臺灣博碩士論文加值系統

研究背景與目的：過去研究指出，具有創傷後負向信念的個體，會將創傷事件視為過度危險且自己沒有能力因應，並會使其持續產生侵入性症狀(Foa, Ehlers, Clark, Tolin, & Orsillo, 1999)；而除了直接影響侵入性症狀外，創傷後負向信念也會透過不良因應方式使侵入性症狀持續產生或趨於嚴重。在眾多不良的因應方式中，創傷後負向信念會使個體傾向透過抽象思考以避免直接經驗創傷，而反芻與反思均為一種抽象思考方式，可避免個體直接經驗創傷細節，但兩者卻會造成不同的結果。反芻除了會維持或增強個體對創傷事件的負向評價外，也被視為是一種可能的認知逃避且為不具適應性的因應方式，使創傷記憶不易被改變，此外更會直接增加個體的負向情緒；上述反芻對個體可能的負向作用，均會使個體持續產生侵入性症狀、強烈情緒與生理喚起症狀(Ehlers & Clark, 2000)；而反思則能增加個體對創傷事件的理解與接受(Watkins, 2008)。因此，反芻與反思在負向信念與侵入性記憶間似乎扮演著中介的角色，當具有創傷後負向信念的個體，若傾向使用反芻作為因應方式，則侵入性症狀就會更加嚴重；相反的，若個體傾向使用反思作為因應方式則能增加個體對創傷事件的理解並幫助個體從創傷中復原(Tedeschi & Calhoun, 2004; Watkins, 2008)。本研究將反思與反思作為中介變項，試著分析兩者的中介模式。透過Trapnell與 Campbell(1999)提出的反思與反芻為基礎，探討反思與反芻中介負向信念對侵入性記憶的效果。預期負向信念會提升個體反思與反芻作用，不過當個體多以反思作為因應策略，則能減少負向信念對侵入性記憶的影響；反之，若當個體多以反芻作為因應策略，則會增加負向信念對侵入性記憶的影響。

研究方法：本研究有兩項研究目的，其一在於檢驗中文版侵入性思考問卷之信效度；其二，為探討創傷後負向信念與反思及反芻對創傷後侵入性記憶之影響。本研究為橫斷研究，以臺灣大專院校學生為研究對象，並使用問卷測量創傷事件、創傷後信念、反芻與反思，以及侵入性記憶等變項。研究工具共包含5個部分，「基本資料表」為收集參與者的人口變項；「創傷後壓力診斷量表」為了解參與者經歷的創傷事件類型以及創傷後壓力症狀；「創傷後認知量表」為了解參與者創傷後的信念類型；「反思反芻量表」為了解參與者慣用的思考形式；「侵入性思考問卷」為了解參與者的侵入性記憶特徵。本研究共收得213份有效問卷，並依照參與者在創傷後壓力診斷量表之填答狀況，分為一般壓力組共124人，並作為探討研究目的一之樣本；另創傷組共89人，則作為探討研究目的二之樣本。本研究使用統計套裝軟體SPSS 23.0版對各變項進行描述統計、信效度分析、差異檢定、相關分析與中介效果分析，並以SPSS Amos進行中介模型的路徑分析。

研究結果：（1）中文版侵入性記憶問卷具有良好的信效度（2）創傷後負向信念能顯著預測侵入性記憶，創傷後負向信念越多者，侵入性記憶也會越嚴重（3）創傷後負向信念能顯著預測反芻，創傷後負向信念越多者其反芻思考越多（4）創傷後負向信念無法顯著預測反思（5）反芻能顯著預測侵入性記憶，反芻思考越多者，侵入性記憶也會越嚴重（6）反思無法顯著預測侵入性記憶（7）反芻能部分中介創傷後負向信念對侵入性記憶的影響（8）反思無法中介創傷後負向信念對侵入性記憶的影響。

研究討論：創傷後負向信念與反芻均能顯著預測侵入性記憶，而反芻也具有部分中介創傷後負向信念對侵入性記憶的效果；創傷後負向信念會使個體使用更多的反芻思考，並使侵入性記憶變得更加嚴重。創傷後負向信念無法預測反思，且反思也無法預測侵入性記憶，因此反思不具有中介效果。代表當個體具有創傷後負向信念時，並不會驅使個體的反思思考增加，且若個體慣用反思思考作為因應方式的話，也不會對侵入性記憶的嚴重程度造成影響。

Background：According to past research, people who have negative posttraumatic cognitions will be traumatic events as excessive dangerous and they don’t have the ability to cope with it, and that will maintenance of intrusive symptoms(Foa et al., 1999). Negative posttraumatic cognitions will make people use abstract thinking style to avoid to experience the details of the traumatic event. Both of the rumination and reflection are kinds of abstract thinking style, and it can help traumatic people to avoid to experience the details of the traumatic event. But they have the different effect on posttraumatic stress symptoms. Rumination is a kind of cognitive avoidance, and it is a maladaptive coping strategy(Ehlers & Clark, 2000). It will maintenance of intrusive symptoms. However, the reflection will help traumatic people to accept the traumatic event. So rumination and reflection saw will mediator the effect of the negative posttraumatic cognitions to intrusive symptoms. When traumatic people who have negative posttraumatic cognitions, use the rumination as a coping strategy will worse and maintenance of intrusive symptoms. In contrast, when traumatic people who have negative posttraumatic cognitions, use the reflection as a coping strategy will help them recover from the traumatic event.(Tedeschi & Calhoun, 2004; Watkins, 2008).
　　Our research will use the rumination and reflection as the mediator, and testing mediating effect of mediators model. We use the concept of rumination and reflection which from Trapnell and Campbell(Trapnell & Campbell, 1999). We expect the traumatic people who have more negative posttraumatic cognitions and more rumination, who will have worse intrusive symptoms. However, the traumatic people who have more negative posttraumatic cognitions and more reflection, who will have less intrusive symptoms.

Method：Our research has two purposes：(1) To investigate the Chinese Intrusive Thought Qusetionnaire’s reliability and validity (2) To investigate the Effects of posttraumatic negative cognition, reflection, and rumination on posttraumatic intrusive memories. Our research is cross-sectional study, and use the student from Taiwan’s college as the subject. The research questionnaire included five part. (1) the basic information form to collect the subject’s demographics information. (2) the Posttraumatic Diagnostic Scale to collect the subject’s type of traumatic event and posttraumatic stress symptoms. (3) Posttraumatic Cognition Inventory to collect the subject’s negative posttraumatic cognitions (4) Rumination-Reflection Questionnaire to collect the subject’s thinking style (5) The Intrusive Thought Questionnaire to collect the subject’s intrusive symptoms. We collect 213 subject’s data, and according to the subject’s traumatic event to assign them into trauma group or normal group. The normal group has 124 subjects, which data will use for research purposes 1. And trauma group has 89 subjects, which data will be used for research purposes 2. We use SPSS 23.0 to descriptive statistics, reliability, validity, t-test, correlation analysis, and mediation effect, and we will use SPSS Amos to path analysis.

Result：（1）negative posttraumatic beliefs can predict intrusive memories when traumatic people have more negative posttraumatic beliefs, who will have worse intrusive memories.（2）negative posttraumatic beliefs can predict rumination when traumatic people have more negative posttraumatic beliefs, who will have more rumination.（3）negative posttraumatic beliefs can not predict reflection.（4）rumination can predict intrusive memories, when traumatic people have more rumination, who will have worse intrusive memories.（5）reflection can not predict intrusive memories.（6）The relationship between negative posttraumatic beliefs and intrusive memories is partially mediated by rumination（7）The relationship between negative posttraumatic beliefs and intrusive memories is not mediated by reflection

Discussion：In research purposes 1, Chinese Intrusive Thoughts Questionnaire has good reliability and validity. In research purposes 2, Negative posttraumatic beliefs and rumination can predict intrusive memories. The relationship between negative posttraumatic beliefs and intrusive memories is partially mediated by rumination. The posttraumatic beliefs will make more rumination, and more rumination will make the intrusive memories worse. The negative posttraumatic beliefs can not predict reflection, and the reflection also can not predict the intrusive memories. When people who have more negative posttraumatic beliefs, they might not get more reflection. And when people who have more reflection, their intrusive memories might not get worse.

目錄
摘要.................................................................................................I
Abstract.........................................................................................III
誌謝................................................................................................V
表目錄............................................................................................IX
圖目錄............................................................................................IX
第一章 緒論......................................................................................1
研究動機..........................................................................................1
第二章 文獻探討..............................................................................3
第一節 侵入性記憶探討....................................................................3
一、創傷後壓力症............................................................................3
二、創傷記憶...................................................................................4
三、創傷後侵入性記憶...................................................................10
四、探討創傷後侵入性記憶的產生與持續的原因..............................12
第二節 創傷後的因應策略-反芻的探討.............................................18
一、反芻的定義.............................................................................18
二、反芻與侵入性記憶的差異.........................................................18
三、反芻－具適應性與不具適應性的因應方式間的爭議....................19
四、反芻的其他觀點-反思與反芻....................................................20
五、負向信念、反思與反芻及侵入性記憶：反思與反芻之中介角色....21
第三節、研究目的、架構與假設......................................................23
一、研究目的................................................................................23
二、研究架構與假設......................................................................24
第三章 研究方法............................................................................26
第一節、研究對象..........................................................................27
一、參與者基本資料.......................................................................27
二、創傷類型分析..........................................................................27
第二節、研究工具..........................................................................29
一、基本資料問卷..........................................................................29
二、中文版侵入性思考問卷............................................................29
三、中文版創傷後壓力診斷量表第五版(Posttraumatic Diagnostic Scale for DSM-5).........................................................................30
四、創傷後認知量表(Posttraumatic Cognition Inventory; PTCI).....31
五、中文版反思反芻量表................................................................31
第三節、研究程序..........................................................................33
第四節、統計分析..........................................................................34
一、基本人口變項統計...................................................................34
二、研究目的ㄧ：中文版侵入性思考問卷之信效度分析...................34
三、研究目的二：探討創傷後負向信念與反思及反芻對創傷後侵入性記憶之影響.......................................................................................34
第四章 研究結果............................................................................37
第一節 研究目的一：中文版侵入性思考問卷探討.............................37
一、鑑別度分析.............................................................................37
二、信度分析................................................................................39
三、效度分析................................................................................39
第二節 研究目的二：探討創傷後負向信念、反思與反芻，以及侵入性記憶之關係.......................................................................................41
一、性別、創傷後壓力症症狀起始時間及目前困擾與主要變項之差異分析.................................................................................................41
二、各主要變項間之相關分析........................................................42
三、負向信念對侵入性記憶之預測－以反芻與反思作為中介.............44
四、負向信念對侵入性記憶之預測－以反思作為中介.......................47
五、負向信念、反芻與反芻以及侵入性記憶路徑分析.......................50
第五章 討論與建議.........................................................................52
第一節 討論...................................................................................52
一、中文版侵入性思考問卷探討.....................................................52
二、負向信念、侵入性記憶與反思及反芻間的關係..........................53
三、反思與反芻對於侵入性記憶之中介效果....................................57
第二節 研究貢獻、研究限制與未來方向..........................................59
一、研究貢獻................................................................................59
二、研究限制與建議......................................................................59
參考文獻.......................................................................................62
附錄..............................................................................................67
附錄一 負向自我、反思、反芻以及侵入性記憶間的路徑分析............68
附錄二 負向世界信念、反思、反芻以及侵入性記憶間的路徑分析.....69
附錄三 自我責備、反思、反芻以及侵入性記憶間的路徑分析............70
附錄四 英文版與中文版創傷後壓力診斷量表與創傷後認知量表授權信 .....................................................................................................71
附錄五 侵入性思考問卷授權信........................................................72
附錄六 英文版與中文版之反思反芻量表授權....................................73
附件七 研究者同意書......................................................................74
附錄八 基本資料問卷......................................................................74
附錄九 中文版創傷後壓力診斷量表.................................................75
附錄十 中文版侵入性思考量表........................................................78
附錄十一 中文版創傷後認知量表....................................................80
附錄十二 中文版反思反芻量表........................................................82
附錄十三 心理衛教單.....................................................................83

表目錄
表3-1-1 創傷類型分析……………………………………………………………......28
表4-1-1 中文版侵入性思考問卷之鑑別度分析..................................38
表4-1-2 中文版侵入性思考問卷之內部一致性信度…………….…………..39
表4-1-3 中文版侵入性思考問卷之因素負荷量……………………………….40
表4-2-1 性別、創傷後壓力症症狀起始時間及目前困擾在主要變項間之分布情形…………………………………………………………………………….........42
表4-2-2 性別、創傷後壓力症症狀起始時間及目前困擾在主要變項間之相關分析………….…………………………………………………………………........43
表4-2-3 整體負向信念對侵入性記憶之預測－以反芻作為中介……….44
表4-2-4 負向自我信念對侵入性記憶之預測－以反芻作為中介……....45
表4-2-5 負向世界信念對侵入性記憶之預測－以反芻作為中介……….46
表4-2-6 自我責備對侵入性記憶之預測－以反芻作為中介……………...46
表4-2-7 整體負向信念對侵入性記憶之預測－以反思作為中介………..47
表4-2-8 負向自我信念對侵入性記憶之預測－以反思作為中介……….48
表4-2-9 負向世界信念對侵入性記憶之預測－以反思作為中介…….…49
表4-2-10自我責備對侵入性記憶之預測－以反思作為中介……………..49
圖目錄
圖1 研究架構圖…………………………………………………………………………...25
圖2 整體負向信念、反思、反芻以及侵入性記憶間的路徑分析…………51

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