2017年8月25日 星期五

England’s Mental Health Experiment: Free Talk Therapy英格蘭的免費談話治療實驗 大減心理治療污名


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2017/09/01 第184期 訂閱/退訂看歷史報份
 
 
紐時周報精選 England's Mental Health Experiment: Free Talk Therapy英格蘭的免費談話治療實驗 大減心理治療污名
It Turns Out Money Can Buy (Some) Happiness美國研究:花錢買時間 讓你覺得更幸福
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England's Mental Health Experiment: Free Talk Therapy英格蘭的免費談話治療實驗 大減心理治療污名
文/Benedict Carey
譯/陳韋廷

England is in the midst of a unique national experiment, the world's most ambitious effort to treat depression, anxiety and other common mental illnesses.

The rapidly growing initiative, which has gotten little publicity outside the country, offers virtually open-ended talk therapy free of charge at clinics throughout the country: in remote farming villages, industrial suburbs, isolated immigrant communities and high-end enclaves. The goal is to eventually create a system of primary care for mental health not just for England but for all of Britain.

英格蘭正進行獨特的全境實驗,一項為治療憂鬱症、焦慮和其他常見精神疾病而展開的舉世最具雄心壯舉。

這項計畫正快速開展,但在英格蘭以外卻鮮為人知,該計畫在全境各地的診所提供幾乎無時間限制的免費談話治療,涵蓋了偏遠農村、工業郊區、孤立移民社區及高檔社區。最終目標是不僅為英格蘭,同時也為全英國建立一套精神健康的初級保健制度。

At a time when many nations are debating large-scale reforms to mental health care, researchers and policymakers are looking hard at England's experience, sizing up both its popularity and its limitations. Mental health care systems vary widely across the Western world, but none have gone nearly so far to provide open-ended access to talk therapies backed by hard evidence. Experts say the English program is the first broad real-world test of treatments that have been studied mostly in carefully controlled lab conditions.

The demand in the first several years has been so strong it has strained the program's resources. According to the latest figures, the program now screens nearly 1 million people a year, and the number of adults in England who have recently received some mental health treatment has jumped to 1 in 3 from 1 in 4 and is expected to continue to grow. Mental health professionals also say the program has gone a long way to shrink the stigma of psychotherapy in a nation culturally steeped in stoicism.

當前許多國家正就大舉改革精神健康照護進行辯論,研究人員和決策人士也緊盯著英格蘭的經驗,分析其普及性和侷限。西方各國精神健康照護制度彼此差別很大,但迄今沒有哪個國家能提供獲確切證據所支持的無時間限制談話治療。專家表示,英格蘭這項計畫是第一個廣泛的現實世界治療試驗,而這些治療法大多是在實驗室精心控制的條件下研究過的。

由於起初幾年需求相當強勁,以致該計畫資源吃緊。最新數據顯示,該計畫每年篩檢近一百萬人,且最近接受過精神健康治療的英格蘭成年人數比例,已從四分之一跳增至三分之一,且料將繼續成長。精神健康專業人士並表示,該計畫已使心理治療在這個文化上充滿堅忍主義的國度汙名大減。

"You now actually hear young people say, 'I might go and get some therapy for this,'" said Dr. Tim Kendall, clinical director for mental health for the National Health Service. "You'd never, ever hear people in this country say that out in public before."

A recent widely shared video of three popular royals — Prince William, Prince Harry and Kate, Duchess of Cambridge — discussing the importance of mental health care and the princes' struggles after their mother's death is another sign of the country's growing openness about treatment.

英國國民保健署精神健康臨床主任提姆.肯達爾博士說:「你現在真的會聽見年輕人說『我可能會去接受些治療』。以前你在這個國家絕不會聽見人們當眾這麼說。」

最近三位皇室人氣成員(威廉王子、哈利王子及劍橋公爵夫人凱特)的一個影片被廣泛分享,其中探討了精神健康照護的重要性,以及兩位王子在母親死後的心理掙扎,這是這個國家對治療日益開放的另一跡象。

The enormous amount of data collected through the program has shown the importance of a quick response after a person's initial call and of a triage-like screening system in deciding a course of treatment. It will potentially help researchers and policymakers around the world to determine which reforms can work — and which most likely will not.

透過該計畫收集的極大量數據顯示,在某人初次呼求後迅速回應,以及以分類篩選系統決定治療過程的重要性。這可能會幫助世界各地的研究人員與決策人士確定哪些改革會有用,哪些又極可能沒用。

說文解字看新聞

文/陳韋廷

精神健康議題正獲全球高度重視,文中英格蘭推行的計畫即為一例,希望藉由提供開放式談話治療,促成英國初級精神健康照護制度的建立,並撕去心理治療的汙名化標籤。根據世界衛生組織的定義,精神健康是指一個人能理解自身能力、能調適生活壓力、能從事有生產力的工作且對所處社區有所貢獻。

現代社會變遷快速,生活節奏忙碌,導致人們易患精神疾病,輕者如精神官能症(neurosis)與歇斯底里症(hysteria),重者則如思覺失調症(Schizophrenia)及憂鬱症(depression),而文中提到的談話治療也稱為心理治療則,是治療憂鬱症的方法之一。

憂鬱症由來已久,聖經與荷馬史詩《伊利亞德》均有記載,這個文明病的一般英文說法為depression,而另個常用來描述此病之單字還有melancholia,而兩者最大差異在於前者是臨床性的精神疾病,後者則指一種心情。

此外,文中單字triage為一醫學名詞,源自法文動詞trier,指的是「檢傷分類」,即根據病患受傷情形決定治療與處理優先等級的一套程序。

 
It Turns Out Money Can Buy (Some) Happiness美國研究:花錢買時間 讓你覺得更幸福
文/Niraj Chokshi
譯/陳韋廷

It's a question central to daily life: Do you spend money to save time or spend time to save money? Well, if happiness is the goal, you might consider opening that wallet.

That's the takeaway of a study, published this week in the Proceedings of the National Academy of Sciences, whose findings suggest that spending money to save time may reduce stress about the limited time in the day, thereby improving happiness.

日常生活裡有這麼個核心問題:你要藉由花錢去省下時間,還是花掉你的時間來省錢?如果幸福感是你的目標,不妨考慮打開荷包。

這是本周《美國國家科學院院刊》所發表的一份研究報告的主要訊息,而研究的結果顯示,花錢以省下時間可減輕每天時間有限帶來的壓力,從而提升幸福感。

"People who spent money to buy themselves time, such as by outsourcing disliked tasks, reported greater overall life satisfaction," said Ashley Whillans, an assistant professor at the Harvard Business School and lead author of the study, which was based on a series of surveys from several countries. Researchers did not see the same effect when people used money for material goods.

In one round, Whillans and her colleagues surveyed nearly 4,500 people in the United States, Denmark, Canada and the Netherlands on well-being and timesaving purchases, such as ordering takeout food, taking a cab, hiring household help or paying someone to run an errand. In another round, using a broader definition of such purchases, they surveyed about 1,800 other Americans.

哈佛商學院助理教授、研究報告主要作者艾希莉·韋蘭斯說:「花錢替自己買時間的人,例如將不喜歡的工作外包出去,告知了較高的整體生活滿意度。」 該研究報告是以來自數個國家的一系列調查為基礎。而當人們用錢買實質商品時,研究人員則未見相同效應。

韋蘭斯與研究夥伴在一次調查中,分析了美國、丹麥、加拿大與荷蘭將近4500人的幸福感,以及為省下時間而從事的購買行為,例如訂購外賣食物、搭計程車、聘用家庭幫傭或付錢請人跑腿。而在另一次調查中,他們放寬了這種購買行為的定義,調查了另外1800名美國人。

About 28 percent of those in the first round and half in the second reported spending money to save time. In both cases, those who made such purchases reported greater life satisfaction than those who did not.

And it didn't matter if they were rich or poor: People benefited from buying time regardless of where they fell on the income spectrum. (The authors note, though, that may not hold true for the poorest of the poor.)

兩次調查分別約有28%和一半的人表示會花錢來節省時間。而在兩次調查中花錢買時間的人所告知的生活滿意度,都高過沒有花錢買時間的人。

而這也跟受調者的貧富無關:不論他們所得落在哪個層級,都可從花錢買時間受益。(但作者指出,這結論可能並不適用於極度貧窮的人。)

The surveys established a link between buying time and happiness, but the researchers wanted to see whether one causes the other.

So they conducted an experiment with a few dozen Canadians. First, they provided the participants with $40 on two consecutive weekends to spend, as directed, on either timesaving purchases or material purchases, like board games, fancy wine or clothes. Then, they asked the participants their mood at the end of the day.

As the researchers predicted, spending money to save time appeared to reduce time-related stress and increase well-being, while spending on material goods did not have the same effect.

這些調查建立了購買時間和幸福感之間的關聯,但研究人員想確定兩者是否有因果關係。

因此,研究人員對幾十名加拿大人做了實驗。首先,他們連續兩個周末提供參與者40美元,要這些人按照指示將錢用於為節省時間而從事的購買行為,或是棋盤遊戲、高檔葡萄酒或衣服等實質商品之上,之後在一天結束時,研究人員詢問了參與者的心情。

一如研究人員的預測,花錢省下時間似乎減少了與時間有關的壓力且增加幸福感,但實質商品的消費則未產生相同效果。

 
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