後設認知訓練改善台灣精神疾病患者之認知偏誤與症狀之成效：單組前後測研究

Abstract

後設認知訓練（Metacognitive Training, MCT）透過改善與精神症狀相關的認知偏誤，能有效減輕精神疾病患者之症狀並提升整體功能。然而目前仍缺乏充分的研究討論MCT在台灣的臨床應用，因此本研究旨在探討繁體中文版MCT應用於台灣慢性精神疾病患者之治療成效。 本研究採單組前後測設計，納入18名參與者（涵蓋思覺失調症、憂鬱症及雙相情緒障礙症患者），進行為期四週、共八次的團體MCT治療。參與者來自台灣北部地區兩處醫療院所（日間病房與社區復健中心）。評估工具包含中文版Davos認知偏誤評估量表（MCL-DACOBS）、中文版精神疾病症狀評量表（C-PSYRATS）、繁體中文版PROMIS憂鬱/焦慮短版量表（PROMIS Depression/ Anxiety 4a v1.0）、圖像化之個人與社會功能自我評估量表（SRG-PSP）、精神科職能治療生活功能量表第3版（sf-ADLS），及Neuro-QoL應用式認知簡短版，並收集參與者滿意度。數據分析使用SPSS 27.0進行，並以無母數統計之威克森符號等級檢定（Wilcoxon Signed-Rank Test）來比較組內前後測差異，以及Cohen’s d 計算組內治療成效之效應值（effect size）。 研究結果顯示，繁體中文版MCT應用於台灣慢性精神疾病患者具良好的臨床成效與可行性。MCT能有效改善思覺失調症患者的認知偏誤（p ≤ 0.01, dz=1.34）、降低症狀帶來的心理困擾（p=0.01, dz=0.66），並提升整體功能（含社會功能、日常生活功能及認知功能；p=0.01~0.03, dz=0.65~0.90）。針對情緒障礙症患者，認知偏誤呈現趨近顯著的改善趨勢（p=0.07, dz=1.73），且焦慮症狀改善幅度（p=0.07, dz=1.31）大於憂鬱症狀（p=0.18, dz=0.85）。而參與者對MCT課程滿意度高，認為課程內容易懂且實用，治療依從性良好。未來研究建議採用隨機對照試驗設計，擴大樣本規模並納入長期追蹤評估，以進一步確認MCT的療效及其長期維持效果。

Metacognitive Training (MCT) has shown promise in alleviating symptoms and enhance general functioning in patients with mental illness by ameliorating cognitive biases associated with psychiatric symptoms. However, the clinical application of MCT in Taiwan has not been fully explored. Therefore, this study aims to examine the effectiveness of the Traditional Chinese version of MCT in patients with chronic mental illness in Taiwan. This study adopted a single-group pretest-posttest design. 18 participants, including patients with schizophrenia, depression, and bipolar disorder, were recruited to undergo an 8-session MCT group intervention over four weeks. Participants were recruited from two psychiatric facilities (a day ward and a community rehabilitation center) located in northern Taiwan. Assessments include the Modified Davos Assessment of Cognitive Biases Scale (MCL-DACOBS), the Chinese versions of the Psychotic Symptom Rating Scales (C-PSYRATS), the Traditional Chinese version of the PROMIS Depression and Anxiety Short Forms (4a v1.0), the Self-reported Graphic Personal and Social Performance Scale (SRG-PSP), Neuro-QoL Item Bank v2.0 – Cognitive Function– Short Form, and Self-Reported Activities of Daily Living Scale, third version (sf-ADLS). Participant satisfaction is also collected. Statistical analyses will utilize non-parametric Wilcoxon Signed-Rank Test and Cohen’s d for effect size calculations. The results indicated that the Traditional Chinese version of MCT demonstrates good clinical efficacy and feasibility for patients with chronic mental illness in Taiwan. MCT effectively improved cognitive biases (p ≤ 0.01, dz=1.34) and reduced symptom-related psychological distress (p=0.01, dz=0.66) in patients with schizophrenia, while also enhancing general functioning (including social, daily, and cognitive functions; p=0.01~0.03, dz=0.65~0.90). For patients with mood disorders, the improvement in anxiety symptoms (p=0.07, dz=1.31) was greater than that in depressive symptoms (p=0.18, dz=0.85), and cognitive biases showed a trend of improvement (p=0.07, dz=1.73). Furthermore, participants reported high satisfaction with the MCT program, finding the content easy to understand and practical, and demonstrated good treatment adherence. Future studies are recommended to adopt a randomized controlled trial design with a larger sample size and long-term follow-up assessments to further confirm the efficacy and long-term maintenance effects of MCT.