臺灣博碩士論文加值系統

在眾多死亡原因中，菸草雖被認為是可被預防的首要死因，然根據行政院衛福部國民健康局(2018)的調查發現，菸害在台灣每年仍至少造成2萬7,000人死亡。近年來，記憶的提取-消除程序(The memory retrieval-extinction procedure)（簡稱提取-消除程序）被視為一種能使戒除者在戒除期間，降低其對藥物的渴求以及復發之有潛力的非藥物方法。關於提取-消除程序，過去的研究多數在動物研究上，且未探討其對認知的影響。鑑於此，本研究欲瞭解提取-消除程序對重度吸菸者的外顯認知與內隱認知的影響，為少數將提取-消除程序應用於人類參與者的研究。
本研究共招募75位（實驗組28位；控制組26位）每日至少抽10根菸，且至少維持一年的男性參與者，並追蹤參與者的認知變化至21天後。在測量內隱認知上，採用情緒促發作業(Affective Priming Task)與視覺偵測作業(Visual probe task)。在測量外顯認知上，採用自陳式量表主觀渴求度、物質使用疾患確認檢查表(Drug Use Disorders Identification Test-Extended; DUDIT-E)及尼古丁成癮度量表(Fagerstrom Test for Nicotine Dependence)。綜合研究結果發現，記憶的提取-消除程序無法影響重度吸菸者的內隱認知與外顯認知。

The retrieval-extinction procedure (the RE procedure) is a nonpharmacological and noninvasive method for decreasing addictive substance use. Many studies employed this procedure on the animal models, rather than the human participants.
Also, the above-mentioned studies did not consider participants’ explicit and implicit cognitions toward addictive substances, critical for substance use. We aimed to examine whether that the RE procedure can alter the heavy smokers’ implicit attitudes and explicit attitudes. Heavy smokers with high motivation to quit smoking were assigned randomly to the RE group (N=28) or active control group (N=26). We measured heavy smokers’ implicit (attentional bias and affective priming effect task) and explicit (self-reported craving, DUDIT and FTND) cognitions at three time points: Before and after the manipulation (the RE or the active control) and 21 days after the manipulation (follow-up). There has no significant between-group differences on attentional bias, DUDIT and FTND across three time points. We found that the current study did not show the RE effects on the alternations of the heavy smokers’ implicit and explicit cognitions. The current study is one of the few human studies adopted the RE procedure. Also, among these studies, the current study is the only one to examine the possible variations of heavy smokers’ implicit and explicit cognitions caused by the RE procedure.

致謝 I
中文摘要 II
英文摘要 III
目錄 I
圖目錄 III
表目錄 IV
緒論 1
成癮行為的外顯認知與內隠認知 1
外顯認知 2
內隱認知 3
記憶的固化與再固化 4
記憶的提取-消除程序在成癮行為之應用 6
研究假設 9
研究方法 10
參與者 10
研究流程 12
儀器與設備 14
認知操弄：實驗組（提取-消除程序組）及控制組（主動控制組） 14
研究材料 14
研究設計及流程 15
內隱認知：情緒促發作業(AFFECTIVE PRIMING TASK, APT) 15
研究材料 15
研究設計及流程 16
內隱認知：視覺偵測作業(VISUAL PROBE TASK, VPT) 18
研究材料 18
研究設計及流程 18
外顯認知：量表問卷 20
自評量表 20
物質使用疾患確認檢測表（Drug Use Disorders Identification Test Extended; DUDIT-E） 20
尼古丁成癮度量表（Fagerstrom Test for Nicotine Dependence；FTND） 20
操弄檢核：學習-再認作業 21
研究材料 21
研究設計及流程 21
研究結果 23
參與者 23
提取-消除程序之操弄檢核 25
分析結果 25
提取-消除程序之內隱認知成效 25
情緒促發作業(Affective priming task, APT) 25
分析結果 26
視覺偵測作業(Visual probe task, VPT) 27
分析結果 27
提取-消除程序之外顯認知成效 28
主觀渴求效果 28
分析結果 28
正向預期、負向預期及準備改變與改變動機 29
分析結果 29
尼古丁依賴程度 31
分析結果 31
綜合討論 32
提取-消除程序無法影響重度吸菸者的內隱認知 32
提取-消除程序無法影響重度吸菸者的外顯認知 33
結論 34
研究貢獻 35
研究限制及未來方向 35
參考文獻 36
附錄 43
附錄一：是否準備好戒菸的心理建設問題 43
附錄二：二代戒菸用藥紀錄表 44
附錄三：研究完整問卷 45

圖目錄
圖一、XUE等人(2012)將提取-消除程序應用於海洛因成癮者之研究程序圖 7
圖二、GERMEROTH等人(2017)將提取-消除程序應用於菸癮者之研究程序圖 8
圖三、詳細納入排除程序 11
圖四、研究流程圖 12
圖五、情緒促發作業實驗畫面及程序 17
圖六、視覺偵測作業實驗畫面及程序 19
圖七、學習-再認作業實驗畫面及程序 22

表目錄
表一、研究材料 14
表二、情緒促發作業的目標雙字詞之統計檢定：接近－遠離向度、詞彙頻率、前字筆劃、後字筆劃及總筆劃之平均數(標準差) 16
表三、參與者之背景變項、控制變項、各測量變項前測之平均數（標準差）及差異檢定 23
表四、使用二代戒菸種類及總數 25
表五、再認階段菸相關圖與中性圖正確率之平均數(標準誤) 25
表六、接近連結分數與遠離連結分數在前後測及追蹤階段之平均數(標準誤) 27
表七、SOA在200MS及2000MS注意力偏誤分數在前測、後測及追蹤階段之平均數(標準誤) 28
表八：參與者對菸主觀渴求在前測、後測及追蹤階段之平均數(標準誤) 29
表九：參與者對菸正向預期、負向預期以及準備改變與改變動機在前測、後測及追蹤階段之平均數及(標準誤) 30
表十：參與者對尼古丁依賴程度在前測、後測及追蹤階段之平均數(標準誤) 31

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