臺灣博碩士論文加值系統

憂鬱症為目前最普遍的心理健康問題之一，且對個人、社會造成的負擔不斷增加，仍需更多完善治療的建立。目前國內外研究結果顯示認知治療對於憂鬱症有顯著的療效及對預防復發的效果。但憂鬱除了影響個體認知層面，主要症狀表現皆與情緒有關，且憂鬱症患者情緒能力的展現確有不足之處，如：傾向注意負向訊息、習慣用芻思、逃避的方式處理情緒等。因此本研究將以憂鬱症患者的情緒經驗為介入焦點，結合認知治療架構及情緒能力的教導，發展一套團體治療療程，並探討療程介入是否有助於改善症狀及提升情緒能力，及症狀變化與情緒能力變化的關係。由於研究顯示持續之治療療效較單一療程佳，因此本研究的階層式情緒焦點認知治療團體（第二階段，七次團體）與林家如（2006）研究中的情緒成長團體（第一階段，六次團體）結合為二階段的團體療程，亦在本研究中探討整體療程的療效。
本研究透過比較17位完整參與療程之憂鬱症患者在療程前中後測的表現，評估團體療效。結果顯示在症狀方面，憂鬱症患者在完成第二階段後，自尊提升；在情緒能力方面，患者在完成第二階段後，情緒調節能力（逃避想到問題程度下降）、情緒運用及反思能力（情緒效能提升）皆提升。而憂鬱症患者在完成整體療程後，在症狀方面，憂鬱改善、自尊提升；在情緒能力方面，患者的情緒覺察與表達能力（感覺辨識困難下降）、情緒調節能力（芻思下降）、情緒運用及反思能力（提升情緒效能、情緒反思）皆提升。而透過階層迴歸分析，發現不同情緒能力的提升，對於症狀的改善具有顯著解釋力，且感覺辨識困難、感覺描述困難、情緒效能為重要的療效改變因子。
整體而言，結合情緒能力理論與認知治療的階層式情緒焦點認知治療團體，確能有助於改善憂鬱症患者之症狀與提升其情緒能力；且二階段的完整療程能讓患者持續治療，帶來更顯著的療效。而本研究中所發現之療效改變因子，對未來憂鬱症的治療及病理，提供了重要的介入指標與研究方向。

Depression is one of the most serious mental health problems, with substantial human suffering as well as society burden, and presently still needing more effective treatments. Considerable evidence from the domestic and foreign studies have demonstrated the efficacy of cognitive-behavioral therapy (CBT) in the treatment of depression and its relapse prevention. But depression not only affects the cognition of individuals, but also has major emotional symptoms. The emotional abilities of depressive patients indeed show certain deficiencies, for example: they tend to remember and recall negative information, and use rumination and avoidance to regulate emotion. Therefore, targeting emotional experiences of depressive patients as the intervention focus, this study developed a group therapy treatment which combined cognitive reconstruction of CBT and promotion of emotion abilities. The purposes were to investigate whether the intervention could help improve the emotional abilities and reduce symptoms, and to explore the relations between the improved emotional abilities and reduced symptoms.
The staged emotion-focused cognition therapy group in this study (stage II) and the emotional growth group (Lin, 2006) consisted of the whole two-stage treatment program. Seventeen depressive patients have completed the whole treatment program, and their pre-, mid-, and post-treatment symptom scores were compared to evaluate the group treatment effect.
The results showed that in term of symptoms, staged emotion-focused cognition therapy group was helpful to promote patients’self-esteem; in terms of emotional abilities, it was helpful to promote patients’emotional regulation ability (ie, the degree of avoiding thinking of problems was reduced), and the emotional utilization and reflection abilities (ie, the emotional efficacy was improved). Furthermore, the whole treatment program was helpful to reduce depression and promote self-esteem; and also helpful to promote the patients’emotional awareness and expression abilities (ie, the degree of difficulty identifying feelings was reduced), emotional regulation abilities (ie, rumination was reduced), and the emotional utilization and reflection abilities (ie, the emotion efficacy and emotion refection was improved). Also, Hierarchical regression analyses indicated that the improvement of different emotional abilities had significant correlations with the improvement of symptoms, such as, difficulty identifying feelings, difficulty describing feelings, emotional efficacy were important treatment change factors.
In conclusion, integrating emotional intelligence model and CBT theory, the staged emotion-focused cognition therapy group was indeed helpful to reduce depressive patients’ symptoms and promote their emotional abilities. Nevertheless, the whole treatment program with longer continued therapy indeed provided more significant treatment effects. Lastly, the treatment change factors discovered in this study offered important guidance for future intervention planning and research direction such as pathology of mood disorders.

第一章 研究動機...…………………………………………………...................1
第二章 文獻回顧
第一節 憂鬱症之介紹...…………………………………………………..5
第二節 認知治療與憂鬱症...…………………………………………..10
第三節 情緒智能與情緒能力……………………………………….…14
第四節 情緒覺察與表達…………………………………….........….…19
第五節 情緒調節...…………………………………………………..........24
第六節 情緒反思與運用...……………………………………………....29
第七節 憂鬱與情緒能力...……………………………………………....31
第八節 研究目的............………........................................……………….36
第三章 研究問題、假設與研究架構
第一節 研究問題與假設……………………….......................................38
第二節 研究架構...…………………………………………………..........40
第四章 研究方法
第一節 研究設計...…………………………………………………..........41
第二節 研究樣本...…………………………………………………..........42
第三節 研究程序...…………………………………………………..........47
第四節 研究工具...…………………………………………………........50
第五節 參與研究人員...…………………………………………….......61
第六節 情緒焦點認知治療團體療程之介紹………………............63
第七節 資料分析方法...………………………………………………...72
第五章 研究結果
第一節 團體介入檢核...…………………………………………….......75
第二節 進入與未進入第二階段療程之憂鬱症患者之第一階段前測及療效評估...……………………………………………..86
第三節 憂鬱課程及混合課程之療效評估...……………………...108
第四節 療程對於憂鬱患者症狀表現之療效評估………............117
第五節 療程對於憂鬱患者情緒能力展現之療效評估………...120
第六節 情緒能力變化與症狀變化關係之迴歸分析……………135
第六章 結論與討論
第一節 研究結果摘要...…………………………………………….....167
第二節 討論...…………………………………………….........................176
第三節 結論...…………………………………………….........................188
第七章 研究限制與未來研究方向
第一節 研究限制...……………………………………………................191
第二節 貢獻與未來研究方向...………………………………………194

參考文獻.................................................................................................................196
附錄一、 團體錄影錄音同意書...………………………………………...206
附錄二、 參與研究同意書(對照組) ...…………………………………..207
附錄三、 情緒歷程評估同意書...………………………………………...208
附錄四、 情緒歷程評估指導語(A) ...…………………………………...209
附錄五、 情緒歷程評估指導語(B) ...……………………………............210
附錄六、 生活壓力檢測表...………………………………........................211
附錄七、 每日狀態記錄表(以單元三為例) ...……………………......212
附錄八、 每日情緒經驗記錄表(以單元三為例) ...………………….214
附錄九、 團體回饋表(以單元二為例) ...……………………................215

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