So can you think of an example of something that's happened recently?

你能舉個最近發生的例子嗎？

Yeah. My daughter has been, she's actually been sick and so she had a fever yesterday and they started her on an antibiotic and I had to go pick it up from the drugstore and that's like, I don't usually go there. It's hard to get there. Like, it's not right in the neighborhood.

我女兒一直在生病我女兒一直在生病 她昨天發燒了 他們給她用了抗生素 我得去藥店買 我一般不去那裡去那裡很難。就像，它不是在附近的權利。

Any expressways or bridges to get there?

有高速公路或橋樑通往那裡嗎？

Not expressways, but it's busy. It's busier and it's like in a mall so, you know, there's like...

不是高速公路，但很繁忙。它更繁忙，就像在一個商場裡，所以，你知道，那裡就像...

Any four lanes or six lanes?

是四車道還是六車道？

Four lanes, yeah.

四車道

Four lanes.

四車道

So it just, it's not someplace I usually would go and if I was going to go, usually I would either have her go with me or my husband go with me, but she was sick and he was at work and...

所以，這不是我通常會去的地方，如果我要去，通常要麼讓她和我一起去，要麼讓我丈夫和我一起去，但她病了，他在工作，所以......

So to try to understand what goes through your mind, let's try to take you back and now you know that the prescription's there and your daughter's sick and I guess you don't want to ask her to drive over there.

所以，為了理解你的想法，讓我們試著把你帶回去，現在你知道處方在那裡，而你的女兒病了，我猜你不想讓她開車去那裡。

I sort of did.

我是這麼想的。

Yeah, probably not the wisest idea. So, you're thinking about doing the drive and what's going through your mind? What are the thoughts that are churning inside?

是啊，這可能不是最明智的主意。那麼，你在考慮參加自駕遊時，腦子裡在想些什麼？內心在翻騰著什麼念頭？

I'm just, you know, I'm sort of thinking about going there and I'm already starting to think, well, you know, what if, you know, what if I'm driving and somebody crashes into me?

我只是，你知道，我有點想去那裡，我已經開始想，好吧，你知道，如果，你知道，如果我開車，有人撞到我怎麼辦？

What if I'm driving and I can't do it? You know, what if I just have to stop because

如果我正在開車，但我做不到怎麼辦？你知道，如果我不得不停下來，因為

I can't do it anymore and, you know, it was raining and I'm sort of like I've got this picture of myself like out in the middle of the road and, you know...

我不能再這樣做了，你知道，下雨了，我有點像我有這樣的照片，我喜歡在路中間，你知道...

What's the picture look like? You're out in the middle of the road and it's raining.

畫面是什麼樣的？你在路中間，下著雨。

I'm stranded and it's dark and my, you know, my shoes are gone. I'm just like, it's like

我被困在一個黑暗的地方 我的鞋子不見了我就像，就像

I, it would be a million miles to get back home.

我，回家的路還很長。

Pretty miserable.

太慘了

Yeah, yeah.

是啊，是啊。

Pretty scary.

挺嚇人的。

Oh, terrifying.

哦，太可怕了。

Yeah.

是啊

And I just, it's so hard to get there.

我只是，要到達那裡太難了。

And Kate, as you put yourself back into that situation and have those thoughts going through your mind, what kinds of feelings go along with it? You know, by feelings, I mean things that are inside, like fear, anxiety, physical things that are going on.

凱特，當你把自己放回到那個情境中，腦海中閃過這些念頭時，你會產生什麼樣的感覺？你知道，我說的感覺是指內心的東西，比如恐懼、焦慮、身體上的東西。

Well, fear and anxiety and I just feel really shaky and I feel really like lightheaded and dizzy and I just don't feel like I can breathe very well and I feel like I'm going to like fall over.

恐懼和焦慮讓我覺得渾身發抖，頭暈目眩，呼吸困難，就像要摔倒一樣。

Is this a panic attack now? You told me about having some panic attacks.

現在是恐慌症發作嗎？你跟我說過恐慌症發作

I've had worse ones, but it's getting there.

我遇到過更糟糕的情況，但也快了。

Not quite to a panic, but, you know, it's brewing.

還沒到恐慌的地步，但是，你知道，它正在醞釀之中。

Yeah.

是啊

Okay.

好的

Yeah, it feels like it might.

是的，感覺有可能。

Yeah, yeah. Well, what I think we might do to try to move things along toward getting a plan of attack on this is to actually sketch this out and see if we can figure out some things we might be able to start doing to give you a better handle on it that you have right now.

是啊，是啊。好吧，我覺得我們可以做的是，先把這個問題勾勒出來，看看我們能不能想出一些辦法來，讓你能夠更好地處理這個問題，而不是像現在這樣。

Okay.

好的

So let's put some boxes here and one of them is going to be event. These are the things that trigger your anxiety. And in this case, the event was...

所以，讓我們在這裡放幾個盒子，其中一個就是事件。這些都是引發你焦慮的事情在這種情況下，事件是...

Having to drive to the pharmacy.

不得不開車去藥店。

Drive to pharmacy. And then this next box I'm going to label something we call automatic thoughts. And by automatic, I mean that they occur relatively automatically. They just sort of pop into your mind and you don't stop to check them out.

開車去藥店然後下一個方框裡，我會標註一些我們稱之為自動想法的東西。所謂 "自動"，是指它們相對自動地出現。它們只是突然出現在你的腦海中，你不會停下來去檢查它們。

Okay.

好的

And we all have these kinds of automatic thoughts. You know, I have them. Everybody I know has them. They're inner thoughts. In fact, if you think about it for a minute, we probably have a lot more thoughts we don't speak out loud that are part of our inner dialogue than thoughts we actually end up speaking aloud to other people. And I suspect that you have lots of those thoughts. And you just gave me some examples of them. So that's why we call them automatic.

我們都有這樣的自動想法。我就有我認識的每個人都有它們是內心的想法。事實上，如果你仔細想一想，我們可能有更多的想法沒有大聲說出來，而這些想法是我們內心對話的一部分，比我們最終對別人大聲說出來的想法要多得多。我懷疑你有很多這樣的想法。你剛剛給了我一些例子。這就是為什麼我們稱它們為自動想法。

So the...

所以...

Yeah.

是啊

Like the what ifs.

就像 "如果"。

Yeah. So let's put a couple of those down in this box.

好的那就在這個盒子裡放幾個吧。

Okay.

好的

In the automatic thought box. And they are...

在自動思維框中。他們...

What if someone runs into me?

如果有人撞到我怎麼辦？

Yeah. What if... What else?

是啊。如果...還有什麼？

What if I get stranded?

如果我被困了怎麼辦？

Get stranded.

被困。

Uh-huh.

嗯哼

I can't do it.

我做不到

I can't do it. And there was this image about the rainstorm and you don't have any shoes on and so forth.

我做不到還有關於暴雨和你沒穿鞋之類的畫面。

Yeah.

是啊

What should we put down for that?

我們該怎麼做？

I think what if I... What if I can't get back home?

我想如果我...如果我回不了家怎麼辦？

I can't get back home. Sort of lost.

我回不了家。有點迷路了

Yeah.

是啊

Yeah. What if I end up on this road forever?

是啊如果我永遠走在這條路上呢？

And then we're going to put another box. There's a sort of a chain of events here.

然後我們再放一個盒子。這裡有一連串的事件。

The event can make you think in ways that stir up feelings of anxiety and so forth.

這一事件會讓你的思維方式激起焦慮等情緒。

So if you're thinking like this, it makes sense that you'd be feeling pretty nervous inside and you might have some of these physical reactions.

是以，如果你有這樣的想法，你的內心會感到非常緊張，你可能會有一些這樣的生理反應，這也是情理之中的。

Let's put those in here. This is the emotions box.

讓我們把它們放在這裡。這是情感箱。

And they are much shaky, you said.

你說過，它們很不穩定。

Yeah.

是啊

A lot of fear.

恐懼

Yeah.

是啊

If we're going to rate that fear on a zero to a hundred scale and zero is none at all and a hundred is the maximum anyone could ever get, where would you be at this point?

如果我們用零到一百來給這種恐懼打分，零代表完全沒有，一百代表任何人都能得到的最大值，那麼此時你的恐懼會在哪裡？

Oh, I'd say about an 80.

哦，我想大概是 80 分吧。

80. Pretty high.

80.相當高。

Yeah.

是啊

It's gone higher though, I suspect.

不過，我懷疑它的價格會更高。

Oh, yeah. Yeah.

哦，是的，是的 Oh, yeah.Oh, yeah. Yeah.

But at this point it's an 80. Okay. And then you had some other feelings inside?

但現在是80分好吧然後你內心還有其他感覺嗎？

Well, yeah, I sort of felt like I might fall over.

嗯，是的，我有點覺得自己可能會摔倒。

And what else?

還有什麼？

My heart was pounding and I didn't feel like I could breathe very well.

我的心怦怦直跳，感覺呼吸不暢。

How about your stomach? Any flip-flops in your stomach or anything like that?

你的胃怎麼樣？胃裡有沒有人字拖之類的東西？

Yeah.

是啊

So a lot going on here.

是以，這裡發生了很多事情。

Yeah.

是啊

And a pretty high level of distress.

而且痛苦程度相當高。

Yes.

是的。

And then we're going to complete this loop by putting a box we're going to call behavior.

然後，我們將放入一個我們稱之為行為的方框來完成這個循環。

This is how you actually acted when you were in this situation.

這就是你在這種情況下的實際表現。

So what did you do after you had these thoughts and you had these feelings?

有了這些想法和感受之後，你做了什麼？

I went to the pharmacy.

我去了藥房。

You did do it?

你做到了？

I had to.

我必須這麼做

Okay. And what was it like for you when you were going to the pharmacy and driving there?

好的你開車去藥房的時候是什麼感覺？

It was so bad.

太糟糕了

Mm-hmm.

嗯

I just, you know, I think I left permanent marks on the steering wheel because I was holding on to it so tight.

我只是，你知道，我想我在方向盤上留下了永久的痕跡，因為我抓得太緊了。

Okay. So you were gripping tightly.

好吧，你抓得很緊

Yeah.

是啊

So in this case you actually did go to the pharmacy.

所以在這種情況下，你確實去了藥房。

Maybe there's some damage to the steering wheel or something like that.

也許方向盤或類似部件有損壞。

Yeah.

是啊

I hope not.

希望不會。

But I really had no choice. I mean, I think usually I wouldn't go to the pharmacy.

但我真的別無選擇。我的意思是，我想通常我是不會去藥房的。

So you were boxed in this time.

所以你這次是被困在這裡了。

I would call my husband and say, can you pick it up on your way home?

我會打電話給我丈夫說，你能在回家的路上來取嗎？

Get an escape route if you would.

如果你願意，可以找一條逃學生路線。

Yeah.

是啊

Mm-hmm.

嗯

So usually you would avoid this.

是以，通常你會避免這樣做。

If we looked at this as a model for many of these situations about driving and feeling anxious, the usual behavior would be to try to get out of it or avoid it.

如果我們把這看作是許多關於駕駛和焦慮的情況的模型，那麼通常的行為就是試圖擺脫它或避免它。

Is that right?

是這樣嗎？

Oh, yeah.

哦，是的

Okay.

好的

And so if you do avoid it, then what happens?

如果你真的避開了，會發生什麼呢？

Well, I feel better.

嗯，我感覺好多了。

You feel better?

感覺好些了嗎？

It's like such a relief.

真是如釋重負。

Relief.

救濟。

Uh-huh.

嗯哼

Better.

更好。

Relief.

救濟。

The emotions calm down now, right?

現在情緒平靜下來了，對嗎？

Well, yeah, because I don't have to worry about it.

是的，因為我不用擔心。

So that's what happens for a single episode of this anxiety.

這就是單次焦慮發作的情況。

I'm wondering, though, if we look at the impact on you of avoiding and getting relief overall as far as managing driving, what do you think it does there?

不過，我想知道，如果我們從整體上看，在管理駕駛方面，避免和緩解對你的影響，你覺得它有什麼作用？

Well, I feel like I don't really have much confidence when it comes to this to being able to do it.

好吧，我覺得我真的沒有什麼信心能做到這一點。

Okay.

好的

So in a way, it decreases your confidence over time.

是以，從某種程度上說，它會隨著時間的推移而降低你的信心。

I think so.

我想是的。

Yeah.

是啊

I suspect that not doing it repeatedly gives you this belief about your capacity to do these driving things.

我猜想，如果不反覆去做，就會讓你相信自己有能力完成這些駕駛任務。

And what's that belief?

這種信念是什麼？

Yeah.

是啊

I don't feel like I can do it.

我覺得我做不到。

I can't do it.

我做不到

Yeah.

是啊

I don't feel like I can do it.

我覺得我做不到。

I can't do it.

我做不到

I can't do it.

我做不到

And I don't do it.

我沒有這麼做。

So it really comes back to this thought, I can't do it.

所以，這又回到了 "我做不到 "這個想法上。

Yeah.

是啊

Uh-huh.

嗯哼

And you can't do it and you don't do it.

你做不到，也不會去做。

Right.

對

So here's this chain of events.

這就是一連串的事件。

Events trigger thoughts.

事件引發思考。

We call them automatic thoughts.

我們稱之為自動思維。

And then they influence your emotions, these feelings you have.

然後它們會影響你的情緒，影響你的感受。

And then that influences how you handle the situation.

然後，這會影響你如何處理這種情況。

Uh-huh.

嗯哼

Okay.

好的

Now, let's think together for a moment before we wrap up of how we might proceed to try to give you some help with this.

現在，讓我們在結束之前一起想一想，我們該如何繼續努力，在這方面為你提供一些幫助。

So, let's take a look at these thoughts for a minute.

那麼，讓我們先來看看這些想法吧。

Do you know anybody else that drives regularly that might think differently than you?

你認識其他經常開車的人，他們的想法可能與你不同嗎？

Yeah.

是啊

Okay.

好的

What would be an example?

有什麼例子？

I mean, I think almost everybody.

我是說，我想幾乎每個人都是這樣。

I think most people drive without too much problem.

我想大多數人開車都不會有太大問題。

Okay.

好的

But, like, my sister loves to drive.

但是，我妹妹喜歡開車。

Yeah.

是啊

I mean, she just, she drives every opportunity she gets.

我是說，她一有機會就開車。

Uh-huh.

嗯哼

So, for some reason, we don't know exactly why, but the key thing here is not looking at why, but to help you with actually making change in this.

是以，出於某種原因，我們不知道究竟是為什麼，但這裡的關鍵不是研究原因，而是幫助你真正在這方面做出改變。

Uh-huh.

嗯哼

But you do have some differences in the way you think about driving that might be something that we could begin to work on in our sessions.

但你們在駕駛思維方式上確實存在一些差異，這也許是我們可以在會議上開始討論的問題。

Uh-huh.

嗯哼

We might, for example, check it out, you know, what's the chances of someone slamming into you?

比如說，我們可能會檢查一下，你知道，有人撞到你的機率有多大？

Or what's the chances of you being stranded out there on the highway?

或者你被困在高速公路上的機率有多大？

And even if you were stranded, is there a way you could cope with that or manage that so you can get back home?

即使你被困了，你有什麼辦法可以應付或處理這種情況，從而回到家裡？

So, these are some things that we could begin to do.

是以，這些都是我們可以開始做的事情。

Yeah.

是啊

So, I'm going to mark here.

所以，我要在這裡做個記號。

Okay.

好的

We could work on these thoughts.

我們可以就這些想法開展工作。

Okay.

好的

And then, by working on the thoughts, we might be able to help you reduce the emotions, but there are also some things that I might be able to teach you that you could use to reduce this level of distress that you have.

然後，通過解決思想問題，我們也許可以幫助你減少情緒，但我也可以教你一些東西，你可以用來減少你的這種痛苦程度。

Oh, that would be really nice.

哦，那真是太好了。

To be able to calm yourself down in situations.

遇事能冷靜下來。

So, we'll have some, try to build some skills to manage your emotions.

是以，我們會嘗試培養一些管理情緒的技能。

And then, on this behavior side, one thing that we might begin to work on is helping you gradually begin to take on some of these driving things so that you can build your confidence back up.

然後，在行為方面，我們可以開始做的一件事就是幫助你逐漸開始承擔一些駕駛任務，這樣你就能重新建立起自信。

Mm-hmm.

嗯

And again, build your skills to do it.

再說一遍，培養自己的動手能力。

Mm-hmm.

嗯

And I can see that that causes a little bit of edginess here.

我看得出，這讓人有點急躁。

What were you thinking when I mentioned that?

我這麼說的時候，你在想什麼？

I was thinking that I hope that this doesn't, like, make me worse.

我在想，我希望這不會讓我變得更糟。

Okay.

好的

You know, like, trying to do some of these things.

你知道的，比如，嘗試做一些這樣的事情。

Yeah.

是啊

Well, I'm glad you gave me that feedback.

很高興你能給我這樣的反饋。

That's an example, by the way, of me wanting to hear from you about the way you're responding to what I'm saying.

順便說一句，這就是一個例子，我想聽聽你對我所說的話的反應。

I certainly wouldn't want to do anything to make you worse.

我當然不想做任何讓你更糟糕的事。

Okay.

好的

Okay.

好的

Or to cause you too much anxiety.

或者讓你過於焦慮。

Uh-huh.

嗯哼

And what we'll try to do is pace it just at a level that's right for you.

我們會盡量把節奏調整到適合你的水準。

Okay.

好的

So that you can make some progress and get to the place you want to be, which is to be able to, you know, drive to your new office.

這樣你就能取得一些進展，達到你想要的目標，也就是能開車去你的新辦公室。

Mm-hmm.

嗯

Across that big bridge.

穿過那座大橋

Mm-hmm.

嗯

And maybe even, you know, drive those couple hours to—

甚至，你知道，開上幾個小時的車--

Visit my son.

探望我的兒子

Visit your son.

去看望你的兒子

Yeah.

是啊

Right?

對不對？

Yeah.

是啊

So what do you think?