臺灣博碩士論文加值系統

目的：本研究旨在探討經歷手術後的乳癌女性，在身體外觀變動中，覺知術前身體外觀與目前身體外觀之差距，以及理想身體外觀與目前身體外觀間之差距，是否會對其憂鬱症狀與創傷後壓力症狀之嚴重程度具有預測效果，以及探討反芻反應在上述歷程中是否扮演一脆弱認知因子的角色，使得患者在覺知差距時可能採用較不具適應的認知因應而影響後續的心理症狀表現。此外，本研究亦探索創傷後壓力症狀中的侵入性症狀是否扮演觸發其他類群創傷後壓力症狀的重要因子，並將嘗試整合檢驗身體外觀差距、反芻反應、侵入性症狀以及其他類群之創傷後壓力症狀之關聯，提出術後乳癌女性在創傷後壓力症狀之病理模式。最後，對於不同年齡層歷經手術後的乳癌女性，其覺知身體外觀差距的衝擊以及心理症狀的嚴重程度可能有所差異，本研究也將進一步延伸探討。方法：本研究透過乳房手術外科門診和乳癌防治基金會衛教活動招募手術後之乳癌女性，有效樣本共265名，平均年齡為54.15歲（標準差為10.95歲），參與者於知情同意後，完成身材外觀評估量表、中文反應風格量表短版（CRSQ-SF）、簡式症狀量表（BSI）憂鬱分量表以及創傷後壓力症狀指標量表短版（PTSRI-SF）等量表。結果：（1）術前與目前身體外觀差距，以及理想與目前身體外觀差距，皆能顯著正向預測憂鬱症狀與創傷後壓力症狀的嚴重程度；（2）反芻反應可分別中介術前與目前身體外觀差距和理想與目前身體外觀差距對憂鬱症狀以及創傷後壓力症狀嚴重程度之預測；（3）反芻反應與侵入性症狀可序列中介術前與目前身體外觀差距和理想與目前身體外觀差距，對逃避症狀、認知與負向情緒改變以及警醒性與反應性改變嚴重程度之預測；（4）不同年齡層的術後乳癌女性，年輕組顯示有較高程度的反芻反應與創傷後壓力症狀之表現，然而，在身體外觀評分上不同年齡組之間皆無顯著差異。討論：研究結果顯示術後乳癌女性在覺知術前與目前身體外觀差距，以及理想與目前身體外觀差距皆能反映患者在憂鬱症狀與創傷後壓力症狀的負向心理適應，而反芻反應在認知因應歷程中也被證實為一脆弱認知因子。侵入性症狀在整體創傷後壓力症狀為重要之核心症狀，可能是術後乳癌女性在覺知身體外觀差距之歷程，惡化或維持創傷後壓力症狀的來源。此外，亦發現年輕術後乳癌女性整體而言具較差的心理適應表現。本研究也將依前述結果，提出對未來研究與臨床應用的建議。

OBJECTIVE: This study aimed to first examine whether perceiving the discrepancy between pre-surgery and current physical appearance (D_PACA) and discrepancy between ideal physical appearance and current physical appearance (D_IACA) could predict the severity of depressive symptoms and posttraumatic stress symptoms (PTSS) in the women with breast cancer (BC) who have undergone BC surgery. Second, viewing rumination as a cognitive vulnerability factor, this study also explored whether those patients adopt maladaptive cognitive strategy to cope with the perceived discrepancy may develop subsequent psychological symptoms. In addition, the current study explored whether intrusion symptoms played an important role in triggering other types of PTSS. By integrating the examinations of the physical appearance discrepancy, rumination, intrusion, and other types of PTSS, this study expected to propose a pathological model of PTSS in postoperative women with BC. Last, the study examined postoperative women with BC in different ages to seek whether age may affect the association of physical appearance and severity of psychological symptoms. METHODS: A total of 265 postoperative women with BC were recruited from the Breast Surgery Clinic of NTUH and Foundation of Breast Cancer Prevention, with average age 54.15±10.95 years. Measures included physical appearance evaluation inventory, Chinese Ruination Style Questionnaire-Short Form (CRSQ-SF), Breif Symptom Inventory (BSI)-Depression Subscale, and Post-Traumatic Stress Reaction Index-Short Form (PTSRI-SF). RESULTS: (1) The D_PACA, as well as the D_IACA, could significantly predict the severity of depressive symptoms and PTSS. (2) Rumination could respectively mediate the predictive effects of the D_PACA and D_IACA on the severity of depressive symptoms and PTSS. (3) Rumination and intrusions could serially mediate the predictive effects of the D_PACA and D_IACA on the severity of avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity, respectively. (4) The younger group of postoperative women with BC showed a greater severity of rumination and PTSS; however, there was no significant difference in physical appearance score between different age groups. DISCCUSION: Perceiving the D_PACA as well as the D_IACA in the postoperative BC women may affect the patient’s negative psychological adaptation to depressive symptoms and PTSS, while rumination was confirmed as a cognitive vulnerability factor in cognitive coping process. In addition, intrusions could be seen as an important core symptom of PTSS, and might lead to other PTSS in postoperative BC women upon perceiving the physical appearance discrepancy. Furthermore, younger postoperative BC women were also found to have poorer psychological adjustment. Based on the above findings, future research and clinical implications are suggested.

第一章 緒論...............................................................................1
第一節 研究動機........................................................................1
第二節 乳癌病理與治療..............................................................3
第三節 術後乳癌女性與身體外觀.................................................7
第四節 憂鬱與術後乳癌女性身體外觀.........................................18
第五節 創傷後壓力症狀與術後乳癌女性身體外觀........................21
第六節 反芻反應：認知脆弱因子...............................................26
第七節 研究目的、研究架構與假設............................................35
第二章 研究方法.......................................................................43
第一節 研究對象與研究程序......................................................43
第二節 研究工具.......................................................................44
第三節 統計分析程序................................................................52
第三章 研究結果.......................................................................55
第一節 描述統計、重要心理變項之組間比較與相關分析..............55
第二節 身體外觀差距與反芻反應於憂鬱症狀之關聯.....................61
第三節 身體外觀差距與反芻反應於創傷後壓力症狀之關聯..........69
第四節 創傷後壓力症狀之病理模式：以侵入性症狀為觸發因子探索 ................................................................................................73
第四章 綜合討論........................................................................83
第一節 身體外觀差距在憂鬱症狀與創傷後壓力症狀之影響.........84
第二節 反芻反應之中介效果.....................................................86
第三節 侵入性症狀在創傷後壓力症狀之角色..............................91
第四節 不同年齡層之影響........................................................94
第五節 研究貢獻與臨床意涵.....................................................96
第六節 研究限制與未來研究方向..............................................98
參考文獻.................................................................................105
中文文獻.................................................................................105
英文文獻..................................................................................107
附錄........................................................................................123
附錄一：研究同意書.................................................................123
附錄二：身材外觀評估量表.......................................................125
附錄三：中文反應風格量表—短版............................................126
附錄四：簡式症狀量表—憂鬱分量表.........................................128
附錄五：創傷後壓力症狀指標量表—短版..................................129
附錄六：個人基本資料..............................................................131

中文文獻
李菁娥、陳淑卿（2004）：〈一位乳癌病人接受乳房重建手術後之身心照護〉。《長庚護理》，15，200-208。
吳英璋、陳慶餘、梁繼權、呂碧鴻、邱泰源、鄭逸如⋯洪福建（2008）：《建構以解析憂鬱情緒為基礎的憂鬱症與自殺預防處置─以慢性病患為對象的臨 床實務研究》，行政院國家科學委員會專題研究成果報告，報告編號：DOH97-TD-M-113-95003，第三年研究報告。未出版。
和信治癌中心醫院乳癌多專科治療團隊（2016）：《一本讀通乳癌》。臺北市：天下生活出版股份有限公司。
周嘉娸（2008）：《憂鬱反芻對工作記憶容量的影響之初探》（未發表之碩士論文）。國立臺灣大學心理學研究所，臺北。
洪久茹（2007）：《乳癌婦女的心理社會適應狀態探討：以中年（35 至 64 歲）女性為例》（未發表之碩士論文）。國立臺灣大學社會工作學研究所，臺北。
胡至家（2005）：《憂鬱傾性，親密關係與乳癌術後婦女身體意象關係之探討》（未發表之碩士論文）。高雄醫學大學行為科學研究所：高雄。
梁宏華（2014）：《乳癌關鍵50問》。臺灣：文經社。
陳淑惠、林耀盛、洪福建、曾旭民（2000）：〈九二一震災後受創者社會心理反應之分析--兼論「變」與「不變」間的心理社會文化意涵〉。《社會文化學報》，10，35-60。
張煥（2017）：《對逝者的內外化持續性連結之探索：特定依戀與傷慟後認知的影響》（未發表之碩士論文）。國立臺灣大學心理學研究所，臺北。
游勝翔 （2004）：《反芻型反應風格，自傳式記憶與憂鬱之關聯性探討》（未發表之碩士論文）。國立臺灣大學心理學研究所，臺北。
程燕敏（2017）：《反芻對乳癌患者憂鬱的影響及因應的調節作用》（未發表之碩士論文）。國立政治大學心理學研究所。臺北。
劉于涵（2011）：《精神分裂症風險青少年之自我感探討》（未發表之碩士論文）。國立臺灣大學心理學研究所，臺北。
衛生福利部國民健康署（2018）：《民國105年癌症登記報告》。2018年12月。摘自衛生福利部網站：https://www.hpa.gov.tw/Pages/ Detail.aspx?n odeid=269&pid=10227
衛生福利部國民健康署（2015）：《擴大篩檢 乳房攝影下修至45歲起》。2015年10月，摘自衛生福利部網站：https://www.hpa.gov.tw/Pages/Det
ail.aspx?nodeid=1129&pid=2045
鄭麗芬（2011）：《初診斷乳癌患者的因應策略與心理症狀之關係研究》（未發表之碩士論文）。國立政治大學心理學研究所，臺北。
賴鴻文、陳達人、陳守棟與張金堅（2015）：〈乳癌手術之進展－內視鏡乳癌微創手術及整型式乳房腫瘤切除手術〉。《臺灣醫學》，58，147-152。

英文文獻
Ahadzadeh, A. S., & Sharif, S. P. (2018). Uncertainty and quality of life in women with breast cancer: Moderating role of coping styles. Cancer Nursing, 41, 484-490. doi:10.1097/ncc.0000000000000552
American Cancer Society. (2019). Breast cancer. Retrieved from:
https://www.cancer.org/cancer/breast-cancer/about/what-is-breast-cancer.html.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: American Psychiatric Publishing, Inc.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing, Inc.
Arciszewski, T., Berjot, S., & Finez, L. (2012). Threat of the thin-ideal body image and body malleability beliefs: Effects on body image self-discrepancies and behavioral intentions. Body Image, 9, 334-341. doi:10.1016/j.bodyim.2012.04.007
Armour, C., Műllerová, J., & Elhai, J. D. (2016). A systematic literature review of PTSD''s latent structure in the Diagnostic and Statistical Manual of Mental Disorders: DSM-IV to DSM-5. Clinical Psychology Review, 44, 60-74. doi:10.1016/j.cpr.2015.12.003
Arnaboldi, P., Lucchiari, C., Santoro, L., Sangalli, C., Luini, A., & Pravettoni, G. (2014). PTSD symptoms as a consequence of breast cancer diagnosis: Clinical implications. SpringerPlus, 3, 392. doi:10.1186/2193-1801-3-392
Andrykowski, M. A., Cordova, M. J., Mcgrath, P. C., Sloan, D. A., & Kenady, D. E. (2000). Stability and change in posttraumatic stress disorder symptoms following breast cancer treatment: A 1‐year follow‐up. Psycho‐Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer, 9, 69-78. doi:10.1002/(sici)1099-1611(200001/02)9:1<69::aid-pon439>3.0.co;2-r
Ashbury, F. D., Madlensky, L., Raich, P., Thompson, M., Whitney, G., Hotz, K., Kralj, B., Edell,W. S. (2003). Antidepressant prescribing in community cancer care. Supportive Care of Cancer, 11, 278-285. doi:10.1007/s00520-003-0446-8
Ball, S. C., & Brewin, C. R. (2012). The effect of rumination on intrusive images and mood: An experimental investigation using the trauma film paradigm. Journal of Experimental Psychopathology, 3, 297-309. doi:10.5127/jep.019511
Barrera, I., & Spiegel, D.(2014) Review of psychotherapeutic interventions on depression in cancer patients and their Impact on disease progression. International Review of Psychiatry, 26, 31-43. doi:10.3109/09540261.2013.864259
Batchelor, D. M., & Middelkoop, M. (1995). 1397 Beauty is in the eye of the beholder. European Journal of Cancer, 31, S295.
Begovic-Juhant, A., Chmielewski, A., Iwuagwu, S., & Chapman, L. A. (2012). Impact of body image on depression and quality of life among women with breast cancer. Journal of Psychosocial Oncology, 30, 446-460. doi:10.1080/07347332.2012.684856
Brunet, J., Sabiston, C. M., & Burke, S. (2013). Surviving breast cancer: Women''s experiences with their changed bodies. Body Image, 10, 344-351. doi:10.1016/j.bodyim.2013.02.002
Butler, L. D., Field, N. P., Busch, A. L., Seplaki, J. E., Hastings, T. A., & Spiegel, D. (2005). Anticipating loss and other temporal stressors predict traumatic stress symptoms among partners of metastatic/recurrent breast cancer patients. Psycho‐Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer, 14, 492-502. doi:10.1002/pon.865
Bryan, S. Turner. (2010)：《身體與社會理論》（謝明珊譯）。臺北：韋伯文化。（原著出版年：2008）[Bryan, S. Turner. (2010). Body and socity: Explorations in social theory (M. S. Hsieh, Trans.). Taipei: Weber (Original
work published 2008)]
Calhoun, L. G., Tedeschi, R. G., Cann, A., & Hanks, E. A. (2010). Positive outcomes following bereavement: Paths to posttraumatic growth. Psychologica Belgica, 50, 125-143.
Cash, T. F. (1995). Developmental teasing about physical appearance: Retrospective descriptions and relationships with body image. Social Behavior and Personality: An international journal, 23, 123-130. doi:10.2224/sbp.1995.23.2.123
Cash, T. F. (2002). Body image: A handbook of theory, research, and clinical practice. New York: Guilford.
Cash, Thomas F. (2004). Body image: Past, present, and future. Body Image, 1, 1-5. doi:10.1016/s1740-1445(03)00011-1
Cash, T. F. (2011). Body image : A handbook of science, practice, and prevention. New York: Guilford Press.
Center for Disease Control and Prevention. (2019). Breast cancer. Retrieved from:
https://www.cdc.gov/cancer/breast/index.htm.
Cerletty, J. M. (2000). To cure, sometimes. To comfort, always. Journal of Palliative Medicine, 3, 483-485. doi:10.1089/jpm.2000.3.4.483
Chen, X., Zheng, Y., Zheng, W., Gu, K., Chen, Z., Lu, W., & Shu, X. O. (2009). Prevalence of depression and its related factors among Chinese women with breast cancer. Acta Oncologica, 48, 1128-1136. doi:10.3109/02841860903188650
Champion, V. L., Wagner, L. I., Monahan, P. O., Daggy, J., Smith, L., Cohee, A., ... Unverzagt, F. W. (2014). Comparison of younger and older breast cancer survivors and age‐matched controls on specific and overall quality of life domains. Cancer, 120, 2237-2246. doi:10.1002/cncr.28737
Chan, M. W., Ho, S. M., Tedeschi, R. G., & Leung, C. W. (2011). The valence of attentional bias and cancer‐related rumination in posttraumatic stress and posttraumatic growth among women with breast cancer. Psycho‐Oncology, 20, 544-552. doi:10.1002/pon.1761
Conway, M. A. (2005). Memory and the self. Journal of Memory and Language, 53, 594-628.
Cordova, M. J., Riba, M. B., & Spiegel, D. (2017). Post-traumatic stress disorder and cancer. The Lancet Psychiatry, 4, 330-338. doi:10.1016/s2215-0366(17)30014-7
de Boer, M., & Slatman, J. (2014). Blogging and breast cancer: Narrating one’s life, body and self on the Internet. Women’s Studies International Forum, 44, 17-25. doi:10.1016/j.wsif.2014.02.014
Den Oudsten, B. L., Van Heck, G. L., Van der Steeg, A. F., Roukema, J. A., & De Vries, J. (2009). Predictors of depressive symptoms 12 months after surgical treatment of early‐stage breast cancer. Psycho‐Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer, 18, 1230-1237. doi:10.1002/pon.1518
Derogatis, L. R. (1993). Brief symptom inventory (BSI): Administration, scoring, and procedures manual (4th ed.). Minneapolis: National Computer Systems.
Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319-345. doi:10.1016/s0005-7967(99)00123-0
Ehlers, A., Hackmann, A., & Michael, T. (2004). Intrusive re‐experiencing in post‐traumatic stress disorder: Phenomenology, theory, and therapy. Memory, 12, 403-415. doi:10.1080/09658210444000025
Ehlers, A., & Steil, R. (1995). Maintenance of intrusive memories in posttraumatic stress disorder: A cognitive approach. Behavioural and Cognitive Psychotherapy, 23, 217-249. doi:10.1017/s135246580001585x
Elklit, A., & Blum, A. (2011). Psychological adjustment one year after the diagnosis of breast cancer: A prototype study of delayed post‐traumatic stress disorder. British Journal of Clinical Psychology, 50, 350-363. doi:10.1348/014466510x527676
Fallbjörk, U., Salander, P., & Rasmussen, B. H. (2012). From “no big deal” to “losing oneself”: Different meanings of mastectomy. Cancer Nursing, 35, E41-E48. doi:10.1097/ncc.0b013e31823528fb
Fang, S. Y., Chang, H. T., & Shu, B. C. (2014). Objectified body consciousness, body image discomfort, and depressive symptoms among breast cancer survivors in Taiwan. Psychology of Women Quarterly, 38, 563-574. doi:10.1177/0361684314552652
Fann, J. R., Thomas-Rich, A. M., Katon, W. J., Cowley, D., Pepping, M., McGregor, B. A., & Gralow, J. (2008). Major depression after breast cancer: A review of epidemiology and treatment. General Hospital Psychiatry, 30, 112-126. doi:10.1016/j.genhosppsych.2007.10.008
Foa, E. B., Zinbarg, R., & Rothbaum, B. O. (1992). Uncontrollability and unpredictability in post-traumatic stress disorder: An animal model. Psychological Bulletin, 112, 218-238. doi:10.1037/0033-2909.112.2.218
Forbes, D., Lockwood, E., Elhai, J. D., Creamer, M., Bryant, R., McFarlane, A., ... O’Donnell, M. (2015). An evaluation of the DSM-5 factor structure for posttraumatic stress disorder in survivors of traumatic injury. Journal of Anxiety Disorders, 29, 43-51. doi:10.1016/j.janxdis.2014.11.004
Freeman‐Gibb, L. A., Janz, N. K., Katapodi, M. C., Zikmund‐Fisher, B. J., & Northouse, L. (2017). The relationship between illness representations, risk perception and fear of cancer recurrence in breast cancer survivors. Psycho‐Oncology, 26, 1270-1277. doi:10.1002/pon.4143
Friedman, M. J., Keane, T. M., & Resick, P. A. (2007). Handbook of PTSD: Science and practice. New York: Guilford Press.
Frierson, G. M., Thiel, D. L., & Andersen, B. L. (2006). Body change stress for women with breast cancer: the Breast-Impact of Treatment Scale. Annals of Behavioral Medicine, 32, 77-81. doi:10.1207/s15324796abm3201_9
Green, B. L., Rowland, J. H., Krupnick, J. L., Epstein, S. A., Stockton, P., Stern, N. M., ... Steakley, C. (1998). Prevalence of posttraumatic stress disorder in women with breast cancer. Psychosomatics, 39, 102-111. doi:10.1016/s0033-3182(98)71356-8
Gu, J., Groot, G., Holtslander, L., & Engler-Stringer, R. (2017). Understanding Women’s choice of mastectomy versus breast conserving therapy in early-stage breast Cancer. Clinical Medicine Insights: Oncology, 11, 1-7. doi:10.1177/1179554917691266
Gumus, M., Ustaalioglu, B. O., Garip, M., Kiziltan, E., Bilici, A., Seker, M., ... Turhal, N. S. (2010). Factors that affect patients'' decision-making about mastectomy or breast conserving surgery, and the psychological effect of this choice on breast cancer patients. Breast Care, 5, 164-168. doi:10.1159/000314266
Gurevich, M., Devins, G. M., & Rodin, G. M. (2002). Stress response syndromes and cancer, conceptual and assessment issues. Psychosomatics, 43, 259–281. doi:10.1176/appi.psy.43.4.259
Han, J., Grothuesmann, D., Neises, M., Hille, U., & Hillemanns, P. (2010). Quality of life and satisfaction after breast cancer operation. Archives of Gynecology and Obstetrics, 282, 75-82. doi:10.1007/s00404-009-1302-y
Higgins, E. T. (1987). Self-discrepancy: A theory relating self and affect. Psychological Review, 94, 319-340. doi:10.1037/0033-295x.94.3.319
Ho, S. S., So, W. K., Leung, D. Y., Lai, E. T., & Chan, C. W. (2013). Anxiety, depression and quality of life in Chinese women with breast cancer during and after treatment: A comparative evaluation. European Journal of Oncology Nursing, 17, 877-882. doi:10.1016/j.ejon.2013.04.005
Horowitz, M. J. (1976). Stress response syndromes. New York: Aronson.
Iyadurai, L., Visser, R. M., Lau-Zhu, A., Porcheret, K., Horsch, A., Holmes, E. A., & James, E. L. (2018). Intrusive memories of trauma: A target for research bridging cognitive science and its clinical application. Clinical Psychology Review. doi:10.1016/j.cpr.2018.08.005
Janoff-Bulman, R. (1992). Shattered assumptions : Towards a new psychology of trauma. New York: Maxwell Macmillan international.
Kangas, M. (2013). DSM-5 trauma and stress-related disorders: Implications for screening for cancer-related stress. Frontiers in Psychiatry, 4. doi:10.3389/fpsyt.2013.00122
Kangas, M., Henry, J. L., & Bryant, R. A. (2002). Posttraumatic stress disorder following cancer: A conceptual and empirical review. Clinical Psychology Review, 22, 499-524. doi:10.1016/s0272-7358(01)00118-0
Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., & Friedman, M. J. (2013). National estimates of exposure to traumatic events and PTSD prevalence using DSM‐IV and DSM‐5 criteria. Journal of Traumatic Stress, 26, 537-547. doi:10.1002/jts.21848
Kline, R. (2011). Principles and practice of structural equation modeling (3rd ed.). New York: The Guilford Press.
Kolokotroni, P., Anagnostopoulos, F., & Tsikkinis, A. (2014). Psychosocial factors related to posttraumatic growth in breast cancer survivors: A review. Women & Health, 54, 569-592. doi:10.1080/03630242.2014.899543
Lehmann, V., Hagedoorn, M., & Tuinman, M. A. (2015). Body image in cancer survivors: A systematic review of case-control studies. Journal of Cancer Survivorship, 9, 339-348. doi:10.1007/s11764-014-0414-y
Lyubomirsky, S., Caldwell, N. D., & Nolen-Hoeksema, S. (1998). Effects of ruminative and distracting responses to depressed mood on retrieval of autobiographical memories. Journal of Personality and Social Psychology, 75, 166-177. doi:10.1037/0022-3514.75.1.166
Lyubomirsky, S., Kasri, F., Chang, O., & Chung, I. (2006). Ruminative response styles and delay of seeking diagnosis for breast cancer symptoms. Journal of Social and Clinical Psychology, 25, 276-304. doi:10.1521/jscp.2006.25.3.276
Lyubomirsky, S., & Nolen-Hoeksema, S. (1993). Self-perpetuating properties of dysphoric rumination. Journal of Personality and Social Psychology, 65, 339-349. doi:10.1037/0022-3514.65.2.339
Lyubomirsky, S., & Tkach, C. (2004). The consequences of dysphoric rumination. In C. Papageorgiou & A. Wells (Eds.), Depressive rumination: Nature, theory, and treatment (p. 21-42). New York: Wiley.
Lyubomirsky, S., Tucker, K. L., Caldwell, N. D., & Berg, K. (1999). Why ruminators are poor problem solvers: Clues from the phenomenology of dysphoric rumination. Journal of Personality and Social Psychology, 77, 1041-1060. doi:10.1037/0022-3514.77.5.1041
Maass, S. W., Roorda, C., Berendsen, A. J., Verhaak, P. F., & de Bock, G. H. (2015). The prevalence of long-term symptoms of depression and anxiety after breast cancer treatment: A systematic review. Maturitas, 82, 100-108. doi:10.1016/j.maturitas.2015.04.010
Martin, L. L., & Tesser, A. (1996). Some ruminative thoughts. Advances in Social Cognition, 9, 1-48.
Merleau-Ponty, M. (1962). Phenomenology of perception. London, UK: Routledge & Kegan Paul.
Michael, T., Halligan, S. L., Clark, D. M., & Ehlers, A. (2007). Rumination in posttraumatic stress disorder. Depression and Anxiety, 24, 307-317. doi:10.1002/da.20228
Miller, S. J., Schnur, J. B., Weinberger-Litman, S. L., & Montgomery, G. H. (2014). The relationship between body image, age, and distress in women facing breast cancer surgery. Palliative & Supportive Care, 12, 363-367. doi:10.1017/s1478951513000321
Moreira, H., & Canavarro, M. C. (2010). A longitudinal study about the body image and psychosocial adjustment of breast cancer patients during the course of the disease. European Journal of Oncology Nursing, 14, 263-270. doi:10.1016/j.ejon.2010.04.001
Nicholson, R. M., Leinster, S., & Sassoon, E. M. (2007). A comparison of the cosmetic and psychological outcome of breast reconstruction, breast conserving surgery and mastectomy without reconstruction. The Breast, 16, 396-410. doi:10.1016/j.breast.2007.01.009
Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100, 569-582. doi:10.1037/0021-843x.100.4.569
Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3, 400-424. doi: 10.1111/j.1745-6924.2008.00088.x
O''Connor, M., Christensen, S., Jensen, A. B., Møller, S., & Zachariae, R. (2011). How traumatic is breast cancer? Post-traumatic stress symptoms (PTSS) and risk factors for severe PTSS at 3 and 15 months after surgery in a nationwide cohort of Danish women treated for primary breast cancer. British Journal of Cancer, 104, 419-426. doi:10.1038/sj.bjc.6606073
O’Connor, M., & Zachariae, R. (2016). Post-traumatic stress symptoms in breast cancer: prevalence, predictors, consequences, and treatment. Comprehensive Guide to Post-Traumatic Stress Disorders, 1-13. doi:10.1007/978-3-319-08613-2_51-1
Ogińska-Bulik, N., & Michalska, P. (2019). The relationship between emotional processing deficits and posttraumatic stress disorder symptoms among breast cancer patients: The mediating role of rumination. Journal of Clinical Psychology in Medical Settings, 1-11. doi:10.1007/s10880-019-09606-6
Pan, X. F., Fei, M. D., Zhang, K. Y., Fan, Z. L., Fu, F. H., & Fan, J. H. (2013). Psychopathological profile of women with breast cancer based on the symptom checklist-90-R. Asian Pacific Journal of Cancer Prevention, 14, 6579-6584.
Pasquini, M. & Biondi, M. (2007). Depression in cancer patients: A critical review. Clinical Practice Epidemiology Mental Health, 3, 2. doi: 10.1186/1745-0179-3-2
Paterson, C., Lengacher, C. A., Donovan, K. A., Kip, K. E., & Tofthagen, C. S. (2016). Body image in younger breast cancer survivors: A systematic review. Cancer Nursing, 39, E39. doi:10.1097/ncc.0000000000000251
Price, B. (1990). A model for body‐image care. Journal of Advanced Nursing, 15, 585-593.
Przezdziecki, A., Sherman, K. A., Baillie, A., Taylor, A., Foley, E., & Stalgis‐Bilinski, K. (2013). My changed body: Breast cancer, body image, distress and self‐compassion. Psycho‐Oncology, 22, 1872-1879. doi:10.1002/pon.3230
Rijken, M., de Kruif, A. T. C., Komproe, I. H., & Roussel, J. G. (1995). Depressive symptomatology of post-menopausal breast cancer patients: A comparison of women recently treated by mastectomy or by breast-conserving therapy. European Journal of Surgical Oncology, 21, 498-503. doi:10.1016/s0748-7983(95)96898-9
Rimes, K. A., & Watkins, E. (2005). The effects of self-focused rumination on global negative self-judgements in depression. Behaviour Research and Therapy, 43, 1673-1681. doi: 10.1016/j.brat.2004.12.002
Roelofs, J., Papageorgiou, C., Gerber, R. D., Huibers, M., Peeters, F., & Arntz, A. (2007). On the links between self-discrepancies, rumination, metacognitions, and symptoms of depression in undergraduates. Behaviour Research and Therapy, 45, 1295-1305. doi:10.1016/j.brat.2006.10.005
Shilder, P. (1935). The image and appearance of the human body. New York: International Universities Press.
Shilling, C. (2009)：《身體三面向：文化、科技與社會》（謝明珊與杜欣欣譯）。臺北：韋伯文化。（原著出版年：2004） [ Shilling, C. (2009). The body in culture, technology and society (M. S. Hsieh, & H. H. Tu, Trans.). Taipei: Weber (Original work published 2004)]
Slatman, J., Halsema, A., & Meershoek, A. (2016). Responding to scars after breast surgery. Qualitative Health Research, 26, 1614-1626. doi:10.1177/1049732315591146
Sobin, L. H. G. M. (2009). International Union Against Cancer (UICC) TNM classification of malignant tumours. Oesophagus including Oesophagogastric Junction, 66-72.
Solomon-Krakus, S., Sabiston, C. M., Brunet, J., Castonguay, A. L., Maximova, K., & Henderson, M. (2017). Body image self-discrepancy and depressive symptoms among early adolescents. Journal of Adolescent Health, 60, 38-43. doi:10.1016/j.jadohealth.2016.08.024
Speckens, A. E. M., Ehlers, A., Hackmann, A., Ruths, F. A., & Clark, D. M. (2007). Intrusive memories and rumination in patients with post-traumatic stress disorder: A phenomenological comparison. Memory, 15, 249-257. doi:10.1080/09658210701256449
Steiner, J. L., Wagner, C. D., Bigatti, S. M., & Storniolo, A. M. (2014). Depressive rumination and cognitive processes associated with depression in breast cancer patients and their spouses. Families, Systems, & Health, 32, 378-388. doi:10.1037/fsh0000066
Sun, L., Ang, E., Ang, W. H. D., & Lopez, V. (2018). Losing the breast: A meta‐synthesis of the impact in women breast cancer survivors. Psycho‐Oncology, 27, 376-385. doi:10.1002/pon.4460
Sutherland, K., & Bryant, R. A. (2008). Autobiographical memory and the self-memory system in posttraumatic stress disorder. Journal of Anxiety Disorders, 22, 555-560. doi:10.1016/j.janxdis.2007.03.008
Sütterlin, S., Paap, M., Babic, S., Kübler, A., & Vögele, C. (2012). Rumination and age: Some things get better. Journal of Aging Research, 1-10. doi:10.1155/2012/267327
Takano, K., & Tanno, Y. (2009). Self-rumination, self-reflection, and depression: Self-rumination counteracts the adaptive effect of self-reflection. Behaviour Research and Therapy, 47, 260-264. doi:10.1016/j.brat.2008.12.008
Thomas–MacLean, R., Towers, A., Quinlan, E., Hack, T. F., Kwan, W., Miedema, B., ... Graham, P. (2009). “This is a kind of betrayal”: A qualitative study of disability after breast cancer. Current Oncology, 16, 26-32. doi:10.3747/co.v16i3.389
Tiggemann, Marika. (2004). Body image across the adult life span: Stability and change. Body Image, 1, 29-41. doi:10.1016/s1740-1445(03)00002-0
Treynor, W., Gonzalez, R., & Nolen-Hoeksema, S. (2003). Rumination reconsidered: A psychometric analysis. Cognitive Therapy and Research, 27, 247-259. doi:10.1023/a:1023910315561
Vartanian, L. R. 2. (2012). Self-discrepancy theory and body image. Encyclopedia of Body Image and Human Appearance, 2, 711-717. doi:10.1016/b978-0-12-384925-0.00112-7
Voigt, V., Neufeld, F., Kaste, J., Bühner, M., Sckopke, P., Wuerstlein, R., ... Silva‐Zürcher, E. (2017). Clinically assessed posttraumatic stress in patients with breast cancer during the first year after diagnosis in the prospective, longitudinal, controlled COGNICARES study. Psycho‐Oncology, 26, 74-80. doi:10.1002/pon.4102
Watkins, E. R. (2008). Constructive and unconstructive repetitive thought. Psychological Bulletin, 134, 163-206. doi:10.1037/0033-2909.134.2.163
White, C. A. (2000). Body image dimensions and cancer: A heuristic cognitive behavioural model. Psycho‐Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer, 9, 183-192. doi: 10.1002/1099-1611(200005/06)9:33.3.CO;2-C
White, R., & Wild, J. (2016). “Why” or “how”: The effect of concrete versus abstract processing on intrusive memories following analogue trauma. Behavior Therapy, 47, 404-415. doi:10.1016/j.beth.2016.02.004
World Health Organization. (2019). Cancer. Retrieved from: https://www.who.int/cancer/en/
Wu, X., Wang, J., Cofie, R., Kaminga, A. C., & Liu, A. (2016). Prevalence of posttraumatic stress disorder among breast cancer patients: A meta‐analysis. Iranian Journal of Public Health, 45, 1533–1544.
Yalom, M. (2000). 《乳房的歷史》（何穎怡譯)。臺北：先覺。（原著出版年：1997）[ Yalom, M. (2000) A history of the breast（Y. Y. Ho, Trans.). Taipei: Prophet Press (Original work published 1997)]
Zetsche, U., & Joormann, J. (2011). Components of interference control predict depressive symptoms and rumination cross-sectionally and at six months follow-up. Journal of Behavior Therapy and Experimental Psychiatry, 42, 65-73. doi:10.1016/j.jbtep.2010.06.001
Zimmermann, T., Scott, J. L., & Heinrichs, N. (2010). Individual and dyadic predictors of body image in women with breast cancer. Psycho‐Oncology, 19, 1061-1068. doi:10.1002/pon.1660