類風濕關節炎患者的認知特徵、因應調節與適應的關係

The relationship of cognitive features, coping, and adaptation in rheumatoid arthritis patients

胡淑娥(Shu-E Hu)

指導教授 ： 譚偉象 ； 陳秀蓉

中原大學/理學院/心理學研究所/碩士(2005年)

https://doi.org/10.6840/cycu200500734

摘要

摘　　　要
研究背景與目的：基於自我調節與正向心理學的概念，本研究建立一個類風濕關節炎患者因應調節的假設性模式，並試圖檢證此模式中四個變項間的關係，即目標差距、認知預期、因應調節及適應結果之間的關係。

研究方法：本研究分三個階段進行資料收集，第一階段是晤談資料收集與分析，由分析結果編製「目標差距量表」與「因應調節量表」；第二階段為預試研究，修訂自編量表；第三階段則是正式研究。正式研究有171位類風濕關節炎患者參與研究，男性21位，女性150位，以問卷調查的方式收集資料。本研究的工具包括：「目標差距量表」、「預期評價量表」、「因應調節量表」、「類風濕關節炎生活品質量表」以及「正負向情感量表」。

研究結果：因應調節假設性模式中，因應調節具有中介效果，且中介途徑不同，放棄努力在確定性預期、財務、尊嚴、生涯、人際等差距預測生活品質時，具有中介效果；放棄努力在確定性預期、財務、尊嚴等差距預測負向情感時，具中介效果；因應未來則是在正向預期預測正向情感時，具中介效果。而其中確定性預期低對採取放棄努力的預測，還受到尊嚴差距的中介影響。因應調節假設性模式中，認知預期則在認知差距預測調整目標、因應未來、生活品質及負向情感時，具調節之效果。

討論：過去對壓力因應的探討，多是針對一般性的壓力，而本研究以類風濕關節炎患者為對象，在評價與因應過程中考慮到疾病特性，將慢性化特徵與對未來的因應，都同時放進調節歷程的模式中考慮，較能反映類風濕關節炎患者的因應特性。本研究對因應調節假設性模式的檢證結果，可以瞭解雖然患者會知覺到認知差距，但患者所採取的因應調節在適應過程中扮演更重要的中介角色，而患者的認知預期能力也對適應過程具有保護因子的效果，因此，心理專業人員在協助此類病患時，認知與行為的介入，將可有效改善患者的適應。

關鍵字

生活品質 ； 認知預期 ； 類風濕關節炎 ； 正負向情感 ； 認知差距 ； 因應調節

並列摘要

ABSTRACT

Derived the concepts of self-regulation and positive psychology, this study purposed to establish a hypothetical model about the coping and adaptation of the rheumatoid arthritis patients, and to examine the relations among four groups of variables of this model, which are expectation discrepancy, cognitive expectancy, coping types and adaptational outcomes.

The study has been divided into three stages, Firstly, using analysis semistructure questions by interviewed with the rheumatoid arthritis patients, the researcher compiled two questionnaires, the Expectation Discrepancy Questionnaire and the Coping Questionnaire. Secondly, a preliminary study which was purposed to revise and validate these two questionnaires . Thirdly , a final study which involving 171 rheumatoid arthritis patients , 21 males and 150 females were scheduled. Five measurements including the Expectation Discrepancy Questionnaire, the Expectancy Appraisal Questionnaire, the Coping Questionnaire, the Rheumatoid Arthritis Quality of Life Questionnaire and the Positive-Negative Affect schedule were used to test our hypothesis.

As the proposed model predicted that the coping types via various paths could have mediatory effects, the results of the study come out that the give up coping type has played mediatory effect when using these variables such as certainty expectancy, cognitive discrepancy of finance , dignity , career and interpersonal relationship predict the participants’ quality of life . Give up also appears a mediatory feature when using these variables such as certainty expectancy, cognitive discrepancy of finance and dignity predict the quality of life . Additionally, proactive coping type also demonstrates mediatory effect when using positive expectation predict the adaptation of the positive affect. Discrepancy of dignity also appears to be a mediator when the certainty expectancy can predict the give up coping. Furtherly, cognitive expectancy specially appears mediatory feature when using cognitive discrepancy variables predict adjust aim, proactive ,quality of life and negative affect.

As focused on general stress by most previous studies, this study specially considered the chronic characteristics of the rheumatoid arthritis patients, from our regulational model took variables such as cognitive features, proactive coping take into the coping and adaptation model. The results of the study have demonstrated that the coping types and cognitive expectancy seem to play both important mediator and protective role for the rheumatoid arthritis patients, although they could also be aware of their own cognitive discrepancies. It is seemed that proper cognition and behavioral intervention provided by professionals of health psychology could help rheumatoid arthritis patients for better adaptation.

並列關鍵字

rheumatoid arthritis ； adaptation ； cognitive expectancy ； expectation discrepancy ； coping

參考文獻

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