2018.5.19纽约时报：正念冥想是否被过度炒作了

Mindfulness may have been over-hyped

正念冥想是否被过度炒作了

In late 1971, US Navy veteran Stephen Islas returned from Vietnam, but the war continued to rage in his head. “I came very close to committing suicide when I came home, I was that emotionally and mentally damaged,” Islas remembers. At his college campus in Los Angeles, a friend suggested he check out a meditation class. He was sceptical, but he found that before long “there were moments that started shifting, where I was happy. I would experience these glimpses of calmness.”

1971年末，一名美国海军退伍军人伊斯拉斯（Stephen Islas）从越南战场归国。身在美国的他，脑海中仍不断重现战争的画面。他回忆道，"回国后，我的情感和心智都近乎崩溃，一度想自杀。"他就读的洛杉矶大学里的一位朋友建议他去试试上冥想课。一开始，他略抱怀疑，但很快发现不久"有一些片刻时间心情有了改观，我变得稍微开心起来，有时候会感觉内心很平静。"

Forty-six years later, Islas says that he has never completely freed himself from his post-traumatic stress disorder (PTSD), which was formally diagnosed in 2000 at the Veterans Affairs (VA) West Los Angeles Medical Center. But he’s convinced that meditation has saved his life.

2000年，美国退伍军人事务部（Veterans Affairs, VA)西洛杉矶医学中心正式确诊伊斯拉斯患有创伤后压力症（post-traumatic stress disorder, PTSD)。时至今日，虽说他身心并未全愈，但伊斯拉斯认为冥想疗法已救了他一命。

Various forms of meditation are now routinely offered to veterans with PTSD. It’s also touted as a therapeutic tool to help anyone suffering from conditions and disorders including stress, anxiety, depression, addiction and chronic pain. More broadly, meditation has come into vogue as a way to enhance human performance, finding its way into classrooms, businesses, sports locker rooms and people’s smartphones through Internet apps like Headspace and Calm.

现在许多患创伤后压力症的退伍军人会定期接受不同形式的冥想疗法。这种疗法也被吹捧为焦虑症、抑郁症、恐慌症等精神症疾病及慢性疼痛等的有效治疗手段，甚至逐渐在大众中流行起来，成为时尚，广泛地运用到各种场合以增强人体心智及能力。冥想疗法进入学校、商业机构、运动健身场所，以及人们智能手机中如"头脑空间"（Headspace）、"平静"（Calm）等应用程式，几乎随处可见。

‘Mindfulness’ meditation, a type of meditation that focuses the mind on the present moment, is wildly popular. It has even become a billion-dollar business.

专注于当下时刻的正念冥想为冥想疗法之一种，非常受欢迎。目前已形成的相关产业规模达亿万美金。

For all its popularity, however, it’s still unclear exactly what mindfulness meditation does to the human brain, how it influences health and to what extent it helps people suffering from physical and mental challenges. Meditation has been practiced for thousands of years, but psychologists and neuroscientists have studied it for only a few decades.

尽管正念冥想如今十分盛行，但关于它究竟是如何影响人们的大脑，改善身心，又在多大程度上帮助那些身心罹患痛苦的人们，至今没有明确的结论。冥想已被人类践行上千年，但心理学家和精神学家们对它的学术研究仅有几十年而已。

Some studies suggest that meditation can help people relax, manage chronic stress and even reduce reliance on pain medication. Some of the most impressive studies to date involve a treatment called mindfulness-based cognitive therapy, which combines meditation with psychotherapy to help patients deal with thoughts that lead to depression.

一些研究指出，冥想能够帮助人们放松、舒缓慢性压力，甚至减轻机体疼痛，缓解药物依赖。近期的一些关键性研究则将正念疗法归类为认知行为疗法的一种。它将冥想与心理治疗相结合，以帮助患者摆脱负面情绪的影响。

Randomised controlled trials have shown that the approach significantly reduces the risk of depression relapse in individuals who have previously had three or more major depressive episodes.

随机对照试验也表明这种疗法能够有效帮助发作过三次以上重度抑郁的患者，减少其抑郁发作的概率。

But many other studies on the effects of meditation have used only small numbers of subjects, lacked follow-up and generally been less scientifically rigorous than other medical studies – clinical trials for new drugs, for example.

然而很多针对冥想开展的研究测试的对象数量少且缺乏后续跟进研究。相较于其他医学研究，如新药品的临床试验等，冥想相关的学术研究并不是太严谨。

A 2017 article that assessed evidence on meditation as a treatment for PTSD summed up the overall state of affairs: “This line of research is in its relative infancy.”

2017年发布的一篇学术文章综合评估了冥想作为创伤后压力症的一种治疗手段的相关实证。在结语的部分，文章写道，"此领域的研究尚处初期阶段。"

While questions about the clinical outcomes of meditation persist, other studies have focused on a more fundamental issue: does meditation physically change the brain? It’s a tough question to answer, but as brain imaging techniques have advanced and meditation interventions have grown more popular, scientists have begun to take a systematic look at what’s going on.

目前，除对冥想的临床疗效始终存在质疑之外，另有一些研究关注的问题则更为根本：究竟冥想是否改变了大脑的生理构造？这个问题很难回答。然而，随着大脑成像技术的日益进步以及冥想作为心理干预手段的日渐流行，科学家开始系统全面地探究这个问题。

Seeking stillness

静坐禅定

Meditation that requires one to sit still and focus on the mere act of breathing can encourage mindfulness, says psychologist David Creswell, who directs the Health and Human Performance Laboratory at Carnegie Mellon University in Pittsburgh.

担任美国匹兹堡卡耐基梅隆大学（Carnegie Mellon University）人类健康及行为实验室（the Health and Human Performance Laboratory）主任的心理学家克雷斯韦尔（David Creswell）介绍说，冥想时人要静坐，并且只关注自己呼吸，这样才能够保持正念状态。

But most people spend most or all of their day being anything but mindful. They skip from one thought to another. They daydream. They ruminate about the past, and they worry about the future. They self-analyse and self-criticise.

但大部分人几乎无法达到正念状态。他们思绪跳跃很大，会想东想西，做白日梦，一会儿反刍过去，一会儿又忧虑未来，时常自我检视又自我批判。

In a 2010 study, Harvard researchers asked 2,250 adults about their thoughts and actions at moments throughout their day via an iPhone app. People’s minds wandered 47% of the time and mind wandering often triggered unhappiness, the scientists reported in Science.

在2010年开展的一项研究中，哈佛大学的研究人员请2,250名成年人在一个iPhone的应用程式中记录下自己每日的想法与行动，并将最终研究成果发布在《科学》（Science）期刊上。研究表明人脑有47%的时间在神游，而这种神游又常常会诱发不愉快的情绪。

“In contrast, the capacity to be mindful is associated with higher well-being in daily life,” Creswell wrote in the 2017 Annual Review of Psychology. He cites a 2003 study showing a correlation between mindfulness and a number of indicators of well-being.

克雷斯韦尔2017年在《心理学年度评论》（Annual Review of Psychology）期刊中写道，"而拥有正念意味着在日常生活中有更高的幸福感。"他在文章中也引述了2003年的一项研究结论，指出正念与一些幸福感指标具有相关性。

When people who meditate say they are paying attention to the present moment, they may be focused on their breathing, but maybe also on an emotion that surfaces and then passes, a mental image, inner chatter or a sensation in the body. “Adopting an attitude of openness and acceptance toward one’s experience is critical” to becoming more mindful, Creswell says. The idea is to be view these moments with a detached and non-judgmental curiosity.

那些进行冥想的人们虽说在关注当下，其实也会专注于自身的呼吸，专注到那些涌起又消逝的情绪，脑海出现的画面，内心的对话，乃至身体上的感官体验。克雷斯韦尔向我们介绍说，"正念的关键在于以一种全然开放的心态接纳自己的体验。" 其核心理念是以超然的、不作评判的好奇之心审视当下时刻。

Creswell first became interested in mindfulness meditation when he took courses on psychology and Buddhism in high school. Later, in graduate school, he began studying meditation in connection with reducing stress and improving overall health.

克雷斯韦尔对正念冥想最初的兴趣来自于高中时他上的心理学与佛教的课程。研究生阶段，他开始研究冥想与解压、改善身心健康之间的关系。

“As a scientist, I’m never convinced. I’ve been trained to be sceptical,” Creswell says. “Nonetheless, I do think that there were a number of experiences I had while on meditation retreats that really struck me as very foundational.”

"作为一名科学家，我从不会深信不疑，学术训练让我带着质疑的眼光看问题。但我的确觉得自己做冥想静修练习时，拥有的体验对我的心理冲击非常大。" 克雷斯韦尔这样说道。

Even the simple but challenging act of sitting still for an hour while meditating made a great impact on Creswell. “Having this disconnect between my body feeling in pain but my mind being completely silent and open… these were very powerful insights for me about how a [meditation] practice could really change people’s lives, or fundamentally change how they relate to suffering in their lives,” he says. “There wasn’t a bolt-of-lightning moment for me, but a lot of these moments of insight in my own retreat experiences that suggested to me that it was worth spending time and effort to do the science.”

甚至简单但有难度的一小时静坐冥想对克雷斯韦尔都有很重大的影响。他说，"身体虽感不适，但心神却完全静谧而开放，在这种身心分离中，强大的内省让我体味到冥想练习真的能够改变人们的生活，或从根本上扭转他们对人生苦痛的态度。尽管我没有那种电光石火灵机一动的时刻，但我在静修时也有过许多顿悟瞬间，启发我认识到，这项科学是值得我花时间和经历去深入研究的。"

People from different religious, cultural and philosophical backgrounds have expounded the benefits of meditation for millennia. Meditation is perhaps most commonly associated with Buddhism, which views it as an instrument for achieving spiritual fulfilment and peace. Creswell calls the act of meditation “a basic feature of being human.”

上千年来，来自不同宗教、文化、哲学背景的人们都阐释冥想带来的益处。人们通常将冥想与佛教联想在一起。在佛教文化中，冥想被视作是获得精神圆满与平和的有效手段。而克雷斯韦尔则将冥想称作是"生而为人的基本能力。"

But the scientific evidence for its benefits is still lacking.

但在学术界，与冥想益处相关的科学依据并不多。

“There is a common misperception in public and government domains that compelling clinical evidence exists for the broad and strong efficacy of mindfulness as a therapeutic intervention,” a group of 15 scholars wrote in a recent article entitled Mind the Hype. The reality is that mindfulness-based therapies have shown “a mixture of only moderate, low or no efficacy, depending on the disorder being treated,” the scholars wrote, citing a 2014 meta-analysis commissioned by the US Agency for Healthcare Research and Quality.

近期，十五位学者共同发布了一篇心理学学术文章，名为《被炒作的正念》（Mind the Hype）。文中有这样一段写道，"公众及政府领域对冥想有一种普遍的误解：他们认为正念作为一种治疗干预手段具有普适性及良好疗效，且这一结论具备强有力的临床依据支撑。"但事实却并非如此。文章引述2014年美国医疗保健研究与质量管理署（US Agency for Healthcare Research and Quality）主持下的一项研究分析结果指出，基于正念作为治疗干预手段的研究表明，"该疗法对于精神疾病及心理障碍的治疗只有轻度和极少的效果，甚至毫无效果。"

Much more research is needed before scientists can say what mental and physical disorders, in which individuals, can be effectively treated with mindfulness meditation, they concluded.

文章结语部分指出，要得出正念冥想对某类病人的某类精神症疾病及身心障碍具有疗效的这一结论，仍需大量的科学研究及临床依据。

Mudra mind

手印心神

Alongside clinical work, neuroscientists have wanted to know how, if at all, meditation might change what actually happens inside the brain. Does meditation make certain regions more active than others, or more robustly connect one region to another? Does meditation result in new neurons, actually changing brain structure? Some studies suggest the answer is yes.

临床医学界与神经科学界共同探究的问题是：冥想是如何起作用又是否会对人脑造成什么变化？大脑的某些区域是否会因为冥想练习而特别活跃，又或是某几个区域之间的神经元连接更为紧密？冥想是否会使大脑产生新的神经元，从而改变人脑的构造？一些研究表明，以上问题的答案是肯定的。

Neuroscientists have studied the physical effects of mindfulness meditation using functional magnetic resonance imaging (fMRI) and other techniques for the last two decades. Progress has followed on the growing recognition that the human brain is capable of physical changes throughout adulthood, even into old age – forming new connections and growing new neurons when someone learns a new skill, challenges themselves mentally or even just exercises. The emerging view of a brain that can be continually shaped through experience, dubbed neuroplasticity, replaced the long-held idea that after the first few decades of life, the brain’s physiological trajectory was basically one of decline. A number of brain studies suggest that mindfulness meditation may spark neuroplastic renovations in the brain’s function and structure.

过去二十多年里，神经科学家们使用功能性磁振造影及其他技术手段来研究正念冥想对人脑带来的生理变化。科学研究揭示，人的大脑在成年后乃至老年时期也会不断发生变化——学习新的技能，从事心智挑战及身体锻炼等体验会使人脑产生新的神经元连接或是促进神经元新生，而这个结论已逐渐获得科学界的承认，而后续研究也有很大进展。随着对人脑认识的加深，科学家发现了"神经可塑性"，这是指人一生的生命体验会不断地引起大脑结构的改变。这一发现彻底扭转了长久以来的固有观点。过去科学界认为，人类成年后大脑的生理构造基本成型，其后功能会渐渐衰减。一些脑科学研究指出，正念冥想可能会激活神经可塑性，促进自我疗愈，从而重塑大脑功能及结构。

Looking under the hood with fMRI, scientists have found that mindfulness meditation activates a network of brain regions that includes the insula (associated with compassion, empathy and self-awareness), the putamen (learning) and portions of the anterior cingulate cortex (regulating blood pressure, heart rate and other autonomic functions) and the prefrontal cortex (the hub of higher-order thinking skills such as planning, decision-making and moderating social behaviour).

科学家使用功能性磁振造影观察人脑时发现，正念冥想会激活人脑中一些区域的神经元连接。这些区域包括负责同情、同理心与自我察觉的岛叶（insula）区域；负责学习与认知的核壳（putamen）区域；控制血压、心跳及其他自主功能的前扣带皮层（anterior cingulate cortex）部分区域；负责高阶思维能力，如规划、决策及规范社交行为的前额叶皮质（prefrontal cortex）等。

It’s uncertain, however, whether these changes in brain activity can be sustained when the individual is not actively meditating, and if so how much people need to meditate for that to happen.

但需要冥想多长时间，这些大脑区域才能被激活；冥想练习结束后，人脑中这些区域是否还能保持活跃状态。这些问题尚无确实结论。

When it comes to actual structural changes in the brain, some studies suggest that mindfulness meditation may increase grey matter density in the hippocampus, a brain region essential to memory. Researchers including Britta Hölzel, now at the Technical University of Munich, and Sara Lazar of Massachusetts General Hospital found evidence for this in a 2011 study.

说到冥想会引发大脑结构实质上的变化，一些研究认为，冥想可能导致海马体中的灰质细胞密度增加。海马体是人脑中负责记忆的区域。一些科学研究者，其中包括慕尼黑工业大学（Technical University of Munich）的霍尔泽尔（Britta Hölzel）及美国麻省总医院（Massachusetts General Hospital）的拉扎尔（Sara Lazar），他们在2011年一项研究中的发现，支持上述说法。

Though intriguing, these studies are nowhere near the end goal. “We need to understand the benefits that the changes in the brain have on behaviour and well-being,” Hölzel says. “‘Changing the brain’ sounds very impressive, but we don’t understand what it actually means.”

这些研究虽然看起来相当奇妙，但离得出结论的终极目标还有很长的距离。霍尔泽尔说："我们得弄清楚冥想所引发人脑中的这些变化对于个体行为与健康究竟有何益处。能改变人脑结构听起来挺好，但是我们尚不清楚到底这意味着什么。"

Lazar agrees. “Most of the data has only looked at changes over the course of two months of [meditation] practice… Most people feel that [meditation] continues to change and get deeper with extended practice. So we need to conduct studies that follow people for much longer time points.”

拉扎尔表示同意，她补充说，"目前大部分的研究数据均只观察了两个月期间内冥想练习所引发的变化。而大部分人都感觉冥想练习越多，时间越久，就越能够感受到自身变化，这些变化也越明显。所以我们需要选取合适的对象并将研究的时间区间拉长。"

Brain wave

脑波激荡

Based on their studies of people engaged in meditation, Creswell and his colleagues have proposed that mindfulness acts as a buffer specifically against stress. It does this by increasing activity in regions of the prefrontal cortex that are important for “top-down stress regulation”, while reducing activity and functional connectivity in regions associated with the brain’s fight-or-flight stress response – in particular the amygdala.

基于参与冥想的对象相关研究，克雷斯韦尔与他的同事认为正念能够有效缓解压力，其作用机制是能够激活大脑中负责"自上而下压力调适"（top-down stress regulation）的前额叶皮质，另一方面在负责"战斗或逃跑反应"（fight-or-flight stress response）的应激反应脑区，能缓解其相关活动及功能性神经元连接，尤其是杏仁核部位的连接。

The idea that mindfulness meditation engages parts of the brain involved in top-down stress regulation is widely accepted among researchers, says University of Michigan clinical psychologist Anthony King. But what’s happening in relation to the amygdala is less clear, he says. The amygdala, one of the most primitive parts of the brain, is not just a simple alarm centre associated with responding to threats. It’s central to what’s called the salience network, which is vital for noticing all kinds of important things in one’s environment. In a mother, for example, the amygdala may become very active in response to her baby’s joyful face.

据美国密歇根大学临床心理学家金教授（Anthony King）介绍，正念冥想对于大脑"自上而下的压力调适机制"有积极作用，这一点已被学术界广为认可。但它对于杏仁核区域相关的应激反应是如何作用的却尚不清楚。杏仁核，是人脑中最为原始的部分，它并不仅仅是一个应对外界刺激与危险的应激反应中心，它也是突显网络（salience network）的关键组成部分，对于观察与判断周围环境中一切重要事物非常重要。例如，一位母亲在看到自己宝宝的笑脸时，杏仁核区域会十分活跃。

Mindfulness meditation “helps people have what the old school psychotherapists call ‘reflective capacity,’” King says. “Instead of automatically responding in certain ways, it allows people to have more nuance in their ability to respond to any type of situation – stressful, fearful or otherwise – and create some psychological distance.”

金教授同时说道，正念冥想对于提升传统心理治疗师所说的"反思能力"也有裨益。"反思能力能使人们在应对各种情景，如面临压力或恐惧时，更加审慎，与这些压力源保持一定的心理距离，而不是一味地以特定的方式自主反应。"

Two studies by Creswell and his colleagues, one in 2015 and the other in 2016, offer some initial findings that seem to support their view of mindfulness meditation as a buffer against stress. Both studies focused on the physiological effects of mindfulness mediation training on small groups of unemployed adults experiencing stress.

克雷斯韦尔与他的同事们在2015年和2016年分别进行了两项研究，对象均为有心理压力的成人失业者，将他们分成小组，研究他们进行正念冥想练习所获得的心理疗效。这些研究同样证实正念冥想能够帮助缓解压力。

In the 2015 study, the researchers found that three days of intensive mindfulness meditation training reduced functional connectivity between the right amygdala, associated with the fight-or-flight stress response, and the subgenual anterior cingulate cortex, which plays a role in modulating emotions.

在2015年开展的研究中，研究人员发现连续三天高强度的正念冥想会显著减少负责"战斗或逃跑反应"的杏仁核右侧区域与负责调节情绪的前扣带皮层区域之间的功能性连接。

In the 2016 study, the researchers found that three days of intensive mindfulness meditation training led to increased connectivity between the default mode network, a network of regions engaged when the brain is at rest, and parts of the prefrontal cortex involved in regulating stress. The study also found that meditation led to reduced levels of interleukin-6, a biomarker in the blood for systemic inflammation that’s elevated in high-stress populations.

而在2016年的研究中，研究人员则发现这种连续三天高强度的"正念"冥想增强了大脑"默认网络"（default mode network）与负责压力调适的前额叶皮质区域之间的连接。人类大脑中的"默认网络"是在大脑处于静息状态时而转为活跃的一种大脑工作系统。研究还发现，冥想会显著降低血液中的白细胞介素-6（interleukin-6）的水平。这种细胞因子能够刺激参与免疫反应的细胞增殖。压力较大的人白介素-6的水平一般较高。

King and his colleagues showed similarly promising results in 23 combat veterans of Afghanistan and Iraq with post-traumatic stress disorder in 2016. Brain scans before and after mindfulness-based group therapy revealed an increase in resting-state connectivity between a network in the brain that allows people to control their attention and other parts of the brain involved in rumination and spontaneous thought. This particular connectivity has been seen in healthy people, as well as people who have meditated for long periods, says King.

2016年，金教授等研究人员进行的另一项研究也有类似的结果。他们的研究对象是23名自阿富汗及伊拉克战区退伍后患有创伤后压力症的军人。对采用正念疗法前后的大脑扫描结果显示，他们在静息状态下控制自身注意力的脑区与负责反刍思维（意指如动物反刍一样对某事不受控制的反复思考）和即时思维的脑区之间的连接加强。金教授介绍道，这种特别的脑区连接一般在身心健康的人脑里常见。而长时进行冥想练习的人也会出现这种状态。

“What’s important about our study… is that people with PTSD can also have this change in brain connectivity patterns when they do mindfulness practice,” King says. The more this connectivity increases as a result of mindfulness training, “the more their symptoms improve,” he adds, summarising a key finding of the study.

他总结该项研究的关键之处说，"此次研究中最重要的一点是，我们发现患有创伤后压力症的人们在进行正念练习后，大脑连接也发生了类似的变化。冥想次数越多，大脑这种连接也越强，病症也就有所缓解。"

Studies of other conditions suggest similar improvements, although many involve small numbers of subjects and other limitations that make them far from conclusive.

其他相关研究也有类似的发现。但由于许多研究涉及的研究对象数量很小，而且还有其他限制或不足，这些发现尚不能视为结论性成果。

Nevertheless, mindfulness meditation may alleviate symptoms of general anxiety disorder by increasing connectivity between the amygdala and the prefrontal cortex, thereby increasing a patient’s ability to regulate emotions. Meditation may also lessen the perception of pain by reducing pain-related activation of the somatosensory cortex and increasing activation of areas involved in the cognitive regulation of pain.

然而无论如何，目前已知的是，正念冥想或许可能促进杏仁核及前额叶皮质区域产生更多神经元连接，从而缓解焦虑等精神障碍的症状，进一步提升患者控制情绪的能力。冥想或许也能够一方面有效降低负责痛感等躯体感觉的大脑皮质区域的细胞活跃度，另一方面提升控制痛感认知调适的大脑区域的细胞活跃度，从而能舒缓人的疼痛感。

Work ahead

展望未来

Fundamentally, mindfulness is an elusive quality to study. It’s an internally generated experience, not a drug that scientists can give to a patient. That creates a question when comparing mindfulness between individuals and especially between distinct studies.

总体而言，正念是个难以捉摸的课题。它不是科学家给病人开的药，而是一种内在形成的体验。这就使得研究时因个体经验不同，不同类型的研究也千差万别，难以比对参照。

What’s more, there is no universally accepted definition of mindfulness or agreement among researchers on the details of what it entails, Lazar and her colleagues note in the Perspectives on Psychological Science article.

再者，正如拉扎尔等研究人员发布在《心理学视角》（Perspectives on Psychological Science）期刊文章的注释中写道的那样，目前正念冥想还没有举世公认的定义，学界也未对正念冥想所涉及的细节达成一致的结论。

In the context of PTSD, King says it’s likely that mindfulness meditation will continue to supplement more conventional psychiatric treatments. “I would never recommend for people to go to a mindfulness class at the YMCA or the local health centre and think that that’s going to be the same as psychotherapy, because it is not. It really is not,” King says.

在创伤后压力症治疗这个领域，金教授认为正念冥想是其他传统精神治疗手段的有益补充。"我不建议人们去什么基督教青年会互助会（YMCA）或是本地健康中心上正念相关课程。因为它并不是一种心理治疗手段，也无法达到心理治疗的效果，更无法替代心理治疗。"

But “I think mindfulness is a useful technique in the context of therapy with somebody who’s trained in PTSD treatment.”

"但我认为正念冥想可以作为创伤后压力症精神治疗中的一种补充工具。"

But people like Islas who have faced serious mental illness, and others who use mindfulness meditation to ease daily stress, say they’re convinced the practice improves their lives. One day, scientists hope to be able to link that experience to what’s physically happening in the meditating mind.

像文章开篇伊斯拉斯那样患有严重心理疾病的人及一些利用正念冥想来缓解现实压力的人，他们坚信冥想练习改善了他们的生活品质。但愿有一天，科学家们能够揭开谜题，弄清楚冥想体验与冥想时人脑发生的生理变化间到底有何关联。