再探菸草使用者之動態決策行為：以原始版與臨床版愛荷華決策作業為例

Reexamining the dynamic decision behavior in the tobacco users-A study using original and clinical Iowa gambling task

梁琬琳(Wan-Ling Liang)

指導教授 ： 林錦宏

高雄醫學大學/人文社會科學院/心理學系碩士班/碩士(2021年)

摘要

菸草使用障礙症(tobacco use disorder, TUD)為一項物質使用障礙症，菸草使用者明知吸菸會伴隨長期的生理健康危害，卻選擇持續吸菸，而此行為造成高戒菸失敗率。菸草使用者往往因為上述欠佳的決策問題而承受健康風險，難以成功戒菸。尼古丁藥理作用會增強菸草使用者對於酬賞相關線索之敏感度，以及性格特質如衝動性、刺激尋求亦會影響其決策行為。過往研究探討菸草使用者的決策功能的主要工具之一為愛荷華決策作業(Iowa gambling task，IGT)，觀察個體能否在不確定情境下，經由情緒訊號及相關生理反應的協助，逐漸產出符合獲益期望值的決策。值得注意的是，IGT已經成為正式的神經心理評估工具。然而，本文針對IGT-TUD相關文獻進行相對全面的回顧，其結果存在不一致的現象，四篇文獻發現菸草使用組相對於控制組易受到立即酬賞的影響；九篇文獻則未觀察到兩組差異；兩篇文獻發現控制組比菸草使用組易受到立即酬賞的影響。本文推論此現象出現的可能原因有，一為文獻間分析與呈現的指標不一致；二為忽略近期IGT文獻常被提及的關鍵變項—輸贏頻率；三為仍較少文獻以正式的臨床版IGT來評估菸草使用組與控制組間的差異；四為較少研究探討衝動性及刺激尋求量表分數與IGT指標之間的相關性。
針對上述議題，本研究以兩實驗，採組間設計，實驗一(原始版IGT)；實驗二(臨床版IGT)，再驗菸草使用組與控制組之間的決策表現。亦比較同一種組別在兩版本IGT表現之差異，並分析IGT各項指標，如期望值、輸贏頻率等指標，以檢視何種指標具區辨力。此外探討菸草使用行為、衝動性和刺激尋求特質及IGT三者間之相關性。本研究結果顯示：一、在原始版IGT，期望值與輸贏頻率皆無法區辨兩組決策行為的差異，此結果支持Lejuze等人九篇研究。二、在臨床版IGT，期望值與輸贏頻率亦無法區辨兩組決策行為的差異。三、在兩種版本IGT中，參與者的選牌模式存在奇異B現象(Prominent Deck B phenomenon, PDB)，顯示其選牌策略可能受輸贏頻率所影響。四、衝動性組成因素「認知複雜性」、「無計畫性」分數與臨床版IGT的A牌選擇數皆為正相關；臨床版IGT淨分數與尼古丁使用程度為負相關，A牌選擇數則與尼古丁使用程度為正相關。淨分數能反映菸草使用者的尼古丁尋求程度，而A牌選擇數能反映其尼古丁使用頻率。
總結而言，本文透過IGT-TUD相關文獻的全面回顧，發現此領域文獻間不一致的現象，並提出原始版與臨床版IGT兩實驗加以驗證。本研究發現，期望值、輸贏頻率皆無法區辨菸草使用組與控制組的決策行為，此與IGT-TUD文獻大部分的結果一致。但是，兩組兩版本皆有PDB現象，顯示輸贏頻率有其影響力。衝動性量表、尼古丁使用程度，以及IGT指標之間存在相關性，顯示IGT部分指標可反映出菸草使用者的動態決策行為之特性。未來IGT-TUD的相關研究應注意輸贏頻率的解釋力，且在臨床上，採用IGT系列的版本於菸草使用者決策行為之評估應更加謹慎。
關鍵字：菸草使用、決策行為、愛荷華決策作業、期望值、輸贏頻率、衝動性

關鍵字

菸草使用 ； 決策行為 ； 愛荷華決策作業 ； 期望值 ； 輸贏頻率 ； 衝動性

並列摘要

Tobacco use disorder (TUD) is a substance use disorder that causes tobacco users to smoke constantly despite knowing that this habit will have long-term physical health consequences. This disadvantageous form of decision-making leads not only to a high failure rate for quitting smoking but is also associated with severe health risks. The pharmacological effects of nicotine on tobacco users include increased sensitivity to reward-related cues, and the personality traits such as impulsive and sensation-seeking behaviors which will, in turn, affect their decision-making behaviors. In previous studies, a primary task used to explore the decision-making function of tobacco users is the Iowa gambling task (IGT), which stimulates the uncertain and complex scenarios of daily decision-making. Although the IGT is a formal neuropsychological assessment tool, it has produced some mixed results when applied to tobacco users. The main problems are inconsistent indices and the fact that few studies have explored the effect of gain-loss frequency on the decision-making behavior of tobacco users. In addition, there is a lack of studies that used the clinical version of the IGT (cIGT) to examine the decision-making function of tobacco users; research examining the correlation between the impulsivity scale, sensation-seeking scale score, and IGT indices is also limited.
This study proposed two experiments (Experiment 1: Between-group comparison of the original IGT; Experiment 2: Between-group comparison of the cIGT) to reexamine performance-related differences between the tobacco use group and the control group for the two versions of the IGT and to analyze several indices of the IGT. It also examines the correlation between tobacco use behavior, impulsivity, and IGT performance. The four main results did not indicate any significant differences between the two groups' decision-making behaviors in terms of net score and gain-loss frequency for both the IGT and cIGT. It is noteworthy that both two groups preferred Deck B, demonstrating the prominent deck B phenomenon (PDB) and indicating that IGT decision-making strategies can be affected by gain-loss frequency. Additionally, there was a positive correlation between BIS subscale scores (for factors such as cognitive complexity and non-planning) and Deck A of the cIGT. The net scores for the cIGT were found to be negatively correlated with the level of nicotine use, but positively correlated with Deck A. The net scores can reflect the nicotine-seeking level of tobacco users as the selected numbers of Deck A was found to be associated with the frequency of nicotine use by tobacco users.
In conclusion, a comprehensive review of IGT-TUD-related literature revealed some inconsistencies between various studies. In this study, two experiments were conducted to examine two versions of the IGT. However, the PDB phenomenon was observed for both versions of the IGT, which showed the effect of gain-loss frequency. There is a correlation between the impulsivity scale, the level of nicotine use, and IGT indices, inferring that some IGT indices could reflect the characteristics of the dynamic decision-making behaviors of tobacco users. In the future, IGT-TUD-related research could further examine the gain-loss frequency effect, involve the clinical use of all versions of the IGT, and adopt a more cautious approach to evaluating tobacco users' decision-making behaviors.

Keywords: tobacco use, decision-making behavior, Iowa gambling task, expected value, gain-loss frequency, impulsivity

並列關鍵字

tobacco use ； decision-making behavior ； Iowa gambling task ； expected value ； gain-loss frequency ； impulsivity

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