憂鬱人際模式之探討：尋求再保證的促發、調節與補償機制

Interpersonal Approach to Depression: The Contributory, Moderating, and Countervailing Mechanism of Reassurance-Seeking

黃天豪(Tien-Hao Huang)

指導教授 ： 陳淑惠

國立臺灣大學/理學院/心理學研究所/碩士(2004年)

https://doi.org/10.6342/NTU.2004.00271

摘要

Coyne（1976b）提出的憂鬱人際模式描繪著一個透過與周遭他人的互動影響憂鬱的循環系統。該系統假設憂鬱個體的症狀會引發他人的負向情緒與拒絕，而他人如此的反應則會返身維持�增強個體的憂鬱。在此脈絡下，Joiner及其同僚自1992年開始，透過一系列的研究，進一步提出「尋求再保證」乃憂鬱人際模式的核心；不僅如此，還試圖將尋求再保證由原先「調節」憂鬱的效果的角色，轉為「促發」憂鬱的脆弱因子。整理過往文獻，發現「尋求再保證」概念在論述與研究中有釵h混亂的情形，包括變項定義�定位的不清、工具的瑕疵、邏輯的謬誤；因此，本研究經過批判式的分析，提出尋求再保證在不同憂鬱階段中扮演的三種作用：前憂鬱時期的促發作用、憂鬱時期中的補償作用、以及後憂鬱時期的調節作用。研究分為三個部分，第一部份建立具有信效度的尋求再保證概念測量工具；第二部分則以前瞻式的研究取向，檢驗尋求再保證的促發與調節作用；第三部分以患者與對照組的比較，檢驗尋求再保證的補償作用。結果發現，（一）尋求再保證確為憂鬱的脆弱因子，與壓力的搭配之下，透過他人負向反應的中介，可預測憂鬱症狀的發生；（二）低正向謬誤的憂鬱患者，在尋求再保證下可提高社會支持滿意度，故尋求再保證在個體憂鬱時確有補償作用；（三）憂鬱的維持，可透過尋求再保證調節初始憂鬱與他人負向反應對後續憂鬱的影響完成。然而，初始憂鬱到後續憂鬱的路徑中，他人負向反應的中介性之不存在，則與原先假設不符。本論文最後針對不符假設的可能原因及尋求再保證之相關臨床應用考量皆做了討論。

關鍵字

他人反應 ； 人際模式 ； 尋求再保證 ； 憂鬱 ； 正向謬誤

並列摘要

Coyne (1976b) proposed an interpersonal theory of depression to portrait the nature of the interaction between depressed people and significant others. Such interaction will eventually produces an interpersonal space whereby symptoms of depressed people will breed negative emotion and rejection from others. More important, he believed that these perceived rejections from others would in turn lead to the maintenance and/or deterioration of depressive symptoms in depressive individuals. Joiner and his colleague further postulated that reassurance-seeking serves as a core element in the interpersonal theory of depression. To demonstrate their theory, he and his colleague completed a series of research since 1992 on this topic and their findings mainly showed that reassurance-seeking not only serves to “moderate” the effects of depression, but also plays as a “vulnerability” role of depression. However, in-depth literature review suggests that there still exists a great sense of vagueness about the role and mechanisms of reassurance-seeking in depression arising from unclearly defined variables, inadequate measurements, and the paradoxical hypotheses in past discourses and studies. Therefore, the present thesis introduces three mechanisms of reassurance-seeking on different depression stages through a dialectical analysis process, i.e., contributory effect during the pre-depression period, countervailing effect during the depression period, and the moderating effect during the post-depression period.
Three studies were conducted to examine: a) the reliability and validity of the Chinese version of Reassurance-Seeking Scale; b) the contributory and moderating effect of reassurance-seeking using prospective strategy; and c) the countervailing effect of reassurance-seeking by comparing depressed patients with normal control. Study 1 reported that the Chinese version of Reassurance-Seeking Scale yielded satisfactory psychometric properties and demonstrated that reassurance-seeking is a reasonably cohesive, replicable, and valid construct. Part 1 of the study 2 prospectively assessed a group of initially symptom-free participants to show that reassurance-seeking predicts future depressive reactions to stress and is mediated by others’ negative responses. The finding from this part is supportive of the vulnerability/ contribution hypothesis of reassurance-seeking. Part 2 of the study 2 prospectively assessed a group of initially depressed participants to investigate whether reassurance-seeking moderates the relation of initial depressive symptoms and negative responses of others with future depressive symptoms. The results are also supportive of the maintainance/ moderation hypothesis of reassurance-seeking. Study 3 demonstrated that reassurance-seeking covaries with social support satisfaction in non-positive illusionlized, depressed people. Our data again provide evidence for the countervailing hypothesis. Specifically, the absence of the mediating effect of “others’ negative responses” of initial depression on future depression is an unexpected result in the study. Some possible explanations for this finding in the context of statistical, conceptual, cultural, and temporal viewpoints will be provided. Finally, in the last part of the thesis, we discuss some clinical implications of reassurance seeking.

並列關鍵字

interpersonal theory ； depression ； responses of others ； positive illusion ； reassurance-seeking

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