生命意义感在经验性回避和焦虑抑郁间的中介效应检验

PSYCH OpenIR > 健康与遗传心理学研究室

	生命意义感在经验性回避和焦虑抑郁间的中介效应检验
其他题名	The Mediating Effect of Meaning in Life between Experiential Avoidance and Anxiety and Depression
	曹静
	2016-05
摘要	目的：本研究聚焦于接纳承诺疗法（ACT）六边病理模型中的经验性回避（Experiential Avoidance，EA）这一核心概念，检验测量经验性回避的中文版接纳与行动问卷第二版（AAQ-II）的信效度，为中国进行经验性回避、心理灵活性或 ACT 的研究提供心理测量学指标良好的评估工具，并进一步探索 ACT 六边模型里经验性回避和生命意义感对大学生群体和癌症群体的焦虑、抑郁情绪的影响，以及对比两个人群中介效应程度的差异。本研究以期为经验性回避作为功能性的跨诊断因素提供证据，为后期对癌症群体的干预方案的设计提供依据和支持。方法：本研究分为三个研究：研究一：接纳与行动问卷第二版中文版在大学生中的信效度检验。整群选取北京、四川和河南某大学大一学生1775 人，回收有效问卷 1749 份，用 SPSS 22.0 和 Amos 21.0进行探索及验证性因素分析。用自评抑郁量表（SDS）和自评焦虑量表（SAS）检验AAQ-II 的效标效度，用正念注意觉知量表（MAAS）和沉思反应量表（RRS）检验聚合效度和递增效度；间隔一个月，从中简单随机选取238 人进行重测，检验重测信度。研究二：大学生群体的生命意义感在经验性回避与焦虑抑郁情绪间的中介效应检验。采用研究一总样本中的366 人，施测AAQ-II、SDS、SAS、MLQ（生命意义感量表），用 SPSS 22.0 对各变量进行描述统计，在各变量间做 Pearson 积差相关，用偏差校正的非参数百分位 Bootstrap 方法进行生命意义感在经验性回避和焦虑抑郁情绪间中介效应的检验。研究三：癌症人群的生命意义感在经验性回避与焦虑抑郁情绪间的中介效应检验。整群选取北京某医院核医学门诊的甲状腺癌患者及肿瘤科患者352 人，与研究二施测同样的问卷，回收有效问卷301 份。统计方法同研究二。在进行大学生群体和癌症群体的中介效应多群组分析时，采用 Mplus 7.0，跨组比较两组结构方程模型中的回归系数及中介系数。结果：研究一探索性因素分析表明，AAQ-Ⅱ的经验性回避单因子累积方差为 62.5%，载荷在 0.72～0.84 间；验证性因素分析显示单因子结构拟合较好（x2/df=4.56，CFI=0.99，TLI=0.97，RMSEA=0.06）；AAQ-Ⅱ得分与SDS、SAS、MAAS、RRS 得分均呈正相关（r=0.26～0.69，Ps<0.01）。控制正念觉知或沉思反应后，AAQ-Ⅱ对焦虑、抑郁的解释力仍显著（ΔR2=0.07～0.13，Ps<0.001）。量表的 Cronbach α系数为 0.88，重测信度为0.80。研究二大学生的AAQ-Ⅱ得分与 SDS、 SAS 得分存在中等程度正相关（r=0.55、 0.57，Ps<0.001），与 MLQ 得分存在中等程度负相关（r=-0.42，P<0.001）；MLQ 得分与 SAS、SDS 得分显著负相关（r=-0.32、-0.44，Ps<0.001）。大学生生命意义感在经验性回避与焦虑间的中介效应值为 0.04，95%CI[0.01~0.08]不包含 0，说明中介效应显著，中介效应值占总效应值的 8.29%。大学生生命意义感在经验性回避与抑郁间的中介效应值为0.10， 95%CI[0.06~0.16]不包含0，说明中介效应显著，中介效应值占总效应值的 18.29%。研究三癌症患者的AAQ-Ⅱ得分与 SAS、SDS得分存在中等程度正相关（r=0.53、0.41，Ps<0.001），与 MLQ 得分存在低等程度负相关（r=-0.28，P<0.001）；MLQ 得分与 SAS、SDS得分存在中等程度负相关（r=-0.44、-0.47，Ps<0.001）。癌症患者生命意义感在经验性回避与焦虑间的中介效应值为 0.07，95%CI[0.03~0.12]不包含 0，说明中介效应显著；中介效应值占总效应值的 13.48%。癌症患者生命意义感在经验性回避与抑郁间的中介效应值为 0.10，95%CI[0.05~0.16]不包含 0，说明中介效应显著；中介效应值占总效应值的 23.84%。因变量是焦虑时，大学生群体和癌症群体间中介效应系数ab间卡方检验的 Wald值为 4.69，P<0.05，两个群体间的中介效应程度存在显著差异，且癌症人群的中介效应程度更大。因变量是抑郁时，大学生群体和癌症群体间中介效应系数 ab间卡方检验的 Wald值为 0.83，P>0.05,即两个群体间的中介效应程度不存在显著差异。结论：第一，AAQ-Ⅱ中文版在大学生中的信效度良好。为中国背景下进行经验性回避、心理灵活性或 ACT 的相关研究提供了有效的测量工具。第二，大学生群体的生命意义感在经验性回避与焦虑抑郁情绪间有中介效应。第三，癌症人群的生命意义感在经验性回避与焦虑抑郁情绪间有中介效应。第四，经验性回避是焦虑抑郁功能性的跨诊断因素之一。第五，生命意义感在经验性回避与焦虑情绪间的中介效应程度，在癌症人群中显著高于大学生群体。
其他摘要	Objective: The present research focuses on Experiential Avoidance, which is one of the core concept among the six processes of psychopathology underlies Acceptance and Commitment therapy (ACT). The Acceptance and Action Questionnaire-the second version (AAQ-Ⅱ) has been used to measure experiential avoidance widely abroad. Three aims are contained in the research. The first is to assess reliability and validity of the Chinese translation of AAQ-Ⅱand so as to provide a stable and psychometrically sound instrument in studies of experiential avoidance, psychological flexibility and ACT in China. The second is to further explore the effect of experiential avoidance and value on anxiety and depression both in college students and cancer patients. And the last is to compare the degree difference of value/meaning of life’s mediation effect between the two groups. In this way, we can provide evidence that experiential avoidance can serve as a functional transdiagnostic dimension, which is beneficial to the treatment. What’s more, we can provide an empirical basis for the design of intervention protocol on cancer patients. Methods： The study was composed of three studies. Study 1: Reliability and validity of AAQ-II in college students. In total, responses were collected from 1775 college student from Beijing, Henan, and Sichuan provinces, and 1749 valid questionnaires were obtained. SPSS version 22.0 and Amos version 21.0 were applied to conduct exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Criterion validity was tested by the Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS). Convergent and incremental validity were tested by the Mindful Attention Awareness Scale (MAAS) and Ruminative Responses Scale (RRS). After 1 month, 238 of the participants from the total sample were randomly sampled out to assess the test-retest reliability. Study 2: Experiential avoidance and anxiety and depression in college students: Mediating role of meaning of life. Totally 366 participants randomly selected from the total sample of study 1 were assessed with AAQ-II、SDS、SAS、MLQ (Meaning in Life Questionnaire). SPSS version 22.0 was used to conduct descriptive statistics and Pearson's correlation. Nonparametric percentile bootstrap method was used to test the mediating effect of meaning in life between experiential avoidance and anxiety as well as depression. Study 3: Experiential avoidance and anxiety and depression in cancer patients: Mediating role of meaning of life. Totally 352 patients with thyroid cancer from nuclear medicine clinic and oncology patients were selected by cluster sampling in two Beijing hospitals. Assessed by the same questionnaires with study 2, a total of 301 valid questionnaires were acquired. Statistical methods were in parallel with study 2. Moreover, when we conducted multiple-group mediating effect analysis, Mplus version 7.0 was applied to compare the regression coefficient and mediating coefficient between the two structural equation models. Results: In study 1, results of EFA showed that one factor solution explained 62.5% of the total variance, and factor loadings ranged between 0.72 to 0.84. Results of CFA confirmed the hypothesized one-factor mode (x2/df=4.56,CFI=0.99,TLI=0.97,RMSEA=0.06). Furthermore, the AAQ-Ⅱ was correlated with SDS, SAS, MAAS and RRS positively (r=0.26～0.69，Ps<0.01). The AAQ-II also showed incremental validity beyond mindfulness or rumination in explaining depression and anxiety (ΔR2=0.07～0.13，Ps<0.001). The AAQ-Ⅱ additionally demonstrated good internal consistency (Cronbach’s α=0.88) and test-retest reliability (Cronbach’s α=0.80). In study 2, the AAQ-Ⅱ was medium positively correlated with SDS and SAS (r=0.55,0.57， Ps<0.001)， and medium negatively correlated with MLQ (r=-0.42， P<0.001) in college students. The MLQ was medium negatively correlated with SAS and SDS (r=-0.32, -0.44，Ps<0.001). Nonparametric percentile bootstrap method showed that meaning in life in college students mediated experiential avoidance and anxiety. The mediating effect was 0.042(95%CI: 0.010~0.08), which accounted for 8.29% of the total effect. Nonparametric percentile bootstrap method showed that meaning in life in college students mediated experiential avoidance and depression. The mediating effect was 0.10 (95%CI: 0.06~0.16), which accounted for 18.29% of the total effect. In study 3, the AAQ-Ⅱ was medium positively correlated with SAS and SDS (r=0.53,0.41，Ps<0.001)，and negatively correlated with MLQ (r=-0.28，P<0.001) in cancer patients. The MLQ was medium negatively correlated with SAS and SDS (r=-0.44, -0.47, Ps<0.001). Nonparametric percentile bootstrap method showed that meaning in life in cancer patients mediated experiential avoidance and anxiety. The mediating effect was 0.07 (95%CI: 0.03~0.12), which accounted for 13.48% of the total effect. Nonparametric percentile bootstrap method showed that meaning in life in cancer patients mediated experiential avoidance and depression. The mediating effect was 0.10 (95%CI: 0.05~0.16), which accounted for 23.84% of the total effect. As for the comparison of the two groups in anxiety, the Wald value of mediating effect ab was 4.69，P<0.05. This indicated that there was significant difference between college students and cancer patients, and the mediating effect was higher in cancer patients. When comparing of the two groups in depression, the Wald value of mediating effect ab was 0.83，P>0.05. This indicated that the mediating effect degree difference between college students and cancer patients was not significant. Conclusion: First, the Chinese version of AAQ-Ⅱ has acceptable psychometric properties in college students. AAQ-Ⅱ can be applied in studies of experiential avoidance and ACT in China. Second, meaning in life mediates experiential avoidance and anxiety and depression in college students. Third, meaning in life mediates experiential avoidance and anxiety and depression in cancer patients. Fourth, experiential avoidance can serve as a functional transdiagnostic dimension for anxiety and depression. Fifth, the mediating effect degree of meaning in life between experiential avoidance and anxiety is different significantly in two groups, and the mediating effect was higher in cancer patients.
学科领域	应用心理学
关键词	经验性回避生命意义感焦虑抑郁情绪接纳承诺疗法中介效应
学位类型	硕士
语种	中文
学位专业	心理学
学位授予单位	中国科学院研究生院
学位授予地点	北京
文献类型	学位论文
条目标识符	http://ir.psych.ac.cn/handle/311026/19873
专题	健康与遗传心理学研究室
作者单位	中国科学院心理研究所
推荐引用方式 GB/T 7714	曹静. 生命意义感在经验性回避和焦虑抑郁间的中介效应检验[D]. 北京. 中国科学院研究生院,2016.

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