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研究生:劉麗棠
研究生(外文):Li-Tang Liu
論文名稱:具被害妄想之精神分裂症患者的歸因偏誤與心智理論能力缺陷之探討性研究
論文名稱(外文):The Study Between Attributional Biases and Theory-of-Mind Deficits for Schizophrenia With Persecutory Delusions
指導教授:洪福建洪福建引用關係
指導教授(外文):Fu-Chien Hung
學位類別:碩士
校院名稱:中原大學
系所名稱:心理學研究所
學門:社會及行為科學學門
學類:心理學類
論文種類:學術論文
論文出版年:2012
畢業學年度:100
語文別:中文
論文頁數:104
中文關鍵詞:精神分裂症被害妄想歸因偏誤心智理論
外文關鍵詞:schizophreniapersecutory delusiontheory of mindattributional bias
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研究背景與目的. 在社會認知領域中,社會歸因和心智理論能力被視為提供個體理解與解釋他人行為及意圖的功能,近年來國內外學者也紛紛嘗試用社會歸因模式與心智理論來解釋被害妄想,認為被害妄想患者的歸因型態具有極度的自利偏誤(exaggerative self-serving bias),且傾向對負向事件做出外在他人歸因的方式,而在心智理論能力的表現上是具缺陷的。對於被害妄想患者具有異常的歸因型態,由Kinderman, Dunbar, & Bentall(1998)提出與心智理論能力的缺損有關,由於心智理論能力的缺損使得被害妄想患者無法瞭解他人意圖及心理狀態,而做出對社會情境歸因的異常偏差現象,但相繼國內外的相關研究卻鮮少將兩者一同進行探討,且由於存在著使用不同的研究方法、不同的症狀取樣方式而造成眾多結果的不一致性與理論上的爭議,因此本研究欲瞭解具被害妄想的精神分裂症患者是否有所謂異常的歸因型態,而在不同的病程表現上是否為一致,以及此歸因偏誤是否存在與心智理論缺陷間的交互影響關係,而促使被害妄想之形成。
研究方法. 本研究採立意取樣方式,共選取29名以被害妄想為主的精神分裂症患者,並區分為活躍期被害妄想組15人與緩解期被害妄想組14人,另招募社區居民15名作為對照控制組。使用中文版內在、他人及環境歸因量表(CIPSAQ)及次級錯誤信念作業(2nd Order False Belief Task),比較各組分數之差異表現,以及各分數間的交互影響關係。
研究結果.在歸因量表CIPSAQ的表現上,三組於EB值與PB值皆無顯著差異,而在次級錯誤信念作業,當控制智力因素,活躍期被害妄想組較緩解期被害妄想組有較差的表現(達邊緣顯著性)。此外,在被害信念嚴重程度上,與EB值有顯著正相關,與錯誤信念分數則有顯著負相關,經由逐步迴歸分析檢定結果,證實EB值與次級錯誤信念分數可對被害信念嚴重程度具顯著的解釋力,但歸因偏誤指標與心智理論能力間的交互作用關係並不顯著。
結論.本研究雖無法證實具被害妄想症狀之精神分裂症患者處於不同病程階段,其歸因型態與心智理論能力缺損之表現有顯著差異,但整體來說,與過去研究相比,趨勢上仍與研究的假設預期是一致的,即活躍期被害妄想者較緩解期患者有較高的歸因偏誤型態,以及較差的心智理論能力表現,且自利偏誤與心智理論能力缺損是可分別作為預測被害妄想嚴重程度的指標因子;當進一步分析在心智理論能力表現低分者,確實有較高的外在他人歸因傾向,推測心智理論能力缺損在被害妄想患者的推論異常歷程中仍存有交互影響之關連性。最後,研究者於文中提出研究可能的限制與干擾因素,並建議未來研究之方向。

Background and Purpose. In the paradigm of social cognition, social attribution and theory of mind provide individuals to understand and explain people’s behavior and intention. During these years, scholars tried to explain the formation of persecutory delusions by using social attribution and theory of mind. They suggested that patients with persecutory delusions tended to attribute negative events to external-personal causes and positive events to internal causes, which was likely an exaggerative self-serving bias. Kinderman, Dunbar, & Bentall(1998) suggested that abnormal attributions for patients with persecutory delusions is related to the deficits of theory-of mind, which caused patients unable to understand others’ intentions and mentality. Because of this, schizophrenic patients with persecutory delusion is considered to have attributional bias. However, only few researches were conducted in both abnormal attributions and deficits of theory-of-mind. As a resut, different methods and symptomatology used among theses researches lead to inconsistent and controversial point of view. Hence, this research will aim at investigating the abnormal attributional bias , deficits of theory-of-mind ,and their interaction of each other by apply differential courses to schizophrenic patients with persecutory delusion.
Methods. A total of 29 Schizophrenic patients with persecutory delusion. The 15 patients were classified as acute persecutory delusion(APD), and 14 were classified as remitted persecutory delusion(RPD). They were assessed and compared by a translated (English to Chinese) attributional questionnaire (CIPSAQ) and task of theory-of-mind (2nd Order False Belief Task) with 15 healty controls.
Results.The three groups show no significant differences in EB and PB. Patients with APD presented poor performance of 2nd Order False Belief Task than patients with RPD. The EB and poor performance of 2nd Order False Belief Task are significant relation to level of persecutory delusion. The interaction of attributional bias and deficits of theory-of-mind were not supported。
Conclusion. The results show the inconsistent findings with hypotheses. But when comparing to previous studies, there were consistent tendency to find. Patients with APD have more self-serving bia and more inability of theory-of-mind than patients with RPD. And Self-serving bias and deficit of theory-of-mind can be an index of persecutory delusion, respectively. In addition, the deficit of theory-of-mind related to higher external-personal attribution. Indicate that attributonal bias and theory-of-mind might still influence each other. Other factors that influence study and future implications were discussed.

目錄
摘要 Ⅰ
Abstract Ⅲ
致謝辭 Ⅴ
目錄 Ⅶ
表目錄 Ⅹ
圖目錄 XI
第一章 緒論 1
一、研究動機 1
二、研究目的 2
第二章 文獻探討 3
第一節 被害妄想 3
一、 發展沿革與定義 3
二、 類別向度與連續向度之觀點 4
第二節 被害妄想形成的心理學理論架構 6
一、 妄想形成的捷思模式 6
二、 被害妄想與異常的推論歷程 6
第三節 被害妄想與異常的歸因型態、心智理論缺陷 8
一、 歸因理論 8
二、 被害妄想與歸因偏誤 8
三、 被害妄想與心智理論 11
四、 歸因偏誤與心智理論 15
第四節 研究問題與假設 17
一、 研究問題 17
二、 研究假設 18
第三章 研究方法 21
第一節 研究對象 21
第二節 研究工具 22
一、 基本資料問卷表 22
二、 被害妄想症狀之評估與篩選工具 23
三、 中文版內在、他人與環境歸因量表(CIPSAQ) 25
四、 心智理論作業-次級錯誤信念作業(2nd order false belief task)26
五、 魏式智力測驗第三版之簡短版(WAIS-Ⅲ short form) 26
第三節 研究程序 27
第四節 研究統計分析 28
第四章 研究結果 30
第一節 基本資料分析 30
一、 基本人口變項分析 30
二、 臨床相關變項分析 31
三、 智商分數分析 32
四、 基本人口變項、臨床相關變項、智商分數與中文版內在、他人與環境歸因量表之相關分析 33
五、 基本人口變項、臨床相關變項、智商分數與次級錯誤信念作業之相關分析 36
第二節 歸因型態—中文版內在、他人與環境歸因量表(CIPSAQ) 37
一、 三組在CIPSAQ正負向事件各項歸因比例之描述統計 37
二、 三組CIPSAQ自利偏誤(EB值>0)與負向事件外在他人偏誤(PB值>0.5)人數比較 38
三、 內在歸因之描述統計與變異數分析 40
四、 外在他人歸因之描述統計與共變數分析 42
五、 外在環境歸因之描述統計與變異數分析 44
六、 自利偏誤分數(EB值)描述統計與單一樣本t檢定 46
七、 自利偏誤分數(EB值)獨立樣本t檢定 47
八、 外在他人歸因偏誤分數(PB值)描述統計與單一樣本t檢定 48
九、 外在他人歸因偏誤分數(PB值)獨立樣本t檢定 49
第三節 心智理論作業—次級錯誤信念作業 49
一、 三組次級錯誤信念之描述統計與共變數分析 49
二、 活躍期被害妄想組與緩解期被害妄想組、精神分裂症被害妄想組與正常控制組在次級錯誤信念分數之共變數分析 50
第四節 歸因作業與心智理論作業之相關與變異數分析 51
一、 整體CIPSAQ各項歸因分數及次級錯誤信念作業表現之相關分析 51
二、 精神分裂症被害妄想病患組CIPSAQ各項歸因作業及次級錯誤信念作業表現之相關分析 51
三、 歸因分數與心智理論作業之二因子變異數分析 52
第五節 歸因偏誤指標分數、心智理論作業分數與被害妄想嚴重程度之迴歸分析 57
第五章 討論 58
第一節 綜合研究結果 58
第二節 歸因偏誤之探討 60
一、 歸因偏誤指標(EB值和PB值)之探討比較 60
二、 CIPSAQ各項歸因向度之探討比較 62
第三節 心智理論能力缺陷之探討 65
第四節 歸因偏誤與心智理論能力關連性之初探 65
第五節 被害妄想與歸因偏誤、心智理論能力間的關係 67
第六節 研究限制與建議 68
一、 研究限制 68
二、 未來研究建議 71
參考文獻 74
中文部分 74
英文部分 75
附錄一 研究同意書 83
附錄二 基本資料問卷 85
附錄三 被害妄想篩檢量表 86
附錄四 中文版內在、他人及環境歸因量表(CIPSAQ) 87
附錄五 次級錯誤信念作業(2nd order false belief task) 92


表目錄
表3-1 受試者樣本來源 22
表4-1 被害妄想活躍組、緩解組及正常控制組之基本人口變項 31
表4-2 活躍期與緩解期被害妄想組初次發病年齡與患病年數之比較 32
表4-3 活躍期與緩解期被害妄想組於妄想量尺(P1)、多疑/被害量尺(P6)、被害妄想(P1+P6)之比較列表 32
表4-4 被害妄想活躍組、緩解組及正常控制組在智力分數之比較 33
表4-5 基本人口變項、臨床相關變項、智商分數與CIPSAQ之相關 35
表4-6 基本人口變項、臨床相關變項、智商分數與次級錯誤信念作業之相關 36
表4-7 三組於CIPSAQ各項歸因比例之比較列表 37
表4-8 三組於自利偏誤(EB值大於0)比例分析 39
表4-9 各組於負向事件外在他人歸因偏誤(PB值大於0.5)比例分析 40
表4-10 正負向事件之內歸因平均數及標準差 41
表4-11 各組與正負向事件內歸因之變異數分析摘要表 41
表4-12 正負向事件之外在他人歸因平均數及標準差 42
表4-13 各組與正負向事件外在他人歸因之共變數分析摘要表 43
表 4-14 三組CIPSAQ之外在他人歸因的正負向事件調節平均數與標準差 43
表4-15 外在他人歸因組別與正負向事件之交互作用單純主要效果分析摘要表 44
表4-16 正負向事件之外在環境歸因平均數及標準差 45
表4-17 各組與正負向事件外在環境歸因之變異數分析摘要表 45
表4-18 三組的自利偏誤分數(EB值)的平均數及標準差 46
表4-19 三組的自利偏誤(EB值)單一樣本T檢定 47
表4-20 三組的外在他人歸因偏誤分數(PB值)之平均數及標準差 48
表4-21 三組的外在他人歸因偏誤(PB值)之單一樣本T檢定 49
表4-22 三組於次級錯誤信念分數之平均數與標準差 50
表4-23 CIPSAQ各項歸因分數與心智理論作業分數之相關分析 51
表4-24 被害妄想病患組於CIPSAQ各項歸因分數與次級錯誤信念作業分數之相關分析 52
表4-25 次級錯誤信念高/低分組於各項歸因分數之平均數與標準差比較 53
表4-26 各組與次級錯誤信念(FB)高/低分組之二因子變異數分析 55
表4-27 迴歸分析摘要表 57
表5-1 國內外研究於IPSAQ之EB值和PB值平均數與標準差之比較 61
表5-2 國內外研究於IPSAQ各項歸因分數的平均數與標準差比較 64

圖目錄
圖2-1.被害信念階層圖 5
圖2-2 信念形成的一個簡單捷思模式 6
圖2-3 防禦性的歸因偏誤與心智理論能力缺損導致被害妄想形成之交互作用關係圖 16
圖3-1 研究程序流程圖 28
圖4-1 三組於CIPSAQ各項歸因百分比平均數 38
圖4-2 三組正負向事件內歸因平均數 42
圖4-3 三組正負向事件外在他人歸因之調節平均數 44
圖4-4 三組正負向事件外在環境歸因平均數 46
圖4-5 三組自利偏誤分數(EB值)之平均數 47
圖4-6 三組外在他人歸因偏誤分數(PB值)之平均數 48
圖5-1 社會認知與社會功能之間的內在運作瞭解的概念架構 66


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