臺灣博碩士論文加值系統

摘　　　要
研究背景與目的：基於自我調節與正向心理學的概念，本研究建立一個類風濕關節炎患者因應調節的假設性模式，並試圖檢證此模式中四個變項間的關係，即目標差距、認知預期、因應調節及適應結果之間的關係。

研究方法：本研究分三個階段進行資料收集，第一階段是晤談資料收集與分析，由分析結果編製「目標差距量表」與「因應調節量表」；第二階段為預試研究，修訂自編量表；第三階段則是正式研究。正式研究有171位類風濕關節炎患者參與研究，男性21位，女性150位，以問卷調查的方式收集資料。本研究的工具包括：「目標差距量表」、「預期評價量表」、「因應調節量表」、「類風濕關節炎生活品質量表」以及「正負向情感量表」。

研究結果：因應調節假設性模式中，因應調節具有中介效果，且中介途徑不同，放棄努力在確定性預期、財務、尊嚴、生涯、人際等差距預測生活品質時，具有中介效果；放棄努力在確定性預期、財務、尊嚴等差距預測負向情感時，具中介效果；因應未來則是在正向預期預測正向情感時，具中介效果。而其中確定性預期低對採取放棄努力的預測，還受到尊嚴差距的中介影響。因應調節假設性模式中，認知預期則在認知差距預測調整目標、因應未來、生活品質及負向情感時，具調節之效果。

討論：過去對壓力因應的探討，多是針對一般性的壓力，而本研究以類風濕關節炎患者為對象，在評價與因應過程中考慮到疾病特性，將慢性化特徵與對未來的因應，都同時放進調節歷程的模式中考慮，較能反映類風濕關節炎患者的因應特性。本研究對因應調節假設性模式的檢證結果，可以瞭解雖然患者會知覺到認知差距，但患者所採取的因應調節在適應過程中扮演更重要的中介角色，而患者的認知預期能力也對適應過程具有保護因子的效果，因此，心理專業人員在協助此類病患時，認知與行為的介入，將可有效改善患者的適應。

ABSTRACT

Derived the concepts of self-regulation and positive psychology, this study purposed to establish a hypothetical model about the coping and adaptation of the rheumatoid arthritis patients, and to examine the relations among four groups of variables of this model, which are expectation discrepancy, cognitive expectancy, coping types and adaptational outcomes.

The study has been divided into three stages, Firstly, using analysis semistructure questions by interviewed with the rheumatoid arthritis patients, the researcher compiled two questionnaires, the Expectation Discrepancy Questionnaire and the Coping Questionnaire. Secondly, a preliminary study which was purposed to revise and validate these two questionnaires . Thirdly , a final study which involving 171 rheumatoid arthritis patients , 21 males and 150 females were scheduled. Five measurements including the Expectation Discrepancy Questionnaire, the Expectancy Appraisal Questionnaire, the Coping Questionnaire, the Rheumatoid Arthritis Quality of Life Questionnaire and the Positive-Negative Affect schedule were used to test our hypothesis.

As the proposed model predicted that the coping types via various paths could have mediatory effects, the results of the study come out that the give up coping type has played mediatory effect when using these variables such as certainty expectancy, cognitive discrepancy of finance , dignity , career and interpersonal relationship predict the participants’ quality of life . Give up also appears a mediatory feature when using these variables such as certainty expectancy, cognitive discrepancy of finance and dignity predict the quality of life . Additionally, proactive coping type also demonstrates mediatory effect when using positive expectation predict the adaptation of the positive affect. Discrepancy of dignity also appears to be a mediator when the certainty expectancy can predict the give up coping. Furtherly, cognitive expectancy specially appears mediatory feature when using cognitive discrepancy variables predict adjust aim, proactive ,quality of life and negative affect.

As focused on general stress by most previous studies, this study specially considered the chronic characteristics of the rheumatoid arthritis patients, from our regulational model took variables such as cognitive features, proactive coping take into the coping and adaptation model. The results of the study have demonstrated that the coping types and cognitive expectancy seem to play both important mediator and protective role for the rheumatoid arthritis patients, although they could also be aware of their own cognitive discrepancies. It is seemed that proper cognition and behavioral intervention provided by professionals of health psychology could help rheumatoid arthritis patients for better adaptation.

目 錄
第一章　緒論………………………………………………………………1
第一節　研究動機與研究目的………………………………………1
第二節　類風濕關節炎的特徵………………………………………2
第二章　文獻探討…………………………………………………………6
第一節　因應的階層概念…………………………………………....7
第二節　以「自我調節模式」探討類風濕關節炎患者
的因應歷程………………………………………………...12
第三節　認知評價歷程的相關變項…………………………………24
第四節　類風濕關節炎患者的適應…………………………………28
第五節　研究架構與問題假設………………………………………35
第三章　研究方法…………………………………………………………43
第一節　晤談資料收集與整理………………………………………43
第二節　預試研究……………………………………………………48
第三節　正式研究之方法……………………………………………58
第四章　研究結果…………………………………………………………69
第一節　人口及疾病特徵變項與因應調節假設性模式中
各變項之關係………………………………………………69
第二節　因應調節假設性模式各變項間的相關……………………76
第三節　認知差距、認知預期及因應調節的關係檢證……………79
第四節　認知差距、認知預期、因應調節與適應結果，
四個變項間的關係檢證……………………………………85
第五章　討論………………………………………………………………92
第一節　人口與疾病特徵變項在各測量變項的差異性討論………92
第二節　因應調節假設性模式檢證結果與修正之討論……………95
第三節　本研究的貢獻與限制…………………………………… 119


參考文獻………………………………………………………………… 124
一．中文部份……………………………………………………… 124
二．英文部份……………………………………………………… 124
附錄
附錄一　類風濕關節炎患者疾病衝擊訪談之半結構式問題架構…135
附錄二　訪談內容分析資料表………………………………………136
附錄三　預試研究問卷首頁…………………………………………143
附錄四　預試量表∼目標差距量表………………………………....144
附錄五　預試量表∼因應調節量表………………………………….147
附錄六　研究參與邀請書…………………………………………….150
附錄七　基本資料與疾病特徵調查表…..………………………….. 151
附錄八　正式量表∼目標差距量表……………………………….... 153
附錄九　預期評價量表…………………………..………………….. 155
附錄十　正式量表∼因應調節量表…………………………...……. 157
附錄十一　類風濕關節炎生活品質量表…………………………....160
附錄十二　正負向情感量表..………………………………………..162
附錄十三　不同教育程度在各個測量變項上的變異數分析………164
附錄十四　不同疼痛時間在各個測量變項上的變異數分析………165
附錄十五　不同影像評估等級在各個測量變項的變異數分析……166
附錄十六　檢驗假設2-2中介效果的階層迴歸分析………………167
附錄十七　檢驗假設2-2中介效果的階層迴歸分析（路徑a）… 168
附錄十八　假設2-3調節效果的階層迴歸分析…………………… 169
附錄十九 假設2-3調節效果的交互作用圖……………………… 170
附錄二十　檢驗假設3-2中介效果的階層迴歸分析……………… 172


附錄二十一　檢驗假設3-2中介效果的階層迴歸分析（路徑a） 176
附錄二十二　檢驗假設3-3中介效果的階層迴歸分析…………… 177
附錄二十三　檢驗假設3-3中介效果的階層迴歸分析（路徑a） 178
附錄二十四　假設3-4調節效果的階層迴歸分析…………………179
附錄二十五　假設3-4調節效果的交互作用圖……………………180
附錄二十六　171位研究參與者因應調節量表之因素分析……… 181



圖 表 目 錄
表目錄
表2-1.1 Krohne (1993) 因應階層模式對照表……………………..11
表3-1.1 類風濕關節炎患者受衝擊的目標及其內容之摘要表……47
表3-2.1　目標差距量表預試結果……………………………………53
表3-2.2　放棄努力分量表之項目分析綜合…………………………55
表3-2.3　堅持原目標分量表之項目分析綜合………………………56
表3-2.4　調整目標分量表之項目分析綜合…………………………57
表3-2.5　因應未來分量表之項目分析綜合…………………………58
表3-3.1　研究參與者的人口背景變項次數分配表…………………60
表4-1.1 各個連續變項與因應調節模式中各變項間之相關………71
表4-1.2　性別在因應調節模式中各變項間之差異………………… 72
表4-1.3　職業在因應調節模式中各變項間之差異………………… 73
表4-2.1　認知差距、認知預期與因應調節之相關…………………77
表4-2.2　認知差距、認知預期、因應調節與適應結果之相關……78
表4-3.1　檢驗假設2-1預測因應調節的階層迴歸分析摘要表……81
表4-3.2　認知預期與因應調節間，具中介效果的認知差距摘要表82
表4-3.3 認知差距與因應調節間，具調節效果的認知預期摘要表84
表4-4.1　檢驗假設3-1預測適應結果的階層迴歸分析摘要表……86
表4-4.2　認知差距與適應結果間，具中介效果的因應調節摘要表88
表4-4.3　認知預期與適應結果間，具中介效果的因應調節摘要表89
表4-4.4 認知差距與適應結果間，具調節效果的認知預期摘要表91

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