正向情緒焦點認知治療團體運用於憂鬱患者：療效評估與改變因子之探討

憂鬱症於現今社會日漸盛行，其耗損之社會成本、多元的病因與不同的治療取向皆提醒著臨床工作人員，針對憂鬱患者提供有效治療的重要性。憂鬱症之主要特徵即是情緒的顯著困擾，研究顯示處理情緒的能力是引發與維持憂鬱症的重要因子，故推論增進情緒能力，有助於個體改善情緒處理歷程，進而提升生活適應與減少困擾情緒。故本研究目的期以情緒處理歷程作為焦點，同時融合正向情緒與認知治療原則，設計一套針對憂鬱症患者的團體心理治療方案，來改善患者之症狀，並增進情緒能力，做為其資源以因應未來之經驗，促進生活適應。正向情緒焦點認知治療團體方案共包括二個階段：第一階段療程共六周，將循序漸進教導不同情緒能力，並包括正向情緒的課程；第二階段課程共八周，除了延續正向情緒之課程，亦會針對疾患症狀表現與病理作介入，並依情緒處理歷程取向與認知治療進行處理，經由對情緒的反思、賦義與改變基模的歷程，期能產生適應情緒以改變長期困擾情緒。本研究第一階段共進行十四個梯次，第二階段共進行六個梯次，皆由臨床心理學碩士研究生擔任團體帶領者。資料分析主要採3×3二因子混合設計，分為不同組別：完整參與兩階段團體之正向組共25人、未參與團體之臨床對照組共8人、社區對照組共10人，與不同測驗時間點(前測、中測、後測)，分析所收集之情緒狀態及症狀評估。綜合而論，本研究結果支持部分研究假設，即正向情緒焦點認知治療團體療程有助於改善症狀與情緒適應，有效地減輕個案憂鬱與焦慮症狀，與提升處理情緒的效能感；更能提昇患者之快樂指數分數與情緒能力，如辨識情緒的覺察能力，聚焦於內在的情緒感受，降低運用無效的失能調節策略，促進患者對自身情緒評估的正常化，並賦予情緒經驗意義。然個體的自尊與正向情緒於療程中的變化是與研究假設相左，研究者認為可能是受療程設計、改變階段的波動或未搭配合宜調適技能所影響。另外，研究結果也可見正向情緒與情緒能力對症狀與情緒適應變化的影響。故正向情緒焦點認知治療團體可提供做為憂鬱症治療的選擇，且以正向情緒與情緒能力做為焦點的介入更有助於探討與理解情緒處理歷程在憂鬱症病理中所扮演的角色。

關鍵字

憂鬱症；正向情緒；情緒處理歷程；情緒能力；情緒焦點-認知治療

並列摘要

The population of depressive disorders has increased dramatically in recent years, and people suffered from the disorders have consumed social resources significantly. Also, various causes of the disorder as well as different therapies all suggested that providing an effective intervention is crucial for patients. The main presentation of depressive disorder is obvious mood disturbed. Many researches show that emotion abilities play a key role in inducing and maintaining depressive disorder. Therefore, we suggest that improving emotion abilities and experiencing more positive emotions will help people process their emotion in a healthier way, further enhance emotion adaptability and decrease disturbed emotion. As a result, we choose self’s emotion experience as a focus in this research, combining with positive emotion and cognition therapy principles, to develop an effective group program for depressive disorder as well as to evaluate its treatment effects. By relieving symptom and increasing their emotion abilities as resources, the patients are expected to have better ability to cope with future scenario and improve their life well-being. Positive Emotion-Focused Cognitive group program has two stages: there were six sessions in first stage, where different emotion abilities including positive emotion were arranged in different sessions. On the second stage, there were eight sessions where positive emotion will be continued. Moreover, the disease causes and symptoms supposed to introduced by the leader, following with emotion processing approach and cognitive therapy to intervene. This study suggests that through emotion reflection ability, endowing negative emotion with meanings and emotion schemas modifying, people will be able to have more adaptive emotion and undo the disturbed emotion. In the study, we hold fourteen first-stage groups and six second-stage groups, all led by clinical psychology graduate students. A 3×3 two way mixed design (Factor 1: three groups; Factor 2: three measure times) was used in the data analysis. There were 25 participants in treatment group program (positive group), 8 clinical patients who are not participated in the group program (clinical control group), and 10 normal cases who are not participated in group program (normal control group). Emotion state, emotion abilities and symptoms were measured in three different times, including prior to the beginning of group program, after finishing the first stage, and after finishing the second stage. The research results partially supported our hypotheses, as to treatment effects of group program, patient’s symptom and emotion adaptation was improved, including depression, anxiety, and emotion efficacy. Besides, patient’s happiness index and emotion awareness ability also obtained improvement. They can focus themselve’s emotion experience more and to distinguish different kinds of emotions. Furthermore, the patients used less dysfunction emotion regulation strategy, and easier to normalize their negative emotion and regard it more meaningful. However, the results show that patient’s self–esteem and positive emotion were declined on the second stage which was very different from our hypotheses. We consider it is due to the program setting, destability in change process, or patients not having enough regulation strategies. In addition, results also show the relationships between the change of positive emotions, emotion abilities, emotion adaptation and symptoms. Thus, we assumed Positive Emotion-Focused Cognitive group would be an effective choice for depression treatment. Using positive emotion and emotion abilities as focuses of intervention can help further understand of emotion processing and psychopathology of depressive disorder.