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系統識別號 U0002-1601201712590300
中文論文名稱 正念減壓課程運用於女性飲食困擾者之成效研究 -以研究參與者觀點探討
英文論文名稱 Exploring the Outcomes of A Mindfulness-Based Stress Reduction Program (MBSR) on Women with Eating Disturbances: Discussions from the Perspectives of Women Participants
校院名稱 淡江大學
系所名稱(中) 教育心理與諮商研究所碩士班
系所名稱(英) Graduate Institute of Educational Psychology and Counseling
學年度 105
學期 1
出版年 106
研究生中文姓名 黃竫茵
研究生英文姓名 Ching-Yin Huang
學號 600690027
學位類別 碩士
語文別 中文
口試日期 2017-01-06
論文頁數 286頁
口試委員 指導教授-郭瓈灔
共同指導教授-李麗君
委員-李燕蕙
委員-陳秀蓉
中文關鍵字 正念  減壓課程  女性  飲食困擾 
英文關鍵字 mindfulness  stress reduction program  women  eating disturbances 
學科別分類 學科別社會科學教育學
中文摘要 本研究主要探討女性飲食困擾者在參與正念減壓課程之前,有關飲食困擾經驗中,個人在身體知覺、身體意象、情緒性飲食、與食物的關係和其他層面的概況為何?參與正念減壓課程之後,對身體知覺、身體意象、情緒性飲食、與食物的關係和其他層面的影響為何?本研究共招募5位研究參與者,經過八週+1日正念減壓課程後
,分別接受研究者1~2次、每次約1.5小時的訪談,訪談內容形成逐字稿文本,作為研究分析的資料來源。研究者以紮根理論方法論中的開放編碼和主軸編碼作為本研究的分析方法。
經過八週+1日正念減壓課程之後,獲得研究成果如下:
一、對身體知覺方面
(一)研究參與者在透過有意識地覺察身體狀況後,均提升對身體的關切程度與敏感度。
(二)意識到情緒會影響生理問題,兩者之間具有關聯性,提高對生理變化的覺察速度。
(三)透過有意識地放鬆,可以減緩身體的緊繃感。
(四)觀察疼痛的樣態,減少對抗的精力,發現疼痛會降低。
(五)升起注意身體健康,練習自我照顧的狀況。
二、對身體意象方面
(一)課程期間,少部分研究參與者有體重自然下降的情形;課程結束後,有位研究參與者仍持續減瘦。
(二)對於某位強調瘦身減重的研究參與者,則容許體重在生理期的些微波動,不再用極端手段逼迫自己減重,並產生對纖細身體意象的新看法,接納現下的身體意象,並拓展出「活命比身材重要」的價值。
三、情緒性飲食
(一)終結無意識地陷入食不知味的暴飲暴食,透過慢食取代狼吞虎嚥,比較能夠帶來飽足感。
(二)能夠改變過去吃東西不太咀嚼就吞嚥的習慣,開始自然地吃飽與停止。
(三)即使心情不好也不會暴食,能夠享受進食的過程,從中得到心理撫慰。
(四)能夠辨別飢餓是生理需求或是壓力情緒造成的心理需求。
(五)有意識地覺察進食時的生理狀況,即使沒有再食,也沒有飢餓感。
(六)降低對垃圾食物的衝動性購買行為。
(七)飲食決策歷程可以降低衝動式飲食的慾望。

四、 與食物的關係
(一)即使沒有飽足感,開始能夠停下來不吃。停下來,才有機會直接覺察身體現況,提升對飽足感或飢餓感的反應與控制力。
(二)對食物的掌握不再在乎立即擁有,與食物的關係變得比較有彈性,有延宕飲食的效果。
(三)減慢吃飯速度,開始能夠控制食量。
(四)意識到飲食中的身體與心理狀態,反思購買與食用零食是為了滿足掌控慾。
(五)覺察暴食的焦慮來自無法自我接納,自我接納促進改變與食物的關係。
(六)開始有意識地思考飲食前的決策,採取較為健康的覓食行動
(七)其中一位研究參與者在練習正念後,已經不太會有把食物吐出來的意念或行為;改變對食物的反應模式,對於過去對食物匱乏要趕快吞食的危機感降低,變成更放鬆地享用食物。
五、其他層面
(一)情緒層面
1.獲得心理或情緒的平穩性,有助處理生活事物的能力。
2.用「放下情緒」替代過去的「偏執情緒」。
3.看清楚情緒背後的意義,可以弱化情緒的反應強度。
4.發現自己的情緒狀態會影響行動。
5.學會緩慢或暫停,有助於覺知內在深層的感受。
6.心理狀態的平靜,透過轉移生活目標,減輕痛苦情緒。
7.能夠轉化衝突事件的情緒,不會憂鬱反芻。
8.改變在壓力事件的回應模式,能夠劃出一個轉圜的空間,在減緩呼吸讓情緒回穩,也能變得比較理智。
9.能自然養成正面解讀別人動機或意圖的習慣,多了很多包容,能心平氣和地面對原本對周遭事物不滿的情緒。
10.討論不愉快事件與溝通困難情境有助於面對生活中的事件。
(二)自我接納層面
從覺察自我開始進入到接納自我的意識,興起溫柔照顧自己的意念。
1.對生理上疼痛的接納
面對長期偏頭痛,練習接納→休息→跟疼痛相處→情緒變得較不暴躁,體驗不耗力在對抗不能控制的事情上,逐漸增強自我控制感與長養出自我疼惜。
2.對心理上的接納
減少逃避與抗拒的情緒,縮短適應時間,提高對挫折經驗的接納程度,心理愈發成熟;改變覺察焦點回到連結內在心理與身體狀態,與自己內在同在,並降低自我評價。
3.對身體意象的接納
真心接納原本不喜歡的事物,願意接納自己身材的不完美,包括比較能真心接納他人肥胖的狀態。
(三)人際關係層面
回復與自己內在接觸,不再向外求,放下工作上與人我關係中的相互期待與評價焦慮,人際互動上更真誠地表達自己,調整人我關係更為自在。與家人的關係變得比較和善,在衝動性言語出口之前,能先轉換情緒降低衝突,減少口角衝突發生的可能。

最後經由本研究結果提供以飲食為主題之相關的後續研究與諮商實務工作建議。
英文摘要 This study explores the outcomes of five women participants with eating disturbances in a Mindfulness-Based Stress Reduction Program (MBSRP). In essence, this study investigated the women participants in the dimensions of individual physical perceptions, body images, emotional eating, individual relationships with food, and others before and after the intervention of the MBSRP. This study recruited five women, and the Program lasted for eight weeks plus one day. Each of the participants were invited for face-to-face interviews before and after the intervention program, 1.5 hours per interview. All interviews were recorded and transcribed for qualitative analyses with the grounded theory approach. At the start of the analysis, the researcher utilized the open coding strategy to identify the themes, and followed by developing core coding schemes for further coding of the entire interview data.
Outcomes of the MBSRP intervention are summarized below:
1. The body perception
1.1 Participants developed a sense of taking better care of their bodies, and became more sensitive.
1.2 Participants understood better the impact of emotions on physical problems, the relationship and interaction between those two dimensions. Consequently, participants became more alerted about their own physical changes.
1.3 Participants were able to practice relaxation which helped reduce the tension of the bodies.
1.4 Participants became more observant of the myriad faces of pain, and reduced their resistance to it. As a consequence, the level of pain was perceived to be decreasing.
1.5 Participants became more aware of health in its own right, and were practicing to take better care of themselves.
2. The body image
1.1 Some of the participants experienced weight losses as a natural consequence during the MBSRP intervention; after the Program, one of the participants continued to have weight loss.
1.2 One of the participants who had been constantly forcing herself to reduce weight became more tolerant to the weight increase during the menstruation. Interestingly, she stopped deviant behaviors of reducing weights, accepted her present body image, adopted more diverse viewpoints on the body image, and even developed the value of “being alive is more precious than being slim”.
3. The emotional eating
1.1 Participants stopped binge eating, and replaced the behaviors by more chewing and slower eating which brought up new experiences of eating satisfaction.
1.2 Participants stopped eating without chewing. They became more able to feel full and thus stop eating naturally.
1.3 Participants stopped binge eating when going through emotional valleys. Instead, they started using proper eating as a tool to comfort their bad emotions.
1.4 Participants became more able to distinguish the physical needs from the emotional pressures when feeling the desire to eat.
1.5 Participants became more observant of their physical conditions. They stopped experiencing the feeling of hunger given that they were not eating.
1.6 Participants reduced the emotional consuming of garbage foods.
1.7 Participants’ decision-making processes in food intake reduced the desire for emotional eating.
4. The relationship with food
1.1 Participants stopped eating given that they haven’t yet felt satisfied with eating. Only when stopping to eat could they observe their body changes more accurately, develop the skills of reacting to feeling full or feeling hungry, and gain a better control of food intake as a whole.
1.2 Participants were better trained in the timing of owning food and eating. Instead of wanting the food right now, they became more able to negotiate with themselves when to have the food, and consequently to extend the time to eat.
1.3 Participants were more able to slow down the eating speed, and to take a better control of the volume of food.
1.4 Participants became more conscious of physical and emotional changes during eating. They realized that the consuming of garbage food was only a reflection of wanting to take control.

1.5 Participants realized that the source of binge eating derived from low level of self-acceptance. Accepting oneself was the key to change the individual relationship with food.
1.6 Participants started to think about and make decisions before eating. Consequently they started to make healthier decisions of food intake.
1.7 One of the participants stopped the intention of vomiting or the behavior of vomiting after the intervention of MBSRP. Having experienced the lack of food at her younger age, the participant changed from swallowing up the food immediately to enjoying the food gracefully after the intervention.

5. Other dimensions
1.1 The emotions
a. More mental and emotional stableness increased the ability of dealing with daily lives.
b. Replacing “sticking with certain emotions” with “releasing certain emotions”.
c. Figuring out the meaning of emotions helps decreasing the emotional reaction.
d. Realizing the situations of emotions of the time could have an impact on actions.
e. Learning to slow down or stop for a moment could unveil the inner feeling.
f. Refocusing the goals in daily lives helped to gain the mental stableness, which could decrease the emotional pain.
g. Able to transfer emotions derived from conflicts, and able to not getting stuck in sadness.
h. Starting to change the reaction mode to stress, gaining the leeway to react, and consciously taking a breath to make better decisions.
i. Starting to decode intentions of other positively and more resilient to annoying matters.
j. Learning to discuss upsetting events and communicate helped to deal with daily lives.

1.2 Accepting oneself
Participants changed from being conscious of oneself to accepting oneself. This shift made participants become more self-compassionate of oneself, and more willing to take better care of oneself.
a. Accepting the physiological pain: Having been experiencing chronic migraine headache, the participant went through the processes of accepting the pain – taking rests – dancing with the pain – emotional stableness. She experienced not to fight against the uncontrollable events, and consequently developed a sense of self control along with self-compassion.
b. Accepting mentally: Participants decreased avoidance and resistance, increased the level of accepting failure, and thus became more mature mentally. The participants also shifted the focus to a deeper connection between the inner oneself and body. They became more present with inner selves, less judgmental to themselves.
c. Accepting to the body image: Participants became more tolerant to things that they originally disliked. They accepted their imperfect bodies, including the obesity of others.

1.3 Interpersonal relationships
Participants changed from pursuing outwards to connecting with inner selves. They released themselves from excessive expectations and judgments in work and interpersonal relations. When interacting with others, they became more honest expressing themselves, and more able to present themselves as they were. Their relationships with families also became better. They were more able to hold back emotional words before they really did, and thought through carefully about their own emotions. This reflecting before reacting decreased oral conflicts.

Finally, this study suggests directions for future practice and research.

論文目次 目 次

第一章 緒論
第一節 研究背景與動機 ………………………………………… 01
第二節 研究目的與問題 …………………………….…………… 06
第三節 名詞界說 ……………………………………………………07
第四節 研究的重要性………………………………….……………09
第二章 文獻探討
第一節 飲食障礙的相關論述……………………….…………… 11
第二節 正念減壓課程的研究成果 ……………….…………… 20
第三節 國內正念之相關實務與研究 …….……………………25
第四節 國外正念減壓課程運用於飲食障礙之相關研究..…32
第三章 研究方法
第一節 研究取向與方法 …………………………….……………43
第二節 研究參與者 ………………………………………………44
第三節 研究工具……………………………………………….……47
第四節 研究實施程序 …………………………………...………53
第五節 資料分析與處理 …………………………………………55
第六節 分析資料效度的檢核 …………………………………...56
第七節 研究倫理考量 …………………………………….…..……60
第四章 研究結果
第一節 焦慮嗜食的A小姐 ………………………….…..….61
第二節 纖纖玉體的B小姐 ………………………….…..…..90
第三節 否定自我的C小姐 …………………………………120
第四節 尋求自我的D小姐 …………………………………147
第五節 渴望認同的E小姐 ………………………………….176
第五章 綜合討論
第一節 課程實施前後身體知覺之概況……………………..214
第二節 課程實施前後身體意象之概況……………………..216
第三節 課程實施前後情緒性飲食之概況…………………..218
第四節 課程實施前後與食物的關係之概況…….…….……220
第五節 課程實施前後其他層面之概況……………………..223
第六章 結論與建議
第一節 研究結論 ……………………………………………228
第二節 研究限制與建議……………………………………232
參考文獻
中文部份 ……………………………………………………….….……..234
英文部份 …………………………………………………..…….………240
附錄
附錄一 : 基本資料、量表.…………………………….………...……250
附錄二 : 研究招募宣傳品………………………….….……….……..252
附錄三 : 研究邀請函…………………………………………….…….253
附錄四 : 研究參與同意書……………………………..…..…………254
附錄五 : 訪談大綱……………………………………….…….……….255
附錄六 : 訪談札記……………………………………..………….……256
附錄七 : 訪談逐字稿效度檢核表…………………….……………..257
附錄八 : 研究分析結果效度檢核表………………….…………….258
附錄九:逐字稿謄打保密同意書…………………….……..………….259
附錄十:團體課程簽到表…………………………….…………………260
附錄十一:正念減壓作業單 …………………………………….262
附錄十二:正念減壓(MBSR)團體活動回饋單………………266
附錄十三:正念減壓練習記錄……………………………………268





表 次

表2-3-1 醫護領域、正念減壓介入團體………………………………………26
表2-4-1 正念應用在飲食障礙之相關研..………………………………….….33
表3-2-1 研究參與者基本資料一覽表…………………………………………46
表3-6-1 逐字稿效度檢核表……………………………………………………57
表3-6-2 研究分析結果效度檢核表……………………………………………58


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