憂鬱情緒與反芻形式對情緒調節與情緒一致/不一致記憶的影響

Abstract

研究背景與目的：憂鬱者的情緒調節長久以來在憂鬱相關模式中都是被探討的議題。Joormann與Siemer ( 2004 ) 結合反芻 ( Nolen-Hoeksema, 1991 ) 與憂鬱者的情緒調節之概念，探討反芻及轉移作業對於高低憂鬱者的情緒一致/不一致記憶之影響。根據Barnard與Teasdale ( 1991 ) 以ICS說明內觀對於憂鬱症之療效機制、Watkins與Teasdale ( 2001 ) 根據ICS區分出不同形式的反芻運作及其相關研究結果、以及李永精 ( 2008 ) 以及李宛霖 ( 2011 ) 的研究結果，皆指出，不同形式之反芻對於個體的認知具有相異的效果。然而過去並無研究探討不同形式之反芻對於個體情緒一致/不一致記憶之影響，亦無研究以記憶可觸接性為指標來直接探討不同形式反芻運作的效果，故本研究擬探討在憂鬱情緒狀態時，個體的憂鬱傾向與使用的反芻形式情緒調節策略，對其情緒修復之效果與其對情緒一致/不一致之影響。 研究方法：本研究先對176位受試者實施負向情緒誘發，然後將受試者分派至分析評價式反芻組或經驗感受式反芻組，最後進行線索回憶作業與實驗操弄檢核。進入正式資料分析的為BDI總分大於14分與小於6分的兩組受試者，分別有47人與48人，共95人。資料分析方式以正負向情緒狀態與正負向線索詞的反應時間為依變項，採2 ( 憂鬱組別：高/低憂鬱 ) × 2 ( 反芻操弄形式：分析評價/經驗感受 ) × 2 ( 線索詞價性：正向/負向 ) 的三因子混合變異數分析。 研究結果：在被誘發憂鬱情緒後，同樣接受分析評價式反芻操弄，低憂鬱組有明顯的情緒不一致記憶，但高憂鬱組則無明顯情緒一致或不一致記憶。同樣接受經驗感受式反芻操弄，高憂鬱組提取正負向記憶皆顯著慢於低憂鬱組。整體而言，高憂鬱組提取正向記憶顯著慢於低憂鬱組，但提取負向記憶的反應時間則二組無差異。高憂鬱組中，經驗感受式反芻組的反應時間，相較於分析評價組顯著較慢。 研究討論：雖然本研究結果顯示無論憂鬱組別或反芻形式，所有受試者皆具明顯情緒修復效果，然而，其在後續的線索回憶作業表現上卻有不同的效果。受試者的情緒在短期內皆獲得修復，然而在認知作業表現上的差異，可能意指在長期的情緒修復效果上，不同憂鬱程度及不同形式的反芻仍具有相異的效果。本研究分別以李宛霖 ( 2011 ) 以及內觀治療之相關研究角度對這些結果加以討論。 研究貢獻：本研究支持過去研究中，高低憂鬱者在情緒一致/不一致記憶之差異，以及高憂鬱者的正向認知缺陷。此外，本研究提供經驗感受式反芻以及MBCT長期療效之自動化歷程證據，更提供未來在進行臨床介入時的一項客觀性參考指標。本研究亦發現高憂鬱者練習經驗感受式反芻較低憂鬱者困難，因此建議進行臨床介入時需要更有耐心地教導個案進行經驗感受式反芻的練習，以及讓個案了解此運作需要長期的練習。

Research on depression has increasingly focused on the issue of emotional regulation. It has become clear that impairment in the regulation of emotions plays a significant role in the onset and maintenance of major depressive disorder. Joormann and Siemer (2004) used negative mood induction paradigm and assessed the effect of rumination on the mood-congruent/incongruent memory in dysphoric and nondysphoric individuals. Recently, research showed that compared to depressive rumination, experiential rumination could be a more adaptive emotional regulation strategy, but few studies examined how experiential rumination influenced mood-congruent/incongruent memory. In this study, the authors investigated how dysphoria and distinct modes of rumination influenced emotion regulation and mood-congruent/incongruent memory under negative mood induction. First, the authors induced negative mood on 176 subjects. After all subjects completed the negative mood induction and pre-tests, they were randomly assigned to analytic rumination or experiential rumination conditions. Finally, all subjects completed post-tests and manipulation check. The authors chose BDI cut point scores > 14 to be dysphoric group and BDI < 6 to be nondysphoric group. Using this criterion, we finally screened 95 subjects to do data analysis. A 2 (dysphoric/nondysphoric group) × 2 (analytic/experiential rumination × 2 (positive/negative cues) three way ANOVA was conducted. The results showed that under negative mood induction, nondysphoric group who ruminated analytically showed mood-incongruent recall of autobiographical memories, while the dysphoric group who ruminated analytically did not show any significant differences in recall latencies for positive and negative memories. Furthermore, compared to nondysphoric group who ruminated experientially, dysphoric group who ruminated experientially recalled significantly slowly to both positive and negative memories. Compared to nondysphoric group, dysphoric group reacted significantly slowly to recall positive memories. Compared to dysphoric group who ruminated analytically, dysphoric group who ruminated experientially showed significant slower reaction times to recall positive and negative memories. We concluded that under negative mood context, dysphoric group did not show a negative bias but instead showed a lack of positive bias. Besides, experiential rumination might have more adaptive effects on automatic information processing, indicating the adaptive effects of experiential rumination on long-term mood recovery. Taken together, the present study supported that experiential rumination was more adaptive. Given that the dysphoric group was more difficult to use experiential rumination compared to their nondysphoric counterparts, we suggest that psychotherapists should help the dysphoric patients know that it takes time and assist them to practice experiential rumination in daily life.