Kurapwa kweinternet kupindwa muropa, kupindwa muropa pabonde uye kumanikidzwa kutenga: Meta-ongororo (2020)

Vhoriyamu / Nyaya: Vhoriyamu 9: Nyaya 1

Authors: Martina Goslar¹, Max Leibetseder¹, Hannah M. Muench², Stefan G. Hofmann³ uye Anton-Rupert Laireita^{1 , 4}

DOI: https://doi.org/10.1556/2006.2020.00005

ngovepo

Mhemberero uye zvinangwa

Kupindwa muropa neInternet, kupindwa muropa nebonde uye kutenga zvinodzvinyirira ndizvo zvinetso zvehunhu, izvo zvinogoverana kufanana nekubhejeka kusagadzikana uye dambudziko rekushandiswa kwezvinodhaka. Nekudaro, zvidiki zvinozivikanwa nezve mashoma ekurapa kwavo. Chinangwa cheiyi meta-kuongorora yaive yekuongorora kukosha kwekurapa kweaya maitiro einetso, uye kukwezva kufanana kune kubhejera dambudziko uye kushandiswa kwezvinodzvinyirira maringe nemhinduro yekurapa.

nzira

Kutsvaga mabhuku kwakaunza 91 zvidzidzo zvinosvika 3,531 vatori vechikamu kuti vape kuongororwa kwakakwana kwenguva pfupi uye kwenguva refu kwekubudirira kwepfungwa, zvemishonga uye zvakabatanidzwa pakurapa kupindwa muropa kweinternet, kupindwa muropa kwepabonde, uye kutenga kwekumanikidza.

Results

Psychological, pharmacological, uye zvakabatanidzwa kurapwa zvaive zvakabatana neyakaomarara pre-post kuvandudza mukuoma kwepasi rose kweinternet kupindwa muropa (Hedges's g: 1.51, 1.13, uye 2.51, zvichiteerana) uye kupindwa muropa kwepabonde (Hedges's g: 1.09, 1.21, uye 1.91, zvichiteerana. ). Zvekumanikidza kutenga, kwepfungwa uye kwemishonga kurapwa kwaivewo kwakabatana nehukuru-hukuru pre-post kuderedzwa mukuoma kwepasirese (Hedges's g: 1.00 uye 1.52, zvichiteerana). Iyo inodzorwa pre-post uye mukati-yeboka pre-yekutevera-maitiro ekukura saizi aive akafanana akaenzana, aine mashoma anosara. Moderator ongororo inoratidza kuti kupindira kwepfungwa kunoshanda pakudzora maitiro ekumanikidza, kunyanya kana akaendeswa kumeso-kumeso uye achiitiswa kwenguva yakareba. Kusanganiswa kwekuziva-kwetsika nzira nemishonga zvakaratidza mukana pamusoro pemamonotherapies.

Kukurukurirana uye Mhedziso

Mhedzisiro yacho inoratidza kuti kurapwa kwemaitiro akapindwa muropa nemaitiro kunoshanda munguva pfupi, kwakafanana neiko kunoitirwa kubhinya uye dambudziko rekushandiswa kwezvinodhaka, asi miedzo yekuchipatara yakawanda inodiwa.

Tsvagurudzo dzichangobva kuitika dzakaratidza kufanana pakati pechishandiswa chekushomeka kwezvinodhaka (SUDs) uye hunhu hwekudyara (BAs; semuenzaniso, Grant, Potenza, Weinstein, & Gorelick, 2010. Nekudaro, izvo zvisiri zvechisimba zvinoenderana nehunhu hwekupindwa muropa zvakange zvatsanangurwa zvichitariswa maererano nemaitiro ekushandiswa kwezvinhu zvinotsanangurwa muDiagnostic uye Statistical Manual yeMental Disorder (DSM IV; American Psychiatric Association, 1994) inosanganisira kufunganya neicho chaicho maitiro, kushaya simba pamusoro pemaitiro, kushivirira, kubvisa, uye kuenderera mberi maitiro kunyangwe mhedzisiro yakaipa (semuenzaniso, Grant et al., 2010. Parizvino, chete kubhejera kusagadzikana (GD), iyo yakapihwa pasi pe "Impulse-Kuvhiringidza Kusina Kunze Kune Imwe Classified" muDMM IV (American Psychiatric Association, 1994), inorongwa pasi pechikamu chitsvaZvidimbu-zvine chekuita neDambudziko rekupinda muropa”YeDSM-5 (American Psychiatric Association, 2013. Uku kuronga patsva kwakamutsa gakava rakawanda pamusoro pekuti mamwe maitiro ane kudzikira kwekumanikidza kudzora anofanirwa kutarisirwa sevanogona kukwikwidza veBA (semuenzaniso, Grant et al., 2010; Mueller et al., 2019).

Kunze kweGD, internet yemitambo kusagadzikana (IGD) ndiyo chete mamiriro ayo akaiswa mu DSM-5 pasi pechikamu Chechitatu nekurudziro yekuenderera mberi kwekutsvaga (American Psychiatric Association, 2013. Inotsigirwa nenyanzvi kubva kune dzakasiyana siyana kliniki uye yeruzhinji hutunhu (semuenzaniso, Rumpf et al., 2018; Saunders et al., 2017), kusagadzikana kwemitambo inoongororwazve mune kunyorwa kweICD-11 (World Health Organization, 2018. Izvo zvakakosha kuti uone kuti IGD inofanirwa kusiyaniswa kubva kune yakasarudzika internet internet kupindwa muropa (IA), sezvo ese ari maviri anomiririra akasiyanaruzha (semuenzaniso, Griffiths & Pontes, 2014; Kiraly et al., 2014. Nekudaro, sezvo zvinyorwa zvakawanda zvichireva iyo yepasi rose IA, izwi iri rakagamuchirwawo pabepa iri. Uyezve, musiyano unofanira kuitwe pakati pe "mutambo" ne "kubhejera": nepo "mutambo uchiti unotsanangurwa nekusangana kwawo, hutambi hwakanyanya-hwakasarudzika, uye zviratidziro zvemberi zvekubudirira uye kubudirira, ... kubhejera kunotsanangurwa nokubheja uye kushambadzira michina, "mukana unogadziriswa unowana mukana, uye maitiro emari inosanganisira njodzi nekubhadhara mutambi." (Mambo, Gainbury, Delfabbro, Hing, & Abarbanel, 2015, p. 216).

Kunyangwe kuisirwa kwe IGD mumabhuku ekuongorora kunoongororwa zvine nharo mumabhuku esainzi (King et al., 2019; Petry, Rehbein, Ko, & O'Brien, 2015; Rumpf et al., 2018; Saunders et al., 2017), kutsvagisa kwakawanda kwatove kwaitwa paIA ne IGD, kunyanya pamatanho ekurapa anoratidza kufanana kwema SUDs (wongororo ona Fauth-Buhler & Mann, 2017; Kuss, Pontes, & Griffiths, 2018. Kunze kwekufanana pakati peSUDs nema BAs maererano nehunhu hwecultical uye yekiriniki, comorbidity uye nhoroondo yemhuri, kunyanya zvawanikwa kubva kutsvagurudzo yezve neuroscience zvinoratidzika zvakakosha pakuzivisa zviratidzo zvehunhu hwekumanikidza (semuenzaniso, Grant et al., 2010; Potenza, Sofuoglu, Carroll, & Rounsaville, 2011).

Zvinoenderana nekufunga uku, imwe kufambira mberi mukuongororwa kwemaitiro europiobiological akajairika neSUDs kwawanikwa munguva pfupi yapfuura mukati memahara ehupombwe kupindwa muropa (SA) uye kutenga kwekumanikidza (CB) nekuongorora zviitiko zvetsika zvakaongororwa muSUDs senzira yekugadzirisa mamiriro (semuenzaniso, Hoffmann, Goodrich, Wilson, & Janssen, 2014; Snagowski, Laier, Duka, & Brand, 2016), cue reacction, kutarisa kwekutarisira uye zvine chekuita neural network activation (semuenzaniso, Brand, Snagowski, Laier, & Maderwald, 2016; Gola et al., 2017; Jiang, Zhao, & Li, 2017; Laier, Pawlikowski, & Brand, 2014; Laier, Schulte, & Brand, 2013; Lawrence, Ciorciari, & Kyrios, 2014; Mechelmans et al., 2014; Pekal, Laier, Snagowski, Stark, & Brand, 2018; Schmidt et al., 2017; Seok & Sohn, 2015; Starcke, Schlereth, Domass, Schöler, & Brand, 2012; Trotzke, Starcke, Pedersen, & Brand, 2014; Trotzke, Starcke, Pedersen, Müller, & Brand, 2015; Voon et al., 2014), kana mukuru anoshanda (Derbyshire, Chamberlain, Odlaug, Schreiber, & Grant, 2014; Messina, Fuentes, Tavares, Abdo, & Scanavino, 2017; Raab, Elger, Neuner, & Weber, 2011; Trotzke et al., 2015. Izvi zvidzidzo zvakaratidza kuti pakati pemamiriro ezvinhu anga asati azivikanwa zviri pamutemo muDMM-5 sema BA, humbowo huripo maererano nehuropiological zviratidzo zvekufanana pakati pezvinhu zvine chekuita nezvezvinhu zvisina hukama nezvinodhaka zvinonyanya kubva munzvimbo dzeIA, SA. uye CB, ndiyo inonyanya kutarisa pepa riripo. Sezvo matambudziko aya ari ekufanirwa kwekiriniki, uye achiwanzobatana nemhedzisiro inokuvadza kune vanhu vakakanganisika (semuenzaniso, Pontes, Kuss, & Griffiths, 2015), inoshanda nzira dzekurapa dzinoda kuongororwa (semuenzaniso, Grant et al., 2010. Parizvino, kwakabudiswa meta-kuongororwa kwakaitwa kunyanya nezveIA kuchiratidza kuve kwakanyanya kwenzira dzakasiyana siyana dzekurapa (Chun, Shim, & Kim, 2017; Liu, Liao, & Smith, 2012; Winkler, Doersing, Rief, Shen, & Glombiewski, 2013. Maviri emeta-inoongorora kuongorora kwepfungwa, zvemishonga uye kusanganisa kwese kupindira, asi humbowo hwaiverengeka kumhedzisiro yemhedzisiro yekurapa muChina (Liu et al., 2012), uye Korea (Chun et al., 2017. Iyo yakazara yakazara meta-analytic kuongororwa yakatsigira humbowo hwekuita kwekurapa kwepfungwa uye kurapwa kwekurapa kuderedza zviratidzo zveIA zvinosanganisira miedzo kubva kuAsia nekunyika dzekumadokero.Winkler et al., 2013. Kupindira kwakabatanidzwa, zvisinei, hakuna kufungwa. Uyezve, iyo meta-kuongororwa kwe Winkler et al. (2013) haina kusanganisira kuwedzera kutsva

Mhedzisiro inofadza yekupindira kwepfungwa uye kwemishonga mukuderedza kushushikana kwepasi rose kweCB kwakawanikwawo mune imwezve meta-analysis.Hague, Horo, & Kellett, 2016). Nekudaro, iko kukanganiswa kwehunhu hwekudzidza uye vamwe mamodhereri pamhedzisiro yekurapa haina kuongororwa. Nekudaro, kuongororwa kwakazara kwesarudzo dzekurapa IA uye CB kuchakamirira. Kunyangwe SA ichionekwa muICD-11 nezwi rekuti "kumanikidzira kusagadzikana kwepabonde" (World Health Organization, 2018), uye "kuzvipembedza kuzvinzwa kupindwa muropa nezvinonyadzisira hakuna kujairika" (Grubbs, Kraus, & Perry, 2019, p. 93), marapirwo eSA haasati aongororwa meta-analytic nzira. Pamusoro pezvo, hapana kuenzanisa kusati kwaitwa pakati peIA, kana IGD-mumiriri wedunhu "Zvidimbu-zvine chekuita neDambudziko rekupinda muropa”YeDSM-uye mamwe maitiro anogona kupindwa muropa, akadai seSA neCB, zvichibva pamhinduro yekurapa, inoonekwa sechiratidzo chakakosha pakufanana pakati peSUDs nema BAs (semuenzaniso, Grant et al., 2010).

Chinangwa chekutanga cheiyo meta-kuongorora, saka, yaive yekuongorora kushanda kwehutano hwepfungwa, zvemishonga uye pamwe nekupindira kwepfungwa neyechipatara kuIA, SA, uye CB yekudzikisira (a) kushomeka kwepasi uye (b) kudzokorora kwekumanikidza. maitiro mushure mekurapwa kurapwa (kwenguva pfupi mhedzisiro) uye panguva yekupedzisira yakateverwa yekutevera nguva (yerefu-mhedzisiro). Kubva pane zvawanikwa muongororo dzazvino (Hague et al., 2016; Winkler et al., 2013), isu taitarisira kurapa kwepfungwa uye kwemishonga kuti zvinyatsobatika pane ese matatu ekupindwa muropa. Isu takatarisira zvakare kuti zvabuda kurapwa zvakafanana neizvo zvakataurwa zvekushandiswa kwezvinodhaka uye kubhejera (Grant et al., 2010; Potenza et al., 2011. Uye zvakare, shuviro yedu yaive yekucherekedza vangangoita mamaneja ezvekukura mukati meboka rekupindwa muropa. Iyo meta-kuongorora yakaitwa zvichienderana nekurudziro yePRISMA Chirevo (Moher, Liberati, Tetzlaff, & Altman, 2009).

nzira

Eligibility criteria

Zvidzidzo zvakaongororwa kuti zvisanganiswe kana ivo (1) vakashandisa chero rudzi rwepfungwa, hwepamakemikari, kana rwakapindirwa kupindira (semuenzaniso, kupindira kwepfungwa uye kwemishonga zvakashandiswa panguva imwe chete); . (2) yakabata vatori vechikamu nekuongororwa kweIA, SA, kana CB; (3) kuyerwa kanenge kamwe kemhedzisiro yemhedzisiro (kureva, kuwanda kwepasi kana kuwanda); uye (4) yakataura data yakakwana yehuwandu hwekuverenga saizi. Zvidzidzo zvakabvisirwa kunze kana (5) chidzidzo ichi chaive chidzidzo chimwe chete; (1) muyenzaniso wekudzidza wakawiriraniswa zvizere netauro yechimwe chidzidzo chakaiswa mune meta-ongororo; (2) kurapwa kwacho hakuna kurondedzerwa, kana (3) hapana chinyorwa kana chizere chekudzidza chakawanikwa. Nekuremekedza SA, isu takangobatanidza zvidzidzo zvinoongorora zvakawandisa maitiro ezvepabonde zvichitevera tsananguro yakatsanangurwa na Kafka (2010), uye isingabvumidzwe zvidzidzo zvinotarisisa kurapwa kwema paraphilias akasiyana neeSA maererano ne “nzira dzisina mutsauko kana 'dzinotsauka' dzekufarira zvepabonde” (Kafka, 2010, p. 392).

Ruzivo nezvinyorwa uye kutsvaga mabhuku

Takaita ongororo yemabhuku e multilevel tichishandisa iyo dhatabheti PsycInfo, Medline, PubMed, Psyndex, uye ISI Webhu reKuziva. Tsvagiridzo yakafukidza zvese zvakadhindwa zvinyorwa kubva gore rekutanga raivepo kusvika June 30, 2019 uchishandisa mazwi anotevera ekuvhiringidzika ane chekuita neshoko: kupindwa muropa neInternet, kupindwa muropa nemhepo ∗, internet mutambo wekutamba, mutambo wevhidhiyo muropa ∗, vhidhiyo yemutauri ∗, videogame addict add, komputa mutambo weropa ∗, mutengesi wefodya ∗, runhare runhare, ∗, midhiya yekushambadzira ∗, facebook addict ∗, dambudziko ∗ mbozhanhare mbozha; bonde ∗ kupindwa muropa ∗, bonde ∗ kumanikidzwa ∗, bonde ∗ kumanikidzirwa ∗, hypersex ∗, kusangana pabonde ∗, chirwere cheparutivi-chakashata ∗; kumanikidza kutenga, kumanikidza kutenga ∗, oniomania, shopaholic ∗, kusarudzika kwakabatanidzwa pamwe nekupindirana-kwakanangana nemazwi makuru kurapwa, kupindira, kurapa, psychotherapy. Iwo mamwe mazwi ekutsvaga aishandiswa kuongorora ProQuest Dhijitari Dissertations yezvinyorwa zvisina kunyorwa, grey. Pashure pacho, isu takaita ongororo yakakwana yezvinyorwa zvinyorwa zvedzokorodzo zvinyorwa, meta-ongororo, uye zvidzidzo zvepakutanga zvakawanikwa kubva mudura. Pamusoro pezvo, vanyori vezvakakodzera zvinyorwa vakafonerwa kuti vabvunze iyo yakarasika data uye / kana mapepa asina kunyorwa akakodzera kuisirwa mune meta-kuongorora. Zvinyorwa zveChinese zvakashandurwa nevatauri vaviri veko vane ruzivo rwekudzidza.

Migumisiro miitiro

Tichitevera nzira dzinowanzo kutaurwa dzekupedza muzvidzidzo zvepakutanga, takataura mhedzisiro miviri yekuongorora kuderedzwa kwezviratidzo zvezvipfungwa: (1) kuomarara kwepasi rose, kwakatsanangurwa nekushandiswa kwezvinhu zvekushandisa zvakakodzera, uye (2) mafambiro (semuenzaniso, nhamba yemaawa anoshandiswa online, kuona zvinonyadzisira, kana huwandu hwekutenga zvikamu muvhiki yekupedzisira kana mwedzi), yakatsanangurwa nemakadhi edhizari kana kuzvishuma.

Kudzidza kusarudza

Sarudzo yekudzidza yakaitwa nevaviri vakazvimiririra vanoongorora (yekutanga neyechipiri vanyori, MG uye ML), uye inotarisirwa nemunyori wekupedzisira weiyi pepa (AL). Kusawirirana pakati pevanyori kwakagadziriswa kuburikidza nekukurukurirana.

Iyo data yekuunganidza maitiro uye kudhonza kwe data

Isu takaburitsa yakarongedzwa dhata yekubvisa fomu yatainatsiridza nekugadzirisa mushure mekutyaira kuyedza sampuli yezvidzidzo gumi. Kuti uverengere pre-post uye pre-tevedza-mukati-group athari saizi, nhamba yehuwandu yakaiswa kune yega yega mamiriro ekurapa uye mhedzisiro zvakasiyana. Kana kwakasiyana kurapa kwepfungwa kana kwekurapa kwakawongororwa mukati meongororo imwe chete, dhata yemamiriro ese akanyorwa zvakasiyana ndokuiswa mukati meboka rehukuru hwekuongororwa kwehuwandu. Kuverengera pre-post inodzora maitiro masayizi, data kubva kumirira-rondedzero, hapana kurapwa, uye placebo kutonga mapoka akaverengerwa. Pamusoro pezvo, isu takadzora manhamba uye data danho kubva mune yega yega kudzidza kuitira kuti moderator aongorore. Kudhonza kwedata kwakaitwa nemunyori wekutanga (MG), uye kwakasimbiswa nemunyori wechipiri (ML). Makero eaviri akazvimirira makodhi anotarisana nemhando dzekurapwa, kuyerwa kwemhedzisiro kusiyanisa, uye kuvimbika nekuvimbika kwechirwere-chakananga kuongororwa. Muzvidzidzo, zvisinei, zvishandiso zvakafanana zvakashandiswa zvese kuongororwa kwehosha-yakananga kuongororwa uye kuyerwa kweiyo mhedzisiro inoshanduka "kupindirana kwepasi rose" panguva yekurapwa. Nekuti chiyero chekuvimbika uye chokwadi chezvishandiso zvinoshandiswa kuyerwa kwezvakabuda mhedzisiro zvaivawo chikamu cheyengozi yengozi yekukosheswa muzvidzidzo zvega zvega (ona pazasi), kuvimbika kwakabvunzana kwakatsanangurwa nekappa statistic kwakaitirwa chete mhando dzekurapa.

Njodzi yekufungirwa mune mumwe nemumwe zvidzidzo

Takaongorora kukosha kwemukati kwechidzidzo chega chega tichishandisa iyo Yekushandisa Kuongororwa Kwemhando yepamusoro yeVadzidzi, yakagadziriswa neIzwi Rinoshanda Reruzhinji Zvekuita Muenzanisiro (EPHPP) (Thomas, Ciliska, Dobbins, & Micucci, 2004. Ichi chishandiso chakaratidza zvirimo uye kuvaka chokwadi (Thomas et al., 2004) uye inokurudzirwa kuongororwa kwakateerana uye meta-kuongororwa (Deeks et al., 2003. Chidzidzo chega chega chakapihwa nenzira yakafanana pamizinda mitanhatu: kusarurudza kusarudzika, dhizaini yekudzidza, kuzivikanwa uye kutonga kwevanokanganisa, kupofumadza, kuvimbika uye kuvimbika kwematengo ekuunganidza dhata, uye kupa chirevo nepesenti yekubvisa uye vanosiya. Dunhu rega rega raiongororwa serakasimba, zvine mwero, kana risina kusimba. Chiyero chepasi rose chakaverengerwa mushure mekuongororwa kwematanho matanhatu. Vaviri vekutanga vanyori (MG uye ML) vakazvimiririra vakaongorora ongororo yega yega uye vakatarisisa huwandu hwepasi rose hweedzo. Kupinda mukati mekuvimbika kwakakamurwa uchishandisa kappa statistic. Kusawirirana pakati pevanyori kwakagadziriswa kuburikidza nekukurukurirana kudzamara kubvumirana kwasvika.

Mhedzisiro ukuru hwekuverenga uye huwandu hwekuumbwa data

Statistical ongororo yakaitwa uchishandisa software software Yakakwana Meta-Analysis (CMA) shanduro 2.2.064 (Borenstein, Hedges, Higgins, & Rothstein, 2005). Muchikamu chega chega chekupindwa muropa, takaverenga saizi yemhedzisiro misiyano yakataurwa mune zvepfungwa, zvezvemishonga, uye zvidzidzo zvakabatanidzwa zvakasiyana-mukati meboka-uye rinodzorwa dhizaini dhizaini (ona Appendikisi yemafomula). Nekuda kwemasampuru madiki esampula, iwo masize ekugadzirisa akagadziridzwa kuitira kusarudzika achishandisa maHedges g neiyo inowirirana 95% chidimbu chekuyera (CI; Hedges & Olkin, 1984. Kana nzira uye kutsauka kwakasiyana kwaisawanikwa, masayizi ekuenzanisa akaverengerwa kubva pane zvakaenzana maitiro ekuyera (semuenzaniso, t zviyero, kana iwo chaiwo mukana mazinga). Kana mhedzisiro yemhedzisiro yakayerwa neanopfuura chiridzwa chimwe, data kubva kune izvi zviridzwa yakaiswa zvakasiyana uye yakarongedzwa pamwechete kuitira mhedzisiro yemhedzisiro (Lipsey & Wilson, 2000). Zvezvidzidzo zvekuburitsa dhata zvichibva kune vese vakapedzisa uye chinangwa-chekurapa (ITT) inoongorora, iyo ITT data yakafungidzirwa. Iwo mafambiro eichi chiitiko akagadziridzwa zvinoenderana ne "kubudirira": saizi mhedzisiro yaive yakanaka kana iro boka rakarapwa rikaita rakakwirira kupfuura iro rinodzora boka. Zvinoenderana nezvakakurudzirwa naCohen (1977), mhedzisiro yakakura ye0.20 kusvika ku0.30 inogona kuverengerwa madiki, iwo ari pedyo ne0.50 svikiro, uye ayo ari pamusoro pe0.80 sehukuru.

Tichifunga heterogeneity pakati pezvidzidzo, isu takasarudza kushandisa iyo isina kujairika mhedzisiro mienzaniso yekubatanidzwa kweaizi saizi. Heterogeneity yemhedzisiro masaizi akaongororwa achishandisa Q nhamba neiyo inoenderana p kukoshesa, uye iyo I² Statistic, zvichiratidza kusvika papi misiyano chaiyo mumasayizi ezviratidziro yairatidzwa nechikamu chesiyano (Borenstein, Hedges, Higgins, & Rothstein, 2009; Higgins, Thompson, Deeks, & Altman, 2003); I² zviyero zve25%, 50%, uye 75% zvakaiswa pasi sedzakaderera, zvine mwero, uye zvakakwirira, zvichiteerana (Higgins et al., 2003).

Njodzi yekufungira pane zvese zvidzidzo

Kuti tidzore kuburitsa pachena, takaita tsvakiridzo yemabhuku uye takaverenga kukundikana kwaRosenthal N (Rosenthal, 1979) uye zvakare akaongorora mafirandiDuval & Tweedie, 2000). Maererano ne Rosenthal (1991), mhedzisiro masaizi anotariswa kunge robust kana huwandu hwezvidzidzo zvinodiwa kuti uwane zvisingaite huwandu hwekuita hwakakura kupfuura 5k + 10, kupi k inomiririra huwandu hwezvidzidzo. Kuwedzera, isu takashandisa nzira-uye-yekuzadza nzira (Duval & Tweedie, 2000) kufungidzira yakarasika zvidzidzo uye mabudiro azvo pane yakagadziriswa maitiro masayizi. Iyi nzira inotariswa maererano nemafungiro ehurongwa hwe funnel uye inotora kuenderana kwekugovera kweaizi masayizi emhedzisiro yemhedzisiro yekusiyana-siyana kwekuvapo kwekushambadzira kusarura. Muchiitiko chekuparadzirwa kweasymmetrical, iyo nzira yekutanga-uye-inozadza inogadzirisa uye inogadzirisa mhedzisiro yesayizi (Borenstein et al., 2009); isu takangoshandisa iyi nzira kana zvidzidzo gumi zvaivepo zvekuongororwa (Sterne, Egger, & Moher, 2011). Funnel plot asymmetry yakaongororwa nekuyedza Egger bvunzoEgger, Smith, Schneider, & Minder, 1997. Sezvo imwe chete yakanyanyisa mhedzisiro size kukosha inogadzira kududzira kwakashata kwemhedzisiro yekurapa (Lipsey & Wilson, 2000), isu takashandisa iyo "imwechete-kudzidza-yakabviswa" nzira yakapihwa neCMA kuongorora kukanganisa kwega kwega kukura kwesimba pesimba pane yakazara maitiro (Borenstein et al., 2005. Kana zvawanikwa zvekare zvikasaita zvakanyanya kukura kwechirongwa uye chakaramba chiri mukati me95% CI, zvidzidzo zvakachengetwa muma ongororo.

Moderator kuongororwa

Kuti utsanangure heterogeneity pakati pemasero masisitimu, takaongorora mhando yekuongororwa kwedata (ITT vs. compter kuongororwa), uye mhando yezvidzidzo (EPHPP global scores) sezvinobvira mamoderators. Nekuti kushungurudzika uye kusagadzikana kwakawanikwa kuve kwakabatana nemaBA (semuenzaniso, González-Bueso et al., 2018; Starcevic & Khazaal, 2017), isu takaongorora kana mhedzisiro yakakura seyakabata basa rezvirwere izvi zvinowanzoitika (kusanganisa vs. kusasanganisira kushungurudzika uye / kana kusagadzikana). Sezvo kusangana kunokonzeresa kusagadzikana, kunyanya kushungurudzika uye kusagadzikana, zvakajairika pakati pevanhu vakakanganiswa neBAs (Starcevic & Khazaal, 2017), zvidzidzo zvakatadza kuburitsa data pamamiriro ezvinhu e comorbid akafungidzirwa kuti aisanganisira vatori vechikamu nekubatana kunoitika kushungurudzika uye kusagadzikana zvakare. Kwezvidzidzo zvepfungwa, takawedzera kuongorora maitiro ekurapa (boka kurongedza vs. kupomoka kwega kupokana kunopesana nemamwe marudzi ezvirongwa [semuenzaniso, kurongeka kwemunhu uye boka, kurongeka kwemhuri], maitiro ekutumira (kumeso-kune- [FTFTs] vs. inozvitungamira kurapwa [SGTs]), uye mhando yekupindira kwepfungwa. Mhando yekupindira kwepfungwa yakaongororwa nekuganhura mazano epfungwa mune anotevera zvikamu: (1) CBT, yakafukidza kungwara uye / kana maitiro ekurapa; (2) Kurapa kwakabatana kunosanganisira nzira dzakasiyana siyana dzekurapwa, uye (3) kurapwa kwepfungwa zvinoenderana nemamwe mapoka, sekurapa kwemhuri, kurapa chaiko, kugamuchira uye kuzvipira kurapa. Tichifunga kuti huwandu hwedzidzo dzakaitwa munyika dzisiri dzekumadokero, kunyanya yeIA, isu takatevera ongororo yeMeta-ongororo (Winkler et al., 2013) uye ndokuongorora kuti kana tsika yetsika (yeAsia pamwe nedzimwe nyika) yakaratidza kuva mutungamiriri. Sezvo yepasi rose IA uye IGD inomiririra kwakasiyana-siyana (semuenzaniso, Griffiths & Pontes, 2014), isu zvakare takaongorora mutsauko uripo pakati pezvidzidzo zvakavakirwa wepasi rose IA uye izvo, zvakaongorora IGD uye zvimwe zviitiko zvinogonesa internet (semuenzaniso, smartphone kupindwa muropa, videogame kupindwa muropa).

Kwemishonga yekurapa, takaongorora kana antidepressants akaitwa akakura kune mamwe marudzi emishonga kana kune yakasanganiswa mishonga (semuenzaniso, antidepressants yakasanganiswa methylphenidate). Yezvezvidzidzo zvakasanganiswa, takaongorora zvese kukanganisika kwemhando dzekupindirana kwepfungwa uye kwemishonga. Kuwedzera, takaongorora kana imwe yemhando dzekurapwa (kwepfungwa nepfungwa dzekutengesa pamwe nekubatanidzwa) mukati meboka rekupindwa muropa rakaratidza mukana pane vamwe. Chekupedzisira, isu takafananidza iwo masikero ezvirwere zvepfungwa uye zvechipatara zvemapoka akasiyana ehurongwa Kuzvidavirira nenyaya yekuti "internet ingori chiteshi chekuti vanhu vanogona kuwana chero zvavanoda (semuenzaniso, kubhejera, kutenga, kutaura, zvepabonde)" (Griffiths & Pontes, 2014, p. 2), takatora zvidzidzo zvaisanganisira vanhu vane tsika dzakanyanya dzebonde kana dzekutenga hunhu pasi pemapoka "kupindwa muropa nekupinda muropa" uye "kumanikidza kutenga", zvisinei nekuti internet yakashandiswa kana kwete.

Moderator inoongorora yemhando dzakasiyana-siyana dzakaitwa uchishandisa iyo yakavhenganiswa mhedzisiro mienzaniso neye pooled fungidziro ye T² uye iyo Q-bvunzo inoenderana nekuongororwa kwekusiyana kwazvinoenderana p kukosha kwekududzirwa kwemisiyano iripo pakati pevashoma (Borenstein et al., 2009. Panyaya yezvidzidzo gumi zvinowanikwa (Madhekisi, Higgins, & Altman, 2011), isu takaenderera zvakare kuita meta-regression inoongorora tichishandisa gore rekuburitsa uye nguva yekurapwa (yakaongororwa nehuwandu hwemaawa akapedzerwa pakurapwa mukuedzwa kwepfungwa, kana nehuwandu hwemavhiki mukuedzwa kwemishonga. Kana iyo isina kukwana nhamba yezvidzidzo zvepfungwa yakaratidza huwandu hwemaawa anoshandiswa pakurapwa, nhamba yemavhiki yakashandiswa kuyera nguva yekurapa. Meta-regression inoongorora pazera rekureva uye huwandu hwevatori vechikadzi / vakadzi havana kuitwa nekuti zera uye zvepabonde pane zvese zvidzidzo zvakasiyana kubva mukati mezvidzidzo zvinokanganisa kududzira zvakavimbika (Thompson & Higgins, 2002).

Results

Kudzidza kusarudza

Dhavhidha dhayamita rechisarudzo chesarudzo inoenzanisirwa mukati Fig. 1. Pakanga pasina kusawirirana pakati pemhando dzekurapa.

Hunhu hwezvidzidzo, kurapwa, uye vatori vechikamu

Kupfuura ese marudzi ekupindwa muropa, iwo aripo svutugadziro yezvidzidzo zvakasiyana mune yerudzi rwemamiriro ekutonga: Hafu yavo yakagadziriswa hapana boka rekutonga (50%) uye zvidzidzo zvinoverengeka zvakashandiswa kumirira, hapana kurapwa, hutano hunodzora, kana placebo control mapoka (30%), kana kumwe kurapa kunoshanda kuenzanisa (20%). Mhedzisiro yacho yainyanya kutarisana nevakamiriri (80%). Yekutevera-data yakapihwa ne32 zvepfungwa zvidzidzo (IA: k = Zvidzidzo gumi nematanhatu zvine nguva kubva pamwedzi kusvika pamatanhatu; M = 3.53, SD = 2.13; SA: k = 11 zvidzidzo nezvenguva kubva ku 1.5 kusvika kumwedzi mitanhatu; M = 4.27, SD = 1.88; CB: k = Zvidzidzo gumi nematanhatu zvine nguva kubva pamwedzi kusvika pamatanhatu; M = 5.4, SD = 1.34), nekudzidza kumwechete kwemakemikari muboka reCB ine mwedzi gumi nemaviri yekutevera, uye nezvidzidzo zviviri muchikamu cheIA icho chakashandisa nzira dzakabatanidzwa, yega yega kuunganidza data pamwedzi mumwe chete unotevera.

Ruzhinji rwepfungwa dzepfungwa dzakaongorora CBT (58%), yakaunza kurapwa kuburikidza neketi yemapoka (71%), uye kumeso-kwechiso (92%). Nhamba yakazara yamaawa anoshandiswa mukupindira kwepfungwa yakatanga kubva pamaminitsi gumi kusvika makumi mana nemakumi mashanu neh (h.M = 12.55 h, SD = 10.49), kubva pavhiki imwe kusvika makumi maviri nemavhiki makumi maviri neshanu (M = 10.44, SD = 6.12), uye kubva pamasvondo masere kusvika pamavhiki makumi maviri (M = 11.71, SD = 3.90) kurapwa kweIA, SA, uye CB, zvichiteerana. Mazhinji emakemikari zvidzidzo zvakaongorora antidepressants (85%); ruzhinji rwemiedzo yakasanganiswa yakashandiswa CBT mukubatana neantidepressants (71%). Iyo nguva yekurapa kwemishonga yakabva pamasvondo matanhatu kusvika makumi mashanu neshanu (M = 15.67, SD = 17.95), kubva pamasvondo gumi nemaviri kusvika makumi manomwe nemaviri (M = 24.83, SD = 23.58), uye kubva pamavhiki manomwe kusvika gumi nemaviri (M = 9.50, SD = 2.20) kurapwa kweIA, SA, uye CB, zvichiteerana.

Pakati pamarudzi ese akapindwa muropa, zviuru zvitatu zvevanhu 3,531 vakapinda muchikamu vakaongororwa (IA: n = 2,427; SA: n = 771; CB: n = 333). Ruzhinji rwezvidzidzo rwacho rwaisanganisira vatori vechikamu vanekuitika pamwe kushungurudzika uye kusagadzikana (77%). Miedzo inotarisana neIA yainyanyoitwa munyika dzeAsia (75%). Muenzaniso wose waive wakanyanya kuve munhurume muzvidzidzo achiongorora IA (76%) aine avhareji yemakore makumi maviri nemasere, uye SA (21%) aine avhareji yemakore makumi matatu nemashanu, asi mukadzi muzvidzidzo anoongorora CB (98%) aine avhareji yemakore makumi mana neshanu Ruzivo rwakadzama maererano nehunhu hwezvidzidzo hunounzwa mukati Matafura 1-3.

Tafura 1.Hunhu hwezvidzidzo zvekupindwa muropa ne internet

Kudzidza / gore	N^a	Kurapa boka (N) / Mode yekurapa / Mode yekutakura^b	Kudzora boka (N) / Mode yekurapa / Mode yekutakura^b	Tsika / D / A (+/−) / IA mhando	chinguva t / c^c	FU (mwedzi)	Migumisiro (ongororo)	Data analysis	EPHPP
Kurapa kwepfungwa
Anuradha uye Singh (2018)	28	CBT (28) / I / FTFT	hapana	Asia / - / IA	NA	hapana	GS (IADQ)	CO	3
Bai uye Fan (2007)	48	IT (CBT; kuzvidzora; kugona kwehukama) (24) / G / FTFT	NT (24)	Asia / + / IA	16	1.5	GS (CIAS-R)	CO	3
Cao et al. (2007)	57	CBT (26) / G / FTFT	NT (31)	Asia / + / IA	10	hapana	GS (YDQ, CIAS)	CO	2
Nyamavhuvhu (2016)	30	EDU (15) / G / FTFT	NT (15)	Turkey / + / IA	10	6	GS (PIUS) FR (% yemutambo weInternet uri kutamba pakati pekushandiswa kweInternet / w)^d	NA	3
Deng et al. (2017)	63	CBI (44) / G / FTFT	WL (19)	Asia / + / IGD	18	6	Kuende (KUE)	CO	2
Du et al. (2010)	56	IT (CBT; kudzidziswa kwevabereki; EDU yevadzidzisi) (32) / G / FTFT	NT (24)	Asia / + / IA	14	6	GS (KUE)	CO	2
González-Bueso et al. (2018)	30	1) CBT (15) / I / FTFT 2) IT (CBT + EDU yevabereki) (15) / I / FTFT	HC (30)^e	Spain / - / IGD	1) 9 2) 9	hapana	Kuende (KUE)	CO	3
Guo et al. (2008)	28	1) CBT (14) / G / FTFT	2) SUPP (semuenzaniso, kugovera ruzivo paIA; kukurudzira kwekuzvishingisa uye zviwanikwa) (14) / G / FTFT^f	Asia / + / IA	1) 8 2) NA	hapana	Kuende (KUE)	CO	2
Han et al. (2012)	14	FT (14) / F / FTFT	hapana	Asia / - / IGD	NA	hapana	GS (YIAS) FR (h / w)	CO	3
Han et al. (2018)	26	CBT (26) / G / FTFT	hapana	Asia / - / IGD	24	hapana	Kuende (KUE) FR (h / w)	CO	3
Hui et al. (2017)	73	1) CBT (37) / G / FTFT	2) IT (CBT + EA) (36) / I + G / FTFT^f	Asia / - / IGD	1) 5 2) 10	hapana	GS (IAD)	CO	2
Ke na Wong (2018)	157	CBT (157) G / FTFT	hapana	Asia / + / IA	12	1	GUS (PIUQ)	CO	3
Khazaei et al. (2017)	48	PI (24) / G / FTFT	WL (24)	Iran / + / IA	NA	hapana	GS (IAT) FR (h / w)	NA	3
Kim (2008)	25	RT (13) / G / FTFT	NT (12)	Asia / + / IA	12.5	hapana	GS (K-IAS)	NA	3
King et al. (2017)^g		CBT (84 h kuramba) (9) / I / NA	hapana	Australia / + / IGD	NA	1	GS (IGD muongorori) FR (h / w)	CO	3
Lan et al. (2018)	54	1) CBT (27) / G / FTFT	2) EDU (27) / G / FTFT^f	Asia / + / SMA	1) 8 2) 1	3	GS (MPIAS) FR (h / w)	CO	2
Lee et al. (2016)	46	CBT (pamba-yakagadzirirwa kunyora zuva nezuva) (46) / FTFT / I	hapana	Asia / + / SMA	NA	hapana	GS (KSAPS)	CO
Li na Dai (2009)	76	CBT (38) / I / FTFT	WL (38)	Asia / + / IA	14	hapana	Kuende (KUE)	CO	3
Li, Garland uye al. (2017)	30	1) ZVIMWE (15) / G / FTFT	2) SUPP (15) / G / FTFT^f	USA / - / IGD	1) 16 2) 16	3	GS (DSM-5 maitiro)	HERE	2
Li, Jin nevamwe. (2017)	73	1) CBT (36) / G / FTFT	2) CBT + EA (37) / I + G / FTFT^f	Asia / + / IGD	1) 5 2) 10	hapana	GS (IAT)	CO	3
Liu et al. (2013)	31	1) CBT (16) / G / FTFT	2) SM (semuenzaniso, zvinyorwa zvakanyorwa zvekuzeza kubhejera; kutsunga kwemaitiro ekuita) (15) / G / SGT^f	Asia / - / IA	1) 54 2) 24	hapana	GS (IAT) FR (h / d)	CO	3
Liu et al. (2015)	46	FT (21) / G / FTFT	WL (25)	Asia / - / IA	12	3	GS (APIUS) FR (h / w)	CO	2
Pallesen et al. (2015)	12	IT (CBT; FT; SFT; MI) (12) / G / FTFT	hapana	Norway / + / VGA	NA	hapana	GS (GASA; PVP)	CO	3
Paki, Kim et al. (2016)	24	1) CBT (12) / G / FTFT	2) VRT (12) / G / SGT^f	Asia / - / IGD	1) 16 2) 4	hapana	GS (YIAS)	CO	3
Zvinonyadzisa et al. (2018)	54	1) IT (CBT + hunyanzvi + mitambo) (24) / G / FTFT	2) EDU (30) / G / FTFT^f	Asia / - / IGD	NA 2) 1	6	Kuende (KUE)	CO	2
Sakuma et al. (2017)^g	10	IT (SDiC inosanganisira CBT; yekubika ekunze, famba nerally; kufamba; kugadzira huni) (10) G / FTFT	hapana	Asia / - / IGD	NA	3	FR (yemitambo h / d; h / w; d / w)	CO	3
Shek et al. (2009)	22	IT (munhu oga uye mazano emhuri; rutsigiro rwevezera) (22) / I / FTFT	hapana	Asia / + / IA	NA	hapana	GS (CIA-Y; CIA-G)	CO	3
Sei et al. (2018)	46	MI (PFB) (46) / I / SGT	hapana	Asia / + / IA	NA	hapana	GS (IAT)	CO	3
Su et al. (2011)	59	CBT (chirongwa chekurapa pamhepo) 1) LE (17) / I / SGT 2) NE (12) / I / SGT 3) NI (14) / I / SGT	NT (16)	Asia / + / IA	1) 0.48 2) 0.48 3) 0.26	hapana	GS (YDQ) FR (h / w)	CO	2
van Rooij et al. (2012)	7	CBT (7) / I / FTFT	hapana	Netherlands / + / IA	7.5	hapana	GS (CIUS) FR (d / w; h / d)	CO	3
Wartberg et al. (2014)	18	CBT (18) / G / FTFT	hapana	Germany / + / IA	12	hapana	GS (CIUS) FR (h / mavhiki; h / vhiki)	CO	3
Woelfling et al. (2014)	42	CBT (42) / G + I / FTFT	hapana	Germany / - / IA	32	hapana	GS (KUA) FR (h / zuva revhiki)	HERE	3
Yang naYako (2005)	52	IT (SFBT; FT; CT) (52) / I / FTFT	hapana	Asia / + / IA	NA	hapana	GS (YDQ)	CO	3
Yang et al. (2017)	14	1) CBT (14) / G + I / FTFT 2) EA (16)^h	HC (16)^e	Asia / - / IA	20	hapana	GS (IAT)	CO	2
Yao et al. (2017)	37	IT (RT; MFM) (18) G / FTFT	NT (19)	Asia / + / IGD	12	hapana	Kuende (KUE)	CO	3
Muduku (2007)	114	CBT (114) / I / FTFT	hapana	USA / + / IA	NA	6	Gs. FR (OA)	CO	3
Muduku (2013)	128	CBT yakagadziridzwa (128) / I / FTFT	hapana	USA / + / IA	NA	6	GS (IADQ)	CO	3
Zhang (2009)	70	IT (CBT; mitambo) (35) / G / FTFT	NT (35)	Asia / + / IA	24	hapana	GS (IAT)	CO	3
Zhang et al. (2009)	11	CBT (11) / G / FTFT	hapana	Asia / + / IA	NA	hapana	GS (IAT)	CO	2
Zhang et al. (2016)	36	IT (CBI + MFTR) (20) / G / FTFT	NT (16)	Asia / + / IGD	17	hapana	Kuende (KUE) FR (h / w)	CO	2
Zhong et al. (2011)	57	1) FT (28) / G / FTFT	2) IT (kudzidziswa kwemauto; mitambo; kurapa kunonongedza maitiro akapindwa muropa) (29) / G / FTFT^f	Asia / - / IA	24.5 2) NA	3	Kuende (KUE)	CO	2
Zhu et al. (2009)	45	1) CBT (22) / G / FTFT	2) IT (CBT + EA) (23) / I + G / FTFT^f	Asia / + / IA	5 2) 10	hapana	Kuende (KUE)	CO	2
Zhu et al. (2012)	73	1) CBT (36) / G / FTFT	2) IT (CBT + EA) (37) / I + G / FTFT^f	Asia / + / IA	5 2) 10	hapana	GS (IAT)	CO	2
Pharmacological kurapwa
Bipeta et al. (2015)	11	Variid antidepressants (mushure mekutambudzika kweconazepam yakaiswa mumavhiki matatu) (3) (vatori vechikamu neIA uye OCD)	2) Yakasiyana-siyana antidepressants (mushure meClazazamu yakavharwa mumavhiki matatu) (3) (vatori vechikamu neOCD chete)^e	India / - / IA	52	hapana	GS (YBOCS; IAT)	NA	3
Dell'Osso et al. (2008)	17	Escitalopram (17)	hapana	USA / + / IA	10	hapana	Gs (IC-IUD-YBOCS) FR (h / w)	CO	3
Han et al. (2009)	21	Methylphenidate (21) (Concerta)	hapana	Asia / - / IGD	8	hapana	GS (YIAS-K) FR (h / d)	CO	3
Han et al. (2010)	11	Bupropion SR (11)	hapana	Asia / - / IGD	6	hapana	GS (YIAS) FR (h / d)	CO	3
Paki, Lee et al. (2016)	86	1) Methylphenidate (44)	2) Atomoxetine (42)^f 10-60 mg / d	Asia / - / IGD	12	hapana	GS (YIAS)	CO	3
Rwiyo et al. (2016)	119	1) Bupropion SR (44) 2) Escitalopram (42)	NT (33)	Asia / - / IGD	6	hapana	GS (YIAS)	CO	2
Mishonga yakasanganiswa
Han naRenshaw (2012)	25	1) Bupropion + 8 zvikamu EdU (25)	2) Placebo + 8 zvikamu EdU (25)^e	Asia / + / IGD	8	1	GS (YIAS) FR (h / w)	CO	2
Kim et al. (2012)	32	1) Bupropion + 8 zvikamu CBT (32)	2) Bupropion + 10 min. kubvunzana vhiki (33)^e	Asia / + / IGD	8	1	GS (YIAS) FR (h / w)	CO	2
Li et al. (2008)	48	Yakasiyana-siyana antidepressants + CBT + FT (48)	hapana	Asia / + / IA	4	hapana	GS (IRQ)	CO	3
Nam et al. (2017)	30	1) Bupropion + EDU (15)	2) Escitalopram + EDU (15)^f	Asia / + / IGD	12	hapana	GS (YIAS)	CO	2
Santos et al. (2016)	39	Mishonga yakasanganiswa + zvikamu gumi zvakagadziridzwa CBT (10)	hapana	Brazil / + / IA	10	hapana	GS (IAT)	CO	3
Yang et al. (2005)	18	CBT + kudzidziswa kwevabereki + Fluoxetine (18)	hapana	Asia / + / IA	10.5	hapana	GS (CIUS)	CO	3

chitsamba.

^aNhamba yezvidzidzo zvinosanganisirwa pakuongorora.

^bIwo mamoderators "maitiro ekurapa" uye "maitiro ekuzvitakura" akaiswa pakurapa kwepfungwa chete.

^cKune zvidzidzo zvepfungwa, iyo nguva yekurapa yakayerwa uchishandisa huwandu hwakazara hweawa dzinoshandiswa mukurapa kurapwa (t) uye mapoka ekudzora (c). Yezve chemacological uye zvidzidzo zvakabatanidzwa, iyo nguva yekurapa yakayerwa uchishandisa huwandu hwevhiki.

^dIdha yeiyo mhedzisiro yekusiyanisa "frequency" yaingowanikwa chete kuboka rekurapa.

^eMamiriro ekudzora akasarudzika kubva kuongororo nekuda kwekusawirirana nemaitiro ekusarudza.

^fMamiriro ekudzora aionekwa senge parutivi kurapwa ruoko

^gChidzidzo chacho chakataura nezve data kubva mukunyepedzera kutevera chete.

^hMamiriro ekurapa akasarudzika kubva kuongororo nekuda kwekusawirirana nemaitiro ekusarudza.

Tafura 2.Hunhu hwezvidzidzo zvekupindwa muropa nebonde

Kudzidza / gore	muunganidzwa N^a	Kurapa boka (N) / Mode yekurapa / Mode yekutakura^b	Kudzora boka (N) Mode yekurapa / Mode yekutumira^b	chinguva t / c^c/ D / A (+/−)	FU (mwedzi)	Migumisiro (ongororo)	Data analysis	EPHPP
Kurapa kwepfungwa
Crosby (2012)	27	ACT (14) / I / FTFT	WL (13)	12 /	5^d	Kuende (KUE) FR (kuona zvinonyadzisira maawa / w; yakagadziridzwa vhezheni yeDDQ)	CO	2
Hallberg nevamwe. (2017)	10	CBT (10) / G / FTFT	hapana	8 / -	6	GS (HD: CAS; HDSI)	HERE	3
Hallberg nevamwe. (2019)	137	CBT (70) / G / FTFT	WL (67)	8 / -	6	GS (HD: CAS; SCS)	HERE	2
Hardy et al. (2010)	138	CBT (Chiroro chirongwa chepamhepo) (138) / I / SGT	hapana	26 /	hapana	GS (PDR) FR (anoshandisa zvinonyadzisira / m; bonhora / m)	CO	3
Hart et al. (2016)	49	MI (49) / G / FTFT	hapana	7 /	3	Kuende (KUE)	CO	3
Hartman et al. (2012)^e	57	IT (chirongwa cheSA uye SA-SUD) / I + G / FTFT (57)	hapana	13 /	6	GS (CSBI)	CO	3
Klontz et al. (2005)	38	1) IT (EXPT; CBT; EDU; M-Medit.), Varume (28) / G / FTFT 2) IT (EXPT; CBT; EDU; M-Medit.), Vakadzi (10) / G / FTFT	hapana	1) 1 / 2) 1 /	6	Kuwedzera	CO	3
Levin et al. (2017)	11	ACT (SHWB) (11) / I / SGT	hapana	8 /	1.5	Kuende (KUE) FR (kuona zvinonyadzisira h / w)	CO	3
Minarcik (2016)	12	CBT (12) / I / FTFT	hapana	12 /	hapana	GS (KUROVA; HBI; SCS) FR (kuona zvinonyadzisira min./w)	CO	3
Orzack et al. (2006)	35	IT (RtC; CBT; MI) (35) / G / FTFT	hapana	16 /	hapana	FR (kuona zvinonyadzisira / w; OTIS)	CO	3
Pachankis et al. (2015)	63	CBT (ESTEEM-SC yakavakirwa pane iyo UP) (32) / I / FTFT	WL (31)	12 /	3	Kuende (KUE)	HERE	2
Parsons et al. (2017)	11	CBT (ESTEEM-SC yakavakirwa pane iyo UP) (11) / I / FTFT	hapana	12 /	hapana	Kuende (KUE)	CO	3
Quadland (1985)^e	15	1) GPT / G / FTFT (15)	2) PT yevatori vechikamu vakanganiswa nemamwe matambudziko / I / FTFT (14)^f	20 /	6	FR (n yevatano vakasiyana-siyana / mwedzi mitatu yadarika;% yevanoita zvepabonde vaionekwa kamwe chete;% yekuita zvepabonde nemumwe wako;	CO	3
Sadiza et al. (2011)	10	CBT (10) / G / FTFT	hapana	12 /	hapana	Kuende (KUE)	CO	3
Twohig uye Crosby (2010)	6	ACT (6) / I / FTFT	hapana	8 /	3	FR (kuona zvinonyadzisira h / d)	CO	3
Wilson (2010)	54	1) Art kurapa (27) / G / FTFT	2) yakagadziriswa CBT (TCA) (27) / G / FTFT^g	1) 6 / 2) 6 /	1.5	GS (HBI-19)	CO	2
Pharmacological kurapwa
Kafka (1991)	10	Yakasiyana-siyana antidepressants + Lithium (10)	hapana	12 /	hapana	Kuende (KUE)	CO	3
Kafka na Prentky (1992)	16	Fluoxetine (16)	hapana	12 /	hapana	Kuende (KUE)	CO	3
Kafka (1994)	11^h	Sertraline (11)	hapana	17 /	hapana	Kuende (KUE) FR (kufungidzira, kukurudzira, zviitwa zvepabonde min./d)	CO	3
Kafka naHennen (2000)	26	Variorantidantressants + methylphenidate (26)	hapana	72 /	hapana	GS (Zvikamu) FR (kufungidzira, kukurudzira, zviitwa zvepabonde min./w)	HERE	3
Wainberg et al. (2006)	28	Citalopram (13)	PLA (15)	12 / -	hapana	GS (YBOCS-CSB; CSBI; CGI-CSB) FR (bonhora, kushandisa internet, kuona zvinonyadzisira h / w)	HERE	2
Mishonga yakasanganiswa
Gola naPotenza (2016)	3	CBT + Paroxetine (3)	hapana	10 /	hapana	FR (zvinonyadzisira shandisa / w)	CO	3
Scanavino et al. (2013)	4	STPGP + dzakasiyana-siyana mishonga (4)	hapana	16 /	hapana	Kuende (KUE)	CO	3

chitsamba. A = kunetseka; ACT = Kugamuchirwa uye Kuzvipira Therapy; BSI = Chikamu Chiratidzo Chiratidzo; CBT = kungwara-maitiro ekurapa; CGI-CSB = Clinical Global Impression Scale yakatorwa kune inomanikidza kuita zvepabonde; CLAPS = Kujeka kweGungwa Kuwedzeredza Kuita Zvinonyadzisira; CO = inoshanda chete; CPUI = Cyber-Zvinonyadzisira Shandisa Inventory; CSBI = Inomanikidzira Bonde Bhizinesi Inventory; D = kushungurudzika; d = zuva; DDQ = Zuva Nezuva Kunwa Mibvunzo EDU = psychoeducation; EPHPP = Inoshanda Yehutano Hutano Prize Project (1 = yakasimba, 2 = zvine mwero, 3 = isina kusimba chiyero); ESTEEM = Unyanzvi Unobudirira Kuwanisa Varume Vanobudirira; EXPT = ruzivo rwekurapa; FR = frequency; FTFT = kurapa-kumeso-kurapwa kurapwa; FU = tevera; G = kuiswa kwemapoka; GPT = boka repfungwa psychotherapy; GS = kunetsa kwepasi rose; GSBI = Garos DzeBonde Beavior Inventory; h = maawa; HBI = Hypersexual Behavior Inventory; HD: CAS = Hypersexual Disorder: Ikozvino Kuongorora Chikero; HDSI = Hypersexual Disorder Kuongorora Inventory; Ini = kupa munhu zano IT = kurapwa kwakabatana; ITT = chinangwa-cheku-kurapa; m = mwedzi; M-Medit. = kufungisisa kufungisisa; MI = Kubvunzurudza Kunokurudzira; NA = isingawanikwe; OTIS = Orzack Nguva Intensity Kuongorora; PDR = maitiro epfungwa ekudzoreredza (pfungwa dzinoona nezvebonde, maitiro anobatsira ekudzora, hutano hwakanaka, hukama husina kunaka, fungidziro yesangano pamusoro pekuda kupindwa muropa, tsika yekuramba mhosva yekupindwa muropa, zvinoreva hupenyu, kubatana nevamwe, kunzwa kwekuregerera. kuziva kwepfungwa uye mamiriro ezvinhu anoedza, hutano hwekunakidzwa mafaro); PLA = placebo; PT = psychotherapy; RtC = Kugadzirira Kuchinja; SA = kupindwa muropa kwepabonde; SA-SUD = komorbid zvepabonde uye zvinodhaka zvinodhaka; SC = zvepabonde kumanikidzwa; SCS = Kuita Zvepabonde Kuwedzerwa Chikero; SGT = kuzvitungamira kurapwa; SHWB = bhuku rekuzvibatsira; SOI = Zvepabonde Outlet Inventory; STPGP = pfupi-yenguva pfupi psychodynamic group psychotherapy; TCA = Basa Rinoshanda ZVINOTI = Mari izere yekubuda pabonde; UP = Yakabatana Protocol yeTransdiagnostic Kurapa Kwemafungiro Kusuwa; W = chinyorwa chekumirira; w = vhiki; YBOCS-CSB = Yale-Brown Obsessive Scaleti Scale yakagadziridzwa yekumanikidza kwepabonde maitiro.

^aNhamba yezvidzidzo zvinosanganisirwa pakuongorora.

^bIwo mamoderators "maitiro ekurapa" uye "maitiro ekuzvitakura" aingoshandiswa chete pakurapa kwepfungwa.

^cNguva yekurapa yakayerwa nekushandisa huwandu hwevhiki.

^dIdzo kubva pakunyepedzera kuteedzera-yaive iripo chete kune mhedzisiro yekusiyanisa "frequency".

^eChidzidzo chacho chakataura nezve data kubva mukunyepedzera kutevera chete.

^fMamiriro ekudzora akasarudzika kubva kuongororo nekuda kwekusawirirana nemaitiro ekusarudza.

^gMamiriro ekudzora aionekwa senge ruoko rwekurapa.

^hChete vatori vechikamu vanoonekwa vaine chirwere chinosangana paraphilia vakaverengerwa muongororo.

Tafura 3.Hunhu hwezvidzidzo zvekumanikidza kutenga

Kudzidza / gore	muunganidzwa N^a	Kurapa boka (N) / Mode yekurapa / Mode yekutakura^b	Kudzora boka (N)	chinguva t / c^c/ D / A (+/−)	FU (mwedzi)	Migumisiro (ongororo)	Data analysis	EPHPP
Kurapa kwepfungwa
Armstrong (2012)	10	MBSR (4) / G / FTFT	NT (6)	8 /	3	Kuwedzera GS	CO	2
Benson et al. (2014)	11	IT (CBT, PSYDYN, PSYEDU, MI, Act, mindfulness element) (6) / G / FTFT	WL (5)	12 /	6	GS (mod. VCBS; RCBS; CBS; YBOCS-SV) FR (min./w yakashandiswa pakutenga; kutenga episode / w)^d	CO	2
Filomensky & Tavares (2009)	9	CBT (9) / G / FTFT	hapana	20 /	hapana	GS (YBOCS-SV)	CO	3
Mitchell et al. (2006)	35	CBT (28) / G / FTFT	WL (7)	10 /	6^e	Chekuita FR (kutenga episode / w; h yakapedza kutenga / w)	HERE	2
Mueller et al. (2008)	60	CBT (31) / G / FTFT	WL (29)	12 /	6^e	Gs	HERE	2
Mueller et al. (2013)	56	1) CBT (22) / G / FTFT 2) GSH-chirongwa (CBT WB + 5 mafoni masekisheni) (20) / I / SGT	WL (14)	1) 10 / 2) 10 /	6	Chekuita	HERE	2
Pharmacological kurapwa
Black et al. (1997)	10	Fluvoxamine (10)	hapana	9 / -	hapana	GS (YBOCS-SV)	CO	2
Black et al. (2000)	23	Fluvoxamine (12)	PLA (11)	9 / -	hapana	GS (YBOCS-SV)	HERE	2
Grant et al. (2012)	9	Memantine (9)	hapana	8 / -	hapana	GS (YBOCS-SV; mod. CB-SAS)	CO	2
Koran et al. (2002)	24	Citalopram (24)	hapana	12 /	hapana	GS (YBOCS-SV)	HERE	2
Koran et al. (2003)	23	Citalopram (23)	hapana	7 /	hapana	Gs	HERE	2
Koran et al. (2007)	26	Escitalopram (26)	hapana	7 /	hapana	GS (YBOCS-SV)	HERE	3
Ninan et al. (2000)	37	Fluvoxamine (20)	PLA (17)	12 /	hapana	GS (YBOCS-SV)	HERE	3

chitsamba. A = kunetseka; ACT = Kugamuchirwa uye Kuzvipira Therapy; CBS = Inomanikidza Kutenga Chikero; CB-SAS = Inomanikidza Kutenga Zviratidzo Kuongorora Chikoro (yakagadziridzwa shanduro Yekubhejera Zviratidzo Kuongorora Chikamu; CBT = kungwara-maitiro ekurapa; CO = inoshanda chete; D = kushungurudzika; EPHPP = Inoshanda Yevatano yeVashandi veHutano hweProjekiti (1 = yakasimba, 2 = zvine mwero) , 3 = isina kusimba chiyero); FTFT = kurapwa kumeso-kumeso; FR = kusarudzika; FU = kuteverwa; G = boka kurongeka; G-CBS = Canadian Inomanikidzwa Kutenga Kuyera Chikero, shanduro yeGerman; GS = kushushikana kwepasi rose; GSH = yakatungamirwa kuzvibatsira, h = maawa; Ini = kupiwa zano kweumwe neumwe, IBS = Kukurudzira Kutenga Chikero; IBTS = Kuburitsa Kutenga Chiyero Chikamu; ITT = chinangwa chekubata ongororo; MBSR = mindfulness-based kushungurudzika kuderedzwa; MI = Kubvunzurudza Kubvunzisisa; NA = isipo = yekumirira; w = vhiki; YBOCS-SV = Yale-Brown Obsessive Com pulsive Scale-Shopping Shanduro.

^aNhamba yezvidzidzo zvinosanganisirwa pakuongorora.

^bIwo mamoderators "maitiro ekurapa" uye "maitiro ekuzvitakura" aingoshandiswa chete pakurapa kwepfungwa.

^cNguva yekurapa yakayerwa nekushandisa huwandu hwevhiki.

^dIdha yeiyo mhedzisiro yekusiyanisa "frequency" yaingowanikwa chete kuboka rekurapa.

^eIzvo zvidzidzo zvakave zvisingabatanidzwe kubva kuFU kuongororwa, nekuti chete data kubva mukutumira kune FU ndiyo yakashumwa.

Njodzi yekuda mukati mezvidzidzo

Iwo uwandu hwepasi rose EPHPP huwandu hwezvidzidzo zvinosanganisirwa mumapoka akasiyana ekupindwa muropa zvakatsanangurwa mune Matafura 1-3. Kuongorora kwehutachiona kwakaitwa nevaviri vakazvimiririra kukonzeresa kuburitsa yakavimbika kati κ = 0.73 yezvidzidzo muIA uye SA mapoka, uye κ = 0.75 yezvidzidzo zviri muCB chikamu.

Synthesis yemhedzisiro uye njodzi yekuda kuteerana pane zvese zvidzidzo

Iyo pooled mhedzisiro yakakura yemhando dzese dzekupindwa muropa uye nekurapa zvakasiyana kune mukati meboka uye yakadzora kudzidza magadzirirwo pane zvese zvabuda pakubata uye nekutevera, iyo 95% CI, uye kukosha miedzo yakarondedzerwa mukati Tafura 4. Iyo masango mapango pane ari mukati-mapoka ezvivigiro saizi yega yega mamiriro, kurapwa, uye mhedzisiro mukutora anoiswa mukati Fig. 2.

Tafura 4.Shandisai hukuru hwemhando dzese dzekupindwa muropa, zvabuda nezvigadziro zvekudzidza pakudzora uye pakuteerana

Mhedzisiro	Rudzi rwemhedzisiro	k	g	95% CI	z	p	I²	FS N
Internet addiction
Kurapa kwepfungwa
Kudzvinyirira kwenyika	mukati meboka	54	1.51	[1.29, 1.72]	13.79		93.66	18,317
	kudzora (posta)	15	1.84	[1.37, 2.31]	7.268		83.56	1,254
	mukati -boka (FU)	17	1.48	[1.11, 1.85]	7.92		94.61	4,221
maitikiro	mukati meboka	17	1.09	[0.73, 1.49]	6.02		92.54	1,801
	kudzora (posta)	6	1.12	[0.41, 1.83]	3.08		78.05	69
	mukati -boka (FU)	6	1.06	[0.12, 2.00]	2.21		97.30	259
Pharmacological Kurapa
Kudzvinyirira kwenyika	mukati meboka	8	1.13	[0.85, 1.42]	7.78		78.76	564
	kudzora (posta)	2	1.28	[0.85, 1.71]	5.85		0.00	-^a
	mukati -boka (FU)	NA
maitikiro	mukati meboka	3	0.72	[0.49, 0.96]	6.01		0.00	27
	kudzora (posta)	NA
	mukati -boka (FU)	NA
Zvakasanganiswa Kurapa
Kudzvinyirira kwenyika	mukati meboka	7	2.51	[1.70, 3.33]	6.03		92.99	756
	kudzora (posta)	NA
	mukati -boka (FU)	2	2.15	[0.66, 3.65]	2.82		93.55	-^a
maitikiro	mukati meboka	2	2.77	[2.29, 3.24]	11.39		14.43	-^a
	kudzora (posta)	NA
	mukati -boka (FU)	2	2.69	[2.06, 3.32]	8.43		49.72	-^a
Sex Addiction
Kurapa Kwepfungwa
Kudzvinyirira kwenyika	mukati meboka	14	1.09	[0.74, 1.45]	6.03		92.54	1,311
	kudzora (posta)	3	0.70	[0.42, 0.99]	4.87		7.02	19
	mukati -boka (FU)	10	1.00	[0.67, 1.32]	6.02		90.02	760
maitikiro	mukati meboka	6	0.75	[0.46, 1.03]	5.10		70.96	177
	kudzora (posta)	1	1.67	[0.82, 2.53]	3.83		0.00	-^a
	mukati -boka (FU)	4	0.83	[0.37, 1.29]	3.57		71.59	45
Pharmacological kurapwa
Kudzvinyirira kwenyika	mukati meboka	5	1.21	[0.88, 1.54]	7.12		50.42	134
	kudzora (posta)	1	0.14	[−0.58, 0.87]	0.38	0.70	0.00	-^a
	mukati -boka (FU)	NA
maitikiro	mukati meboka	3	0.87	[0.63, 1.12]	6.92		0.00	33
	kudzora (posta)	1	0.79	[0.04, 1.55]	2.06		0.00	-^a
	mukati -boka (FU)	NA
Mishonga yakasanganiswa
Kudzvinyirira kwenyika	mukati meboka	1	1.91	[0.75, 3.08]	3.22		0.00	-^a
	kudzora (posta)	NA
	mukati -boka (FU)	NA
maitikiro	mukati meboka	1	1.04	[0.22,1.85]	2.49		0.00	-^a
	kudzora (posta)	NA
	mukati -boka (FU)	NA
Kumanikidzira kutenga
Kurapa kwepfungwa
Kudzvinyirira kwenyika	mukati meboka	7	1.00	[0.75, 1.25]	7.88		46.43	210
	kudzora (posta)	6	0.75	[0.42, 1.08]	4.45		0.00	27
	mukati -boka (FU)	4	1.36	[0.88, 1.84]	5.57		53.65	66
maitikiro	mukati meboka	2	0.97	[0.68; 1.26]	6.55		0.00	-^a
	kudzora (posta)	1	2.48	[1.46, 3.49]	4.76		0.00	-^a
	mukati -boka (FU)	1	1.01	[0.47, 1.55]	3.68		0.00	-^a
Pharmacological kurapwa
Kudzvinyirira kwenyika	mukati meboka	7	1.52	[1.18, 1.86]	8.84		63.17	386
	kudzora (posta)	2	-0.13	[−0.82, 0.57]	-0.35	0.724	0.00	-^a
	mukati -boka (FU)	1	-0.49	[−1.00, 0.03]	-1.86	0.063	0.00	-^a
maitikiro	mukati meboka	NA
	kudzora (posta)	NA
	mukati -boka (FU)	NA

Cherechedzo. k = nhamba yemamiriro ekurapa; g = Hedges's g; CI = nguva yekuvimba; I² = muzana yezana rakazara misiyano pane zvidzidzo; FS N = Kukundikana-kuchengeteka N (nhamba yezvidzidzo zvinodiwa kuti iwane isingakoshe kurapwa maitiro); NA = isingawanikwe.

^aKukundikana-kuchengeteka N haina kuverengerwa nekuti mashoma pane matatu zvidzidzo zvaivepo.

Mhedzisiro masaizi ekurapa kwepfungwa kurapwa kwepashure uye kutevera

Psychological kurapwa kwese kweakapindwa muropa mapoinzi akapfupika -kushoma maitiro kukura kubva pakati kusvika kumahombekombe mune ese maviri maitiro ekufunda. Yakareba mhedzisiro mhedzisiro saizi muzvikamu zvese zvekupindwa muropa yakaratidza kuti kurapwa mhedzisiro yakachengetwa Sezvinoratidzwa ne Tafura 4, yakanyanya heterogeneity yakakwira kune ese zvidzidzo yakaonekwa kune mhedzisiro misiyano mukati meIA neSA mapoka, uye zvine mwero heterogeneity kana homogeneity yakacherechedzwa muboka reCB.

Mukati meiyo chikamu cheIA, nzira yekudhara-uye-yekuzadza yakaratidza zvidzidzo gumi nezvitanhatu zvichikonzera funeral kuronga symmetry yekudzora kushomeka kwepasirese uye imwe chete yekudzidza yekudzora kwema frequency mukati meboka rekudzidza maumbirwo. Iyo inoongorora neaya akazadzwa zvidzidzo yakakurudzira zvishoma kuderedzwa mhedzisiro sengo (kurema kwepasi: g = 0.87; 95% CI [0.82, 0.92]; Muedzo waEgger p <0.001; frequency: g = 0.93; 95% CI [0.84, 1.03]; Muedzo waEgger p = 0.282) ichiratidza kusagadzikana kwekushambadzira kusarura. Hapana chinoratidza kushambadzira kusarudzika kwakawanikwa pakuderedzwa kwekuomarara kwepasirese zvichienderana nemadhizaini ekudzidza (Egger bvunzo p = 0.067). Mukati meiyo chikamu cheSA, nzira yekudhara-uye-yekuzadza yakaratidza imwe ongororo ichikonzera funnel kuronga symmetry yekudzora kushomeka kwepasirese kunotungamira kune zvishoma yakaderedzwa mhedzisiro saizi yemhedzisiro iyi mhedzisiro (g = 0.88; 95% CI [0.79; 0.97], bvunzo yaEgger p = 0.318) .Pose painotadza -chengetedzeka N kuongororwa kwakaitwa, mhedzisiro yemasekero pamarudzi ese akapindwa muropa yaionekwa seyakaomeserwa mhedzisiro, kunze kwekuda kudzorwa kwemugadziro maererano nekudzora kwekuoma kwepasi rose muSA uye zvikamu zveCB, zvaive zvisina simba.

Mhedzisiro miuyo yekurapa kwemishonga panguva yekurapa uye nekutevera

Pakutora kurapwa, iwo mukati-seboka maitiro masayizi pakati pemarudzi ese ekupindwa muropa aive pakati nepakati. Yakadzora mhedzisiro masaizi aive akavakirwa zvakanyanya pamiyedzo imwechete kubva kune yakakura muboka reIA kusvika kudiki uye isina kunaka muSA uye CB zvikamu. Iko kushayikwa kwekutevera-data kwakadzora kududzirwa kwehurefu-hwekuita maitiro saizi. Yakakwirira uye ine mwero heterogeneity pane zvidzidzo zvakaonekwa kune mhedzisiro misiyano mukati memhando dzekupindwa muropa. Kukundikana-chengeteka N inoongorora inoitirwa kune data iripo, yakaratidza kukurudzira kwemasero ezvekuita.

Mhedzisiro masaizi ekurapa akabatanidzwa pakurapwa uye ekutevera

Kupindirana kwakasanganiswa kwakaitwa chete kwekurapa IA neSA zvichibva mukati meboka boka rekudzidza magiraidhi akakura kwenguva-pfupi mhedzisiro maizi. Yekutevera-data data yaivapo chete muiyo IA chikamu inogadzira zvakaenzana zvakakura mhedzisiro saizi. Yepamusoro heterogeneity pamusoro pezvidzidzo zvakacherechedzwa kuti kuderedzwa kwekunetseka kwepasi rose muboka IA; zvisinei kutadza-kuchengeteka N airatidza kusimba kweiyo size size.

Kunongedzerwa kwekunze kuburikidza neiyo-yekudzidza-kubviswa maitiro hakuna kwakakanganisa chero kudzidza kumwechete pane zvese zvakakanganiswa nepfungwa, chemishonga, uye pamwe nemishonga inorapwa.

Moderator inoongorora

Moderator kuongororwa kwakaitirwa mukati-group athari saizi. Mhedzisiro yezvakasiyana-siyana pamamiriro ekudzora anotumirwa mukati Tafura 5.

Tafura 5.Moderator inoongorora yemhando dzakasiyana-siyana dzese mhando dzekupindwa muropa, uye zvabuda

		IA		SA		CB
Moderator	Zvakabuda zvinoshanduka	Qbet	p (Q)	Qbet	p (Q)	Qbet	p (Q)
Kurapa kwepfungwa
Rudzi rwekurapa kwepfungwa (CBT vs. IT vs. zvimwe)
	GS	4.24	0.120	4.50	0.105	0.34	0.945
	FR	0.11	0.947	15.67	^a	-	-
Nzira yekurapa (group vs. itself vs. imwe)
	GS	0.47	0.792	0.11	0.741^b	0.44	0.508^b
	FR	0.55	0.761	14.55	^b
Mode yekutumira (FTFT vs. SGT)
	GS	9.15		0.56	0.453	0.44	0.508
	FR	2.03	0.154	0.76	0.384	-	-
Comorbidity (D / A inosanganiswa vs. isina kubviswa)
	GS	0.02	0.898	0.84	0.360	0.00	1.00
	FR	1.13	0.289	0.00	1.00	-	-
Kuongororwa kwedata (compter vs. ITT)^c
	GS	0.30	0.586	0.99	0.320	0.007	0.933
	FR	0.09	0.771	0.00	1.00	-	-
EPHPP (1 = yakasimba vs. 2 = ine mwero vs. 3 = kusasimba kwemukati kusimbisa)^d
	GS	1.14	0.285	2.24	0.134	0.02	0.903
	FR	1.94	0.164	0.53	0.466	-	-
Tsika (Nyika dzeAsia pamwe nenyika dzekumadokero)
	GS	0.54	0.461	-	-	-	-
	FR	0.58	0.447	-	-	-	-
IA mhando (wepasi rose IA vs. IGD vs. zvimwe)
	GS	1.63	0.653	-	-	-	-
	FR	4.21	0.122	-	-	-	-
Pharmacological kurapwa^e
Rudzi rwemishonga yemishonga (AD vs. yakasanganiswa kana zvimwe)
	GS	5.62	^f	0.09	0.765	0.65	0.421^g
Comorbidity (D / A inosanganiswa vs. isina kubviswa)
	GS	0.73	0.392	-^h	-^h	0.22	0.642
Kuongororwa kwedata (compter vs. ITT)
	GS	0.00	1.00	0.76	0.383	4.89
EPHPP (1 = yakasimba vs. 2 = ine mwero vs. 3 = kusasimba kwemukati kusimbisa)^d
	GS	0.47	0.493	-^h	-^h	2.52	0.112
Tsika (Nyika dzeAsia pamwe nenyika dzekumadokero)
	GS	7.32		-	-	-	-
IA mhando (wepasi rose IA vs. IGD vs. zvimwe)
	GS	7.32	ⁱ	-	-	-	-
Mishonga yakasanganiswa^e
Rudzi rwemishonga yemishonga (AD vs. yakasanganiswa kana zvimwe)
	GS	0.83	0.362^j	-	-	-	-
Rudzi rwekurapa kwepfungwa (CBT vs. IT vs. zvimwe)
	GS	20.81	^k	-	-	-	-
Mamiriro ekurapa kwepfungwa (group vs. itself vs. zvimwe)
	GS	0.29	0.592^b	-	-	-	-
Comorbidity (D / A inosanganiswa vs. isina kubviswa)
	GS	0.00	1.00	-	-	-	-
Kuongororwa kwedata (compter vs. ITT)
	GS	0.00	1.00	-	-	-	-
EPHPP (1 = yakasimba vs. 2 = ine mwero vs. 3 = kusasimba kwemukati kusimbisa)^d
	GS	6.06		-	-	-	-
Tsika (Nyika dzeAsia pamwe nenyika dzekumadokero)
	GS	0.83	0.362	-	-	-	-
IA mhando (wepasi rose IA vs. IGD vs. zvimwe)
	GS	6.06	ⁱ	-	-	-	-

chitsamba. A = kunetseka; AD = antidepressants; CB = inomanikidza kutenga; CBT = inoziva maitiro ekurapa; D = kushungurudzika; EPHPP = Inoshanda Inowanikwa Hutano Hutano hweProjekti Yekuita (hutano hwekutarisisa huwandu hwezvidzidzo zvehuwandu); GS = kunetsa kwepasi rose; FR = frequency; FTFT = kurapa-kumeso-kurapwa kurapwa; IA = internet kupindwa muropa; IGD = internet kusagadzikana kwemitambo; IT = kurapwa kwakabatana; ITT = chinangwa chekubata kuongorora; Qbet = homogeneity statistic yekusiyanisa pakati pe subgroups; SA = kupindwa muropa kwepabonde; SGT = kuzvitungamira kurapwa.

^aCBT: g = 0.98; 95% CI [0.83, 1.13]; p ≤ 0.001; IT: g = 0.25; 95% CI [-0.08, 0.58]; p = 0.132; Dzimwe kurapa (kureva, kugamuchira uye kuzvipira kurapa): g = 0.80; 95% CI [0.51, 1.10]; p ≤ 0.001.

^bModerator kuongororwa kwaisanganisira chete maviri subgroups (boka vs. munhu).

^cIzvo chete zvidzidzo izvo zvairatidza mhando yekuongororwa kwedata yakaiswa mune izvo zvaiongorora (ona Tafura 1).

^dModerator kuongororwa yaisanganisira chete maviri subgroups (2 = ane mwero; 3 = asina simba).

^eModerator inoongorora pamhedzisiro yekuchinja "frequency" haina kuitiswa nekuda kwehuwandu husina kukwana hwezvidzidzo.

^fModerator kuongororwa yaisanganisira chete maviri subgroups (AD vs. mamwe mishonga [ie, methylphenidate, atomoxetine]).

^gModerator kuongororwa kwaisanganisira maviri subgroups chete (AD vs. mamwe mishonga [ie, memantine]).

^hMhedzisiro yekuongorora moderator haina kududzirwa, nekuti kungongororwa kumwe chete kwakangosara mune rimwe remazita maviri.

ⁱModerator kuongororwa kwaisanganisira chete maviri subgroups (IA vs. IGD).

^jModerator kuongororwa yaisanganisira maviri maviri subgroups (AD vs. musanganiswa).

^kKuongorora moderator kwaisanganisira chete maviri magroups (CBT vs. mamwe marapirwo [ie chirongwa chedzidzo]).

Mhedzisiro yakakura pamhando dzese dzekupindwa muropa uye kupindira kwakaramba kusingawanikwe nemhando yezvidzidzo, zvinoitika-kushungurudzika uye kusagadzikana, uye gore rekuburitswa (IA: kushomeka kwepasi: β = -0.02; SE = 0.03; p = 0.417; frequency: β = -0.09; SE = 0.05; p = 0.075; SA: kudzvinyirira kwenyika: β = -0.03; SE = 0.04; p = 0.519).

Panyaya yeIA, hukuru hwakakura hwakawanikwa hweFTFTs kana huchienzaniswa neSGTs, uye nekupindira kunosanganisira kuwanda kwemaawa pakurapwa kwekudzikisira kwekunetseka kwepasi (β = 0.04; SE = 0.01; p <0.01) uye kuwanda (β = 0.03; SE = 0.009; p <0.01). Zvekuderedzwa kwehunyanzvi hwepasi rose muzvidzidzo zvezvemishonga, hukuru hwakakura hunobuda hweanodzvinyirira kana ichienzaniswa nemamwe makemikari vamiririri (kureva, methylphenidate, atomoxetine), kune avo vanoitwa mune dzimwe nyika zvichienzaniswa nenyika dzeAsia, uye kuongorora pasi rose IA ichienzaniswa neGG uye nhare mbozha. kupindwa muropa.

Nekuremekedza SA, CBT uye kumwe kurapa kwepfungwa (sekuti, kugamuchirwa uye kuzvipira kurapa) kwakaratidza mukana pane kupindirana kwakabatana uye kwekupa zano wega pamusoro pehurongwa hweboka kuderedzwa kwema frequency. Mukati meboka reCB, mishonga yemishonga ichishandisa ongororo yekuenzanisa yakagadzira hukuru hwakawanda hwekuita kupfuura hwakavakirwa paITT inoongorora maererano nekudzikisira kwekushomeka kwepasi.

Moderator inoongorora pamishonga yakasanganiswa yakaitwa chete yerudzi rweIA. Mhedzisiro dzakaratidza kuti hukuru hwemhedzisiro masaizi aive akabatana neBPT-musanganiswa, miedzo yepasi-yemhando, uye avo vanoongorora IA yepasirese.

Psychological vs. pharmacological vs. yakasanganiswa mishonga

Nezve IA, kurapwa kwakabatanidzwa kwakaburitsa yakakura mhedzisiro mienzaniso kana ichienzaniswa nepfungwa uye zvechipatara kupindira kwekudzora kwekunetsa kwepasi (kwepfungwa nepfungwa dzakasanganiswa: Q_pakati = 7.80, p <0.01; pharmacological vs. yakasanganiswa: Q_pakati = 14.69, p <0.001), uye kuwanda (kwepfungwa pamwe nekusanganiswa: Q_pakati = 8.73, p <0.01; pharmacological vs. yakasanganiswa: Q_pakati = 63.02, p <0.001). Mhedzisiro isingakoshe yakawanikwa pakati pehukuru hwekuita kwechena kwepfungwa uye kwemishonga kurapwa (kusimba kwepasirese: p = 0.173; frequency: p = 0.492). Kufunga nezve CB, kurapwa kwemishonga kwakaratidza mukana pamusoro pekurapa kwepfungwa kwekudzora kwekuoma kwepasirese (Q_pakati = 5.45, p <0.05). Hapana imwe misiyano yakakosha pakati pemhando dzekurapa dzakaonekwa.

Kusiyana pakati pezvikamu zvekupindwa muropa

Kufananidza kwemhedzisiro yemasvosve emapoka akapindwa muropa yakaunza mhedzisiro dzisina kukosha zvine chekuita nepfungwa (kupenga kwepasi: p = 0.174; frequency: p = 0.559) uye kupindira kwepamishonga (kusagadzikana kwepasi: p = 0.203; frequency: p = 0.389).

hurukuro

Chinangwa chebepa iri yaive yekuongorora kushanda kwehutano hwepfungwa, hwezvemishonga uye hwakabatanidzwa hweIA, SA neCB uye kuona vangangofungidzira nezvekurapwa. Zvakare, kuenzanisa pakati pemhando nhatu dzeBAs zvichikonzerwa nemasayizi ehutano hwepfungwa uye zvekurapa akaitwa kekutanga, nechinangwa chekuwedzera kujira kwakafanana nekusagadzikana kubhejera neSUDs maererano nemhinduro yekurapa.

Takawana kuti kurapa kwepfungwa kwakanyatso kuderedza kushushikana kwepasi rose uye kuwanda kweIA neSA nemhinduro yekurapa ichichengetwa kwenguva yakareba kwenguva. Kune CB, kurapwa kwepfungwa kwakabatanidzwawo nehukuru hwakakura pre-post uye pre-kutevera-kuderedza kuderera kwepasi rose. Yakakura uye ine mwero nguva pfupi-inowanikwa maererano neyemhedzisiro mhedzisiro dzakasiyana dzakasimbiswa mumidziro yekudzora kudzidza, kunyanya nezve IA uye mune imwe neimwe zvidzidzo muSA uye CB zvikamu. Mhedzisiro iyi iri mune yakafanana neiyo yakawanikwa mune meta-kuongororwa kwakaongorora kurapa kwepfungwa kune vakakanganiswa kubhejera (Cowlishaw et al., 2012; Kunaka & Tarrier, 2009; Goslar, Leibetseder, Muench, Hofmann, & Laireiter, 2017; Leibetseder, Laireiter, Vierhauser, & Hittenberger, 2011; Pallesen, Mitsem, Kvale, Johnsen, & Molde, 2005) uye SUDs (Dutra et al., 2008; Tripodi, Bender, Litschge, & Vaughn, 2010).

Kunyangwe CBT yainyanya kushandiswa mumapoka matatu ekupindwa muropa, dzimwe nzira dzakasiyana siyana dzakaratidza kuve dzakanyatsobudirira mukuderedza maitiro anechinetso zvisinei nemamiriro ekurapa uye-kunyanya nezve IA-mamiriro etsika. Izvi zviwanikwa zvakasiyana kubva kune izvo zvataurwa mune meta-kuongorora, yakawana mukana weCBT pamusoro pedzimwe kurapwa kwepfungwa kwekudzora nguva yakashandiswa pamhepo pamhepo, kupa munhu zano, uye nezvidzidzo zvakaitiswa muUS (Winkler et al., 2013. Kusabvumirana, zvakadaro, kunogona kunge kuri nekuda kwekuti moderator ongororo yakaitwa pane yakabiwa mukati -boka uye yakadzora mhedzisiro masayizi uye kuwedzera kwekutsvaga kwekupedzisira mhedzisiro yedu meta-kuongorora. Pakati peizvi, nzira dzaiwanzoshandiswa dzinosanganisira kurapa kwemhuri, iyo kana ichiona mamiriro akasiyana emamwe emhuri (semuenzaniso, Schneider, King, & Delfabbro, 2017) ita seinobatsira kwete chete kune vechidiki vaneti internet inonetsa vatambi (semuenzaniso, Han, Kim, Lee, & Renshaw, 2012), asiwo zvevayaruka vane maSUD (ekuongororwa ona Mafirigi, Andersen, & Jørgensen, 2018. Saizvozvo, mind mind based based programmes zvinobudirira kushandisa zviratidzo zvinonakidza zveIA (Li, Garland, et al., 2017) uye CB (Armstrong, 2012), uye kubvuma uye kuzvipira kurapwa kunoitwa kurapwa kweSA (semuenzaniso, Crosby, 2012) yaratidza kuve yakakosha yekudzikisa zviratidzo zvekuparadzwa kubhejera uye maSUD (A-tjak et al., 2015; Li, Howard, Garland, McGovern, & Lazar, 2017; Maynard, Wilson, Labuzienski, & Whiting, 2018. Zvirongwa zvekubatanidza, izvo zvaive zvakanyanya neBTT zvinhu, zvakagadzirwa zvakakura zvakakura mhedzisiro mativi matatu matatu ekupindwa muropa, kunze kwekudzikiswa kwehuwandu hwekumanikidza kugona maitiro. Mhedzisiro iyi, zvisinei, yaive yakavakirwa pachiyedzo chimwe chete chakasiyana nevamwe nekushandisa Orzack Nguva Inventory Survey (OTIS; Orzack, 1999) yakaonekwa "isina kubatanidzwa zvakakwana" (Orzack, Voluse, Wolf, & Hennen, 2006, p. 354) kuyera mafambiro ekushandiswa kwemakomputa zvisiri izvo. Nekuti Orzack et al. (2006) yakaunzwa kurapwa muzvirongwa zveboka, yakadzika mhedzisiro saizi kudzidza zvakare kuverengerwa kune dambudziko rekugadzikwa kwemapoka kana zvichienzaniswa nekupihwa zano kweumwe neumwe achisimbisa kukosha kwekushandisa matanho ekuyera uye akavimbika (ona zvakare Hook, Reid, Penberthy, Davis, & Jennings, 2014. Uyezve, mhinduro yekurapa yairatidzika kunge yakazvimirira kubva kurudzi rwekuzvara, neimwe chete nzira: IA yakabata vanhu vanogamuchira FTFTs vaiita sevanowana mari zhinji kubva kurapwa kupfuura iya inosanganiswa neSGTs. SGTs yakagadzirirwa kurapwa kweIA, zvisinei, yaisanganisira yakaderera nhamba yezvikamu kupfuura FTFTs. Naizvozvo, iyo nguva kwete yemhando yekutumira inogona kuverengera izvi zviri pakati-seboka, ichitsigira zvawanikwa zvichangoburwa meta-ongororo (Goslar et al., 2017) iyo yakaratidza kuti pfupi SGTs inogona kuburitsa yakaderera yekuvandudzwa kupfuura kukwirira-kwakadzika, yakarongeka yekuzvibatsira zvirongwa. Uchapupu hwekutsvaga uku hwakapihwa neakanyanya SGTs yakaiswa kurapwa kweSA (Hardy, Ruchty, Hull, & Hyde, 2010; Levin, Heninger, Pierce, & Twohig, 2017) uye CB (Mueller, Arikian, de Zwaan, & Mitchell, 2013), kupa simba mhedzisiro yakafanana neiyo yakawanikwa yeFTFTs. Saizvozvo, kubudirira kurapwa kwakawedzera pamwe nekureba kwepfungwa, kunyanya nezve kuderedzwa kwekunetseka kwepasi uye kuwanda kweIA. Mhedzisiro yakafanana, asi isingaenzaniswi mhedzisiro yakacherechedzawo kuderedzwa kwekunetseka kwepasi rose kweSA. Izvi zvinowanikwa zvinoenderana nevaya vanobva kuAsia IA research (Chun et al., 2017), uye neaya akawanikwa kubva mukubhejera akagwinha (Goslar et al., 2017; Leibetseder et al., 2011; Pallesen et al., 2005), ichiratidzira kuti kuratidzwa kwemaitiro akapindwa muropa kunoda kurapwa kwakawandisa kuti uwane kugadzirisa.

Sezvineiwo nezvepfungwa dzekurapa, marapirwo ekurapa emishonga airatidza kudzikiswa kwakakura uye kwakasimba kusati kwatanga mune zviratidzo zvemukati mumapoka matatu ekupindwa muropa. Hapana mhedziso, zvisinei, inogona kudhonzwa zvine chekuita nekusimba kwemaitiro ekurapa uye hushoma-pfupi mibairo yemishonga pamusoro peiyo placebo nekuda kweiyo shoma data. Uyezve, kuyedzwa-kwakarongeka kweiyo placebo kwakaitirwa kurapwa kweSA neCB kwakakanganisika nerumwe rutsigiro rwakadai sekugara sevanorapa Therapist kusanganisira kuratidzwa nezve maitiro ane dambudziko (Dema, Gabel, Hansen, & Schlosser, 2000; Wainberg et al., 2006) kana nzira dzinoenderana dzakadai sekuchengeta diary rekutenga (semuenzaniso, Black et al., 2000; Ninan et al., 2000) kupa zvidiki pakati peboka mapoka, uye kuvanza mhedzisiro yemakemikari vamiririri (Black et al., 2000; Ninan et al., 2000; Wainberg et al., 2006. Kuenzanisa, pfupi-pfupi mhedzisiro yemishonga yekurapa pamusoro peiyo placebo yekubhejera dambudziko iri yaive yepakati sosi (Goslar, Leibetseder, Muench, Hofmann, & Laireiter, 2018), yakafanana neyakataurwa kune doro rekushandisa doro, uye yezvirwere zvakasiyana-siyana zvekurapa pamwe nehutano hwepfungwa (semuenzaniso, Jonas et al., 2014; Leucht, Hierl, Kissling, Dold, & Davis, 2012).

Moderator inoongorora haina kana mutsauko wakakura pakati pemakirasi ekurapa, asi kuwana kurapwa kwekudzora kushomeka kwepasi kwe CB kwakaratidzika kuve kwakawedzeredzwa nekuda kwekukura kwemasayizi akavakirwa pamakomputa anoonekwa mumiedzo miviri (Dema, Monahan, & Gabel, 1997; Grant, Odlaug, Mooney, O'Brien, & Kim, 2012) achienzaniswa neaya anowanikwa kubva kuITT inoongorora. Iyi miedzo yakatemawo hukuru hwepamakemikari pamusoro pekurapa kwepfungwa kudzikisira kwekushomeka kwepasirese kutsigira kushandiswa kwekuongororwa kweITT, iyo inomiririra nzira yakasarudzika yenhamba inoratidza mamwe mamiriro echokwadi mune mamiriro ekurapa (semuenzaniso ,. Sedgwick, 2015. Mukati meboka reIA chete, antidepressant akaoneka akakunda kune mamwe mishonga. Kunyatsoongorora iyo data, zvisinei, kwakaratidza kuti subgroup neiyo yepamusoro kurapwa inowana yakafukidzwa vakuru vatori vechikamu neyekuora mwoyo kusagadzikana, uye kusarudzika -kumanikidza kushushikana kurapwa nemaantidepressants, uye kwakabatanidza kutongwa nehukuru hukuru hwemhedzisiro (g = 2.54; Dell'Osso et al., 2008. Iyo subgroup ine yakaderedzwa yekurapa kuwana, zvakare, yaisanganisira vechidiki ne comorbid attention deficit hyperactivity disorder (ADHD) inobatwa ne psychostimulants (methylphenidate), uye yaive neyekuyedzwa neiyo yakaderera mhedzisiro saizi yekuongorora vanhu vane yakadzika Baseline kuomarara kweIA (g = 0.57; Han et al., 2009. Misiyano iyi yakanganisawo vatariri "tsika" uye "IA mhando". Nezviitiko zviviri izvi zvakabviswa kubva kumodherekitori inoongorora, mukana weantidepressants, uye zvakakosha mhedzisiro ye "mamenemari" tsika ", uye" IA mhando "yakanyangarika. Kunyangwe kurapwa mune ese ari maviri magroup akaunza zvinobatsira, mutsauko wakaratidzika uchitungamirwa nemuyedzo imwechete. Naizvozvo, kudyidzana pakati pekubatana kuri kuitika kweADHD, kurapwa kwemishonga, zera, uye tsika zvinoda kuferefetwa kana nhamba yepamusoro yezvidzidzo ichizowanikwa. Kunze kwe comorbid ADHD, zvisinei, kusagadzikana-kwakanangana kugadzirisa kwakave kwakazvimirira kubva kune comorbid kushungurudzika uye kusagadzikana, kutsigira zvakawanikwa kubva kune yekare IA (semuenzaniso, Han & Renshaw, 2012) uye disordered kubhejera tsvakurudzo (yeongororo ona Dowling, Merkouris, & Lorains, 2016).

Pakati pematatu emhando yekupindwa muropa, kunyanya serotonin inosarudza reuptake inhibitors (SSRIs) yakaongororwa maererano nehuwandu hwakanyanya hwe comorbid mood kusagadzikana (semuenzaniso ,. Kafka, 1991) uye-kunyanya nezve SA, iyo inhibitory midziyo yeSyotonin pane zvinoitika pabonde (semuenzaniso, Kafka & Prentky, 1992. Opioid antagonists (semuenzaniso, naltrexone) uye glutamatergic mishonga (semuenzaniso, topiramate) yaingotariswa muzviitiko zvezviitiko zvekurapa SA (semuenzaniso, Grant & Kim, 2001; Khazaal & Zullino, 2006) uye CB (semuenzaniso, Ipa, 2003; Guzman, Filomensky, & Tavares, 2007) kuratidza zvinobatsira. Nekuti opioid vanopesana uye ma glutamatergic vamiririri vakaratidza sarudzo dzakanaka dzekurapa kweSUDs (Guglielmo et al., 2015; Jonas et al., 2014; Minarini et al., 2017) uye kusagadzikana kubhejeraBartley & Bloch, 2013; Goslar et al., 2018), idzi mhando dzemishonga inoita senge inovimbisa kuferefetwa mune yakakura-yakakwenenzverwa uye yakadzora madzidziro ekudzidza, kunyanya muchiedza chemitengo yakakwira yeva comorbid SUDs dzinoonekwa muma BA (semuenzaniso, Grant et al., 2010).

Mishonga yakasanganiswa yeIA, kunyanya mishonga pamwe neBTT, yakagadzira yakawedzerwa kudzidziswa miganho ichienzaniswa nekuchena kwepfungwa nepfungwa zvekupindira zvichitsigira kurudziro yeongororo yapfuura yeIA kurapwa mhedzisiro zvidzidzo (Przepiorka, Blachnio, Miziak, & Czuczwar, 2014. Ukuru hwekubatanidzwa kweBTT pamusoro peavo hwakasanganiswa nedzimwe nzira dzepfungwa dzaifungidzirwa kuve hwakavakirwa pachiyedzo chimwechete chaiwanza yakakura mhedzisiro saizi (g = 5.31; Yang, Shao, & Zheng, 2005), zvichikanganisa zvakare mameneja "mhando" uye "IA mhando". Nekudzidza uku kwakabviswa pane subgroup kuongororwa, zvisinei, chete mukana wekusanganisa weBTT wakaramba wakakosha.

Kunyangwe ruzivo rwakawanda rwakapiwa neIA mhedzisiro yekurapa mhedzisiro, uye data kubva kumiedzo yakadzora ichiri mashoma, maitiro epfungwa neyemishonga akataridza zvakanakira zvenguva pfupi-pfupi pamamiriro ese matatu ezvinhu, ayo akafananidzwa neavo anoshandiswa kushandiswa kwezvinwiwa uye kubhejera kwakakanganiswa (semuenzaniso, Goslar et al., 2017; Grant et al., 2010) kutsigira yedu hypotheses. Izvi zviwanikwa hazvina kukwana kujekesa kuiswa kweIA, SA uye CB mukati mekuonekwa kwehutano hwepfungwa nekuda kwekushomeka kwechokwadi kwekutarisisa maitiro, uye mashoma eproseological, genetic uye neurobiological data (semuenzaniso, Grant et al., 2010. Nekudaro, vanofunga, kuti vanhu vanopindurawo nenzira yakafanana pakurapa zvisinei nerudzi rwekupindwa muropa. Mhedzisiro iyi inokodzera chaizvo mune dzekupidigura mhando dzekupindwa muropa izvo zvinokonzeresa zvakajairika mashandisirwo ezvirwere zvese zvine chekuita nezvinokanganisa-zvinetso zvezvinhu uye ma BA (Griffiths, 2005; Jacobs, 1986; Orford, 2001; Shaffer et al., 2004), iyo inogona kushandurwa nekushandisa kwepfungwa uye mishonga yemishonga (Potenza et al., 2011. Muchiedza chekusagadziriswa kwekutanga kushanda uye mubayiro wedunhu panguva yekushandiswa kusingaperi kwemishonga uye maitiro (semuenzaniso, Nestler, 2005), kurapwa kwepfungwa, kunyanya CBT-based sarudzo, zvine mukana wekuchinja kushaya hanya uye maitiro asina kunaka (Kim & Hodgins, 2018), uye kusimbisa kuzvidzora maitiro nekutarisa nzvimbo dzepamberi dzepfungwa (Potenza et al., 2011. Pharmacological kurapwa, zvakare, inovavarira kudzora kuchiva uye kubvisa zviratidzo kuburikidza nekunanga iwo mubairo nzira uye neurotransmitter system (Potenza et al., 2011. Zvakare, sekucherechedzwa kwekurapa kweIA, kusanganiswa kweCBT uye kurapwa kwemishonga kunogona kunge kuchiwedzera, kunyangwe kuwirirana pakati pezviri zviviri kuchiri kujekesa (Potenza et al., 2011).

Izvi zvinotevera miganho inofanirwa kucherechedzwa: Chekutanga, sezvazviri kune vakawanda meta-analytic ongororo, izvo zvidzidzo zvinosanganisirwa zvakasarudzika mumhando yavo yekuita zvinhu, kunyangwe pakatariswa zvirevo, hatina kucherechedza zvakatemwa pamhedzisiro yekukanganisa. yezvidzidzo. Hapana imwe yezvidzidzo, zvakadaro, yakawana mwero wepamusoro unoratidza hushoma hweuchapupu zvine chekuita nekusarudzwa uye-nekuda kwekufambiswa kwezvakagadzirwa mukati meboka-dhizaini pakuziva uye kutonga kwevanokanganisa, uye kupofumadza. Naizvozvo, maRCT akagadzirwa zvakaomarara anodiwa, kusanganisira kuongororwa kwekutsigirwa kwepfungwa uye nekutevera data, kunyanya zvine chekuita nemiedzo yemishonga. Zvakare, mazhinji eIA zvidzidzo aisanganisira akasiyana maitiro aiita pamusoro pewebhu (semuenzaniso, pamhepo mutambo wemitambo, kuona zvinonyadzisira), kunyangwe kutsvagurudza kwakaratidza kusiyana pakati peipfungwa yakajairika yeIA nemhando dzakasarudzika dzehunhu hunoperekedzwa neInternet (Montag et al., 2015. Nekudaro, takaedza kukunda dambudziko iri nekuisa mapoka muzvidzidzo maererano nemaitiro akateerana, zvisinei nesvikiro raishandiswa. Nezve kunetsekana-kunoitika kusagadzikana, isu mashoma moder anoongorora kushungurudzika uye kusagadzikana kwete chete nekuda kwekuwanda kwavo kwakanyanya pakati pehukama hwehunhu (semuenzaniso, Starcevic & Khazaal, 2017), asi zvakare nekuti iwo data iri rainyatso zivikanwa kubva munzira yekubvisa yezvidzidzo zvekutanga. Sezvo mamwe mamiriro ezvinhu achiwanzo kuitika pamwe nema BAs (semuenzaniso, Grant et al., 2010), uye mhinduro yekurapa inogona kuchinjirwa nemhando ye comorbidity (Dowling et al., 2016), zvakare zvidzidzo zvinokurudzirwa kuti zvitaure zvakatemwa mhando uye mwero wekunetseka kuitika kuitira kuti uongorore ruzivo urwu mune ramangwana meta-ongorora. Zvidzidzo zvakawanda zvakundikanawo kupa ruzivo rwekuti hutachiona hwawanikwa sei. Maitiro ekutsvaga iwo anoongorora, zvisinei, anogona kukanganisa kwavo (Carlbring et al., 2002; onawo Andersson & Titov, 2014. Zvidzidzo zvenguva yemberi zvinofanirwa kuudza kuti izvo hutachiona hwawanikwa nevarapi, kuzvireurura, kumeso-kana, kana pamusoro pewebhu. Zvakare, zvidzidzo zvenguva yemberi zvinokurudzirwa kuenzanisa zvakananga maitiro evanorapa vanhu vane BA uye maSUD kuitira kuti vaongorore kufanana uye mutsauko pakati pezvinhu zvinopesana nezvinodhaka uye zvisiri- zvinokamana nema BA maererano nemhinduro yekurapa.

Kunyangwe izvi zvisingabvumirwe, mhedzisiro yazvino meta-kuongororwa inoratidza kuti kwakasiyana-siyana kupindira kwepfungwa kwakabudirira mukuderedza zviratidzo zveIA, kunyanya painounzwa kumeso uye nekuitiswa kwenguva yakareba. Kunyangwe antidepressants uye psychostimulants kune vanhu vane-inoitika ADHD yakavandudzwa IA zviratidzo, CBT inosanganiswa nemishonga yekurwisa antidepressants yakaratidza mukana pane monotherapies. Kubva pane iripo mamiriro ekutsvagisa, CBT uye antidepressants vanoita sevanoshanda pakurapa kweSA uye CB. Nekuda kwekuda kwekurapwa, kutsvaga kweuropathy kunofanirwa kuenderera kuitira kuti uone kufanana pakati pechinhu chinokanganiswa nezvinhu uye zvimwe maitiro akapindwa muropa, uye nekuvandudza marapiro emamiriro aya anoodza mwoyo (Grant et al., 2010; Potenza et al., 2011).

Mari yemari

Tsvagiridzo iyi haina kuwana rutsigiro rwemari zvakananga kubva kumakambani ehurumende, evatengesi, kana asiri mapato.

Mupiro weMunyori

Martina Goslar akatsvaga mabhuku, akabvisa dhata nekuita ongororo. Mapepa ekuverengerwa mune meta-kuongorora akaongororwa naMartina Goslar naMax Leibetseder uyo akasimbisawo kubviswa kwedata. Anton-Rupert Laireiter akatarisira maitiro aya. Martina Goslar naMax Leibetseder vakahodha chokwadi chezvidzidzo zvacho. Hannah M. Muench vakatsigira kurongeka kweiyo data uye vakapa zano rehuwandu. Manyoro akanyorwa naMartina Goslar nemashoko akapihwa naHana M. Muench, Anton-Rupert Laireiter, naStefan G. Hofmann. Vanyori vese vakabatsira uye vakabvumidza manyoro ekupedzisira.

Kurwisana kwekufarira

Martina Goslar anozivisa kuti haana kupokana kwekufarira. Max Leibetseder anozivisa kuti haana kupokana kwekufarira. Hannah M. Muench anozivisa kuti haana kupokana kwekufarira. Dr. Hofmann anowana rutsigiro rwemari kubva kuAlexander von Humboldt Foundation (sechikamu chemubairo weHumboldt), NIH / NCCIH (R01AT007257), NIH / NIMH (R01MH099021, U01MH108168), uye James S. McDonnell Foundation 21^st Century Science Initiative mukunzwisisa Kwevanhu Kucherechedzwa - Yakakosha Initiative. Anogamuchira muripo webasa rake semupepeti kubva kuSpringer Nature uye Association for Psychological Science, uye semupi wezano kubva kuPalo Alto Health Sayenzi uye nebasa rake seMusoro Wezvinhu Nyanzvi kubva kuna John Wiley & Sons, Inc. uye SilverCloud Health, Inc Anogamuchirawo mvumo nemubhadharo webasa rake rekupepeta kubva kuvaparidzi vakasiyana Anton-Rupert Laireiter anozivisa kuti haana kukakavara kwechido.

Kutenda

Vanyori vanoshuvira kutenda Mai Xuan Wang und Mr. Yang Zhang avo vakashandura zvinyorwa zveChinese.

chinamatidzwaMaforamu eAnakisi Kuverenga Kuverenga

Kuti compute yakakura-muboka maitiro masizi, anotevera maitiro aishandiswa (Borenstein et al. 2005, 2009):

d = (Y ¯¯¯ 1 - Y ¯¯¯ 2 S D i f f e r e n c e) 2 (1 - r) ------- \sqrt,

zvakadaro Y¯¯¯1 inoratidza kureva kwekunyepedzera, Y¯¯¯2 inoratidza iyo post-kurapwa zvinoreva S_diferencia inoratidza kutsauka kwemisiyano, uye r inoratidza kuwirirana pakati pekufanobata kurapwa uye zvipatara zvekumashure. Nekuda kwemasampuru madiki esamu, ese masisitimu esimba akagadziriswa kwenyasha achishandisa maHedges g iyo yakamanikidzwa nekuwanda d nechinhu chekugadzirisa

J (d f) = 1 - 3 4 d f - 1,

zvakadaro df inomiririra madhigirii erusununguko kuti afungidzire kutsauka kuri mukati -boka. Aya mafomasi akaiswazve kuwerengerwa kwemasayizi ezviratidzo kubva pakufungidzira kusvika kune yekupedzisira-yekutevera. Iwo aidzora mhedzisiro masaizi akaomeserwa achishandisa nzira inotevera:

g = ( Δ ¯¯¯ TREAT - Δ ¯¯¯ CONT ) ( n TREAT - 1 ) S D 2 TREAT + ( n CONT - 1 ) S D 2 CONT n muunganidzwa - 2 ------------------------- \sqrt \times (1 - 3 4 ( n muunganidzwa - 9 )),

zvakadaro Δ ¯¯¯¯ inzira yekutanga kurapwa kurapwa, SD ndiko kutsauka kwakajairika kweanotevera-kurapwa makora, n ndiko kukura kwemuenzaniso, TURU inoreva iyo inoshanda yekurapa mamiriro, uye CONT inoreva mamiriro ekutonga. Kutevera Rosenthal (1991), isu takafungidzira iyo yekutanga-post yekubatana kuva r = 0.70.

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Kurapa kwekupindwa muropa neinternet, kupindwa muropa nebonde uye kumanikidza kutenga: A meta-analysis (2020)

ngovepo

Mhemberero uye zvinangwa

nzira

Results

Kukurukurirana uye Mhedziso

nzira

Eligibility criteria

Ruzivo nezvinyorwa uye kutsvaga mabhuku

Migumisiro miitiro

Kudzidza kusarudza

Iyo data yekuunganidza maitiro uye kudhonza kwe data

Njodzi yekufungirwa mune mumwe nemumwe zvidzidzo

Mhedzisiro ukuru hwekuverenga uye huwandu hwekuumbwa data

Njodzi yekufungira pane zvese zvidzidzo

Moderator kuongororwa

Results

Kudzidza kusarudza

Hunhu hwezvidzidzo, kurapwa, uye vatori vechikamu

Njodzi yekuda mukati mezvidzidzo

Synthesis yemhedzisiro uye njodzi yekuda kuteerana pane zvese zvidzidzo

Mhedzisiro masaizi ekurapa kwepfungwa kurapwa kwepashure uye kutevera

Mhedzisiro miuyo yekurapa kwemishonga panguva yekurapa uye nekutevera

Mhedzisiro masaizi ekurapa akabatanidzwa pakurapwa uye ekutevera

Moderator inoongorora

Psychological vs. pharmacological vs. yakasanganiswa mishonga

Kusiyana pakati pezvikamu zvekupindwa muropa

hurukuro

Mari yemari

Mupiro weMunyori

Kurwisana kwekufarira

Kutenda

References

Mareferensi Anosanganisirwa Meta-Kuongorora

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