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題名:臺灣地區成人精神病患被迫害妄想之認知理論建構
作者:林國慶
作者(外文):Lin Kuo-Ching
校院名稱:高雄師範大學
系所名稱:輔導與諮商研究所
指導教授:廖鳳池
學位類別:博士
出版日期:2012
主題關鍵詞:被迫害妄想核心信念認知偏誤札根理論精神病患the persecutory delusioncore beliefcognitive biasground theorythe psychosis
原始連結:連回原系統網址new window
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本研究旨在探討台灣地區具被迫害妄想症狀之成人精神病患者,其被迫害妄想內容、核心信念及認知偏誤等相關情形,並試圖建構台灣本土之被迫害妄想之相關理論。本研究方法採扎根理論來蒐集與分析資料,以協同分析及同儕簡報等方式加強研究品質。本研究於台灣北中南東四區共四個精神科專科醫院為收案點,深入訪談22位具被迫害妄想症狀之成人,重要研究結果為:
一、 被迫害妄想內容及其應對方式
被迫害者於妄想經驗過程中之思維、身心影響、以及發展出的應對方式共可歸納為八個因素,分別為:1.「不尋常身體感受」;2.「不尋常的生活經驗」;3.「加害者」;4.「加害手法」;5.「加害動機」;6.「加害型態」;7.「身心衝擊」與8.「應對行為」。這些因素可茲據以描述案主的妄想主題和內容。
二、 影響被迫害妄想之核心信念
歸納之核心信念分天人關係和人我關係二層面,在天人關係中有:「善惡有報,因果不昧」、「生死由命,富貴在天」及「天地不仁,物各爭存」。在人我關係層面有:「我行羞愧,世道不容」;「我豈量小,人心惟危」與「成王敗寇,盡其在我」。影響核心信念的兩項前置因素分別為:「個人脆弱性」、「社會文化背景」。另與核心信念存在對應關係的兩項因素分別為:「自我/迫害關聯架構」和「關鍵危害性」。根據核心信念中的自我觀進一步分析,被迫害妄想可區分為三個子類型,分別為「自我責難批判型」、「自我維護保存型」及「自我擴張受阻型」。
三、 認知因素與被迫害妄想
案主對精神症狀引發之異常經驗會有其主動的歸因和分析,其認知型態因素包括七個因素,分別為:「認知/思考/推理」、「成效判斷基準」、「有效對抗之反思」、「無效對抗之反思」、「害源撤離原因」與「旁人回應態度」及「想法與自己契合度」等。被迫害者由上述因素之聯動產生條件性變化,使妄想症狀出現固化、維持或緩解等不同樣貌。由認知型態分析可歸納出案主三種認知偏誤,分別為「自我經驗型偏誤」、「自我關聯型偏誤」及「自我融通型偏誤」。
四、 建構被迫害妄想之認知理論
本研究所建構之實質理論,可再將之切割成「一個主軸」、「三個階段」及「五個循環」等化約概念。「一個主軸」是「被迫害妄想之核心信念與認知行為關聯軸」。「三個階段」分別是「未知覺迫害時期」、「被迫害時期」以及「害源撤離時期」。而「五個循環」分別為「加害性循環」、「自我/迫害性循環」、「身心衝擊性循環」、「因應成效性循環」及「被迫害記憶循環」,此理論概念皆有所說明。
本研究所建構之新理論有助於對本土被迫害妄想現象進一步理解,並可用於精神症狀評估,心理介入處遇之參考。本研究限制在於理論架構是以曾就醫患者分析之所得,未必適用於不曾就醫之妄想症狀者。
關鍵字:被迫害妄想、核心信念、認知偏誤、札根理論、精神病患
The purposes of this research were to understand the perception and reaction of adults with persecutory delusion in Taiwan perceive and react to their situation. With the scope of core belief and cognitive bias, the researcher deeply-interviewed 22 participators, using constructive grounded theory as a method to analyzing and collecting data, tried to produce an indigenous theory of the persecutory delusion. The major findings were:
1. The ideas of being-persecuted were directly influenced by the usual body sensation, the paranormal experiences and long-existing core beliefs, and subsequently influenced the related reasoning and explanation. The whole persecutory episode could be classified to the three stages, which were “the unperceived stage”, “the persecuted staged”, and “the withdrawal stage”. Factors to format the persecuted stage were “the persecutor”, “the persecution methods”, “the motives”, “the persecutory patterns”, “the physical and psychological impact”, and “the reactive behavior”. Factors to format “the withdrawal stage” were “criteria for judging efficacy”, “reflection on the ineffective coping”, “reflection on the effective coping”, “responding attitude of others”, and “reasons for the withdrawal”.
2. The core beliefs to influence the persecutory ideas had two layers structure, one was “the heaven/human relationship”, and the other was “other/me relationship”. Factors to influence core beliefs were “personal vulnerability” and “the socio-culture background”. The core beliefs caused “the ego/persecution related structure” mobilized, thus made “the crucial impact” different. The persecutory delusion could be classified to three subtype, they were “Type of self-censure”, “Type of self-protection”, and “Type of self-expansion and being sabotaged”.
3. The self-explanation cognitive style of the participants created five closed circles that made the delusion solid and maintained. These were “the persecutor circle”, “the ego/persecution circle”, “the impact circle”, “the coping efficacy circle”, and “the persecutory memory circle”. The circles stringed up the whole course of the symptom and connected to “the core belief-cognition-behavior axis” of the theoretical structure. The specific and characteristic of cognitive bias and cognitive patterns were discussed.
Keywords: the persecutory delusion; core belief; cognitive bias; ground theory
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