透過您的圖書館登入
IP:54.226.226.30
  • 學位論文

以基模糾結模式探討憂鬱傾向之偏頭痛患者的解釋偏差

Based on schema enmeshment model to investigate interpretation bias on migraine patients with depressive symptoms

指導教授 : 洪福建

摘要


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。

並列摘要


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.

參考文獻


陳怡誠、陳怡安譯(2010)。頭痛的診斷與治療。台北市:合記。
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。
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。
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.

延伸閱讀