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| Title: | 失眠脆弱特質、壓力因應及睡眠的不當認知在失眠發展歷程所扮演的角色
The Roles of Sleep Vulnerability to Stress, Coping and Maladaptive Sleep Belief in the Development of Insomnia |
| Authors: | 洪智盈
Hung, Chih Ying |
| Contributors: | 楊建銘
Yang, Chien Ming
洪智盈
Hung, Chih Ying |
| Keywords: | 失眠
失眠脆弱特質
因應方式
睡前激發狀態
不良睡眠信念
insomnia
sleep-related vulnerability
coping strategies
pre-sleep arousal
dysfunctional belief |
| Date: | 2012 |
| Issue Date: | 2013-07-22 17:17:02 (UTC+8) |
| Abstract: | 研究目的：失眠病因理論指出失眠可能受到壓力誘發，進而提高激發程度，干擾睡眠；壓力下的睡眠脆弱特質可能為一危險因子，而伴隨有不當的睡眠信念與壓力因應者可能讓失眠症狀更易延續。過去研究也支持了上述因子與失眠的關聯性，但由於過去研究多為橫斷相關研究，對於了解這些因素如何交互影響造成失眠的發生仍相當有限。本研究透過追蹤2006年針對大學生睡眠調查的研究受試者以更進一步了解此一問題，欲探討兩研究目的：一為了解壓力下睡眠脆弱特質是否可預測失眠症狀的發生；其次為探討壓力因應風格及睡眠的不適當認知在負向生活經驗對身心激發程度及失眠的影響是否扮演調節變項的角色。
研究方法：本研究以問卷調查法進行，以2006年10月由政治大學睡眠實驗室於政治大學進行睡眠調查研究之受試者為研究對象，該研究中有330位受試者簽名表示同意接受後續追蹤調查。本研究透過電話可聯絡到192位受試者，一共回收126份（66%）有效問卷。問卷內容包含失眠嚴重度指標(Insomnia Severity Index; ISI)、匹茲堡睡眠品質量表(Pittsburgh Sleep Quality Index; PSQI)、福特壓力下失眠反應量表( Ford Insomnia Response to Stress Test; FIRST)、睡眠失功能信念及態度量表(Dysfunctional Beliefs and Attitudes about Sleep; DBAS)、睡前激發程度量表(Pre-Sleep Arousal Scale; PSAS)、生活經驗調查(Life Experiences Survey; LES)以及因應量表(COPE)。統計方式則分別以邏輯斯迴歸分析探討失眠脆弱特質對失眠症狀發生的預測力，以階層迴歸分析探討睡前身心激發程度在負向生活經驗預測失眠嚴重度的中介效果，以及壓力因應方式和睡眠的不適當認知對負向生活經驗預測睡前激發程度的調節效果。
研究結果：研究結果發現失眠脆弱特質對失眠症狀之發生有接近顯著的預測效果，呈現失眠脆弱特質越高，未來失眠風險就越高的趨勢。負向生活經驗會透過睡前身心激發程度的完全中介效果之作用，來影響失眠的嚴重程度；且失眠脆弱特質對負向生活經驗與生理激發程度的關聯性有調節效果，而情緒因應方式對負向生活經驗與認知激發程度的關聯性有調節效果，進而影響失眠嚴重程度。然而對睡眠的不當認知並無顯著調節效果，而是會直接影響睡前身心激發程度，進而影響失眠的嚴重度。
研究結論：研究結果基本上支持失眠病因理論的預測，壓力會透過提高激發程度進而干擾睡眠，然而不同的調節因子可能有不同的作用路徑。在失眠脆弱特質的預測性上，呈現出特質越高未來失眠風險就越高的趨勢，但其預測力並未達到顯著，且此特質較高者在面對壓力時會引發較高的生理激發；而面對壓力時若採情緒風格因應者則易引發較高的認知激發程度，進而提高失眠嚴重程度。此外，不當之睡眠信念則不需與生活壓力形成交互作用，直接就對睡眠形成影響，推論這些信念會使得睡眠本身成為壓力的來源。這些結果有其臨床意涵，建議壓力下睡眠脆弱特質可作為篩選失眠的高危險族群的指標，針對此族群提供衛教，教導適當有效的因應壓力方式及放鬆技巧訓練，以降低其生理或認知激發狀態，以降低失眠的發生率。
OBJECTIVE: Various etiological models of insomnia suggest that stress might interfere with sleep by increasing level of arousal. Sleep vulnerability to stress might precipitate an individual to this effect, and maladaptive belief and coping skills could perpetuate the transient sleep disturbance into more long term insomnia symptoms. Previous studies have supported the associations between these factors and insomnia. However, past studies were mostly cross-sectional in nature, how these factors interact to contribute to the development of insomnia is still limited. Thus, the goals of present study are to examine (1) whether normal sleepers who are vulnerable to stress-related sleep disturbance are at higher risk for subsequent development of insomnia symptoms at a long-term follow-up, and (2) whether pre-sleep arousal serves as a mediator, and coping and maladaptive sleep belief serve as moderators of the association between stress and insomnia severity.
METHOD: The sample was from the participants of a sleep survey at National Chengchi University in 2006. There were 330 participants agreed to be contacted for follow-up sleep surveys. They were invited to participate in the study through telephone in 2012. Participants who agreed to take part in the study were asked to complete a battery of questionnaires online, including the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Ford Insomnia Response to Stress Test (FIRST), the Dysfunctional beliefs and attitudes about sleep questionnaire (DBAS), the Pre-sleep arousal scale (PSAS), the Perceived Stress Scale (PSS), the Life Experiences Survey (LES) and the COPE. Logistic regression analysis was used to examine whether sleep vulnerability to stress predicts insomnia symptoms, and linear regression analysis was used to explore whether pre-sleep arousal serves as a mediator and coping and maladaptive sleep belief as moderators for the association between stress and the development of insomnia.
RESULTS: Sleep vulnerability to stress showed a near significant trend in predicting insomnia symptoms. Pre-sleep arousal plays a mediating role between negative life experiences and insomnia severity. On the other hand, sleep vulnerability to stress moderates the association between negative life experiences and pre-sleep somatic arousal; emotional coping strategies serve as a moderator for the association between negative life experiences and pre-sleep cognitive arousal affecting insomnia severity. Although maladaptive sleep belief does not play a moderating role, it predicts pre-sleep arousal directly.
CONCLUSIONS: The findings basically support the prediction of insomnia etiological models that stress interferes with sleep by increased arousal; however, different psychological factors play different roles in the process. It showed a tendency that participants have more sleep vulnerability to stress are at high risk to develop insomnia symptoms. However, the predictability of sleep vulnerability does not reach significant level. Individuals with high vulnerability might have increased somatic arousal when facing stressful situations and those who use more emotional coping strategies might increase cognitive arousal. Maladaptive sleep belief predicts pre-sleep arousal directly instead of interacting with negative events. It is possible that the maladaptive sleep belief can increase sleep-related stress directly. The results imply that sleep vulnerability to stress can serve as an indicator to identify individuals with higher risk for insomnia. A preventive program with sleep education and relaxation training to reduce pre-sleep arousal can be provided to prevent occurrence of insomnia. |
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| Description: | 碩士
國立政治大學
心理學研究所
97752018
101 |
| Source URI: | http://thesis.lib.nccu.edu.tw/record/#G0097752018 |
| Data Type: | thesis |
| Appears in Collections: | [心理學系] 學位論文
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