臺灣博碩士論文加值系統

思覺失調症是所有疾病中最致失能的疾病之一，此疾病對於患者會減少社會連結、就業率下降及獨立生活能力受損，建立有目標性的認知介入方法已被發現是可以改善精神疾病患者的社會心理功能，突顯出針對思覺失調症患者進行認知介入方法的重要性。
社會認知是一種能夠構建自身與他人關係的心理表徵，彈性地運用這些表徵有助於引導社會行為，而社會認知層面中的情緒辨識缺損是在思覺失調症患者身上穩定被觀察到的特徵之一，許多研究結果皆發現思覺失調症具有較不佳的臉部情緒辨識能力。情緒辨識的範圍包含微表情辨識，其持續時間僅1/25至1/5秒，是一種非自主性地洩露個人的內在真實情緒，藉由辨識這些表情和相關的情緒可以知道對方的感受，並且可能進一步改善人際關係、增強自我覺察及整體的健康。國外已將微表情訓練工具應用於訓練門診思覺失調症患者的臉部情緒辨識能力，結果顯示具有改善效果，然而國內尚缺乏相關的研究。另外，思覺失調症患者的社會認知與神經認知功能兩者之間可能具有相關，特別是神經認知當中的持續性注意力與執行功能可以部分解釋臉部情緒辨識之缺損。綜上所述，本研究的目的為探討微表情訓練工具應用於思覺失調症患者之臉部情緒辨識能力之介入成效，並進一步檢驗持續性注意力和執行功能對此訓練成效的可能影響。
本研究使用微表情訓練工具（Micro-expression training tool, METT）針對精神復健機構的思覺失調症患者（22位病人組）與一般社區民眾（32位健康控制組）進行前測、四週訓練、隔一週後測及一個月追蹤，檢驗其效果，並採用台灣版診斷性非語言行為準確性分析工具（Analysis of Nonverbal Accuracy 2-Taiwan version, DANVA-2-TW）來探討經微表情訓練後能否類化至一般情緒辨識。另外，採用克氏注意力持續度表現測驗第三版（Conners Continuous Performance Test, CPT-3）、威斯康辛卡片分類測驗（Wisconsin Card Sorting Test ,WCST-128）探討神經認知功能與微表情辨識準確度之關聯。
結果發現，在METT成效方面，（1）健康控制組訓練前的微表情辨識準確度顯著高於病人組，（2）病人組訓練後的整體微表情辨識準確度比訓練前顯著較高，（3）病人組於訓練前後的一般臉部情緒辨識準確度無顯著差異，（4）健康控制組與病人組大多數的微情緒辨識準確度增加幅度於訓練前後有顯著差異，且病人組的增加幅度較低，（5）健康控制組與病人組之一般情緒辨識準確度於訓練前後沒有顯著增加。此外，在微表情辨識與神經認知功能的關聯方面，（1）健康控制組和病人組的整體、各情緒的微表情辨識準確度與CPT-3區辨力指標無顯著相關，（2）健康控制組的整體微表情辨識準確度與WCST-128續發性錯誤次數有顯著負相關。
目前，臨床上對於思覺失調症的社會認知訓練不多，本研究初步結果顯示聚焦於微表情情緒辨識的認知介入方法具有成效。本研究盼望透過初步研究結果，對微表情領域具有部分貢獻，並且提供未來有興趣進一步研究的學者做為參考。

Schizophrenia is one of the most disabling disorders, and it has been found that targeted cognitive interventions can improve the psychosocial functioning of schizophrenia patients, including social bonding, employment, and independent living. This highlights the importance of cognitive interventions for schizophrenia patients.
Social cognition is mental representations that can construct relationships between oneself and others, and the flexible use of these representations can guide individual’s appropriate social behavior. At the social cognition level, poor emotion recognition deficit is one of the characteristics that are steadily observed in schizophrenia patients. Emotion recognition includes micro-expression recognition, which lasts only 1/25 to 1/5 of a second and is an involuntary disclosure of one's inner true emotions. By recognizing these micro-expressions, individuals can understand other people's feelings, and may further improve their relationships, self-awareness, and health. The micro-expression training tool (METT) has been applied to improve the facial emotion recognition ability in outpatients with schizophrenia, and the results show that the METT has an improvement effect on micro-expressions recognition, but there is still a lack of relevant research in Taiwan. In addition, there may be a correlation between social cognition and cognitive neurological function in patients with schizophrenia. In particular, sustained attention and executive function may partially explain the deficit in facial emotion recognition. In conclusion, the aim of this study was to investigate the intervention effect of the METT on the facial emotion recognition ability of schizophrenic patients and to further examine the possible effects of sustained attention and executive function on the intervention effect.
This study used the micro-expression training tool (METT) to train 22 schizophrenia patients and 32 normal controls at seven assessment times: pre-test (T1), four-week training (T2-T5), post-test one week after the last training session (T6), and a follow-up one month after the last training session (T7). The Analysis of Nonverbal Accuracy 2-Taiwan version (DANVA-2-TW) was used to explore whether the training effect can be generalized to general facial emotion recognition. In addition, the third edition of Conners' Continuous Performance Test (CPT-3) and Wisconsin Card Sorting Test (WCST-128) were used to explore the relationship between cognitive neurocognitive function and micro-expression recognition accuracy.
The results showed that, in terms of the METT intervention effect, (1) at T1: the micro-expression recognition accuracy of the control group was significantly higher than the patient group; (2) across T1-T5: the overall micro-expression recognition accuracy after METT training was significantly higher than that before training in the patient group; (3) across T1-T5: there was no significant difference in the accuracy of general facial emotion recognition after METT training in the patient group; (4) at T1, T6, and T7: the increase in the accuracy of micro-expression recognition between the control group and the patient group was significantly different, and the patient group increased less. (5) at T1, T6, and T7: there was no significant increase in the general facial emotion recognition accuracy between the control group and the patient group after training. Moreover, in terms of the correlation between micro-expression recognition and neurocognitive function, (1) the overall and each emotion recognition accuracy of micro-expression was not significantly correlated with the CPT-3 detectability(d’) in both groups; (2) the overall micro-expression recognition accuracy was significantly negatively correlated with the number of WCST-128 secondary errors in the control group.
As we know so far, there is not much social cognitive training for schizophrenia in clinical practice. The preliminary results of this study show that the social cognitive intervention focusing on micro-expression emotion recognition is effective. This research expects to make some contributions to the field of micro-expression, and provide researchers who are interested in micro-expression as a reference in the future.

目錄
摘要 i
Abstract iii
誌謝 vi
目錄 vii
圖目錄 ix
表目錄 x
第一章 研究動機 1
第二章 文獻探討 3
第一節 思覺失調症 3
第二節 社會認知與神經認知功能 4
第三節 思覺失調症的社會認知與情緒辨識缺損 5
第四節 臉部表情和微表情 9
第五節 微表情訓練工具（Micro-expression training tool, METT） 13
第六節 思覺失調症的情緒辨識缺損與神經認知功能之關聯 15
第七節 研究目的與假設 18
第三章 研究方法與結果 20
第一節 研究參與者 20
第二節 研究工具 22
第三節 研究程序 29
第四節 研究結果 31
第四章 討論與建議 70
第一節 微表情訓練（METT）介入結果之討論 70
第二節 研究限制與未來方向 76
第三節 研究貢獻 80
參考文獻 81
中文文獻 81
英文文獻 81

圖目錄
圖 2- 1、思覺失調症社會認知歷程 8
圖 3- 1、生氣的臉部表情 25
圖 3- 2、害怕的臉部表情 26
圖 3- 3、悲傷的臉部表情 26
圖 3- 4、厭惡的臉部表情 27
圖 3- 5、輕蔑的臉部表情 27
圖 3- 6、驚訝的臉部表情 28
圖 3- 7、高興的臉部表情 28
圖 3- 8、研究流程圖 30
圖 3- 9、組別、5個時間點在METT整體微表情辨識準確度之交互作用圖 34
圖 3- 10、組別、3個時間點在METT整體微表情辨識準確度之交互作用圖 45

表目錄
表 3- 1、組別在年齡與智商上之t檢定 21
表 3- 2、性別和組別的列聯表 21
表 3- 3、病人組之臨床相關變項（n = 22） 21
表 3- 4、組別在WAIS-IV短版、DANVA、CPT-3和WCST-128之t檢定 31
表 3- 5、各細格描述統計 33
表 3- 6、組別、5個時間點在METT整體微表情辨識準確度上之ANOVA 33
表 3- 7、組別、5個時間點在METT整體微表情辨識準確度上之單純主效果分析 34
表 3- 8、各細格描述統計 35
表 3- 9、組別、5個時間點在METT高興微表情辨識準確度上之ANOVA 35
表 3- 10、各細格描述統計 36
表 3- 11、組別、5個時間點在METT悲傷微表情辨識準確度上之ANOVA 36
表 3- 12、各細格描述統計 37
表 3- 13、組別、5個時間點在METT厭惡微表情辨識準確度上之ANOVA 37
表 3- 14、各細格描述統計 38
表 3- 15、組別、時間點在METT輕蔑微表情辨識準確度上之ANOVA 39
表 3- 16、各細格描述統計 39
表 3- 17、組別、5個時間點在METT生氣微表情辨識準確度上之ANOVA 40
表 3- 18、各細格描述統計 41
表 3- 19、組別、5個時間點在METT害怕微表情辨識準確度上之ANOVA 41
表 3- 20、各細格描述統計 42
表 3- 21、組別、5個時間點在METT驚訝微表情辨識準確度上之單純主效果分析 42
表 3- 22、各細格描述統計 44
表 3- 23、組別、3個時間點在METT整體微表情辨識準確度上之ANOVA 44
表 3- 24、組別、3個時間點在METT整體微表情辨識準確度上之單純主效果分析 44
表 3- 25、各細格描述統計 46
表 3- 26、組別、3個時間點在METT高興辨識準確度上之ANOVA 46
表 3- 27、各細格描述統計 47
表 3- 28、組別、3個時間點在METT悲傷辨識準確度上之ANOVA 47
表 3- 29、各細格描述統計 48
表 3- 30、組別、3個時間點在METT厭惡辨識準確度上之ANOVA 48
表 3- 31、各細格描述統計 49
表 3- 32、組別、3個時間點在METT輕蔑辨識準確度上之ANOVA 50
表 3- 33、各細格描述統計 51
表 3- 34、組別、3個時間點在METT生氣辨識準確度上之ANOVA 51
表 3- 35、各細格描述統計 52
表 3- 36、組別、3個時間點在METT害怕辨識準確度上之ANOVA 52
表 3- 37、各細格描述統計 53
表 3- 38、組別、3個時間點在METT驚訝辨識準確度上之ANOVA 53
表 3- 39、各細格描述統計 54
表 3- 40、組別、3個時間點在DANVA高興辨識準確度上之ANOVA 54
表 3- 41、各細格描述統計 55
表 3- 42、組別、3個時間點在DANVA悲傷辨識準確度上之ANOVA 55
表 3- 43、各細格描述統計 56
表 3- 44、組別、3個時間點在DANVA生氣辨識準確度上之ANOVA 56
表 3- 45、各細格描述統計 57
表 3- 46、組別、3個時間點在DANVA害怕辨識準確度上之ANOVA 57
表 3- 47、各細格描述統計 58
表 3- 48、組別、時間點在WCST持續性錯誤上之ANOVA 58
表 3- 49、各細格描述統計 59
表 3- 50、組別、時間點在CPT-3區辨力指標上之ANOVA 59
表 3- 51、七個時間點的METT分數描述統計 62
表 3- 52、控制性別、年齡與智商後的GEE分析（METT） 64
表 3- 53、控制性別、年齡與智商後的GEE分析（METT） （續） 66
表 3- 54、METT微表情辨識準確度與WCST續發性反應錯誤次數、CPT-3區辨力指標之相關矩陣（N = 52） 68

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