認知行為取向療效探究：後設分析

認知行為取向介入係當代最快速成長、研究數量最多的心理治療學派，同時也是一種結構化之短期心理治療模式。它主要針對個案的失功能認知做評估，藉此協助治療者修正他們的失功能思想、行為。近二十年來，國內認知行為取向介入之研究累積已趨成熟，並被廣泛運用於各類心理議題，但卻尚未有人針對這些研究做較全面性之療效評估，因此本研究欲以後設分析對此主題進行探討。本研究使用台灣碩博士論文知識加值系統、華藝線上圖書館，搜尋1998年至2018年8月間所有符合認知行為治療、理情行為治療、正念認知治療定義之實徵研究，刪除不符合收錄準則之研究後，最終保留86篇研究，其中包含2122位研究對象。除了評估國內認知行為取向介入效果外，本研究亦探討對不同介入議題使用認知行為介入方式之成效，以及可能影響整體介入效果之調節變項。結果顯示：（一）國內認知行為取向介入無論於立即（g=.632）與維持（g=.613）成效層面，皆具中度效果。（二）當使用認知行為介入對不同心理議題進行處遇時，焦慮、人際問題與情緒教育具高度立即介入效果；憂鬱、生理疾患、成癮問題、兒童期疾患、生活壓力問題具中度立即介入效果；失眠問題則是接近中度立即介入效果。介入效果之維持層面，焦慮、人際問題、情緒教育之介入具高度維持效果；憂鬱之介入則具中度維持效果。（三）次群組分析結果顯示並無顯著的調節變項，但部分特徵變項對介入效果可能有些影響趨勢。本研究對國內近二十年來認知行為取向介入之研究進行一整體性分析，並就理論與方法上之缺失，為實務工作者與相關領域研究者提供建議及改進方向。

關鍵字

後設分析；認知行為治療；理情行為治療；正念認知治療

並列摘要

Cognitive behavioral intervention is a structured and short-term therapeutic approach that is currently the fastest growing and the most widely researched. Therapists utilize this technique to evaluate their clients’ cognitive functioning, so that they could further use it to modify these individuals’ inappropriate thinking and behavior if needed. In the past two decades, a great deal of studies of cognitive behavioral interventions has been conducted in Taiwan, and knowledge gained through the empirical research has been applied to resolve various types of mental health issues. However, no one had investigated the overall efficacy of this therapeutic approach. Therefore, the present study aimed to solve this problem by conducting a meta-analysis. This investigator searched Digital Library of Theses and Dissertations in Taiwan and Airiti Library databases using the keywords cognitive behavior therapy, rational emotive behavior therapy, and mindfulness-based cognitive therapy. This search was limited to articles that were published from 1998 to August 2018. After deleting the references that did not meet the screening criteria, 86 studies that consisted of 2,122 participants remained. In addition to assessing the effectiveness of cognitive behavioral interventions, this study also explored how this therapeutic approach would benefit individuals dealing with different mental health issues, and how the potential moderator variables might influence the treatment outcomes of cognitive behavioral interventions. Our results supported the following conclusions: Frist of all, the cognitive behavioral interventions had a medium effect size in both immediate（g=.632）and sustained treatment outcomes（g=.613）. Secondly, the cognitive behavioral interventions had a large effect size in immediate treatment outcomes when used to help individuals with anxiety, interpersonal, or emotional problems. However, the effect size would decrease to a medium level when the cognitive behavioral interventions were used to treat depression, physical illnesses, addiction, childhood developmental disorders, stress-related disorders, and to a nearly medium level when treating insomnia. With regard to sustained treatment outcomes, the cognitive behavioral interventions had a large effect size when used to help individuals with anxiety, interpersonal, or emotional problems, but had a medium one when they were used to treat depression. Thirdly, the subgroup analysis revealed that no moderating variable was found, but some variables showed a tendency to influence the treatment outcomes of cognitive behavioral interventions. The present study, based on the empirical research data accumulated in Taiwan over the past 20 years, performed a meta-analysis examining the efficacy of cognitive behavioral interventions. It also pointed out the methodological flaws and weaknesses revealed in the previous studies. By conducting the research in this way, this investigator intended to provide useful recommendations for future research in a relevant field.