生物心理社會取向之壓力衡鑑與壓力調適之效果評估

The Outcome Evaluation of Biopsychosocial Stress Assessment and Stress Management

近年來，由於疾病型態的轉變，醫療服務的重點已由急性疾病轉為慢性疾病，而有關病因的了解亦已擴及生活壓力引起之心理社會問題，因此，傳統偏向生物醫學層面之病因模式與照顧方式已有所不足，取而代之的是兼顧個人身體狀況、自我功能、社會支持及生活壓力的生物心理社會模式。相對於醫學的改革，心理學也有相應的省思，在衡鑑與治療上逐漸看重生物心理社會的整體性考量。在台灣，臨床上以生物心理社會模式為中心理念的代表性領域有健康心理學及家庭醫學，這兩個領域自1987年即在台北某醫學中心家庭醫學科有實務上的合作，對患者提供身心壓力衡鑑與壓力調適之服務。身心壓力衡鑑與調適不同於傳統在精神科的心理衡鑑與心理治療，它是根據壓力模式發展出的一套本土化專業。在累積多年的臨床經驗及成效後，藉由研究證實其效果，並探索可能的機轉，是勢在必行的工作，也是本研究的目的。本研究的主要發現是，身心壓力衡鑑與調適對心理社會問題的患者確實具有療效，可緩解其心身症狀、情緒困擾，並改善控制信念及自我效能。研究結果也顯示患者對其心身困擾似乎自有一套解釋模式，他們會尋求何種處理，是否接受某種治療，都與此有關，醫療應當包含這部份的溝通與處理，才能更完整、有效。

According to pattern changes in illnesses, the focus of medical service has changed from acute to chronic diseases in recent years. The exploration of etiology has included psychosocial problems induced by life stresses. Instead of pure medical treatment, the biopsychosocial approach is more suitable. The revolution occurs in psychology too. The stress assessment and management does not address psychosocial but also biological aspects. In Taiwan, two representative fields are health psychology and family medicine. These two fields cooperated in practical works since 1987, offering stress assessment and management to patients. Stress assessment and management is different from traditional psychological assessment and psychotherapy in psychiatric field. It is a clinical application of culture-based health psychology based on stress model. This study is to prove its clinical effect and explore the possible mechanism. The result supports its clinical effect. It also shows patients have their own explanations of their problems . This must be taken into consideration to make treatment more effective.