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系統識別號 U0026-3108201620562500
論文名稱(中文) 水川模式(Kawa Model)治療性團體對愷他命使用者之成效探討
論文名稱(英文) The Effects of Kawa Model Therapeutic Group for Ketamine Users.
校院名稱 成功大學
系所名稱(中) 職能治療學系
系所名稱(英) Department of Occupational Therapy
學年度 104
學期 2
出版年 105
研究生(中文) 蕭涵憶
研究生(英文) Han-Yi Hsiao
學號 t76031034
學位類別 碩士
語文別 中文
論文頁數 86頁
口試委員 指導教授-汪翠瀅
召集委員-唐心北
口試委員-李俊宏
中文關鍵字 愷他命  物質使用障礙症  水川模式  改變動機  自我效能  生活品質  治療滿意度  戒治因子 
英文關鍵字 Ketamine user  substance abuse  Kawa model  motivation to change  self-efficacy  quality of life  group satisfaction  facilitators and barriers to abstinence 
學科別分類
中文摘要 研究背景與目的:愷他命使用近期在台灣成為嚴重的問題,影響患者心理、生理健康與生活品質,但我國針對愷他命使用者的社會心理處遇介入無一致性的標準處遇治療,且其成效探討少。而愷他命使用者多屬於非自願性治療之患者,因此在治療同盟建立更顯困難。水川模式(Kawa Model)以象徵之方式,將人生比喻為河流,透過以個案自我生活經驗(experience of daily life)之主體,使用繪畫與敘事方式進行處遇計畫。該模式是考量個案本身文化價值觀並高度以個案為中心的介入模式。過去研究也指出水川模式可創造一個舒適與安全的治療場域,幫助個案和治療者雙方共同溝通互動,提升個案的治療合作程度、促進個案治療願意。但目前尚未有水川模式介入愷他命使用的探討,因此本研究目的為探討水川模式(繪畫敘事治療性團體)處遇對愷他命使用者在藥物渴求、改變動機、自我效能與生活品質之成效與治療滿意度。

研究方法:本研究共招募68名20至39歲愷他命使用者,實驗組23名進行8小時「水川模式」團體(每週一次,每次2小時,共四次),對照組45名接受8小時「毒品危害講習」團體(單日8小時)。兩組受試者皆進行藥物渴求、改變動機、自我效能與生活品質之前後測評估,實驗組透過水川繪畫圖了解其戒治助力與阻力,並於每次團體結束進行滿意度評值。

結果:以重複量數二因子變異數分析(two-way ANOVA)檢驗兩組愷他命使用者接受8小時治療後在藥物渴求、改變動機、自我效能與生活品質之改變。實驗組透過李克特氏(Likert Scale)六點滿意度量表(1=完全不同意; 6=完全同意)瞭解治療滿意度,並透過水川繪畫圖分析其戒治因子。結果發現實驗組68.75%受試者其改變階段有變化;在改變階段量表的沉思期(df=1,F=9.78,p=0.003,d=0.15)與行動期(df=1,F=7.07, p=0.001,d=0.11)、整體綜合生活品質(df=1,F=5.05,p=0.029,d=0.083)兩組交互作用效果達顯著,其餘變項無達統計之顯著。影響愷他命使用者之生活(戒治)阻力包含:經濟、情緒壓力、愷他命(毒品)、法令罰則等;生活(戒治)助力包含:工作、朋友、家人、休閒興趣等。整體參與滿意度平均為5.37(SD=0.756),整體治療滿意度平均為5.38(SD=0.752)。

結論:水川模式團體可促進愷他命使用者改變階段之運作(特別是沉思期與行動期)、提升整體綜合生活品質、得到其治療喜好與治療滿意、確認自我生活(戒治)的危險與保護因子。但該模式仍無法顯著影響其藥物渴求、自我效能與其他生活品質層面,建議未來可提升樣本數、增加介入時間、追蹤後續成效,以了解治療介入的立即影響性與延續性效益。

關鍵字:愷他命;物質使用障礙症;水川模式;改變動機;自我效能;生活品質;治療滿意度;戒治因子
英文摘要 The Effects of Kawa Model Therapeutic Group for Ketamine Users
Han-Yi Hsiao
Tsui-Ying Wang
Department of Occupational Therapy
National Cheng Kung University


Summary

The Kawa model used the river metaphor to elicit the clients’ narratives of their day to day realities, and making the therapist-client interactions more comfortable and therapeutic for the clients. This study aims to explore the therapeutic effects of Kawa model for ketamine users, in terms of drug craving behavior, motivation to change, self-efficacy, quality of life, and the experiences with Kawa group. A sample of 68 ketamine users were randomly assigned to the Kawa model group (n=23) and the controls (n=45). The Kawa model group was a 4-week group meeting for 2 hours once a week, group processed with drawing the personal river, describing the life experiences with the river flow. The control group attended a full day substance abuse education course for 8 hours. The Kawa model group made significant improvements in overall quality of life and motivation to change, especially for contemplation and the action stages. From group experience, the drawing notes showed that the facilitators to abstinence were stable jobs, friends, family support, and leisure activities etc.; the barriers to abstinence were financial stress, negative emotions and stress, ketamine use, and legal issues etc. Average score for willingness to participate was 5.37; for group satisfaction was 5.38, based on a 6-point Likert scale. The findings suggest Kawa model group was a suitable intervention for ketamine users for a short term group therapy.

Keywords: Ketamine user; substance abuse; Kawa model; motivation to change; self-efficacy; quality of life; group satisfaction; facilitators and barriers to abstinence






BACKGROUNG AND PURPOSE

Ketamine use has become a serious problem for youths in Taiwan lately. Extended use of this kind of substance has detrimental effect on physical and mental health, as well as one’s quality of life. However, both medical and legal correction plans were not effectively implemented to increase the abstinence of Ketamine. Nevertheless, users with poor compliance toward the interventions were often associated with poor therapeutic alliance with the therapists. The reason may be that each party was holding discrete values and living rules that were not mutually accepted and recognized. An effective communication may change the relationship and make it become an enabler to the intervention.

Previous studies have showed that the Kawa (river) model creates a comfortable context and addresses problems defined by the client. By describing the life experience through drawing the river with river walls and bottom (symbolizing the circumstance), rocks (symbolizing the problems), driftwood (symbolizing personal assets and liabilities), water (symbolizing one’s life flow and health), the person’s expectations, assets and limitations were discovered. This strategy placed the persons at the center of his/her story without stigmatizing them by their problems, and that may enhance the self-awareness and motivation to change.

So far, no study has discussed the effects of Kawa model among ketamine users. Therefore, This study aims to explore the therapeutic effects of Kawa model for ketamine users, in terms of drug craving behavior, motivation to change, self-efficacy, quality of life, and the experiences with Kawa group. In addition, the study also investigate the factors that effects of abstinence from ketamine.


MATERIALS AND METHODS

Random sampling sixty-eight ketamine users assigned to the Kawa model group
(n = 23) and the control group (n = 45). On Kawa model group, the narratives of their life trajectory and the issues related to the drug use were also explored. The 4-week group met 2 hours once a week. Participants drew and shared their river images as well as their life experiences. Followed by discussions about these emerged life issues and the roles of drug in their life. The control group attended substance abuse education course. The 8 hours course once a day.

Both groups were assessed with drug craving, motivation to change, self-efficacy and quality of life before and after the interventions. Except pretest and posttest, this study examined the satisfaction of the Kawa model group experience for group participants.

RESULTS AND DISSCUSSION

The Kawa model group made significant improvement in overall quality of life (df=1, F=5.05, p=0.029, d=0.083) and motivation to change, especially at contemplation stage (df=1, F=9.78, p=0.003, d=0.15) and the action stage (df=1, F=7.07, p=0.001, d=0.11).

Analysis from 16 completed drawing and personal narratives, we found that the facilitators to abstinence were stable jobs, friends, family support, and leisure activities etc.; the barriers to abstinence were financial stress, negative emotions and stress, ketamine use, and legal issues etc.

Average scores for willingness to participate were 5.37(SD=0.756); satisfaction of the group was 5.38(SD=0.752). (6-point Likert scale; 1=strongly disagree, 6=strongly agree; no neutral rating).

This research found that, for ketamine users, group intervention based on Kawa model could improve therapist-client interaction and alliance, and reduce clients’ defensiveness demonstrated by willingness to tell their life stories from their perspectives. The client’s self-analysis of drawing increased the awareness and therapist-client mutual understanding of the barriers and facilitators with the abstinence issues. The Kawa model group made a significant improvement regarding overall quality of life and motivation to change, especially at contemplation and the action stage.

CONCLUSION

The subjective ratings of satisfaction and narrative findings support the use of Kawa model as an effective strategy in group intervention, and the Kawa model group have made improvement regarding overall quality of life and motivation to change. It is noted that four weeks of group therapy may be short for a substantial change of behaviors for this population, and which may undermine the effect on motivation to change. The present finding suggests an extension of intervention and a follow-up investigation to explore the effects of Kawa model on the ketamine users

論文目次 中文摘要------------------------------------------------------------------------------------------ I
英文摘要------------------------------------------------------------------------------------------ III
致謝------------------------------------------------------------------------------------------------ VI
目錄------------------------------------------------------------------------------------------------ VII
表目錄--------------------------------------------------------------------------------------------- X
圖目錄--------------------------------------------------------------------------------------------- XI
第壹章 前言-------------------------------------------------------------------------------------1
第一節 研究背景------------------------------------------------------------------------------1
第二節 研究目的------------------------------------------------------------------------------3
第貳章 文獻討論-------------------------------------------------------------------------------4
第一節 物質使用障礙症(愷他命使用者)定義------------------------------------------4
第二節 物質使用障礙症(愷他命使用者)對健康之影響------------------------------7
第三節 物質使用障礙症的疾病成因(含愷他命使用的成癮原因)------------------9
第四節 以跨理論(行為改變模式)說明物質使用障礙症之介入評估--------------16
第五節 以水川模式說明物質使用障礙症介入策略----------------------------------18
第六節 總結----------------------------------------------------------------------------------22
第參章 研究方法------------------------------------------------------------------------------23
第一節 研究架構----------------------------------------------------------------------------23
第二節 研究問題與研究假設-------------------------------------------------------------24
第三節 研究對象----------------------------------------------------------------------------25
第四節 研究流程----------------------------------------------------------------------------26
第五節 研究設計----------------------------------------------------------------------------28
第六節 研究工具----------------------------------------------------------------------------34
第七節 研究統計方法----------------------------------------------------------------------38
第肆章 研究結果------------------------------------------------------------------------------39
第一節 研究對象之基本資料-------------------------------------------------------------39
第二節 水川模式團體對愷他命使用者戒治改變之影響----------------------------41
第三節 水川模式團體對愷他命使用者自我效能層面之影響----------------------44
第四節 水川模式團體對愷他命使用者生活品質層面之影響----------------------45
第五節 影響愷他命使用者戒治之因素與治療回饋----------------------------------46
第六節 愷他命使用者參與水川模式團體滿意度成效-------------------------------47
第伍章 討論-------------------------------------------------------------------------------------49
第一節 愷他命使用特性探討-------------------------------------------------------------49
第二節 水川模式團體介入對愷他命使用者在戒治改變層面之探討-------------51
第三節 水川模式團體介入對愷他命使用者在自我效能層面之探討-------------53
第四節 水川模式團體介入對愷他命使用者在生活品質層面之探討-------------55
第五節 愷他命使用者參與水川模式團體滿意度之探討----------------------------56
第六節 影響愷他命使用者戒治因子之探討-------------------------------------------57
第七節 水川模式團體相較其他團體心理處遇之探討-------------------------------59
第陸章 結論與建議----------------------------------------------------------------------------61
參考文獻-----------------------------------------------------------------------------------------64
附錄-----------------------------------------------------------------------------------------------72
附錄一 基本資料問卷-------------------------------------------------------------------------72
附錄二 成癮嚴重度量表----------------------------------------------------------------------73
附錄三 藥物渴求量表-------------------------------------------------------------------------74
附錄四 一般自我效能量表-------------------------------------------------------------------75
附錄五 自尊量表-------------------------------------------------------------------------------76
附錄六 藥物使用信心量表-------------------------------------------------------------------77
附錄七 URIC改變階段中文量表----------------------------------------------------------78
附錄八 台灣簡明版生活品質問卷---------------------------------------------------------81
附錄九 團體紀錄評值問卷與團體活動執行表------------------------------------------83

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