焦慮處理訓練團體之有效性評估

The Effectiveness of an Anxiety Management Training Group in Alleviating Anxiety Symptoms

本研究旨在評估以團體進行認知行為治療取向的成套焦慮處理訓練課程，對焦慮狀態的精神官能症病患之治療效果。由精神專科醫院門診招募焦慮狀態的精神官能症病患計19人，依照轉介時間的不同，分三梯次接受一週一次、共12次的焦慮處理訓練團體，並在團體結束後進行一個月一次，共三次的團體追蹤評估。受試者於每次團體開始前填寫曾氏焦慮量表，量表分數代表其前一週的平均焦慮程度，藉以探討受試者參加團體前後的焦慮症狀變化。另外，透過觀察、團體歷程記錄、與受試者完成的家庭作業等資料，分析歸納出對療效有貢獻的涉入因子。
研究結果顯示：接受團體課程的病患，第一次與最末一次團體前測量的焦慮程度有顯著的下降，但最末一次訓練團體前與最末一次追蹤評估團體前測量的焦慮程度並無顯著的變化，顯示該焦慮處理團體訓練課程能夠有效降低焦慮病患之焦慮程度，且在課程結束後三個月內的療效能夠持續維持。歸納團體歷程中，對療效有貢獻的涉入因子共分為三類：一、焦慮知識的改變（如：對焦慮反應的去威脅性與去模糊性）﹔二、團體歷程的貢獻（如：增加知覺到的社會支持度、增加宣洩負向情緒的機會、學習其他成員的楷模行為），三、實際成功應對的經驗（如：透過肌肉放鬆法與正確呼吸法緩解身體不適症狀、透過轉移注意力與想法替代改善認知症狀）。本研究的發現與限制亦在文中做進一步討論。

This study intended to evaluate the effectiveness of a cognitive-behavioral-based anxiety management training group (AMTG) in alleviating anxiety symptoms. Nineteen patients received psychiatric diagnosis of anxiety disorder were referred by psychiatrists. They were assigned into three groups and received the same AMTG protocol. The AMTG consisted of 12 therapy sessions over three months. The Zung’s Anxiety Scale was administered before each of the 12 group therapy sessions in order to measure the severity of anxiety. In addition, categories of contributing effects were formed from analyses of group sessions and homework in which participants reported thoughts and feelings about anxiety events during each week.
Results showed a significant decrease of mean anxiety scores from pre- to posttreatment on the Zung’s Anxiety Scale. The analysis of group sessions and homework revealed three categories of effectiveness. The first category-- the change of negative concepts about anxiety -- included de-threatening and de-ambiguity about overanxious responses. The second category, the benefits from group processes, included perceived social support, opportunities for ventilating pent-up negative emotions, vicarious learning, and adaptive performance. The last category-- successful experiences to cope with anxiety -- included the use of muscle relaxation and controlled breathing to control physical symptoms, and the adoption of thought distraction and thought replacement to control automatic negative thoughts. In conclusion, AMTG effectively decreased the perceived level of anxiety-provoking stressors as well as increased self-efficacy to cope with stressors. The findings and limitations of the study are discussed.