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研究生:翁欣凱
研究生(外文):Wung, Sing-Kai
論文名稱:重複性思考、睡前激發狀態和睡眠品質之關聯性探討
論文名稱(外文):Relationships Between Repetitive Thought, Pre-sleep Arousal And Sleep Quality
指導教授:葉在庭葉在庭引用關係
指導教授(外文):Yeh, Zai-Ting
口試委員:楊建銘韓德彥王元凱
口試委員(外文):Yang, Chien-MingHan, Der-yanWang, Yuan-Kai
口試日期:2012-07-06
學位類別:碩士
校院名稱:輔仁大學
系所名稱:臨床心理學系碩士班
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:2012
畢業學年度:100
語文別:中文
論文頁數:87
中文關鍵詞:重複性思考反芻性思考憂慮睡眠品質睡前激發狀態
外文關鍵詞:repetitive thoughtruminationworrysleep qualitypre-sleep arousal
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研究目的 重複性思考特質與心理疾病的研究已由憂鬱、焦慮等疾患拓展到失眠相關領域,其中反芻性思考、憂慮與睡眠的關聯是研究的焦點之一。依照Perlis等人(1997)提出的神經認知模型,重複性思考影響睡眠的可能機制為睡前激發程度的增加。本研究以成年早期族群的受試者為研究對象,探討反芻性思考、憂慮、睡前激發狀態與睡眠品質之間的關聯,並於研究一和研究二中分別檢驗睡前激發狀態與睡眠品質的主觀指標和客觀指標。藉以探討:(1)反芻性思考、憂慮與睡眠品質的關聯;(2)反芻性思考、憂慮和睡前激發狀態的關聯;(3)睡前激發狀態與睡眠品質的關聯;進而探討在反芻性思考、憂慮對睡眠品質的預測中,睡前激發狀態的中介效果,藉以推論反芻性思考、憂慮與睡眠品質關聯間的可能機制。

方法 研究一之目的為探討反芻性思考、憂慮與主觀睡前激發狀態、主觀睡眠品質的關聯,受試者為202名大學生 (72男,130女),塡答反芻性反應量表(Ruminative response style questionnaire, RRS)、賓州憂慮量表(Penn state worry questionnaire, PSWQ)、睡前激發程度量表(Pre-sleep Arousal Scale, PSAS)與匹茲堡睡眠品質量表(Pittsburgh sleep quality index, PSQI),檢驗各量表得分之間的關聯。
  研究二之目的為探討反芻性思考、憂慮與客觀睡前激發狀態、客觀睡眠品質的關聯,使用貝克憂鬱量表第二版(Beck Depression Inventory-second edition, BDI-II)與貝克焦慮量表(Beck Anxiety Inventory, BAI)排除中度以上憂鬱或焦慮的受試者後,隨機挑選受試者進行訪談、連續七天的活動腕錶紀錄與一個晚上的多頻道睡眠紀錄篩選,直到30名受試者(9男,21女)符合納入標準,檢驗客觀睡眠測量與各量表得分之間的關聯。

結果 研究一將反芻性反應量表與賓州憂慮量表的題項進行因素分析後,得到三個因子:負面主題性思考、擔憂性思考與主動的認知評估,睡前認知激發分量表與三個因子的相關均達顯著,睡前生理激發分量表與負面主題性思考、擔憂性思考的相關均達顯著,匹茲堡睡眠品質量表總分與三個因子的相關亦均達顯著。在排除中度以上憂鬱或焦慮的受試者後,匹茲堡睡眠品質量表總分與負面主題性思考、擔憂性思考的相關仍達顯著,顯示負面主題性思考與擔憂性思考的得分愈高,可預測睡前激發程度愈高、主觀睡眠品質愈差,而迴歸分析與結構方程模型的分析結果支持睡前激發程度為重複性思考預測睡眠品質的中介變項。
  研究二的結果顯示在活動腕錶的測量上,負面主題性思考與入睡後清醒時間增加、睡眠效率減少之相關達臨界的顯著,擔憂性思考與入睡時距增加之相關達顯著,睡前認知激發與入睡時距增加之相關達顯著,睡前生理激發與入睡時距增加、睡眠效率減少之相關達顯著。多頻道睡眠紀錄的測量上,擔憂性思考與入睡時距增加之相關達顯著,而睡眠起始階段的睡前生理激發與腦電圖beta-1活動增加之相關達顯著。

結論 本研究探討反芻性思考、憂慮與睡眠品質的關聯,結果顯示經因素分析萃取後的反芻性思考因子中,負面主題性思考和擔憂性思考特質愈高,可預測愈高的睡前激發程度,睡前激發程度愈高可預測較差的主觀睡眠品質,且睡前激發狀態為重複性思考特質對主觀睡眠品質預測的中介變項,而活動腕錶測得的結果亦支持負面主題性思考、擔憂性思考與睡眠起始或維持困難有關。可推論反芻性思考與憂慮這兩種清醒狀態下的認知特質,對於身心的影響會透過睡前激發程度的增加而延續到清醒與睡眠的轉換階段,進而對睡眠造成影響。

Introduction: Research about repetitive thought and mental disorders has been extended form depressive and anxiety disorders to insomnia, and many studies focus on the relationship between rumination, worry and sleep quality. According to the neurocognitive model of insomnia proposed by Perlis et al.(1997), the effect of repetitive thought on sleep may be mediated by increased pre-sleep arousal. The participants of this study are young adults. The purpose of this study is to investigate the relationships between rumination, worry, pre-sleep arousal and sleep quality. The measurements of subjective pre-sleep arousal and subjective sleep quality in study 1 are self-report questionnaires. The measurements of objective pre-sleep arousal are polysomnography in study 2, and measurements of objective sleep quality are actiwatch and polysomnography. This study explored both subjective and objective measurements to examine: 1)the relationships between rumination, worry and sleep quality, 2) the relationships between rumination, worry and pre-sleep arousal, and 3) the relationships between pre-sleep arousal and sleep quality, then we examined the mediator effect of pre-sleep arousal between the prediction from rumination and worry to sleep quality.

Method Study 1:The participants were 202 college students (130 women, age between 18-30). They finished the following self-report questionnaires: Ruminative response style questionnaire (RRS), Penn state worry questionnaire (PSWQ), Pre-sleep arousal scale (PSAS) and Pittsburgh sleep quality index (PSQI).
Study 2: The participants were 30 college students (21 women, age between 18-22) randomly selected form study 1 after ruling out moderate to severe depression or anxiety by Beck depression inventory-second edition (BDI-II) and Beck anxiety inventory (BAI). And they finished consecutive 7 days of actiwatch record and one night polysomnography record.

Results Study 1: After factor analysis of RRS and PSWQ, three factors retained: dwelling on the negative, worry engagement and active cognitive appraisal. The following correlations with pre-sleep cognitive arousal were significant: dwelling on the negative, worry engagement and active cognitive appraisal. The following correlations with pre-sleep somatic arousal were significant: dwelling on the negative and worry engagement. The following correlations with PSQI global score were significant: dwelling on the negative, worry engagement and active cognitive appraisal. The following correlations with PSQI global remained significant after ruling out moderate to severe depression and anxiety: dwelling on the negative and worry engagement. The results suggest that people with higher score of dwelling on the negative or worry engagement would experience higher level of pre-sleep arousal and poorer subjective sleep quality. The results of regression analysis and structure equation model (SEM) analysis support pre-sleep arousal is a mediator between the prediction from repetitive thought to sleep quality.
Study 2: For actiwatch, dwelling on the negative was marginally correlated with increased wake after sleep onset and with decreased sleep efficiency. Worry engagement was correlated with increased sleep latency measured. Pre-sleep cognitive arousal was correlated with increased sleep latency. Pre-sleep somatic arousal was correlated with increased sleep latency and decreased sleep efficiency. For polysomnography, worry engagement was correlated with increased sleep latency. In sleep onset period, pre-sleep somatic arousal was correlated with increased EEG beta-1 activity.

Conclusion: This study examined the relationships between rumination, worry and sleep quality. The results suggest dwelling on the negative and worry engagement can predict higher pre-sleep arousal, pre-sleep arousal can predict poor subjective quality, and pre-sleep arousal is the mediator between the effect of repetitive thought on sleep quality. The results of actiwatch suggest that dwelling on the negative and worry engagement are correlated more severe sleep initiate or maintenance difficulity. We can postulate that the psychophysiological effect of rumination and worry would be extended by increased pre-sleep arousal, and further impact on sleep quality.

第一章 緒論
第二章 文獻回顧
 第一節 失眠的神經認知模型
 第二節 反芻性思考的相關研究
 第三節 憂慮的相關研究
 第四節 反芻性思考、憂慮與睡眠
 第五節 睡前激發狀態與睡眠
 第六節 研究目的與假設
第三章 研究方法與研究結果
 第一節 研究一:主觀睡前激發與睡眠品質的探討
 第二節 研究二:客觀睡前激發與睡眠指標的探討
第四章 綜合討論
 第一節 反芻性思考與憂慮
 第二節 反芻性思考、憂慮與睡眠品質
 第三節 睡前激發狀態的中介效果
 第四節 反芻性思考、憂慮與客觀睡眠指標
 第五節 結論
第五章 研究貢獻、限制與未來研究方向
 第一節 研究貢獻
 第二節 研究限制
第三節 未來研究方向………………………………………………………..70
參考文獻……………………………………………………………………………..71

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