臺灣博碩士論文加值系統

研究問題：目前文獻中對於頭痛與壓力的研究較缺乏完整性的探討，只是選擇壓力歷程其中的向度，基於此本研究提出兩個主要的研究目的，第一為探討偏頭痛患者、緊張型頭痛患者與控制組在壓力相關變項上有其特殊性與差異性，壓力相關變項包含：人格傾向、主觀之生活瑣事的頻率與影響嚴重度、對生活瑣事的認知評估、對生活瑣事的因應策略、因應有效性與滿意度、情緒狀態，且探討偏頭痛患者與緊張型頭痛患者在主觀頭痛特性、對頭痛的認知評估、對頭痛的因應策略、因應有效性與滿意度的差異。另外，在Lazarus與Folkman（1984）所提出的壓力交流理論為背景之下，第二個研究目的為分別探討偏頭痛與緊張型頭痛患者其壓力相關變項之間的關係。

研究方法：本研究以50位偏頭痛患者、45位緊張型頭痛患者與41位控制組為研究對象。採用橫斷研究法與立意取樣，偏頭痛患者與緊張型頭痛患者填寫「壓力經驗問卷」，其中包含了：個人基本資料、生活瑣事量表、生活瑣事評估量表、因應策略量表、頭痛評估量表、慢性疼痛因應量表、情緒量表與人格傾向量表共八部分。控制組的參與者除了頭痛評估量表與慢性疼痛因應量表未填寫之外，他們填寫其他六部分。在資料分析方面，使用獨立樣本t檢定、卡方檢定、單因子變異數分析、邏輯斯迴歸與典型相關檢驗研究假設。

研究結果：研究結果分別如下：（1）在人格傾向方面，偏頭痛組的神經質、焦慮、生氣敵意、憂鬱顯著高於控制組，而外向性、溫暖、合群顯著低於控制組；緊張型頭痛組的神經質、焦慮顯著高於控制組，而深思熟慮顯著低於控制組。（2）在生活瑣事方面，偏頭痛組比控制組有顯著較高的頻率、嚴重度與密度（頻率成嚴重度）。（3）在生活瑣事的認知評估方面，偏頭痛組的重要性、威脅、動機不一致評估顯著高於控制組，而控制、有效性、情緒焦點因應的可能性評估顯著低於控制組；緊張型頭痛組的重要性評估顯著高於控制組；偏頭痛組的威脅評估顯著高於緊張型頭痛組。（4）在頭痛的特性方面，偏頭痛組與緊張型頭痛組之頭痛部位有顯著的不同。（5）在生活瑣事的因應方面，偏頭痛組比控制組顯著更常使用自我責備、社會退縮與情緒焦點的逃離，緊張型頭痛組比控制組顯著更不常使用社會支持。在因應的有效性與滿意度方面，偏頭痛組的因應有效性顯著低於控制組。（6）在對頭痛的因應策略方面，偏頭痛組的使用藥物天數顯著比緊張型頭痛組多，而兩組患者的因應有效性與滿意度無顯著差異。（7）在情緒狀態方面，偏頭痛組的廣泛擔心、症狀擔心、憂鬱、緊繃不安與心情低落顯著高於控制組；緊張型頭痛組的症狀擔心顯著高於控制組；偏頭痛組的心情低落顯著高於緊張型頭痛組。（8）使用邏輯斯迴歸發現疾病的特殊性方面，最能區分控制組與偏頭痛組的變項為焦慮人格傾向、合群人格傾向與瑣事威脅評估；最能區分控制組與緊張型頭痛組的變項為焦慮人格傾向、瑣事重要性評估、瑣事情緒焦點因應的可能性評估與社會支持；最能區分緊張型頭痛組與偏頭痛組的變項為瑣事嚴重度與瑣事威脅評估。（9）在偏頭痛組的典型相關結果方面，偏頭痛患者的神經質人格越高、生活瑣事頻率越高、生活瑣事嚴重度越高，則越會對於生活瑣事做出高威脅性的認知評估；對生活瑣事評估積極性越低，則越不常使用投入因應、越常使用逃離因應；越常使用逃離因應，則其因應效果越低、越常經驗到負面情緒。在緊張型頭痛組的典型相關結果方面，緊張型頭痛患者的神經質人格越高、生活瑣事頻率越高、生活瑣事嚴重度越高，則越會對於生活瑣事做出威脅性的認知評估、越不會對生活瑣事做出積極性的認知評估；越對瑣事做出高威脅性的認知評估，則越常使用投入與逃離的因應策略；越對瑣事所出低積極性認知評估時，則越常使用逃離的因應策略；越常使用投入與逃離的因應策略，則越常經驗到負面的情緒。

討論：研究結果讓我們瞭解偏頭痛組、緊張型頭痛組與控制組在各壓力相關變項上的差異，並且瞭解偏頭痛與緊張型頭痛患者的特殊性，透過壓力模式與典型相關的分析，分別瞭解偏頭痛組與緊張型頭痛組其各變項之間的影響。從本研究的發現可提出針對偏頭痛與緊張型頭痛患者在臨床上的治療建議。

Research background & aim: Considering researches about stress on headache haven’t completed which they have just studied parts of variables in stress process, so this study has two purposes. The first purpose was to investigate differences and specialty in each stress variables among migraine headache (MH), tension-type headache (TH) and control group. Variables of stress included personality factors, density of daily hassles, appraisals and coping of daily hassles, effectiveness and satisfaction of coping and emotional outcomes. We also investigate differences in subjective characteristics of headache, appraisals of headache, coping with headache, effectiveness and satisfaction of headache coping between MH and TH groups. Furthermore, based on transactional model of stress of Lazarus and Folkman, the second purpose of this study was to test pattern of relationship of stress variables in MH or TH groups.

Methods: Fifty MH suffers, forty-five TH suffers, and forty-one controls were scheduled in our study. Both of headache participators were asked to complete a package questionnaires there included the demographic data, the Daily Hassle Scale, the Cognitive Appraisal of Daily Hassle, the Coping Strategies Inventory, the Cognitive Appraisal of headache, the Chronic Pain Coping Inventory, the Emotion Inventory, and the NEO PI-R. The control group had also completed those questionnaires except the Cognitive Appraisal of headache and the Chronic Pain Coping Inventory. For examining the hypothesis of this study, the independent-samples t test, the Chi-square, one-way ANOVA, the logistic regression, and the canonical correlation were conducted for statistics analysis.

Result: (1) In terms of personality, MH group had significantly higher scores on neuroticism, anxiety, anger hostility, depression and lower scores on extraversion, warmth, and gregariousness than controls. TH group had significantly higher scores on neuroticism and anxiety and lower scores on deliberation than controls. (2) MH group reported higher frequency, severity and density of daily hassles than control group. (3) In appraisals of daily hassles, MH group perceived more importance, threat, motivational incongruence and less control, effectiveness, emotion-focused coping potential than control group, but TH group perceived only more importance than control group, MH group perceived more threat than TH group. (4) MH and TH suffers had different pain characteristics such as pain location. (5) In copings with daily hassles, MH group reported greater use of self criticism, social withdraw, and emotion disengagement than control group. TH group reported fewer use of social support than control group. MH group perceived lower effectiveness of coping than control group. (6) In ways of coping with headache, MH group were more than TH group in days of taking medications, but two groups did not differ in effectiveness and satisfaction of coping. (7) Compared to controls, MH group showed higher levels of extensive worry, somatic worry, depression, disquiet and dysthymia. Compared to controls, TH group showed higher level of somatic worry. MH showed higher level of dysthymia than TH group. (8) Logistic regression revealed that: (a) Personality of anxiety and gregariousness, and appraisals of threat reliably differentiated MH and controls; (b) Personality of anxiety, appraisals of importance and emotion-focused coping potential and coping of social support reliably differentiated TH and controls; (c) Severity of daily hassles and appraisals of threat reliably differentiated two headache groups. (9) In the MH group, results of canonical correlation indicated that: (a) higher neuroticism and frequency and severity of daily hassles were associated with higher negative appraisal; (b) lower positive appraisal was associated with fewer use of engagement and more use of disengagement coping; (c) more use of disengagement coping was associated with lower effectiveness of coping and higher negative emotion. In the TH group, results of canonical correlation indicated that: (a) higher neuroticism and frequency and severity of daily hassles were associated with higher negative and lower positive appraisal; (b) higher negative appraisal was associated with more use of engagement and disengagement coping; (c) lower positive appraisal was associated with more use of disengagement coping; (d) more use of engagement and disengagement coping were associated with higher negative emotion.

Conclusions: Our results showed MH, TH and control groups differed in term of personality, daily hassles, appraisal, coping, effectiveness of coping, and emotions. From the stress model and canonical correlation results, we confirmed that variables of stress presented the contributions on two types of headache in the different combinations each other. This finding can also suggest using in clinical practice as therapeutic regimens on headache patients.

摘要...i
目錄...v
圖表目錄...vii
第一章 緒論
 第一節 研究動機與目的...1
第二章 文獻探討
 第一節 偏頭痛與緊張型頭痛之定義與特徵...4
 第二節 壓力的概念...17
 第三節 偏頭痛與緊張型頭痛患者的人格傾向...29
 第四節 偏頭痛與緊張型頭痛患者的主觀壓力知覺...38
 第五節 偏頭痛與緊張型頭痛患者的認知評估...42
 第六節 偏頭痛與緊張型頭痛患者的因應策略...45
 第七節 偏頭痛與緊張型頭痛患者的情緒狀態...51
 第八節 研究架構與研究假設...54
第三章 研究方法
 第一節 研究對象...60
 第二節 研究工具...63
 第三節 研究程序...71
 第四節 資料分析...72
第四章 研究結果
 第一節 偏頭痛組、緊張型頭痛組與控制組在各變項上的差異...73
 第二節 偏頭痛組、緊張型頭痛組與控制組在壓力相關變項上的特殊性...86
 第三節 偏頭痛組與緊張型頭痛組各壓力變項之間的相關...90
第五節 討論與建議
 第一節 討論...99
 第二節 建議...108
參考文獻
 中文資料...111
 西文資料...111
附錄
 附錄一 無預兆偏頭痛與有預兆偏頭痛的診斷準則...121
 附錄二 陣發性緊張型頭痛與慢性緊張型頭痛的診斷準則...122
 附錄三 頭痛特性調查表...123
附錄四 壓力經驗量表（頭痛患者組）...124
 附錄五 壓力經驗量表（控制組）...142
附錄六 台灣版NEO PI-R使用同意書...143
圖表目錄
圖目錄
圖2.2-1 疾病的特定性模式...21
圖2.2-2 壓力、因應與適應的理論概要圖...21
圖2.8-1 研究架構圖...54
圖4.3-1 偏頭痛組之典型相關路徑圖-1...91
圖4.3-2 偏頭痛組之典型相關路徑圖-2...92
圖4.3-3 偏頭痛組之典型相關路徑圖-3...93
圖4.3-4 緊張型頭痛組之典型相關路徑圖-1...95
圖4.3-5 緊張型頭痛組之典型相關路徑圖-2...96
圖4.3-6 緊張型頭痛組之典型相關路徑圖-3...97

表目錄
表2.1-1 偏頭痛與緊張型頭痛之特性比較...7
表2.3-1 頭痛患者人格傾向之研究比較表...35
表2.4-1 頭痛患者主觀壓力知覺之研究比較表...40
表2.5-1 頭痛患者認知評估之研究比較表...44
表2.6-1 頭痛患者因應策略之研究比較表...49
表2.7-1 頭痛患者情緒狀態之研究比較表...52
表3.1-1 受試者的人口統計學資料之次數分配與變異數分析...61
表3.1-2 受試者的人口統計學資料之次數分配與適合度考驗...62
表3.2-1 台灣版NEO PI-R分量表之得分解釋...63
表3.2-2 台灣版NEO PI-R的α信度...64
表3.2-3 因應策略量表分量表間的關係...67
表3.2-4 因應策略量表分量表之解釋...68
表3.2-5 慢性疼痛因應量表分量表之解釋...70
表4.1-1 不同組別在神經質人格向度與相關切面上的平均數、標準差與變異數分析...74
表4.1-2 不同組別在外向性人格向度與相關切面上的平均數、標準差與變異數分析...75
表4.1-3 不同組別在嚴謹性人格向度與相關切面上的平均數、標準差與變異數分析...76
表4.1-4 不同組別在生活瑣事上的平均數、標準差與變異數分析...77
表4.1-5 不同組別對生活瑣事的認知評估的平均數、標準差與變異數分析...78
表4.1-6 偏頭痛組與緊張型頭痛組在主觀的頭痛特性的分佈與卡方分析...79
表4.1-7 偏頭痛組與緊張型頭痛組第一次頭痛年齡的平均數、標準差與t檢定...79
表4.1-8 偏頭痛組與緊張型頭痛組在對頭痛的認知評估的平均數、標準差與t檢定...80
表4.1-9 不同組別在對生活瑣事的因應策略的平均數、標準差與變異數分析...82
表4.1-10不同組別在對生活瑣事的因應有效性與因應滿意度的平均數、標準差與變異數分析...83
表4.1-11偏頭痛組與緊張型頭痛組對頭痛的因應策略的平均數、標準差與t檢定...84
表4.1-12偏頭痛組與緊張型頭痛組對頭痛因應策略的有效性與滿意度之平均數、標準差與t檢定...85
表4.1-13不同組別的情緒狀態之平均數、標準差、變異數分析...85
表4.2-1 以壓力相關變項區辨控制組或偏頭痛組之邏輯斯迴歸分析摘要表...87
表4.2-2 以壓力相關變項區辨控制組或緊張型頭痛組之邏輯斯迴歸分析摘要表...88
表4.2-3 以壓力相關變項區辨緊張型頭痛組或偏頭痛之邏輯斯迴歸分析摘要表...89
表4.3-1 偏頭痛組的典型相關分析摘要表-1...91
表4.3-2 偏頭痛組的典型相關分析摘要表-2...92
表4.3-3 偏頭痛組的典型相關分析摘要表-3...93
表4.3-4 緊張型頭痛組的典型相關分析摘要表-1...94
表4.3-5 緊張型頭痛組的典型相關分析摘要表-2...96
表4.3-6 緊張型頭痛組的典型相關分析摘要表-3...97
表5.1-1 受試者每日使用電腦時數的平均數、標準差與變異數分析...102

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