有彈性的最適老化—內在覺感與以失落為基礎的選擇對老化適應心理歷程之可能影響初探

協助個體「好的老化」可以促進個體生活品質與提升社會群體發展。本研究採納最適老化觀點，主張個體在老化的過程中，若能良好運用「選擇—最適化—補償」歷程，則能達到較佳的心理適應結果。其中「以失落為基礎的選擇」是個體在面對老化常見的資源失落時，重要的因應策略。然而，目前的實徵研究卻無法提供臨床工作者該如何協助個體啟動此歷程的解答。本研究藉整合壓力因應模式與目標設定理論，主張「準確地認識到自己的失落」是啟動「以失落為基礎的選擇」的重要因素。內在覺感構念可反映個體對生理訊號的覺察，本研究關注與情緒歷程高度相關的心血管內在覺感。理論與實徵研究皆支持內在覺感是許多心理歷程的重要基礎。然而，過去的研究對心血管內在覺感特性的測量侷限於「準確」與「不準確」，本研究則整合呼吸道內在覺感、憂鬱情緒、症狀誇大與低估等幾方面的研究資料，主張心血管內在覺感之本質應是由非常低估至非常高估的連續面向，「準確」則是連續面向中間的某一點。本研究嘗試以連續面向的操作型定義出發，更貼近該現象的瞭解老化適應心理歷程中內在覺感所扮演的可能角色。研究目的可以分為兩大部分。第一部分探索內在覺感之本質，建立內在覺感連續向度的測量方式與指標，檢驗其信效度並探索隨年齡的改變。第二部分則探討「以失落為基礎的選擇」在個體面對失落時，對於各種心理適應結果所發揮的效用，以及影響其效用的可能因素，包括年齡與內在覺感傾向特性。本研究藉由社區平台與網路平台，納入125位研究參與者，包括46位男性，年齡在20歲至81歲之間，平均52.02 ± 18.09歲。依年齡可區分為青年成人、中年成人、與老年成人三組。藉由情緒誘發後的心跳偵測作業測量並計算內在覺感指標，並以以失落為基礎的選擇量表、身心症狀量表、慢性病患負向情緒量表與台灣簡明版世界衛生組織生活品質問卷等自陳式問卷，進行研究探討。研究結果發現內在覺感高低估連續向度指標具有令人滿意的內部一致性與情境穩定性，但效標（身心症狀困擾）關連效度則沒有顯著相關性。內在覺感準確性不隨年齡而有顯著變化，但以連續向度來看，則隨年齡而漸趨高估。「以失落為基礎的選擇」相關的多元迴歸分析結果則發現：（1）在控制年齡的情況下，個體使用越多以失落為基礎的選擇來面對失落，會對負向情緒、整體健康滿意度、心理生活品質與社會生活品質等幾項心理適應結果產生負向不利效果；（2）將年齡視為獨立的預測因素進行考量時，則發現中年人若較傾向於使用以失落為基礎的選擇來面對失落，會預測較高的身心症狀困擾，但亦預測較佳的生理生活品質；（3）在控制年齡並考量內在覺感的可能影響時，發現準確者使用以失落為基礎的選擇來面對失落可以預測較佳的生理生活品質與心理生活品質。低估者使用以失落為基礎的選擇來面對失落則會預測較高的身心症狀困擾與較差的心理生活品質；但在沒有主觀失落的情況下，以失落為基礎的選擇則能預測帶來較佳的心理生活品質。高估者使用以失落為基礎的選擇來面對失落可以預測較低的身心症狀困擾與較佳的生理生活品質，但在沒有主觀失落的狀況下，以失落為基礎的選擇則會預測較差的生理生活品質。綜上所述，準確與高估的內在覺感對於使用以失落為基礎的選擇來面對失落是有利的，低估則是不利的；然而，在沒有失落的情況下，高估者使用以失落為基礎的選擇則是不利的，低估者卻是有利的。本研究建立了對內在覺感本質的新觀點與測量方式，對於「以失落為基礎的選擇」作為「因應歷程」有更深入的瞭解。根據結果，內在覺感「連續向度」比「準確性」更能反映其在年齡上的變化，及對心理歷程的影響。「以失落為基礎的選擇」不一定有利，而中年應是因應型態轉折的重要階段。內在覺感影響個體因應效能，對身體狀態的準確判斷能讓個體以較恰當的方式因應失落，高估身體狀態的變化使個體在沒有明顯失落的狀態下產生過早的放棄，低估身體狀態的變化則使個體無法恰當的面對失落。研究結果能提供臨床服務相關思考，最後，本研究亦檢討了研究限制，並試提出未來研究方向。

關鍵字

老化；選擇—最適化—補償；以失落為基礎的選擇；內在覺感；內在覺感連續向度

並列摘要

Aging well promotes not only the quality of life of individuals, but also the positivity of society. According to the perspective of Baltes and his colleagues, the usage of “selection-optimization-compensation (SOC)” process leads to better psychological adaptation to aging. In the SOC process, loss-based selection (LBS) is crucial when facing loss. However, how to facilitate LBS is not well established by empirical evidence yet. According to cognitive appraisal and goal-setting theory, “to appraise loss objectively” facilitates LBS. Interoception is used to explore how individuals perceive own physiological signal. Interoceptive awareness (IA) is the representation of one’s own physiological state as a whole, and is regarded as “trait-like” attribution. Empirical evidences support that cardiac IA is related to multiple psychological processes. However, the operation definition of individual differences of cardiac IA was limited in “accurate” vs. “inaccurate” in previous study. By integrating the research of respiratory IA, depressive emotion, symptom amplification and symptom underestimation, the present study suggest that the nature of interoception is a continuum from overestimated (i.e., hyperinteroceptive) to underestimated (i.e., hypointeroceptive), and “accurate” is the midpoint of the continuum. The role of interoception in psychological adaptation to aging was explored by the continuously defined IA. There are two main purpose of this study. First, in order to investigate the nature of interoception, the measurement and index of cardiac interoceptive continuum were established. The reliability and criterion-related validity (psychosomatic symptom disturbance as the criterion) of the index were examined, also the change with age. Second, the effect of LBS on psychological adaptation when facing loss, and possible influences of age and IA were explored. A total of 125 participants were recruited in community and through internet, including 46 male, age between 20 to 81 (52.02 ± 18.09) years old. Participants were divided into young, mid age, and old adults. IA index was measured and computed by heartbeat detection task following mood-induction task. Demographical data, LBS scale, psychosomatic symptom checklist, Negative Emotions due to Chronic Illness Screening Test, and WHO-QOL BREF were administrated by self-report. Results revealed that the IA index developed in this study showed satisfied internal consistency and situational stability. However, the criterion-related validity is not evidenced. The interoceptive accuracy did not change with age. However, the subjects distributed differently across the whole interoceptive continuum, and tend to be more hyperinteroceptive with age increasing. The multiple regression analysis about LBS showed that: (1) After controlling with age, the more LBS participants used to face loss, the more negative psychological adaptation outcome is, including negative emotions, general health satisfaction, mental quality of life (QOL) and social QOL. (2) The interaction of age and LBS was found. Only among the middle age adults, when loss is present, higher LBS predict higher psychosomatic symptom disturbance and better physical QOL. (3) After controlling with age, when IA is accurate and loss is present, higher LBS predict better physical and mental QOL. When IA is hypointeroceptive and loss is present, higher LBS predict higher psychosomatic symptom disturbance and worse mental QOL; however, when loss is not present, higher LBS predict better mental QOL. When IA is hyperinteroceptive and loss is present, higher LBS predict lower psychosomatic symptom disturbance and better physical QOL; however, when loss is not present, higher LBS predict worse physical QOL. In sum, when facing loss, accurate IA and hyperinteroception facilitate LBS, but hypointeroception damages LBS. However, when loss is not present, hyperinteroception damages LBS, but hypointeroception facilitates LBS. The present study established the new perspective and measurement of interoceptive awareness, and explored LBS as a coping process. According to the results, interoceptive continuum shows phenomenal change across age and its effect on other psychological process. LBS is not always good to individuals, and middle age is important that coping style is changing. Interoceptive awareness shows differential effect on coping efficiency with accurate, hyper-, and hypointeroception. Results contribute in clinical application and future direction.