臺灣博碩士論文加值系統

敵意與心血管疾病之間的關聯性過去已獲得釵h研究的證實。但是過去研究對於敵意與心臟疾病之間的推論多建立於較高的心血管生理反應與交感神經過度激活假說上，從而也較偏向急性病理的探討。然而，這樣並無法涵遞譟N心理特質與心血管自主神經之間的長期慢性化致病機制。Brosschot與Thayer（1998）提出一副交感神經活性低落的假說來整合交感神經過度激活假說，認為高敵意者其副交感神經活動長期受到抑制，影響其調節心血管系統的弁遄A方形成心血管自主神經傾向交感優勢進而提高心血管疾病的危險性。除此，他們針對副交感神經的調節受到抑制，提出調節弁鄐ㄗ}的指標：壓抑敵意（生氣）之後的心血管反應恢復速率較慢。本研究旨在以實徵研究驗證此一副交感活性低落假說。受試者由嘉義大林慈濟醫院之健康檢查門診篩選出無心血管疾病、無長期服藥與家族病史之健康成人17名（男性9人），平均年齡62.7歲（SD 7.7）。採用實驗室研究方式，以Sargent、Flora與Williams（1999）所發展的人際衝突情境引發受試者的生氣情緒，要求受試者以向外表達生氣與向內壓抑生氣兩種方式加以表達，並利用非侵入式的自主神經測量以及心跳改變量的分析方法，比較敵意特質高低與生氣情境下不同表達方式對自主神經反應與心血管恢復調節的影響。本研究以SDNN為心跳變異率指標；以頻譜分析之高頻部份（HF）為副交感神經活性指標；以頻譜分析之低頻/高頻（LF/HF）為交感神經活性指標；以曲線下面積（area under curve，簡稱AUC）公式所計算之心跳改變量為恢復速率指標。研究結果發現：（1）在自主神經活性方面，敵意特質分數在基準期（一般休息狀態下）與副交感神經活性呈顯著負相關；（2）在恢復速率方面，在經歷向內壓抑生氣情境之後，高敵意組的心跳恢復速率低於低敵意組。可見，本研究結果大致支持Brosschot與Thayer副交感神經活性低落的假設。另外，高敵意組的交感神經活性較低敵意組低則與過去研究之發現不相同。

The relationship between hostility and cardiovascular disease(CVD) has been confirmed by lots of studies. However, previous researches were based largely on the notion that hyper cardiovascular reactivity and high sympathetic tone, lacking for the chronic mechanism underlying the CVD risk associated with hostility. Brosschot and Thayer (1998) proposed a low vagal tone model based upon anger inhibition, slow cardiovascular recovery, and low parasympathetic activity, attempting to account for the chronic pathogenic state lead to CVD. To further evaluate this model, the present study used 17 healthy people as subjects. Advances were made by (1) measuring both reactivity and recovery to anger induction task ,using (2) heart rate variability (HRV) to more specifically quantify parasympathetic and sympathetic activity (HF and LF/HF within the HRV power spectrum ,respectively) and (3) using area under curve (AUC) for computing cardiac recovery index. Results indicated that vagal tone was inversely related to hostility in baseline (resting state). Moreover, relative to low-hostiles, high-hostile subjects evidenced slow recovery after anger inhibition task. These data largely support the low vagal tone model, showing that hostility influences vagal modulation of the cardiovascular system.

第一章 緒論…………………………………………………………………………1
第一節 心臟疾病的盛行率……………………………………………………1
第二節 心臟疾病的危險因子…………………………………………………1
第三節 敵意與冠狀動脈心臟病………………………………………………2
第二章 文獻回顧……………………………………………………………………5
第一節 敵意的概念定義與測量………………………………………………5
一、A型行為組型………………………………………………………… 5
二、敵意概念的形成……………………………………………………… 6
三、敵意概念的定義………………………………………………………7
四、敵意的測量……………………………………………………………8
第二節 敵意與心血管疾病的關係………………………………………… 12
一、 敵意與冠狀動脈心病……………………………………………… 12
二、 敵意表達與冠狀動脈心臟病……………………………………… 14
第三節 心血管的生理測量與意義………………………………………… 19
一、 連續心跳的測量與心電圖………………………………………… 19
二、 自主神經活動的測量……………………………………………… 21
三、 心跳的PSA及其意義……………………………………………… 24
第四節 敵意與自主神經反應的關係……………………………………… 25
一、 敵意與自主神經反應的關係……………………………………… 26
二、 恢復速率…………………………………………………………… 29
第五節 研究目的與研究假設……………………………………………… 33
第三章 研究方法………………………………………………………………… 35
一、實驗設計…………………………………………………………… 35
二、受試者……………………………………………………………… 35
三、 測量工具…………………………………………………………… 36
四、 實驗程序…………………………………………………………… 38
五、 實驗原始資料處理與轉換………………………………………… 40
第四章 結果……………………………………………………………………… 42
第一節 實驗操弄之檢核…………………………………………………… 42
一、情緒自評…………………………………………………………… 42
二、生理反應程度……………………………………………………… 44
第二節 敵意特質與自主神經反應的關聯性……………………………… 45
一、 描述統計…………………………………………………………… 45
二、 相關分析…………………………………………………………… 45
第三節 不同敵意程度與表達方式對心跳恢復速率的影響……………… 49
一、 基本資料差異檢定………………………………………………… 49
二、 恢復速率…………………………………………………………… 50
三、 副交感神經………………………………………………………… 51
第四節 壓抑生氣情境下交感神經活動之分組比較………………………52
第五章 討論……………………………………………………………………… 53
第一節 敵意特質與副交感神經抑制反應………………………………… 53
第二節 敵意程度與生氣表達方式對心跳恢復速率的影響……………… 54
第三節 綜合討論…………………………………………………………… 55
一、 研究貢獻…………………………………………………………… 55
二、 在臨床上可能的應用……………………………………………… 55
第四節 研究限制與未來方向……………………………………………… 56
參考文獻…………………………………………………………………………… 58

中文部分：
行政院衛生署（民93）「衛生統計—民國九十三年台灣地區主要死亡原因」。
林宜美、翁嘉英(民91) 冠狀動脈心臟病與頭痛病人的敵意型態比較。中華心理學刊，44(2)，211-226。
林宜美、翁嘉英(尚未發表)短式華人敵意量表之發展與信效度考驗。

英文部分：
Akselrod, S.（1981）. Power spectrum analysis of heart rate fluctuation: A quantitative probe of beat-to-beat cardiovascular control. Science, 213(10), 220-222
Barefoot, J. C., Dahlstrom. W.G., Williams, R. B. （1983）. Hostility, CAD Incidence, and Total Mortality: A 25-year Follow-up Study of 255 Physicians. Psychosomatic Medicine, 45, 59-63.
Barefoot, J. C., Dodge, K. A., Peterson, B.L., Dahlstrom, G., & Williams, R. B.（1989）. The Cook-Medley Hostility Scale: Item Content and Ability to Predict Survival. Psychosomatic Medicine, 51, 46-57.
Barefoot, J. C., Larsen, S., Lieth, L., & Schroll, M. （1995）. Hostility, Incidence of Acute Myocardial Infarction, and Mortality in a Sample of Older Danish Men and Women. American Journal of Epidemiology, 142（5）, 447-484.
Baum, A., Gatchel, R. J., & Krantz, D. S. （Eds.）. （1997）. Cardiovascular Disorders and Behavior. An Introduction to Health Psychology（pp135-164）. New York: The McGraw-Hill Companies.
Berntson, G. G., Cacioppo, J. T., & Fieldstone, A. （1996）. Illusions, arithmetic, and the bidirectional modulation of vagal control of the heart. Biological Psychology, 44, 1-17.
Brosschot, J. F., & Thayer, J. F. (1998). Anger inhibition, cardiovascular recovery, and vagal function: A model of the link between hostility and cardiovascular disease. Annals of Behavioral Medicine, 20(4), 326-332.
Brownley, K. A., Hurwitz, B. E., Schneiderman, N. (2000). Cardiovascular psychophysiology. In Cacioppo, J. T., Tassinary, L. G. (Eds), Handbook of psychophysiology (2nd ed.). (pp. 224-264). New York : Cambridge University Press.
Buss, A. H., & Durkee, A. （1957）. An Inventory for Assessing Different Kinds of Hostility. Journal of Consulting Psychology, 21（4）, 343-349.
Buss, A. H., Fischer, H. & Simmons, A. J. （1962）. Aggression and Hostility in Psychiatric Patients. Journal of Consulting Psychology, 26（1）, 84-89.
Buss, A.H., & Perry, M.（1992）. Personality Processes and Individual Differences: The Aggression Questionnaire. Journal of Personality and Social Psychology, 63（3）, 452-459.
Cohen, H., Matar, M. A., Kaplan, Z. & Kotler, M.（1999）. Power spectral analysis of heart rate variability in psychiatry. Psychotherapy and Psychosomatics, 68(2), 59-66.
Cook, W. W. & Medley, D. M.（1954）. Proposed Hostility and Pharisaic-Virtue Scales for the MMPI. The Journal of Applied Psychology, 38（6）, 414-418.
Costa, P. T., Krantz, D. S., Blumenthal, J. A., Furberg, C. D., Rosenman, R.H., & Shekelle, R. B.（1987）. Task Force 2:Psychological Risk Factor in Coronary Artery Disease. Circulation, 76, I-145~I-149.
Demaree, H. A., & Everhart, D. E. （2004）. Healthy high-hostiles: reduced parasympathetic activity and decreased sympathovagal flexibility during negative emotional processing. Personality and Individual Differences 36, 457-469
Demaree, H. A., & Harrison, D. W. （1997）. Physiological and neuropsychological correlates of hostility. Neuropsychologia, 35(10), 1405-1411.
Dembroski, T. M., & Costa, P. T. （1987）. Coronary Prone Behavior: Components of the Type A Pattern and Hostility. Journal of Personality, 55（2）, 211-235.
Dembroski, T. M., MacDougall, J. M., Williams, R. B., Haney, T. L., & Blumenthal, J. A.（1985）. Components of Type A, Hostility, and Anger-in: Relationship to Angiographic Findings. Psychosomatic Medicine, 47（3）, 219-233.
Eckhardt, C. I., & Deffenbacher, J. L. （1995）. Diagnosis of Anger Disorders. In H. Kassinove（Ed.）, Anger Disorders: Definition, Diagnosis, and Treatment（pp27-47）. London: Taylor & Francis.
Friedman, H. S., & Booth-Kewley, S. （1987）. The ” Disease-Prone Personality”: A Meta-Analytic View of the Construct. American Psychologist, 42（6）, 539-555.
Friedman, M. & Rosenman, R. H.（1959）. Association of Specific Overt Behavior Pattern with Bolld Cardiovascular Finging. Blood Cholesterol, Blood Clotting Time, Incidence of Arcus Senilis and Clinical Coronary Artery Disease. Journal of American Medical Association, 169, 1286-1296.
Funkenstein, D. H., King, S. H., & Dorlette, M., (1954). The direction of anger during a laboratory stress-inducing situation. Psychosomatic Medicine, 16(5), 404-413.
Gentry, W. D., Chesney, A. P., Kennedy, C. D., Hall, R. P., Gray, H. E. & Harburg, E. (1982). Habitual anger-coping styles:Ⅰ.effect on mean blood pressure and risk for essential hypertension. Psychosomatic Medicine, 44, 195-203.
Goldstein, I. B., & Shapiro, D. (2000). Ambulatory blood pressure in women: Family history of hypertension and personality. Psychological Health Medicine 5, 227-240.
Guyll, M., & Contrada, R. J. (1988). Trait hostility and ambulatory cardiovascular activity: responses to social interaction. Health Psychology, 17(1), 30-39
Harburg, E., Erfurt, J. C., Hauenstein, L. S., Chape, C., Schull, W. J., & Schork, M. A. (1973). Socio-ecological stress, suppressed hostility, skin color, and black-white male blood pressure: Detroit. Psychosomatic medicine, 35, 276-296.
Hayano, J., Sakakibara, Y., Yamada, M., Ohte, N., Fujinami, T., Yokoyama, K., Watanabe, Y., & Takata, K. (1990). Decreased magnitude of heart rate spectral components in coronary artery disease. Its relation to angiographic severity. Circulation,81(4), 1217-24.
Haynes, S. G., Feinleib, M., & Kannel, W. B. （1980）. The Relationship of Psychosocial Factors to Coronary Heart Disease in The Framingham Study: III. Eight-year Incidence of Coronary Heart Disease. American Journal of Epidemiology, 111, 37-58.
Hearn, M., Murray, D., & Luepker, R. （1989）. Hostility, Coronary Heart Disease, and Total Mortality: A 33-year Follow-up Study of University Students. Journal of Behavioral Medicine, 12, 105-121.
Hecker, M. H. L., Chesney, M. A., Black, G. W., & Frautschi, N.（1988）. Coronary-Prone Behaviors in the Western Collaborative Group Study. Psychosomatic Medicine, 50, 153-164.
Helmers, K. F., Krantz, D. S., Howell, R. H., Klein, J., Bairey, C. N., & Rozanski, A. （1993）. Hostility and Myocardial Ischemia in Coronary Artery Disease Patients: Evaluation by Gender and Ischemic Index. Psychosomatic Medicine, 55, 29-36.
Iribarren, C., Sidney, S., Bild, D.E., Liu, K., Markovitz, J.H., Roseman, J.M., & Matthews, K. (2000). Association of hostility with coronary artery calcification in young adults. JAMA, 283(19), 2546-2551.
Krantz, D. S., & Manuck, S. B. (1984). Acute psychophysiologic reactivity and risk for cardiovascular disease: A review and methodologic critique. Psychological Bulletin, 96, 435-464
Leon, G., Finn, S., Bailey, J., & Murray, D. （1987）. The Inability to Predict Cardiovascular Disease form MMPI Special Scales Related to Type-A Patterns. Psychosomatic Medicine, 49, 205.
Sirota, A. D., Schwartz, G. E., & Kristeller, J. L. (1987). Facial muscle activity during induced mood states: differential growth and carry-over of elated versus depressed patterns. Psychophysiology, 24, 691-699.
MacDougall J.M., Dembroski, T. M., Dimsdale, J. E. & Hackett, T. P., (1985). Components of Type A, hostility, and anger-in: Further relationship to angiographic findings. Health Psychology, 4, 137-152.
Matthews, K. A., Glass, D. C. Rosenman, R. H., & Bortner, R. W. （1977）. Competitive Drive, Pattern A and Coronary Heart Disease: A Further Analysis of Some Data form the Western Collaborative Group Study. Journal of Chronic Disease, 30, 489-498.
McCranie, E., Watkins, L., Brandsma, J., & Sisson, B. （1986）. Hostility, Coronary Heart Disease（CAD） Incidence, and Total Mortality: Lack of Association in a 25-year Follow-up Study of 478 Physicians. Journal of Behavioral Medicine, 9, 119-125.
Meesters, C. M. G., & Smulders, J. （1994）. Hostility and Myocardial Infarction in Men. Journal of Psychosomatic Research, 38（7）, 727-734.
Niaura, R., Spiro III, A., Ward, K.D., & Weiss, S. (2002). Hostility, the metabolic syndrome, and incident coronary heart disease. Health Psychology, 21(6), 588-593.
Obrist, P. A. (1981). Cardiovascular psychophysiology: A perspective. New York: Plenum Press.
Pomeranz, B., Macaulay, J.B., Cauill, M.A., Kutz, I., Adam, D., Gordon, D., Kilborn, K.M., Barger, A.C., Shannon, D.C., Cohen, R.J., and Benson, H. (1985). Assessment of autonomic function in humans by heart rate special analysis. American Journal of Physiology, 248, H151-H153.
Porges, S. W., Doussard-Roosevelt, J. A., Maiti, A. K. (1994). Vagal tone and the physiological regulation of emotion. In Fox N (ed), Emotional of the Society for Research in Child Development, 59, 167-186.
Porges, S. W., Doussard-Roosevelt, J. A., Portales, A. L., & Greenspan, S. I. （1996）. Infant regulation of the vagal “brake” predicts child behavior problems: a psychobiological model of social behavior. Developmental Psychobiology, 29, 697-712.
Pruessner, J. C., Kirschbaum, C., Meinlschmid, G., Hellhammer, D. H. (2003). Two formulas for computation of the area under the curve represent measures of total hormone concentration versus time-dependent change. Psychoneuroendocrinology, 28, 916-931
Ragland, D. R., & Brand, R. J. （1988）. Type A Behavior and Mortality from Coronary Heart Disease. The New England Journal of Medicine, 318（2）, 65-69.
Rosenman, R. H., Brand, R. J., Sholtz, R. I., & Friedman, M. （1976）. Multivariate Prediction of Coronary Heart Disease During 8.5 Year Follow-Up in the Western Collaborative Group Study. The American Journal of Cardiology, 37, 903-910.
Sargent, C. A., Flora, S. R., & Williams S. L., (1999). Vocal expression of anger and cardiovascular reactivity within dyadic interaction. Psychological Report, 84, 809-816.
Schum, J. L., Jorgensen, R. S., Verhaeghen, P., Sauro, M., & Thibodeau, R. (2003). Trait Anger, Anger Expression, andAmbulatory Bolld Pressure: A Meta-nalytic Review. Journal of Behavioral Medicine, 26(5), 395-415.
Shekelle, R. B., Gale, M., Ostfeld, A. M., & Paul, O. （1983）. Hostility, Risk of Coronary Disease, and Mortality. Psychosomatic Medicine, 45, 219-228.
Shekelle, R. B., Hulley, S.B., Neaton, J. D., Billings, J. H., Borhani, N. O., & Gerace, T. A. （1985）. The MRFIT Behavior Pattern Study:Type A Behavior and Incidence of Coronary Heart Disease. American Journal of Epidemiology, 122（4）, 559-570.
Siegel, J. M. （1986）. The Multidimensional Anger Inventory. Journal of Personality and Social Psychology, 51（1）, 191-200.
Siegman, A. W., Dembroski, T. M., & Ringel, N. （1987）. Components of Hostility and the Severity of Coronary Artery Disease. Psychosomatic Medicine, 49（2）, 127-135.
Siegman, A. W., Anderson, R., Herbst, J., Boyle, S., & Wilkinson, J. （1992）. Dimensions of Anger-Hostility and Cardiovascular Reactivity in Provoked and Angered Men. Journal of Behavioral Medicine, 15（3）, 257-272.
Siegman, A. W., & Snow, S. C., (1997). The outward expression of anger, the inward experience of anger and CVR: The role of vocal expression. Journal of Behavioral Medicine, 20, 29-45.
Sloan, R. P., Bagiella, E., Shapiro, P. A., Kuhl, J. P., Chernikhova, D., Berg, J., & Myers, M. M. (2001). Hostility, gender, and cardiac autonomic control. Psychosomatic Medicine, 63, 434-440.
Smith, T. W. （1992）. Hostility and Health : Current Status of a Psychosomatic Hypothesis. Health Psychology, 11（3）, 139-150.
Smith, T. W. & Gallo. L. C. （1994）. Psychosocial Influences on Coronary Heart Disease. The Lrish Journal of Psychology, 15（1）, 8-26.
Spielberger, C. D., Johnson, E. H., Russell, S. F., Crane, R. J., Jacobs, G. A. & Worden, T. J. （1985）. The Experience and Expression of Anger: Construction and Validation of Anger Exoression Scale. In M. A. Chesney & R. H. Rosenman （Eds.）, Anger and Hostlity in Cardiovascular and Behavioral Disorders （pp5-30）. New York: McGraw-Hill.
Suarez, E. C., & Williams, R. B. （1989）. Situational Determinants of Cardiovascular and Emotional Reactivity in High and Low Hostile Men. Psychosomatic Medicine, 51, 404-418.
Task Force of The European Society of Cardiology and The North American Society of Pacing and Electrophysilogy. (1996) Heart rate variability. European Heart Journal,17, 354-381
Thayer, J. F., Friedman, B. H., & Borkovec, T. D. (1996). Autonomic characteristics of generalized anxiety disorder and worry. Society of Biological Psychiatry, 39, 255-266.
Thoresen, C. E., & Powell, L. H. （1992）. Type A Behavior Pattern: New Perspectives on Theory, Assessment, and Intervention. Journal of Consulting and Clinical Psychology, 60（4）, 595-604.
Williams, R. B., Haney, T. L., Lee, K. L., Kong, Y. H., Blumenthal, J. A., & Whalen, R. E. （1980）. Type A Behavior, Hostility, and Coronary Atherosclerosis. Psychosomatic Medicine, 42（6）, 539-549.