注意力偏誤修正訓練是近年對於焦慮症的新興療法，藉由改變個體的注意力來降低焦慮症狀，目前在研究上已顯示出療效，但對於其減輕焦慮的機制，以及注意力偏誤修正—威脅逃避訓練和注意力偏誤修正—正向搜尋訓練兩者間的差異，還有許多的討論空間。本研究目的為探討注意力偏誤修正—正向搜尋訓練對於注意力表現的影響，以及一次性訓練下對焦慮的影響。本研究分為第一階段篩選和第二階段訓練與測量。第一階段招募362名研究參與者進行特質焦慮篩選，以分數大於等於整體第三四分位數者定義為高特質焦慮者進入第二階段。第二階段共59名高特質焦慮研究參與者，隨機分派至實驗組和控制組，實驗組進行注意力偏誤修正—正向搜尋訓練，控制組則進行一般性視覺搜尋訓練，並於訓練前後測量其注意力、注意力偏誤、自評焦慮分數，以及膚溫、心跳速率與心跳變異率三項生理指標。研究結果顯示，無論接受實驗組或控制組訓練，研究參與者的執行控制注意力能力皆提升，對威脅刺激的注意力偏誤下降，自評焦慮分數下降，生理指標中的心跳速率下降，心跳變異率和心跳變異率中的高頻功率皆提升。根據本研究發現，支持焦慮下降與執行控制注意力改善之間的相關性；另說明無論訓練中是否存在威脅刺激，皆可改善其由上至下的執行控制注意力。

Attention Bias Modification (ABM) training is a new treatment for anxiety disorders in recent years, which reduces anxiety symptoms by altering an individual's attention. It has been shown to be effective in research, but there is still need to discuss about its mechanism for reducing anxiety and the differences between ABM-threat-avoidance training and ABM-positive-search training. The purpose of this study was to investigate the effects of the Attentional Bias Modification-positive-search Training on attentional performance and the effects of the one-time training on anxiety. The study consisted of a screening phase and a measurement phase. In the screening phase, 362 participants were recruited for trait anxiety screening, and those with scores greater than or equal to the third quartile were defined as high trait anxiety. A total of 59 participants with high trait anxiety enter the measurement phase. They were randomly assigned to the experimental and control groups. The experimental group underwent Attentional Bias Modification-positive-search Training, while the control group underwent general visual search training, and their attention, attentional bias, self-assessed anxiety scores, as well as three physiological indices, namely, skin temperature, heartbeat rate, and heartbeat variability, were measured before and after the training. The results of the study showed that both experimental and control group training resulted in improved executive control of attention, decreased attentional bias to threatening stimuli, decreased self-rated anxiety scores, decreased heart rate, and increased heart rate and high-frequency power of heart rate. Based on the findings of this study, the correlation between decreased anxiety and improved executive control attention is supported, and it also suggests that top-to-bottom executive control attention can be improved regardless of the presence or absence of threatening stimuli during training.

摘要 I
Abstract III
目次 V
表目次 VII
圖目次 IX
第一章 緒論 1
第一節 研究動機 1
第二節 研究目的與研究問題 2
第二章 文獻回顧 5
第一節 注意力理論 5
第二節 焦慮與注意力偏誤的認知模型 6
第三節 常見的注意力偏誤測量工具 8
第四節 用在焦慮症的注意力偏誤修正訓練 10
第五節 特質焦慮 12
第六節 焦慮與生理回饋 13
第七節 研究假設 14
第三章 研究方法與步驟 17
第一節 研究對象 17
第三節 研究工具 19
第四節 研究程序 24
第五節 資料處理 26
第四章 研究結果 29
第一節 注意力網絡作業(ANT)分析結果 29
壹、注意力網絡作業描述統計 29
貳、不同組別注意力網絡作業前後測之差異分析 29
第二節 情緒視覺搜尋作業(EVST)分析結果 32
壹、情緒視覺搜尋作業分數之描述統計 32
貳、不同組別注意力偏誤情形(EVST前測分析) 33
參、不同組別情緒視覺搜尋作業前後測反應時間之差異分析 34
肆、不同組別情緒視覺搜尋作業前後測正確率之差異分析 36
第三節 視覺焦慮量表(VASA)和膚溫分析結果 37
壹、視覺焦慮量表和膚溫的描述性統計 37
貳、不同組別視覺焦慮量表和膚溫前後測差異 38
第四節 心跳速率和心跳變異率分析結果 39
壹、心跳速率和心跳變異率的描述統計 39
貳、不同組別心跳速率和心跳變異率前後測差異 41
第五節 研究結果統整 45
第五章 討論 47
第一節 ABM正向搜尋訓練對注意力網絡的影響 47
第二節 ABM正向搜尋訓練對注意力偏誤的影響 48
第三節 ABM正向搜尋訓練對焦慮的影響 48
第六章 結論與建議 51
第一節 結論 51
第二節 研究限制與建議 51
參考文獻 53
附錄 59
附錄一、IRB同意臨床試驗證明書 59
附錄二、招募廣告 60
附錄三、第一階段知情同意書 61
附錄四、第一階段問卷(基本資料與STAI-T量表) 65
附錄五、第二階段知情同意書 67
附錄六、ANT指導語 71
附錄七、焦慮視覺類比量表(VASA) 72
附錄八、EVST指導語 73
附錄九、ABM正向搜尋訓練/安慰劑訓練的指導語 74
附錄十、情緒臉孔授權合約書 75

王三瑜、林維君、林宜美、黃文聰、馮雅瑄 (2017)。 心跳變異生理回饋在癌症存活者之療效 [The Effect of Heart Rate Variability Biofeedback for a Cancer Survivor]。 臨床心理學刊，11(1/2)，53-63。https://doi.org/10.6550/ACP.201712_11(2).0004
王慶福、鍾麗珍、王郁茗、何應瑞、賴德仁 (2007)。 生理回饋訓練與放鬆訓練對大學生焦慮與憂鬱反應之影響效果 [Effect of Biofeedback Training and Relaxation Training on Anxiety and Depressive Reactions of College Students]。中山醫學雜誌，18(2)，255-270。https://doi.org/10.30096/csmj.200712.0009
林子筠 (2021)。 從自主神經彈性觀點探討類廣泛性焦慮疾患和高特質焦慮的自主神經反應、注意控制與情緒調節〔未出版之碩士論文〕。國立中正大學。https://hdl.handle.net/11296/57v9p2
侯育銘、鄧閔鴻、張素凰 (2020)。 以情緒注意網絡作業探討廣泛性焦慮症的注意偏誤修正之潛在機制 [Efficacy of Attention Bias Modification for Patients with Generalized Anxiety Disorder: Using Emotional Attention Network Test as an Evaluation of the Underlying Mechanism]。中華心理學刊，62(1)，51-72。https://doi.org/10.6129/CJP.202003_62(1).0003
徐翊健、高廉程、張杰、葉大全、黃郁絜、黃鈺蘋、鄒長志、趙培竣、劉佑閿(譯)(2018) 。DSM-V精神疾病診斷與統計。台北：合記。（原著：American Psychiatric Association, 2013）
張本聖、徐儷瑜、黃君瑜、古黃守廉、曾幼涵(譯) (2017)。變態心理學。台北：雙葉書廊。(原著：Kring, A. M., Johnson, S. L., Davison, G. C., & Neale, J. M., 2016)
陳李綢 (2012)。 大學生心理健康與多元生理回饋 [A Study of the Relationships between Mental Health and Biofeedback for NTNU Students]。教育心理學報，44(1)，159-183。https://doi.org/10.6251/BEP.20110914
陳建中、卓淑玲、曾榮瑜 (2013)。 台灣地區華人情緒與相關心理生理資料庫─專業表演者臉部表情常模資料 [Taiwan Corpora of Chinese Emotions and Relevant Psychophysiological Data-Behavioral Evaluation Norm for Facial Expressions of Professional Performer]。中華心理學刊，55(4)，439-454。 https://doi.org/10.6129/CJP.20130314
蔡宜倩 (2012)。禁忌字在注意力作業中的即刻效果與延宕效果〔未出版之碩士論文〕。 國立中正大學。https://hdl.handle.net/11296/8372kg
衛生福利部統計處(2019)。精神疾病患者門、住診統計。取自：https://dep.mohw.gov.tw/dos/cp-1720-7337-113.html
劉芳均（2018）。生理回饋與意象訓練應用於高中棒球選手競賽焦慮及提升心理技能之研究﹝未出版之碩士論文﹞。國立東華大學。 https://hdl.handle.net/11296/6232a2。
Andrews, G., Cuijpers, P., Craske, M. G., McEvoy, P., & Titov, N. (2010). Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLoS One, 5(10), e13196. https://doi.org/10.1371/journal.pone.0013196
Bar-Haim, Y. (2010). Research Review: Attention bias modification (ABM): A novel treatment for anxiety disorders. Journal of child psychology and psychiatry, and allied disciplines, 51, 859-870. https://doi.org/10.1111/j.1469-7610.2010.02251.x
Bar-Haim, Y., Lamy, D., Pergamin, L., Bakermans-Kranenburg, M. J., & van Ijzendoorn, M. H. (2007). Threat-related attentional bias in anxious and nonanxious individuals: A meta-analytic study. Psychological Bulletin, 133(1), 1-24. https://doi.org/10.1037/0033-2909.133.1.1
Chalmers, J. A., Quintana, D. S., Abbott, M. J., & Kemp, A. H. (2014). Anxiety Disorders are Associated with Reduced Heart Rate Variability: A Meta-Analysis. Front Psychiatry, 5, 80. https://doi.org/10.3389/fpsyt.2014.00080
Corbetta, M., & Shulman, G. L. (2002). Control of goal-directed and stimulus-driven attention in the brain. Nat Rev Neurosci, 3(3), 201-215. https://doi.org/10.1038/nrn755
Dandeneau, S., Baldwin, M., Baker, J., Sakellaropoulo, M., & Pruessner, J. (2007). Cutting Stress Off at the Pass: Reducing Vigilance and Responsiveness to Social Threat by Manipulating Attention. Journal of personality and social psychology, 93, 651-666. https://doi.org/10.1037/0022-3514.93.4.651
De Voogd, E. L., Wiers, R. W., Prins, P. J. M., & Salemink, E. (2014). Visual search attentional bias modification reduced social phobia in adolescents. Journal of Behavior Therapy and Experimental Psychiatry, 45(2), 252-259. https://doi.org/https://doi.org/10.1016/j.jbtep.2013.11.006
Desimone, R., & Duncan, J. (1995). Neural mechanisms of selective visual attention. Annu Rev Neurosci, 18, 193-222. https://doi.org/10.1146/annurev.ne.18.030195.001205
Diamond, A. (2013). Executive functions. Annual review of psychology, 64, 135-168. https://doi.org/10.1146/annurev-psych-113011-143750
Eysenck, M. W., Derakshan, N., Santos, R., & Calvo, M. G. (2007). Anxiety and cognitive performance: attentional control theory. Emotion, 7(2), 336-353. https://doi.org/10.1037/1528-3542.7.2.336
Fan, J., McCandliss, B. D., Fossella, J., Flombaum, J. I., & Posner, M. I. (2005). The activation of attentional networks. Neuroimage, 26(2), 471-479. https://doi.org/10.1016/j.neuroimage.2005.02.004
Fan, J., McCandliss, B. D., Sommer, T., Raz, A., & Posner, M. I. (2002). Testing the efficiency and independence of attentional networks. J Cogn Neurosci, 14(3), 340-347. https://doi.org/10.1162/089892902317361886
Fox, E., Lester, V., Russo, R., Bowles, R. J., Pichler, A., & Dutton, K. (2000). Facial Expressions of Emotion: Are Angry Faces Detected More Efficiently? Cogn Emot, 14(1), 61-92. https://doi.org/10.1080/026999300378996
Fox, E., Russo, R., Bowles, R., & Dutton, K. (2001). Do threatening stimuli draw or hold visual attention in subclinical anxiety? Journal of experimental psychology. General, 130(4), 681-700. https://pubmed.ncbi.nlm.nih.gov/11757875
Gray, M. A., Minati, L., Harrison, N. A., Gianaros, P. J., Napadow, V., & Critchley, H. D. (2009). Physiological recordings: basic concepts and implementation during functional magnetic resonance imaging. Neuroimage, 47(3), 1105-1115. https://doi.org/10.1016/j.neuroimage.2009.05.033
Heeren, A., Mogoaşe, C., McNally, R. J., Schmitz, A., & Philippot, P. (2015). Does attention bias modification improve attentional control? A double-blind randomized experiment with individuals with social anxiety disorder. J Anxiety Disord, 29, 35-42. https://doi.org/10.1016/j.janxdis.2014.10.007
Hornblow, A. R., & Kidson, M. A. (1976). The Visual Analogue Scale for Anxiety. Australian and New Zealand Journal of Psychiatry, 10(4), 339-341. https://doi.org/10.3109/00048677609159523
Karavidas, M. K., Lehrer, P. M., Vaschillo, E., Vaschillo, B., Marin, H., Buyske, S., Malinovsky, I., Radvanski, D., & Hassett, A. (2007). Preliminary results of an open label study of heart rate variability biofeedback for the treatment of major depression [Article]. Applied psychophysiology and biofeedback, 32(1), 19-30. https://doi.org/10.1007/s10484-006-9029-z
Kreibig, S. D. (2010). Autonomic nervous system activity in emotion: A review. Biological Psychology, 84(3), 394-421. https://doi.org/https://doi.org/10.1016/j.biopsycho.2010.03.010
MacLeod, C., Mathews, A., & Tata, P. (1986). Attentional Bias in Emotional Disorders. Journal of Abnormal Psychology, 95, 15-20. https://doi.org/10.1037/0021-843X.95.1.15
Mathews, A., & Mackintosh, B. (1998). A Cognitive Model of Selective Processing in Anxiety. Cognitive Therapy and Research, 22(6), 539-560. https://doi.org/10.1023/A:1018738019346
Mathews, A., & MacLeod, C. (1985). Selective processing of threat cues in anxiety states. Behav Res Ther, 23(5), 563-569. https://doi.org/10.1016/0005-7967(85)90104-4
McAusland, L., & Addington, J. (2018). Biofeedback to treat anxiety in young people at clinical high risk for developing psychosis. Early intervention in psychiatry, 12(4), 694-701. https://doi.org/10.1111/eip.12368
Mogg, K., & Bradley, B. P. (1998). A cognitive-motivational analysis of anxiety. Behav Res Ther, 36(9), 809-848. https://doi.org/10.1016/s0005-7967(98)00063-1
Mogg, K., & Bradley, B. P. (2016). Anxiety and attention to threat: Cognitive mechanisms and treatment with attention bias modification. Behav Res Ther, 87, 76-108. https://doi.org/10.1016/j.brat.2016.08.001
Mogg, K., Waters, A. M., & Bradley, B. P. (2017). Attention bias modification (ABM): Review of effects of multisession ABM training on anxiety and threat-related attention in high-anxious individuals. Clinical Psychological Science, 5(4), 698-717. https://journals.sagepub.com/doi/pdf/10.1177/2167702617696359
Mogoaşe, C., David, D., & Koster, E. H. W. (2014). Clinical Efficacy of Attentional Bias Modification Procedures: An Updated Meta-Analysis. Journal of Clinical Psychology, 70(12), 1133-1157. https://doi.org/10.1002/jclp.22081
Morgan, S. J., & Mora, J. A. M. (2017). Effect of Heart Rate Variability Biofeedback on Sport Performance, a Systematic Review [Review]. Applied psychophysiology and biofeedback, 42(3), 235-245. https://doi.org/10.1007/s10484-017-9364-2
Murata, T., Takahashi, T., Hamada, T., Omori, M., Kosaka, H., Yoshida, H., & Wada, Y. (2004). Individual trait anxiety levels characterizing the properties of zen meditation. Neuropsychobiology, 50(2), 189-194. https://doi.org/10.1159/000079113
Ohman, A., Lundqvist, D., & Esteves, F. (2001). The Face in the Crowd Revisited: A Threat Advantage With Schematic Stimuli. Journal of personality and social psychology, 80, 381-396. https://doi.org/10.1037/0022-3514.80.3.381
Ollendick, T. H., White, S. W., Richey, J., Kim-Spoon, J., Ryan, S. M., Wieckowski, A. T., Coffman, M. C., Elias, R., Strege, M. V., Capriola-Hall, N. N., & Smith, M. (2019). Attention Bias Modification Treatment for Adolescents With Social Anxiety Disorder. Behavior Therapy, 50(1), 126-139. https://doi.org/https://doi.org/10.1016/j.beth.2018.04.002
Pacheco-Unguetti, A. P., Acosta, A., Callejas, A., & Lupianez, J. (2010). Attention and Anxiety: Different Attentional Functioning Under State and Trait Anxiety. PSYCHOLOGICAL SCIENCE, 21(2), 298-304. https://doi.org/10.1177/0956797609359624
Pergamin-Hight, L., Pine, D. S., Fox, N. A., & Bar-Haim, Y. (2016). Attention bias modification for youth with social anxiety disorder. Journal of Child Psychology and Psychiatry, 57(11), 1317-1325. https://doi.org/10.1111/jcpp.12599
Petersen, S. E., & Posner, M. I. (2012). The attention system of the human brain: 20 years after. Annual review of neuroscience, 35, 73-89. https://doi.org/10.1146/annurev-neuro-062111-150525
Posner, M., & Petersen, S. (1990). The Attention System of the Human Brain. Annual review of neuroscience, 13, 25-42. https://doi.org/10.1146/annurev.ne.13.030190.000325
Powers, M. B., & Emmelkamp, P. M. (2008). Virtual reality exposure therapy for anxiety disorders: A meta-analysis. J Anxiety Disord, 22(3), 561-569. https://doi.org/10.1016/j.janxdis.2007.04.006
Spielberger, C.D. (2010). State-Trait Anxiety Inventory. In The Corsini Encyclopedia of Psychology (eds I.B. Weiner and W.E. Craighead). https://doi.org/10.1002/9780470479216.corpsy0943
Spielberger, C., Gorsuch, R., Lushene, R., Vagg, P. R., & Jacobs, G. (1983). Manual for the State-Trait Anxiety Inventory (Form Y1 – Y2) (Vol. IV).
Spielberger, C. D. (1972). Chapter 14 - CONCEPTUAL AND METHODOLOGICAL ISSUES IN ANXIETY RESEARCH. In C. D. Spielberger (Ed.), Anxiety (pp. 481-493). Academic Press. https://doi.org/https://doi.org/10.1016/B978-0-12-657402-9.50013-2
Spielberger, C. D., & Sydeman, S. J. (1994). State-Trait Anxiety Inventory and State-Trait Anger Expression Inventory. In The use of psychological testing for treatment planning and outcome assessment. (pp. 292-321). Lawrence Erlbaum Associates, Inc.
Thyer, B. A., Papsdorf, J. D., Davis, R., & Vallecorsa, S. (1984). Autonomic correlates of the subjective anxiety scale. J Behav Ther Exp Psychiatry, 15(1), 3-7. https://doi.org/10.1016/0005-7916(84)90115-0
van den Berg, M. E., Rijnbeek, P. R., Niemeijer, M. N., Hofman, A., van Herpen, G., Bots, M. L., Hillege, H., Swenne, C. A., Eijgelsheim, M., Stricker, B. H., & Kors, J. A. (2018). Normal Values of Corrected Heart-Rate Variability in 10-Second Electrocardiograms for All Ages. Front Physiol, 9, 424. https://doi.org/10.3389/fphys.2018.00424
Williams, J. M., Mathews, A., & MacLeod, C. (1996). The emotional Stroop task and psychopathology. Psychol Bull, 120(1), 3-24. https://doi.org/10.1037/0033-2909.120.1.3
Yuan, L., Tian, Y., Zhang, F., Dai, F., Luo, L., Fan, J., & Wang, K. (2014). Impairment of attention networks in patients with untreated hyperthyroidism. Neurosci Lett, 574, 26-30. https://doi.org/10.1016/j.neulet.2014.05.016