由上而下的注意力控制訓練方案對類廣泛性焦慮症者的療效：隨機對照實驗

Abstract

許多研究顯示焦慮症狀與注意力控制缺損有相互影響的關係，而增強由上而下的注意力歷程與焦慮程度的降低有關。研究指出視覺搜尋作業可有效的測量及操弄由上而下及由下而上的注意力歷程，但此部份研究仍在發展中。本研究旨在探討以非威脅性分心物的視覺搜尋作業進行注意力偏誤訓練是否能夠增進注意力控制及類廣泛性焦慮症者的注意力控制、廣泛性焦慮症狀，並且進一步探討多次訓練的效果。本研究邀請52位GAD-7得分為8分或以上之類廣泛性焦慮大學生參與實驗操弄（實驗組及對照組各26位），進行共五次的注意力訓練，實驗組接受特徵搜尋模式的訓練，對照組則以獨特性偵測模式訓練。本研究也邀請30位低類廣泛性焦慮的大學生（GAD-7得分7分或以下且STAI-T得分43分或以下），他們僅完成前後測。本研究以重複量測多變量變異數分析（MANOVA）以及重複量測變異數分析（ANOVA）評估訓練效果。結果顯示，在後測時視覺搜尋作業對實驗組及對照組二者間的注意力控制產生顯著差異，實驗組的注意力控制能力增加而對照組的注意力控制能力降低，並且在增加訓練次數後注意力控制的改變量更加明顯。特別是對照組在五次訓練後，其注意力控制能力變得顯著的比低類廣泛性焦慮組低，而實驗組則與低類廣泛性焦慮無差異。另外，本研究亦顯示兩組在後測的焦慮相關症狀均有減緩，但組別及時間的交互作用並未顯著。綜上所述，本研究結果支持視覺搜尋作業在注意力控制能力操弄上的效果，但未來仍需要進一步探討注意力訓練以及情緒之間的運作機制，俾更增進與維持治療效應。

Studies have suggested that there may be at least a bidirectional causal relationship between anxiety symptoms and impairments in attentional control. Increase in top-down attentional control has been associated with anxiety reduction. Visual search task has been suggested to be effective in measuring and modifying top-down and bottom-up attentional processes; nonetheless, research has been scarce and awaits developing. The main purpose of the current study was to investigate whether visual search task with non-threat distractors could improve attentional control, decrease GAD pathology, and anxiety symptoms of subclinical GAD students. The efficacy of multi-sessional training was also investigated. Fifty-two undergraduate students with GAD-7 score equal or above 8 were recruited to participate in a 5-day session (26 participants in each group). The experimental group received feature search training, and the control group received singleton search training. Thirty non-subclinical GAD control samples (GAD-7 equal or below 7 and STAI-T equal or below 43) were also recruited. However, they only completed the pre- and post- assessments. Multivariate analysis of variance (MANOVA) and analysis of variance (ANOVA) with repeated measures were used to investigate the efficacy of the intervention. It was found that after the training sessions provided with visual search task, the level of attentional control between the experimental and control groups was significantly different at posttest: the attentional control ability of the experimental group improved while the control group worsened. Also, it was found that with increased number of sessions, the effect on attentional control became more profound. Specifically, the attention control ability of the control group became significantly worse than the non-subclinical GAD group after five sessions of training, while the experimental group showed no different from the non-subclinical GAD group. On the other hand, though participants in both the experimental and control groups had less intense anxiety symptoms at posttests, the group × time interaction was insignificant. In conclusion, the present study supported that the visual search task with non-threat distractor is efficacious for increase top-down attentional process; however, the mechanism on producing emotional change requires further research, so that it can increase the likelihood to produce desired and stable emotional adjustments.