终结“社交恐惧症”
戴维·盖伊第一次怯场是在16岁的时候。那是在一堂英语课上,戴维的老师要他在课堂上朗读他的周记,而他头脑中浮现的都是同学们的影子。尽管戴维立志做一名作家,而且也在不断尝试新的写作技巧,但是他的同学们都对写作不屑一顾。和其他处于青春期的孩子一样,他们讨厌装腔作势,而且一个个尖酸刻薄。
戴维极力避免他们的讽刺与嘲笑。这时他发现自己一个字也说不出来了。他的怯场表现还不仅如此:他的脸变得通红,手心在出汗,而且心跳快得都要喘不过气来了。他越是想努力摆脱这种状态,怯场的症状就越严重。
从此戴维就落下了怯场的毛病。尽管他在第二年被提名为班长,但是一想到做班长要演讲他就放弃了。即使在他到了30多岁,发表了第一部小说之后,他仍然避免公开演讲,也拒绝朗诵自己的小说。[37]
戴维·盖伊这种害怕公开演讲的症状十分普遍。调查显示,这是最常见的一种恐惧症,每5个美国人中就有一个有此症状。但是在观众面前怯场只是“社交恐惧症”的众多症状之一,精神病诊断手册把这些焦虑统称为“社交恐惧”。其他的形式还包括从结交新朋友或与陌生人交谈,到在公共场所进餐或者共同使用洗手间等场合下的不安表现。
就像戴维的情况一样,社交恐惧症通常出现在青春期,但是这种恐惧可能会持续一生。患有此症的人会尽量避免可能引发自己恐惧的场合,而且一想到这些场合就会引发他们的焦虑。
戴维这样的人的怯场还会对他们的生理系统产生深远的影响。只要他们想到任何一个观众的嘲弄,他们的杏仁核就会被激活,使身体产生大量压力荷尔蒙。因此戴维仅仅想象同学们的嘲笑就会引发生理系统的强烈反应。
这种习得性恐惧部分是由杏仁核回路中心的一类神经系统导致的,约瑟夫·勒杜克斯把它称为“恐惧中心”。[38] 勒杜克斯几十年来一直在纽约大学神经科学中心从事神经细胞的研究,因此非常熟悉杏仁核中的神经分布情况。勒杜克斯发现,接受感官信息的杏仁核中的神经细胞,以及接受恐惧信息的相邻区域,在感知到恐惧时的活动会与平时不同。[39]
我们的记忆总是处于不断重构的过程中。只要我们回忆某次经历,大脑就会根据我们现在的兴趣和理解来更新它。勒杜克斯解释说,回忆某次经历在细胞层面上意味着它会被重新巩固,随后新合成的蛋白质会稍微改变它的化学构成。[40]
每当我们进行回忆的时候,我们都会调整它的化学构成,调整的具体情况取决于我们回忆时出现的新信息。如果我们只是重新经历同样的恐惧,那么这种恐惧就会进一步加深。
但是大路神经系统是可以对小路神经系统进行调节的。如果我们在恐惧的时候找到减轻恐惧的方式,那么在大脑对同样的经历进行再次编码时就会减弱它对我们的影响力。这样,曾经使我们感到恐惧的经历对我们的影响就会逐渐减小。勒杜克斯认为,在这种情况下,杏仁核内的细胞会发生改变,使我们对以前的恐惧经历产生免疫力。[41]因此,治疗恐惧的目标之一就是改变恐惧的神经细胞。[42]
事实上,有些治疗有时会刻意使人们重新体验引发他们恐惧的经历,这样他们可以在经历恐惧的时候练习克服恐惧的方法。这种治疗首先通过缓慢的腹部呼吸使人们平静下来,然后使他们体验威胁性情景,而且通常威胁的程度会不断上升。
通过这种方式控制愤怒情绪也可以达到同样的效果。纽约市的一位交警因为被一个骑摩托车的人骂作“下流母狗”而怒火中烧,因此她在接受这种治疗时,这个词语被反复提到了多次,首先是用平静的语调,然后用比较恶劣的语气,最后还加上了下流手势。而这位交警在治疗中的任务就是坐在那里,尽可能地使自己平静。最后治疗取得了疗效:不管这个词语的表达方式多么令人厌恶,她都能够平静对待了。这样她重新投入工作之后即使再次碰到辱骂,大概也能心平气和地开罚单了。[43]
有时治疗师们会在安全范围之内尽可能地为病人重现引发他们社交焦虑的场景。一位认知治疗师的方法远近闻名,他让治疗小组作为临时观众来帮助病人克服自己对于公开演讲的恐惧。[44]在治疗过程中,病人不仅练习放松的方式,还会锻炼抵抗焦虑的能力。同时,治疗师还要求临时观众为病人增加困难,比如讥笑他们,或者做出百无聊赖或毫无兴趣的表情等。
当然这种对于恐慌或者愤怒的体验必须在病人可以承受的范围之内。曾经有一位即将接受这种治疗的女士找了个借口跑进卫生间把自己反锁了起来,拒绝出来面对挑战。最后在医生的耐心劝说之下她才出来继续接受治疗。
勒杜克斯认为,只要能够找到一个可以帮助你从不同视角看待自己痛苦经历的人一起重新体验过去的痛苦经历,就可以重新对这种经历进行编码,从而减轻你的痛苦。这可能就是病人和治疗师在遇到困难时安慰自己的良方之一:接受治疗的过程本身就有可能改变大脑对不良信息的储存。
勒杜克斯说:“这就像是内心产生忧虑之后我们又从新的视角来看待它。我们是在利用大路神经系统来重新塑造小路神经系统。”[45]
- The OFC has been called the “ultimate neural integrating convergence zone.” Among the key brainareas with strong connections to the OFC are the dorsolateral prefrontal cortex, regulating attention; thesensory cortex, for perception; the somatosensory cortex and brain stem, for sensations within the body;the hypothalamus, the brain’s neuroendocrine center that regulates hormones throughout the body; theautonomic nervous system, controlling bodily functions like heart rate and digestion; the medialtemporal lobe, for memory; the association cortex, for abstract thought; and brain stem centers like thereticular formation, which regulates levels of arousal in the brain. For functions of the OFC andconnecting brain structures, see, for example, Allan Schore, Affect Regulation and the Origin of theSelf: The Neurobiology of Emotional Development (Hillsdale, N.J.: Erlbaum, 1994); Simon Baron-Cohen, Mindblindness: An Essay on Autism and Theory of Mind (Cambridge, Mass.: MIT Press,1995); Antonio Damasio, Descartes’ Error: Emotion, Reason and the Human Brain (New York:Grosset/Putnam, 1994).
- The orbitofrontal region (Brodmann’s areas 11, 12, 14, and 47) regulates a wide range of socialbehavior. It has rich connections to the amygdala, the anterior cingulate cortex, and the somatosensoryareas. Another linked cortical area is the temporal lobe, crucial for identifying what an object is, or thesignificance of things. All these areas play roles in coordinating smooth social interactions. Theorbitofrontal lobe has an extensive network of projections throughout the emotional centers, allowing itto modulate emotional responses. One of the primary functions of these networks during a socialinteraction seems to be inhibiting emotional reactions, coordinating them with inputs about the socialmoment to make our responses well tuned socially. See, for example, Schore, Affect Regulation. Seealso Jennifer S. Beer et al., “The Regulatory Function of Self-conscious Emotion: Insights fromPatients with Orbitofrontal Damage,” Journal of Personality and Social Psychology 85 (2003), pp. 594–604; Jennifer S. Beer, “Orbitofrontal Cortex and Social Behavior: Integrating Self-monitoring andEmotion-Cognition Interactions,” Journal of Cognitive Neuroscience (2006), 18, pp. 871–80.
- The OFC connects directly to the autonomic system, making it a control center for bodily arousaland relaxation. Other cortical areas with autonomic projections include the anterior cingulate cortex andthe medial prefrontal cortex.
- During moments of motherly love the OFC essentially swamps other areas of the brain, presumablytriggering a flood of warm thoughts. See Jack B. Nitschke et al., “Orbitofrontal Cortex Tracks PositiveMood in Mothers Viewing Pictures of Their Newborn Infants,” NeuroImage 21 (2004), pp. 583–92.
- On first impressions, see Michael Sunnafrank and Artemio Ramirez, Jr., “At First Sight: PersistentRelationship Effects of Get-Acquainted Conversations,” Journal of Social and Personal Relationships21, no. 3 (2004), pp. 361–79. Not surprisingly, the partner who is less drawn to the other has the mostpower in determining whether a friendship will blossom. If one person wants to connect while the otherdoes not, the reluctant one has veto power. In other words, if you don’t want to be my friend, I can’tmake you. Two factors that would intuitively seem to matter did not: initial attraction and a feeling ofsimilarity.
- The ACC is involved in a range of functions, notably guiding attention, sensing pain, noting errors,and regulating internal organs like breathing and heart rate. This part of the cortex has rich connectionsto emotional centers, such as the amygdala, lower in the brain; some neuroanatomical researchersspeculate the ACC evolved as an interface connecting our thoughts with our feelings. This intertwininggives the ACC a key role in social awareness.
- On spindle cells, see John M. Allman et al., “The Anterior Cingulate Cortex: The Evolution of anInterface Between Emotion and Cognition,” Annals of the New York Academy of Sciences 935 (2001),pp. 107–17.
- While most all the hundreds of types of neurons in the human brain are found in other mammals,spindle cells are a rare exception. We share them only with our closest cousins, the apes. Orangutans, adistant relative, have a few hundred; our closer genetic relatives the gorillas, chimps, and bonobos havefar more. And we humans have the most, close to a hundred thousand of them.
- See A. D. Craig, “Human Feelings: Why Are Some More Aware Than Others,” Trends inCognitive Sciences 8 (2004), pp. 239–41.
- On ACC and social insight, see R. D. Lane et al., “Neural Correlates of Levels of EmotionalAwareness: Evidence of an Interaction Between Emotion and Attention in the Anterior CingulateCortex,” Journal of Cognitive Neuroscience 10 (1998), pp. 525–35. People who are so chronicallydepressed that medications do not help them typically have unusually little activity in the ACC.
- On social emotions, see Andrea Bartels and Semir Zeki, “The Neural Basis of Romantic Love,”NeuroReport 17 (2000), pp. 3829–34. Area F1 of the OFC and area Z4 of the ACC are rich in spindlecells.
- On the ACC and OFC in social judgment, see Don M. Tucker et al., “Corticolimbic Mechanismsin Emotional Decisions,” Emotion 3, no. 2 (2003), pp. 127–49.
- Tanya Chartrand and John Bargh, “The Chameleon Effect: The Perception- Behavior Link andSocial Interaction,” Journal of Personality and Social Psychology 76 (1999), pp. 893–910.
- The ACC may be only one region among many involved in a widely distributed liking-loathingneural system. Other candidates include the insula.
- Henry James, The Golden Bowl (1904; New York: Penguin, 1987), pp. 147–49.
- On the “people circuits,” see J. P. Mitchell et al., “Distinct Neural Systems Subserve Person andObject Knowledge,” Proceedings of the National Academy of Sciences 99, no. 23 (2002), pp. 15238–43. The neural circuits that activate during judgments about people: dorsal and ventral aspects of themedial prefrontal cortex, right intraparietal sulcus, right fusiform gyrus, left superior temporal andmedial temporal cortex, left motor cortex, and regions of the occipital cortex. The three that areactivated while the brain is at rest: dorsal and ventral aspects of the medial prefrontal cortex, and areasof the intraparietal sulcus.
- Matthew Lieberman is director of the Social Cognitive Neuroscience Laboratory at UCLA. In2001 he and Kevin Ochsner scored an unheard-of professional coup. An article they had written aslowly graduate students at Harvard was accepted in psychology’s most prestigious journal, TheAmerican Psychologist, one where even famed professors can have a tough time getting published.Their article proclaimed the joining of social psychology, cognitive science, and brain studies,launching a major strand in social neuroscience. Lieberman will be the editor of that discipline’s firstscholarly journal, Social, Cognitive, and Affective Neuroscience, set to launch sometime in 2006.
- On the default activity, see Marco Iacoboni et al., “Watching Social Interactions ProducesDorsomedial Prefrontal and Medial Parietal BOLD fMRI Signal Increases Compared to a RestingBaseline,” NeuroImage 21 (2004), pp. 1167–73.
- On emotions as the brain’s value system, see, for example, Daniel J. Siegel, The DevelopingMind: How Relationships and the Brain Interact to Shape Who We Are (New York: Guilford Press,1999).
- This binary decision yields a characteristic “yes” or “no” pattern of cell firing, the neuralequivalent of a thumbs up or thumbs down. That neural firing signature lasts for just one-twentieth of asecond, holding the decision in place for long enough to give other areas a chance to read it. It takesabout ten times longer—around 500 milliseconds—for the yes/no pattern to eventually registerdistinctly in the OFC. This initial stage of the like/dislike decision takes roughly a half second.
- If this is a bargaining session—that is, with opportunities for repeated interactions— then therejection actually becomes rational (and common), as it establishes a bargaining position that pays offin later offers. The rejection is “irrational” only if it occurs in a “one-shot” confidential situation, wherethere is no opportunity to establish a bargaining position with the current partner, or a reputation forother potential partners.
- The more prefrontal activity, the better the outcome of the Ultimatum Game; see Alan G. Sanfeyet al., “The Neural Basis of Economic Decision-making in the Ultimatum Game,” Science 300 (2003),pp. 1755–57.
- The dorsolateral prefrontal area contains an inhibitory array that deploys when we consciouslyinhibit an impulse. Another route for inhibition travels via the medial area of the prefrontal cortex,which harbors excitatory neurons that activate inhibitory neurons within the amygdala. See Gregory J.Quirk and Donald R. Gehlert, “Inhibition of the Amygdala: Key to Pathological States?” Annals of theNew York Academy of Sciences 985 (2003), pp. 263–72. However, neuroscientists disagree about thespecifics of pathways for inhibition.
- On regret, see Natalie Camille et al., “The Involvement of the Orbitofrontal Cortex in theExperience of Regret,” Science 304 (2004), pp. 1167–70.
- The OFC is but one high-road mechanism for modulating the amygdala. The ventromedial area isanother prefrontal region that does so. The influence runs both ways, with the amygdala affectingprefrontal function. Precisely what conditions determine whether the OFC and the amygdala inhibiteach other or act synergistically have yet to be discovered.
- This obliviousness is known as “social anosognia,” the lack of insight into one’s owninappropriateness. For OFC lesion and social gaffes, see Beer et al., “Orbitofrontal Cortex and SocialBehavior.”
- The OFC seems important for regulating behavior implicitly, whereas the dorsolateral prefrontalcortex is important for doing so explicitly. If the latter remains intact, these patients can correct some oftheir behavior once they become explicitly aware of the fact that they behaved inappropriately. Thetrick for them is noticing they did something wrong in the first place.
- On chat rooms, see Kate G. Niederhoffer and James W. Pennebaker, “Linguistic Style Matching inSocial Interaction,” Journal of Language and Social Psychology 21 (2002), pp. 337–60.
- A sign of Internet disinhibition among girls in their early teens is “cyberbullying,” excessivelycruel harassment, teasing, and gossip that reduces the target to tears. See Kristin Palpini, “ComputerHarassment: Meanness Bottled in a Message,” Daily Hampshire Gazette, December 17, 2005, p. 1. Amore ominous downside of cyberdisinhibition is the sleazy practice of adults who via the Internet lureteenagers to perform sex acts in front of webcams in their own homes, in return for payment. See KurtEichenwald, “Through His Webcam, a Boy Joins a Sordid Online World,” New York Times, December19, 2005, p. 1.
- Kevin Ochsner et al., “Rethinking Feelings: An fMRI Study of the Cognitive Regulation ofEmotion,” Journal of Cognitive Neuroscience 14 (2002), pp. 1215–29. The thoughts of the woman arereconstructed from the description of the study.
- Some MRI studies use special goggles to present the images instead.
- The dorsolateral prefrontal cortex (PFC) appears to be involved when a person uses language andworking memory to work out a new “solution” to an emotional problem, and does so via explicit,deliberative reasoning. By contrast, the OFC regulates emotion apparently via representations of socialcontext, social rules, and so on, which are not explicitly verbalizable. Kevin Ochsner sees this processin terms of associative representations that link actions to affective values. The dorsolateral PFC canhold in mind descriptions of these associations and guide behavior on their basis. See Kevin Ochsnerand James Gross, “The Cognitive Control of Emotion,” Trends in Neuroscience 9 (2005), pp. 242–49.
- On alternate routes, see Kevin Ochsner et al., “For Better or for Worse: Neural SystemsSupporting the Cognitive Down- and Up-regulation of Negative Emotion,” NeuroImage 23 (2004), pp.483–99.
- Kevin Ochsner, “How Thinking Controls Feeling: A Social Cognitive Neuroscience Approach,” inP. Winkleman and E. Harmon-Jones, eds., Social Neuroscience (New York: Oxford University Press,in press).
- On naming an emotion, see A. R. Hariri et al., “Modulating Emotional Response: Effects of aNeocortical Network on the Limbic System,” NeuroReport 8 (2000), pp. 11–43; Matthew D.Lieberman et al., “Putting Feelings into Words: Affect Labeling Disrupts Affect-related AmygdalaActivity,” UCLA, unpublished manuscript.
- Though in the first moment of looping the brain matches our emotions with those we perceive, thehigh road then offers us a choice point, where we may follow with either of two types of responses. Inone we continue to match how the other person feels—their joy gladdens us, their distress upsets us. Inthe other we feel envy at their joy or schadenfreude at their distress.
- On stage fright, see David Guy, “Trying to Speak: A Personal History,” Tricycle (Summer 2003).
- On the amygdala and social phobia, see, for example, M. B. Stein et al., “Increased AmygdalaActivation to Angry and Contemptuous Faces in Generalized Social Phobia,” Archives of GeneralPsychiatry 59 (2002), pp. 1027–34.
- The lateral portion of the amygdala harbors a site where all sensory information first registers; thenearby central area holds the cells that acquire a fear, according to Joseph LeDoux.
- For memory reconsolidation, see the work of Karim Nader at McGill University, cited by JosephLeDoux, presentation at the meeting of the Consortium for Research on Emotional Intelligence inOrganizations, Cambridge, Mass., December 14, 2004.
- This strategy applies both to cognitive therapy and to pharmacological interventions likepropanolol. When it comes to overcoming a traumatic fear, reconsolidating the memory with less fearwould be neurally direct, according to LeDoux. The neurons that store the fearfulness of the memoryare in a part of the amygdala that does not directly connect to the area of the prefrontal cortex thatretrieves the conscious aspect of the memory, such as the details of what happened, where, and withwhom. But intentional relaxation—as in extinction therapy—utilizes the part of the prefrontal area thatlinks straight to the amygdala’s fear center, offering a route to alter the fearful memory viareconsolidation. LeDoux proposes that each time we reexperience the original fear, we may have atwohour window for reconsolidation of a fearful memory. Within that window, taking propanolol,which blocks the action of cells in the amygdala (or presumably undergoing deep relaxation as inextinction therapy), alters the reconsolidation so that the amygdala will not react with such fear the nexttime the traumatic memory is revisited.
- An alternate theory holds that therapy strengthens prefrontal circuitry that projects to inhibitorycircuitry in the amygdala: See Quirk and Gehlert, “Inhibition of Amygdala.”
- On anger reduction, see Elizabeth Brondolo et al., “Exposure-based Treatment for AngerProblems: Focus on the Feeling,” Cognitive and Behavioral Practice 4 (1997), pp. 75–98. Increasingly,exposure to the stimulus is virtual, as in simulations of an airplane flight.
- On therapy for social phobia, see David Barlow, Anxiety and Its Disorders (New York: GuilfordPress, 1988).
- LeDoux uses the terms “high” and “low road” here in a particular technical sense, to refer tosensory input pathways to the amygdala from the sensory thalamus and sensory cortex. The “low road”provides a quick and dirty sensory impression, while the high road provides more sensory information.The low road can’t distinguish a snake from a stick, but the high road can. The low road hedges itssensory bets—better safe than sorry. In terms of automatic versus controlled processing— the sense inwhich I use the high-low road heuristic—LeDoux’s high and low roads are both “low road,” automaticand rapid.






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