目的：本研究探討乳癌患者從受苦到經驗正向改變的轉化，以王韋婷（2014）研究為基礎進行探討。該研究於術後一日、三個月、六個月與一年，追蹤測量乳癌患者的創傷後成長（PTG），並依量表分數變化將參與者分為四種軌跡發展組別，分別為高穩定組、中間組、上升組與下降組。本研究以訪談方式進行後續追蹤。 方法：研究採取雙盲設計，抽取王韋婷（2014）研究參與者樣本，共有五位參與者，平均罹癌年齡35.6歲，接受單次訪談。資料分析以現象學心理學方法進行，並對應其受創傷成長發展軌跡組別（分別為高穩定組三位、中間組兩位），進行討論。 結果與討論：研究結果發現，參與者的主題置身結構包括：「癌症療程是溢出常態的受苦經驗」、「受苦經驗中的照顧倫理行動」、「反求諸己的受苦意涵」、「在世牽掛的流變」，並由此帶出「生活是日常與非日常的背景-前景辯證歷程」。本研究顯示PTG高穩定組的參與者，從焦慮過渡到操煩，朝向生活世界的歷程，是打開此在與生活世界、社會的交往。PTG中間組的兩位參與者，試圖領會身體限制的存在意義，仍在尋求身體的安居。只有身體的返家意識，在安居中獲得熟悉感，才能夠出發朝向世界，因此在未來的時間流變中，仍有持續邁向成長的可能性。 結論：PTG高維持組受訪者以釋放控制，帶出了「朝死而生」的本真活動，是「在己生命」開展了生活世界。PTG中間組以固守控制，將現今未能解除的困境寄望未來，是他人束縛下求全的「為己生命」。最後，提出研究限制與未來研究建議。 / Objectives: The study aims to explore how the young breast cancer survivors perceived psychological growth since operation treatment, focusing on their transformative experiences of interpersonal situatedness and sense of future temporality. Methods: Based on the dissertation by Wang (2014), the participants are recruited from Wang’s research the subjects were divided into four groups (stable high, middle stable, low increasing, and sharp decreasing) by the patterns of their posttraumatic growth(PTG) scores assessed at 1day, 3, 6, 12 months after surgery. There are five participants whose mean age 35.6 at diagnosis were interviewed and data transcribed, and analyzed by phenomenological psychology approach. Results: Four themes emerged from the data analysis, including: (1) Enduring suffering out of daily order under cancer treatment. (2) Ethical act to care for suffering experiencing. (3) Meaning transformation of the suffering. (4) Different solicitude modes of being-in-the-world. Participants belonging to stable high group turn their state of mind from anxiety (Angst) into care (Sorge), facing the life situation and engage in life world. Participants belonging to middle stable group try to realize existential meaning and the sense of uncanny body, seeking for the dwelling of the habitual body. The ill life is an unhomelike being-in-the-world in which the lived body, the central vehicle of this being-in of Da-sein, takes on alien and uncanny qualities. Health, in contrast to this frustrating unhomelikeness, is a homelike being-in-the-world in which the lived body in most cases has a transparent quality as the point of access to the world in understanding activities. Conclusion: Participants belonging to stable high group carry on limited lifetime and take authentic mode of being toward death, illustrating ‘being-in-itself’, and the experience of illness underlines our homeless predicament, but it can also serve as a springboard to addressing and living with existential uncertainty in a more authentic way. Participants belonging to middle stable group hold on limited lifetime and take future temporality as a hope to leave the predicament, illustrating ‘being-for-itself’, and it projects the possibilities of the future, on the basis of the care pattern of meaning constituting its past, as a means of constructing its present. In Heidegger’s words, ‘‘The totality of being of Dasein as care means: ahead-of-itself-already-being-in (a world) as being-together-with beings encountered in the world”. The outcome implication and further research agenda are discussed.

本研究之目的是檢驗因應與創傷後成長隨時間變化的相互關聯性，除了重複驗證因應與創傷後成長的時序關係之外，考量創傷後成長不同向度之間可能具有不同特性，本研究也進一步探討不同向度的創傷後成長與不同因應向度之間的關係是否有所差異。創傷後成長方面，除了將創傷後成長視為單一構念之外，以Ho等人(2013)針對台灣女性乳癌樣本之因素分析結果為基礎，將創傷後成長初步分為個體內PTG與個體間PTG；因應向度方面，則根據探索性因素分析之結果將因應策略分為自我導向式因應、社會導向式因應和逃避因應等三個因應向度。 本研究採用縱貫研究法，針對中部某教學醫院之初診斷女性乳癌患者進行為期兩年的追蹤研究，分別在術後三個月(T1)、術後半年(T2)、術後一年(T3)以及術後兩年(T4)進行調查，測量參與者在癌症壓力之後所使用的因應策略及創傷後成長，最後完成四個時間點測量的研究參與者共283人。統計分析方法方面，因考量因應與創傷後成長會隨時間而變動的可能性，故採用適合縱貫資料且能估計變項發展軌跡的潛在成長模式 (Latent growth model) 來進行資料分析。 研究結果顯示不同向度的因應與不同向度的創傷後成長之間關聯性不同，但此差異是反映在不同因應向度之間，至於相同因應與不同向度PTG之間的結果則無太大差異：在測量初始點，不管是哪一種因應方式，都跟整體PTG、不同向度PTG具有交互預測的關係，但在斜率方面，只有自我導向因應與整體PTG以及不同向度的PTG具有相互預測性。但是否區分個體內PTG和個體間PTG，對於因應與創傷後成長之關聯性結果差異不大。過去對於PTG是單一構念或多因素的爭論方興未艾，後續討論也納入是否有必要區分創傷後成長不同向度的必要性，最後討論本研究之限制，並提供未來研究可供參考之方向。 / Aims: The purpose of this article was to examine the time-varying reciprocal relationships between coping and posttraumatic growth (PTG) as well as their domains. PTG was divided into two dimensions－intrapersonal PTG (intra-PTG) and interpersonal PTG (inter-PTG) as suggested in Ho et al. (2013) while coping was divided into self-sufficient coping, socially-supported coping, and avoidant copingbased on the results of our exploratory factor analysis (EFA). Methods: Participants were Taiwanese women underwent surgery for breast cancer. Measures of PTG and coping were assessed at three-month, six-month, one-year and two-year. Of the 358 women who were recruited, 283 completed all four measures and were included in the analyses. As coping and PTG may change over time, the data was analyzed using latent growth curve model (LGM). Results: Our results showed that there’re different relationships between coping strategies and PTG dimensions. At the initial measure, all kinds of coping strategies have a reciprocal relationship with PTGs, but when it comes to the directions between slopes of coping and PTG, only self-sufficient coping has a reciprocal relationship with PTG. There’s almost no difference while comparing different PTG dimensions models. In other words, there’s almost no difference in LGM models between intra-PTG and inter-PTG. In the end of the study, the necessity of the division of PTG and limitations of this study were discussed.

本研究主要目的在探討不同治療階段中創傷後成長與因應策略之關係。由於過去創傷後成長與因應策略之間的研究，均是將創傷後成長視為個體因應後的結果，而忽略創傷後成長的經驗對個體的影響，因此本研究透過雙面神模式的理論，以更多元的角度來檢視「創傷後成長」，並將追蹤三個時間點，根據不同治療階段進一步提出三個假設模式，並採用交叉延宕分析（Cross-lagged analyses）來檢驗。 研究方法採立意取樣，以中部某教學醫學之乳房中心的乳癌患者為對象，共262 人，蒐集患者之「基本資料」、「創傷後成長」及「因應策略」，並在術後三個月、術後六個月及術後一年進行問卷調查。資料分析以探索性因素分析將因應策略分為三個因素：「自我導向因應」、「社會導向因應」及「逃避因應」，並與創傷後成長進行交叉延宕分析。 研究主要發現如下：（一）診斷時年齡愈小及教育程度愈高者，可以預測術後三個月較高的「自我導向因應」、「社會導向因應」及「創傷後成長」；（二）術後三個月到六個月之間，「自我導向因應」與「創傷後成長」呈現互惠關係，即術後三個月較高的「自我導向因應」可以預測術後六個月較高的「創傷後成長」，而術後三個月較高的「創傷後成長」也可以預測術後六個月較高的「自我導向因應」；（三）術後六個月的「創傷後成長」可以預測術後一年的「社會導向因應」，即在術後六個月時「創傷後成長」愈高，可以預測後續較高的「社會導向因應」；（四）三個時間點中，「逃避因應」均無法預測「創傷後成長」，「創傷後成長」亦無法預測「逃避因應」。 最後將根據研究結果提出其貢獻與實務運用，並依據研究限制提出相關建議，以供臨床工作者與未來研究學者參考。 / This study is aimed to investigate the relationships between coping strategies and Posttraumatic Growth (PTG) on three different timing of the breast cancer treatment. According to Janus-Faced Model, PTG is assumed as both a coping effort and a coping result. In order to investigate the possible relationships between coping strategies and PTG, three hypothetic models were proposed and tested by cross-lagged analyses. By purposive sampling, 262 participants were recruited from the breast center unit at a hospital in central Taiwan. Demographic and disease-related information were gathered after surgery. The Posttraumatic Growth Inventory (PTGI) and the Brief Coping Orientations to Problems Experienced scale (Brief COPE) were assessed 3, 6 and 12 months later. The Brief COPE included 3 factors: self-sufficient coping, socially-supported coping and avoidant coping. Each was assumed to associate with PTG differently. Results of the current study were as follows: 1. Younger patients or women of higher education level reported more PTG, self-sufficient coping and socially-supported coping at T1. 2. The reciprocal relation was found between self-sufficient coping and PTG within 6 months postsurgery, which indicated the positive effect of T1 self-sufficient coping on T2 PTG, as well as the reciprocal effects of T1 PTG on T2 self-sufficient coping. 3. Higher level of PTG at T2 predicted more socially-supported coping at T3. 4. Within 1 year postsurgery, there were no significant cross-lagged effects between avoidant coping and PTG, but only autoregressive correlations within constructs over time. Implications of these findings are discussed, along with potential directions for future research.