趨近動機、失功能態度、情緒能力對情感性疾患症狀表現之相關探討

情感性疾患患者在台灣地區每年有逐年升高的趨勢，雖然目前在藥治療在具有相當之成效，但仍受限於患者本身之求助與遵從醫療行為，亦與情感性疾患的療效、預後息息相關。研究指出，若能搭配心理治療之介入，可改善患者之預後，因此本研究目的為探討情感性疾患之趨近動機、認知系統、情緒能力對情感性疾患症狀表現之相關，進行了解背後失調之歷程，以作為進一步介入之依據。本研究設計採臨床組（診斷分組：單極組、雙極組；症狀分組：躁狂組、憂鬱組、緩解組）與社區組的單一時間點測驗之受試者間準實驗設計。其中臨床組66人(診斷分組：單極組37人、雙極組29人；症狀分組：躁狂組13人、憂鬱組32人、緩解組21人)，社區組48人，總計114人。評估各組間趨近動機、認知系統、情緒能力與情感性症狀表現之差異，與探討趨近動機、認知系統、與情緒能力之失調造成情感性症狀表現之歷程。結果顯示，在診斷分組中，單極組與雙極組在負向趨近動機、依賴信念、情緒覺察(覺察負向情緒影響)、情緒調節(減少負向情緒、失能調節)、負向情緒、憂鬱症狀分數顯著高於社區組，而正向趨近動機、正向情緒、中華雙極性量表顯著低於社區組；單極組與社區組在情緒調節(發展新觀點)上顯著高於雙極組。在症狀分組中，憂鬱組之負向趨近動機、依賴信念、情緒覺察(覺察負向情緒)、情緒調節(降低負向情緒、失能調節)、貝克憂鬱量表分數、與負向情緒顯著高於社區組；憂鬱組之貝克憂鬱量表分數、與情緒覺察(覺察負向情緒)顯著高於躁狂組；躁狂組之負向趨近動機、依賴信念、情緒調節(失能調節)、中華雙極性量表分數、貝克憂鬱量表分數顯著高於社區組；躁狂組之目標達成信念、情緒調節(發展新觀點)、中華雙極性量表分數、與正向情緒顯著高於憂鬱組。透過結構方程式模型得知，憂鬱症狀的歷程是直接受到正向趨近動機、依賴信念、情緒覺察(覺察負向情緒影響)、與情緒調節(失能調節、尋求社會支持)所作用，而躁狂症狀的歷程是直接受到正向趨近動機、目標達成信念、情緒覺察(覺察正向情緒影響、覺察負向情緒影響)、情緒調節(發展新觀點)之作用，而趨近動機系統、失功能態度、情緒覺察與情緒調節之失調亦會間接引發情感性症狀。整體而言，情感性疾患患者在躁狂狀態時受正向趨近影響與目標達成信念越大，也感受到更多之正向情緒，而憂鬱狀態時則較不受正向趨近動機影響，但有相當程度之依賴信念；雙極組與單極組因易覺察負向情緒影響而處於憂鬱狀態，而雙極組個體易受覺察正向情緒影響；處於躁狂狀態之個體，其發展新觀點能力、增加正向情緒優於處在憂鬱狀態者；憂鬱狀態個體對於自身在情緒調節上，傾向會放任問題，而躁狂狀態則較少。透過上述結果，可了解從症狀來探討失調之心理病理與情緒能力，更有助益於臨床之實務工作，以便作為介入之基礎。

關鍵字

情感性疾患；趨近動機系統；認知能力；情緒能力；失調歷程

並列摘要

People with mood disorders have increased every year in Taiwan. Although the medications have been effective in treating these disorders to certain degree, psychological treatments can supplement drug treatment. The fact that combining psychotherapy and medications can improve the prognosis of mood disorders indicates that it is important to investigate the psychopathology of mood disorders. Therefore, the aim of the study was to explore different psychopathological factors of mood disorders in an integrated model, including approach motivational system, dysfunctional attitudes, emotional skills, and symptoms. Based on the findings, we expect to further the understanding of the processes leading to mood disorders and the development of effective interventions. The study adopted a quasi-experimental design, and compared mood disorders groups (66 patients) and community control group (48 persons) on approach motivations, emotional skills, and symptoms. With diagnosis grouping, the results were similar, and thus, the results of comparing symptom groups with community group were reported in the following. Both the depressive group and the manic group showed significant higher negative approach motivation, dependence dysfunctional attitude, maladaptive regulation, and depressive symptoms than the community group. In addition, the depressive group showed (1) significant higher awareness of negative emotion, decreasing negative emotion regulation, and negative affects, and significant lower positive approach motivation, goal-attainment dysfunctional attitude, developing new viewpoint regulation, and manic symptoms than community group, and (2) significant higher awareness of negative emotions, and depressive symptoms than manic group. Also, furthermore, the manic group showed significant higher manic symptoms than community group, and significant higher goal-attainment dysfunctional attitude, developing new viewpoint regulation, positive affects, and manic symptoms than depressive group. Structural Equation Modeling of the interrelations of approach motivations, emotional skills, and symptoms indicated that (1) the process leading to depressive episode involving the hypofunctioning positive approach motivation, dependence dysfunctional attitude, awareness of negative emotions, maladaptive regulation, and lack of social support regulation, and (2) the process leading to manic episode involving the hyperfunctioning positive approach motivation, goal-attainment dysfunctional attitude, aware of positive emotions, less aware of negative emotions, and increasing positive emotion regulation. Furthermore, emotion awareness was affected by approach motivations and dysfunctional attitudes, and emotion regulation was affected more by approach motivations and less by emotion awareness. In conclusion, patients with mood disorders were affected by the specific psychopathological factors, including approach motivations, dysfunctions attitudes, and emotional skills. According to the findings, we would suggest that it is helpful to the patient with mood disorders to monitor their approach motivational system and dysfunctional beliefs, and improve their emotional skills.