A longitudinal study of the relationship between benefit-finding, vulnerability and psychological adjustment

過去益處發現與心理適應之間關係的研究常常呈現不一致的結果。學者們建議在探討個體益處發現與心理適應間關係，需要同時加入個體經歷創傷所產生的負向知覺以及其他調節變項共同考量。其中，有一派學者認為負向知覺會遮蔽益處發現對心理適應的正向預測；而另一派學者則認為經歷創傷的個體需要同時經歷益處發現與負向知覺，才有助於心理適應。本研究之目的是為了檢驗上述兩派學者的說法，以迴歸統計探討初診斷乳癌患者益處發現、負向知覺以及交互作用對不同心理適應指標間的預測關係。 我們為台灣中部某醫學中心為初診斷乳癌患者進行了兩年的追蹤，分別在術後一週內（T1）、術後三個月（T2）、術後半年（T3）、術後一年（T4）以及術後兩年（T5）進行測量。最後完成五個時間點測量的研究參與者共280人。我們以可以測量個體內心理歷程變化的階層線性模式（Hierarchical Linear Modeling, HLM）發現，乳癌患者的益處發現可以預測正向情緒增加，負向知覺則可以預測個體焦慮與負向情緒的增加。而在憂鬱的預測上，益處發現與負向知覺的主要效果可以預測憂鬱的增加，但兩者間的交互作用則可以預測憂鬱的減少。後續的簡單斜率分析顯示，相較於中度與低度脆弱性感受，個體在經歷高脆弱性感受時，正向意義預測憂鬱程度下降的效果最好。除此之外，我們也發現婚姻狀態以及癌症期數是乳癌患者益處發現及負向知覺對心理適應的預測關係中重要的調節變項。 我們的研究結果顯示益處發現可能具有正向錯覺與真實成長兩個面向。益處發現可以為個體帶來正向適應，還需要個體對事件也同時知覺到負向結果。此外，我們也認為益處發現與負向知覺對於不同的心理適應指標（如憂鬱與焦慮）有不同形態的預測關係，可能來自益處發現影響這兩種症狀心理歷程的相異。Aims: This study was designed to examine the relations between benefit-finding, vulnerability as well as their interaction term to psychological adjustments. Methods: Participants were Taiwanese women underwent surgery for breast cancer. Measures of benefit-finding, vulnerability and psychological adjustment were assessed at one-week, three-month, six-month, one-year and two-year. Of the 358 women who were recruited, 280 completed all five measures and were included in the analyses. The data was analyzed with Hierarchical Linear Modeling (HLM). Results: Our results showed benefit-finding was positively associated with positive affect, whereas vulnerability was associated with anxiety and negative affect. The interaction term between benefit-finding and vulnerability was significant in predicting depression. Simple slope analysis showed that benefit-finding had a stronger negative association with depression when vulnerability increased. Marital status as well as cancer stage were significant moderators in the prediction of benefit-finding and vulnerability to psychological adjustment. Conclusions: Our research suggested the relationship between benefit-finding and vulnerability to psychological adjustment might vary by the indexes of well-being. The effect of benefit-finding in preventing psychopathology may be most important in the presence of high vulnerability