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題名 癌症相關失眠之睡眠失功能信念與病理機轉探討
The Dysfunctional Beliefs and Pathological Mechanism of Cancer Related Insomnia作者 蕭立瀛
Hsiao, Li-Ying貢獻者 楊建銘
Yang, Chien-Ming
蕭立瀛
Hsiao, Li-Ying關鍵詞 癌症相關失眠
睡眠失功能信念
癌症相關疲憊
Cancer-related insomnia
Sleep dysfunctional beliefs
Cancer-related fatigue日期 2018 上傳時間 2-Mar-2018 11:48:52 (UTC+8) 摘要 睡眠失功能信念在慢性失眠的病理上扮演重要的角色，可能讓個體產生不良睡眠行為與過度睡前激發狀態，進而造成失眠。而癌症相關失眠患者由於其病理的獨特性也可能出現其獨特的睡眠失功能信念，本研究探討在癌症相關失眠的病理機轉中加入癌症相關睡眠失功能信念，是否可較單純一般慢性失眠之睡眠失功能信念對癌症相關失眠有更全面的了解。而癌症相關失眠具有許多不同於一般慢性失眠的要素，其中除了與疾病相關的特殊睡眠失功能信念外，尚有可能與睡眠困擾相關的癌因性疲憊干擾存在。因此，本研究的目的在探討：1）加入癌症相關的睡眠信念之整合睡眠失功能信念與失眠症狀的關聯性是否與單純一般的睡眠失功能信念有所不同；2）其影響路徑是否透過不良睡眠行為與睡前激發狀態影響失眠嚴重度；3）疲憊嚴重度是否使整合睡眠失功能信念對不良睡眠行為的預測力增加。本研究使用問卷調查對混合癌症患者進行各因素的測量後 (N=148)，運用結構方程模型進行路徑與因果分析，研究結果顯示，在疲憊嚴重度較高時，加入癌症相關睡眠失功能信念的整合睡眠失功能信念，其中「對失眠之負向影響預期與擔憂」向度會透過睡前生理激發狀態對「失眠對白天功能影響」程度有正向預測力、而「安眠藥物對疾病影響」向度對「失眠對白天功能影響」程度有負向預測力、不良睡眠行為對「失眠對白天功能影響」程度有正向預測力、一般睡眠失功能信念之預測路徑則多透過認知激發狀態影響；在疲憊嚴重度較低時，「對失眠之負向影響預期與擔憂」向度對「失眠對白天功能影響」程度有正向預測力、「睡眠與健康及病後修復關聯性的信念」向度對「失眠對白天功能影響」程度有負向預測力、「安眠藥物對疾病影響」向度對「睡眠困難」與「主觀痛苦」程度有正向預測力、一般睡眠失功能信念可預測之細項有所減少。研究結果顯示一般睡眠失功能信念會透過睡前認知激發影響失眠嚴重度，而加入癌症睡眠失功能信念後的整合睡眠失功能信念會透過睡前生理激發影響失眠嚴重度，疲憊嚴重度在其中扮演調節變項的角色，疲憊程度高低會使癌症睡眠失功能信念透過不同路徑影響失眠嚴重度。
Dysfunctional beliefs about sleep play an important role in the pathological mechanism of chronic insomnia. Sleep-related behaviors and presleep arousal may mediate the relationship between the dysfunctional beliefs and severity of insomnia. Since cancer-related insomnia is associated with specific physiological and psychological conditions, there are specific dysfunctional beliefs that might have different influence to patients` sleep. Also, cancer-related fatigue could be closely related to sleep disturbance in cancer patients and demands to be explored. Therefore, the primary purpose of the current study is to explore: 1) whether adding cancer-related dysfunctional sleep beliefs to general dysfunctional sleep beliefs would show different pattern of association with severity of insomnia, comparing to the pattern of general dysfunctional sleep beliefs alone; 2) whether the sleep behavior and presleep arousal mediate the relationship between the dysfunctional beliefs to severity of insomnia in this path of model or not; 3) whether the severity of fatigue is a moderator of the predictibility of combided dysfunctional sleep beliefs to sleep-related behavior. The study recruited 148 mixed cancer diagnosis patients. They were instructed to fill out a package of questionnaires to assess their dysfunctional sleep beliefs, insomnia severity, cancer-related fatigue, etc. Structural equation modeling (SEM) was conducted for path analysis and causality test. Accroding to the result of SEM, presleep arousal was found to be a mediator of the positive association between the beliefs about “expectation and worries of negative consequence of insomnia” and daytime difficulties among subjects with high level of fatigue. Also the beliefs about “harmfulness of hypnotic” have negative predictibility to “daytime difficulty” in these subjects. Sleep behavior, on the other hand, have positive prediction to the “daytime difficulty”. General sleep dysfunctional beliefs showed pathway through presleep cognitive arousal level. For subjects with lower level of fatigue, the beliefs about “expectation and worries of negative consequence of insomnia” have positive association with the “daytime difficulty”. The beliefs about “beliefs about association between sleep and health and recovery from illnesss” were shown to have negative prediction to the “daytime difficulty”. The belief about “hypnotic related to disease” showed positive association with the “sleep difficulty” and associated “distress”. General sleep dysfunctional beliefs had less predictive factors. Based on the results of this study, adding cancer-related dysfunctional sleep beliefs was shown to have different relationship with severity of insomnia compared to general sleep dysfunctional beliefs. General dysfunctional sleep beliefs showed a pathway to insomnia severity through the mediation presleep cognitive arousal level. On the other hand, combided sleep dysfunctional beliefs showed a pathway to insomnia severity through the mediation of presleep somatic arousal level. Furthermore, severity of fatigue is a moderator. 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國立政治大學
心理學系
102752018資料來源 http://thesis.lib.nccu.edu.tw/record/#G0102752018 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) 蕭立瀛 zh_TW dc.contributor.author (Authors) Hsiao, Li-Ying en_US dc.creator (作者) 蕭立瀛 zh_TW dc.creator (作者) Hsiao, Li-Ying en_US dc.date (日期) 2018 en_US dc.date.accessioned 2-Mar-2018 11:48:52 (UTC+8) - dc.date.available 2-Mar-2018 11:48:52 (UTC+8) - dc.date.issued (上傳時間) 2-Mar-2018 11:48:52 (UTC+8) - dc.identifier (Other Identifiers) G0102752018 en_US dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/116076 - 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) 102752018 zh_TW dc.description.abstract (摘要) 睡眠失功能信念在慢性失眠的病理上扮演重要的角色，可能讓個體產生不良睡眠行為與過度睡前激發狀態，進而造成失眠。而癌症相關失眠患者由於其病理的獨特性也可能出現其獨特的睡眠失功能信念，本研究探討在癌症相關失眠的病理機轉中加入癌症相關睡眠失功能信念，是否可較單純一般慢性失眠之睡眠失功能信念對癌症相關失眠有更全面的了解。而癌症相關失眠具有許多不同於一般慢性失眠的要素，其中除了與疾病相關的特殊睡眠失功能信念外，尚有可能與睡眠困擾相關的癌因性疲憊干擾存在。因此，本研究的目的在探討：1）加入癌症相關的睡眠信念之整合睡眠失功能信念與失眠症狀的關聯性是否與單純一般的睡眠失功能信念有所不同；2）其影響路徑是否透過不良睡眠行為與睡前激發狀態影響失眠嚴重度；3）疲憊嚴重度是否使整合睡眠失功能信念對不良睡眠行為的預測力增加。本研究使用問卷調查對混合癌症患者進行各因素的測量後 (N=148)，運用結構方程模型進行路徑與因果分析，研究結果顯示，在疲憊嚴重度較高時，加入癌症相關睡眠失功能信念的整合睡眠失功能信念，其中「對失眠之負向影響預期與擔憂」向度會透過睡前生理激發狀態對「失眠對白天功能影響」程度有正向預測力、而「安眠藥物對疾病影響」向度對「失眠對白天功能影響」程度有負向預測力、不良睡眠行為對「失眠對白天功能影響」程度有正向預測力、一般睡眠失功能信念之預測路徑則多透過認知激發狀態影響；在疲憊嚴重度較低時，「對失眠之負向影響預期與擔憂」向度對「失眠對白天功能影響」程度有正向預測力、「睡眠與健康及病後修復關聯性的信念」向度對「失眠對白天功能影響」程度有負向預測力、「安眠藥物對疾病影響」向度對「睡眠困難」與「主觀痛苦」程度有正向預測力、一般睡眠失功能信念可預測之細項有所減少。研究結果顯示一般睡眠失功能信念會透過睡前認知激發影響失眠嚴重度，而加入癌症睡眠失功能信念後的整合睡眠失功能信念會透過睡前生理激發影響失眠嚴重度，疲憊嚴重度在其中扮演調節變項的角色，疲憊程度高低會使癌症睡眠失功能信念透過不同路徑影響失眠嚴重度。 zh_TW dc.description.abstract (摘要) Dysfunctional beliefs about sleep play an important role in the pathological mechanism of chronic insomnia. Sleep-related behaviors and presleep arousal may mediate the relationship between the dysfunctional beliefs and severity of insomnia. Since cancer-related insomnia is associated with specific physiological and psychological conditions, there are specific dysfunctional beliefs that might have different influence to patients` sleep. Also, cancer-related fatigue could be closely related to sleep disturbance in cancer patients and demands to be explored. Therefore, the primary purpose of the current study is to explore: 1) whether adding cancer-related dysfunctional sleep beliefs to general dysfunctional sleep beliefs would show different pattern of association with severity of insomnia, comparing to the pattern of general dysfunctional sleep beliefs alone; 2) whether the sleep behavior and presleep arousal mediate the relationship between the dysfunctional beliefs to severity of insomnia in this path of model or not; 3) whether the severity of fatigue is a moderator of the predictibility of combided dysfunctional sleep beliefs to sleep-related behavior. The study recruited 148 mixed cancer diagnosis patients. They were instructed to fill out a package of questionnaires to assess their dysfunctional sleep beliefs, insomnia severity, cancer-related fatigue, etc. Structural equation modeling (SEM) was conducted for path analysis and causality test. Accroding to the result of SEM, presleep arousal was found to be a mediator of the positive association between the beliefs about “expectation and worries of negative consequence of insomnia” and daytime difficulties among subjects with high level of fatigue. Also the beliefs about “harmfulness of hypnotic” have negative predictibility to “daytime difficulty” in these subjects. Sleep behavior, on the other hand, have positive prediction to the “daytime difficulty”. General sleep dysfunctional beliefs showed pathway through presleep cognitive arousal level. For subjects with lower level of fatigue, the beliefs about “expectation and worries of negative consequence of insomnia” have positive association with the “daytime difficulty”. The beliefs about “beliefs about association between sleep and health and recovery from illnesss” were shown to have negative prediction to the “daytime difficulty”. The belief about “hypnotic related to disease” showed positive association with the “sleep difficulty” and associated “distress”. General sleep dysfunctional beliefs had less predictive factors. Based on the results of this study, adding cancer-related dysfunctional sleep beliefs was shown to have different relationship with severity of insomnia compared to general sleep dysfunctional beliefs. General dysfunctional sleep beliefs showed a pathway to insomnia severity through the mediation presleep cognitive arousal level. On the other hand, combided sleep dysfunctional beliefs showed a pathway to insomnia severity through the mediation of presleep somatic arousal level. Furthermore, severity of fatigue is a moderator. Subjets differed in the level of fatigue showed different path from combided dysfunctional sleep beliefs to severity of insomnia. en_US dc.description.tableofcontents 第壹章 緒論 1第一節、研究動機與研究問題 1第貳章 文獻探討 4第一節、 癌症相關失眠 41.1癌症相關失眠的盛行率 41.2 癌症相關失眠的症狀表現與影響 51.3 慢性失眠的病因模式 81.4 癌症相關失眠的特殊病因模式 111.5 癌因性疲憊的定義與成因 161.6 癌因性疲憊與失眠 17第二節、 睡眠相關信念探討 192.1 失功能信念之定義 192.2 睡眠失功能信念 202.3 癌症相關失眠的特殊睡眠失功能信念 22第三節、研究問題與假設 24第參章 研究方法 27第一節、 研究對象 27第二節、 研究設計與流程 27第三節、 研究工具 283.1 基本資料、睡眠情形及藥物使用問卷 (附錄一) 283.2 睡眠失功能信念與態度量表 (Dysfunctional Beliefs and Attitudes about Sleep，簡稱DBAS-16) (附錄二) 283.3 癌症相關睡眠失功能信念與態度量表 (Dysfunctional Beliefs and Attitudes about Sleep-Cancer Related Insomnia，簡稱DBAS-CRI) (附錄三) 293.4 臺灣版簡明疲憊量表 (Brief Fatigue Inventory-Taiwan，簡稱 BFI-T) (附錄四) 303.5 睡眠相關行為量表 (Sleep-Related Behaviour Questionnaire，簡稱SRBQ) (附錄五) 303.6 睡前激發狀態量表 (Pre-Sleep Arousal Scale，簡稱 PSAS) (附錄六) 313.7 失眠嚴重度量表 (Insomnia Severity Index，簡稱 ISI) (附錄七) 323.8 貝克憂鬱量表第二版-中文版 (Beck Depression Inventory II，簡稱BDI-II) 323.9 貝克焦慮量表中文版 (Beck Anxiety Inventory，簡稱BAI) 33第四節、 資料分析 33第肆章 研究結果 36第一節、人口學資料與疾病特性統計資料 36第二節、整合睡眠失功能信念之題項分析與整合因素分析 38第三節、量表描述統計資料 39第二節、各變項之相關情形 46第三節、結構方程模式之假設驗證 503.1 整體模型適配度之評鑑 523.2 因果模式、路徑分析與中介變項之模型驗證 54第伍章 討論 75第一節、整合睡眠失功能信念與一般睡眠失功能信念之比較 76第二節、睡眠失功能信念透過行為因素與激發因素影響失眠嚴重度的中介機制 77第三節、疲憊嚴重度對於相關因素影響不良睡眠行為的調節效果 78參考文獻 82附錄 93附錄一：基本資料、睡眠情形及藥物使用問卷 93附錄二：睡眠失功能信念與態度量表 96附錄三：癌症相關睡眠失功能信念與態度量表 98附錄四：臺灣版簡明疲憊量表 100附錄五：睡眠相關行為量表 102附錄六：睡前激發狀態量表 104附錄七：失眠嚴重度量表 105 zh_TW dc.format.extent 1867842 bytes - dc.format.mimetype application/pdf - dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0102752018 en_US dc.subject (關鍵詞) 癌症相關失眠 zh_TW dc.subject (關鍵詞) 睡眠失功能信念 zh_TW dc.subject (關鍵詞) 癌症相關疲憊 zh_TW dc.subject (關鍵詞) Cancer-related insomnia en_US dc.subject (關鍵詞) Sleep dysfunctional beliefs en_US dc.subject (關鍵詞) Cancer-related fatigue en_US dc.title (題名) 癌症相關失眠之睡眠失功能信念與病理機轉探討 zh_TW dc.title (題名) The Dysfunctional Beliefs and Pathological Mechanism of Cancer Related Insomnia en_US dc.type (資料類型) thesis en_US dc.relation.reference (參考文獻) 行政院衛生署國民健康局 (2013)。中華民國 99 年癌症登記報告。2017 年 8 月取自http://www.hpa.gov.tw/BHPNet/Portal/File/StatisticsFile/201305061037065219/99%E5%B9%B4%E7%99%8C%E7%97%87%E7%99%BB%E8%A8%98%E5%A0%B1%E5%91%8A.pdf行政院衛生福利部國民健康署 (2016)。中華民國 102 年癌症登記報告。2017 年 8 月取自https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=269&pid=5191臺灣癌症登記中心 (2008)。癌症五年相對存活率 (僅含侵襲癌)。2017 年 8 月取自http://tcr.cph.ntu.edu.tw/uploadimages/Sur_Total.pdf余民寧 (2006)。潛在變項模式：SIMLPLIS的應用=Latent variable models：the application of SIMPLIS。台北：高等教育。林一真 (譯) (2000)。貝克焦慮量表 (BAI) 指導手冊 (原作者：Beck, AT & Steer, R. 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