對逝者的內外化持續性連結之探索：特定依戀與傷慟後認知的影響

Abstract

依戀觀點傷慟歷程概念衍生之內外化持續性連結的相關研究結果尚乏一致，本研究重新檢視其概念，釐清特定依戀、傷慟後認知與兩持續性連結之關聯；嘗試解構哀傷症狀組成，驗證兩持續性連結與相關症狀之關聯；探索兩持續性連結間之預測關係，以及離世預期與否於傷慟後認知與症狀的差異。招募經歷親愛他人離世者176名，完成傷慟事件、特定依戀、傷慟後認知、持續性連結、哀傷症狀、創傷後壓力症狀與憂鬱症狀相關量表。結果發現：（1）哀傷症狀含悼念逝者與空洞自我兩向度。（2）僅特定逃避依戀負預測內化持續性連結；傷慟後負向自我或世界認知皆正預測內化或外化持續性連結；自我責備認知則正預測外化持續性連結。（3）特定焦慮依戀與外化持續性連結間受傷慟後負向自我、負向世界或自我責備認知調節；特定焦慮依戀與內化持續性連結間僅受自我責備認知調節。（4）內化或外化持續性連結皆正預測悼念逝者哀傷、空洞自我哀傷、創傷後壓力或憂鬱症狀。（5）外化中介內化持續性連結與悼念逝者哀傷、空洞自我哀傷、創傷後壓力或憂鬱症狀間關係；內化僅中介外化持續性連結與悼念逝者哀傷症狀間關係。（6）內化至外化持續性連結之預測，受特定焦慮依戀或自我責備認知調節，然外化至內化則無。（7）相對於離世預期組，非預期組有較高傷慟後認知與相關症狀。最後，依據前述結果以關係與認知交互影響之角度探討內外化持續性連結與各前置及後續因素的關聯，並說明研究貢獻、臨床意涵、限制與未來方向。

The concepts of internalized and externalized continuing bonds have been proposed and examined incorporated into bereavement process based on attachment viewpoint. However, the findings of related studies were inconsistent. Therefore, the present thesis study has three objectives. First, it aimed to elucidate the associations of specific attachments and post-bereavement cognitions with the two continuing bonds. Second, the study planned to re-analyze the construct of grief symptoms, and elucidate the associations of continuing bonds with grief related symptoms. Third, the predictive relationships between internalized and externalized continuing bonds as well as the differences of impact between unexpected and expected death on post-bereavement cognitions and grief related symptoms will be explored. The study recruited 176 participants who experienced the loss of beloved other. Participants were asked to complete the questionnaires about bereavement event, specific attachments, post-bereavement cognitions, continuing bonds, grief symptoms, posttraumatic stress symptoms, and depression symptoms. Factor analysis, regression analysis, t-test were performed. Results show: 1) Grief symptoms consisted of two components, i.e., sorrows at deceased and nullification in self. 2) Specific avoidance attachment negatively predicted internalized continuing bond. Concerning post-bereavement cognitions, negative self and negative world cognition positively predicted internalized and externalized continuing bonds, while self-blame cognition positively predicted externalized continuing bond. 3) The relationship between specific anxiety attachment and externalized continuing bond was separately moderated by post-bereavement negative self, negative world or self-blame, while the relationship between specific anxiety attachment and internalized continuing bond was moderated only by self-blame. 4) Both internalized and externalized continuing bonds positively predicted sorrows at deceased grief, nullification in self grief, posttraumatic stress and depression symptoms. 5) Externalized continuing bond mediated the relationship of internalized continuing bond with sorrows at deceased grief, nullification in self grief, posttraumatic stress or depression symptoms, but internalized continuing bond only mediated the relationship between externalized continuing bond and sorrows at deceased grief symptoms. 6) The relationship from internalized to externalized continuing bonds was moderated by specific anxiety attachment or post-bereavement self-blame, but no significant result was noted in the reverse direction. 7) The unexpected death group showed significantly more post-bereavement cognitions and grief related symptoms, compared to the expected death group. Based on above findings, the associations among continuing bonds, specific attachments, post-bereavement cognitions, and grief were discussed, using interactive viewpoint of relationship and cognition, to explore the plausible development of internalized and externalized continuing bonds in response to loss. Finally, applications, clinical implications, limitations and future direction of research were further addressed.