具被害妄想症狀之精神分裂症患者的歸因偏誤

Attributional Biases in Schziophrenic Patients With Persecutory Delusions

詹盈盈(Ying-Ying Tsan)

指導教授 ： 洪福建

中原大學/理學院/心理學系/碩士(2007年)

https://doi.org/10.6840/cycu200700756

摘要

摘　要

研究背景與目的 被害妄想是最常見的妄想類型，近年來受到許多研究的重視。隨著社會認知典範興起，許多精神分裂症之研究漸以症狀學取向為主。以學者Bentall及其同事為主的一系列研究，發現被害妄想患者有異常之歸因型態，傾向對正向事件作內歸因，負向事件作外歸因，是一種極度的自利偏誤(self-serving bias)。並認為這樣的認知偏誤與抵抗潛在的內在憂鬱與低自尊有關，是一種防衛的機制，因而導致外顯與內隱的歸因型態會不相同。但至目前為止相關研究尚未有一致的定論。本研究目的是欲瞭解精神分裂症被害妄想患者的歸因型態，是否有所謂的歸因偏誤存在，又此歸因偏誤是否在外顯與內隱的表現上有不一致。

研究方法 本研究共選取60名受試者，分為精神分裂症被害妄想組、精神分裂症非妄想組、憂鬱症組、正常控制組，每組共15人。使用英譯中之外顯(CIPSAQ)與內隱(CPIT)歸因量表，比較各組分數表現。另使用141名大學生受試者，進行兩翻譯量表的初步信度考驗與CIPSAQ的效度考驗。

研究結果 外顯歸因中，精神分裂症被害妄想組之自利偏誤歸因分數(EB值)t考驗達顯著，但負向事件外在他人偏誤歸因分數(PB值)未達顯著;四組在三歸因向度(內在、外在他人、外在環境)都未有組間之顯著差異。內隱歸因中，精神分裂症被害妄想患者之EB值有減少的情形，但四組分數亦無組間之顯著差異。在大學生樣本中，發現翻譯之外顯歸因量表CIPSAQ有良好的信度，而內隱歸因量表CPIT信度不佳。

結論 研究僅部分證實具有被害妄想症狀之精神分裂症患者在外顯有極度之自利偏誤歸因。在內隱歸因的部分，精神分裂症被害妄想患者雖出現自利偏誤歸因減少的情形，但與過去研究相比，並未達到所謂之憂鬱型態歸因。整體來說，縱然無法證實被害妄想患者的自利偏誤歸因是抵抗內隱憂鬱之防衛機制，但在趨勢上與研究預期是一致的。最後，文中亦指出一些研究可能的限制及受干擾的因素並討論未來研究之方向。

關鍵字

歸因型態 ； 被害妄想 ； 精神分裂症 ； 自利偏誤

並列摘要

Background and purpose. Persecutory delusions are the most common type observed in clinical practice and have recently become the focus of empirical researches. Because of the rising of the paradigm of social cognition, symptomatology has become the major research aspect in schizophrenia. Among these researches, Bentall et.al. noticed that patients with persecutory delusions tended to attribute negative events to external causes and positive events to internal causes, which was likely an extreme form of the self-serving bias. They suggested that persecutory delusion was a defense mechanism to protect the implicit low self-esteem and depression. However, a consistent conclusion has not been reached so far. Therefore, the aim of this research is to investigate if there is attributional bias in the schizophrenic patients with persecutory and if there are differences between overt and covert attributions.

Methods. A total of 60 subjects were recruited, and classified as schizophrenia with persecutory delusion、schizophrenia with non-delusion、depression and control group. Each group has fifteen individuals. The attributional styles of all groups were measured and compared by using a translated (English to Chinese) overt (CIPSAQ) and covert (CPIT) attributional questionnaire. In addition, 141 undergraduates were recruited to examine the reliability of the both questionnaires and the validity of the CIPSAQ.

Results. In overt attribution, a t-test conducted on the scores of externalizing bias (EB) reveals significance in schizophrenic patient with persecutory delusions, but not the personalizing bias(PB). The four groups show no significant differences in any of the internal, personal or situational attributions. In covert attribution, EB in schizophrenic patients with persecutory delusions is declined, but there are no significant differences between groups. In the undergraduate sample, the reliability of the CIPSAQ is good while the CPIT is not.

Conclusions. The study only partially demonstrates the overtly extreme self-serving bias in schizophrenic patients with persecutory delusions. Although the covert self-serving bias is declined in schizophrenic patients with persecutory delusions, it is not large enough to be considered defensive when comparing to the past researches. As a whole, the study might not replicate those of previous studies in demonstrating excessively self-serving bias that is defensive mechanism to protect the underlying low-self esteem and depression, but the tendency can be found. Other factors that influence the study and future implications are discussed.

並列關鍵字

schizophrenia ； persecutory delusion ； attributional style ； self-serving bias

參考文獻

顏詩尹(民95)。精神分裂症妄想症狀、心智理論能力和執行功能之相關探討。中原大學心理學研究所碩士論文，未出版，桃園縣。

Freeman, D., & Garety, P. A. (2002). Cognitive therapy for an individual with a long-standing persecutory delusion: Incorporating emotional processes into a multi-factorial perspective on delusional beliefs. In A. P. Morrison (Ed.), A casebook of cognitive therapy for psychosis. (pp. 173-196)Brunner-Routledge.

Maher, B. A. (1988). Anomalous experience and delusional thinking: The logic of explanations. In T. F. Oltmanns, & B. A. Maher (Eds.), Delusional beliefs. (pp. 15-33)John Wiley & Sons.

Abramson, L. Y., Metalsky, G. I., & Alloy, L. B. (1989). Hopelessness depression: A theory-based subtype of depression. Psychological Review, 96(2), 358-372.

Abramson, L. Y., Seligman, M. E., & Teasdale, J. D. (1978). Learned helplessness in humans: Critique and reformulation. Journal of Abnormal Psychology, 87(1), 49-74.