焦慮敏感度、恐慌史與認知操弄生物誘發試驗之效應：認知特異質在恐慌病因之角色

ANXIETY SENSITIVITY AND MISINTERPRETATION OF AMBIGUOUS STIMULI: THE ROLE OF COGNITIVE DIATHESIS IN PANIC PATHOGENESIS

本研究探討恐慌發作病理上認知與生理因素的互涉作用，旨在驗證Clark恐慌發作的認知仲介模式在恐慌發作所扮演的角色，並作為焦慮症臨床診療之參考。藉由2×2×3的受試者間三因子設計，本研究操弄三個獨變項，分別為焦慮敏感度（高焦慮敏感度與低焦慮敏感度二組）、恐慌史（恐慌史與無恐慌史二組）與認知操弄（不明線索組、災難性認知操弄組、明確線索與正向認知操弄組三組）。120名非臨床受試者在經施測焦慮敏感度量表與主觀恐慌發作評量後，他們接受過度換氣的生物誘發試驗，並完成恐慌認知與身體感覺檢選表。結果發現，在接受生物誘發試驗時，就本研究的三個與恐慌症狀有關的主要依變項而言（即客觀生理反應評量－－心跳速率、主觀感覺評量與主觀認知評量），在心跳速率指標方面，焦慮敏感度×情境線索×時間交互作用效果顯著；在主觀認知評量與主觀感覺評量二指標方面，焦慮敏感度×時間交互作用效果顯著。這些結果顯示，認知因素在恐慌發作歷程中可能扮演著重要的角色。此一研究結果，除了在理論上作為恐慌症病因的驗証外，於臨床上亦將使得認知心理治療模式在治療恐慌症疾患時獲得理論基礎的實徵証據。

Cognitive models claim that panic episodes may be initiated by fear resulting from misinterpreting enhanced somatic sensations as personally threatening or harmful rather than resulting from direct stimulation of aberrant biochemical systems (Clark, 1986). The present study examined the role of cognition in the etiology of panickers. Specifically, the effects of anxiety sensitivity, panic history, cognitive manipulation and biological challenge on subjective and cardiac responses of Ss during the course of a biological challenge, brief hyperventilation, were examined. One hundred and twenty nonclinical subjects were chosen on the basis of level of anxiety sensitivity and panic history. They were randomly assigned to one of the three cognitive interpretation manipulation groups (twelve groups of 10 Ss). They were all subjected to a 180-sec period of voluntary hyperventilation and heart rate was measured simultaneously. An anxiety sensitivity x panic history x cognitive manipulation x time mixed factorial design was performed and the interaction effects were emphasized and examined. The results showed that anxiety sensitivity might serve as an important cognitive mediator during the process of a panic attack experience. It is proposed that results of the present study could theoretically shed light on the understanding of the psychopathology of panic disorder and clinically improve the treatment of panickers. Besides, owing to the Ss being college students, the present results would also have contribution to the field of student mental health spectrum.