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題名:921震災受創者災後身心反應之變動與維持:災後環境壓力、因應資源與因應歷程的追蹤研究
作者:洪福建 引用關係
作者(外文):Fu-Chien Hung
校院名稱:國立臺灣大學
系所名稱:心理學研究所
指導教授:吳英璋
學位類別:博士
出版日期:2003
主題關鍵詞:921集集大地震天然災難創傷壓力創傷暴露程度災後環境變動壓力因應資源認知評估與因應創傷後壓力症候群921 Chi Chi Earthquakenatural disastertraumatic stresstraumatic exposure levelpost-disaster stresscoping resourcescognitive appraisal and copingpost-traumatic stress reaction
原始連結:連回原系統網址new window
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921集集大地震是社區性的天然災難事件,災難事件不僅造成人文與生態環境的破壞,更會造成個人與集體的心理創傷。受創者的災後身心反應,主要包含再經驗與逃避兩大類症狀。災後身心反應會隨著時間過往而逐漸減緩,但仍有部份受創者會持續出現災後身心症候,甚至罹患創傷後壓力疾患以及焦慮憂鬱等心理症候群。災後身心反應是由多重因子所決定,依據災難發生的時間向度,有效的預測因子可區分為災難前因素(例如,受創者背景特性、先前災難經驗等)、災難當下因素(例如,災難暴露程度)、災難後因素(例如,環境變動壓力、因應資源損失、以及因應策略等)。就受創者個人層次而言,災難的衝擊包括「事件」、「環境」以及「個人」三部份。(1).事件部份:921地震在短暫時限內,突發湧入超量訊息並造成強烈負向情緒,將直接衝擊個體情緒訊息處理的適應歷程;(2).環境部分:921地震重擊並摧毀個體所處的生活環境,造成外在社會資源的巨量流失與劇烈的環境變動壓力;(3).個人部份:921地震衝擊個體往常經驗建構的內在世界模式,因而重創受創者的內在心理資源。
災後身心反應的發生機制,是因災難訊息的處理不全以及災難經驗與災前經驗結構的不一致,大部分受創者均能漸次的再處理,成功整合創傷經驗並緩解災後身心反應。但部份受創者透過負向認知評估、以及功能不良的因應策略等機制,造成災後身心反應的變動與維持。而災後環境變動壓力與因應資源匱乏,將影響認知評估與因應策略的選擇,進而影響災後身心反應的變動與維持。
研究的主要目的是:(1).從時間向度的變化,瞭解災難前、災難當下以及災難後等因素如何影響災後身心反應。(2).從受衝擊的層面,瞭解災後環境壓力、因應資源、以及訊息處理的認知因素對災後身心反應的影響。(3).嘗試整合時間向度的變化與災難衝擊的層面,勾勒出災後身心反應變動與維持的心理機制。
研究者採取順溯式的追蹤研究設計,在災後2年家訪241位東勢鎮的成人受創者,並於災後3年半時成功追蹤其中的186位(男性65位,女性121位)。利用結構式訪談與自陳式報告,收集以下四部分資料:(A).災後主客觀的環境壓力與外在社會資源。(B).災難事件的特性與認知處理,包括921地震創傷暴露程度與災後再經驗症狀的認知評估與反應策略。(C).災後身心反應,包括創傷後壓力症候、情緒狀態以及焦慮與憂鬱症候。(D).個人基本信念與內在心理資源。
研究結果顯示:(1).災難當下因素的地震創傷暴露程度,會影響災後環境壓力、因應資源流失、以及災後身心反應。其中的生活破壞指標越嚴重,受創者感受到災後環境變動壓力越大,因應資源越匱乏,間接影響受創者出現較多的創傷後壓力反應。而生命威脅指標只會直接影響創傷後壓力反應。(2).災難前因素的個人基本背景特性,包括女性、不良婚姻狀況以及低教育程度等,均是影響創傷後壓力反應的風險因子。(3)災難後因素,包括環境變動壓力與因應資源,對創傷後壓力反應的影響重大。尤其因應資源的匱乏,不僅直接影響創傷後壓力反應,亦會影響環境變動壓力,再間接影響創傷後壓力反應。且隨著時間的過往,因應資源的影響越大。(4).負向認知評估是災後身心反應增高或維持的重要因素,但不同因應策略則有不同的效果,不良適應的因應策略(包括「行為逃避與解離」與「思考反芻」)是災後身心反應增高或維持的重要因素。「分心策略」則是適應且有效的因應策略。「思考壓抑」、「社會控制」、以及「認知再評估」則有不同效果,要能有效的因應創傷訊息,情緒狀態可能是重要的中介變項。(5).預測不同的創傷後壓力症候群,最有力的變項區段不同。且隨時間的變動亦會產生變化,災難當下因素的影響漸趨式微,而災難後因素相形將更加重要,尤其是災後因應資源的變化以及認知評估與因應策略的運用。
最後,研究者以因應資源及因應策略為核心觀點,討論創傷後身心反應變動與維持的心理機制,並嘗試整合認知取向、壓力因應取向以及社會認知取向的創傷壓力觀點。
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