憂鬱反芻反應之促發與維持因素：探討憂鬱疾病狀態對個體憂鬱反芻調控歷程之影響

Abstract

文獻指出憂鬱反芻為不適應的因應策略，不僅增強憂鬱並且干擾個體的認知功能。然而，目前仍不清楚為何在憂鬱反芻造成負向效應的情況下，某些憂鬱個體卻仍持續反芻。本研究將藉由檢驗憂鬱反芻之促發因素與維持因素對此議題進行探討。根據文獻回顧，促發因素方面，提出憂鬱或負向情緒、壓力情境及缺乏人際互動等因素很可能為反芻反應的促發因素。維持因素方面，提出對反芻反應之心智控制歷程為憂鬱個體難以停止反芻的可能機制。因此，本研究之主要研究目的包括：（1）藉由分析個體真實生活中反芻反應之情境特徵探討憂鬱反芻之促發因素；（2）藉由檢驗憂鬱疾病狀態如何影響個體對反芻反應之心智調控歷程，探討憂鬱反芻之可能維持機制；以及（3）驗證不同面向之憂鬱反芻與憂鬱的關係。 本研究之研究對象為精神科門診憂鬱患者與未曾憂鬱之成人對照組，各30人。為能有效測量反芻反應隨時間的變動情形，研究設計採取經驗取樣法。研究的進行程序為：首先，評估研究參與者之診斷狀態與智能水準，並測量參與者之心情狀態、反應風格、認知抑制功能及憂鬱症狀嚴重度。第二階段為經驗取樣階段，利用手機記錄參與者之情緒狀態、反芻反應及對反芻之心智控制等變項，每日五次，持續十天。最後，再次評估參與者之憂鬱症狀嚴重度與心情狀態。 研究結果發現：（1）較高的憂鬱情緒與較少的社會互動可預測日常生活的反芻反應；（2）苦惱自責式反芻對憂鬱情緒與憂鬱症狀具顯著正向預測力；（3）憂鬱患者之認知抑制功能表現顯著低於對照組；（4）憂鬱症狀與個體之反芻調控策略組型有關，憂鬱症狀愈高者，採取愈多的思考壓抑與愈少的認知重評策略；（5）以思考壓抑調控反芻將增加反芻維持程度，且此效應受認知抑制功能之調節。 本研究結果支持較高的憂鬱情緒與缺乏人際互動為反芻之促發因素，但不支持壓力對反芻反應之促發效果。反芻發生之後，個體採用之調控策略將影響反芻之維持程度，思考壓抑可預測較高的反芻維持程度，而認知重評則可預測較低的反芻維持程度。此外，認知抑制功能可調節思考壓抑對反芻反應的影響。綜言之，本研究針對憂鬱疾病狀態對憂鬱反芻、反芻調控策略及認知抑制功能之影響進行討論，並提出一憂鬱、憂鬱反芻、思考壓抑之惡性循環模式嘗試說明上述變項間的關係路徑。最後，本研究提出對憂鬱反芻之臨床介入建議與後續研究方向。

Literatures indicate that depressive rumination is a maladaptive coping strategy. It not only intensifies depression but also impairs one’s cognitive function. However, it is still unclear why some depressed individuals still keep ruminating in spite of its negative consequences. In order to investigate this issue, the precipitating factors and maintaining factors of depressive rumination were examined in this study. In terms of precipitating factors of depressive rumination, depressive or negative emotions, stressful situations, and lack of social interaction may be the possible candidates. In terms of maintaining factors, the mental control of one’s ruminative thoughts may be the possible mechanism for depressed individuals to have difficulty in stopping rumination. Accordingly, the aims of the present study are (1) to examine the situational characteristics in real life in order to investigate the precipitating factors of depressive rumination, (2) to investigate how depression symptoms affect one’s mental control process of rumination in order to verify the maintaining factors of rumination, and (3) to re-examine the relationships between different forms of rumination and depression. The participants of the present study included 30 depressed outpatients and 30 never depressed healthy adults. To adequately assess the temporal variation of rumination, the experience sampling method (ESM) was adopted. Data collection was proceeded as follows. Firstly, general level of intelligence and current diagnostic status of the participants were evaluated. They were also asked to complete the measurement of mood status, response style, cognitive inhibitory function, and severity of depression symptoms. Secondly, in ESM stage, participants were provided a mobile phone on which they were asked to make responses to the measures of mood, rumination, and the mental control strategy of rumination five times per day for ten days. Finally, participants were asked to complete the measurement of mood status and severity of depression symptoms again. Results reveal that: (1) depressed emotion and lack of social interaction predicted rumination in real life; (2) brooding significantly predicted depressed emotion and depression symptom; (3) the cognitive inhibitory function of the depressed outpatient group was significantly lower than that of the healthy group; (4) depression symptom severity was associated with the pattern of mental control strategies toward rumination. Individuals with more severe depression symptoms tended to adopt more thought suppression and less cognitive reappraisal to control their rumination; (5) thought suppression predicted the maintenance of rumination, and the effect was moderated by cognitive inhibitory function. The findings of this study support that both depressed emotion and lack of social interaction can precipitate rumination in real life, but stress does not play a precipitating role in rumination. Once rumination occurs, the strategy one uses to control it could affect its maintainence. Thought suppression could predict the maintenance of rumination positively, but cognitive reappraisal predicts the maintenance negatively. Moreover, cognitive inhibitory function could moderate the relationship between thought suppression and rumination maintenance. In sum, this dissertation discusses how depression symptomatology affects rumination, mental control process, and inhibitory function. A vicious cycle among depression, rumination, and thought suppression is suggested to explain the relationships of the above-mentioned variables. Finally, clinical implications and directions of future research are suggested.