第五章 討論
第四節 研究貢獻、限制及未來研究方向
國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
第四節 研究貢獻、限制及未來研究方向
二、 研究貢獻
本研究檢驗因應與創傷後成長隨時間變化的相互關聯性，延伸錢映融（2014）
的一年期的乳癌病人縱貫研究，以創傷後成長的多向度本質特性以及 Zoellner 和 Maecker (2006) 的雙面神理論為基礎，檢驗不同因應向度與不同向度之創傷後成 長隨時間發展的交互影響關係，在研究上有以下幾點突破：
(一) 兩年期縱貫研究
過去研究因應與創傷後成長之關聯性研究多為橫斷研究，無法看出因應和創 傷後成長隨著時間發展的相互影響情形，過去的縱貫研究也多為兩點測量或三點 測量的一年期研究，本研究為兩年期追蹤研究，檢驗乳癌患者在術後兩年的因應 與創傷後成長之共變情形，提供不同時間點中，不同因應與創傷後成長的豐富資 料。此外，由於 Tedeschi & Calhoun (2004) PTG 模式中提到創傷後成長是一連串 認知調適與因應的結果，真實而穩定的正向改變涉及個體假設世界觀的重建，因 此將測量時間延長到兩年，能檢驗及呈現創傷後成長是否屬於真實的改變。
(二) PTG 構念上的突破
過去研究多將創傷後成長視為一個單一整體來進行討論，而忽略了其內在不 同向度之間的差異性，少有研究將創傷後成長的不同向度區分開來進行討論，即 或有，也是以橫斷研究為主。本研究在長期追蹤的脈絡下，將創傷後成長進一步 區分為不同向度，以其呈現創傷後成長的更多面向，增加對創傷後成長本質的理 解。因素結構方面，也使用適於華人文化的四因素結構來加以檢驗和討論，也期 望在臨床應用上能對華人乳癌患者有所貢獻。
(三) 研究方法上的突破
研究方法方面，本研究採用縱貫研究法，統計分析方面使用潛在成長模式，
除了重複驗證因應與創傷後成長的時序關係，更進一步提供了因應與創傷後成長 在不同時間點中的共變關係，以期能對兩者關係有更深入的了解及探討。
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
三、 研究限制與未來研究方向 (一) 樣本數不足以進行分組
研究結果顯示 PTG 斜率之變異數顯著，但 PTG 斜率平均數不顯著，反映 PTG 變化軌跡存在異質性，但平均之後看不出效果。為考量異質性需要進行 分組，分組方式可針對因應和 PTG 的變化軌跡來分，或根據重要背景變項（如 年齡、教育程度）進行分組以探討調節變項的效果。但本研究之樣本總人數 為 283 人，若要針對不同背景變項（如年齡、教育程度）進行分組，探討背 景變項的調節效果，會有樣本數不足的情況，而在此情況下進行的 LGM 結果 也沒有意義，因此也無法進一步探討個體間異質性。
(二) 控制變項少
影響創傷後成長的因素包含許多個人變項及疾病關聯變項，本研究控制 變項僅納入年齡、教育程度，無法探討其他變項對因應與創傷後成長之關聯 性的影響。未來研究建議可納入其他變項來檢驗因應與創傷後成長的關係。
(三) 標準化估計值的顯著性問題
附錄二的 LGM 模式圖中，有些模式的標準化估計值雖較大，但卻未達顯 著（如圖 4-7、圖 4-9），關於較大的標準化估計值卻不顯著的部分主要發生在 斜率之間的預測，推測可能原因有二，其中一個可能是因斜率變異性太高有 關，另一個原因則是社會因應跟 PTG 的斜率平均數都不顯著，兩個接近 0 的 斜率相互預測，可能產生高的相關性，但因為實際上是沒有變化的，所以預 測性並不顯著。這顯示未來在考量這兩個變項之間的變化軌跡以及兩者個關 係時，可能需要採用其他分析方法來將個體內異質性高的因素考量進去。
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
(四) LGM 的限制及型一錯誤率 (type I error) 膨脹的問題
本研究為檢驗創傷後成長之不同向度與不同因應向度之間的關聯性，而將因 應與創傷後成長都區分出不同向度，創傷後成長部分，除了整體 PTG 之外，分 為個體內和個體間兩大向度；因應方面，則根據探索性因素分析結果分為三個向 度。考量因應與創傷後成長之間具有時間上的改變性 (Frazier et al., 2004) ，本 研究使用 LGM 統計方法，但因為 LGM 無法一次納入不同因應向度以及創傷後 成長的不同向度，因此在探討因應與創傷後成長的關聯性時，兩個變項分別一次 只能各放一個向度，加上方向性的檢驗部分，本研究一共跑了 3x3x2 共 18 個模 型，在如此多模型的情況下，可能產生型一錯誤率 (type I error) 過度膨脹的問 題，因此在整體結果的推論及應用上須特別謹慎。
(五) 外在效度
本研究之樣本皆取自中部某教學醫院的乳癌患者，且樣本皆為女性乳癌 患者，此結果是否可以類推到台灣其他不同地區，甚至華人文化，以及男性 乳癌患者或其他癌症上，還需要更多的資料來加以檢驗。因此，未來研究建 議能納入不同地區的樣本，以提高研究成果的外在效度。
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
參考文獻
王韋婷（2014），初診斷乳癌患者創傷後成長與心理適應的關係之長期追蹤研究
－從創傷後成長異質性變化軌跡的觀點探討。國立政治大學心理學研究所 博士論文，未出版，台北市。
台灣精神醫學會（2014），《DSM-5 精神疾病診斷準則手冊》。台北︰合記。
行政院衛生福利部（2014）。民國 102 年主要死因分析。台北：行政院衛生福利 部。
余民寧（2014）。縱貫性資料分析：LGM 的應用。台北：心理。
錢映融（2014），以交叉延宕分析探討乳癌患者的創傷後成長與因應策略之關係。
國立政治大學心理學研究所碩士論文，未出版，台北市。
Aitkan, A., & Crawford, L. (2007). Coping with stress: Dispositional coping strategies of project managers. International Journal of Project Management, 25,
666-673.
Amir, M., & Ramati, A. (2002). Post-traumatic symptoms, emotional distress and quality of life in long-term survivors of breast cancer: A preliminary research.
Journal of Anxiety Disorders, 16(2), 191-206.
Bellizzi, K. M., & Blank, T. O. (2006). Predicting posttraumatic growth in breast cancer survivors. Health Psychology, 25(1), 47-56.
Benson, P. R. (2010). Coping, distress, and well-being in mothers of children with autism. Research in Autism Spectrum Disorders, 4, 217-228.
Bower, J. E., Meyerowitz, B. E., Desmond, K. A., Leedham, B., Rowland,J. H.,
&Ganz, P. A. (2001). Perceptions of meaning andvulnerability following breast
cancer. Paper presented at the annualmeeting of the American Psychological
Association, San Francisco, CA.Bower, J. E., Meyerowitz, B. E., Bernaards, C. A., Rowland, J. H., Ganz, P. A., &
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
Desmond, K. A. (2005). Perceptions of positive meaning and vulnerability following breast cancer: predictors and outcomes among long-term breast cancer survivors. Annals of Behavioral Medicine, 29(3), 236-245.
Bussell, V. A., & Naus, M. J. (2010). A Longitudinal investigation of coping and posttraumatic growth in breast cancer survivors. Journal of Psychosocial
Oncology, 28(1), 61-78.
Calhoun, L. G., Cann, A., Tedeschi, R. G. & Millan, J. (2000). Acorrelation test of the relationship between posttraumatic growth, religion, and cognitive processing.
Journal of Traumatic Stress, 13(3), 521-527.
Calhoun, L. G., &Tedeschi, R. G. (2006), Handbook of Posttraumatic Growth:
Research and Practice. Mahwah, NJ: Lawrence Erlbaum.
Carver, C. S. (1997). You want to measure coping but your protocol’s too long:
Consider the Brief COPE. International Journal of Behavioral Medicine, 4, 92-100.
Carver, C. S., Pozo, C., Harris, S. D., Noriega, V., Scheier, M. F., Robinson, D. S., Ketcham, A. S., Moffat, Jr., F. L., & Clark, K. C. (1993). How coping mediates the effect of optimism on distress: A study of women with early stage breast cancer. Journal of Personality and Social Psychology, 65(2), 375-390.
Carver, C. S., Scheier, M. F., & Weintraub, J. K. (1989). Assessing coping strategies:
A theoretically based approach. Journal of Personality and Social Psychology,
56(2), 267-283.
Cordova, M. J., Cunningham, L. L., Carlson, C. R., & Andrykowski, M. A. (2001).
Posttraumatic growth following breast cancer: A controlled comparison study.
Health Psychology, 20, 176-185.
Danhauer, S. C., Case, L. D., Tedeschi, R., Russell, G., Vishnevsky, T., Triplett, K., Ip, E. H., & Avis, N. E. (2013). Predictors of posttraumatic growth in women with
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
breast cancer. Psycho-Oncology, 22, 2676-2683.
Ehlers, A., & Steil, R. (1995). Maintenance of intrusive memories in posttraumatic stress disorder: A cognitive approach. Behavioural and Cognitive Psychotherapy,
23(3), 217-249.
Frazier, P., Tashiro, T., Berman, M., Steger, M., & Long, J. (2004). Correlates of levels and patterns of positive life changes following sexual assault. Journal of
consulting and clinical psychology, 72(1), 19-30.
Frazier, P., Tennen, H., Gavian, M., Park, C., Tomich, P., & Tashiro, T. (2009). Does Self-reported posttraumatic growth reflect genuine positive change?
Psychological Science, 20(7), 912-919.
Green, B. L., Rowland, J. H., Krupnick, J. L., Epstein, S. A., Stockton, P., Stern, N.
M., Spertus, I. L., & Steakley, C. (1998). Prevalence of posttraumatic stress disorder in women with breast cancer. Psychosomatics, 39(2), 102-111.
Gutiérrez, F., Peri, J. M., Torres, X., Caseras, X., & Valdés, M. (2007). Three dimensions of coping and a look at their evolutionary origin. Journal of
Research in Personality 41, 1032-1053.
Helgeson, V. S., Reynolds, K. A., & Tomich, P. L. (2006). A meta-analytic review of benefit finding and growth. Journal of Consulting and Clinical Psychology,
74(5), 797-816.
Ho, S. M. Y., Chan, C. L.W., & Ho, R. T. H. (2004). Posttraumatic growth in Chinese cancer survivors. Psycho-Oncology, 13, 377-389.
Ho, S. M. Y., Law, L. S. C., Wang, G., Shih, S., Hsu, S., & Hou, Y. (2013).
Psychometric analysis of the Chinese version of the Posttraumatic Growth Inventory with cancer patients in Hong Kong and Taiwan. Psycho-Oncology, 22, 715-719.
Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
structure analysis: Conventional criteria versus new alternatives. Structural
equation modeling: A multidisciplinary journal, 6(1), 1-55.
Janoff-Bulman, R. (2004). Posttraumatic growth: Three explanatory models.
Psychological Inquiry, 15(1), 30-34.
Jim, H. S., Richardson, S. A., Golden-Kreutz, D. M., & Andersen, B. L. (2006).
Strategies used in coping with a cancer diagnosis predict meaning in life for survivors. Health Psychology, 25(6), 753-761.
Joseph, S., & Linley, P. A. (2005). Positive adjustment to threatening events: An organismic valuing theory of growth through adversity. Review of general
psychology, 9(3), 262-280.
Kangas, M., Henry, J. L., & Bryant, R. A. (2002). Posttraumatic stress disorder following cancer: A conceptual and empirical review. Clinical Psychology
Review, 22(4), 499-524.
Kapsou, M., Panayiotou, G., Kokkinos, C. M., & Demetriou, A. G. (2010).
Dimensionality of coping: an empirical contribution to the construct validation of the brief-COPE with a Greek-speaking sample. Journal of Health Psychology,
15(2), 215-229.
Kimemia, M., Asner-Self, K. K., & Daire, A. P. (2011). An exploratory factor analysis of the Brief COPE with a Sample of Kenyan caregivers. Int J Adv Counselling,
33, 149-160.
Kim, H. S., Sherman, D. K., & Taylor, S. E. (2008). Culture and social support.
American Psychologist, 63, 518-526.
Krägeloh, C. U. (2011). A systematic review of studies using the Brief COPE:
Religious coping in factor analyses. Religions, 2(3), 216-246.
Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. NY: Springer.
Lechner, S. C., Zakowski, S. G., Antoni, M. H., Greenhawt, M., Block, K., & Block, P.
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
(2003). Do sociodemographic and disease-related variables influence benefit-finding in cancer patients? Psycho-Oncology, 12(5), 491-499.
Lechner, S. C., Carver, C. S., Antoni, M. H., Weaver, K. E., & Phillip, K. M. (2006).
Curvilinear associations between benefit finding and psychosocial adjustment to breast cancer. Journal of Consulting and Clinical Psychology, 74(5), 828-840.
Lelorain, S., Bonnaud-Antignac, A., Florin, A. (2010). Long term post- traumatic growth after breast cancer: prevalence, predictors and relationships with psychological health. Journal of Clinical Psychology, 17, 14-22.
Linley, P. A., & Joseph, S. (2004). Positive change following trauma and adversity: A review. Journal of Traumatic Stress, 17, 11-21.
Litman, J.A. (2006). The COPE inventory: dimensionality and relationships with approach- and avoidance- motives and positive and negative traits. Personality
and Individual Differences, 41, 273-284.
Maercker, A., Langner, R. (2001). Posttraumatic personal growth: validation of german versions of two questionnaires. Diagnostica, 47, 153-162.
Morris, B. A., Shakespeare-Finch, J., Rieck, M., & Newbery, J. (2005).
Multidimensional nature of posttraumatic growth in an Australian population.
Journal of Traumatic Stress, 18(5), 575-585.
Morris, B. A., Shakespeare-Finch, J. E., & Scott, J. L. (2007). Coping processes and dimensions of posttraumatic growth. The Australasian Journal of Disaster and
Trauma Studies, 2007(1), 1-12.
Park, C. L. (1998). Stress-related growth and thriving through coping: The roles of personality and cognitive processes. Journal of social issues, 54(2), 267-277.
Park, C. L., Cohen, L. H., & Murch, R. L. (1996). Assessment and Prediction of Stress-Related Growth. Journal of Personality, 64, 71-104.
Park, C. L., Edmondson, D., Fenster, J. R., & Blank, T. O. (2008). Positive and
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
negative health behavior changes in cancer survivors : A stress and coping perspective. Journal of Health Psychology, 13(8), 1198-1206.
Park, C. L., & Folkman, S. (1997). Meaning in the context of stress and coping.
Review of General Psychology, 1(2), 115-144.
Parkes, C. M, (1971). Psycho-social transitions: A field for Study. Social Science and
Medicine, 5(2), 101-115.
Pollard, C., & Kennedy, P. (2007). A longitudinal analysis of emotional impact, coping strategies and post-traumatic psychological growth following spinal cord injury: A 10-year review. British Journal of Health Psychology, 12, 347-362.
Powell, S., Rosner, R., Butollo, W., Tedeschi, R. G., & Calhoun, L. G. (2003).
Posttraumatic growth after war: a study with former refugees and displaced people in Sarajevo. Journal of Clinical Psychology, 59(1), 71-83.
Prati, G., & Pietrantoni, L. (2009). Optimism, social support, and coping strategies as factors contributing to posttraumatic growth: A meta-analysis. Journal of Loss
and Trauma, 14, 364-388.
Schaefer, J. A., & Moos, R. H. (1992).Life crises and personal growth. In B. N.
Carpenter (Ed.), Personal coping: Theory, Research, and Application (pp.
149-170). Westport, CT: Praeger.
Scheier, M. F., & Carver, C. S. (1985). Optimism, coping, and health: Assessment and implications of generalized outcome expectancies. Health Psychology, 4(3), 219-247.
Schroevers, M. J., & Teo, I. (2008). The report of posttraumatic growth in Malaysian cancer patients: relationships with psychological distress and coping strategies.
Psycho-Oncology, 17(12), 1239-1246.
Scrignaro, M., Barni, S., & Magrin, M. E. (2011). The combined contribution of social support and coping strategies in predicting post-traumatic growth: A
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
longitudinal study on cancer patients. Psycho-Oncology, 20(8), 823-831.
Sears, S. R., Stanton, A. L., & Danoff-Burg, S. (2003). The yellow brick road and the emerald city: Benefit finding, positive reappraisal coping, and posttraumatic growth in women with early-stage breast cancer. Health Psychology, 22(5), 487-497.
Snell, D. L., Siegert, R. J., Hay-Smith, E. J., & Surgenor, L. J. (2011). Factor structure of the Brief COPE in people with mild traumatic brain injury. Journal of Head
Trauma Rehabilitation, 26(6), 468-477.
Snyder, C. R., Harris, C., Anderson, J. R., Holleran, S. A., Irving, L. M., Sigmon, S. T., et al. (1991). The will and the ways: Development and validation of an
individual-differences measure of hope. Journal of Personality and Social
Psychology, 60, 570-585.
Stanton, A. L., Bower, J. E., & Low, C. A. (2006). Posttraumatic growth after cancer.
In L. G. Calhoun & R. G. Tedeschi (Eds.), Handbook of posttraumatic growth:
Research and practice (pp. 138-175). Mahwah, NJ: Erlbaum.
Taku, K., Calhoun, L. G., Tedeschi, R. G., Gil-Rivas, V., Kilmer, R. P., Cann, A.
(2007). Examining posttraumatic growth among Japanese university students.
Anxiety, Stress and Coping, 20(4), 353-367.
Taku, K., Cann, A., Calhoun, L. G., &Tedeschi, R. G. (2008). The factor structure of the posttraumatic growth inventory: A comparison of five models using confirmatory factor analysis. Journal of Traumatic Stress, 21(2), 158-164.
Taylor, S. E. (1983). Adjustment to threatening events: A theory of cognitive adaptation. American Psychologist, 38, 1161-1173.
Tedeschi, R. G., & Calhoun, L. G. (1995). Trauma and transformation: Growing in
the aftermath of suffering. Thousand Oaks, CA: Sage.
Tedeschi, R. G., & Calhoun, L. G. (1996). The post-traumatic growth inventory:
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9(3), 455-471.
Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic Growth: Conceptual Foundations and Empirical Evidence. Psychological Inquiry, 15(1), 1-18.
Tennen, H., Affleck, G., Urrows, S., Higgins, P., & Mendola, R. (1992). Perceiving control, construing benefits, and daily processes in rheumatoid arthritis.
Canadian Journal of Behavioural Science, 24(2), 186-203.
Thornton, A. A., & Perez, M. A. (2006). Posttraumatic growth in prostate cancer survivors and their partners. Psycho‐Oncology, 15(4), 285-296.
Tomich, P. L., & Helgeson, V. S. (2004). Is finding something good in the bad always good? Benefit-finding among women with breast cancer. Health Psychology, 23, 16-23.
Updegraff, J. A., Taylor, S. E., Kemeny, M. E., & Wyatt, G. E. (2002). Positive and negative effects of HIV infection in women with low socioeconomic resources.
Personality and Social Psychology Bulletin, 28, 382-394.
Urcuyo, K. R., Boyers, A. E., Carver, C. S., &Antoni, M. H. (2005). Finding benefit in breast cancer: Relations with personality, coping, and concurrent well-being.
Psychology and Health, 20(2), 175-192.
Weiss, T., & Berger, R. (2006). Reliability and validity of a Spanish version of the Posttraumatic Growth Inventory. Research on Social Work Practice, 16(2), 191-199.
Widows, M. R., Jacobsen, P. B., Booth-Jones, M., & Fields, K. K. (2005). Predictors of posttraumatic growth following bone marrow transplantation for cancer.
Health Psychology, 24(3), 266-273.
Wu, T. Y., Hsu, W. L. & Cheng, B. S. (2002). Expressing or suppressing
anger:Subordinates’ anger responses to supervisors’ authoritarian behaviors in a
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
Taiwan enterprise. Indigenous Psychological Research in Chinese Societies, 18, 3-49.
Yang, H. C, Brothers, B. M., & Andersen, B. L. (2008). Stress and Quality of Life in
Yang, H. C, Brothers, B. M., & Andersen, B. L. (2008). Stress and Quality of Life in