親友對憂鬱病患的反應：覺知尋求再保證與關係義務感的機制探討

The Responses of Relatives and Friends toward Depressed Individuals: The Mechanism of Perceived Reassurance-Seeking and Sense of Relation Obligation

王偉信(Wei-shin Wang)

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.2004.01016

摘要

本研究旨在探究親友的覺知尋求再保證與關係義務感如何影響其對憂鬱者之反應。Coyne（1976b）提出憂鬱人際模式以描繪一個透過與周圍他人的互動進而影響憂鬱之維持或惡化的循環系統。在此系統中，憂鬱者的症狀會使他人產生負向情緒與拒絕行為，而他人的反應又會返身增強/維持個體的憂鬱。在此概念脈絡下，Joiner及其同僚自1992年開始，透過一系列的研究，進一步提出病患的「尋求再保證」乃是憂鬱人際理論的核心。截至目前，西方憂鬱人際理論的概念建構及實徵研究均有相當的進展，相較之下，台灣本地在此方面的探討卻仍屬闕如。有鑑於此，本研究整合西方的理論概念模式，並考慮台灣本地的文化特性，一方面檢驗西方憂鬱人際理論之預測在台灣本地臨床憂鬱樣本的適用性，另一方面主張「關係義務感」及「拒絕概念多面向性」乃西方理論所忽略之重要觀點，並進一步設計實徵研究來修正與拓展憂鬱人際理論。本研究以九十四名門診憂鬱患者之親友為研究對象，透過自行發展的覺知尋求再保證與關係義務感等量表與訪談，結果發現：（一）親友覺知憂鬱者的尋求再保證與其負向情緒確為拒絕反應之影響因子，但台灣與西方所呈現的拒絕樣貌相當不同；（二）親友的關係義務感調節其覺知尋求再保證對拒絕及負向情緒的預測效果。是故，憂鬱人際理論模式應納入關係義務感之構念，才能對憂鬱的人際互動現象有更細緻的瞭解與預測。本論文最後以華人關係特性切入，嘗試討論「台灣與西方之不同樣貌的拒絕」、「關係義務感之調節效果」等論點，另一方面，對本地臨床實務中的憂鬱防治亦作了討論與建議。

關鍵字

關係義務感 ； 親友反應 ； 人際模式 ； 覺知尋求再保證 ； 憂鬱

並列摘要

The present thesis aimed to investigate the responses of relatives and friends toward depressed individuals. Specifically, we postulated that perceived reassurance-seeking (P-RS) and sense of relation obligation (SRO) of the relatives and friends would influence their own negative emotions and rejection. Coyne (1976b) proposed an interpersonal theory of depression which describes the nature of the interaction between depressed people and their significant others. In essence, the interaction between the depressed and their significant others would eventually produce an interpersonal space whereby depressed people's reassurance seeking would breed negative emotions and rejection from their significant others. The theory also asserted that others' negative emotions and rejection would in turn lead to the maintenance and/or deterioration of depressive symptoms in depressed individuals. Joiner and his colleagues further suggested that reassurance- seeking serves as a core element in the interpersonal theory of depression and completed a series of research since 1992 to verify it. Up till now, there has already existed ample of research on the interpersonal theory of depression in the Western literature, while in Taiwan there is considerably insufficient research evidence. Therefore, we designed the present study to examine several predictions elicited from the interpersonal theory of depression. In addition, we believed that emphasis on “relations” between people is unique in Taiwanese culture and expression of rejection may manifest in various forms. It is thus intriguing and important to add two culture-relevant variables, i.e., “sense of relation obligation” and “different expressions of rejection”, into account for the expanded interpersonal theory of depression. In order to investigate the expanded theory in Taiwan, the present thesis has developed the Perceived Reassurance-Seeking Scale and Multi-phasic Rejection Scale first. Participants of this study consisted of 94 relatives and friends of depressive outpatients. Brief diagnostic interview and the self-report scales were given at individual base. Results of the study indicated that: (1) P-RS and negative emotions were significantly associated with rejection; however, there was a difference in the expression of rejection between the findings in Western culture and that of Taiwanese culture; (2) SRO served as a moderator of the links between the P-RS and rejection; as well as between the P-RS and negative emotions. The findings of the study were discussed in the context of Chinese relational characteristic. Finally, clinical implications for the prevention and treatment of depression were also addressed.

並列關鍵字

interpersonal theory ； sense of relation obligation ； perceived reassurance-seeking ； depression ； responses of others

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