疼痛学（疼痛）再播：蕾切尔·佐夫内斯

我们人类常犯的一个大错误，就是觉得一疼就肯定哪里受伤或坏了。

So one of the biggest errors we often make as humans is believing that just because you have pain, it means necessarily that a body part is damaged or broken.

但疼痛并不总是意味着真的有损伤。

And that's not always what pain means.

其实我们已经知道，没受伤的地方也可能疼。

You can actually have pain without damage in a particular body part is what we've learned.

而慢性疼痛，说白了就是这么回事。

And that's what chronic pain is, believe it or not.

所以疼痛其实也有它的适应性。

So pain is also adaptive.

它again，是能救你命的东西。

Again, it's this thing that saves your life.

接下来我要用一个词，别人总说别用，说太容易让人糊涂，但我还是想用。

It is also this word that I'm going to use that I've been told I shouldn't use because it's confusing, but I'm going to do it anyway.

说吧。

Let's have it.

生物心理社会模型

Biopsychosocial.

明白了。

Okay.

对。

Yeah.

这是什么意思？

What does that mean?

疼痛就是生物心理社会性的。

Pain is biopsychosocial.

简单说，不管你是急性疼痛——也就是三个月以内——还是慢性疼痛，也就是超过三个月或者超出正常恢复时间的疼痛，你的疼痛都发生在我说的这三个因素的交界处。

So what that means is 100% of the time, whether your pain is acute, which means short term, so any pain three months or less, or chronic pain, which is pain that's three months or longer or beyond expected healing time, Your pain lives in the middle of these three bubbles or domains that I'm going call.

第一个是生理层面，也就是身体上的疼痛来源。

So one is biology, biological sources of pain.

第二个是心理层面，也就是心理因素引起的疼痛。

One is psychology or psychological sources of pain.

还有一个是社会层面，也就是社会学因素。

And one is social or sociological.

接下来我给大家解释一下这个模型到底是什么意思。

And I want to say what that means.

你可以想象一张维恩图，有三个相互交叠的圆圈，疼痛就存在于这三个圆圈完全重叠的中心位置。

So if you imagine a Venn diagram, so there are these three bubbles that overlap, and in the middle, where they overlap, that's where pain lives.

好的，大家注意听哦。

Okay, pay attention.

接下来，

So Dr.

佐夫医生会逐一拆解疼痛的这三大诱因，先从生物层面讲起。

Zoff is going to break down the three sources of pain, starting with biological.

说到医生，

Doctor.

生物层面的那些疼痛诱因其实都是大家平时常听说的事儿。

In the middle of So these three the biological components of pain are the things that you hear about all the time.

就是基因、组织损伤、系统功能紊乱，还有免疫系统、睡眠、饮食和运动这些方面。

So it's genetics and tissue damage and system dysfunction, and like immune functioning and sleep and diet and exercise.

这些对疼痛来说都特别重要。

And those are all very important when it comes to pain.

这个我们都知道。

We all know that.

没错。

Yeah.

但如果你只盯着这个维恩图里的生物部分，那你其实漏掉了疼痛问题的三分之二。

However, if you think about this Venn diagram, if you're only focusing on the bio component of pain, you're actually missing two thirds of the pain problem.

因为我们知道疼痛是生物、心理、社会三者交织的现象，我待会儿会解释为什么。

Because we know that pain is this biopsychosocial phenomenon, and I promise I'll explain why.

还有心理层面的各种因素，以及社会或文化层面的各种影响。

But then there's all these psychological components and all these social or sociological components.

而疼痛治疗的问题就在于，我们只关注生物层面，也就是吃药和做手术。

And the problem with pain management is that we focus just on the bio, which is pills and procedures.

很多慢性疼痛患者都会说，这些方法根本治不好他们的痛，因为只针对了问题的三分之一。

And a lot of people with chronic pain will confirm that it doesn't cure their pain because it's focusing just on one third of the problem.

所以，这是疼痛的第二个来源，也是我最担心的地方。

So here is the second source of pain, and also where I freak out.

在心理层面，说来你可能不信，想法本身也会引发疼痛。

In the psychological domain of pain, we've got, believe it or not, thoughts.

因为神经科学告诉我们，你怎么想，真的会直接影响你的感受。

Because neuroscience tells us that how you think, shockingly, affects how you feel.

没错。

So, right.

你可以想象，脑子里有个疼痛的旋钮，当你焦虑、压力大、情绪低落的时候，这个旋钮就会被调高。

So if you imagine that you have this like, if you imagine you have like this pain volume that lives in your brain, this pain dial, when you have anxious, stressed out and depressed thoughts, pain volume actually gets turned up.

你脑子里想什么，身体就真会怎么疼，百分百如此。

So the things you think affect the way your body feels 100% of the time.

在心理这一块，还有创伤，创伤也百分百会加剧疼痛。

Then in the psychological bubble, we also have things like trauma, because trauma 100% of the time also amplifies pain.

有一系列很出色的研究，叫ACES研究，也就是不良童年经历。

There's these great studies called the ACES studies, adverse childhood experiences.

研究发现，童年经历过创伤的孩子——其实成年人也一样——只要有过创伤，这种疼痛的音量旋钮就会被调得更高。

And they have shown that kids who have had adverse experiences, and by the way, adults too, who have trauma, it also amplifies this pain volume, this pain dial.

所以如果你小时候或成年后经历过疼痛，那你就更容易出现更强烈的疼痛，或者发展成慢性疼痛。

So if you are someone who has had pain in childhood or in adulthood, chances are you're going to be more susceptible to higher pain or and or developing chronic pain.

在心理层面，还有记忆这个因素。

And in the psych bubble also, there's memories.

你大脑里有个叫海马体的区域，它负责存储所有记忆。

So there's a part of your brain called the hippocampus, and it stores all of your memories.

而其中有一块专门负责存储疼痛相关的记忆。

And there's a dedicated portion for pain memories.

你小时候第一次被按住打针的时候，海马体就把这段经历记下来了。

So the first time you were held down and given an injection as a child, your hippocampus stores that information.

为什么呢？

Why?

记住那些痛苦的事其实是有用的，因为这些经历可能救你一命。

It's adaptive to remember the things that are painful because those things might save your life.

所以记忆也会影响疼痛。

So memories also affect pain.

还有情绪这回事。

There's also emotions.

情绪同样会影响疼痛。

Emotions also affect pain.

这听起来可能根本说不通。

That seems not even intuitive.

但研究也表明，你的情绪状态会直接影响身体的感受。

But research also shows that how you feel emotionally affects how your body feels.

这个道理我们都懂，对吧？

And we all know that, right?

比如你心情低落的时候，身体就特别沉，肌肉也酸得不行。

Like when you're depressed, your body feels heavy, your muscles feel sore.

就是懒得从沙发上起来，对吧？

It's just like harder to get off the couch, right?

对。

Yeah.

因为情绪也会直接影响身体。

Because emotions affect the body too.

然后还有应对方式，这也属于心理层面的。

And then there's coping behaviors, also in the psych bubble.

所谓应对方式，就是你平时怎么应对疼痛？

And coping behaviors just means what are you doing to manage your pain?

你疼的时候，一般会怎么做？

When you have pain, what do you do?

有些人，包括我，就像我之前说的，一待就是一年，窝在沙发上，不运动、不见朋友、什么都不干。

So some people, including me, as I mentioned for a year, will stay inside on their couch, not exercising, not seeing friends, not moving.

但我们知道，这样反而会让疼痛变得更严重。

But what we know is that that's going to amplify pain also.

明白了。

Okay.

所以前两个圈是生理的和心理的。

So those first two bubbles were biological and psychological.

那第三个圈是什么？

What is the third bubble?

还有就是社会或社会学层面的圈。

And then there's the social or the sociological bubble.

就是所有其他的东西。

And that's everything else.

比如社会经济地位和医疗资源的可及性。

So socioeconomic status and access to care.

你的意思不是在谈医疗本身，而是在谈疼痛或者疾病吗？

I mean, you're not talking about that, are you really talking about health care at all or pain or disease?

还有种族和族裔，尤其是种族歧视，它怎么影响你的压力系统，又怎么加重你的疼痛？

Race and ethnicity, and racism in particular, what does that do to your stress system, and how does that affect your pain?

还有朋友和家人呢。

There's also friends and family.

你有没有一个支持你的圈子？

Like, do you have a support network?

你觉得自己是跟人连着的，还是孤零零的？

Do you feel like you're connected socially, or are you isolated?

孤单或者有人支持，会一直影响你的感受。

Being isolated or being socially supported affects how you feel all the time also.

所以这些因素加在一起，你想啊，人本来就是特别复杂的生物，这些事儿天天在互相作用，直接影响你的疼痛感受。

So all these things together, as you imagine, like human beings are these complex animals with all these things going on, and they interact all of the time to affect your pain system.

这回答可够长的了，谢谢你问这个问题。

That was a long answer to your question.

不，答得太好了。

No, it was great.

特别形象。

It was visual.

哦，还有一个有趣的知识点。

Oh, and a fascinating fact.

疼痛的定义最近更新了，就是为了反映这些社会和心理因素。2020年《骨科与运动物理治疗杂志》上有一篇文章提到，国际疼痛研究协会时隔四十年首次更新了疼痛的定义。原来的定义是：‘由实际或潜在组织损伤引起的不愉快感觉和情绪体验’，但这个说法被批评过于侧重于实际的组织损伤。

So the definition of pain has recently been changed to reflect those social and psychological So a twenty twenty piece in the Journal of Orthopedic and Sports Physical Therapy explains that the International Association for the Study of Pain has updated its definition of pain for the first time in four decades, And that the original definition of pain was, quote, an unpleasant sensory and emotional experience associated with actual or potential tissue damage, which was criticized for being too focused on actual tissue injury.

所以，2020年新版的疼痛定义是：‘一种与实际或潜在组织损伤相关，或类似这种损伤所引发的不愉快感觉和情绪体验。’

And so the shiny, new, updated 2020 definition of pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.

也就是说，现在疼痛不一定非得跟实际受伤挂钩了。

So now pain does not need to be associated with actual injury.

所以，医生。

So Doctor.

佐夫尼斯说，新定义虽然还有改进空间，但比起过去那些过时的观念，已经算进步了。

Zoffness says, The new definition leaves much to be desired, but it is an improvement upon past disco era definitions.

这跟她的三个疼痛来源完全对得上。

But yes, right in line with her three sources of pain.

而且跟我以前对疼痛那种模糊混乱的理解也完全不一样——现在回头听那些想法，都觉得挺痛苦的。

And really different from this foggy, jumbled mess that I thought pain was, which is now painful to listen back to.

我根本不知道疼痛还有这三方面。

And I never knew that there were three aspects of it.

我以前一想到疼痛，就想象有一根像细线一样的神经。

What I picture pain, I picture you have this nerve that looks like a thread.

这根神经上受了伤。

And it has an injury on it.

然后它会发出电信号，让细胞抽搐。

And it sends out electrical pulses that make your cells twitch.

我一直以为疼痛就是这么回事。

That is what I would think pain was.

其实完全不是这么回事。

That's not accurate at all.

对啊。

Right.

但这么想确实挺有道理的。

But that that makes sense.

而且，研究已经表明，人体内确实存在对触觉、温度和伤害性刺激做出反应的受体。

And B, like they have done all this research that shows you do have receptors in your body that respond to things like touch and temperature and nociceptive input, which is potentially dangerous input.

但他们发现了一个特别酷、特别 geek 的事实：疼痛根本不可能只存在于身体里。

But what they've discovered is, here's like this really cool, really nerdy fun fact, is that pain can't possibly live exclusively in the body.

可我们所有人都这么以为。

But we all think that.

比如，我腰疼，就理所当然觉得腰肯定出问题了，对吧？

We all think like, well, if I have back pain, that means definitely there's something wrong with my back, right?

或者膝盖疼，就觉得疼痛肯定就锁在膝盖里。

Or if I have knee pain, that means that the pain lives exclusively in my knee.

但其实，我们有证据证明疼痛并不只存在于身体里。

But here's how we know that pain does not live exclusively in the body.

有一种病叫幻肢痛。

There's a condition called phantom limb pain.

就是说，有人真的失去了一条胳膊或一条腿，可还是能感受到那个已经没了的部位剧痛无比。

And phantom limb pain is when someone literally loses a limb, like an arm or a leg, and they continue to have terrible excruciating pain in the missing body part.

所以，如果你的腿明明已经没了，却还疼得要命，那就说明疼痛根本不是长在腿上的。

So if you can have excruciating leg pain in a leg that isn't there, that has to mean that pain is produced somewhere else.

那个地方，其实就是大脑。

And that somewhere else is the brain.

你身体里确实有这些感受器，会把信号传给大脑，而大脑也一直在往身体发回信息。

So you definitely have these receptors in your body that are communicating messages up to your brain, and your brain is always sending messages back down to your body.

这完全是双向互动。

It's definitely like a two way street.

它们俩一直在配合着工作。

They're always working together.

但真正制造出疼痛感的，归根结底还是你的大脑。

But the part of your body ultimately that constructs pain has to be your brain.

那在这三个因素里，你觉得哪个影响最大？

And how do you know, of those three bubbles, What is the biggest contributing factor?

比如，你腰椎间盘突出，确实疼得厉害；可有的人片子上啥都没有，却长期疼得不行，这又是为啥？

Like if you have a slipped disc in your back, and that definitely hurts versus if their x rays show nothing, but there is chronic pain?

那你该怎么

How do you

开始处理这个问题呢？

know how to start to address it?

答案就在这儿。

Here's the answer.

其实，这三方面时时刻刻都在共同起作用。

So the answer is all three things are always contributing all of the time.

当然，在某个特定时刻，这三个因素中的某一个可能会更突出、更活跃。

And yes, in any given moment, something in any one of those bubbles might be like activated or up.

但它们三个始终都在同时发挥作用，从不间断。

But they're always, all three are always acting all the time.

所以，不管疼痛是强是弱，它始终是由这三方面共同调制出来的‘配方’，而且这个配方100%都包含这三个要素。

So, there's always this like, recipe for pain, whether it's high or low, and the recipe always, 100% of the time includes all three bubbles.

不过你说得对，没错吧？

But But you're right, right?

那先说说急性疼痛，也就是短期疼痛，它通常是在给你发信号：你的身体出了点状况，得去检查一下，对吧？

So with acute pain, which is short term pain, it is usually a message that there's something going on with your body that you need to check out, right?

举个例子，要是有人刚做了膝盖手术，那你的身体绝对会疯狂给你发各种警报。

So like, for example, let's say someone has knee surgery, you bet your ass your body's going to be giving you all of these messages.

就是在告诉你哪里出问题了。

Something's wrong.

毕竟啊，你的组织刚被切开过，这是实打实的事。

Like some, and yes, someone has just sliced into your tissue.

对，而且你正在恢复的过程中。

Yeah, and you're healing.

但对于急性疼痛来说，确实是这样。

But so with acute pain, yes.

你得先排查一下，看看你的身体到底出了什么问题。

You want to check that out and find out what's going on with your body.

慢性疼痛的情况就不太一样了，我来跟你说说原因。

It's a little bit different with chronic pain, and I'm going to tell you why.

但回到你最初的问题，如果我们不解决这三方面，就根本谈不上真正处理疼痛。

But to go back to your original question, if we don't address all three things, we're not ever addressing pain.

打个比方，假设你某天被炒了鱿鱼，同时又不小心撞到了脚趾头，你没了收入，连房租都快付不起了。

So if you imagine there's this like common analogy, if you stub your toe on a day you get fired, you've just lost your income and you don't know if you're going to be able to afford your rent.

这时候撞到脚趾，你肯定又骂又叫，疼得要命。

When you stub your toe, you're going to be cursing and screaming and it's going to feel awful.

但如果你是在和朋友吃冰淇淋、晒着太阳、玩得正开心的时候撞到脚趾，那感觉完全不一样。

If you stub your toe when you're out with your friends eating ice cream, you're out in the sun, you're having a lot of fun, it feels qualitatively different to you.

你的大脑会根据环境、情绪、地点、身边的人、当时发生的事，还有你对这种感觉的解读，来重新解释这个疼痛信号。

Your brain interprets the message differently depending on circumstance, environment, how you're feeling emotionally, where you are, who you're with, what's happening, how you interpret that the sensation.

所以即使是对急性疼痛，这些因素也一直在同时起作用。

So the answer is even with acute pain, all the time, all those things are working in concert.

比如你去儿童医院的病房，墙上画着卡通图案，椅子上还摆着毛绒玩具。

So like, if you go to a children's hospital in the ward, you'll see there's like murals on the wall and stuffies on the chairs.

这可不是随便布置的——当你让人感到安全和放松，他们的疼痛感也会跟着减轻。

And there's a reason for that because when you help people feel safe and calm, your pain system is going to feel better too.

身体就会放松一点，没那么紧张了。

It's going be like less on alert.

成年人也是同样的道理。

And that's true with adults also.

不管是急性痛还是慢性痛，所有这些因素始终都在一起起作用。

So whether acute pain or chronic pain, all the time, all the things are always working together.

那我们现在用的那些生物医学方法呢？

And what about the biological methods that we have right now?

比如阿司匹林是怎么起作用的？

Like, how does aspirin work?

萘普生又是怎么起作用的？

How does Aleve work?

布洛芬呢？它是怎么缓解疼痛的？

How does ibuprofen work?

阿片类药物又是怎么工作的？

How do opiates work?

它们到底在阻断什么？

What are they blocking?

有时候我真的觉得不可思议，吃点药，偏头痛说没就没。

Because sometimes that absolutely blows my mind that I can take something and a migraine will go away.

完全没错。

100%.

确实如此。

Absolutely.

对啊。

Yes.

这话说得一点都没错。

That is totally true.

所有的药作用方式都不一样。

And all the medications work in different ways.

但它们都是通过作用于大脑里的受体，来阻断我说的那些疼痛信号。

But they target receptors in your brain to block what I'm going to call pain messages.

对，从化学成分上来说，这个机制确实挺复杂的。

So yes, chemically, it's pretty complex.

你就把止痛药的作用理解成，它们会卡在特定的位置上，直接搅黄疼痛信号的传递流程就行。

But just think of pain relievers fitting and locking into places and thus just ruining the vibe of the pain messages.

完全就是 Pain 传递路上的拦路虎。

Real cock blockers.

不过说到阿片类药物还有这类止疼药，我觉得阿片类这点特别有意思——毕竟现在大家都在聊阿片类药物和止痛的关系——阿片类药物是作用于大脑里本身就存在的内源受体的。

But what's really interesting to me about opioids, by the way, and all these medications, but opioids in particular, because there's so much talk about opioids and pain, is that opioids work on an endogenous receptor in your brain.

我这么说吧，你的大脑本身会分泌一种化学物质，阿片类药物其实就是在模拟这种物质，它就是内啡肽。

By that, mean, you already produce a chemical in your brain that opioids imitate, and they're called endorphins.

你应该听过跑步者高潮吧？就是你跑完步之后，大脑就会分泌这种类似阿片类的物质，也就是内啡肽。

So when you've heard if you hear of like a runner's high, after you go for a run, your brain produces this opioid substance called endorphins.

而阿片类药物就是和这个受体结合的。

So opioids bind to that receptor.

所有药物其实都是这个原理。

So it's true of all medications.

你吃任何药，都是在跟大脑本来就会产生的化学物质的受体结合。

Whenever you take a medication, it's binding to a receptor in your brain for a chemical your brain already makes.

顺带一提，我们以后会专门做一期节目，讲讲‘镇痛学’，也就是鸦片和阿片类药物的研究，包括阿片类药物成瘾的流行问题。

Side note, we're going to do a whole episode in the future on mechanology, which is the study of opium and opiates, including the epidemic of opioid addiction.

不过没错，药物的好坏，全看你怎么用。

But yes, medicines have pluses and minuses depending on their use.

我得特别澄清一下，我绝对不是反对吃药的人。

And I also need to be very careful and clear with so I am in no way anti medication.

我本人可是打心眼儿里感激，要不是有阿片类药和其他止痛药，术后疼痛、偏头痛，还有那些人类遭的其他罪，真不知道怎么熬过去。

Like I'm like a person who's like, thank God that opioids and other analgesics exist for postsurgical pain and things like migraine and all the other horrible things that happen to human beings.

这些药太有用了，太棒了，也太重要了。

Like super helpful, super wonderful, and very important.

但与此同时，因为咱们国家对疼痛的处理实在太糟糕了，医学院、心理学项目、护理课程，到处都缺疼痛教育，结果我们完全把疼痛给搞砸了。

And simultaneously, because pain is so mistreated in our country, and because there's such poor pain education in medical school, in psychology programs, in nursing programs, across the board, we completely and utterly mistreat pain.

人们都被灌输：吃药就是唯一解法。

And people are told that medications are the only answer.

所以，长期受慢性疼痛折磨的人常常感到特别无助和绝望，要么是因为他们的药被停了，要么是这事儿争议太大，或者他们觉得除了吃药之外别无他法。

So people living with chronic pain oftentimes feel really helpless and hopeless, because either their medication is being taken away from them, or there's like a lot of controversy around it, or they feel like they don't have other options or alternatives.

所以，真心感谢药物的存在，但它绝不是唯一的解决办法。

So thank God for medication, and it is not the only answer.

这话可能挺有争议，我知道说了会惹麻烦，但我还是得说。

And controversially, and like, I'm going to get in trouble for saying this, but I'm going say it anyway.

opioids 治疗疼痛的问题在于——顺便说一句，这可不是我瞎编的。

The problem with opioids for pain, and by the way, this is not like I didn't make this up.

这完全是研究得出的结论。

This is just what research shows.

时间一长，阿片类药物反而会让大脑对疼痛更敏感。

Over time, opioids sensitize the brain to pain.

时间一长，真的会这样。

Over time.

是的，这背后有个完整的敏化综合征。

Yeah, there's a whole there's, it's a sensitization syndrome.

这可是公认的事实。

It's a well known established fact.

明白了。

Okay.

对了，我专门去查了下，这叫阿片类药物引起的痛觉过敏。

Side note, I went to fact check this and look it up and it's called Opioid Induced Hyperalgesia.

而且确实，有大量研究都证实了这一点，比如《有阿片类药物滥用风险的慢性疼痛患者痛觉敏感性升高》《长期使用处方阿片类药物的慢性疼痛患者对急性疼痛的大脑反应更敏感》这些论文。

And yes, it is well, well established in countless papers with titles like Elevated Pain Sensitivity in Chronic Pain Patients at Risk for Opioid Misuse and Sensitized Brain Response to Acute Pain in Patients Using Prescription Opiates for Chronic Pain.

所以，你去搜一下‘阿片类药物引起的痛觉过敏’就对了。

So yes, Google opioid induced hyperalgesia.

那资料多得跟储物间似的，只不过掉下来的不是雨伞和保龄球，而是一堆堆讲疼痛和阿片类药物的研究论文。

It's like a closet just stuffed with items, but instead of umbrellas and bowling balls falling onto your face, you're just going to be covered in studies about pain and opioids.

所以，医生啊。

So Doctor.

佐夫是这么说的。

Zoff explains.

所以实际上，随着时间推移，你的大脑会越来越敏感地捕捉身体传来的各种感觉信号。

So actually what happens over time is that your brain gets more and more tuned in to the sensory messages coming from your body.

所以如果你突然停药，当然会感觉特别糟糕、特别难受。

So if you ever try and go off, of course, you're going to feel awful and terrible.

再说一遍，我不是反对阿片类药物，也不是反对用药，但我觉得大家有必要知道，长期使用的话，大脑会变得异常敏感。

And again, I am not anti opioid, I'm not anti medication, but it seems important for people to know that long term, their brain is going to get extra sensitive.

那对于正在经历疼痛的人呢？

Now, what about someone who is experiencing pain?

比如说，是那种长期的、持续性的疼痛。

Let's say it's chronic, let's say it's ongoing.

那这种情况下，怎么开始做认知行为疗法这类非药物的干预呢？

Where do you even start that CBT or something that is non pharmacological?

你是直接做个疼痛自检吗？

Like, do you just do like a pain check-in?

就是坐着好好琢磨，哪儿疼、怎么疼、为啥疼？

You just sit and try and figure out like what hurts where and why?

我能不能换个角度来回答你的问题？

Can I answer your question in a sort of backwards way?

当然可以。

Yes.

慢性疼痛这事儿，跟别的都不一样。

So chronic pain is its own animal.

它本身就被当成一种独立的疾病。

It's considered its own disease process.

慢性疼痛到底是怎么回事呢？

So here's what happens with chronic pain.

所以，回答你的问题，我第一件事就是跟他们讲清楚疼痛是怎么回事。

So to answer your question, the first thing that I do is I explain how pain works.

我总会问那些来我这儿、疼了十年的人：‘有没有人跟你解释过疼痛到底是怎么产生的？’

And I always ask people who come to my office who've been in pain for like ten years, Hey, has anyone ever explained how pain works to you?

他们都说：‘没有。’

And they're like, No.

大概吧。

Roughly.

百分之百的人都说没听过，这真让我觉得不可思议。

100% of people say no, which is so wild to me.

你都疼了十年了，人家能跟你讲清楚肝脏是怎么工作的，却从来没跟你讲过疼痛是怎么回事？

Like, you've had pain for ten years, people will explain how the liver works, but they've never explained how pain works?

这简直太离谱了。

That's crazy pants.

所以我们已经明确了，疼痛是大脑和身体共同构建出来的。

So, we've established that pain is constructed by the brain, of course, in conjunction with the body.

我们也明确了，急性疼痛和慢性疼痛是两码事。

We've established that acute pain and chronic pain are different.

它们的运作机制完全不同。

They work differently.

身体里确实有感受器，但大脑会综合所有信息，来决定要不要产生疼痛，以及疼到什么程度。

There's receptors in the body, but the brain is always working with all of the information to decide whether or not to make pain and how much.

这里要区分一下，急性疼痛通常是突然发生的，它有个作用，比如提醒你‘这东西太烫了’，或者‘有人在咬你’。

Just to differentiate here, acute pain is typically sudden in onset, and it serves a purpose, like telling you, This is hot, or, Hey, something is gnawing on you.

而且急性疼痛一般治起来都挺管用的。

And acute pain usually responds to treatment.

但慢性疼痛不一样，它比受伤持续得更久，是长期的，可能拖上几周甚至好几年。

Now chronic pain outlasts the injury and is long term, lasting weeks to even years.

美国疾控中心2018年估计，有五千万美国人——也就是五分之一的人——正遭受某种慢性疼痛，每年治疗费用高达六千三百五十亿美元。

And the CDC estimated in 2018 that fifty million Americans, that's one in five, has some form of chronic pain, and it costs up to $635,000,000,000 per year to treat.

这其中一大笔钱都是患者自己掏腰包的。

Billions of that coming out of pocket by people experiencing it.

更别提因病误工和生活质量的损失了。

Not to mention lost wages and quality of life.

所以慢性疼痛患者本身已经够痛苦了，可他们往往连‘为什么疼’‘怎么疼的’都没人跟他们说清楚。

So people with chronic pain are already suffering, and then on top of that, they may not even be told how or why things hurt.

所以瑞秋当然特别乐意把这事讲明白，因为她就是最懂的。

So Rachel, of course, is enthusiastic to lay it out because she is the best.

慢性疼痛就是这样发生的。

With chronic pain, here's what happens.

我问你个问题。

So I'm going to ask you a question.

你有没有练过什么技能？就是一开始特别烂，但练着练着就变厉害了？

Have you ever practiced anything, like any skill that you were bad at and you practiced it and you got good at it?

当然有。

Absolutely.

说一个例子。

Give me a thing.

尤克里里。

Ukulele.

这个例子太棒了。

Oh, that's the best one.

没错。

Yes.

太好了。

Great.

太棒了。

Great.

你有没有发现，弹尤克里里久了，手指好像自己就知道该怎么动了？

Have you noticed with the ukulele, like eventually your fingers sort of know what to do?

对，

Yeah,

是啊，完全没错。

yeah, absolutely.

我现在弹歌能更快了。

And I can go faster on a song.

我从来没在别人面前弹过。

I never have played in front of anyone.

我只是因为一个人弹着好玩才练的。

It's just something I do because it's fun to do alone.

你知道吗，要是早知道这样，我肯定让你把尤克里里带过来。

You know, if I had known that I would have demanded that you brought your ukulele.

不行，当着这么多人我可弹不了。

No, can't do it in front of everyone.

不过确实，我现在能先在脑子里过一遍曲子，再慢慢放好每个手指。

But yeah, and I can and I can think about the the song before positioning each finger.

对，完全就是这样。

Yeah, so totally.

没错。

Right.

那我换种说法，用点神经科学的术语跟你讲讲。

So I'm gonna say it back to you a little differently in like the neuroscience nerd way.

嗯，明白。

Okay.

你大脑里的神经通路，就跟身上的肌肉一样。

The pathways in your brain are like the muscles in your body.

用得越多，这些通路就越粗壮、越强大。

The more you use them, the bigger and stronger they get.

所以如果你跟我说，佐夫尼斯，我想练出大块头二头肌，我会说，阿莉，那当然了。

So if you said to me, Zoffness, I want huge biceps, I would say, Alie, of course you do.

去健身房多举铁，或者干脆在家单独练，随便你。

Go to the gym and lift weights a lot, or like actually be isolated at home, whatever.

对，多举铁就对了。

Yeah, lift weights a lot.

时间一长，你的二头肌自然就变得又大又有力。

And over time, your biceps will get big and strong.

大脑里的通路也是一样，你越频繁用它来做某件事，它就越发达、越强韧。

It's the same with the pathways in your brain, the more you use them for any particular thing, the bigger and stronger they get.

你练尤克里里练得越多，大脑里跟尤克里里相关的通路就越强健。

So the more you practice ukulele, the bigger and stronger the ukulele pathway in your brain gets.

你能听出音符，手指知道该在弦上怎么按，也知道怎么拿稳乐器。

Like you can hear the notes, your fingers know what to do on the strings, you know how to position the instrument.

这都是靠长期练习得来的。

And that's with practice over time.

那你猜猜，如果你一不小心、反反复复地练习痛苦，持续几周、几个月甚至几年，会发生什么？

Guess what happens when you inadvertently accidentally practice pain over and over for weeks and months and years?

结果都一样。

Same thing.

你大脑里的疼痛通路会变得特别粗壮、特别强。

The pain pathway in your brain gets really big and strong.

一旦这样，我们就说你的大脑对疼痛变得敏感了。

And when that happens, we say that your brain has become sensitive to pain.

这到底是什么意思？

What does that mean?

我花了好长时间才想明白，该怎么跟人解释这个事儿。

That took me a long time to figure out how do you explain that to someone?

大脑对疼痛敏感，到底指的是什么？

What does that mean that your brain is sensitive to pain?

意思是，你身体传来的那些微小感觉信号，会被一个敏感的大脑当成特别严重的威胁。

What it means is that small bits of sensory input from your body are interpreted by a sensitive brain as very big.

就像狗对气味特别敏感一样。

So like, dogs are sensitive to smell, Or sense.

要是现在有只狗跑进来闻一闻，它能闻出我们根本察觉不到的气味，因为它的大脑对气味特别敏感。

So if a dog came in here right now and sniffed around, they would pick up on the scents that you and I can't even detect because their brain is sensitive to smell.

疼痛也一样，当你的大脑对疼痛敏感时，身体传来的那些其实无害的小信号，它也会放大，还告诉你：‘危险！’

So with pain, when your brain is sensitive to pain, it means that you might have little bits of sensory input coming from your body that are not dangerous, that are not dangerous, but your brain is going to amplify it and tell you that it's dangerous.

疼痛其实就是这么回事。

And that's what pain is.

它是个强烈到离谱的危险警报，实际上根本没那么危险。

It's this big danger response, this big danger warning message that actually is inaccurate.

这就是慢性疼痛。

And that's chronic pain.

所以，慢性疼痛背后的一个机制就是这个过程，叫中枢敏化。

So the system, one of the systems underlying chronic pain is this process, it's called central sensitization.

但这并不是所有疼痛的根源，它确实能解释很多慢性疼痛。

And it doesn't underlie all pain, but it explains a lot of chronic pain.

我觉得特别有意思的是，你可以跟人说：‘你很可能是因为大脑太敏感了，反应过度了。’

And to me, it's so fascinating to be able to say to someone, Hey, the chances are really high that your brain is hypersensitive and it's overreacting.

这不是你的错，但你的大脑在明明身体没危险的时候，还不断发出危险警报。

It's not your fault, but it's giving you these danger messages when in fact your body might not be in danger.

比如纤维肌痛这种慢性疼痛，你跟朋友去野餐，坐在户外，却疼得要命。

So, for example, with fibromyalgia, which is a chronic pain condition, you can go for a picnic with your friends and be sitting outside and be in terrible pain.

可和朋友去野餐，真的有危险吗？

But is having a picnic with your friends dangerous?

答案当然没有。

And the answer is no.

但你的大脑却在不断发出危险信号，逼你回家、躲起来、别动、别见朋友。

But your brain is producing these danger messages and telling you you should go home and isolate and be alone and not move and not see your friends.

这完全是胡说八道。

And that is a big fat lie.

如果你听从大脑的指挥，真的躲起来、窝在沙发上四十年，那你是不可能好转的。

And if you listen to your brain and you do those things and you go and isolate and you lay on your couch for forty years, you are not going to get better.

所以，治疗慢性疼痛的方法，恰恰跟你想的完全相反。

So the treatment for chronic pain is the total opposite of what you think it is.

你的身体和大脑都在告诉你：躲起来、别出门、别动。

Your body and your brain are telling you isolate, stay home, don't move.

但治疗慢性疼痛呢，我的比喻是——你有没有待过一个全黑的房间，然后有人突然拉开一点窗帘，你立马就想拉上？

And the treatment for chronic pain is like, my metaphor is like, you've ever been in a dark room, and someone opens the blinds a little bit, and you're like, close the blinds,

我看不见。

I can't see.

因为你刚从黑暗里出来，大脑对光特别敏感。

Because your brain is sensitive to light when you've been in a dark room.

对。

Yeah.

但你只要在那儿坐两分钟，大脑就会慢慢适应光线了。

But if you sit there for two minutes, your brain desensitizes to the light.

然后你就没事了，对吧？

And then you're fine, right?

如果他们再把窗帘拉开一点，你就会说：天啊，快拉上！我受不了了

And if they open the blinds a little more, you're like, shit, close the blinds, I can't

看不清。

see.

但过两分钟，你的大脑就适应了，你就没事了。

And then eventually, two minutes later, your brain desensitizes, you're fine.

慢性疼痛的治疗就是这样，顺便说，这其实就是认知行为疗法。

Treatment for chronic pain, and that's what cognitive behavioral therapy is, by the way.

它就是一点点地帮你的大脑和身体适应轻微的刺激，就像从完全黑暗的房间，慢慢、一点点地让光线透进来，最后你整个人都适应了，大脑和身体都安然无恙。

It's helping someone's brain and body desensitize to little bits of stimulation a little bit at a time, until like someone who's in a dark room, suddenly you're in a room full of light gradually little bits at a time and your brain and body are okay.

所以，治疗就是这么回事。

So that's the treatment.

但如果你不理解背后的科学原理，你是不会接受这种治疗的。

But you're not going to buy into the treatment unless you understand the science.

所以这对我来说特别重要，一定要先把基础打牢。

So that's why it's so important to me to always lay that foundation.

那杏仁核在这中间也有作用吗？

And is the amygdala at all involved in this?

比如焦虑和恐惧？

Like is anxiety and fear?

这些跟疼痛感知关系大吗？

Is that a big part of pain perception?

是的，关系可大了。

Yeah.

我就猜到是老杏仁核在搞鬼。

Had a feeling old Amy up there.

把它搞得一团糟。

Fucking shit up.

百分百没错。

100% yes.

你得帮帮我们。

You're to help us.

是的。

Yeah.

好。

Okay.

来，给大家快速讲讲疼痛的神经科学，疼痛科学入门课。

So crash course in pain neuroscience, pain neuroscience 101.

事情是这样的。

Here's how it goes.

准备好了吗？

Ready?

好。

Okay.

我早就准备好了。

I'm so ready.

来，说说你脑袋里哪儿真正在让你头疼。

Let's hear what parts of your head are being a literal pain in your ass.

其实大脑里有好多地方都会参与疼痛的感觉。

So there's lots of parts of your brain that contribute to pain.

有些情况呢，好像就只有一个脑区在起作用。

With some things, it's like, Oh, there's just one part of your brain.

但疼痛不一样，它是个遍布全脑的神经过程。

But with pain, it's a diffuse neurological process.

也就是说，很多脑区都在共同塑造我们所说的‘疼痛’这种体验。

And what that means is there's lots of parts of your brain that contribute to this experience we call pain.

所以我来跟你讲几个关键的脑区。

So I'm going to tell you a couple of parts of the brain.

第一个是大脑皮层。

One is your cerebral cortex.

明白了。

Okay.

你的大脑皮层负责思考。

Your cerebral cortex is the part of your brain responsible for thoughts.

想法时时刻刻都在影响疼痛。

Thoughts contribute to pain all the time.

大脑的第二个部分是前额叶皮层。

The second part of your brain is your prefrontal cortex.

它管的是你的决策能力和注意力。

And that's the part of your brain responsible for executive functioning and attention.

你关注什么、想什么，都归它管。

What you're focusing on, what you're thinking about.

第三个部分是边缘系统。

And the third part of the brain is your limbic system.

你的边缘系统和杏仁核是边缘系统的核心部分，说白了，边缘系统就是大脑的情绪中枢。

Yes, your limbic system and your amygdala is a major part of your brain's limbic system and your limbic system by the by is your brain's emotion center.

这说明了什么呢？

And here's what this means.

这意味着，百分之百——我不是在夸张——身体传来的所有感觉信号，都得先经过你的情绪中枢，才会变成我们所说的‘疼痛’体验。

That means that 100%, and I'm not exaggerating, 100% of the sensory signals that come from your body filter through your emotion center before they become this experience we call pain.

所以人们总问我：你治的是身体上的痛，还是心理上的痛？

So people always ask me, do you treat physical pain or emotional pain?

哎，你是个疼痛心理学家？

Like, oh, you're a pain psychologist?

这说法也太奇怪了吧。

That's so weird.

你治的是身体上的痛，还是心理上的痛？

Do you treat physical pain or emotional pain?

答案永远都只能是：是的。

And the answer is always necessarily, yes.

对。

Yes.

因为疼痛，从来都是身体和情绪交织在一起的。

Because pain is always physical and emotional.

这些信号都会经过你的边缘系统。

It's filtering through your limbic system.

在变成我们所说的疼痛之前，它们都会先经过你的情绪中枢。

It's filtering through your emotion center before it becomes this complex experience we call pain.

所以没错。

So yes.

现在我想让你想象一下，我们之前稍微提过，你体内有个‘疼痛旋钮’，就像汽车音响的音量旋钮，可以调高调低。

So now I want you to imagine we sort of touched on this earlier, that you have what I'm going to call a pain dial, like the volume knob on your car stereo, and you can turn it up and down.

这个旋钮就在你的中枢神经系统里——大脑和脊髓协同工作，控制着一切，包括疼痛。

And it lives in your central nervous system, your brain and your spinal cord, which work together to control all the shit, including pain.

对。

Yeah.

事情是这样的：

So here's how this works.

很多因素都会影响疼痛的强度，不管是急性痛还是慢性痛，哪怕你才痛了五秒，或者已经痛了十年。

Lots of things can change pain volume, whether it's acute pain or chronic pain, whether you've had it for five seconds or ten years.

很多因素都会影响疼痛的强弱，让它变大或变小。

Lots of factors change pain volume to turn it up and down.

我想跟你聊三个关键点。

So three things I want to tell you about.

第一，压力和焦虑总会让疼痛加剧。

One is stress and anxiety always changes pain volume.

天哪。

Oh, no.

对吧，简直太真实了。

I know, right?

尤其是在疫情期间。

During a pandemic.

疫情期间，慢性疼痛的情况直线上升。

Chronic pain during the pandemic went through the roof.

与阿片类药物相关的过量服用案例增加了百分之四十。

Opioid related overdoses went up forty percent.

打自杀热线的电话增加了八千倍。

Calls to suicide hotlines went up eight thousand percent.

天哪。

Oh my God.

老兄，真有人在受苦啊。

Dude, people are suffering.

大家这么痛苦，其实跟我们刚才说的这些神经科学道理完全说得通，对吧？

People are really so people in pain because of all this neuroscience we're talking about, it makes sense, right?

所以，压力和焦虑。

So stress and anxiety.

第二点，情绪和心情也总在影响疼痛的强弱。

Thing two is mood and emotions always change pain volume.

第三点呢，是你的注意力——你把心思放在哪儿。

And thing three is attention or what you're focusing on.

接下来我具体跟你说说这背后的机制。

So I'm going to tell you specifically how this works.

所以，刚才说的，就是压力、情绪和注意力。

So again, that was stress, emotions and attention.

当压力和焦虑高涨时，你的身体和肌肉会紧绷——这本来就是压力和焦虑的常态，再加上脑子里总在担心事儿，大脑就会给那个‘疼痛旋钮’发信号，把疼痛音量调高。

When stress and anxiety are high and your body and your muscles are tense and tight, which is what happens when you're stressed and anxious, and your thoughts are worried, your brain sends a message to this pain dial, turning up pain volume.

不管你之前有多疼，只要一压力大、焦虑，比如刚失业、赶上疫情，或者跟伴侣吵架闹矛盾，你的大脑都会把疼痛的音量往上调。

So whatever pain you had before, when you're stressed or anxious, like you just lost your job or it's a pandemic or like whatever, you're stressed out because you're fighting with your partner or whatever, your brain is going to amplify pain volume.

压力和焦虑越大的时候，疼痛感就越强烈。

Pain is going to feel worse when stress and anxiety are high.

任何有慢性疼痛的人都会告诉你，压力和焦虑简直就是疼痛的触发器和放大器。

And anyone with any chronic pain condition will tell you that stress and anxiety can be a trigger or an amplifier of pain.

第二点，是情绪。

Thing two is mood.

还是那句话，负面情绪。

So again, negative emotion.

当你情绪低落、痛苦抑郁——这其实挺讽刺的，因为疼痛本身就会让人这样——或者你生闷气、特别烦躁，你的边缘系统，包括负责负面情绪的杏仁核，都会把疼痛音量给拉上去。

So when your mood is low, and you're miserable and depressed, which ironically happens when you have pain, or emotions are negative in general, or you're angry or you're very frustrated, your limbic system, including your amygdala, of course, which is implicated in all the negative, amplify pain volume.

所以情绪低落的时候，疼痛会更明显。

So pain feels worse when emotions are negative.

第三点是注意力，还是那个你专注的东西。

And thing three is attention, again, what you're focusing on.

当你躺在床上或瘫在沙发上，老盯着自己的身体，想着哪里疼，那个痛的地方，你的前额叶就会给疼痛旋钮发信号，把音量调高。

So when you are sitting in bed or laying on your couch, and you're focusing on your body, and you're thinking about your pain, that body part that's hurting, your prefrontal cortex sends a message to that pain dial, raising pain volume.

所以你越琢磨疼的地方，疼痛感就越强。

So pain feels worse when you're thinking about it, and when you're focusing on the body part that hurts.

但对我们这些有疼痛的人来说——其实百分百的人都有——这一点特别关键，因为反过来也成立。

But the reason this is critically important for those of us who have pain, which is one hundred percent of us, is that the opposite is also true.

反过来也一样成立。

The opposite is also true.

要是想想这对疼痛管理意味着什么，简直太惊人了。

And if you think about the implications for pain management, that's pretty wild.

那咱们来聊聊反过来的情况。

So let's talk about the opposite.

当压力和焦虑低的时候，你的身体和肌肉都会放松，思绪也平静下来。

When stress and anxiety are low, your body and your muscles are relaxed, and your thoughts are calm.

你的大脑会向那个疼痛旋钮发送信号，把疼痛音量调低。

Your brain sends a message to that pain dial lowering pain volume.

所以当你放松又平静的时候，疼痛就没那么难受了。

So pain feels less bad when you are relaxed and calm.

第二点是情绪，你的心情。

Thing two is mood, emotions.

当你情绪积极，感到开心、快乐、感恩，和朋友一起做些有趣的事时。

So when your emotions are positive, you're feeling happy and joyful and grateful, and you're doing fun things with friends.

你的边缘系统就会降低疼痛的强度。

Your limbic system lowers pain volume.

情绪积极的时候，疼痛也会没那么难受。

Pain feels less bad when emotions are positive.

第三点是注意力。

And thing three is attention.

当你注意力被别的事吸引，全神贯注做某件事时，就会暂时忘了疼。

So, when you are distracted, when you're so absorbed in some activity, you briefly forget about your pain.

我们都经历过这种事。

We've all had that experience.

这可不是什么魔法。

That is not magic.

这就是你大脑里的疼痛旋钮在起作用。

That is your brain's pain dial.

当你专心做事、不再想着身体、不再想着疼痛时，大脑的前额叶就会把那个疼痛旋钮调低。

So your brain, your prefrontal cortex will lower this pain dial when you are absorbed in things and you're not thinking about your body and you're not thinking about pain.

所以你给孩子打疫苗的时候——这事儿谁都该做——给他个屏幕看喜欢的节目，他分心了，疼得就没那么厉害。

So that's why when you go to give a child a vaccine, which everyone should do and get an injection, you give them a screen and they can watch their favorite show and they're distracted and it hurts less.

总的来说，在我看来，这些因素帮我们明白：疼痛其实是个生物-心理-社会综合现象，受情绪、想法、注意力、所处环境和身边的人共同调节。

So, all these things together, in my mind, help us understand that pain again, is this biopsychosocial thing that's regulated by mood, and thoughts and what you're focusing on, and where you are and who you're with in your context.

这些因素都会影响大脑的判断：到底要不要疼，疼多少。

And all those things are going to matter to your brain when it makes this pain decision whether or not to make pain, and how much.

那第一步该怎么做呢？

And so what are some of the first steps?

如果一个人不是你的专属病人，或者他们的心理医生、主治医生根本没这方面的知识，该怎么办？

If someone doesn't have the privilege of being your specific patient, for example, or maybe their psychologist or their medical doctors don't have this much information in their brains about it.

你一般怎么引导这些人？

Where do you start with people?

是直接开始冥想吗？

You start with just like, start meditating?

还是去门廊坐坐？

Go on the porch?

到底从哪儿开始才好？

Where do you even begin?

我用的是认知行为疗法。

So I do this treatment called cognitive behavioral therapy.

但很多人对这疗法到底是什么、怎么用在疼痛管理上，都存在误解和错误信息。

And there's a lot of misunderstanding and misinformation about what that is and how it applies to pain.

其实就是一种最初为焦虑和抑郁开发的疗法，已经有充分的证据证明它有效。

So what it is, is it's a treatment that was originally developed for anxiety and depression that does have evidence of effectiveness.

而且它还能用来改善睡眠、家庭关系紧张这些问题——顺便说一句，这些也都跟疼痛有关，这让我特别着迷，因为所有事情都是连在一起的。

And it also is a treatment, by the way, for sleep and family dysfunction and all these other things, by the way, that also contribute to pain, which is so fascinating to me, because all the things are interconnected.

所以我觉得，这种疗法对缓解疼痛应该也有帮助。

So it makes sense to me that this thing might be useful for pain.

它告诉我们，你的想法会影响你的情绪，情绪又会影响身体感受，进而影响你的行为。

And it teaches us that how you think affects how you feel emotionally, affects how you feel physically, affects how you behave or act.

就这么一圈圈转下去：你怎么想，决定你有什么情绪；情绪影响身体感受；身体感受又反过来影响你怎么做。

So round and round in a circle, what you think affects how you feel affects how your body feels affects how you act.

我可以给你举个例子。

And I can give you an example of that.

比如说，有个人邀请你去参加派对，对，就是那个叫Alie Ward的人，疫情都一年半了，她说：‘来我家吧，我在后院办个派对！’

So let's say someone invites you to a party, okay, they're like Alie Ward, it's been like a year and a half pandemic, come to my house, we're gonna have a party in my backyard.

肯定特别有意思。

It's gonna be really fun.

你脑子里冒出个念头：我是个失败者，没人喜欢我。

And you have this thought in your head, you think to yourself, I am a loser, and nobody likes me.

要是我去参加派对，肯定没人理我。

And if I go to the party, no one will talk to me.

我就一个人傻站着。

I'll just be standing by myself.

那时候，我感觉特别沮丧，也很丢脸。

At this point, I was feeling depressed and ashamed.

这种想法会直接影响你的情绪。

That thought is going to affect your emotions.

如果你这么想的话，

How might you feel if

你会有什么感觉？

you thought that thought?

当然是沮丧又羞愧啊。

Oh, depressed and ashamed.

百分百。

100%.

对。

Yes.

可不是嘛。

Yeah, right.

所以你现在感觉沮丧、痛苦又羞愧。

So you're feeling depressed and miserable and ashamed.

那抑郁会对身体有什么影响呢？

So how does depression affect your body?

我觉得我可能会更难爬起来，准备去面对。

I think I would have a harder time getting up and getting ready for it.

没错。

That's

对。

right.

我觉得我会直接陷进我坐着的那块软布料里。

I think I would sink into whatever soft fabric I am sitting on at the moment.

百分百。

100%.

对。

Yes.

所以我们知道，负面情绪会影响身体，对吧？

So we know that negative emotions impact the body, right?

我想说的是，负面情绪不只停留在脑子里，它们也会体现在身体上。

And I'd like to say that negative emotions don't just live in your head, they also come out in your body.

如果你曾经紧张或压力大到手心冒汗、嘴巴发干、心跳加速，那说明情绪确实会表现在身体上。

And if you've ever been stressed out or nervous and your palms get sweaty and your mouth goes dry and your heart races, Of course emotions come out in your body.

或者你要是经历过抑郁，就知道那种浑身沉重、提不起劲儿的感觉。

Or if you've ever been depressed, you know that you feel heavy and unmotivated.

没错。

So right.

所以这种‘我是个失败者，没人喜欢我，我肯定要惨了’的想法，会引发负面情绪，进而影响你的身体。

So that thought, I'm a loser, nobody likes me, I'm gonna have a terrible time, is going to trigger negative emotions and that's going to affect your body.

你会觉得提不起劲，整个人沉甸甸的。

You're going to feel unmotivated and heavy.

那面对这些想法和感受，你通常会怎么做？

So what do you do as a result of those thoughts and feelings?

你刚才说得太到位了。

You already said it perfectly.

你往沙发上一瘫，然后发条消息说‘我赶 deadline’，其实根本不是这么回事。

You sink into a couch, and then I send a text about being on deadline, which is a lie.

对，没错。

Right, right.

然后你套上毛茸茸的睡衣，搬出一桶冰淇淋，瘫在那儿刷剧。

And you like put on your fuzzy pajamas, and you get a tub of ice cream, and you binge watch Netflix.

对极了。

Yeah, totally.

没错。

Totally.

就是这样。

Exactly.

对啊。

Yeah.

但这个循环一直在转。

But the cycle spins around.

所以你现在错过了派对，窝在沙发上，穿着睡衣吃一整盒冰淇淋。

So now you're missing out on the party, and you're sitting on your couch, and you're in your pajamas eating a tub of ice cream.

是啊。

Yeah.

那你现在心里在想什么？

And what are you thinking to yourself now?

我是摇滚巨星？

I'm a rock star?

你在想什么？

Are you thinking?

我知道，我就是那个我以为自己是的蜥蜴。

I know, I am the lizard that I thought that I was

百分百。

100%.

对。

Yeah.

这就是我们说的认知行为疗法循环：想法如何影响大脑，进而影响身体。

And that's what we call the cognitive behavioral therapy cycle of how thoughts affect the brain affect the body.

对吧？

Right?

但现在，让我给你反过来说一遍。

But now let me give you the opposite.

有人对你说：‘艾莉·沃德，来我家吧，我们在开派对，你想穿什么裙子都行，把最漂亮的鞋子也穿上。’

Someone says, Alie Ward, come to my house, we're having a great party, you can wear whatever dress you want put on your nicest shoes.

是的。

Yeah.

你心里想：我真是个摇滚明星。

And you think to yourself, I am a rock star.

大家都超爱我。

People love me.

我是派对的灵魂人物。

I'm the life of the party.

我要跳街舞，亮出我的所有舞步。

I'm gonna break dance, I'm gonna pull out my breakdancing moves.

我还要烤些布朗尼，分给大家，所有人都会想：这想法让你感觉怎么样？

I'm And going to like bake brownies and like, bring them everyone's just going to think, how does that thought make you feel?

哦，我感觉轻松、兴奋，还有点紧张。

Oh, I lighter and excited and a little nervous.

太棒了。

Great.

真喜欢这种情绪的组合。

Love that constellation of emotions.

对吧？

Right?

兴奋，特别兴奋，又有点紧张。

Excite, totally excited, a little nervous.

那这种感觉对身体有什么影响？

So how does that affect the body?

通常你兴奋的时候，会特别有劲儿。

Usually when you're excited, you have a lot of energy.

你是不是觉得特别有动力？

You know, you feel like motivated?

是的。

Yeah.

那你的行为会有什么变化？

And then what's your behavior?

你平时会干嘛？

What do you do?

肯定会涂口红、画睫毛膏，把液态眼线笔翻出来，烤点布朗尼，顺便偷吃点生面糊。

Definitely put on lipstick, do some mascara, dig out the liquid liner, bake some brownies, eat some of the batter.

要是我想彻底放飞自我的话。

If I want to totally Yeah.

然后说不定还能准时出门。

And then and maybe even leave the house on time.

没错。

That's right.

那你去参加派对了。

So you go to the party.

对，就是这样。

Yeah, that's right.

你穿着裙子去派对，还带了布朗尼，十有八九会有人主动跟你搭话。

You show up at the party in your dress and you bring some brownies, chances are pretty high, some person is going to be talking to you.

如果你真觉得自己像个摇滚明星，打算好好玩一把，那别人主动跟你搭话的可能性就很大。

And if you're really feeling like if you're thinking I'm a rock star, I'm gonna have fun, chances are high.

你很可能就会吸引别人过来跟你聊天。

You probably you probably will you'll attract someone to come talk to you.

对吧？

Right?

没错。

Right.

你脑子里想什么，会影响你的情绪，进而影响你的行为——这永远都成立。

So, so the things you think affect the things you feel affect how you behave always, that's always true.

麻烦的是，当你焦虑或抑郁时，就会陷在这些负面想法里，反而让情况越来越糟。

And the shit of it is when you're anxious and depressed, you get stuck in these thought cycles that contribute to the perpetuation of the cycle.

这种事发生起来真的很容易理解。

And you can see how that would easily happen.

是的。

Yeah.