(3.238.96.184) 您好!臺灣時間:2021/05/08 21:29
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果

詳目顯示:::

: 
twitterline
研究生:張凱評
研究生(外文):Kai-Ping Chang
論文名稱:以基模糾結模式探討憂鬱傾向之偏頭痛患者的解釋偏差
論文名稱(外文):Based on schema enmeshment model to investigate interpretation bias on migraine patients with depressive symptoms
指導教授:洪福建洪福建引用關係
指導教授(外文):Fu-Chien Hung
學位類別:碩士
校院名稱:中原大學
系所名稱:心理學研究所
學門:社會及行為科學學門
學類:心理學類
論文種類:學術論文
論文出版年:2011
畢業學年度:99
語文別:中文
論文頁數:128
中文關鍵詞:情緒促發自我參照解釋偏差基模糾結模式憂鬱偏頭痛基模
外文關鍵詞:DepressionMigraineschema enmeshment modelmood inductioninterpretation biasself-reference
相關次數:
  • 被引用被引用:2
  • 點閱點閱:496
  • 評分評分:系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔
  • 下載下載:100
  • 收藏至我的研究室書目清單書目收藏:2
ㄧ 研究背景與目的:
流行病學研究指出偏頭痛與憂鬱具有雙向關係,因此偏頭痛與憂鬱的關係常被研究。目前慢性疼痛的憂鬱研究在理論上仍以負向自我基模或自尊理論為主,然而這些憂鬱理論應用於慢性疼痛的憂鬱研究可能不足,因為除了考量負向自我觀點之外,亦應考量疼痛或疾病如何與自我互動而導致憂鬱。本研究欲探討Pincus &; Morley (2001)提出的基模糾結模式,該理論提出疼痛、疾病、自我基模糾結程度不同對患者適應程度亦不同的觀點,因此比一般憂鬱理論更能清楚瞭解偏頭痛與憂鬱的互動關係。另外,自我參照編碼(encoding)是一種強大的編碼方式,能精緻化訊息、整合記憶系統。Wisco(2009)認為憂鬱患者在自我參照情境會對負向刺激有偏差,而非憂鬱個體則對正向刺激有所偏好,因此本研究加入自我參照的探討,瞭解憂鬱組與非憂鬱組在自我參照編碼是否有不同
的解釋偏差。

二 研究方法:
本研究共選取59位偏頭痛患者,以BDI-II分數界定29名為憂鬱組、30名為非憂鬱組,然後先給予受試情緒促發然後再進行語句完成作業。每組需同時接受疾病、疼痛、自我語句三類語句,並由評分者判斷該語句正向、中性、負向語句性質。接著,加入自我參照探討,憂鬱組、非憂鬱組各約一半受試接受自我參照、非自我參照操弄,並由評分者判斷健康語句之正向、中性、負向語句性質。

三 研究結果:
研究發現,偏頭痛憂鬱組較非憂鬱組在疾病及自我語句上反映較多負向語句完成,較少中性疼痛、疾病及正向自我語句完成。另外,在自我參照操弄發現,偏頭痛憂鬱組患者在非自我參照下有較多正向性質健康語句。

四 結論:
偏頭痛憂鬱組較非憂鬱組在三類基模有較多負向解釋偏差,顯示憂鬱組在三類基模彼此糾結。另外,當偏頭痛產生憂鬱情緒時,臨床工作者盡量少讓患者涉入自我負向經驗,可能減少患者焦慮、憂鬱程度、提高自尊,使三類基模糾結程度較小。


1.Introduction:
The bi-direction relationship had been proven by the researches of epidemiology field. Now the main theme of researches about chronic pain with depression still focused on negative self schema or self esteem theory. But the fitness of these explanations about chronic pain with depression was not satisfied. Because the interaction process between pain and self should be studied together also, not only negative schema itself. This research would discuss the schema enmeshment model by Pincus & Morley(2001) who proposed that the level of enmeshed between pain, disease and self schema could affect the quality of patient’s adaptation. This theory could explain better about the interaction process between pain and depression than other theories.Otherwise, the self-reference encoding is a powerful coding process which can refine the massage integrate the memory systems. Wisco(2009) proposed that bias of negative stimulus would emerge but not the preference of positive stimulus in self reference situations by depression patients. Therefore this study tried to understand the difference of the interpretation bias between the depression patients and non-depression patients through the process of self reference
encoding.

2.Method:
We collected fifty-nine migraine patients and divided into two groups by BDI-II scores (depression group: twenty-nine persons. Non-depression group: thirty persons). And then we arrange them take the mood induction manipulations and sentence completion tasks. And after the half patients of depression and non-depression groups take the self- reference manipulations and non-self reference manipulations, the experimenters would judge the quality of sentences about the level
of positive, negative or natural.

3.Results:
We discovered that migraine patients would have more negative sentences in disease and self reference situations, and although have positive sentences in non-self reference situations.

4.Conclusions:
Migraine with depression patients have more negative interpretation bias against non-depression patients. This study demonstrates the enmeshment relationships of these three schemas of depression patients. And we suggested the clinical workers could reduce the patients’ involvements of negative self schema when they have pain-induced depression. If the patients’ anxiety, depression and self -esteem improve, the level of enmeshment between these three schemas would
decrease.


目 錄
摘要…………………………………………………………………………………I
Abstract……………………………………………………………………………III
誌謝…………………………………………………………………………………V
目錄…………………………………………………………………………………VI
表目錄………………………………………………………………………………IX
圖目錄………………………………………………………………………………XII

第一章 緒論………………………………………………………………………1
ㄧ、研究動機………………………………………………………………1
二、研究目的………………………………………………………………3

第二章 文獻探討…………………………………………………………………4
第一節 偏頭痛之定義………………………………………………………4
ㄧ、偏頭痛的類別…………………………………………………………4
二、偏頭痛的生理機轉……………………………………………………6
三、偏頭痛盛行率以及與憂鬱的共病……………………………………6
第二節 慢性疼痛的憂鬱症理論……………………………………………8
ㄧ、憂鬱症的心理病理理論………………………………………………8
二、 Pincus 的基模糾結理論……………………………………………10
第三節 慢性疼痛的訊息處理研究現況……………………………………15
ㄧ、慢性疼痛的訊息處理相關研究………………………………………15
二、自陳式研究外的另一種選擇:訊息處理研究 ………………………25
第四節 憂鬱患者的解釋偏差………………………………………………26
ㄧ、憂鬱的解釋偏差概念與相關研究……………………………………26
二、慢性疼痛患者的解釋偏差與相關研究………………………………30
第五節 自我參照編碼………………………………………………………32
ㄧ、自我參照編碼…………………………………………………………32
二、自我參照可能在憂鬱研究具有重要性………………………………33
三、訊息處理研究取向在自我參照上的現況……………………………34
四、慢性疼痛憂鬱患者的自我參照編碼…………………………………35
第六節 情緒促發作業………………………………………………………36
ㄧ、情緒促發作業在傳統憂鬱研究的重要性……………………………36
二、情緒促發作業應用於慢性疼痛………………………………………37
第七節 研究架構與假設……………………………………………………38

第三章 研究方法…………………………………………………………………42
第一節 研究設計……………………………………………………………42
第二節 研究對象……………………………………………………………42
第三節 研究程序……………………………………………………………46
第四節 研究工具……………………………………………………………48

第四章 研究結果…………………………………………………………………52
第一節 臨床變項之檢定 ……………………………………………………52
第二節 各臨床變項之相關分析 ……………………………………………56
第三節 語句完成分析 ………………………………………………………61
第四節 自我參照效果分析 …………………………………………………71

第五章 綜合討論與建議…………………………………………………………76
第一節 研究結果與整理 ……………………………………………………76
第二節 綜合討論 ……………………………………………………………80
第三節 研究貢獻、限制、未來研究方向 …………………………………92
參考文獻……………………………………………………………………………97

附錄
附錄一、無預兆偏頭痛、有預兆偏頭痛、慢性偏頭痛之診斷準則………105
附錄二、研究者評分指南……………………………………………………107
附錄三、頭痛患者基本資料…………………………………………………108
附錄四、偏頭痛失能評估問卷(MIDAS 問卷)………………………………110
附錄五、自我喜愛/自我能力量表-修正版(SLCS-R)………………………111
附錄六、語句完成測驗-自我參照組………………………………………112
附錄七、語句完成測驗-非自我參照組……………………………………114
附錄八、視覺類比量表………………………………………………………116

圖表目錄
表目錄
表2-3-1 基模糾結理論模式相關研究……………………………………………21
表2-4-1 憂鬱的解釋偏差研究……………………………………………………28
表2-5-1 處理深度以及憂鬱認知…………………………………………………35
表2-5-2 各項作業的自我參照方式………………………………………………36
表3-2-1 受試者性別分佈…………………………………………………………43
表3-2-2 受試者年齡分佈…………………………………………………………44
表3-2-3 受試者學歷………………………………………………………………44
表3-2-4 受試者宗教別……………………………………………………………45
表3-2-5 受試者婚姻狀態…………………………………………………………45
表3-2-6 受試者社會關係…………………………………………………………46
表3-3-1 三類基模的語句呈現順序………………………………………………47
表4-1-1 受試者近三個月主觀疼痛程度…………………………………………52
表4-1-2 受試者近三個月來每星期大頭痛天數…………………………………53
表4-1-3 受試者近三個月來每星期小頭痛天數…………………………………53
表4-1-4 受試者近三個月來頭痛天數(含大、小頭痛)…………………………54
表4-1-5 受試者頭痛惡化後的年數………………………………………………54
表4-1-6 受試者MIDAS分數………………………………………………………55
表4-1-7 受試者BDI-II分數 ……………………………………………………55
表4-1-8 受試者BAI分數…………………………………………………………55
表4-1-9 受試者SLCS-R分數 ……………………………………………………56
表4-2-1 各臨床變項之相關………………………………………………………58
表4-2-2 各臨床變項與語句完成性質之相關……………………………………60
表4-3-1 組別在情緒觸發前後之效果……………………………………………61
表4-3-2 組別X情緒觸發前後之變異數分析摘要表……………………………62
表4-3-3 組別在情緒觸發效果之差異……………………………………………62
表4-3-4 正向性質語句共變數分析摘要表………………………………………64
表4-3-5 正向語句描述統計………………………………………………………64
表4-3-6 正向語句之單純主要效果摘要表………………………………………65
表4-3-7 中性性質語句共變數分析摘要表………………………………………66
表4-3-8 組別在中性語句之單純主要效果摘要表………………………………67
表4-3-9 中性語句描述統計………………………………………………………68
表4-3-10 負向語句描述統計 ……………………………………………………68
表4-3-11 負向性質語句共變數分析摘要表 ……………………………………69
表4-3-12 組別在負向語句之單純主要效果摘要表 ……………………………70
表4-4-1 正向性質健康語句共變數分析摘要表…………………………………71
表4-4-2 正向健康語句之單純主要效果摘要表…………………………………72
表4-4-3 正向健康語句描述統計…………………………………………………73
表4-4-4 中性性質健康語句共變數分析摘要表…………………………………73
表4-4-5 中性健康語句之單純主要效果摘要表…………………………………74
表4-4-6 中性健康語句描述統計…………………………………………………74
表4-4-7 負向性質健康語句共變數分析摘要表…………………………………75
表4-4-8 負向健康語句描述統計…………………………………………………75
表5-1-1 正向語句之假設與研究結果對照表……………………………………76
表5-1-2 中性語句之假設與研究結果對照表……………………………………77
表5-1-3 負向語句之假設與研究結果對照表……………………………………77
表5-1-4 正向語句自我參照之假設與研究結果對照表…………………………78
表5-1-5 中性語句自我參照之假設與研究結果對照表…………………………78
表5-1-6 負向語句自我參照之假設與研究結果對照表…………………………79
表5-2-1 訊息處理偏差相關研究比較……………………………………………82
表5-2-2 各性質語句之主要效果摘要表…………………………………………86
表5-2-3 各性質語句之單純主要效果摘要表……………………………………86
表5-3-1 不同來源偏頭痛憂鬱患者之解釋偏差可能……………………………94

圖目錄
圖一 各種基模糾結程度對適應的影響……………………………………………13
圖二 基模糾結模式的訊息處理偏差………………………………………………14
圖三 研究程序流程…………………………………………………………………46
圖四 正向語句交互作用……………………………………………………………65
圖五 中性語句交互作用……………………………………………………………67
圖六 負向語句交互作用……………………………………………………………69
圖七 正向健康語句交互作用………………………………………………………72
圖八 中性健康語句交互作用………………………………………………………74
圖九 自我調節模式…………………………………………………………………88
圖十 連結自我調節理論與解釋偏差………………………………………………89

參考文獻
中文部分
台灣頭痛學會(2004)。國際頭痛疾病分類中文版第二版。

台灣頭痛學會(2006)。預兆是什麼?為什麼會發生?。頭痛電子報,41,1-3。

車先蕙、盧孟良、陳錫中、張尚文、李宇宙(2006)。中文版貝克焦慮量表之信效度。台灣醫學,10(4),447-454。

陳怡誠、陳怡安譯(2010)。頭痛的診斷與治療。台北市:合記。

陳韋達(2007)。預兆偏頭痛。台灣頭痛學會頭痛電子報,49,1-4。

盧孟良、車先蕙、張尚文、沈武典(2002)。中文版貝克憂鬱量表第二版之信度和效度。台灣精神醫學,16(4),
301-309。

劉樹斐(1999)。自尊的多面向對大學生憂鬱與攻擊行為的影響。國立政治大學心理學系碩士論文。

洪錦益(2006)。頭痛、憂鬱與焦慮。台灣頭痛學會頭痛電子報,37,1-3。

中國行為科學社 (2001)。貝克憂鬱量表第二版(中文版)。台北市:中國行為科學社。

中國行為科學社(2000)。貝克焦慮量表(中文版)。台北市:中國行為科學社。

身心醫學:基礎照顧手冊。(陳美君、林宜美譯) (2006)。台北:五南出版社。(原著出版年﹕2002年)。

認知治療的實務手冊-以處理憂鬱與焦慮為例。(姜忠信、洪福建譯)(2000)。台北:揚智出版社。(原著出版年﹕2000年)。

邱嘉玲(2008)。鬱症患者認知易脆性與負向情緒持續之探討。私立中原大學心理學系碩士論文。

翁嘉英(1997)。失能慢性病患之自我評價歷程與自尊感對其初期因應策略的影響。台大心理學系博士論文。

英文部分
Asmundson, G.J.G., Kuperos, J.L., & Norton, G.R.(1997). Do patients with chronic pain selectively attend to pain-related information? Preliminary evidence for the mediating role of fear. Pain, 72,27-32.

Asmundson, G.J.G., Carleton, R., & Nicholas; E.J.( 2005). Dot-probe evaluation ofselective attentional processing of pain cues in patients with chronic headaches.Pain, Vol 114(1-2), Mar,. pp. 250-256.

Barton, S. B., Houghton, P., & Morley, S.(2005). Quantifiers in depressed future thinking: All of the future will be bleak, but some of it will be good. Cognition and Emotion, 19, 1083-1094.

Baskin, S.M., Lipchik, G.L.,& Smitherman,T.A.(2006). Mood and Anxiety Disorders in Chronic Headache.Headache.46.76-87.

Beck, A. T. (1976). Cognitive therapy and the emotional disorder. New York: International Universities Press.

Bower, G. H.(1981). Mood and memory. American Psychologist, 36,129-148.

Bower, G. H. (1983). Affect and cognition. Philosophical Transactions of the Royal Society of London, Series B, 302, 387-402.

Breslau, N.(1998).Psychiatric comorbidity in migraine.Cephalalgia.18,56-61.

Brockner, J., & Guare, J.(1983). Improving the performance of low self-esteem individuals: An attributional approach. Academy of Management Journal, 26,642-656.

Busch, H., Montgomery, W., Melin, B., & Lundberg, U.( 2006). Visuospatial and Verbal Memory in Chronic Pain Patients: An Explorative Study. Pain Practice,6,179-185.

Calfas, K.J., Ingram, R.E., & Kaplan, R.M.(1997). Information processing and affective distress in osteoarthritis patients, Journal of Consulting and Clinical Psychology, 65,576-581.

Caver,C. S., Scheier,M.F., & Pozo,C.(1992).Concepualizing the process of coping with health problems. In S. Horward, & Friedman(Eds.). Hostitly, coping, & health (pp.167-187).Washington DC:American Psychological Association.

Dehghani, M., Sharpe, L., & Nicholas, M.K. (2003). Selective attention to pain- related information in chronic musculoskeletal pain patients. Pain, 105, 37-46.

Dubuisson, D., & Melzack, R.( 1976). Classification of clinical pain descriptions by multiple group discriminant analysis. Experimental Neurology, 51, 480-487.

Eccleston, C., & Crombez, G.(1999). Pain demands attention: A cognitive-affective model of the interruptive function of pain.Psychological Bulletin, 125, 356-366.

Edwards, L.C., & Pearce, S.A. (1994). Word completion in chronic pain:Evidence for schematic representation of pain? Journal of Abnormal Psychology, 103,379-382.

Glover, V., Jarman, J., & Sandler M.(1993). Migraine and depression:Biological aspects. Journal of Psychiatric Research, 27, 223-231.

Grisart, J. M., & Plaghki, L. H.( 1999). Impaired selective attention in chronic pain patients. European Journal of Pain, 3, 325-333.

Hamelsky, S.W., & Lipton, R.B. (2006). Psychiatric comorbidity of migraine.Headache, 46, 1327-1333.

Hung PH, Fuh JL,& Wang SJ.(2006).Validity, reliability and application of the Taiwan version of the migraine disability assessment questionnaire.Journal of the Formosan Medical association, 105, 563-568.

Ingram, R. E., Miranda, J., & Segal, Z. V.(1998). Cognitive vulnerability to depression. New York: Guilford Press,.

Klein, S. B.,& Kihlstrom, J. F.(1986). Elaboration, organization, and the self-reference effect in memory. Journal of Experimental Psychology, 115, 26-38.

Kovacs, M., & Beck, A.T.(1978). Maladaptive cognitive structures in depression. The American Journal of Psychiatry, 135,525-533.

Kuiper, N. A., Derry, P. A., & MacDonld, M. R. (1982). Self reference and person perception in depression: A social cognition perspective. In G. Weary & H. Mirels (Eds.), Intergrations of Social and Clinical Psychology.New York: Oxford University Press.

Lantéri-Minet, M., Radat, F., Chautard, M-H., & Lucas, C.(2005). Anxiety and depression associated with migraine: Influence on migraine subjects'disability and quality of life, and acute migraine management. Pain, 118, 319-326.

Lawson, C., & MacLeod, C. (1999). Depression and the interpretation of ambiguity.Behaviour Research and Therapy, 37, 463-474.

Lawson, C., MacLeod, C., Hammond, G., (2002). Interpretation revealed in the blink of an eye: Depressive bias in the resolution of ambiguity. Journal of Abnormal Psychology, 111, 321-328.

Lau, R.R., & Hartman, K.A.(1983). Common sense representations of common illnesses. Health Psychology, 2, 167-185.

Leventhal, H., Meyer, D., & Nerenz, D. R. (1980). The common sense representation of illness danger. In S.Rachman (Ed.), Medical Psychology,Volume II. New York:Pergamon Press.

Lipton, R. B., Stewart, W.F., Diamond, S., Diamond, M.L.,& Reed, M.(2001).Prevalence and burden of migraine in the United States: date from the American migraine study II. Headache. 41, 646-657.

McWilliams, L. A.,, Goodwin, R. D., Cox, B. J. (2004). Depression and anxiety associated with three pain conditions: results from a nationally
representative sample.

Melzack, R., & Wall, P. D. (1965). Pain mechanisms: A new theory. Science,150, 971-979.

Melzack, R. (1975). The McGill pain questionnaire:Major properties and scoring methods. Pain, 1, 277-299.

Melzack, R. (1987). The short-form McGill pain questionnaire. Pain, 30, 191-197.

Melzack, R., & Katz, J. (1992). The McGill Pain Questionnaire: Appraisal and current status. InD.C.Turk & R. Melzack, (Eds.), Handbook of pain assessment (pp. 152-168). New York: Guilford Press.

Meyer, D., Leventhal, H., & Gutmann. (1985). Common-sense models of illness: The example of hypertension. Health Psychology, 4, 115-135.

Mogg, K., Bradbury, K.E., & Bradley, B. P. (2006). Interpretation of ambiguous information in clinical depression. Behaviour Research and
Therapy,44,1411-1419.

Pincus, T., & Morley, S.(2001).Cognitive-processing bias in chronic pain: a review and integration. Psychological Bulletin, 27, 599-617.

Pincus, T., & Newman, S.(2001). Recall bias, pain, depression and cost in back pain patients.British Journal of Clinical Psychology, 40, 143- 156.

Pincus, T., Santos, R., Morley, S. (2007). Depressed cognitions in chronic pain patients are focused on health: Evidence from a sentence completion task.Pain,130, 84-92.

Read, J., & Pincus, T.(2004). Cognitive bias in back pain patients attending osteopathy: Testing the enmeshment model in reference to future thinking. European Journal of Pain, 8, 525-531.

Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press.

Rogers, T. B., Kuiper, N. A., & Kirker, W. S.(1977). Self-reference and the encoding of personal information. Journal of Personality and Social Psychology, 35, 677-688.

Rehm, L.P., & Naus, M. J. (1990). A memory model of emotion. In R. E. Ingram (Ed.), Contemporary psychological approaches to depression: Theory,
research,and treatment(pp. 23-35). New York: Plenum Press.

Scher, C.D.,Ingram, R.E., & Segal, Z.V.( 2005). Cognitive reactivity and vulnerability:Empirical evaluation of construct activation and cognitive
diatheses in unipolar depression. Clinical Psychology Review, 25, 487-510.

Segal, Z.V., & Ingram, R.E.(1994). Mood priming and construct activation in tests of cognitive vulnerability to unipolar depression. Clinical Psychology Review,14,663- 695.

Segal, Z. V., Lau, M. A., Rokke, P. D.(1999). Cognition and emotion research and the practice of cognitive–behavioural therapy. In: T. Dalgleish & M. J. Power (Eds.),

Handbook of cognition and emotion.(pp.705-726).Chichester, England: Wiley.

Symons, C. S., & Johnson, B. T.(1997). The self-reference effect in memory: A meta-analysis.Psychological Bulletin, 121, 371-394.

Tafarodi, R. W., & Swann, W. B., Jr. (1995). Self-liking and self-competence asdimensions of global self-esteem: Initial validation of a Measure. Journal of Personality Assessment, 65, 322-342.

Tafarodi, R. W., & Swann, W. B., Jr. (2001). Two-dimentional self-esteem:theory and measurement. Personality and individual differences, 31, 653-673.

Timbremont, B., & Braet, C. (2004). Cognitive vulnerability in remitted depressed children and adolescents. Behaviour Research and Therapy, 42 ,423-437.

Wang S-J., Fuh J-L., Young Y-H ., Lu S-R, & Shia B-C.(2001). Frequency and predictors of physician consultations for headache. Cephalalgia, 21:25-30.

Wang S-J, Fuh J-L, Lu S-R, & Juang K-D. (2001).Quality of life differs among headache diagnoses: analysis of SF-36 survey in 901 headache patients.Pain ,89,285–292.

Wang S-J, Fuh J-L, Juang K-D, & Lu S-R. (2009). Migraine and suicidal ideation in adolescents aged 13 to 15 years. Neurology, 72, 1146-1152.

Wells, H. J., Pincus, T., McWilliams, E. (2003). Information processing biases among chronic pain patients and ankylosing spondylitis patients: The impact of diagnosis. European Journal of Pain, 7, 105-111.

Williams,J.M., Watts,f.n., MacLeod,C., & Mathews, A. (1997). Cognitive psychology and emotion disorder.Chichester, England: Wiley.

Wisco,B. E. (2009). Depressive cognition: Self-reference and depth of processing.Clinical Psychology Review, 29, 382-392.

QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
系統版面圖檔 系統版面圖檔