強迫症的認知向度心理病理探討：個案研究

Abstract

本研究引用鄭昭明（2006）學習與認知系統模式建立-強迫症病理發生模式來檢視強迫症的認知監控系統；以及失功能的信念或基模的角色，嘗試分析強迫症的發生與維持過程中，認知功能與特殊的信念和意義所扮演的角色。強迫症患者會選擇性地注意外在的（知覺的）或內在的（認知的）刺激，特別是針對闖入性想法（IT）。本研究系統性的探討患者的這些認知扭曲的發生歷程，試圖瞭解強迫症患者認知監控上的失能與知識系統失功能信念是如何形成，特別是想法行動融合（TAF）形式的失功能信念。本研究提出如圖一的研究架構，分成兩大部分，一部份是認知運作歷程，以個體「認知監控」與「注意功能」為關切的出發點，第二部份是「認知內涵」為關切的出發點。研究收集北部某財團法人地區教學醫院的二名強迫症患者的深度訪談資料，資料的整理採用內容分析法。由兩位患者的資料中發現，兩位患者在認知運作上出現兩類的缺失，一類是認知功能缺失它包括：注意功能缺失以及監控認知功能缺失，另一類是認知內涵的缺失它包括：過度評估負向事件發生的可能性，對IT或TAF作災難化的解釋、過度的誇大責任、過度的要求完美主義等） 。此兩類認知運作會相互影響：認知功能的缺失可能引導形成認知內涵的缺失（不良的信念）。在注意功能缺失部分，強迫症患者會選擇性注意某些特定的訊息，而且持續的注意較多是負面的與自我有關的訊息。在監控認知雖可以作部份的監測，但缺乏對於監測結果的控制與調整，或者是在監測策略效果或控制不同的策略選擇上是不適當的。

In order to survey the cognitive monitoring system of OCD and its dysfunctional believe or schema, the present study attempt to utilize the human learning and cognitive system model to construct a psychopathological model of OCD. In this analysis of patients’ emergence and maintaining with OCD, their cognitive functioning and particular beliefs would play critical role. Patients would selectively attentive to outward (perceptual) or inward (cognitive) stimulus, especially focus on intrusive thoughts (IT). The present study systematically analysis OCD patients’ cognition which would distort processing, so that researcher could find out their inability of cognitive monitoring and knowledge structure which generated their dysfunctional belief, particularly the form of dysfunctional belief, that is Thought-Action fusion (TAF). There are two parts in our study (figure-1), one is the process of cognitive operation which focus on “cognitive monitoring” and “attention functioning”, the other is toward “cognitive content”. Researcher adopts case study method to content analysis two OCD patients’ intensive interview data. The research results found that existed two kinds of deficit in patients’ cognitive operation, one of them include problem of attention functioning and cognitive monitoring. The other is deficiency of cognitive content, which include overstate the probability of negative events, traumatized interpretation of IT or TAF, exaggerated personal responsibility, and demanding of perfectionism. Those cognitive operations would influence each other, such as deficit of cognitive function could induce problematic cognitive content (irrational beliefs). On the other hand, OCD patients’ would selectively pay attention to some special stimulus, such as focus on negative and self related information. Although cognitive monitoring would function, they lack of adjusting with monitoring results, or cognitive monitoring strategies are inappropriate.