- 學位論文
焦慮敏感度與無害事件的災難性解釋在恐慌發作病理的角色：以運動為例
The Role of Anxiety Sensitivity and Catastrophic Misinterpretation for Innocuous Events on the Psychopatholgogy of Panic Attacks: Example of Exercise
摘要
Clark（1986）認知模式提出，無害事件如運動所產生的身體感覺亦可能成為誘發刺激造成恐慌發作。過去有關運動是否造成恐慌發作的研究，幾乎都只操弄運動的強度或方式，且其目的幾乎都與驗證Clark（1986）認知模式無關，在實驗設計上亦有釵h瑕疪。本研究以Cox（1996）提出之互動觀點，同時操弄焦慮敏感度（高焦慮敏感度組與低焦慮敏感度組）、認知操弄（正向組與負向組）、及運動作業（分為前測、運動、及後測三個階段或前後測兩個階段），形成2 × 2 × 3或2 × 2 × 2的三因子混合設計。依變項為主觀知覺運動費力程度、客觀之心跳速率、主觀之恐慌身體感覺分數與恐慌認知分數、及運動時間。64名非臨床受試者由焦慮敏感度指標篩選為高低分兩組，經恐慌發作問卷簡版評量後，隨機接受不同認知操弄操弄，之後均進行強度漸增之腳踏車運動作業，完成恐慌認知與身體感覺檢選表。結果顯示，在知覺運動費力程度方面，認知操弄在前測之主要效果顯著；在後測各組均不顯著。在心跳速率方面，唯有階段之主要效果顯著；在恐慌身體感覺與認知分數方面，階段之主要效果顯著，焦慮敏感度指標 × 階段之交互作用顯著，而三階交互作用均有顯著之趨勢；另外，焦慮敏感度之主要效果僅在身體感覺分數上顯著，認知操弄 × 階段僅在認知分數上顯著；在運動時間方面，焦慮敏感度指標 × 認知操弄 × 性別三階交互作用顯著。這些結果顯示，在生理激發各組無差異的情況下，認知因素可能扮演重要的角色。同時，以互動觀點來探討Clark（1986）災難解釋亦可獲得證實。本研究亦針對上述結果，在恐慌症之心理病理與臨床應用之意義加以討論。
並列摘要
Clark’s cognitive model (1986) proposed that the trigger for panic attacks could also be the perception of bodily sensations caused by innocuous events such as exercise. However, laboratory investigations which measured either anxiety symptoms or sought to assess exercise-induced panic attacks were almost irrelevant of testing Clark’s model. Many of them employed high intensity exercise to see whether such a stimulus would provoke a panic attack. Some even have drawbacks of experimental designs. The present study followed an interactional approach postulated by Cox (1996), a ‘person-by-situation’ perspective, to examine Clark’s proposition. The effects of anxiety sensitivity, cognitive manipulation on subjective and cardiac responses during the course of exercise were examined. Specifically, 64 nonclinical subjects selected from anxiety sensitivity index finished panic attack questionnaire, then were randomly assigned to one of two different cognitive manipulations. They underwent a graded exercise test and finished a checklist of cognitions and bodily sensations. Heart rate was measured simultaneously. An anxiety sensitivity × cognitive manipulation or anxiety sensitivity × cognitive manipulation × stages factorial design were performed. Results showed that under equivalent bodily activation levels, cognitive factors did play a significant role in the development of panic attacks. Meanwhile, the interactional approach could be verified. It was claimed that the present study could add the understanding of the psychopathology of panic patients and make some contribution to how to use exercise task in clinical settings.