內觀認知治療團體於憂鬱症緩解患者之療效研究

Abstract

探討內觀為本認知治療對憂鬱症緩解患者之治療效果已有許多研究成果，但國內研究相當少。本研究目的欲以內觀為本的認知治療團體進行療效探討，研究者假設經過團體後可改善個案憂鬱及認知導向策略。研究對象為十位完成團體之門診憂鬱症緩解患者於團體前、後及五個月的追蹤期填寫研究問卷，並接受團體過程的錄影錄音，十三位未來有意願參與團體之門診憂鬱症緩解患者做為對照組。研究方法：採量化與質性研究分析，量化研究工具有五份：基本資料表、貝克憂鬱量表、負向自我思考習慣量表、心智專注覺察量表、自我監控覺察量表，質性資料為十位參與者團體歷程逐字稿文本內容進行資料分析。結果發現：1. MBCT團體的療效實驗組與對照組相比在憂鬱總分、憂鬱的身體－情感向度及憂鬱的認知向度的變化上皆有顯著的改變，並達到高度效果量；在心智專注覺察上分數差異接近顯著，有高度效果量；在主觀壓力感受、負向自我思考及自我監控覺察上則沒有顯著的差異。2.就MBCT團體追蹤後持續的療效看，實驗組於團體結束後在憂鬱總分、憂鬱的身體－情感向度、負向自我思考、心智專注覺察與自我監控覺察上皆有顯著的改善，且具中度至高度的效果量；在主觀壓力感受及憂鬱的認知向度上則無顯著改變。而實驗組從團體開始至追蹤期間在憂鬱總分、憂鬱的身體－情感向度、負向自我思考、與自我監控覺察上有顯著的改變，且具中度至高度的效果量；在心智專注覺察上則未顯現出明顯的改變，但仍具高度的效果量；在主觀壓力感受及憂鬱的認知向度上則無顯著差異。質性分析發現：MBCT能影響憂鬱症緩解患者內在運作中的兩類認知能力及兩類態度，包含：注意力的自我調節、認知的自我監控、特殊態度傾向、意圖與有效益的生活態度，而此四種與內觀運作有關的核心元素會隨著八週的內觀學習歷程逐漸轉化，且彼此相互影響，以調節患者的身心狀態，使其有效面對生活處境。研究者據此結果加以討論，並提出未來研究的方向及實務應用的重點以供參考。

Rare studies about effects of mindfulness-based cognitive therapy(MBCT） used in remission phase of depressive patients in Taiwan. The purpose of this research aimed to apply MBCT group therapy in those patients who came from psychiatric OPD to explore the outcome of MBCT, and researcher hypothesized that patients’ depressive mood and cognitive-oriented tactics will improve after MBCT treatment. Research participators included ten treatment group members they attended 8 weeks group program and also completed research scales at the group beginning, end group and five months follow-up, and accepted videoing and taping in group. Thirteen patients were control group members who will wait for MBCT treatment. Research methods: This research acquired quantified outcome from five scales: personal information, BDI-II, the habit of negative self-thinking scale, mindful of attention awareness scale, self-monitoring awareness scale, and obtained qualitative results from analyzing the verbatim of eight weeks group process. Quantified results: 1. The treatment group’s depression, depressive physical-affective dimension and depressive cognitive dimension had significantly lower than the control group’s after MBCT treatment, reaching large effect size, two groups were nearly significant difference in mindful attention awareness, reaching large effect size, but they had no difference in subjective stress feeling, the habit of negative self-thinking, and self-monitoring awareness. 2. The treatment group’s depression, depressive physical-affective dimension, the habit of negative self-thinking, mindful attention awareness, and self-monitoring awareness had significantly difference after MBCT treatment, reaching medium to large effect size, but their subjective stress feeling and depressive cognitive dimension had no difference. Their depression, depressive physical-affective dimension, the habit of negative self-thinking, self-monitoring awareness had significantly difference in five months follow-up, reaching medium to large effect size; although their mindful attention awareness had no difference, it still reached large effect size. However, their subjective stress feeling and depressive cognitive dimension had no difference in five months follow-up. Qualitative research found that MBCT treatment could impact depression remission patients’ two cognitive abilities and two attitudes, including: self-regulation of attention, self-monitoring awareness, exceptional attitude orientation, intention and beneficial life manners. Those core elements were relating each other during the mindfulness practicing process and gradually transformed into more mindful in 8 weeks learning course by way of adjusting patients’ physical and mental health and living validly. Based on the findings, researcher took discussions and provided suggestions as references for future studies and practices.