Abstract
Bayani da manufofin
Rashin halayyar halayyar jima'i mai haɗari (CSBD) yanayin lafiya ne wanda zai iya lalata zamantakewar jama'a da aikinsu da haifar da mummunan wahala. Zuwa yau, karatun ingantaccen magani na CSBD ba su ci gaba ba; yawanci, magani ga CSBD yana dogara ne akan jagororin abu ko wasu ƙwarewar ɗabi'a. Yin rigakafin sake dawowa daga hankali (MBRP) magani ne na tushen shaida game da jarabar abubuwa da nufin, tare da sauran abubuwa, rage ƙyashi da mummunan tasiri - watau hanyoyin da suke da alaƙa da kiyaye matsalolin halayen jima'i. Koyaya, ga iliminmu babu wani binciken da aka gabatar da aka ƙaddamar da ƙididdigar hankali (MBI) a cikin maganin CSBD, sai dai rahotanni biyu na asibiti. Sabili da haka, manufar binciken matukin jirgi na yanzu shine bincika ko MBRP na iya haifar da ingantaccen asibiti a cikin CSBD. Hanyar: Mahalarta sun kasance manya 13 maza tare da ganewar asali na CSBD. Kafin da bayan makonni takwas na MBRP, mahalarta sun kammala ɗan littafin tambayoyin tare da auna ma'aunin kallon batsa, al'aura da damuwa na motsin rai. results: Kamar yadda ake tsammani, mun gano cewa bayan mahalarta MBRP sun ɗan ba da ɗan lokaci kaɗan don yin amfani da batsa ta amfani da batsa da kuma nuna raguwar damuwa, ɓacin rai da alamun damuwa (OC). Tattaunawa da Karshe: Abubuwan binciken sun nuna cewa MBRP na iya zama da amfani ga mutanen CSBD. Furtherarin karatu na ingantaccen asibiti tare da manyan samfuran samfuran, jinkirta matakan bayan horo da ƙirar gwajin gwaji bazuwar suna da garanti. A ƙarshe, MBRP yana haifar da raguwar lokacin da ake kallon kallon batsa da raguwar baƙin cikin motsin rai a cikin marasa lafiyar CSBD.
Gabatarwa
Rashin halayyar halayyar jima'i mai haɗari (CSBD), musamman ma matsalar amfani da batsa, sabon abu ne kuma har yanzu ba a fahimci yanayin asibiti da ƙalubalen al'umma ba (Gola & Potenza, 2018). Ga yawancin mutane kallon batsa wani nau'i ne na nishaɗi; ga wasu, duk da haka, amfani da batsa mai rikitarwa yana haɗuwa da tsauraran al'aura da yawa kuma yana haifar da sakamako mara kyau a wasu fannoni na rayuwa, wanda shine dalilin neman magani da kuma bincika CSBD (Gola, Lewczuk, & Skorko, 2016).
Abubuwan binciken bincike na CSBD ne kawai Hukumar Lafiya ta Duniya ta gabatar da su kwanan nan a cikin rarrabawar ICD-11 mai zuwa (Kraus et al., 2018; WHO, 2019). Saboda gaskiyar cewa CSBD sabon abu ne mai ban mamaki, akwai ƙarancin tabbatattun samfuran maganin sa (Efrati & Gola, 2018). Reviewaya daga cikin nazarin littattafai (Efrati & Gola, 2018) bai sami karatun karatu ba don maganin CSBD ko matsalolin halayen jima'i, sai dai wanda aka buga a 1985 (McConaghy, Armstrong, & Blaszczynski, 1985). Akwai fatan cewa horar da hankali zai iya dacewa da mutanen CSBD yayin da yake ƙaddamar da sha'awar da mummunan tasiri, hanyoyin da ke tattare da CSBD (Blycker & Potenza, 2018).
Rigakafin Rushewar hankali
Wani ingantaccen magani da aka kafa kwanan nan don jaraba, rigakafin sake dawowa hankali (MBRP; Witkiewitz, Marlatt, & Walker, 2005) ya haɗu da fasaha na halayyar halayyar halayyar mutum wanda aka mayar da hankali akan haɓaka ƙwarewar rigakafin sake dawowa (Marlatt & Gordon, 1985) da kuma horar da hankali game da al'adar rage karfin danniya (MBSR; Kabat-Zinn, 1990).
Babban dalilan haɓaka hankali a matsayin wani ɓangare na maganin jaraba shine haɓaka ci gaban wayar da kai game da abubuwan da ke haifar da ɗabi'a da na cikin gida don haɓaka halayyar jaraba da haɓaka haɓaka iya jure ƙalubalen motsin rai, ƙwarewa da ƙwarewar jiki (Bowen et al., 2009). Broadari mafi mahimmanci, horar da hankali wani nau'in tsari ne na yau da kullun don haɓaka ƙwarewar kwarewar mutane ciki har da na ƙwarewa daga ƙalubalen tunaniJankowski & Holas, 2014). Tabbas, karatun ya nuna cewa ayyukan tunani da aka koya a cikin MBRP na iya haifar da kulawa sosai (Chambers, Lo, & Allen, 2008) da hanawa (Hope, 2006) sarrafawa ta hanyar koyawa marasa lafiya lura da ƙalubale ko rashin jin daɗi ko jihohi ba tare da saba musu da al'ada ba. MBRP ya nuna yana da tasiri wajen maganin wasu abubuwan maye (Witkiewitz, Lustyk, & Bowen, 2013). A cikin 'yan shekarun nan, wasu hujjoji na farko sun bayyana wanda ke nuna cewa horon wayar da kan jama'a dangane da shirin MBRP ya haifar da ci gaba a rayuwar masu caca matsala (misali. Chen, Jindani, Perry, & Turner, 2014).
Ingancin MBRP a cikin CSBD, duk da haka, har yanzu ba a kafa shi ba, wanda ya haifar mana da gudanar da wannan binciken na matukin jirgi. Binciken tasirin tasirin maganin gargajiya don CSBD yana da mahimmanci musamman, tun da damuwa game da halayen jima'i da ba shi da iko yana ƙaruwa saboda haɓakar amfani da batsa ta Intanet (misali Kor, Fogel, Reid, & Potenza, 2013), kuma tunda babu ingantaccen magani game da wannan matsalar al'umma.
Nazarin na yanzu
Don iliminmu, kodayake an ba da shawarar cewa abubuwan da ke tattare da hankali (MBIs) na da tasiri sosai wajen magance CSBD (Blycker & Potenza, 2018), kawai rahoton shari'ar asibiti ne kawai wanda ke bayanin tasirin horo kan sanin makamar aiki (MAT) a cikin jarabar jima'i an buga shi (Van Gordon, Shonin, & Griffiths, 2016). Mawallafa sun sami ingantaccen ingantaccen asibiti a cikin CSBD, da ragi a cikin ɓacin rai. Bugu da kari, Twohig & Crosby (2010) gano cewa karɓar yarda da sadaukarwa (ACT), tsoma baki wanda ya haɗa da motsa jiki, ya haifar da rage lokacin kallon hotunan batsa da raguwa akan matakan tilastawa (OC).
Sabili da haka, a cikin binciken matukin jirgi na yanzu mun bi wannan taken ta hanyar bincika tasirin MBRP a cikin marasa lafiya da ke neman taimako ga CSBD. Binciken yana da yanayin bincike amma ya dogara da hujjoji daga wasu jarabawar jarabar da kuma adabin da aka bayyana a sama, muna sa ran cewa MBRP yana rage baƙin ciki (damuwa, damuwa), rage alamun OC kuma, ƙari, yana haifar da rage yawan kallon hotunan batsa.
Hanyar
Wanda su ka Halarta
Mahalarta (N = 13), Caucasian, fararen maza masu shekaru tsakanin 23 da 45 shekaru (Mshekaru = 32.69; SDshekaru = 5.74), an tattara su daga maza don neman magani don halayen jima'i ta hanyar talla da aka buga akan Intanet.
Matakan
Kafin da bayan horo, mahalarta sun kammala waɗannan matakan:
Takaitaccen Labarin Batsa (BPS; Kraus et al., 2017). Wannan taƙaitaccen rahoto ne na mutum (abu biyar) wanda aka haɓaka don gano matsalar amfani da batsa (PPU) tsakanin samfuran asibiti da marasa asibiti. Musamman, yana tantance matsalar amfani da batsa a cikin watanni shida da suka gabata. Kowane mutum yana ba da amsoshi a kan sikeli daga 0 zuwa 2. Dogaro kamar yadda Mcdonald's ya tantance shi ω (Dunn, Baguley, & Brunsden, 2013): asali, ω = 0.93; 2nd ji, ω = 0.93. An ƙididdige ƙididdigar amincin ta amfani da R package Psych, sigar 2.0.7 (Revelle, 2014).
Tashin hankali da rashin damuwa na Asibiti (HADS: Zigmond & Snaith, 1983). HADS abu ne mai tambayoyi 14 wanda ke auna alamun bayyanar cututtuka na damuwa da damuwa. Abubuwa bakwai suna auna damuwa da bakwai damuwa. An umurci mahalarta su karanta kowane bayani kuma su zaɓi amsar da ta fi kyau bayanin yadda suka ji a cikin makon da ya gabata. Kowane abu an ci shi ta amfani da sikelin 0-3. Amintacce, sikelin ɓacin rai: asali, ω = 0.92; 2nd ji, ω = 0.67; sikelin damuwa: asali: ω = 0.91; Gwaji na biyu: ω = 0.70.
Bsididdigar kayan ƙididdiga masu tilastawa (OCI-R; Foa et al., 2002). OCI-R shine samfurin rahoton kai tsaye na 18 wanda ke tantance alamun cututtukan Cutar Tashin hankali (OCD). Ana ƙididdige abubuwa akan sikelin 0 zuwa 4. Icesididdigar amincin: asali, ω = 0.91; 2nd ji, ω = 0.91.
Bugu da kari, mun tantance tsawon lokacin da batutuwa suka shafe kan harkar jima'i, shan hotunan batsa da al'aura yayin makon da ya gabata da bayan MBRP.
hanya
Dukkanin batutuwa an tattara su tsakanin mazaje masu neman magani don CSBD a asibitocin ilimin jima'i a cikin [GANE NA BATUN SHARARA]. Bayanin game da binciken an aika shi zuwa ga kwararru daga waɗancan asibitocin waɗanda suka ba da shi ga marasa lafiya. Masu yuwuwar halartar mahalarta sun tuntuɓi ma'aikatan bincike ta wayar tarho, sun ba da izinin magana don dubawa kuma sun kammala binciken cancantar tarho. Muna neman mutane masu cika 4 daga 5 ƙa'idodin rashin daidaituwa tsakanin maza da mata waɗanda aka tsara ta Kafka (2010) kamar yadda aka gudanar da aikin kafin a buga sharuddan CSBD. Bayan ganawa ta farko, an bincika marasa lafiya ta amfani da SCID-I (Inganci, 2004) don rikicewar yanayi, rikicewar damuwa, OCD, cututtukan kwakwalwa, cin zarafin abu / dogaro. Wadancan maza ne kawai waɗanda suka haɗu da ƙa'idodin rashin daidaituwa tsakanin maza da mata kuma babu ɗayan waɗannan abubuwan da aka ambata a sama waɗanda aka gayyata don shiga. Ka'idodin keɓancewa sun haɗa da kowane nau'in maganin hauka.
Mahalarta masu cancanta sun kammala nazarin asalin yanar gizo. Zaman MBRP ya gudana a cikin keɓaɓɓun Cibiyar don Zuciya a cikin [DELETE FOR BLIND REVIEW]. An gabatar da MBRP daga baya ta hanyar ƙwararru biyu masu ƙwarewa da ƙwarewa da haɓaka-halayyar halayyar halayyar mutum, tare da masu halartar taron mako-mako don zaman awa biyu na takwas. Zaman ya hada da zuzzurfan tunani, atisayen gwaji, bincike, ilimin boko da tattaunawa. An ba wa mahalarta CDs don yin zuzzurfan tunani na yau da kullun da motsa jiki don yin tsakanin zama.
Ethics
Hukumar Kula da Nazarin Ma’aikata ta [DELETE for BLIND REVIEW] ta amince da binciken. An sanar da dukkan batutuwa game da binciken kuma sun ba da sanarwar izini.
results
Statisticsididdigar ƙididdiga ta asali tare da sakamakon gwajin sa hannun saiti na Wilcoxon don matakan sakamako a cikin Baseline da Measurement 2 (bayan MBRP-horo) an gabatar da su a Table 1. Table 1 Hakanan ya ƙunshi girman tasirin r don kwatancen matsayi mai dacewa (Cohen, 1988). Da yake ba duka mahalarta suke ba don kammala dukkan tambayoyin tambayoyin, girman samfuran kowane ma'auni ya bambanta kuma an ruwaito su a ciki Table 1. A cikin bincikenmu, mun ɗauki daidaitaccen, matakin ƙarfin zuciya na 95% kuma muna amfani da gwaje-gwaje biyu na wutsiya, kodayake, kamar yadda sakamakonmu ya dogara ne akan binciken matukin jirgi na farko, muna kuma haskaka abubuwan da aka gano akan matakin ci gaba.
Table 1.Statisticsididdiga masu bayyanawa da sakamakon gwajin sa hannun saiti-Wilcoxon tare da r girman tasiri, kwatanta Baseline da Mizani 2 (bayan horo)
| canji | baseline | Gwaji 2 | Gwajin alamar Wilcoxon | r Girman sakamako | ||||
| N | M | SD | M | SD | Z | P | ||
| Lokacin da aka yi amfani da batsa (makon da ya gabata, a cikin min) | 6 | 200.00 | 235.97 | 39.00 | 23.68 | -2.20 | 0.028 | -0.64 |
| Lokaci da aka yi a kan al'aura (makon da ya gabata, a cikin min) | 7 | 5.86 | 2.80 | 4.00 | 3.00 | -1.19 | 0.235 | -0.32 |
| Lokaci da aka yi akan jima'i (makon da ya gabata, a cikin min) | 5 | 22.40 | 42.88 | 3.60 | 3.58 | -0.54 | 0.593 | -0.17 |
| BPS | 10 | 6.00 | 3.30 | 4.20 | 3.46 | -1.78 | 0.075 | -0.40 |
| HADS damuwa | 8 | 8.88 | 5.30 | 4.63 | 2.13 | -1.87 | 0.062 | -0.47 |
| HADS damuwa | 8 | 6.25 | 4.53 | 3.00 | 2.07 | -2.21 | 0.027 | -0.55 |
| OCI-R | 10 | 15.80 | 10.49 | 11.20 | 9.11 | -1.94 | 0.052 | -0.43 |
Note. BPS - Takaitaccen Labaran Batsa; OCI-R - vididdigar ventwarewar ventaddamarwa; HADS - Matsalar Raunin Asibiti da Ciwon Ciki; STAI - Kirkirar Tashin Hankali na Jiha; r An ƙididdige girman sakamako ta amfani da dabara Z/ √nx + ny (Pallant, 2007). Cohen ya gabatar da fassarar r sizearfin ƙarfin sakamako kamar haka: 0.1 - ƙananan sakamako; 0.3 - matsakaici sakamako; 0.5 - babban sakamako (Cohen, 1988).
Sakamakon da aka samo ya nuna cewa bayan sanya hankali, mahalarta sun ɗan rage lokaci kaɗan don yin amfani da batsa ta amfani da batsa (kamar yadda aka nuna ta hanyar amfani da rahoto a makon da ya gabata; babban tasirin sakamako: r = 0.64). Bugu da ƙari, batsa mai rikitarwa yana amfani da alamun bayyanar kamar yadda aka auna ta Brief Pornography Screener ya ragu, sakamakon ƙididdigar lissafi yana kasancewa a yanayin ci gaba (P = 0.075; matsakaiciyar girman tasiri: r = -0.40). MBRP kuma ya haifar da rage baƙin ciki kamar yadda aka nuna ta ƙananan damuwa na HADS (sakamako a kan yanayin ci gaba: P = 0.062; matsakaiciyar girman tasiri: r = -0.47) da rage cututtukan cututtukan ciki (HADS P = 0.027; babban sakamako girman: r = -0.52). Har ila yau, an sami raguwa a cikin alamun bayyanar cututtuka (OCI-R) bayan horarwa (binciken akan matakin ci gaba: P = 0.052; matsakaiciyar girman tasiri: r = -0.43). Ba mu sami raguwar lokacin da aka yi amfani da shi ba a kan al'aura ko jima'i ba (P > 0.100).
Tattaunawa da kuma yanke shawara
Maza goma sha uku masu fama da halayen halayen jima'i an tantance su kafin da kuma bayan shirin MBRP wanda aka tsara don ƙaddamar da halayen jima'i.
Gabaɗaya, mun sami matsakaici zuwa manyan sakamako masu girma (r na tsakanin 0.4 da 0.65; Cohen, 1988) don yawancin kwatancen tasirin MBRPs. Dangane da tsammanin, mun lura da ragin rahoton kai da aka yi a lokacin da aka shafe ana kallon hotunan batsa, yayin da alamun alamun batsa masu matsala ke amfani da su kamar yadda BPS suka auna ya ragu zuwa matakin ci gaba. Lura, duk da haka, cewa BPS yayi la'akari da tsawon watanni shida, wanda ya fi tsayi fiye da makonni takwas na MBRP. Hakanan an sami raguwar yawan amfani da batsa a cikin Yaro biyu Crosby (2010) nazarin, tare da biyar daga cikin mahalarta shida da ke nuna ƙarancin raguwa a cikin lokacin kallon su bayan sa hannun ACT. Har ila yau, mun lura da raguwar rashin muhimmanci a lokacin da aka kashe a kan al'aura da yin jima'i, sakamakon da zai iya fitowa daga ƙananan mahalarta. Nazarin gaba ya kamata ya haɗa da girma, mafi ƙarfin ilimin lissafi, samfurori.
Kamar yadda ake tsammani, mun sami hujja na rage damuwa na motsin rai, wanda aka nuna ta raguwar ɓacin rai da matakan damuwa. Wannan binciken ya yi daidai da nazarin-zane wanda ke nuna cewa MBI na rage yawan damuwa, damuwa da matakan danniya a cikin yanayi daban-daban na asibiti da rashin kulawa (misali. Goyal et al., 2014), gami da yin amfani da kayan maye da zagi (misali meta-bincike Li et al., 2017). Hakanan ga Twohig & Crosby (2010) nazarin kuma mun sami raguwa akan matakan OC a cikin mutanenmu na CSBD bayan sa baki.
Abubuwan bincikenmu suna cikin layi tare da karatun da yawa waɗanda ke nuna rashin daidaituwa tsakanin yanayin tunani da matsalolin halayen jima'i. Misali, Reid, Bramen, Anderson, & Cohen (2014) ya nuna dangantaka mai rikitarwa game da yin jima'i game da haɗin kai sama da ƙungiyoyi tare da ƙa'idodin motsin rai, impulsivity da saurin magana ga damuwa.
Ba a bincika hanyoyin da aka bayyana canji mai fa'ida a cikin wannan binciken ba. Aiki na baya ya nuna cewa MBI yana haɓaka buɗewa da karɓar wayar da kan kowane irin ƙwarewa (misali Hope, 2006), wanda zai iya taimakawa duka wajen rage damuwa na motsin rai da rage rage kallon batsa. Evidenceara shaidar kimiyya ba ta nuna cewa MBRP yana shafar dukkanin keɓaɓɓun ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwa da ƙananan cibiyoyin sadarwa na gaba waɗanda ke ba da kulawar kulawa da hankali game da rikicewar jarabawar abu (don nazarin duba Witkiewitz et al., 2013). Karatu na gaba yakamata su binciki abubuwan da ke haifar da dabi'ar rashin amfani da batsa ta hanyar rage amfani da MBRP don a gwada ko wannan tasirin rage sha'awa ne, aiki ne na inganta haƙuri don tayar da hankali, ko duka biyun.
Akwai iyakoki da yawa na binciken yanzu. Na farko, ba a yi amfani da rukunin sarrafawa a cikin wannan binciken ba kuma babu matakan aunawa. Na biyu, samfurin ƙarami ne kuma ya ƙunshi maza kawai na Caucasian. Samfurin mafi girma kuma mafi bambancin kabila zai haɓaka ikon ƙididdigar lissafi da kuma rashin daidaiton sakamakon, kuma yana iya haifar da wasu tasirin maganin da aka bayyana waɗanda ba a kiyaye su anan. Don tabbatar da ikon da ya dace na binciken da kuma kara yin rubutuwa, girman samfurin a cikin karatun gaba ya kamata a tsara shi ta hanyar nazarin ikon fifiko. Bugu da ƙari, yayin da muke gudanar da kwatancen lissafi da yawa, bincikenmu na matukin jirgi yana da haɗarin samar da ƙirar ƙarya (rubuta kuskuren I) - nazarin da zai zo nan gaba bisa manyan samfura ya kamata a yi amfani da gyaran lissafin da ya dace. Bugu da ƙari kuma, duk bayanan da aka yi amfani da su sun dogara ne da rahoton kai, wanda ƙila ya sami tasiri ta hanyar buƙatun zamantakewar da mai ba da ilimin ko kuma ɗan mahalartar ya ɗora kansa.
Don haɓaka ingantaccen yarjejeniya don CSBD, gwajin gaba na MBRP da sauran maganganun zamantakewar al'umma, yakamata suyi amfani da ƙirar sarrafawa ta bazuwar da amfani da jinkirin auna don bincika dorewar kowane tasirin horo.
A taƙaice, kamar yadda na farko na MBI da aka bincika a cikin yanayin CSBD, binciken na yanzu yana ba da sakamako na farko game da MBRP. Ana fatan cewa binciken da aka yi amfani da shi a gaba game da CSBD zai samar da bayanai game da tasirin hanyoyin daban-daban na psychosocial da magani na magani, ɗayan kuma haɗe, don gano mahimman hanyoyin kwantar da hankali da keɓaɓɓu a cikin wannan yanki mai girma na damuwa na asibiti.
Asusun kuɗi
PH ya sami tallafi daga Cikin Gida (BST, babu 181400-32) na Kwalejin Ilimin halin Ilimin Jami'ar Warsaw; MD, an ba da horo na ƙwaƙwalwa ta Grantasa Grant na Cibiyar Ilimin Kimiyyar Ilimin Kwalejin Ilimin Kimiyya ta Poland (aka ba MG); EK da MG sun sami tallafi daga Cibiyar Kimiyyar Kasa ta Poland, OPUS lambar bayarwa 2014/15 / B / HS6 / 03792 (zuwa MG); kuma MD ta sami tallafi daga Cibiyar Kimiyyar Kasa ta Poland KYAUTA lambar tallafi ta PRELUDIUM 2016/23 / N / HS6 / 02906 (zuwa MD).
Taimakon masu aiki
Nazarin nazari da zane: MG, PH; tarin bayanai: MD, EK, nazari da fassarar bayanai: PH, MG da KL; nazarin ilimin lissafi: KL; kula da karatu: PH da MG; rubutun rubutu: PH, MG.
Rikici na sha'awa
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