Zomwe Zimapangidwira. 2014; 2014: 425924. doi: 10.1155 / 2014 / 425924. Epub 2014 Jul 1.
Wölfling K, Beutel INE, Dreier M, Müller KW.
Kudalirika
Kuledzera kwa pa intaneti kumawoneka ngati nkhawa yayikulupo kumadera ambiri padziko lapansi ndi kuchuluka kwa 1-2% ku Europe mpaka 7% m'maiko ena aku Asia. Kafukufuku wachipatala wasonyeza kuti kusiya kugwiritsa ntchito intaneti kumayendera limodzi ndi kutaya chidwi, kuchepa kwa ntchito zamaganizidwe, kubwezeretsana, komanso kusokonezeka kwa malingaliro. Mapulogalamu apadera othandizira amafunikira kuthana ndi vutoli lomwe langowonjezedwa posachedwa ndi zowonjezera za DSM-5. Ngakhale pali maphunziro ambiri owunika zaumoyo wa odwala omwe ali ndi vuto la intaneti, chidziwitso chakuthandiza kwa mapulogalamu othandizira sichochepa. Ngakhale kuwunika kwaposachedwa kwa meta kukuwonetsa kuti mapulogalamu amenewo akuwonetsa zotsatira, kafukufuku wazachipatala ambiri akufunika pano. Kuti tiwonjezere chidziwitso, tinachita kafukufuku woyendetsa ndege pazotsatira za pulogalamu yokhazikika yodziwika bwino ya IA. Miyezo ya akulu akulu a 42 yaukadaulo yomwe adalembera pakompyuta idalembedwa. Zizindikiro zawo za IA, malingaliro a psychopathological, ndikuyembekeza kudzidalira kwangoyesedwa asanachitike chithandizo. Zotsatira zikuwonetsa kuti 70.3% ya odwala amamaliza mankhwalawo pafupipafupi. Pambuyo mankhwala zizindikiro za IA anali utachepa kwambiri. Zizindikiro za Psychopathological zidachepetsedwa komanso zovuta zokhudzana ndi psychosocial. Zotsatira za kafukufukuyu zatsimikiza zomwe zapezeka kuchokera pazowunika meta zokha zomwe zachitika mpaka pano.
1. Introduction
Kafukufuku wambiri wazaka khumi zapitazi akuwonetsa zamakhalidwe olowerera pa intaneti ngati vuto laumoyo lomwe likukula m'malo osiyanasiyana. Zowerengera zam'mbuyomu zimafika mpaka 6.7% mkati mwa achinyamata ndi achinyamata achinyamata kumwera chakum'mawa kwa Asia [1], 0.6% ku United States [2], komanso pakati pa 1 ndi 2.1% ku mayiko aku Europe [3, 4] pomwe achinyamata akuwonetsa kuchuluka kwakukulu. (mwachitsanzo, [4]). Kutengera ndi zomwe awerengazi, APA yaganiza zophatikiza intaneti ya intaneti - gawo limodzi lachiwonetsero cha intaneti (DSA-5) "ngati chinthu chofunikira pakufufuza ndi kudziwa zambiri zomwe zachitika asanaziganizire. m'buku lalikulu ngati vuto lovomerezeka ”[5].
Anthu omwe akukhudzidwa ndi zisonyezo za IA amafanana ndi omwe amadziwika kuchokera kuzinthu zokhudzana ndi zinthu zina komanso zina zokhudzana ndi kusuta (mwachitsanzo, vuto la kutchova njuga) matenda osokoneza bongo. Amawonetsa chidwi chambiri ndi zochitika za pa intaneti, amakhala ndi chidwi chofuna kulowa pa intaneti, kuwonetsa kuwonjezeka kwa nthawi yogwiritsidwa ntchito pa intaneti (kulolerana), kukwiya komanso kusokoneza pomwe mwayi wawo wapaintaneti waletsedwa kapena kukanidwa (kusiya), kupitiliza kuyenda pa intaneti ngakhale zitakhala ndi zotsatirapo zoipa magawo osiyanasiyana am'moyo (mwachitsanzo, kusamvana ndi am'banja ndi kuchepa kwapamwamba kusukulu, koleji, kapena ntchito), ndipo sangathe kusiya zomwe achita (kulephera kuwongolera). Popeza kufanana kwina kunanenedwa za magawo amtundu wa neurobiological (mwachitsanzo, [6]; kuti muwunikenso onani [7]) ndi zofanana mikhalidwe yamunthu (mwachitsanzo, [8, 9]), afunsidwa kuti azindikire IA ngati ina mtundu wamatenda osokoneza bongo okhudzana ndi chisangalalo. Kuphatikiza apo, kuchuluka kwa comorbid IA mkati mwa odwala omwe ali ndi vuto lina lokonda kuwonetsa omwe adanenedwa kuti amalimbitsa lingaliro ili [6, 10].
Kafukufuku wazachipatala omwe adayang'aniridwa adakulitsa zizindikiro za psychopathological ndikuchepa kwa magwiridwe othandizira odwala [11], kuwonongeka kwaumoyo wa moyo [12], kubwezeretsanso anthu ena, kudzipatula, motero [13], komanso kuchuluka kwa malingaliro a psychosocial and psychopathological [14, 15 ]. Mwachitsanzo, Morrison ndi Gore [16] adanenanso za kukhumudwa kwakukulu mwa zitsanzo za omwe ali ndi kafukufuku wa 1319. Momwemonso, a Jang ndi anzawo [17] adalemba zomwe zikuwonjezera nkhawa, makamaka zokhudzana ndi malingaliro okakamira komanso achisoni kwa achinyamata omwe ali ndi IA.
Popeza IA imadziwika kwambiri ngati vuto lalikulu la matenda amisala yomwe imayambitsa kusokonezeka komanso kuchepa kwa magwiridwe antchito ndi omwe akukhudzidwa ndi izi, kuyesetsa kwachulukidwe ndikupanga njira zosiyanasiyana zamankhwala zatulukira, kuphatikizapo kulowetsedwa kwamisala ndi psychopharmacological kwa IA [18]. Ngakhale wina akuyenera kuvomereza kuti kufufuza kwapazachipatala kwaposachedwa kukuchepa mu njira yaukadaulo kapena kutengera zitsanzo zazing'ono za odwala (zowunikira kafukufuku wazotsatira zamankhwala ku IA onani King et al. [18]), zoyambirira zoyambirira zokhudzana ndi kuyankha ndikhululukidwa pambuyo chithandizo ku IA ndikulonjeza.
Kafukufuku wina yemwe anakwaniritsa miyezo ingapo ya maphunziro azachipatala malinga ndi kuwunika kwa a King et al. [18] idasanthula zotsatira za pulogalamu ya makulidwe azikhalidwe zambiri zamagulu achinyamata mu IA [19]. Odwala a 32 omwe amathandizidwa chifukwa cha IA anali amodzi poyerekeza ndi gulu loyang'anira mndandanda omwe sanalandire chithandizo (maphunziro a 24). Mapeto oyambira pa kafukufukuyu anaphatikizanso momwe angadziperekire wekha pazoyeserera za IA (Internet Overuse Self-Rating Scale zolemba Cao ndi Su [20]) komanso njira zodziwonera zomwe zimawunika luso lazoyang'anira nthawi ndi zizindikiro za psychosocial. Zosintha pazotsatira izi zidawunikidwa kale, atangomaliza, ndi kumapeto kwa chithandizo. Kutsatira kunachitika miyezi isanu ndi umodzi chithandizo. Zotsatira zake zidawonetsa kuti, m'magulu onse awiri, kuchepa kwakukulu kwa zisonyezo za IA-kuonekera komanso kukhazikika pakapita miyezi isanu ndi umodzi. Komabe, gulu lokhalokha lamankhwala linali kuwonetsa kuwongolera kwakukulu mu luso la kasamalidwe ka nthawi ndikuchepetsa zovuta zamaganizidwe okhudzana ndi nkhawa komanso mavuto ammudzi.
Momwemonso, maphunziro omwe amagwiritsa ntchito chithandizo cha psychopharmacological awonetsa zotsatira zowonjezera zomwe zikuwonetsa kuti odwala omwe ali ndi IA amapindula ndi SSRI ndi methylphenidate [21, 22], ofanananso ndi zomwe apeza kuchokera ku umboni wazachipatala pothandizira odwala omwe ali ndi vuto la juga [23].
Komanso, kafukufuku waposachedwa wa meta-analytic wolemba Winkler ndi anzawo [24] omwe adaphatikiza mayesero azachipatala a 16 ndi njira zosiyanasiyana zochiritsira zozikidwa pa odwala a 670 zikuwonetsa kukhudzana kwakukulu kwa chithandizo cha IA: zotsatira zatsatanetsatane zikusonyeza kuti panali kusiyana kwakukulu kutengera mtundu mankhwalawa achire othandizirana poyerekeza ndi njira zowonetsera zazikulu () zokhudzana ndi kuchepa kwa matenda a IA kuposa njira zina zothandizira psychotherapeutic (). Komabe, zotsatira zake zikusonyeza kuti njira iliyonse yochiritsira yomwe idafufuzidwa idakhala ndi zotsatirapo zake.
Komabe, mabuku pazotsatira za chithandizo chamankhwala ku IA akadakwaniritsidwa komanso amakulitsa m'njira zambiri, monga momwe amanenera olemba ma meta-analysis [24, tsamba 327]: "Komabe kafukufukuyu akuwonetsa kuchepa kwa maphunziro othandizira othandizika munjira, akuwunikira momwe dziko liliri pakufufuza zamankhwala pa intaneti, kulimbikitsa kufufuza kochokera ku "East" ndi "West" ndipo ndi gawo loyamba pakukonzekera kwa umboni wakuzindikira. ”Izi zikutsindika kufunika mayesero azachipatala ambiri odalira mapulogalamu olondola a chithandizo. Chifukwa cha izi, tidzakhazikitsa njira yochepetsera vuto la psychotherapeutic ya IA ndikuwonetsa zoyamba kuchokera pa kafukufuku woyendetsa ndege ponena za kufunikira kwake ndi zotsatira zake. Ngakhale kafukufukuyu akhoza kukhazikitsidwa pamiyeso yocheperako komanso kusakhala ndi gulu loyang'anira mndandanda, timawona kuti ndizothandiza kufalitsa izi.
1.1. Chithandizo Chapafupi
Kuyambira 2008, gulu la ogwira ntchito ku Outpatient Clinic for Behaeveal Addiction ku Germany lidapereka uphungu kwa odwala omwe ali ndi mitundu yosiyanasiyana ya IA. Pakadali pano, za odwala 650, makamaka amuna azaka zapakati pa 16 ndi 35 - adadziwonetsa okha ngati ofuna chithandizo. Potengera kuwonjezereka kwa kulumikizana ndi odwala, pulogalamu yokhazikika ya psychotherapeutic ya IA idakhazikitsidwa ndipo buku la zochiritsira lidapangidwa (STICA) [25] lomwe lakhazikitsidwa ndi luso lodzizindikira lomwe limadziwika kuchokera kumapulogalamu amachitidwe amtundu wina wamachitidwe osokoneza. STICA imatanthawuza kugwiritsidwa ntchito pochiza odwala ndipo ili ndi magawo a gulu la 15 kuphatikiza magawo asanu ndi atatu a chithandizo cha munthu payekha.
Pomwe magawo amomwe akukambirana ndi zomwe zikuchitika payokha, magawo akutsata dongosolo lomveka bwino. Mu gawo lachitatu loyamba la pulogalamuyi, mitu yayikulu ikukonzekera kukhazikika kwa chithandizo cha munthu payekha, kuzindikira njira yogwiritsira ntchito intaneti yomwe imalumikizidwa ndi zizindikiro za IA, komanso kakhazikitsidwe kazakafukufuku wazaka zonse za matenda a psychopathological, zoperewera, zothandizira, ndi mavuto a comorbid. Maluso othandizira amagwiritsidwanso ntchito kupititsa patsogolo cholinga cha odwala kuti achepetse kusagwira ntchito. Mu lachitatu lachiwiri, psychoeducative zinthu zimayambitsidwa ndikuwunikira mozama momwe amagwiritsira ntchito intaneti, kuyang'ana zomwe zimayambitsa komanso momwe wodwalayo amaganizira, magwiridwe antchito, zamaganizidwe, komanso machitidwe a mkhalidwewo (SORKC-scheme, [18]) , zimachitidwa. Cholinga chimodzi chofunikira kwambiri pakadali pano ndikukhazikitsa mtundu wa IA wodwala aliyense, potengera momwe intaneti imagwirira ntchito, kudziwikiratu ndikusamalira zomwe wodwalayo akuchita (mwachitsanzo, umunthu wake) komanso malo omwe odwala akukhala nawo. Pa gawo lomaliza la mankhwalawa, mikhalidwe yolakalaka kwambiri yolumikizidwa pa intaneti imafotokozedwanso mwatsatanetsatane ndipo njira zopewera kuyambiranso zimayamba. Kuwona mwatsatanetsatane kapangidwe ka STICA kwaperekedwa mu Table 1.
tab1
Table 1: Zithandizo zochizira pulogalamu "Njira yochepa yothandizira intaneti ndi chizolowezi cha masewera apakompyuta" (STICA).
1.2. Mafunso Ofufuza
Phunziroli, tinali ndi cholinga chofuna kupeza zofunikira pa STICA. Tidapangitsanso kukhala ndi odwala omwe akuphatikizidwa pokhudzana ndi zizindikiro zama psychosocial, comorbidity, ndi mawonekedwe a umunthu omwe angatenge gawo pazithandizo zamankhwala zokhudzana ndikumanga mgwirizano wogwirizanitsa ndi kusiyana kwa mayankho azithandizo [13]. Kuphatikiza apo, zotsatira za zovuta zama psychosocial koyambirira kwa chithandizo ndi umunthu pazotsatira zamankhwala zimanenedwa. Pomaliza, tikufuna kupereka fanizo pakati pa odwala omwe amaliza chithandizo chamankhwala nthawi zonse ndi omwe adasiya pulogalamuyi (omwe adasiya ntchito).
2. Zida ndi njira
2.1. Kupeza Kwambiri ndi Kafukufuku wa Statistical
Mu mayeserowa, deta idasonkhanitsidwa kuchokera kwa odwala a 42 mobwerezabwereza kuti adziwonetsere okha ku Chipatala cha Outpatient for Behavioural Addictions ku Germany chifukwa cha IA (chitsanzo cha kuthandizira kuchipatala). Odwala awa adaphatikizidwa kuchokera pachiwonetsero choyambirira cha matenda a 218 ofuna chithandizo. Kuchokera pamenepa, 74 (33.9%) adayenera kuyesedwa chifukwa chosagwirizana ndi zomwe IA ikupangira. Maphunziro ena a 29 (13.3%) adayenera kusasankhidwa chifukwa chakufika zaka XXUMX. Kusiyidwa kwina kwa 17 (73%) kunali chifukwa cha zovuta kwambiri za comorbid, kukana kulandira chithandizo chamankhwala, kapena kuopsa kwa IA kupanga chithandizo choyenera. Odwalawo adapemphedwa kuti apereke zomwe adatha kuchita asayansi ndipo adapereka chilolezo chodziwitsa. Kufufuzaku kunali kogwirizana ndi kulengeza kwa Helsinki. Chifukwa chosowa kapena chosakwanira kumapeto kwenikweni kwa T33.5, maphunziro a 1 adasiyidwa pakuwunika kotsiriza komaliza.
Njira zophatikizira zinali kupezeka kwa IA malinga ndi AICA-S (Scale for the Internet of Internet and Computer Game Addiction, AICA-S [26]; onani ndime 2.2) ndi kuyimitsidwa koyenera kachipatala kwa IA (AICA-C, Mndandanda wa mayendedwe a Kuunikira kwa Zowonetsa paintaneti ndi Makompyuta, [15]. Kuphatikiza apo, kugonana amuna ndi akazi kuposa zaka 16 zinali zofunikira zina.
Njira zochotsedwera pamatchulidwe azovuta zazikulu za comorbid (zovuta zina zowonjezera, kusokonezeka kwa malingaliro, kupsinjika kwakukulu, vuto lakumanzere, komanso kusokonekera kwa umunthu). Komanso, odwala omwe akunenera zamankhwala pakalipano chifukwa chazovuta zamisala komanso omwe akunenedwa kuti ali mu chithandizo cham'thupi sanatengedwe kusanthula deta.
Monga malembedwe oyambira, kukhululukidwa kwa IA malinga ndi mafunso odziyimira pawokha (AICA-S) kudafotokozedwa. Monga malembedwe achiwiri, kusintha pamitundu yotsatirayi kunayesedwa: kuopsa kwa zizindikiro zam'mutu, nthawi yogwiritsidwa ntchito pa intaneti, zotsatira zoyipa chifukwa chogwiritsa ntchito intaneti, komanso chiyembekezo chodzakwaniritsa.
Zambiri zidayesedwa koyambirira kwamankhwala (T0) ndipo atangochotsa mankhwalawo (T1). Kusanthula kwa data kumanenedwa pamikhalidwe yonseyi, cholinga chothandizira (kuphatikiza odwala omwe atuluka mu chithandizo) ndi othandizira. Pazomwe tikufuna kuchitira pang'onopang'ono, njira yotsiriza yowonekera patsogolo (LOCF) idagwiritsidwa ntchito. A LOCF akuchenjeza kugwiritsa ntchito deta yomaliza yomwe ilipo mu mitu yomwe sinamalize chithandizo chamankhwala nthawi zonse. Mu kafukufuku wapano, deta kuchokera ku T0 idagwiritsidwa ntchito pazophunzirazi zomwe zidatuluka mu pulogalamu yachipatala T1 isanayesedwe.
Pakuwona kwa mawerengero, mayeso apakati pa chi-mraba adagwiritsidwa ntchito kuyerekezera kosintha kwa dichotomous ndi cramer-v ngati muyeso wa mphamvu. Zosintha mumapeto oyambira ndi sekondale adayezedwa pogwiritsa ntchito zophatikizika ndi zipatso za m'mbuyomu komanso za postcomparison za mtundu umodzi, ndi muyeso wa momwe maselo amadalira. Malinga ndi zomwe a Dunlap et al. [27], kusinthidwa kunawerengeredwa ngati kuphatikiza pakati pa pre- ndi nsanamira za mitundu yodalira kunali kwakukulu kuposa 0.50. Kusanthula konse kunachitika pogwiritsa ntchito SPSS 21.
2.2. Zida
Pa gulu la IA, miyeso iwiri idagwiritsidwa ntchito ku T0. Pa Scale for the Internet of Internet and Computer Game Addiction (AICA-S, [26]), muyezo wodziyimira pawokha unagwiritsidwa ntchito kuyesa IA malingana ndi njira zosinthidwa zamavuto amtundu wa juga ndi zovuta zokhudzana ndi zinthu monga mwachitsanzo, chidwi, kulekerera , kudzipatula, ndi kutaya ulamuliro). Choyimira chilichonse chomwe chikuonetsa IA chimayesedwa pamakwerero asanu a Likert (osati nthawi zambiri) kapena mumapangidwe a dichotomous (inde / ayi) ndi kuchuluka kolembetsedwa kuchokera kuzinthu zomwe zapezeka. Kudulidwa kwa mfundo za 7 (zomwe zikufanana ndi kuchuluka kwa njira za 4 zomwe zakwaniritsidwa) zapezeka kuti ndizolondola kwambiri pakuzindikira IA (sensitivity = 80.5%; specificity = 82.4%) pakufufuza kwa odwala omwe akutuluka mu zotsatira zathu chipatala. Malinga ndi kafukufuku wakale, AICA-S ikhoza kuonedwa ngati yowonetsa katundu wabwino wama psychometric (Cronbach's), imapanga zovomerezeka, komanso zamankhwala [11]. Popeza AICA-S idalinso mathero oyambira, idayesedwanso ku T1.
Kuti muwonetsetse kuti mukudwala matenda a IA, chiwonetsero chazachipatala chinaperekedwanso. Mndandanda wa Check Internet for Internet and Computer Game Addiction (AICA-C, [15]) udagwiritsidwa ntchito pachifukwa chimenecho. AICA-C imaphatikizapo magawo asanu ndi limodzi oyambira a IA (chidwi, kulephera kuwongolera, kuchoka, zotsatira zoyipa, kulolerana, ndikukhumba) zomwe ziyenera kuvoteredwa ndi katswiri wophunzitsidwa pazinthu zisanu ndi imodzi kuyambira 0 = chitsimikizo chosakumana ndi 5 = chitsimikizo chidakumana ndi zonse. Malinga ndikuwunikira pazotsatira zake zodziwikiratu, kudula kwa mfundo za 13 kwatulutsa zinthu zabwino kwambiri (zomverera = 85.1%; kutsimikizika = 87.5%). Iwunikiridwa bwino chifukwa cha malo ake a psychometric (Cronbach's) komanso kulondola kwachipatala [15].
General Self-Efficacy Scale (GSE; [28]) idagwiritsidwa ntchito poyesa kupanga zinthu zomwe zikuyembekezeka kukhala zokwaniritsa mwa zinthu khumi. GES imamveka ngati kuchuluka kwa zigamulo zogwirizana ndi kuchuluka kwa kuthekera kwakumatha kuthana ndi mavuto ndi zovuta za tsiku ndi tsiku. Kafukufuku wambiri wanena kuti GSE iyenera kuwonedwa ngati chinthu chofunikira kwambiri chokhazikika, chokhala ndi GSE yayikulu yolosera zamachitidwe ogwira ntchito ndikupangitsa anthu kuti akumane ndi zochitika zowopsa [29]. GSE idatumizidwa ku T0 ndi T1.
NEO Five-Factor Inventory [30] idapangidwa kuti ikhale yoyeserera magawo asanu a Model Factor Model. Muli ndi zinthu za 60 zoyankhidwa pa sikelo ya 5-point Likert ndipo ndi imodzi mwazomwe zimagwiritsidwa ntchito podzifufuza. Kafukufuku wambiri adatsimikiza zaubwino wake wa psychometric komanso kuvomerezeka [4]. NEO-FFI idagwiritsidwa ntchito ku T0 kokha kuti iwunike mphamvu yolosera pazinthu zisanu pazotsatira zamankhwala ndikutsatira.
Pamalo oyeza, T0 ndi T1, zizindikiro za psychopathological zidayesedwa pogwiritsa ntchito Sy Symbom Checklist 90R [31], funso lazachipatala lomwe limagwiritsidwa ntchito kwambiri ndi katundu wa psychometric omveka [32]. Kupsinjika kwa Psychopathological kumayesedwa ndi zinthu za 90 (0 = palibe chizindikiro ku 4 = zizindikiro zamphamvu) kutsitsa pamathandizo asanu ndi anayi. SCL-90R ikulozera pamlingo womwe mutuwo udakumana ndi zizindikiro sabata yatha. Mlozera wolimba padziko lonse lapansi (GSI) - kuchuluka padziko lonse lapansi pazinthu zisanu ndi zinayi - akuimira kuvutika konse.
3. Zotsatira
3.1. Kufotokozera Kwachitsanzo
Ziwerengero za anthu omwe amafunafuna chithandizo chamankhwala zimapezeka mu Table 2.
tab2
Gawo la 2: Chidziwitso cha Sociodemographic cha omwe amafunafuna chithandizo chophatikizidwa pamayesowa.
Monga momwe lingatengeredwe ndi Table 2, odwala ambiri sanali mgwirizano ndi pafupifupi theka laiwo omwe amakhalabe kunyumba ndi makolo awo. Ambiri mwa omwe amafunafuna chithandizo anali asanagwire ntchito koma anali ndi maphunziro a kusekondale.
Ambiri mwa odwala anali kuwonetsa kugwiritsa ntchito mwamasewera masewera apakompyuta (78.4%). 10.8% anali kugwiritsa ntchito mitundu yosiyanasiyana ya intaneti mwachidwi, 8.1% amagwiritsa ntchito malo ochezera a pa Intaneti, ndipo 2.7% anali akuchita kafukufuku wambiri m'mazenera azidziwitso.
Ponena za mawonekedwe apansi panthaka, mafotokozedwe otsatirawa adapezeka a NEO-FFI: () ya neuroticism, () yowonjezera, () yotseguka, () yovomerezeka, ndi () yovomerezeka.
3.2. Zosintha M'maphunziro Oyambirira ndi A Sekondale
70.3% (26) anamaliza zochiritsidwazo pafupipafupi (othandizira), odwala 29.7% (11) adataya nthawi yamaphunziro. Zotsatira zikuwonetsa kuti othandizira anali ndi kusintha kwakukulu pamayendedwe oyambira komanso ambiri omaliza. Zomwe zimatsogolera komanso zoyambirira zam'maphunziro oyambilira komanso apamwamba kwa othandizira zimachokera ku
Gawo la 3: Zosintha pamagawo am'mbuyomu ndi apamwamba kumapeto kwa othandizira.
Monga tikuwonera mu tebulo la 3, kuchepa kwakukulu kwa chiwerengero cha AICA-S kumaonekera pambuyo pa chithandizo. Kuphatikiza apo, kuchepa kwakukulu kwa maola omwe amagwiritsidwa ntchito pa intaneti patsiku la sabata ndikumachepetsa mikangano chifukwa chogwiritsa ntchito intaneti m'malo asanu mwa asanu ndi amodzi omwe adawonedwa anali owonekera. Momwemonso, kuchepa kwakukulu kwa GSI kunapezeka, ndi othandizira omwe akuwonetsa kwambiri kuchepa kwamankhwala atalandira chithandizo mu zisanu ndi ziwiri zamapepala asanu ndi anayi a SCL-90R.
Monga momwe timayembekezera, chithandizo chamankhwala chidali chocheperako pakuwonjezera zomwe zidatsalira pakuwunika. Komabe, malingaliro ofuna kuchitira zinthu amawunikiranso kuti mankhwala atatha, manambala mu AICA-S adatsika kwambiri (,;). Zomwezo zinkawonekera pa kuchuluka kwa nthawi yomwe amagwiritsidwa ntchito pa intaneti tsiku limodzi la sabata (,;) ndi zotsatirapo zoyipa zomwe zimakhudzana ndi kugwiritsidwa ntchito kwa intaneti (,;). Komanso, muzochitika za psychopathological, ma pre-ndi ma post omwe anali atasinthika anawonedwa, okhudzana ndi GSI (,;) ndi SCL-subscales obsessive-activive (,;), kusakhazikika kwachikhalidwe (,;), kukhumudwa (,;); ), nkhanza (,;), nkhawa za phobic (,;), ndi psychoticism,,;). Komanso, chiyembekezo chodzikwaniritsa chinakula kwambiri pambuyo pa chithandizo (,;).
3.3. Zikoka pa Kuyankha Kwa Chithandizo
Kuwunikira kwa kusiyana pakati pa anthu pakati pa omwe amapanga ndi omwe adasiya ntchito sikunawonetse phindu lililonse pazaka, mgwirizano, udindo wabanja, malo okhala, kapena ntchito. Kusiyana kokhako komwe kukuwonetsa kufunikira kwa kusintha (;; cramer-v = .438) adapezeka m'maphunziro ndi othandizira omwe akuwonetsa maphunziro apamwamba (76.9%) kuposa otsika (63.7%).
Pazokhudzana ndi kuthekera kwa mikhalidwe yokhudza kuchira, palibe kusiyana kwakukulu kwamagulu komwe kunapezekanso, kupatula kungotseguka kwa chinthu. Kusintha kwapangidweko kukuwonetsa kuti ophatikizira (;) anali kuwonetsa zochulukira kuposa zotsika (;;;,,). Momwemonso, palibe kusiyana kwamagulu komwe kunapezeka pokhudzana ndi zizindikiro zama psychosocial mu T0 (SCL-90R) kapena kuchuluka kwa chiyembekezo chodzithandizira (GSE). Komanso, kuwopsa kwa zisonyezo za IA sizinasankhe pakati pa othandizira ndi omwe amasiya ntchito komanso kuchuluka kwa maola omwe adagwiritsidwa ntchito pa intaneti (kuyesedwa ndi AICA-S).
4. Kukambirana
Mu phunziroli loyendetsa ndege, tasanthula zotsatira za psychotherapy yochepa yochepa pakanthawi kochepa kwa makasitomala akunja omwe akudwala IA. Pachifukwa chimenecho, odwala onse a 42 oyambirirawo adawathandizira malinga ndi pulogalamuyi yochizira odwala matenda amisala omwe amayesedwa atangolowa chithandizo. Monga malembedwe oyambira, tinayesa zizindikiro za IA malinga ndi njira yodalirika yodziyimira nokha (AICA-S; [26]). Kuphatikiza apo, nthawi yogwiritsidwa ntchito pa intaneti, zoyipa zomwe zimachitika chifukwa cha ntchito za pa intaneti, kukhala ndi moyo wabwino, komanso chizindikiro cha psychosocial zidafotokozedwa kuti ndizotsatira zam'mbuyomu.
Pafupifupi 70% ya omwe amafunafuna chithandizo adadutsa pulogalamu yonse ya othandizira (othandizira), ndipo pafupifupi gawo limodzi mwa magawo atatu adachokapo nthawi yamankhwala. Chifukwa chake, chiwopsezo cha kusiya ntchito chilipo mkati mwa ziwonetsero zakumapeto kwakanthawi kachipatala (onani [33]; 19-51%) koma kupitirira zomwe zidanenedwa ndi Winkler ndi anzawo (onani [24]; 18.6%). Zotsatira zina zikuwonetsa kuti pulogalamu yachipatala ili ndi zotsatira zabwino. Pambuyo pa mankhwalawa, kuchepa kwakukulu kwa zizindikiro za IA-kungawonedwe. Zosintha zomwe zapezeka pano zinali zofunikira kwa owakwaniritsa komanso monga zitsanzo zonse kuphatikizapo zotsitsa. Malinga ndi tanthauzo la Cohen [34], izi zitha kuwonedwa ngati chisonyezo cha zotsatira zazikulu. Kuphatikiza apo, ikufanana ndi momwe kukula kwa IA-state pambuyo pa psychotherapy (;; ndi chidaliro pakati pa .84 ndi 2.13) zanenedwa mu meta-kusanthula kwa Winkler et al. [24]. Momwemonso, nthawi yogwiritsidwa ntchito pa intaneti kumapeto kwa sabata idachepetsedwa kwambiri atatha kuchira ndi kukula kwakukulu () komwe kuli kochepa kuyerekeza ndi deta yomwe yaperekedwa ndi kuwunika kwaposachedwa kwa meta pamutuwu (onani [24];).
Ndikofunikira kufotokoza kuti cholinga cha njira zamankhwala ichi sichakuti odwala asagwiritsidwe ntchito intaneti iliyonse. M'malo mwake, zolinga zenizeni zamankhwala zimapangidwa potengera zotsatira za njira yowonjezera yomwe makina ogwiritsa ntchito intaneti odwala amakhala akuwunikiridwa ndikuzindikiritsidwa movomerezeka pa intaneti. Chithandizocho chikufuna kulimbikitsa wodwalayo kuti ayambe kudzipatula kuntchito ya intaneti yomwe imadziwika kuti ikugwirizana ndi zizindikiro zoyambirira za IA, monga kulephera kuwongolera komanso kukhumba. Chifukwa chake, phindu la maola zero omwe athera pa intaneti silinkayembekezeredwa. Zowonadi, nthawi yapaintaneti ya maola a 2.6 patsiku ili bwino kwambiri pakati pa anthu achi Germany. Pa kafukufuku woyimira pazinthu pafupifupi za 2500 zaku Germany, Müller et al. [35] idati nthawi yayitali yomwe imagwiritsidwa ntchito pa intaneti patsiku la sabata, inali maola a 2.2 mkati mwa ogwiritsa ntchito pa intaneti.
Komanso, nthawi yayitali yotsiriza idasinthiratu panthawi yamankhwala. Choyamba, mavuto omwe amabwera chifukwa chogwiritsa ntchito kwambiri intaneti amachepera m'malo angapo, okhudza pafupipafupi mikangano yabanja, kukana zochitika zina zosangalatsa, pafupipafupi mavuto azaumoyo, kulimbana ndi abwenzi, komanso zotsatira zoyipa kusukulu kapena kuntchito. Kuyembekezerera kudzidalira kwamphamvu kumakulirakulira ndi kukula kwamlingo wokulirapo ndi kuchuluka kwamankhwala mu GSE mukalandira chithandizo kufananizidwa ndi komwe kumachokera kwa ambiri aku Germany [28]. Izi zikuwonetsa kuti chiyembekezo chodzakwaniritsa kuthekera kwawanthu kuti athe kuthana ndi zovuta komanso zovuta zimakhala pamlingo wovomerezeka pambuyo pa chithandizo. Ngati kusiyana pakubala kwodalirika pakati pa odwala pambuyo pa chithandizo kumatha kuzindikira ngati cholosera cham'tsogolo komanso chachitali, zotsatira ziyenera kufufuzidwa m'maphunziro owunika.
Pomaliza, zizindikiro za psychosocial zogwirizana ndi IA zinachepa kwambiri pambuyo pa chithandizo. Umu ndi momwe zinaliri kuti padziko lonse lapansi pakhale zovuta komanso ma subscales asanu ndi awiri mwa asanu ndi anayi a SCL-90R. Zosiyanasiyana zazikulu zakwaniritsidwa chifukwa cha kuwonongeka konsekonse kwa Index komanso zowoneka-zokakamiza komanso zododometsa, komanso chifukwa chokhala pangozi.
Modabwitsa, sitinapeze zosiyanitsa zilizonse pakati pa odwala omwe akupereka chithandizo chonse ndi omwe adasiya pulogalamu yomwe ikadatha kukhala zofunikira polemba mankhwalawo. Panali zowerengera zomwe zimawonetsa kuti odwala omwe ali ndi maphunziro apamwamba kwambiri amatha kumaliza chithandizocho pafupipafupi. Komanso, tinapezanso, monga chizolowezi - kuti odwala omwe amaliza chithandizo chamankhwala amawonetsa mapangidwe apamwamba mu mikhalidwe yotseguka. M'mabuku ofotokoza za umunthu, kutseguka kwambiri kumafotokozedwa kuti akukonda njira zina zoganiza zachikhalidwe ndikuchita komanso kuwonetsa chidwi pazinthu zatsopano ndi njira zamaganizidwe [36]. Wina anganene kuchokera pamenepa kuti odwala omwe akuwadalira kwambiri pamalopo amatha kukhala ndi malingaliro okhudzana ndi psychotherapy motero angathe kusinthika ndi psychotherapy. Komabe, maubale omwe adanenedwa pano anali othandiza kwambiri. Izi zitha kufotokozedwa ndi kukula kakang'ono, makamaka zokhudzana ndi odwala omwe asiya chithandizo. Mwachidziwikire, kafukufuku wowonjezereka akufunika kuti azindikire kulosera kwa kumaliza kwa mankhwala omwe ali ndi odwala IA.
Phunziroli lili ndi zolephera zingapo zomwe zikufunika kuthana ndi mavuto. Kuchepetsa kwakukulu kuyenera kuwoneka pakuperewera kwa gulu lowongolera, kaya ndikuwongolera mndandanda (WLC) kapena chithandizo chamankhwala monga chizolowezi gulu (TAU). Popeza panali chikhalidwe chimodzi chokha cha gulu lachipatala, ziwerengero (poyerekeza ndi ena) ndi malire omasulira ndiwodziwikiratu. Sizotheka kuti pamapeto pake muzindikire ngati zotsatira za kuchepa kwa IA ndi zovuta zama psychopathological zimachitika chifukwa cha kulowererapo kwa malingaliro kapena chiyambi kuchokera kuzosintha zomwe sizinawongoleredwe. Kachiwiri, zitsanzo zosavuta za omwe amafunafuna chithandizo adaziyesa popanda njira yodziwira okha. Izi zimabweretsa funso ngati omwe akuchita nawo kafukufukuyu akuyenera kuwayang'anira. Kuphatikiza apo, zitsanzo zachipatala zomwe zinali kufufuzidwa zidapangidwa ndi odwala amuna a 42 okha. Uku ndi zitsanzo zazing'ono kwambiri zomwe sizinalole kusanthula kwakuzama kulikonse (mwachitsanzo, kutengera kwa mitundu yosiyanasiyana ya IA pazotsatira zamankhwala). Popeza chitsanzocho chinali cha odwala amuna okhaokha, zomwe zimapezeka sizingafanane ndi odwala achikazi. Pomaliza, mapangidwe a kafukufukuyu sanaphatikizepo kutsatira kwawoko, motero sikungatheke kuzindikira zomwe zimachitika pakukhazikika kwa chithandizo chamankhwala zomwe zimawonedwa atangopezeka chithandizo. Kuti muwongolere zolakwika izi, alembawo akuyesa kutsatidwa kwachipatala pano [17]. Ntchitoyi yomwe ikufuna kuphatikizidwa kwa odwala a 193 omwe akuvutika ndi IA imakhala ndi mayeso ambiri osasankhidwa komanso owongoleredwa ndikuwunika koyesa kwa 12 miyezi ingapo atamaliza kuthandizira.
5. Kutsiliza
Kutengera ndi zomwe zapezeka mu kafukufukuyu woyendetsa ndege, ndizomveka kulingalira kuti chithandizo cham'thupi chamtundu wa odwala omwe ali ndi IA ndichothandiza. Pambuyo pakugwiritsira ntchito chithandizo chamankhwala chokhazikika, tinapeza kusintha kwakukulu kwa zisonyezo za IA, nthawi yogwiritsidwa ntchito pa intaneti, zovuta zoyipa zomwe zimagwiritsidwa ntchito pa intaneti, komanso zokhudzana ndi psychopathological, zomwe zimabweretsa zotsatira zoyipa komanso zolemetsa. Kafukufukuyu, yemwe anatsogolera poyambitsa mayeso akulu, osasankhidwa, ndikuwongoleredwa, akutsimikizira kuti Winkler ndi anzawo [24] achokera ku data ya kusanthula kwawo meta: IA ikuwoneka ngati vuto lamisala omwe mutha kuthandizira moyenera ndi maupangiri amisala — makamaka pofotokoza za chithandizo chomwe mwalandira.
Kusamvana kwa Zosangalatsa
Olembawo akunena kuti palibe kutsutsana kwa zofuna zokhudzana ndi kutuluka kwa pepala lino.
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