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多动症患者反而会拖延?

Why People with ADHD Procrastinate

Hi, I’m Dr. Tracey Marks, a psychiatrist,
大家好 我是精神科医生特蕾西·马科斯
and I make mental health education videos.
我录制心理健康教育视频
Anyone can be unmotivated to do something,
每个人做事都会有缺乏积极性的时候
but when you have attention deficit hyperactivity disorder,
但是患上“注意力缺陷多动症”(ADHD)时
you’re wired to have trouble getting things started
你会紧张不安 因为你做事难以开始
or following through.
或不能坚持
ADHD is a brain disorder where you struggle with attention,
ADHD是一种大脑疾病 患者难以应付注意力
concentration, impulsivity, distractibility,
专注力 易冲动 易分心
or hyperactivity.
或易多动等问题
And you may not have all of these things going on at once,
你不一定有以上所有症状
but you usually have some of them.
但难免会有其中一些
With the inattentive type, you don’t have the hyperactivity
注意障碍型的患者就不会有多动表现
and the main problem is around the focus
他们的主要问题出在专注
and concentration issues.
和集中注意力上面
But a symptom that’s not talked about that much
但有一个症状人们讨论不多
is impaired motivation,
那就是积极性受损
and this is a huge problem with ADHD.
这是ADHD患者的一个大问题
It’s a symptom that causes conflicts with others
正是这个导致患者与他人的冲突
and can affect how you think about yourself.
并会影响着自我评价
You can think, “Why can’t I just do this?”
你会想 “为何我就做不了?”
You can have something that you need to get done
你会有一些必须完成的事情
and it just feels physically painful
但要突破惰性来完成
to break through the inertia to do it.
你会感觉肉体之痛
And it may not even be all that much that you need to do,
你需要做的事情可能并没那么多
but if your head isn’t in it,
但如果你心思全无
those five steps can seem like a thousand,
简单几步即可完成的事变得千头万绪
and the people in your life who are affected
生活中因你的工作不能完成
by your failure to follow through with something
而受你影响的人
can conclude that you’re just lazy and unreliable.
就会得出你只是懒 不可靠这样的结论
But it’s not lazy, it’s a brain problem.
但这不是懒惰 而是一种脑部问题
Researchers have seen through positron emission tomography,
研究者们通过PET(一种脑部扫描术)
which is a brain scan,
进行检测发现:
that people with ADHD have a disruption
ADHD的患者的大脑中
in the dopamine reward pathway in the brain.
多巴胺“奖赏”通路中断了
What is the dopamine reward pathway?
何为多巴胺“奖赏”通路?
Well, here’s a quick explanation of dopamine.
我在这简要说明一下多巴胺
There’s four dopamine pathways in the brain.
大脑中有四条多巴胺通路
Think of the pathways as messaging systems
这些通路可以视为这样的信息系统
that use nerves to transport dopamine
它们通过神经将多巴胺
from one part of the brain to the next.
从大脑的一处输送到另一处
Within each of these pathways,
在每一个通路内部
dopamine sends specific messages
多巴胺会将特定的信息
to the end-point destination that tells it what to do.
发送到对其行为进行指示的终点端
Two of the pathways affect motivation.
影响积极性的通道有两个
The first one is the mesolimbic pathway
第一个是中脑边缘通道
where you get dopamine traveling from your midbrain
来自你中脑的多巴胺就是经由该通道
to structures in your limbic system.
传送到大脑边缘系的组织中去
Your limbic area processes emotional memory.
大脑边缘区是处理情感记忆的
Therefore, when you experience something that’s pleasurable
因而当你经历愉悦的事
this part of the brain is activated by dopamine
多巴胺就把这个脑区激活了
and you learn that this activity brings pleasure.
你就知道这个活动带来愉悦
That pleasure can be basic needs, like food and sex,
愉悦可以是像食物 性交这些基本的需求
or more complex gratification, like praise and validation.
或是像表扬 认可这样更复杂的满足感
And this is what we mean by reward.
这就是所谓的“奖赏”
You do something, like eat a piece of chocolate,
你做一件事情 比如吃一块巧克力
and you learn that the chocolate feels good
然后你知道吃巧克力感觉很好
and you desire to eat more chocolate.
你就想吃更多巧克力
Likewise, if you prepare for a task and you’re successful,
同理 如果你准备一个任务并成功了
you learn that hard work produces success at some level.
你就明白努力会导致某种程度的成功
The second important pathway that affects the ADHD brain
影响ADHD大脑的第二个重要的通路
is the mesocortical pathway.
是中脑皮质通路
With this pathway,
经由这个通路
dopamine is produced by nerve cells in the midbrain
中脑神经细胞产生的多巴胺
and it travels to your prefrontal cortex.
传送到你的前额叶皮质区
This area of your brain is responsible for motivation
这个区域负责你的积极性
and executive functions.
和执行功能
Executive functions are things like working memory,
执行功能包括工作记忆
thinking, and decision making.
思维和决策 等等
Stimulants, like Adderall, Ritalin and Vyvanse,
一些兴奋类药物 如阿得拉 利他林和甲磺酸利地美
work to increase dopamine in this pathway.
会增加这个通路的多巴胺
So with ADHD, this reward system is impaired
ADHD患者这个奖赏系统受损
because you have less dopamine transport proteins
是因为你的“多巴胺转运蛋白”少了
to carry the dopamine along the track
这些转运蛋白将多巴胺沿着通道
to get to its intended destination.
输送到它要去的目的地
It’s like having a massive supply chain shortage
说到输送多巴胺的这个话题
when it comes to transporting your dopamine,
这犹如一个供应链的巨大缺口
so you don’t get the proper dopamine signals
所以你没有正确的多巴胺信号
to reinforce positive and productive behaviors.
来强化积极的 富有成效的行为
Without this reinforcement,
没有这种行为强化
your efforts don’t feel satisfying and you lose motivation.
你就不会从努力中获得满足 就没有积极性
So we’ve established that low motivation in ADHD
刚才已证实:ADHD患者缺乏积极性
comes from a dopamine transporter low supply problem,
是多巴胺供给不足造成的
how can you make it better?
那如何改善呢?
Stimulant medications
兴奋类药物
work predominantly in the mesocortical pathway
主要在中脑皮质通路中起作用
and the effect lasts only as long as the medication lasts.
其药效时间取决于药物留存体内时间的长短
So even if you take medication, and not everyone does,
因而即便你服药(且不是所有人都用药)
you may still struggle with motivation.
你仍会有积极性不够的情况
Motivation in ADHD is driven by four factors,
ADHD患者的积极性源自四个因素:
interest, urgency, degree of challenge, and novelty.
趣味性 紧迫性 艰难度和新颖度
Things are novel when they’re fresh and new.
新鲜出炉的事物就是新颖
So what you do to increase your motivation
想要提高积极性 你要做的事情
is to find ways to increase these four factors
就是要找到强化任何任务的
for any given task.
这四个因素的办法
The need for urgency is why you work better under pressure.
紧迫性使你在压力之下工作效果更好
If the deadline’s too far away,
倘若截止期限太遥远
you don’t feel motivated to start.
你就缺乏开始的动力
But urgency gives you the kick that you need
而你需要紧迫性带来的推动力
to power through and get it done, or at least start,
来坚持到底 或至少开始
even if it feels stressful to you
尽管因为你拖延到最后一刻
because you waited until the last minute.
让你感觉压力山大!
Now, you may be someone who says,
现在你可以说:
“I do my best work the night before it’s due.”
“我最出色的工作是在到期前一晚做的”
And in general, last minute is still not a great way to work
总体说来 “最后期限法”还不是好的工作方式
because things don’t always come together
因为事情不总是朝着
the way you want them to,
你想要的方式发展
especially if the task requires input from other people.
尤其是你的任务需要他人的投入
Also, if last minute work makes you anxious,
而且 如果最后期限的工作使你焦虑的话
then this strategy causes other problems.
那这个策略就会引起其他问题
A workaround to this
一个变通方案
is to find another way to create urgency,
就是找到产生紧迫性的另外一个方法
like using a timer while you’re working.
譬如工作时使用定时器
Let’s say you have something that’s due in three days.
假设你有一件三天之后到期的事情
Rather than start it the night before,
不要在到期前一晚才开始
do part of the work using a timer.
而要借助定时器完成一部分
See if you can beat the timer.
看看能否提前完成
Using the timer turns it into a challenge for you
定时就把工作变成了挑战
which can also make it more interesting.
也会增加工作的趣味
Another thing the timer can do for your mindset
定时能改变你思维定势的另外一件事
is to take this project
就是做这个
that may seem like it’ll take forever
表面看来永远做不完的项目
and make it time limited.
并限定它的时间
You’ve got one hour to do the work
你有一个小时来完成工作
and after that hour you’re done working,
一小时后不管任务有否完成
even if the task isn’t complete.
你都不用管
Then you plan to do something that you really enjoy,
然后你计划做你真正喜欢的事情
like spend 30 minutes on TikTok.
比方说玩半个小时抖音
Another thing you can do to add interest
你还可以与他人一起工作
is to work alongside someone.
以增加趣味性
Some people refer to this as body doubling.
有人把这称为找“陪练”
You could do homework with someone over video chat.
你可以通过视频聊天找个人和你一起做作业
You’re both working on different assignments,
尽管你们两个做的作业不同
but the other person’s presence can be reassuring,
但另一人的陪伴让你安心
like we’re all in this together.
仿佛我们都参与进来一样
Or they can be a model for you,
或者他们充当你的模范
showing you how to work calmly and stay focused.
教你如何平静而专注地工作
You need to choose the person
但你需要谨慎挑选
that you work alongside carefully.
与你一起做事的人
It needs to be someone
这人需要这样:
that you can work with without distracting you.
工作时不会让你分心
It also should be someone who can watch you work
也能监督你工作
without shaming you when you struggle to stay focused.
当你难于专注工作时不会耻笑你
If you don’t have someone that you can do this with,
实在找不到这样的人
there’s plenty of body doubling videos on YouTube
在油管上也能找到一大堆有关
for studying, cleaning, and other chores.
学习 清洁和其他杂活的“陪练”视频
If you want to add novelty to something that was boring,
如果你想在原本枯燥的工作中增添新颖度
try doing it in a different setting.
可试试在不同的场景中去工作
Let’s say you need to write a paper,
举例说你想写一篇论文
maybe sitting in a coffee shop
或许坐到咖啡馆里写
will make the process more interesting.
会增添过程的趣味性
You may say, “How can a person with ADHD
你可能会问:“坐在热闹的咖啡馆里
“stay focused in a busy coffee shop?”
一个ADHD的患者怎能专注做事呢?”
Well, this may not be a great setting for you,
于你而言 这场所可能不好
but it’s not a given that any busy setting will distract you
但谁说热闹的场所就一定让人分心 ?
because remember, with ADHD, you can hyper focus on things
别忘了:患有ADHD的人能过度专注
that you’re interested in.
他们感兴趣的事
So if sitting in a cozy coffee shop
因而坐在舒适的咖啡店
with the smell of pastries and people chatting
在糕点气息和人们聊天的氛围中
makes you feel warm and fuzzy,
你会感到温暖 噪音会模糊
that mood and attitude change may help you
这种心情和态度的转变可助你
stay engaged with your task
即使在有干扰因素的环境中
despite the distracting elements in your environment.
亦能专注工作
One last suggestion on how to improve your motivation
提高积极性的最后一个建议
is to try the Pomodoro Technique.
就是试试番茄工作法
This is a time management system
这是个时间管理系统
that’s been around for 30 years
创立以来有30年了
and works by alternating periods of timed work
原理是在定时工作周期之间
with short breaks.
交替进行短时休息
It’s usually difficult for the ADHD brain
通常ADHD患者的大脑
to sustain focus on something for a long time
想做到不分心 不无聊
without getting distracted or bored.
维持长时间专注是很难的
With the Pomodoro Pattern, you work for 25 minutes at a time
使用番茄工作法 你每次工作25分钟
and then you take a five minute break.
然后休息5分钟
This is one 30 minute cycle.
这样30分钟一个周期循环
After four cycles, you take a longer break of 30 minutes.
四次循环后 你把休息时间延长到30分钟
I have a cheat sheet for you
我做了个备忘单给你
that you can get as a free download from my website.
你可以在我网站免费下载
The link is in the description.
下载链接在视频描述中
So here’s what I’ve told you today.
今天我的教学可小结为:
Low motivation with ADHD is partly caused
ADHD患者积极性不够的部分原因
by inadequate dopamine in your brain’s reward pathway.
是你大脑奖赏通路中多巴胺不足
To overcome this, you can do things
为此采取的措施包括:
to make tasks fun and interesting,
增加任务的趣味性;
make them urgent or challenging,
增加紧迫性和艰难度;
or make them feel fresh and new.
或者增强任务的新鲜感
I gave you examples of using a timer to create urgency,
我列举的例子是:用定时器创造紧迫感;
doing the task in a new location,
到新地方工作;
working alongside a body double,
找“陪练”一起工作
and breaking up the task into timed segments
和通过使用番茄工作法或类似方法
using the Pomodoro Technique or some version of it.
把任务分解为多个定时段
Take a look at my ADHD Skills Training Playlist
想要得到ADHD管理方法的更多建议
for more tips on how manage your ADHD.
可以看ADHD技能培训播放清单
Thanks for watching. See you next time.
感谢观看 再见!

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视频概述

ADHD(注意缺陷多动症)的患者办事拖拉并不是因为其懒惰,而是因为其大脑多巴胺通路受损而引起的病变。

听录译者

收集自网络

翻译译者

Beau

审核员

审核员SRY

视频来源

https://www.youtube.com/watch?v=Xp805f-j1VI

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