minutes.

这看起来可能并不像是一种重要或特别的练习，也不会产生任何影响，但令人惊讶的是，仅仅一次进行十七分钟的这种练习，就显著减少了人们出现的注意力瞬脱次数。

That might not seem like a significant or unusual practice or that it would have any impact at all, But remarkably, just doing that once for seventeen minutes significantly reduced the number of attentional blinks that people would carry out.

换句话说，他们的专注力得到了近乎永久性的提升，而无需任何额外的训练。

In other words, their focus got better in a near permanent way without any additional training.

这种练习的核心在于减少视觉信息的输入，并学会关注自己的内在状态，也就是我们所说的内感受，这使他们具备了一种觉知能力：当需要寻找视觉目标，或需要依次关注多个事物时，他们不再经历同样多的注意力瞬脱。

There's something about that practice of reducing the amount of visual information coming in and learning to pay attention to one's internal state, what we call interoception that allow them an awareness such that when they needed to look for visual targets, when they need to focus on multiple things in sequence, they didn't experience the same number of attentional blinks.

我顺便提一下，随着人们年龄增长，工作记忆下降，专注力减弱，他们出现的注意力瞬脱次数也会增加。

And I should mention not incidentally as people age and their working memory gets worse and their ability to focus gets worse, the number of attentional blinks that they carry out goes up.

现在已有研究正在探索，这种类似冥想的简单练习——大约十五到二十分钟，安静坐着，专注于呼吸和内在状态——是否也能缓解一些与年龄相关的认知衰退。

And there are now studies exploring whether or not this simple meditation like practice of fifteen to twenty minutes or so of sitting and just quietly resting and paying attention to one's breathing and internal state can also offset some of that age related, what is called cognitive decline.

因此，这些数据告诉我，无论你是儿童还是成人，无论你是否有注意力缺陷多动障碍，无论你是否正在经历与年龄相关的认知衰退，或者你只是希望避免这种衰退，只需花十七分钟安静坐着，关注自己的内在状态，进行内感受，觉察呼吸，觉察皮肤与所接触表面的接触感，就能永久性地重塑你的大脑，使其更能集中注意力，甚至可能缓解一些与年龄相关的注意力分散。

So what these data tell me is that regardless of whether or not you're a child or you're an adult, whether or not you have ADHD or not, whether or not you're experiencing age related cognitive decline, or you would simply like to avoid age related cognitive decline, a simple practice of taking seventeen minutes sitting and paying attention to your internal state, just interocepting, registering your breathing, registering the contact of your skin with whatever surface you're on can forever rewire your brain to be able to attend better and possibly even offset some of that age related attentional drift.

不过，我并不指望每个人都会开始规律地冥想。

Now, I don't expect anyone to start meditating regularly.

我不指望任何人做他们不想做的事，但我认为我们大多数人应该都能抽出大约十七分钟进行一次冥想。

I don't expect anyone to do anything they don't want to do, but I think most of us could handle one meditation session of seventeen minutes or so.

因此，如果真有什么工具能以强有力的方式重塑我们的注意力回路，那似乎就是这个了。

And so if ever there was a tool that stood to rewire our attentional circuitry in a powerful way, this seems to be it.

此外，能够进行全景视觉、扩大视野——这种所谓的开放监控，能让大脑以更快的速度感知更多信息，这也是一种强大的工具。

And in addition, the ability to engage in panoramic vision to dilate our gaze, this so called open monitoring that allows the brain to function in a way that it can detect more information faster, that's a powerful tool as well.

而这个工具的美妙之处在于，它第一次使用就有效，每次使用都有效。

And the beauty of that tool is that it works the first time and it works every time.

不过，它具体是如何起作用的，目前还不太清楚。

Now, how exactly it works is a little bit unclear.

比如，它是否在默认模式网络和任务相关网络之间协调同步或非同步？

Is it for instance, orchestrating this synchrony or asynchrony between the default mode network and the task related networks?

我们还不知道。

We don't know.

这些研究尚未进行。

Those studies have not yet been carried out.

然而，这些效果是显著的。

Nonetheless, the effects are significant.

它们是持久的，并且在仅仅一次十七分钟的内感受静修后就似乎已经存在，这让我觉得对每个人来说都非常值得去做。

They are long lasting and they appear to exist after just one session of this quiet seventeen minute interoception, which to me makes it seem like a very worthwhile thing to do for everybody.

我们刚刚谈到了注意力盲点，这本质上是思维的短暂中断。

So we just talked about attentional blinks, which are essentially blinks of thinking.

这是你的大脑在一瞬间关闭，从而错过了某些信息。

It's your mind shutting off for a moment and missing information.

现在我们来谈谈实际的眼睑眨动。

Now let's talk about actual blinks, the sort that you do with your eyelids.

这可能听起来有些显而易见，但你可以快速地进行所谓的自发性眨眼。

Now, this might come across as somewhat obvious, but you can do fast, what are called spontaneous blinks.

它们总是双眼协调一致，或者你也可以进行长时间的眨眼。

And they are always coordinated between the two eyes, or you can do long blinks.

就像你晚上睡觉时，会做一次非常长的眨眼，我可不是在开玩笑。

Like when you go to sleep at night, you do one very long blink and I'm not being facetious.

当你晚上睡觉时，你会闭上眼睛，减少外界信息的输入，随着你进入睡眠，对时间的感知也会开始发生偏移。

When you go to sleep at night, you are shutting your eyelids and you are limiting the amount of information coming in and your perception of time starts to drift as you go into sleep.

你在睡眠中的时间感知会从瞬间的极快变为极慢，这意味着你在睡眠中分析信息、做梦等的‘帧率’是可变的。

Your perception of time changes from very fast at one moment to very slow, meaning the frame rate at which you are analyzing information, dreaming, etcetera is variable when you are in sleep.

有时它非常快，意味着你会以慢动作体验事物，有时它又非常快。

Sometimes it's very fast, meaning you experience things in slow motion, sometimes it's very fast.

在清醒状态下，你对时间的体验有时也会非常快，有时又非常慢。

In waking too, your experience of time can sometimes be very fast, sometimes be very slow.

通常，你越警觉，帧率就越高，你会更精细地切分你的体验。

Typically the more alert you are, the higher the frame rate, you're thin slicing your experience.

如果你曾经在压力很大时等待某事或某人，你可能会有过这种经历——感觉时间仿佛过得很慢，因为你的帧率提高了。

You've probably had this happen if you're ever very stressed and you're waiting for something or somebody, it seems like it takes forever because your frame rate is higher.

你对时间的分析变得更加精细。

You're analyzing time more finely.

相反，如果你非常放松甚至困倦，醒来后想到要做的所有事情时，会觉得世界过得太快，而自己却行动迟缓。

Conversely, if you are very relaxed or even sleepy, you wake up and you have to think about all the things you have to do, will seem like the world is going by very, very fast and that you are moving very slow.

时间本身并没有改变，改变的是你对时间的感知。

Time is going at the same rate, but your perception of time is what's changed.

信不信由你，你的眨眼频率也会在瞬间不断改变你对时间的感知。

Believe it or not, your perception of time is also changed on a rapid basis, moment to moment basis by how often you blink.

在神经科学领域，关于眨眼与时间感知关系的研究已有充分证据支持，这与那些声称眨眼与反社会人格有关的说法不同，后者毫无科学依据。

This is a well established literature in the world of neuroscience that unlike the literature and claims about blinking and sociopathy, which have no basis, the science of blinking as it relates to time perception has some very good data to support it.

我想特别强调一项研究，其标题非常贴切：《自发眨眼后时间会延长》。

I want to just emphasize one study in particular, which is quite appropriately titled Time Dilates After Spontaneous Blinking.

这篇论文发表于《当代生物学》期刊。

This is a paper that was published in Current Biology.

第一作者是特尔胡恩（Terhune, T E R H U N E）。

The first author is Terhune, T E R H U N E.

这是一篇非常出色的研究论文。

It's a wonderful paper.

他们研究了时间感知波动与眨眼之间的关系。

They examined the relationship between fluctuations in timing and blinking.

简而言之，他们发现，在眨眼之后，我们会重置对时间的感知。

And to make a long story short, what they found is that right after blinks, we reset our perception of time.

明白吗？

Okay?

所以从这个意义上说，眨眼有点像戏剧或电影中场景之间的幕布落下，或者他们拍板开始新一场戏的时候，你知道，他们会喊‘Action’。

So blinks in that sense are a little bit like the curtain coming down on a scene between scenes in a play or takes in a movie, you know, when they clap the clap thing, they started take, or what do they say, action.

到了结尾，他们会做那个动作，然后按下板子说，这是第几场。

And then at the end, they do the thing and they click it down and they say, it's a take.

这是第几场。

That's one take.

当你眨眼的时候，那就是一场戏，明白吗？

When you blink, it's a take, okay?

有趣的是，这一点对你来说会立刻变得清晰，为什么这很重要：眨眼的频率是由多巴胺控制的。

Now what's interesting and will immediately make sense to you as to why this is important is that the rate of blinking is controlled by dopamine.

这意味着，多巴胺控制着注意力，眨眼与注意力和专注力相关，因此多巴胺与眨眼系统是你不断调节和更新时间感知的一种方式。

So what this means is that dopamine is controlling attention, blinks relate to attention and focus, and therefore the dopamine and blinking system is one way that you constantly modulate and update your perception of time.

幸运的是，这也是你可以控制的。

And fortunately, it's also one that you can control.

因此，这项研究的主要结论是：眨眼控制着时间感知，同时多巴胺水平会改变你对时间的感受，请继续听下去，眨眼和多巴胺是密不可分的。

So the basic takeaway of this study was that blinking controls time perception, but also that levels of dopamine can alter your sense of time and stay with me here, and that blinking and dopamine are inextricably linked.

它们协同作用，控制着你的注意力。

They are working together to control your attention.

当多巴胺水平升高时，人们往往会高估某件事持续的时间。

When dopamine levels go up, people tend to overestimate how long something lasted.

为什么？

Why?

因为他们对时间的处理更加精细，就像慢动作模式。

Because they are processing time more finely, it's slow motion mode.

当多巴胺水平较低时，人们往往会低估时间间隔。

When dopamine levels are lower, they tend to underestimate time intervals.

让我们回想一下本集开头时，ADHD患者身上发生的情况。

Let's remember back to the very beginning of the episode, what's going on in people with ADHD.

他们不擅长管理时间。

They are not good at managing their time.

他们常常迟到或做事杂乱无章。

They tend to run late or they are disorganized.

他们不仅在物理空间上杂乱无章，在时间上也同样缺乏条理。

They are not just disorganized in space, meaning in the physical space around them, they're disorganized in time.

他们的多巴胺水平偏低。

Their dopamine is low.

这一点我们也很清楚。

We know that as well.

因此，他们会低估时间间隔。

And so they are underestimating time intervals.

所以他们迟到也就完全说得通了。

And so it makes perfect sense that they would be late.

他们容易失去时间感或难以集中注意力，这也就完全说得通了。

It makes perfect sense that they would lose track of time or the ability to focus.

这非常令人兴奋，因为这意味着患有注意力缺陷多动障碍的儿童、成人，或者那些专注力正常但希望提升专注能力的人，都可以通过一种训练来实现，这种训练涉及学习何时以及如何眨眼，以及如何将视觉焦点保持在特定目标上。

This is really exciting because what it means is that children with ADHD, adults with ADHD, or people with normal levels of focus that want to improve their ability to focus can do so through a training that involves learning how often to blink and when, and how to keep their visual focus on a given target.

事实上，这项研究已经完成。

And it turns out this study has actually been done.

还有一项研究，我会提供这篇题为《通过聚焦训练提高小学生注意力》的研究链接。

There's a study again, I'll link to this study entitled improvement of attention in elementary School Students Through Fixation Focused Training Activity.

我不会详述所有细节，但他们的发现是，短暂地将注意力集中在视觉目标上，能显著提升这些学生对其他类型信息的专注能力。

And I won't go through all the details, but what they found was a short period of focusing on a visual target allowed these school children to greatly enhance their ability to focus on other types of information.

这种效果的一个重要组成部分，源于他们对眼睑和眨眼的控制方式。

And a significant component of the effect was due to the way that they were controlling the shutters on their eyes, their eyelids, and controlling their blinks.

因此，这项研究中，他们让这些孩子将视觉注意力集中在某个相对较近的物体上，比如自己的手，持续大约一分钟——如果你亲自尝试过，就会知道这其实需要一定的努力。

So what they did in this study is they had these kids focus their visual attention on some object that was relatively close like their hand for a minute or so, which actually takes some effort if you try and do that.

他们被允许眨眼。

They were allowed to blink.

然而，根据其他研究可知，如果人们能够有意识地抑制眨眼的冲动，至少抑制到感觉必须眨眼、否则眼睛会干涩的程度，实际上可以进一步提升注意力。

However, it's known from other work that if people can consciously override the desire to blink, at least to the point where they feel like they have to, or else their eyes would dry out, that actually can increase attention even further.

他们还设置了不同的条件，让孩子们注视房间更远处的一个点，甚至更更远的点。

And they had conditions where they would look at a point further across the room and even further across the room.

每天只需几分钟即可完成这项训练，比如在一种条件下持续三十秒，或者在另一种条件下持续一分钟，然后换到另一个位置，注视稍远一点的点，再更远一点的点。

It only took a few minutes each day to do this thirty seconds in one condition or maybe a minute, and then at another station of looking a little bit further out and a little bit further out.

然而，这项研究有一个重要特点非常值得提及：在进行这种视觉专注训练之前，他们先让孩子们做了一系列身体活动，帮助孩子们消除或释放一些想动的冲动，从而增强他们静坐的能力。

However, there was an important feature of this study that is definitely worth mentioning, which is before they did this visual focus task or training, they did a series of physical movements with the kids so that the kids could sort of eliminate or move out some of their desire to move and would thereby enhance their ability to sit still.

长期以来，人们都知道孩子需要课间休息。

Now it's long been known that kids need a recess.

他们需要时间跑动、玩耍、打滚，做各种事情，才能真正坐得住。

They need time to run around and play and roll around, do whatever it is that they do in order to be able to sit still at all.

成年人可能也需要这样，说实话，但孩子更需要，因为大脑中控制反射性动作、以及我们所说的那种有节奏的起伏行为的神经回路，需要主动抑制。

Adults probably need this too, frankly, but kids need it more because the circuits in the brain that control reflexive movements and as we say, kind of rhythmic undulating behavior and things like that, that's an active suppression.

而孩子们直到大约15或16岁，这些神经回路才发育得比较完善。

And kids have less of that circuitry built up until they hit about age 15 or 16.

因此，他们先让孩子们稍微活动一下，然后再进行这种专注训练。

So they had the kids move around a bit and then do this focused training.

这让我想到另一种目前在学校中广泛用于多动症儿童的治疗方法，也开始被许多孩子和家长用来帮助孩子在车上保持专注、避免行为失控。

That brings me to another treatment that's actively used nowadays in schools for kids with ADHD, but also starting to be used by many kids and by parents in order to keep their kids focusing and not going crazy in the car or not acting out in general.

这就是所谓的减压玩具的普及，孩子们可以通过这些玩具进行主动且重复性的动作，以释放神经系统中潜在的反复性活动。

And that's the prevalence of these so called fidgeter toys or things that kids can do actively and repetitively in order to move out some of their underlying reverberatory activity in their nervous system.

因此你会发现，一些多动症儿童现在会在课桌上放一根橡皮筋， literally 一根固定在桌上的橡皮筋。

So what you will find is that some kids with ADHD are now given a rubber band on their desk, literally a rubber band that's attached to their desk.

他们可以拉扯它，甚至弹击桌面。

And they're able to pull on it, even snap it against the desk.

如果我小时候这么做，老师大概会把我赶出教室，但我认为现在允许他们这样做非常好，这能帮助他们释放或调动身体能量，而不是一直强迫自己像雕像一样静坐并集中注意力。

If I'd done that when I was a kid, think my teachers would have thrown me out of class, but I think it's great that they're allowing them to do this now as a way of moving some of their physical energy out or engage their physical energy rather, as opposed to trying to sit statue still all the time and attend.

事实证明，当孩子们有一些身体活动可以参与时，他们的心理专注力确实会得到提升。

And it turns out that does enhance these children's ability to focus mentally when they have some physical activity to attend to.

而且事实表明，这种方法对成年人也同样有效。

And it turns out it also can work for adults.

我来和你们分享一个相关的轶事，因为它说明了背后的机制。

I'll share with you a related anecdote because it illustrates the underlying mechanism.

在我的职业生涯中，我有幸参与过多次脑部手术。

I've had the great privilege of being able to do a number of surgeries, brain surgeries during my career.

所以当你做脑部手术时，你会发现大脑体积很小，无论你操作的是哪种生物，你都需要在其中完成非常精确的操作。

So one thing you find when you do brain surgeries is that the brain's pretty small, regardless of the species that you're working on and you're in there and you're trying to do something very specific.

你越努力让双手保持稳定，它们就越想颤抖，明白吗？

And the more you try and hold your hands really steady, the more they want to shake, all right?

我们的任何肢体都不可能自然地完全静止不动。

So it's not natural for any of our limbs to sit perfectly still.

根据你喝了多少咖啡、休息得如何以及你的自主神经兴奋水平，有些人可能能够将手伸出来纹丝不动。

Depending on how much coffee you've had, how well rested you are and your sort of baseline level of autonomic arousal, some of you may find that you can hold out your hand absolutely rock solid.

而另一些人则会抖得更明显一些。

Others will shake a little bit more.

手抖并不意味着你紧张，手稳也不代表你平静。

Doesn't mean you're nervous if you're shaking, doesn't mean you're calm if you're still.

这实际上与我们所说的‘前运动活动’有关，也就是系统中发送的运动指令的数量。

What it relates to is the amount of what we call premotor activity, the number of commands to move that are being sent through the system.

这就是我所说的回响性活动。

And that's what I mean by reverberatory activity.

看起来，患有多动症的孩子和成人都有大量神经系统的回响性活动。

And it does seem that kids with ADHD and adults with ADHD have a lot of reverberatory activity in their nervous system.

因此，他们总是有不断想动的冲动。

And so that's that constant desire to move.

他们很难保持静坐，因此也很难集中和掌控自己的注意力。

It's hard for them to sit still and therefore it's hard for them to attend to harness their attention.

当你做手术时，如果发现手在颤抖，你会从导师那里学到——我也这么做过——一个非常有效的方法，无论你是否在做手术：轻轻跺脚或轻微抖动膝盖。你可能觉得这会让手抖得更厉害，但只要动作轻微，它实际上会把一部分前运动回路的活动转移到身体其他部位。

When you do a surgery and you find that your hands are shaking, what you learn from your mentors, which I did, and what works extremely well, whether or not you're doing a surgery or not, is that you simply tap your foot or you bounce your knee a little bit, which you might think would make your hands shake even more, but provided that it's subtle, what it does is it actually shuttles some of the activity from those premotor circuits to elsewhere in the body.

然后你的手就能更加稳定了。

And then you're able to sit much more still with your hand.

你就能更精准地完成手术。

You're able to perform the surgery with much more precision.

你的字迹也会变得更好。

You are able to write with much better handwriting.

对于那些从事公开演讲的人，如果你感到过于紧张，这就是为什么在演讲时踱步会有帮助，为什么在讲台后轻轻抖腿也有效的原因。

And for those of you who engage in public speaking, if you're ever too nervous, that's why pacing while you public speak helps if you're nervous, that's why bouncing your knee behind the podium works as well.

这就是为什么点头和手势也能起到帮助作用。

That's why nodding your head and gesticulating can help.

这并不是把能量从体内释放出去，实际上并不会发生这种情况。

It's not a matter of moving energy out of the body that doesn't actually happen.

真正的原因是你激活了那些发送指令的前运动回路。

What it is is you're engaging those pre motor circuits that are sending through commands.

这就像试图把一大堆东西塞进一个漏斗，从而产生了紧张感。

It's like trying to stuff a bunch of stuff through a funnel and it creates this tension.

因此，你为神经回路提供了一个出口，让它能够活动某些部分，从而使你身体的其他部分和心理注意力能够保持集中并锁定在某件事上，也就是我们所说的专注。

So you're giving it an outlet for the neural circuitry to be able to move something so that you can keep other components of your body and your mental attention engaged and locked onto something, what we call focus.

与此相关的另一个问题是眨眼、专注以及训练自己专注而不眨眼等，大多数药物，如利他林、阿得拉以及能增加多巴胺的娱乐性药物，甚至咖啡、茶和其他形式的咖啡因，都会让我们眨眼减少。

One thing related to this whole business of blinking and focus and training yourself to focus and not blinking, etcetera, is that most all of the drugs, Ritalin, Adderall and recreational drugs that increase dopamine, even coffee and tea and other forms of caffeine, they tend to make us blink less.

当我们感到疲倦时，往往会更频繁地眨眼。

And when we get tired, we tend to blink more.

这有点显而易见，对吧？

Now this is sort of a duh, right?

但当你因兴奋或恐惧而睁大眼睛，或者眼睛几乎睁不开时，现在你应该完全明白，眼睛前方的这些‘遮帘’不仅仅是为了眨眼或 cosmetic（美观）目的，它们的作用是调节进入你神经系统的信息量，以及你让信息进入神经系统的时间长度和信息分类方式——你眨眼的频率决定了你如何划分时间，而你是否像瞄准镜或吸管那样精准地捕捉视觉信息，还是处于全景式的、鱼眼镜头或广角镜头般的整体环境模式，则决定了你如何获取视觉世界的注意力。

But being wide eyed with excitement or fear, or with your eyes barely being able to keep them open, now it should make perfect sense that these shutters on the front of your eyes, they aren't just there for winking and they aren't just there for cosmetic purposes, they are there to regulate the amount of information going into your nervous system and they're there to regulate how long you are bringing information into your nervous system and in what bins, how widely or finally you are binning time is set by how often you blink and how widely or specifically you are grabbing attention from the visual world is set by whether or not you're viewing things very specifically like a crosshair or through a soda straw view like this, or whether or not you are in this panoramic sort of whole environment mode, this kind of fisheye lens or wide angle lens mode.

公平地说，从药理学和神经回路的角度来看，多巴胺水平升高、警觉性和兴奋感增强通常会减少眨眼频率并增强注意力。

And in fairness to the pharmacology and the circuitry, while dopamine and heightened levels of alertness and excitement tend to make us blink less and attend more.

实际上，已有研究探讨了其他神经化学系统和药物如何与眨眼相关。

There's actually a study that's looked at the other neurochemical systems and drugs and how those relate to blinking.

因此，我即将与你们分享的这篇论文标题，会让这一切变得显而易见。

And so this will all be obvious by the title of the paper I'm about to share with you.

这篇论文题为《慢性使用大麻导致自发性眨眼率降低：纹状体大麻素与多巴胺相互作用的证据》。

This is a paper entitled Decreased Spontaneous Eye Blink Rates in Chronic Evidence for Striatal Cannabinoid Dopamine Interactions.

好吧，我不会在这里深入所有细节，但有一点有点令人惊讶：许多注意力缺陷多动障碍（ADHD）患者会使用或滥用大麻。

Okay, I'm not going to go into all the details here, but one thing that is somewhat surprising is that many people with ADHD use or abuse cannabis.

你可能会想，他们为什么要这么做？

You might think, well, why would they do that?

因为我认为多巴胺的增加实际上会带来注意力的提升。

Because I thought that a increase in dopamine is actually what's going to lead to heightened levels of attention.

而这正是这些人和孩子们所渴望的。

And that's what these people and children crave.

结果发现，大麻也会增加大脑中的多巴胺传递，但由于它还提升了其他化学物质，比如血清素以及大麻素和阿片系统的一些成分，因此会让人产生一种警觉但放松的感觉。

Well, it turns out that cannabis also increases dopamine transmission in the brain, but because of the other chemicals it increases, namely serotonin and some components of the cannabinoid and opioid system, it creates that kind of alert but mellow feel.

而且在这里，我并不支持这种做法。

And again, here, I'm not a proponent of this.

我个人并不使用THC或大麻。

I personally am not a THC or cannabis user.

这根本不是我的风格。

It's just not my thing.

而且显然在某些地方它是非法的。

And obviously it's illegal some places.

所以你需要自己做出判断。

And so you have to determine that for yourself.

它确实有医疗用途，在某些地方也是合法的，但THC会增加多巴胺以及能带来平静状态的其他神经化学物质。

It does have medical purposes and in some places it is legal, but THC increases dopamine and increases neurochemicals that can also create a state of calm.

所以这是一种中间状态。

So it's that sort of middle ground.

这篇论文有一个精彩的演示，不仅在人们使用大麻时，而且根据他们一生中使用大麻的时长，眨眼频率也会发生变化。

And this paper has a beautiful demonstration whereby not just while people are using cannabis, but depending on how long they've been using cannabis across their lifespan, the rates of eye blinking change.

因此，如果你观察人们长期规律使用大麻的年数——无论是每天还是每周最多每天使用，你会发现，那些从未使用过大麻或仅使用了大约两年的人，其眨眼频率远高于那些长期使用十年的人。

So if you look at the number of years that people have been using cannabis on a regular basis, either daily or up to, excuse me, weekly or up to daily, what you find is that for people that have not been using cannabis at all, or have only been using it for about two years, their rates of eye blinks are much higher than people who've been using it chronically for ten years.

换句话说，使用大麻十年的人几乎不怎么眨眼。

In other words, people who've been using cannabis for ten years don't blink very often at all.

虽然它众所周知会损害记忆，但它似乎以某种方式激活了专注和眨眼系统，从而提升了专注力。

Now, has well known effects in depleting memory, but it does seem to engage the focus and blinking system in a way that increases focus.

所以，我基本上想说的是，大麻似乎能提升人们的专注力，但人们却记不住自己当时在专注什么。

So basically what I'm saying is marijuana seems to increase people's focus, but then they can't remember what they were focusing on.

我想简单讨论一下ADHD人群（包括儿童和成人）所具有的所谓内感受觉察能力。

Something I'd like to discuss just briefly is the so called interoceptive awareness that's present in people with ADHD, both children and adults.

内感受觉是指对自身内部状态的一种感知，比如心跳、呼吸、皮肤与特定表面的接触等。

Interoceptive awareness is one sense of one's own internal state, heartbeat, breathing, contact of skin with a given surface, etcetera.

长期以来，有一种假设认为，患有多动症的人并不了解自己的感受，似乎他们没有察觉到体内发生的所有变化，比如心率的变化等等。

For a long time, there was this hypothesis, this idea that people with ADHD were just not in touch with how they felt, that somehow they weren't registering all the stuff that was going on inside them, changes in heart rate and so forth.

因此，他们的行为显得失调或看似失调。

And so they behaving in a way that was dysregulated or appeared dysregulated.

如果他们能学会更好地关注自己的内在状态，或许就能在世界上表现得更好。

And that if they could just learn to attend to their internal state better, that somehow they would function better in the world.

在此之前，我们描述了一项长达十七分钟的内感受练习，这项练习确实能提高人们长时间集中注意力的能力。

Now, before we described a process, literally a seventeen minute interoceptive exercise, that does seem to lead to improvements in one's ability to focus for a longer period of time.

然而，这种改善几乎不可能是由于增强了内感受觉本身。

However, it's very unlikely that that was due to increasing interoceptive awareness per se.

这很可能不是因为人们获得了更敏锐或更佳的内部状态理解能力。

It probably wasn't because people gain a much heightened or improved ability to understand what's going on internally.

事实上，你可以想象，这种能力可能会妨碍一个人关注外部世界事物的能力。

In fact, you can imagine how that might actually prevent one's ability to pay attention to things in the outside world.

因此，尽管只是静坐不动、专注于呼吸和内在状态，以此来获取外部世界的信息确实有益，但一项名为《注意力缺陷多动障碍中的内感受觉察》的出色研究探讨了ADHD患者与非ADHD人群在内感受觉察上是否存在差异。

So while there is benefit to just sitting there and being in stillness as they say, or focusing on one's breathing and internal state for sake of then accessing information in the external world, a really nice study called interoceptive awareness in attention deficit hyperactivity disorder explored whether or not interoceptive awareness was different in people with ADHD or did not have ADHD.

研究结果基本表明，两者并无差异，无论是儿童还是成人ADHD患者，他们对自己体内状况的感知程度与其他人都一样。

And the findings were essentially that there's no difference, that people with ADHD, children and adults, they are aware of what's going on inside them just as much as anyone else's.

衡量内感受觉察的常用方法是个人能否准确数出自己的心跳次数。

And the typical measure of interoceptive awareness is one's ability to count their own heartbeats.

这对一些人来说非常困难，对另一些人则轻而易举，而这与他们的注意力水平无关。

This is actually challenging for some individuals and very easy for other individuals, regardless of their attentional capacity.

有些人能清晰地感受到自己的心跳，无需测量脉搏；而另一些人则完全感受不到。

Some people just can really feel their heartbeat without taking their pulse, other people cannot.

这些研究的实施方式相当直接。

And these studies are pretty straightforward to do.

你让受试者静坐并数自己的心跳，同时用设备监测他们的真实心跳，从而评估他们的计数准确度。

You ask people to sit there and to count their heartbeats, and then you are monitoring their heartbeats and you get to gauge how accurate they are.

因此，重要的是要明白，ADHD患者对自己感受的觉察是清晰的。

So, it's important to understand that people with ADHD are in touch with how they feel.

这其实是一个关于他们是否能应对所面临的要求，并进入一种能帮助他们获取所需信息的认知状态或心理状态的问题。

It's really a question of whether or not they can take the demands that are placed upon them and enter a cognitive state, a mental state that allows them to access the information they need to access.

换句话说，就是他们是否能集中注意力，但认为一个孩子在短短六分钟的餐桌互动中起身十一次，或一个孩子每时每刻都不得不分心，又或你的成年同事总是坐立不安、摆弄东西，就说明他们对自己毫无觉知——这种想法是完全错误的。

In other words, whether or not they can focus, but it is absolutely wrong to think that the child that's getting up 11 times during a short six minute interaction at the table, or whether or not a child who somehow has to venture off every moment or a coworker of yours, who's an adult, who's constantly fidgeting or moving things around that somehow they are unaware that they are oblivious.

他们并非对自己的感受毫无觉察。

They are not oblivious to how they feel.

他们很可能在当前的情境中面临巨大挑战，正竭尽全力试图调节自己的注意力。

Chances are they are very challenged in the situations that they're doing everything they can to try and regulate their attention.

因此，我认为这项研究非常重要，因为它深刻地表明，另有其他因素在起作用，而这些因素完全关乎协调这些任务导向网络，并以恰当的方式将其与默认模式网络协调起来的能力。

So I think it's an important study to highlight because it really underscores the fact that something else is going on and that something else has everything to do with this ability to coordinate these task directed networks and to coordinate that in the proper way with that default mode network.

正如你现在所知，这一过程由某些神经化学物质精妙地调节，尤其是多巴胺、去甲肾上腺素和血清素。

And that is a process as you now know, that's regulated exquisitely by certain neurochemicals and in particular, the neurochemicals, dopamine, norepinephrine, and serotonin.

我还想补充第四种物质，那就是乙酰胆碱，它对认知专注力至关重要。

And a fourth one I'd like to throw into the mix, which is acetylcholine, which is very vital for cognitive focus.

现在我想转回讨论通常用于调节这些系统的药物——处方药，同时谈谈一些新兴的非处方方法，这些方法通过各种补充剂来提升大脑中的多巴胺、乙酰胆碱和血清素水平，因为其中几种已在高质量的同行评审研究中显示出显著效果。

So now I want to switch back to talking about some of the drugs that are typically used to access those systems, prescription drugs, And I want to talk about some of the new and emerging non prescription approaches to increasing the levels of dopamine, acetylcholine, and serotonin in the brain using various supplement type compounds, because several of them are showing really remarkable efficacy in excellent peer reviewed studies.

在转向一些新型非典型化合物和非处方产品之前，我想简要回顾一下常用于治疗注意力缺陷多动障碍的经典药物。

So before moving to some of the newer atypical compounds and things sold over the counter, I'd like to just briefly return to the classic drugs that are used to treat ADHD.

这些就是我之前提到的药物：哌甲酯，也叫利他林；莫达非尼；阿莫达非尼；还有阿得拉尔。

These are the ones I mentioned earlier, methylphenidate, also called Ritalin, modafinil, armodafinil is another one and Adderall.

这些药物都是通过提高多巴胺和去甲肾上腺素的水平来发挥作用的。

Again, all of these work by increasing levels of dopamine and norepinephrine.

它们通常以口服药片的形式服用，有时也以胶囊形式服用。

Typically they are taken orally in pill form, or sometimes in capsule form.

合适的剂量因个体病情的严重程度和年龄而异。

The dosages that are appropriate vary according to severity of the condition for a given person and the age of the person.

对每个人来说，这都是一个复杂的局面。

This is a complicated landscape for each individual.

他们需要找出最适合自己的药理方案。

They have to figure out the pharmacology that's best for them.

有些人甚至会将长效或缓释型利他林与小剂量的阿得拉尔联合使用，情况可能非常复杂，也可能相当简单。

Some individuals are even layering long or time to release Ritalin with Adderall in smaller doses, it can get quite complex or it can be quite straightforward.

如果你对这些药物及其作用机制非常感兴趣，并希望了解目前已有的数百项研究的全部结果，有一篇优秀的综述文章详细探讨了这些药物的使用、与结构相似药物（特别是MDMA、可卡因和街头安非他命）的比较，以阐明它们作用机制的相似性以及长期使用带来的问题。

If you are really interested in these drugs and how they work, and you'd like to get a glance at a table of all the results from all the studies of which there are now hundreds, there's an excellent review about these drugs and their use and their comparison to similarly structured drugs in particular MDMA and cocaine and amphetamine, meaning street amphetamine to really illustrate the similarities of action and some of the problems associated with long term use.

我不指望你们通读这篇文章。

I don't expect you to read this article in full.

我在这里的目的就是为了让你们不必去读这些文章，但如果你想要大量信息，这篇论文是Esposito等人发表在《前沿生物科学》上的。

I'm here so that you don't have to go read these articles, but in case you want a ton of information, the paper is Esposito et al Frontiers in Biosciences.

这是一篇关于整个文献的极佳综述。

It's an excellent, excellent review of the entire literature.

它相当长。

It is quite long.

我可以在我们的视频说明中放上这篇研究的链接。

I can put a link to that study in our caption.

它基本上涵盖了所有已发表的同行评审研究。

And it essentially describes all the studies that have been done peer reviewed and published.

它以一种有趣的方式提及了这些药物。

And it refers to these drugs in an interesting way.