以情緒注意網絡作業探討廣泛性焦慮症的注意偏誤修正之潛在機制

Efficacy of Attention Bias Modification for Patients with Generalized Anxiety Disorder: Using Emotional Attention Network Test as an Evaluation of the Underlying Mechanism

注意偏誤修正（attention bias modification, ABM）能修正廣泛性焦慮症（generalized anxiety disorder, GAD）患者的注意偏誤並改善症狀，然而療效機制仍未明（MacLeod & Clarke, 2015）。本研究招募28位以GAD為主診斷的病患組參與者（女性18位，平均年齡46.04），以及28位年齡、性別比例相符的控制組參與者（女性22位，平均年齡45.43）。兩組參與者分別被隨機分派到ABM（訓練注意中性刺激）、和安慰訓練（無特定訓練注意對象）情境。而在訓練前後，兩組參與者都接受兩種注意網絡作業（attention network test, ANT），一種是標準ANT，一種是以威脅詞、中性詞為線索的情緒ANT（e-ANT）|藉此評估參與者的對符號刺激、中性情緒刺激，以及威脅刺激的警覺性網絡、導向性網絡及執行控制功能的變化。本研究結果發現，GAD病患組參與者的注意分配可能較無彈性，表現在他們相對於控制組有較差的執行控制能力，並且對符號線索、中性刺激線索、以及威脅刺激線索都有顯著的警覺注意|而且他們也比控制組更難從威脅刺激抽離並轉向中性刺激。另外，值得注意的是，GAD病患組參與者無論接受何種注意訓練，在訓練後他們的執行控制能力、以及由威脅刺激轉向中性刺激的能力有明顯進步。本研究結果有助於了解廣泛性焦慮症患者在接受ABM介入前後的注意控制功能改變機制，並作為ABM研究後續改進的參考。

Attention bias modification (ABM) can correct the attention bias of patients with generalized anxiety disorder (GAD) and improve their symptoms. However, the therapeutic mechanism of ABM is poorly understood (Macleod & Clarke, 2015). In this study, 28 patients (18 women and 10 men| average age = 46.04 years) with GAD were recruited. In addition, 28 healthy people (22 women and 6 men| average age = 45.43 years) were recruited as the control group. All participants were randomly assigned to either the ABM group (receiving neutral stimuli for attention training) or the placebo-training group (receiving no specific stimuli). Before and after training, both groups received two types of attention network test (ANT)-the standard ANT and the emotion ANT (e-ANT)-to assess changes in the alerting network, the orienting network, and the executive control network of the participants| e-ANT, in which threatening and neutral words serve as clues, is used to assess alertness to neutral or threatening stimuli as well as orientations, from neutral to threatening and from threatening to neutral stimuli. The results indicated that the attention allocation of the patients with GAD was inflexible. Compared with the control group, the patients' conflict-monitoring abilities were unsatisfactory. Moreover, the patients were significantly highly alert to symbols, neutral stimuli, and threatening stimuli. Compared with the control group, shifting attention from threatening stimuli to neutral stimuli was more difficult for patients with GAD. After receiving training (of any type), the ability of patients with GAD to shift their attention from threatening stimuli to neutral stimuli improved significantly, possibly because the participants responded strategically during attention training. These results clarify the processes underlying attention bias in patients with GAD as well as the relationship between such processes and ABM, from the perspectives of the alerting, orienting, and executive control networks proposed by Posner.