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題名 失眠脆弱特質、壓力因應及睡眠的不當認知在失眠發展歷程所扮演的角色
The Roles of Sleep Vulnerability to Stress, Coping and Maladaptive Sleep Belief in the Development of Insomnia作者 洪智盈
Hung, Chih Ying貢獻者 楊建銘
Yang, Chien Ming
洪智盈
Hung, Chih Ying關鍵詞 失眠
失眠脆弱特質
因應方式
睡前激發狀態
不良睡眠信念
insomnia
sleep-related vulnerability
coping strategies
pre-sleep arousal
dysfunctional belief日期 2012 上傳時間 22-Jul-2013 17:17:02 (UTC+8) 摘要 研究目的：失眠病因理論指出失眠可能受到壓力誘發，進而提高激發程度，干擾睡眠；壓力下的睡眠脆弱特質可能為一危險因子，而伴隨有不當的睡眠信念與壓力因應者可能讓失眠症狀更易延續。過去研究也支持了上述因子與失眠的關聯性，但由於過去研究多為橫斷相關研究，對於了解這些因素如何交互影響造成失眠的發生仍相當有限。本研究透過追蹤2006年針對大學生睡眠調查的研究受試者以更進一步了解此一問題，欲探討兩研究目的：一為了解壓力下睡眠脆弱特質是否可預測失眠症狀的發生；其次為探討壓力因應風格及睡眠的不適當認知在負向生活經驗對身心激發程度及失眠的影響是否扮演調節變項的角色。研究方法：本研究以問卷調查法進行，以2006年10月由政治大學睡眠實驗室於政治大學進行睡眠調查研究之受試者為研究對象，該研究中有330位受試者簽名表示同意接受後續追蹤調查。本研究透過電話可聯絡到192位受試者，一共回收126份（66%）有效問卷。問卷內容包含失眠嚴重度指標(Insomnia Severity Index; ISI)、匹茲堡睡眠品質量表(Pittsburgh Sleep Quality Index; PSQI)、福特壓力下失眠反應量表( Ford Insomnia Response to Stress Test; FIRST)、睡眠失功能信念及態度量表(Dysfunctional Beliefs and Attitudes about Sleep; DBAS)、睡前激發程度量表(Pre-Sleep Arousal Scale; PSAS)、生活經驗調查(Life Experiences Survey; LES)以及因應量表(COPE)。統計方式則分別以邏輯斯迴歸分析探討失眠脆弱特質對失眠症狀發生的預測力，以階層迴歸分析探討睡前身心激發程度在負向生活經驗預測失眠嚴重度的中介效果，以及壓力因應方式和睡眠的不適當認知對負向生活經驗預測睡前激發程度的調節效果。研究結果：研究結果發現失眠脆弱特質對失眠症狀之發生有接近顯著的預測效果，呈現失眠脆弱特質越高，未來失眠風險就越高的趨勢。負向生活經驗會透過睡前身心激發程度的完全中介效果之作用，來影響失眠的嚴重程度；且失眠脆弱特質對負向生活經驗與生理激發程度的關聯性有調節效果，而情緒因應方式對負向生活經驗與認知激發程度的關聯性有調節效果，進而影響失眠嚴重程度。然而對睡眠的不當認知並無顯著調節效果，而是會直接影響睡前身心激發程度，進而影響失眠的嚴重度。研究結論：研究結果基本上支持失眠病因理論的預測，壓力會透過提高激發程度進而干擾睡眠，然而不同的調節因子可能有不同的作用路徑。在失眠脆弱特質的預測性上，呈現出特質越高未來失眠風險就越高的趨勢，但其預測力並未達到顯著，且此特質較高者在面對壓力時會引發較高的生理激發；而面對壓力時若採情緒風格因應者則易引發較高的認知激發程度，進而提高失眠嚴重程度。此外，不當之睡眠信念則不需與生活壓力形成交互作用，直接就對睡眠形成影響，推論這些信念會使得睡眠本身成為壓力的來源。這些結果有其臨床意涵，建議壓力下睡眠脆弱特質可作為篩選失眠的高危險族群的指標，針對此族群提供衛教，教導適當有效的因應壓力方式及放鬆技巧訓練，以降低其生理或認知激發狀態，以降低失眠的發生率。
OBJECTIVE: Various etiological models of insomnia suggest that stress might interfere with sleep by increasing level of arousal. Sleep vulnerability to stress might precipitate an individual to this effect, and maladaptive belief and coping skills could perpetuate the transient sleep disturbance into more long term insomnia symptoms. Previous studies have supported the associations between these factors and insomnia. However, past studies were mostly cross-sectional in nature, how these factors interact to contribute to the development of insomnia is still limited. Thus, the goals of present study are to examine (1) whether normal sleepers who are vulnerable to stress-related sleep disturbance are at higher risk for subsequent development of insomnia symptoms at a long-term follow-up, and (2) whether pre-sleep arousal serves as a mediator, and coping and maladaptive sleep belief serve as moderators of the association between stress and insomnia severity. METHOD: The sample was from the participants of a sleep survey at National Chengchi University in 2006. There were 330 participants agreed to be contacted for follow-up sleep surveys. They were invited to participate in the study through telephone in 2012. Participants who agreed to take part in the study were asked to complete a battery of questionnaires online, including the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Ford Insomnia Response to Stress Test (FIRST), the Dysfunctional beliefs and attitudes about sleep questionnaire (DBAS), the Pre-sleep arousal scale (PSAS), the Perceived Stress Scale (PSS), the Life Experiences Survey (LES) and the COPE. Logistic regression analysis was used to examine whether sleep vulnerability to stress predicts insomnia symptoms, and linear regression analysis was used to explore whether pre-sleep arousal serves as a mediator and coping and maladaptive sleep belief as moderators for the association between stress and the development of insomnia. RESULTS: Sleep vulnerability to stress showed a near significant trend in predicting insomnia symptoms. Pre-sleep arousal plays a mediating role between negative life experiences and insomnia severity. On the other hand, sleep vulnerability to stress moderates the association between negative life experiences and pre-sleep somatic arousal; emotional coping strategies serve as a moderator for the association between negative life experiences and pre-sleep cognitive arousal affecting insomnia severity. Although maladaptive sleep belief does not play a moderating role, it predicts pre-sleep arousal directly.CONCLUSIONS: The findings basically support the prediction of insomnia etiological models that stress interferes with sleep by increased arousal; however, different psychological factors play different roles in the process. It showed a tendency that participants have more sleep vulnerability to stress are at high risk to develop insomnia symptoms. However, the predictability of sleep vulnerability does not reach significant level. Individuals with high vulnerability might have increased somatic arousal when facing stressful situations and those who use more emotional coping strategies might increase cognitive arousal. Maladaptive sleep belief predicts pre-sleep arousal directly instead of interacting with negative events. It is possible that the maladaptive sleep belief can increase sleep-related stress directly. 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國立政治大學
心理學研究所
97752018
101資料來源 http://thesis.lib.nccu.edu.tw/record/#G0097752018 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) 洪智盈 zh_TW dc.contributor.author (Authors) Hung, Chih Ying en_US dc.creator (作者) 洪智盈 zh_TW dc.creator (作者) Hung, Chih Ying en_US dc.date (日期) 2012 en_US dc.date.accessioned 22-Jul-2013 17:17:02 (UTC+8) - dc.date.available 22-Jul-2013 17:17:02 (UTC+8) - dc.date.issued (上傳時間) 22-Jul-2013 17:17:02 (UTC+8) - dc.identifier (Other Identifiers) G0097752018 en_US dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/58971 - 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) 97752018 zh_TW dc.description (描述) 101 zh_TW dc.description.abstract (摘要) 研究目的：失眠病因理論指出失眠可能受到壓力誘發，進而提高激發程度，干擾睡眠；壓力下的睡眠脆弱特質可能為一危險因子，而伴隨有不當的睡眠信念與壓力因應者可能讓失眠症狀更易延續。過去研究也支持了上述因子與失眠的關聯性，但由於過去研究多為橫斷相關研究，對於了解這些因素如何交互影響造成失眠的發生仍相當有限。本研究透過追蹤2006年針對大學生睡眠調查的研究受試者以更進一步了解此一問題，欲探討兩研究目的：一為了解壓力下睡眠脆弱特質是否可預測失眠症狀的發生；其次為探討壓力因應風格及睡眠的不適當認知在負向生活經驗對身心激發程度及失眠的影響是否扮演調節變項的角色。研究方法：本研究以問卷調查法進行，以2006年10月由政治大學睡眠實驗室於政治大學進行睡眠調查研究之受試者為研究對象，該研究中有330位受試者簽名表示同意接受後續追蹤調查。本研究透過電話可聯絡到192位受試者，一共回收126份（66%）有效問卷。問卷內容包含失眠嚴重度指標(Insomnia Severity Index; ISI)、匹茲堡睡眠品質量表(Pittsburgh Sleep Quality Index; PSQI)、福特壓力下失眠反應量表( Ford Insomnia Response to Stress Test; FIRST)、睡眠失功能信念及態度量表(Dysfunctional Beliefs and Attitudes about Sleep; DBAS)、睡前激發程度量表(Pre-Sleep Arousal Scale; PSAS)、生活經驗調查(Life Experiences Survey; LES)以及因應量表(COPE)。統計方式則分別以邏輯斯迴歸分析探討失眠脆弱特質對失眠症狀發生的預測力，以階層迴歸分析探討睡前身心激發程度在負向生活經驗預測失眠嚴重度的中介效果，以及壓力因應方式和睡眠的不適當認知對負向生活經驗預測睡前激發程度的調節效果。研究結果：研究結果發現失眠脆弱特質對失眠症狀之發生有接近顯著的預測效果，呈現失眠脆弱特質越高，未來失眠風險就越高的趨勢。負向生活經驗會透過睡前身心激發程度的完全中介效果之作用，來影響失眠的嚴重程度；且失眠脆弱特質對負向生活經驗與生理激發程度的關聯性有調節效果，而情緒因應方式對負向生活經驗與認知激發程度的關聯性有調節效果，進而影響失眠嚴重程度。然而對睡眠的不當認知並無顯著調節效果，而是會直接影響睡前身心激發程度，進而影響失眠的嚴重度。研究結論：研究結果基本上支持失眠病因理論的預測，壓力會透過提高激發程度進而干擾睡眠，然而不同的調節因子可能有不同的作用路徑。在失眠脆弱特質的預測性上，呈現出特質越高未來失眠風險就越高的趨勢，但其預測力並未達到顯著，且此特質較高者在面對壓力時會引發較高的生理激發；而面對壓力時若採情緒風格因應者則易引發較高的認知激發程度，進而提高失眠嚴重程度。此外，不當之睡眠信念則不需與生活壓力形成交互作用，直接就對睡眠形成影響，推論這些信念會使得睡眠本身成為壓力的來源。這些結果有其臨床意涵，建議壓力下睡眠脆弱特質可作為篩選失眠的高危險族群的指標，針對此族群提供衛教，教導適當有效的因應壓力方式及放鬆技巧訓練，以降低其生理或認知激發狀態，以降低失眠的發生率。 zh_TW dc.description.abstract (摘要) OBJECTIVE: Various etiological models of insomnia suggest that stress might interfere with sleep by increasing level of arousal. Sleep vulnerability to stress might precipitate an individual to this effect, and maladaptive belief and coping skills could perpetuate the transient sleep disturbance into more long term insomnia symptoms. Previous studies have supported the associations between these factors and insomnia. However, past studies were mostly cross-sectional in nature, how these factors interact to contribute to the development of insomnia is still limited. Thus, the goals of present study are to examine (1) whether normal sleepers who are vulnerable to stress-related sleep disturbance are at higher risk for subsequent development of insomnia symptoms at a long-term follow-up, and (2) whether pre-sleep arousal serves as a mediator, and coping and maladaptive sleep belief serve as moderators of the association between stress and insomnia severity. METHOD: The sample was from the participants of a sleep survey at National Chengchi University in 2006. There were 330 participants agreed to be contacted for follow-up sleep surveys. They were invited to participate in the study through telephone in 2012. Participants who agreed to take part in the study were asked to complete a battery of questionnaires online, including the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Ford Insomnia Response to Stress Test (FIRST), the Dysfunctional beliefs and attitudes about sleep questionnaire (DBAS), the Pre-sleep arousal scale (PSAS), the Perceived Stress Scale (PSS), the Life Experiences Survey (LES) and the COPE. Logistic regression analysis was used to examine whether sleep vulnerability to stress predicts insomnia symptoms, and linear regression analysis was used to explore whether pre-sleep arousal serves as a mediator and coping and maladaptive sleep belief as moderators for the association between stress and the development of insomnia. RESULTS: Sleep vulnerability to stress showed a near significant trend in predicting insomnia symptoms. Pre-sleep arousal plays a mediating role between negative life experiences and insomnia severity. On the other hand, sleep vulnerability to stress moderates the association between negative life experiences and pre-sleep somatic arousal; emotional coping strategies serve as a moderator for the association between negative life experiences and pre-sleep cognitive arousal affecting insomnia severity. Although maladaptive sleep belief does not play a moderating role, it predicts pre-sleep arousal directly.CONCLUSIONS: The findings basically support the prediction of insomnia etiological models that stress interferes with sleep by increased arousal; however, different psychological factors play different roles in the process. It showed a tendency that participants have more sleep vulnerability to stress are at high risk to develop insomnia symptoms. However, the predictability of sleep vulnerability does not reach significant level. Individuals with high vulnerability might have increased somatic arousal when facing stressful situations and those who use more emotional coping strategies might increase cognitive arousal. Maladaptive sleep belief predicts pre-sleep arousal directly instead of interacting with negative events. It is possible that the maladaptive sleep belief can increase sleep-related stress directly. The results imply that sleep vulnerability to stress can serve as an indicator to identify individuals with higher risk for insomnia. A preventive program with sleep education and relaxation training to reduce pre-sleep arousal can be provided to prevent occurrence of insomnia. en_US dc.description.tableofcontents 中文摘要 i英文摘要 iii第一章、前言 1第二章、文獻探討 4第一節、失眠的定義與流行病學研究 4第二節、失眠的病程發展 6第三節、壓力下誘發的短暫性失眠 8第四節、與失眠脆弱特質相關的失眠病理因素 11（一）身心激發程度 11 （二）睡眠的認知信念 13第五節、失眠者的壓力因應方式 14第六節、研究問題與假設 16第三章、研究方法 19第一節、研究對象及研究程序 19第二節、研究工具 19（一）匹茲堡睡眠品質量表 (PSQI) 19（二）失眠嚴重度指標 (ISI) 20（三）福特壓力下失眠反應量表 (FIRST) 20（四）睡眠失功能信念及態度量表 (DBAS) 21（五）睡前激發程度量表 (PSAS) 22（六）壓力知覺量表 (PSS) 22（七）生活經驗調查 (LES) 23（八）因應量表 (COPE) 23第三節、資料分析 24第四章、研究結果 26第一節、受試者之人口學變項與量表描述統計資料 26第二節、壓力下易干擾睡眠之脆弱特質對失眠症狀發生的預測效果 31第三節、中介效果與調節效果的檢驗 32（一）各變項間之相關 34（二）睡前身心激發程度在生活壓力預測失眠嚴重程度的中介效果 36（三）失眠脆弱特質、睡眠的不當認知及因應方式在負向生活經驗預測 睡前身心激發程度的調節效果 38（四）失眠脆弱特質、睡眠的不當認知及因應方式在負向生活經驗預測 睡前認知激發程度的調節效果 42（五）失眠脆弱特質、睡眠的不當認知及因應方式在負向生活經驗預測 睡前生理激發程度的調節效果 45（六）六年後失眠脆弱特質、睡眠的不當認知及因應方式在負向生活經 驗預測睡前生理激發程度的調節效果 48第五章、討論 51第一節、失眠脆弱特質對失眠症狀之預測效果 51第二節、失眠相關病理因素的中介效果與調節效果之結果 52第三節、失眠脆弱特質的穩定性與模式預測之討論 55第四節、失眠相關變項之性別差異 57第五節、未來展望與研究限制 57參考文獻 60附錄 69附錄一、睡眠品質 (PSQI) 70附錄二、睡眠困擾 (ISI) 72附錄三、壓力下失眠反應量表 (FIRST) 73附錄四、睡眠信念 (DBAS) 74附錄五、睡眠身心狀態 (PSAS) 75附錄六、壓力知覺量表 (PSS) 76附錄七、生活經驗量調查表 (LES) 77附錄八、因應量表 (COPE) 81 zh_TW dc.format.extent 1329386 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/#G0097752018 en_US dc.subject (關鍵詞) 失眠 zh_TW dc.subject (關鍵詞) 失眠脆弱特質 zh_TW dc.subject (關鍵詞) 因應方式 zh_TW dc.subject (關鍵詞) 睡前激發狀態 zh_TW dc.subject (關鍵詞) 不良睡眠信念 zh_TW dc.subject (關鍵詞) insomnia en_US dc.subject (關鍵詞) sleep-related vulnerability en_US dc.subject (關鍵詞) coping strategies en_US dc.subject (關鍵詞) pre-sleep arousal en_US dc.subject (關鍵詞) dysfunctional belief en_US dc.title (題名) 失眠脆弱特質、壓力因應及睡眠的不當認知在失眠發展歷程所扮演的角色 zh_TW dc.title (題名) The Roles of Sleep Vulnerability to Stress, Coping and Maladaptive Sleep Belief in the Development of Insomnia en_US dc.type (資料類型) thesis en dc.relation.reference (參考文獻) 孔繁鐘 (1999)。精神疾病的診斷與統計。台北市：合計圖書出版社。林詩淳 (2008)。慢性失眠者與情境性失眠高危險族群之壓力因應與失眠的關係。國立政治大學心理所碩士論文，未出版，台北市。邱兆宏 (2004)。壓力與健康：整合分析與模式驗證之研究。高學醫學大學行為科學研究所碩士論文，未出版，高雄市。初麗娟、高尚仁 (2005)。壓力知覺對負面心理健康影響：靜坐經驗、情緒智能調節效果之探討。中華心理學刊，47(2)，157-179。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、效度探討。臨床心理學刊，4(1)，59-67。蕭仁釗、林耀盛、鄭逸如 (譯) (1997)。健康心理學 (原作者：E. 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