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    Title: 長期助眠藥物使用之心理機轉探討(第三年)
    Other Titles: Psychological Process of Long Term Hypnotic Use
    Authors: 楊建銘;李信謙
    Contributors: 心理學系
    Keywords: 失眠;助眠藥物;停藥;計畫行為理論;渴求;注意力偏誤
    insomnia;hypnotics;theory of planned behavior;craving;attention bias
    Date: 2012
    Issue Date: 2016-04-11 17:36:18 (UTC+8)
    Abstract: 長期使用助眠藥物而難以停藥是臨床上失眠患者常見的現象,然而少有研究探討其機制。本計劃參考其他物質成癮的理論模式,對於助眠藥物長期使用的心理機制進行兩個研究,分別由對於藥物使用的認知信念的角度以及長期用藥後產生的渴求 (craving) 現象加以探討。研究一以計畫行為理論 (Theory of Planned Behavior)為架構,編製助眠藥物之認知信念與用藥意圖量表,探討對於藥物的態度、主觀規範以及覺知行為控制對於停藥意圖的影響,檢視此意圖是否能預測藥物實際使用的情形;除此之外,也參考過去物質成癮之理論與相關量表,編製助眠藥物渴求量表,藉以瞭解個體對助眠藥物之渴求程度是否在行為意圖到實際用藥行為之間具有可能的中介效果。本研究透過失眠患者的訪談,以及諮詢專家的意見,完成助眠藥物之認知信念與用藥意圖量表及助眠藥物渴求量表之編製,以及問卷之信、效度考驗,並招募 356位失眠並長期服用助眠藥物之受試者,追蹤用藥 18 個月。研究結果以計畫行為理論的架構分析顯示,知覺行為控制對於用藥行為意圖有最高的預測力;而加入渴求為調節變項後的計劃行為理論架構分析則顯示渴求程度對行為意圖與實際使用行為呈現負向調節效果。研究二則招募19位長期用藥的失眠患者探索對助眠藥物的渴求現象,根據Baker等人 (2004) 提出的負增強情感處理模式 (Affective ProcessingModel of Negative Reinforcement),探索負向情緒對於渴求及認知歷程的影響。研究要求受試者至實驗室,藉由誘發挫折情緒,測量其主觀渴求程度、事件相關電位測量的注意力偏誤、對藥物線索產生的自主神經系統激發反應,以了解負向情緒對於用藥的渴求的影響,結果顯示P300與SPW振幅皆與其對藥物的主觀渴求程度呈正相關,而助眠藥物及睡眠相關的刺激所引發的P300振幅較中性刺激所引發的振幅大,助眠藥物線索所引發的SPW也較中性線索更為持續。然而,負向情緒的誘發並沒有出現預期中對於渴求及注意力偏誤的影響。整體來說,研究結果支持助眠藥物使用並非單純是理性判斷下的決策行為,而會受到情境因素及渴求的影響。因此,臨床上協助長期助眠藥物使用者停藥,必須評估情境及渴求的影響,並針對這些因素發展出因應的策略。
    Many patients with chronic insomnia use hypnotics for prolonged periods of time, and find it difficult to stop using them. There are very few studies addressed this phenomenon in comparison to studies on the dependence of other substances. The current proposal contains two studies that are designed to explore the psychological mechanisms underlying long-term use of hypnotics based on theoretical models for the addiction of other substances. Study 1 will investigate this phenomenon based on the assumption that substance use is an informed choice based on cognitive beliefs. The study will recruit 180 hypnotic users and follow their hypnotic use for 12 months. Their cognitive beliefs about hypnotic use and intention of quitting drug will be assessed based on the Theory of Planned Behavior, in order to evaluate the extent to which the cognitive factors can predict long-term drug use. Study 2 will focus on the phenomenon of craving that was theorized to lead to uncontrollable substance use. Since hypnotics are used primarily to reduce sleeplessness and the associated worries and not to lead to pleasant affect, the Affective Processing Model of Negative Reinforcement (Baker, Piper, McCarthy, Majeskie, & Fiore, 2004) that stresses the influence of negative affect on drug use will be tested in the study. Twenty-four long-term hypnotic users and 24 insomnia patients who are not regular hypnotic users will be recruited for the study. They will come to the sleep laboratory in NCCU for two nights: one experimental night during which negative affect will be induced by giving negative comments on their performance on a cognitive task, and a control night with exactly the same procedure but the negative comments will be replaced by neutral comments. For both nights, assessment of subjective craving, recording of event-related potentials (ERPs) induced by pictures related to hypnotic use and neutral pictures, and measuring of heart rate, blood-pressure, and skin conductance level in reacting to drug-related cue will be conducted. Their decision on using hypnotics during the nights in the laboratory will also be recorded. It is hypothesized that subjective craving, attention bias as measured by ERPs, psychophysiological reactivities to drug-related cue, and drug-using behaviors will all be elevated by negative affect. The proposed studies will enhance the understanding of both the stable cognitive factors and situation-induced craving that might contribute to long-term hypnotic use. The findings of the studies are expected to be applied in the development of better strategies to assist patients to stop drug use. It is expected not only to eliminate the struggle of long-term hypnotic user, but also to decrease unnecessary medical expenses.
    Relation: 計畫編號 MOST 101-2410-H004-082-MY3
    Data Type: report
    Appears in Collections:[心理學系] 國科會研究計畫

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