臺灣博碩士論文加值系統

　　鬱症患者常會出現生理、情緒及認知等方面的症狀，導致生活功能與品質降低。許多學者認為鬱症患者的情緒調節功能異常與注意力偏誤跟情緒上的現象有關，即所謂的「憂鬱反芻」。先前研究顯示，憂鬱反芻與鬱症狀皆與「執行功能」缺損有關。當執行功能缺損將干擾個體的情緒調節功能，可能導致憂鬱反芻與憂鬱症狀的惡化。晚近研究發現，高頻Alpha腦波活動與執行功能有關，而高憂鬱傾向者在高頻alpha波的頻率平均值較一般健康成人為低（Tement et al, 2016），故推測鬱症患者之高頻alpha波異常與其執行功能缺損有關。神經回饋是一種藉由將神經活動狀態以視覺等具體形式回饋給個體，使其能夠學習有效控制自身腦部活動的技術。因此，本研究旨在檢驗高頻alpha波神經回饋訓練是否能提升其執行功能，並降低憂鬱反芻與憂鬱症狀。
本研究包含兩個子研究，研究一對象為高憂鬱傾向之大學生，排除不反應者後，正式樣本為實驗組16人、控制組17人；研究二對象則為臨床鬱症患者，排除退出研究與不反應者後，最終樣本為4名鬱症患者。本神經回饋訓練程序之EEG取樣點為兩側額葉處，提供參與者視覺回饋以增加其高頻alpha波活動。訓練全程皆有研究人員協助，每次整體時間50分鐘，每周兩次共十次訓練。於訓練前、後測量參與者的執行功能、憂鬱症狀、憂鬱反芻風格。研究一結果發現，本神經回饋訓練能夠有效緩解憂鬱嚴重程度與苦惱自責反芻程度，並且對於提升抑制、轉換執行功能表現具有中度的效果量；研究二結果發現本神經回饋訓練能夠緩解鬱症患者的憂鬱症狀與苦惱自責程度。綜上所述，本神經回饋程序可實際應用於臨床患者，為鬱症治療提供新的選擇。

摘要 I
致謝 II
目錄 III
圖目錄 IV
表目錄 V
壹、 文獻回顧 1
一、 研究動機 1
二、 鬱症患者的臨床表現 2
三、 憂鬱反芻與認知功能 4
四、 鬱症的臨床療法 7
五、 鬱症患者的神經回饋訓練 10
六、 研究目的與假設 15
貳、 研究方法 19
研究一 19
一、 研究對象 19
二、 研究工具 20
三、 研究設計與研究程序 26
四、 研究結果 28
五、 討論 35
研究二 41
一、 研究對象 41
二、 研究工具 43
三、 研究程序與腦波訓練 44
四、 研究結果 45
五、 結果與討論結果與討論 48
參、 研究貢獻、研究限制及未來方向 51
一、 研究貢獻 51
二、 研究限制 51
三、 未來方向 52
參考文獻 54
附錄 69

圖目錄
圖 1 注意力脫離受損假說（修改自Koster et al., 2011） 7
圖 2 潛在抑制作業基本圖形 21
圖 3 潛在抑制作業施測流程 22
圖 4 數字-字母測驗之施測流程 23
圖 5 更新作業之施測流程 24
圖 6 本研究使用電極位置（國際10-20系統） 25
圖 7 本研究之研究程序 27
圖 8 本研究神經回饋訓練之視覺回饋畫面 28
圖 9　F3處PAF趨勢（全樣本） 35
圖 10　F4處PAF趨勢（全樣本） 35
圖 11　F3處PAF趨勢（刪除後） 35
圖 12　F4處PAF趨勢（刪除後） 35
圖 13 研究二之研究程序 44
圖 14 參與者腦波變化圖 45

表目錄
表 一 常用腦波的簡介 11
表 二 本研究與Yu等人（2020）之神經回饋程序差異 16
表 三 針對健康樣本的upper Alpha波NFT訓練列表 17
表 四 針對鬱症患者的upper Alpha波NFT訓練列表 18
表 五 所有參與者的前測各量表描述統計與差異比較（雙尾） 30
表 六 排除數據後的前測各量表描述統計與差異比較（雙尾） 31
表 七 兩組差異分析（ANCOVA） 33
表 八 過往神經回饋研究中不反應者比例列表。 39
表 九 反應組與不反應組之前測差異（雙尾） 39
表 十 研究二臨床參與者基本資料 42
表 十一 參與者量表資料 47
表 十二 研究二臨床參與者的Wilcoxon符號檢定表 48
 

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