臺灣博碩士論文加值系統

研究目的：恐慌症患者受疾病的困擾，損害適應功能、及耗損個人及醫療的資源，認知行為的療法被證實對改善恐慌症的狀況有效，而當中Clark災難化錯誤解釋的認知理論最為普遍被接受，臨床上可以觀察到焦慮症個案常有困擾的插入式記憶，焦慮情緒與認知的關係漸逐為人所關注，過往的研究發現焦慮的注意力偏差，然而焦慮的記憶偏差仍存在爭論，但恐慌症的記憶偏差成為焦慮疾患中的特例，不同的理論學者對於認知前期整合性或後期精緻化的歷程意見不一，但實徵研究的結果傾向支持與概念化編碼相關較高的外顯記憶偏差，回憶的表現較再認記憶的結果佳，而內隱記憶偏差的研究結果則不一致。恐慌症的認知理論中，Clark提到有關病人會對身體感官作災難化錯誤的解釋，本研究嘗試探討，承接過往記憶偏差的研究上，若恐慌相關的訊息配以中性刺激，記憶偏差是否延申到配對的中性刺激上。

研究方法：本研究以精神科門診的恐慌症病患25名為實驗組，健康受試25名為控制組，施測恐慌發作問卷，狀態－特質量表，以及貝克憂鬱量表，並以嘗試以三類（恐慌相關、正向、負向）詞配對一個關聯性低的中性詞成為詞對，採偶發學習的讓受試對詞對進行自我關聯深度的方式編碼，同時對每對詞對作三項評分（關聯度、價性、激發度），在非引發焦慮的分心作業後，非預期的作三種記憶作業（自由回憶、線索回憶及再認）來檢驗恐慌症記憶偏差的存在與否，同時檢驗記憶偏差會否在中性配對的刺激上發生。

研究結果：研究結果與過往的研究不一致，沒有發現恐慌個案對恐慌訊息的記憶偏差；當刺激呈現的方式配以中性刺激一同出現時，記憶偏差的情況也沒有出現在中性刺激上，自由回憶及線索回憶的記憶沒有顯著的發現，而再認中，假警報上恐慌病患出現對情緒訊息有更多假記憶的現象，而健康的人較恐慌者而言則能夠記得更多情緒刺激周邊的訊息。

討論：恐慌症患者對於與恐慌相關的訊息同時出現的低相關的中性刺激，回憶的方式可能存在恐慌症患者迴避的狀況，抵消了記憶偏差的效果；低狀態焦慮也可能影響訊息處理的歷程；另外，中文的刺激材料的處理可能影響外顯記憶的呈現。

Research background & aim: Patients with panic disorder are disturbed by the illness in aspect of their adaptation functioning impairments and the wastes of personal and medical resources. Cognitive Behavioral Therapy is proved efficient in improving panic condition and Clark’s catastrophic misinterpretation is one of the most popularly accepted cognitive theory. Intrusive memories are quite commonly observed among cases with anxiety disorder. The relationship between anxious emotion and cognition is gradually concerned by people. Researches found the attention bias of anxiety, while the existence of memory bias of anxiety is still a controversy. However panic disorder appears to be the exceptions among the anxiety disorders. Theorists hold different ideas about process of the early stage of integration and the later stage of elaboration. The empirical researches showed support to explicit memory bias which is high related to conceptual encoding and the performance of recall is better than that of recognition. The result from implicit memory is inconsistent. In cognitive theory of panic disorder, Clark mentioned of patient will misinterpret their bodily sensation catastrophically. The aim of research is to explore if memory bias will still exist to the extension of the neutral stimulus which is paried with panic related information.


Methods: 25 patients with panic disorder from psychiatric out patient department as experiement group and 25 normal subjects as control group. Panic Attack Questionnaire (PAQ), State-Trait Anxiety Inventory (STAI) & Beck Depression Inventory-II (BDI-II) are assessed. 3 kinds (panic related, positive & negative) of word are paired with the low-degree related neutral word and becomes word pairs. Subjects encoded word pairs deeply by the way of self-referrening from incidiental learning and rate in 3dimensions (relatedness, valence, arousal). After the neutral distracting task, 3 kinds of unexpected memory tasks (free recall, cued recall & recognition) will be performed for testing the memory bias of panic disorder and the neutral stimulus.
Results: No memory bias was shown on panic case on panic related information. When emotional stimulus is paried with the neutral stimulus, no effect of memory bias can also not be shown. No finding on free recall and cued recall. In recognition, panic patient showed more false memory and healthy person could recognize more neutral information paired with emotional stimuli.

Conclusions: When panic related information and the paired low-related netural stimulus occurred concurrently, cognitive avoidance may happen on panic individuals. and off-set the effect of memory bias. Low state anxiety may also influence the process of information. Stimulus material of Chinese language may influence the presentation of explicit memory.

摘要………………………………………………………………………………………i
目錄……………………………………………………………………………………..iv
圖目錄…………………………………………………………………………………..vi
表目錄………………………………………………………………………………….vii
第一章 緒論
第一節 研究動機………………………………………………………………...1
第二章 文獻探討
第一節 焦慮與恐慌症的發展…………………………………………………...3
第二節 恐慌症的認知理論……………………………………………………...9
第三節 情緒與訊息處理理論………………………………………………….16
第四節 焦慮中的選擇性記憶………………………………………………….22
第五節 研究目的與假設……………………………………………………….36
第三章 研究方法
第一節 研究對象……………………………………………………………….43
第二節 實驗材料……………………………………………………………….47
第三節 研究量表……………………………………………………………….52
第四節 實驗設計……………………………………………………………….56
第五節 研究程序……………………………………………………………….57
第六節 實驗步驟……………………………………………………………….60
第四章 研究結果
第一節 向度評分及記憶表現………………………………………………….64


第五章 討論與建議
第一節 結果討論……………………………………………………………….79
第二節 綜合討論……………………………………………………………….87
第三節 研究貢獻、研究限制、及未來研究方向………………………………88
參考文獻
中文資料………………………………………………………………………….91
西文資料………………………………………………………………………….92
附錄
　　附錄一 受試者參與研究同意書……………………………………………...100
附錄二 實驗開始指導語……………………………………………………...101
附錄三 編碼中三項評分表格………………………………………………...102
附錄四 分心作業指導語……………………………………………………...104
附錄五 自由回憶測驗階段指導語及表格…………………………………...104
附錄六 線索回憶測驗階段指導語及表格……………………………...……105
附錄七 再認測驗階段指導語及表格………………………………………...106
附錄八 編碼作業中所有出現詞對的次序…………………………………...108
附錄九 挑選正式實驗用刺激材料的問卷…………………………………...109

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