注意力、工作記憶與侵入性症狀之關聯性探討：以人際創傷倖存者為例

目的：過去研究顯示個體在經歷創傷事件後，最常經驗到創傷相關的侵入性症狀，且若採取不適應之因應方式將可能進而發展為創傷後壓力疾患。此外，在所經驗的各種創傷事件類型中，人際創傷事件被認為是更容易造成創傷後壓力心理病理的創傷類型。因此，本研究將探討人際創傷倖存者之侵入性症狀。過去針對創傷後壓力疾患的文獻認為，注意力抽離的困難與抑制功能的缺損，可能是使得個體之侵入性症狀持續進而發展為創傷後壓力疾患的重要因素。然而，截至目前仍未有研究同時探討注意力、抑制功能與侵入性症狀之間的關聯性，因此，本研究欲進一步探討這三者間的關係，以期對於侵入性症狀的病理機制有更清楚的瞭解。方法與結果：為檢驗上述問題，本研究共設計了三個子研究。研究一為檢驗中文版注意力控制量表的信效度，共招募412位研究參與者，請其填寫注意力控制量表、憂鬱症狀與特質焦慮等問卷。經題目－總分之相關分析，刪除1題後，中文版注意力控制量表具有穩定的心理計量特性，全量表具備良好的內部一致性和滿意程度的再測信度。探索性因素分析的結果顯示，兩個因素是最適因素數目，分別為注意力專注與注意力轉換。同時，此量表總分與憂鬱症狀和特質焦慮程度均呈顯著負相關，具有良好的效標關聯效度。因此，本量表可作為後續注意力研究的合理測量工具。研究二為探討注意力控制、工作記憶表現與創傷後壓力症狀之間的關係，從網路及課堂招募共118位曾經歷過人際創傷事件之倖存者做為研究參與者，請其填寫注意力控制、創傷後壓力症狀相關問卷，並完成電腦化之工作記憶評量作業，以探討這三個變項間的關係。結果發現，工作記憶表現與創傷後壓力疾患各症狀類別間呈現顯著負相關，但注意力控制則與創傷後壓力疾患各症狀類別無顯著相關。此外，注意力控制在工作記憶表現至侵入性症狀間的關係上具有顯著的調節效果。在注意力控制較佳的人際創傷倖存者身上，工作記憶表現與侵入性症狀間有顯著負相關，顯示好的工作記憶對侵入性症狀有緩衝效果；但在注意力控制較差的人際創傷倖存者身上，則無此緩衝效果。研究三為探討注意力偏誤操弄效果對人際創傷倖存者之侵入性症狀的影響，針對研究二的研究參與者，排除18位無法依照實驗程序的參與者，留下100位參與者，隨機分派到「注意警覺組」和「注意逃離組」，以檢驗對威脅臉孔之注意力偏誤對侵入性症狀的影響。結果發現，注意力偏誤分數與創傷後壓力疾患各症狀類別雖無顯著相關，但透過注意力操弄可以有效改變個體注意力偏誤的情形，其中，注意警覺組的個體其去注意威脅臉孔的訓練效果較穩定，但注意逃離組的個體去逃避注意威脅臉孔的訓練效果較不穩定。在經歷注意力偏誤操弄後，不論注意警覺組或注意逃離組的個體之侵入性症狀均有明顯改善，但訓練方式的不同，並沒有造成不同程度的改善效果。討論：本論文嘗試以注意力、抑制功能等認知角度來討論個體注意力、工作記憶與侵入性症狀間的關係，並依序說明研究結果的貢獻、臨床應用、限制與未來研究方向。

關鍵字

注意力控制；工作記憶；抑制功能；侵入性症狀；人際創傷；創傷後壓力疾患

並列摘要

OBJECTIVE: It has been proposed that both attention disengagement difficulty and inhibitory function impairment play important roles in the maintenance of intrusive symptoms in PTSD. However, there is still no research empirically investigating the concurrent association among attentional control, working memory capacity, and trauma-related intrusions. This study aimed to investigate the aforementioned issue. METHOD and RESULTS: In examining the question, three studies were conducted. Study 1 aimed to construct the psychometric properties of the Traditional Chinese version of Attentional Control Scale. Four hundred and twelve participants were recruited. Results showed that, after deleting one item via item-total correlation analysis, the Traditional Chinese version of Attentional Control Scale showed good internal consistency and moderate test-retest reliability. In exploratory factor analysis, we found that two-factor structure, i.e., attentional focusing and attentional shifting, was the best solution. Moreover, good criterion-related validity was indicated by significant negative correlations between the total score of attentional control scale and depressive symptoms and trait anxiety. In Study 2, in order to investigate the associations among attentional control, working memory capacity, and intrusions, we recruited 118 participant who had experienced at least an interpersonal trauma event via Internet advertisement or psychological course requirement. They were asked to complete attentional control scale, posttraumatic stress diagnostic scale, and an automated computerized working memory task (i.e., operation span task). Results showed that working memory capacity was negatively related to all subclusters of PTSD symptoms, while attentional control showed no significant correlation with any subcluster of PTSD symptoms. Moreover, attentional control was found to moderate the relationship between working memory capacity and trauma-related intrusions. For those with high attentional control, higher working memory capacity was correlated with less intrusions. However, for those with low attention control, working memory capacity was not related with intrusions. In Study 3, participants were those who have taken part in Study 2 except 18 participants who could not follow the instruction. Therefore, 100 participants were obtained in Study 3. They were randomly assigned to two different attentional training groups, i.e., attention vigilance group and attention avoidance group, in order to investigate the potential effect of attention bias on trauma-related intrusions. Results showed that, first, there was no significant correlation between attention bias score and all subclusters of PTSD symptoms. Second, through attention training manipulation, we found that it was easier to train participants to show attention vigilance than to show attention avoidance. Through attention bias manipulation, both groups show significant reduction of trauma-related intrusions. However, there were no significant group difference on intrusions. Discussions: Based on the above findings, the present thesis will discuss the associations among attention, working memory capacity, and intrusions with the viewpoint of attention disengagement and inhibitory function. Possible applications, clinical implications, limitations and future direction are further discussed.

並列關鍵字

attentional control ； working memory ； inhibitory function ； intrusions ； interpersonal trauma ； posttraumatic stress disorder

參考文獻

Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing and interpreting interactions. Newbury Park, London: Sage.

American Pychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

Amir, N., Beard, C., Burns, M., & Bomyea, J. (2009). Attention modification program in individuals with generalized anxiety disorder. Journal of Abnormal Psychology, 118, 28-33. doi: 10.1037/a0012589.

Aupperle, R. L., Melrose, A. J., Stein, M. B., & Paulus, M. P. (2012). Executive function and PTSD: Disengaging from trauma. Neuropharmacology, 62, 686-694. doi: 10.1016/j.neuropharm.2011.02.008.

Bar-Haim, Y., Holoshitz, Y., Eldar, S., Frenkel, T. I., Muller, D., Charney, D. S., . . . Wald, I. (2010). Life-threatening danger and suppression of attention bias to threat. The American Journal of Psychiatry, 167, 694-698. doi: 10.1176/appi.ajp.2009.09070956

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注意力、工作記憶與侵入性症狀之關聯性探討：以人際創傷倖存者為例

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