罹癌患者的核心信念破壞、反芻思考與心理成長之關係：心理苦惱與情緒調節策略的調節角色

研究背景與目的：許多研究已證實侵入性反芻與精緻性反芻對創傷後成長的重要性，且侵入性反芻轉變為精緻性反芻是產生創傷後成長的關鍵。近來Tedeschi與Calhoun修正了創傷後成長的理論模型，並強調苦惱情緒的角色，他們認為不僅是反芻焦點的轉變有助於創傷後成長的發生，創傷事件後的苦惱情緒也會與兩類反芻相互影響，進而影響創傷後成長的可能性；從臨床介入研究中Tedeschi與Calhoun也發現，若能協助個案進行情緒管理，有助於反芻焦點的轉變。有鑑於目前還未有實證研究探討苦惱情緒與情緒調節策略在創傷後成長中的角色，且反芻焦點的轉變與創傷後成長之間的研究多以單一時間點或自然災害的樣本為主，因此本研究以癌症患者為樣本，且採用回溯性的兩點測量方式，檢驗罹癌後的核心信念破壞、兩類反芻思考與心理成長之歷程關係，並探討心理苦惱與情緒調節策略在關係中是否具有調節功能，以期擴展對於個體心理成長之認知歷程的瞭解。研究方法：本研究採用兩個時間點的回溯性研究設計，以完成初次密集性治療後半年以上且罹癌五年內的癌症患者為研究對象，共184名。研究工具為五份自陳式問卷，包含：信念違反量表、事件相關反芻量表、加長版創傷後成長量表、醫院版焦慮及憂鬱量表、情緒調控問卷。最後以相關分析、中介分析及調節式中介分析來進行檢驗。研究結果：（1）罹癌診斷與治療對核心信念的破壞會透過「初期侵入性反芻」或「近期侵入性反芻」促發「近期精緻性反芻」，進而預測心理成長或直接透過「近期精緻性反芻」預測心理成長。（2）心理苦惱程度可調節「初期侵入性反芻」與「近期侵入性反芻」之間關係，以及「近期侵入性反芻」與「近期精緻性反芻」之間關係。（3）「重新評估」策略能調節「初期侵入性反芻」與「近期侵入性反芻」之間的關係，也具有調節「近期侵入性反芻」與「近期精緻性反芻」之間關係的邊緣效果。結論：本研究結果支持核心信念的破壞、兩類反芻思考與心理成長的序列關係，並首次以實徵結果指出心理苦惱與情緒調節策略在心理成長模型中具有調節的效果。提供臨床工作者瞭解當罹癌患者出現信念衝擊時，如何協助他們轉化反芻思考來促進心理成長。

關鍵字

侵入性反芻；精緻性反芻；心理成長；心理苦惱；情緒調節策略；癌症

並列摘要

Background: Many studies have supported that the intrusive rumination and the deliberate rumination have played major roles in posttraumatic growth, and when the form of rumination changes from intrusive to deliberated type would be the key to facilitate posttraumatic growth. Recently, the revised model of posttraumatic growth, supposed by Tedeschi and Calhoun, has emphasized the role of psychological distress after a traumatic event in posttraumatic growth. They assumed that not only the transformed form of rumination may promote the development of posttraumatic growth, but also that psychological distress after a traumatic event may interact with both types of rumination, thus influencing the likelihood of posttraumatic growth. From clinical intervention studies, Tedeschi and Calhoun have also found that offering individuals with emotion management skills can change their rumination from intrusive to deliberated type. Since there has been no empirical study to investigate the role of psychological distress and emotion regulation strategies in posttraumatic growth, and most studies exploring the relationship between the rumination and posttraumatic growth have conducted the cross-sectional design or have often used natural disaster samples; therefore, this current research adopted cancer outpatients as study sample and used the retrospective two-time-point approach to examine the process of violated core belief, two types of ruminative thoughts, and psychological growth among cancer out patients, as well as exploring whether psychological distress and emotion regulation strategies may moderate the above relationship, in order to expand the understanding of the cognitive process of posttraumatic growth. Method: This retrospective study adopted a two-time-point design and recruited 184 cancer outpatients with diagnosed time from six months to 5 years after completing their first intensive treatment. Major instruments were five self-reported questionnaires, including the Belief Violation Questionnaire, Events Related Rumination Inventory, Posttraumatic growth inventory-X, Hospital Anxiety and Depression Scale, and Emotional Regulation Questionnaire. The study questions were tested by the correlation analysis, the mediation analysis and the moderator-mediator analysis. Results: (1) The violated core beliefs due to cancer diagnosis and treatments would be through initial or recent intrusive rumination to promotes recent deliberate rumination or may be directly through recent deliberate rumination to predict psychological growth. (2) The level of psychological distress may moderate the relationship between initial intrusive rumination and recent intrusive rumination as well as between recent intrusive rumination and recent deliberate rumination. (3) The reappraisal strategy would moderate the relationship between initial intrusive rumination and recent intrusive rumination, and showed a borderline effect in moderating the relationship between recent intrusive rumination and recent deliberate rumination. Conclusion: This current study indicated the sequential relationship among the disruption of core belief, two types of rumination, and psychological growth that the PTG model assumed and is the first one to demonstrate the moderating effect of psychological distress and emotion regulation strategies in psychological growth among cancer patients. These results may provide clinicians how to help cancer patients transform their ruminative thoughts from intrusive to deliberated type, then enhance psychological growth while experiencing disruption in core beliefs origins from cancer diagnosis and treatments.

並列關鍵字

intrusive rumination ； deliberate rumination ； psychological growth ； psychological distress ； emotion regulation strategies ； cancer

參考文獻

Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2(3), 271-299. https://doi.org/10.1037/1089-2680.2.3.271

Gross, J. J. (2002). Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology, 39(3), 281-291. https://doi.org/10.1017/S0048577201393198

Gross, J. J. (2015). Emotion regulation: Current status and future prospects. Psychological Inquiry, 26(1), 1-26. https://doi.org/10.1080/1047840X.2014.940781

Ogińska-Bulik, N. (2016). The role of rumination in the occurrence of positive effects of experienced traumatic events. Health Psychology Report, 4(4), 321-331. https://doi.org/10.5114/hpr.2016.60915

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罹癌患者的核心信念破壞、反芻思考與心理成長之關係：心理苦惱與情緒調節策略的調節角色

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