Phekolo ea Inthanete ea Tlhekefetso le Matšoenyeho a Tšoenyeho: Phekolo ea Ts'ebetsong le Pele Pele Liphello Tse Bileng li Amanang le Pharmacotherapy le Modified Therapy Behavioral Therapy (2016)

HO HLOKA

Semelo: Kholo ea inthanete e lebisitse phetohong e kholo ebile e fetohile karolo ea bohlokoa ea bophelo ba sejoale-joale. E entse hore bophelo bo be bonolo le ho fana ka melemo e mengata; leha ho le joalo, tšebeliso e feteletseng e tlisitse monyetla oa bokhoba ba tahi, e lebisang ho ho senyeha ho hoholo mesebetsing ea sechaba, thuto, lichelete, kelello le mosebetsi. Batho ba lemaletseng inthanete hangata ba na le mathata a kelello. Ho tšoha ka tšabo (PD) le ho tšoenyeha ka kakaretso (GAD) ke mathata a kelello a atileng, a kenyang tšenyo e kholo bophelong ba mokuli.

Sepheo: Phuputso ena e bulehileng ea teko e hlalosa protocol ea kalafo har'a bakuli ba 39 ba nang le mathata a ho tšoenyeha le bokhoba ba marang-rang (IA) bo kenyeletsang pharmacotherapy le kalafo e fetotsoeng ea boits'oaro ea kalafo (CBT).

Mekhoa: Ho bakuli ba 39, 25 e fumanoe e na le PD le 14 e nang le GAD, ntle le ts'ebeliso ea lithethefatsi tsa inthanete. Ha ba hlahlobisisa bakuli ba ile ba arabela ho MINI 5.0, Hamilton Anxcare Rating Scale, Hamilton Depression Rating Scale, Clinical Global Impressions Scale, le Scale ea bacha ea Inthanete. Ka nako eo, IA e ne e bonoa e nahana ka sekala sa IAT (lintlha tsa cutoff tse kaholimo ho 50), ha mathata a ho tšoenyeha a fumanoe ke ngaka ea mafu a kelello. Bakuli ba ile ba fetisetsoa bakeng sa pharmacotherapy le protocol e fetotsoeng ea CBT. Psychotherapy e ne e etsoa ka bonngoe, hang ka beke, ho feta nako ea libeke tsa 10, 'me liphetho li bontša hore kalafo e ne e sebetsa bakeng sa matšoenyeho le ts'ebeliso ea inthanete.

Liphetho: Pele ho kalafo, maemo a matšoenyeho a khothalelitse ho tšoenyeha ho hoholo, ka sekhahla sa 34.26 (SD 6.13); leha ho le joalo, kamora kalafo, tlhaiso e ne e le 15.03 (SD 3.88) (P<.001). Ho ile ha bonoa ntlafatso e kholo ea lipalo tsa bokhoba ba inthanete ho tloha 67.67 (SD 7.69) pele ho kalafo, e bonts'a ts'ebeliso e thata ea inthanete ho 37.56 (SD 9.32) kamora kalafo (P<.001), e bonts'a ts'ebeliso e mahareng ea inthanete. Mabapi le kamano pakeng tsa IA le matšoenyeho, khokahano lipakeng tsa lintlha e ne e le .724.

Qeto: Phuputso ena ke lipatlisiso tsa pele mabapi le kalafo ea IA ea baahi ba Brazil. Phetoho eo e ne e tsoteha ka lebaka la ho kenya letsoho ha bakuli kalafong, e thusitseng katlehong ea kalafo ho tloha ka pono ea boits'oaro, mme e file bakuli tshepo ea ho tsoelapele ho laola ts'ebeliso ea inthanete maphelong a bona.

JMIR Res Protoc 2016; 5 (1): e46

Doi: 10.2196 / resprot.5278

Background

Keketseho e potlakileng ea inthanete le ho kopanngoa ha eona bophelong ba sejoale-joale e lebisitse ho liphetoho tse hole haholo bophelong ba rona ba letsatsi le letsatsi. Marang-rang a ka u fa melemo e mengata; leha ho le joalo, tšebeliso e feteletseng e tlisitse menyetla ea ho lemalla ebile e bakile ho senyeha mekhoeng ea sechaba, thuto, lichelete, kelello le mosebetsi. Tlatsetso ea inthanete (IA) e hlalosoa e le ho haelloa ke bokhoni ba ho laola tšebeliso ea inthanete, e bakang khatello ea maikutlo, e jella nako, kapa e baka mathata a bohlokoa sechabeng, mathata a mosebetsing kapa mathata a lichelete [1]. Ho ferekana kelellong le kelellong joalo ka ho jeoa ke bolutu, ho itšepa ho tlase, ho se khone ho sebetsana ka katleho le uena, ho tšoenyeha, khatello ea maikutlo le khatello ea maikutlo le tsona li teng [2-4]. Boitšoaro bo bobe bo ka amana le tšebeliso e feteletseng ea inthanete [5].

IA ha se bokuli bo tsebahalang ho Diagnostic and Statistical Manual of Mental Dis shida (DSM-5) [6], mme ha ho lumellanoa ka mekhoa ea tlhahlobo ea mafu; leha ho le joalo, bafuputsi ba bang ba fana ka maikutlo a likarolo tse kang ho sesa, ho feto-fetoha ha maikutlo, ho mamella, ho khaola, likhohlano le ho khutlela morao, ba re lipapatso li arolelana likarolo tsa lits'ebetso tsa biopsychosocial [7]. Litekanyetso tse ling tse sebelisoang khafetsa tsa tlhahlobo ea marang-rang tse thehiloeng ho litekanyetso tse fetotsoeng bakeng sa papali ea marang-rang ea methapo e kenyelletsa tse latelang: ho tsepamisa mohopolo ho feteletseng ka inthanete; tlhokeho ea ho sebelisa marang-rang bakeng sa nako e eketsehileng; boiteko bo sa atleheng ba ho laola tšebeliso ea marang-rang; ho ikutloa o sa phomole, o morusu, o tepelletse maikutlo kapa o teneha ha o leka ho fokotsa tšebeliso ea inthanete; ho lula inthaneteng nako e telele ho feta kamoo ho neng ho reretsoe ho tloha qalong; ho lahleheloa ke kamano ea bohlokoa, mosebetsi, kapa monyetla oa thuto; ho thetsa ba bang hore ba pate ho kenella ha Marang-rang; le ho sebelisa inthanete ho baleha mathata kapa ho imolla letsoalo. Ho nkoa e le tlatsetso ha mekhoa ea 5 kapa ho feta e le teng ka nako ea khoeli ea 6 [8,9].

Ka lebaka la hore ha ho na mekhoa ea semolao ea tlhahlobo ea mafu, bafuputsi ba netefalitse lisebelisoa tse 'maloa ho hlahloba IA, le litekanyetso tsa ho ata ha machaba li fapana haholo. Lintlha tsa lipotso tse sebelisoang haholo ke tse latelang: Tlhahlobo e Mpe ea ho Lemalla Inthanete (IAT) [10], Scale e Ts'ebelletsang ea Tšebeliso ea Inthanete (CIUS) [11], Scale e Feteletseng ea Tšebeliso ea Inthanete (EIU) [12], Potso ea Mathata ea Ts'ebeliso ea Marang-rang13], Chen Internet Addiction Scale (CIAS) [14], Mofuta oa Tlatsetso ea K'homphieutha ea Tepo ea Tepo ea Inthanete (BAPINT-SV) [15], Internet Addiction Proneness Scale (sekala sa KS) [16], le bukana ea lipotso tse fumanehang ka mocha oa Diagnostic (YDQ) [8]. Ka hona, litekanyetso tsa lefatše tsa IA tsa lefatše ka bophara li fapana haholo ebile lia fapana, ho tloha 1.0% ho 18.7% [17].

Mathata a ho tšoenyeha a arolelana likarolo tsa ho tšoha ho feteletseng le matšoenyeho le litšitiso tse amanang le boitšoaro. Matšoao ana a baka mahlomola a maholo mesebetsing ea sechaba, mosebetsing kapa libakeng tse ling tsa tšebetso. Tšabo (PD) e kenyelletsa tlhaselo e sa khaotseng ea tšabo e sa bonahaleng e hlahisoang ke ts'ebetso e tšohanyetso ea tšabo e matla e fihlang tlhōrōng ka motsotso, e tsamaisana le matšoao a mmele le a kelello a kang ho hlapoloha, ho fufuleloa, ho opeloa ke sefuba, tšabo ea ho lahleheloa ke taolo, ho tšaba ho shoa, ho thothomela, le ho nyekeloa. Khatello ea ho tšoenyeha ka kakaretso (GAD) e kenyelletsa ho tšoenyeha ho feteletseng le ho tšoenyeha ka mesebetsi ea letsatsi le letsatsi eo mokuli a fumanang ho le thata ho e laola ebile e amana le ho tepella habonolo, ho se tsitsipane, khatello ea mesifa, ho khathatseha boroko, ho tsepamisa mohopolo le ho hloka botsitso [6].

Batho ba nang le mekhoa e mengata ea ts'ebeliso e joalo ka joala, koae, lithethefatsi, lijo le thobalano ba kotsing e kholo ea ho holisa IA, hobane ba ithutile ho sebetsana le matšoenyeho le mathata ka boits'oaro bo qobelloang [18]. Batho ba nang le IA hangata ba na le mathata a kelello a kelello 'me mokhatlo ona o mpefatsa tšebeliso ea inthanete; kamano e pakeng tsa IA le mafu a 'maloa a kelello e bohlokoa ebile e tsosa thahasello ea thuto. Bafuputsi ba amahantse IA le khatello ea maikutlo [19,20-22], khaello ea tlhokomelo le khatello e matla ea kelello [23-25], khaello e akaretsang ea ho tšoenyeha le khatello ea maikutlo ea sechaba [23,26-28], dysthymia [26], bokuli ba tšebeliso ea joala [29], bokuli ba ho ja [30], bofokoli bo shebelletseng bo amang botho, bofokoli ba botho bo moeling le tšenyo ea botho e thibelang [26], le ho hloka boroko [31]. Bafuputsi ba bang ba boletse hore IA e ka ba sesupo sa tlhahlobo e 'ngoe e joalo ka matšoenyeho kapa khatello ea maikutlo mme eseng bothata bo arohaneng [4,32], mme ke bapisitse IA le tšusumetso ea taolo ea tšusumetso [2,33-35]; leha ho le joalo, ba bang ba pheha khang ea hore IA e lokela ho fumanoa e le lefu la mantlha [10,36].

Li-comorbidities tsena li bapala karolo ea bohlokoa kalafong ea IA, e lokelang ho totobatsa boemo ba kelello le ho phekola tšebeliso e mpe ea inthanete [19]. Boithuto bo totobatsa hore IA e baka tšenyo ntlheng ea bophelo, 'meleng le kelellong, e baka ho lahleheloa ke mosebetsi, tlhalo, ho hloka kutloano ka lapeng, ho itšehla thajana, ho se atlehe sekolong, ho lahla kapa ho lelekoa sekolong [37,38], ho hloka boroko, ho opeloa ke masapo a mokokotlo, ho tšoaroa ke hlooho e bohloko, khaello ea phepo e nepahetseng, mokhathala, le pono e foufetseng [31] le mathata a kelello a kang ho se tsotelle, ho tsepamisa mohopolo, ho lieha, le mesebetsi e sa phethahalang [39,40].

Litlhare

Tse ling tsa pharmacological [41,42] le psychotherapeutic [4,18,43-46] ho phekotsoe kalafo le ho khothaletsoa IA bobeli ka thoko le hammoho [47]. Bokhoba ba tahi e kholo ebile IA e ka arolelana mochine o tšoanang oa neurobiological, ka hona ka kutloisiso ena, meriana e lemalloang e ka thusa batho ba bang [3]. Motsoako o joalo ka escitalopram [48], citalopram [49], bupropion [41,50], olanzapine [51], quetiapine [52], naltrexone [53], methylphenidate [54], le memantine [55] kaofela li sebelisitsoe ho phekola IA.

Cognitive-boitšoaroal therapy (CBT) e bontšitsoe hore e sebetsa hantle ho phekola IA mme ho fanoe ka lithuto tse ngata [18,43,56-58]. CBT e totobatsa kamano lipakeng tsa menahano, maikutlo le boits'oaro, 'me e ruta bakuli ho ela hloko tsena le ho itokisetsa ho tseba lintho tse susumetsang ka menahano le maikutlo a bona. Lingaka tsa kelello tsa CBT li ruta mekhoa ea ho sebetsana le maemo, le ho khothaletsa ho khomarela kalafo, ho fetola boitšoaro, le ho thibela ho oela hape [58]. E le kalafo bakeng sa IA, bafuputsi ba bang ba khothalelitse CBT ea setso [43,44,59-62], CBT le tlhabollo [63], CBT e nang le electroacupuncture (EA) [64,65], CBT le tlhahlobo ea lipotso tse khothatsang (MI) [66], CBT le meriana [59,61,67], kalafo ea kelello kapa ea boits'oaro [68], le lenaneo le fetotsoeng la CBT le bitsitsoeng kalafo ea nako e khuts'oane ea ts'ebeliso ea lithethefatsi tsa inthanete le k'homphieutha (STICA) ka ts'ebetso ea motho ka mong le sehlopha [44].

Psychotherapy ea sehlopha le sepetlele bakeng sa detoxation le tsona ke mehlala ea kalafo bakeng sa IA [5]; ho feta moo, ho fanoa ka mekhoa ea multimodal e sebelisang CBT, psychotherapy le malapa, kalafo ea li-comorbidities, meriana le ho kena sepetlele [69].

Ka hona, sepheo sa mantlha sa thuto ena ke ho leka bonnete ba kalafo bakeng sa PD kapa GAD le IA e kenyeletsang pharmacotherapy le CBT e fetotsoeng. Morero oa bobeli ke ho hlahisa tlhaiso-leseling ea tlhahlobo ea bongaka ho tiisa ho amohela IA e le tšibollo ea boitšoaro le ho netefatsa mofuta oa kamano lipakeng tsa mathata a ho tšoenyeha le IA.

mekhoa

Mekhoa ea ho kenyelletsoa e amohetsoeng e ne e le bakuli ba latelang: (1) pakeng tsa 18 le 65 ea lilemo li nang le IA; (2) tlhahlobo ea tlhahlobo ea PD kapa GAD ka Mini International Psychiatric Puisano (MINI), mme e netefalitsoe ke ngaka ea mafu a kelello; (3) ho ea le ho phethela tlhahlobo ea pele; le (4) ho ba le bokhoni bo lekaneng ba ho utloisisa litaelo. Bakuli ba neng ba sa tsebe ho bala kapa ho ngola, kapa ba nang le Axis II pathology [6], ba ne ba qheletsoe ka thoko.

Boithuto bona bo amohetsoe ke Komiti ea Boitšoaro ea The Federal University ea Rio de Janeiro, CAAE 2704531460000526. Bakuli bohle ba ile ba saena foromo ea tumello mme ba ea Laborator of Panic and Karabelo ho Institute of Psychiatry ea Univesithi ea Federale ea Rio de Janeiro (IPUB / UFRJ).

Bakuli bohle ba ne ba batla kalafo bakeng sa matšoao a ho tšoenyeha. Ha ba hlahlobisisa, ba ile ba araba likala tse latelang: MINI 5.0 [70], Hamilton Anxcare Rating Scale (HAM-A) [71], Hamilton Depression Rating Scale (HDRS) [72], Khatiso ea Maemo a Tlaase ea Clinical Global Impressions (CGI) [73], le Teko ea Bacha ea Tebello ea Inthanete (IAT) [10]. IA e ile ea hlahlojoa ho latela IAT (lintlha tse kaholimo ho 50), ha mathata a ho tšoenyeha a fumanoe ke ngaka ea mafu a kelello. Bakuli ba ile ba memeloa ho nka karolo phuputsong ena mme ba fetisetsoa bakeng sa pharmacotherapy le protocol e fetotsoeng ea CBT.

Bakuli ba ile ba hlahlojoa ke ngaka ea mafu a kelello qalong ea kalafo, ba lumelloa ho nka meriana e laetsoeng ke ngaka ea mafu a kelello nakong ea kalafo, mme ba tsamaea le ngaka ea mafu a kelello kalafo eohle.

Bakuli bohle ba 39 ba kile ba fuoa psychotherapy (e fetotsoeng CBT), e neng e etsoa hang ka beke bakeng sa libeke tsa 10. Sepheo sa mantlha e ne e le ho ruta bakuli ho sebetsana le matšoao a ho tšoenyeha ntle le ho sebelisa marang-rang, le ho khothaletsa ts'ebeliso e ntle ea inthanete. Psychotherapy e ile ea latela mekhahlelo ea 4: psychoed thuto mabapi le matšoenyeho le ts'ebeliso ea marang-rang, tlhahlobo ea kelello ea kelello, phetoho ea boitšoaro le thibelo ea ho oela hape (Lethathamo 1).

  

‎Sheba tafole ena

 

Karolo ea pele ea psychotherapy e tšoarella linako tsa 3 mme e shebane le psychoedfundo mabapi le mokhoa oa ho tšoenyeha, ho supa maemo a tšosang, le lisosa tse eketsang ho tšoenyeha le ts'ebeliso e mpe ea ts'ebeliso ea inthanete. Morero ke ho ruta ho phefumoloha ho phefumoloha ka ho ikoetlisa le maano a ho phefumoloha, ntle le ho sebelisa marang-rang ho sebetsana le menahano le maemo a tšoenyehileng. Nakong ena, bakuli ba ithuta ho khetholla le ho amohela maikutlo le ho emisa ho loants'a le matšoenyeho a bona. Bakuli ba qala ho utloisisa matšoenyeho a bona le kamano ea eona le tšebeliso ea inthanete ka ho itlhokomela tšebeliso ea bona ea inthanete nakong ea maemo a amang matšoenyeho. Lintlha tse ling tsa tokiso tse amanang le tlhekefetso ea marang-rang le matšoenyeho le tsona lia hlahlojoa. Lintho tsena li ka kenyelletsa maemo a motho, maemo, maemo a bophelo, kelello, kapa maemo a mosebetsi. 

Karolo ea bobeli e bua ka ho lekola botjha ho tšoenyeha le ts'ebeliso ea inthanete. Nakong ena, bakuli ba nahana ka ts'ebeliso ea bona ea letsatsi le letsatsi ea Marang-rang, likelello tse amehang ts'ebelisong ena, le matšoenyeho. Ho tšoaetsoa liphoso tsa kelello 'me mokuli o qala ho utloisisa hore litšitiso tse kang tse latelang li kenya letsoho ts'ebelisong e fetelletseng ea Marang-rang: "Ho qeta metsotso e seng mekae ho Marang-rang ho ke ke ha nkutloisa bohloko"; "Ke tlameha ho araba metsoalle ea ka hanghang, ho seng joalo ba ke ke ba ntšoarela"; "Haeba metsoalle ea ka e sa fane ka" likhahla "linthong tseo ke li romelletseng kapa lifoto tsa ka, ke sesupo sa hore ha ba nthate kapa hore ho na le phoso eo ke e entseng”; hape, "Haeba ke khaohana le inthanete, ke tla lahleheloa ke lintho tsa bohlokoa hobane lintho tse ntle ke tse fumanehang inthaneteng." Mehopolo eohle e amanang le ho tšoenyeha le tšebeliso ea inthanete e hlophisitsoe bocha mme ho nahanoa mehopolo e ncha; litumelo tse fapaneng li hlahisoa ka linako tsa 2.

Karolo ea boraro (likarolo tsa 3) e kenyelletsa phetolo ea boits'oaro ka ho pepesehela maemo a ts'abehang / ts'oaetso, koetliso ea taolo ea nako, le tlhahiso ea lethathamo la tšebeliso ea inthanete. Ho fetola mekhoa ea boits'oaro ho kenyelletsa mekhoa e mengata ea ts'ebeliso ea marang-rang, mme ho kenyelletsa mekhoa e fetohileng ea ho sebetsana le ba lelapa, metsoalle, mesebetsi ea sechaba, boikoetliso ba 'mele le likarolo tse ling tsa bophelo. Likarolo tsohle tsa maemo li ea hlahlojoa, ebe li nkeloa sebaka kapa li tlosoa ho hlokahala ho etsa lintho ka tsela e fapaneng le ho fetola ka katleho mekhoa ea khale ea ho sebetsa. Karolo e 'ngoe ea bohlokoa mohatong ona ke ho kenyelletsa maikutlo a matle mesebetsing ea letsatsi le letsatsi ho nts'etsapele litsebo tsa sechaba, molemong oa ho khothaletsa tšebeliso e tlase ea inthanete le litšebelisano tse fetang tsa motho ka mong. Ho ea ka psychology e ntle, ho matlafatsa maikutlo a matle ho matlafatsa boiketlo, ho thusa ho fokotsa matšoao le matšoao a ho tšoenyeha le khatello ea maikutlo le ho thibela ho oela hape [74].

Karolo ea bone e tšoarella mananeo a 2 a shebelletse ho hlaphoheloa le ho khutlisetsa thibelo hape ka ho tiisa litumelo le boits'oaro bo bocha, le litsebo tsa kahisano joaloka boiketlo, ho rarolla mathata, puisano ka mantsoe le kutloelo-bohloko. Katleho / ntlafatso li ngolisitsoe kareteng (karete ea katleho) mme bakuli ba khothaletsoa ho tsoelapele ho sebelisa seo ba ithutileng sona ho psychotherapy. Sebokeng sa ho qetela, baithaopi ba ile ba arabela sekaleng se le seng se sebelisitsoeng qalong ea kalafo (IAT, HAM-A, HAM-D, le CGI), ho latela le ho netefatsa ntlafatso maemong a mangata. Ntle le ntlafatso ea lipalo tsa maemo a phahameng, lintlha tse ling tsa bohlokoa li fokotsoe nako e sebelisoang inthaneteng, likhokahano tsa tšebelisano ea motho, 'me haholoholo, li na le tlhoko ea ho sebelisa Inthanete ho baleha mathata kapa ho sebetsana le matšoenyeho.

Results

Phuputso ena e bulehileng ea liteko e khothalelitse ho kenella ha litlhare le psychotherapeutic ho phekola bakuli ba fumanoeng ba na le PD kapa GAD le IA. Qalong, bakuli ba 41 ba ile ba phethahatsa mekhoa mme ba khethoa ho amohela kalafo ea psychotherapy bakeng sa PD kapa GAD le IA; leha ho le joalo, ba babeli ha baa ka ba tsoela pele ka kalafo (mokhanni oa tekesi ea 33 ea lilemo li X le IA ea ileng a fallela naheng e 'ngoe kamora seboka sa boraro; mme mosali ea lilemo li 36 ea nang le PD le IA hammoho le tse ling tse fumanoeng joalo e le bothata ba ho ja le khatello ea maikutlo ea morao-rao, ea neng a ea libokeng tsa 2 feela tsa psychotherapy). Bakuli ba bang ba 39 ba bile teng libokeng tsohle; Litšobotsi tsa palo ea batho li hlahisoa ho Lethathamo 2.

Lingaka tsa mafu a kelello li fane ka litlhare tsa kalafo ho phekola PD kapa GAD le IA. Ba bang ba litlhare tse sebelisitsoeng e ne e le li-antidepressants tse kang fluoxetine, sertraline, venlafaxine, desvenlafaxine, paroxetine, escitalopram, zolpidem, le duloxetine; anxiolytics joalo ka clonazepam le alprazolam; li-psychostimulants tse kang methylphenidate; le li-antipsychotic tse kang quetiapine.

Ho bakuli ba 39, 25 e fumanoe e na le PD le 14 e nang le GAD, ntle le ho ba le IA. Pele ho kalafo, maemo a matšoenyeho ho HAM-A a fana ka maikutlo a ho tšoenyeha ho hoholo, ka sekhahla sa 34.26 (SD 6.13); kamora kalafo, kakaretso e ne e le 15.03 (SD 3.88). Palo e mahareng ea IAT qalong ea kalafo e ne e le 67.67 (SD 7.69), e bonts'ang ts'ebeliso e mpe ea inthanete; kamora linako, litekanyetso tsa IAT e ne e le 37.56 (SD 9.32), e bonts'ang ts'ebeliso e nepahetseng ea inthanete le ntlafatso e boleloang ho lemeng. Moetso oa HDRS o neng o le motheong oa motheo e ne e le 16.72 (SD 5.56), e fanang ka maikutlo a khatello ea maikutlo, athe kamora kalafo boemo ba boleng e ne e le 7.28 (SD 2.52), bo bonts'ang khatello ea maikutlo. Liphetho tsa t Liteko tsa ho bapisa lintlha pele le kamora kalafo li tlalehiloe Lethathamo 3.

  

‎Sheba tafole ena

 

  

‎Sheba tafole ena

 

Likamano pakeng tsa lintlha tse ngata le tsona li ile tsa qaptjoa. Khokahano pakeng tsa lintlha ho IAT le HAM-A e ne e le .724, lipakeng tsa lintlha ho HAM-A le HDRS e ne e le .815, 'me pakeng tsa lintlha ho IAT le HDRS e ne e le .535.

Qetellong ea psychotherapy, bakuli bohle ba ile ba ikutloa ba le motle ka kalafo ea bona mme ba itšepa haholo, kamora hore ba fole bophelo ba bona ba boiketlo. Bakuli ba bontšitse ntlafatso matšoao a ho tšoenyeha le ho sebetsana le ho tšoenyeha ntle le ts'ebeliso ea Marang-rang. Ts'ebeliso ea inthanete kamora kalafo e ile ea tsebahala mme bakuli bohle ba khetholloa e le basebelisi ba bonolo. Liphetho tsena li bonts'a hore bakuli ba atlehile ho hlaphoheloa mosebetsing.

Puisano

Thutong ea hona joale, bangoli ba hlalositse protocol ea kalafo e fetotsoeng ea CBT, ba hlahloba litlamorao tsa kalafo ena le pharmacotherapy ho bakuli ba 39 ba nang le PD / GAD le IA, mme ba sekaseka kamano lipakeng tsa matšoenyeho le IA. Leha ho bile le ngangisano mabapi le ho amoheloa ha IA e le pherekano ea semmuso, litlamorao tse mpe tsa ts'ebetso ena ea ts'ebeliso ea boitšoaro li totobalitsoe lithutong tse 'maloa [75-80]. Protocol ea psychotherapy e bontšitsoe e sebetsa hantle kalafong ea matšoenyeho le IA, hobane bakuli bohle ba ithutile ho sebetsana le ho tšoenyeha ntle le Marang-rang mme ba bonts'itse ts'ebeliso qetellong ea lithuto.

Lithuto tse 'maloa li netefalitse kamano pakeng tsa khatello ea maikutlo le IA [19-23,27]; leha ho le joalo, ke liphuputso tse fokolang tse ileng tsa hlahloba kamano pakeng tsa matšoenyeho le IA [26,81,82]. Boithuto ba ho ts'oasa li bontsa hore IA e sebetsa ka mokhoa o ts'oanang ho susumetsa taolo ea taolo; monahano oa matla a matla a khoheli o bontšitse hore libaka tse qalileng ha motho ea nang le IA a na le tšusumetso ea ho sebelisa marang-rang ke tsona libaka tse hlahisoang ke lintho tse lemalloang. [5]. Ka nako e ts'oanang, matšoenyeho a bapala karolo ea bohlokoa ho ekeiseng tšebeliso ea inthanete le ho matlafatsa temallo. Bangoli ba totobalitse kamano lipakeng tsa mathata a ho tšoenyeha le IA ka ho ikopanya ho bontšitsoeng (.724), e bonts'ang 'nete ea hore litumelo le boits'oaro bo amanang le matšoenyeho li na le tšusumetso ea bohlokoa ts'ebelisong ea inthanete le ho ikopanya le lefats'e.

Litlhare tsa pele tsa kalafo bakeng sa IA li hlalositsoe libukeng tse kang CBT [45,56,60,83], CBT le meriana [59,67,68], le mananeo a multimodal a kenyeletsang kalafo ea motho ka mong le sehlopha, tlhabollo le kalafo ea malapa [44,61,84].

Moeli oa thuto e ne e le saese e nyane ea sampole (barupeluoa ba 39); leha ho le joalo, liphetho li bonts'a katleho ea kalafo e reriloeng, ka bobeli ho fokotsa matšoao a ho tšoenyeha le ho khothaletsa tšebeliso e ntle ea inthanete, ho ntlafatsa IA ho bakuli. Ntle le moo, thuto ena ke lipatlisiso tsa pele tse phatlalalitsoeng ka kalafo ea IA ho baahi ba Brazil.

Patlisiso ea nako e tlang e lokela ho supa kalafo e ka bang teng bakeng sa IA u sebelisa maano le mekhoa e mecha, joalo ka gestalt, tlhabollo, kalafo ea lelapa, kelello, kalafo ea psychodynamic, psychology e ntle, le kalafo ea transdiagnostic. Ho etsa lipatlisiso le ho sekaseka ho boetse ho lokela ho etsoa ho nts'etsapele mekhoa e mecha ea kalafo moo IA e nang le tšusumetso e kotsi, joalo ka baratani ba nang le mathata a lenyalo, batho ba nang le bothata ba ho hlobaela, batho ba nang le bothata ba khaello ea tlhokomelo, le batho ba nang le boits'oaro bo bong ba tlhekefetso, joalo ka ho tsuba, ho sebelisa lithethefatsi, ho ja, ho kopanela liphate kapa ho ea mabenkeleng.

Seo re se fumaneng se fana ka maikutlo a hore pharmacotherapy le protocol e ntlafalitsoeng ea psychotherapy kalafo ea bakuli ba nang le matšoenyeho le IA e ne e le merero e sebetsang. Ntlafatso e ne e tsoteha ka lebaka la ho kenya letsoho ha bakuli kalafong, e thusitseng katlehong ea kalafo ho tloha ka pono ea boits'oaro, mme e file bakuli ts'epo ea ho tsoela pele le ho laola ts'ebeliso ea inthanete maphelong a bona.

IA e ntse e eketseha ho potoloha lefatše le linaheng tse ling, tse kang Korea Boroa le China, e nkoa e le boemo ba bophelo bo botle ba sechaba. Ka kutloisiso ena, ho ka etsoa tlhahiso ea kalafo e sebetsang 'me ea tlaleha e khothalletsang tšebeliso e ntle ea inthanete,' me e kenyelletsa ho nka bohlokoa ba lelapa, metsoalle, bophelo ba boithabiso le boikoetliso. Kahoo, ts'ebeliso ea marang-rang e lokela ho ba hlokolosi e le hore e se ke ea hlekefetsoa, ​​'me tšebelisano-leseling ka marang-rang e lokela ho tiisa le ho holisa tšebelisano-ka-motho.