Kafukufuku woyendetsa ndege wokhudzana ndi kupewa kukumbukira zomwe zimapangitsa kuti munthu akhale ndi vuto logonana (2020)

J Behav Chizolowezi. 2020 Novembala 17.
Paweł Holas  1 , Małgorzata Draps  2 , Ewelina Kowalewska  3 , Karol Lewczuk  4 , Mateusz Gola  2   5
PMID: 33216012DOI: 10.1556/2006.2020.00075

Kudalirika

Mbiri ndi zolinga

Matenda okakamira pakugonana (CSBD) ndichachipatala chomwe chingasokoneze magwiridwe antchito ndi ntchito ndikubweretsa zovuta. Mpaka pano, maphunziro ogwira ntchito a CSBD sanakhazikitsidwe; Nthawi zambiri, chithandizo cha CSBD chimakhazikitsidwa ndi malangizo amomwe mungagwiritse ntchito mankhwala osokoneza bongo. Kupewanso kubwereranso m'malingaliro (MBRP) ndi njira yochiritsira yochotsa chizolowezi chomwa mankhwala osokoneza bongo yomwe cholinga chake ndi, pakati pazinthu zina, kuchepetsa kulakalaka ndi zoyipa zomwe sizikutanthauza - njira zomwe zimakhudzana ndi kusamalira machitidwe azovuta zakugonana. Komabe, monga tikudziwira palibe kafukufuku wam'mbuyomu yemwe adasindikizidwa wowunika kulingalira mozama (MBI) pochiza CSBD, kupatula malipoti awiri azachipatala. Chifukwa chake, cholinga cha kafukufuku woyendetsa ndege wapano ndikuwunika ngati MBRP ingayambitse kusintha kwa CSBD. Njira: Ophunzira nawo anali amuna akulu 13 omwe ali ndi matenda a CSBD. Asanachitike komanso atadutsa milungu isanu ndi itatu ya MBRP, omwe adatenga nawo gawo adamaliza kulemba kabuku kofunsira mafunso kuphatikiza miyezo yakuwonera zolaula, maliseche komanso kupsinjika kwamaganizidwe. Results: Monga momwe timayembekezera, tidapeza kuti ophunzira a MBRP atakhala nthawi yocheperako akuchita zolaula akuwonetsa kuchepa kwa nkhawa, kukhumudwa komanso kuzindikiritsa (OC). Zokambirana ndi Zotsatira: Zomwe zapezazi zikuwonetsa kuti MBRP itha kupindulitsa anthu a CSBD. Kafukufuku wowonjezera wazachipatala wokhala ndi kukula kwakukulu kwazitsanzo, kuyeza koyeserera pambuyo pakuphunzitsidwa ndikuwunika koyeserera koyenera kuli koyenera. Pomaliza, MBRP imabweretsa kuchepa kwa nthawi yogwiritsira ntchito zolaula komanso kuchepa kwamavuto a CSBD.

Introduction

Matenda okakamiza kuchita zachiwerewere (CSBD), makamaka zovuta kugwiritsa ntchito zolaula, ndichinthu chatsopano komanso chosamvetsetseka bwino chazachipatala komanso zovuta zamagulu (Gola & Potenza, 2018). Kwa anthu ambiri kuonera zolaula ndi mtundu wa zosangalatsa; kwa ena, komabe, kugwiritsa ntchito zolaula zovuta kumayendera limodzi ndi kuseweretsa maliseche mopitilira muyeso ndipo kumabweretsa zotsatirapo zoyipa mbali zina za moyo, chomwe ndi chifukwa chofunira chithandizo ndikupeza CSBD (Gola, Lewczuk, & Skorko, 2016).

Njira zodziwitsa matenda a CSBD zidangotchulidwa ndi World Health Organisation mgulu la ICD-11 lomwe likubwera (Kraus et al., 2018; WHO, 2019). Chifukwa chakuti CSBD ndichinthu chatsopano, palibe mitundu yotsimikizika yamankhwala ake (Efrati & Gola, 2018). Kubwereza kumodzi kwa mabukuwa (Efrati & Gola, 2018) sanapeze maphunziro olamulidwa a CSBD kapena zovuta zokhudzana ndi kugonana, kupatula zomwe zidafalitsidwa mu 1985 (McConaghy, Armstrong, & Blaszczynski, 1985). Pali chiyembekezo kuti maphunziro olingalira akhoza kukhala oyenera kwa anthu a CSBD chifukwa amalimbana ndi kulakalaka komanso kuwonongeka, njira zazikulu za CSBD (Blycker & Potenza, 2018).

Kupewa Kuthana Ndi Maganizo

Chithandizo chatsopano chokhazikitsidwa posachedwa chomangika, kupewa kupewa kuganizira mozama (MBRP; Witkiewitz, Marlatt, & Walker, 2005Kuphatikiza njira zamatenda amisala moganizira kukulitsa luso lotha kubwereranso (Marlatt & Gordon, 1985) ndi maphunziro olingalira pamalingaliro amalingaliro ochepetsa kupsinjika (MBSR; Kabat-Zinn, 1990).

Zifukwa zikuluzikulu zokhalira osamala monga gawo la mankhwala osokoneza bongo ndikumvetsetsa zazomwe zimayambitsa zakunja komanso zamkati mwamakhalidwe olowerera ndikuwongolera kuthekera kopirira zovuta zamalingaliro, zidziwitso komanso zakuthupi (Bowen et al., 2009). Zowonjezera, kuphunzitsa kulingalira ndi mtundu wamachitidwe mwadongosolo olimbikitsira kuthekera kwazindikiritso za anthu kuphatikiza kuphatikizika kwamachitidwe azovuta zamaganizidwe (Jankowski & Holas, 2014). Zowonadi, kafukufuku wasonyeza kuti machitidwe olingalira omwe amaphunzitsidwa mu MBRP atha kubweretsa chidwi chachikulu (Zipinda, Lo, & Allen, 2008) ndi zoletsa (Hope, 2006) kuwongolera pophunzitsa odwala kuti azisamalira madera ovuta kapena osakhazikika kapena olakalaka osazolowera. MBRP yasonyezedwa kuti ndi yothandiza pochiza mankhwala osokoneza bongo osiyanasiyana (Witkiewitz, Lustyk, & Bowen, 2013). M'zaka zaposachedwa, umboni wina woyambirira wazowonekera womwe ukuwonetsa kuti maphunziro olingalira mozama potengera pulogalamu ya MBRP adabweretsa kusintha m'miyoyo ya otchova njuga (mwachitsanzo Chen, Jindani, Perry, & Turner, 2014).

Kuchita bwino kwa MBRP mu CSBD, komabe, sikunakhazikitsidwe, zomwe zidatipangitsa kuti tichite kafukufukuyu asanachitike. Kufufuza momwe njira zochiritsira zatsopano za CSBD zikuyendera bwino zikuwoneka ngati zofunika kwambiri, popeza nkhawa zokhudzana ndi zikhalidwe zosalamulirika zakugonana zikuchulukirachulukira chifukwa cha kuchuluka kwa zolaula pa intaneti (mwachitsanzo. Kor, Fogel, Reid, & Potenza, 2013), ndipo popeza palibe chithandizo chovomerezeka chavutoli.

Phunziroli

Kudziwa kwathu, ngakhale akuti malingaliro olingalira (MBIs) anali othandiza pochiza CSBD (Blycker & Potenza, 2018), Lipoti limodzi lokhalo lonena za kusinkhasinkha (MAT) pakukhudzana ndi chiwerewere lasindikizidwa (Van Gordon, Shonin, & Griffiths, 2016). Olembawo adapeza kusintha kwakatikati pa CSBD, komanso kuchepetsedwa kwamavuto. Kuphatikiza apo, Chimamanda Ngozi Adichie (2010) adapeza kuti chithandizo chovomerezeka ndi kudzipereka (ACT), kulowererapo komwe kumaphatikizapo zolimbitsa thupi, kudapangitsa kuchepa kwanthawi yowonera zolaula ndikuchepetsa pamachitidwe okakamira (OC).

Chifukwa chake, mu kafukufuku wapano woyendetsa ndege tidatsata mutuwu pofufuza momwe MBRP imagwirira ntchito mwa odwala omwe akufuna thandizo la CSBD. Kafukufukuyu ali ndi mawonekedwe owunikira koma kutengera maumboni ochokera kumayeso ena osokoneza bongo komanso zolemba zochepa zomwe tazitchula pamwambapa, timayembekezera kuti MBRP imachepetsa kupsinjika kwam'mutu (kukhumudwa, nkhawa), kumachepetsa zizindikiritso za OC ndipo, kuwonjezera apo, kumabweretsa kuchepa kwa kuwonera zolaula mopitirira muyeso.

Njira

ophunzira

Ophunzira (N = 13), azungu, azungu azaka zapakati pa 23 ndi 45 zaka (Mm'badwo = 32.69; SDm'badwo = 5.74), adalembedwa ntchito kuchokera kwa amuna omwe amafuna chithandizo chakuchita zachiwerewere kudzera pazotsatsa zomwe zidalembedwa pa intaneti.

Njira

Asanaphunzire komanso ataphunzira, ophunzira adakwaniritsa izi:

Pafupifupi Zithunzi Zolaula (BPS; Kraus et al., 2017). Ili ndiye lipoti lalifupi (la zinthu zisanu) lodziwonetsera lomwe lapangidwa kuti lizindikire kugwiritsa ntchito zolaula (PPU) pamavuto azachipatala komanso omwe siachipatala. Makamaka, imayesa zolaula zomwe zimagwiritsidwa ntchito miyezi isanu ndi umodzi yapitayo. Anthu pawokha amapereka mayankho pamlingo kuyambira 0 mpaka 2. Kudalirika monga kuyesedwa ndi Mcdonald's ω (Dunn, Baguley, & Brunsden, 2013): zoyambira, ω = 0.93; Muyeso wa 2, ω = 0.93. Zizindikiro zodalirika zinawerengedwa pogwiritsa ntchito R package Psych, version 2.0.7 (Chisangalalo, 2014).

Nkhawa Zachipatala ndi Kukhumudwa Kwambiri (HADS: Zigmond & Snaith, 1983). HADS ndi funso lazinthu 14 loyesa kuyeza za kukhumudwa ndi nkhawa. Zinthu zisanu ndi ziwiri zimayeza kukhumudwa komanso nkhawa zisanu ndi ziwiri. Ophunzira awuzidwa kuti awerenge ziganizo zilizonse ndikusankha yankho lomwe likufotokoza bwino momwe adamvera sabata yapitayi. Chilichonse chimachotsedwa pogwiritsa ntchito sikelo ya 0-3. Kudalirika, kuchuluka kwa kukhumudwa: zoyambira, ω = 0.92; Muyeso wa 2, ω = 0.67; kuchuluka kwa nkhawa: momwe ziriri pano: ω = 0.91; Muyeso wachiwiri: ω = 0.70.

Zowonongeka-zowonongedwa (OCI-R; Foa et al., 2002). OCI-R ndichinthu chodzinenera nokha chazinthu 18 chomwe chimayesa zizindikiro za Obsessive-Compulsive Disorder (OCD). Zinthu zidavotera pamiyeso 0 mpaka 4. Zizindikiro zodalirika: zoyambira, ω = 0.91; Muyeso wa 2, ω = 0.91.

Kuphatikiza apo, tinayesa kuchuluka kwa nthawi yomwe timagwiritsa ntchito pazochita zogonana, zolaula komanso maliseche sabata latha komanso pambuyo pa MBRP.

Kayendesedwe

Maphunziro onse adalembedwa pakati pa amuna omwe akufuna chithandizo cha CSBD m'makliniki azakugonana ku [DELETE for BLIND REVIEW]. Chidziwitso chokhudza kafukufukuyu chidatumizidwa kwa akatswiri azachipatala omwe amaperekanso kwa odwala awo. Omwe atenga nawo mbali adalumikizana ndi omwe adafufuza pafoni, atapereka chilolezo pakamwa kuti awonetsetse ndikumaliza kuyesedwa kwa foni. Tidali kufunafuna anthu omwe akukwaniritsa zofunikira za 4 pa 5 zokhudzana ndi matenda opatsirana pogonana zomwe akufuna Kafka (2010) pomwe ntchitoyo idachitika asanafalitsidwe njira za CSBD. Pambuyo poyankhulana koyambirira, odwala adayesedwa pogwiritsa ntchito SCID-I (Kuvomerezeka, 2004) pamavuto amisala, nkhawa, OCD, matenda amisala, kugwiritsa ntchito mankhwala osokoneza bongo / kudalira. Amuna okhawo omwe adakwaniritsa zovuta zokhudzana ndi hypersexual ndipo palibe zomwe zanenedwa pamwambapa omwe adapemphedwa kutenga nawo mbali. Njira zoperekedwazo zidaphatikizaponso mtundu uliwonse wamankhwala amisala.

Ophunzira oyenerera adamaliza kuyesa koyambira pa intaneti. Gawo la MBRP lidachitikira ku Private Center for Mindfulness mu [DELETE FOR BLIND REVIEW]. MBRP idaperekedwa pambuyo pake ndi akatswiri awiri ovomerezeka komanso odziwa zambiri, komanso otenga nawo mbali pamisonkhano sabata zisanu ndi zitatu. Gawoli lidaphatikizapo kusinkhasinkha motsogozedwa, zochitika zolimbitsa thupi, kufunsa, maphunziro amisala komanso kukambirana. Ophunzira adapatsidwa ma CD kuti azisinkhasinkha tsiku ndi tsiku ndikuchita masewera olimbitsa thupi pakati pa magawo.

Ethics

Institutional Review Board of [DELETE for BLIND REVIEW] inavomereza phunzirolo. Ophunzira onse adadziwitsidwa za kafukufukuyu ndipo adapereka chidziwitso chazidziwitso.

Results

Ziwerengero zoyambira komanso Wilcoxon adasainira zotsatira zamayeso pazotsatira mu Baseline ndi Measurement 2 (maphunziro a MBRP) amaperekedwa mu Gulu 1. Gulu 1 Mulinso kukula kwa zotsatira zake poyerekeza kufananitsidwa kwa maudindo (Cohen, 1988). Popeza si onse omwe adapezeka kuti amalize kufunsa mafunso, kukula kwa zitsanzo pamiyeso yonse kumasiyananso ndipo amanenedwa Gulu 1. Pakuwunika kwathu, timakhala ndi chidaliro, 95% ndikulimba mtima ndikugwiritsa ntchito mayeso awiri, ngakhale, popeza zotsatira zathu zimachokera koyambirira koyendetsa ndege, tikuunikiranso zomwe zapezedwa pamlingo woyenda.

Gulu 1.Ziwerengero zofotokozera ndi Wilcoxon adasainira zotsatira zoyeserera limodzi ndi r kukula kwamphamvu, kuyerekeza momwe ziriri pano ndi Muyeso 2 (pambuyo pa maphunziro)

ZosiyanasiyanaBaselineMuyeso 2Kuyesa kwa chikwangwani cha Wilcoxonr kukula kwa mphamvu
NMSDMSDZP
Nthawi yogwiritsira ntchito zolaula (sabata yatha, mu min)6200.00235.9739.0023.68-2.200.028-0.64
Nthawi yogwiritsira ntchito maliseche (sabata yatha, min)75.862.804.003.00-1.190.235-0.32
Nthawi yogwiritsidwa ntchito pogonana (sabata yatha, mu min)522.4042.883.603.58-0.540.593-0.17
BPS106.003.304.203.46-1.780.075-0.40
ANALI ndi nkhawa88.885.304.632.13-1.870.062-0.47
ANAKHALA ovutika maganizo86.254.533.002.07-2.210.027-0.55
OCI-R1015.8010.4911.209.11-1.940.052-0.43

Zindikirani. BPS - Zithunzi Zazifupi Pazithunzi; OCI-R - Zowonongeka-Zowonongeka Zomwe Zasinthidwa; HADS - Kuda nkhawa ndi Chipatala; STAI - State-Trait Kuda Nkhawa; r kukula kwake kumayesedwa pogwiritsa ntchito njira Z/ √nx + ny (Pallant, 2007). Kutanthauzira kwa Cohen kwa r kukula kwa mphamvu ndi izi: 0.1 - zotsatira zochepa; 0.3 - sing'anga zotsatira; 0.5 - zotsatira zazikulu (Cohen, 1988).

Zotsatira zomwe zapezeka zikuwonetsa kuti kutsatira kulowererapo kwamalingaliro, omwe adatenga nawo gawo adakhala nthawi yocheperako akuchita zovuta zolaula (monga akuwonetsera pakugwiritsa ntchito sabata yatha; kukula kwakukulu: r = 0.64). Kuphatikiza apo, zolaula zomwe zimakhala zovuta zimagwiritsa ntchito zizindikilo monga zimayesedwa ndi Brief Pornography Screener zatsika, ziwerengero zowerengera zotsatira zimakhala pamlingo wotsatira (P = 0.075; kukula kwapakatikati: r = -0.40). MBRP idadzetsanso kuchepa kwa nkhawa monga akuwonetsera ndi nkhawa ya HADS (zotsatira pamlingo woyenda: P = 0.062; kukula kwapakatikati: r = -0.47) ndikuchepetsa kuchepa kwazizindikiro (HADS P = 0.027; kukula kwakukulu: r = -0.52). Panalinso kuchepa kwa zizindikiritso zowakakamiza (OCI-R) kutsatira maphunzirowa (zomwe zapezedwa pamlingo wotsatira: P = 0.052; kukula kwapakatikati: r = -0.43). Sitinapeze kuchepa kwa nthawi yomwe timagwiritsa ntchito maliseche kapena chiwerewere (P > 0.100).

Zokambirana ndi zolingalira

Amuna khumi ndi atatu achikulire omwe ali ndi chizolowezi chogonana adayesedwa isanachitike komanso itatha pulogalamu ya MBRP yomwe idakwaniritsidwa kuti ikwaniritse zachiwerewere.

Ponseponse, tapeza zazikulu mpaka zazikulu (r pakati pa 0.4 ndi 0.65; Cohen, 1988) poyerekeza kufananizira kwa ma MBRP ambiri. Malinga ndi zomwe timayembekezera, tinawona kuchepa kwa nthawi yomwe timathera pakuwonera zolaula, pomwe zisonyezo zamavuto ogwiritsa ntchito poyerekeza ndi BPS zidatsika mpaka pamlingo woyenda. Tawonani, komabe, kuti BPS imaganizira nyengo ya miyezi isanu ndi umodzi, yomwe ndi yayitali kwambiri kuposa milungu isanu ndi itatu ya MBRP. Kuchepetsa kugwiritsa ntchito zolaula kunapezekanso mu Twohig ndi Crosby (2010) kuphunzira, pomwe ophunzira asanu mwa asanu ndi m'modzi akuwonetsa kuchepa kwakukulu kwakanthawi kakuwona kwawo positi KULowererapo kwa ACT. Tinawonanso kuchepa kopanda tanthauzo kwakanthawi kogwiritsa ntchito maliseche komanso zolaula, zotsatira zake zomwe zimachokera kwa ochepa omwe akutenga nawo mbali. Kafukufuku wamtsogolo akuyenera kuphatikiza zitsanzo zazikulu, zowerengera kwambiri.

Monga tikuyembekezera, tapezanso umboni wakuchepetsa kukhumudwa kwam'mutu, komwe kumawonekera pakuchepetsa kukhumudwa komanso nkhawa. Izi zikugwirizana ndi kuwunika kwa meta komwe kumawonetsa kuti ma MBI amachepetsa nkhawa, kukhumudwa komanso kupsinjika kwamavuto osiyanasiyana azachipatala komanso osagwiritsa ntchito mankhwala (mwachitsanzo. Goyal et al., 2014), kuphatikiza kugwiritsa ntchito mankhwala osokoneza bongo komanso zosokoneza bongo (mwachitsanzo kusanthula meta Li et al., 2017). Momwemonso ku Chimamanda Ngozi Adichie (2010) kafukufuku tidapezanso kuchepetsedwa kwa njira za OC mwa anthu athu a CSBD kutsatira kulowererapo.

Zomwe tapezazi zikugwirizananso ndi maphunziro angapo omwe akuwonetsa kulumikizana koyipa pakati pamaganizidwe ndi zovuta zamagonana. Mwachitsanzo, Reid, Bramen, Anderson, & Cohen (2014) adawonetsa kulumikizana kosagwirizana ndi chiwerewere mopitilira muyeso wamaubwenzi ndi malingaliro am'maganizo, kutengeka mtima komanso kutanthauzira kupsinjika.

Njira zosinthira zopindulitsa sizinafufuzidwe mu kafukufukuyu. Ntchito zam'mbuyomu zidanenanso kuti MBI imalimbikitsa kuzindikira momasuka ndi kuvomereza zamtundu uliwonse (monga Hope, 2006), zomwe zitha kuthandiza pakuchepetsa kupsinjika kwamaganizidwe ndikuchepetsa kuwonera zolaula. Umboni wowonjezeka wa sayansi ukuwonetsa kuti MBRP imakhudza maubongo am'munsi-m'miyendo am'miyendo am'munsi komanso opondereza omwe amapereka chidwi chazovuta zomwe zimachitika chifukwa chogwiritsa ntchito mankhwala osokoneza bongo (onani ndemanga onani Witkiewitz et al., 2013). Kafukufuku wamtsogolo akuyenera kufufuza njira zomwe zimapangitsa kuti anthu azigwiritsa ntchito zolaula pambuyo pa MBRP kuti awone ngati izi ndi zomwe zimapangitsa kuti munthu akhale ndi chilakolako chocheperako, ntchito yolekerera bwino kuti ichititse chidwi, kapena zonse ziwiri.

Pali zoperewera zingapo pakufufuza kwaposachedwa. Choyamba, palibe gulu lolamulira lomwe linagwiritsidwa ntchito phunziroli ndipo panalibe njira yotsatira. Chachiwiri, chitsanzocho chinali chaching'ono ndipo chinali amuna okhaokha aku Caucasus okha. Zitsanzo zazikulu komanso zamitundu yambiri zitha kukulitsa kuchuluka kwa ziwerengero komanso kuthekera kwa zotsatira, ndipo zitha kubweretsa zovuta zina zamankhwala omwe awululidwa omwe sanawonedwe pano. Kuonetsetsa kuti phunziroli lili ndi mphamvu ndikuwonjezeranso kuyambiranso, kukula kwa zitsanzo m'maphunziro amtsogolo kuyenera kulamulidwa ndi kuwunika kwamphamvu kwa priori. Kuphatikiza apo, pomwe timayerekezera zowerengera zingapo, kuwunika kwathu koyendetsa ndege kuli pachiwopsezo chachikulu chotulutsa zabwino zabodza (zolakwika zamtundu wa I) - maphunziro amtsogolo otengera zitsanzo zazikulu ayenera kutsatira kuwongolera koyenera. Kuphatikiza apo, zidziwitso zonse zomwe zidagwiritsidwa ntchito zimadalira malipoti anu, omwe atha kukhala kuti adakhudzidwa ndi zofuna za akatswiri kapena zomwe wachita nawo.

Kuti apange njira yovomerezeka yothandizira CSBD, mayesero amtsogolo a MBRP ndi njira zina zamaganizidwe, ayenera kugwiritsa ntchito njira zowongolera mosiyanasiyana ndikugwiritsa ntchito njira zochepetsera kuti athe kufufuza za maphunziro.

Mwachidule, monga MBI yoyamba idasanthula potengera CSBD, kafukufuku wapano amapereka zotsatira zoyambirira za MBRP. Tikuyembekeza kuti kafukufuku wothandizidwa mtsogolo pa CSBD apanga chidziwitso cha kuthekera kwa njira zosiyanasiyana zamankhwala amisala komanso mankhwala, osagwirizana komanso ophatikizika, kuti athe kuzindikira njira zothandiza kwambiri komanso zothandizirana ndi anthu m'derali lomwe likukula.

Magwero azandalama

PH idathandizidwa ndi Internal Grant (BST, no 181400-32) of Psychology Faculty University of Warsaw; MD, Maphunziro a kulingalira adalipira ndi Internal Grant of Institute of Psychology Polish Academy of Science (yoperekedwa kwa MG); EK ndi MG adathandizidwa ndi Polish National Science Center, OPUS nambala ya 2014/15 / B / HS6 / 03792 (kupita ku MG); ndipo MD idathandizidwa ndi Polish National Science Center PRELUDIUM nambala ya 2016/23 / N / HS6 / 02906 (kupita ku MD).

Zopereka za olemba

Lingaliro pakupanga ndi kapangidwe: MG, PH; kusonkhanitsa deta: MD, EK, kusanthula ndi kutanthauzira deta: PH, MG ndi KL; kusanthula ziwerengero: KL; kuyang'anira kuphunzira: PH ndi MG; zolemba pamanja: PH, MG.

Kusamvana kwa chidwi

Olembawo akulengeza kuti palibe zokangana.