探究述情障礙在創傷後壓力症狀對人際互動的影響途徑之調節角色

Abstract

創傷倖存者可能會經歷嚴重的認知與情緒困擾，進而在人際互動上產生負向影響，研究顯示創傷後壓力疾患（posttraumatic stress disorder [PTSD]）症狀嚴重度與冷漠、多衝突的人際關係有顯著正向關聯。Sifneos於1973年彙整臨床觀察心身症病人的臨床行為表現而提出的－述情障礙特質，意涵辨識與表達情緒困難、著重於表象的外向性思考，背後意味著對情緒訊息的認知處理缺損，與情緒調節能力息息相關；此特質常被視為難以進行深層心理治療的阻礙因素，近年來亦在研究創傷領域逐漸受到重視。本研究期望更深入探討述情障礙對PTSD症狀嚴重度的預測力，以及是否在創傷後壓力症狀影響人際互動的關係中扮演調節角色。在人際互動方面選用兩個變項，一為常被視為影響PTSD症狀嚴重度的保護或危險因子－社會支持，另一為倖存者藉以處理日常生活中頻繁接觸的社會情緒刺激－臉部表情辨識能力。本研究預期PTSD症狀會使得倖存者感受到社會支持度降低，以及PTSD症狀可能影響認知能力，而使得臉部表情辨識能力下降，且述情障礙在兩種途徑中可能扮演著調節角色，即述情障礙愈高者，PTSD症狀嚴重度與社會支持、臉部表情辨識能力的負向關聯程度愈趨明顯。研究方法為邀請符合DSM-IV PTSD診斷準則A的大學生進行後續研究，共181名大學生參與正式研究。研究結果發現：（1）在排除神經質與特質焦慮影響下，述情障礙仍對PTSD症狀有顯著的預測力；（2）PTSD症狀與社會支持負相關未達顯著，述情障礙並未有顯著調節效果；以及（3）PTSD症狀與臉部情緒辨識正確率具顯著負相關，述情障礙亦呈現顯著調節效果。此結果顯示PTSD對兩種層次的人際互動變項有不同的影響，且更進一步分析各種臉部情緒辨識率與PTSD關係，發現僅生氣臉部情緒辨識率與PTSD症狀有顯著負相關，且僅在高述情障礙組呈現此顯著負相關，低述情障礙組則否。本研究將根據上述各項結果進行討論及提出在實徵研究與臨床應用建議。

Trauma survivors may experience seriously cognitive and emotional disturbance which will impact their interpersonal interaction negatively. Some researches indicated that PTSD severity has positive relationship with cold or impulsive interpersonal relationship. In 1973, Sifneos observed clinical psychosomatic patients’ behaviors and named it Alexithymia, meaning difficulty in identifying and describing emotions and focus on surface-level external oriented thinking. Alexithymia indeed refers to cognitive process deficiency of emotional information and correlates with their emotional regulation. Therefore, it is often considered as an obstacle when conducting deep insight-oriented psychological therapy, and has been gaining more attention in recent trauma researches. This research aimed to investigate alexithymia’s predictability towards PTSD symptoms severity, and whether it may moderate the process when posttraumatic stress symptoms impacting interpersonal interaction. Two variables are chosen in interpersonal interaction area. One is social support, which often being considered as protect or risk factor that impact PTSD symptoms severity; the other one is facial emotional recognition ability, which the survivors encounter frequently when dealing with social emotional stimuli in their daily life. This research expected PTSD symptoms would make the survivors feel low in social support, and it may also impact negatively on facial emotional recognition ability. Besides, alexithymia may play the role of moderator in both processes, i.e., when alexithymia is higher, high adverse corrections were noted in PTSD symptoms severity with social support as well as PTSD symptoms severity with facial emotional recognition ability. Research samples were 181 college students who matched with trauma event in PTSD diagnostic principle of DSM-IV. Results showed: (1) after excluding the impact of neuroticism and trait anxiety, alexithymia still had significant impact on predicting PTSD symptoms. (2) The negative relationship of PTSD symptoms and social support was not significant, and alexithymia did not show significant effect on this relationship either. (3) The relationship of PTSD symptoms and facial emotional recognition accuracy was significant, and alexithymia also had significant effect on this relationship. The result revealed that PTSD had different impact on these two factors of interpersonal interaction. Further analyses displayed various relationships between different emotional recognition accuracy and PTSD. Specifically, only anger, not other emotions, facial emotional recognition accuracy significantly correlated with PTSD adversely within high-level, rather than low-level, alexithymia survivors. Finally, this research discussed the above results in terms of the role alexithymia may play in PTSD etiology and its methodology, and provided suggestions for future research and clinical applications.