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題名 反芻對乳癌患者憂鬱的影響及因應的調節作用
The prediction of rumination to depression and the moderating effect of coping among breast cancer patients作者 程燕敏
Cheng, Yan Min貢獻者 許文耀
Hsu,Wen Yau
程燕敏
Cheng, Yan Min關鍵詞 乳癌
憂鬱
苦惱自責式反芻
深思反省式反芻
因應
Breast cancer
Depression
Brooding
Reflective pondering
Coping日期 2017 上傳時間 10-Aug-2017 09:57:41 (UTC+8) 摘要 研究背景：乳癌患者常伴隨憂鬱症狀，而反芻是癌症患者憂鬱情形的重要預測因 數。過往研究指出苦惱自責式反芻增加憂鬱的效果得到較一致的結果，而深思反 省式反芻對於憂鬱影響的結果則不太一致。深思反省式反芻意在解決問題，過程 中患者採用不同因應策略可能對其憂鬱會有不同影響，但過去較少研究探討乳癌 患者的因應如何調節深思反省式反芻對患者憂鬱變化的影響。研究目的：探究苦惱自責式反芻與深思反省式反芻如何影響乳癌患者的憂鬱，逃 避與趨近這兩種因應方式是否在深思反省式反芻影響憂鬱的過程中有調節作用。研究方法：本研究採用長期追蹤之研究方法，對平均年齡為 48 歲的 359 位乳癌 患者，於手術後三個月、六個月、一年和兩年四個時間點，測量其苦惱自責式反 芻、深思反省式反芻，趨近、逃避等因應模式及憂鬱狀況後進行分析。為了探索 考個體內和個體間變項的影響，包含臨床背景資料對憂鬱的預測效果，研究擬採 用階層線性模型（HLM）之方法進行統計分析。研究結果：苦惱自責式反芻正向預測乳癌患者憂鬱情形，深思反省式反芻對憂鬱 的預測效果則受到趨近因應的調節，趨近因應越高，深思反省式反芻越能負向預 測憂鬱情形。依此結果可知對於乳癌患者而言，苦惱自責式反芻為不適應的反芻 類型，會增加乳癌患者的憂鬱情形，而深思反省式反芻的適應性僅存在於更多使 用趨近因應的患者之中。
Background: Depressive symptoms occur frequently with breast cancer. Rumination is a major risk factor of depression. Numerous research evidence shows that brooding, the maladaptive subtype of rumination, increases depression while the effect of reflective pondering, the other subtype, remain inconsistent. Individuals who reflective ponder mean to solve the problem they face, but there is little research to explore what role coping plays in the process that reflective pondering contribute to or eliminate depression.Purpose: To examine how two subtypes of rumination predict the depression of women with breast cancer, and whether the moderating effect of two different coping strategies, approach and avoidance, exists and how it works.Method: Longitudinal data of rumination, coping, and depression at Time 1 (3 months after surgery), Time 2 (6 months after surgery), Time 3 (1year after surgery), and Time 4 (2 years after surgery) among 359 women with breast cancer whose mean age was 48 was collected to explore the prediction of rumination and the moderating effect of coping. To address the effect of both with- and between- subject variables including background materials and disease-related information, HLM is adopted as the analysis method.Results: Brooding predicts the increase of depressive symptoms and acts as the maladaptive subtype of rumination. In addition, reflective pondering’ prediction to decreased depression only appears with the interaction of approach coping, which means that patients who reflective ponder more and take more approach coping at the meanwhile will experience more recovery from the depressive symptoms.參考文獻 王韋婷（2013）。初診斷乳癌患者創傷後成長與心理適應的關係之長期追蹤研 究－從創傷後成長異質性變化軌跡的觀點探討。國立政治大學心理學研究所， 博士論文。周嘉娸（2008）。憂鬱反芻對工作記憶容量的影響之初探。國立臺灣大學理學 院心理學研究所，碩士論文。黃荷芳（2015）。乳癌患者的反芻型態對憂鬱的影響。國立政治大學心理學研 究所，碩士論文。賴世華（2010）。頭頸癌症患者復發擔憂對癌症關連疲勞之影響 - 以因應型態 及負向情緒為仲介變項。中原大學心理學系，碩士論文。Abela, J. R. Z., Vanderbilt, E., & Rochon, A. (2004). A test of the integration of the response styles and social support theories of depression in third and seventh grade children. Journal of Social and Clinical Psychology, 23(5), 653-674. doi:DOI 10.1521/jscp.23.5.653.50752Brennan, K., Barnhofer, T., Crane, C., Duggan, D., & Williams, J. M. G. (2015). Memory Specificity and Mindfulness Jointly Moderate the Effect of Reflective Pondering on Depressive Symptoms in Individuals With a History of Recurrent Depression. Journal of Abnormal Psychology, 124(2), 246-255. doi:10.1037/abn0000027Burwell, 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(1), 56-65. doi:DOI 10.1207/s15374424jccp3601_6Donaldson, C., & Lam, D. (2004). Rumination, mood and social problem-solving in major depression. Psychological Medicine, 34(7), 1309-1318. doi:10.1017/S0033291704001904Franks, H. M., & Roesch, S. C. (2006). Appraisals and coping in people living with cancer: A meta-analysis. Psycho-Oncology, 15(12), 1027-1037. doi:10.1002/pon.1043Galloway, S. K., Baker, M., Giglio, P., Chin, S., Madan, A., Malcolm, R., . . . Borckardt,J. (2012). Depression and anxiety symptoms relate to distinct components of pain experience among patients with breast cancer. Pain research and treatment, 5. doi:10.1155/2012/851276Hong, R. Y. (2007). Worry and rumination: Differential associations with anxious and depressive symptoms and coping behavior. Behaviour Research and Therapy, 45(2), 277-290. doi:10.1016/j.brat.2006.03.006Hung, Y. P., Liu, C. J., Tsai, C. F., Hung, M. H., Tzeng, C. H., Liu, C. Y., & Chen, T. J. (2013). Incidence and risk of mood disorders in patients with breast cancers in Taiwan: a nationwide population-based study. Psycho-Oncology, 22(10), 2227- 2234. doi:10.1002/pon.3277Joormann, J., Dkane, M., & Gotlib, I. H. (2006). Adaptive and maladaptive components of rumination? Diagnostic specificity and relation to depressive biases. Behavior Therapy, 37(3).Lam, K. F. Y., Lim, H. A., Tan, J. Y. S., & Mahendran, R. (2015). The relationships between dysfunctional attitudes, rumination, and non-somatic depressive symptomatology in newly diagnosed Asian cancer patients. Comprehensive Psychiatry, 61, 49-56. doi:10.1016/j.comppsych.2015.06.001Lyubomirsky, S., & Nolenhoeksema, S. (1995). Effects of Self-Focused Rumination on Negative Thinking and Interpersonal Problem-Solving. Journal of Personality and Social Psychology, 69(1), 176-190. doi:Doi 10.1037//0022-3514.69.1.176Lyubomirsky, S., & Tkach, C. (2004). Rumination: Nature, Theory, and Treatment of Negative Thinking in Depression.Martin, L. L., & Tesser, A. (1989). Toward a motivational and structural theory of ruminative thought. In J. S. Uleman & J. A. Bargh (Eds.), Unintended thought New York: Guilford. 306-326Martin, L. L., & Tesser, A. (1996). Some ruminative thoughts. Advances in social cognition, 9, 1-47.Marroquin, B. M., Fontes, M., Scilletta, A., & Miranda, R. (2010). Ruminative subtypes and coping responses: Active and passive pathways to depressive symptoms. Cognition & Emotion, 24(8), 1446-1455. doi:Pii 930042469Miranda, R., & Nolen-Hoeksema, S. (2007). Brooding and reflection: Rumination predicts suicidal ideation at 1-year follow-up in a community sample. Behaviour Research and Therapy, 45(12), 3088-3095. doi:10.1016/j.brat.2007.07.015Nolen-Hoeksema, S. (2000). The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. Journal of Abnormal Psychology, 109(3), 504- 511. doi:Doi 10.1037/0021-843x.109.3.504Nolen-Hoeksema, S., Larson, J., & Grayson, C. (1999). Explaining the gender difference in depressive symptoms. Journal of Personality and Social Psychology, 77(5), 1061-1072. doi: 10.1037//0022-3514.77.5.1061Nolenhoeksema, S. (1991). Responses to Depression and Their Effects on the Duration of Depressive Episodes. Journal of Abnormal Psychology, 100(4), 569-582. doi:Doi 10.1037/0021-843x.100.4.569Papadakis, A. A., Prince, R. P., Jones, N. P., & Strauman, T. J. (2006). Self-regulation, rumination, and vulnerability to depression in adolescent girls. Development and Psychopathology, 18(3), 815-829. doi:10.1017/S0954579406060408Rude, S. S., Little Maestas, K., & Neff, K. (2007). Paying attention to distress: What`s wrong with rumination? Cognition and Emotion, 21(4).Smith, J. M., & Alloy, L. B. (2009). Aroadmap to rumination: Areview of the definition, assessment, and conceptualization of this multifaceted construct. Clinical Psychology Review, 29(2), 116-128. doi:10.1016/j.cpr.2008.10.003Soo, H., & Sherman, K. A. (2015). Rumination, psychological distress and post- traumatic growth in women diagnosed with breast cancer. Psycho-Oncology, 24(1), 70-79. doi:10.1002/pon.3596Sumner, J. A., Mineka, S., Adam, E. K., Craske, M. G., Vrshek-Schallhorn, S., Wolitzky-Taylor, K., & Zinbarg, R. E. (2014). Testing the CaR-FA-X Model: Investigating the Mechanisms Underlying Reduced Autobiographical Memory Specificity in Individuals With and Without a History of Depression. Journal of Abnormal Psychology, 123(3), 471-486. doi:10.1037/a0037271Takano, K., & Tanno, Y. (2009). Self-rumination, self-reflection, and depression: Self-rumination counteracts the adaptive effect of self-reflection. Behaviour Research and Therapy, 47(3), 260-264. doi:10.1016/j.brat.2008.12.008Thompson, R. J., Mata, J., Jaeggi, S. M., Buschkuehl, M., Jonides, J., & Gotlib, I. H. (2010). Maladaptive coping, adaptive coping, and depressive symptoms: Variations across age and depressive state. Behaviour Research and Therapy, 48(6), 459-466. doi:10.1016/j.brat.2010.01.007Thomsen, D. K., Jensen, A. B., Jensen, T., Mehlsen, M. Y., Pedersen, C. G., & Zachariae, R. (2013). Rumination, Reflection and Distress: An 8-Month Prospective Study of Colon-Cancer Patients. Cognitive Therapy and Research, 37(6), 1262-1268. doi:10.1007/s10608-013-9556-xTrapnell, P. D., & Campbell, J. D. (1999). Private self-consciousness and the five-factor model of personality: Distinguishing rumination from reflection. Journal of Personality and Social Psychology, 76(2), 284-304. doi: 10.1037/0022- 3514.76.2.284Treynor, W., Gonzalez, R., & Nolen-Hoeksema, S. (2003). Rumination reconsidered: A psychometric analysis. Cognitive Therapy and Research, 27(3), 247-259. doi: 10.1023/A:1023910315561Verhaeghen, P., Joormann, J., & Aikman, S. N. (2014). Creativity, Mood, and the Examined Life: Self-Reflective Rumination Boosts Creativity, Brooding Breeds Dysphoria. Psychology of Aesthetics Creativity and the Arts, 8(2), 211-218. doi:10.1037/a0035594Watkins. (2008). Constructive and unconstructive repetitive thought. Psychological Bulletin, 134(2), 163-206. doi:10.1037/0033-2909.134.2.163Watkins, & Moulds, M. (2005). Distinct modes of ruminative self-focus: Impact of abstract versus concrete rumination on problem solving in depression. Emotion, 5(3), 319-328. doi:10.1037/1528-3542.5.3.319Watkins, E., & Baracaia, S. (2002). Rumination and social problem-solving in depression. Behaviour Research and Therapy, 40(10), 1179-1189. doi:Pii S0005-7967(01)00098-5.Whitmer, A., & Gotlib, I. H. (2011). Brooding and Reflection Reconsidered: A FactorAnalytic Examination of Rumination in Currently Depressed, Formerly Depressed, and Never Depressed Individuals. Cognitive Therapy and Research, 35(2), 99-107. doi:10.1007/s10608-011-9361-3Yu, S. H., Chen, S. H., & Chang, K. J. (2008). Rumination predicting depression and PTSD symptoms in postoperative breast cancer patients. Chinese Journal of Psychology, 50. doi:10.6129/CJPZigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67(6), 361-370. doi:10.1111/j.1600- 0447.1983.tb09716.x 描述 碩士
國立政治大學
心理學系
104752025資料來源 http://thesis.lib.nccu.edu.tw/record/#G0104752025 資料類型 thesis dc.contributor.advisor 許文耀 zh_TW dc.contributor.advisor Hsu,Wen Yau en_US dc.contributor.author (Authors) 程燕敏 zh_TW dc.contributor.author (Authors) Cheng, Yan Min en_US dc.creator (作者) 程燕敏 zh_TW dc.creator (作者) Cheng, Yan Min en_US dc.date (日期) 2017 en_US dc.date.accessioned 10-Aug-2017 09:57:41 (UTC+8) - dc.date.available 10-Aug-2017 09:57:41 (UTC+8) - dc.date.issued (上傳時間) 10-Aug-2017 09:57:41 (UTC+8) - dc.identifier (Other Identifiers) G0104752025 en_US dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/111781 - 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) 104752025 zh_TW dc.description.abstract (摘要) 研究背景：乳癌患者常伴隨憂鬱症狀，而反芻是癌症患者憂鬱情形的重要預測因 數。過往研究指出苦惱自責式反芻增加憂鬱的效果得到較一致的結果，而深思反 省式反芻對於憂鬱影響的結果則不太一致。深思反省式反芻意在解決問題，過程 中患者採用不同因應策略可能對其憂鬱會有不同影響，但過去較少研究探討乳癌 患者的因應如何調節深思反省式反芻對患者憂鬱變化的影響。研究目的：探究苦惱自責式反芻與深思反省式反芻如何影響乳癌患者的憂鬱，逃 避與趨近這兩種因應方式是否在深思反省式反芻影響憂鬱的過程中有調節作用。研究方法：本研究採用長期追蹤之研究方法，對平均年齡為 48 歲的 359 位乳癌 患者，於手術後三個月、六個月、一年和兩年四個時間點，測量其苦惱自責式反 芻、深思反省式反芻，趨近、逃避等因應模式及憂鬱狀況後進行分析。為了探索 考個體內和個體間變項的影響，包含臨床背景資料對憂鬱的預測效果，研究擬採 用階層線性模型（HLM）之方法進行統計分析。研究結果：苦惱自責式反芻正向預測乳癌患者憂鬱情形，深思反省式反芻對憂鬱 的預測效果則受到趨近因應的調節，趨近因應越高，深思反省式反芻越能負向預 測憂鬱情形。依此結果可知對於乳癌患者而言，苦惱自責式反芻為不適應的反芻 類型，會增加乳癌患者的憂鬱情形，而深思反省式反芻的適應性僅存在於更多使 用趨近因應的患者之中。 zh_TW dc.description.abstract (摘要) Background: Depressive symptoms occur frequently with breast cancer. Rumination is a major risk factor of depression. Numerous research evidence shows that brooding, the maladaptive subtype of rumination, increases depression while the effect of reflective pondering, the other subtype, remain inconsistent. Individuals who reflective ponder mean to solve the problem they face, but there is little research to explore what role coping plays in the process that reflective pondering contribute to or eliminate depression.Purpose: To examine how two subtypes of rumination predict the depression of women with breast cancer, and whether the moderating effect of two different coping strategies, approach and avoidance, exists and how it works.Method: Longitudinal data of rumination, coping, and depression at Time 1 (3 months after surgery), Time 2 (6 months after surgery), Time 3 (1year after surgery), and Time 4 (2 years after surgery) among 359 women with breast cancer whose mean age was 48 was collected to explore the prediction of rumination and the moderating effect of coping. To address the effect of both with- and between- subject variables including background materials and disease-related information, HLM is adopted as the analysis method.Results: Brooding predicts the increase of depressive symptoms and acts as the maladaptive subtype of rumination. In addition, reflective pondering’ prediction to decreased depression only appears with the interaction of approach coping, which means that patients who reflective ponder more and take more approach coping at the meanwhile will experience more recovery from the depressive symptoms. en_US dc.description.tableofcontents 第一章 緒論 1第二章 文獻綜述 3第一節 反芻與憂鬱的關聯 3第二節 反芻與因應對憂鬱的影響 11第三節 癌症患者反芻與憂鬱之關聯 13第四節 癌症患者的因應 16第五節 階層線性模型 17第六節 研究目的與假設 19第三章 研究方法 21第一節 研究參與者 21第二節 研究程序 21第三節 研究工具 22第四節 資料分析 27第四章 研究結果 31第一節 描述分析 31第二節 相關分析與單因素 ANOVA 35第三節 HLM 模型 40第五章 討論 45第一節 反芻與憂鬱的關係 45第二節 反芻對憂鬱的影響及趨近因應的調節作用 46第三節 研究貢獻 49第四節 研究限制與未來研究方向 50參考文獻 51附錄一 基本資料表 56附錄二 反芻反應風格量表 57附錄三 因應策略量表 58附錄四 醫院焦慮憂鬱量表 60 zh_TW dc.format.extent 962446 bytes - dc.format.mimetype application/pdf - dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0104752025 en_US dc.subject (關鍵詞) 乳癌 zh_TW dc.subject (關鍵詞) 憂鬱 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) 因應 zh_TW dc.subject (關鍵詞) Breast cancer en_US dc.subject (關鍵詞) Depression en_US dc.subject (關鍵詞) Brooding en_US dc.subject (關鍵詞) Reflective pondering en_US dc.subject (關鍵詞) Coping en_US dc.title (題名) 反芻對乳癌患者憂鬱的影響及因應的調節作用 zh_TW dc.title (題名) The prediction of rumination to depression and the moderating effect of coping among breast cancer patients en_US dc.type (資料類型) thesis en_US dc.relation.reference (參考文獻) 王韋婷（2013）。初診斷乳癌患者創傷後成長與心理適應的關係之長期追蹤研 究－從創傷後成長異質性變化軌跡的觀點探討。國立政治大學心理學研究所， 博士論文。周嘉娸（2008）。憂鬱反芻對工作記憶容量的影響之初探。國立臺灣大學理學 院心理學研究所，碩士論文。黃荷芳（2015）。乳癌患者的反芻型態對憂鬱的影響。國立政治大學心理學研 究所，碩士論文。賴世華（2010）。頭頸癌症患者復發擔憂對癌症關連疲勞之影響 - 以因應型態 及負向情緒為仲介變項。中原大學心理學系，碩士論文。Abela, J. R. Z., Vanderbilt, E., & Rochon, A. (2004). A test of the integration of the response styles and social support theories of depression in third and seventh grade children. Journal of Social and Clinical Psychology, 23(5), 653-674. doi:DOI 10.1521/jscp.23.5.653.50752Brennan, K., Barnhofer, T., Crane, C., Duggan, D., & Williams, J. M. G. (2015). Memory Specificity and Mindfulness Jointly Moderate the Effect of Reflective Pondering on Depressive Symptoms in Individuals With a History of Recurrent Depression. Journal of Abnormal Psychology, 124(2), 246-255. doi:10.1037/abn0000027Burwell, 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(1), 56-65. doi:DOI 10.1207/s15374424jccp3601_6Donaldson, C., & Lam, D. (2004). Rumination, mood and social problem-solving in major depression. Psychological Medicine, 34(7), 1309-1318. doi:10.1017/S0033291704001904Franks, H. M., & Roesch, S. C. (2006). Appraisals and coping in people living with cancer: A meta-analysis. Psycho-Oncology, 15(12), 1027-1037. doi:10.1002/pon.1043Galloway, S. K., Baker, M., Giglio, P., Chin, S., Madan, A., Malcolm, R., . . . Borckardt,J. (2012). Depression and anxiety symptoms relate to distinct components of pain experience among patients with breast cancer. Pain research and treatment, 5. doi:10.1155/2012/851276Hong, R. Y. (2007). Worry and rumination: Differential associations with anxious and depressive symptoms and coping behavior. Behaviour Research and Therapy, 45(2), 277-290. doi:10.1016/j.brat.2006.03.006Hung, Y. P., Liu, C. J., Tsai, C. F., Hung, M. H., Tzeng, C. H., Liu, C. Y., & Chen, T. J. (2013). Incidence and risk of mood disorders in patients with breast cancers in Taiwan: a nationwide population-based study. Psycho-Oncology, 22(10), 2227- 2234. doi:10.1002/pon.3277Joormann, J., Dkane, M., & Gotlib, I. H. (2006). Adaptive and maladaptive components of rumination? Diagnostic specificity and relation to depressive biases. Behavior Therapy, 37(3).Lam, K. F. Y., Lim, H. A., Tan, J. Y. S., & Mahendran, R. (2015). The relationships between dysfunctional attitudes, rumination, and non-somatic depressive symptomatology in newly diagnosed Asian cancer patients. Comprehensive Psychiatry, 61, 49-56. doi:10.1016/j.comppsych.2015.06.001Lyubomirsky, S., & Nolenhoeksema, S. (1995). Effects of Self-Focused Rumination on Negative Thinking and Interpersonal Problem-Solving. Journal of Personality and Social Psychology, 69(1), 176-190. doi:Doi 10.1037//0022-3514.69.1.176Lyubomirsky, S., & Tkach, C. (2004). Rumination: Nature, Theory, and Treatment of Negative Thinking in Depression.Martin, L. L., & Tesser, A. (1989). Toward a motivational and structural theory of ruminative thought. In J. S. Uleman & J. A. 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