以壓力反應特性、注意力偏誤、與睡眠監控行為探討不同失眠病程發展之相關因素 - 政大學術集成

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(1)國立政治大學心理學研究所博士學位論文. 政治大. 以壓力反應特性、注意力偏誤、與睡眠監控行為探討不同. 立. 失眠病程發展之相關因素. ‧ 國. 學. The Contributing Roles of Stress Reactivity, Attentional Bias, and Monitoring Behaviors in the Course of the. Nat. n. al. er. io. sit. y. ‧. Development of Insomnia. Ch. engchi. i n U. v. 指導教授：楊建銘教授研究生：詹雅雯. 中華民國一百零五年六月.

(2) 摘要. 研究目的失眠的過度激發是目前最廣為接受的失眠病因之一。無論在生理、認知、. 行為三不同層面上，多可觀察到失眠者有身心過度激發的狀態。根據失眠三因子模式，不同失眠病程階段，影響過度激發的背後成因有所差異。在慢性失眠部分，過去累積了相當多的實證研究證實其過度激發的現象，但尚未進入慢性病程前之過度激發相關機轉，仍有待研究進一步探討。本研究嘗試以橫斷式的研究方法，並依據過去失眠病因發展推導，選擇從壓力反應特性 (包含壓力操弄後的壓力反應強度和. 治政大行為三個面向切入，探討不同病程階段個體過度激發的背後機轉，並進一步檢驗上立述之差異是否可用以預測在壓力操弄情境下，不同病程個體睡前的激發反應變化，消退速度)、注意力偏誤 (包含警覺性注意力和注意力移除困難)、與睡前的睡眠監控. ‧ 國. 學. 藉此檢驗失眠病程發展之病因假說，並希望未來可據此發展有效之失眠防治與介入策略。. ‧. y. Nat. 研究方法本研究共計招募受試者 58 人，年齡介於 24-48 歲，包含符合 ICSD-3 慢性. sit. 失眠者 18 人，以及以壓力下失眠反應量表( Ford Insomnia Response to Stress Test;. n. al. er. io. FIRST)區分出急性失眠高危險組 19 人與低危險組 21 人。每位受試者皆需到睡眠實. i n U. v. 驗室進行兩階段的實驗，第一階段包含晤談評估、問卷填答、壓力反應的生理測量(以. Ch. engchi. 指溫與膚電為指標)、與包含威脅與睡眠刺激之點偵測注意力作業，之後需配戴腕錶與記錄睡眠日誌配合充足且規律作息一週後，再到睡眠實驗室進行第二階段的評量，包含睡前 2 小時、1 小時、關燈前生理指標 (指溫、膚電) 與腦波的測量和主觀身心激發狀態 (Pre-Sleep Arousal Scale, 簡稱 PSAS) 評量，於睡前填寫睡眠相關監測指標 (Sleep Associated Monitoring Index，簡稱 SAMI)，並完成一晚的 PSG 測量以排除其他睡眠相關疾患。. 研究結果首先，以單因子變異數分析比較不同組別間在壓力反應與回復和二因子變. 異數分析注意力警覺/移除困難指標的差異。在壓力生理反應表現上，慢性失眠組與.

(3) 高危險組在接受壓力操弄後的激發消退時間較低危險組來得長。在注意力層面，高危險組對壓力(威脅圖片) 刺激有顯著的警覺與移除困難注意力偏誤，慢性失眠組則是對睡眠刺激有顯著的移除困難注意力偏誤。在行為層面，慢性失眠組與高危險組睡前的注意力監控行為 (包含監測自身身體感覺訊息是否與入睡狀態不一致、鬧鐘時間、環境) 均顯著較低危險組來得多。再者，以皮爾森相關探討注意力偏誤與睡前激發反應之關聯性，結果顯示高危險組的注意力偏誤現象與睡前高頻腦波與主觀生理激發的降幅呈現顯著負相關; 而慢性失眠組的注意力偏誤指標卻與膚電、主觀認知激發的降幅呈顯著正相關。. 政治大慢的激發消退能力與對壓力源的認知偏誤的前置因子，可能為急性失眠者易受日常立結論本研究結果支持不同失眠病程背後的過度激發影響機制有所差異，生理層面較. ‧ 國. 學. 壓力源誘發睡眠困擾之原因；而影響慢性失眠族群的持續因子主要在於其將睡眠視為壓力源的認知歷程與行為轉變。此外，研究更進一步發現兩組分別對於壓力與睡. ‧. 眠的注意力轉移困難，使其在覺察壓力後易持續表現出過度激發現象。本研究結果除支持失眠過度激發理論之外，更釐清不同階段失眠的認知歷程的機制，並彰顯不. Nat. n. al. er. io. sit. y. 同失眠病程介入策略應有所差異，和急性失眠高危險族群及早介入預防之重要性。. Ch. i n U. v. 關鍵字: 慢性失眠、失眠脆弱特質、注意力偏誤、壓力反應、睡前激發狀態. engchi.

(4) Abstract Introduction Hyperarousal has been recognized to be a major etiological factor of chronic insomnia. Cumulated research evidences have demonstrated that chronic insomnia patients are hyperaroused in somatic, cognitive, and behavioral aspects. According to Spielman’s 3P Model of Insomnia, there were different factors are involved at different points during the course of insomnia. However, there are seldom study to investigate the difference mechanism of hyperarousal in the course of the development of insomnia. The present study used cross-sectional design to compare the difference of good sleeper (low sleep vulnerability, LV), acute insomnia (high sleep vulnerability, HV),. 政治大. and chronic insomnia (CI) in stress reaction (eg. reactivity and recovery), attentional bias (eg. vigilance and disengagement), and sleep associated monitoring behaviors to. 立. investigate the underlying mechanism of hyperarousal. Furthermore, the study. ‧ 國. 學. examined the correlation between attentional bias indices and subsequent pre-sleep arousal to investigate the impact of attentional bias on sleep in different groups. Method. ‧. The present study recruited fifty-eight subjects, aged between 24-48. They included. y. Nat. eighteen chronic insomniacs (CI) diagnosed ICSD-3, nineteen healthy individuals. sit. scoring high (HV) and twenty-one healthy individuals scoring low (LV) on the Ford. al. er. io. Insomnia Response to Stress Test (FIRST). All subjects visited sleep lab twice.. n. v i n C h (including) of U through psychophysiological recording e n g c h i stress reaction, and a visual During the first visit, the subjects filled in a package of questionnaires, and went. dot-probe task. They then were required to keep a sleep log and wear actigraphy at. home for one-week to make sure they followed a regular sleep schedule. During the second visit, subjects went through a pre-sleep physiological recording (including peripheral temperature, skin conductance, and EEG) and filled in two questionnaires (Pre Sleep Arousal Scale [PSAS] and Sleep Associated Monitoring Index[SAMI]) at three time points and had a PSG recording to screen for sleep disorders. Result One-way ANOVAs were conducted to compare the differences of stress reaction/recovery among three groups. Two-way ANOVAs were used to compare the differences in attentional bias (vigilance/ disengagement) of threatening and sleep-related stimulus among three groups. In stress related physiological activity, CI and HV showed slower recovery rate than LV. Considering attentional bias, HV had.

(5) significant vigilance and disengagement bias to threatening pictures, and CI had significant disengagement bias to sleep-related pictures. CI and HV also showed more prevalent sleep-associated monitoring behaviors than LV. Furthermore, Spearman’s correlation was used to examine the association between attentional bias and pre-sleep arousal. The result shows the attentional bias of HV had negative correlation with reduction of high frequency EEG and somatic sub-score on the PSAS. In contrast to our prediction, CI showed positive correlation between decrease of skin conductance and the cognitive sub-score on the PSAS. Conclusion The study showed that stress recovery ability and stress-related attentional bias were the major differences between individuals with low and high sleep vulnerability,. 政治大. indicating that increased information processing to threats and stress-related stimulus as well as decreased recovery ability of autonomic arousal in reacting to stress may. 立. predisposed an individual to stress-related sleep disturbances. On the other hand, the. ‧ 國. 學. attention shift from threat toward sleep can differentiate chronic insomnia from those individual with frequent acute insomnia. Moreover, the difficulty in disengagement from sleep-related stimulus, rather the vigilance, might explain the cause of. ‧. hyperarousal that perpetuate insomnia. The results support the transition of arousal. y. Nat. from general treat to sleep-related stimulus in the development of chronic insomnia.. sit. The study not only further the understanding of the etiological mechanism of. n. al. er. io. insomnia, but also imply that different strategies should be applied in the treatment of. i n C intervention for individuals with high h esleep n gvulnerability. chi U. v. acute and chronic insomnia. It also highlights the importance of preventive.

(6) 目錄第一章、前言...................................................................................................................... 1 第一節、研究動機與研究問題................... .......................................................... 1 第二章、文獻探討............................................................................................................. 4 第一節、不同病程之失眠之定義與盛行率............................................................. 4 第二節、急性與慢性失眠者之過度激發探討....................................................... 5 一、慢性失眠者的過度激發................................................................................... 5 二、急性失眠者的過度激發.................................................................................. 7. 政治大. 第三節、急性與慢性失眠病因模式...................................................................... 10. 立. 一、Spielman 的失眠三因子模式....................................................................... 10. ‧ 國. 學. 二、 Espie 的注意力-意圖-努力路徑模式........................................................... 15. ‧. 第四節、失眠者的注意力偏誤歷程與其影響...................................................... 17 一、情緒史楚普作業.............................................................................................. 17. y. Nat. io. sit. 二、視覺閃爍作業.................................................................................................. 20. n. al. er. 三、Posner 的線索典範........................................................................................... 20. Ch. i n U. v. 四、點偵測作業....................................................................................................... 21. engchi. 五、注意偏誤對激發反應的影響......................................................................... 24 第五節研究目的與假設........................................................................................ 30 第三章研究方法.............................................................................................................. 33 第一節. 研究對象................................................................................................... 33. 一、慢性失眠組..................................................................................................... 33 二、急性失眠高危險組........................................................................................ 33 三、急性失眠低危險組........................................................................................ 34 第二節研究流程..................................................................................................... 34 第三節研究工具..................................................................................................... 36 . I .

(7) 一、迷你國際神經精神醫學面談問卷......................................................... 36 二、壓力下失眠反應量表.............................................................................. 37 三、失眠嚴重度量表...................................................................................... 37 四、貝克焦慮量表中文版.............................................................................. 38 五、貝克憂鬱量表第二版中文版................................................................... 38 六、生活事件量表......................................................................................... 39 七、壓力知覺量表........................................................................................... 39 八、壓力操弄作業........................................................................................... 40. 政治大十、睡眠活動腕錶.......................................................................................... 41 立九、睡眠日誌................................................................................................... 40. 十一、睡前激發程度量表............................................................................... 41. ‧ 國. 學. 十二、睡眠相關監測指標............................................................................. 41. ‧. 十三、多頻道睡眠記錄儀.............................................................................. 42. y. Nat. 十四、腦波頻譜分析....................................................................................... 43. er. io. sit. 十五、生理反應測量..................................................................................... 43 十六、視覺點偵測作業................................................................................. 43. al. n. v i n (一)刺激材料.............................................................................................. 43 Ch engchi U (二)刺激呈現.............................................................................................. 44. 第四節資料分析..................................................................................................... 45 第四章研究結果............................................................................................................. 48 第一節受試者之人口學變項與量表描述統計資料......................................... 48 第二節主客觀測量之睡眠相關參數資料.......................................................... 49 第三節壓力反應特性............................................................................................ 50 第四節注意力偏誤特性........................................................................................ 52 第五節入睡前客觀生理與皮質激發................................................................... 58 (一) 客觀生理激發........................................................................................ 58 . II .

(8) (二) 客觀皮質激發........................................................................................ 61 第六節入睡前主觀生理與認知激發................................................................ 67 第七節入睡前睡眠監控指標............................................................................. 70 第八節注意力偏誤與睡眠監控對睡前激發狀態的影響............................... 71 第五章討論...................................................................................................................... 73 第一節壓力反應特性............................................................................................ 74 第二節注意力偏誤表現........................................................................................ 75 第三節睡前監控行為............................................................................................ 77. 政治大第五節壓力反應特性、注意力偏誤、睡眠監控行為與睡前激發反應之立. 第四節睡前激發狀態的主客觀結果................................................................... 77. 關聯性......................................................................................................... 79. ‧ 國. 學. 第六節結論............................................................................................................. 80. ‧. 第七節研究限制與未來研究方向....................................................................... 81. y. Nat. 參考文獻............................................................................................................................ 82. 附錄三. er. 壓力下失眠反應量表................................................................................ 94. al. v i n 生活事件量表............................................................................................ 95 Ch engchi U n. 附錄二. io. 附錄一. sit. 附錄.................................................................................................................................... 94. 壓力知覺量表............................................................................................ 98. 附錄四睡眠日誌.................................................................................................... 99 附錄五. 睡前激發程度量表................................................................................... 100. 附錄六睡眠相關監測指標................................................................................... 101. . III .

(9) 表目錄. 表 1、失眠疾患之注意力偏誤研究整理一覽表....................................................... 26 表 2、研究假設一覽表............................................................................................... 33 表 3. 三組在年齡與各量表得分............................................................................... 49 表 4. 三組在睡眠紀錄腕錶與睡眠日誌上所得參數............................................... 50 表 5. 三組在指溫與膚電上的壓力與回復指標比較............................................... 52 表 6. 三組在不同類圖片刺激上的反應時間比較................................................... 53. 政治大. 表 7. 三組在不同類圖片刺激上的注意偏誤指標平均值與標準差....................... 54. 立. 表 8. 100m 組別 x 圖片類型的二因子混合設計變異數分析結果_警覺指標….…54. ‧ 國. 學. 表 9. 500m 組別*圖片類型的二因子混合設計變異數分析結果_警覺指標….….54 表 10. 500m 組別*圖片類型的二因子混合設計變異數分析結果_移除困難指標 55. ‧. Nat. sit. 表 12. 1000m 組別*圖片類型的二因子混合設計變異數分析. y. 表 11. 組別和圖片類別在 500m 移除困難指標的單純主要效果………...………55. n. al. er. io. 結果_移除困難指標…………………………………………………………56. i n U. v. 表 13. 組別和圖片類別在 1000m 移除困難指標的單純主要效果……..….…..…57. Ch. engchi. 表 14. 三組對不同類之刺激圖片的評分向度一覽表…….………………….……58 表 15. 三組在睡前兩時間點之指溫與膚電….……………………………….……59 表 16. 組別 x 時間點的二因子混合設計變異數分析結果_指溫………..…..……60 表 17.. 組別 x 時間點的二因子混合設計變異數分析結果_膚電………......……61. 表 18.. 入睡兩時間區段的指溫和膚電改變量之單因子變異數分析…......…..…61. 表 19. 三組在睡前兩時間點在 C3/C4 各頻譜腦波之相對功率…...............…..…63 表 21. C3_Beta1 的組別 x 時間點二因子混合設計變異數分析結果.........…….…65 表 22. C4_Beta1 的組別 x 時間點二因子混合設計變異數分析結果........……..…65 表 23. C3_Beta2 的組別 x 時間點二因子混合設計變異數分析結果........……...…65 . IV .

(10) 表 24. C4_Beta2 的組別 x 時間點二因子混合設計變異數分析結果........……...…66 表 25. C3_Gamma 的組別 x 時間點二因子混合設計變異數分析結果...…..…..…66 表 26. C4_Gamma 的組別 x 時間點二因子混合設計變異數分析結果...…..…..…66 表 27. 入睡兩時間區段不同頻譜腦波改變量之單因子變異數分析...….....…..…67 表 28. 三組在睡前兩時間點在 PSAS 生理與認知分量表上之平均分數...………68 表 29. PSAS_生理分量表的組別 x 時間點二因子混合設計變異數分析結果……69 表 30. PSAS_認知分量表的組別 x 時間點二因子混合設計變異數分析結果……69 表 31. 入睡兩時間區段 PSAS 不同分量表改變量之單因子變異數分析…………70. 政治大表 33. 壓力回復指標、注意力偏誤指標與主客觀激發狀態下降之相關表………72 立表 32. 入睡前睡眠監控指標之組別差異分析………………………………..……70. 表 34. 研究假設與結果對照表………………………………………………..……73. ‧. ‧ 國. 學. n. er. io. sit. y. Nat. al. . Ch. engchi. V . i n U. v.

(11) 圖目錄. 圖 1. Spielman 與 Glovinsky 的失眠三因子模式.................................................... 14 圖 2. AIE 路徑模式..................................................................................................... 16 圖 3. 本研究假設之失眠病程模式........................................................................... 30 圖 4. 實驗流程........................................................................................................... 36 圖 5. 注意力評估作業程序…................................................................................... 45 圖 6. 三組在不同階段的指溫反應變化……........................................................... 51. 政治大. 圖 7. 三組在不同階段的膚電反應變化................................................................... 51. 立. 圖 8. 500m 移除困難指標的組別 x 圖片類型交互作用圖........................................ 56. ‧ 國. 學. 圖 9. 1000m 移除困難指標的組別 x 圖片類型交互作用圖...................................... 57 圖 10. 睡前三組指溫趨勢變化圖............................................................................. 59. ‧. 圖 11. 睡前三組膚電趨勢變化圖............................................................................. 60. y. Nat. sit. 圖 12. 睡前三組不同頻譜腦之趨勢變化圖............................................................. 64. n. al. er. io. 圖 13. 睡前三組 PSAS_生理分量表之趨勢變化圖................................................. 68. i n U. v. 圖 14. 睡前三組 PSAS_認知分量表之趨勢變化圖................................................. 69. . Ch. engchi. VI .

(12) !. Maslow. (need-. hierarchy theory) (Maslow, 1943) / (. ). 立. 10.3%. (9.9%). (4%). 學. ‧ 國. 785. 政治大. (Nomura, Yamaoka, Nakao, & Yano, 2005). 9298. Kao. (2008). 25.5 %. ‧. n. er. io. sit. y. Nat. al. (hyperarousal) ”. Ch. i n U. engchi. v. “. 78.3%. (Bastien, Vallieres, &Morin, 2004) (heart rate). (blood pressure) “. (arousal) ”. (Han, Kim, &Shim, 2012) “. ”. Spielman (1986). ( ). !. ). ( (. ) (Spielman, 1986). 1!.

(13) !. 」 (Jarrin, Chen, Ivers, & Morin, 2010). Drake. 』. (2004). (Ford Insomnia Rseponse to Stress Test, FIRST). ). 2010. 立. (2008). ‧ 國. ‧ 」. n. al. Ch. engchi. y. ). sit. io. ). , 2008). Nat. (. FIRST. 學. (. 政治大. Fernández-Mendoza. (. er. (. i n U. v. 」. (Espie et al., 2006; Harvey, 2002; Morin & Espie, 1993; Perlis et al., 1997; Yang, Spielman, & Glovinsky, 2006). (Morin et al.,. 1993). (Espie et al., 2006; Harvey, 2002; Perlis. et al., 1997). (Harvey, 2002; Ree & Harvey, 2004;. Spielman, Caruso, & Glovinsky, 1987). !. (Bonnet &. 2!.

(14) !. Arand, 1997; Perlis et al., 1997). (distraction). (Ellis. &Cropley, 2002). Taylor. (2003). /. 立」. ‧. ‧ 國. ). 學. (. 政治大Espie. Nat. y. 」. n. er. io. al. sit. 」. ( /. Ch. engchi 、. ). v. ). ( (. ). !. i n U. 3!.

(15) !. (International Classification of Sleep Disorder ICSD). (AASM, 2013). 」. (shortterm insomnia disorder). (chronic insomnia disorder). 3. 3. 立. 政治大. ICSD-3. 2013. ‧ 國. 學「. y. sit. io. DSM-5. n. al. 15%. Ch. (2009). 10%. er. 30-35%. Morin 119. ICSD-II. ‧. Nat. ICSD-3. 10%. 3. 「. DSM-5. (insomnia disorder). ICSD-3. 3. 「. engchi. i v6-10% n U. DSM-5. 」. DSM-IV. 269. DSM-5 (first onset) (recurrent) 1095 (. !. ( ). 2861. 7.9%. ). 9.5% 87.5% (. ). ( ). 67% (Ellis,. 4!.

(16) !. et al., 2012). 11 (Collins et al., 2011). Neckelmann. (2007). (Morin, 1993). 立. 」. 政治大. ‧. ‧ 國. 學」. n. (. )!. Ch. 」. engchi. er. io. al. sit. y. Nat 」. i n U. v. Monroe (1967) 16. 30. (oxygen consumption , VO2) (cortisol). ACTH. (Bonnet &Arand, 1995; 1997). -6 (interleukin-6). 2006; Vgontzas et al., 2001). (Bonnet. 1994). (. !. 5!. (Burgos et al., Arand, 1998; Stepanski et al., ).

(17) !. (Bonnet & Arand, 1998). (thought sampling) (Sleep Onset Latency,. SOL). Wicklow Espie (2000). Kuisk, Bertelson, & Walsh (1989). (Pre-sleep Arousal Scale. PSAS). Morin, Gendron, & 政治 (Bélanger, 大 Blais, 2005; Broman & Hetta,1994; 立 Chen, Lin, Lee, & Chou, 2011; Lichstein, &. ‧ 國. Broomfield, & Espie (2007). PSAS. Robertson,. ‧. n. al. -. er. io. sit. y. Nat (conditioned arousal). 學. Rosenthal, 1980; Nicassio, Mendlowitz, Fussell &Petras,1985). Ch. engchi U. (cortical activity) Broomfield, & Espie, 2007). v ni. 、 (Robertson,. Freedman (1986) (Spectrum Analysis) (Stage 1). (Rapid eye movement. REM). beta. (. ) (cortical arousal). delta. (. Larmarche. Ogilvie (1997). ) Perlis. (1997) 」. !. 6!.

(18) !. beta. (multiple sleep latency tests,. MSLTs). beta. beta. (Wolynczyk-Gmaj & Szelenberger, 2011) (event-related potentials. ERPs). (Bastien, St-Jean, Morin, Turcotte, & Carrier, 2008; Yang & Lo, 2007). 政治大 Harvey(2002b) (safety behaviours) 立 ‧. ‧ 國. 學. Nat. n. al. sit. 」. er. io. (2000). y. (Salkovskis, 1991). Ch. engchi. i n U. v. Harvey. Semler & Harvey (2004a 2004b) 『 Associated Monitoring Index. (. !. (Sleep SAMI). )!. 7!.

(19) !. Bonnet& Arand (1992) (metabolic rate) (sleep efficiency). MSLT Hall. SOL. (2004). 2010. 」. Fernández-Mendoza. ( (Arousability Predisposition Scale. 立. PSAS. APS 政治大. (. LF/HF. ‧. (. APS). 學. ‧ 國. (Coren & Mah, 1993). ). 2011). Nat. er. io. sit. y. HFn.u.). n. al. Ansfield. C h (1996) engchi “. i n U. ” “. v. 」 ”」. SOL (mental load) Gross. (sleep urgency). Borkovec (1982). 」 (sleep-only). (speech-only ). 」」. 」. (speech-plus-topic. ). (skin. conductance) (cognitive. !. 8!.

(20) !. intrusion). Ellisc. Cropley (2002). (worry). (punishment). (2011). 」 NREM N1. N350. P2. P900 P2. 」. 立. 政治大. ‧ 國. 學. PSAS. P900. ‧. Yang. n. al. er. io. sit. y. Nat (. (2013). ). Ch. engchi. i n U. v. 、 Morin. (2003). (Morin, Rodrigue, & Ivers, 2003). (2008) 。 (. Ellisc. !. Cropley (2002). 9!. , 2008).

(21) !. (distraction). ( ) 、. 」. 立. 政治大. ‧. ‧ 國. 學 y. sit. io. n. Spielman (1986). (. al. er. )! Spielman. Nat. (. 1). Ch. v. (Spielman, 1986; Spielman et al., 1987). engchi. i n U. (Predisposing factors) 』. (Edinger, Stout, & Hoelscher, 1988; Kales, Caldwell, Preston, Healey, & Kales, 1976; Kales et al., 1983; Monroe & Marks, 1977; Shealy, Lowe, & Ritzler, 1980) (Coren, 1988; Espie, 1991; Schneider-Helmert, 1987; Vollrath, Wicki, & Angst, 1989). !. 10!.

(22) !. Drake. (2004). 『. (FIRST) 104. FIRST. (sleep efficiency. SE). SOL. (first night effect) MSLT. Drake. (2006). 政治大. 立. 學. ‧ 國. SOL. SOL. (Precipitating factors). 」. io. -. 65%. al. n (AASM, 2005). sit. y. Nat. 78.3%. 345. 」. Ch. engchi. Morin. er. (2004). (Healy, et al., 1981). ‧. Bastien. 74%. i n U. 4.6%. v. (2003). (appraisal process). (Brannon & Feist, 2000; Sarafino, 2002; Taylor, 1999). (. 、 Fernández-Mendoza. !. (2010). 11!. ).

(23) !. (arousability). (rumination). FIRST. FIRST -. (2008) 。 ( , 2008). ). 立. 」政治大 /. ‧ 國. 學. io. Mendelson. (1997). aHarvey i v(Cognitive model of l C (2002) n (2006) h e n Model) i U g c h(Neurobehaviroal. n. (Neurocognitive model) insomnia). Yang. (. Perlis. sit. Nat. Perlis, Giles,. y. ‧. (Perpetuating factors). er. (. 』. ). (1997) “. (cognitive arousal) “ ”. (cortical arousal) “. 』. “ (conditioned arousal)” 」. !. 12!.

(24) !. (Perlis, Smith, Andrews, Orff, & Giles, 2001) Harvey (2002). (excessive worries) (ruminations). (autonomic arousal). (emotional distress). 」. 。. (Dalgleish & Watts, 1990) (. ). 立. Harsh, 1994). (Bonnet, 1990; Ogilvie & 政治大 (Bastien et al., 2003). (. Nat. ). io. (Ree & Harvey, 2004). n. al. Yang. (2006). Ch. engchi. ). er. (Salkovskis, 1991). sit. (. y. Harvey. ‧. ‧ 國. 學. ). (. i n U. v. (Edinger et al., 2000). Perlis !. 13!.

(25) !. (1997) Harvey (2002). Yang. (2007). ( 1. (. ). 立. /. 政治大. ‧. ‧ 國. 學. n. er. io. sit. y. Nat. al. 1. !. Ch. engchi. i n U. v. Spielman Glovinsky ( Spielman & Glovinsky, 1991). 14!. ).

(26) !. (. ). Espie. AIE. -. -. (Attention-Intention-Effort Pathway. ). AIE. (2006). Espie 2002. (Psychological inhibition model). (plasticity). (automaticity). 立. ‧ 國. 」. 政治大. AIE. (. 學. Espie. (. 2). ‧. n. !. ”. Ch. ”. engchi. 15!. er. io. sit. y. Nat. al. i n U. v. ).

(27) !. !. !. ! !. !. !. !. !. !. A1 !. !. 政治大. 立. A2 ! ! ! E!. (Espie et al., 2006). n. al. sit. io. 2. AIE. er. Nat. y. ‧. ‧ 國. 學. I. CAIE hengchi. (. i n U. ). v. AIE. ( ) !. 16!. !.

(28) !. 」. (. ). (Yang, Chou, &Hsiao, 2011) (Yang, Lin& Cheng, 2013). 政治大立(2006). 」 Espie. ‧. ‧ 國. 學. n. al. er. io. sit. y. Nat 」. 」. Ch. engchi. i n U. v. (paradigm) 」 (vigilace) (disengagement). 。. (avoidance) (. (. ). (emotional stroop task (Stroop). 1935. !. Stroop. Stroop. 17!. 1) EST).

(29) !. 」. (Stroop effect). EST. 」. (. 」 ). (. ). 政治大『 (Williams, Mathews, & MacLeod, 1996; Musa,. (emotional interference effect). 立. ‧ 國. (1997). 12-18. n. al. 2003). (. y. EST. ). io. (. (2003). 0-3. ). er. Taylor. (Lundh, Fröding, Gyllenhammer, Broman, & Hetta,. Nat. 1997). ‧. (persistant insomnia). EST. sit. Lundh. 學. Lépine, Clark,Mansell, & Ehlers, 2003; Mogg & Bradley, 2005). Ch. engchi. iv n U (Taylor, Espie, & White,. Barclay Ellis (2013) 『 (Pittsburgh Sleep Quality Index, PSQI > 5). Spiegelhalder. !. 18!.

(30) !. (2008) (frequency of concept usage) EST 」. 」. (Spiegelhalder, Espie, Nissen, & Riemann, 2008). (. ). (Robinson & Berridge, 1993; Field & Cox, 2008). 立」. 。. AIE. (Espie, Broomfield, MacMahon, Macphee, & Taylor, 2006). (. io. al. ). sit. Nat. ). v i n C h (Spiegelhalder, e n g c h i U Kyle, & Feige, et al., 2010). n. (Spiegelhalder, Espie, & Riemann, 2009) (PSG). (. De Ruiter. (. y. EST. er. Spiegelhalder. ‧. ‧ 國. Espie. (Mogg & Bradley,. 學. 2005). 政治大 (elaborated). ). Brosschot (1994). 。. (. ). EST. EST 。. (cognitive avoidance processing). EST. (perceptual). (response) (visual dot-probe task, blindness paradigm,. 」 VDP) Flicker ICB). (flicker induced change Posner. paradigm). !. 19!. (Posner cueing.

(31) !. (. ) Flicker ICB (. ). (Simons, 2000) Jones. (2005). Flicker ICB. 政治大. 立. ‧ 國. 學. Marchetti. (2006). ‧. &Espie, 2005). (Jones, Macphee, Broomfield, Jones,. (delayed sleep phase syndrome,. y. n. al. sit. io Flicker ICB. DSPS. er. DSPS) 」. Nat. 『. DSPS. Ch. engchi. i n U. v. (Marchetti, Biello, Broomfield, Macmahon, & Espie, 2006). Flicker ICB 」 Posner. 、. (. ). Posner. Posner. 1980. Posner (cue). !. 20!. Peterson.

(32) !. (cued trial) (uncued trial). (valid cue trial). (invalid cue trial). 50%. (engagement) (disengagement). 立. 政治大. ‧ 國 “. Woods. (2009). ”. (. sit. n. al. Biello, & Espie, 2009). 、. Ch. ). engchi. er. io (eg.. y. Nat. 」. 2AM). ‧. Posner. 學. (cost effect). (benefit effect). i n U. v. (Woods, Marchetti, 」. (Tang, Anne Schmidt, & Harvey, 2007). (. !. Posner. ). 21!.

(33) !. MacLeod Mathews. Tata (1986). (dichotic listening task) VDP VDP. 」. (1986). (attentional bias index). =. ‧. Peterson (1990). io. al. n (disengagement). (shifting). Ch. (engagement). engchi U. v ni. Koster. 。 (2004). VDP. : =. =. !. y. 。. sit. Nat. Posner. 學. ‧ 國. 立. 政治大. VDP. er. MacLeod. 22!. Crombez. Verschuere.

(34) !. VDP. (Koster, Crombez, Verschuere, & De Houwer, 2006; Koster,. 。. Crombez, Verschuere, & Van Damme, 2006) Koster. (2006). ). (. (exposure time). (degree of threat) Koster. (millisecond,. 1250ms. 學. 。. 政治大立500 ms. (2005). ms). ‧ 國. 100. 。. VDP. ‧. 50-500 ms. Nat. y. 1000-1500 ms. sit. (Bar-Haim, et al., 2007). n. al. er. io. 500 ms 2500 ms. Ch. (Calvo & Avero, 2005). engchi. i n U. v. 。. VDP MacMahon. DSPS. VDP. (MacMahon, Broomfield, & Espie, 2006). !. Spiegelhalder. 23!. (2010). (2006).

(35) !. (Spiegelhalder, Kyle, Feige, and et al., 2010) Jansson-Fröjmark. Koster. (2004). 2013. VDP. /. 500ms. (. 政治大. ). (. 學. ‧ 國. 立. ). ‧. n. er. io. sit. y. Nat. al. Ellisc. Ch. engchi. Cropley (2002). /. (. !. ). 24!. i n U. v. /.

(36) !. Mathews. MacLeod. (MacLeod, et al., 2002; Mathews & MacLeod,. 2002). 」. Harvey Schmidt (2000). Tang 30. (2007) ). (30 (38. ) (Tang, Anne. 政治大. Schmidt, & Harvey, 2007). 立. (Brosschot, Gerin,. ‧ 國. 學. & Thayer, 2006; Brosschot, van Dijk, & Thayer, 2007; Pieper, Brosschot, van der Leeden, & Thayer, 2007). (worry). ‧. Harvey (2002). Nat. n. al. (self-focus). er. io. (monitoring). sit. y. 」. Ch. engchi. i n U. v. Semler. Harvey (2004). Associated Monitoring Index. SAMI). 」. !. (Sleep. 」. 25!.

(37) !. 1. 5 5 10. ). (1093.5±159.9ms) (1049.5±135.7ms) (t=.71). 40 12-. PI SE NS. 20 60. al. n. 20 20 20. io. ). (964.6±11.4ms) (1089.9±177.5ms) 6.12**). Nat. ( 18. ‧. 0-3 15. 學. 20 20. (. Spiegelhalder (2008). 立. 政治大. y. 18. PI (68±15.68sec) GS (69.31±14.35sec) (p=.21). Ch. (t=-. sit. (2003). PI NS. er. Taylor. 20 20. ‧ 國. Emotional stroop Lundh (1997). PI (3.8±15.4ms) >GS (1.8±14.8ms) >SE (-8.7±15.7ms). n engchi U. iv. PI. (frequency of concept usage). !. 26!.

(38) !. Spiegelhalder (2009). 105. 30 10. -PSQI (t=2.83, p<.01) -SSS (t=2.16, p<.05) t 2.79, p<.01). 30 30. PI NS. 30 10. 立 20 20. 65 42. GS (0-4 ) PS (≥5 ). 20. 21 22 20. PI DSPS NS. 20. : PS (723.35±172.55ms) >GS (713.20±166.32ms) (p=.88) : PS (723.35±172.55ms) > (694.63±162.17ms) (p<.05). PS. y. n. al. PI 3.9±9.4ms DSPSi v1.1±8.3 ms C h 2.5±9.7ms U n ePIn g c h i = .03) DSPS (t = -1.27, p = .10). !. GS. sit. io. 68. PI. ‧. Nat. Dot-probe MacMahon (2006). 107 PSQI. ‧ 國. Ellis. 學. Barclay (2013). PI (883±206ms) >GS 治 (p=.27) 政(844±211ms) 大. er. Spiegelhalder (2010). 27!. PI GS (t = -1.88, p GS. DSPS. PI PI.

(39) !. 40 ( 120 (. PI (492±132ms) (509±174ms) −.59, p = 0.56). ). ). 20. 政治大 /. ‧ 國. PI NS. GS .56±18.34. 80. = .005) (F = 5.81, p = .021). NS (0-2 ) PS (4-5 ) PI (>5 ). al. n. 64 64 64. 7. 7. Ch. engchi U. 28!. PI. PI PI GS (F = 8.72, p GS. v i n. 14.5±9.4sec 15.5±10.7sec 23.1± 7.6sec F=6.59 p<.01 t=0.34 p>.05. !. ‧. io. 192 PSQI. PI 4.5±39.87ms;. 20.79±38.29ms; GS 9.53±27.35. Nat. Flicker ICB Jones (2005). GS. PI 8.9±30.5ms; GS (t= 1.75,. 學. 21 21. PI (t =. 7.6±41.6ms p = .085). 立 Jansson-Fröjmark (2013). GS. y. PI NS. sit. 30 30. er. Spiegelhalder (2010). PI. PS. VDP.

(40) !. 7. PI (18.2±1.64sec) GS (12.3±3.10sec) DSPS (11.2±3.14sec) PI (4.7±2.14sec) DSPS (9.7±3.5sec) GS ( 12.4± 2.99sec) F=6.59 p<.01 DSPS GS. ) 30 30. DSPS NS. 立. ‧ 國. GS (F=10.53 p. PI. ‧. DSPS:. >0.01). io. SE:. al. PS:. n. !. PI. GS (F=8.98, p>0.01). Nat. NS:. PI. 政治大. 學. Modified Posner paradigm Woods (2009) 22 PI 22 NS. PI:. 7. y. PI (. sit. 30. er. Marchetti (2006). Ch. engchi U. 29!. v i n. PI.

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(44) !. 62. (. ) 20 ICSD-3 3. 3. 「. (1). 20. 「. 60. (2). ( ). (3). 「. (4) (5) (6) (7) (. ) 5. (2008). FIRST. 20. (1). (2). !. 「. 33!. FIRST」. 17.

(45) !. (3) (4) (5) (6) (. ) 22. FIRST」. 16. (1)!. (2). 「. (3) (4) (5) (6). 、. (Mini International Neuropsychiatric Interview (Beck Anxiety Inventory Depression Inventory II 」 Uplift Scale. !. BAI). BDI-II). (Perceived Stress Scale. MINI). 」 (Beck. 」 FIRST」. PSS). CHUS). 34!. (Combined Hassle and.

(46) !. 」」. 」. (350 c.c.. ( ). 8. →. 」. PSAS. SAMI. / PSG. PSG (sleep-related breathing disorders) (periodic limb movements disorder). !. 35!. ).

(47) !. (N=62) 4 PSG,!2. FIRST. 2 AHI>15 !. FIRST. ≤16 (N=21). >16 (N=19). (N=18). VDP. : 1. 2. 3.. ( ):→ (T1) :→ (T0): →. 」」」. PSAS PSAS SAMI. PSG. 4.. /. (. ). (MINI) MINI. DSM-IV (International Statistical Classification of. Diseases and Related Health Problems 10th Revision 17. !. 25. 36!. ICD-10) DSM-IV.

(48) !. DSM-III-R Clinical Interview for DSM-III-R Patients) Interview. SCID-P (Structured. CIDI (Composite International Diagnostic. ICD-10. MINI. (. SCID-P. ). kappa. .43-.90. CIDI. kappa. .43-.82) (Sheehan, et al., 1998). (. ). (FIRST. 」 FIRST. Drake. 2004. 9. 4. ) 」 4. 」. (1. 、. FIRST. 」. ). (4. Drake. 」. (Cranbach’s α .83). .92. (2007) r. ). Chou, Yang, & Chen (Cranbach’s α .79. .80). (2008). FIRST 」. (Cranbach’s α=.89). Drake. highFIRST lowFIRST. Drake. FIRST. (Drake et al., 2006) 」. (. 、. ). (. ). (2004). Drake (2008). 148. FIRST」 FIRST. 16. ±. 17.26±5.62. 17. 16 (. ). 「「. !. 」. 」. (Insomnia severity inventory, Morin (1993). ISI) 」. 37!. 「.

(49) !. (. 2009). ISI. (Chronbach’s α = 0.74). ISI (r = 0.32-0.55). (Bastien, Vallières, & Morin, 2001). ISI. (Chronbach’s α = .94). (Chinese. 」. Pittsburgh Sleep Quality Index, CPSQI). .88. ISI. (F = 729.32, p < .001) ROC (91.8%) (. 9. (91.2%) (. ). 2009) (BAI). 」. Beck, Epstein, Brown,. 」. Steer. 1988. 」. 「 (. 2000). BAI. 21. 「. 「. 、 0-7. /. 8-15. 16-25. BAI. 「 BAI. 、 26-63. (Chronbach’s α = .85-.93). 」. (r = .22-. 」. .58). BAI. BAI. (Chronbach’s α = .95). (r = .91). ( 2006) (. 」. /. ). (BDI-II). 」」. 、. Beck. 」. Ward. Mendelson. Mock. Erbaugh. 1994. 「 (. 2000). DSM-IV 「. BDI-II. 21 「. 0-3. 、 0-13. !. 1961. 38!. 14-19. / 20-28.

(50) !. 29-63. BDI-II. 「. .93). (α= .92-. BDI-II (Chronbach’s α = .94). (r = .91). -. BDI-II. (. 2002). 」. 、 (. ). (CHUS. 」. ) (hassles). 」 (uplifts). (. 」. ). (DeLongis, Coyne, Dakof, Folkman, & Lazarus, 1982; DeLongis, Folkman, & Lazarus, 1988). CHUS. (. 」 ). 0. (. 1. ) 2. 3. 」. .77. 」 .82 1988) (. 」. 」. ). (PSS. 」 PSS. 14. 」. 」. 1. 2 4. Chronbach’s α. 5. 0.84. 6. 3 7. 9. 10. 4. 7 」. 0.55. 2. 7. 13. 0.86. 1 10. Mermelstein (1983). 」. 0. !. ). Cohen, Kamarck, 」. 」. (DeLongis, Folkman, & Lazarus,. 」. 0.85. 4. 」. 」 Cohen. (1988). 10 39!. 」.

(51) !. Chen (1994) (r = 0.81). (. (Cronbach's α = 0.85). 」. ) -. 」. (Cacioppo,. Tassinary, &Berntson, 2007; Schwartz & Andrasik, 2016) 5 1. 2. ). (. 3. -. 6. / (Le Bon et al., 2000) (Le Bon et al., 2001). PSG (Hutchinson et al., 2007). /. 」. (Bonnet &Arand, 2003; Drake et al., 2004; Roth, Roehrs, &Vogel, 1995) (. ). (. ). /. Usui. 」. 1999). (1998. 」 93.48%. 86.71%. 97.04% 70.88%. 94.02 / (SOL). (bed time, BT). (wake after sleep onset, WASO). (rise time, RT). 」. / 」. !. 40!.

(52) !. (. ). (actigraphy). 」 (SOL) SE). (sleep efficiency, (nighttime. 」. awakening, NWK). (TST). (SE). PSG. 」. (r = .70~.89) (Sadeh, Hauri, Kripke, & Lavie, 1995). (. ). 」. (PSAS. ). PSAS. 16. 」. 1. 」. 8 」. 9. 16. PSAS. 」. (Nicassio,. 」 Mendlowitz, Fussell, & Petras, 1985). 」. 0.79 0.84. 0.67. 」. 0.76 PSAS. Alpha. (. Cronbach’s Alpha. 」. 0.82. 0.72. 」」. 0.88 PSAS (Cronbach’s. 」. 0.89) (. ). Cronbach’s Alpha. 2009). (SAMI. 」. ). SAMI. 」 30. !. SAMI. 」. 41!.

(53) !. (1-5. 」. ) (Cronbach’s Alpha. .91). (r=.82). 8. /. (Semler & Harvey,. 」. 2004a, 2004b). SAMI. 」. (Cronbach’s Alpha .95) Cronbach’s Alpha .72. .85-.95 SAMI. (r=.65). 」. BAI (r=.67). BDI-II (r=.67). (Chan, Chen, Liao, & Tsai, 2011). SAMI」. /. (. ). (PSG) →. /. RemLogic™ PSG Software (Embla Systems, Inc., Broomfield, US.) (1) → F3 F4 C3 A2. (2). (3). (electroencephalograph. C4 O1 O2. (electrooculogram (electromyogram. 6. EMG). 3 (4). (5) (6). (oximetry). (chest respiratory effort). 」. (electrocardiogram. (nasal airflow). (abdomen respiratory effort). 」. 」. 42!. (7). _ (8). _ EEG. 」 5KΩ. !. A1. EOG). 4 ECG). EEG). EOG. EMG. 」.

(54) !. 」 30 (Rechtschaffen & Kales, 1968) (filter) (. ). 0.3 Hz. EEG. 200. 35 Hz. → EEG. BrainVision Analyzer 2.0. →. (Brain Products,33 Inc., Munich, Germany) C4/A1. EEG. C3/A2. 。 →. 75µV. (artifacts). (segmentation). 2. Transform. FFT). Beta1 (14-20Hz). 1. 「. (Fast Fourier. (Hanning Window). Beta2 (20-35Hz). 10%. Gamma (35-45Hz). (log-transformed) (. ). 」」 (Lazarus, Speisman, & Mordkoff, 1963) MP150. BIOPAC (Skin Temperature, SKT). ( Galvanic skin response, SCR) (AcqKnowledge 4.2) (. 」. ). (VDP). (1). (International Affective Picture System, IAPS) 、 46. 45. 40 (valence). (9. !. 42. 、. 」. 20-65. (arousal). ). (Koster et al., 2006;. 43!.

(55) !. Jansson-Fröjmark, Bermås, & Kjellén, 2013; Zvielli, Bernstein, & Koster, 2014) 24. (. 4.87-5.69. 1.15-3.23. 1.25-2.97) 4.74-6.18. (. 、. 1.95-2.82. 24. (. 1.92-3.91. 5.59-7.87 3.71-6.03. 1.23-1.95) 2.26-3.45. 24 1.44-3.08. 6.73-7.89) 24 (2) E-prime Version 2.0 (Koster, Crombez, Verschuere, & De Houwer , 2004). 」. (Koster et al., 2005; Koster et al., 2006). (. 5. 100ms. 500ms. +. 1000ms). (750ms). 25ms. O. 500ms. 4.6. 6.5 2.86. 60 432. 24 6. 「. 4. !. 44!.

(56) !. !. +! !. 750ms!. +! !. 100ms,!500ms! 1500ms!. !. !. !. 25ms!. !!. 5. SPSS for MAC 20.0 」. LSD. 1.!. (Cacioppo, !. 45!.

(57) !. Tassinary, &Berntson, 2007; Schwartz & Andrasik, 2016). LSD. / 2.!. VDP 200ms 2000ms 3 3 4%. Koster, Cromnez, Verschuere, & De Houwer (2004). ( (. )×2(. ). 3. ). -. -. 3.!. 」 8 → 2 。. !. -. 2. -. 2 3(. -. 2. )×2(. 46!. 」 ).

(58) !. → → 」 LSD. /. 4.! PSAS」 3(. ) ×2 (. 」 ). 」. 」 /. LSD 5.!. SAMI. 」. LSD 6.!. 」. !. (Pearson’s correlation). 47!.

(59) !. 」 20. 20. ). 22. (. 24. 14 48. 2.6±2.44 PSG 15. 1. PLMI. 15. 1. PSG. 1. AHI. PSG. PSG. AHI. 15. 1. AHI AHI. 5. 5. 1. 」 18 14. ) (. 」. 19 5. (FIRST). 16. (. 5. 14. (. 4. ). 21. BDI-II). (. ) 「. nCHUS. (ISI). / ( BAI. CHUS). (PSS). 3. (F =.036 p < .965) (F =100.387 p < .001). 」. 「 (F =105.783 p < .001). BAI. / 11.3 p < .001; F = 16.536. 「. BDI-II 」. p < .001). (F = /. (F = 4.232. p = .019; F = 13.794 p < .001) ;. !. 48!.

(60) !. 3.. (N=19) 32.35±4.88. (N=21) 32.19±5.13. F .036. p .965. Post hoc. Age. (N=18) 31.95±4.02. FIRST. 26.89±3.30. 27.30±4.17. 13.8±2.82. 100.387***. <.001. CI, HF>LF. ISI. 18.0±3.14. 11.35±4.6. 2.29±2.15. 105.783***. <.001. CI>HF>LF. BDI. 13.82±10.64. 8.6±6.43. 2.5±3.58. 11.300***. <.001. CI>HF>LF. BAI. 13.0±9.4. 7.95±6.03. 1.43±1.47. 16.536***. <.001. CI>HF>LF. 41.53±24.5. 34.80±18.37. 32.2±16.66. 1.117. .334. 61.9±20.85. *. .019. CI, HF<LF. <.001. CI, HF>LF. nCHUS CHUS PSS *. 」. 44.58±24.07. 44.55±19.99. 21.47±5.41. 19.7±6.20. 4.232. ***. 12.48±5.71. 13.794. p < .05, **p < .01, ***p < .001. 」」. 5. 4. 19. 14. 16 (SOL). 」 (F =8.363 (SE). (WASO). p < .001; F =14.673. p < .001). ( F =15.744 p < .001) ;. (TST). TST. ;. WASO 」. 4. !. 49!. 」.

(61) !. 4.. (N=14) 375.4±78. TST. *. (N=19) 385.19±91.4. SOL WASO SE. 34.8±47.9 54.4±33.5 77.1±12.4. TST SOL WASO SE. (N=18) 378.46±130.11 40.38±52.16 23.44±52.42 76.97±21.45. (N=16) 394.5±72.7. 21.6±27.2 37.5±25.1 82.9±10.81. 16.4±22.6 37.1±19.5 85.0±8.24. (N=19) (N=21) 398.16±107.33 422.88±73.21 26.76±33.85 10.92±20.88 10.19±33.61 6.50±12.96 83.70±16.33 91.27±6.68. F. p. 1.456 ***. poshoc. .235. 8.363 14.673*** 15.744***. <.001 <.001 <.001. CI>HF,LF. F. p. poshoc. 4.463* 15.815*** 6.031** 20.458***. .012 <.001 .003 <.001. CI<LF CI>HF>LF CI>HF,LF CI<HF<LF. CI>HF,LF CI<HF,LF. p < .05, **p < .01, ***p < .001. 6 7 (. ) (F = .587. (. p = .560; F =1.203 p = .311) (F = .072. (F = 4.73. ). p = .931). p = .013). 5. !. 50!.

(62) 1 6 11 16 21 26 31 36 41 46 51 56 61 66 71 76 81 86 91 96 101 106 111 116 121 126 131 136 141 146. [umho]! 1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 73 77 81 85 89 93 97 101 105 109 113 117 121 125 129 133 137 141 145. [ºC]!. !. 32. 31.5. 31. ! 30.5. 30. 29.5. 29. ! !. [6ms]!. 7.. 51!. !. 28.5. [6ms]!. 6.. 16. 14. 12. 10. 8. 6. 4. 2. 0.

(63) !. 5. p. Post hoc. _. (N=18) -1.05±.56. (N=19) -1.27±.73. (N=21) -1.21±.55. .587. .560. _. 75.66±49.14. 90.09±54.06. 107.64±75.42. 1.203. .310. _. 14.36±9.24. 14.00±9.40. 13.14±10.36. .931. 168.72±84.84. 143.04±77.64. 95.64±38.58. .072 4.73. _ *. F. **. p < .05, p < .01,. ***. .013. CI, HF>LF. p < .001. x. 6. 」 100ms. 500ms. 500ms. 1000ms 7. 100ms 8. 500ms. 9. 100ms. (F = 3.543 p =.036) =.556). (F = .351 p. x. (F = .945 p =.395). LSD (p. =.029). (p =.074). (p =.719). 500m. (F =.150 p =.861) (F = 2.169 p =.146). x. (F. = .982 p =.381) 500ms 10 (F = .693 p =.504). (F =.002. (F = .250 p =.779) x. !. 12. 500ms. p =.966). 1000ms. (F = .037 p =.849) (F = 6.194. 8. 1000ms. 9. p =.004; F = 3.803 p =.028) 11. 52!.

(64) !. 500ms. (F = 3.93. (F = 6.01. 1000ms. p =.017; F = 6.36. p =.023). p =.015). 13 (F = 4.83. p =.032). 36. 」 14. 6. 1000ms 389.52±70.17 374.38±53.84 357.41±59.66. 362.96±49.60 373.22±52.22 351.91±57.75. 357.62±35.88 362.26±56.09 358.00±61.17 *. !. 391.59±75.32 377.13±65.86 364.11±65.54 500ms 367.90±50.30 383.88±58.58 355.25±55.97 100ms 361.07±41.07 358.61±52.30 361.02±57.87. p < .05, **p < .01, ***p < .001. 53!. 397.19±78.43 378.97±60.91 359.47±61.41. F .054 .029 .061. p .948 .971 .941. 369.60±51.73 376.24±54.44 355.92±59.53. F .093 .199 .028. p .911 .820 .973. 362.95±39.35 362.71±53.59 358.93±60.10. F .092 .035 .013. p .912 .966 .987.

(65) !. 7. VT_100ms VS_100ms VT_500ms VS_500ms DT_500ms DS_500ms DT_1000ms DS_1000ms. -3.41±12 -5.82±11.68 -8.85±14.08 -1.10±20.56 1.02±14.46 12.17±15.94 -2.99±15.41 7.52±19.11. VT: DT:. 4.51±14.41 2.05±11.61 -7.40±19.45 -3.59±13.69 13.92±19.09 2.45±16.97 2.77±20.87 1.48±16.54 ; DS: ; DS:. 8. 100m _. ;. x SS. df. MS. 1409.227 2 704.613 11165.662 56 199.387 25.171 135.620 4016.620. x *. p. 3.534. .036. 1 2 56. 25.171 67.810 71.725. .351 .945. .556 .395. df. MS. F. p. 91.695 2 45.848 17388.349 57 305.059. .150. .861. 393.870 1 393.870 356.593 2 178.296 10350.829 57 181.593. 2.169 .982. .146 .381. x SS. x. !. F. p < .05, **p < .01, ***p < .001. 9. 500m _. *. -4.33±10.56 -2.23±8.90 -3.09±10.41 -3.78±12.85 3.59±13.32 4.25±11.51 8.53±15.36 .86±10.06. p < .05, **p < .01, ***p < .001. 54!.

(66) !. 10. 500m _. x SS. df. MS. F. p. 185.976 268.276. .693. .504. .375 1 .375 .002 2561.703 2 1280.852 6.194 11787.925 57 206.806. .966 .004. 371.952 2 15291.741 57. x *. p < .05, **p < .01, ***p < .001. 11.. *. !. 500m SS. df1. df2. MS. F. p. ηp2. 1864.83 1069.63 27079.67. 2 2 114. 114 114. 932.41 534.82 237.54. 3.93* 2.25. 0.0225 0.1099. 0.1087 0.0654. 1243.23 1315.61 4.36. 1 1 1. 57 57 57. 1243.23 1315.61 4.36. 6.01* 6.36* 0.02. 0.0173 0.0145 0.8851. 0.0752 0.0792 0.0003. p < .05, **p < .01, ***p < .001. 55!.

(67) !. 16. [ms]. 14 12 10. 500ms. 8 6 4 2 0. 8. 500m. 12. 1000m _. x SS. x *. !. x. df. MS. F. p. 165.972 2 82.986 18569.898 56 331.605. .250. .779. 7.948 1 7.948 1651.105 2 825.553 12155.020 56 217.054. .037 3.803. .849 .028. p < .05, **p < .01, ***p < .001. 56!.

(68) !. 13.. *. 1000m SS. df1. df2. MS. F. p. ηp2. 1293.93 523.56. 2 2. 112 112. 646.96 261.78. 2.36 0.95. 0.0993 0.3882. 0.0651 0.0274. 30724.90. 112. 1049.37 16.64. 1 1. 56 56. 1049.37 16.64. 4.83 0.08. 0.0320 0.7829. 0.0535 0.0009. 588.29. 1. 56. 588.29. 2.71. 0.1053. 0.0307. 12155.02. 56. p < .05, **p < .01, ***p < .001. 274.33. 217.05. 10. [ms]. 8. 6. 4. 1000ms. 2. 0. ?2. ?4. 9. 1000m. !. x. 57!.

(69) !. 14. F. *. 5.26±.53. p. 4.99±.37. 5.15±.33. 2.75±1.58. 2.63±1.45 1.93±1.26 1.248 .298. 2.02±1.09. 1.49±.64. 1.63±.84. 1.414 .255. 1.87±.98. 1.67±.88. 1.61±.85. .323. 3.29±.59. 2.73±.92. 3.55±1.51 2.152 .130. 4.53±1.78. 5.16±1.63 4.46±1.49 .755. 5.75±2.01. 6.67±1.47 5.76±2.22 1.057 .357. 1.66±.91. 2.02±1.71 1.65±.92. .405. .670. 5.08±.59. 5.21±.58. .157. .855. 3.07±1.59. 3.14±1.38 2.39±1.64 .962. .391. 2.14±1.18. 1.82±.75. 1.75±.80. .505. 7.03±1.26. 7.64±.81. 6.12±2.46 3.011 .061. 5.15±.72. 1.459 .245. .695. .726 .477. p < .05, **p < .01, ***p < .001. (. ) 15 10. 11. x 16. 17. (F = 1.327 p =.274; F =.760 p. =.473). x. (F =.747 p =.479; F =1.173. p =.318 ). (F = 8.347 p =.006; F =17.867 p <.001) T. (t = -2.650, p. = .016). (t = 2.654, p. = .019; t = 4.298, p <.001) 」 18 p =.318) !. (F = .747 p =.479). 」 58!. (F = 1.173.

(70) !. 15. 1. *. 32.30±1.92 30.31± 7.48 32.68± 1.96. -.762 -1.767 -2.650*. .457 .093 .016. 4.88±3.57 3.93± 2.98 3.31± 3.46. 2.68±2.27 1.76±1.29 2.42±3.07. 2.654* 4.298*** 1.173. .019 <.001 .255. p<.05, ** p<.01, *** p<.001. 32.5 32 31.5. [ºC]. p. 31.87±1.88 29.62±7.53 31.46±2.61. 33. 31 30.5 30 29.5 29 28.5 28 1. 10.. !. t. 59!.

(71) !. 6. [umho]. 5 4 3 2 1 0 1. 11.. 16.. x. _ SS. df. MS. 115.417 2 57.709 2348.678 54 43.494 17.133 1 17.133 x 3.065 2 1.532 110.843 54 2.053 * ** *** p<.05, p<.01, p<.001. !. F. p. 1.327. .274. 8.347** .747. .006 .479. 60!.

(72) !. 17.. x. _ SS. df. MS. 18.599 2 9.300 624.024 51 12.236. p. .760. .473. 81.940 1 81.940 17.867*** <.001 10.761 2 5.380 1.173 .318 233.896 51 4.586. x *. F. p<.05, ** p<.01, *** p<.001. 18.. 」 F. p. T0-T1. .42±2.27 (17). .70±1.77 (20). 1.22±2.05 (20). .747. .479. T1-T0. 2.21±3.22 (15). 2.17±2.15 (18). .89±3.49 (21). 1.173. .318. T1: ; T0: * p<.05, ** p<.01, *** p<.001. (. ) 19. → 12 x C3. Beta1. (F =1.646 C4. 21 (F = 1.442. p =.205). (F =.042. Beta1. p =.959) ;. (F = 12.819. T. C4_Beta1. 2.430, p = .026) ;. 22. (F = 2.319 p =.108). (F =1.855 p =.166). 23. (F = 1.126. !. p =.245). 24. C3/C4. p =.332; F = 1.956 p =.151). 61!. p =.001) (t =. Beta2 x.

(73) !. (F = .240 p =.787; F = .611 p =.564) p =.007; F = 15.996 p < .001). (F = 8.018 T. C3_Beta2. (t = 2.328, p = .033). C4_Beta2 25. (t = 2.211, p = .041; t = 2.801, p = .013) ; ;. C3. Gamma. x. (F = 1.514 p =.229). (F = .396. (F = 13.069. p =.001). p =.675). T. C3_Gamma. (t = 2.306, p = .034) ;. 26. C4. Gamma. (F = 3.800 p =.029) 22.196 p <.001). (F =. x. (F = 2.045 p =.139). T. C4_Gamma (t = 3.727, p = .002; t = 2.311, p = .032) C4. Gamma. (F = 2.186, p=.122). C4. (F = 4.564, p=.015). Gamma. LSD. (p=.036). (p=.005). (p=.476) →. 27 C3/C4. Beta2 (F = .240. C3/C4. p =.787; F = .611 p =.547). p =.675; F = 2.045 p =.139). !. Beta1 (F = .042. 」. 62!. 」 p =.959; F =1.855 p =.166) C3/C4. Gamma (F = ..396.

(74) !. 19.. C3/C4. (. →. 1. ). t. p. C3 Beta1 7.64±2.456 8.57±4.441 7.21±2.232. 7.12±2.281 7.62±4.761 6.39±2.423. 1.421 .551 1.706. .174 .589 .104. 7.78±2.074 9.64±4.720 6.92±2.220. 6.95±1.978 7.23±4.445 6.06±2.313. 2.062 2.430* 1.927. .056 .026 .068. 12.00±7.309 10.08±5.632 9.09±4.582. 9.36±5.004 8.28±5.693 7.61±4.370. 2.328* 1.090 1.929. .033 .291 .068. 13.11±.772 11.29±5.321 9.28±4.249. 9.89±6.325 7.96±5.867 7.56±3.379. 2.801* 2.211* 1.895. .013 .041 .073. 4.33±4.108 2.99±2.092 2.59±3.170. 2.80±2.734 1.69±2.006 1.74±2.644. 2.096 2.306* 1.772. .052 .034 .092. 5.54±5.302 3.12±1.955 2.35±1.853. 3.29±3.863 1.82±2.087 1.60±1.791. 3.727** 1.999 2.311*. .002 .062 .032. C4 Beta1. C3 Beta2. C4 Beta2. C3 Gamma. C4 Gamma. *. !. p<.05, ** p<.01, *** p<.001. 63!.

(75) !. 13.5. C3_Beta1. 13.5. 11.5. 11.5. 9.5. 9.5. 7.5. 7.5. 5.5. 5.5. 3.5. 3.5 1.5. 1.5. 1. 1. 13.5. C3_Beta2. 13.5. 11.5. 11.5. 9.5. 9.5. 7.5. 7.5. 5.5. 5.5. 3.5. 3.5. 1.5. 1. C3_Gamma. 13.5. 11.5. 11.5. 9.5. 9.5. 7.5. 7.5. 5.5. 5.5. 3.5. 3.5. C4_Gamma. 1.5. 1.5. 1. 1. 12.. !. C4_Beta2. 1.5 1. 13.5. C4_Beta1. →. 64!.

(76) !. 21. C3_Beta1. x SS. x *. df. F. p. 32.442 2 16.221 596.036 53 11.246. 1.442. .245. 16.197 1 16.197 .827 2 .413 521.383 53 9.837. 1.646 .042. .205 .959. p < .05, **p < .01, ***p < .001. 22. C4_Beta1. x SS. df. 73.346 838. x *. 2 36.673 53 15.811. F. p. 2.319. 0.108. p < .05, **p < .01, ***p < .001. x. !. MS. 51.657 1 51.657 12.819** 0.001 14.95 2 7.475 1.855 0.166 213.577 53 4.03. 23. C3_Beta2. *. MS. x SS. df. MS. F. p. 103.384. 2. 51.692. 1.126. .332. 2432.385 53. 45.894 8.018* .240. .007 .787. 108.192 6.488 715.184. 1 108.192 2 3.244 53 13.494. p < .05, **p < .01, ***p < .001. 65!.

(77) !. 24. C4_Beta2. x *. x SS. df. MS. F. p. 179.292. 2. 89.646. 1.956. .151. 2429.027 53. 45.831. 211.190 16.135 699.747. 1 211.190 15.996*** <.001 2 8.068 .611 .564 53 13.203. p < .05, **p < .01, ***p < .001. 25. C3_Gamma. x SS. df. MS. 40.318 2 20.159 705.868 53 13.318. x *. F. p. 1.514. .229. 42.928 1 42.928 13.069** .001 2.605 2 1.302 .396 .675 174.088 53 3.285. p < .05, **p < .01, ***p < .001. 26. C4_Gamma. x SS. df. MS. F. p. 120.276. 2. 60.138. 3.800*. .029. 838.864 53 15.828. x *. !. 57.122 1 57.111 22.196*** <.001 10.528 2 5.264 2.045 .139 136.395 53 2.573. p < .05, **p < .01, ***p < .001. 66!.

(78) !. 27.. →. 」 (N=18) .95±7.31. (N=21) .82±2.20. F. p. C3Beta1T1-T0. (N=17) .52±1.52. .042. .959. C4Beta1T1-T0. .83±1.65. 2.41±4.20. .86±2.04. 1.855. .166. C3Beta2T1-T0. 2.64±4.67. 1.80±7.00. 1.49±3.53. .240. .787. C4Beta2T1-T0 C3GammaT1-T0. 3.23±4.75 1.58±3.11. 3.33±6.39 1.30±2.39. 1.71±4.15 .85±2.19. .611 .396. .547 .675. C4GammaT1-T0. 2.25±2.49. 1.30±2.75. .76±1.50. 2.045. .139. T1: ; T0: * ** p < .05, p < .01, ***p < .001. PSAS. 」. 28. 13. 29. 14. * PSAS. 4.514 p =.015). (F =.577. (F =.472. (F =. 」 p =.451). x. p =.626 ). (F = 3.372, p =.042). (F = 4.889, p =.011). PSAS. 」. LSD (p=.013) (p=.271). (p=.149) ;. (p=.003). (p=.074). x. 」 30. PSAS. (p=.208). (F = 5.960 p =.005). 」 (F =8.508. p =.005). x. (F =.030 p =.971 ) (F = 6.787, p =.002). (F = 4.691, p =.013). LSD. !. PSAS. 」 (p=.001). 67!.

(79) !. (p=.031) (p=.162). (p=.004) (p=.280). (p=.058). ;. T (t = 2.896,. p = .009) 31 」 = .030. p =.971). PSAS. 」. (F = .472. p =.626). 」」. 」. 28.. PSAS. 」. 1. t. p. PSAS_ 11.17±3.28 10.21±2.92 9±1.41. 11.22±3.41 10.10±3.09 8.57±1.03. -.175 .221 1.574. .863 .828 .131. 14.29±6.45 12.63±3.90 9.57±1.78. 13.06±7.59 11.37±3.56 8.52±.68. 1.329 1.606 2.896**. .203 .126 .009. PSAS_. *. p<.05, ** p<.01, *** p<.001. PSAS_ 15 14 13 12 11 10 9 8 1. 13.. !. PSAS_. 」. 68!. (F.

(80) !. PSAS_ 15 14 13 12 11 10 9 8 1. 14.. 29. PSAS_. PSAS_. x. 」 SS. df. MS. 114.203 2 57.101 695.763 55 12.650. x *. .734 1.200 69.938. .734 .600 1.272. p. 4.514*. .015. .577 .472. .451 .626. x. x. 」 SS. !. 1 2 55. F. p < .05, **p < .01, ***p < .001. 30. PSAS_. *. 」. df. F. p. 422.277 2 211.138 1912.846 55 34.779. 5.960*. .005. 39.524 .275 250.848. 8.508* .030. .005 .971. 1 2 55. MS. 39.524 .138 4.561. p < .05, **p < .01, ***p < .001. 69!.

(81) !. 31.. PSAS. 」. 」. (N=18). (N=19). (N=21). -.06±1.35 1.24±3.83. .11±2.08 1.26±3.43. .43±1.25 1.05±1.68. F. p. .472 .030. .626 .971. PSAS T1-T0` T1-T0. T1: *. ; T0: **. p < .05, p < .01, ***p < .001. SAMI」. (F = 9.043 p <.001). / (F = 11.059 p <.001) (F = 7.847. 32. 」. (F = 10.005 p <.001). p =.001). LSD (p. / <.001; p =.002 ). (p <.001; p =.013). <.001). (p <.001; p. (p =.001; p =.002) (p. .044). 32.. *. !. **. p < .05, p < .01,. ***. F. p. poshoc. 11.26±.02. 11.26±5.4. 8.9±4.0. 1.799. .175. 12.61±2.48. 12.89±3.33. 11.33±5.28. .891. .416. 11.32±4.24. 10.58±3.4. 6.67±3.54. 9.043. <.001. CI, HF>LF. 5.84±2.91. 4.37±2.06. 2.57±1.47. 11.059. <.001. CI>HF>LF. 5.89±2.55. 5.89±2.38. 3.19±1.69. 10.005. <.001. CI, HF>LF. 45.83±10.78. 45.0±11.97. 32.67±12.42. 7.847. .001. CI, HF>LF. p < .001. 70!.

(82) !. /. 100ms. 500ms. 」(. 」. -. -. ). 1000ms. 1. 1. (Pearson’s correlation). 33. (r =.567, p =.028) ; (r =.583, p =.014). C3. Beta1. (r =-.502, p =.034) ; (r =.499, p =.03) ;. 」. (r =-.461, p =.047). (r =.577, p =.012). (. ). !. 71!.

(83) !. 33.. DT_500ms DS_500ms VT_100ms aSAMI. DT_500ms DS_500ms VT_100ms aSAMI. DT_500ms DS_500ms VT_100ms aSAMI C3: C3. !. , C4: C4. C3_B1. C4_B1. C3_B2. C4_B2. C3_G. C4_G. -.367. -.083. -.358. -.058. -.304. -.250. 0.303 -0.003 -0.487 -0.124. 0.092 -0.024 -0.223 -0.273. 0.383 0.186 -0.247 -0.303. 0.035 0.009 0.069 -0.197. C3B1. C4B1. C3B2. C4B2. -.019 -0.502* -0.133 -0.193 0.139. -.326 -0.215 0.139 0.162 0.418. .038 -0.387 -0.159 -0.239 0.056. -.117 -0.191 -0.064 -0.066 0.175. C3B1. C4B1. C3B2. C4B2. .006 0.211 0.045 -0.066 0.093. -.161 0.216 0.019 -0.161 0.286. .292 0.352 0.264 -0.314 -0.04. .014 0.115 0.104 -0.255 0.259. PSAS_ -.613*. -.386 *. 0.397 0.378 0.457 0.567 0.146 -0.11 -0.238 0.441 -0.328 -0.095 0.044 -0.151 -0.307 -0.217 -0.264 -0.146 C3G. C4G. -.235. -.435. 0.132 0.583* -0.182 0.318. 0.116 0.184 -0.066 -0.174. PSAS_. .171 .047 -0.014 0.02 0.061 0.001 -0.219 -0.077 0.153 0.139 C3G. PSAS_. .448 0.103 0.205 -0.21 0.286. .393 0.13 0.12 -0.212 0.245. C4G. PSAS_. -.117 -0.046 -0.169 -0.156 -0.177 PSAS_. .387 .066 .035 .020 * 0.302 0.08 0.577 0.148 0.166 0.095 0.158 0.001 -0.007 -0.129 -0.08 -0.095 -0.182 0.241 -0.118 0.223. ; B1:Beta1, B2: Beta2, G: Gamma; DT:. , DS:. 72!. .018 0.015 -0.147 -0.461* 0.107 PSAS_. .072 0.073 0.242 0.248 0.066 , VT:. -.054 -0.095 -0.359 -0.029 0.1.

(84) !. 「. 『. 「「 ( 34). 34.. --. ---. /. !. , --. ---. --. ---. --. --. --. --. --. --. --. --. --. --. --. --. --. --. --. --. --. ----. --. --. a. --. a. -/. -,. 73!. a. :. --. --.

(85) !. Drake. 「. (Drake et al.,2004; Drake et al., 2006). (. 2008; Fernández-Mendoza et al, 2010). ,. (Fernández-Mendoza et al, 2010). (Drake, Pillai, & Roth, 2015). (stress-related intrusion). (. 」. ). (Bonnet & Arand, 2003) Wright,. Roth, 2011). (Drake, Friedman,. (Richardson, Gradisar, &Pulford, 2015). (. 2009; Waters et al., 2008). (Steptoe et al., 2007; Lin, Weng, Lin, &Lin, 2015). CHUS. 」. PSS. 」. !. (general state). 74!. BAI. BDI.

(86) !. BAI. (LeBlanc, et al., 2009; Fernandez-Mendoza et al, 2010) 」 Buysse 2. 5. 8. (2007). 12. (Harvey, 2002). (psysiological arousal). 2006. Espie. (emotional arousal). AIE. (. ). Koster. 100 ms. 500 ms. 100ms !. (2005). AIE 75!.

(87) !. (. ). 500ms. 2002. Ellis. Cropley. 500ms 2010. (facilitated attention). Cisler. Koster. (difficulty in disengaging). (attentional avoidence). /. Flicker ICB (Jones et al., 2005; Marchetti et al., 2006) VDP. (MacMahon, Broomfield, & Espie, 2006) VDP (Spiegelhalder et al.,. 2010; Jansson-Fröjmark et al., 2013). VDP. 500ms. VDP. (Bar-Haim. et al., 2007) Jansson-Fröjmark. !. (2013). 76!.

(88) !. 「. 。 Chan. (2012) SAMI (. 」. 5). (. ) (“. ” “. ”). /. AIE (VDP. (. ). (. ). ). (Drake et al, 2004). / 」. !. 77!. 」 ;.

(89) !. C4. 。. Gamma. Gamma C4 Gamma. C3. Beta2. ;. C4. C3. Beta2. Beta1. Beta2. Gamma. C4. Gamma 。. FIRST 」. 1989 Hauri. Olmstead. PSG. ”. “(Reverse first night effect). PSG. Hirscher. (2015) 」. 」 ;. 。. !. 78!.

(90) !. (. ). (Spielman et al, 1987) 2014. Pillai (Pillai, Roth, Mullins, &Drake, 2014). PSG /. 」. (C3 Beta1). PSAS (. (. ). ). ;. !. /. 79!.

(91) !. 「。. Spielman. (Spielman et al., 1987). AIE (Espie et al., 2006). (overall bias). (vigilance). 」(Jones et. al., 2005; Lundh et al., 1997; Marchetti et al., 2006; Spiegelhalder et al., 2008, 2010; Taylor et al., 2003) 2002). AIE. (Espie et al., 2006). (Harvey,. / 「. 」. ( 「. !. 80!. ).

(92) !. (. ). (. ). 『. FIRST. (Bonnet & Arand, 2003b; Drake, Jefferson, Roehrs, & Roth, 2006; Drake, Richardson, Roehrs, Scofield, & Roth, 2004). 」『 ;. 『. !. 81!.

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以壓力反應特性、注意力偏誤、與睡眠監控行為探討不同 失眠病程發展之相關因素 - 政大學術集成

以壓力反應特性、注意力偏誤、與睡眠監控行為探討不同失眠病程發展之相關因素 - 政大學術集成