臺灣博碩士論文加值系統

目的：本研究探討有家族遺傳的成人口吃者，深陷在長期的言語不流暢中，不僅造成自己的情緒負擔，在社交和工作上也有顯著影響。本文探討「接受與承諾治療法」（Acceptance and Commitment Therapy, ACT）應用於口吃者治療，聚焦於社交焦慮、認知行為和調節歷程。
方法：本研究針對二名個案，進行一個半小時共八周整合式「接受與承諾治療法」。整合式的 ACT 結合言語方案目的是增加心理彈性。量化和質性的資料收集，分析個案、療程和治療師。
結果：經過 8 周的課程，在正念的覺察和生活品質有些微的提升，但在流暢度和社交焦慮則沒有改善。ACT 的三個功能是接受想法、感受和在當下，選擇符合價值的，採取行動。縱然個案經歷非常多心理-社會的負擔，本研究發現正念對於聚焦在當下和感覺導向，對言語是有益的。
結論：個案對說話有恐懼，早在成長經驗已形成創傷反應，言語治療或認知行為治療並不足夠，安撫和安靜的身體面向的準備也許是更需要的。最後，治療是一個協力合作的過程，不僅個案，治療師也要能開放探索自我，方能提高治療效果；透過解析個案自我接受的歷程，治療師也在其中一起學習接受自我。

Purpose: The adults who stutter (AWS), influenced by family history of stuttering, suffered from disfluency of speaking; the symptoms not only caused the disturbance of emotion, but also had great impact on their social and work aspects of life. This research investigated the process of how to apply Acceptance and Commitment Therapy (ACT) in stuttered adults, focusing on both social anxiety, cognitive processing of the adjustment.
Method: The research conducted an 8-week therapeutic program, consisted of 1.5-h sessions each week. Two severe AWSs participated in the program jointly, i.e. group intervention for 2 clients. Integrated approach of fluency language therapy with ACT were applied to enhance the psychological flexibility. A quantitative and qualitative data collection approach was employed to analyze the process and effects of the program.
Results: The 8-week program had lightly cultivated the clients’ mindful awareness and quality of life; however, there was no significant difference in fluency and social anxiety. Three functional foci of ACT were to accept, choose and take action, especially mindfulness skills was used to accept thought, feelings and be present/flexible. During the process, the clients experienced much psycho-social stresses, it was found that mindfulness could be an effective way to focus the moment and induce sensory-oriented, which were useful for speech production.
Conclusion: Speech therapy or cognitive behavior therapy seemed not enough with severe AWSs. They need a new approach to calm and soothe physical dimension; this research found ACT has good potential in this regard. Finally, this research also found that therapy was a process of collaboration; it benefits not only the clients, but also the attitude and skills of therapist. Both clients and therapist in this research were more open-up, be present and accepting themselves.

摘要.............................................................. ⅰ
英文摘要 ......................................................... ⅱ
致謝.............................................................. ⅲ
目錄...............................................................ⅳ
附錄..................................................... ⅴ
圖目錄........................................................... . ⅵ
表目錄................................................... ⅶ
第一章 緒論........................................................ 1
一、研究動機............................................... 1
二、研究目的與問題........................................ 1
三、解釋名詞.............................................. .2
第二章 文獻探討........................................... 4
壹、口吃 .............................................. 4
第一節 甚麼是口吃？ ................................ 4
第二節 口吃多因素之探索 ........................... 5
第三節 口吃與社交焦慮 ............................. 7
第四節 口吃治療之問題焦點與情緒焦點................ 9
第五節 口吃與適應、韌性、自我接受和生活滿意度..... 10
第六節 成功之口吃治療療程 ........................ 12
貳、接受與承諾治療法.................................. 15
第一節 第三波行為治療 ............................. 15
第二節 ACT 的理論基礎 ............................. 16
第三節 ACT 核心歷程 ............................... 19
第四節 ACT 的療程 ................................. 25
第三章 研究方法.......................................... 28
第一節 研究對象 ................................... 28
第二節 研究方案.......................................... 31
第三節 評估工具 ................................... 34
第四節 研究和分析之方向與策略 ..................... 36
第五節 實施程序與研究步驟 ......................... 37
第四章 研究成果......................................... 39
第一節 治療前中後和十天後之言語表現 .............. 39
第二節 治療前中後和十天後之量表表現分析 .......... 41
第三節 治療成效與反思訪談分析 ..................... 43
第五章 討論.............................................. 47
第一節 ACT 三角模式的應用與語言治療............... 47
第二節 個案...................................... 50
第三節 療程...................................... 57
第四節 治療師.................................... .61
第六章 建議與限制....................................... .65
參考文獻................................................. 69

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