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4个步骤帮你改善强迫行为

How To Stop Skin Picking and Hair Pulling In 4 Steps

Hi, I’m Dr. Tracey Marks, a psychiatrist,
嗨 我是精神科医师 翠西·马克斯
and I make mental health education videos.
我制作心理健康教育视频
In a previous video, I talked in detail
在之前一期视频里 我详细介绍了
about the body-focused repetitive behaviors,
聚焦于身体的重复行为
such as hair pulling, skin picking, and nail biting.
比如拔毛发 抠皮肤 咬指甲
These are compulsive behaviors that can cause a lot of problems
这些都是会带来很多问题的强迫行为
and are much more than just having a nervous habit.
远不止是一种紧张性习惯那么简单
These compulsions don’t respond well to medication,
药物对这些强迫行为的疗效不佳
but can respond well to a therapy called habit reversal training.
但是被称作“行为反向训练”的疗法却行之有效
This therapy can also work with tics
这种疗法对抽动症
and nervous habits, like touching your face.
还有摸脸之类的紧张性习惯 也都有效
Important precautions for COVID are that you disinfect your hands
预防新冠的重要措施包括手部消毒
and refrain from touching your face,
还有克制摸脸的冲动
but we touch our face a lot more than we realize.
但我们摸脸的次数远比我们意识到的要多
Some studies have shown that
一些研究显示
people touch their face on average of 10 to 20 times an hour
人们平均每小时摸脸10到20次
without even being aware of it.
自己甚至都没意识到
In this case, touching your face isn’t necessarily a compulsion
这种情况下 摸自己的脸不一定是强迫行为
but a habit.
而是种习惯
So habit reversal training can also help with touching as well.
因此 行为反向训练对这种习惯同样有效
The most effective way to use this technique
使用这项技术最有效的方法是
is with a trained therapist, who can create a customized plan for you,
找一个训练有素的治疗师为你定制治疗方案
but you can apply the concepts on your own.
不过你也可以自己运用这些理念
Habit reversal training can be broken down into three phases:
行为反向训练可以分为三个阶段:
awareness training, competing response training,
意识训练阶段 对抗反应训练阶段
and establishing motivation and support.
以及建立动力和支持阶段
And then there’s an add-on technique called stimulus control
还有项附加技术 叫刺激控制
that pairs well with habit reversal training to make it even more effective.
它和行为反向训练结合使用 疗效更好
Let’s take a closer look at each phase.
我们来详细了解下每个阶段
First, there’s awareness training,
首先是意识训练
which we can further break down into three steps.
我们可以把它进一步分为三个步骤
The first step is to identify the habit or the problem behavior that you want to break.
第一步是确认你想要改掉的习惯或问题行为
This could be hair pulling, skin picking, nail biting,
有可能是拔毛发 抠皮肤 咬指甲
or even touching your face.
或者只是摸自己的脸
The next step is to recognize when you engage in the behavior
下一步是要辨别出你什么时候会做出这种行为
and what triggers it.
诱因是什么
Even though you may have an idea of when you do it,
即便你可能知道自己何时会做这个行为
you should get someone to spend time around you
还是应该找人陪伴你一段时间
to point out when you do it,
指出你何时做了该行为
because there may be times that you mindlessly engage in the behavior
因为有时候你可能会无意识地做出这个行为
like when reading or watching television.
比如阅读或者看电视的时候
Stress is a common trigger, but so is boredom.
压力虽为常见诱因 但无聊也是
Once you start paying attention to the behavior,
一旦你开始注意这种行为
you’ll get good at recognizing when you do it.
你便会更善于发现自己什么时候在做
Then, the third step in this phase of awareness training
接下来 意识训练阶段的第三步是
is to identify the earliest signs of the behavior
在你最开始感觉到想做这个动作的冲动时
when you first feel the urge to do it.
识别出最早的迹象
This is called early warning training.
这叫作预警训练
With the compulsive behaviors, you may have physical sensations.
随着强迫行为的出现 你身体上可能会有感觉
For example, you may feel tingling in your hands when you want to chew them
比如当你想咬手时 可能觉得手上有麻刺感
or tightness around your mouth that makes you want to chew your lip.
当你想咬嘴唇时 可能觉得嘴部周围有紧绷感
Also, think about if there’s any situations that makes this most likely to occur.
还要想想 有没有哪种情况最有可能让你做出这种行为
By the time you complete these steps,
做完这些步骤的时候
you should be fully aware of the problematic behaviors,
你应该充分意识到自己的问题行为
when and where they happen,
它们出现于何时何地
and under what circumstances they’re most likely to happen.
在何种情况下最容易出现
So write down the places, situations, and early signs down in a journal
所以请把地点 情景 和早期迹象记录在日记上
so that you can refer back to them.
供你以后参考
The next phase is training yourself to engage in competing behaviors.
下一个阶段是训练自己做对抗行为
Here, you substitute a new behavior for the old one that you want to extinguish.
在这一步 你需要用一个新行为来替代你想消除的旧行为
And here are some examples.
这里有一些例子
For things that involve your hands,
对于涉及手部的行为
like nail biting, skin picking, or hair pulling;
比如咬指甲 抠皮肤 或者拔毛发
you could squeeze a ball, snap a rubber band on your wrist,
你可以捏球 或在手腕上绑一根橡皮筋
or you could play with yarn to substitute for playing with a pulled hair.
或者摆弄纱线 替代拔下来的毛发
You want to pick something that occupies the body part that’s involved in the behavior,
你得选一件能让涉及问题行为的身体部分忙起来的事情
so it can’t do the old behavior.
这样就无暇去做原来的行为了
It’s even better if the activity somewhat resembles the old behavior.
如果新行为跟旧行为有相似之处 那样会更好
For example, with hair pulling and skin picking,
举例来说 在拔毛发或抠皮肤时
you not only pick,
你不光做出这些动作
but part of the ritual usually involves playing with the object
动作流程通常还包括摆弄毛发或皮肤
and feeling the texture of it.
并感受它的质地
So wrapping a piece of yarn around your finger
因此 将纱线在手指上缠绕
or fiddling with the yarn can be a good substitute
或者摆弄纱线 可以是很好的替代动作
because it keeps your hands busy
因为这样可以让你的手忙着
and you can play with the texture of the string.
感受纱线的质地
Now, you may wonder, “How is this helpful?
现在你可能会想 “这有用吗?
“I’m still fidgeting with something, and I’m just trading one thing for another.”
“我还是在不安地摆弄东西 只不过换了个东西罢了”
And that’s true.
这没错
The goal is not to keep your hands still,
治疗目标不是让你的手保持不动
but to keep them busy with something
而是让手忙着做某事
that doesn’t produce a negative consequence
却不会造成例如斑秃
like bald spots, chewed fingers with sores,
咬得手指上生疮 或把病毒揉进眼睛里
viruses in your eyes.
这样的不良后果
You get the picture.
你明白了吧
That said, it’s still important that the competing behavior be something
话虽如此 但对抗行为不应当引人注目
that’s not noticeable to others.
这仍然很重要
Some people will clench their hands into fists
有些人的对抗行为是握拳
or fold their hands across their chest as their competing behavior.
或者把双手交叉胸前
And it doesn’t have to only be one thing,
不一定只能做一种对抗行为
you can have a few options.
你可以选几个动作
To practice the behavior,
为了练习这个动作
you pretend to do the old behavior,
你得假装自己要做旧动作
but before you do it, you switch to the new behavior
但在做旧动作之前 转而去做新动作
and do it for one minute.
并持续做一分钟
This breaks the pattern and weakens the urge.
这样做能打破行为模式 削弱冲动
Because remember, with the compulsive behaviors,
因为别忘了 你做强迫行为时
you have strong urges to do them.
会有很强的冲动
And this technique works to interrupt the urge.
这个技巧可以有效扼制冲动
That one minute interruption takes some of the wind out of the sails and lessens the urge.
这一分钟的打断会一定程度上削弱你的行为动机 并使冲动减弱
The next phase is cultivating motivation and support.
下一个阶段要培养动力和支持
For the motivation,
就培养动力来说
you write down all of the negative consequences of the behavior.
写下这个行为导致的所有不良后果
How did it, or how can it cause problems for you?
它曾经 或将会给你造成怎样的问题?
It doesn’t always have to be serious, as far as the outcome.
当然 就后果来说 不一定非得是很严重的
What’s the inconvenience cost to the behavior?
该行为造成了哪些不便?
Writing these things down is also a good journal exercise.
记录这些事情也会是一种很好的日记练习
You want to use this list as a reminder
你可以把这个列表当成一种提醒
for why you need to stick to the plan.
提醒你为什么需要坚持计划
Support is what you get from someone you choose to make part of your plan.
支持是指 把从你选定的人那里得到的帮助 当成计划的一部分
This person will know what your problem behaviors or habits are
这个人得知道你的问题行为或习惯
and know what your new competing behaviors are.
以及你的新的对抗行为是什么
Then, that person will be on the lookout
然后这个人会监督
for the compulsive behavior and its warning signs,
你的强迫行为以及前期征兆
and reminds you to use your competing behavior.
并提醒你使用对抗行为
They can also cheer you on, so to speak,
就是说 如果他发现你没有做强迫行为
if they noticed that you haven’t engaged in the compulsive behavior.
还可以鼓励你继续坚持
So the support person provides positive reinforcement
所以这个支持你的人会带来正面的情感强化
and helps you detect warning signs
而在你没注意到的时候
or detect the behaviors when you don’t notice them.
他还能帮你识别早期征兆或问题行为
The last part of the strategy is what’s called stimulus control.
这个治疗策略的最后一部分被称为刺激控制
It’s a separate process, but it combines well with habit reversal training.
这是一个独立的流程 但是能与反向行为训练较好结合
It’s designed to reduce the things in your environment
刺激控制的原理是减少环境中
that can trigger your behavior.
会诱发你行为的事物
With stimulus control, you take a list of the triggers and situations
在做刺激控制时 你要拿出意识训练阶段中
that you made in the awareness training phase,
罗列着诱因和情境的清单
and then put blocks in place to make it harder for you to be triggered.
然后设置适当的阻碍 让你的行为更难以被诱发
With competing behaviors,
做对抗行为时
you’re blocking the compulsive behavior or the habit.
你是在阻碍强迫行为或习惯
But with stimulus control, you’re blocking the trigger.
而在做刺激控制时 你是在阻断诱因
So it’s like you’re trying to catch things early.
这就好像你在尝试尽早控制事态
Examples of stimulus control are
举几个刺激控制的例子:
covering your bathroom mirror to discourage face picking,
遮住卫生间的镜子或减少呆在卫生间的时间
or limit the time that you spend in the bathroom,
以阻止自己抠脸
putting salve or petroleum jelly on your fingers or skin,
在手指或皮肤上涂药膏或凡士林
keeping your skin slick with heavy creams makes it harder to pick.
用厚厚的膏体保持皮肤光滑 就不那么容易抠了
If you use instruments like tweezers to pick,
如果你是用镊子之类的工具抠
then discard them so that you’re not tempted to use them.
扔了吧 这样你就不会蠢蠢欲动
If you lie in bed at night and pick, wear gloves to bed.
如果你夜里躺床上抠 那就戴上手套睡觉
And these are just a few examples of ways
以上只是简单列举了几种
to control your triggers or things in your environment
帮你控制环境中诱因或事物的方法
that make it easier for you to engage in your behavior.
让你可以更轻易地做出对抗行为
You may realize that over time, as things change,
你也许会发现 随着时间和事态的变化
you recognize new warning signs
出现了新的前期征兆
for which you can create another control.
对此你可以创造另一种刺激控制
Keeping up with all of this is where journaling comes in handy
如果你想随时了解训练进度 日记就派上用场了
so that you’re not having to keep it all in your head.
这样你就不必全都记在脑子里
To help you organize this process,
为了帮你规划这个流程
I created a handout that summarizes the steps.
我写了一份讲义 归纳了所有的步骤
You can download it from my website,
你可以从我的网站上下载
and you don’t even need to put in your email address to get it.
都不用填邮箱地址就能获取
But if you are a part of my email community,
不过如果你是我电邮社区的一员
you already got the handout in your inbox when this video publish,
在本视频发布之时 这份讲义就已经在你的收件箱里了
so you don’t have to go searching on my website.
无需去我的主页搜索
Watch this video
观看这个视频
for more on the nuances of body-focused repetitive behaviors.
了解更多聚焦于身体的重复行为之间的细微差别
Thanks for watching!
感谢观看!
See you next time.
下回见

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视频概述

本期视频介绍了行为反向训练的具体方法和步骤,该疗法能够有效改善诸如拔毛发癖、抠皮肤、咬指甲之类的重复性行为,对抽动症也有一定疗效。

听录译者

收集自网络

翻译译者

云团子

审核员

审核员TL

视频来源

https://www.youtube.com/watch?v=Y0xffNT0jTE

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