國內關於華語文教學之研究多著重於漢語語音、詞彙、語法本身，以及不同國籍間之教材設計、對比分析等外在因素，關於外籍學習者本身學習情況之探討較為有限。外籍學生在全外語學習環境下產生的學習困擾，對於學習之影響力不容小覷。因此本研究旨在以半結構式訪談，深入瞭解台灣外籍學生於內在原因、外在原因，以及華語作為第二語言等原因之影響下，所產生的學習困擾與因應策略，並比較不同國籍、學習動機與目的、語言學習背景等研究對象之間的學習困擾及因應策略差異情形，提出結論及相關建議。 為達上述研究目的，本研究以質性研究方法中的訪談法進行研究，訪談五位曾在台灣學習華語超過一年以上之外籍學生，根據「台灣外籍學生學習困擾及因應策略訪談大綱」實施訪談，並將訪談資料整理歸納後，提出研究結果分析與討論及研究發現。根據本研究目的與問題，提出本研究結論如下： 一、引起受訪之外籍學生產生華語學習困擾原因中，最多為外在原因，其次為內在原因及華語作為第二語言之因 二、令多數受訪之外籍學生產生華語學習困擾之因有：實用性不足、華語語序與外籍學生母語差異之問題，以及華語中聲調太困難等困擾 三、受訪之外籍學生較特殊的華語學習困擾有：對於課堂練習方式不滿的困擾、聽不懂台語的困擾，以及在台灣繼續求學或工作後發現華語能力不足的困擾 四、受訪之台灣外籍學生面對華語學習困擾之因應策略，多為行為層面因應，其中以「主動尋求解決」居多，態度上以「正面積極」居多 五、受訪之外籍學生面對華語作為第二語言所引起的學習困擾之因應策略以「不回應」居多 六、不同國家、華語學習動機與目的、華語學習背景之受訪外籍學生具華語學習之差異 基於以上述研究結論，本研究提出之建議如下： 一、對華語教學相關單位之建議 (一)宜提高聘任華語教師教學知能方面的門檻，並轉換對發音之要求 (二)建立華語教師進修方案及開設多元文化研習 (三)可以志願性或實習的方式，招募有志從事華語教學者，協助語言中心實施課後輔導，或依個人專長開設華語相關才藝課程 (四)宜事先根據外籍學生華語學習背景及學習目的，安排適當課程內容 (五)實施教學意見調查制度，提供長期累積困擾者反應之管道 二、對華語教學者之建議 (一)增進華語教學內容之實用性 (二)觀摩或吸收資深華語教師之經驗，了解不同程度及背景之外籍學生華語學習差異情形以因材施教 (三)宜善用社會資源及多媒體資源，幫助外籍學生增進中華文化知識 三、對華語教學政策之建議 (一)建立更完善的華語教學政策，結合不同取向的華語師資 (二)建立多元化之華語教師評鑑制度 四、對未來研究之建議 (一)在研究方向上的建議：可增加影響華語學習之原因或縮小影響原因至某一層面研究 (二)在研究方法上的建議：可繼續使用質性研究方法，從不同角度或層面，對此相關議題作更深入之探討 (三)在研究對象上的建議：研究對象範圍可擴大至中、南或東部地區，或是在私人華語補習班中學習的外籍學生；選取條件之設定上，可加入不同社會因素之受訪者條件 / Much research about Teaching Chinese as a Second Language (CSL) in Taiwan has been on Chinese phonetics, vocabulary, grammar, and the design of teaching materials as well as comparative analysis among different countries. Few studies, however, were conducted to explore the actual learning conditions facing foreign students in Taiwan. That is, the influence of foreign students’ learning difficulties from all foreign language environments should not be underestimated. Therefore, the purpose of this study was to understand foreign students of Chinese learning difficulties and their coping strategies influenced by external and internal reasons and to compare the individual student differences of learning motivation and goals, language learning backgrounds of different countries via semi-structure interviews. This study concludes with recommendations for future research. To accomplish the purpose of the study, this research adopted qualitative research methods through interviewing five foreign students who had learned Chinese in Taiwan more than one year. The interview outline was developed based on “Chinese learning difficulties and coping strategies for foreign students in Taiwan.” The conclusions of the study are as follows: 1.Among the reasons for Chinese learning difficulties facing the interviewed foreign students in Taiwan, the external reason mentioned by the participants outnumber the internal reason and the reason of Chinese learning difficulties; 2.The main reason of Chinese learning difficulties for the foreign students in Taiwan include lack of practicality, problem of word order between their first language and Chinese and the difficult Chinese tone; 3.The salient Chinese learning difficulties facing the foreign students include their dissatisfaction with practice activities in class, difficulty in understanding the local dialect Taiwanese and insufficient Chinese proficiency for continuing their study or work in Taiwan; 4.The coping strategies used by the foreign students who faced Chinese learning difficulties are mostly behavior-related, and the most frequently used strategy is “seeking solution actively”. 5.The attitude of the interviewed foreign students is generally positive. As of the coping strategies of learning difficulties of CSL, most foreign students made no response; 6.Since the foreign students in Taiwan come from different countries with various language learning backgrounds and learning motivations and goals, the Chinese teaching style in Taiwan may generate different aspects of learning difficulties and coping strategies. Based on the conclusions in this study, several recommendations are made: 1.Suggestions for relevant institutions of Chinese teaching include: (1) Enhancing the condition of teaching knowledge and ability when employing Chinese teacher, reducing the emphasis on pronunciation; (2) Establishing the advancement scheme for CSL teachers and opening workshops of multiculturalism (3) Recruiting volunteers or interns who wish to be Chinese teachers who can assist the language center after school or who can conduct Chinese courses according to their expertise; (4) Considering the educational backgrounds and learning goals of the foreign students to arrange appropriate proficiency-level courses; (5) Implementing teacher evaluation survey and providing an opportunity for students with learning difficulties to express their concern about teaching. 2. Suggestions for Chinese language teachers include: (1) Enhancing the practicality of the CSL content; (2) Observing or absorbing senior CSL teachers’ teaching experiences, heeding individual differences of foreign students with varied language proficiencies to teach according to their proficiencies; (3) Capitalizing on social and multimedia resources to help foreign students enhance their knowledge of Chinese culture. 3. Suggestions for Chinese language teaching policy include: (1) Implementing a more rigid Chinese teaching policy and gathering Chinese teachers with different orientations of teaching; (2) Establishing diversified Chinese teaching evaluation system; 4. Future research is suggested to: (1) Explore the factors that may facilitate the learning of Chinese learners or investigate a given factor that may influence the learning of Chinese to a certain degree; (2) Use qualitative research methods to yield more in-depth discussions in related issues from different perspectives; (3) Include more participants in other areas in Taiwan or foreign students learning in private Chinese language centers and the settings of different selected conditions to explore other social factors.

本研究旨在瞭解青少年的親子關係、自我概念對其壓力因應策略的影響。以臺北市與新北市的國中二年級學生為研究對象，採分層隨機抽樣與自填問卷方式進行資料蒐集，共回收427份有效問卷。透過卡方檢定、獨立樣本T檢定、皮爾森積差相關、單因子變異數分析進行統計檢定，並由迴歸分析與路徑分析建立親子關係、自我概念與壓力因應策略的路徑圖。本研究之主要發現如下： 一、 在背景變項的部分，男女性青少年在自我概念上有差異；父母的教育程度、職業、家庭社經地位對自我概念皆有影響；而青少年居住地區不同，其親子關係、自我概念與壓力因應策略亦有所差異。 二、 在青少年的親子關係中，相較於彼此的支持信任，與父母理性的溝通以及情感上的交流分享較缺乏。 三、 青少年的心理自我概念與生理自我概念普遍偏低。 四、 面臨壓力時，青少年多採正向的因應策略；在正向策略中，最常採取暫時擱置問題策略，最少採取尋求師長的建議策略。 五、 青少年的親子關係越好、自我概念越佳，壓力因應策略越正向，透過迴歸分析預測壓力因應策略發現，親子關係與自我概念可解釋達42.1%的變異量。 據此，本研究提出以下建議： 一、 學校應規劃壓力因應策略的方案課程，使青少年學習更多元的因應策略；並重視青少年期的心理風險與社會適應問題，提升青少年的自我概念。 二、 社會工作實務的部分，可安排親子溝通相關議題的親職教育課程，同時設計親子團體，增加親子互動與學習的機會。 三、 父母應尊重青少年為一獨立的個體，不過度干涉青少年的隱私，避免以權威的態度來管教子女，而是在相互信任的關係中，以開放平等的態度，適時地關懷青少年的生活狀況。 四、 傳播媒體可增加親職教育、親子關係等相關資訊的普及性，但也應對所傳播之訊息嚴格把關，將各類資訊分級以符合各年齡層的閱聽人。 / This study aimed at understanding the effect that parent-child relationship and self-concept has on the coping strategies of adolescents. The subjects of this study were selected from the second grade junior high school students in Taipei City and New Taipei City. In-class survey method with structured questionnaire was employed to collect data for the study. A total of 427 valid samples were collected. Based on statistical data analyses, the study findings are as follows: 1. There are differences between male and female’s self-concept. The education, occupation of parents and social economic status have influences on adolescents’ self-concept. Adolescents of different city present significant differences in parent-child relationship, self-concept and coping strategies. 2. Compared to support and trust, adolescents are lack of communication and emotional interaction with their parents. 3. The mental self-concept and social self-concept of adolescents are generally low. 4. When under pressure, adolescents adopt more positive coping strategies. In the positive strategies, the most frequently used coping strategy is temporary- put-off strategies. The least frequently used one is support- seeking strategies. 5. Parent-child relationship and self-concept are significantly associated with coping strategies. Finally, the research provides suggestions based on the result. First, school should pay attention to psychological risks and social adjustment problems of adolescents. Second, social work agencies can provide parenting education program and group work to increase parent-child interaction. Thirdly, parents should respect that the adolescent is an independent individual and should not excessively interfere his/her privacy. Finally, the media community should ensure the correctness of dissemination of information about parenting education and parent-child relationship.

台灣科技研發能力與先進國家有一段落差，因此多年來一直處於宏碁施振榮先生所述微笑曲線中間段之製造導向；因此導入國外技術及引進相關設備、儀器、元件、材料等等產品，是協助產業快速與全球科技接軌的必要；而代理商居中穿針引線所扮演之角色就相形重要。然而，隨著科技的進步、資訊的發達、溝通的方便、產業全球化及景氣循環週期壓縮等各項環境的變遷影響，代理行業所面臨的挑戰就日益嚴峻。隨著台灣科技產業演進，代理商生態是滄海桑田，如何尋求生存之道，找出因應成長策略及適時轉型，是個有趣而值得一窺究竟。 在大環境變遷之下，企業先綜觀處於環境之中地位與優劣勢，了解產業版圖之移動與技術之發展，並檢視組織之核心能耐與資源分配，進而探討產業鏈上下游之關係，特別是原廠、代理商及客戶之互動，然後分析競爭優勢與相關內、外在之威脅，洞悉各方之意圖與了解自我之企圖，隨之根據各種情況找出適當之因應策略。 在探討遴選之個案公司之前，本研究首先一觀台灣科技產業之概況與演進，認識代理商在這產業的角色、規模發展及存在價值；之後開始對個案公司在二十餘年經營之背景做一巡禮，而挑選出三大重要時辰的里程碑作為探討，包括:(1)營運模式之調整所作之轉型策略；(2)營運規模拓展及併購所作之成長策略；(3)營運事業項目裁撤、整併與開發所作之縮編與成長策略。本研究將此三個因應策略整理、分析及歸納後，提出可供業者因應環境變化時可參考之策略。 / In professional field of R&D (Research and Development), firms in Taiwan lack behind firms based in developed countries. The gap causes high-tech industries falling on the middle section of the “Smiling Curve”—the concept brought up by Stan Shih, CEO of Acer CEO, in 1992. The middle section of the smiling curve focuses on “assembly” and “manufacturing”. Under this circumstance, in order to enhance the capabilities of Taiwanese firms, it is necessary to import equipment, instruments, parts and related materials from outside of Taiwan. During the process, the role of distributors who acts as a mediator is very significant. However, with the fast changes of environment, such as development of technology, advancement of information and communications technologies, industry globalization and short industrial cycles, these distributors are facing more intense competition and severe challenges than before. It is worthy of finding the strategies to cope with these environmental changes so distributors (firms) can survive in the long-run. With the research objective in mind and taking the perspective of a firm, the research first focuses on the industry environment to understand the nature of the high-tech industry faced by a firm. Second, the firm evaluates its core competencies and resource allocation. Third, the firm explores the relationship between the upstream and downstream industry chain, especially the interaction among principal, agents and customers to do a SWOT analysis to identify adapting strategies. The research starts with Taiwan's high-tech industries overview and evolution, and the value chain in the industry, and the roles of technology middlemen. Then, focuses on the case study to review the technology company’s (i.e., the technology middleman) operational history for the past two decades and selects three major important milestones including strategy for business model adjustment and transformation, strategy for business expansion and merger, and strategy for business reduction, consolidation and development. Finally, the study summarizes the findings and offer implications to firms and suggestions for future research.

本研究以情緒安全感假說，與認知背景架構觀點為基礎，探討父母衝突對兒童的直接影響。藉由統整情緒安全感與認知評估之概念，釐清情緒與認知在兒童適應父母衝突時所產生的影響。並加上因應行為的觀點，探索兒童的因應行為，在適應父母衝突時之角色，比較兒童的情緒、認知及因應行為，三者對兒童適應父母衝突的影響性。 本研究的目的有四：一、將情緒安全感概念與認知背景架構中認知評估概念予以純化與細化；二、以純化與細化後的情緒認知反應，預測兒童在父母衝突下的內化問題與外化問題；三、探討兒童的因應行為，在情緒認知反應及適應問題之間的中介與調節效果；四、比較一般家庭兒童與高衝突家庭兒童在情緒、認知、因應行為及內化、外化適應問題之差異，並檢驗兩組兒童在內化與外化問題之不同影響機制。 本研究以台北市與台北縣各一所國小的五年級兒童及其父母、導師為研究對象，共有566名兒童、413位父母、20位導師參與，以問卷法收集資料。研究工具為「兒童知覺父母衝突量表」（CPIC）、「父母間次系統安全感量表」（SIS）、「兒童因應量表」（CCSC）、「夫妻衝突策略量表」（CTS）、兒童行為檢核表兒童版（CBCL-YSR）、老師版（CBCL-TRF）及家長版（CBCL）。資料分析採因素分析法及多元迴歸分析法進行。 本研究的結果如下：一、將情緒安全感與認知評估純化與細化後，形成兩個情緒反應：情緒激起及情緒失調；與六個認知反應：自責感、波及我、因應效能、建設性家庭表徵、破壞性家庭表徵、及父母衝突特徵。二、情緒認知反應能預測39%兒童內化問題，以情緒失調、情緒激起、缺乏因應效能、自責感、與波及我具有顯著預測力；對外化問題，情緒認知反應只能預測6%的變異量，以缺乏情緒激起、與自責感具顯著預測力。三、因應行為在情緒認知反應與適應問題之間，不具有中介效果，但有顯著調節效果，特別是在當兒童對父母衝突出現高自責時，越採取介入與尋求支持行為，其內化問題越顯著，但若採取低介入與低尋求支持行為，對其內化問題具有緩解效果。四、高衝突家庭兒童之內化較一般衝突家庭兒童顯著，他們對父母衝突的情緒激起、破壞性家庭表徵、建設性家庭表徵及缺乏因應效能均較高。情緒認知反應對不同衝突家庭兒童之不同適應問題，各有不同預測效果。高衝突家庭兒童之內化問題，情緒認知反應具有39%之預測力，以缺乏建設性家庭表徵波及我及兩種認知表徵最具預測力；對一般家庭兒童之內化問題，情緒認知反應亦有39%之預測力，以情緒失調、缺乏因應效能、自責感具有顯著預測力；而一般家庭兒童之外化問題，情緒認知反應有6%之預測力，以缺乏情緒激起、及自責感具有顯著預測力。 本研究進一步討論此研究結果的意涵，以及在研究概念與實務運用之貢獻，並提出研究限制及未來研究方向建議。

研究目的：過去的心理生理學研究顯示，個體在壓抑生氣與表達生氣情緒時，分別對於情緒調節和生理反應上有著不同的作用機制。本研究試圖以Engebretson等人（1989）提出的「適配假說」（Matching Hypothesis），進一步延伸探討其對於後續睡眠的影響，並預期在引起受試者的生氣情緒後，若其當下所採用的生氣表達方式與自身所慣用的方式是一致的，則能有效地降低個體睡前的生理激發狀態，促使其恢復到先前的水準，因此對於個體後續睡眠的負面影響也會較小。 方法：本研究共收案35人(男12人，女23人)，對象為年齡介於20到35歲之間，身心健康的正常睡眠者。研究者先透過短式華人敵意量表，將受試者分類為高壓抑敵意特質組(HS)18人、高表達敵意特質組(HE)17人，之後再將其隨機分派到壓抑生氣(AI)或表達生氣(AO)其中一種實驗情境。實驗中，係透過高難度的認知作業來引發受試者的壓力和挫敗感，再於過程中不停地打斷其作答狀態來造成其煩擾，以達到生氣情緒的誘發；隨後再經由有/無給予機會讓受試者表達心情並對主試者(激怒者)進行評價，來達到表達/壓抑生氣的實驗操弄，之後即請其入睡。期間持續以Biopac MP150生理儀器來測量受試者的心跳速率(HR)、收縮壓(SBP)、舒張壓(DBP)和膚電反應(SCR)，以了解其於入睡前的生理激發與恢復狀態；後續以多頻道睡眠記錄儀（polysomnography, PSG）來進行夜間睡眠之記錄，並以受試者的自評睡眠狀況作為主觀睡眠品質的分析指標。 研究結果：在誘發生氣情緒後，不論是在表達生氣或壓抑生氣的情境下，HE都比HS有顯著更高的DBP上升反應。在恢復期期間，HE的DBP則有低於HS的傾向；AO比AI有更多的DBP恢復程度，以及較短的SCR恢復時間。而在適配情境下，受試者後續的HR恢復時間較短，且DBP的下降程度較多，此也支持了適配假說的觀點；然而，不論適配與否，對於後續的睡眠相關參數並無顯著的影響，此未支持本研究假設。再以2(特質)x 2(情境)之二因子獨立樣本變異數分析比較各組在睡眠結構上的差異，結果顯示階段二睡眠以及慢波睡眠的比例，皆有來自特質的主要效果；其中HS的階段二睡眠時間比例高於HE，HE的慢波睡眠時間比例則高於HS。另外，AO的慢波睡眠時間比例高於AI──顯示比起壓抑生氣，表達生氣的因應方式對於深睡期的增加可能較具正向的影響。最後，研究發現睡前SBP、DBP的上升皆和主觀入睡耗時的增加呈顯著正相關；PSG的檢查結果亦顯示，入睡期HR、SCR、SBP的上升和階段二睡眠潛時的增加呈顯著正相關；此外，當SCR的恢復時間越長，階段二睡眠潛時越長，顯示個體睡前較高的生理激發狀態和較慢的恢復速率，對於主客觀睡眠品質皆具有負面的影響。 結論：在經驗生氣情緒時，表達生氣相對而言是對於生理恢復狀態較為有利的因應方式；然而，「特質」不僅可能影響著生氣情緒當下的生理激起狀態，且對於後續的生理恢復亦具有一定之影響力。本研究支持了適配假說的觀點：當採用的生氣表達方式與自身所慣用的方式一致時，最能有效地降低心血管反應；然而，再去檢驗適配假說和後續睡眠品質之間的關係，並未發現符合預期的結果，故若欲以適配假說來預測後續較佳的睡眠品質，仍須更多相關的研究加以支持和驗證，且可能尚須納入其他重要變項加以探討，例如個人的認知風格、內在情緒調節策略等。最後，本研究結果再度彰顯了睡前的生理激發和恢復狀態對於後續睡眠歷程的影響力；而生理激發狀態在情緒、因應行為和睡眠間之關係所扮演的角色，也為急性失眠的病因機制提供了一種可能的註解。 / Introduction：From past studies it is known that anger suppression and anger expression may play different roles in emotion regulation and in psychophysiological response. Engebretson and his colleagues (1989) had proposed ‘Matching Hypothesis’-- that is, if one used his/her preferred mode of anger expression style in response to the instigation, then his/her cardiovascular reactivity (CVR) would be less elevated and would have a faster recovery rate of CVR than those who were engage in a manner of anger expression that was inconsistent with their preferred mode. To do a further study, we intend to know what would bring on in the following sleep if we used the two different anger expression style during the pre-sleep period. Besides, in according to Matching Hypothesis, we predict that if one expressed his/her anger in a preferred way, then this ‘matching’ state would make one’s physiological arousal effectively declined and would help it back to the baseline level more quickly; therefore, it would have less negative effect on the following sleep, and vice versa. Method：35 healthy individuals who has psychometric characteristic of high hostility were examined. All subjects’ preferred style of anger expression-- highly suppressive (HS) or highly expressive (HE), had been assessed by a self-report questionnaire. After the anger instigation, subjects were randomly assigned to two experimental conditions: anger in (AI) or anger out (AO), and then went to sleep. Biopac instrument and software were used to measure heart rate (HR), blood pressure (BP) and skin conductance response (SCR). Besides, polysomnography (PSG) was used to record the nocturnal sleep. In addition, the subjects were asked to fill out the self-report questionnaires next morning, as a measurement of subjective sleep quality. Finally, statistic analyzed the influence of two variables (trait and condition) on the physical arousal level, recovery rate and sleep quality. Results：HE showed higher DBP elevation than HS, both in the two conditions. During the recovery phase, there was an inclination that HE showed lower DBP than HS; AO showed a higher DBP recovery level, and a shorter SCR recovery time, comparing to AI. Subjects in the matching state showed a shorter HR recovery time, and much DBP decline; however, no matter in the matching state or not, there was no difference in the nocturnal sleep quality. To view the sleep architecture, HS showed higher percentage of stage 2 sleep than HE, and HE showed higher slow-wave sleep percentage than HS. On the other hand, AO showed higher slow-wave sleep percentage than AI, suggesting that expressing anger seems to be much helpful for the promotion of slow-wave sleep. Finally, the findings demonstrated that before sleep, the elevation of SBP and DBP showed positive correlations with longer subjective sleep onset latency. Besides, the elevation of HR, SCR and SBP was positively correlated with the longer onset latency of stage 2 sleep. Furthermore, longer SCR recovery time accompanied longer onset latency of stage 2, indicating that both high arousal state and low recovery rate brought negative effects on the following sleep. Conclusions：The CVR results generally were consistent with Matching Hypothesis. However, the findings indicated that the matching/non-matching state couldn’t be merely used to predict the sleep quality. Therefore, there is still a need to do more research to figure it out. In addition, variables such as personal cognitive style and emotional regulation strategy, should be bring into the future studies. In conclusion, the findings pointed out that the physical arousal state during the pre-sleep period will impact on the following sleep process significantly, and it plays a important role in the relationships between emotion, coping behavior and sleep.

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.

本研究目的在探討反芻與因應對於失功能態度及憂鬱情緒之關係的影響，欲藉由此議題的探討，了解在憂鬱症預防的臨床實務工作中，除了改善個人具有的失功能態度外，尚存在其他可介入調整的有效因子為何。 過去研究顯示，具有失功能態度的人，不一定會具有憂鬱情緒，二者的關係可能受到其他因素的影響。近期研究者認為，反芻可能擴大失功能態度對憂鬱情緒的效果，對於失功能態度與憂鬱情緒之關係，反芻可能扮演中介因子或調節因子的角色，本研究將以反省式反芻與自責式反芻作為反芻概念的探討。 另一方面，反芻被認為與問題解決有關，並且反芻作為一種情緒反應型態，亦可視為對於負向情緒的一種因應方式，因此，本研究納入因應之概念一同探討。過去研究顯示，反芻與因應之間可能存在中介關係或者調節關係，本研究將以主動因應與被動因應作為因應概念的探討。 本研究從過去的研究觀點，整合失功能態度、反芻、因應與憂鬱情緒之間可能存在的關係，發現存在三種不同的型態，分別為失功能態度、反芻與因應的交互作用效果、將反芻作為一認知特性在失功能態度、反芻、因應與憂鬱情緒之中介模式，以及將反芻作為一因應策略在失功能態度、反芻、因應與憂鬱情緒之中介模式，本研究將進一步檢驗此三種型態是否能說明上述關係。 本研究有效樣本為557位台灣的大學生，以自陳式量表填答失功能態度量表、中文反芻反應風格量表、簡版因應量表、中文版貝克憂鬱量表第二版，及其背景資料，其中男性有189人、女性有333人；政治大學有238人、玄奘大學有119人、東南大學有118人、台灣藝術大學有82人。本研究以階層回歸以及單因子變異數分析檢驗失功能態度、反芻、因應之間的交互作用效果及單純主要效果，以路徑分析檢驗上述概念之間的中介效果。 研究結果顯示，失功能態度與憂鬱情緒之間的關係，可受到自責式反芻、被動因應，以及主動因應的調節，此外，被動因應可調節自責式反芻與憂鬱情緒之間的關係。另一方面，反芻作為認知特性之失功能態度、反芻、因應與憂鬱之中介關係，以及反芻作為因應策略之失功能態度、反芻、因應與憂鬱之中介關係，也受到實徵資料支持。 因此，個人被動地將目前狀態與未達到的標準進行比較，或者採取自責、行為脫離及否認等因應方式時，將會增加失功能態度對憂鬱情緒之效果；當個人採取計畫、接受、正向重釋、幽默與主動因應之因應策略時，將會降低失功能態度對憂鬱情緒之效果。另一方面，失功能態度愈高的人，將採取自責式反芻，繼而可能再透過被動因應而增加憂鬱情緒；若個人採取反省式反芻，可能透過轉變為自責式反芻而增加憂鬱情緒，或者可能透過主動因應而降低憂鬱情緒。此外，具失功能態度者將傾向採取反省式反芻、自責式反芻以及被動因應的因應策略，這些策略將增加個人的憂鬱情緒；具失功能態度者將較少採取主動因應的策略，而此策略將減緩憂鬱情緒。 反芻因應對失功能態度及憂鬱關係之影響，及其在臨床實務應用上的意涵，在文中將進一步的討論。

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.

本研究旨在比較不同背景和臨床因素的乳癌患者其因應策略、正向情緒和心理症狀的差異情形。本研究除了關注個體所採取的因應策略與情緒的關聯性；另一方面，研究者認為患者的情緒亦可能影響其因應策略之選擇，因此因應策略與情緒間的變化關係，亦為本研究目的之一。 本研究採立意取樣，並以中部某一教學醫學乳房中心初診斷之乳癌患者共計113位為研究對象，蒐集患者之｢基本資料表｣、｢短版因應策略量表｣、｢醫院版焦慮-憂鬱量表｣和｢情緒平衡量尺｣，並以術後3個月和6個月進行追蹤研究。 資料處理以相關分析、t考驗、單因子變異數分析及階層迴歸分析等統計方法為主。由於本研究擬以Brief COPE作為臺灣乳癌病患因應壓力之測量工具，因此將採用探索性因素分析(Exploratory Factor Analysis；EFA)，探討此量表在初診斷乳癌患者身上的因素結構。 依據本研究問題與假設，主要發現摘述如下: 一、本研究以主成分分析法抽取Brief COPE量表因素，並以斜交轉軸進行因素轉軸，依據陡坡圖和平行分析結果抽取三個因素。此三因素的解釋總變異量為62.1%。研究者將因素I命名為｢趨近因應｣；因素II命名為｢情緒性因應｣和因素III命名為｢逃避因應｣。 二、教育程度、收入和有無職業與正向情緒呈正相關；現有小孩人數和年齡與正向情緒呈負相關；年齡和副作用與憂鬱具有正向關係，教育程度則與憂鬱呈負相關;副作用與焦慮呈正相關。有無結婚、有無職業、教育程度、收入、乳房重建與趨近因應呈正相關，期數和年齡則和趨近因應有顯著負相關；有無職業和情緒性因應呈正相關。 三、乳癌患者於術後3、6個月最常採用的因應策略為趨近因應，其次為情緒性因應，最少採用逃避因應。 四、焦慮對逃避和趨近因應有獨特的預測力，即焦慮程度愈高會愈使用逃避和趨近因應策略；憂鬱則對趨近因應有獨特的預測力，憂鬱程度愈高者，其趨近因應的使用愈少；在因應策略的部分，只有趨近因應可顯著預測正向情緒；正向情緒在趨近因應和焦慮的關係中並無法形成部份或完全中介之角色。 最後，根據研究結果與限制提出若干具體建議，以供臨床工作者及未來研究之相關人員參考。 / The purpose of this study is to explore the differences of coping strategies, positive affect and psychological symptoms among newly-diagnosed breast cancer patients in different sociodemographic backgrounds. Research has found that coping strategies predict psychological outcomes; however, a few studies have also reported that psychological symptoms could predict the use of coping strategies. Therefore, the relationship between coping strategies and psychological symptoms was the first aim of the current study. One-hundred and thirteen participants were recruited by purposive sampling. The data were draw from newly-diagnosed breast cancer patients in a breast center unit at a hospital in central of Taiwan. Demographic and clinical data were gathered at the first time point, and the Brief Coping Orientations to Problems Experienced scale (Brief COPE), the Hospital Anxiety and Depression Scale (HADS), Positive Affect subscale of Affect Balance, and side effect checklists were gathered 2 times during the first 3- and 6-month after discharge respectively. Pearson product-moment correlation, t-test, one-way ANOVA, post Scheffe test and hierarchical regression analysis were applied. In an attempt to confirm the factor structure of the Brief COPE, the Exploratory Factor Analyses (EFA) were performed before those analyses. The major findings of the current study were as follows： 1.Using principal components factor analysis with oblique rotation, scree plot and parallel analyses revealed three factors for the Brief COPE were the best factor structure of the current sample: (1) approach coping, (2) emotional coping, and (3) avoidance coping. These 3 factors accounted for 62.1% of the total variance of the data. 2.Education, income and employment status were significantly correlated with positive affect. Number of kids and age were found to be inversely correlated with positive affect. Age and side effects were positively correlated with depression. Side effects were found to be correlated with anxiety. Marital status, employment status, cancer stage, education, income, age, breast reconstruction surgery were found to be correlated with approach coping. Meanwhile stage and age were found to be negatively correlated with emotional coping. 3.Approach coping was the most commonly used coping strategies, while avoidance coping was the least commonly used coping strategies. 4.Anxiety could reliably predict the use of avoidance and approach coping. High anxiety level predicted more use of avoidance and approach coping, whereas depression predicted the use of approach coping, high depressive mood predicted less use of approach coping. Approach coping predicted higher positive affect, but positive affect was fail to be the mediator between approach coping and anxiety. Implications for these results were discussed. The results can also serve as a helpful reference for healthcare professionals.

研究背景：乳癌患者常伴隨憂鬱症狀，而反芻是癌症患者憂鬱情形的重要預測因 數。過往研究指出苦惱自責式反芻增加憂鬱的效果得到較一致的結果，而深思反 省式反芻對於憂鬱影響的結果則不太一致。深思反省式反芻意在解決問題，過程 中患者採用不同因應策略可能對其憂鬱會有不同影響，但過去較少研究探討乳癌 患者的因應如何調節深思反省式反芻對患者憂鬱變化的影響。 研究目的：探究苦惱自責式反芻與深思反省式反芻如何影響乳癌患者的憂鬱，逃 避與趨近這兩種因應方式是否在深思反省式反芻影響憂鬱的過程中有調節作用。 研究方法：本研究採用長期追蹤之研究方法，對平均年齡為 48 歲的 359 位乳癌 患者，於手術後三個月、六個月、一年和兩年四個時間點，測量其苦惱自責式反 芻、深思反省式反芻，趨近、逃避等因應模式及憂鬱狀況後進行分析。為了探索 考個體內和個體間變項的影響，包含臨床背景資料對憂鬱的預測效果，研究擬採 用階層線性模型（HLM）之方法進行統計分析。 研究結果：苦惱自責式反芻正向預測乳癌患者憂鬱情形，深思反省式反芻對憂鬱 的預測效果則受到趨近因應的調節，趨近因應越高，深思反省式反芻越能負向預 測憂鬱情形。依此結果可知對於乳癌患者而言，苦惱自責式反芻為不適應的反芻 類型，會增加乳癌患者的憂鬱情形，而深思反省式反芻的適應性僅存在於更多使 用趨近因應的患者之中。 / Background: Depressive symptoms occur frequently with breast cancer. Rumination is a major risk factor of depression. Numerous research evidence shows that brooding, the maladaptive subtype of rumination, increases depression while the effect of reflective pondering, the other subtype, remain inconsistent. Individuals who reflective ponder mean to solve the problem they face, but there is little research to explore what role coping plays in the process that reflective pondering contribute to or eliminate depression. Purpose: To examine how two subtypes of rumination predict the depression of women with breast cancer, and whether the moderating effect of two different coping strategies, approach and avoidance, exists and how it works. Method: Longitudinal data of rumination, coping, and depression at Time 1 (3 months after surgery), Time 2 (6 months after surgery), Time 3 (1year after surgery), and Time 4 (2 years after surgery) among 359 women with breast cancer whose mean age was 48 was collected to explore the prediction of rumination and the moderating effect of coping. To address the effect of both with- and between- subject variables including background materials and disease-related information, HLM is adopted as the analysis method. Results: Brooding predicts the increase of depressive symptoms and acts as the maladaptive subtype of rumination. In addition, reflective pondering’ prediction to decreased depression only appears with the interaction of approach coping, which means that patients who reflective ponder more and take more approach coping at the meanwhile will experience more recovery from the depressive symptoms.