經歷背叛之創傷後壓力症狀的風險因子與心理病理模式

Could Betrayal be a Potential Trauma? Examining Risk Factors and Psychopathological Model of Betrayal-Related Posttraumatic Stress Symptoms

劉亭妤(Ting-Yu Liu)

指導教授 ： 陳淑惠

國立臺灣大學/理學院/心理學研究所/碩士(2014年)

https://doi.org/10.6342/NTU.2014.03086

摘要

目的 經歷背叛事件可能造成某些個體相當嚴重的心理創傷，甚至產生創傷後壓力疾患（posttraumatic stress disorder, PTSD）相關症狀。臨床中亦常見個案受到背叛經驗之影響，甚至因為被背叛而產生強烈的心理困擾。然而，回顧過去文獻，針對背叛經驗對個體之影響來進行探討的實徵研究為數不多，而在少數探討被背叛者之心理狀態的研究中，亦缺乏評估個體主觀背叛程度的相關量表。本研究將探討經歷背叛後是否會出現類似PTSD之症狀，檢驗相關的風險因子，並據此提出背叛引發之PTSD症狀的心理病理模式。方法 參與者來源為普通心理學修課學生和網路招募，為了建立可評量主觀背叛感受之量表，本研究先進行前置研究，共蒐集63位參與者的背叛經驗及感受。研究一採橫斷式研究，包含267位參與者，在知情同意後，所有參與者均先書寫其所經歷過的背叛事件，再完成數份自陳量表，包括：背叛距今的時間、關係類別、關係親密/親近/信任程度、關係改變、背叛時負向情緒、憤怒/報復反應、背叛評估、覺知背叛嚴重度、失功能認知（負向自我與負向世界）、不良的認知策略（反芻與思考壓抑），以及背叛引發的PTSD症狀（回想事發後一個月與最近一個月的PTSD症狀）。研究二為前瞻式研究，107位參與者完成與研究一相同之測量後，間隔六週後，追蹤測量背叛引發的PTSD症狀。結果 前置研究、研究一及研究二結果顯示：（1）信任/背叛評估量表具良好的內部一致性及可接受的再測信度；（2）針對目標背叛事件，本研究中共有17.2%的受試者目前極可能符合創傷後壓力疾患之診斷；（3）相關分析結果發現，背叛後雙方的關係變差、背叛時負向情緒、憤怒/報復反應、覺知背叛嚴重度、背叛評估、背叛後的失功能認知及不良的認知策略，與事發後一個月及目前的PTSD症狀嚴重度均有顯著正相關。此外，中介分析顯示，背叛評估透過失功能認知與不良的認知策略，影響目前的PTSD症狀；（4）根據路徑分析結果，本研究所提出之背叛引發的PTSD症狀心理病理模式展現良好的模型適配度，顯示對背叛事件的主觀評估背叛程度，可透過不良的認知策略及失功能認知，進而影響背叛引發的PTSD症狀。討論 本研究結果顯示背叛所引發的PTSD症狀及強烈情緒困擾，可能不亞於現今診斷系統所定義之創傷事件。此外，本研究所提出的背叛後PTSD症狀心理病理模式，可作為臨床工作者處遇遭遇背叛的個案之參考。

關鍵字

背叛 ； 創傷後壓力疾患 ； 失功能認知 ； 反芻 ； 思考壓抑 ； 人際關係

並列摘要

Background: Betrayal by a trusted individual is highly distressing and may cause symptoms similar to posttraumatic stress disorder (PTSD). Given that the issue has theoretical and clinical importance but lacks sufficient data, it is crucial to investigate the risk factors and psychopathological model of betrayal-related PTSD. Among the possible risk factors, catastrophic betrayals, like potentially traumatic events, tends to shatter one’s fundamental assumptions of safety, control, trust, and justice in the self and the world. This may further lead to negative beliefs pertaining to the self and the world, resulting in prominent PTSD symptomatology. Certain maladaptive coping strategies may prevent the negative beliefs from being corrected, so as to maintain PTSD symptomatology. Accordingly, we proposed a psychopathological model of betrayal-related PTSD, in which the interplay of appraisal of betrayal, dysfunctional cognitions, and maladaptive cognitive strategies contribute to the development of betrayal-related PTSD. The aim of the study is threefold: (1) to develop a subjective betrayal appraisal scale; (2) to investigate risk factors for betrayal-related PTSD and examine whether betrayal could result in PTSD symptomatology; and (3) to examine the proposed psychopathological model of betrayal-related PTSD by using a prospective design. Method: The pilot study surveyed 63 college students’ knowledge and conceptualization of betrayal. Study 1, using a cross-sectional design, surveyed 267 young adults who reported to have been betrayed. They were instructed to provide a narrative of the most distressing betrayal experience in their lifetime, as well as to elaborate the nature and appraisals of the relationship and betrayal. Dysfunctional cognitions, maladaptive cognitive strategies, and PTSD symptoms pertinent to the betrayal were assessed. The Study 2, using a prospective design, surveyed 107 young adults who completed baseline and 6-week follow-up assessment. Results: (1) The self-developed Trust-Betrayal Inventory demonstrates a good internal consistency and an acceptable test-retest reliability. (2) Approximately one-fifth (17.2%) of the sample met the criteria for current probable PTSD. (3) Relationship change, peri-betrayal negative emotions, current anger/revenge responses, perceived betrayal severity, betrayal appraisal, and post-betrayal cognitive factors were significantly associated with both acute (first months since betrayal) and current PTSD symptoms. Moreover, post-betrayal cognitive factors significantly mediated the relationship between betrayal appraisal and PTSD. (4) Path analysis indicated a good fit for the proposed psychopathological model. Conclusion: Our study provides preliminary evidence that betrayal might be viewed as a potential traumatic event that may cause PTSD. Subjectively-rated betrayal and post-betrayal cognitive factors were shown to be the crucial risk factors of betrayal-related PTSD. Moreover, the proposed psychopathological model for post-betrayal PTSD was supported. The clinical implications of the findings and future directions are discussed.

並列關鍵字

betrayal ； PTSD ； dysfunctional cognition ； rumination ； thought suppression ； interpersonal relationship

參考文獻

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TRR: American Psychiatric Pub.

American Psychiatric Association. (2013). The Diagnostic and Statistical Manual of Mental Disorders: DSM 5: bookpointUS.

Amir, M., Kaplan, Z., Efroni, R., Levine, Y., Benjamin, J., & Kotler, M. (1997). Coping styles in post-traumatic stress disorder (PTSD) patients. Personality and Individual differences, 23(3), 399-405.

Beck, J. G., Coffey, S. F., Palyo, S. A., Gudmundsdottir, B., Miller, L. M., & Colder, C. R. (2004). Psychometric Properties of the Posttraumatic Cognitions Inventory (PTCI): A replication with motor vehicle accident survivors. Psychological Assessment, 16(3), 289.

Blow, A. J., & Hartnett, K. (2005). Infidelity in committed relationships I: A methodological review. Journal of Marital and Family Therapy, 31(2), 183-216.