臺灣博碩士論文加值系統

創傷後壓力症（posttraumatic stress disorder; PTSD）患者常受侵入、迴避、負向情緒與認知，及過度警覺等症狀所苦。近三十年來，以實證研究為基礎的心理治療在歐美等國蓬勃發展，其中針對創傷記憶為焦點的延長暴露治療（prolonged exposure; PE），具有當今最多實證研究支持與良好的治療效果。PE屬於暴露基礎的認知行為治療，包含三個主要治療元素：實境暴露、想像暴露及認知處理。長年以來，臺灣遭逢許多天然或人為災難，其中有一部份倖存者發展出PTSD，對生活、工作或人際等帶來明顯影響。目前本地仍相當缺乏PTSD的心理治療研究，而PE對臺灣PTSD個案的療效仍屬未知，故本研究旨在探討PE對臺灣PTSD個案的可行性。本研究招募一符合DSM-5 PTSD診斷的個案進行PE治療，於治療前、治療期間及治療後重複評估個案的PTSD症狀、創傷後負面認知、憂鬱及一般焦慮症狀之變化。治療結果顯示個案在第三次治療時，症狀得分已低於PTSD自陳量表的診斷切截點。完成十次PE治療後，個案的PTSD症狀明顯緩解，且創傷後負面認知、憂鬱及一般焦慮症狀亦皆明顯改善。整體來說，研究結果初步支持PE或可應用於臺灣的PTSD個案，未顯現文化適應性的問題。

Individuals with posttraumatic stress disorder (PTSD) usually suffer from intrusion, avoidance, negative alterations in cognition and mood, and hyperarousal symptoms. Over the past three decades, a number of evidence-based psychotherapies of PTSD have been developed in America and Europe. Prolong exposure (PE) therapy, with a focus on traumatic memory, has the strongest evidence supporting its effectiveness nowadays. PE consists of three main components: 1) in vivo exposure; 2) imaginal exposure; and 3) cognitive processing. Over the years, Taiwan has faced many natural and man-made disasters. A significant minority of survivors develop PTSD, which may have great impact in their daily lives, work, or interpersonal relationships. However, only few studies to date has examined the efficacy of psychotherapy for PTSD in Taiwan. In addition, the efficacy of PE among Taiwanese PTSD patients is unknown. Consequently, this study aims to explore the feasibility of PE in Taiwanese PTSD patients. The present study recruited one PTSD patient with the diagnosis of DSM-5 PTSD. PTSD symptoms, posttraumatic negative cognitions, and symptoms of depression and general anxiety were repeatedly assessed at pre-treatment, during treatment, and post-treatment. The results showed that the participant’s PTSD symptoms decreased and was lower than the cut-off point of self-report PTSD scale in the third session. After completing 10 sessions of PE, the participant demonstrated considerable improvements in PTSD symptoms, posttraumatic negative cognitions, and symptoms of depression and general anxiety. Overall, the results provides preliminary support that PE might apply to Taiwanese PTSD patients and does not show cultural inadaptability.

指導教授推薦書………………………………………………………
口試委員審定書………………………………………………………
致謝……………………………………………………………………iii
中文摘要……………………………………………………………v
Abstract………………………………………………………………vi
第一章 緒論………………………………………………………- 1 -
第一節 創傷後壓力症……………………………….....……- 4 -
第二節 創傷後壓力症的心理治療…………………......- 6 -
第三節 以實證研究為基礎的延長暴露治療...........- 8 -
第四節 延長暴露治療的證據與批判…………………..- 13 -
第五節 研究目的與假設……………………………………- 17 -
第二章 研究方法……………………………………………..- 19 -
第一節 參與者…………………………………………………- 19 -
第二節 研究工具……………………………………..........- 22 -
第三節 研究程序……………………………………………..- 27 -
第三章 個案治療歷程………………………………………- 30 -
壹、第一次治療……………………………………...........- 30 -
貳、第二次治療………………………………………………- 32 -
參、第三次治療………………………………………………- 36 -
肆、第四至九次治療………………………………………..- 39 -
伍、最後一次治療……………………………………………- 43 -
第四章 研究結果………………………………………………- 48 -
第一節 主要變項………………………………………………- 48 -
第二節 次要變項………………………………………………- 51 -
第五章討論………………………………………………………- 56 -
第一節 PE的治療效果………………………………………- 56 -
第二節 PE歷程中的困境……………………………………- 59 -
第三節 PE的臨床適用範圍………………………………..- 61 -
第四節 個人觀察或治療反思……………………………..- 63 -
第五節 研究限制與展望……………………………………- 65 -
參考文獻………………………………………………………....- 67 -
附錄……………………………………………………..............- 80 -


圖目錄

圖2-1 研究程序………………………...………………………...…………………….....-27-
圖3-1 個案A第一次想像暴露………………………...…………..-38-
圖3-2 第七次治療的想像暴露SUDs變化圖……………………...-41-
圖3-3 個案A於想像暴露期間的SUDs……………………….........-47-
圖4-1 個案A的PDS-5………………………...……………..……...-49-
圖4-2 個案A的PTCI變化情形………………………..……..…….-51-
圖4-3 個案A的PTCI三分量表變化情形…………………….........-52-
圖4-4 個案A的BDI-II變化情形……………………….........……..-52-
圖4-5 個案A的BAI變化情形………………………...…...……….-53-
圖4-6 個案A每次想像暴露之頂峰分數………………...…….........-55-
圖5-1 PTSD四症狀變化圖………………………....……...…………-58-


表目錄

表2-1個案評估時程…………………………………………………-29-
表3-1 第一次治療流程…………………………………………...…-30-
表3-2 第二次治療流程……………………………………………...-32-
表3-3 個案A的PE實境暴露階層表（第二次治療建構）………-35-
表3-4 第三次治療流程……………………………………...………-36-
表3-5 第四至九次治療流程………………………………...………-39-
表3-6 第八次實境暴露作業……………………………………..…-42-
表3-7 最後一次治療流程……………………………………..……-43-
表3-8 個案A的PE實境暴露階層表（最後一次治療建構）…...-45-
表4-1 個案A各項症狀評估摘要表………………………..………-49-
表4-2 各次想像暴露的治療內習慣化程度………………...………-54-

中文部分：
車先蕙、盧孟良、陳錫中、張尚文與李宇宙（2006）。中文版貝克焦慮量表之信效度。台灣醫學，10，447－454。
謝馨儀（2010）。EMDR介入PTSD治療歷程與效果之個案研究。臺灣師範大學碩士論文，台北市。
蘇逸人、龔怡文、洪福建與陳淑惠（2018，4月）。中文版DSM-5創傷後壓力診斷量表：心理計量特性與因素結構？台灣臨床心理學會第12屆年會，高雄，台灣。

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