執行功能對慢性期創傷性腦傷患者自評創傷後成長狀態的影響

Effects of Executive Functions on Posttraumatic Growth Factors in Chronic Traumatic Brain Injury

10.6550/ACP.202012_14(1_2).0001

郭曜語(Yao-Yu Kuo)；郭乃文(Nai-Wen Guo)；蘇倍儀(Bei-Yi Su)；陳南君(Nan-Chun Chen)；林昇賢(Sheng-Sian Lin)；郭進榮(Jinn-Rung Kuo)；周偉倪(Willy Chou)；林澄蔚(Cheng-Wei Lin)

創傷性腦傷 ； 執行功能 ； 創傷後成長 ； traumatic brain injury ； executive function ； posttraumatic growth

臨床心理學刊

14卷1/2期（2020 / 12 / 01）

1 - 17

繁體中文

目的：為研究創傷性腦傷（traumatic brain injury, TBI）患者於創傷事件後經歷正向心理改變，即創傷後成長（posttraumatic growth, PTG）的不同狀態，基於過去研究結果紛雜，而提出以腦功能為基礎且可以量化的執行功能（executive function, EF）來探討不同EF對TBI患者之PTG狀態的影響。方法：共67位受傷後滿一年TBI患者參與研究，男性占61.2%，其中輕度占79.1%，平均年齡為34.2歲（±12.7），腦傷後24.5月（±3.9）。研究使用自編PTG量表，並進行專家效度、內部一致性考驗（α=.93）以及因素分析（總解釋量69.39%），共得到四個因素。受試者接受EF測驗組，共六個指標代表衝動抑制、工作記憶以及認知彈性的三類EF功能。依受試者在EF測驗的表現，高於PR值60以上者為高分組，低於PR值40以下者為低分組，以t檢定比較兩組在PTG量表中新可能性、行動力、資源力及心靈力四個因素分數的差異。結果：衝動抑制、聽覺工作記憶以及認知彈性高分組皆顯著報告在新可能性有較佳的成長。且衝動抑制組高分組也顯著報告有較佳的行動力。而三種EF皆未對資源力與心靈力達到顯著影響。結論：慢性期TBI患者的EF對於PTG確實有影響，尤其對於PTG內的新可能性面向，同時較佳衝動抑制更能影響其行動力。因此，提升TBI患者的EF作為促進傷後PTG應是可行的途徑，此可作為未來神經心理治療之參考。

Objectives: To study the positive changes which are called the different states of posttraumatic growth (PTG) in traumatic brain injury (TBI) patients after injury. Because of the mixed results of past studies, the objective of this study is to propose brain-based and quantifiable executive function (EF) to investigate how each aspect of EF can affect the PTG factors that are present in TBI patients. Methods: A total of 67 TBI patients who are one year after injury were enrolled from a medical center in Tainan City after they signed an informed consent: 61.2% of the patients are male, 79.1% are mild TBI, average age is 34.2 years (± 12.7), and the average post-injury time is 24.5 months (± 3.9). Four factors were obtained by using the self-edited PTG scale after conducting for expert validity, internal consistency test (α = .93) and factor analysis (69.39%). After taking EF tests (including inhibition, working memory, and cognitive flexibility), they were divided into preferred groups (percentile rank score of 60 or above) and less preferred groups (percentile rank score of 40 or below) according to the results, to which an independent samples t-test was carried out to examine the differences between the two groups in terms of different PTG factors (including new possibility, active power, resources power, and mind power). Results: In terms of inhibition, auditory working memory, and cognitive flexibility, the preferred group had higher scores in new possibility. In terms of inhibition, the preferred group also had higher scores in active power. EFs had no effect on resources power and mind power. Conclusions: Inhibition, cognitive flexibility, and auditory working memory can have great effects on the condition of PTG factors that are present in chronic TBI patients, and may affect the new possibility of PTG mostly. Especially the better control of inhibition would affect the active power of PTG. Accordingly, it is feasible to promote PTG by enhancing the EFs of TBI patients. These results can be contributed to build the future basis of neuropsychological therapy.

1. Azouvi, P.,Arnould, A.,Dromer, E.,Vallat-Azouvi, C.(2017).Neuropsychology of traumatic brain injury: An expert overview.Revue Neurologique,173(7-8),461-472.
2. Baddeley, A.(1992).Working memory.Science,255(5044),556-559.
3. Bishop, S.,Duncan, J.,Brett, M.,Lawrence, A. D.(2004).Prefrontal cortical function and anxiety: Controlling attention to threat-related stimuli.Nature Neuroscience,7(2),184-188.
4. Busch, R. M.,McBride, A.,Curtiss, G.,Vanderploeg, R. D.(2005).The components of executive functioning in traumatic brain injury.Journal of Clinical and Experimental Neuropsychology,27(8),1022-1032.
5. Chang, Y.-C.,Guo, N.-W.,Huang, C.-C.,Wang, S.-T.,Tsai, J.-J.(2000).Neurocognitive attention and behavior outcome of school-age children with a history of febrile convulsions: A population study.Epilepsia,41(4),412-420.
6. Cohen, R. A.,Sparling-Cohen, Y. A.,O’Donnell, B. F.(1993).The neuropsychology of attention.Plenum Press.
7. Duncan, J.,Owen, A. M.(2000).Common regions of the human frontal lobe recruited by diverse cognitive demands.Trends in Neurosciences,23(10),475-483.
8. Farran, C. J.,Miller, B. H.,Kaufman, J. E.,Donner, E.,Fogg, L.(1999).Finding meaning through caregiving: Development of an instrument for family caregivers of persons with Alzheimer’s disease.Journal of Clinical Psychology,55(9),1107-1125.
9. Goldin, P. R.,McRae, K.,Ramel, W.,Gross, J. J.(2008).The neural bases of emotion regulation: Reappraisal and suppression of negative emotion.Biological Psychiatry,63(6),577-586.
10. Hart, T.,Whyte, J.,Kim, J.,Vaccaro, M.(2005).Executive function and self-awareness of “real-world” behavior and attention deficits following traumatic brain injury.The Journal of Head Trauma Rehabilitation,20(4),333-347.
11. Heaton, R. K.,Chelune, G. J.,Talley, J. L.,Kay, G. G.,Curtiss, G.(1993).Wisconsin card sorting test manual: Revised and expanded.Psychological Assessment Resources.
12. Hofmann, W.,Schmeichel, B. J.,Baddeley, A. D.(2012).Executive functions and self-regulation.Trends in Cognitive Sciences,16(3),174-180.
13. Horn, N. R.,Dolan, M.,Elliott, R.,Deakin, J. F. W.,Woodruff, P. W. R.(2003).Response inhibition and impulsivity: An fMRI study.Neuropsychologia,41(14),1959-1966.
14. Joseph, S.,Murphy, D.,Regel, S.(2012).An affective-cognitive processing model of post-traumatic growth.Clinical Psychology & Psychotherapy,19(4),316-325.
15. Krpan, K. M.,Levine, B.,Stuss, D. T.,Dawson, D. R.(2007).Executive function and coping at one-year post traumatic brain injury.Journal of Clinical and Experimental Neuropsychology,29(1),36-46.
16. Lawton, M. P.,Brody, E. M.(1988).Instrumental activities of daily living (IADL) scale: Original observer-rated version-does do form-for women only.Psychopharmacology Bulletin,24(4),785-787.
17. Levin, H. S.(1998).Cognitive function outcomes after traumatic brain injury.Current Opinion in Neurology,11(6),643-646.
18. Levine, B.,Robertson, I. H.,Clare, L.,Carter, G.,Hong, J.,Wilson, B. A.,Duncan, J.,Stuss, D.(2000).Rehabilitation of executive functioning: An experimental-clinical validation of goal management training.Journal of the International Neuropsychological Society,6(3),299-312.
19. Lezak, M. D.,Howieson, D. B.,Loring, D. W.,Fischer, J. S.(2004).Neuropsychological assessment.Oxford University Press.
20. MacDonald, A. W.,Cohen, J. D.,Stenger, V. A.,Carter, C. S.(2000).Dissociating the role of the dorsolateral prefrontal and anterior cingulate cortex in cognitive control.Science,288(5472),1835-1838.
21. Marvel, C. L.,Desmond, J. E.(2012).From storage to manipulation: How the neural correlates of verbal working memory reflect varying demands on inner speech.Brain and Language,120(1),42-51.
22. Monsell, S.(2003).Task switching.Trends in Cognitive Sciences,7(3),134-140.
23. Ochsner, K. N.,Bunge, S. A.,Gross, J. J.,Gabrieli, J. D.(2002).Rethinking feelings: An fMRI study of the cognitive regulation of emotion.Journal of Cognitive Neuroscience,14(8),1215-1229.
24. Ownsworth, T. L.,McFarland, K.,Young, R. M.(2002).The investigation of factors underlying deficits in self-awareness and self-regulation.Brain Injury,16(4),291-309.
25. Ownsworth, T., L.,McFarland, K.(2004).Investigation of psychological and neuropsychological factors associated with clinical outcome following a group rehabilitation programme.Neuropsychological Rehabilitation,14(5),535-562.
26. Park, C. L.,Cohen, L. H.,Murch, R. L.(1996).Assessment and prediction of stress-related growth.Journal of Personality,64(1),71-105.
27. Powell, T.,Ekin-Wood, A.,Collin, C.(2007).Post-traumatic growth after head injury: A long-term follow-up.Brain Injury,21(1),31-38.
28. Powell, T.,Gilson, R.,Collin, C.(2012).TBI 13 years on: Factors associated with post-traumatic growth.Disability and Rehabilitation,34(17),1461-1467.
29. Rabe, S.,Zöllner, T.,Maercker, A.,Karl, A.(2006).Neural correlates of posttraumatic growth after severe motor vehicle accidents.Journal of Consulting and Clinical Psychology,74(5),880-886.
30. Rogan, C.,Fortune, D. G.,Prentice, G.(2013).Post-traumatic growth, illness perceptions and coping in people with acquired brain injury.Neuropsychological Rehabilitation,23(5),639-657.
31. Ross, B. L.,Temkin, N. R.,Newell, D.,Dikmen, S. S.(1994).Neuropsychological outcome in relation to head injury severity: Contributions of coma length and focal abnormalities.American Journal of Physical Medicine & Rehabilitation,73(5),341-347.
32. Scheier, M. F.,Carver, C. S.,Bridges, M. W.(1994).Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A reevaluation of the Life Orientation Test.Journal of Personality and Social Psychology,67(6),1063-1078.
33. Schmeichel, B. J.,Demaree, H. A.(2010).Working memory capacity and spontaneous emotion regulation: High capacity predicts self-enhancement in response to negative feedback.Emotion,10(5),739-744.
34. Schmeichel, B. J.,Volokhov, R. N.,Demaree, H. A.(2008).Working memory capacity and the self-regulation of emotional expression and experience.Journal of Personality and Social Psychology,95(6),1526-1540.
35. Silva, J.,Ownsworth, T.,Shields, C.,Fleming, J.(2011).Enhanced appreciation of life following acquired brain injury: Posttraumatic growth at 6 months postdischarge.Brain Impairment,12(2),93-104.
36. Teasdale, G.,Jennett, B.(1974).Assessment of coma and impaired consciousness: A practical scale.The Lancet,304(7872),81-84.
37. Teasdale, G.,Jennett, B.(1976).Assessment and prognosis of coma after head injury.Acta Neurochirurgica,34(1),45-55.
38. Tedeschi, R. G.(Ed.),Park, C. L.(Ed.),Calhoun, L. G.(Ed.)(1998).Posttraumatic growth: Positive changes in the aftermath of crisis.Routledge.
39. Tedeschi, R. G.,Calhoun, L. G.(1996).The posttraumatic growth inventory: Measuring the positive legacy of trauma.Journal of Traumatic Stress,9(3),455-471.
40. Tedeschi, R. G.,Calhoun, L. G.(2004).Posttraumatic growth: Conceptual foundations and empirical evidence.Psychological Inquiry,15(1),1-18.
41. Tedeschi, R. G.,Calhoun, L. G.(1995).Trauma & transformation.Sage.
42. Welsh, M. C.,Pennington, B. F.(1988).Assessing frontal lobe functioning in children: Views from developmental psychology.Developmental Neuropsychology,4(3),199-230.
43. 中華民國內政部戶政司全球資訊網（2020）。人口統計資料。https://www.ris.gov.tw/app/portal/346
44. 何曉婷,吳玉欣,黃茂雄,郭乃文(2011)。生態化執行功能訓練對腦傷病人之治療：病例報告。台灣復健醫學雜誌，39(1)，31-38。
45. 杜家興(2003)。中原大學。
46. 郭乃文(2002).非語文性注意力與記憶力測驗指導手冊.台灣師範大學特殊教育中心.