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1 徳島大学人間科学研究第巻 () 1) 2) Effects of structured disclosure of trauma on physical and mental function: An examination of individuals who have maintained posttraumatic stress reactions and the written content. Akari YUASA 1), and Kenji SATO 2) Abstract The purposes of this study were to examine effects of written disclosure of trauma on physical and mental functions and the written content for the individuals who have maintained posttraumatic stress reactions (PTSR). The written disclosure was structured to take distance from the reactions of the trauma. The participants were randomly assigned to three groups and received three times of writing sessions of 20 minutes once a week: the structured disclosure group(n=6), the free disclosure group(n=4) and the control group(n=4). Although it was found that the degree of the distancing in the structured disclosure group was higher than those of the free disclosure and control groups, these difference were not statistically significant. The changes were not seen in PTSR and other health indexes before and after disclosure. The written content analyses suggested that the more cognitive words increased, the better the health was in only the structured disclosure group. At the same time, the more cognitive words increased, the stronger the subjective degree of the distress was aroused. To summarize the above, it was suggested that the procedures to take the distance from the reactions of the trauma in this study were not enough. Further examination of the instruction of structuring is needed in future. The result of this study was discussed by theoretical framework. Key Words; trauma, posttraumatic stress reactions, structured disclosure 1) 25 Master s degree in Clinical Psychology Studies, Graduate School of Integrated Arts and Science, The University of Tokushima in ) Graduate School of Integrated Arts and Sciences, The Tokushima University 29

2 湯淺明李佐藤健二 1995 Posttraumatic Stress Disorder( PTSD) DSM- IV -TR(APA, 2000) PTSD ( A1) ( A2) 1 ( E) ( B) ( C) ( D) A (, 2009) A B D (Posttraumatic Stress Reaction PTSR) (2009) PTSR PTSR PTSD A Shapiro & Forrest(1997) PTSR (Gold, Marx, Soler-Baillo, & Sloan 2005) PTSD A ( 2001) (2005) DSM- IV -TR A ( ) (2005) 30

3 トラウマの構造化開示が心身の機能に及ぼす影響外傷後ストレス反応を維持させている個人とその筆記内容の検討 (2009) PTSD A PTSR PTSR PTSR PTSD (Cognitive Behavioral Therapy/ CBT) (Prolonged Exposue/ PE) (EMDR) (Bisson, Ehlers, Matthews, Pilling, Richards, & Turner, 2007) PTSR ( ) Pennebaker ( Pennebaker & Beall 1986) ( ) (Klein & Boals 2001) (Smyth 1998) (Working Memory WM ) (Klein & Boals 2001) WM ( ) (Klein & Boals 2001) ( 2001) WM ( 2006 Yogo & Fujihara, 2008) 1 ( 2009) ( ) ( 2001 ) Frattaroli(2006) 31

4 湯淺明李佐藤健二 146 8(5%) 36(25%) 7 2 PTSR 1 Foa, Keane,& Friedman (2000) PTSR (cognitive reappraisal) Lange et al.(2001) ( ;structured disclosure) PTSR (Lange et al., 2001) (2005) IES (2009) CBT ( ) 1 ( 2008) (2009) WM PTSR (Ehlers et al., 2005) ( stuck point hot spots ) (Grey, Holmes,& Brewin, 2001) (Holmes, Grey,& Young, 2005) ( ) PTSR (Ehlers & Clark, 2000) (2012) (2009) 32

5 トラウマの構造化開示が心身の機能に及ぼす影響外傷後ストレス反応を維持させている個人とその筆記内容の検討 1 WM PTSR (2011) ( ) (metacognition) 2 Beck(1976) PTSR (Kabat-Zinn, 1994) CBT CBT CBT ( 2008) ( 2008) (2011) (2012) CBT CBT (2012) (2011) Beck(1976) PTSR ( ) ( ) 33

6 湯淺明李佐藤健二 ( 2008) (2008) (2008) Ehlers & Clark (2000) ( ) ( ) (Pennebaker & Francis 1996) Lutgendorf & Antoni(1999) (2012) (2008) 6 1. A ( time1) (2001) Impact of Event Scale/ IES (Asukai & Miyake,

7 トラウマの構造化開示が心身の機能に及ぼす影響外傷後ストレス反応を維持させている個人とその筆記内容の検討 2 ( time2) IES time1 6 time2 E time1 IES 9 57 time1 time2 (2008) time1 time1 1 time time time2 IES 9 time2 (Sheehan & Lecrubier, 2003; M.I.N.I.) PTSD (I.C.) 25 7 ( IES )

8 湯淺明李佐藤健二 ( ) Pennebaker(2004) ( ) ( ) ( ) 2. I.C. 1 ( pre) 1 3 (S1 S2 S3) S3 2 ( 2w) 1 ( 1m) 2w 1m (2012) ( S1) 2 ( S2) ( S3) S2 S1 S1 1 36

9 トラウマの構造化開示が心身の機能に及ぼす影響外傷後ストレス反応を維持させている個人とその筆記内容の検討 S2 2 S S1 3 S1 37

10 湯淺明李佐藤健二 S2 S3 4. ( (2008) ) 20 (Bagby et al., 1994) ( 2003 TAS-20) (Radloff 1977) ( 1985 CES-D) ( 2006 PSS) ( ) ( ) ( ) Positive Affect and Negative Affect Scale(Watson et al., 1988) (, 2001 PANAS) PTSR IES 11 ( ) ( 2007 CC) ( ) 4( ) 4 Pennebaker Inventory of Limbic Languidness (Pennebaker, 1982) ( 2001 PILL) The General Health Questionnaire 28 (Goldberg, 1972) ( 38

11 トラウマの構造化開示が心身の機能に及ぼす影響外傷後ストレス反応を維持させている個人とその筆記内容の検討 1985 GHQ28) (time1 ) (3) F(2,11)=.105 p= F(2,11)=.050 p=.951 F(2,11)=.192 p= TAS-20 CES-D (3) TAS-20 F(2,11)=.105 p=.901 CES-D F(2,11)=.050 p=.951 PSS (3) (3) (F(4,22)=.024 p=.976) 3. (3) (3) a. (F(4,22)=1.321 p=.293) (F(2,11)= p<.001) (p=.001) (p<.001) b. (F(2,11)= p=.003) (F(1.345, )=6.658 p=.015) (p=.044) (p=.002) S1 S3 (p=.018) (F(2.690,14.798)=2.993 p=.069) 2 (p=.009) (p<.001) Greenhouse-Geisser c. (F(4,22)=1.624 p=.204) (F(2,11)= p=.001) (p=.040) (p=.001) 39

12 湯淺明李佐藤健二 (p=.047) d. S1 S1 S2 S2 S3 S3 S3 S2 4. a. PANAS (3) (3) (2) (F(1,22)= p=.005) (2) (3) (F(2, 8)=.931 p=.414) (F(2,8)=8.902 p=.018) b. IES IES IES CC PILL GHQ28 OSPAN (3) IES (3) (3) (F(1.305,14.358)=5.819 p=.023) pre 2w (p=.054) IES (F(2,22)=5.260 p=.014) pre 1m (p=.074) IES (F(1.292,14.214)=4.234 p=.050) pre 2w (p=.049) (F(2,11)=4.445 p=.038) (F(1.320,14.515)=2.963 p=.099) (p=.039) pre 1m (p=.007) ( 1) CC PILL GHQ28 OSPAN 5. 1) 6 4 S

13 トラウマの構造化開示が心身の機能に及ぼす影響外傷後ストレス反応を維持させている個人とその筆記内容の検討 2) Pennebaker & Francis(1996), Pennebaker & King(1999), Pennebaker, Mayne & Francis(1997) (2009) 4 a. b. ( ) ( ) ( ) c. d. 4 S1 S2 S3 S1 S3 3) (2) (F(1,7)=3.758 p=.094) (F(1,7)=4.550 p=.070) S1 (p=.034) 1 S2 (p=.020) 4) 5 pre 1 a. 41

14 湯淺明李佐藤健二 b. IES (Asukai & Miyake, 1998 c. CC( 2007) d. PILL ( 2001) e. GHQ28 ( 1985) f. OSPAN (Turner & Engle, 1989) 5 2)a.~d. S1 S3 2)e. S1 S3 (r=-.908 p=.033) (r=-.858 p=.063) (r=-.869 p=.056) (r=-.924 p=.025) IES (r=.808 p=.098) IES (r=.881 p=.049) GHQ28 (r=.985 p=.002) (r=.912 p=.031) IES IES (r=-.933 p=.067) (r=-.998 p=.002) OSPAN (r=-.957 p=.043) 1. 1) 2) ( ) ( ) ( ) 2 1)2) 2. 1) 42

15 トラウマの構造化開示が心身の機能に及ぼす影響外傷後ストレス反応を維持させている個人とその筆記内容の検討 3. 1) (2012) (2012) (2010) 2) WM (2010) WM 3)PTSR IES PTSR pre 1m 4) 43

16 湯淺明李佐藤健二 Pennebaker(1986) Smyth(1998) WM 1 4. (2008) 6 6 time2 (2008) 5. (2009) 4 Pennebaker(1997) PTSR WM WM 44

17 トラウマの構造化開示が心身の機能に及ぼす影響外傷後ストレス反応を維持させている個人とその筆記内容の検討 C American Psychiatric Association 2000 Diagnostic and statistical manual of mental disorders forth edition text revision. American Psychiatric Association Washington D. C. ( ) 2002 DSM- -TR Asukai, N. & Miyake, Y PTSD as function of the traumatic event, post-traumatic stress, and pre-trauma vulnerability. Psychiatry and Clinical Neurosciences 52 (Suppl.) pp Bagby, R. M., Parker, J. D. & Taylor, G. J The twenty-item Toronto Alexthymia Scale-I; Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38, pp Beck, A.T Cognitive therapy and the emotional disorders. New York: International University Press. ( A.T. ( ) 1990 ) Bisson, J., Ehlers, A., Matthews, R., Pilling, S., Richards, D., & Turner, S Psychological treatments for chronic post-traumatic stress disorder Systematic review and meta-analysis. British journal of psychiatry 190 pp Ehlers, A. & Clark, D. M A cognitive model of posttraumatic stress disorder. Behavior Research and Therapy, 38, 4, Ehlers,A.,Clark,D.M.,Hackmann,A.,McM anus,f., & Fennnell,M Cognitive therapy for post-traumatic stress disorder; Development and evaluation. Behaviour Resesrch and Therapy, 43, Foa, E.B., Keane, T.M. & Friedman, M.J Effective treatments for PTSD. Practice guidelines from the nternational society for traumatic stress studies. New York: Guilford press. ( E.B. T.M. M.J. ( ) 2005 PTSD ) Frattaroli, J Experimental disclosure and its moderators: A meta-analysis. Psychological Bulletin, 132, Frattaroli, J Experimental disclosure and its moderators A meta-analysis. Psychological Bulletin 132(6) pp

18 湯淺明李佐藤健二 Gold S. D. Marx B. P. Soler-Baillo J. M. & Sloan D. M Is life stress more traumatic than traumatic stress? Journal of Anxiety Disorders Goldberg, D.P The detection of psychiatric illness by questionnaire. Oxford: Oxford University Press.Grey,N.,Holmes,E.,&Brewin,C.R Pritoraumatic emo Cognitine Psychotherapy, 29, (1) 36 pp : 2 6, 46-53, : 39(2) pp Holmes,E.A., Grey,N.,& Young,K.A.D Intrusive images and trauma memories in Posttraumatic Stress Disorder: an exploratory investigation of emotions and cognitive themes. Journal of Behavior Therapy and experimental Psychiatry, 36, pp (1) pp Kabat-Zinn, J Wherever you go, there you are: Mindfulness meditation in everyday life. New York: Hyperion ( ) pp3-15 Klein K. & Boals A. 2001a Expressive writing can increase working memory capacity. Journal of Experimental Psychology. General Klein K. & Boals A. 2001b The relationship of life event stress and working memory capacity. Applied Cognitive Psychology (1) The 20-item Tronto Alexithymia Scale TAS-20, 43, 12, pp Lange, A., van de Ven,J.P., Schrieken, B.,& Emmelkamp P.M.G Interapy. 46

19 トラウマの構造化開示が心身の機能に及ぼす影響外傷後ストレス反応を維持させている個人とその筆記内容の検討 Treatment of posttraumatic stress through the Internet: A controlled trial. Journal of Behavior Therapy and Experimental Psychiatry. 32, Lutgendorf, S. K., & Antoni, M. H Emotional and cognitive processing in a trauma disclosure paradigm. Cognitive Therapyand Research, 23, DSM PTSD 7(2) pp : 19, 31-48, GHQ pp : 20, pp Pennebaker, J. W The psychology of physical symptoms. New York Springer-Verlag. Pennebaker, J. W. & Beall, S. K Confronting a traumatic event Toward an understanding of inhibition and disease. Journal of Abnormal Psychology, 95, 3, pp Pennebaker, J. W., & Francis, M. E Cognitive, emotional, and language process in disclosure.cognition and Emotion, 10, Pennebaker, J.W Writing about emotional experiences as a therapeutic process. Psychological Science, 8, Pennebaker, J. W., & King, L. A Linguistic styles language use as an individual differences. Journal of Personalityand Social Psychology, 77, Pennebaker, J. W Writing to heal A guided journal for recovering from trauma & emotional upheaval. New York New Harbinger Publications. ( ( ) 2007 ) Radloff, L. S The CES-D Scale A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, pp

20 湯淺明李佐藤健二 34 pp PANAS, 9, 2, pp pp Sheehan, D. V. & Lecrubier, Y M. I. N. I. Mini-International Neuropsychiatric Interview Japanese version Tokyo Seiwa Shoten Pubulishers. ( ) 2003 M. I. N. I Shpiro,F., Forrest,M.S EMDR: The breakthrough therapy for overcoming anxiety, stress, and trauma. Basic Books, New yoek. 1985, 27, 6, pp Smyth, J. M Written emotional expression Effect sizes, outcome types, and moderating variables. Journal of Consulting and Clinical Psychology 66 pp Smyth JM, Stone AA, Hurewitz A & Kaell A Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis: a randomized trial. JAMA 281(14) pp (2) pp Turner, M. L. & Engle, R. W Is working memory capacity task dependent? Journal of Memory and Language, 28, Perceived Stress Scale, 19, 2, pp Watson, D., Clark, L.A., & Tellegen, A Development and validation of brief measure of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, Yogo, M., & Fujihara, S Working memory capacity can be improved by expressive writing: A randomized experiment in a Japanese sample. British Journal of Health Psychology, 13, ( 受付日年 9 月日 ) ( 受理日年 9 月日 ) 48

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