失眠於生物心理心靈社會面向之壓力－資源／調適模型圖的考量

Stress-Resource/Coping Model Diagram for Insomnia Using Biopsychospiritosocial Aspects

10.3966/168232812014062402001

蔡崇煌(Chung-Huang Tsai)；林哲鈺(James Che-Yu Lin)；黃素雲(Su-Yun Huang)；王俊堯(Jiun-Yao Wang)；李孟智(Meng-Chih Lee)

生物心理社會 ； 健康輪 ； 睡眠 ； 心靈 ； 太極 ； biopsychosocial ； health wheel ； sleep ； spirituality ； Tai Chi

台灣家庭醫學雜誌

24卷2期（2014 / 06 / 01）

49 - 61

繁體中文

失眠是相當常見的睡眠主觀症狀之一，其會困擾患者的生活品質，甚至引起失能而影響工作。長期失眠，若沒有適當的治療，亦易產生精神方面的疾病及心血管疾病，因此是值得我們去探討的問題。Spielman等曾對失眠因子提出3P理論，其內容為：1.前置因子，即容易產生失眠的個人特質、2.誘發因子，導致失眠開始發生的事件及3.持續因子，讓失眠長時間維持下去的因素等，其歸類方式清楚明瞭，前2者分別相當於生物心理及社會因素，最後者相當於對事件的處置或調適策略，以上可由蔡氏等提出之生物心理心靈社會面向於疾病之壓力－資源／調適（SR/C）模型圖做解釋。以SR/C模型圖思考，分類更直覺易懂，其強調壓力與資源要一併考量，並將其融入了太極陰陽圖及健康輪的概念，加入動態平衡的蹺蹺板支點概念表示調適策略，使解釋及應用範圍更廣，亦適用於住院醫師的全人醫療教學。

Insomnia, one of the most common subjective sleep symptoms, not only disturbs the quality of patients' life but may even lead to disability. Long-term insomnia without appropriate treatment is especially prone to cause mental disorders and cardiovascular diseases. All these make insomnia a disorder worth in-depth exploration. Spielman et al. introduced the easy-to-understand and now classic 3P model of insomnia identifying the following three groups of factors: 1. Predisposing factors (personal traits raising susceptibility to insomnia); 2. Precipitating factors (events causing insomnia); and 3. Perpetuating factors (factors maintaining or even exacerbating insomnia). The first two P's are equivalent to biopsychosocial (BPS) factors, and the last one to coping strategy. In order to accentuate the need for simultaneous consideration of both stress and resource, the study proposes to improve the 3P model of insomnia by using the stress-resource/coping (SR/C) model diagram that examines the biopsychospiritosocial (BPSS, an extension of BPS with the addition of spirituality) aspects of an illness. The concepts of Tai Chi Yin Yang and health wheel have also been integrated into the proposed approach, together with use of the dynamic seesaw fulcrum to represent coping strategies. Compared to the 3P model, the SR/C model diagram can be expected to render the classification more intuitive and easily understandable as well as to expand the range of its applications, including for teaching residents in holistic medicine.

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