冠狀動脈心臟病與頭痛患者的敵意型態比較

RELATIONSHIP BETWEEN HOSTILITY PATTERN AND PSYCHOPHYSIOLOGICAL DISORDERS: CASES OF CORONARY ARTERY DISEASE AND HEADACHE

本研究皆在探討冠狀動脈心臟病（coronary Artery disease；簡稱CAD）與頭痛（headache）的敵意型態（hostility pattern）。本研究統整過去研究對敵意的概念後發現，敵意是一多向度概念，其中包含敵意認知、敵意情感以及敵意行為三個元素，而敵意行為元素又包含表達敵意和壓抑敵意。並根據敵意多向度概念發展「敵意量表」，共包含「敵意認知」、「敵意情感」、「敵意行為－表達敵意」、以及「敵意行為－壓抑敵意」四個分量表，以此深入探討各個敵意元素在不同疾病上是否具有不同的表現。本研究採個案配對研究（case control study），以冠狀動脈心臟病患者、頭痛患者以及控制組各30名為受試樣本。本研究以「生理心理社會模式（biopsychosocial model）」為基礎，來檢驗敵意之「疾病特異性（disease specificity）」假設。因此，研究工具除了「敵意量表」外，尚包括「基本資料調查表」「壓力知覺量表」、「憂鬱與焦慮量表」、以及「社會支持資源量表」。在配對三組參與者的年齡、性別以及教育程度後，發現三組參與者在相關的生理因素指標（血壓、心跳）、敵意以外的心理因素指標（壓力、焦慮、與憂鬱），以及社會因素指標（情感支持與實質支持）皆無顯著差異，只有在敵意元素上有顯著差異。因此，本研究進而檢驗敵意元素的疾病特異性。結果發現，CAD病患組在敵意認知、敵意情感與表達敵意顯著高於控制組；而頭痛病患組在敵意情感與壓抑敵意顯著高於控制組，顯示敵意元素在CAD和頭痛確實具有疾病特異性。接著，本研究根據敵意之疾病特異性現象，推論CAD及頭痛可能的心理病理機制以及臨床心理介入方案。

The hostility patterns of coronary artery disease (CAD) and headache patients were studied. The approach of Barefoot et al. (1992) and Spielberger et al. (1985) was used to integrate the concepts of hostility, anger, and aggression to form a multi-dimensional construct of hostility. Based on this integration, a hostility inventory was developed. The inventory consists of 4 sub-scales: Hostility Cognition, Hostility Affection, Hostility Expressive Mode (anger-out) and Hostility Suppressive Mode (anger-in). Three groups of subjects (CAD, headache, and normal control; n = 30 per group) matched by age, gender, and education, were administrated with this inventory. Results indicated that (a) cognition, affection, and expressive mode of the CAD group were significantly higher than those of the control group, (b) affection and suppressive mode of the headache group were higher than those of the control group, and furthermore, (c) these two patient groups were different in that the CAD group has higher cognition and expressive mode and lower suppressive mode than the headache group. The results support that the CAD and the headache patients have disease-specific hostility pattern. We therefore concluded that different psychopathological/emotional/stress mechanisms were involved in these two groups of patients and proposed specific psychological interventions to control the symptoms effectively.