Reassurance-Seeking in Depression: Implicit and Explicit Processes

過度尋求再保證（excessive reassurance seeking, ERS）為Coyne（1976）之人際取向憂鬱理論的核心概念，過去研究已發現ERS與憂鬱的形成與維持有關，本研究則主張個體對正向保證的態度(包括真誠與足夠)很可能在其間扮演重要的角色。本研究依循過去研究，將ERS分為尋求再保證行為（Reassurance seeking behavior, RSB）與尋求再保證後果（Reassurance seeking outcome, RSO）兩個概念，以兩個子研究來探討：（一）不同憂鬱程度組別之ERS歷程的差異；（二）個體對正向保證的態度(包括真誠與足夠)與ERS歷程的關聯；（三）ERS歷程的相關變項在內隱態度、外顯態度、及內隱態度減去外顯態度的差值，變項包括：個體對正向保證的態度、被他人接受的程度、自尊；以及（四）非臨床樣本之ERS歷程研究結果在臨床樣本應用的可行性。在研究一中，將107名校園招募的參與者分為健康對照組（n = 46）、情緒低落組（n = 30）、及校園憂鬱組（n = 31）進行內隱與外顯態度的測量。研究結果發現：憂鬱程度跟RSB與RSO的正相關皆僅在健康對照組達顯著，其餘兩組的相關未達顯著。外顯態度部分發現，憂鬱程度越高的組別，外顯態度越負向；RSO越差，自尊、他人接受度、他人保證足夠度及真誠度皆越低；路徑分析結果顯示，低自尊會提高RSB造成不良RSO，接著個體會認為保證真誠度低，並認為他人接受自己的程度低，最後認為保證不足夠而惡化憂鬱。內隱態度部分發現，在校園憂鬱組，同時內隱自尊高或內隱保證足夠度高時，會有較多的RSB。內隱減去外顯態度的差值發現，憂鬱程度越高的組別，其差值越大；此外，保證足夠度的內隱減去外顯態度差值越大，RSB越多，RSO越差；而且保證足夠度的內隱減去外顯態度差值，會經由提高RSB的中介，導致不良的RSO。在研究二中，以15名臨床憂鬱病人納入資料分析。研究結果顯示，RSB與負向人際互動的後果幾乎無關，但是與外顯被他人接受度較高、保證真誠度較高、保證足夠度較高的正向後果有關，與研究一結果不同。最後，討論本研究的研究結果於人際互動歷程可能的意涵、研究限制及未來方向。Excessive reassurance seeking (ERS) was deemed as the core concept of Coyne’s interpersonal theory of depression. Past research indicated that ERS is related to the development and maintenance of depression, and the present study further proposed that the attitude toward positive assurance (inlcluding sincerity and sufficiency) may very likely play an important role in the link between ERS and depression. According to past researches, ERS was separated into 2 concepts, i.e., reassurance seeking behavior (RSB) and reassurance seeking outcome (RSO).In this thesis, we designed two studies to investigate: (a) the differences of interpersonal processes among groups with different degree of depression; (b) the association between attitudes toward positive assurance provided by close others (including sincerity and sufficiency) and ERS; (c) explicit attitude, implicit attitude (using Single-Target IAT as measure), and discrepancies between two attitudes of related variables including attitudes toward close others’ positive assurance , acceptance by close others, and self-esteem; and (d) the applicability of results from nonclinical samples to clinical samples. In Study 1, 107 participants recruited from college were separated into healthy control group (n = 46), dysphoric group (n = 30), and subclinical depressive group (n = 31). Results showed that the positive associations of depression with RSB and RSO were both significant only in the healthy control group, but not significant in the other two groups. For explicit attitude, there were negative associations between depression and explicit variables. Individuals with worse RSO had lower self-esteem, experienced less accepted by others, and felt less sincere and less sufficient about others’ assurance. Path analysis showed that individuals with low self-esteem would have increased RSB and then deteriorated RSO, and others’ assurances were deemed less sincere. As a consequence, these individuals thought that they were less accepted by others. Finally, assurances provided by others were deemed less sufficient. Altogether led to subsequent depressive symptoms. For implicit attitude, subclinical depressive group with high implicit self-esteem or high implicit attitude about sufficient assurance had more RSB. With regard to discrepancies between implicit and explicit attitudes, there were positive associations with depression. Specifically, there existed positive associations among discrepant attitudes (high implicit attitudes combined with low explicit attitudes) about sufficient assurance, RSB and RSO. Furthermore, this discrepant attitude about sufficient assurance was mediated by RSB to affect RSO. In study 2, data from 15 clinical patients with depressive disorders were analyzed. Results showed that RSB had little association with negative interpersonal outcome, whereas RSB had greater associations with higher explicit acceptance as well as more authentic and sufficient assurance provided by others. These results were different from study 1. Finally, we discuss the possible implications of our findings, address limitations, and provide some suggestions for future research