The Research of Association between Overgeneral Memory and Posttraumatic Stress Symptoms with the adult survivors of the 921 Earthquake

本研究的目的在於以實徵研究的方式，針對九二一震災之創傷並以認知的角度，嘗試釐清過度概化記憶與創傷後壓力症狀的關聯性。創傷後壓力症狀以侵入與逃避兩症狀為主，症狀的展現反映著受創者對創傷訊息的處理過程與狀態。在臨床治療與理論上，個案對創傷的具體化陳述為治療必經之途，且有助於創傷後壓力症狀的緩解。實徵研究上也發現，創傷個體之自傳式記憶有過度概化的現象。綜上推之，自傳式記憶之過度概化與兩大創傷後壓力症狀之間存有相關性。然而，針對此議題之實徵研究數量有限，且研究結果尚無定論。再者，大多研究所測之自傳式記憶為情緒事件，而且少有區分創傷事件的類型，同時以AMT典範測量自傳式記憶的過度概化也缺乏生態效度。是故，本研究針對特定類型的創傷事件，選用與發展合宜之研究工具與程序，對過度概化記憶與創傷後壓力症狀之關聯性進行探索性實徵研究。本研究樣本為經歷九二一地震之南投縣埔里鎮成年居民192位，針對九二一地震之經歷進行回憶記錄，用改良之自傳式記憶內容概化測量指標進行自傳式記憶概化的客觀分析。再者，進行事件衝擊量表中文版之心理計量檢驗，並以事件衝擊量表中文版測量個體對九二一地震的逃避與侵入症狀的發生頻率。另外，考量創傷後壓力症候群與憂鬱症之高共病與相似之認知特性，用SCL-90-R之憂鬱分量表測得憂鬱症狀且予以排除。研究結果顯示，整體過度概化記憶與兩大創傷後壓力症狀之關聯不顯著。但是，記憶過度概化測量中的部分指標，像是非單一事件、無事件後果、持續時間超過一天、無事件發生地點、地點重複等指標，與侵入症狀呈顯著負向關聯；而逃避症狀與非具體描述、持續時間超過一天、無事件發生地點、地點重複、無特定人物等指標有顯著正向關聯。上述結果的顯著性，不受憂鬱症狀的影響。最後，本研究以認知角度切入討論研究結果之意涵，並且報告本研究之限制，及提出未來可供後續研究的方向。This study aims to investigate the possible association between overgeneral memory and posttraumatic stress symptoms with earthquake survivors in Taiwan. Intrusion and avoidance, as the main posttraumatic stress symptoms, reflect the cognitive processing state of traumatic information in survivors. Many empirical studies have found overgenerality of autobiographical memory in survivors. Both clinical therapists and theorist think that remission of posttraumatic stress symptoms may accompany more specific description of traumatic event in traumatized clients. Therefore, we infer that there may be plausible association between overgeneral memory and posttraumatic stress symptoms in Earthquake survivors. However, there exists very few empirical studies and most have resulted inconsistently. In addition, most measurements of autobiographical memory fail to specify trauma categories, and the most broadly used AMT paradigm lacks sufficient ecological validity in measuring overgeneral memory. Thus, we conduct the thesis with more sufficient and valid tool and procedure. The participants of this study are 192 adult survivors residing near the epicenter who were recruited three years post the earthquake. The Impact of Events Scale- Chinese Version (IES-C) was used to assess intrusive and avoidance symptoms, the depression subscale of SCL-90-R was used for depressive symptoms, and modified context-based autobiographical memory task was used to assess the memory about 921 earthquake. Results revealed that various indexes of overgeneral memory were found to have various associations with different elements of posttraumatic stress symptoms. More specifically, intrusive symptom correlated negatively with the indexes of not-single event, no-outcome, duration more than one day, no-place, and repeated place. Avoidance symptom correlated positively with the indexes of not-concrete description, duration more than one day, no-place, repeated place, and not-specific person. Moreover, although there is evident comorbidity between PTSD and depression, the above-mentioned significant results hold after controlling for depression. Finally, discussion on the limitation of the present study as well as possible follow-up research is provided.第一章 緒論 …………………………………………………… 1 研究動機………………………………………………………… 1 第一節 創傷與災難…………………………………………… 6 第二節 創傷後壓力症狀……………………………………… 9 第三節 自傳式記憶的過度概化現象………………………… 14 第四節 過度概化記憶與創傷後壓力症狀…………………… 24 第五節 研究目的與假設……………………………………… 27 第二章 研究方法 …………………………………………… 29 第一節 受試者………………………………………………… 29 第二節 研究工具……………………………………………… 30 第三節 統計分析……………………………………………… 33 第三章 研究結果 …………………………………………… 34 第四章 結論與討論 ………………………………………… 43 第一節 地震受創區居民之創傷後壓力症狀………………… 44 第二節 過度概化記憶與創傷後壓力症狀之關聯性………… 46 第三節 過度概化記憶與憂鬱症狀之關聯性………………… 48 第五章 研究貢獻、限制及未來研究方向 ………………… 50 第一節 研究貢獻與臨床應用………………………………… 50 第二節 研究限制……………………………………………… 51 第三節 未來研究方向………………………………………… 53 參考文獻 ………………………………………………………… 56 附 錄 ………………………………………………………… 64 附錄一 事件衝擊量表中文版翻譯授權書……………………64 附錄二 自傳式記憶提取作業與事件衝擊量表中文版………65 作者簡歷 ………………………………………………………… 6