66 Effects of Social Skills Training 50Grant & Beck, 2010; Pilling et al., 2002; Rector, Beck, & Stolar, Eklund, 1999 ㈠ Perivoliotis, Grant, &

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1 65 社交技巧訓練對住院精神分裂症病患表達與溝通成效之探討羅惠敏 1 李麗花 2 葉靜宜 3* 社交技巧訓練 (social skill training) 是目前精神醫療體系中應用最廣的治療理論, 也是目前最普遍用來解決精神病人社交問題的方法本研究旨在探討社交技巧訓練介入, 對住院精神分裂症患者溝通表達的成效本研究採類實驗單組前後測設計, 以結構式問卷自 2007 年 6 月 26 日至 2007 年 8 月 19 日收集資料, 內容包括人口學變項溝通功能和社交技巧研究對象為缺乏人際溝通技巧退化行為, 住院連續達 3 天, 且注意力能夠持續超過 30 分鐘者, 介入每週 2 次, 每次 60 分鐘的社交技巧訓練, 為期一個月完成研究之病患共計 8 位, 研究結果顯示研究對象在社交技巧訓練介入後, 自我介紹拒絕 / 被拒絕借物 / 被借物道歉及邀請 / 被邀請之社會功能表現上均呈現統計上的顯著差異 (p <.01) 本研究顯示社交技巧訓練介入對住院精神症患者溝通表達有顯著成效, 建議在臨床照護上能安排類似此訓練課程, 促進病患之社會功能, 提升其問題解決能力, 使其重拾信心回歸社區關鍵詞 : 社交技巧訓練精神分裂症病人人際溝通技巧 741, , % % , , %7, %24.63% 2009 social skill training * 卷 1 期中華民國 100 年 3 月

2 66 Effects of Social Skills Training 50Grant & Beck, 2010; Pilling et al., 2002; Rector, Beck, & Stolar, Eklund, 1999 ㈠ Perivoliotis, Grant, & Beck, 2009 Grant & Beck, 2010Libert Lewinsohn 1973 Ladd Mize 1983 Beck & Rector, 2005; Eric et al., 2005 ㈡ Bandura 1969 Wolpe 1958 Cicerone et al., 2008; Perivoliotis et al., 2009 Bellack, Hersen, & Alan, 1976 Eric et al., Hoffmann, Kupper, & Kunz, 1998; Varcarolis, Carson, & Shoemaker, 2006 Heinssen, Liberman, & Kopelowicz, 2000; Pilling et al., 2002; Sensky et al., 2000Heinssen et al., 2000Heinssen Pinninti, Rissmiller, Steer, & Beck, 2006 Eric et al., 2005; Sensky et al., 卷 1 期中華民國 100 年 3 月

3 67 ㈠㈡ 1994 Conbach s α Likert 1 71% 100% 2 41% 70% 3 40% CVI.89 Conbach s α.91 Institutional review board, IRB SPSS 10.0 for Windows /19 7/22 7/26 7/29 8/01 8/06 8/ / 卷 1 期中華民國 100 年 3 月

4 68 Effects of Social Skills Training % 28~62 M = 40.13n = 4, 50% n = 5, 62.5% n = 5, 62.5% n = 8, 100% 3~8 M = ~30 M = 13 70%~100% Mean = 5.5; Mean = Mean = 7.875, Mean = Mean = 6.25; Mean = 10.0 Mean = 8.25; Mean = Mean = 2.75; Mean = 5.0 Wilcoxon Signed Ranks Testp <.05 A Schizophrenia B Schizophrenia C Schizophrenia D 51 6 Schizophrenia E Schizophrenia F Schizophrenia G 34 9 Schizophrenia H Schizophrenia 卷 1 期中華民國 100 年 3 月

5 69 N = 8 n % Likert 171% 100% 241% 70% 3 40% 4 N = 8 Mean * * * ** * *p <.05. **p <.01. p Eric2005 Grant2010 Bandura Wolpe 2000 Liberman 卷 1 期中華民國 100 年 3 月

6 70 Effects of Social Skills Training Cicerone et al., 2008; Perivoliotis et al., 2009 Cicerone et al., 2008; Perivoliotis et al., [National Health Insurance Bureau, Taiwan, ROC. (2009, February 18). Disease statistics. Retrieved May 22, 2010, from [Ministry of the Interior, Taiwan, ROC. (2009, April 4). Demographic statistics. Retrieved May 22, 2010, from tw/stat/stat01.aspx] aspx [Department of Health, Executive Yuan, Taiwan, ROC. (2009, February 1). Mental illness. Retrieved June 12, 2009, from index_populace.aspx] [Lee, S., Yeh, M. Y., & Hung, T. M. (1994). Effects of social skills training on improving expression and communication of hospitalized psychotic patients. Nursing Research(Taiwan), 2(2), ] [Tasi, C. Y., Lee, H. L., Tan, Y. K., & 7 卷 1 期中華民國 100 年 3 月

7 71 Wu, C. Y. (2002). Effectiveness of an independent living skills training group for clients with chronic psychiatric illness. Journal of Occupational Therapy Association, 20, 3 10.] Bandura, A. (1969). Principle of behavior modification. New York: Holte, Rinehart & Winston. Beck, A. T., & Rector, N. (2005). Cognitive approaches to schizophrenia: Theory and therapy. Annual Review of Clinical Psychology, 1(3), Bellack, S. T., Hersen, M., & Alan, S. (1976). Social skills training to teach prosocial behaviors in an organically impaired and retarded patient. Journal of Behavior Therapy and Experimental Psychiatry, 9(3), Cicerone, D. M., Dahlberg, C., Kalmar, K., Lanqenbahn, D. M., Malec, J. F., Berqquist, T. F., et al. (2008). Evidencebased cognitive rehabilitation: Recommendations for clinical practice. Archives Physical Medicine Rehabilitation, 81(12), Eric, G., John, R. M., Fauzia, S., M., Lisa, A. A., Dimitri, M. S., Paola, P., et al. (2005). A randomized, controlled trial of cognitive behavioral social skills training for middle-aged and older outpatients with chronic schizophrenia. American Journal of Psychiatry, 162(3), Eklund, M. (1999). Outcome of occupational therapy in a psychiatric day care unit for long-term mentally ill patients. Occupational Therapy in Mental Health, 14(4), Grant, P. M., & Beck, A. T. (2010). Asocial beliefs as predictors of asocial behavior in schizophrenia. Psychiatry Research, 177(1-2), Heinssen, R. K., Liberman, R. P., & Kopelowicz, A. (2000). Psychosocial skills training for schizophrenia: Lessons from the laboratory. Schizophrenia Bulletin, 26(1), Hoffmann, H., Kupper, Z., & Kunz, B. (1998). Predicting schizophrenic outpatients behavior by symptomatology and social skills. The Journal of Nervous and Mental Disease, 186(4), Ladd, G. W., & Mize, J. (1983). A cognitive social learning model of social skill training. Psychological Review, 90(2), Liberman, R. P. (1986). Social skills training for schizophrenia individuals at risk for replace. American Journal of Psychiatry, 143(1), Libert, J., & Lewinsohn, P. M. (1973). Concept of social skill with special reference to thebehavior of depressed person. Journal of Consulting and Clinical Psychology, 40(2), Perivoliotis, D., Grant, P. M., & Beck, A. T. (2009). Advances in cognitive therapy for schizophrenia: Empowerment and recovery in the absence of insight. Clinical Case Studies, 8(6), Pilling, S., Bebbington, P., Kuipers, E., Garety, P., Geddes, J., Orbach, G., et al. (2002). Psychological treatments in schizophrenia: I. Meta analysis of family interventions and cognitive behaviour therapy. Psychological Medicine, 32(5), Pinninti, N., Rissmiller, D. J., Steer, R. A., & Beck, A. T. (2006). Severity of self-reported depression in patients with a schizoaffective disorder. Journal of Psychopathology and Behavioral Assessment, 28(3), Rector, N. A., Beck, A. T., & Stolar, N. (2005). The negative symptoms of schizophrenia: A cognitive perspective. Canadian Journal of Psychiatry, 50(5), Sensky, T., Turkington, D., Kingdon, D., Scott, J. L., Scott, J., Siddle, R. et al. (2000). A randomized controlled trial of cognitive-behavioral therapy for persistent symptoms in schizophrenia resistant to medication. Archives of General Psychiatry, 57(2), Varcarolis, E. M., Carson, V. B., & Shoemaker, N. C. (2006). Foundations of psychiatric mental health nursing (5th ed.). Philadelphia: Saunders. Wolpe, J. (1958). Psychotherapy by reciprocal inhibition. Stanford, CA: Stanford University Press. 7 卷 1 期中華民國 100 年 3 月

8 72 Effects of Social Skills Training Social Skills Training: Effects on Expression and Communication in Hospitalized Schizophrenic Patients Hui-Min Lo 1 Li-Hua Lee 2 Ching-Yi Yeh 3 * Abstract Background: Social skills training is currently the theory most widely applied in the mental health treatment system. It is also the most frequently employed approach to social problem solving. Purpose: The authors designed this study to investigate the effects of social skills training on expression and communication in hospitalized schizophrenic patients. Method: This study used a quasi-experimental design. Structured questionnaires collected data covering demographics, communication functions and social skills. Data were collected from 26 June to 19 August, The eight participants enrolled all exhibited poor communication skills and withdrawal behavior in interpersonal relationships; had been hospitalized for three days; and were capable of paying attention for more than 30 minutes. Researchers administered a 60-minute social skills training course intervention to participants two times a week for a one-month period. Results: A total of 8 valid responses were received, giving a response rate of 72.7%. Major findings after the intervention found significant differences in participant capacities to introduce themselves, reject and be rejected, borrow and lend, apologize, and invite and be invited. Changes in such social functions exhibited statistically significant differences (p <.01). Conclusion / Implication for practice: This study shows that social skill training intervention significantly affects schizophrenic patient communication skills. Such training courses can improve patient social functions and enhance problem solving abilities. Key Words: social skill training, schizophrenic, interpersonal skill. 1 RN, MSN, Instructor, School of Nursing, St. Mary s Medicine Nursing and Management College & Doctoral Candidate, Graduate Institute of Medicine, Tzu Chi University; MSN, Director, Medical Affairs Office, Yuanshan Veterans Hospital. 2 RN, MSN, Instructor, School of Nursing, Tzu Chi University; Received: June 29, 2010 Revised: November 7, 2010 Accepted: February 12, 2011 *Address correspondence to: Ching-Yi Yeh, No. 701, Central Rd., Hualien City 97004, Taiwan, ROC. Tel: ; Hua410229@mail.tcu.edu.tw 3 RN, 7 卷 1 期中華民國 100 年 3 月

自傷行為 67 難化個人化及妄下結論等皆是有系統的邏輯謬誤吳陳 4 羅 6 憂鬱患者的症狀困擾自我情緒人際及生活品質若只靠個人意志是無法自行恢復通常需要藥物或心理治療才能恢復健康而照顧憂鬱症患者護理人員需維持溫暖接納與尊重的態度利用治療性溝通技巧引導表達感受以提高健

自傷行為 67 難化個人化及妄下結論等皆是有系統的邏輯謬誤吳陳 4 羅 6 憂鬱患者的症狀困擾自我情緒人際及生活品質若只靠個人意志是無法自行恢復通常需要藥物或心理治療才能恢復健康而照顧憂鬱症患者護理人員需維持溫暖接納與尊重的態度利用治療性溝通技巧引導表達感受以提高健 66 Self-Mutilation 日間病房反覆自傷之憂鬱症患者的護理經驗蔡佳吟余靜雲文獻查證摘要本文描述在日間病房照顧一位反覆出現自傷行為之憂鬱症個案的護理經驗筆者自8年月日開始照護個案發現個案6年月8日住院迄今無效性因應能力及自傷行為實質改善情形不佳故除了平時的復健與團體護理治療之外於8年月日至4月4日介入十次個別治療性會談與個案討論日記會談中運用認知行為改