代償性認知訓練對思覺失調症病人心理社會功能及自我污名的影響

The influence of compensatory cognitive training on psychosocial outcomes and self-stigma in patients with schizophrenia

廖于萱(Liaw Yu-Shiuan)

指導教授 ： 連盈如

國立臺灣師範大學/教育學院/健康促進與衛生教育學系/碩士(2018年)

https://doi.org/10.6345/THE.NTNU.DHPHE.007.2019.F02

摘要

研究目的：思覺失調症病人的認知與心理社會功能（自尊、自我效能、生活品質）及自我污名具有關聯性，且透過代償性認知訓練可以促進其認知表現並提升生活品質。因此，本研究欲檢驗代償性認知訓練介入是否有效提升思覺失調症病人心理社會功能（自尊、自我效能、生活品質）及改善自我污名。
研究方法：本研究對象為臺灣北部某精神專科醫院日間病房的思覺失調症病人 (n = 38)，隨機分配為實驗組 (n = 18) 及對照組 (n = 20)。實驗組參與代償性認知訓練團體，共計十週，每週2次，每次50分鐘；對照組則參與相同治療時間的其他日間病房活動。本研究使用羅森伯格自尊量表、一般自我效能量表、思覺失調症生活品質量表，以及精神疾病自我污名量表進行施測，問卷施測共計3次，分別在介入前（基線）、介入後（立即後測）及介入後一個月（追蹤）實施。以廣義估計方程式來分析代償性認知訓練介入後之立即效果及延宕效果；以點二系列相關、皮爾森積差相關及變異數分析來檢驗社會人口學因素、心理社會功能及自我污名之相關性。
研究結果：經過十週的團體介入課程後，關於自我效能方面，實驗組相較於對照組在後測分數具有邊緣顯著差異 (p = .06)；關於生活品質及自我污名方面，實驗組相較於對照組在後測分數未達到統計上的顯著差異 (p > .05)，但兩組在追蹤時的生活品質 (p = .002) 以及自我污名 (p = .02) 分數均有顯著差異；至於自尊的部分，兩組間後測及追蹤分數均未達到統計顯著差異 (p > .05)。在社會人口學變項、心理社會功能及自我污名之相關性中，僅有年齡與生活品質呈顯著正相關 (p < .01)。
研究結論：代償性認知訓練介入對於思覺失調症病人的自我效能具有立即介入效果，而在生活品質及改善自我污名則具有延宕介入效果，可提升思覺失調症病人的自我效能與生活品質以及改善自我污名。

關鍵字

代償性認知訓練 ； 思覺失調症 ； 心理社會功能 ； 自我污名 ； 廣義估計方程式

並列摘要

Purpose: Previous studies indicated that cognitive function associated with self-stigma and psychosocial outcomes (i.e., self-esteem, self-efficacy, and quality of life) in individuals with schizophrenia. Additionally, compensatory cognitive training improved cognitive performance and quality of life in this disease group. This study aimed to investigate the effects of compensatory cognitive training on psychosocial outcomes and self-stigma in individuals with schizophrenia.
Methods: Study participants included patients with schizophrenia at the day care center in a psychiatric hospital in northern Taiwan. The participants randomly assigned into accepted compensatory cognitive training (CCT) (n = 18) and the control group received treatment as usual (n = 20). The CCT intervention consisted of two 50-minute sessions each week for 10 weeks. The Rosenberg Self-Esteem Scale (RSES), the General Self-Efficacy Scale (GSES), the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4), and the Internalized Stigma of Mental Illness (ISMIS) were administered. Three waves of measures were conducted, including pre-test, post-test and one-month follow-up. Generalized estimating equation (GEE) was used to examine the effect of compensatory cognitive training on psychosocial outcomes and self-stigma. Point-biserial correlation analysis, Pearson correlation analysis, and ANOVA were performed to examine the relationship between socio-demographic characteristics, psychosocial outcomes and self-stigma.
Results: Borderline significant result was found at post-test in the GSES score (p = .06) between the CCT group and the control group. Significant results were noted at one-month follow-up in the SQLS-R4 score (p = .002) and the ISMIS score (p = .02). No statistical difference was observed in RSES score (p > .05). With regard to correlations between socio-demographic variables and psychosocial outcomes, significant correlations were found between age and quality of life (p < .01). There were no significant associations of all of the socio-demographic variables with self-esteem, self-efficacy, and self-stigma (p > .05).
Conclusions: Our findings indicated that compensatory cognitive training for patients in schizophrenia might improve their self-efficacy, quality of life, and self-stigma.

並列關鍵字

compensatory cognitive training ； schizophrenia ； psychosocial outcomes ； self-stigma ； generalized estimating equation

參考文獻

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