強迫特質與非恰好性感受對執行感的影響

Abstract

研究背景與目的：自Summerfeldt（2004）提出逃避傷害（harm avoidance）與不完整性/非恰好性感受（incompleteness/ not just right）為強迫行為的兩個主要核心動機後。一些研究者即開始探討不完整性/非恰好性感受對強迫行為的影響。這些研究的結果皆指出不完整性/非恰好性感受確實對強迫行為的影響甚鉅，且能用來預測強迫行為的持續性及嚴重程度。然而，針對此項行為動機的認知歷程之研究仍舊不足。近年的幾篇研究顯示，此不完整性/非恰好性感受為個體對其行為的執行感，研究者並透過對行為的監控歷程與內在正演模型的比較機制，來探討此強迫行為動機。這些研究結果發現擁有高強迫特質與高不完整性/非恰好性感受特質者，其內在比較機制可能有所缺損，導致無法透過促發操弄增進其執行感。然而，過去並無研究直接探討個體在經歷不完整性/非恰好性感受下，其執行感之變化。故本研究擬探討在經驗恰好性或不完整性/非恰好性的感受狀態下，個體的強迫特質對其執行感之影響。 研究方法：本研究先將242位參與者隨機分派至恰好性或非恰好性感受操弄兩組，使其分別有恰好性或是不完整/非恰好性感受的經驗後，最後皆進行錯覺執行作業。進入正式資料分析的為強迫量表修訂版（OCI-R）總分大於21分或小於8分的兩組參與者，並排除在錯覺執行作業中主動報告在參與中覺察到有促發操弄的參與者後，OCI-R的高低分者分別有54位及56位，共110位。這110位參與者的資料分析方式乃以其執行感為依變項，以2（高/低強迫特質組）× 2（恰好性/非恰好性感受操弄）× 2（圖片價性：中性/非中性圖片）× 2（嘗試序列：促發操弄/非促發操弄）四因子為獨變項，採用四因子重複量數變異數分析。 研究結果：在非促發操弄時，低強迫特質者有顯著較低的執行感；而在促發操弄時，高/低強迫特質兩組則無顯著差異。此外，在接受恰好性感受操弄的參與者中，促發操弄能夠增進低強迫特質者的執行感，但對高強迫特質者則沒有影響。然而，接受非恰好性感受操弄的參與者中，無論強迫特質高與低，促發操弄對其執行感皆無顯著影響。 討論：對接受非恰好性感受操弄之受試者而言，促發操弄無法顯著增進他們的執行感；而接受恰好性感受操受之受試者，僅低強迫特質者能透過促發操弄增進其執行感，此結果顯示高強迫特質者以及接受非恰好性感受操弄者，無法透過正確的前饋線索，減低錯誤的訊號匹配，其可能的機制為內在的正演模型比較功能有所缺損。此外，雖然接受非恰好性感受操弄之參與者在促發操弄和非促發操弄時的執行感兩者間未達到顯著差異，然而卻與低強迫特質且接受恰好性感受操弄之參與者，在促發操弄和非促發操弄時之執行感差異的斜率，有相同的趨勢，即在促發操弄的執行感略高於非促發操弄的執行感。本研究分別以Synofzik（2008a）提出的執行感整合模式與研究觀點對這些結果加以討論。 結論：本研究支持過去研究中，促發操弄確實能增進低強迫特質且接受恰好性感受誘發操弄的參與者之執行感；但在高強迫特質者或接受非恰好性感受操弄的參與者，促發操弄則無法有效增益其執行感，進而削弱感官知覺的強烈程度。然而，本研究也發現，在非恰好性感受的經驗當下，前饋線索能略為能提升參與者之執行感，因此可能為情緒調節的重要依據、指標，因此，本研究建議對不完整性/非恰好性感受強迫行為者的治療，處理此方面的情緒感受為首要的治療目標。

Background and objectives: Since Summerfeldt (2004) proposed that the core behavior motivations of obsessive-compulsive behavior are harm avoidance and incompleteness (INc)/not just right experiences (NJREs), some researchers have focused on INc/NJRE on compulsive behaviors. They found that the INc/NJREs strongly influenced compulsive behaviors and could be used to predict the severity of compulsive behaviors. Nevertheless, research on the cognitive process of the INc/NJRE still has been elusive. Some recent studies indicated that the nature of INc/NJRE was related to self-agency and could be explained by behavior monitoring and forward models. They found that individuals with high obsessive-compulsive tendency or high INc/NJREs may have defects in their internal forward models. Nevertheless, there was no research directly addressed the effects of INc/NJREs on sense of agency. As such, this study explored the effects of obsessive-compulsive tendency and experience of INc/NJREs on sense of agncy. Method: Two hundred and forty-two participants were randomly assigned to induce just right experiences (JREs) or not just right experiences (NJREs). Then they performed the illusion of agency task. We chose OCI-R scores > 21 to be high-OC tendency and OCI-R < 8 to be low-OC tendency. Using these criteria, we finally screened 110 participants for data analyses. A 2 (high/low-OC group) × 2 (JREs/NJREs induced) × 2 (neutral/non-neutral pictures) × 2 (priming/non-priming conditions) four way repeated measures ANOVA was conducted. Results: It showed that for the non-priming condition, low obsessive-compulsive group had lower sense of agency. For the priming condition, there was no significant difference in sense of agency between high-OC group and low-OC group. The results also indicated that priming condition could enhance the low-OC group under JREs, but neither the high-OC nor the low-OC groups under NJREs. Discussion: For the high-OC group or the participants under NJREs, the priming condition could not significantly enhance their sense of agency; only the low-OC group under JREs enhanced their sense of agency by priming. This indicated that high-OC or NJREs might result in functional defect of their internal forward models. It was noted that though participants under NJREs did not have significant difference between priming and non-priming conditions on sense of agency, the difference between the two slopes were similar to that of the low-OC group under JREs. Put together, the results of this study were discussed by the integrated model of self-agency proposed by Synofzik (2008a). Conclusions: The present study supported that the priming condition could enhance the sense of agency in the low-OC group under JREs. Nevertheless, we also found that when experiencing the not just right experiences, feed-forward cues might be an important indicator for emotional regulation. Therefore, we suggest that for INc/NJREs type of obsessive-compulsive behaviors, treating these related emotions to be the primary goal.