注意偏誤操弄的潛在機制在類廣泛性焦慮疾患上的探討：投注注意與注意轉移困難的角色

Latent Mechanisms of Attention Bias Modificationin Individuals with Sub-Clinical Generalized Anxiety Disorder: Roles of Facilitated Engagement and Difficulty Disengagement

過去研究指出，廣泛性焦慮疾患（generalized anxiety disorder, GAD）病患會對威脅刺激產生明顯的注意偏誤（attentional bias）；且這樣的偏誤可能與對威脅刺激的抽離注意困難（difficulty disengagement）有關（Cisler & Koster, 2010）。而近幾年的研究也發現，注意偏誤操弄（attention bias modification, ABM）（See, MacLeod, & Bridle, 2009）作業，可能具有改善GAD症狀的療效（Hallion & Ruscio, 2011）。然而，GAD有關的注意偏誤潛在機制尚未被完全釐清，另一方面，ABM作業如何影響GAD病患的注意偏誤狀態也還未被探討。本研究主要目的有二：（一）驗證GAD病患的注意偏誤是否與對威脅刺激的抽離注意困難有關。（二）探討ABM作業對該抽離注意困難歷程的影響。在本研究中，42位符合GAD診斷之類GAD組（sub-clinical GAD）參與者與47位無診斷之控制組參與者，在接受第一次的隨機點偵測作業後，皆被隨機分配至3種目標對象的ABM作業，包括注意威脅刺激、注意中性刺激、以及注意正向刺激。在ABM作業前後，參與者各接受一次隨機點偵測作業（dot-probe task）的測量，之後再接受憂慮引發作業，並在該作業後再接受第三次的隨機點偵測作業。研究結果發現：（一）在ABM作業前，類GAD組參與者對威脅刺激與正向刺激具有抽離注意困難。（二）接受注意中性刺激ABM作業的類GAD組參與者，其抽離注意困難在操弄後降低。本研究針對ABM作業後續的研究方向，以及其作為實證基礎（evidence-based）認知治療法的可能性提出討論。

Accumulating evidence suggests the existence of attentional bias toward threatening stimuli in patients with generalized anxiety disorder (GAD). We examined whether disengagement difficulty is a major component of attentional bias in GAD, and tested the causality of disengagement difficulty before and after attention bias modification (ABM). In this study, we used the diagnostic interview schedule to screen subclinical GAD participants (n = 42) and normal control participants (n = 47); each group was randomly assigned to three distinct ABM programs. The results revealed that (1) the subclinical GAD participants exhibited difficulty in disengagement from threatening stimuli; and (2) the extent of difficulty in disengagement was reduced in the subclinical GAD participants who were trained to focuson neutral stimuli. These results support the assumptions that the prominent characteristic of attentional bias in GAD might be difficulty in disengagement, and ABM can reduce the extent of difficulty in disengagement.