第四章 討論
第三節 正向訊息所扮演的角色
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研究使用偵測物在中性反應時間減去中性-中性配對反應時間做為該指標)。總結 以上的結果，本研究 ERP 結果與國內外相關研究具有一致性，支持難以轉移假 設。
第三節 正向訊息所扮演的角色
由 ERP 結果發現高、低社交焦慮者對訊息處理的差別主要在於注意力難以 從情緒刺激轉移，高社交焦慮者面對正向與威脅訊息，都會出現比中性訊息更大 的引導效果，而低社交焦慮者無此現象，且當正向與威脅訊息同時出現時，兩者 的引導程度並無差異。由此推論，對於高社交焦慮者而言，正向與威脅訊息同屬 於具有情緒性的威脅訊息，因此可能採用相似的處理方式 (Alden et al., 2008)。
行為量表的結果也提供了相對應的證據，即高社交焦慮者將正向評價訊息視為具 有威脅性的訊息。根據研究預期(3)、(4)，由訓練後三個社交焦慮量表分數的改 變可以推論社交焦慮者如何處理正向訊息，但三個社交焦慮分數並無發現有一致 的變化，雖然正向訓練組在追蹤時害怕負向評價分數有下降，但在社交迴避和苦 惱量表與害怕正向評價量表分數上並無改變。由訓練效果的 ERP 證據可知，正 向訓練組在訓練後會減少對於威脅訊息的引導效果，而不是朝向正向訊息，因此 焦慮下降較可能來自於逃離威脅的效果，而非注意正向訊息使得焦慮下降。以上 幾點較支持社交焦慮者害怕正向評價訊息的看法。
過去較多注意到社交焦慮者害怕負向評價的訊息，但社交焦慮者對於正向訊 息的處理方式仍然不清楚。目前可以簡單歸納出兩種看法，一種看法認為社交焦 慮者較少注意正向訊息(Taylor et al., 2010 等)，另外一種看法可能是社交焦慮者 害怕正向評價的訊息(Alden et al., 2008 等)。由演化的觀點來看，害怕正向的評 價可以保護個體免於衝突(Gilbert, 2001)，或者可以避免未來可能的負向評價 (Wallace & Alden, 1995, 1997)。由過去的量表研究證據，發現害怕負向評價與害 怕正向評價兩種心理現象同時存在，且透過這種觀點可以更清楚的描述社交焦慮
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族群的狀況(Weeks, Heimberg, & Rodebaugh, 2008; Weeks, Heimberg, Rodebaugh
& Norton, 2008)，例如社交焦慮者會解釋正向的社交訊息可能會伴隨負向的結 果，因此對正向社交訊息做出負向的詮釋(Alden et al., 2008)。
若社交焦慮者視情緒刺激(例如本研究使用威脅與正向刺激)皆具有威脅 性，中性訓練組在訓練前容易將注意力投注在威脅臉孔而難以轉移，經過本研究 的注意力訓練後，社交焦慮者可成功的將注意力由威脅臉孔轉移開，此訓練效果 也可以類推到正向臉孔上，因此經過中性訓練後，社交焦慮者可遠離威脅與正向 刺激；反之，由於正向與威脅訊息同為令社交焦慮者感到害怕的訊息，所以透過 正向訓練無法將注意力成功引導到正向訊息上，因此只有得到遠離威脅訊息的效 果。
害怕負向評價量表分數在訓練前後的改變與上述推論是一致的。中性訓練組 的害怕負向評價量表分數在訓練後下降，但是正向訓練組則到追蹤階段才出現害 怕負向評價量表分數顯著的下降。我推論注意力訓練可能改變高社交焦慮者的注 意力習慣，因此訓練效果在結束訓練後依然可以持續累積，由於正向訓練組遠離 威脅訊息的訓練效果，因此需要較久的時間才能有效的克服負向評價訊息。本論 文建議未來研究可增加追蹤時間次數，了解正向訓練後遠離威脅訊息注意力習慣 的累積於何時發揮成效。此外，正向訓練組 STAI-T 與 STAI-S 分數在追蹤時下 降，可能是將注意力引導到正向訊息的訓練過程，也改變了原先高社交焦慮者對 於環境訊息的負向假設(例如假設情緒訊息皆為負向訊息) (Leppänen & Hietanen, 2004)，使得訓練後，高社交焦慮者不再過於害怕正向訊息，也能降低對於平常 生活中情緒性訊息處理的焦慮感。由於本研究只能對注意力歷程的改變進行推 論，但在注意力後的詮釋、記憶、提取等歷程都會影響到行為表現，這些歷程與 社交焦慮者對於正向訊息的處理都需要未來研究釐清。
綜合以上，透過注意力訓練前後的比較，發現注意力訓練確實可以降低害怕
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負向評價的程度，其改變機制在於幫助高社交焦慮者避開威脅訊息。由量測高、
低社交焦慮者在不同臉孔刺激配對的 ERP 資料，沒有發現高社交焦慮者對於威 脅訊息有警覺的現象，但到注意力後期，面對威脅與正向訊息的會有較大的注意 力引導效果。透過行為與 ERP 證據，本論文研究推論高社交焦慮者害怕正向評 價而非缺少對正向訊息之注意，更重要的是本研究提供了一個改善社交焦慮者焦 慮程度的訓練方式，且說明其訓練與改善的注意力與訊息處理機制。本研究以社 交焦慮程度相對較高之大學生為研究對象，未來希望可以將本研究的結果延伸至 臨床樣本，並且對於此改變歷程，在神經與行為的關係做更深入的探討。
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