本研究旨在探討「健康、性格、習慣量表(HPH)」的臨床效度。HPH最初是由柯永河教授(民84)編製，後來廣泛使用在國內臨床場域中。發展至今已有中上程度的信效度支持，但過去較缺乏臨床上區辨與構念效度的研究，因此本研究旨在探討HPH區辨不同疾患的能力，以及以臨床疾患為受試時量尺之構念效度。 本研究回顧國內外類似測驗─MMPI、KMHQ、MCMI─的發展軌跡，並參照前人作法來進行HPH的臨床區辨效度研究。初步以臨床場域中常見的精神分裂症、重鬱症、低落型情感疾患、焦慮疾患，共257名患者為受試。先以共變數分析(ANCOVA)探討控制人口與臨床變項後，不同疾患組別在HPH的A、B、D類量尺的影響。再進一步使用羅吉斯迴歸(logistic regression)探討哪些量尺及其組合可以區辨兩兩疾患間的差異。最後，本研究也進行HPH的探索性因素分析(exploratory factor analysis)，以檢驗其臨床上的因素結構。 本研究發現，精神分裂症(A1)、躁症傾向(A2)、憂鬱自殺類(A3、B4、A4)、心理功能與健康(D1、D3、D4、D5、D6)量尺在共變數分析上的差異情形與假設大致相符，後續討論分析也支持強迫症(B5)量尺效度。羅吉斯迴歸中，A1、A3、B4、B5能在兩兩疾患間區辨有顯著預測力。其中A1能在精神分裂症與其他三組疾患的兩兩區辨中預測，A3能在重鬱症與另外兩組(精神分裂症、焦慮症)的兩兩區辨中預測，B4能在低落型情感與精神分裂症的兩兩區辨中預測，B5能在強迫症與其他疾患間的兩兩區辨中預測。但是在重鬱症與低落型情感疾患間，以及低落型情感與焦慮疾患間，沒有量尺能在兩者的區辨中有顯著預測力。而各兩兩疾患間整體區辨效果有中至高度的關聯性，分類正確率也多有七成以上，顯示HPH量表在臨床上的區辨效度獲得支持。 構念效度部分，A、D類量尺因素結構與當初編製的每個量尺構念相近，B類量尺構念雖與原量尺略有不同，但仍不違背原量尺編製架構，因此構念效度亦獲得支持。不過各量尺仍有值得編修之處，討論一節中針對結果提出HPH後續編修之建議。 最後，本研究也將此結果之臨床實務應用於討論一節中詳述，以供後續研究與實務者參考。 / The purpose of this study is to examine the clinical validity of the Health, Personality, and Habit Test (HPH). The HPH was developed by Dr. Yung-Ho Ko in 1995, and has been widely used in clinical settings. The HPH has demonstrated appropriate reliability and validity, but little research has been done on its differential and construct validity in the clinical settings. Therefore, the aim of this study is to explore the HPH’s ability to differentiate between disorders and its construct validity in clinical context. This research reviewed the developments of similar tests, such as MMPI, KMHQ, and MCMI, and examined validity of the HPH with the same methods. Subjects were 257 patients who suffered from common disorders in clinical settings, including schizophrenia, major depression, dysthymia, and anxiety disorders. ANCOVA was first used to explore whether different disorders have an effect on category A, B, and D scales after controlling demographic and clinical variables. Next, logistic regression was used to clarify which scales and combinations can differentiate between two of four disorders. Finally, exploratory factor analysis was conducted to examine the structure of HPH in clinical setting. The results of ANCOVA showed that the differences of schizophrenia scale (A1), manic scale (A2), depression/suicide scales (A3, B4, & A4), obsessive-compulsive disorder (OCD) scale (B5), and psychological function and health scales (D1, D3, D4, D5, D6) were partly consistent with assumptions, supporting the differential validity of HPH. The results of logistic regression analysis also supported the validity of A1, A3, B4, and B5 scales. More specifically, A1 was able to differentiate schizophrenia from any other three disorders, A3 was able to differentiate MDD from schizophrenia and anxiety disorders, B4 was able to differentiate dysthymia from schizophrenia, and B5 was able to differentiate OCD from other disorders. However, none of the scales was able to differentiate MDD from dysthymia, nor were they able to differentiate dysthymia from anxiety disorders. Moreover, each of the logistic regression functions showed moderate to high correlations, and most of them achieved high overall hit rates (above 70%), providing support for the clinical differential validity of the HPH. As for construct validity, these factors in category A and D scales were essentially similar to original scales. Similarly, factors in category B scales were compatible to original scales though difference was found. In sum, these results lent support to the construct validity of the HPH in the clinical settings. However, refining of the scales is needed and suggestions are discussed. Finally, the practical uses of the findings were also discussed.

本研究的主要目的有二：其一，驗證經過修改後的「句詞關聯作業」此一實驗派典，是否可以成為一套能有效區辨高、低社交焦慮者解釋性認知偏誤的測量工具。其二，驗證以「句詞關聯作業」作為解釋性認知偏誤修正工具時，是否能夠有效且持續地改善高社交焦慮者不適應的解釋性偏誤情形與社交焦慮症狀。為達到上述兩個研究目的，分為研究一與研究二進行。研究一選取86名高社交焦慮與59名低社交焦慮之非臨床大學校內學生，施予社交焦慮與情緒相關量表、句詞關聯作業以及解釋性偏誤相關問卷。研究一的結果顯示，相較於低社交焦慮者，高社交焦慮者同時具有較高程度的威脅解釋偏誤，以及較低程度的非威脅解釋偏誤。當執行組內比較時，則進一步發現並非高社交焦慮者具備某種解釋性的偏誤，反而是低社交焦慮者的解釋傾向展現出某些特殊性。此外，藉由相關分析，發現解釋性偏誤的在線與離線歷程、威脅與非威脅解釋偏誤之間具有緊密關聯，而句詞關聯作業與其他相關的測量工具彼此具備聚斂性。研究二邀請研究一之80名高社交焦慮者繼續參與實驗，隨機分派為改善訓練組與中性訓練組。受試者根據所屬組別接受相對應的訓練程序，為期四週共八次。訓練結束後再度施予社交焦慮與情緒相關量表、句詞關聯作業以及解釋性偏誤相關問卷，並於一個月後進行追蹤評估。研究二的結果顯示，改善訓練程序的確可有效地降低高社交焦慮者的威脅解釋偏誤，並且提升其非威脅解釋偏誤。細究此療效之所以發生的機制，主要在於促使高社交焦慮者形成與低社交焦慮者相似的解釋偏誤特性。然而，在降低社交焦慮症狀上，本研究並未看見明顯效果，內文將對此非預期結果進行討論。總體而言，針對社交焦慮者的解釋性偏誤情形，「句詞關聯作業」的確具備成為輔助性評估與介入工具之潛力。 / The purpose of the present study was twofold. First, it aimed to examine if the modified paradigm, sentence word association paradigm (SWAP), can differentiate interpretation between high and low social anxious individuals. Second, it tried to investigate the effects of interpretational training, using the training version of SWAP as cognitive bias modification program, in modifying interpretative bias and in reducing social anxiety symptoms in high social anxious individuals. In study 1, a total of 86 high social anxious and 59 low social anxious participants completed seven questionnaires and SWAP. The results showed that high social anxious individuals had greater threat interpretative bias and smaller benign interpretative bias compared to low social anxious individuals. Further, it was important to note that when comparing within group, actually not high but low social anxious individuals showed some special interpretation patterns. In addition, the statistics revealed significant correlations between on-line and off-line data, threat and benign interpretative bias. The current study also had found the consistency between SWAP and questionnaires measurements. In study 2, eighty high social anxious participants from study 1 were assigned randomly into modification training and neutral control group. All participants completed eight interpretaional training sessions delivered over four weeks (twice a week). Participants were also required to complete postassessments and follow-up assessments. The results indicated that the modification training program successfully increased the benign interpretative bias and decreased the threat interpretative bias, compared to the neutral control condition. When exploring the training mechanism, the current study discovered that modification training program helped high social anxious individuals gain the same interpretation patterns as low social anxious individuals had. However, the modification training program didn’t reduce social anxiety symptoms in high social anxious individuals. This unexpected finding were discussed. In conclusion, SWAP may have clinical utility when applied as assessment and intervention.