罹癌後的反芻思考與創傷後成長的關係：心理苦惱與情緒調節策略之調節角色

Post-traumatic Growth and Rumination Following a Cancer Diagnosis: The Moderating Roles of Psychological Distress and Emotional Regulation Strategies

背景與目的：許多研究證實侵入性反芻與精緻性反芻對創傷後成長的重要性，且侵入性反芻轉變為精緻性反芻可能是促進創傷後成長的關鍵。有鑑於過往研究多以單一時間點或自然災害的樣本為主，目前還未有研究針對創傷後成長修正模式中新加入的心理苦惱與情緒調節策略的角色進行探討，所以本研究採回溯性的兩點測量方式，探討罹癌後的核心信念破壞所引發的兩類反芻思考與創傷後成長之間的序列中介關係，並檢視心理苦惱與情緒調節策略在上述關係中是否具有調節角色，以期擴展對於創傷後成長模式之瞭解。研究方法：研究對象為罹癌五年內的患者，共184名，研究工具主要為自陳式問卷並採用調節式中介分析。結果：「初期侵入性反芻」－－「近期侵入性反芻」與「初期侵入性反芻」－－「近期侵入性反芻」－－「近期精緻性反芻」之路徑，能部分中介罹癌後的核心信念破壞與創傷後成長之關係；心理苦惱可正向調節「初期侵入性反芻」與「近期侵入性反芻」之關係，降低創傷後成長；重新評估可負向調節「初期侵入性反芻」與「近期侵入性反芻」之關係，促進創傷後成長。結論：本研究支持侵入性反芻與精緻性反芻在核心信念破壞與創傷後成長之間的序列中介角色，且首次驗證了罹癌後的心理苦惱與重新評估策略能調節罹癌不同時期的侵入性反芻關係，進而影響創傷後成長。

Backgrounds: Many studies have found that the concepts of intrusive rumination (IR) and deliberate rumination (DR) play significant roles in post-traumatic growth, and it is the change from intrusive to deliberate rumination that facilitates post-traumatic growth. However, most studies exploring the relationship between rumination and posttraumatic growth have utilized a cross-sectional methodology or individuals from natural disasters. Additionally, no empirical study has investigated the role of psychological distress and emotion regulation strategies in the revised model of post-traumatic growth. Therefore, this current research employed cancer outpatients as participants and a retrospective two-time-point approach to examine the process of violated core beliefs, two types of ruminative thoughts, and post-traumatic growth among cancer outpatients. Furthermore, the study explored whether psychological distress and emotion-regulation strategies may moderate the above relationship to expand the understanding of the cognitive process of post-traumatic growth. Methods: This study recruited 184 cancer outpatients diagnosed between six months and five years following their initial intensive treatment. Self-reported questionnaires were the major instruments used, and the moderator-mediator analysis was employed to examine the data. Results: The pathways of the sequential relationship between (1) initial IR and recent IR, and (2) initial IR and recent IR, as well as recent DR, can partially mediate the relationship between the destruction of core beliefs by the cancer diagnosis and the post-traumatic growth. Psychological distress positively moderated the relationship between initial IR and recent IR and subsequently impaired post-traumatic growth. The reappraisal strategy negatively moderated the relationship between initial IR and recent IR and then facilitated the subsequent post-traumatic growth. Conclusions: This current study found that IR and DR had a sequential mediating role in the association between the disruption of core beliefs and post-traumatic growth. It is also the first to demonstrate the moderating effect of psychological distress and emotion-regulation strategies on intrusive rumination at different time points, which then affects the post-traumatic growth among cancer patients.