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The Effects of Low-structured Play Therapy Group on Patients with Schizophrenia
低結構遊戲治療團體對精神分裂症病人之效果
摘要
目的：有關精神分裂症病人的復健治療多專注於提升用藥順從度、自我照顧能力與職業功能，但較少關注增加病人自發性、自然與愉悅的本能，以增加創造力與問題解決能力。本文嘗試運用遊戲治療團體於日間照護，以探討對精神症狀的影響。方法：研究對象為精神分裂症病人66人，31人為實驗組，35人為控制組；平均年齡39.08歲。以低結構遊戲治療團體為獨變項控制，病人自陳量表、專家評量與團體內遊戲行為分析為依變項，以了解團體對病人精神症狀與行為的影響。結果：參與團體後，實驗組與控制組在病人自陳量表、活性症狀與六題負性症狀中的四項未達顯著差異，僅「不喜歡活動」與「不喜與人接觸」出現顯著性差異。團體遊戲行為分析顯示，在不同階段之認知活動、社會單獨與平行活動中，未達顯著性差異，但社會團體遊戲行為在第三階段明顯增加。結論：本研究結果有助了解低結構遊戲團體對病人負性症狀之影響，然對於有限團體次數、行為評估時間點與缺乏病人家屬佐證等，則仍需進一步了解。
並列摘要
Background: Rehabilitation treatments for patients with schizophrenia mainly focus on promoting the amenability of drug treatment, the capacity for self-care, and the ability to find and to maintain employment. They are less focused on spontaneity and pleasure capacity, which can lead to enhanced creativity and problem solving ability. This study was intended to apply play therapy group to the patients in a psychiatric day hospital, to investigate its influence on patients with schizophrenia. Methods: We studied 66 patients, 31 of which were in the experimental condition and 35 of which were in the control condition. They had a mean age of 39.08 years. Attending a low-structured play therapy group was the independent variable. Dependent variables, including patients' self-report on life adjustment, a professional assessment on psychiatric symptoms, and the analysis on patients' group play behaviors, were used to understand how the therapy group influenced patients with schizophrenia. Results: After attending the play therapy group, the patients were found not to have significant difference in life adjustment, positive symptoms, and 4 out of 6 of the negative symptoms in the two conditions. However, compared to the control condition, patients in the experimental condition performed better in negative symptoms ”lack of action” and ”lack of connection with others.” Also, analysis of patients' group behaviors showed that patients displayed no significant differences on four levels of cognitive play, or the social solitary and parallel play among three stages, but increased their social group play behaviors in the third stage. Conclusion: This study helped understand how to apply low-structured play therapy group in a psychiatric day hospital. More issues on group sessions, assessment timing and observations by significant others need to be discussed.