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題名 慢性疼痛病人的敵意覺知、寂寞感與疼痛程度之關聯探究
Exploring the Relationship among Hostility, Loneliness, and Pain Level in Chronic Pain Patients
作者 林彤
貢獻者 吳治勳
林彤
關鍵詞 慢性疼痛
敵意
寂寞感
chronic pain
hostility
loneliness
日期 2022
上傳時間 1-Aug-2022 18:10:48 (UTC+8)
摘要 研究背景：慢性疼痛影響個人生活的生理、心理與社會層面，衍生負面情緒，降低個人的生活品質。慢性疼痛病人面對環境中具威脅性的訊號時，形成一系列與敵意有關之認知、情緒與行為歷程，並可能因此延續與強化病人的疼痛程度。本研究藉由文獻回顧，推測敵意與疼痛程度之間應存在顯著關聯，並將寂寞感作為一主觀社會變項，探討寂寞感如何影響敵意對於疼痛程度的關係。為此，本研究將進行以橫斷性與縱貫性資料檢驗變項間的關聯。
研究方法：本研究參與者來自北部某醫學中心疼痛門診之慢性疼痛病人。參與者將進行多時間點的評估，每次皆填答基本資料與疼痛評估，台灣疼痛評估量表、慢性病負向情緒篩檢量表、UCLA-3寂寞量表、及短式華人敵意量表。研究一將採用第一次評估之樣本資料進行橫斷式分析。探討敵意與疼痛之同時性關係時，先以皮爾森相關檢驗整體敵意與整體疼痛程度之相關性，再以路徑分析探討敵意四因素「敵意認知」、「敵意情感」、「表達敵意」、及「壓抑敵意」，與疼痛四因素「疼痛衝擊」、「疼痛－無助」、「疼痛－丟臉」、「疼痛－逃避」之關係；探討寂寞感、敵意與疼痛程度之關聯時，先以線性迴歸檢驗寂寞感是否能調節整體敵意與整體疼痛程度之關係，再根據寂寞感分數將參與者分為高／低寂寞感組，以多組別分析檢驗寂寞感對敵意四因素與疼痛四因素之關係是否具調節效果。研究二則採用第一次（T0）與三個月後第二次評估（T1）的追蹤樣本資料進行縱貫式分析，先以路徑分析檢驗敵意四因素（T0）與疼痛四因素（T1）的時序性關係，並以多組別分析檢驗寂寞感對於敵意四因素（T0）與疼痛四因素（T1）時序性關係的調節效果，最後再將寂寞感（T1）作為中介變項，檢驗寂寞感對於敵意四因素（T0）與疼痛四因素（T1）時序性關係的中介效果。
研究結果：研究一共納入280位慢性疼痛病人。在敵意與疼痛的同時性關係中，整體敵意與整體疼痛程度顯著相關，路徑分析結果顯示「敵意情感」可正向預測「疼痛－逃避」，「壓抑敵意」可正向預測「疼痛衝擊」、「疼痛－無助」、「疼痛－丟臉」。以寂寞感作為調節變項，結果顯示寂寞感對於整體敵意與整體疼痛程度不具顯著調節效果。在多組別路徑分析結果中，寂寞感對敵意四因素與疼痛四因素之關係雖有部分調節效果，但效果於統計上皆未達顯著。研究二共納入167位病人之追蹤樣本。結果發現在敵意與疼痛在時序性關係中，「敵意認知T0」可正向預測「疼痛－丟臉T1」，「敵意情感T0」可正向預測「疼痛衝擊T1」，「壓抑敵意T0」可正向預測「疼痛衝擊T1」與「疼痛－無助T1」。以寂寞感T1作為調節變項時，寂寞感對敵意四因素T0與疼痛四因素T1之時序性關係雖有部分調節效果，但於統計上皆未達顯著。以寂寞感T1作為中介變項時，寂寞感可完全中介「敵意認知T0」、「壓抑敵意T0」兩個敵意面向對後續「疼痛衝擊T1」、「疼痛－丟臉T1」的關係。
討論：本研究發現敵意對疼痛具有部分的預測效果，且相較同時性的關係，敵意與疼痛在時序性關係有更多面向之預測效果。另外，本研究發現寂寞感雖然無法作為調節變項影響敵意與疼痛的關係，但可作為中介變項部分影響敵意與疼痛的關係。綜合上述，當慢性疼痛病人抱持高敵意之認知思考，或傾向運用高強度之敵意壓抑行為，上述敵意表現將增強病人後續的寂寞感，強化後續疼痛讓病人感到丟臉、沒有面子等感受，並且放大慢性疼痛造成的身心衝擊。本研究藉由寂寞感、敵意與疼痛關係之多面向探討，增進對台灣慢性疼痛病人心理社會狀態之理解，並盼能藉此對病人的疼痛與生活適應有所助益。
Background: Chronic pain has strong influence on the physical, psychological and social aspects of patients’ life, which giving rise to negative emotions and reducing quality of life. When faced with threat signals in the environment, chronic pain patients initiate a series of cognitive, emotional and behavioral process related to hostility, which may prolong and intensify their pain level. Based of literature review, this study presumes that there is a significant relationship between hostility and pain level. This study also uses loneliness as a subjective social variable to explore how loneliness affects the relationship between hostility and pain level.
Methods: Participants in this study were chronic pain patients in the pain clinic of a medical center in north Taiwan. Patients were asked to complete surveys at baseline(T0) and 3-month follow-up(T1.) They filled out the basic pain assessment, "the Pain Assessment Scale Taiwan," "the Negative Emotions due to Chronic Illness Screening Test," "the UCLA-3 Loneliness Scale-3", and "the Chinese Hostility Inventory-Short Form" in each survey. In study 1, T0 data were used for cross-sectional analysis. To investigate the simultaneous relation between hostility and pain, Pearson`s correlation was used to test the correlation between overall hostility and overall pain level. Path analysis was used to test the relationship among four factors of hostility ("hostile cognition," "hostile affection," "expressive hostility behavior," and "suppressive hostility behavior") and four factors of pain ("pain impact," "pain-helplessness," "pain-losing-face," and "pain-avoidance.")
To explore the simultaneous relationship among hostility, pain, and loneliness, first linear regression was used to test whether loneliness could moderate the relationship between overall hostility and overall pain level. Then, after dividing into high/low loneliness groups according to their loneliness score, multi-group path analysis was used to test whether loneliness could moderate the relationship among the factors of hostility and pain. In study 2, T0 and T1 data were used for longitudinal analysis. First, to investigate their temporal association, path analysis was used to test the relationship among the factors of hostility(T0) and pain(T1.) Then multi-group path analysis was used to test whether loneliness(T1) could be the moderator among the factors of hostility(T0) and pain(T1.) Finally, path analysis was used to test whether loneliness(T1) could be the mediator among the factors of hostility(T0) and pain(T1.)
Results: A total of 280 chronic pain patients were included in study 1. Regarding the simultaneous relationship between hostility and pain, overall hostility is significantly correlated with overall pain level. Path analysis results show that "hostile affections" can positively predict "pain-avoidance" "suppressive hostility behavior" positively predicts "pain impact," "pain-helplessness," and "pain-losing-face." When used loneliness as a moderator, the results showed that loneliness had no significant moderating effect between overall hostility and overall pain level. Through the multi-group path analysis, loneliness has partial but not significant moderating effects on the relationship among the four factors of hostility and the four factors of pain. A total of 167 follow-up samples were included in study 2. Regarding the temporal relationship between hostility and pain, path analysis results show that "hostile cognition(T0)" can positively predict "pain-losing-face(T1)" "hostile affection(T0)" can positively predict "pain impact(T1)", "pain-helplessness(T1)" "suppressive hostility behavior(T0)" positively predict "pain impact(T1)", "pain-helplessness(T1)." When used loneliness(T1) as a moderator, loneliness has partial but not significant moderating effects on the temporal relationship among the four factors of hostility(T0) and the four factors of pain(T1) through the multi-group path analysis. When used loneliness(T1) as a mediator, loneliness can fully mediate the temporal relationship between "hostile cognition(T0)"/"suppressive hostility behavior(T0)" and the "pain impact(T1)"/"pain-losing-face(T1)."
Discussion: According to cross-sectional and longitudinal analysis, this study finds that hostility factors can be more predictive and influence more aspects of pain in longitudinal analysis. Besides, loneliness substantially affects the relationship between hostility and pain when regarded as a mediator. In conclusion, when chronic pain patients hold higher hostility cognitive thinking in mind or tend to use suppressive hostility behaviors frequently, these hostility presentations would increase loneliness subsequently, making the patient feel shame on themselves, amplifying the physical and psychological impact of pain on patients. By exploring the relationship among hostility, pain, and loneliness in different scopes, this study expands the understanding of the psychosocial context of chronic pain patients in Taiwan, looking forward to helping patients with chronic pain coping and general life adaptation.
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描述 碩士
國立政治大學
心理學系
107752003
資料來源 http://thesis.lib.nccu.edu.tw/record/#G0107752003
資料類型 thesis
dc.contributor.advisor 吳治勳zh_TW
dc.contributor.author (Authors) 林彤zh_TW
dc.creator (作者) 林彤zh_TW
dc.date (日期) 2022en_US
dc.date.accessioned 1-Aug-2022 18:10:48 (UTC+8)-
dc.date.available 1-Aug-2022 18:10:48 (UTC+8)-
dc.date.issued (上傳時間) 1-Aug-2022 18:10:48 (UTC+8)-
dc.identifier (Other Identifiers) G0107752003en_US
dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/141171-
dc.description (描述) 碩士zh_TW
dc.description (描述) 國立政治大學zh_TW
dc.description (描述) 心理學系zh_TW
dc.description (描述) 107752003zh_TW
dc.description.abstract (摘要) 研究背景：慢性疼痛影響個人生活的生理、心理與社會層面，衍生負面情緒，降低個人的生活品質。慢性疼痛病人面對環境中具威脅性的訊號時，形成一系列與敵意有關之認知、情緒與行為歷程，並可能因此延續與強化病人的疼痛程度。本研究藉由文獻回顧，推測敵意與疼痛程度之間應存在顯著關聯，並將寂寞感作為一主觀社會變項，探討寂寞感如何影響敵意對於疼痛程度的關係。為此，本研究將進行以橫斷性與縱貫性資料檢驗變項間的關聯。
研究方法：本研究參與者來自北部某醫學中心疼痛門診之慢性疼痛病人。參與者將進行多時間點的評估，每次皆填答基本資料與疼痛評估，台灣疼痛評估量表、慢性病負向情緒篩檢量表、UCLA-3寂寞量表、及短式華人敵意量表。研究一將採用第一次評估之樣本資料進行橫斷式分析。探討敵意與疼痛之同時性關係時，先以皮爾森相關檢驗整體敵意與整體疼痛程度之相關性，再以路徑分析探討敵意四因素「敵意認知」、「敵意情感」、「表達敵意」、及「壓抑敵意」，與疼痛四因素「疼痛衝擊」、「疼痛－無助」、「疼痛－丟臉」、「疼痛－逃避」之關係；探討寂寞感、敵意與疼痛程度之關聯時，先以線性迴歸檢驗寂寞感是否能調節整體敵意與整體疼痛程度之關係，再根據寂寞感分數將參與者分為高／低寂寞感組，以多組別分析檢驗寂寞感對敵意四因素與疼痛四因素之關係是否具調節效果。研究二則採用第一次（T0）與三個月後第二次評估（T1）的追蹤樣本資料進行縱貫式分析，先以路徑分析檢驗敵意四因素（T0）與疼痛四因素（T1）的時序性關係，並以多組別分析檢驗寂寞感對於敵意四因素（T0）與疼痛四因素（T1）時序性關係的調節效果，最後再將寂寞感（T1）作為中介變項，檢驗寂寞感對於敵意四因素（T0）與疼痛四因素（T1）時序性關係的中介效果。
研究結果：研究一共納入280位慢性疼痛病人。在敵意與疼痛的同時性關係中，整體敵意與整體疼痛程度顯著相關，路徑分析結果顯示「敵意情感」可正向預測「疼痛－逃避」，「壓抑敵意」可正向預測「疼痛衝擊」、「疼痛－無助」、「疼痛－丟臉」。以寂寞感作為調節變項，結果顯示寂寞感對於整體敵意與整體疼痛程度不具顯著調節效果。在多組別路徑分析結果中，寂寞感對敵意四因素與疼痛四因素之關係雖有部分調節效果，但效果於統計上皆未達顯著。研究二共納入167位病人之追蹤樣本。結果發現在敵意與疼痛在時序性關係中，「敵意認知T0」可正向預測「疼痛－丟臉T1」，「敵意情感T0」可正向預測「疼痛衝擊T1」，「壓抑敵意T0」可正向預測「疼痛衝擊T1」與「疼痛－無助T1」。以寂寞感T1作為調節變項時，寂寞感對敵意四因素T0與疼痛四因素T1之時序性關係雖有部分調節效果，但於統計上皆未達顯著。以寂寞感T1作為中介變項時，寂寞感可完全中介「敵意認知T0」、「壓抑敵意T0」兩個敵意面向對後續「疼痛衝擊T1」、「疼痛－丟臉T1」的關係。
討論：本研究發現敵意對疼痛具有部分的預測效果，且相較同時性的關係，敵意與疼痛在時序性關係有更多面向之預測效果。另外，本研究發現寂寞感雖然無法作為調節變項影響敵意與疼痛的關係，但可作為中介變項部分影響敵意與疼痛的關係。綜合上述，當慢性疼痛病人抱持高敵意之認知思考，或傾向運用高強度之敵意壓抑行為，上述敵意表現將增強病人後續的寂寞感，強化後續疼痛讓病人感到丟臉、沒有面子等感受，並且放大慢性疼痛造成的身心衝擊。本研究藉由寂寞感、敵意與疼痛關係之多面向探討，增進對台灣慢性疼痛病人心理社會狀態之理解，並盼能藉此對病人的疼痛與生活適應有所助益。		zh_TW
dc.description.abstract (摘要) Background: Chronic pain has strong influence on the physical, psychological and social aspects of patients’ life, which giving rise to negative emotions and reducing quality of life. When faced with threat signals in the environment, chronic pain patients initiate a series of cognitive, emotional and behavioral process related to hostility, which may prolong and intensify their pain level. Based of literature review, this study presumes that there is a significant relationship between hostility and pain level. This study also uses loneliness as a subjective social variable to explore how loneliness affects the relationship between hostility and pain level.
Methods: Participants in this study were chronic pain patients in the pain clinic of a medical center in north Taiwan. Patients were asked to complete surveys at baseline(T0) and 3-month follow-up(T1.) They filled out the basic pain assessment, "the Pain Assessment Scale Taiwan," "the Negative Emotions due to Chronic Illness Screening Test," "the UCLA-3 Loneliness Scale-3", and "the Chinese Hostility Inventory-Short Form" in each survey. In study 1, T0 data were used for cross-sectional analysis. To investigate the simultaneous relation between hostility and pain, Pearson`s correlation was used to test the correlation between overall hostility and overall pain level. Path analysis was used to test the relationship among four factors of hostility ("hostile cognition," "hostile affection," "expressive hostility behavior," and "suppressive hostility behavior") and four factors of pain ("pain impact," "pain-helplessness," "pain-losing-face," and "pain-avoidance.")
To explore the simultaneous relationship among hostility, pain, and loneliness, first linear regression was used to test whether loneliness could moderate the relationship between overall hostility and overall pain level. Then, after dividing into high/low loneliness groups according to their loneliness score, multi-group path analysis was used to test whether loneliness could moderate the relationship among the factors of hostility and pain. In study 2, T0 and T1 data were used for longitudinal analysis. First, to investigate their temporal association, path analysis was used to test the relationship among the factors of hostility(T0) and pain(T1.) Then multi-group path analysis was used to test whether loneliness(T1) could be the moderator among the factors of hostility(T0) and pain(T1.) Finally, path analysis was used to test whether loneliness(T1) could be the mediator among the factors of hostility(T0) and pain(T1.)
Results: A total of 280 chronic pain patients were included in study 1. Regarding the simultaneous relationship between hostility and pain, overall hostility is significantly correlated with overall pain level. Path analysis results show that "hostile affections" can positively predict "pain-avoidance" "suppressive hostility behavior" positively predicts "pain impact," "pain-helplessness," and "pain-losing-face." When used loneliness as a moderator, the results showed that loneliness had no significant moderating effect between overall hostility and overall pain level. Through the multi-group path analysis, loneliness has partial but not significant moderating effects on the relationship among the four factors of hostility and the four factors of pain. A total of 167 follow-up samples were included in study 2. Regarding the temporal relationship between hostility and pain, path analysis results show that "hostile cognition(T0)" can positively predict "pain-losing-face(T1)" "hostile affection(T0)" can positively predict "pain impact(T1)", "pain-helplessness(T1)" "suppressive hostility behavior(T0)" positively predict "pain impact(T1)", "pain-helplessness(T1)." When used loneliness(T1) as a moderator, loneliness has partial but not significant moderating effects on the temporal relationship among the four factors of hostility(T0) and the four factors of pain(T1) through the multi-group path analysis. When used loneliness(T1) as a mediator, loneliness can fully mediate the temporal relationship between "hostile cognition(T0)"/"suppressive hostility behavior(T0)" and the "pain impact(T1)"/"pain-losing-face(T1)."
Discussion: According to cross-sectional and longitudinal analysis, this study finds that hostility factors can be more predictive and influence more aspects of pain in longitudinal analysis. Besides, loneliness substantially affects the relationship between hostility and pain when regarded as a mediator. In conclusion, when chronic pain patients hold higher hostility cognitive thinking in mind or tend to use suppressive hostility behaviors frequently, these hostility presentations would increase loneliness subsequently, making the patient feel shame on themselves, amplifying the physical and psychological impact of pain on patients. By exploring the relationship among hostility, pain, and loneliness in different scopes, this study expands the understanding of the psychosocial context of chronic pain patients in Taiwan, looking forward to helping patients with chronic pain coping and general life adaptation.		en_US
dc.description.tableofcontents 第一章 緒論 1

第二章 文獻回顧 3
第一節 慢性疼痛 3
第二節 慢性疼痛病人的敵意經驗 11
第三節 寂寞感、敵意與慢性疼痛之關係 18
第四節 研究架構及假設 25

第三章 研究方法 30
第一節 研究參與者與研究流程 30
第二節 研究工具 31
第三節 資料分析 38

第四章 研究一結果 41
第一節 樣本概述與各變項描述統計 41
第二節 量表工具信度檢驗 44
第三節 敵意與疼痛程度之同時性關係 45
第四節 寂寞感對敵意與疼痛同時性關係之調節效果 52

第五章 研究二結果 57
第一節 敵意與疼痛程度之時序性關係 57
第二節 寂寞感對敵意與疼痛時序性關係之影響 59

第六章 討論 68
第一節 敵意與疼痛程度之關係統整 68
第二節 寂寞感對敵意與疼痛關係之影響概述 72
第三節 研究貢獻與應用、限制與未來方向 76

參考文獻 80

附錄 91
一、基本資料與疼痛評估 91
二、台灣疼痛評估量表（第三版） 92
三、慢性病負向情緒篩檢量表 93
四、台灣慢性疼痛病人寂寞量表（初版） 93
五、短式華人敵意量表 94		zh_TW
dc.format.extent 4704757 bytes-
dc.format.mimetype application/pdf-
dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0107752003en_US
dc.subject (關鍵詞) 慢性疼痛zh_TW
dc.subject (關鍵詞) 敵意zh_TW
dc.subject (關鍵詞) 寂寞感zh_TW
dc.subject (關鍵詞) chronic painen_US
dc.subject (關鍵詞) hostilityen_US
dc.subject (關鍵詞) lonelinessen_US
dc.title (題名) 慢性疼痛病人的敵意覺知、寂寞感與疼痛程度之關聯探究zh_TW
dc.title (題名) Exploring the Relationship among Hostility, Loneliness, and Pain Level in Chronic Pain Patientsen_US
dc.type (資料類型) thesisen_US
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dc.identifier.doi (DOI) 10.6814/NCCU202200772en_US