重新训练边缘大脑以克服肥胖和成瘾
重新训练边缘大脑以克服肥胖和上瘾
托德·贝克尔 19 Oct 2019 in未分类
我于 2019 年 8 月 10 日在圣地亚哥举行的祖先健康研讨会上发表了这个演讲。这完全是关于导致成瘾和肥胖的大脑过程，以及如何重新连接这些过程以重新获得控制。
点击图片在 YouTube 上查看：
下面是演讲的幻灯片摘要。
重新训练边缘大脑以克服肥胖和成瘾
- 前几年我在 AHS 就低压作用原理（有益的低剂量压力）、营养补剂的局限性、近视减少以及高海拔生活的好处进行了演讲。
- 肥胖和上瘾的流行是更美味的食物、烈性药物和其他超常刺激的必然结果吗？
- 超过三分之一的美国人临床上肥胖。吸毒成瘾，尤其是阿片类药物成瘾，已达到流行程度。
- 上瘾不仅针对食物和化学品等物质，还针对赌博、购物、色情、互联网、智能手机和社交媒体等活动和技术。
- 肥胖和上瘾是多因素的，包括遗传和许多环境变量。在本次演讲中，我将重点讨论两者共有的一个因果因素：渴望，即使是计划最好的饮食或康复治疗也可能失败。
- 一个普遍的想法是，上瘾和肥胖是由超常刺激引起的——食物、性和社交的强烈暗示会劫持大脑。
- 但是食物和药物真的能劫持大脑吗？刺激不是天生容易上瘾，但只能通过学习过程变得如此。
- 克服上瘾的一种方法是禁欲和 12 步计划。但即使是戒酒者匿名组织的数据也表明，只有不到 1/3 的成员保持清醒超过 10 年；独立研究表明成功率较低。
- 我们可以像斯蒂芬·古内特 Stephan Guyenet 建议的那样少吃可口的食物吗？这可能会有所帮助，但这是一种没有吸引力的方法，有其自身的局限性。
- 成瘾专家布林·莫尔Bryn Mawr 和 心理学教授专家玛雅·萨拉维茨 Maya Szalavitz 曾是上瘾者，她为将成瘾概念化为学习障碍提供支持。
- 成瘾的大脑过程在原始哺乳动物大脑中编码： 边缘系统和基底神经节的奖励回路。
- 成瘾是两个独立过程的结果：由下丘脑受体下调引起的快感逆转的一般过程；和强化根植于经典条件反射的高度特异性成瘾反应。这些被编码在边缘系统的杏仁核和奖励回路中。
- 对一般成瘾倾向的最佳解释是 Solomon 和 Corbit 的对抗过程理论它解释了成瘾是如何从追求快乐中产生的，同时压力或刺激的经历如何导致持续的欣快感。
- 对抗过程理论起源于对跳伞产生的欣快感的观察，随着重复跳跃，这种欣快感逐渐变得更加持久。
- 该模型可以概括来解释相反的情况：由于适应对毒品、赌博或性等强烈乐趣的反复追求而导致的渐进式绝望和成瘾。
- 这些对抗过程是大脑维持身体功能和驱动力（如体温、食欲和情绪）稳态的方式——所有这些都由下丘脑控制。
- 朱迪思·格里塞尔 Judith Grisel 是另一位成瘾专家和前瘾君子，她描述了不同的药物类别如何激活与特定神经递质相关的不同对抗过程。兴奋剂激活“想要”和多巴胺受体，在那对抗产生“渴望”；阿片类药物和抑制剂会激活“喜欢”和阿片受体，而对抗在此过程中会产生烦躁甚至身体疼痛。
- 贝里奇和罗宾逊 Berridge 和 Robinson 的激励突出模型显示了这些对手的过程如何导致预期、暴饮暴食和退缩的逐渐功能失调的循环。
- Koob 和 Volkow 认为，当这些对手过程的多个循环超过稳态耐受阈值时，愉悦设定点会被重置为逐渐降低的享乐状态。这个过程称为“稳态”。随着这种平衡过程的加深，成瘾者追求他们的成瘾甚至不是为了感觉良好，而只是为了摆脱绝望。
- 我提出了一个生理学假说来解释心理对抗过程理论，我称之为受体控制理论。从本质上讲，快乐设定点或基线“快乐”是由大脑（和其他地方）中多巴胺受体的密度和敏感性决定的。在这种观点下，肥胖和上瘾是“多巴胺抵抗”过程的结果，受体下调会损害满足感并引发渴望。相反，高受体密度和敏感性会促进满足感并抑制渴望。
- 这一理论在诺拉·沃尔科 (Nora Volkow) 的 PET 扫描中得到了支持，该扫描显示上瘾和肥胖的人类受试者大脑中的多巴胺受体密度降低。
- Whitten 已经表明，随着可卡因的持续使用，多巴胺受体密度会逐渐下降。
- 多巴胺奖励周期不仅与物质使用有关，还与大量使用智能手机等强化活动有关。
- 好消息是：大鼠和人类的 PET 脑部扫描证明了肥胖和上瘾引起的受体下调是如何通过低压作用逆转的，暴露于热量限制和锻炼等心理要求很高的活动。
- 现在讨论另外涉及的特定过程：这些是由经典或巴甫洛夫条件反射形成的，由杏仁核和奖励电路编码的刺激反应行为。
- 斯金纳描述了自愿行为的操作性条件反射。
- 巴甫洛夫描述了非自愿生理反应的经典条件反射。巴甫洛夫著名的研究表明，狗如何学会流涎作为对不熟悉的提示（如铃铛）的“条件”反应，这与重复喂食自然或“无条件”提示（如肉）有关。人们对糕点的香气和视觉的饥饿反应是经典调整的一个常见例子。
- 正人们对食物、性和睡眠的一般驱动由下丘脑控制一样，人们对特定食物、性伴侣和睡眠线索的条件反应也在杏仁核中编码。
- 杏仁核和海马体控制着“肠道反应”。
- 贝里奇和罗宾逊所描述的加强想要和喜欢循环的多巴胺和阿片类药物奖励回路编码在基底神经节中。
- 还有特定的时间提示。控制与进餐时间和频率相关的食欲线索的激素生长素释放肽可以被调节，例如通过间歇无食。
- 我们可以通过使用 4 种策略有效地应用对经典条件反射的这种理解来阻止对线索的不必要反应：（1）刺激回避；(2) 提示曝光和消光；(3) 反调理；(4) 提示。
- 大多数人都没有意识到，巴甫洛夫在 1927 年对狗的研究中，展示了即使他们对肉的呈现被认为是无条件的“先天”唾液分泌反应也可能被熄灭，或者通过反复呈现肉而不让狗吃。
- 线索暴露疗法通过系统地暴露于线索而不允许反应来重新训练对成瘾线索的反应。
- Conklin 和 Tiffany 回顾了 18 项线索暴露疗法治疗成瘾的试验，发现成功的研究包含四个因素：（1）不同的背景；(2) 间隔时间重复呈现；(3) 在没有正常提示的情况下呈现刺激；(4) 消除行为线索，而不仅仅是感官线索。
- 修复的一个具体例子是将风味线索与食物奖励分开。由赛斯·罗伯茨 (Seth Roberts) 设计的香格里拉饮食就是一个有效的例子，使用无味的热量或无热量的口味来破坏食物线索。
- 断绝和反调节是消除渴望的非常有效的方法，例如，对食物、酒精或智能手机的渴望。
- 我开发了去调节饮食作为克服食物渴望的特定方案。分为三个阶段：（1）低胰岛素饮食，不吃零食；(2) 使用消光和反调节进行去调节。饿的时候不要吃东西！不吃东西，让自己暴露在食物的香气中！(3) 间歇无食以支持长期饮食目标。
- 我们可以用更一般的 3 阶段方法来对抗渴望和上瘾：（1）首先使用心理刺激来增加弹性和一般的享乐状态——从事剧烈或具有挑战性的体育活动；(2) 使用断绝、暗示暴露和反调节来解除特定的渴望；(3) 基于减少或消除“令人上瘾”的愉悦的目标，重新平衡生活中的愉悦。用另类的乐趣强化有问题的线索。
- 在视频的最后，我在此站点上提供了参考资料和博客文章，以供进一步阅读。
- 总之，上瘾很复杂，但一个核心挑战是克服渴望。超常刺激并不是天生就会上瘾，而是通过条件反射变得上瘾。我们可以通过低压作用（以提高恢复力和基线愉悦感）和使用暗示暴露和反调节来解除特定渴望的组合来摆脱上瘾。
在问答环节中，我回答了几个主题的问题，包括动机障碍、正念等补充方法、认知行为疗法 (CBT)、对运动的“积极”成瘾、生酮饮食的享乐挑战、积极强化与驱逐惩罚渴望、间歇性强化和唱歌训练。
如果您对本次演讲感兴趣，以下是此博客上相关帖子的链接：
https://gettingstronger.org/2019/10/retraining-the-limbic-brain-to-overcome-obesity-and-addiction/
兴奋剂
兴奋作用是一种生物学现象，通过暴露于低剂量的药剂而产生有益效果（改善健康、压力耐受性、生长或长寿），否则在高剂量给药时会产生毒性或致死性。本博客中提倡的Hormetism哲学 是基于以有意识和系统的方式利用这种生物现象来增加力量和恢复力。
下图说明了兴奋剂化合物如何表现出特征性的双相或“倒 U”剂量反应曲线，而不是线性或至少连续降低但仍保持抑制作用的抑制作用，因为剂量变得更稀薄。线性剂量反应，即所谓的 LNT 或“线性无阈值”模型在传统毒理学中被假设。但事实证明，在大多数情况下，hormesis 是比 LNT 更好的模型。仔细观察该图：在低剂量下，“有毒”或抑制剂的反应实际上对生物体变得刺激或有益。这真的是 - 高剂量有害的东西在低剂量下对你有好处吗？令人惊讶的是，答案是肯定的，而且不仅在个别情况下，而且在广泛的化学品、能源、和其他压力因素。让我们来看看证据。
兴奋剂剂量反应。
化学品。在 1943 年C. Southam 和 J. Ehrlich 的一期Phytopathology 中首次报道了兴奋作用 ，他们描述了一种橡树皮化合物，该化合物在低剂量下促进真菌生长，但在高剂量下强烈抑制真菌生长。该术语源自希腊语“hormo”，意思是激发或刺激。兴奋剂不应与顺势疗法混淆，顺势疗法声称使用如此极端的稀释水平来治疗疾病，甚至可能不存在一个分子的物质，同时假定不存在的顺势疗法物质会留下“记忆痕迹”，以某种方式触发积极的反应在生物体中。相比之下，兴奋剂已得到广泛的经验证实。
自从 Southam 和 Erlich 的论文以来，已经记录了数以千计的其他表现出兴奋作用的化合物的例子。其中一些是我们饮食中公认的成分——包括微量金属、酒精和咖啡因——被认为在低剂量时必不可少或有益健康，但在高剂量时有害或有毒。Edward Calabrese 是马萨诸塞大学阿默斯特分校公共卫生与健康科学学院的毒理学家，他在记录多种化学物质（活性氧、促氧化剂、拮抗剂、诱变剂）的刺激作用方面所做的工作可能比任何人都多。 ) 广泛存在于微生物、植物和动物中。
辐射。超越化学刺激，我们进入更具争议的水域。虽然早就知道高或中等水平的电离或核辐射具有破坏性或致命性，但许多人会惊讶地发现，暴露于低水平的辐射——例如在高海拔地区看到的背景辐射水平——实际上可能有益效果。然而，这正是越来越多的证据所显示的。这包括记录降低 (a) 处理低水平放射性材料的工业工人的癌症和死亡率的研究；(b) 科罗拉多等高海拔地区的居民；© 暴露于较高水平的天然氡气的人；(d) 原子弹爆炸的幸存者 a 住在直接爆炸区域之外。
阳光。暴露于低或中等剂量的其他低能量辐射形式，包括伽马射线和紫外线辐射，与健康益处有关。紫外线辐射与皮肤癌之间的有据可查的联系导致社会普遍倾向于避免无保护的晒黑，并在前往海滩或滑雪场时涂抹防晒霜。然而，有强烈的迹象表明，低剂量或中等剂量的阳光照射有几个好处。众所周知，阳光是在体内生成天然维生素 D 的最有效方式之一；鲜为人知的是，正如 2005 年 2 月 2 日出版的《国家癌症研究所杂志》所报道的那样，阳光实际上可以降低癌症的发病率 。
二恶英。研究甚至表明，最臭名昭著的环境毒素之一，二恶英，在非常低的剂量下是有益的。二恶英与越南时代的落叶剂橙剂有关，是一种已知的致癌物质。在住宅区发现的二恶英污染导致纽约拉夫运河和密苏里州时代海滩的整个社区多次疏散。根据美国环保署的说法，二恶英没有“安全”水平。然而，在大鼠中，低剂量的二恶英已被证明可以大大降低肿瘤的发生率。国家职业安全与健康研究所数据分析 令人惊讶的是，工厂工人暴露于低浓度或中等浓度的二恶英后，多种癌症的发病率有所降低。关于二恶英如何与 DNA 结合的分子研究表明，它可以诱导和抑制致癌作用，具体取决于所涉及的剂量和组织类型。因此，这个故事似乎并不像 EPA 所希望的那样简明扼要。
其他压力。除了化学物质和辐射之外，其他生物应激也已被证明具有激素效应。其中一些更有趣的刺激压力包括：热量限制、低温、热休克和超重力。
通用机制？是否有一个共同的线索来解释如此多样化的生物损伤——化学物质、辐射、温度、重力和卡路里限制——如何能增强生物体，并解释为什么这种现象会发生在微生物、植物和动物的世界中？激素效应似乎还涉及几个看似独立的生理系统，包括内分泌和免疫系统、组织修复和生长机制以及神经可塑性。
体内平衡。这些系统的共同点是，它们都是适应性的“稳态”系统，可帮助机体在受到外部压力源“扰动”后恢复最佳功能。一百多年前，生理学家克劳德·伯纳德 (Claude Bernard) 首次阐明了体内平衡的原理，此后它在广泛的生物系统中得到了很好的记录。然而，兴奋剂的显着之处在于，对如此多不同的压力源可能会发生类似的适应，并且这种适应可能是显着的，并且在许多情况下是永久性的或持久的。虽然有据可查，但我们才刚刚开始了解兴奋作用的常见机制。
抗压基因。马萨诸塞大学的研究人员提出，激素应激通过激活“抗应激”基因调控网络引起细胞适应起作用。在他们的文章 “Hormesis 和自适应细胞控制系统”中在《剂量-反应》杂志上，梅尔文·安德森 (Melvin Anderson) 和其他人提出的证据表明，激素应激源首先由分子传感器检测到，分子传感器激活“转录因子”并上调一系列抗应激基因网络的表达。这些基因反过来激活一系列“稳态途径”，即保护细胞免受压力环境影响的适应性反应。一个例子是激活从细菌到哺乳动物的细胞表达的所谓“热休克蛋白”，作为对热应激的适应性反应，使细胞能够抵抗细胞蛋白的热变性。这些代谢适应保护细胞或器官免受毒性，但需要生物体显着增加能量消耗。根据接触的浓度和持续时间，细胞可以从正常功能状态转变为轻度至中度暴露的适应性和压力状态，或者最终在压力源过多的情况下转变为明显的毒性状态。如果这个模型是正确的，细胞状态的准确分类可以直接用于各种生物应激的风险评估。
免疫疗法。可以说免疫系统是一种激素系统，其中压力源是一种抗原。响应抗原暴露的免疫细胞增殖代表了激素适应。正如 Calabresi 的一篇评论中所述，与其他兴奋现象一样，抗原的剂量至关重要。（ “免疫学中的激素剂量反应关系”）。这种理解构成了疫苗接种原则的基础，从而提高了对外来病原体（例如传染性病毒病原体）的耐受性。越来越明显和令人兴奋的是，免疫“耐受”的原则可以扩展到传染源以外的压力源，以解决自身免疫性疾病、过敏和哮喘等疾病。 过敏原免疫疗法通过引入非常低剂量的过敏原并逐渐增加剂量以建立耐受性来起作用。美国过敏、哮喘和免疫学学会 (ACAAI) 免疫治疗和诊断委员会主席 Linda Cox 博士表示，德国和美国的研究表明，与传统抗过敏药物相比，过敏原免疫治疗的成本效益显着提高。治疗过敏性鼻炎和哮喘。我在我关于过敏和兴奋的文章中发表了关于过敏原免疫疗法的科学基础的更全面的讨论。
渐进性激素。在文献中，有一个隐含的假设，即有益范围和有害范围之间的阈值剂量是固定的。因此，关于兴奋作用的研究试图表征 所研究的每种特定化合物相对于一类生物的阈值剂量。阈值剂量被假定为恒定的——不仅对于群体而且对于个体。但它可能因人群中的个体而异。如果它实际上不是静态阈值，而是动态阈值呢？在那种情况下，个人可以接受培训以适应越来越高水平的压力源吗？ 当然，这已经在上述一个案例中得到明确承认，过敏原免疫疗法，其中耐受性是由逐渐增加过敏原剂量引起的。渐进性兴奋的另一个公认的例子是重量训练。只要一个人不过度训练，通常可以通过逐渐增加举重的大小来显着增加肌肉力量，允许有足够的休息间隔以允许足够的组织修复和肌肉组织的生长。 Hormetism**提出的论点是，渐进性兴奋是一种普遍现象，几乎适用于任何压力源。遵循本网站第一页中概述的强度、约束、振荡和渐进原则，应该可以提高对广泛的、几乎无限范围的挑战和压力源的力量和容忍度。探索这种强化方法的不同应用将会很有趣。
https://gettingstronger.org/hormesis/
so I'd like to talk to you today about a
所以我今天想和你谈谈
small piece of a very big puzzle which
一个非常大的谜题的一小
is obesity and addiction and I think
部分 肥胖和成瘾 我
that by understanding how your limbic
认为通过了解你的边缘
brain works that's your your paleo brain
大脑是你的古大脑
your paleo mammalian brain you can
你的古哺乳动物大脑 你
actually retrain the brain to
实际上可以重新训练大脑
effectively combat some of the things
有效地打击一些
that undermine attempts to overcome
破坏克服
obesity and addiction so as Tyler
肥胖和成瘾尝试的事情，所以正如泰勒
mentioned I write the blog getting
提到的，我写的博客越来越
stronger I'm applying the concept of
强大，我正在应用
hormesis or low-dose stress beneficial
兴奋剂或低剂量压力有益
stress to deal with a whole range of
压力的概念来处理各种
different health issues so you know I've
不同的健康问题 所以你知道我已经
talked about myopia reduction and the
谈到了近视减少和
benefits of living at high altitude some
生活在高海拔地区的好处 一些
of the issues with nutritional
营养补充剂的问题，
supplements and just generally about
以及一般关于
hormesis and a disclaimer I'm not an
兴奋剂和免责声明 我不是
expert on addiction I you know I don't
成瘾专家 我你知道我不
counsel addiction patients all right
建议成瘾 病人 好吧
former addicts I'm not an expert on
以前的瘾君子 我不是肥胖专家，
obesity other than having some good
除了自己有一些
experience with losing weight myself you
减肥的好经验 你
know that's not my field I I'm really
知道这不是我的领域 我真的很
looking at the research and seeing what
喜欢 参与研究，看看
it can can tell us so as a caveat you'll
它可以告诉我们什么，所以作为警告，你会
see some interesting ideas that may be
看到一些有趣的想法，这些想法
controversial here but consult with your
在这里可能会引起争议，但
own professional before trying to do
在尝试做任何极端的事情之前请咨询你自己的专业人士，
anything extreme so here's the three key
所以这是我想要的三个关键
questions I'd like to talk about today
问题 今天
first of all these epidemics that we're
首先谈谈我们所
seeing of obesity and addiction you know
看到的关于肥胖和成瘾的流行病 你知道
are they the inevitable result of the
它们
supernormal stimuli that we see around
是我们在我们周围看到的超常刺激的必然结果
us you know tasty food stronger drugs or
你知道美味的食物 强效的药物 还是
is something else going on and then what
其他正在发生的事情 然后是什么
are the psychological and brain
processes that drive our cravings for
推动我们对
food drugs and addictive behavior and
食物毒品和成瘾行为的渴望的心理和大脑过程，以及
how can we actually retrain our brains
once we understand that to make us less
一旦我们了解了这一点，我们如何才能真正重新训练我们的大脑，使我们不太
susceptible to those cravings which
容易受到那些
often undermine diets and attempts to
经常破坏饮食和试图
overcome addictions so I think we can't
克服成瘾的渴望，所以我认为我们可以”
deny these are huge issues
不可否认，这些都是大问题，
more than a third of Americans are now
超过三分之一的美国人现在
clinically obese and you can see that
临床上肥胖，您可以看到，在
regionally this is a big problem
地区范围内，这是一个大问题，
particularly in the in the southwest and
尤其是在 t 他是西南和
Midwest but it's even elsewhere in the
中西部，但它甚至在该国的其他地方，
country and the CDC is tracking even you
即使您知道成瘾，CDC 也在追踪
know addiction a similar wave of
类似的流行病浪潮，
epidemics going on particularly the
特别是
opioid epidemic which we hear in the
我们每天在新闻中听到的阿片类药物流行病，
news every day but not just synthetic
但不仅仅是合成
opioids you know heroin other drugs that
阿片类药物，您知道海洛因其他药物
are opioids are having very strong
阿片类药物是否具有非常强烈的
negative effects and even a lot of
负面影响，甚至大量
overdosing so it's a serious issue but
过量服用，所以这是一个严重的问题，
it's not just food and and chemicals
但不仅仅是食物和化学
that lead to addictions right it's
物质导致成瘾，它的
activities it's gambling smartphones
活动它赌博智能手机
even now shopping is an addiction
即使现在购物也是一种
apparently social media choreography the
上瘾社交媒体编舞
internet and so it's got to be more than
互联网和 所以它肯定
just chemicals that are driving
不仅仅是导致成瘾的化学物质，如果
addictions what is it if you look at
both you put addiction and obesity side
你把成瘾和肥胖放在一起看是什么
by side they're multifactorial and I'm
，它们是多因素的，
not possibly going to be able to talk
我不可能
about all of the causal inputs to these
谈论所有的因果关系 对这
two issues I mean if you look at obesity
两个问题的投入 我的意思是如果你看看
there's dietary factors inflammation the
肥胖症 饮食因素 炎症
microbiome we've been hearing about
微生物组 我们听说过
exercise addiction there's a lot of
运动成瘾者
developmental issues with the stage at
在你开始吸毒的阶段有很多发育问题
which you start using drugs your risk
你的风险
profile your mindset but then there's
状况 你的心态 但是
some common elements to both the
genetics depression anxiety your social
遗传抑郁焦虑和社会
status stress these all contribute to
地位压力这些都有一些共同的因素 这些都会导致
both problems but what I like to do
这两个问题 但我今天喜欢做什么
today is just pick out one factor in
只是
this entire causal network cravings
在整个因果网络渴望中挑出一个因素
why because you can have the best diet
为什么因为你可以拥有世界上最好的
in the world or a very good you know
饮食或一个非常好的你知道的
addiction coach who's going to help you
成瘾教练会帮助
with treatment and if you have cravings
你治疗如果你
that are irresistible all bets are off
有不可抗拒的渴望所有赌注都没有
so how can we deal with cravings let's
那么我们如何处理渴望让我们
go back to this question of supernormal
回到超常刺激这个问题
stimuli
I can recommend two good books one by
我可以推荐两本好书 一本
Deirdre Barrett from Harvard on you know
是哈佛的迪尔德丽·巴雷特 (Deirdre Barrett) 关于超常刺激
the sort of classical biological
的经典生物学
evolutionary reasons for supernormal
进化原因
stimuli you know
你
the key the classic concept here comes
知道关键 经典概念来了
from Tinbergen who studied how cuckoos
来自 Tinbergen，他研究了布谷鸟如何
can trick other birds to watch the eggs
and their nests by laying very similar
通过更频繁地产下非常相似的方式来欺骗其他鸟类观察它们的蛋和它们的巢穴
often more attractive eggs in here you
在这里，您
can probably guess which of the blue
可能会猜出
eggs
the cuckoo snuck into the nest it's the
布谷鸟偷偷溜进巢中的蓝色鸡蛋中的哪个
one in the upper right and then Stefan
是右上角
Glen a who's familiar to all of us here
的那个，然后是我们在 AHS 的所有人都熟悉的 Stefan Glen
at AHS has written a an outstanding book
写了一本出色的
the hungry brain where he goes into the
书饥饿的大脑在哪里 他进入
brain processes but not just the brain
大脑过程，但不仅仅是大脑
processes the social phenomena that lead
处理社会现象，这些社会现象
to these supernormal stimuli targeting
导致这些针对
different reward circuitry and you can
不同奖励回路的超常刺激，你可以
see here that now just like the cuckoo
在这里看到，现在就像布谷鸟
makes a brighter egg we make bright
制造更亮的蛋一样，我们制造出
shiny donuts that trick us into eating
闪亮的甜甜圈，诱使我们进食
more calories but is this an inevitable
更多的卡路里，但这是否是
process to food and drugs really just
食物和药物不可避免的过程真的只是
hijack our brains or is it something a
劫持了我们的大脑，或者它是否
little bit more subtle is it a
有点微妙，它是一种
behavioral conditioning process I mean
行为调节过程我的意思是
only a small percentage of people who
只有一小部分人
consume alcohol or stimulants or even
消费酒精或兴奋剂甚至
opioids for example in hospitals for
阿片类药物 在医院
brief stays only a small percentage
短暂停留 只有一小部分
actually turn into addicts and eating
实际上会变成瘾君子 吃
tasty food by itself doesn't
美味的食物本身并不会
automatically lead to a food addiction
自动导致食物 成瘾
or overeating I mean obviously genetics
或暴饮暴食 我的意思显然是遗传
and your social environment and stress
和你的社会环境和压力
play a large role all right so it's not
起着很大的作用，所以这
just the the chemistry itself
不仅仅是化学本身
and I think a key point here stimuli are
，我认为这里的一个关键点刺激
not inherently addictive in fact the
并不是天生上瘾的，事实上，
desire for even Coca Cola varies
对可口可乐的渴望也在
globally and seth roberts who some of
全球范围内变化 你们中有些人熟悉的赛斯·罗伯茨 (seth roberts)
you are familiar with he cites the case
引用
of this japanese cookbook author Kaku
了这位日本食谱作者 Kaku Homa 的案例，
Homa
who first described his first taste of
他首先将他第一次尝到的
coca-cola as like medicine so we we have
可口可乐描述为像药一样，所以我们
to learn flavours we have to learn
必须学习口味，我们必须学习
pleasures so let's suppose you're in
快乐，所以让我们假设你 在
this world and you're overwhelmed with
这个世界上，你被
supernormal stimuli and you're you're
超常的刺激所淹没，你会
finding yourself to have an addiction or
发现自己对上瘾
a craving should you just abstain well
或渴望，如果你很好地戒酒，
you know this might work and and 12-step
你知道这可能有效，而且 12 步
programs can be effective for some
程序对某些人可能有效
individuals right
对，
you basically once an alcoholic always
你基本上曾经是个酒鬼，
now call right stay away from the stuff
现在总是打电话远离这些东西
and similarly there's 12-step programs
，同样有 12 步计划，
for smoking and sex and pornography and
用于吸烟、性、色情和
kleptomania gambling and even
盗窃癖赌博 甚至
workaholism but it's not successful for
工作狂，但它并不是对
everyone I mean even AAA finds that
每个人都成功 我的意思是即使是 AAA 也发现，
after ten years only a third of their
十年后
from their own internal surveys remain
，他们自己内部调查中只有三分之一的人保持
sober and some don't even another third
清醒，有些人甚至没有三分之一
can't even make it for a year there's a
甚至无法坚持
high dropout rate and independent
一年 辍学率和
studies of the you know these kind of
对你知道的这些
abstinence processes showed that the
戒酒过程的独立研究表明，
true sex long-term success might be
真正的性行为长期成功可能
something on the order of five to ten
是百分之五到十
percent so I'm not trying to diss these
左右，所以我不是要贬低这些
programs someone's just saying it may
计划，有人只是说它可能
not be enough and also on the food side
不会 够了，而且在食物方面
can we just eat less palatable food
，我们能不能少吃些可口的食物
I mean Stephan on his on his blog was
我的意思是斯蒂芬在他的博客上
talking about how you know some some of
谈论你是如何知道
our ancestral tribes ate far less
我们的一些祖先部落吃的食物要少得多
palatable food and so they weren't
，所以他们并没有
driven to eat all these calories so he
被迫吃掉所有的食物 这些卡路里，
came up with this I did the bland food
所以他想出了
cookbook and you know one of the recipes
might be a baked potato but if if you
look more closely I mean Stefan is not
he's got a sense of humor and he wrote
this post on April 1st but he was trying
这个 4 月 1 日，但他
to get a certain point across here all
试图在这里得到某个点，
right
so what's the other model then of
那么其他成瘾模型是什么，
addiction um I'm gonna dig into two
嗯，我要深入研究两
books recent books both by former
本书，这两本书都是前
addicts so even I can't speak from the
成瘾者的书，所以即使我也无法从
experience of addiction here's two
成瘾的经历中说话 这里有两个
people who I think have some authority
我认为有一定权威的人
and my salivates has written this great
，我的唾液写了这本伟大的
book unbroken brain she was a an addict
书 完整的大脑 她是一个瘾君子
she tried just about every drug in the
她尝试了书中的几乎所有药物
book and worked her way out of it and
并努力摆脱它，
her view is that drugs are not
她的观点是药物本身不会
inherently addictive they only become
上瘾 只有
that way if people learn over time to
当人们随着时间的推移学会
associate them with pleasure or relief
将它们与快乐或解脱联系起来时，它们才会变成那样，
so he she's postulating that we should
所以她假设我们应该
think of addiction as a learning
将成瘾视为一种学习
disorder and she writes a lot now on
障碍，她现在写了很多关于
addiction she's got this New York Times
成瘾的文章 她有纽约时报的
bestseller and speaks a lot
畅销书并且说了很多
so let's look then at what are the
那么让我们看看
processes that are going on here well
这里发生的过程是什么
addictive frame processes are are coded
令人上瘾的框架过程是
in our
在我们的
paleo mammalian brain and there's really
古哺乳动物大脑中编码的，
two parts I'll focus on here and reflect
我将在这里重点关注和反映两个部分
on here one is the limbic system which
在这里是边缘系统，
we'll get into it's the hypothalamus the
我们将进入它 下丘脑
amygdala the hippocampus and maybe its
杏仁核 海马体 可能还有
other pieces and then there's some
其他部分 然后
reward circuits in the basal ganglia the
在基底神经节中有一些奖励回路
ventral striatum the VTA and the nucleus
腹侧纹状体 VTA 和
accumbens this is kind of the pleasure
伏隔核 这是一种乐趣
center and these work together to
中心和这些一起工作以
reinforce our reactions to stimuli and
加强我们对刺激的反应，
even lead to they can explain a lot
甚至导致它们可以解释很多
about addiction so I think it's most
关于成瘾的问题，所以我认为
useful to separate to look at two
分开看成瘾中
separate kinds of processes involved in
涉及的两种不同的过程是最有用的
addiction one is a very general process
一种是非常普遍的过程，
a hedonic process that modulates
一种享乐过程 调节
homeostatic lee your just general level
体内平衡 lee 你只是
of pleasure in life and I'll get into
生活中的一般快乐水平，我将
the opponent-process theory and this
进入对手过程理论和
concept of ala stasis and these how
ala stasis 的概念，以及
these modulate the hypothalamus and your
这些如何通过下调成瘾中的下丘脑和受体来调节下丘脑和
receptors by down-regulating them in
受体，
addiction the other is a set of very
另一个是 一组非常
specific reinforcement processes and
具体的强化过程，
here the model is Pavlovian or classical
这里的模型是巴甫洛夫或经典
conditioning and this is where your
条件反射，这是你的
amygdala and some of these dopamine
杏仁核和其中一些
based reward circuits play in so let's
基于多巴胺的奖励回路发挥作用 所以让我们
start with the general process for
从
homeostatic control of pleasure and pain
快乐和痛苦的稳态控制的一般过程开始
great set of papers by by Solomon and
所罗门和
his graduate student Corbett who looked
他的研究生 Corbett 撰写的大量论文 他们研究
at these paradoxes they were trying to
了这些悖论 他们试图
explain what they called hedonic
解释他们所谓的享乐
reversal and one in one case how is it
逆转 一个案例
that you started out taking something
，你是怎么开始吃
that's very pleasurable you know drug
一些非常令人愉快的东西的，你知道药物
alcohol sex food but over time it
酒精性食物，但随着时间的推移它
becomes less satisfactory and you even
变得不那么令人满意，你甚至
start to fall into a state of despair
开始陷入绝望
and depression and life is just not fun
和抑郁的状态，生活不再有趣
anymore and on the other hand how is it
了 另一方面
that people who expose themselves to
，那些让自己暴露在
stressful pleasures like skydiving or
诸如跳伞、
firefighting or marathon running or my
消防或马拉松赛跑或我
favorite cold showers how is it that
最喜欢的冷水澡之类的有压力的快乐中的人是怎么回事，
even though they after they make it
即使他们在
through that experience they actually
经历了那些经历之后，他们实际上也
experience pleasure so here's a classic
体验到了快乐，所以这是一个经典的
case study that Solomon and in Corbett
案例研究 Solomon 和 Corbett
we're looking at skydivers and I'll just
我们正在研究跳伞运动员 我只会给
read you the physiology of this because
你读一下这个生理学 因为
you kind of get the idea of this hedonic
你善良 了解这种享乐的
reverse
反向
process so during the first freefall a
过程，因此在第一次自由落体期间，
novice Gina parachuter before it opens
新手 Gina 跳伞者在打开之前
the parachutist may experience terror
可能会感到恐惧
they may yell their pupils are dilated
他们可能会大喊大叫 他们的瞳孔扩大
their eyes are bulging their bodies are
他们的眼睛凸出 他们的身体
curled forward and stiff heart is racing
向前卷曲 并且在着陆后僵硬的心脏
after they land safely they may walk
在跳动 安全地，他们可能会
around with a stunned expression for a
带着震惊的表情四处走动
few minutes and then they smile and
几分钟，然后他们会微笑和
chatter and they're socially active and
喋喋不休，他们在社交方面很活跃，
they appear to be elated now here's the
现在他们似乎很高兴，这是
key after repeating this multiple times
重复多次后的关键
the signs of effective habituation are
有效习惯的迹象很
clear the fearful reaction is usually
明显 恐惧的反应 通常
undetectable or very short the parrot
无法检测到或非常矮
the parachutists look tense and during
鹦鹉 跳伞者看起来很紧张，在自由落体过程中
the freefall they experience a thrill
，他们体验到
the activity level is high with leaping
刺激 活动水平很高，跳跃
and shouting and euphoria and the period
、喊叫和欣快感，并且这段时间
extends to as much as two to three hours
延长至两到三个小时，
so you can see the processes changed so
因此您可以看到过程发生了变化 所以
here's the model and this works for both
这是模型，当你看到快乐变成痛苦和天空时，这对两种
addiction when you're looking at the
成瘾都有效
pleasure turning into pain and skydiving
when you're looking at pain turning into
当你看到痛苦变成
pleasure so take a look at these plots
快乐的时候，所以看看
here and you'll see what's called the
这里的这些图，你会看到所谓的
neutral line that's the zero going
中性线，它是
through through these plots that's where
通过这些图的零，这是
you start out you you first expose
你开始的地方，你首先暴露
yourself let's now take to a drug
自己，现在让我们看看 对毒品
alcohol cocaine whatever you get this
酒精可卡因 无论你得到这种
positive state with called the a process
积极的状态 被称为一个
where it's Pleasant now here's the key
过程 令人愉快 现在这里是关键
here your your brain doesn't want too
你的大脑不想要
much pleasure or too much pain so it
太多的快乐或太多的痛苦 所以它
immediately kicks in an a counter
立即启动一个反
process an inhibitory process to kind of
过程 一个抑制过程 有点
keep you within a range too much
让你在一个范围内太多的
pleasure not good so we'll now start
快乐不好所以我们现在开始
adding a little bit of down regulation
添加一些
of those receptors and now that initial
对这些受体的下调，现在初始的
hi starts to flatten out and you can see
hi 开始变平，你可以
in that first plot on the left
在左边的第一个图中
that's the adaptation now the experience
看到 现在的适应
is over you actually go into a somewhat
体验结束了 你实际上进入了
of a down where you're you're feeling
一些低谷 你感觉
less happy than you were to start with
不如开始时那么快乐
and it takes a while to recover if you
如果你看一下情节需要一段时间才能恢复
look at the plot on the right side this
右侧这
is after many many repetitions you can
是经过多次重复后，您可以
see that pleasurable state is getting
看到愉悦的状态越来越
weaker you take the drug or whatever and
弱，您服用药物或其他任何东西，
it's just not as pleasurable it's the
它不像
first time so you have to increase the
第一次那么愉悦，所以您必须增加
dose and the problem is now you after
剂量，问题是现在您之后
that you've used the drug your deep
已经使用了药物，你的深层
processes is now
过程现在
strengthen because it's trying to combat
得到加强，因为它试图
the a process and you feel lousy and
对抗过程，你会感觉很糟糕，
even for longer periods of time so it's
甚至更长的时间，所以正是
this process with repetition that gets
这个重复的过程让
you into the addictive cycle and I think
你进入上瘾循环，我认为
also can get you out of it if you
也可以让你 如果你
replace the initial painful or a
用痛苦或不舒服的过程代替最初的痛苦或
pleasurable process with a painful or
愉快的
uncomfortable process so how does this
过程 那么这在大脑中是如何
work in the brain it's again in the
工作的 它又
hypothalamus the hypothalamus I have
在下丘脑 下丘脑 我在
here you can see a set of little dials
这里你可以看到一组小表盘
it basically keeps track of your you
它基本上跟踪 你
know where you are in terms of too much
知道你在哪里
or too little your body temperature your
体温过高或过低 你的
heart rate your appetite your thirst
心率 你的食欲 你的口渴
mood sleep wet weight cycle sex drive
情绪 睡眠 湿重循环 性欲
and even for certain periods of time it
，甚至是某些 它在一段时间内
regulates childbirth but it's blind to
调节分娩，但它对世界视而不见
the world
it just gets input from you know
它只是从你那里得到输入 它知道
external signals from hormones and
来自激素和
neurotransmitters it tells it tells it
神经递质的外部信号 它告诉它
you know turn up the heat turn down the
你知道打开
heat in the case of appetite one part of
热量 在有食欲的情况下降低热量
the hypothalamus the lipeh stat is
下丘脑的一部分 lipeh stat
composed of two sets of counter
由两组反
regulatory receptors the lateral
调节受体组成
hypothalamus has some neurons in it that
下丘脑外侧有一些神经元，
worked to increase appetite and slow fat
在受到刺激时可以增加食欲和减缓脂肪
burning when stimulated and in the green
燃烧，而在绿色中
the ventromedial hypothalamus does the
，腹内侧下丘脑则
opposite that suppresses appetite and it
相反，抑制食欲，
burns fat and it's basically just taking
燃烧脂肪，它是 基本上只是接收
signals turning it up turning it down
信号把它调低
and this applies to all those other
，这适用于所有其他
drives so Judith grisel another great
驱动器，所以朱迪思·格里瑟尔另一
book and I recommend this called never
本好书，我推荐这本书叫做永远
enough again a former addict and took
不再是一个前瘾君子，并接受了
her experience and she actually tried to
她的经验，她实际上试图
hack her addictions and studied
破解她的瘾并研究
neurobiology and actually now is a
神经生物学 实际上现在是
professor of psychology at Bucknell and
巴克内尔大学的心理学教授
an expert on addiction and she kind of
和成瘾专家，她和蔼可亲
actually looked use this
实际上看起来使用这个
opponent-process model to look at the a
对手过程模型来查看
and B processes for different classes of
不同类别药物的a和B过程
drugs for so for stimulants the
对于兴奋剂
stimulate the dopamine receptors these
刺激多巴胺受体这些
are you know mild stimulants caffeine
是你知道的温和兴奋剂咖啡因
and nicotine but this could be as strong
和尼古丁但这可能
as cocaine and amphetamine and you get
与可卡因和安非他明一样强 你得到
this desire an energy level it's called
这个欲望的能量水平 它被称为
wanting process right and and but the B
想要过程正确 但是
process kicks in when that disappears
当它消失时 B 过程
that's where craving anxiety and boredom
开始 渴望焦虑和无聊
and tiredness
和疲倦
chicken opioids depressants it's kind of
鸡阿片类药物抑制剂 这是
a different process it's you go
一种不同的过程 你
immediately to this liking process by
立即进入这个喜欢的过程
stimulating the different opioid
在一定程度上刺激不同的阿片
receptors and serotonin to some extent
受体和血清素
and gaba and glutamate and ion channels
以及 gaba、谷氨酸和离子通道，
but then when that a process the liking
但是当那个过程结束时，喜欢
process is over the B process kicks in
过程就会开始
and you feel irritable you feel actually
，你会感到烦躁，你实际上会感到
pain or suffering and anxiety and
疼痛或痛苦、焦虑和
malaise and so you're driven to do
不适，所以你 被驱使做
something about it
一些事情，
so Kent barrage and Robin Robinson and
所以肯特弹幕和罗宾罗宾逊，
also kuben and Nora Volkow who've
还有库本和诺拉沃尔科 我
written a lot on an addiction to put
写了很多关于成瘾的东西，把
this into this model kind of the
它放到这个
incentive salience model of addiction
模型中 成瘾的激励显着模型
and if you start over here on the very
如果你从最底层重新开始
bottom the anticipation you know you're
期待你知道你正在
looking for something you're excited you
寻找的东西 你很兴奋
you're this is called the pleasure of
你就是这个 被称为狩猎的乐趣，
the hunt you're hunting for something
你在这里寻找一些
here and and you there's a certain
东西，你有一种
pleasure associated with that so now
与之相关的乐趣，所以现在
you've been you drink a lot you smoke a
你喝了很多酒，抽了很多烟，
lot whatever it is you engage in some
不管是什么你从事一些
activity and now you're in the liking
活动，现在你” 回到喜欢
phase everything is good the world is
阶段 一切都很好 世界
fine your opioids are stimulated this is
很好 你的阿片类药物受到刺激 这
the pleasures of the feast
是盛宴的乐趣
you know you've eaten a big meal you
你知道你吃过一顿大餐
know you you you you're feeling great
你知道你 你 酒后感觉很好
after the alcohol but then you go
但然后你
through this kind of withdrawal the B
经历了 这种 B
process kicks in you're frustrated
过程开始的退出 你感到
there's less reward increased stress and
沮丧 奖励减少 压力增加
so this leads to the other renewal of
所以这导致了另一种
anticipation now you're out there
期待的更新 现在你在那里
looking for more pleasure and again you
寻找更多的快乐 又一次你
go through this multiple times and this
经历了多次这样
is really cool George Kubb extended this
真的很酷 George Kubb 扩展
opponent-process theory of Solomon and
了 Solomon 的这个对手过程理论，并
said you know you don't just always come
说你知道你不会总是
back to the same baseline every time you
在每次
exceed these homeostatic thresholds the
超过这些稳态阈值时回到相同的基线，
a process gets too much and the B
a 过程变得太多，而 B
process comes down each time you do this
过程每次都会下降 你这样做，
your baseline goes down and down and
你的基线越来越低
down and I love this diagram that shows
，我喜欢这张图表，它显示了
sort of the spiraling down into
一种螺旋式下降到
discontent and at the end of it the
不满的状态，最后
addicts they actually are taking the
成瘾者实际上正在服用
drug just to get rid of the just to get
药物只是为了摆脱只是为了得到
relief and they don't necessarily even
解脱和 他们甚至不一定
feel good and you know if you play with
感觉良好，你知道如果你经常玩
your smartphone a lot you start playing
你的智能手机，你就会开始玩，
whether you play a gaming or like you
无论你是玩游戏还是你
know this is a waste of time
知道这是浪费时间，
but you're driven to do it
但你被驱使去做
you've got this drive to do something
你有这个 开车去
and you don't even feel good in the
做某事，你甚至在
satisfaction phase so if you look at
满意阶段都感觉不舒服 所以如果你
this at the level of receptors you can
在感受器的层面上看，你也可以
see it too I have a just kind of
看到它 我有一个
hypothesis I call it the receptor
假设，我称之为感受器
control theory and that is the more and
控制理论，那就是 越来越
more more sensitive receptors you have
多 你拥有
of any kind the better off you are
的任何类型的受体越敏感，你就会越好
so we know this with for example insulin
所以我们知道这一点，例如胰岛素
and leptin receptors they're more
和瘦素受体 它们更
sensitive insulin sensitivity leptin
敏感 胰岛素敏感性 瘦素
sensitivity you can control your diet
敏感性 你可以控制你的饮食
but I think the same thing is true of
但我认为
dopamine and if you have if you look at
多巴胺也是如此 如果你有，如果你看看
the guy on the far left here who has
这里最左边的那个人，他
only a few receptors of whatever kind
只有少数几种受体，
he's unhappy if you moved to the middle
如果你移动到右边的人中间，他会不高兴，
to the right guy the one with a lot of
那个有很多
these receptors he's basically doesn't
这些受体的人，他基本上
need much of any stimulus and whatever
不需要太多 任何刺激和任何
stimulates his receptors whether they be
刺激他的受体的东西，无论是
dietarily or pleasure he's happy and so
饮食上的还是快乐的，他都很高兴，所以
I would say obesity and addiction can be
我想说肥胖和成瘾可以被
thought of as dopamine resistance you're
认为是多巴胺抵抗，你
just over stimulating these receptors
只是过度刺激
they shut down and now you need more and
它们关闭的这些受体，现在你需要更多，
you can actually see this Nora Volkow
你可以 实际上看到这个 Nora Volkow
has done PE T scans looking at the
已经做了 PE T 扫描，观察
brains of cocaine addicts meth addicts
可卡因成瘾者的大脑 冰毒成瘾者
alcohol addicts heroin addicts you can
酒精成瘾者 海洛因成瘾者 你可以
see versus the control this is looking
看到与控制相比，这是在
at the activity of the dopamine receptor
看活动 多巴胺受体
you know using a an imaging study on the
PE T scan you can see that there's the
的含量 你知道使用对 PE T 扫描的成像研究 你可以看到
red is good right red means there's a
红色是好的 红色意味着有
lot of receptor activity you can see
很多受体活性 你可以
that the addicted equivalent for every
看到这里每个控制的成瘾等效物
every control here the red is missing
红色是 丢失
and similarly for obese subjects you can
和类似的对于肥胖受试者，您可以
see that the control subjects had a lot
看到对照受试者有
more red had more dopamine receptor
更多的红色具有比肥胖受试者更多的多巴胺受体
activity than the obese subjects it gets
活性
worse with time here's a study by
随着时间的推移它变得更糟这是一项目击者的研究
witness showing that after six months
表明在
and after 12 months the activation of
六个月后和 12 个月
the receptors is going down if you're
后 如果你
using cocaine and don't think it's just
使用可卡因并且不认为它只是
substances smartphones I mean the
物质 智能手机 我的意思是
average American is looking at their
美国人平均每天看他们的
smartphone for two to four hours a day
智能手机两到四个小时
you're 2600 touches all those dopamine
你有 2600 次接触所有这些多巴胺
cycles there's even something here
循环 这里甚至有一种
called phantom phone
叫做 幻听电话的
sensation I don't know if you've ever
感觉 我不知道你是否有过这样的
experienced this way you think you're
经历 你
feeling your phone vibrating in your
认为你的手机在你的
pocket you think you're hearing it ring
口袋里振动 你认为你听到它响了
but it's not your brain is just primed
但它是 不是你的大脑只是
there how do you reverse this
在那里准备好 你如何扭转这个
it's my standard answer hormesis if you
这是我的标准答案 hormesis 如果你
look at calorie restricted mice whether
看看卡路里限制的老鼠，无论
they're they start out obese or lean
他们是从肥胖开始还是
over their calorie restricted for four
瘦下来，他们的卡路里限制了
months look at the top which is
四个月，看看顶部是
unrestricted food access and then look
不受限制的食物获取 然后查看
at the two scans at the bottom much more
底部的两次扫描，
dopamine receptor activity so they don't
多巴胺受体活性更高，因此他们
need as much dopamine to feel happy
不需要那么多的多巴胺来
similarly in humans exercise there's a
在人类运动中同样感到快乐 有
study of exercise for meth addicts and
一项针对冰毒成瘾者的运动研究，
the study was done by Robertson and
该研究是由罗伯逊完成的，
found that the d2 and d3 dopamine
发现 d2 和 d3 多巴胺
receptors were significantly up
受体显着
regulated providing a protective effect
上调，
for these addicts so now let's get into
为这些成瘾者提供保护作用，所以现在让我们
the specific processes this is about up
进入具体过程，这是关于
regulating or down regulating your
上调或下调您的
general hedonic level and if you start
一般快感水平，如果您开始
out with feeling good generally and
时总体感觉良好，而
you're not miserable you're gonna have a
您不是 悲惨，你会有
better chance but you still have to deal
更好的机会，但你仍然必须
with the specific cues that we respond
处理我们对周围所有人做出反应的特定线索，这些线索
to all around us that trigger cravings
会引发渴望
so classical conditioning is really a
所以经典条件反射真的是一个
process that goes on all the time
一直持续的过程，
whether it's in the lab or outside and
无论是在实验室里还是在外面
basically it's stimulus response
behavior its response to specific cues
and these are mediated by the amygdala
and the reward circuits and these can be
conditioned for good or for bad so
坏的，所以
there's a number of even deep
有一些甚至是深度
conditioning strategies but let's talk
调节策略，但让我们
about what conditioning is first the the
先谈谈什么是调节
kind that most people are familiar with
，大多数人都熟悉
it's called operant conditioning and
它被称为操作性调节，
this is from Skinner and it's the
这是来自斯金纳的，这是
classic case of how you train your dog
你如何正确训练你的狗的经典案例
right the dog catches the ball and you
狗接住球，
you signal that maybe with a clicker and
你发出信号，也许是用答题器
at first there's no cue but now you ring
，一开始没有提示，但现在你
the bell or blow a whistle and if he
按铃或吹哨子，如果他
doesn't catch it you don't reward it but
没有接住球，你不会奖励它，但
if you if he does catch it you reward it
如果他接住了你 你奖励它
and you're reinforcing that behavior
，你在强化这种行为
Pavlov you know I think looked at a
巴甫洛夫你知道我认为看到了一种
different phenomenon which is just
不同的现象，
involuntary physiological responses
这只是非自愿的生理反应
which can also be trained
，也可以训练
and I think these you can think of these
，我 想想这些 你可以把这些
as a specific special case of operant
看作是操作性条件反射的特殊情况
conditioning your training a involuntary
你的训练 非自愿
response not not a voluntary behavior so
反应而不是自愿行为 所以
you have this unconditioned stimulus UCS
你有这种无条件刺激 UCS
piece of meat the dog naturally
一块狗自然
salivates and you reinforce it when you
流涎的肉，当你
give it the meat now you ring a bell
现在给它肉时你会加强它 你敲响一个
which doesn't know anything about that's
对它一无所知的铃铛，这
called a neutral stimulus there's no
被称为中性刺激，没有
response
反应，
but what Pavlov found is to be rang the
但巴甫洛夫发现
bell at the same time the dog saw the
在狗看到
meat the dog started to associate the
肉的同时响铃，狗开始将
bell with the meat and it would salivate
铃铛与肉联系起来，它 会流口水
and now he could just ring the bell
，现在他可以在
without the meat there and that's called
没有肉的情况下按铃响，这就是所谓
the conditioned stimulus and the
的条件刺激和
conditioned response and now the dog is
条件反应，现在狗只
conditioned to just the cue so just like
适应提示，就像
you walk into the bakery and you see the
你走进面包店，你看到
the pastry there you didn't eat it but
那里的糕点 没吃，但
all of a sudden you're feeling hungry so
突然间你觉得饿了所以
let's contrast the hypothalamus and the
让我们对比下丘脑和
amygdala here the hypothalamus it
杏仁核这里的下丘脑它
doesn't know what's going on it's just
不知道发生了什么它只是
either hungry but it doesn't know what
要么饿了，但不知道该
to eat
the amygdala says I want that specific
吃什么 杏仁核说我想要那块特定
piece of dark chocolate but I'm
的黑巧克力 但我已经
conditioned to I won't take milk
习惯了 我不会吃牛奶
chocolate only dark chocolate will do
巧克力 只有黑巧克力可以
the hypothalamus has a sex drive hey got
下丘脑有性欲 嘿
to have sex but if there's no tall dark
必须有 性但如果周围没有高大的黑
men around no facial hair no good sense
男人 没有胡须 没有
of humor maybe even not a husband um
幽默感 甚至可能不是丈夫 嗯
it's all bets are off the hypothalamus
一切都打赌 下丘脑
wants to go to sleep right it's
想睡觉了 它正在
regulating sleep but the amygdala hears
调节睡眠 但杏仁核
the suspicious noise outside and it
听到外面可疑的噪音 它
can't get to sleep
可以 不用睡觉
so all this information is now
所以所有这些信息现在都在
modulating the hypothalamic response so
调节下丘脑的反应 所以
you can think of the amygdala and it's
你可以想到杏仁核
its helper which is the hippocampus
它是它的助手 海马
which basically is storing memories it's
体 基本上是存储记忆 它
storing all those conditions
存储所有这些条件
associations the amygdala it immediately
关联 杏仁核 它立即
gets gut reactions it sees a barking dog
得到它看到的直觉反应 一只吠叫的狗
immediate fear you see the ice cream I
立即害怕你看到冰淇淋我
want it you know it's there's not even
想要它你知道它甚至
you're not even going through any
你甚至没有经历任何
cognitive process here it's you're
认知过程在这里你正在
training these gut reactions and
训练这些 直觉反应，
similarly then there are these reward
类似地
circuits in the in the basal ganglia
，基底神经节中有这些奖励回路
that reinforced the wanting cycle and
，加强了想要的循环，
this is again from barrage and robertson
这又是来自弹幕和罗伯森，
you can see there's the wanting cycle
你可以看到每个人都注意到了想要的循环
which everybody pays attention to that's
，那就是
the dopamine circuit there on the right
右侧的多巴胺回路，但是
but
and that's going to the you know nucleus
那是你知道的伏
accumbens but then there's also a an
隔核，然后还有一种
opioid or a sort of a liking cycle
阿片类药物或一种喜欢的循环
that's going to you know different parts
，你会知道
of the brain and these are trading off
大脑的不同部分，这些都在权衡，
alright so you got to take the different
所以你必须考虑到不同的
circuits into account that work in
回路
tandem with the amygdala now there's
与杏仁核协同工作现在
also one more element I'd like to go
还有一个因素我想
into before getting into the solutions
在进入解决方案之前进入
here and that is timing
这里，那就是时间，
so there's another hormone called
所以有另一种激素叫做
ghrelin that the stomach produces when
生长素释放肽，当你饿的时候胃会产生
you're hungry and tells you huh it's
它并告诉你是
time to eat what's interesting is again
时候了 吃什么有趣又
that's conditioned it's yeah you think
是有条件的，是的，你认为
you're hungry at noon but that's just
中午饿了，但这只是
because you're used to eating at noon so
因为你习惯了中午吃饭，所以
here's a study of actually some of some
在这里 '实际上是对一些
humans that were put on different meal
人进行了不同的进餐
frequency programs either eating every
频率计划的研究，或者
ting lunch three hours after breakfast
在早餐后三小时
or six hours after breakfast and they
或早餐后六小时吃每顿午餐，他们
did this for two months and what's
这样做了两个月，
interesting here is if you look at the
如果你看一下这里的有趣之
at the gralen plots they tracked with
处 他们用饥饿追踪的gralen图
hunger the grey line is the black
灰线是黑
circles and the hunger is the white
圈，饥饿是白
circles and eventually the the Grayland
圈，最终格雷兰
secretions and the appetite adjusted to
分泌物和食欲调整
the meal frequency and this is why
到进餐频率，这就是为什么
intermittent fasting can work you think
间歇性禁食可以工作，你认为
you can't wait until dinner it once you
你等不及了
do it enough you're no longer hungry
吃饱了就吃，吃饱了就不会饿了
until dinner so let's go into the
所以让我们
strategies that you can use here how do
来看看你可以在这里使用的策略 当你
you actually stop when wanting cue
想要很好的提示反应时，你是如何真正停下来
responses well the first is stimulus
的 第一个是
avoidance that's the a a process abstain
避免刺激，这是 aa 过程 放弃
it's great as long as there's no cues
它是很好的 因为周围没有线索
around but it doesn't actually rewire
，但它实际上并没有重新连接
your brain to respond differently
你的大脑以做出不同的反应
there's cue exposure and extinction
processes which I'd like to talk about
，所以我想谈谈线索暴露和灭绝过程
and that's where you expose yourself to
这就是你将自己暴露
the stimulus but you don't let yourself
在刺激下的地方，但你不让自己
respond and then there's counter
做出反应，然后是反
conditioning where you substitute an
条件
alternate response when you see the cue
反射，当你看到提示时，你会用另一种反应代替
and then there's one called putting on
，然后有一个叫做
cue which is you you plan a particular
提示，这是你计划的特定
time in place where you'll be allowed to
时间 在你被允许
have the the cue so Pavlov even showed
有线索的地方，巴甫洛夫甚至展示了
this and believed in off Pavlov showed
这一点，并相信巴甫洛夫表明
you could not only decondition a a bell
你不仅
but you could decondition the dog's
可以解除铃铛，而且可以解除狗
response to meat so there really is no
对肉的反应，所以真的没有
such
is an unconditioned stimulus permanently
这种无条件刺激 永久地
so he exposed the dog to meet time after
所以他让狗一次又一次地
time and eventually they'll start stop
见面，最终他们甚至会开始停止
selling even eating he says I'm not
销售甚至吃他说我
gonna get any meat so why should I get
不会得到任何肉所以我为什么要
hungry and actually the he measured you
饿，实际上他测量了你
know salivation and the dog stopped
知道流涎和狗停止
salivating amazingly so there's actually
流涎 令人惊讶的是，实际上
a therapy that called queue exposure
有一种疗法叫做队列暴露
therapy and this is one that's
疗法，这是一种很
interesting to study I'm not necessarily
有趣的研究 我不一定
recommending that you do this but think
建议你这样做，但想想
about this as a model and you retrain
ab 把它作为一个模型，你
the responses by systematically exposing
通过系统地让
yourself to cues they could be sensory
自己接触线索来重新训练反应，它们可能是感官
stimuli objects places and times but
刺激对象的地点和时间，但
don't let the response follow through so
不要让反应持续下去，
a drug user might look at the
所以吸毒者可能会看着
paraphernalia handle it but not take the
用具处理它但不
drug the alcoholic drive by the bar go
吸毒 酒吧里的酒后驾车
into the bar but don't consume handle
进入酒吧但不要消费
the cigarette but don't smoke it it
握住香烟但不要吸烟
sounds painful and sounds awful but it's
听起来很痛苦，听起来很糟糕 但
amazing it works and Conklin and Tiffany
令人惊讶的是它有效 康克林和蒂芙尼
did a study of 18 different trials now
对 18 次不同的试验进行了研究 现在
only nine of nine of the 18 I'm sorry
只有 9 次 18 人中有 9 人很抱歉
only nine of the 18 had control groups
，18 人中只有 9 人有控制组
and about half of them those who were
，其中大约一半是
successful but the half that we're
成功的，但我们成功的一半
successful were very successful and he
是非常成功的，他
found there were some key factors you
发现有些关键因素你
can't just do this you know a couple
不能做 这你知道
times you've got to do it repeatedly you
几次 你必须反复这样做 你
have to vary the context of the exposure
必须改变暴露的背景
so in in different settings not in a lab
所以在不同的环境中而不是在实验室
setting you can't just go look at a
环境中 你不能只看
bottle of gin and in a lab you got to
一瓶杜松子酒 而在实验室中 必须
actually handle it in a variety of
实际处理 它在各种
situations and you got to do it
情况下，你必须反复这样做
repeatedly and you'll even have to fold
，你甚至不得不
in some behavioural effects but they
折叠一些行为影响，但他们
found that this in the studies where
发现，在这样做的研究中，
this was done it was very effective and
这是非常有效的，
then the addicts lost their cravings
然后成瘾者失去了他们的
there's a variation of this process
渴望 这个过程的变异
called flavor calorie Association
称为风味卡路里协会
extinction and some of you are familiar
灭绝，你们中的一些人
with Seth Roberts who was a key a key
熟悉塞思·罗伯茨，他是
speaker at many of the AHS is one of the
许多 AHS 的关键发言人，也是
founders his shangri-la diet was also
创始人之一 他的香格里拉饮食
tested in in one of the posters we saw
也在我们的一张海报中进行了测试 在
here the key thing here is what's unique
这里看到这里的关键是这里的独特之
here is you've got in food a queue and a
处在于你在食物中获得了一个队列和
reward all in one
一个奖励，
not two separate things so the food has
而不是两个单独的东西，所以食物
the flavor which is the cue and it has
有味道，这是提示，它
the reward which is the calories and
有奖励，即卡路里和
what Seth found both from his own
什么 赛斯从他自己的
experience and and looking at
经验和观察
experimentation and then but writing a
实验中发现，然后写一
diet book on this is that if you
本关于这一点的饮食书是，如果你
separate the calories from the food you
把卡路里从食物中分离出来，你
can decondition those cravings so for
可以消除这些渴望，
example you can take flavorless calories
例如你可以服用无味的卡路里
like light olive oil or eating well
像淡橄榄油或吃得好
pinching your nose because really flavor
捏你的鼻子，因为真正的
is mostly olfactory and then you break
味道主要是嗅觉，然后你打破了
that association or you can just have
这种联系，或者你可以
the the flavor without any calories or
只吃味道而没有任何卡路里，或者
you can even eat foods with unfamiliar
你甚至可以吃味道不熟悉的食物，
flavors because cue conditioning is only
因为提示条件只
effective with familiar flavors now this
对 熟悉的味道 现在这
might sound strange but I lost weight
听起来可能很奇怪 但我
very easily following the study and some
在研究后很容易减肥 并且有些
people have lost over a hundred pounds
人已经减掉了 100 多磅
doing this so there's something to it
所以
it's a very strange concept but it's
这是一个非常奇怪的概念 但它
really an example of extinction so let
确实是灭绝的一个例子 所以让
me give you a few examples of of how you
我给你一个 关于
might apply this to different food or or
如何将其应用于不同食物或
other addictions so let's take say you
其他成瘾的几个例子，让我们假设
want to decrease your cravings for
你想减少对肉桂面包的渴望，
cinnamon buns
so the normal response would be eat the
所以正常的反应是正确地吃
bun right but what you do instead is you
面包，但你要做的是
go into the bakery you look at it you
进入面包店 你看着它
smell it and you do this again and again
闻它你一次又一次地这样做
sounds like torture
听起来像是折磨
it actually works I've done this myself
它实际上有效我自己已经这样做了
I've gone for those foods that I crave
我已经去了那些我喜欢的食物 渴望
and I don't you know I I don't want to
，我不知道你不知道我不想
eat too much of and after a while that
吃太多，过了一段时间
you don't respond to that stimulus
你不再对这种刺激做出反应，
anymore so the counter conditioning is
所以反调节
to substitute another activity and this
是替代另一项活动，这
would be smell the bun go for a walk
将是闻到面包的味道
similarly if your if your cue is the bar
如果你的提示是
the sign at the bar you'd normally crave
酒吧，你通常会
a drink so instead of stopping for a
drink look at the sign and drive by and
想喝一杯酒吧的标志，所以走类似的路
just call a friend the key here with
counter conditioning is to substitute an
替代
alternate pleasure you see your smart
另一种乐趣 你看到你的智能
phone you're always I got to check it I
手机 你总是我必须检查它
got to check it well touch the phone
我必须仔细检查它 触摸手机
don't put it away look at but don't look
不要把它收起来 看但不要
at it and schedule a time window to look
看它 并安排一个时间窗口
at it so here's how you boil this down
看 所以这里是你如何将其归结
into
为
some practical techniques this is I
一些实用的技术 这是
something I wrote about called the
我写的关于去
deconditioning diet is on my blog it's
调节饮食的东西 在我的博客上 它
in three phases you reduce insulin and
分为三个阶段 你可以减少胰岛素并
stabilize your blood levels follow low
稳定你的血液水平 遵循低
carb diet eat three meals kind of lower
碳水化合物饮食 吃三
the general level of stimulation you D
顿饭 一般刺激水平 你
conditioned by a couple things don't eat
受一些东西的限制，
right when you're hungry actually resist
当你饿的时候不吃东西实际上抵制
that wait until your hunger subsides and
，等到你的饥饿感消退
then eat so you're not reinforcing the
然后再吃，这样你就不会加强
cue and even more so expose yourself to
暗示，更重要的是让自己暴露
the strong food cues the aromas the
在强烈的食物暗示中
shapes and then substitute an alternate
形状，然后替代另一种
pleasure go into the bakery walk around
乐趣 走进面包店 四处走走
smell everything now go for a walk and
闻一闻现在的一切 去散步并
call a friend and then the more you can
打电话给朋友 然后您可以做的越多
do that you can embrace intermittent
，您就可以接受间歇性
fasting because you're less consumed
禁食，因为您
with cravings you can reduce your meal
的渴望减少了 您可以减少用餐
frequency and can continue the
频率并且可以继续去
deconditioning process so then the
调节过程 那么
general approach then how do I apply
一般方法 那么我如何将
this just to addictions and cravings in
它应用于一般的成瘾和渴望
general I start by using physiological
我首先使用生理
hormesis to increase my hedonic level
刺激来增加我的享乐水平，
right instead of engaging in pleasures I
而不是享受快乐 我
engage in difficult activities like not
从事困难的活动，比如
necessarily skydiving but maybe going
不一定 跳伞，但也许
for a run
去跑步
lifting weights trying cold showers
举重 尝试冷水淋浴
fasting these are hard things but the
禁食 这些都是很难的事情，但
more you do them you actually increase
你做的越多，你实际上会增加 减少
your number of dopamine receptors and
你的多巴胺受体数量，
you're more resistant now decondition
你现在更有抵抗力 现在
the specific cravings it doesn't have to
消除特定的渴望 这次不必
be food this time it could be you know
是食物 这可能是你知道
some drug cue it could be a gambling cue
一些药物线索 它可能是赌博线索，
whatever expose yourself to the stimulus
无论你暴露在刺激下，
but don't allow the response to happen
但不要“ 不要让反应发生
and substitute something else now the
并用其他东西代替现在
key thing here is plan it out so you
这里的关键是
have those alternate activities planned
计划好这些替代活动
and then rebalance your life rebalance
然后重新平衡你的生活重新平衡
pleasure don't necessarily illumine
快乐不一定要
eliminate all pleasure you can't do that
消除所有快乐你不能这样做
but you can you now are in a position to
但你可以 你现在可以
decide what you're going to respond to
决定你要对什么做出反应，对
and what not you can pursue a healthy
什么不做出反应 你可以追求健康的
diet you can you can either reduce or
饮食 你可以减少或
eliminate drugs so I've got here you can
消除药物 所以我在这里 你可以
check this out when the videos were on
在视频播放时查看
some further reading here right
在这里进一步阅读
I've also would encourage you there's a
我也鼓励你有
number of articles on getting stronger
很多关于变得更强大的组织的文章
org that deal with these issues of the
，这些文章处理了
opponent-process theory
对手过程理论
addiction and eating and fasting and my
成瘾、饮食和禁食以及我的
final summary addiction and obesity are
最后总结等这些问题 成瘾和肥胖
very complex they're multifactorial
非常复杂 它们是多
it's very challenging in both the
因素的 在这两个中心挑战中都非常具
central challenge that defeats both
有挑战性 战胜这两个挑战
there are these is overcoming
克服
irresistible cravings supernormal
不可抗拒的渴望
stimuli around us but they're not
我们周围的超常刺激 但它们并不是
inherently addictive they're only so
天生就会上瘾 它们只是
because they're conditioned to be so so
因为它们是有条件的 这样
we can respond and get our way out of it
我们就可以通过两个过程做出反应并摆脱它
by two processes one had done a general
一个已经完成了一般的
hedonic reversal and receptor down
快感逆转和受体
regulation we can use physical challenge
下调我们可以利用身体挑战
to work our way out hormetic exercise
来解决
fasting in cold showers and we can
在冷水淋浴中禁食的刺激性运动，我们可以
recondition those those conditioned
修复那些
responses to specific cues by cue
通过暗示暴露和反调节对特定线索的条件反应
exposure and counter conditioning so
again my goal here was to put some ideas
所以我的目标是提出一些想法
out not to give individual medical
而不是提供个人医疗
advice so seek assistance if you're
建议所以如果你正在
dealing with a very difficult addiction
处理一个非常困难的成瘾
but if it's something pretty light like
但如果它像
smartphone addiction or you're eating a
智能手机成瘾一样很轻，请寻求帮助 或者你
little bit too much you might try this
吃得太多了，你可以试试这个，
so that's my talk any questions so we've
所以这就是我的谈话任何问题，所以我们
got about 10 minutes for questions and
有大约 10 英里
then the good news is there's nobody in
好消息是
here for an hour or so as long as you
这里一个小时左右没有人，只要你
can corner Todd and keep him away from
能把托德逼到角落里，让他远离
food or drink you will be able to keep
食物或饮料，你就能
in mind for questions hey Todd thanks
记住问题，嘿，托德，
for sharing all that it was interesting
感谢分享所有这些 这很有趣
and also validating as a health coach
，也证明了作为
who's still pretty new I use almost
一名仍然很新的健康教练我几乎使用了
every technique you have in there even
你在那里的所有技术，
though I don't have a food addiction
即使我没有食物成瘾
history or anyone in my life like that I
史或我生活中的任何人我
I wanted to ask you my point of view has
想问问你我的观点
been so far that people will come to me
到目前为止，人们会来找我
for help say they want to quit smoking
寻求帮助，说他们想戒烟
or they want to lose weight and they
或减肥，他们
swear that this is all that matters to
发誓这对
them right now they really want it but
他们来说现在最重要他们真的想要它，但
they can't make themselves do it so say
他们不能让自己做到 所以说
they have the perfect information that
他们有完美的信息，
has the potential to change that
有可能改变
particular person's life but what is the
那个人的生活，但是心理障碍是什么，
psychological barrier or that point at
或者
which it becomes the right moment that's
说它成为正确时刻的那个
a good point and there's many other
点是一个很好的点，还有许多其他
aspects to counselling right that this
方面的咨询 对，这个去
deconditioning process is a small piece
适应的过程是一小部分，
there's men there maybe depression there
有男人，可能有抑郁症，
maybe trauma there's a lot of other
可能有创伤，还有很多其他的
things going on so I'm not going to deal
事情在发生，所以我不会
with that but what I would maybe start
处理这个，但我可能
with is ask them to make a log before
会先让他们先做一个记录
they start any process have them observe
他们开始任何过程，让他们观察
their own behavior and figure out what
自己的行为并
are their cues what is it immediately
找出他们的线索是什么立即
proceeds reaching for the you know glass
进行到你知道
of wine or lighting up or you know
的一杯酒或点灯，或者你知道
engaging in pornography on the internet
在互联网上参与色情内容在
what immediately precedes that what time
of day so start by observation and then
一天中的什么时间之前 所以从观察开始，然后
you can maybe develop a plan for counter
你也许可以制定一个反
conditioning and extinction I guess to
条件反射和灭绝的计划我想
further explain what I'm asking is what
进一步解释我要问的是
about when they almost ignore it like
当他们几乎忽略它
they shut down they rebelled like
就像他们关闭一样他们反抗时
they're like I don't care anymore like
他们就像我不一样 不再关心
what is going on there exactly I know
那里发生的事情了 我知道
you can't say exactly so yeah I mean
你不能确切地说 所以是的 我的意思是
there's a moat there's a motivation
有一条护城河 有一个动机
issue I think I'll make the assumption
问题 我想我会在
here that the person is motivated yeah
这里假设这个人是 mot 是的
that's step one its if they're not
，这是第一步，如果他们没有
motivated this won't help but there's a
动力，这无济于事，但有
lot of people who are motivated and this
很多人有动力，这
is what trips them up it's the cravings
就是他们的渴望
and they know they should be eating low
，他们知道他们应该吃低
carb and they know they should be
碳水化合物，他们知道他们应该
avoiding it and they're motivated but
避免它并且他们有动力但
they can't overcome the the craving so I
他们无法克服渴望所以我
can't deal with those who are not
无法处理那些没有
motivated that's a different talk yes
动力的人这是一个不同的谈话是的
interesting yeah thank you so my
有趣是的谢谢你所以我的
question is related to neuroplasticity
问题与神经可塑性有关
I'm really tapping into the work of dr.
我真的很在乎 进入博士的工作。
Joe Dispenza and dr. Bruce Lipton on the
乔·迪斯彭萨和博士。 布鲁斯·利普顿 (Bruce Lipton)
idea that neurons that fire together
认为，一起激发的神经元
wire together and the idea that 95% of
连接在一起，以及我们 95%
our thoughts and behaviors are
的想法和行为
controlled by the subconscious mind
都由潜意识控制的想法
which we don't even oftentimes we're not
，而我们甚至常常不
even aware of and so my question is what
知道，我们甚至不知道，所以我的问题是什么
are your thoughts on using along with
是 你对使用的想法和
your suggestions also incorporating
你的建议也结合了
techniques like meditation and
冥想和
visualization and maybe certain forms of
可视化等技术，也许某些形式的
breath work that really help get our
呼吸工作真的有助于让我们的
brains out of that high beta state into
大脑从高贝塔状态
that alpha state where we can really
进入阿尔法状态，在那里我们可以真正
start to tune into our subconscious mind
开始调整到我们的潜意识
and change those I think those are great
和 改变那些我认为那些是很棒的
ideas I mean so this is IC this is a
想法我的意思是这是 IC 这是
complementary set of tools right it's
一套互补的工具对它
just as just one to add to that yeah but
只是添加到那个是的但是
on your point about neuroplasticity and
在你关于神经可塑性和
the automat
to city of this behavior I also think
这种行为的城市的自动机的观点上我也认为
cognitive behavioral therapy is great
认知 行为疗法很棒，
you know but thoughts are these
你知道，但想法是这些
conscious thoughts this is not CBT this
有意识的想法，这不是 CBT
is going to a very basic level of just
这将达到一个非常基本的水平，只是
pure behavioral conditioning it's going
纯粹的行为调节它'
after those automatic responses but you
追求那些自动响应，但你
can use this in tandem with CBT in
可以将它与 CBT 结合使用，
tandem with you know mindfulness and
同时结合你知道正念和
other techniques fascinating talk I wish
其他技巧 迷人的谈话我希望
I had gotten here at the very beginning
我在一开始就到这里
thank you so much
非常感谢你
at the near the end when you were
在接近结束时
talking about dopamine response dopamine
谈论 多巴胺反应 多巴胺
receptor sensitivity which is something
受体敏感性，据
that I understand it decreases with time
我所知，它会随着时间的推移
and you mentioned hormetic stressors
而降低，您
that would restore that dopamine
提到了可以恢复
receptor sensitive yes yes is that is
多巴胺受体敏感性的
that always the case that you use a
hermetic stressor to restore that or is
it context specific for instance if I
兴奋性压力源 例如，如果我
get a spurt of dopamine from both
entering giveaways on Instagram and
在 Instagram 上参加赠品活动并
pressing myself to do a hit workout that
强迫自己进行一次热门锻炼，这
is not probably not pleasurable in the
在中间可能并不令人愉快，
middle of it but you know at the end
但你知道最后
there's there's the sort of endorphin
会有一种内啡肽
response
反应，
yeah and it's it's a hormetic stressor
是的，它是 这是一种刺激性压力源，
all right the Instagram giveaway that's
好吧 Instagram 赠品
easy exactly are these both restoring
很容易，这些都是恢复
the or I mean are these affecting the
的，或者我的意思是这些是
dopamine receptor sensitivity in
以
different ways in different ways the
不同的方式以不同的方式影响多巴胺受体的敏感性
other is more difficult yes the
另一个更困难 是的
difficult one is helping to up regulate
困难的是帮助
the dopamine receptors you're still
上调多巴胺受体
getting dopamine in both cases right
在这两种情况下你仍然得到多巴胺 正确的
that's the signal so I'm focusing not on
这就是信号 所以我不
the signal but on the receptor which is
关注信号 但是在感受器上，这
really a key difference that people
确实是人们
sometimes ignore and this goes back to
有时会忽略的一个关键差异，这可以
the opponent process that when you're
追溯到对手流程，当您
engaging in these difficult activities
参与
that share a process you're now the
这些共享流程的困难活动时，您现在的
response
going to actually make you more
反应实际上会让您对它更加
sensitive to dopamine and it won't take
敏感 多巴胺，下次不需要
as much the next time can I pose an
那么多，我可以提出
alternate situation okay which you're
另一种情况，你正在
doing the the hit work out but you're
做命中工作，但
getting getting you're doing it because
你正在做你正在做的事情，因为
you get a dopamine response from it so
你从中得到了多巴胺的反应，所以
it's both during and afterwards and you
它是 期间和之后，你
yeah you engage in it because it's an
是的，你参与其中，因为这是一种
addiction I hear you and people one
瘾 我听到你和人们
question people have asked is what about
问的一个问题是人们问的一个问题是
running as an addiction or what about
跑步是一种瘾还是
sports is an addiction yeah there's good
运动是一种 n 成瘾 是的，有好的
addictions and there's bad addictions in
上瘾，也有坏的上瘾
the way I would say addictions aren't
，我想说上瘾
necessarily bad right addictions are bad
不一定是坏事 正确的上瘾是不好的
going back to this learning theory is if
回到这个学习理论是如果
they interfere with your life if they
他们干扰你的生活 如果他们
interfere with your coping if they're
干扰你的应对 如果他们
interfere with your health but if
干扰 与你的健康有关，但
they're not interfering if they're
如果他们不干涉他们是否
actually improving your life and if your
真的在改善你的生活，如果你的
happiness is going up fine reinforce
幸福感在上升，那就加强
those good things I'm just looking at
那些美好的事情，我只是在看
the case where you pursue pleasure and
你追求快乐
get kicked in the butt because that
并被踢屁股的情况，因为那
doesn't work but it's but you're a
没有用，但它是，但你是一个
directly pursuing pleasure where if when
直接追求快乐的人，
you're doing the hit workout you're
如果你在进行高强度训练时
first
首先
exposing yourself to a stressor to get a
让自己暴露在压力之下以获得
subsequent pleasure it makes a big
随后的快乐，这会产生很大的
difference
不同，
but the tolerance over time where you
但是随着时间的推移，你的容忍度
need to increase the time or the
需要增加时间或
intensity yep and with diminishing
强度是的，并且随着
response diminishing dopamine response
反应减弱，多巴胺反应减弱
that's where you might run into problems
，这就是你可能遇到问题的地方，
possibly but that's not what Solomon and
但这不是所罗门和
Corbett found they found that the
科贝特发现的 他们发现
skydivers actually needed their fear
跳伞者实际上需要他们的恐惧
level went down and their pleasure went
水平下降，他们的快乐
up over time so that's the whole paradox
随着时间的推移而增加，所以这就是整个悖论
here that's so wonderful if we can
，如果我们可以
exploit it okay pleasure it's not the
利用它，那就太棒了，好吧，快乐这不是
problem right thanks so much yeah I
问题，非常感谢，是的，我
really enjoyed that I wanted to ask you
真的很喜欢我想要的 问你
about carbohydrates because I noticed at
关于碳水化合物的问题，因为我在
the beginning of your protocol the first
你的方案开始时注意到
thing you do is try to get people to
你做的第一件事是试图让人们
stabilize their blood sugar intake I
稳定他们的血糖
guess inadvertedly also maybe taking out
some of those real trigger foods that
are very much at the center of food
摄入量 食物
addiction yes yeah and we know that that
成瘾是的，我们
both fat and and carbohydrate stimulated
知道脂肪和碳水化合物都刺激了
oka main response and that when you eat
oka 主要反应，当你
them together that dopamine responses
一起吃它们时，多巴胺反应是
some yeah
一些是的，
so I just wondered wait what do you
所以我想知道你
think that the powerful say a ketogenic
认为什么是强者说的生酮
protocol to undo the attachment to those
协议来撤销 对
kinds of highly rewarding foods its
那些高回报食物的依恋
sustainable over a long term like will
是长期可持续的，就像
somebody on a Canadian diet also then
加拿大饮食的人也会
develop a hedonic response to high-fat
发展出一种快乐 c
foods over time no that that's a good
随着时间的推移对高脂肪食物的反应 不，这是一个很好的
question
问题
I don't necessarily know the answer but
我不一定知道答案，
to follow on there I found that it was
但接下来我发现
very easy to start a ketogenic diet in
开始生酮饮食很容易，
the beginning but after a while it's
但过了一段时间就
hard to stick with it because it's
很难了 坚持下去，因为它很
boring or there's not enough pleasure
无聊或者没有足够的
from it or and you're still now become
乐趣，或者你现在仍然
tempted by other foods that's where I
受到其他食物的诱惑，我
think some of these conditioning
认为这些调理
strategies might help to you know get
策略中的一些可能有助于你了解让
you through that phase but it's a really
你度过那个阶段，但这是一个非常
good question I couldn't answer exactly
好的问题 我无法准确回答
you know and specifically with the
你知道的，特别是
ketogenic diet Todd that was a
生酮饮食托德，这是一个
pleasurable talk I liked it a lot
令人愉快的谈话，我现在非常喜欢它，
now you're not gonna like it tomorrow
你明天不会喜欢它
now I'm gonna be wanting more appear
现在我想要更多的出现
with a serious comment because it came
并发表严肃的评论，因为它来了
up about the the role of other
关于其他
approaches in cognitive behavioral
方法在认知行为
therapy that can work possibly in tandem
疗法中的作用，
when he's conditioning level any types
当他调节水平任何类型
of mechanism and it turns out one of my
的机制时，这些方法可能会协同工作，结果我
colleagues at UCLA Michele crass a
在加州大学洛杉矶分校的一位同事米歇尔·克拉斯
professor of clinical psychology that's
教授 f 临床心理学 这
what her lab has actually been looking
就是她的实验室实际上一直
at she's done a lot of work on de treat
在研究的内容
in her lab anxiety largely as a main
她在实验室焦虑症方面做了很多工作，主要是作为主要
focus and PTSD and developing treatments
关注点和 PTSD 以及开发治疗方法
and understanding the science of it but
和了解它的科学，但
one of the things they've been turning
他们一直在做的事情之一
to over the past five years or so is
在过去五年左右的
they for a long time have been applying
时间里他们一直在应用
conditioning you know Pavlovian
条件反射你知道巴甫洛夫条件反射的
conditioning history and that knowledge
历史和知识
to studying it in clinical patients
在临床患者中研究它
they've been now turning to that in
他们现在已经转向
conjunction with mindfulness or with
与正念或
cognitive approaches ideation things
认知方法结合的知识
like that to see if you get more
像这样的事情，看看
efficacious treatments when you combine
当你把它们结合起来时你是否会得到更有效的治疗
them I think that's a great concept
我认为这是一个很好的概念，
because by stilling the mind and
因为通过让大脑
quieting and making it more receptive to
安静下来，让它更容易接受
inputs I might get a more effective
输入，我可能会得到一个更有效的
conditioning or reconditioning process
调节或修复过程，
because you're not distracted by so many
因为你不是 被这么多刺激分心，
stimuli you're focusing on just the ones
你只关注
that are involved but you first got to
那些涉及的刺激，但你首先要
achieve that mindfulness state and all
达到那种正念状态和
the lower yeah you know I'd like to see
是的，你知道的，我想看看它是
how that works work to it I think it
如何运作的，我认为它
would add to what your yeah that's
会增加你的东西，这
intriguing thank you so you were talking
很有趣，谢谢你，所以你说
about walking in and getting the
的是走进去并获得
stimulus of the Cinnabon factory and
Cinnabon 工厂的刺激，
then not not eating it yeah going for a
然后不是不 吃它是的 去
walk calling a friend so adding that
散步 打电话给朋友 所以添加那个
pleasurable substituting a pleasurable
令人愉快的
thing you know in place of eating the
东西 代替吃肉桂的你知道的
Cinnabon yeah what if you walked into
the Cinnabon Factory but before you went
on the walk and called someone
you added a negative or an unpleasant or
令人愉快的事情 一个不愉快的或
just something negative a little prick
只是一些负面的东西
of a pen or something just something
笔的一点点刺痛或一些
really minor negative is that does that
非常小的负面影响 是否会
enhance or speed up the processes I mean
增强或加速过程 我的意思是
that might work although I've from what
这可能有效，尽管我从我读过的内容来看，
I've read aversive conditioning is far
厌恶条件作用远
less effective than positive
没有那么有效 除了正
reinforcement there's a great book if
强化，如果
you want to train an animal or train
你想训练动物或训练
yourself called and it's in in the
自己，这是一本很棒的书，它在
syllabus there then my reference is
教学大纲中，然后我的参考文献
called don't shoot the dog by karen
叫做不要射击狗，ka ren
prior it's wonderful and it's about you
之前它很棒而且是关于你
know the bet why negative reinforcement
知道为什么负强化
or actually why punishment doesn't work
或实际上为什么惩罚
a negative reinforcement is just not you
不起作用负强化只是不你
know rien is is is not is a different
知道 rien 是不是与惩罚不同，
thing than punishment but of all the
但在所有
conditioning positive reinforcement
条件下正强化
works far better and especially when
有效 更好，尤其是当
it's reinforced immediately at the very
它立即立即强化
same time without a delay and strongly
时，没有延迟，并且强烈地
there's a she trains dolphins and she
有一个她训练海豚，她
can get them to do anything with
可以让他们做任何
positive reinforcement and it doesn't
积极强化的事情，这
work with punishment so you can try it
对惩罚不起作用，所以你可以尝试，
but it often tends to condition a
但它往往倾向于 调节
alternate behavior to avoid the whole
替代行为以避免整个
situation and it doesn't really deal
情况，它并没有
with the the actual you know Pavlovian
真正处理你所知道的巴甫洛夫
conditioning thank you yep
调节谢谢你是的
hey Dad I seem to recall that in my
嘿爸爸我似乎记得在我
admittedly limited research on the
对这个主题的有限研究中
subject
intermittent positive reinforcement
间歇性积极强化
often works better than completely
通常比 完全
consistent positive reinforcement eg if
一致的积极强化，例如，如果
you know you you are you're absolutely
你知道你是你，那么你
correct in that receiving the rorg
在接受
right away so that it's powerfully
rorg 立即
associated it is extremely important but
关联它是非常重要的但
in a lot of research I remember if that
在很多研究中我记得如果这
doesn't always happen it actually ends
并不总是发生它实际上最终会
up being a more powerful conditioning
成为一个更强大的条件
stimulus than simply rewarding at every
刺激而不是在
single time you're exactly right in fact
你完全正确的每一次奖励 事实上，
skinner found that out by surprise right
斯金纳意外地发现了这一点
and then he used it to explain gambling
，然后他用它来解释赌博
behavior if you get if you hit the
行为，如果你
jackpot every time you're not gonna
每次都中头奖的话，你不会
nearly as reinforced as if you get it
像有时得到它一样得到加强
sometimes and then you know that might
，然后你知道明天可能会
happen tomorrow it might happen again
发生它 可能会再次发生
and yeah so intermittent reinforcement
，是的，所以间歇性强化
far more powerful which is why with
更强大，这就是为什么在第一次几次后
clicker training in that slide I showed
我和狗一起展示的幻灯片中的点击训练，
with the dog after the first couple
times you can just click and the dog
你可以点击并且狗
goes oh that means I might get hurt I
去哦，这意味着我可能会受伤我
might get the meat and it's actually
可能会得到肉 而且它实际上
very powerful so that's a really good
非常强大，所以这是一个非常好的
point thanks for reading it up Jay well
观点，感谢您阅读它，杰伊很好，
I guess that's it so so go out and try
我想就是这样，所以出去尝试
this extinct extinction you know process
这种灭绝的灭绝，你知道过程
or counter conditioning and I'd be I'd
或cou 我
love to hear from you as to whether it
很想听听你的意见，看看它
works for me it's amazing how quickly it
是否对我有用
works in a matter of days it's
几天之内它的作用如此之快
unbelievable you know your your
令人难以置信 你知道你的
hypothalamus is smarter than you are
下丘脑比你更聪明
so take care
所以要小心