神經回饋訓練對於憂鬱症患者之介入效果：個案報告

目的：文獻指出憂鬱症患者之前額葉功能低落很可能是造成其執行功能缺損的關鍵因素，故能提升前額葉活動的介入方式將有助增進個案的執行功能與情緒調控效能。神經回饋訓練可有效改變大腦特定區域的活動程度並能提升認知表現，近年來已被運用於憂鬱個體的治療中。方法：本研究以三名臨床憂鬱症門診患者為對象，檢視接受神經回饋訓練對症狀嚴重度、認知功能之影響效果。三位個案依序接受前測、神經回饋訓練階段、後測等三階段。神經回饋訓練方式是以視覺回饋提升額葉高頻α波活動，每次50分鐘，每週兩次，共10次。結果：結果顯示本研究使用的神經回饋訓練程序可有效提升憂鬱症患者的額葉高頻α活動。相較於前測，接受訓練後患者之憂鬱症狀與苦惱自責反芻皆有明顯降低。此外，三名個案中的兩位病情較嚴重的患者之執行功能表現亦有顯著提升。結論：整體而言，本研究結果支持神經回饋訓練具有正向介入效果，值得後續深入研究與臨床推廣。因本研究屬於初探性質，樣本人數較少，故在結果推論仍有所限制。本文亦將根據對憂鬱患者的治療經驗，提供執行神經回饋訓練時的參考建議。

關鍵字

憂鬱症；神經回饋訓練；執行功能；憂鬱症狀；反芻

並列摘要

Objectives: The literature indicated that the impairment in prefrontal function is a possible mechanism of executive dysfunction of the depressed patients. Thus, an intervention that can increase prefrontal activity is expected to enhance depressed patients' executive function and emotion regulation ability. Neurofeedback training (NFT) can effectively change neural activities and enhance individuals' cognitive function. NFT had already been applied to the intervention of depressed patients recently. Methods: This study is a case report for three outpatients diagnosed with major depressive disorder (MDD). The effects of NFT on patients' depressive symptomatology and cognitive function were examined. This NFT was designed to increase prefrontal upper α activity by providing visual feedback. The participants received 10 sessions of NFT (50 minutes each), twice a week over five weeks. The results show that this NFT can enhance the prefrontal peak α frequency of depressive patients. Results: The result supports the trainability of one's upper α activities by the present NFT protocol. In comparison with those in the pre-training, both the severity of the depression symptoms and the level of brooding rumination were both decreased. This result provides supportive evidence of this NFT has positive treatment effects for depressed patients. Besides, two of three patients' performances in the executive function tasks were enhanced. Conclusions: Overall, the results provide preliminary supportive evidence of the present upper α NFT in depressive patients. However, caution is needed in interpreting the results due to the small sample size. More future empirical studies with larger sample sizes and follow-up examinations of the treatment effects are needed. Some experiences and suggestions for conducting NFT on depressive patients are also discussed. The authors believe that this upper α NFT is suitable for intervening clinical depressed patients.

並列關鍵字

depressive disorder ； neurofeedback training ； executive function ； depression ； rumination

參考文獻

廖御圻、林育岑、郭乃文、黃冠堂、蘇倍儀（2016）。運用神經回饋訓練之神經心理治療模組於重度腦傷患者改善執行功能效果分析 ─個案報告。臨床心理學刊，10(2)，31–49。https://doi.org/10.6550/ACP. 201612_10(2).0003

Angelakis, E., Lubar, J. F., & Stathopoulou, S. (2004). Electroencephalographic peak alpha frequency correlates of cognitive traits. Neuroscience Letters, 371(1), 60–63. https://doi.org/10.1016/j.neulet.2004.08.041

Arns, M., Etkin, A., Hegerl, U., Williams, L. M., DeBattista, C., Palmer, D. M., Fitzgerald, P. B., Harris, A., deBeuss, R., & Gordon, E. (2015). Frontal and rostral anterior cingulate (rACC) theta EEG in depression: Implications for treatment outcome? European Neuropsychopharmacology, 25(8), 1190-1200. https://doi.org/10.1016/j.euroneuro.2015.03.007

Auerbach, R. P., Webb, C. A., Gardiner, C. K., & Pechtel, P. (2013). Behavioral and neural mechanisms underlying cognitive vulnerability models of depression. Journal of Psychotherapy Integration, 23(3), 222–235. https://doi.org/10.1037/a0031417

Basso, M. R., Lowery, N., Ghormley, C., & Bornstein, R. A. (2001). Practice effects on the Wisconsin Card Sorting Test-64 card version across 12 months. The Clinical Neuropsychologist, 15(4), 471–478. https://doi.org/10.1076/clin.15.4.471.1883

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神經回饋訓練對於憂鬱症患者之介入效果：個案報告

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