慢性病之心理威脅與自我調節模式之研究

Abstract

研究目的：人類天生是目標取向的生物，追求舒適、穩定、成長、正向感受，利於生存。本研究的目的在探討個人追求「保持身體健康」目標的過程中，當發生罹患慢性病之事件—一個衝擊個人原來對自己身體之理解與把握、且不可逆的變動時—個人將在心理上感受到何種程度的威脅，此威脅在患病的過程中如何變化，以及此變化與自我調節歷程的關係。研究方法：本研究發展「慢性病之心理威脅與自我調節模式」，編製「威脅指標—台灣版」及「自我調節量表」，以初次檢查出異常之血糖、血壓、膽固醇數值之患者，或檢查出異常不到半年者，或已確定診斷患有糖尿病、高血壓或高血脂症，但至今不到半年者為研究對象，進行一對一訪談，以探索慢性病患者在初檢查出異常或確定診斷之後，所感受到之慢性病威脅的變化，以及在這變化背後之自我調節歷程的運作。研究結果：主要的研究結果有四點。第一，慢性病威脅在經過一段罹病時間之後會降低；第二，慢性病威脅的降低與「處在概念探索狀態」的減輕，以及「同以正向概念建構自我與慢性病」與「同以正向概念建構理想自我與慢性病」的增加有關；第三，「慢性病對理想自我的威脅」是「啟動」自我調節的要素；第四，「目標」在整個自我調節的路徑中是一個在路徑前端的要素，後續促動「監督」與「修正」的進行。研究結論：從本研究對象看到，患者在罹患慢性病後會經歷心理威脅，並啟動自我調節歷程。心理威脅的變化與「自我」、「理想自我」及「慢性病」的認知建構有關；即使患者逐漸感受到慢性病對生活的影響，但在罹病初期的自我調節歷程中，仍維持「目標」，繼續「監督」與「修正」，獲得現況的改善，並對慢性病狀況及瞭解程度在評分上有進步。

Purpose: Human beings have a general purpose to their daily life in terms of comfort, stability, and growth. Chronic disease however is irreversible and a threat to the above approaches to life, as well as leading an individual to have a psychological crisis. This research investigates what the psychological threat and its change is when an individual encounters a chronic disease. The relationship between psychological threat and self-regulation is also investigated. Methods: The purpose of this research is to build up “the psychological threat of chronic illness and self-regulation model” by examining the theoretical concepts of psychological threat and self-regulation. The main tools are “Threat Index—Taiwan Version” and “The Self-Regulation Inventory.” These tools are used on newly diagnosed patients with chronic disease to investigate the psychological threat of chronic illness and self-regulation. Chronic diseases included diabetes mellitus, hypertension, and hyperlipidemia in this research. Results: There are four main results in this study. First, the psychological threat of chronic illness reduced after having the chronic disease for a period of time. Second, the reduction of psychological threat of chronic illness related to the decrease of “concept exploring,” the increase of “construing both self and chronic disease as positive,” and “construing both ideal self and chronic disease as positive.” Third, “the psychological threat of chronic illness to ideal self” plays a role to activate self-regulation process. Fourth, “goal” is the basic component of self-regulation. Conclusions: The newly diagnosed patients would experience psychological threat of chronic illness, and this threat would activate self-regulation. The change of psychological threat relates to the variation of cognitive constructs of self, ideal self, and chronic Illness. Though these patients gradually realize the influence of chronic illness, they keep the goal, monitoring, and modification of self-regulation, and get improvement.