自我感、復原力與創傷後症狀之關聯性研究:以燒傷病人為例

Abstract

本研究的目地在於從傳統與正向心理學的角度，以實徵方式探討燒燙傷病患之創傷，並嘗試釐清自我感、復原力與創傷後心理症狀的關聯性。本研究的參與者為來自南臺灣國軍左營醫院燒傷中心輕中重度單純燒傷病患，共33名，以個別施測方式蒐集資料。研究中檢驗的假設與分析結果包括下列數項：首先，由於過去的文獻指出外科燒傷所定義之檢傷系統無法解釋燒傷後病患之心理困擾，因此，本研究就此議題進行檢驗，結果發現，外科燒傷嚴重等級與創傷後症狀並無存在顯著相關。在基本假定理論中，Janoff-Bulman (1985,1992,2006)認為個體之內在假定為個體組織評估自我，以及評價自我歸屬感與他人連結感之認知表徵。在創傷發生後，創傷衝擊內在對世界與自我的假定而造成心理損害，也就是自我感的損壞。PTSD則被視為個體內在假定受到動搖後所產生之不適應的因應反應。過去的研究結果雖大致符合創傷事件前後個體基本信念產生變動，並與心理症狀呈正相關，但由於研究方法與結果上，仍有諸多岐異，因此本研究以本土發展之自我感量表首度進行理論驗證。結果發現，燒傷前後的自我感變動呈顯著差異，而與創傷後症狀存在正相關，且能顯著預測創傷後症狀。由正向心理學角度切入，探討有關復原力(resilience)的特性，復原力可被視為一種人的特質，亦是個體經歷逆境中所展現的一種動力過程，強調在顯著的負向情境中個體所表現出的正向適應力。由於過去的復原力研究大都對逆境事件與正向心理適應的界定內容並不一致，測量單一或多重負向事件的方法與正向適應的標準不同，因此本研究嘗試以芬蘭學者Friborg等人（Friborg, Hjemdal, Rosenvinge, Martinussen, Aslaksen, & Flaten, 2006）所發展之成人復原力量表(Resilience Scale for Adults)做為直接測量復原力的工具。結果顯示，燒傷前後的復原力變動並無顯著差異，燒傷後復原力與創傷後心理症狀存在正相關，且能顯著預測創傷後心理症狀。無論自我感或是復原力研究之結果，大致符合本研究之假設與過去的文獻理論推論。不過，與研究假設不一致之處，在於復原力的變動量不能預測創傷後心理症狀之能力，而燒傷前的復原力無法預測燒傷後心理症狀，此結果可能導因自研究參與者之特性，而復原力特徵的確在創傷事件發生後才會明顯展現的特質。最後，針對本研究的貢獻與臨床上可能的應用進行討論，並提出研究的限制，與未來可供研究的方向。 關鍵字: 自我感、基本假定理論、復原力、創傷後心理症狀、燒燙傷。

The main purpose of the present empirical study was to investigate the associations of sense of self, resilience and posttraumatic stress symptoms in burn patients in Taiwan. There were 33 burn patients from Kaoshiung Tsuo-Ying hospital participated in this study. All According to the literature review, there were no direct association between the degree of severity rated by surgeons and postburn psychological problems. This study reexamined this issue and resulted similarly. The basic assumptive theory, proposed by Janoff-Bulman (1985, 1992, 2006), is about cognitive representation of valuations that organize the self as well as the value of sense of connection and belonging. While the trauma has shattered the assumptions, collapse and breaking-down in self severs as the consequence of damage in the assumptive world. PTSD is then seen as maladjusted response after violation of the assumptions. Some previous studies had shown that the basic assumptions were impacted by the trauma, and also positively correlated to psychological symptoms. However, the measures used in previous studies were inconsistent. This study used indigenous measure of Sense of Self Scale. The results showed that the scores of pre/post burn trauma were significantly different, positively related to posttraumatic stress symptoms, and able to predict the posttraumatic stress symptoms. Based on the positive psychology, resilience is not only defined as personal characteristic but also dynamic process which leads to positive adjustment to adversity. Due to the inconsistency of definition about adversity and adjustment to single or multiple negative events in previous studies, this study adopted the Resilience Scale for Adults developed by Dr. Friborg（Friborg, Hjemdal, Rosenvinge, Martinussen, Aslaksen, & Flaten, 2006） to measure resilience. The results showed that there were no significant differences between pre- and post-burn resilience; the score of postburn resilience were negatively related to posttraumatic stress symptoms. Results of both sense of self and resilience generally met the hypotheses and were consistent with previous theoretical inference. Nevertheless, it is inconsistent with of the hypotheses about resilience that the total change score between pre- and post-burn Resilience Scale were not able to predict posttraumatic stress symptoms. In addition, preburn resilience was not able to predict posttraumatic stress symptoms. These results may be because of the diversities of the characteristics of the participants, or the characteristic of resilience may indeed emerge to manifest itself after the traumatic event. Finally, the contributions, limitations, and clinical applications of the present study were addressed in the last chapter. Some possibilities to carry on further researches were also provided. Keywords: sense of self, the basic assumption theory, resilience, posttraumatic symptoms, burn injury.