臺灣博碩士論文加值系統

研究目的：在現今高壓力與忙碌的社會中，失眠是很常見的問題。在國外的失眠的相關調查結果顯示，失眠的盛行率會受對於失眠定義之嚴謹程度影響，而有大範圍的變異，其範圍約落在6~48%。當定義符合臨床上之診斷標準時，失眠盛行率約降至6~15%。因此，受失眠之苦的個體中，有一大部分可能未達診斷標準，而為暫時性或急性失眠之患者。然而過去的研究大多將重點聚焦在符合失眠疾患診斷的失眠族群上，針對剩下雖未符合失眠疾患診斷標準，但又飽受失眠症狀困擾之群體，卻是缺乏探討。此外，失眠的縱貫研究中也發現，暫時性失眠個體到最後會有一部份會發展成為慢性失眠。因此，針對這群為數不少，且容易經歷暫時性失眠之個體，若能更加了解其暫時性失眠發生的成因與相關機制，便能及早介入，協助個體不落入慢性失眠的惡性循環中。過去研究發現，暫時性失眠的發生，最常見的促發因素為壓力事件。Drake、Richardson、Roehrs、Scofield與Roth（2004）便發展出福特壓力失眠反應量表（Ford Insomnia Response to Stress Test, FIRST）來測量個體特質上遭遇壓力情境的睡眠脆弱程度；且研究結果也發現個體身心激發程度是和睡眠脆弱特質息息相關的因素之一。由於過去在失眠的相關研究中，少有研究探討暫時性失眠的相關機制，因此，本研究從和暫時性失眠相關的壓力下睡眠脆弱特質出發，探討此脆弱特質與過度激發的關聯性，並欲探討其他會提升激發程度的相關認知與情緒因子，如：失功能信念、情緒反應性、反芻特質、情緒遲惰特質和此特質間的關係。本研究假設個體對於睡眠的失功能信念與對負向事件的情緒反應性可能會透過提高睡前身心的激發程度，而使個體容易經歷壓力下的急性失眠，增加睡眠的脆弱性；即睡前身心激發程度在睡眠的失功能信念與情緒反應性對睡眠脆弱性的關係間扮演一中介作用之角色。另外，也假設睡眠的失功能信念與情緒反應性與睡前身心激發程度間的關係，會分別受反芻特質與情緒遲惰特質調節，即具有高反芻特質與高情緒遲惰特質者，其睡眠的失功能信念與情緒反應性與睡前身心激發程度間的關係更強烈，因此在壓力下，其有較高的睡眠脆弱性，容易經歷暫時性失眠。
研究方法：本研究於大學中招募60位20~35歲之受試者（男：22位；女：38位），經晤談以確認受試者符合收案標準後，將請受試者填寫研究相關問卷（包含：壓力下失眠反應量表、反芻型反應風格短版量表、睡前激發程度量表、睡眠失功能信念及態度簡式量表、情緒反應量表、失眠嚴重度量表、貝克憂鬱量表第二版與貝克焦慮量表）；並在詳細解釋情緒經驗取樣流程後，請受試者回到日常生活環境中進行連續三天的情緒遲惰經驗取樣紀錄。
研究結果：根據執行檢驗中介效果步驟的階層迴歸與Sobel test的分析結果，睡前認知激發程度對擔憂的失功能信念與情緒持續性和睡眠脆弱性間的關係具中介的作用；即對睡眠有過度擔憂的失功能信念、情緒持續性較久皆可能會提高睡前認知激發程度而增加壓力下的睡眠脆弱性。其他失功能信念之向度，如：知覺失眠造成的影響、對睡眠的期待、藥物使用，以及情緒反應性之其他向度，如：情緒敏感度與情緒激發度對睡前認知過度激發狀態無顯著的預測力。另外，根據執行檢驗調節效果步驟的階層迴歸分析結果，反芻特質與情緒遲惰特質分別在失功能信念與情緒反應性對認知激發程度的關係上，皆未有顯著的調節效果。
研究結論：研究結果部分支持身心激發程度為對睡眠的失功能信念與情緒反應性影響壓力下睡眠脆弱性的中介因子之假設。本研究發現過度擔憂睡眠的信念以及情緒持續度較久這兩個因子會分別獨立地提高睡前認知激發程度，顯示睡前認知激發程度分別受認知與情緒因素影響；且相較與睡前的生理激發狀態，睡前的認知激發對於壓力下的失眠反應之影響具有顯著的預測力，顯示認知激發在失眠的前置因子中可能扮演較重要的角色。另外，反芻特質與情緒遲惰特質分別在失功能信念與情緒反應性對認知激發程度的關係上，皆未有顯著的調節效果，此部份不符合研究預期。基於本研究結果，在臨床上對於容易經歷失眠之個體，若能及早調整對於睡眠的擔憂相關的信念，並學習有效調節情緒的方式，皆可有效降低個體睡前的認知激發活動，減少失眠的發生率與改善失眠症狀，避免使其落入失眠慢性化的惡性循環中。

中文摘要.................................................i
英文摘要.................................................iii
第一章 研究動機.........................................01
第二章 文獻探討.........................................05
第一節 失眠的定義與流行病學研究....................05
第二節 失眠的縱貫研究............................06
第三節 壓力誘發之失眠............................07
第四節 失眠的過度激發理論.........................09
第五節 與睡眠脆弱特質相關的失眠病理因素..............10
第六節 研究問題與假設.............................19
第三章 研究方法.........................................21
第一節 研究對象..................................21
第二節 研究程序..................................21
第三節 研究工具..................................22
第四節 資料分析..................................26
第四章 研究結果.........................................28
第一節 受試者之人口學變項與量表描述統計資料...........28
第二節 中介效果與調節效果的檢驗.....................29
第五章 討論............................................42
第一節 睡眠脆弱性相關因素的中介效果之結果.............42
第二節 睡眠脆弱性相關因素的調節效果之結果.............44
第三節 反芻特質與睡眠脆弱性間的關係..................45
第四節 未來展望與研究限制..........................45
參考文獻.................................................47
附錄....................................................57
附錄一 壓力下失眠反應量表（FIRST）.................58
附錄二 中文版反芻反應風格量表短版（RRS..............59
附錄三 睡前激發程度量表（PSAS）....................60
附錄四 睡眠失功能信念與態度簡式量表（DBAS-16）.......61
附錄五 情緒反應量表（ERS）........................63
附錄六 失眠嚴重度量表（ISI）.......................64


表目次
表1 研究中各量表之描述統計資料及性別在各量表之得分差異資料........34
表2 控制睡眠嚴重度、憂鬱與焦慮分數後之各變項相關矩陣表...........37
表3 以睡前認知激發量表分數為效標變項，探討擔憂失功能信念、
情緒持續度之預測力.....................................38
表4 以壓力下失眠反應量表分數為效標變項，探討睡前認知激發程度
在擔憂失功能信念、情緒持續度與睡眠脆弱特質間之中介效果........39
表5 以睡前認知激發量表分數為效標變項，探討負向情緒遲惰特質、
反芻特質在擔憂失功能信念、情緒持續度與認知激發程度的調節效果...40




圖目次
圖2-1 壓力下短期失眠相關心理因素在失眠機制中之關係架構圖..........25

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