Therapeutic Science for Rehabilitation (재활치료과학)

Korean Society of Neurological Occupational Therapy (대한신경계작업치료학회)
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Effects of Cognitive and Behavioral Avoidance on Sleep Quality through Depressive Symptoms in Female College Students

여대생의 인지 및 행동적 회피요인이 우울증상을 매개로 수면의 질에 미치는 영향

  • Kwak, Jin-Young (Dept. of Art Therapy, Graduate School of Psychotherapy, Sookmyung Women's University) ;
  • Ha, Eun-Hye (Dept. of Child Welfare, Sookmyung Women's University)
  • 곽진영 (숙명여자대학교 심리치료대학원 미술치료학과) ;
  • 하은혜 (숙명여자대학교 생활과학대학 아동복지학부)
  • Received : 2020.01.08
  • Accepted : 2020.02.04
  • Published : 2020.05.31
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Abstract

Objective : The purpose of this study was to examine the effects of depressive symptoms on the relationship between avoidance(brooding, reflection, and behavioral avoidance) and sleep quality. Methods : In total, there were 947 subjects who were assessed using self-reports on three measures: Center for Epidemiological Studies-Depression (CES-D), Ruminative Response Style (RRS), Cognitive-Behavioral Avoidance Scale (CBAS), and Pittsburgh Sleep Quality Assessment (PSQI). Results : First, depressive symptoms fully mediated the relationship between brooding and sleep quality. Second, reflection did not mediate the relationship between brooding and sleep quality, and reflection had no direct effects on depressive symptoms. Third, depressive symptoms partially mediated the relationship between behavioral avoidance and sleep quality. Conclusion : This study was confirmed the pathological characteristics of brooding compare to reflection, and the essential role of behavioral avoidance and depressive symptoms on sleep problems.

목적 : 본 연구의 목적은 여대생의 인지(자책, 숙고) 및 행동적 회피요인과 수면의 질의 관계에서 우울증상의 매개효과를 검증하는 것이다 연구방법 : 본 연구는 지역사회 1,000명의 여대생을 대상으로 우울증상(CES-D), 반추적 반응(K-RRS), 인지-행동 회피(CBAS), 수면의 질(PSQI)을 평가하였다. 최종 분석대상은 총 947명이었다. 자료분석은 SPSS 18.0과 AMOS 22.0 통계프로그램을 사용하였다. 결과 : 첫째, 자책과 수면의 질의 관계에서 우울증상의 완전매개효과가 유의미한 것으로 나타났다. 둘째, 숙고와 수면의 질의 관계에서 우울증상의 매개효과는 유의하지 않았으며, 숙고는 우울증상을 예측하지 않았다. 셋째, 행동적 회피와 수면의 질의 관계에서 우울증상의 매개효과가 유의미한 것으로 나타났다. 또한 행동적 회피는 수면의 질을 직접적으로 예측하였다. 결론 : 본 연구는 지역사회의 일반 여대생의 우울증상과 수면문제에 대한 자책의 더 병리적인 특성을 숙고와 비교하여 입증하였다. 또한 수면문제에 영향을 미치는 우울증상과 행동적 회피 요인의 주요한 역할을 밝혔다는데 의의가 있다.

Keywords

References

  1. Alvaro, P. K., Roberts, R. M., & Harris, J. K. (2013). A systematic review assessing directionality between sleep disturbances, anxiety, and depression. Sleep, 36(7), 1059-1068. doi:10.5665/sleep.2810
  2. Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic(2nd ed.). New York: Guilford.
  3. Borders, A., Rothman, D. J., & McAndrew, L. M. (2015). Sleep problems may mediate association between rumination and PTSD and depressive symptoms among OIF/OEF veterans. Psychological Trauma: Theory, Research, Practice and Policy, 7(1), 76-84. doi:10.1037/a0036937
  4. Burwell, R. A., & Skirk, S. R. (2007). Subtype of rumination in adolescent: Association between brooding, reflection, depressive symptoms, and coping. Journal of Clinical and Adolescent Psychology, 36(1), 56-65. doi:10.1207/s15374424jccp3601_6
  5. Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Journal of Psychiatry Research, 28(2), 193-213. https://doi.org/10.1016/0165-1781(89)90047-4
  6. Carney, C. E., Harris, A. L., Moss, T. C., & Edinger, J. D. (2010). Distinguishing rumination from worry in clinical insomnia. Behaviour Research and Therapy, 48(6), 540-546. doi:10.1016/j.brat.2010.03.004
  7. Carvalho, J. P., & Hopko, D. R. (2011). Behavioral theory of depression: Reinforcement as a mediating variable between avoidance and depression. Journal of Behavioral Therapy and Experimental Psychiatry, 42(2), 154-162. doi:10.1016/j.jbtep.2010.10.001
  8. Cheung, G. W., & Lau, R. S. (2008). Testing mediation and suppression effects of latent variables: Bootstrapping with structural equation model. Organizational Research Methods, 11(2), 296-325. doi:10.1177/1094428107300343
  9. Cheref, S., Lane, R., Polanco-Roman, L., Gadol, E., & Miranda, R. (2015). Suicidal ideation among racial/ethnic minorities: Moderating effects of rumination and depressive symptoms. Cultural Diversity and Ethnic Minority Psychology, 21(1), 31-40. doi:10.1037/ a0037139
  10. Cho, Y. W., Shin, W. C., Yun, C. H., Hong, S. B., Kim, J., & Earley C. J. (2009). Epidemiology of insomnia in Korean adults: Prevalence and associated factors. Journal of Clinical Neurology, 5(1), 20-23. doi:10.3988/jcn.2009.5.1.20
  11. Cho, S. Y., & Jo, H. I. (2017). The effects of rumination on stress response: The mediating effects of psychological inflexibility and coping flexibility. Korean Journal of Counseling, 18(6), 37-62. doi:10.23844/kjcp.2017.08.29.3.809
  12. Chon, K. K., Choi, S. C., & Yang, B. C. (2001). Integrated adaptation of CES - D in Korea. Korean Journal of Health Psychology, 6(1), 59-76.
  13. Hair, J. F., Black, W. C., Babin, B. J., Anderson, R. E., & Tatham, R. L. (2006). Multivariate data analysis(6th ed.). New Jersey: Prentice-Hall.
  14. Hasegawa, A., Yoshida, T., Hattori, Y., Nishimaru, H., Morimoto, H., & Tanno, Y. (2015). Depressive rumination and social problem solving in Japanese university students. Journal of Cognitive Psychotherapy: An International Quarterly, 29(2), 134-151. doi:10.1891/0889-8391.29.2.134
  15. Hong, H. J., Kim, N. H., & Park, J. Y. (2016). Relationship of smartphone addiction, living stress and quality of sleep in university students. Keimyung Journal of Nursing Science, 19(3), 1-13. doi:10.1016/j.chb.2015.12.045
  16. Jang, A. W., & Yong, J. S. (2019). Three shifts of nurse spirituality, health promotion behaviors and quality of sleep. The Journal of Spirituality, Health and Welfare, 6(1), 87-104.
  17. Jeon, S. Y., & Kim, E. J. (2013). The relationship between rumination subtypes(brooding vs reflection) and depression in undergraduate students: The mediating effect of avoidance. Cognitive Behavioral Therapy, 13(2), 285-306.
  18. Joormann, J., Dkane, M., & Gotlin, I. H. (2006). Adaptive and maladaptive components of rumination? Diagnostic specificity and relation to depressive biases. Behavior Therapy, 37(3), 269-280. doi:10.1016/j.beth.2006.01.002
  19. Jung, E. S., & Jeon, M. K. (2013). Comparison of the activities of daily living and sleep according to the presence depression in the elderly. Journal of Digital Convergence, 11(1), 289-297. doi:10.14400/JDPM.2013.11.1.289
  20. Jung, S. H., Park, J. H., Yoon, H. J., Kim, J. H., Kim N. C., & Kim, S. H. (2018). The relationship between sleep quality and depressive symptoms among university students: Moderating effect of the positive psychology. Journal of the Korean Society of Biological Therapies in Psychiatry, 24(3), 173-183. https://doi.org/10.22802/JKSBTP.2018.24.3.173
  21. Kessler, R. C., Berglund, P., Borges, G., Nock, M., & Wang, P. S. (2005). Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990-1992 to 2001-2003. Journal of the American Medical Association, 293(20), 2487-2495. doi:10.1001/jama.293.20.2487
  22. Kim, G. U., & Lee, J. H. (2019). Systematic review of the pittsburgh sleep quality index used for measuring sleep quality among adults with trauma experiences. Korean Journal of Adult Nursing, 31(4), 337-350. doi:10.7475/kjan.2019.31.4.337
  23. Kim, S. J., Kim, J. H., & Yoon, S. C., (2010). Validation of the Korean-Ruminative Response Scale(K-RRS). Korean Journal of Clinical Psychology, 29(1), 1-19. doi:10.15842/kjcp.2010.29.1.001
  24. Kwak, J. Y., & Ha, E. H. (2019). The effects of cognitive avoidance and behavioral on depressive symptoms of female college students. Health & Welfare, 21(3), 29-50. doi:10.23948/kshw.2019.09.21.3.29
  25. Kwon, S. M. (2013). Modern abnormal psychology. Seoul: Hakjisa.
  26. Leahy, R. L., Holland, S. J., & McGinn, L. K. (2012). Treatment plans and interventions for depression and anxiety disorders(2nd ed.). New York: The Guilford Press.
  27. Lee, G. E., Mun, S. J., Lee, S. I., Lim, J. H., We, Y. M., Moon, K. S., ... Kang, H. Y. (2016). Analysis of quantitative electroencephalograpy (QEEG) following acupunture treatment in patients with insomnia: Z scored absolute power and sLORETA. Journal of Oriental Neuropychiatry, 27(3), 169-184. doi:10.7231/jon.2016.27.3.169
  28. Lee, S. Y., Shin, M. S., & Kim, E. J. (2010). The effects of functionally different self-focused attention on depressive mood: Ruminative, reflective and experiential processing. Cognitive Behavioral Therapy, 10(1), 75-95.
  29. Lee, S. S., Kim, B. N., Park, S. B., & Park, M. H. (2017). Relationship between depression and sleep patterns of middle school student in seoul. Journal of the Korean Neuropsychiatric Association, 56(2), 78-83. doi:10.4306/jknpa.2017.56.2.78
  30. Lee, Y. H., & Lee, K. J. (2013). The effects of stress, rumination, dysfunctional beliefs and boundary on university student's sleep quality. The Korean Psychological Association, 18(1), 121-148. doi:10.17315/kjhp.2013.18.1.008
  31. Lovato, N., & Gradisar, M. (2014). A meta-analysis and model of the relationship between sleep and depression in adolescents: Recommendations for future research and clinical practice. Sleep Medicine Reviews, 18(6), 521-529. doi:10.1016/j.smrv.2014.03.006
  32. Mackenzie, S., Wiegel, J. R., Mundt, M., Brown, D., Saewyc, E., Heiligenstein, E. ... Fleming, M. (2011). Depression and suicide ideation among students accessing campus healthcare. American Journal of Orthopsychiatry, 81(1), 101-107. doi:10.1111/j.1939-0025.2010.01077.x
  33. Morin, C. M. (1993). Insomnia' psychological assessment and management. New York: The Guilford Press.
  34. Moulds, M. L., Kandris, E., Starr, S., & Wong, A. C. M. (2007). The relationship between rumination, avoidance and depression in a non-clinical sample. Behavior Research and Therapy, 45(2), 251-261. doi:10.1016/j.brat.2006.03.003
  35. Noh, S., Cho, Y., & Choi, M. (2014). The influences of self-compassion and life stress on suicidal ideation among undergraduate students: Mediating roles of rumination and depression. Korean Journal of Clinical Psychology, 33(4), 735-754. doi:10.15842/kjcp.2014.33.4.005
  36. Nolen-Hoeksema, S., & Morrow, J. (1991). A prospective study of depression and posttrumatic stress symptoms after a natural disaster: 1989 Loma Prieta earthquake. Journal of Personality and Social Psychology, 61(1), 115-212. doi:10.1037/0022-3514.61.1.115
  37. Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking and rumination. Perpectives on Psychological Sciences, 3(5), 400-424. doi:10.1111/j.1745-6924.2008.00088.x
  38. Ottenbreit, N. D., & Dobson, K. S. (2004). Avoidance and depression: The construction of the cognitive-behavioral avoidance scale. Behaviour Research and Therapy, 42(3), 292-313. doi:10.1016/S0005-7967(03)00140-2
  39. Ottenbreit, N. D., Dobson, K. S., & Quigley, L. (2014). A psychometric evaluation of the cognitive-behavioral avoidance scale in women with major depressive disorder. Journal of Psychopathology and Behavioral Assessment, 36(4), 591-599. doi:10.1007/s10862-014-9416-3
  40. Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 365-401. https://doi.org/10.1177/014662167700100306
  41. Sadigh, M. R., Himmanen, S. A., & Scepansky, J. A. (2014). An investigation of the prevalence of insomnia in college students and its relationship to trait anxiety. College Student Journal, 48(1), 397-406.
  42. Shen, X., Wu, Y., & Zhang, D. (2016). Nighttime sleep duration, 24-hour sleep duration and risk of all-cause mortality among adults: A meta-analysis of prospective cohort studies. Scientific Reports, 6, 21480. doi:10.1038/srep21480
  43. Shin, J. E., Lee, T. H., & Yoon, S. J. (2017). A bifactor approach to the factor structure study of the CES-D Scale. Korean Journal of Stress Research, 25(4), 272-278. doi:10.17547/kjsr.2017.25.4.272
  44. Siberman, S. A. (2008). The insomnia workbook: A comprehensive guide to getting the sleep you need. CA: New Harbinger Publication, Inc.
  45. Siversten, B., Harvey, A. G., Lundervold, A. J., & Hysing, M. (2014). Sleep problems and depression in adolescence: Results from a large population-based study of norwegian adolescents aged 16-18 years. European Child and Adolescent Psychiatry, 23(8), 681-689. doi:10.1007/s00787-013-0502-y
  46. Sohn, G. J., Kim, H. J., Kang, S. H., Lim M. H., Chung, H. G., Choi, J. H. ... So, H. (2014). Sleep patterns and predictors of daytime sleepiness in high school students. Journal of Korean Neuropsychiatr Association, 53(6), 426-433. doi:10.4306/jknpa.2014.53.6.426
  47. Stockton, H., Hunt, N., & Joshep, S. (2011). Cognitive processing, rumination, and posttraumatic growth. Journal of Traumatic Stress, 24(1), 85-92. doi:10.1002/jts.20606
  48. Takano, K., Iijima, Y., & Tanno, Y. (2012). Repetitive thought and self-reported sleep disturbance. Behaviour Therapy, 43(4), 779-789. doi:10.1016/j.beth.2012.04.002
  49. Trew, J. L. (2011). Exploring the roles of approach and avoidance in depression: An integrative model. Clinical Psychology Review, 31(7), 1156-1168. doi:10.1016/j.cpr.2011.07.007
  50. Treynor, W., Gonzalez, R., & Nolen-Hoeksema, S. (2003). Ruminative reconsidered: A psychometric analysis. Cognitive Therapy and Research, 27(3), 247-259. doi:10.1023/A:102391031556
  51. Voss, U., Kolling, T., & Heidenreich, T. (2006). Role of monitoring and blunting coping styles in primary insomnia. Psychosomatic Medicine, 68(1), 1364-1371.
  52. Yang, C. M., Wu, C. H., Hsieh, M. H., Liu, M. H., & Lu, F. W. (2003). Coping with sleep disturbances among young adults: A survey of first- year college students in Taiwan. Behavioral Medicine, 29(3), 133-138. doi:10.1080/08964280309596066
  53. Yi, H. R. (2013). Sleep quality and its associated factors in adults. Journal of Korean Public Health Nursing, 27(1), 76-88. doi:10.5932/JKPHN.2013.27.1.76
  54. Wang, T. J., Lee, S. C., Tsay, S. L., & Tung, H. H. (2010). Factors influencing heart failure patients' sleep quality. Journal of Advanced Nursing, 66(8), 1730-1740. doi: 10.1111/j.1365-2648.2010.05342.x
  55. Woo, J. P. (2013). Concept and understanding of AMOS model. Seoul: Hanarae.
  56. Zhen, R., Quan, L., & Zhou, X. (2018). Fear, negative cognition and depression mediate the relationship between traumatic exposure and sleep problem among food victims in china. Psychological Trauma: Theory, Research, Practice, and Policy, 10(5), 602-609. doi: 10.1037/tra0000331