具被害妄想之精神分裂症患者的歸因偏誤與心智理論能力缺陷之探討性研究

The Study Between Attributional Biases and Theory-of-Mind Deficits for Schizophrenia With Persecutory Delusions

劉麗棠(Li-Tang Liu)

指導教授 ： 洪福建

中原大學/理學院/心理學研究所/碩士(2012年)

https://doi.org/10.6840/cycu201200058

摘要

研究背景與目的. 在社會認知領域中，社會歸因和心智理論能力被視為提供個體理解與解釋他人行為及意圖的功能，近年來國內外學者也紛紛嘗試用社會歸因模式與心智理論來解釋被害妄想，認為被害妄想患者的歸因型態具有極度的自利偏誤（exaggerative self-serving bias），且傾向對負向事件做出外在他人歸因的方式，而在心智理論能力的表現上是具缺陷的。對於被害妄想患者具有異常的歸因型態，由Kinderman, Dunbar, ＆ Bentall(1998)提出與心智理論能力的缺損有關，由於心智理論能力的缺損使得被害妄想患者無法瞭解他人意圖及心理狀態，而做出對社會情境歸因的異常偏差現象，但相繼國內外的相關研究卻鮮少將兩者一同進行探討，且由於存在著使用不同的研究方法、不同的症狀取樣方式而造成眾多結果的不一致性與理論上的爭議，因此本研究欲瞭解具被害妄想的精神分裂症患者是否有所謂異常的歸因型態，而在不同的病程表現上是否為一致，以及此歸因偏誤是否存在與心智理論缺陷間的交互影響關係，而促使被害妄想之形成。
研究方法. 本研究採立意取樣方式，共選取29名以被害妄想為主的精神分裂症患者，並區分為活躍期被害妄想組15人與緩解期被害妄想組14人，另招募社區居民15名作為對照控制組。使用中文版內在、他人及環境歸因量表（CIPSAQ）及次級錯誤信念作業(2nd Order False Belief Task)，比較各組分數之差異表現，以及各分數間的交互影響關係。
研究結果.在歸因量表CIPSAQ的表現上，三組於EB值與PB值皆無顯著差異，而在次級錯誤信念作業，當控制智力因素，活躍期被害妄想組較緩解期被害妄想組有較差的表現（達邊緣顯著性）。此外，在被害信念嚴重程度上，與EB值有顯著正相關，與錯誤信念分數則有顯著負相關，經由逐步迴歸分析檢定結果，證實EB值與次級錯誤信念分數可對被害信念嚴重程度具顯著的解釋力，但歸因偏誤指標與心智理論能力間的交互作用關係並不顯著。
結論.本研究雖無法證實具被害妄想症狀之精神分裂症患者處於不同病程階段，其歸因型態與心智理論能力缺損之表現有顯著差異，但整體來說，與過去研究相比，趨勢上仍與研究的假設預期是一致的，即活躍期被害妄想者較緩解期患者有較高的歸因偏誤型態，以及較差的心智理論能力表現，且自利偏誤與心智理論能力缺損是可分別作為預測被害妄想嚴重程度的指標因子；當進一步分析在心智理論能力表現低分者，確實有較高的外在他人歸因傾向，推測心智理論能力缺損在被害妄想患者的推論異常歷程中仍存有交互影響之關連性。最後，研究者於文中提出研究可能的限制與干擾因素，並建議未來研究之方向。

關鍵字

精神分裂症 ； 被害妄想 ； 歸因偏誤 ； 心智理論

並列摘要

Background and Purpose. In the paradigm of social cognition, social attribution and theory of mind provide individuals to understand and explain people’s behavior and intention. During these years, scholars tried to explain the formation of persecutory delusions by using social attribution and theory of mind. They suggested that patients with persecutory delusions tended to attribute negative events to external-personal causes and positive events to internal causes, which was likely an exaggerative self-serving bias. Kinderman, Dunbar, ＆ Bentall(1998) suggested that abnormal attributions for patients with persecutory delusions is related to the deficits of theory-of mind, which caused patients unable to understand others’ intentions and mentality. Because of this, schizophrenic patients with persecutory delusion is considered to have attributional bias. However, only few researches were conducted in both abnormal attributions and deficits of theory-of-mind. As a resut, different methods and symptomatology used among theses researches lead to inconsistent and controversial point of view. Hence, this research will aim at investigating the abnormal attributional bias , deficits of theory-of-mind ,and their interaction of each other by apply differential courses to schizophrenic patients with persecutory delusion.
Methods. A total of 29 Schizophrenic patients with persecutory delusion. The 15 patients were classified as acute persecutory delusion(APD), and 14 were classified as remitted persecutory delusion(RPD). They were assessed and compared by a translated (English to Chinese) attributional questionnaire (CIPSAQ) and task of theory-of-mind (2nd Order False Belief Task) with 15 healty controls.
Results.The three groups show no significant differences in EB and PB. Patients with APD presented poor performance of 2nd Order False Belief Task than patients with RPD. The EB and poor performance of 2nd Order False Belief Task are significant relation to level of persecutory delusion. The interaction of attributional bias and deficits of theory-of-mind were not supported。
Conclusion. The results show the inconsistent findings with hypotheses. But when comparing to previous studies, there were consistent tendency to find. Patients with APD have more self-serving bia and more inability of theory-of-mind than patients with RPD. And Self-serving bias and deficit of theory-of-mind can be an index of persecutory delusion, respectively. In addition, the deficit of theory-of-mind related to higher external-personal attribution. Indicate that attributonal bias and theory-of-mind might still influence each other. Other factors that influence study and future implications were discussed.

並列關鍵字

schizophrenia ； persecutory delusion ； theory of mind ； attributional bias

參考文獻

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