2016年8月6日 星期六

正念教育:培養你內在的悲憫心或疼惜力

大致翻譯整理了以下文獻的附錄一、二、三的資料,對悲憫心(compassion mind)有個初步的認識和使用工具。
悲憫心,將是用來對治人們內在的自我批評的最佳方式。

Paul Gilbert and Sue Procter (2006). Compassionate Mind Training for People with High Shame and Self-Criticism: Overview and Pilot Study of a Group Therapy Approach. Clinical Psychology and Psychotherapy. 13, 353–379


附錄一、培育內在的悲憫心
APPENDIX 1. DEVELOPING QUALITIES OF INNER COMPASSION


自我批評帶給自己莫大的壓力並使自己感覺很糟糕。面對這種失望以及自己的「內在霸凌」的其中一種方法就是學會悲憫自己。因此我們需要培養以下的特質:
一、重視悲憫心。Valuing compassion
二、同理心。Empathy
三、同情心。Sympathy
四、寬容。Forgiveness
五、接納/忍受力。Acceptance/tolerance
六、培養溫暖的感覺。Developing feelings of warmth
七、成長。Growth
八、負責。Taking responsibility
九、訓練。Training


一、重視悲憫心。Valuing compassion
有人會擔心悲憫自己會讓他們變得懦弱或缺乏上進心。他們因此不會真正的重視疼惜。然而,我們想想那些以悲憫出名的人,如佛陀、基督、甘地、南丁格爾與曼德拉,他們很難被視為是懦弱的人或不成功。學會悲憫心,真得可以讓我們更堅強、感覺更有自信。

二、同理心。Empathy
同理心意謂著我們可以瞭解其他人有什麼感受與想法、從他們的觀點立場來看待事情。同樣的,當我們用同理心對待自己,我們可以更瞭解自己的某些痛苦感受,像是失望、焦慮、憤怒或悲傷。這可能會要我們去學習溫柔地覺察到自己的感受與苦惱,而不是試圖注意或避開這些感受與苦惱。
我們有時候會告訴自己我們不應該去感受或思考我們有的感受或思考,要試圖否認而不是要去處理我們的感受。這樣的問題在於我們沒有好好探索以瞭解這些感受或想法,所以這些感受或想法就會讓我們感到好害怕。我們可以學習去瞭解我們是如何以及為什麼會變得自我批評,通嘗是因為我們在某些方面感覺到威脅。"有同理心" 意謂著要能夠看見在自我批評背後的那些威脅

三、同情心。Sympathy
同情心比較無關乎我們的瞭解,而與我們的感覺和想要去關懷、協助與療癒的心意比較有關。當我們同情某人,我們會為他們感到難過或苦惱。學會對自己有同情心,意謂著我們可以學會感到難過但不是陷入憂鬱,例如,不會跟自己說感覺到難過是有些不好或錯誤的。我們可以聚焦在我們的同情心裡的慈愛。

四、寬容。Forgiveness
我們內在的自我批評通常很不寬容,通常認為不應錯過任何一個攻擊或譴責的機會。然而,學會寬容之道,卻非常重要。寬容讓我們得以學會如何改變,我們坦誠地面對自己的錯誤並從中學習與成長。

五、接納/忍受力。Acceptance/tolerance
我們可能很想改變自己本身的許多部分,有時這麼做是很有助益的。然而,學會 如實地接納身為人類的自己,也是很重要的。接納,並不是被動的順從,像是被打敗的感覺,也不是為自己操心。接納是以開放的心來看待我們自己所有的錯誤和努力。這就好像我們得了流行性感冒,要接受自己必須躺床好好休息,但也要盡力去做有助於自己康復的事情。

六、培養溫暖的感覺。Developing feelings of warmth
這需要我們開始去體驗及練習用溫暖的心來對待自己。為了做到這點,我們可以利用畫面來練習讓溫暖的感覺傳入自己的內心。當我們憂鬱時,這種溫暖的感覺可能會變得非常微弱且難以產生 ---- 所以我們才需要多練習。這聽起來很奇怪,有時甚至讓人害怕 ---- 所以我們要一步一步來。

七、成長。Growth
悲憫心是專注在幫助人們成長、改變與發展。這是以某種方法來提升生活,但霸凌就做不到。當我們學會以悲憫心對待自己,我們正在學習處理我們犯了錯的自己,然後我們得以從中獲得成長與改變。悲憫心也幫助我們得以面對一些我們希望避開的痛苦感受。

八、負責。Taking responsibility
讓悲憫心得以有效的要素之一就是對自己的自我批評的想法負起責任。為做到這點,我們要學會辨認我們何時在自我批判,然後運用我們內在的悲憫心提供另一種不同的觀點與感受。

九、訓練。Training
當我們攻擊自己,就是激活了我們腦中的某些路徑,但是當我們學會疼惜與支持自己的付出,我們就是刺激到不同的路徑。我們有時很擅長於激活內在的攻擊與批評,以致於我們刺激內在的支持與溫暖的能力就顯得相當微弱。
因此,我們現在已經瞭解到我們可以選擇與自己的自我攻擊型想法不同的其他方法,我們可以探索有哪些方式可以使這些方法更能影響到我們的情緒。這不是要趕走哪些令人痛苦的事實,而是要幫助我們用不同的方式來因應。
在訓練的部分就像是去找物理治療師一樣,你學會要做一些練習並建立某些強項。腦中的疼惜/悲憫系統就是我們試圖透過我們的練習來加以強化的系統。


As we have seen from our work together, being self-critical can be very stressful and make us feel worse. One way of coping with disappointment and our ‘inner bully’ is to learn be compassionate to the self. This requires a number of things of us:

1. Valuing compassion. Some people are worried that if they are compassionate with themselves they may somehow be weak or lack the drive to succeed. Thus, they don’t really value compassion. However, if we think about people who are renowned for their compassion, such as Buddha, Jesus, Ghandi, Florence Nightingale and Nelson Mandela, they can hardly be regarded as weak or ‘unsuccessful’. Learning to be compassionate can actually make us stronger and feel more confident.

2. Empathy. Empathy means that we can understand how people feel and think, see things from their point of view. Similarly, when we have empathy for ourselves we can develop a better understanding for some of our painful feelings of disappointment, anxiety, anger or sadness. This can mean we may need to learn when to be gently sensitive to our feelings and distress—rather than try not to notice them or avoid them. Sometimes we tell ourselves that we shouldn’t feel or think as we do, and try to deny our feelings rather than working with them. The problem with this is that we don’t explore them to understand them and then they can be frightening to us. We can learn to understand how and why we became selfcritical, often because we feel threatened in some way. Becoming empathic means coming to see the threats that lay behind self-criticism.

3. Sympathy. Sympathy is less about our understanding and more about feeling and wanting to care, help and heal. When we feel sympathy for someone, we can feel sad or distressed with them. Learning to have sympathy for ourselves means that we can learn to be sad, without being depressed, e.g., without telling ourselves that there is something wrong or bad about feeling sad. We can also focus on feelings of kindness in our sympathy.

4. Forgiveness. Our self-critical part is often very unforgiving, and will usually see any opportunity to attack or condemn as an opportunity not to be missed. Learning the art of forgiveness, however, can be important. Forgiveness allows us to learn how to change; we are open to our mistakes and learn from them.

5. Acceptance/tolerance. There can be many things about ourselves that we might like to change, and sometimes it is helpful to do that. However, it is also important to develop acceptance of ourselves as human beings ‘as we are’ with a full range of positive and negative emotions. Acceptance isn’t passive resignation, such as feelings of being defeated, or not bothering with oneself. It is an open-heartedness to all our fallibilities and efforts. It is like having the flu and accepting that you have to go to bed perhaps but also doing all you can to help your recovery.

6. Developing feelings of warmth. This requires us to begin to experience and practice generating feelings of warmth for the self. To do this we can use images and practice feeling warmth coming into us. When we are depressed this feeling may be very toned down and hard to generate—so we will have to practice. It can seem strange and sometimes even frightening—so we can go step at a time.

7. Growth. Compassion is focused on helping people grow, change and develop. It is life enhancing in a way that bullying often is not. When we learn to be compassionate with ourselves, we are learning to deal with our fallible selves, such that we can grow and change. Compassion can also help us face some of the painful feelings we wish to avoid.

8. Taking responsibility. One element of compassionate mind work is taking responsibility for one’s self-critical thinking. To do this we can learn to recognize when it’s happening and then use our compassionate side to provide alternative views and feelings.

9. Training. When we attack ourselves we stimulate certain pathways in our brain but when we learn to be compassionate and supportive to our efforts we stimulate different pathways. Sometimes we are so well practiced at stimulating inner attacks/criticisms that our ability to stimulate inner support and warmth is rather under-developed. Hence, now that we have seen how we can generate alternatives to our self-attacking thoughts, we can explore ways to help them have more emotional impact. It does not take away painful realities but it can help us to cope in a different way. The training part can be like going to a physiotherapist, where you learn to do exercises and build up certain strengths. The compassion systems in your brain are the ones we are trying to strengthen with our exercises.






附錄二、建立一個疼惜的內在心像
APPENDIX 2. BUILDING A COMPASSIONATE IMAGE

圖片來源:http://blog.sina.com.cn/s/blog_a46bc7ca0102vjej.html

此練習是幫助你建立一個悲憫的心像(譯註:觀音菩薩、媽祖、聖母瑪利亞等等應該是國人最常見的悲憫心像),讓你得以運用與發展(只要你想要,你也可以建立多個心像,一段時間之後你也可以改變這些心像)。每當心像浮現腦海,或你選擇要加以處理時,請記得這是你的創作,因而是你自己個人的理想 ---- 也就是在被關照與被在意的感覺當中你真正想要的東西。可是,在這個練習中,很重要的是你要試圖對你的心像賦予某些特質。這些特質包括:
智慧、力量、溫暖與不評價

所以在以下表格每個欄位裡,請想想每一個特質(智慧、力量、溫暖與不評價),然後想像這些特質看起來、聽起來與感覺起來像是什麼樣子。可能的話,先聚焦在你的呼吸上,找到我們平靜的節奏並保持淺淺的微笑。然後我們讓心像浮現腦海 ---- 盡力而為,但不要太過努力 ---- 若沒什麼東西浮現,或心思漫遊到他處了,只要溫和地將心思焦點帶回到呼吸上並練習以慈悲的心接納這一切。以下有一些問句,可以幫助你建立一個內在心像:
你是否想要你的照顧/滋養型心像感覺起來/看起來老練一點還是年輕一點;是男性還是女性(或是非人類的形象,如動物、大海或光)?什麼樣的顏色和聲音穢語智慧、力量、溫暖和不評價等特質有關?
請想像你的內在心像將慈悲與疼惜帶給你。

你希望你理想的照顧型/慈悲型的內在心像看起來是怎麼樣子的?



你希望你理想的照顧型/慈悲型的內在心像聽起來是什麼樣子的?(如,聲調音頻)



你還希望賦予這個內在心像什麼樣的感官特質?(如味道、觸感)



你希望你理想的照顧型/慈悲型的內在心像會如何跟你互動?



你希望你自己會如何跟你理想的照顧型/慈悲型的內在心像互動?




This exercise is to help you build up a compassionate image for you to work with and develop (you can have more than one if you wish, and they can change over time). Whatever image comes to mind, or you choose to work with, note that it is your creation and therefore your own personal ideal—what you would really like from feeling cared for and cared about. However, in this practice it is important that you try to give your image certain qualities. These will include:

Wisdom, Strength, Warmth and Non-judgement

So in each box below think of these qualities (wisdom, strength, warmth and non-judgement) and imagine what they would look, sound and feel like. If possible we begin by focusing on our breathing, finding our calming rhythm and making a half smile. Then we can let images emerge in the mind—as best we can—do not too try to hard—if nothing comes to the mind, or the mind wanders, just gently bring it back to the breathing and practice compassionately accepting. Here are some questions that might help you build an image: would you want your caring/nurturing image to feel/look/seem old or young; male or female (or non-human looking, e.g., an animal, sea or light)? What colours and sounds are associated with the qualities of wisdom, strength, warmth and non-judgement? Remember your image brings compassion to you and for you.

How would you like your ideal caring–compassionate image to look—visual qualities?
How would you like your ideal caring–compassionate image to sound (e.g., voice tone)?
What other sensory qualities can you give to it?
How would you like your ideal caring–compassionate image to relate to you?
How would like to relate to your ideal caring-compassionate image?





附錄三 自我報告日誌
APPENDIX 3. SELF-REPORT DIARIES

自我批評的想法Self-critical thoughts

回想過去一週,你曾經有過任何自我批評的想法嗎?
Looking back over the week, can you recall any self-critical thoughts?
自我疼惜/安撫的想法Self-compassion/soothing thoughts
回想過去一週,你曾經有過任何自我安撫/自我保證的想法?
Looking back over the week, can you recall any self-soothing/reassuring thoughts?
一、是什麼樣的情境/事件引起這些想法?
1. What situations/events brought them about?





一、是什麼樣的情境/事件引起這些想法?
1. What situations/events brought them about?
二、你有怎麼樣的自我批評的想法與感受?
2. What were your self-critical thoughts and feelings?






二、你有怎麼樣的自我安撫/自我保證的想法與感受?
2. What were your self-soothing/reassuring thought and feelings?
三、回想過去一週的情形(請在下列每一題勾選出適當的數字):
1.你有多常出現自我批評的想法?
從來沒有 1 2 3 4 5 6 7 8 9 10 經常出現
2.你的自我批評的想法的力道有多強?
完全沒有 1 2 3 4 5 6 7 8 9 10 非常有力
3.你的自我批評的想法對你的干擾程度有多少?
完全沒有 1 2 3 4 5 6 7 8 9 10 非常干擾
4.你自我批評的想法會持續多久?
飛逝而過 1 2 3 4 5 6 7 8 9 10 幾近整天
5.自我批評的想法對你造成多大的苦惱?
完全沒有 1 2 3 4 5 6 7 8 9 10 非常苦惱
6.你的自我批評的想法有多大程度的憤怒/敵意呢?
完全沒有 1 2 3 4 5 6 7 8 9 10 非常騷擾
7.將你跟你的自我批評的想法區分開來,有多容易呢?
一點都不容易 1 2 3 4 5 6 7 8 9 10 非常容易


三、回想過去一週的情形(請在下列每一題勾選出適當的數字):
1.你多常出現自我安撫的想法?
從來沒有 1 2 3 4 5 6 7 8 9 10 經常出現
2.你的自我安撫的想法的力道有多強?
完全沒有 1 2 3 4 5 6 7 8 9 10 非常有力
3.你的自我安撫的想法對你的干擾程度有多少?
4.你的自我安撫的想法能持續多久?
飛逝而過 1 2 3 4 5 6 7 8 9 10 幾近整天
5.你的自我安撫的想法有多大程度的安慰效果?
完全沒有 1 2 3 4 5 6 7 8 9 10 非常撫慰
6.你的自我安撫的想法有多大程度的平靜與愉悅呢?
完全沒有 1 2 3 4 5 6 7 8 9 10 非常平靜愉悅
7.維持你的自我安撫的想法,有多容易呢?
一點都不容易 1 2 3 4 5 6 7 8 9 10 非常容易
3. Thinking back over the week (please circle on each):
(a) How often did you have self-critical thoughts?
Had none 1 2 3 4 5 6 7 8 9 10 A lot of the time
3. Thinking back over the week (please circle on each):
(a) How often did you have self-soothing thoughts?
Had none 1 2 3 4 5 6 7 8 9 10 A lot of the time
 (b) How powerful were your self-critical thoughts?
Not at all 1 2 3 4 5 6 7 8 9 10 Very powerful
 (b) How powerful were your self-soothing thoughts?
Not at all 1 2 3 4 5 6 7 8 9 10 Very powerful
 (c) How intrusive were your self-critical thoughts?
Not at all 1 2 3 4 5 6 7 8 9 10 Very intrusive
完全沒有 1 2 3 4 5 6 7 8 9 10 非常干擾
(c) How intrusive were your self-soothing thoughts?
Not at all 1 2 3 4 5 6 7 8 9 10 Very intrusive
 (d) How long did your self-critical thoughts last?
Fleetingly 1 2 3 4 5 6 7 8 9 10 Most of the day
 (d) How long did your self-soothing thoughts last?
Fleetingly 1 2 3 4 5 6 7 8 9 10 Most of the day
 (e) How distressed were you by your self-critical thoughts?
Not at all 1 2 3 4 5 6 7 8 9 10 Very distressed
 (e) How comforting were your self-soothing thoughts?
Not at all 1 2 3 4 5 6 7 8 9 10 Very comforting
 (f) How angry/hostile were your self-critical thoughts?
Not at all 1 2 3 4 5 6 7 8 9 10 Very harassing
 (f) How calming/pleasant were your self-soothing thoughts?
Not at all 1 2 3 4 5 6 7 8 9 10 Very calming/pleasant
 (g) How easy was it to distract yourself from your self-critical thoughts?
Not at all easy 1 2 3 4 5 6 7 8 9 10 Very easy
 (g) How easy was it to maintain your self-soothing thoughts?
Not at all easy 1 2 3 4 5 6 7 8 9 10 Very easy



看到這裡,給你鼓掌肯定!
希望有助於大家散播慈愛悲憫之心! 


4 則留言:

  1. 補充這項研究的摘要:
    悲憫心訓練是為了有高度的羞愧及自我批評的人(這些人的問題很容易變得長期性的問題),以及那些發現難以或害怕對自己溫柔與自我接納的人,而發展出來的。
    本文獻簡短回顧了羞愧(shame)與自我批評(self-criticism)在心理困擾當中扮演的角色、在型式極為不同(激活型 vs 安撫型)的情感系統裡以及在悲憫心訓練之論與治療歷程裡的重要性。
    本文獻從非控制性的研究試驗中,探索了患者對使用及練習各種以悲憫為焦點的歷程的接受度、瞭解度和能力,然後還探索了悲憫心訓練的效果。
    六名參與某家適合長期困境的認知行為導向之日間中心的個案,完成了12堂每次兩小時的悲憫心訓練療程。他們被告知這是一個檢視悲憫心訓練之歷程與效果的研究方案的一部份,他們要積極合作,以告訴研究者什麼有幫助什麼沒有幫助。
    結果顯示在憂鬱、焦慮、自我批評、羞愧、低劣感和順從行為上有明顯的減少。研究參與者在自我安撫、專注在溫暖感受以及給自己再保證的能力上都有明顯的增加。
    悲憫心訓練對有長期困擾的患者來說可能一項有用的補充服務,尤其是那些有創傷背景的長期個案,他們可能缺乏溫暖的內在感受或自我安撫的能力。

    回覆刪除
  2. 另一項2014年的文獻指出「自我悲憫」(self-compassion)是另一項對重鬱症患者有效的情緒調節策略。
    *****************************************************
    該文獻的摘要如下:
    認知再評價(cognitive reappraisal)與接納(acceptance)是兩項對憂鬱症來說也許是適應性的情緒調節策略。最近,自我悲憫(self-compassion)在討論中被認為是另一個可以有效因應憂鬱症的策略。
    在本研究裡,我們以臨床憂鬱症樣本的等候條件、再評價及接納來比較自我悲憫的效果,並檢測了以下的假設:憂鬱心情的強度將調節了這些策略的不同效能。
    在實驗設計中,我們於四個時間點在48位符合重鬱症診斷準則的參與者身上引發憂鬱情緒。在每次的情緒誘發,參與者被指導去等待、對情境重新評價、接納他們的負面情緒、或是採用自我悲憫來調節他們的憂鬱情緒。在每次的情緒誘發與調節階段的之前與之後都進行了憂鬱情緒的自我評量。
    結果顯示,自我悲憫組的憂鬱情緒的減少程度明顯大於等候組。但是,參與者對憂鬱情緒的評量,在自我悲憫組與重新評價組之間,以及在自我悲憫組和接納組之間,都沒有明顯差異。
    可是,於基準期自我評量的憂鬱情緒,被發現會中介地調節了自我悲憫組與再評價組的對照效果,其中有一股趨勢是在基準期有較高之憂鬱情緒的參與者身上,自我悲憫比重新評價有效。
    這些發現支持了自我悲憫可當作重鬱症患者另一樣有效的情緒調節策略,尤其是那些受苦於高度憂鬱情緒的人。

    http://self-compassion.org/wp-content/uploads/publications/MajorDepression.pdf

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    1. 自我調適團體的成員問我,認知治療是建議大家要為自己的想法找出證據,才能克服憂鬱或焦慮,這是一種從認知上重新進行評價的方法。
      但是,我從正念為導向的治療法裡學到的是,太著墨於自己的想法,則會陷入鑽牛角尖的思緒當中(國外稱為芻思 ruminations)。
      而這篇研究文獻則初步認為,對於有高度憂鬱情緒的人來說,「練習對自己悲憫」可能會比「從認知上進行重新評價」更有助於憂鬱情緒的調節。

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    2. 從該研究報告的圖一與表二,從以上的表格可以看見這六位參與者對各種調適策略的作法的平均評比分數。蠻有趣的!
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      調節策略:認知再評價(M=3.08)
      1.找出符合的爭論與情境(M=2.54)
      2.找出質疑的爭論與情境(M=3.24)
      3.形成一個比較積極正面的說法(M=3.45)

      調節策略:接納(M=3.42)
      1.對覺察到的感受給一個形容詞或標籤(M=3.02)
      2.評比感受的強度(M=3.43)
      3.接納感受(M=3.45)
      4.用一個積極正面的態度來面對這些感受(M=3.86)

      調節策略:自我悲憫(M=3.00)
      1.從外人的角度來看待自己(M=3.00)
      2.去注意這些感受如何反映在身體姿勢和臉部表情上(M=2.95)
      3.去體會以悲憫心來對待自己是什麼觀感並支持自己(M=3.23)
      4.鼓勵自己並為自己歡呼(M=3.09)

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