第五章 研究討論
第五節 臨床應用
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3) 本研究雖於實驗前控制作息、物質使用影響，並於評估時排除近期有 經驗壓力者，但因收案期間較長，對於實驗前生活壓力事件難以一一控制，此 為實驗型研究較難以避免之困擾，建議後續研究可納入實驗期生活壓力事件問 卷的評估，以做後續分析上的控制變項。
4) 研究為了使首夜效應的影響降低，於晤談中排除自覺睡眠會受陌生情 境影響的個案，且安排受試者至實驗室的兩晚至少間隔 3 天以上時間（中間皆 需於家中熟悉環境有良好睡眠）。次外，檢驗各能力指標與壓力失眠反應量表 的分數（First）皆無顯著關聯，但因實驗流程中缺乏適應晚的安排，而無法完 全排除首夜效應的影響。
5) 本研究所採用客觀能力指標未見如主觀能力指標之結果，此可能因研 究於作業中測量之膚電水平受到多種因素影響，包括：作業長度不足讓生理反 應有良好情緒調節效果、再評估策略使用即會引發生理反應、受試者調節目標 之不同（嘗試增加正向感覺或嘗試減少負向感覺可能會引發不同膚電水平，本 研究再評估指導語則同時包含兩者），需於後續研究再分別釐清。
6) 近期探討再評估策略效果之研究發現，在因應可控的壓力情境時，再 評估策略使用能力較佳者反而會有較高的憂鬱程度（Troy, Shallcross, Mauss, 2013）。此控制性與否在於個體是否能去改變情境，而本研究所採取影片作業 與夜間負向情境皆為不可控壓力情境，雖於情緒調節效果上具一致性，但可能 無法完全類推於日常生活中所有壓力情境的因應。
第五節 臨床應用
再評估策略非單一構念，而測量再評估使用效果上也非由單一變項即可 反應其策略使用的適應性。本研究發現除了個體使用再評估策略的調節能力 外，於再評估策略使用的控制感亦會影響其於睡前使用的效果。
研究結果發現，當個體能有效的使用策略，將可成功減少睡前的負向情 緒感受，維持較低的激發狀態與避免對後續睡眠耗時之高估，進而可能降低失 眠感受與促進後續睡眠，長期而言，便能形成生活中睡眠與情緒調適的良好循 環（Mauss, Troy, LeBourgeois, 2012）。在失眠認知行為治療上亦可看到再評估 策略之變形應用，治療師會教導失眠患者如何辨認與睡眠相關不當認知、找出 此認知的不合理處、以及以更彈性、具適應性的想法去替代，一開始患者經常
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會因無法有效轉換念頭而可能對失眠情況更焦慮，而可能出現更嚴重失眠狀 況，但經由治療師指導與多次練習後，便能使患者減少失功能的睡眠信念與態 度，並能在睡不好時以具適應性的想法因應，進而減少失眠的機會與持續性。
值得注意的是，再評估策略的能力雖存在個別差異，但仍可透過練習來提高熟 練度（Troy, Shallcross, Davis,& Mauss, 2013）。
當個體於再評估策略使用上較具控制感者，能更適宜的運用策略，因而 即使於睡前進行情緒調節後，因可獲得較高情緒控制感，而較不需要持續運用 策略，因而可減少睡前認知活動，進而不干擾後續睡眠。近期於情緒調節策略 研究中，開始有學者提倡情緒調節的彈性度（flexibility），包含情感彈性度
（個體可彈性選擇關注或抽離情境或刺激情緒面向的程度）與策略使用彈性度
（個體可根據不同情境選擇不同策略的能力）更能決定情緒策略的效果與適應 性（Aldao, Sheppes,& Gross, 2015; Bonanno & Burton, 2014; Malooly, Genet,&
Siemer, 2013）。因而，在教導個案如何使用情緒調節策略時，除了教導策略的 使用方式並鼓勵個案多練習外，也應教導個案策略適宜的使用情境與時機。
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