強迫症與思考行動混淆：負向想法、負向自我評價與反應時間的角色

Obsessive-Compulsive Disorder and Thought-Action Fusion: The Roles of Negative Thoughts, Negative Self-Worth Evaluation, and Reaction Time

黃國甄(Guo-Zhen Huang)

指導教授 ： 張素凰

國立臺灣大學/理學院/心理學研究所/碩士(2016年)

https://doi.org/10.6342/NTU201600903

摘要

思考行動混淆常見於強迫症病人，他們易認為「想法即是行動」（Salkovskis, 1985），當產生包含禁忌行為的強迫思考時，他們傾向將之視為道德上、儼然已實行的等價，這些想法使得強迫症病人感到罪惡，並且自我詆毀（Rachman, 1993）。本研究旨在探討影響思考行動混淆的因素，並且提出一個思考行動混淆可能的形成機制。Hayes（2004）提出關聯框架理論（relational frame theory），認為語言是透過事物間的各種關聯學習而來的概念，Collins與Loftus（1975）提出語意記憶處理的擴散激發理論，認為人的語意記憶是以網絡的形式組成，而本研究則進一步假設：過去的學習經驗讓事物之間產生了連結，而高、低程度不同的思考行動混淆的個體，在其對事物的語意激發歷程中，對產生的想法與其後引發對自己的負向評價之間的反應時間不同。本研究在第一階段藉由相關法，先檢驗思考行動混淆、強迫症傾向與個人負向信念評價之關係，在第二階段藉由實驗法進一步檢驗高、低思考行動混淆程度的個體在想法至負向評價間的反應時間是否不同。藉由字詞判斷作業，第二階段的實驗設計為2×3因子的混合設計，第一因子為「思考行動混淆程度」，分為高思考行動混淆程度與低思考行動混淆程度二組；第二因子為「刺激詞類型」，分為「一般負向詞類」、「強迫詞類」與「中性詞類」三類型。第一因子為受試者間設計，第二因子為受試者內設計。本研究預測，思考行動混淆程度與強迫症症狀傾向呈正相關，且兩者皆與負向自我評價程度呈正相關；另外，相對於面對中性想法而言，在面對負向想法（即一般負向詞類及強迫詞類）時，思考行動混淆程度高者，其想法與負向評價之間的反應時間，應顯著的小於思考行動混淆程度低者。本研究邀請102位參與者填寫量表及進行字詞判斷作業，最後進入字詞判斷作業資料分析的參與者為思考行動混淆量表得分在40分以上者或18分以下者，分為高、低思考行動混淆程度兩組。研究結果顯示，思考行動混淆程度與強迫症症狀傾向呈正相關，且兩者皆與負向自我評價程度呈正相關。另外，字詞判斷作業之結果顯示，在負向想法詞彙的促發下，思考行動混淆程度高者，其負向想法與負向評價間的反應時間顯著的小於低思考行動混淆程度者。本研究結果與假設相符，顯示當語意記憶網絡之一般負向詞類及強迫症狀概念被激發時，高思考行動混淆程度者對相對應之負向評價概念的辨識速度較為快速。因此，本研究建議在探討強迫症與思考行動混淆之關係時，需考慮負向自我評價在思考行動混淆的重要性，並據以擬定相關治療策略。本研究亦針對未來相關臨床研究及治療介入的可能性提出討論。

關鍵字

強迫症 ； 思考行動混淆 ； 擴散激發理論 ； 關聯框架理論 ； 字詞判斷作業

並列摘要

Thought-action fusion (TAF) is a phenomenon associated with patients with obsessive-compulsive disorder (OCD). Patients with TAF are prone to believe that “Thinking it is doing it”. When their obsessions relate to forbidden actions, they tend to view the obsessions as being morally equivalent to performing them in reality, and these thoughts lead to guilt and self-denigration. (Rachman, 1993) The goal of this study was to investigate factors influencing TAF, and to propose a hypothetic mechanism of it. Hayes (2004) proposed relational frame theory (RFT), suggesting that language is learned through different relations between events. Collins and Loftus (1975) proposed spreading activation theory (SAT) on semantic memory. In their hypothesis, semantic memory is composed in the form of a network. According to the theories above, we further hypothesized that learning experiences in the past form connections between events. People with different level of TAF (high/low) would have different reaction times from the onset of negative thought to their subsequent negative self-evaluations. The first part of the study aimed to explore the relations between TAF, OCD, and the negative self-worth evaluation through correlational approach. In the second part, using lexical decision task, we examined whether there would be a difference on the reaction times from the onset of negative thought to the subsequent negative self-evaluation between participants with different levels of TAF (high/low) groups. An experiment with 2 (TAF group: high/low)×3 (type of the word-sets: general negative/obsessive-compulsive/neutral) mixed factorial design was conducted, with the first factor being between Ss factor, and the second factor being within Ss factor. We hypothesized that level of TAF would be positively correlated with OCD tendency, and both the level of TAF and OCD tendency would positively correlated with level of negative self-worth evaluation. We also hypothesized that, compared with neutral thoughts, the reaction times from the onset of negative thought (composed of general negative and obsessive-compulsive word sets) and their subsequent negative self-evaluation in the high TAF group would be shorter than their low TAF group counterparts. A total of 102 participants completed the questionnaires and performed the lexical decision task. For the data analysis of lexical decision task, we assigned those who scored higher than 40 points and lower than 18 points to be the high and low TAF groups, respectively. The results showed that level of TAF was positively correlated with the level of OC symptoms, and both of which were positively correlated with the level of negative self-evaluations. The results of lexical decision task showed that under the priming effect of wordsets of negative thoughts, the reaction times were shorter for the hight TAF group compared to those of the low TAF group. Our study suggests that when the semantic memory network of general negative/obsessive-compulsive related concepts is activated, those who have high level of TAF have faster reaction time in recognizing corresponding negative evalutions. Therefore, we suggest that negative self-evaluation in TAF paly an important role in the relationship between OCD and TAF, and propose some possible subsequent treatment strategies, accordingly. The related clinical applications are also discussed.

並列關鍵字

obsessive compulsive disorder ； thought-action fusion ； spreading activation theory ； relational frame theory ； lexical decision task

參考文獻

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