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題名 以失眠的認知模型探討失眠患者每日睡眠與情緒狀態的關聯性
The day-to-day association of sleep and mood state in insomnia patients：From the perspective of cognitive model of insomnia.作者 陳琬渝
Chen, Wan Yu貢獻者 楊建銘
Yang, Chien Ming
陳琬渝
Chen, Wan Yu關鍵詞 失眠
情緒狀態
失眠的認知模型
insomnia
mood state
cognitive model of insomnia日期 2012 上傳時間 22-Jul-2013 17:16:51 (UTC+8) 摘要 研究背景與目的：在失眠患者上，除了夜間睡眠症狀外，白天功能缺損亦是常見的問題。過去研究較少去探討可能影響失眠患者產生白天功能缺損的相關因素，特別在情緒困擾此一面向上，研究更為缺乏。而根據 Harvey (2002)失眠的認知模型，假定失眠患者在早晨醒來時，思考的內容便會聚焦在睡眠困擾上，這些過度的負向認知活動會為失眠患者帶來高度激發的狀況，使得患者會在一整天當中不斷地自我監測睡不好所帶來的影響，而對於睡眠的不適應信念則會加劇負向認知活動，上述這些認知歷程的過度活動，可能為造成失眠患者白天功能缺損的相關因素，並為患者帶來痛苦的感受。因此本研究的目的為探討失眠患者其每日睡眠狀況對於隔天情緒狀態的影響，並以失眠的認知模型為框架，進一步澄清睡眠相關失功能信念及對睡眠相關訊息自我監測的傾向對於失眠患者其睡眠與情緒狀態間的關係的影響，以期有助於增加對失眠病理的瞭解。 研究方法：本研究運用生態瞬間評估法，在每天的四個隨機時間點，請40名失眠受試者（10名男性、30名女性，平均年齡43歲）進行情緒狀態的評估，並即時的回覆評估結果，同時請受試者配戴活動記錄儀及填寫睡眠日誌，進行連續一週的睡眠狀態測量，此外並請受試者填寫睡眠相關失功能信念與睡眠相關監測指標等兩份問卷。研究結果以階層線性模式進行分析，階層一分析個人內的主客觀睡眠指標是否能預測隔天的情緒狀態，階層二則分析個人間的睡眠相關失功能信念及自我監測行為是否會調節夜間睡眠及白天情緒狀態間的關係。 研究結果：本研究發現在失眠受試者上，其主客觀睡眠指標間有所不一致，多數的主觀睡眠指標可以預測隔天的正負向情緒，其中以主觀的總睡眠時數為最能預測失眠患者的負向情緒；在客觀睡眠指標上，僅有客觀總睡眠時間的增加，能預測隔天會有較少的負向情緒，而多數客觀睡眠指標則未能預測隔天的情緒狀態。另外，睡眠相關失功能信念以及睡眠相關監測行為並非扮演調節變項的角色，而是能顯著地預測失眠受試者的負向情緒。 結論：相較於實際的睡眠狀況，失眠患者對於睡眠的主觀知覺，可能是影響失眠患者產生情緒困擾的相關因素，而失眠患者其實際睡眠量的減少，可能會有近似部份睡眠剝奪的效果，影響隔天的情緒；此外，在失眠患者上，當擁有更多對於睡眠的不當認知時，以及愈傾向去監測睡眠相關訊息時，失眠患者會在一天當中有較多的情緒困擾。因此，調整失眠患者對於睡眠的不當認知，以及減少患者在一天當中不斷自我監測睡眠相關訊息的行為，並在後續研究中探討影響失眠患者其主客觀睡眠指標有所不一致的因素，可望能減少失眠患者的白天情緒困擾，增加生活品質。
OBJECTIVE：In addition to the nocturnal symptoms, daytime dysfunction is a common problem in insomnia patients. There are only limited number of studies to explore the factors that may influence daytime function in insomnia patients, particularly in mood disturbance. The Cognitive Model of Insomnia by Harvey (2004) suggests that the patients with insomnia tend to think about their sleep disturbance in the morning and throughout the day. These excessive negatively toned cognitive activity will enhance the patients’ level of arousal, and make them monitoring the impacts of sleep disturbances on daytime functioning throughout the day. The dysfunctional belief about sleep may further exacerbate the negatively toned cognitive activity. Such excessive daytime cognitive activities may be more the cause of their daytime dysfunction than their sleep disturbances, and may bring the distress of the patients. Therefore, the aim of this study is to explore the day-to-day association of sleep and mood state in insomnia patient, and to use the Cognitive Model of Insomnia as a framework to clarify the influence of dysfunctional beliefs and attitudes about sleep and the self-monitoring tendency of sleep-associated threat on the association between sleep and mood state, in order to further the understanding of pathological of insomnia. METHOD：Forty insomnia patients (10 male and 30 female, mean age 43) participated in the study. Their daytime emotion function were measured using the ecological momentary assessment, by asking them to rate their mood state and to submit the ratings immediately through text messages four times a day for a week. They were also asked to wear the actigraphy and to fill the sleep diary during the week. Moreover, participates were required to complete the Dysfunctional Beliefs and Attitude about Sleep Scale-16-item version and the Sleep-Associated Monitoring Index. Hieratical linear model was conducted for data analyses. Mood state ratings and subjective/objective sleep indicators were the variables for within-individual level analysis (level one), to examine whether the subjective/objective sleep indicators can predict the next day’s mood state; dysfunctional belief and self-monitoring of sleep-related threat included the variables for between individual level (level two), to examine whether these variables moderate the relationship of sleep and mood state. RESULT：The data showed inconsistency results between the subjective and objective sleep indicators. Most of the subjective sleep indicators can predict the next day’s mood state, particularly the amount of sleep time they subjectively experienced. On the other hand, only the total sleep time among the objective sleep indicators can predict negative mood the next day. Most objective sleep indicators failed to predict daytime emotion the next day`s. In addition, the dysfunctional beliefs about sleep and the self-monitoring tendency for sleep-related threat can significantly predicted the negative affect, but do not play a role as moderators for the relationship of sleep indicators and mood state. CONCLUSION：In patients with insomnia, the subjective experience rather than the objective measure of nighttime sleep is the major factor that determine their mood state the next day. The reduction of the actual amount of sleep may have negative impact on their mood through partial sleep deprivation. Also, when they have more dysfunctional beliefs about sleep, and the tendency for monitoring sleep-related threat, during the day, they may have more emotional disturbance during the day.The findings of the current study suggests that adjust the dysfunctional beliefs about sleep and reduce the tendency for monitoring the sleep-related threat, and explore the factors that may influence the inconsistent of objective and subjective sleep index in insomnia patients in subsequent studies, is expect to reduce emotional distress during the day, and increase the quality of life in insomnia patients參考文獻 中文部份： 林一真（2000）。貝克焦慮量表中文版指導手冊。台北市：中國行為科學社。 李宇宙、曾美智、陳映燁、謝明憲、許森彥、李信謙等人（1999）。MINI 台灣版：台灣精神醫學會。 車先蕙、盧孟良、陳錫中、張尚文、李宇宙 （2006）。中文版貝克焦慮量表之信效度。台灣醫學，10（4），447-454。 陳心怡（2000）。貝克憂鬱量表第二版（BDI-II）中文版。台北市：中國行為科學社。 陳昌偉、詹雅雯、楊建銘、林詩淳（2009）。中文版睡眠失功能信念及態度量表之信度探討。臨床心理學刊，4（1），59-67。 溫福星、邱皓政（2009）。多層次模型方法論：階層線性模式的關鍵議題與試解。台大管理論叢，19（2），263-294。 鄧閔鴻、張素凰（民 95）。廣泛性焦慮疾患與憂鬱疾患共病現象的階層病理模式。中華心理學刊，48（2），203-218。 盧孟良、車先蕙、張尚文、沈武典（民 91）。中文版貝克憂鬱量表第二版之信度和效度。臺灣精神醫學，16（4），301-310。 英文部份： Arroll, B., Fernando, A., 3rd, Falloon, K., Warman, G., & Goodyear-Smith, F. 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國立政治大學
心理學研究所
97752017
101資料來源 http://thesis.lib.nccu.edu.tw/record/#G0097752017 資料類型 thesis dc.contributor.advisor 楊建銘 zh_TW dc.contributor.advisor Yang, Chien Ming en_US dc.contributor.author (Authors) 陳琬渝 zh_TW dc.contributor.author (Authors) Chen, Wan Yu en_US dc.creator (作者) 陳琬渝 zh_TW dc.creator (作者) Chen, Wan Yu en_US dc.date (日期) 2012 en_US dc.date.accessioned 22-Jul-2013 17:16:51 (UTC+8) - dc.date.available 22-Jul-2013 17:16:51 (UTC+8) - dc.date.issued (上傳時間) 22-Jul-2013 17:16:51 (UTC+8) - dc.identifier (Other Identifiers) G0097752017 en_US dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/58970 - dc.description (描述) 碩士 zh_TW dc.description (描述) 國立政治大學 zh_TW dc.description (描述) 心理學研究所 zh_TW dc.description (描述) 97752017 zh_TW dc.description (描述) 101 zh_TW dc.description.abstract (摘要) 研究背景與目的：在失眠患者上，除了夜間睡眠症狀外，白天功能缺損亦是常見的問題。過去研究較少去探討可能影響失眠患者產生白天功能缺損的相關因素，特別在情緒困擾此一面向上，研究更為缺乏。而根據 Harvey (2002)失眠的認知模型，假定失眠患者在早晨醒來時，思考的內容便會聚焦在睡眠困擾上，這些過度的負向認知活動會為失眠患者帶來高度激發的狀況，使得患者會在一整天當中不斷地自我監測睡不好所帶來的影響，而對於睡眠的不適應信念則會加劇負向認知活動，上述這些認知歷程的過度活動，可能為造成失眠患者白天功能缺損的相關因素，並為患者帶來痛苦的感受。因此本研究的目的為探討失眠患者其每日睡眠狀況對於隔天情緒狀態的影響，並以失眠的認知模型為框架，進一步澄清睡眠相關失功能信念及對睡眠相關訊息自我監測的傾向對於失眠患者其睡眠與情緒狀態間的關係的影響，以期有助於增加對失眠病理的瞭解。 研究方法：本研究運用生態瞬間評估法，在每天的四個隨機時間點，請40名失眠受試者（10名男性、30名女性，平均年齡43歲）進行情緒狀態的評估，並即時的回覆評估結果，同時請受試者配戴活動記錄儀及填寫睡眠日誌，進行連續一週的睡眠狀態測量，此外並請受試者填寫睡眠相關失功能信念與睡眠相關監測指標等兩份問卷。研究結果以階層線性模式進行分析，階層一分析個人內的主客觀睡眠指標是否能預測隔天的情緒狀態，階層二則分析個人間的睡眠相關失功能信念及自我監測行為是否會調節夜間睡眠及白天情緒狀態間的關係。 研究結果：本研究發現在失眠受試者上，其主客觀睡眠指標間有所不一致，多數的主觀睡眠指標可以預測隔天的正負向情緒，其中以主觀的總睡眠時數為最能預測失眠患者的負向情緒；在客觀睡眠指標上，僅有客觀總睡眠時間的增加，能預測隔天會有較少的負向情緒，而多數客觀睡眠指標則未能預測隔天的情緒狀態。另外，睡眠相關失功能信念以及睡眠相關監測行為並非扮演調節變項的角色，而是能顯著地預測失眠受試者的負向情緒。 結論：相較於實際的睡眠狀況，失眠患者對於睡眠的主觀知覺，可能是影響失眠患者產生情緒困擾的相關因素，而失眠患者其實際睡眠量的減少，可能會有近似部份睡眠剝奪的效果，影響隔天的情緒；此外，在失眠患者上，當擁有更多對於睡眠的不當認知時，以及愈傾向去監測睡眠相關訊息時，失眠患者會在一天當中有較多的情緒困擾。因此，調整失眠患者對於睡眠的不當認知，以及減少患者在一天當中不斷自我監測睡眠相關訊息的行為，並在後續研究中探討影響失眠患者其主客觀睡眠指標有所不一致的因素，可望能減少失眠患者的白天情緒困擾，增加生活品質。 zh_TW dc.description.abstract (摘要) OBJECTIVE：In addition to the nocturnal symptoms, daytime dysfunction is a common problem in insomnia patients. There are only limited number of studies to explore the factors that may influence daytime function in insomnia patients, particularly in mood disturbance. The Cognitive Model of Insomnia by Harvey (2004) suggests that the patients with insomnia tend to think about their sleep disturbance in the morning and throughout the day. These excessive negatively toned cognitive activity will enhance the patients’ level of arousal, and make them monitoring the impacts of sleep disturbances on daytime functioning throughout the day. The dysfunctional belief about sleep may further exacerbate the negatively toned cognitive activity. Such excessive daytime cognitive activities may be more the cause of their daytime dysfunction than their sleep disturbances, and may bring the distress of the patients. Therefore, the aim of this study is to explore the day-to-day association of sleep and mood state in insomnia patient, and to use the Cognitive Model of Insomnia as a framework to clarify the influence of dysfunctional beliefs and attitudes about sleep and the self-monitoring tendency of sleep-associated threat on the association between sleep and mood state, in order to further the understanding of pathological of insomnia. METHOD：Forty insomnia patients (10 male and 30 female, mean age 43) participated in the study. Their daytime emotion function were measured using the ecological momentary assessment, by asking them to rate their mood state and to submit the ratings immediately through text messages four times a day for a week. They were also asked to wear the actigraphy and to fill the sleep diary during the week. Moreover, participates were required to complete the Dysfunctional Beliefs and Attitude about Sleep Scale-16-item version and the Sleep-Associated Monitoring Index. Hieratical linear model was conducted for data analyses. Mood state ratings and subjective/objective sleep indicators were the variables for within-individual level analysis (level one), to examine whether the subjective/objective sleep indicators can predict the next day’s mood state; dysfunctional belief and self-monitoring of sleep-related threat included the variables for between individual level (level two), to examine whether these variables moderate the relationship of sleep and mood state. RESULT：The data showed inconsistency results between the subjective and objective sleep indicators. Most of the subjective sleep indicators can predict the next day’s mood state, particularly the amount of sleep time they subjectively experienced. On the other hand, only the total sleep time among the objective sleep indicators can predict negative mood the next day. Most objective sleep indicators failed to predict daytime emotion the next day`s. In addition, the dysfunctional beliefs about sleep and the self-monitoring tendency for sleep-related threat can significantly predicted the negative affect, but do not play a role as moderators for the relationship of sleep indicators and mood state. CONCLUSION：In patients with insomnia, the subjective experience rather than the objective measure of nighttime sleep is the major factor that determine their mood state the next day. The reduction of the actual amount of sleep may have negative impact on their mood through partial sleep deprivation. Also, when they have more dysfunctional beliefs about sleep, and the tendency for monitoring sleep-related threat, during the day, they may have more emotional disturbance during the day.The findings of the current study suggests that adjust the dysfunctional beliefs about sleep and reduce the tendency for monitoring the sleep-related threat, and explore the factors that may influence the inconsistent of objective and subjective sleep index in insomnia patients in subsequent studies, is expect to reduce emotional distress during the day, and increase the quality of life in insomnia patients en_US dc.description.tableofcontents 摘要 I 第一章 前言 1 第二章 文獻探討 3 第一節 失眠的定義及流行病學研究 4 第二節 失眠患者的認知歷程 5 第三節 失眠患者的白天功能 9 第四節 研究問題與假設 14 第三章 研究方法 17 第一節 研究對象 17 第二節 實驗流程 18 第三節 研究工具 20 第四節 資料分析 26 第四章 研究結果 27 第一節 受試者人口學資料分析 27 第二節 受試者夜間睡眠狀況及情緒狀態分析 28 第三節 夜間睡眠狀況對失眠患者隔天情緒狀態的影響之階層線性模式分析 31 第四節 失眠患者其個體間變項對於夜間睡眠狀態對隔天情緒狀態影響的調節 效果之階層線性模式分析 39 第五節 失眠患者其睡眠相關失功能信念與睡眠相關監測行為對於情緒狀態影響之階層線性模式分析 43 第五章 討論 50 第一節 夜間主客觀睡眠指標與隔天情緒狀態間的關係 50 第二節 睡眠相關失功能信念以及睡眠相關監測行為的調節效果 54 第三節 研究限制與建議 55 參考文獻 58 附錄 65 附錄一 中文版睡眠相關監測指標 65 附錄二 簡版睡眠失功能信念與態度量表 67 附錄三 日間失眠症狀量表 69 附錄四 奧克蘭睡眠問卷 70 附錄五 每日檢核表 76 附錄六 ASQ 問卷中各種疾患的診斷標準 77 附錄七 睡眠日誌 79 zh_TW dc.format.extent 1462021 bytes - dc.format.mimetype application/pdf - dc.language.iso en_US - dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0097752017 en_US dc.subject (關鍵詞) 失眠 zh_TW dc.subject (關鍵詞) 情緒狀態 zh_TW dc.subject (關鍵詞) 失眠的認知模型 zh_TW dc.subject (關鍵詞) insomnia en_US dc.subject (關鍵詞) mood state en_US dc.subject (關鍵詞) cognitive model of insomnia en_US dc.title (題名) 以失眠的認知模型探討失眠患者每日睡眠與情緒狀態的關聯性 zh_TW dc.title (題名) The day-to-day association of sleep and mood state in insomnia patients：From the perspective of cognitive model of insomnia. en_US dc.type (資料類型) thesis en dc.relation.reference (參考文獻) 中文部份： 林一真（2000）。貝克焦慮量表中文版指導手冊。台北市：中國行為科學社。 李宇宙、曾美智、陳映燁、謝明憲、許森彥、李信謙等人（1999）。MINI 台灣版：台灣精神醫學會。 車先蕙、盧孟良、陳錫中、張尚文、李宇宙 （2006）。中文版貝克焦慮量表之信效度。台灣醫學，10（4），447-454。 陳心怡（2000）。貝克憂鬱量表第二版（BDI-II）中文版。台北市：中國行為科學社。 陳昌偉、詹雅雯、楊建銘、林詩淳（2009）。中文版睡眠失功能信念及態度量表之信度探討。臨床心理學刊，4（1），59-67。 溫福星、邱皓政（2009）。多層次模型方法論：階層線性模式的關鍵議題與試解。台大管理論叢，19（2），263-294。 鄧閔鴻、張素凰（民 95）。廣泛性焦慮疾患與憂鬱疾患共病現象的階層病理模式。中華心理學刊，48（2），203-218。 盧孟良、車先蕙、張尚文、沈武典（民 91）。中文版貝克憂鬱量表第二版之信度和效度。臺灣精神醫學，16（4），301-310。 英文部份： Arroll, B., Fernando, A., 3rd, Falloon, K., Warman, G., & Goodyear-Smith, F. 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