66 Effects of Social Skills Training 50Grant & Beck, 2010; Pilling et al., 2002; Rector, Beck, & Stolar, 2005 50 Eklund, 1999 ㈠ Perivoliotis, Grant, &

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 741,804 9.5 2009 2005 9 85,531 9.25% 0.38 30 64 2009 45% 2 98 9 21,299 502,631 4.24%7,000 45.02%24.63% 2009 social skill training 1 2 3 99 6 29 99 11 7 100 2 12 * 97004 701 0975372766 7 卷 1 期 中 華 民 國 100 年 3 月

66 Effects of Social Skills Training 50Grant & Beck, 2010; Pilling et al., 2002; Rector, Beck, & Stolar, 2005 50 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., 2005 1994 Hoffmann, Kupper, & Kunz, 1998; Varcarolis, Carson, & Shoemaker, 2006 Heinssen, Liberman, & Kopelowicz, 2000; Pilling et al., 2002; Sensky et al., 2000Heinssen et al., 2000Heinssen 2000 27 Pinninti, Rissmiller, Steer, & Beck, 2006 Eric et al., 2005; Sensky et al., 2000 96 6 268 19 7 10 60 15 15 7 卷 1 期 中 華 民 國 100 年 3 月

67 ㈠ ㈡ 1994 Conbach s α.78.88 Likert 1 71% 100% 2 41% 70% 3 40% 4 4 16 6 24 5 20 6 24 2 8 CVI.89 Conbach s α.91 Institutional review board, IRB 1 2 3 5.89 SPSS 10.0 for Windows 216 8 60 7/19 7/22 7/26 7/29 8/01 8/06 8/08 1. 2. 3. 1. 2. 3. 4. 8/12 1. 2. 3. 1. 2. 3. 4. 1. 2. 3. 1. 2. 3. 7 卷 1 期 中 華 民 國 100 年 3 月

68 Effects of Social Skills Training 8 72.7% 28~62 M = 40.13n = 4, 50% n = 5, 62.5% n = 5, 62.5% n = 8, 100% 3~8 M = 5.23 2~30 M = 13 70%~100% Mean = 5.5; Mean = 11.25 Mean = 7.875, Mean = 13.002 Mean = 6.25; Mean = 10.0 Mean = 8.25; Mean = 15.378 Mean = 2.75; Mean = 5.0 Wilcoxon Signed Ranks Testp <.05 A 28 10 Schizophrenia 10 4 8 B 36 12 Schizophrenia 17 8 8 C 62 16 Schizophrenia 30 4 8 D 51 6 Schizophrenia 10 7 8 E 34 12 Schizophrenia 8 5 8 F 35 12 Schizophrenia 12 4 8 G 34 9 Schizophrenia 2 7 7 H 40 12 Schizophrenia 15 3 7 7 卷 1 期 中 華 民 國 100 年 3 月

69 N = 8 n % 1 2 3 1 2 3 4 5 62.5 3 37.5 0 1 12.5 6 75.0 1 12.5 0 5 62.5 3 37.5 0 0 4 50.0 4 50.0 0 5 62.5 3 37.5 0 0 0 3 37.5 5 62.5 5 62.5 3 37.5 0 0 1 12.5 5 62.5 2 25.0 4 50.0 4 50.0 0 2 25.0 4 50.0 2 25.0 0 6 75.0 2 25.0 0 3 37.5 4 50.0 1 12.5 0 6 75.0 2 25.0 0 3 37.5 3 37.5 2 25.0 0 7 87.5 1 12.5 0 5 62.5 2 25.0 1 12.5 0 5 62.5 3 37.5 0 0 1 12.5 5 62.5 2 25.0 5 62.5 3 37.5 0 0 3 37.5 4 50.0 1 12.5 5 62.5 3 37.5 0 2 25.0 5 62.5 1 12.5 0 6 75.0 2 25.0 0 2 25.0 5 62.5 1 12.5 0 5 62.5 3 37.5 0 4 50.0 2 25.0 2 25.0 0 8 100. 0 0 6 75.0 1 12.5 1 12.5 0 6 75.0 2 25.0 0 0 1 12.5 5 62.5 2 25.0 2 25.0 6 75.0 1 12.5 2 25.0 4 50.0 1 12.5 6 75.0 2 25.0 0 2 25.0 3 37.5 3 37.5 0 7 87.5 1 12.5 0 5 62.5 2 25.0 1 12.5 0 5 62.5 3 37.5 0 0 0 5 62.5 3 37.5 6 75.0 2 25.0 0 0 3 37.5 3 37.5 2 25.0 4 50.0 4 50.0 0 0 2 25.0 5 62.5 1 12.5 4 50.0 4 50.0 0 3 37.5 2 25.0 3 37.5 0 6 75.0 2 25.0 0 0 1 12.5 6 75.0 1 12.5 Likert 171% 100% 241% 70% 3 40% 4 N = 8 Mean 4 16 5.500 11.250.006* 6 24 7.875 13.002.025* 5 20 6.250 10.000.046* 6 24 8.250 15.378.023** 2 8 2.750 5.000.033* *p <.05. **p <.01. p Eric2005 Grant2010 Bandura Wolpe 2000 Liberman 1986 7 卷 1 期 中 華 民 國 100 年 3 月

70 Effects of Social Skills Training 12 16 Cicerone et al., 2008; Perivoliotis et al., 2009 Cicerone et al., 2008; Perivoliotis et al., 2009 10 2 2009 2 18 2010 5 22 http://www.doh.gov.tw/statistic/data/ [National Health Insurance Bureau, Taiwan, ROC. (2009, February 18). Disease statistics. Retrieved May 22, 2010, from http://www.doh.gov.tw/statistic/data/] 2009 4 4 2010 5 22 http://www.moi.gov.tw/stat/stat01.aspx [Ministry of the Interior, Taiwan, ROC. (2009, April 4). Demographic statistics. Retrieved May 22, 2010, from http://www.moi.gov. tw/stat/stat01.aspx] 2009 2 12009 6 12 http://www.doh.gov.tw/cht2006/index_populace. aspx [Department of Health, Executive Yuan, Taiwan, ROC. (2009, February 1). Mental illness. Retrieved June 12, 2009, from http://http://www.doh.gov.tw/cht2006/ index_populace.aspx] 1994 2 2166 179 [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), 166 179.] 2002 20 3 10 [Tasi, C. Y., Lee, H. L., Tan, Y. K., & 7 卷 1 期 中 華 民 國 100 年 3 月

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), 577 606. 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), 253 258. 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), 1596 1615. 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), 520 529. 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), 21 45. Grant, P. M., & Beck, A. T. (2010). Asocial beliefs as predictors of asocial behavior in schizophrenia. Psychiatry Research, 177(1-2), 65 70. Heinssen, R. K., Liberman, R. P., & Kopelowicz, A. (2000). Psychosocial skills training for schizophrenia: Lessons from the laboratory. Schizophrenia Bulletin, 26(1), 4615 4622. 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), 214 222. Ladd, G. W., & Mize, J. (1983). A cognitive social learning model of social skill training. Psychological Review, 90(2), 127 157. Liberman, R. P. (1986). Social skills training for schizophrenia individuals at risk for replace. American Journal of Psychiatry, 143(1), 523 526. 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), 304 312. 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), 424 437. 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), 763 782. 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), 165 170. Rector, N. A., Beck, A. T., & Stolar, N. (2005). The negative symptoms of schizophrenia: A cognitive perspective. Canadian Journal of Psychiatry, 50(5), 247 257. 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), 165 172. 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

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, 2007. 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: +886-975-372766; E-mail: Hua410229@mail.tcu.edu.tw 3 RN, 7 卷 1 期 中 華 民 國 100 年 3 月