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研究生:李婕寧
研究生(外文):Lee, Chieh-Ning
論文名稱:阿茲海默引起的認知障礙症患者其照顧者在 依附關係、社會支持、因應模式及心理困擾之關係研究
論文名稱(外文):The Relationship among Attachment, Coping Strategies, Social Support and Psychological Distress in Neuro-Cognitive Disorder Patients’ Caregivers
指導教授:王鵬智王鵬智引用關係
指導教授(外文):Wang, Peng-Chih
口試委員:洪福建張玉萱
口試委員(外文):Hung, Fu-ChienChang, Yu-Hsuan
口試日期:2017-12-15
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:2017
畢業學年度:106
語文別:中文
論文頁數:185
中文關鍵詞:阿茲海默失智症照顧者依附關係社會支持因應模式心理困擾
外文關鍵詞:Alzheimer’s diseaseattachmentcoping strategiessocial supportpsychological distress
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中文摘要
研究目的:失智症不僅影響患者,亦影響其照顧者與家庭,過去研究顯示照顧者的依附關係與其心理困擾有關,而依附關係亦與社會支持相關能力發展及因應模式選擇有關,而這兩個變項在照顧者研究領域中經常扮演了中介變項之角色。過去研究鮮少同時納入依附關係、社會支持、因應模式一同討論。因此本研究以Pearlin et al(1990)的阿茲海默照顧者壓力歷程模式為基礎,探討失智症照顧者在照顧壓力下,其依附關係、社會支持、因應模式與心理困擾之關係。
研究方法:公開招募並經研究人員確認符合本研究參與者共80位。參與者須填寫量表,包含基本資料、關係經驗量表、因應方法檢核表、耶魯社會支持量表及醫院焦慮憂鬱量表。
研究結果:序列中介結果發現情緒性社會支持可完全中介依附關係及心理困擾,同時,較低的情緒性社會支持,亦透過較少的問題導向因應去影響照顧者的心理困擾。另一方面,責怪他人因應亦扮演了部分中介的角色。
結論與建議:不安全依附的照顧者傾向對自我或他人抱持者負向觀感,他們的內在資源較為缺乏,遇到壓力時,他們傾向覺知到較少的情緒性社會支持,此情況使得它們就會有越低的機率去使用面對問題的因應方式,他們似乎有越高的機率採用情緒導向因應:責怪他人,此方法會使之容易產生心理壓力,進一步加深對自我及他人的負向觀感,形成負向循環。因此本研究建議臨床工作者學習辨識照顧者與患者之間的依附關係,如是不安全依附傾向高的照顧者,可(1)增加情緒性社會支持或提升照顧者對情緒性社會支持的覺知能力,例如:各式支持性團體或感恩訓練介入,亦可(2)增加具適應性的因應模式或溝通技巧。







關鍵字:阿茲海默失智症照顧者、依附關係、因應策略、社會支持、心理困擾



Abstract
Aim. Preliminary evidence indicates that the caregivers’ attachment is related to higher psychological distress. In current study, for the first time, using the conceptual model of Alzheimer’s caregivers’ stress to explore the relationship between attachment, coping strategies, social support and psychological distress in dementia patients’ adult child.
Methods. Eighty participants recruited in public. Caregivers filled out a validated measure about their attachment style, the RWCCL to measure coping strategies, YSS to social support and Hospital Anxiety and Depression Scale.
Results. Emotional social support fully mediated attachment and psychological distress. When coping strategies was combined as a second serial mediator, it was found that emotional social support could lead to psychological distress through problem focused coping. On the other hand, the coping strategy, blame of others, played a partial mediator role was also found.
Conclusions. Adult child who were more unsecure attached reported less emotional social support perceived, which affect them using less problem focused coping. Instead of facing the caregiving problem directly, it seems that they tend to choose blame of others coping strategies which often leads to higher level of psychological distress. Interventions that aim to enhance the perception of emotional social support, such as support caregiving group intervention and suitable coping strategies and communicative skill training, such as gratitude intervention are recommended for caregivers with more unsecure attached. We suggests they are likely to benefit from such interventions.











Keywords: Alzheimer’s disease, attachment, coping strategies, social support, psychological distress

Table of Contents
致謝 I
中文摘要 III
ABSTRACT IV
TABLE OF CONTENTS V
LIST OF TABLES VII
LIST OF FIGURES IX
I. INTRODUCTION AND PURPOSE OF STUDY 1
II. LITERATURE REVIEW 11
2.1 NEUROCOGNITIVE DISORDER DUE TO ALZHEIMER’S DISEASE (NCD-AD) 11
2.2 ATTACHMENT THEORY 19
2.3 COPING THEORY 45
2.4 SOCIAL SUPPORT 57
2.5 PSYCHOLOGICAL DISTRESS 71
III. MATERIALS AND METHODS 79
3.1 RESEARCH CONSTRUCT AND HYPOTHESIS 79
3.2 PROCEDURE 82
3.3 PARTICIPANTS 84
3.4 MEASURES 86
3.5 DATA ANALYSES 93
IV. RESULT 95
4.1DEMOGRAPHIC DISTRIBUTION 95
4.2 CORRELATION 105
4.3 ANALYSIS OF VARIANCE 111
4.4 REGRESSION 114
V. DISCUSSION 119
5.1 HYPOTHESIS VERIFICATION 120
5.2 SAMPLE CHARACTERISTICS 121
5.3 CORRELATION, ANOVA 125
5.4 MULTIPLE REGRESSION 137
VI. CONCLUSION 141
VII. REFERENCES 147
VIII. APPENDIX 167


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