[[alternative]]The Effects of Nature Experience Group Activities on Psychotic Symptoms, Cognitive Function and Community Living Skills in Chronic Schizophrenic Patients

[[abstract]]本研究運用臺北市立聯合醫院松德院區之生態療癒環境，以正接受日間留院治療且病情穩定之慢性精神分裂病患為研究對象，推動自然體驗小團體實驗處置活動，驗證個人變項、實驗處置與時間變項對實驗組與對照組在精神病症狀、認知功能與社區生活功能之作用，並瞭解實驗組成員參與自然體驗活動的經驗與反應。本研究為類實驗性研究，採目的取樣，實驗組25位，對照組23位。實驗組與對照組均依原計畫進行日間留院常態精神復健治療活動；另外，實驗組額外接受每週一次，每次90分鐘，8次的自然體驗實驗處置活動。分別由三個時間點(接受處置活動前、8週活動結束後、活動結束後4週追蹤)收集病患在精神病症狀、認知功能及社區生活功能的資料。以背景傾向因子分析法（Propensity Score Analysis）及概括性估計等式 (Generalized Estimating Equations )的迴歸法分析實驗處置、時間變項與病患之背景傾向因子對研究主要變項之作用。研究結果發現，實驗組在接受自然體驗活動結束後4週追蹤，精神病症狀受到實驗處置及時間變項的交互作用與背景傾向因子的影響而有顯著的改善。進一步分析發現，精神病症狀中的一般精神病理症狀因為自然體驗處置介入而有顯著改善(B = -2.42, p = .039)，特別是焦慮、愧疚感、身體緊張、衝動控制障礙及刻意迴避社交等五項，其症狀嚴重度顯著較對照組改善。在認知功能方面，自然體驗活動顯著提升實驗組病患的專注度、學習能力、決斷能力、遵行指示及解決問題能力（B＝4.180，p<.001）；對照組則無顯著改變。在社區生活功能方面，則受病患之性別及艾倫認知能力階層之影響，尤其女性在社區生活功能較男性好，但自然體驗活動並未顯著提升實驗組之社區生活功能。本研究呈現自然體驗處置與時間變項能交互影響及改善慢性精神分裂病患之精神病症狀與認知功能，自然體驗活動之設計能協助病患接觸自然環境，並透過體驗、探索、反思及團體活動的影響，不僅病患們展現與社區連結的行動，並豐富了個案的社區生活內涵。[[abstract]]ABSTRACTThe purpose of this study was to examine the effects of nature experience group activities on chronic schizophrenia patients, using the restorative environment around the Taipei City Hospital, Songde Branch. Specifically, three outcome measures were pursued: (1) psychotic symptoms, (2) cognitive functions, and (3) community living skills.In this study, quasi-experiment design was used. A convenience sample of 48 patients diagnosed with chronic schizophrenia were recruited from the day care ward, and then 25 patients activly participated into the experiment group, and 23 patients activly participated into the control group. Patients in the experiment group, participated the routine rehabilitation activities as well as the nature experience group, 1.5 hours per week, for eight weeks, Howerever, patients in the control group participated the routine rehabilitation programs only. The psychotic symptoms, cognitive functions, and community living skills were measured at 3 time points: before interventions, after 8 weeks interventions , and follow-up (4 weeks after the 8 weeks interventions). Propensity score analysis and generalized estimating equation were used to analyze the data. As the results revealed, patients in the nature experience group showed significant relief on psychotic symptoms(B = -2.420, p = .039), especially in anxiety, guilty, tension, poor impulse control, and active social avoidance. For cognitive functions, patients in the nature experience group also showed significant improvement (B = 4.18, p<.001), especially on focus, ability of learning, decision making , following orders, and problem solving . However, the effects on improving community living skills were not significantly different. In conclusion, the nature experience group activities may benefit chronic schizophrenic patients on relieving psychotic symptoms and improving cognitive functions, but not on improving community living skills