導讀
創傷後應激障礙，就是我們常說的PTSD，是指人在經歷過重大創傷事件之後患上的精神疾病。新冠肺炎疫情下，很多群體中患上這種疾病的人數開始增加，新的治療方法也開始出現。對於那些經歷了病痛折磨的治癒患者，目睹親友被病毒奪走的普通人，以及曾奮戰在一線的醫務人員，心理上的恐慌也許從未停止。如何對這類人進行心理疏導？如何對已有PTSD症狀的人群進行更有效的治療？
New PTSD Treatments Emerge as Cases Rise Among Some Groups
創傷後應激障礙在某些群體凸顯，新療法出現
By Andrea Petersen
Psychologists and psychiatrists say new treatments for PTSD, some of which involve combining psychotherapy and drugs, are sorely needed, as some Covid-19 survivors and front-line workers grapple with the disorder.
心理學家和精神病學家表示，部分新冠肺炎倖存者和一線工作人員正在與創傷後應激障礙（下文簡稱PTSD）搏鬥，人們迫切需要針對PTSD的新療法，包括心理治療結合藥物治療。
Scientists are seeing early positive studies combining psychotherapy with certain drugs, including MDMA (known as the street drug Ecstasy), to enhance the treatments』 efficacy. A growing body of research shows that transcranial magnetic stimulation, which uses a high-powered magnet placed on the scalp to stimulate neurons in certain parts of the brain, can ease PTSD symptoms. Early research is finding that ketamine, a version of which the Food and Drug Administration approved last year for treatment-resistant depression, also can alleviate PTSD.
科學家們發現，將心理治療和特定藥物進行結合的研究，初步結果喜人，有助於提升治療效果。這些特定藥物其中就包括MDMA（俗稱搖頭丸）。越來越多的研究表明，經顱磁刺激技術可以緩解創傷後應激障礙症狀。經顱磁刺激技術，就是將高功率的磁裝置放置在頭部，貼在頭皮上，來刺激大腦特定部位的神經元。早期研究發現，美國食品藥品監督管理局去年批准用於治療難治性抑鬱症的氯胺酮，也可以緩解PTSD。
The most effective psychotherapies for PTSD are cognitive processing therapy and prolonged exposure therapy, versions of cognitive behavioral therapy. Researchers are trying to make psychotherapy more effective.
治療PTSD最有效的心理療法，是認知加工療法和延長暴露療法。這兩種療法都屬於認知行為療法。研究人員正試圖進一步提升心理治療的療效。
Scientists are also combining therapy with medications to boost efficacy. The use of MDMA combined with psychotherapy is being studied in two Phase 3 clinical trials. In a review of six Phase 2 studies published in 2019, 54% of participants who received two treatments no longer met criteria for PTSD, compared with 23% of participants who received psychotherapy and a placebo. About 40% of people who received the MDMA treatment reported side effects including anxiety, headaches and nausea.
科學家們為了提高療效，也正在將心理治療和藥物治療進行結合。當前有兩項仍在進行中的Ⅲ期臨床試驗，在研究使用MDMA藥物和心理療法相結合的功效。回顧2019年發表的6項Ⅱ期臨床研究，在接受兩種治療的受試者中，54%不再符合PTSD標準。相比之下，在接受心理治療和安慰劑（指給無實際治療需要者使用的）的受試者中，這一比例為23%。接受MDMA治療的受試者中，約有40%報告稱出現副作用，例如焦慮、頭痛和噁心。
今日作業
以下四個插入成分有何共同點？
· Psychologists and psychiatrists say new treatments for PTSD, some of which involve combining psychotherapy and drugs, are sorely needed, as some Covid-19 survivors and front-line workers grapple with the disorder.
· Scientists are seeing early positive studies combining psychotherapy with certain drugs, including MDMA (known as the street drug Ecstasy), to enhance the treatments』 efficacy.
· A growing body of research shows that transcranial magnetic stimulation, which uses a high-powered magnet placed on the scalp to stimulate neurons in certain parts of the brain, can ease PTSD symptoms.
· Early research is finding that ketamine, a version of which the Food and Drug Administration approved last year for treatment-resistant depression, also can alleviate PTSD.
生詞好句
1.PTSD
創傷後應激障礙/創傷後遺症（全稱：post-traumatic stress disorder）
拓展:
post做前綴表示"在.之後"（相當於after）
trauma n. 創傷
stress n. 精神壓力
disorder n. 混亂，凌亂
2.emerge英 [ɪˈmɜːdʒ] 美 [ɪˈmɜːrdʒ] vi. 出現，浮現
3.case英 [keɪs] 美 [keɪs] n. 病例
4.psychologist英 [saɪˈkɒlədʒɪst] 美 [saɪˈkɑːlədʒɪst] n. 心理學家
5.psychiatrist英 [saɪˈkaɪətrɪst] 美 [saɪˈkaɪətrɪst] n. 精神病醫生，精神病學家
拓展:
psycho是psychopath（精神病患者）的簡稱。因此，以psycho為前綴的單詞大多與精神和心理層面相關。
psychoanalysis n. 精神分析，心理分析
psychotherapy n. 心理治療
6.treatment英 [ˈtriːtmənt] 美 [ˈtriːtmənt] n. 治療
拓展:
treatment與cure有何區別？
treatment是治療，指治療的動作，強調治療的過程；cure指治癒，強調治療的結果。
treatable but not curable 可以治療，但無法治癒
7.drug英 [drʌɡ] 美 [drʌɡ] n. 藥物
拓展:
近義詞：medication
8.sorely英 [ˈsɔːli] 美 [ˈsɔːrli] adv. 嚴重地（badly; severely; to a high degree）
拓展:
sore adj. 酸痛的，疼痛的
sore throat 喉嚨痛
sore muscle 肌肉酸痛
9.grapple with
努力克服，設法應對（to work hard to deal with or overcome a difficulty or challenge）
拓展: grapple with sb. 與某人扭打在一起
US colleges continue to grapple with coronavirus outbreaks.
（秋季開學後，）美國大學疫情難控。
10.MDMA
亞甲基雙氧甲基苯丙胺（搖頭丸和迷幻藥的主要成分）
11.ecstasy英 [ˈekstəsi] 美 [ˈekstəsi] n. 搖頭丸，迷幻藥（a kind of street drug）
12.enhance英 [ɪnˈhɑːns] 美 [ɪnˈhæns] vt. 提升（improve）
13.efficacy英 [ˈefɪkəsi] 美 [ˈefəkəsi] n. 藥物或者治療的功效
14.a growing body of越來越多的
拓展:
a growing body of sth. = a growing amount of sth. （通常用於修飾不可數名詞）
a growing number of + 可數名詞複數形式
15.transcranial magnetic stimulation
經顱磁刺激技術（簡稱TMS，是一項通過強有力的磁鐵非入侵性地刺激大腦細胞的治療方法，常用於治療抑鬱症）
16.high-powered adj. 大功率的
17.scalp英 [skælp] 美 [skælp]n. 頭皮
18.stimulate英 [ˈstɪmjəleɪt] 美 [ˈstɪmjəleɪt] vt. 刺激
19.neuron英 [ˈnjʊərɒn] 美 [ˈnʊrɑːn] n. 神經元
20.ease英 [iːz] 美 [iːz] vt. 減輕，緩解（alleviate）
拓展:
ease symptoms 緩解症狀
21.Food and Drug Administration 美國食品藥品監督管理局（簡稱FDA）
22.treatment-resistant depression 難治性抑鬱症
23.cognitive英 [ˈkɒɡnətɪv] 美 [ˈkɑːɡnətɪv] adj. 認知的
拓展: cognition n. 認知
24.prolonged英 [prəˈlɒŋd] 美 [prəˈlɑːŋd] adj. 延長的
拓展: prolong vt. 延長
25.exposure英 [ɪkˈspəʊʒə] 美 [ɪkˈspoʊʒər] n. 暴露
拓展: expose vt. 暴露
26.placebo英 [pləˈsiːbəʊ] 美 [pləˈsiːboʊ] n. 安慰劑
27.side effect副作用
英文原文
New PTSD Treatments Emerge as Cases Rise Among Some Groups
By Andrea Petersen
@ The Wall Street Journal
As the pandemic grinds on, psychologists and psychiatrists are bracing for rising rates of post traumatic stress disorder. The concern comes as a wave of potential treatments for PTSD are on the horizon.
Psychologists and psychiatrists say new treatments for PTSD, some of which involve combining psychotherapy and drugs, are sorely needed, as some Covid-19 survivors and front-line workers grapple with the disorder.
Only around 20% to 30% of people who take the medications that are FDA-approved to treat the disorder, the antidepressants Zoloft and Paxil, achieve complete remission. The most evidence-based talk therapies for trauma are effective for about half of patients. Skilled therapists who can deliver those treatments are in short supply in some parts of the country.
Scientists are seeing early positive studies combining psychotherapy with certain drugs, including MDMA (known as the street drug Ecstasy), to enhance the treatments』 efficacy. A growing body of research shows that transcranial magnetic stimulation, which uses a high-powered magnet placed on the scalp to stimulate neurons in certain parts of the brain, can ease PTSD symptoms. Early research is finding that ketamine, a version of which the Food and Drug Administration approved last year for treatment-resistant depression, also can alleviate PTSD.
Already, some studies are finding elevated rates of PTSD among health-care workers and young people. In a study published in August in the journal Psychological Trauma that surveyed 270 health-care professionals in Greece in April, 16.7% met criteria for a diagnosis of PTSD. A survey of nearly 900 18-to-30 year-olds conducted between April 13 and May 19 found that about 32% of young adults had high levels of PTSD symptoms, with those expressing more loneliness and worries about Covid most affected. The study was published in the journal Psychiatry Research in June.
Doctors say people who have had severe Covid-19 infections are likely to face a higher risk, too. A meta-analysis published in May in the Lancet found that about 32% of patients who had the coronavirus SARS during that earlier outbreak had PTSD about three years after their acute illnesses.
「Front line workers have direct trauma exposure, witnessing people dying in pretty large numbers, or where they had to make some really difficult decisions about who they give resources to,」 says Tanja Jovanovic, professor of psychiatry at Wayne State University in Detroit. 「The more traumas you have, the higher your symptoms.」
Only a fraction of people who experience or witness a life-threatening traumatic event develop PTSD. The numbers vary depending on the study and the type of trauma—whether from combat, a sexual assault or a car accident, for example, but researchers say that, in general, about 10% to 20% of people do. The disorder is characterized by nightmares, flashbacks, difficulty sleeping, avoidance of situations that remind the person of the trauma and other symptoms that last for more than one month and impair functioning.
「If you’re irritable and you can’t sleep and you have nightmares, it’s hard to maintain relationships or a job,」 says Dr. Jovanovic. People with PTSD have a greater risk of substance abuse, physical health problems and suicide, notes Barbara Rothbaum, professor of psychiatry and director of the Emory Healthcare veteran’s program and trauma and anxiety recovery program at Emory University School of Medicine.
People who have pre-existing mental health issues, like anxiety or depression, are more likely to develop PTSD after a trauma, says Murray Stein, a professor of psychiatry at the University of California, San Diego and a staff psychiatrist at the VA San Diego Healthcare System. The risk for PTSD is about 40% to 50% genetic, says Kerry Ressler, chief scientific officer at McLean Hospital and a professor of psychiatry at Harvard Medical School.
Michael Skinner says he has been dealing with PTSD since the early 1990s, the result of childhood abuse. The trauma 「just overwhelmed me,」 he says. Mr. Skinner became unable to work, his marriage fell apart and he attempted suicide twice. He spent years bouncing between therapists and trying various medications without getting much relief before he found a therapist who specializes in treating trauma. This treatment, he says, helped. So has connecting with other survivors of childhood abuse in support groups. In recent years, he has continued to see therapists off and on.
「I have found peace in my life. I have found joy,」 says Mr. Skinner, a 66-year-old musician in Goffstown, N.H. But he still has nightmares and sometimes 「the emotional triggers come out of nowhere,」 he says. 「This stuff is with me every day and every night.」
The most effective psychotherapies for PTSD are cognitive processing therapy and prolonged exposure therapy, versions of cognitive behavioral therapy. In cognitive processing therapy, people learn to challenge thoughts and beliefs that fuel PTSD symptoms. In prolonged exposure, people recount their trauma to a therapist many times and visit places that remind them of the traumatic experience. 「Folks with PTSD, they avoid thinking about [the traumatic event], they avoid all reminders, so then it festers and haunts them,」 says Dr. Rothbaum. 「We help them confront the memories and reminders in a therapeutic environment.」
Researchers are trying to make psychotherapy more effective. Kim Felingham, chair of clinical psychology at the University of Melbourne, is conducting a randomized controlled trial combining prolonged exposure with aerobic exercise. Participants doing the intervention ride an exercise bicycle for 20 minutes before beginning their therapy session. Aerobic exercise boosts the levels of a protein called brain-derived neurotrophic factor, or BDNF. In studies, higher levels of BDNF improve fear extinction learning. Extinction learning is part of how scientists believe exposure therapy works in people: with repeated exposure to traumatic memories in a safe space, people with PTSD learn not to fear their traumatic memories.
Scientists are also combining therapy with medications to boost efficacy. The use of MDMA combined with psychotherapy is being studied in two Phase 3 clinical trials, says Rick Doblin, executive director of the Multidisciplinary Association for Psychedelic Studies, the nonprofit funding the research. In a review of six Phase 2 studies published in 2019 in the journal Psychopharmacology, 54% of participants who received two treatments, each of which included a dose of MDMA and an eight-hour psychotherapy session where patients relayed their traumatic experiences, no longer met criteria for PTSD, compared with 23% of participants who received psychotherapy and a placebo. About 40% of people who received the MDMA treatment reported side effects including anxiety, headaches and nausea.
「MDMA allows people to engage trustingly with other people in a therapeutic context,」 says Boadie W. Dunlop, director of the Mood and Anxiety Disorders Program at Emory University School of Medicine, who is an investigator on studies involving MDMA. Researchers are examining other drugs, including the steroid dexamethasone and D-cycloserine, a medication used for tuberculosis, in combination with psychotherapy to treat PTSD.
Reprinted by permission of The Wall Street Journal, Copyright 2020 Dow Jones & Company, Inc. All Rights Reserved Worldwide.
Original Date of Publication: Sept. 21, 2020