Loading...
|
Please use this identifier to cite or link to this item:
https://nccur.lib.nccu.edu.tw/handle/140.119/80282
|
| Title: | 以計劃行為理論及渴想探討長期助眠藥物使用之心理因素
The Psychological Factors of Long-Term Hypnotics Use: Base on the Theory of Planned Behavior and Craving |
| Authors: | 賴羽琁
Lai, Yu Syuan |
| Contributors: | 楊建銘
Yang, Chien Ming
賴羽琁
Lai, Yu Syuan |
| Keywords: | 助眠藥物
長期使用
計劃行為理論
渴想
hypnotics
long-term user
the theory of planned behavior
craving |
| Date: | 2015 |
| Issue Date: | 2016-01-04 16:52:00 (UTC+8) |
| Abstract: | 研究目的：失眠盛行率高，且容易發展為慢性化的問題，目前多以助眠藥物作為失眠的治療，短期使用雖可幫助緩解失眠症狀，但長期使用的有效性及安全仍有較大爭議，且容易發展出依賴性及耐受性的問題。然而失眠患者中仍有相當高的比例在對藥物療效不滿意的情況下，使用遠超過臨床指引建議的期間，許多失眠患者亦表達出對助眠藥物使用的矛盾心態，顯示助眠藥物的使用仍受其他心理因素影響。過去研究指出計劃行為理論能有效預測及幫助探討物質使用相關行為的認知因素，但助眠藥物的使用除了認知因素的影響外，也會出現較為衝動及難以控制的渴想狀態。因此本研究目的是在於了解長期助眠藥物使用的心理因素，探討助眠藥物使用行為的認知因素，以及在計劃行為理論的架構下，失眠患者對於助眠藥物使用的認知因素是否會受到渴想的影響。
研究方法與結果：本研究以21名失眠患者進行開放式訪談後編制助眠藥物使用之計劃行為理論問卷，招募失眠且有助眠藥物使用經驗的受試者填寫助眠藥物使用計劃行為理論問卷以及助眠藥物渴想量表，並於施測後一個月及三個月的時間點，以電話追蹤其助眠藥物使用狀況，一個月及三個月有效問卷分別為143及139份。結果顯示知覺行為控制為行為意圖的主要預測因子，行為意圖及知覺行為控制能預測一個月及三個月時的藥物使用行為，且行為意圖為使用行為的最佳預測因子；助眠藥物使用行為意圖對一個月及三個月時的助眠藥物使用情況的預測力會受到渴想的負向調節。
結論：本研究結果顯示助眠藥物使用的行為意圖是行為出現與否的主要決定因素，說明失眠患者的確會在認知決策後選擇使用助眠藥物，也會在知覺到較多促進助眠藥物使用之情境或因素時產生助眠藥物使用的行為意圖或直接出現助眠藥物的使用行為，顯示助眠藥物使用行為上外在情境及因素的重要性。此外，本研究結果也顯示助眠藥物使用的行為意圖會受到渴想的干擾，當渴想程度愈高時行為意圖對於實際行為的預測力愈低，而渴想程度愈低時行為意圖對實際行為的預測愈高。此研究結果幫助了解長期助眠藥物使用的心理因素，亦可將其用於幫協助擬定助眠藥物減藥策略。
Insomnia has high prevalence and is prone to develop into a chronic problem. Hypnotics are the most common choice of treatment for insomnia. Although short-term usage is effective in relieving insomnia, the safety and efficacy of long-term usage are still in controversy. Long-term usage has also been reported to increase risks of tolerance and dependence. Even though the efficacy of hypnotics is not always satisfying, the duration of hypnotics use in insomnia patients is often longer than clinical recommendation. This may be influenced by some psychological factors.
The theory of planned behavior has been demonstrated to be able to predict cognitive factors of substance use behaviors. It can therefore possibly be used to model hypnotic use behavior. In addition to cognitive factors, craving that is associated with losing control over drug use may also play a role in the use of hypnotics. The purpose of current study is to 1) explore the cognitive factors of long-term hypnotics use based on the theory of planned behavior, and 2) understand whether the cognitive factors would be influenced by the craving state.
Method and result:
We first conducted a semi-structured interview with 21 insomnia patients to develop the questionnaire of the theory of planned behavior of hypnotics use and a hypnotic craving scale. The insomnia patients who had used or are currently using hypnotics were recruited to complete the questionnaires. They were contacted by telephone at 1-month and 3-month follow-ups. Total number of valid questionnaires of 1-month and 3-month follow-ups were 143 and 139, respectively. We found that behavior intention could be predicted by perceived behavior control, but not attitude and subjective norms. Frequency of hypnotics use at 1-month and 3-month follow-ups could be predicted by behavior intention and perceived behavior control, and behavior intention was the best predictor. Craving has a negative moderating effect on the relationship between behavior intention and the hypnotics use behavior at both 1-month and 3-month follow-ups.
Conclusion:
The findings of current study show that behavior intention is the most crucial cognitive factor to predict hypnotics use behavior. It indicates that insomnia patients may have higher behavior intention and are more likely to use hypnotics when they perceive more situational factors that lead to drug use. In addition, our study indicates the association between behavior intention and actual hypnotic use behavior can be moderated by craving. The higher the craving state the lower the predictability of hypnotic use by behavior intention, and vice versa. Our study helps understand the psychological factors of long-term hypnotics use, and assists in developing the tapering interventions. |
| Reference: | 中文部份
苯二氮平類(Benzodiazepines)藥品用於鎮靜安眠之使用指引. (2007)
車先蕙, 盧孟良, 陳錫中, 張尚文, & 李宇宙. (2006). 中文版貝克焦慮量表之信效度. 臺灣醫學, 10(4), 447-454.
吳佳璇. (2007). 台灣鎮靜安眠藥品使用盛行率以及相關後遺症之研究：行政院衛生署管制藥品管理局九十六年度委託科技研究計畫報告.
袁美珍. (2008). 運用計劃行為理論探討臺北市某美沙冬門診男性藥物成癮者之共用針頭行為意圖. 碩士論文，國立台灣大學，台北.
翁德怡. (2012). 我國鎮靜安眠類管制藥品處方用藥之盛行率：行政院衛生署管制藥品管理局一○一年度委託科技研究計畫報告.
陳昌偉. (2014). 安眠藥物長期使用型態之探討. 未出版之博士論文, 國立政治大學, 台北市.
黃榮宗. (2009). 應用計劃行為理論探討青少年早期成癮物質濫用行為傾向. 碩士論文，亞洲大學，台中.
楊建銘，許世杰，林詩淳，周映妤，&陳瑩明. (2009) 失眠嚴重度量表中文版的信、效度研究. 臨床心理學刊, 4(2), 95-104.
盧孟良, 車先蕙, 張尚文, & 沈武典. (2002). 中文版貝克憂鬱量表第二版之信度和效度. Taiwanese J Psychiatry, 16, 301-310.
英文部份
Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179-211.
Ajzen, I. (2006). Constructing a TPB questionnaire: Conceptual and methodological considerations, Retrieved March 22, 2007.
Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behaviour. Englewood Cliffs, NJ: Prentice-Hall.
Armitage, C. J., & Conner, M. (2001). Efficacy of the theory of planned behaviour: A meta analytic review. British Journal of Social Psychology, 40(4), 471-499.
Armitage, C. J., Conner, M., Loach, J., & Willetts, D. (1999). Different perceptions of control: Applying an extended theory of planned behavior to legal and illegal drug use. Basic and Applied Social Psychology, 21(4), 301-316.
Baillargeon, L., Landreville, P., Verreault, R., Beauchemin, J. P., Gregoire, J. P., & Morin, C. M. (2003). Discontinuation of benzodiazepines among older insomniac adults treated with cognitive-behavioural therapy combined with gradual tapering: a randomized trial. Canadian Medical Association Journal, 169(10), 1015.
Baker, T. B., Morse, E., & Sherman, J. E. (1986). The motivation to use drugs: a psychobiological analysis of urges. Nebraska Symposium on Motivation, 34，257-323
Baker, T. B., Piper, M. E., McCarthy, D. E., Majeskie, M. R., & Fiore, M. C. (2004). Addiction motivation reformulated: an affective processing model of negative reinforcement. Psychological Review, 111(1), 33.
Bandura, A. (1986). Social foundations of thought and action: A cognitive social theory. Pretince Hall, Englewood Cliffs, New York.
Barker, M. J., Greenwood, K. M., Jackson, M., & Crowe, S. F. (2004). Cognitive effects of long-term benzodiazepine use. CNS drugs, 18(1), 37-48.
Baron, R. M., & David, A. K. (1986) The moderator-mediator variable distinction in social Psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173-1182.
Bastien, C. H., LeBlanc, M., Carrier, J., & Morin, C. M. (2003). Sleep EEG power spectra, insomnia, and chronic use of benzodiazepines. Sleep-New York then Westchester, 26(3), 313-317.
Cialdini, R. B., Kallgren, C. A., Reno, R. R. (1991). A focus theory of normative conduct: A theorerical refinement and reevaluation of the role of norms in human behavior. Experimental Soial Psychology, 24, 201-243.
Charng, H.W., Piliavin, J.A., & Callero, P.L. (1988). Role identity and reasoned action in the prediction of repeated behavior. Social Psychology Quarterly, 48, 303-317.
Clift, A. (1972). Factors leading to dependence on hypnotic drugs. British Medical Journal, 3(5827), 614.
Conner, M., & McMillan, B. (1999). Interaction effects in the theory of planned behaviour: Studying cannabis use. British Journal of Social Psychology, 38(2), 195-222.
Conner, M., Norman, P., & Bell, R. (2002). The theory of planned behavior and healthy eating. Health Psychology, 21(2), 194.
Conner, M., & Sparks, P. (1995). The theory of planned behaviour and health behaviours. In M. Conner & P. Norman (Eds.), Predicting health behaviour: Research and practice with social cognition models (pp. 121-162; 197). Buckingham: Open University Press.
Dolder, C. R., & Nelson, M. H. (2008). Hypnosedative-Induced Complex Behaviours. CNS drugs, 22(12), 1021-1036.
Drummond, D. C. (2001). Theories of drug craving, ancient and modern. Addiction, 96(1), 33-46.
Drummond, D. C., Cooper, T., & Glautier, S. P. (1990). Conditioned learning in alcohol dependence: implications for cue exposure treatment. British Journal of Addiction, 85(6), 725-743.
Einarson, T. (1980). Systematic review of the benzodiazepines. British Medical Journal, 281(6246), 1009.
Fishbein, M., & Ajzen, I. (1975). Belief, attitude, intention and behavior: An introduction to theory and research. MA: Addison-Wesley.
Francis, J. J., Eccles, M. P., Johnston, M., Walker, A., Grimshaw, J., Foy, R., et al. (2004). Constructing questionnaires based on the theory of planned behaviour. A Manual for Health Services Researchers.
Godin, G., & Kok, G. (1996). The theory of planned behavior: a review of its applications to health-related behaviors. American Journal of Health Promotion.
Godin, G., Valois, P., Lepage, L., & Desharnais, R. (1992). Predictors of smoking behaviour: an application of Ajzen`s theory of planned behaviour. British Journal of Addiction, 87(9), 1335-1343.
Hohagen, F., Rink, K., Käppler, C., Schramm, E., Riemann, D., Weyerer, S., et al. (1993). Prevalence and treatment of insomnia in general practice. European Archives of Psychiatry and Clinical Neuroscience, 242(6), 329-336.
Holbrook, A. M., Crowther, R., Lotter, A., Cheng, C., & King, D. (2000). Meta-analysis of benzodiazepine use in the treatment of insomnia. Canadian Medical Association Journal, 162(2), 225-233.
Jansson-Fröjmark, M., & Linton, S. J. (2008). The course of insomnia over one year: a longitudinal study in the general population in Sweden. Sleep, 31(6), 881.
Jellinek, E. M. (1960). The disease concept of alcoholism. Hillhuse Press, New Haven.
Johnston, K. L., & White, K. M. (2003). Binge-drinking: A test of the role of group norms in the theory of planned behaviour. Psychology and Health, 18(1), 63-77.
Kales, A., Scharf, M. B., & Kales, J. D. (1978). Rebound insomnia: a new clinical syndrome. Science, 201(4360), 1039-1041.
Kales, A., Soldatos, C. R., Bixler, E. O., Kales, J. D., & Vela-Bueno, A. (1988). Diazepam: effects on sleep and withdrawal phenomena. Journal of Clinical Psychopharmacology, 8(5), 340-346.
Kang, D.Y., Park, S., Rhee, C.W., Kim, Y.J., Choi, N.K., Lee, J., & Park, B.J. (2012). Zolpidem use and risk of fracture in elderly insomnia patients. Journal of Preventive Medicine and Public Health, 45(4), 219.
Kanno, O., Watanabe, H., Iyo, R., Nakagome, K., Ichikawa, I., Takazawa, S., Kazamatsuri, H. (1992). Effects of zolpidem and triazolam on all-night sleep EEG in nornal volunteers-assessing the sleep stages by thirds of the night. Clinical Neuropharmacology, 15(Part B), 543B.
Kao, C.-C., Huang, C.-J., Wang, M.-Y., & Tsai, P.-S. (2008). Insomnia: prevalence and its impact on excessive daytime sleepiness and psychological well-being in the adult Taiwanese population. Quality of Life Research, 17(8), 1073-1080.
Katz, D. A., & McHorney, C. A. (2002). The relationship between insomnia and health-related quality of life in patients with chronic illness. Journal of Family Practice, 51(3), 229-236.
Kripke, D. F. (2000). Chronic hypnotic use: deadly risks, doubtful benefit: Review article. Sleep Medicine Reviews, 4(1), 5-20.
Krystal, A. D., Erman, M., Zammit, G. K., Soubrane, C., & Roth, T. (2008). Long-term efficacy and safety of zolpidem extended-release 12.5 mg, administered 3 to 7 nights per week for 24 weeks, in patients with chronic primary insomnia: a 6-month, randomized, double-blind, placebo-controlled, parallel-group, multicenter study. Sleep, 31(1), 79.
Lai, M.M., Lin, C.C., Lin, C.C., Liu, C.S., Li, T.C., & Kao, C.H. (2014). Long-term use of zolpidem increases the risk of major injury: a population-based cohort study. Mayo Clinic Proceedings, 89(5), 589-594.
Liappas, I., Malitas, P., Dimopoulos, N., Gitsa, O., Liappas, A., Nikolaou, C. K., & Christodoulou, G. (2003). Zolpidem dependence case series: possible neurobiological mechanisms and clinical management. Journal of Psychopharmacology, 17(1), 131-135.
Linden, M., Bär, T., & Geiselmann, B. (1998). Patient treatment insistence and medication craving in long-term low-dosage benzodiazepine prescriptions. Psychological Medicine, 28(03), 721-729.
Maarek, L., Cramer, P., Attali, P., Coquelin, J., & Morselli, P. (1992). The safety and efficacy of zolpidem in insomniac patients: a long-term open study in general practice. Journal of International Medical Research, 20(2), 162-170.
MacFarlane, J., Morin, C. M., & Montplaisir, J. (2014). Hypnotics in Insomnia: The Experience of Zolpidem. Clinical Therapeutics, 36(11), 1676-1701.
Marlatt, G. A. (1985). Cognitive factors in the relapse process. Relapse Prevention, 128-200.
Marlatt, G. A. (1987). Craving notes. British Journal of Addiction, 82(1), 42-44.
McEachan, R., Conner, M., & Lawton, R. (2005). A meta-analysis of theory of planned behaviour studies: the impact of behaviour type. Unpublished Manuscript.
McMillan, B., & Conner, M. (2003). Using the theory of planned behaviour to understand alcohol and tobacco use in students. Psychology, Health and Medicine, 8(3), 317-328.
McMillan, B., & Conner, M. (2006). Applying an Extended Version of the Theory of Planned Behavior to Illicit Drug Use Among Students1. Journal of Applied Social Psychology, 33(8), 1662-1683.
Metcalfe, J., & Mischel, W. (1999). A hot/cool-system analysis of delay of gratification: dynamics of willpower. Psychological Review, 106(1), 3.
Mets, M. A., Volkerts, E. R., Olivier, B., & Verster, J. C. (2010). Effect of hypnotic drugs on body balance and standing steadiness. Sleep Medicine Reviews, 14(4), 259-267.
Mol, A. J., Voshaar, R. C. O., Gorgels, W. J., Breteler, M. H., Balkom, A. J. v., Lisdonk, E. H. v. d., . . . Zitman, F. G. (2007). The role of craving in relapse after discontinuation of long-term benzodiazepine use. Journal of Clinical Psychiatry, 68(12), 1894-1900.
Morgan, K., Dixon, S., Mathers, N., Thompson, J., & Tomeny, M. (2003). Psychological treatment for insomnia in the management of long-term hypnotic drug use: a pragmatic randomised controlled trial. The British Journal of General Practice, 53(497), 923.
Morin, C. M., Bastien, C., Guay, B., Radouco-Thomas, M., Leblanc, J., & Vallieres, A. (2004). Randomized clinical trial of supervised tapering and cognitive behavior therapy to facilitate benzodiazepine discontinuation in older adults with chronic insomnia. American Journal of Psychiatry, 161(2), 332.
Morin, C. M., Belanger, L., Bastien, C., & Vallieres, A. (2005). Long-term outcome after discontinuation of benzodiazepines for insomnia: a survival analysis of relapse. Behaviour Research and Therapy, 43(1), 1-14.
Morin, C. M., Bélanger, L., LeBlanc, M., Ivers, H., Savard, J., Espie, C. A., et al. (2009). The natural history of insomnia: a population-based 3-year longitudinal study. Archives of Internal Medicine, 169(5), 447.
Morin, C. M., Colecchi, C., Stone, J., Sood, R., & Brink, D. (1999). Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial. Jama, 281(11), 991-999.
Morin, C. M., LeBlanc, M., Bélanger, L., Ivers, H., Mérette, C., & Savard, J. (2011). Prevalence of insomnia and its treatment in Canada. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 56(9), 540-548.
Motel, S. (2014). 6 facts about marijuana. Pew Research Center, April, 7.
Neutel, C. I., Hirdes, J. P., Maxwell, C. J., & Patten, S. B. (1996). New evidence on benzodiazepine use and falls: the time factor. Age and Ageing, 25(4), 273-278.
Nicholson, A. (1980). Hypnotics: rebound insomnia and residual sequelae. British Journal of Clinical Pharmacology, 9(3), 223-225.
Nomura, K., Yamaoka, K., Nakao, M., & Yano, E. (2005). Impact of insomnia on individual health dissatisfaction in Japan, South Korea, and Taiwan. Sleep, 28(10), 1328-1332.
Nunnally, J.C., (1978). Psychometric Theory, New York: McGraw-Hill.
Ohayon, M. M., & Reynolds III, C. F. (2009). Epidemiological and clinical relevance of insomnia diagnosis algorithms according to the DSM-IV and the International Classification of Sleep Disorders (ICSD). Sleep Medicine, 10(9), 952-960.
Owen, R., & Tyrer, P. (1983). Benzodiazepine dependence. Drugs, 25(4), 385-398.
Ray, W. A., Griffin, M. R., & Downey, W. (1989). Benzodiazepines of long and short elimination half-life and the risk of hip fracture. Jama, 262(23), 3303-3307.
Riemann, D., & Perlis, M. L. (2009). The treatments of chronic insomnia: a review of benzodiazepine receptor agonists and psychological and behavioral therapies. Sleep Medicine Reviews, 13(3), 205-214.
Roth, T., Tietz, E. I., Kramer, M., & Kaffeman, M. (1979). The effect of a single dose of quazepam (Sch-16134) on the sleep of chronic insomniacs. Journal of International Medical Research, 7(6), 583-587.
Saddichha, S. (2010). Diagnosis and treatment of chronic insomnia. Annals of Indian Academy of Neurology, 13(2), 94.
Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., et al. (1998). The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22-33.
Shiffrin, R. M., & Schneider, W. (1977). Controlled and automatic human information processing: II. Perceptual learning, automatic attending and a general theory. Psychological Review, 84(2), 127.
Sobel, M. E. (1982). Asymptotic confidence intervals for indirect effects in structural equations models. Sociological methodology, 13(1982), 290-312.
Stewart, J., De Wit, H., & Eikelboom, R. (1984). Role of unconditioned and conditioned drug effects in the self-administration of opiates and stimulants. Psychological Review, 91(2), 251.
Sutton, S., McVey, D., & Glanz, A. (1999). A comparative test of the theory of reasoned action and the theory of planned behavior in the prediction of condom use intentions in a national sample of English young people. Health Psychology, 18(1), 72.
Tiffany, S. T. (1999). Cognitive concepts of craving. Alcohol Research and Health, 23(3), 215-224.
Umeh, K., & Patel, R. (2004). Theory of planned behaviour and ecstasy use: An analysis of moderator interactions. British Journal of Health Psychology, 9(1), 25-38.
Van Hulten, R., Bakker, A. B., Lodder, A. C., Teeuw, K. B., Bakker, A., & Leufkens, H. G. (2003). The impact of attitudes and beliefs on length of benzodiazepine use: a study among inexperienced and experienced benzodiazepine users. Social Science & Medicine, 56(6), 1345-1354.
Van Hulten, R., Lodder, A. C., Teeuw, K. B., Bakker, A., Leufkens, H. G., & Bakker, A. B. (2001). Determinants of change in the intention to use benzodiazepines. Pharmacy World & Science, 23(2), 70-75.
Victorri‐Vigneau, C., Dailly, E., Veyrac, G., & Jolliet, P. (2007). Evidence of zolpidem abuse and dependence: results of the French Centre for Evaluation and Information on Pharmacodependence (CEIP) network survey. British Journal of Clinical Pharmacology, 64(2), 198-209.
Wikler, A. (1948). Recent progress in research on the neurophysiologic basis of morphine addiction. American Journal of Psychiatry, 105(5), 329-338.
Zammit, G. (2009). Comparative tolerability of newer agents for insomnia. Drug Safety, 32(9), 735-748. |
| Description: | 碩士
國立政治大學
心理學系
101752006 |
| Source URI: | http://thesis.lib.nccu.edu.tw/record/#G0101752006 |
| Data Type: | thesis |
| Appears in Collections: | [心理學系] 學位論文
|
Files in This Item:
| File |
Size | Format | |
|---|
| 200601.pdf | 1345Kb | Adobe PDF2 | 381 | View/Open |
|
All items in 政大典藏 are protected by copyright, with all rights reserved.
|
