| 摘要: | 本研究的目的是以質性研究之低結構、深入訪談法，探討強迫性精神官能症患者，對其強迫性思考與行為發展歷程之生命敘說。藉由自我敘說的脈絡化方式來理解強迫症患者主觀的內心感受、想法及其發展歷程之自我建構。
最後選定之兩位研究參與者是從完整參加完一梯次研究者所參與觀察之某醫療機構門診強迫症認知行為治療團體中，找尋可撥出時間，並能以完整流利的口語表達自己想法與故事的自願者。研究過程為期一年半。
研究結果發現，兩位研究參與者強迫症發生的歷程有：個人信念與注意力狹隘；發生危急事件時；認知衝突與負荷；焦慮產生；嘗試調適；無法負荷；逃避；干擾的思想；轉移、蔓延；遠離主題；強迫思想產生；自覺困惑；焦慮升高；逃避強迫思考的痛苦；強迫行為產生；惡性循環；形成自動化反應模式。而在生命敘說中的認知與行為變化歷程則有：敘說；整理；覺察；頓悟；修正；實際的行動。研究對象經由生命故事的敘說，不斷的進行瞭解自我核心認知建構、解構與重構，發現可增進自我掌握與自信心的建立、核心個人建構歷程之理解、偏誤認知建構的覺察，增進其強迫症疾病改變的動機，發展正向的調適之道。
本研究可增進研究對象自我覺察與統整生命各歷程的機會；對於其他部份強迫症患者，有機會從分享別人的經驗中，增加對疾病的瞭解與治療的動機；對於一般大眾，可增進對此疾病之同理與強迫症患者主觀世界之瞭解；對於精神科臨床工作者，則從強迫症發展歷程脈絡觀的方向，提供另一種故事性思考的可能性。
關鍵詞：生命敘說、強迫性精神官能症、強迫思考、強迫行為
The purpose of this study is to explore the developmental process of patient’s obsessive-compulsive thoughts and behaviors via qualitative research the narrative of OCD patients for clinical practice reference.
The two participants were selected from one of the OCD treatment groups of a medical institute that the researcher participated as a group observer who were willing to offer time for interviews and were able to orally express themselves freely. The research process lasted one and a half year.
The result found that both of the research participants have experienced weak faith and narrow attention focus, history of crisis happening, heavy cognition burden, anxiety, attempt to readjust, over-burdened, escape, intrusive thoughts, transfer , digression from the theme, beginning of obsessive-compulsive thoughts, feeling being trapped, elevation of anxiety, suffering of avoiding obsessive-compulsive thoughts, beginning of obsessive-compulsive behaviors, worsen circulation, automatic response model. Cognitive and behavioral changes happened during the life narrative process are as followed: narrative, organization, detection, understanding, modification, and actions. The process of life narrative is a continuously repeating changing process of realizing self core constructs, deconstructing and reconstructing for the research participants, it helped them to build the confidence, to understand the core development of their personal life and the meaning of his life experiences, to self-detect their own mis-interpretations, to motivate them to change the symptoms of obsessive-compulsive disorder, and to readjust toward normal development.
This methodology of narrative research is an opportunity for the research participants to understand and re-structure their life, but also offer an opportunity for them to learn from each other’s experience, to share the results and to motivate them for treatment. It also helps the general public to understand this disorder better and those who suffered from it . As to the psychiatry clinical workers, it offers a possibly alternative thinking direction- life narrtive, to understand the developmental process of OCD.
Keyword：life narrative , obseesive-compulsive disorder,
obseesive-compulsive thoughts,
obseesive-compulsive behaviors |
