無法忍受不確定性、控制需求與控制知感在強迫檢查之角色

Abstract

無法忍受不確定性為強迫症相關失能信念之一，與強迫檢查有關，而無法忍受不確定性對於強迫症患者強迫行為的影響，可能來自於控制感，包括控制需求與控制知感。在不確定性之情境下，無法忍受不確定性分別會引發個體產生較高的控制需求和較低的控制知感，當控制知感與控制需求產生落差時就會引發強迫行為，個體希望藉此來提升其控制知感。此外，高強迫特質傾向者會有控制知感錯覺，這可能的原因為強迫行為後的結果。雖然強迫症患者對其強迫行為較難有確信感，然而無法忍受不確定性的特質會驅使產生強迫行為，且執行強迫行為直到其內在之確信感被滿足為止，亦即直到強迫症患者認為強迫行為執行確實為止。但目前研究尚少探討無法忍受不確定性對強迫檢查的影響，且尚無研究直接探討不確定性情境對個體的強迫檢查行為之影響，以及當個體執行強迫行為之後，該行為對其控制知感與檢查信心的影響。故本研究擬探討個體在高低情境不確定性下，無法忍受不確定性與強迫檢查傾向特質對於控制需求、控制知感、檢查次數、反應時間與檢查信心之影響。本研究對209位參與者實施延遲匹配圖片作業，最後進入正式資料分析的參與者為無法忍受不確定性量表（IUS）得分在75分以上或54分以下，且莫斯利強迫症量表得分在12分以上或8分以下，檢查分量表在5分以上或2分以下。經由以上問卷分為高無法忍受不確定性且具強迫檢查傾向組與低無法忍受不確定性且無強迫檢查組二組，分別為22人與23人。正式資料分析以控制需求、控制知感、檢查信心、檢查次數、反應時間、確定性為依變項，前測為共變項，採2（無法忍受不確定性與強迫檢查傾向組別：高/低）x 2（圖片種類：中性圖/檢查相關圖）x 2（情境不確定性操弄：高/低）的三因子混合共變數分析。研究結果發現，高無法忍受不確定性且具強迫檢查傾向組有較高的控制需求與控制知感與較多的檢查次數，然高無法忍受不確定性且具強迫檢查傾向組的控制需求與控制知感仍有落差。高無法忍受不確定性且具強迫檢查傾向組在接受高情境不確定性的操弄後，相較於低情境不確定性操弄，其檢查信心較低。在檢查次數方面，參與者在高情境不確定性操弄後，相較於低情境不確定性操弄，其檢查次數較多。在反應時間方面，高無法忍受不確定性且具強迫檢查傾向組在有進行檢查行為與圖片相同時的反應時間較長。高無法忍受不確定性且具強迫檢查傾向組之控制知感高於其對照組，可能是因為控制知感會受強迫行為的影響，為控制知感錯覺的展現。而兩組參與者在檢查信心並無明顯差異，這可能來自於高無法忍受不確定性且具強迫檢查傾向組有較高的檢查次數之故。然而，高無法忍受不確定性且具強迫檢查傾向組之控制知感與控制需求仍有所落差，對此結果本研究以Tallis等人（1991）所提的高證據需求特性加以討論。本研究發現高無法忍受不確定性且具強迫檢查傾向組有控制知感錯覺的現象，同時也驗證無法忍受不確定性的個體會有較高的控制需求。然而控制知感錯覺可能是短暫的現象，且有可能造成負向增強，易言之，使得強迫症患者在下一次陷入低控制知感時，會以強迫行為的模式來增加其控制知感，而形成惡性循環。故，未來在治療上或許可進一步讓強迫症個案了解執行完強迫行為後，其控制知感的增加並非真實，同時可透過接納與承諾治療減少無法忍受不確定性的個體為了達到全然確定性而引發的高控制需求。

Intolerance of uncertainty (IU) is one of the OCD-related dysfunctional beliefs, and is linked to compulsive checking. Desire for control (DC) and Sense of control (SC) might be involved in the effect of IU on compulsive checking. Specifically, high uncertainty circumstances might exert high DC and low SC for high IU individuals. Discrepancy between DC and SC would motivate compulsions to increase SC. Further, individuals with high OC tendencies showed illusion of control when completing their compulsions. Though it’s hard for individuals with OCD to experience conviction of their compulsive behaviors, IU would promote them to repeat their compulsions until the feeling of conviction was satisfied. Nevertheless, there has been little research aimed to explore the effect of IU on compulsive checking, neither was research directly addressed the effect of situational uncertainty on compulsive checking, nor was compulsions on subsequent SC and confidence of checking compulsions investigated. As such, this study explored the effects of IU and OC checking tendencies on the DC, SC, checking frequency, response time, and confidence after checking under high/low uncertainty circumstances. 209 participants performed the delayed matching-to-sample task, among which we chose those IUS score > 75, MOCI total score > 12, and checking subscale score > 5 to be the high IU high OC checking tendency group (n = 22), and IUS score < 54, MOCI total score < 8, and checking subscale score < 2 to be the low IU low OC checking tendency group (n = 23). Using these criteria, we screened 45 participants for data analysis. A series of 2 (IU_OCC group: high/low) x 2 (neutral/checking-relevant pictures) x 2 (high/low uncertainty circumstances manipulation) three way ANOVAs were conducted. High IU_OCC group showed higher DC, SC, and more checking behaviors, nonetheless, this group still revealed significant discrepancy between DC and SC. Furthermore, though all participants checked more frequently under high uncertainty circumstance, high IU_OCC group indicated lower confidence in their checking behaviors under this high uncertainty circumstance. High IU_OCC group exhibited longer response time for both the checking condition and same-pictures condition. Illusion of control in high IU_OCC group could be affected by their compulsion activity. The no differences regarding confidence of checking behaviors between the two groups might result from more frequent checking activity in high IU_OCC group. Nevertheless, high IU_OCC group still showed lower SC compared to DC which was discussed in terms of the elevated evidence requirements proposed by Tallis et al. (1991). We found that high IU_OCC group showed illusion of control. The present study also supported that IU is related to high DC. Given that illusion of control is short-lived, it could negatively reinforce individuals with OCD using more compulsions thereafter to enhance their SC. Therefore, we suggest that CBT therapists help patients with OCD to realize the elevated SC after their compulsions is not real, and assist individuals with high IU through Acceptance and Commitment Therapy to reduce their high DC.