在誘發生氣情境下D型人格之自主神經系統及心跳反應之影響

The Autonomic Nervous System and Heart Rate Response in Type D Personality after Induced Anger Reaction

黃昱翔(Yu-Hsiang Huang)

指導教授 ： 翁嘉英

國立中正大學/社會科學院/臨床心理學研究所/碩士(2014年)

摘要

D型人格與心血管疾病之間的關聯性過去已獲得許多研究證實，但其中影響病程發展、疾病復發或嚴重度之心理病理機制尚未有明確定論。Sloan等人(1999)提出冠狀動脈疾病之心理生理模式，假設心血管自主的調控(cardiac autonomic control)可能為心理及健康行為等危險因子之重要機制之一。心血管反應主要由自主神經系統調控，除了研究已證實交感神經過度活動，為心血管疾病之重要機制。Thayer與Lane(2007)進一步納入副交感神經調控交感神經的概念，提出自主神經系統失衡的假說：在環境壓力下或壓力消失後，副交感神經未能啟動有效調節，來抑制交感神經活動，形成自主神經系統調節失衡的狀態，可能為影響心血管疾病的另一關鍵因素。本研究在自主神經失衡假說架構下，提出另一種失衡的假設：當個體使用「壓抑」的方式因應壓力，可能藉由大腦皮質的意識控制產生抑制功能，提高副交感神經的反應，來抑制交感神經活動，因而形成副交感神經過度活動的情況。本研究旨在以實徵研究驗證D型人格特質（包含「負向情感」與「社交抑制」兩項特質）與自主神經失衡假說的關聯性。本研究邀請南部某綜合醫院成人健檢中心之健康成人參與，排除精神疾患、心血管疾病、癌症病史及血液生化值呈現異常者，納入45人進行資料分析，平均年齡51歲，男性25人、女性20人。以雙盲實驗設計進行研究，並使用人際衝突作業操弄參與者之情緒與生理反應，其中包括基準期、人際衝突期、與恢復期各五分鐘。研究結果呈現男性樣本的結果與全樣本相當接近，在男性樣本中發現「負向情感」特質傾向在人際衝突壓力下，與副交感神經活性呈顯著負相關 (ln(HF)：r = -.367，p = .085；HF(%)：r = -.453，p < .05)；在恢復期，與副交感神經活性呈顯著負相關（ln(HF)：r = -.428，p < .05）、與心跳速率呈現顯著正向關聯性( r = .429, p < .05)。此一結果支持Thayer與Lane（2007）所提出的副交感神經過低的自主神經失衡假設。此外，「社交抑制」特質傾向，在基準期（而非人際衝突壓力期），與交感神經活性呈顯著負相關( r = -.413, p < .05)，與副交感神經呈正相關聯傾向；在壓力期與副交感神經呈顯著負相關（ln(HF)：r = -.533，p = <.01；HF(%)：r = -.399，p = .059），並且在恢復期，與副交感神經活性呈顯著負相關（ln(HF)：r = -.666，p = <.01）、與心跳速率呈現顯著正向關聯性( r = .482, p < .05)。此一結果部分支持本研究基於「壓抑」因應方式所提出的副交感神經活性過高，導致交感神經過低的另一類自主神經失衡假設。本研究結果支持，D型人格特質者，分別在社交情境中及人際衝突壓力下，符合兩種自主神經失衡假說。本研究結果，不僅證實D型性格者，可能透過自主神經失衡路徑，介入心血管疾病的病理機制。同時在理論的層次，提出另一種自主神經失衡假說補充Thayer與Lane(2007)所提出理論之不足，並獲得實徵資料之支持。

關鍵字

交感神經系統 ； 心跳變異率 ； 自主神經失衡 ； 心血管疾病 ； D型人格 ； 副交感神經系統

並列摘要

The association between Type D personality and the adverse prognosis of cardiovascular disease (CVD) has been proved by empirical research. But the psychopathological mechanism linking the disease course, recurrence and severity of CVD with Type D personality is still unknown. Sloan (1999) proposed that autonomic control of the heart may be one of the candidates linking psychological factors to the disease development. Thayer and Lane (2007) suggested that the autonomic imbalance, hypo-activity of parasympathetic nervous system (PSNS) or hyper-activity of sympathetic nervous system (SNS), may be a common pathway to increased morbidity and mortality of CVD. In this study we proposed that in addition to hypo-activity of PSNS for fight-or-flight response, there may be another type of autonomic imbalance, hyper-activity of PSNS for suppressive strategy for stress coping in daily life. The aim of the present study was to examine the associations between Type D personality and the two types of autonomic imbalance mentioned above. Forty five healthy adults (mean age 51, females: 44.4%) were recruited. They underwent the interpersonal conflict task and their heart rate variety (HRV) was recorded during baseline (5 minutes), interpersonal conflict (5 minutes) and recovery (5 minutes) stage separately. Negative affectivity (NA) score was negatively correlated with parasympathetic activity during the conflict stage( ln HF: r = -.367，p = .085, HF(%): r = -.453，p < .05), and recovery stage( ln HF: r = -.428，p < .05). Social inhibition (SI) score was also negatively correlated with parasympathetic activity during conflict stage (ln HF：r = -.533，p <.01；HF(%)：r = -.399，p = .059), and recovery stage (ln HF：r = -.666，p = <.01). These results validated the traditional type of autonomic imbalance, hypo-activity of PSNS for fight-or-flight response. Furthermore, SI score was negatively correlated with sympathetic activity in baseline stage ( r = -.413, p < .05) thus validate the new type of autonomic imbalance, hyper-activity of PSNS for suppressive response. The results of this study demonstrated that individuals with Type D personality displayed two types of autonomic imbalance conditions, hyper-activity of PSNS in social condition (SI) and hypo-activity of PSNS in interpersonal conflict environment (both NA and SI). To experience more negative emotion and to suppress the feelings may be the behavioral mechanism that impact on the autonomic imbalance, which might link the Type D personality to the development of CVD.

並列關鍵字

parasympathetic nervous system ； sympathetic nervous system ； heart rate variety ； autonomic imbalance ； cardiovascular disease ； Type D personality

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