妄想型精神分裂症病患之認知治療教育團體：學習成效之評估

A Cognitive Therapy Educational Group for Paranoid Schizophrenics: Evaluation of Its Effects on Learning Performance

謝碧玲(Bi-Ling Shieh) ； 張雅惠(Ya-Huei Jang) ； 李培壅(Pei-Yong Li) ； 顏正芳(Cheng-Fang Yen) ； 張明永(Mian-Yoon Chong) ； 黃俊仁(Chun-Jen Huang)

《高雄行為科學學刊》 1卷1期 (2009/01) Pp. 40-48

https://doi.org/10.29854/TJKBS.200901.0003

摘要

目的：針對國內妄想型精神分裂症患者，發展一套認知治療教育團體與評估其對病患的學習之成效，亦探索對精神分裂症患者的認知治療策略，以利精神分裂症患者的治療與適應。方法：18至50歲，學歷為國中畢業以上的妄想型精神分裂症患者，24人參與認知治療教育團體組（簡稱教育團體組），還有23人單只進行衡鑑追蹤，無團體之介入，稱為藥物對照組（簡稱為對照組）。所有患者接受兩次精神症狀與心理狀態評估，而教育團體組亦於每次團體時填寫練習集與回饋表。此外，取樣30名大學一年級學生，填寫認知治療教育團體之知識性題目。結果：完成認知治療教育團體的患者，(1)對於認知治療教育團體的滿意度高，(2)對於課程內容的理解與運用性主觀評價上較低，(3)就學習成效而言，對於所教導的認知治療思考方式在基礎理解上，有良好的學習表現，高於未接受教育團體的對照組患者，且與未接受教育團體的一般大學生相當，(4)運用認知治療思考方式於實例方面，學習表現較低，且因人而異有高低不同的表現，(5)在精神症狀與心理狀態上，完成團體後未有改善。結論：本研究所發展的認知治療教育團體是適用於國內妄想型精神分裂症患者。患者對於認知治療教育團體滿意度高，且對認知治療思考方式展現出基本學習能力與學習成效，然而可能受限於認知教育團體時間僅三週，超過半數患者未能活用此技能於實例或生活中。因此，患者需要更進一步的教導與支持，以期受益於認知治療而改善精神症狀與心理適應。針對精神分裂症患者的認知治療策略建議有：(1)內容上，具體教導認知治療的思考模式，且大量使用練習與作業；(2)形式上，可以採用團體方式進行，有助於病患對認知治療模式的基本理解，而學習過程需要治療師大量的協助；(3)患者的篩選是不可避免必要的，如患者需要願意參加、以及能夠填寫完成團體過程中的量表與練習等，方能持續參與而完成整套團體。

關鍵字

認知治療 ； 精神分裂症 ； 團體治療

並列摘要

Object: To develop a cognitive therapy educational group program for paranoid schizophrenic patients in Taiwan and to evaluate its effects on learning as well as to explore relevant strategies suitable to the patients to improve their treatment effects and adaptation. Methods: Of paranoid schizophrenic patients (aged 18-50, with above 9^th grade education), 24 attended the cognitive therapy educational group (called educational group), and 23 received scheduled assessments without attending the educational group (called control group); all patients were assessed twice for symptoms and psychological adaptation, and the educational group did exercises and filled out a feedback form for each group sessions. In addition, there were 30 university freshmen filled out content exercise of the educational group program materials. Results: Patients who completed the cognitive therapy educational group program (1) were highly satisfied, (2) gave lower ratings of understanding and helpfulness of program materials, (3) showed better performance on basic knowledge of the cognitive model taught than the control group, and no difference from the university student group who did not attend the educational group, (4) showed a lower level of performance in application of the cognitive model to real situations and with variance, (5) their symptoms and adaptation did not change after the group. Conclusion: The cognitive therapy educational group program developed in the study was effective for paranoid schizophrenic patients in Taiwan. The patients were satisfied with the educational group, demonstrated basic ability to learn and good performance about the cognitive model taught in the group, but probably due to the short duration of educational group, more than half patients were unable to apply the knowledge learned to life concerns. Thus, patients needed more guidance and support in order to benefit from cognitive therapy to improve symptoms and adaptation. As to cognitive therapy strategies, our suggestions were: (1) To teach the cognitive model in concrete manner, and use abundant exercises and homeworks. (2) Group form was effective to promote patients' learning; nevertheless, high levels of help and assistance from leaders or therapists were needed. (3) Screening patients out was inevitable; patients could only complete the group program, if they were willing to participate and were able to complete scales and exercises of the group program.

並列關鍵字

Cognitive therapy ； Schizophrenia ； Group therapy