恐懼症狀的治療策略

PREDICTING TREATMENT OUTCOME: ACQUISITION PATHWAYS, YESPONSE PATTERNS AND FEAR REDUCTION MECHODS IN THE TREATMENT OF COCKROACHPHOBIA

本研究之目的有二。第一，從個案個別差異的角度比較兩種治療方法的優劣，俾將結果作為治療懼蟑症時選用治療策略的參考。第二，探討個别差異與治療方法的配合度對療效的影響，以檢定目前文獻上頗受學者注目，但待進一步實徵研究的兩項假設。藉由2×2×2的受試者間三因子設計，本研究所操弄的個别差異變項有：(1)懼怕的習得途徑（分直接經驗習得與訊息傳遞習得二組），與(2)懼怕的反應方式（分生理反應與認知反應二種組型）；所操弄的治療方法變項有敏感遞減與認知治療二種方法。本文所檢驗的是(1)Wolpe（1981）的假設：不管經由何種途徑習得懼怕，治療方法與習得途徑相配時，將比不相配時療效佳；以及(2)Rachman（1976）的假設：不管何種懼怕反應組型，治療方法與反應組型相配時，將比兩者不相配時療效佳。經由將衡鑑工具具體化，治療過程明確化，並在受試者分組方式上改進前人的缺點，以及將受試者盡量控制為同質，本研究以69名懼蟑症的大學女生為受試者，分别施行八次的個别治療後，得到如下的結果：(1)敏感遞減法與認知治療法對懼蟑症受試者的懼怕行為皆具相當程度的療效，但療效的大小與發生療效的速率不盡相同。(2)在後測時有四療效指標一致顯示認知治療法的療效優於敏感遞減法；有一療效指標顯示個案個別差異變項中的懼怕反應組型變項與治療方法的配合度會影響療效的大小。(3)在治療後二個月追踪測量時，雖然認知治療法仍有勢優療效但漸趨不明顯；有一指標顯出個案個别差異變項中的習得途徑與反應組型的不同組合方式，會因治療方法的不同而導致療效的差異。(4) Wolpe或Rachman之假設在本研究中皆未獲支持。本文亦就研究方法的問題，研究結果的意義與未來的研究方向提出討論。

The importance of individual acquisition pathways and individual fear response patterns in the treatinent of phobra was examined in the presant study. Spec fically Rachman's (1976) and Wolpe's (1981) hypothesis were tested. First, based on a sample of 838 and a cross—validation sample of 18.2 undergraduate femele Ss. An instrument, Cockroach Phobia Questionnaire (CPQ), which contains three acquisition pathway subscales and three response subscales, was constructed, Secondly, 69 undergradvate female voluntiers with a phobis of cockreach were selected. On the basis of their scores on CPQ, Ss. were divided into four groups showing different combination of different acquisition modes and response patterns. Wihtin each group the Ss. were then randomly assigned to one physiologically-focused method (Systematic desensitization) and one cognitively-focused method (Systematic rational restructuring). The Ss. were treated individually in eight sessions. The posttreatment and follow-up assessment failed to confirm either Wolpe's or Rachman's hypothesis. The implications of the findings are discussed in relation to the determination of the most efficacious treatment approach for a given client, and several future research possibilities are postulated.