臺灣博碩士論文加值系統

目的：慢性精神分裂症患者憂鬱症的盛行率較正常人高了2~3倍，目前憂鬱症與憂鬱症狀的心理治療多採用認知行為治療(CBT)模式，但實徵研究發現行為活化療效與CBT相當甚至優於CBT。因此，本研究主要目的是建立一個有效的慢性住院精神分裂症患者憂鬱症狀行為活化治療模式，以團體方式進行，並採取長期日記研究法，檢驗患者行為活化量、正向情緒、負向情緒及憂鬱症狀的變化，以作為療效的指標，其中行為活化量指的是受試者每週所訂定目標的完成率。
方法：本研究受試者為精神科慢性病房住院的男、女性精神分裂症患者共48位(男、女各半)，並採用分層隨機分派至實驗組與對照組進行研究，以卡加利憂鬱量表及台灣NAPA簡式量表做為本研究之研究工具。並以成對t考驗、ANCOVA及階層線性模式(HLM)進行資料分析。
結果：行為活化團體對於慢性精神分裂症患者的正向情緒提升、負向情緒下降及憂鬱症狀改善是有療效的，且這樣的療效不只可持續一個月且在三個月時仍能保持。與對照組比較，結果也顯示不論在團體剛結束或團體結束後三個月，行為活化的療效仍然持續。再者，隨著患者行為活化量的累積，正向情緒會逐漸的升高且負向情緒會逐漸的降低。
結論：本研究主要貢獻在於建立一個適合慢性精神分裂症患者憂鬱症狀行為活化治療模式，並且發現行為活化團體治療對於慢性精神分裂症患者憂鬱症狀治療確實有療效，且在治療結束後的三個月追蹤時療效仍然維持。這樣的發現可以提供臨床心理師於治療慢性精神分裂症患者憂鬱症狀時另一個不同的治療選擇。再者，本研究亦發現，慢性精神分裂症患者的正向情緒及負向情緒變化確實受到時間及行為活化量的影響，因此給予慢性精神分裂症患者訂定個別性目標，有計畫逐步達成訂定的正向行為目標，確實可以提升住院慢性精神分裂症患者的正向情緒及降低負向情緒。

Propose: The prevalence of depression of chronic schizophrenia is 2 or 3 times higher than that of normal people. The recent main psychotherapy for treating depression of chronic schizophrenia is cognitive behavior therapy (CBT). However, some researchers found that behavioral activation therapy (BA) were better than CBT in treating depressive disorders. Therefore, the purposes of the study are to establish the BA group therapy model of treating depression of chronic schizophrenia patients and to test the effect of the model.
Methodology: This research recruited 48 chronic schizophrenia patients and assigned them to BA group or control group. The Calgary Depression Scale for Schizophrenia and the short version of Taiwan NAPA Scale were used in the pretest, post test, and follow up for testing the effects of BA. Pair t-test, ANCOVA and hierarchical linear model were used to analyze data.
Result: BA is effective to increase positive affect, decrease negative affect and improve depressive symptoms of the BA groups. Such effect holds not only one month after treatment, but also three months. Moreover, as the quantity of behavioral activation was accumulating, positive affect would gradually increase and negative affect would gradually reduce.
Conclusion: The contribution of this research is to set up a fitful behavioral activation group therapy model for treating chronic schizophrenia’s depressive symptoms. Furthermore, the 3-month maintaining effect of the BA group suggests that the BA should be a simple and effective method for treating chronic schizophrenia patients’ depressive symptoms.

目錄
摘要
第一章 緒論及文獻探討 1
第一節 精神分裂症與憂鬱症狀 1
第二節 精神分裂症憂鬱症狀的藥物及認知行為治療 7
第三節 行為活化運用於精神分裂症的憂鬱治療 10
第四節 研究目的與假設 25
第二章 研究方法 28
第一節 研究對象 28
第二節 研究工具 30
第三節 研究設計與序程 32
第四節 資料分析方法 34
第三章 研究結果 35
第一節 研究樣本現況描述統計摘要 35
第二節 行為活化團體療效分析 36
第三節 行為活化團體階層線性模式分析 40
第四章 綜合討論與建議 46
第一節 綜合討論 46
第二節 研究限制與未來發展 51
第三節 研究貢獻 52
參考文獻 53
附錄一 卡加利憂鬱量表(CDSS) 61
附錄二 台灣NAPA簡式量表 64
附錄三 一週生活作息調查表 65
附錄四 行為確認表 66
附錄五 受試者研究同意書 67
附錄六 零模式(負向情緒) 68
附錄七 零模式(正向情緒) 69
附錄八 團體計畫書 70

圖目錄
圖一 正向情緒、負向情緒隨時間變化趨勢圖 27
圖二 研究程序圖 33
圖三 正向情緒及負向情緒變化圖 45

表目錄
表一 團體相關技巧訓練、對應憂鬱症狀及用意一覽表 17
表二 行為活化團體治療單元主題、團體目標及活動一覽表 18
表三 實驗組與對照組在人口學變項、憂鬱症狀及正負向情緒等變項之描述統計 35
表四 實驗組正、負向情緒及憂鬱症狀t檢定摘要表 37
表五 實驗組與控制組後測共變數分析摘要表 39
表六 實驗組與控制組三個月後追蹤共變數分析摘要表 39
表七 負向情緒一階模式(時間、行為活化量) 42
表八 正向情緒一階模式(時間、行為活化量) 44

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