探討慢性精神分裂症患者接受社交技巧訓練後之溝通表達能力成效

鍾佩君(Chung Pei Chun)

指導教授 ： 謝嫣娉

亞洲大學/健康學院/長期照護研究所在職專班/碩士(2008年)

摘要

慢性精神分裂症患者受疾病症狀、殘留負性症狀影響及病程呈慢性化，導致病患社交互動障礙，與人因應互動困難。基於此點，研究者希望能以認知行為治療理論為導向的社交技巧訓練團體課程內容為主，和透過團體互動學習過程中，使病患的社交應用技巧及溝通表達能力可獲得改善並提昇，亦為研究動機。研究主在探討經社交技巧訓練團體課程介入後，患者於實際運用相關社交技巧上，是否可達到溝通表達能力增進之成效，故目的有：一、探討慢性精神分裂症患者，在接受過社交技巧訓練課程後及經實地演練和運用社交互動技巧後，是否可確實提升其社交性溝通表達能力。二、了解患者在接受社交技巧訓練課程後，其溝通表達能力、傾聽能力、同理反應能力，較未接受社交技巧訓練課程前，是否具有明顯的正向進步差異性存在。受試者來自中部某地區醫院精神科慢性病房，經篩選後共12人參加，並針對受試者進行每週二次，每次60分鐘，共八次的社交技巧團體訓練活動，並於課程活動結束後5週，安排受試者參加院外娛樂治療活動。於課程訓練前一週、第四週及結束後一週，進行溝通表達能力量表之前、中間、後測並於後測時加填溝通能力評量開放式回饋意見，為資料收集。研究方法是以量性為主，質性為輔，運用描述性統計及Wilcoxon signed rank test分析，研究結果摘述如下：
一、受試者在接受過社交技巧訓練團體課程內容後其溝通表達能力量表中間測與前測總分相比為P=0.002＜0.05，後測量與前測總分相比為P=0.002＜0.05，達顯著水準，顯示社交技巧能力確實優於未接受前。
二、受試者其溝通表達能力量表各分量表之相比得分結果，在語言溝通方面：中間測與前測方面：P為0.003＜0.05；後測量與前測方面：P為0.028＜0.05；後測量與前測主動性方面：P為0.004＜0.05；後測量與前測同理反應方面：P為0.021＜0.05，以上皆達顯著水準，證實於語言溝通和同理反應方面可達具體成效，而在傾聽分數方面：後測量與中間測方面總分相比，雖統計學上並未達到顯著差異成果，但由結果分析得知，確實亦有些微進步。
三、分析受試者填寫的回饋意見內容結果可發現，多數成員對社交技巧團體訓練課程感到滿意與正向肯定，且在實際運用社交技巧後也認為對其人際互動有顯著幫助。
最後，根據結果加以討論，提出建議、以供治療者、教育工作者、對其研究有興趣者未來之參考，並可進一步微觀研究、深入分析。

關鍵字

慢性精神分裂症患者 ； 社交技巧團體訓練課程 ； 溝通表達能力

並列摘要

Affected by the symptoms and negative symptoms during the residual phase, the chronic schizophrenic patients often encounter social difficulties and other personal communication problems. The researcher hope that the social skills training project based on cognitive behavior theory and the process of group learning will help the patients to improve their social skills and expression abilities. This would also be the research motive. The purposes of the research are (1) find out the effect of social skills and expression ability improvements for chronic schizophrenic patients who have taken the social skills training course. (2) find out if there exists significant progress in the patients’ expression ability, listening ability, and empathetic response after they have taken the social skills training course.

The research methods are mainly quantitative, while qualitative methods were also be adopted. We (the researcher) chose twelve patients as our trainees. They were all from a local hospital in the central area of Taiwan. The training group meets twice a week for 60 minutes, total for 8 times. A field trip was also held after 4 weeks the whole training course had been completed. To facilitate the efficacy assessment and data collection, the trainees were asked to take the communication competence scale test for 3 times, which were scheduled one week before the training course, the fifth week, and 1 weeks after the training course, respectively. Meanwhile, an open questionnaire was also taken as a follow-up feedback. By using the Wilcoxon signed rank test and other descriptive statistical tools, the result reveals the following: (1) In respect of social skills, the pretest-posttest and pretest-follow-up comparison have both the same p-value is 0.002, which is statistically significant at the 5% level. This also indicates that the trainees’ social skills had been improved obviously after the training course. (2) Regarding the expression ability, in the aspect of verbal ability, the pretest-posttest comparison’s p-value is 0.003, and the pretest-follow-up comparison’s p-value is 0.028; in the aspect of activity, the pretest-follow-up comparison’s p-value is 0.004; in the aspect of empathetic response, the pretest-follow-up comparison’s p-value is 0.021. The results above suggest that the training course can benefit the patients’ verbal ability and empathetic response. In the aspect of listening ability, the p-value implied it is not statistically significant at the 5% level, however, the trainees indeed showed slight progress after the training course. (3) According to the follow-up open questionnaire, most trainees felt satisfied with the training course. After onsite practice, they also thought these social skills were very helpful to their personal relationship.

Based on the research results, the researcher made conclusion and proposed several suggestions for further study in the future.

並列關鍵字

chronic schizophrenic patients ； social skills training ； test ； AND ； expression ability

參考文獻

何長珠（1997）‧心理團體的理論與實際‧台北：五南出版社。

蔡桂芳（2001）‧高職階段智能障礙學生社會技能訓練效果之研究‧國立彰化師範大學：特殊教育學系論文（未出版）。

廖華芳（1997）‧非口語溝通‧ 當代醫學，24(2)，154-166 。

林靜蘭、熊秉荃（2004）‧社區中精神分裂症病患的社會技能訓練‧台灣精神醫學，19（3），p 192-202。

李明濱主編（1999）‧《實用精神醫學》‧台北：台大醫學院。