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題名 乳癌患者的反芻型態對憂鬱的影響
The Effects of Brooding and Reflective Pondering on Depression in Breast Cancer Patients作者 黃荷芳
Huang, Ho Fang貢獻者 許文耀
黃荷芳
Huang, Ho Fang關鍵詞 乳癌患者
憂鬱
反芻
苦惱自責式反芻
深思反省式反芻
breast cancer
depression
rumination
brooding
reflective pondering日期 2015 上傳時間 1-Sep-2015 16:17:48 (UTC+8) 摘要 過去的研究顯示，反芻為憂鬱的危險因子，對憂鬱的發展與維持扮演重要的角色。然而，並不是所有反芻型態都會對個體帶來不利的影響。Treynor, Gonzalez與Nolen-Hoeksema（2003）從反芻反應風格量表中抽取出兩個因素結構：苦惱自責式反芻與深思反省式反芻。苦惱自責式反芻能正向預測憂鬱症狀，而深思反省式則是負向預測憂鬱症狀，為較具適應性的反芻型態。然而，過去文獻在深思反省式反芻上未能獲得一致的結論，可能與研究方法及受到苦惱自責式反芻污染的影響。為釐清深思反省式反芻對乳癌患者而言是否具適應性，本研究欲探討兩類反芻與憂鬱之關聯性，並在控制初始的憂鬱症狀後，檢驗兩類反芻對一年後憂鬱症狀的預測力，最後修正Takano與Tanno（2009）的模型探索兩類反芻之路徑關係如何影響憂鬱。 本研究以立意取樣的方式，追蹤283名乳癌患者，分別於受術後一年（T1）與手術後兩年（T2）進行問卷評量。每位參與者皆需完成知情同意書、背景資料、短版反芻反應風格量表、醫院憂鬱量表。根據研究目的，以相關分析、階層迴歸分析與路徑分析進行假設考驗。 研究結果顯示，苦惱自責式反芻、深思反省式反芻與憂鬱具有同時的正向關聯性。然而，在控制時間點一的憂鬱症狀後，深思反省式反芻則會預測一年後較低的憂鬱症狀，顯示其會帶來適應性的結果，與Treynor, Gonzalez與Nolen-Hoe ksema（2003）的研究結果一致。路徑分析結果發現，苦惱自責式反芻能預測一年後較低的深思反省式反芻與增加憂鬱症狀，但能同時增加深思反省式反芻；深思反省式反芻則能抑制苦惱自責式反芻，無法預測憂鬱症狀。 本研究發現與過去研究結果一致，在乳癌患者樣本上亦能發現兩類反芻具有不同的適應性功能，尤其深思反省式反芻可能透過抑制苦惱自責式反芻來降低一年後的憂鬱症狀，進一步支持反芻反應風格應區分為兩構念進行探討。建議在臨床上可針對乳癌患者進行反芻反應篩檢，以協助判斷患者在憂鬱症狀之預後，並針對高自責式反芻的患者進行心理介入。
Literature review has shown that rumination is one of risk factors of depression. It plays a crucial rule of developing and sustaining depressive symptoms. However, the different types of rumination may not all lead to depression. Treynor, Gonzalez and Nolen-Hoeksema (2003) have extracted two factors from Ruminative Respon -ses Scale, brooding and reflective pondering. In their study, brooding positively pre -dicts depressive symptoms, but reflective pondering negatively predicts depressive symptoms, depicting that reflective pondering is an adaptive repetitive thinking. Yet, past studies haven’t reached a consensus on reflective pondering. It is probably due to research method and not taking the contamination of brooding into account. For clarifying the possible adaptive characteristic of reflective pondering, the present study examines the relationship between reflective pondering and depression. Furthermore, after controlling T1 depression, the present study explores the prediction of rumination to T2 depression. Last, we examine the predictive paths between brooding and reflective pondering to depression. Patients were eligible if they have been diagnosed with breast cancer. We survey 283 patients after they had completed operation for a year, and follow-up at one year later. All patients complete the informed consent, the demographic survey, the short version of Ruminative Responses Scale, the Hospital Depression Scale. Analysis are conducted using Pearson correlation analysis, multiple regression analysis and path analysis. The result revealed that brooding and reflective pondering are positively related to depression at T1. However, after controlling T1 depression, reflective pondering negatively predicted T2 depression. This result indicates that reflective pondering may be an adaptive form of rumination, matched the result of Treynor, Gonzalez and Nolen-Hoeksema (2003). In the result of path analysis, we also found brooding predicts less reflective pondering and more depression after one year, but it concurrently predicts more reflective pondering. On the other hand, reflective pondering predicts less brooding and has no significant impact on depression.The present study supports the finding of Treynor, Gonzalez and Nolen-Hoeksema (2003). In patients with breast cancer, reflective pondering negatively predicts depressive symptoms through reducing brooding. Brooding and reflective pondering are different forms of rumination, the former is more maladaptive and latter is adaptive. According to the study result, we suggest that clinicians screen for the high-brooder, and practice psychological interventions.參考文獻 周嘉娸（2007）。「憂鬱反芻對工作記憶容量的影響之初探」。台北：國立台灣大學心理學研究所。林玲華、陳景彥、劉嘉逸、陳美伶（2002）。癌症住院病患憂鬱狀態的盛行率及預測因素。「台灣醫學」，6，535-545。行政院衛生署國民健康局（2013）。癌症登記報告【資料檔】。台北：行政院衛生署國民健康局。游勝翔（2011）。「憂鬱反芻反應之促發與維持因素: 探討憂鬱疾病狀態對個體憂鬱反芻調控歷程之影響」。台北：國立臺灣大學心理學研究所。游勝翔、陳淑惠、張金堅（2008）。乳癌患者之反芻反應風格對其術後憂鬱與創傷後壓力症狀之預測。「中華心理學刊」，50，289-302。顏妙倪（2012）。「憂鬱程度、反芻形式對知覺後反映性歷程的認知控制及記憶效能之影響」。台北：國立臺灣大學心理學研究所。Bardwell, W. A., & Fiorentino, L. (2012). Risk factors for depression in breast cancer survivors: An update. International Journal of Clinical and Health Psychology, 12, 311-331. Burwell R. A., & Shirk S. R. (2007). Subtypes of rumination in adolescence: Associations between brooding, reflection, depressive symptoms, and coping. Journal of Clinical Child and Adolescent Psychology, 36, 56–65.Cann, A., Calhoun, L. G., Tedeschi, R. G., Triplett, K. N., Vishnevsky, T, & Lindstrom, C. M. (2011). 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(2007). Rumination-focused cognitive behavior therapy for residual depression: A case series. Behaviour Research and Therapy, 45, 2144-2154.Watkins, E. (2008). Constructive and unconstructive repetitive thought. Psychological Bulletin, 143, 163−206.Weiss, D. S., & Marmar, C. R. (1997). The impact of event scale-revised. In Assessing Psychological Trauma and PTSD. Wilson JP, Keane TM (eds). Guilford: New YorkWhitmer, A., & Gotlib, I. H. (2011). Brooding and reflection reconsidered: A factor analytic examination of rumination in currently depressed, formerly depressed, and never depressed individuals. Cognitive Therapy and Research, 35, 99–107. 描述 碩士
國立政治大學
心理學研究所
100752003資料來源 http://thesis.lib.nccu.edu.tw/record/#G0100752003 資料類型 thesis dc.contributor.advisor 許文耀 zh_TW dc.contributor.author (Authors) 黃荷芳 zh_TW dc.contributor.author (Authors) Huang, Ho Fang en_US dc.creator (作者) 黃荷芳 zh_TW dc.creator (作者) Huang, Ho Fang en_US dc.date (日期) 2015 en_US dc.date.accessioned 1-Sep-2015 16:17:48 (UTC+8) - dc.date.available 1-Sep-2015 16:17:48 (UTC+8) - dc.date.issued (上傳時間) 1-Sep-2015 16:17:48 (UTC+8) - dc.identifier (Other Identifiers) G0100752003 en_US dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/78088 - 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) 100752003 zh_TW dc.description.abstract (摘要) 過去的研究顯示，反芻為憂鬱的危險因子，對憂鬱的發展與維持扮演重要的角色。然而，並不是所有反芻型態都會對個體帶來不利的影響。Treynor, Gonzalez與Nolen-Hoeksema（2003）從反芻反應風格量表中抽取出兩個因素結構：苦惱自責式反芻與深思反省式反芻。苦惱自責式反芻能正向預測憂鬱症狀，而深思反省式則是負向預測憂鬱症狀，為較具適應性的反芻型態。然而，過去文獻在深思反省式反芻上未能獲得一致的結論，可能與研究方法及受到苦惱自責式反芻污染的影響。為釐清深思反省式反芻對乳癌患者而言是否具適應性，本研究欲探討兩類反芻與憂鬱之關聯性，並在控制初始的憂鬱症狀後，檢驗兩類反芻對一年後憂鬱症狀的預測力，最後修正Takano與Tanno（2009）的模型探索兩類反芻之路徑關係如何影響憂鬱。 本研究以立意取樣的方式，追蹤283名乳癌患者，分別於受術後一年（T1）與手術後兩年（T2）進行問卷評量。每位參與者皆需完成知情同意書、背景資料、短版反芻反應風格量表、醫院憂鬱量表。根據研究目的，以相關分析、階層迴歸分析與路徑分析進行假設考驗。 研究結果顯示，苦惱自責式反芻、深思反省式反芻與憂鬱具有同時的正向關聯性。然而，在控制時間點一的憂鬱症狀後，深思反省式反芻則會預測一年後較低的憂鬱症狀，顯示其會帶來適應性的結果，與Treynor, Gonzalez與Nolen-Hoe ksema（2003）的研究結果一致。路徑分析結果發現，苦惱自責式反芻能預測一年後較低的深思反省式反芻與增加憂鬱症狀，但能同時增加深思反省式反芻；深思反省式反芻則能抑制苦惱自責式反芻，無法預測憂鬱症狀。 本研究發現與過去研究結果一致，在乳癌患者樣本上亦能發現兩類反芻具有不同的適應性功能，尤其深思反省式反芻可能透過抑制苦惱自責式反芻來降低一年後的憂鬱症狀，進一步支持反芻反應風格應區分為兩構念進行探討。建議在臨床上可針對乳癌患者進行反芻反應篩檢，以協助判斷患者在憂鬱症狀之預後，並針對高自責式反芻的患者進行心理介入。 zh_TW dc.description.abstract (摘要) Literature review has shown that rumination is one of risk factors of depression. It plays a crucial rule of developing and sustaining depressive symptoms. However, the different types of rumination may not all lead to depression. Treynor, Gonzalez and Nolen-Hoeksema (2003) have extracted two factors from Ruminative Respon -ses Scale, brooding and reflective pondering. In their study, brooding positively pre -dicts depressive symptoms, but reflective pondering negatively predicts depressive symptoms, depicting that reflective pondering is an adaptive repetitive thinking. Yet, past studies haven’t reached a consensus on reflective pondering. It is probably due to research method and not taking the contamination of brooding into account. For clarifying the possible adaptive characteristic of reflective pondering, the present study examines the relationship between reflective pondering and depression. Furthermore, after controlling T1 depression, the present study explores the prediction of rumination to T2 depression. Last, we examine the predictive paths between brooding and reflective pondering to depression. Patients were eligible if they have been diagnosed with breast cancer. We survey 283 patients after they had completed operation for a year, and follow-up at one year later. All patients complete the informed consent, the demographic survey, the short version of Ruminative Responses Scale, the Hospital Depression Scale. Analysis are conducted using Pearson correlation analysis, multiple regression analysis and path analysis. The result revealed that brooding and reflective pondering are positively related to depression at T1. However, after controlling T1 depression, reflective pondering negatively predicted T2 depression. This result indicates that reflective pondering may be an adaptive form of rumination, matched the result of Treynor, Gonzalez and Nolen-Hoeksema (2003). In the result of path analysis, we also found brooding predicts less reflective pondering and more depression after one year, but it concurrently predicts more reflective pondering. On the other hand, reflective pondering predicts less brooding and has no significant impact on depression.The present study supports the finding of Treynor, Gonzalez and Nolen-Hoeksema (2003). In patients with breast cancer, reflective pondering negatively predicts depressive symptoms through reducing brooding. Brooding and reflective pondering are different forms of rumination, the former is more maladaptive and latter is adaptive. According to the study result, we suggest that clinicians screen for the high-brooder, and practice psychological interventions. en_US dc.description.tableofcontents 第一章 緒論…………………………………………………………………………………………………1第二章 文獻探討………………………………………………………………………………………3第一節 乳癌患者的憂鬱情形………………………………………………………………3第二節 反芻類型與憂鬱…………………………………………………………………………3第三節 苦惱自責式反芻與深思反省式反芻對憂鬱的影響………6第四節 研究目的、架構與問題…………………………………………………………16第三章 研究方法………………………………………………………………………………………20第一節 參與者……………………………………………………………………………………………20第二節 研究工具………………………………………………………………………………………22第三節 研究程序………………………………………………………………………………………25第四節 統計分析………………………………………………………………………………………25第四章 研究結果………………………………………………………………………………………26第一節 參與者在主要變項之描述統計與相關分析……………………26第二節 兩類反芻對憂鬱之影響…………………………………………………………27第三節 路徑分析之考驗結果………………………………………………………………31第五章 綜合討論………………………………………………………………………………………34第一節 結果討論………………………………………………………………………………………34第二節 研究貢獻、限制與建議…………………………………………………………40參考文獻…………………………………………………………………………………………………………43附錄一 基本資料…………………………………………………………………………………………48附錄二 反芻量表…………………………………………………………………………………………49附錄三 憂鬱量表…………………………………………………………………………………………50 zh_TW dc.format.extent 658165 bytes - dc.format.mimetype application/pdf - dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0100752003 en_US dc.subject (關鍵詞) 乳癌患者 zh_TW dc.subject (關鍵詞) 憂鬱 zh_TW dc.subject (關鍵詞) 反芻 zh_TW dc.subject (關鍵詞) 苦惱自責式反芻 zh_TW dc.subject (關鍵詞) 深思反省式反芻 zh_TW dc.subject (關鍵詞) breast cancer en_US dc.subject (關鍵詞) depression en_US dc.subject (關鍵詞) rumination en_US dc.subject (關鍵詞) brooding en_US dc.subject (關鍵詞) reflective pondering en_US dc.title (題名) 乳癌患者的反芻型態對憂鬱的影響 zh_TW dc.title (題名) The Effects of Brooding and Reflective Pondering on Depression in Breast Cancer Patients en_US dc.type (資料類型) thesis en dc.relation.reference (參考文獻) 周嘉娸（2007）。「憂鬱反芻對工作記憶容量的影響之初探」。台北：國立台灣大學心理學研究所。林玲華、陳景彥、劉嘉逸、陳美伶（2002）。癌症住院病患憂鬱狀態的盛行率及預測因素。「台灣醫學」，6，535-545。行政院衛生署國民健康局（2013）。癌症登記報告【資料檔】。台北：行政院衛生署國民健康局。游勝翔（2011）。「憂鬱反芻反應之促發與維持因素: 探討憂鬱疾病狀態對個體憂鬱反芻調控歷程之影響」。台北：國立臺灣大學心理學研究所。游勝翔、陳淑惠、張金堅（2008）。乳癌患者之反芻反應風格對其術後憂鬱與創傷後壓力症狀之預測。「中華心理學刊」，50，289-302。顏妙倪（2012）。「憂鬱程度、反芻形式對知覺後反映性歷程的認知控制及記憶效能之影響」。台北：國立臺灣大學心理學研究所。Bardwell, W. 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