思覺失調症為心理疾患中盛行率極高的一個疾病，常伴隨社交功能之障礙。已有研究顯示此族群的非口語表達行為有不同於常人之傾向，此行為表現可能與人際關係建立、人際互動網絡維持等社會成果相關。目前的文獻在研究設計上常見幾個限制：探討非口語表達行為的文獻數量有限、研究多採用實驗室情境、非口語行為之分析方法未採用具體參考架構。故本研究欲錄影思覺失調症個案於真實面談中之非口語表達行為，以透鏡模型理論為資料分析之參考架構，以量性方式檢驗思覺失調症個案之非口語行為模式。具體研究目的為：探討思覺失調症個案之非口語行為在不同話題下的差異；探討個案與旁觀他人對於人際印象的同意度；探討個案/他人如何使用非口語行為來呈現/判讀人際印象；檢視非口語行為，社交功能，與日常功能之相關性。
本研究採方便取樣，以接受復健中之慢性思覺失調症個案28名為研究對象。個案與熟識之職能治療師會談並錄影，進行臨床特徵、社交功能、日常生活功能等評估；會談採用半結構形式，引導個案分享近期正面與負面生活經驗；個案與會談者於會談後填寫人際印象 (關係、情緒、特質) 量性評量。會談之影片透過切片方法(thin-slices methodology)取得每個個案正面與負面話題下之代表性片段各20秒；6位招募之大學生根據代表性片段，分別對個案在正面與負面話題下的人際印象進行量性評量；另外3位研究人員則根據代表性影片，將非口語行為做量性評量。最後對應研究問題進行描述性、配對t檢定、皮爾森相關係數統計分析。
研究結果發現，個案在正向話題情境下，除臉上半部動作與非溝通類表達外，非口語行為外顯程度顯著高於負向話題情境。根據透鏡模型理論，分析人際印象同意度、線索有效性及線索使用性，結果如下：人際印象同意度上，個案自評與會談者，在特定項目上呈現顯著中度或高度正相關 (r = .39~.61)；反之，個案與招募之大學生旁觀者之同意度皆未達統計顯著之相關，甚至在正向話題下的「緊張」、負向話題下的「高興」之情緒，同意度呈現顯著負相關(r = -.39與 -.61)。個案在非口語行為的使用上(線索有效性)，整體來看，在正向與負向話題下，非口語行為與自評人際印象相關性皆未達統計顯著。若將其下細項分開檢驗，則發現在正向話題下，個案表現出較多之「利社會表達」時，越有可能自評較低之「有活力、自信」情緒 (r = -.38 與 -.41)；在負向話題下，個案表現出較多之「利社會表達」或「軀幹及肢體動作」時，越有可能自評較高之「緊張、急躁、害怕」情緒 (r = .44~ .60)；負向話題下，個案表現出較多之「整體溝通表達、臉下半部動作、軀幹及肢體動作」時，越有可能自評較高之「愛批評」人格特質 (r = .48~ .56)。在旁觀者的線索使用性上，不論個案處於哪個話題下，旁觀者皆傾向系統性地使用非口語行為當作判斷線索 (絕對值r = .37~ .85, p < .05)。最後，正向話題與負向話題下之非口語行為中之「非溝通類表達」與社交功能表現呈現顯著負相關 (r = -.43 與 -.41) ，其餘非口語行為與社交功能、日常生活功能、社會成果則未發現顯著相關。
此研究結果顯示，未來於臨床應用或研究中需注意不同話題情境下，個案可能會有不同之非口語行為。個案與不熟識之旁觀者，可能在人際印象看法上較難達到共識，甚至產生反向解釋。個案於正向話題情境下並無有效使用非口語行為；在負向話題情境下，反而有可能有效利用特定行為表達特定的負面內在情緒與特質。研究結果也顯示不論話題情境，旁觀者皆傾向有系統地使用個案的行為線索來判讀，但其所使用的線索與個案並不一致。本研究之結果尚需更多未來研究重複驗證，此類之證據未來可用來回饋個案，提升其人際互動的自覺以及作為訓練之內容；也可衛教臨床工作者與社會大眾，降低汙名化。提升個案能力與降低社會障礙兩方面著手，進而促進個案之社會結果與生活品質。

Changes in nonverbal behaviors in schizophrenia may have a negative impact on social outcomes. This study investigated whether conversation contents influence nonverbal behavior in individuals with schizophrenia, how nonverbal behavior is used, and whether nonverbal behavior associates with social outcomes.
Participants received a semi-structured videotaped interview with a therapist. After the interview, the interviewee and the interviewer rated the interpersonal impressions (i.e. rapport, interviewee’s emotions and personal traits). Six observers reviewed excerpts of interviews to provide ratings on interpersonal impressions. Three research assistants reviewed excerpts to provided ratings on nonverbal behaviors.
Twenty-eight participants were recruited. Ratings of nonverbal behavior were significantly higher during the conversation about positive experience, except for movement in upper face and non-communicated expressions. There were moderate to high degree of agreements on interpersonal impressions between self-reports and interviewer’s judgments. The agreements between self-reports and observers were low in general. There were no significant associations between cues and self-perceived interpersonal impression. When examining individual items, during negative conversations, certain nonverbal cues positively associated with nervous, irritable, and afraid, and self-reported quarrelsome personality. Healthy observers tended to use cues systematically regardless of conversation contents. Non-communicated expression in nonverbal behavior showed negative association with social skills.
Our results suggest that individuals with schizophrenia show different nonverbally expressive behaviors under different contexts. Individuals with schizophrenia do not use nonverbal cues efficiently to communicate. Strengths and limitations of this study were discussed. This research provides evidences for improving current social skill training and education.

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