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系統識別號 U0026-0601201310101100
論文名稱(中文) 強化執行功能之團體神經心理治療的成效研究─以高身心症狀抱怨青少女為例
論文名稱(英文) The Effects of Group-Based Neuropsychotherapy on Executive Function for Adolescent Girls with Somatic Symptoms.
校院名稱 成功大學
系所名稱(中) 行為醫學研究所
系所名稱(英) Institute of Behavioral Medicine
學年度 101
學期 1
出版年 102
研究生(中文) 張凱茵
研究生(英文) Kai-Yin Chang
學號 s86981036
學位類別 碩士
語文別 中文
論文頁數 87頁
口試委員 指導教授-郭乃文
口試委員-謝碧玲
口試委員-林麗娟
中文關鍵字 身心症狀  執行功能  神經心理治療  團體情境 
英文關鍵字 Somatization syndromes  Executive function  Neuropsychotherapy  In Group 
學科別分類
中文摘要 目的:高身心症狀抱怨在青少年族群的盛行率相當高,其中女性比男性有較多的身心症狀抱怨;而身心症患者常見有不佳的執行功能。且身心症狀抱怨影響對青少年自我身心健康的評價影響深遠並能預測其未來的身心健康。前額葉系統主導的執行功能使個體能夠自我調控其身心理健康狀態,而執行功能可以透過訓練而增強。但此增加神經心理功能的訓練概念,目前仍少見應用在高身心症狀抱怨之對象。此外,青少年時期是前額葉系統趨向完整發展之重要階段。故本研究欲建構以增強執行功能為目標之「強化自我監控功能之放鬆訓練團體」,並檢驗其對提升高身心症青少女之身心健康自我調控的成效。
方法:本研究採混合設計。受試者為某台南市某女中99學年度經身心生活適應量表篩選,符合第二級預防篩選標準「主觀抱怨多項身心症狀且抱怨數多於母樣本平均數兩個標準差以上」之青少女。在1136名高中職學生中,有134名符此標準,身心症狀抱怨數達19~26項;其中47名自願參與本研究並取得家長同意書。本研究包括兩個研究,依照受試者可參與之時間分派至研究一與研究二。研究一於99學年度上學期進行,實驗組一共17名隨機分派至第一梯的兩個治療團體,30名等待介入者則為控制組;等待介入組中有14名於下學期進入第二梯之兩個治療團體為實驗組二,以此作為研究二之受試者來檢驗本研究本案的可複製性。方案設計以增進執行功能為核心目標,訓練包括專注覺察、認知彈性與計畫行動以及自我監控之心智功能。兩梯團體之前後及追蹤測均使用電腦化身心生活適應量表、身體覺察能力量表、青少年版執行功能行為量表、一般性自我效能量表來評估身心狀況與自我調控功能。以團體治療因素量表評估團體歷程。
結果:研究一的身心健康報告方面,實驗組一與控制組在身心症狀抱怨數上皆達前後測顯著差異;實驗組一比控制組自評健康有進步,交互作用達顯著。自我調控功能方面,實驗組一在身體覺察、執行功能及一般性自我效能皆較控制組進步,交互作用達顯著。研究二將實驗組一與實驗組二之資料合併,並加入追蹤測量之結果。將實驗組一、實驗組二及純控制組在其各自的測量時間點上之變化分別呈現。身心健康報告方面,兩組的身心症狀抱怨數於後測與追蹤皆較前測顯著下降,追蹤時與後測相比無顯著差異;實驗組之健康自評於後測與追蹤皆較前測有顯著進步,追蹤時與後測相比無顯著差異。自我調控功能方面,實驗組的各項指標在後測與追蹤皆較前測顯著進步,追蹤跟後測相比無顯著差異。結果反映出實驗組一與實驗組二在接受本研究方案訓練前後與追蹤時,所呈現的相似進步趨勢,因此能夠支持本研究方案的穩定性與可複製性,且透過追蹤顯示實驗組的進步維持穩定。
另外,實驗組的多項團體療效因子的分數於中期與後期皆顯著地高於前期,中期到後期則無顯著差異。顯示團體成員對團體的正向感受隨著團體的進程逐漸增加且穩定。
討論:本研究以兩階段共四個團體證實強化執行功能的神經心理治療方案,能有效改善受試者之健康自評與提升身心健康之自我調控,達中等至高強度之進步效果量。未來應持續探討此治療模式之療效穩定度與應用於其他對象之效果。
英文摘要 Purpose:To investigate the efficacy of a group-based neuropsychotherapy on executive function in adolescent girls with somatic symptoms and to evaluate the effect on enhancing their self-regulation ability.
Method: The research was composed of two studies. Subjects were recruited from the girls ' senior high school and were eligible to participate as they had 19-26 physical complaints with poor subjective health ratings on the Computerized Adjustment Check List (N=134). After obtaining the informed consent from 47 of them, they were randomly allocated to two training groups (N = 17) or a wait-list control arm (N = 30) in study 1. Another subjects came from the wait-list control arm (N = 14) were randomly assigned to two training groups in study 2. The brain-based executive function training program is designed to improve one's self-regulation ability. The activities in the program put emphasis on training their self-awareness, planning, purposive action and self-monitor abilites. Both experimental and control groups completed the pre and post test questionnaires. The data were collected by Computerized Adjustment Check List, Executive Function Scale, Body Awareness Ability Inventory, and General Self-Efficacy Scale. Group Therapeutic Factor Inventory is used to evaluate the process of group situation. Two-way ANOVA and paired-t test was used.
Results: In study 1, both two groups demonstrated significant decrease in somatization symptoms on the pre-post comparisons. Physical-mental health self-report improvement was significantly greater in the experimental group than in the control group. The interaction was significant. Eexperimental group significantly improved their performance on each index of self-regulation measurement such as body awareness, executive function, and self efficacy compared with those in the control group. The interaction was also significant.
The experimental groups’ data from all four training groups were merged together in study 2. Both experimental and control groups demonstrated significant decrease in somatization symptoms on the pre-post, pre-follow up comparisons. Physical-mental health self-report and each index of self-regulation measurement were significantly improved in the experimental groups on the pre-post, pre-follow up comparisons. And there was no significant difference on all the post-follow up comparisons. Besides, experimental group in the study 2 shows the similar progress trend to those in the study 1. Both of them improved on every measuements and could maintain improved performance. The results suggest that the training program is repeatable.
Besides, there were many scores on the Group Therapeutic Factor Inventory significantly increased on the pre-medium, pre-post term comparisons. And there was no significant difference on the medium-post term comparisons. It suggested that subjects had positive view toward groups and almost maintained stable.
Conclusions: In summary, the executive functions of experimental groups were improved by training that allows them to utilize their self-regulation abilities. Subjects can benefit from the group-based neuropsychotherapy that improving the subjective feelings of health and the efficacy of self-regulation. And the effect size was medium to large (.06≦η2≦.27).We are going to explore the stability of therapeutic effect and the application for other kinds of subjects.
論文目次 第壹章 緒論 - 1 -
第一節、執行功能對身心健康的調控 - 1 -
一、 執行功能的定義 - 1 -
二、 執行功能與自我身心健康調控功能 - 4 -
三、 青少年期的執行功能發展與可塑性 - 7 -
第二節、高身心症狀抱怨之探討 - 10 -
一、 青少年常見的高頻率身心症狀抱怨與成因 - 10 -
二、 高身心症狀抱怨者的執行功能 - 14 -
三、 高身心症狀的心理治療 - 16 -
第三節、神經心理治療與團體情境 - 22 -
一、 神經心理治療 - 22 -
二、 執行功能與團體情境之療效 - 26 -
第四節、 研究動機與問題假設 - 30 -
一、 研究動機 - 30 -
二、 問題假設 - 31 -
第貳章 研究方法 - 32 -
第一節、研究設計與流程 - 32 -
第二節、研究對象 - 34 -
一、 受試者篩選與招募 - 34 -
二、 受試者分派 - 35 -
第三節、研究工具 - 35 -
一、 身心狀況與執行功能量表 - 36 -
二、 強化執行功能之團體神經心理治療訓練方案 - 41 -
三、 團體歷程之評估 - 44 -
第四節、統計分析 - 46 -

第參章、研究結果 - 47 -
第一節、受試者基本資料 - 47 -
第二節、團體神經心理治療成效分析 - 48 -
一、 研究一之訓練成效 - 48 -
二、 研究二之訓練成效 - 52 -
第三節、團體歷程監控指標 - 59 -
第肆章、討論 - 61 -
第一節、強化執行功能之團體神經心理治療之訓練結果分析 - 61 -
一、 身心症狀抱怨數 - 61 -
二、 主觀健康自評 - 62 -
三、 自我調控功能 - 62 -
第二節、本研究之療效與過去神經心理治療效果的對照 - 64 -
第三節、本研究之神經心理治療方案的特點 - 66 -
一、 方法學之設計 - 66 -
二、 與傳統治療方式之比較 - 67 -
三、 治療特色 - 69 -
第三節、研究限制 - 71 -
第四節、研究貢獻與未來展望 - 71 -
參考文獻 - 73 -
中文部分 - 73 -
英文部分 - 74 -
附錄 - 85 -
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