--- rhymes from the comic book The Sandman
「為什麼醫學知識那麼多，人們還是照幹不健康的事」——從認知行為去解釋
There is a saying that many of you probably may have heard before: people can't be forced to change if they don't genuinely want to.
有一句話應該很多人都聽過：人們需要有改變的意願，如果沒有，就不會改變。
However, this response is grossly oversimplified and does not provide the full picture. It also seems to imply that the core reason bad habits or unhealthy behaviour cannot be changed is because the person involved does not want to change.
然而，這種回答過於簡化且不完整，而且似乎暗示著無法改善不良習慣或行為，都是因為當事者不想改。
Forming new habits and changing health behaviours comes down to inducing neuroplasticity.
養成新習慣和改變行為，歸根究底都和誘導神經的再塑性脫不了關係。
Anyone who tells you that health behaviour change is only a matter of your desires, your individual choices and decisions does not have an adequate and complete understanding of how the brain works.
那些認為只要意志力夠堅定、做出對的個人選擇和決定，就能改掉壞的慣性或養成好習慣
的人，可能沒有充分的了解我們的大腦是如何運作的。
We live in an era where medical and health knowledge can be found online within a second, physicians or health promoters are running blogs and fan pages, and social media or platforms provide a space for subcultures and small groups to exchange opinions and information enthusiastically. However, there is still a gap between scientific knowledge and application into our lives, society and culture.
我們活在一個醫療保健知識上網查就有的時代，許多醫師或其他形式的健康促進者都經營著不同面向的部落格、粉絲專頁，很多個社群平台也提供空間讓次文化和小圈子熱烈交流意見和訊息。但是，科學知識與人們的日常生活、社會和文化之間仍然出現了差距。
Here's why: Our social and environmental exposures directly influence our health beliefs, motivation and the neurochemistry involved with decision-making and risk assessment.
是這樣子的：我們的社會和環境因素直接影響了我們對於健康的信念和動機，也直接影響著所有與我們「做決定」和「評估風險」相關的神經化學。
Encoding health and nutrition information in our brain is not sufficient to initiate action or behaviour change in the long term. And while a desire for change is indeed a prerequisite for motivation, desire itself does not automatically lead to motivation.
在大腦中輸入保健和食物營養的資訊，並不足以引發長期持續的行動或導致一個人真的改變行為。再者，雖然「渴望改變」確實是產生動力的先決條件。然而，欲望本身並不總是能為我們帶來動力。
The desire for change activates the brain's reward system, signalling the potential for future rewards. But this initial desire must be supported by a well-functioning prefrontal cortex to translate into sustained motivation.
「想要改變」的渴望會活化大腦的獎勵系統，發出「未來可能獲得獎勵」的訊號。
但這種最初的渴望必須得到功能良好的前額葉皮質的支持，才能轉化為持續的動力。
Without sufficient cognitive capacity, executive function, or support, the neurochemical drive from desire might not sustain long-term motivation. And oftentimes, introducing new habits requires deconstructing previously formed habits. So you see, a health behaviour change and new habits are not introduced solely by having information and desiring the habit to be formed.
如果沒有足夠的認知能力、執行功能或支持，來自渴望的神經化學衝動可能無法長期維持動力。而且很多時候，養成新習慣需要先拆除以前養成的習慣。所以你看，只靠擁有資訊和想要改變的渴望，是無法讓我們養成新習慣的。
Motivation is also constantly affected by the person’s allostatic load. Allostatic load refers to the cumulative wear and tear on the body and brain from chronic stress and the effort to maintain stability. A prolonged allostatic load increase can deplete the body, leaving it unable to cope with even slight stressors.
動機還受到當事者「適應負荷」的影響；「適應負荷」是指一個人面對生活事件和環境壓力而必須維持平衡，長期累積下來對大腦和身體所造成的「磨損」。長時間增加的適應負荷會耗盡身體的精力，使一個人無法應付即使是最輕微的壓力。
Allostatic load is often significantly elevated among individuals with chronic health conditions or a history of traumatic stress, which can dysregulate neurobiology. And this dysregulation can negatively impact motivation.
患有慢性疾病或遭受過創傷性壓力的個體，適應負荷通常會顯著升高，這會導致神經生物學上所說的失調，而這種失調會削弱個體的動機。
The brain's basal ganglia govern the formation and execution of habits, operating largely outside of conscious awareness. Once habits are established, they can be difficult to override because the brain favours efficiency and routine, often overriding rational decision-making in favour of familiarity.
大腦的基底核控制著習慣的形成和執行，而這些過程主要都是在我們的意識之外運作的。
習慣一旦養成就很難改變，因為大腦注重效率和常規，常常會讓熟悉的東西凌駕於理性決策之上。
Cognitive dissonance occurs when there's a conflict between a person's knowledge and their actions. The prefrontal cortex, which is responsible for reconciling these conflicts, can be overwhelmed by immediate desires or social influences. This dissonance often leads to rationalizations or justifications that undermine the motivation to change, despite an awareness of the consequences.
當一個人的知識與其實際行為發生衝突時，就會出現認知失調。而負責調解這些衝突的前額葉皮質，可能會因當下的欲望、壓力或所處的社會環境影響而難以承受。儘管意識到了後果，這種不諧調往往促使人做出合理化或辯解，一旦合理化之後，做出改變的動力就大幅減弱了。
The brain often equates familiarity with physiological and psychological safety. Familiar routines, even unhealthy ones, provide a sense of stability and control, which reduces anxiety. The brain reinforces these habits, making it challenging to embrace new choices that might seem uncertain and potentially threatening.
由於大腦常將熟悉感與生理和心理安全劃上等號，熟悉的日常生活，即使是不健康的日常生活，也能帶來穩定感和控制感，進而減輕焦慮。大腦會強化這些習慣，使得那些看似不確定且具潛在威脅的新改變顯得具有挑戰性。
We can call this conflict between what feels safe and familiar versus what we know is actually safer and better for us the pleasure-safety paradox.
我們可以將這種感覺安全和熟悉的事物與我們知道實際上更安全、對我們更好的事物之間的衝突，稱為快樂或安全之矛盾。
When someone is motivated to engage in a new behaviour, they need to have a sense of coherence (SOC). Sense of coherence is a concept introduced by medical sociologist Aaron Antonovsky in 1979, which describes a person's overall feeling that their life is understandable, manageable, and meaningful; essentially acting as a buffer against stress and promoting health.
要某人真正有動力去從事一項對他來說是新的行為，就必須要讓他能體驗到「生命凝聚感」(sense of coherence, SOC)。生命凝聚感是醫療社會學家安東諾夫斯基(Antonovsky)於1979年提出的概念，描述一個人可以理解其生活中的經歷、應付生活中的要求、並且獲得生活的意義時，就能擁有一種完整的感覺；本質上有緩解壓力和促進健康的作用。
No SOC, no change.
少了生命凝聚感，人就不會真正做出改變。
雖說如此，有很多方法可以克服這些讓人往好的方向改變的阻礙。有很多方法可以療癒、成長和自我復元。就像其他的一切一樣，改變的渴望和動力都是需要培養的。有時，我們自己就有能力培養出這種動力並改變自己。其他時候，我們需要他人的支持、指導、關懷和指引方向。
Still, there are so, so many ways to overcome these challenges. There are so many ways to heal, grow, and recover. The desire and motivation for change, just like everything else, must be cultivated. Sometimes, we have the capacity to cultivate that motivation and change ourselves. Other times, we need support, guidance, care, and direction from others.
༒
有三個要素，組合起來能讓人產生生命凝聚感：
1. 可理解：理解身處之情況和要求，能夠清楚的掌握在特定情況下對於自己的期望。相信這世界是合理的。
2. 可掌控：相信自己擁有足夠的資源和能力來應付生活中的挑戰和壓力。
3. 有意義：相信並理解為此所付出的努力是值得的。這讓人能對生活投入情感。
There are three key components of sense of coherence (SOC):
1. Comprehensibility: can make sense of the situations and demands around oneself, essentially means to have a clear grasp of what is expected of oneself in a given circumstance. The belief that the world makes sense.
2. Manageability: a belief of having the necessary resources and abilities to cope with the demands and stressors life throws at oneself, essentially feeling like “I can handle challenges and situations effectively.”
3. Meaningfulness: the belief and understanding that the effort required to produce the outcome is worth it, which leads to an emotional investment in life.
༞༝𒀸༝༞
我發現聽節奏感很強的音樂可以激勵士氣，讓降到負值的動力回升一點，夠讓你完成生活中的基本任務了。
但有些音樂會打斷思考，有些音樂不會，跟音樂類型無關，為什麼呢？
這個世界真的是需要音樂、需要歌曲！
不過也是有那種時候，聽什麼都聽不下去，最後連一點聲音都受不了了，真是可怕。可能是抓不到適合的節奏嗎？
很珍惜能夠聽歌的日子。
☄
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