研究背景與目的
文獻指出大學生族群每五人就有一位至少符合一種性格障礙，且日常生活功能減損，並導致很多行為問題；然而，少於25%的學生曾接受相關專業協助。其中，邊緣性性格障礙 (Borderline Personality Disorder;簡稱 BPD) 是最常被臨床診斷的性格障礙，其心理病理包括認知偏差、衝動行為、人際互動障礙及情緒不穩定。因BPD有心理社會功能缺損且常出現憂鬱自傷、自殺嘗試及較高自殺死亡率，故探討BPD大學生的心理病理機制與其自殺嘗試的防治策略有其必要性。
研究指出人際互動事件常是BPD情緒反應的觸發因子，因此BPD對人際情緒表情辨識的認知調控與情緒調控機制是近年來BPD心理病理研究的重點之一，可以釐清BPD常見的憂鬱與自殺嘗試行為的心理病理機制。
過去研究指出對於BPD個案的憂鬱與自傷的心理介入，使用認知療法與辯證療法均具療效。認知行為心理介入透過修正BPD的負向信念與想法來降低憂鬱與自殺行為，辯證行為心理介入方式則是結合情緒調控與認知調控來降低憂鬱與自殺行為。在介入的心理病理概念有相似之處; 但辯證行為心理介入合併了個別認知行為介入與情緒技巧訓練團體介入兩種介入策略故須耗用較高的介入資源，若只使用以情緒調控為主的技巧訓練團體是否仍有效有待探討，釐清此問題極具理論興實務運用價值，可提供後續有效降低BPD大學生憂鬱與再度自殺嘗試的臨床應用重要資料。以下將分二個研究來進行。

研究一 邊緣性性格障礙大學生的情緒表情辨識驗證
背景與目的
研究指出人際互動是BPD情感不穩定的強力促發因子，若個體能夠準確地辨識他人的情緒狀態並調節自己的情緒狀態是重要的，因此，情緒表情的辨識可視為完整社會功能的認知基礎，並可促進同理心、信任和社會化的行為。過去研究指出，BPD個案較健康個案更容易在人際互動中出現負向類別情緒表情的錯誤辨識，而錯誤辨識的結果可能引發BPD個案較高的情緒反應，造成反應時間的延遲，也造成BPD生活中較多的人際障礙。由於過去研究多以臨床個案為研究對象，常受藥物的干擾，並且較少以華人為研究對象，本研究擬取樣未經治療的大學社區BPD大學生，比較非BPD大學生對不同臉孔表情刺激的辨識正確率、辨識錯誤的反應型態、反應時間，並比較兩組在情緒表情辨識歷程中被引發的情緒強度及其與反應時間的相關性，以了解在無藥物干擾下，BPD大學生與對照組在表情辨識歷程以及情緒強度干擾反應時間上的差異。
研究方法
研究使用指導教授柯慧貞教授所主持的科技部專題研究計畫 (NSC 96-2413-H-006-007) 中所抽樣10所大專院校一年級新生，經知後同意，進行柯氏憂鬱量表與BPD特徵問卷篩檢，篩選憂鬱、BPD高危險群，再邀請5所科技大學學生進一步接受診斷晤談，乃由受訓練之研究人員透過結構晤談標準化診斷晤談手冊施以晤談，篩出23位未經治療與服用藥物的BPD個案與32位控制組個案進行研究。本論文研究進一步實施電腦化人際情緒表情辨識測驗。
研究結果
BPD大學生相較於對照組在正確辨識生氣、厭惡、快樂、悲傷表情之反應時間較長，對於錯誤辨識表情的反應時間在生氣、害怕、快樂與驚訝的辨識反應時間亦較長。在辨識不同表情刺激的錯誤辨識反應模式上，顯示BPD和對照組之間沒有顯著差異。另外， 在正確辨識反應下被引發的情緒強度上，BPD組在生氣、厭惡、悲傷的反應強度較對照組高；在錯誤辨識反應下BPD個案被引發的生氣、厭惡、害怕、悲傷反應強度較對照組高。進一步比較個案被引發的情緒強度與反應時間的相關，結果顯示BPD組在正確辨識表情的反應時間與被引發的情緒強度的相關上達顯著正相關，但對照組的正確辨識表情的反應時間與被引發的情緒強度間無相關；另在錯誤辨識表情時BPD組在被引發的情緒的反應強度與反應時間關係亦達顯著正相關；但對照組的被引發的情緒的反應強度與反應時間間也是無相關。

研究二 邊緣性性格障礙大學生的自殺嘗試介入成效探討
背景目的
研究指出運用認知行為心理療法(Cognitive behavior therapy 簡稱CBT)治療與基於CBT改良的辯證行為心理療法(Dialectical behavior therapy；簡稱DBT)均可以有效降低BPD的自殺意念與自殺嘗試，CBT的優勢是在有限時間內提供有效的介入，但有較高的個案流失率。DBT則是包含CBT個別介入與結合內觀的心理社會技巧訓練團體，可有效改善個案流失比率、降低個案住院的停留時間並降低介入後再度自殺行為的發生率，但DBT其缺點是較高的介入成本與其療效的機制未完全清楚，故如何發展更經濟有效的介入方法是目前BPD療法的發展的目標。近年來，研究開始探討單獨進行心理社會技巧訓練團體的介入效果，是故本研究擬比較辯證行為療法技巧訓練團體(Dialectical behavior therapy skills training group，簡稱DBTDTG)、認知療法團體(cognitive therapy group, 簡稱CTG)兩種介入方式在降低BPD憂鬱分數、自殺嘗試與情緒調控歷程上的成效；並且，由於CTG介入焦點強調對事件認知歷程(antecedent-focused)的改變；而DBTDTG介入焦點則在以情緒反應為焦點(response-focused)的調控，故本研究亦擬比較此二種不同介入焦點策略的成效。
研究方法
研究經過成大醫院人體試驗委員會審核通過後，於兩所大專院校一年級新生進行篩檢，施測BPD特徵量表與憂鬱量表，篩選出可能是BPD與憂鬱症狀高風險個案，並經由受訓練之研究人員透過結構晤談標準化診斷晤談手冊施以晤談後將符合BPD個案納入研究，此外，經晤談評估個案若有中度以上自殺危險性，則進行自殺危機處置。研究共篩出82位個案參與研究，並將個案隨機分派到CTG(40位)或DBTSTG組(42位)進行介入。並在團體介入前、中(4週)、後(8週)與追蹤期(介入後第3個月、第6個月)各施測情緒調控歷程之認知再評估、注意力移轉、情緒壓抑與情緒接受等分量表、柯氏憂鬱量表與認知偏誤問卷以及評估個案的再自殺風險。
研究結果
結果顯示8週的CTG與DBTSTG組介入均降低 BPD大學生的再度自殺嘗試與憂鬱量表分數，且在介入後與追蹤期的再自殺嘗試比例與憂鬱量表分數改善上兩組無顯著差異；比較兩組個案介入流失情況，兩組個案在介入完成率與個案流失率亦無顯著差異。在認知偏誤問卷結果顯示CTG在介入期間(第4週)、介入後(第8週)與追蹤期(第3、6個月)的認知偏誤問卷分數均較DBSTG組低，在認知再評估分量表分數CTG組追蹤期(第3、6個月)顯著較DBTSTG組高；但在情緒壓抑分量表分數改善上，則顯示DBTSTG組較CTG組在追蹤期(第3、第6個月)顯著較低。在接受分量表部分，結果亦顯示DBTSTG相較於CTG組在介入後第8週、追蹤期第 3個月與6個月有較高的接受分量表分數改善程度。

研究結論
本研究以人際情緒表情辨識電腦測驗探討BPD對人際互動表情辨識時的可能障礙，經取樣未經治療與服用藥物的BPD與對照組大學生比較下，發現在生氣、厭惡、害怕、快樂、悲傷與驚訝表情刺激的辨識反應錯誤辨識率與辨識型態上並無顯著差異；但是BPD大學生相較於對照組在正確辨識或錯誤辨識生氣表情之反應時間較長，且在辨識生氣、厭惡及悲傷反應下，呈現較強的反應強度；且無論正確或錯誤辨識情緒反應時間與被引發的情緒強度達顯著正相關，但對照組的辨識負向情緒的反應時間與被引發的情緒強度無關。本研究指出在BPD個案的人際情感基模可能影響在生氣與厭惡情緒辨的辨識與解釋，而使用基本情緒圖片與實際人際生活事件存在差異，日後研究可以針對此部分進行設計，例如增加人際情緒經驗的認知評估，而更能夠貼近BPD個案之生活經驗，另外，本研究的BPD個案非嚴重BPD之個案且樣本較小，後續研究可以進一步探討。
在針對BPD大學生的憂鬱與自殺嘗試介入研究成果顯示，認知團體介入可以改善BPD大學生自殺嘗試相關的認知偏誤，而辯證行為技巧訓練團體則可降低壓抑、增強接受等強化情緒調控技巧的學習，然而，兩者皆可協助BPD大學生降低自殺嘗試與憂鬱分數。認知介入團體呈現在情緒調控策略之事件認知歷程的改善; 辯證行為技巧訓練團體則增進情緒調控策略之情緒焦點調控的技巧，團體介入上使用可以透過上述兩種團體介入方法，以降低BPD個案的再自殺嘗試與憂鬱程度。
未來研究可以進一步探討情緒調控策略的機制，及其在憂鬱或自殺嘗試的心理病理的角色。並針對不同個案的診斷與症狀探討個別化情緒調控的介入策略，以最大化介入成效。此外，本研究中未評估內觀技巧，未來研究可增加內觀技巧的測量；進一步的研究亦可探討CTG、DBTSTG以及合併藥物治療的介入方式對於BPD的不同症狀面向的影響。過去BPD研究中的侷限性之一是大多數的DBT介入研究僅針對女性參與者進行，雖然本研究納入男性學生，佔參與研究的個案14.6％，進一步的研究仍宜增加男性個案的數量。最後，未來研究可探討DBTSTG與CTG用於預防BPD憂鬱大學生的成本效益。

The core feature of BPD is emotional dyregulation followed by depression, self-injury, suicide attempts and higher suicide mortality rate. The psychopathology of emotional vulnerability and develop suicide prevention strategies for college students with BPD are important issues which have to be drawn carefully.All participants provided informed consent by using protocols approved by the Institutional Review Board. Cluster sampling was used and 23 out of these 68 BPD participants agreed to participate in the facial expression recognition task. The investigators also recruited 32 healthy students as the control group. Study2 participants were referred by counseling centers based on freshman screening during 2009-2014, 82 cases were screened to participate in the stud and randomly assigned to the CTG group (n=40) or the DBTSTG group (n=42). Measurements were made before intervention: in the middle (4 weeks), after (8 weeks) and in the follow-up period.Study1 results showed that the BPD group spent more time on anger, disgust, happiness and sadness. Results showed that the reaction time of the BPD group was significantly and positively correlated with the intensity evoked by the emotional stimul. Study2 results showed that 8 weeks of CTG and DBTSTG intervention reduced the suicide reattempts and depression scores of BPD college student. The DBTSTG group was significantly improved in the emotion suppression scale scores, and scored lower than the CTG group in the follow-up period. In the emotion acceptance subscale, the results also showed that DBTSTG was better than the CTG group at the eight-week after intervention, third months in the follow-up period and sixth months in the follow-up period. Both the DBTSG and CTG programs conducted by an experienced therapist with regular supervision, were able to successfully reduce suicide attempts, suicide ideations, depression, and increase adaptive strategies of emotion regulation among college BPD students with moderate-severe depression who have had at least one suicide attempt in the past 6 months.

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