Phekolo ea bokhoba ba inthanete, bokhoba ba thobalano le ho reka ka qobello: Tlhatlhobo ea meta (2020)

Buka / Taba: Buka ea 9: Taba ea 1

bangodi: Martina Goslar¹, Max Leibetseder¹, Hannah M. Muench², Stefan G. Hofmann³ 'me Laireiter ea Anton-Rupert^{1 , 4}

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

inahaneloang

Ka morao le sepheo

Bokhoba ba marang-rang, ho lemalla ho kopanela liphate le ho reka ka thata ke mathata a tloaelehileng a boitšoaro, a arohanang le bothata ba papali ea chelete le mathata a tšebeliso ea lithethefatsi. Leha ho le joalo, ha ho tsejoe letho ka katleho ea phekolo ea bona. Morero oa tlhahlobo ena ea meta e ne e le ho lekola ts'ebetso ea liphekolo tsa boits'oaro bo joalo ba mathata, le ho ts'oana ho ts'oana le bothata ba ho becha le mathata a ts'ebeliso ea lithethefatsi mabapi le karabelo ea kalafo.

mekhoa

Patlo ea lingoliloeng e hlahisitse lithuto tse 91 tse akaretsang barupeluoa ba 3,531 ho fana ka tlhahlobo e felletseng ea katleho ea nako e telele le ea nako e telele ea maikutlo a kelello, a meriana le a kopaneng bakeng sa ho lemalla inthanete, bokhoba ba thobalano le ho reka ka matla.

Results

Phekolo ea kelello, ea litlhare le e kopantsoeng e ne e amahanngoa le ntlafatso e matla ea pele ho poso bothateng ba lefatše ba bokhoba ba inthanete (Hedges's g: 1.51, 1.13, le 2.51, ka ho latellana) le bokhoba ba thobalano (Hedges's g: 1.09, 1.21, le 1.91, ka ho latellana. ). Bakeng sa ho reka ka mokhoa o qobelloang, kalafo ea kelello le ea kalafo ea meriana le eona e ne e amahanngoa le phokotso ea boholo-holo ea pele ho poso ea boima ba lefatše (Hedges's g: 1.00 le 1.52, ka ho latellana). Mefuta e laoloang ea "pre-post" le "sehlopha" e neng e laoloa pele e ne e le ka bongata bo ts'oanang, ntle le mekhelo e fokolang. Litlhahlobo tsa Moderator li fana ka maikutlo a hore mehato ea kelello e sebetsa bakeng sa ho fokotsa boits'oaro bo qobelloang, haholo ha bo fanoa lifahleho li talimane 'me bo etsoa ka nako e telele. Motsoako oa mekhoa ea ts'oaetso le boits'oaro le meriana e bonts'a molemo ho feta monotherapies.

Puisano le Liphetho

Liphetho li bontša hore liphekolo bakeng sa bokhoba ba boitšoaro bo tloaelehileng li sebetsa ka nako e khuts'oane, tse ts'oanang le tse sebelisitsoeng bakeng sa bothata ba ho becha le mathata a ts'ebeliso ea lithethefatsi, empa ho hlokahala liteko tse matla tsa tliliniki.

Patlisiso ea morao tjena e bontšitse ho tšoana lipakeng tsa mathata a tšebeliso ea lithethefatsi (SUDs) le bokhoba ba boitšoaro (BAs; mohlala, Grant, Potenza, Weinstein, & Gorelick, 2010). Ka hona, litakatso tsa boitšoaro bo sa amaneng le litheko li ne li hlalositsoe ho ipapisitse le litekanyetso tsa ts'ebeliso ea lithethefatsi tse boletsoeng ho Diagnostic and Statistical Manual of Mental Dis shida (DSM IV; Mokhatlo oa Mahlale oa Amerika, 1994) ho kenyelletsa ho nahanisisa ka boits'oaro bo ikhethang, ho se khone ho laola boitšoaro, ho mamella, ho tlohela, le boitšoaro bo tsoelang pele ho sa na le litlamorao tse mpe (mohlala, Grant et al., 2010). Hajoale, ke bothata ba ho becha feela (GD), bo ileng ba kenngoa tlasa "Lits'ireletso tsa Ts'usumetso ea Batho ba sa Ts'oaneng le Karohano e 'Ngoe" sebakeng sa DSM IV (Mokhatlo oa Mahlale oa Amerika, 1994), e arotsoe ka tlas'a karolo e nchaMathata a amanang le lithethefatsi le ho lemalla”Ea DSM-5 (Mokhatlo oa Mahlale oa Amerika, 2013). Ho hlophisoa hona ho boetse ho tsitsitse khang e kholo mabapi le hore na boits'oaro bo eketsehileng bo nang le taolo e fokotsehileng ea taolo bo lokela ho nkuoa e le batseteli ba ka khonehang bakeng sa li-BA (mohlala, Grant et al., 2010; Mueller et al., 2019).

Ntle le GD, bothata ba lipapali tsa inthanete (IGD) ke bona feela maemo a behiloeng DSM-5 tlasa Karolo ea Boraro ka tlhahiso ea hore ho etsoe lipatlisiso tse ling (Mokhatlo oa Mahlale oa Amerika, 2013). E tšehetsoa ke litsebi tse tsoang litsing tse fapaneng tsa bophelo bo botle ba kliniki le ba sechaba (mohlala, Rumpf et al., 2018; Saunders et al., 2017), bokuli ba lipapali le bona bo nkuoa e le moralo oa ICD-11 (Mokhatlo oa Lefatše oa Bophelo, 2018). Ho bohlokoa ho hlokomela hore IGD e lokela ho khetholloa ho ts'ebetso ea ts'ebeliso ea marang-rang ea lefats'e ea marang-rang (IA), kaha bobeli ba eona e emela liqeto tse fapaneng (mohlala, Griffiths le Liponte, 2014; Kiraly et al., 2014). Leha ho le joalo, kaha lingoliloeng tse ngata li bua ka IA ea lefats'e, polelo ena e amohetse le pampiring ena. Ntle le moo, phapang e lokela ho etsoa lipakeng tsa "papali ea papali ea chelete" le "papali ea chelete": Ha "papali e hlalosoa haholo ke ts'ebetso ea eona, papali e thehiloeng ho boiphihlelo, le matšoao a tsoelo-pele le katleho, ... papali ea chelete e hlalosoa ke ho becha le ho hlapanya, liphetho tse reriloeng esale pele, le lintlha tsa chelete tse amanang le kotsi le ho lefa sebapali. ” (Morena, Gainsbury, Delfabbro, Hing, & Abarbanel, 2015, leq. 216).

Leha ho kenyelletsoa ho kenyelletsoa ha IGD ho libuka tsa tlhahlobo ea mafu ho buisanoa ka phehisano ho lingoliloeng tsa mahlale (King et al., 2019; Petry, Rehbein, Ko, & O'Brien, 2015; Rumpf et al., 2018; Saunders et al., 2017), lipatlisiso tse ngata li se li entsoe ho IA le IGD, haholo-holo ka mehato ea neurobiological e fanang ka maikutlo a tšoanang ho li-SUDs (bakeng sa litlhahlobo tsa bona Fauth-Buhler le Mann, 2017; Kuss, Pontes, & Griffiths, 2018). Ntle le ho tšoana pakeng tsa li-SUD le li-BA mabapi le litšobotsi tse makatsang le tsa bongaka, komello le nalane ea lelapa, haholo liphumano tse tsoang lipatlisisong tsa neuroscience li bonahala li le bohlokoa ho khetholla matšoao a boitšoaro bo lematsang (mohlala, Grant et al., 2010; Potenza, Sofuoglu, Carroll, & Rounsaville, 2011).

Tumellanong le ho nahanisisa hona, tsoelo-pele e 'ngoe lithutong tsa liteko tse amanang le methapo ea kutlo le SUDs e fumanoe haufinyane haholo kahara lithethefatsi tsa thobalano (SA) le theko e tlamang ea ho reka (CB) ka ho sekaseka liketsahalo tse neng li etsoa lipatlisiso ka setso ho SUDs joalo ka lits'ebetso tsa maemo (mohlala, Hoffmann, Goodrich, Wilson, & Janssen, 2014; Snagowski, Laier, Duka, & Brand, 2016), ho etsa lintho hape, ho tsotella le ho kenella hoa ts'ebetso ea neural e amanang (mohlala, Moetso, 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, le Brand, 2015; Voon et al., 2014, kapa tšebetso e sebetsang (Derbyshire, Chamberlain, Odlaug, Schreiber, le Grant, 2014; Messina, Fuentes, Tavares, Abdo, & Scanavino, 2017; Raab, Elger, Neuner, & Weber, 2011; Trotzke et al., 2015). Lithuto tsena li bonts'itse hore har'a maemo ao a seng a amohetsoe ka molao ho DSM-5 joalo ka li-BA, bopaki bo fumanehang hona joale mabapi le matšoao a amanang le methapo bakeng sa ho tšoana pakeng tsa boits'oaro bo amanang le lintho tse amanang le tlhekefetso bo tsoa libakeng tsa IA, SA. le CB, e shebaneng le pampiri ea joale. Kaha mathata ana ke a amanang le bongaka, 'me hangata a amana le litlamorao tse mpe ho batho ba amehang (mohlala, Pontes, Kuss, & Griffiths, 2015), likhetho tse sebetsang tsa kalafo li hloka ho hlahlojoa (mohlala, Grant et al., 2010). Ho fihla joale, lipatlisiso tsa meta tse phatlalalitsoeng li entsoe haholo mabapi le IA ho paka katleho ea mekhoa e fapaneng ea kalafo (Chun, Shim, & Kim, 2017; Liu, Liao, & Smith, 2012; Winkler, Doersing, Rief, Shen, & Glombiewski, 2013). Tse peli tsa litlhahlobo tsa "meta" li hlahlobisitse ts'ebetso ea kelello, ea meriana le ea motsoako oa mekhoa e 'meli, empa bopaki bo ne bo lekanyelitsoe lithutong tsa sephetho sa kalafo Chaena (Liu et al., 2012) le Korea (Chun et al., 2017). Tlhahlobo e ntlafalitsoeng ka ho fetisisa ea meta-analytic e tšehelitse bopaki ba ho sebetsa hantle ha kalafo ea psychotherapy le kalafo ea bongaka ho fokotsa matšoao a IA ho kenyeletsa liteko tse tsoang linaheng tsa Asia le bophirima (Winkler et al., 2013). Likamano tse kopaneng, leha ho le joalo, ha lia ka tsa tsotelloa. Ho feta moo, tlhahlobo ea meta Winkler et al. (2013) ha e kenyeletse lipatlisiso tsa morao tjena.

Liphetho tse ntle tsa ho kena lipakeng maikutlong le kelellong ho fokotsa boima ba lefatše ba CB le tsona li fumanoe tlhahlobisong e 'ngoe ea morao-rao ea meta (Hague, Holo, & Kellett, 2016). Leha ho le joalo, litlamorao tsa boleng ba boithuto le bo-moderata ba bang liphellong tsa kalafo ha lia ka tsa hlahlojoa. Ka lebaka leo, patlisiso e felletseng ea likhetho tsa kalafo bakeng sa IA le CB e ntse e emetse. Le ha SA e nkuoa ho ICD-11 ka poleloana "khatello ea boitšoaro bo hlephileng ba thobalano" (Mokhatlo oa Lefatše oa Bophelo, 2018), le "maikutlo a ho itlaleha a ho lemalla litšoantšo tse litšila tse tsosang takatso ha a tloaelehe" (Grubbs, Kraus, & Perry, 2019, leq. 93), kalafo bakeng sa SA ha e so hlahlojoe ka mekhoa ea meta-analytic. Ho kenyelletsa moo, ha ho e-so bapisoe pakeng tsa IA, kapa IGD-mokhethoa oa karolo "Mathata a amanang le lithethefatsi le ho lemalla”Ea DSM-le mekhoa e meng e ka lemalloang, e kang SA le CB, e thehiloeng karabong ea kalafo, e nkoang e le sesupo sa bohlokoa lipapaling lipakeng tsa li-SUD le BAs (mohlala, Grant et al., 2010).

Morero oa mantlha oa tlhahlobo ea hona joale ea meta, ka hona, e ne e le ho etsa lipatlisiso tsa ts'ebetso ea kelello, ea bongaka le ea bongaka e kopantsoeng ea IA, SA, le CB bakeng sa ho fokotsa (a) botebo ba lefatše lohle le (b) khafetsa ea ho qobella boits'oaro kamora ho tlohela kalafo (litlamorao tsa nako e khuts'oane) le nakong ea ho latela ea ho latela (litlamorao tsa nako e telele). Ho ipapisitsoe le liphumotso litlhahlobo tsa morao-rao (Hague et al., 2016; Winkler et al., 2013), re ne re lebelletse hore mekhoa ea phekolo ea kelello le ea bongaka e ka sebetsa ka mokhoa o ts'oanang ho mekhahlelo e meraro ea ho lemalla. Re boetse re lebelletse hore sephetho sa kalafo se ts'oana le se tlalehiloeng ts'ebeliso ea lithethefatsi le papali ea chelete (Grant et al., 2010; Potenza et al., 2011). Ntle le moo, sepheo sa rona e ne e le ho khetholla bao e ka bang baokameli ba boholo ba litlamorao kahare ho sehlopha ka seng sa bokhoba. Tlhahlobo ea meta e entsoe ho latela likhothaletso tsa Polelo ea PRISMA (Moher, Liberati, Tetzlaff, & Altman, 2009).

mekhoa

Mekhoa e amohelehang

Boithuto bo ile ba nkuoa hore bo kenyeletsoe haeba (1) ba sebelisitse mofuta o mong le o mong oa ts'ebeliso ea kelello, pharmacological, kapa ho kenella ho kopaneng (mohlala, ts'ebetso ea kelello le ts'ebetso ea meriana e sebelisitsoeng ka nako e le 'ngoe); (2) e sebelisoang kahare ho sehlopha, meralo e sa laoloang, kapa e sa hlophisoang e sa reroang, ho kenyelletsa taolo ea lenane la ho emela, barupeluoa ba sa fumanang kalafo, mefuta e meng ea kalafo e sebetsang, kapa ho kenella ka mokhoa oa placebo; (3) ba nkile karolo ba nang le tšoaetso ea IA, SA kapa CB; (4) lekanya bonyane ba tse ling tsa sephetho sa sephetho (ke hore, botebo ba lefatše kapa khafetsa); hape (5) e tlaleha lintlha tse lekaneng tsa lipalo bakeng sa lipalo tsa boholo ba phello. Lithuto ha lia ka tsa kenyelletsoa haeba (1) thuto e le thuto e le 'ngoe ea linyeoe; (2) mohlala o ithutile o felletse ka botlalo ka sampole ea thuto e 'ngoe e kenyellelitsoeng tlhahlobisong ea meta; (3) kalafo e ne e sa hlalosoe, kapa (4) ha ho na sengoloa kapa thuto e felletseng ea thuto e neng e fumaneha. Mabapi le SA, re kenyelletsa feela lithuto tse etsang lipatlisiso tsa boitsoaro bo bobe ba botona le botšehali ho latela litlhaloso tse reriloeng ke Khafetsa (2010), le lithuto tse qheletsoeng ka thoko tse buang ka liphekolo tsa paraphilias tse fapaneng le tsa SA ka mekhoa ea "khethollo ea sechaba kapa e 'khelohileng' ea khetho ea thobalano" (Kafka, 2010, leq. 392).

Mehloli ea tlhahisoleseling le patlo ea lingoliloeng

Re ile ra etsa patlisiso ea lingoliloeng tsa multilevel re sebelisa li-database tsa PsycInfo, Medline, PubMed, Psyndex, le ISI Web of Tsebo. Patlo e koahetse lingoliloeng tsohle tse loketseng ho tloha selemong sa pele se fumanehang ho fihlela ka la 30 Phuptjane 2019 ho sebelisoa mantsoe a latelang a amanang le pherekano: Ho lemalla Inthaneteng, ho lemalla Inthaneteng disorder taolo ea lipapali tsa komporo ∗, motho ea lemaletseng fono ∗, moemeli oa mohala oa selefouno ∗, setho sa marang-rang sa litumeliso ∗, facebook addict ∗, bothata ∗ mehala ea selefouno; thobalano ∗ addict ∗, thobalano ∗ qobelloa ∗, thobalano ∗ ho qobelleha ∗, hypersex ∗, thobalano e sa ikhethileng ∗, lefu le amanang le paraphilia ∗; ho reka ka mokhoa o qobelloang, ho reka ho sa qobelloang, om oniomania, shopaholic ∗, ho bala ka mokhoa o fetelletseng hammoho le kalafo ea mantsoe a bohlokoa a amanang le kalafo, ho kenella, kalafo, psychotherapy. Mantsoe a tšoanang a ho batla a sebelisitsoe ho sheba lingoloa tsa Dijiti tsa ProQuest bakeng sa lingoliloeng tse sa ngolisoang, tse putsoa. Kamora nako, re ile ra etsa tlhahlobo e felletseng ea lenane la litšupiso tsa lingoloa tsa tlhahlobo, lits'oants'o tsa meta, le lithuto tsa mantlha tse khutlisitsoeng lethathamong. Ntle le moo, bangoli ba lingoliloeng tse amehang ba ile ba ikopanya ho kopa lintlha tse lahlehileng le / kapa lipampiri tse sa ngolisoang tse loketseng ho kenyelletsoa tlhahlobisong ea meta. Lingoliloeng tsa China li ile tsa fetoleloa ke libui tse peli tsa matsoalloa a semmuso tse nang le semelo sa thuto.

Liphello tsa liphello

Kamora mehato ea sephetho e tlalehiloeng khafetsa lithutong tsa pele, re hlalositse liphetho tse peli tsa sephetho ho tseba phokotso ea matšoao a hore: (1) botebo ba lefatše, bo arotsoeng ke ts'ebeliso ea lisebelisoa tse loketseng tsa tlhahlobo, le (2) khafetsa (mohlala, palo ea lihora tse sebelisitsoeng marang-rang, ho shebella litšoantšo tsa bootsoa, kapa palo ea likarolo tsa ho reka bekeng kapa khoeling e fetileng, e hlalositsoeng ka likarete tsa ho ngolla kapa ho itlaleha.

Khetho ea thuto

Khetho ea boithuto e entsoe ke bahlahlobisisi ba babeli ba ikemetseng (bangoli ba pele le ba bobeli, MG le ML), mme ba tsamaisoa ke mongoli oa ho qetela oa pampiri ena (AL). Ho se lumellane pakeng tsa bangoli ho rarollotsoe ka lipuisano.

Ts'ebetso ea ho bokella ya data le ho ntšoa ha data

Re hlahisitse foromo e hlophisitsoeng ea ho kenyelletsa lintlha eo re e ntlafalitseng le ho e fetola kamora ho hlahloba liteko tsa lithuto tse 10. Ho bala lipalo le ho latela esale pele boholo ba phello ea sehlopha, ho ile ha nkuoa lintlha tsa lipalo bakeng sa boemo ka bong ba kalafo le sephetho ka thoko. Haeba kalafo e fapaneng ea kelello kapa ea bongaka e ne e hlahlobiloe ka har'a phuputso e le 'ngoe, datha tsa boemo bo bong le bo bong li ne li tlalehiloe ka thoko' me li kenyelelitsoe ka boholo ba sehlopha sa litlhahlobo tsa lipalo. Ho bala boholo ba phello e laoloang pele ho poso, datha ho tsoa lenaneng la ho leta, ha ho na kalafo, le lihlopha tsa taolo ea placebo li kentsoe. Ntle le moo, re fumane lintlha tsa lipalo le tsa sehlopha ho tsoa thutong e 'ngoe le e' ngoe e le ho etsa tlhahlobo ea motsamaisi. Tlhatlhobo ea data e entsoe ke mongoli oa pele (MG), mme e netefalitsoe ke mongoli oa bobeli (ML). Litekanyetso tsa li-coder tse peli tse ikemetseng li tsepamisitse maikutlo ho mefuta ea kalafo, tekanyo ea liphetho tse fapaneng, le ho ts'epahala le ho nepahala ha tlhahlobo e ikhethileng ea lefu lena. Leha ho le joalo, lithutong, ho sebelisitsoe lisebelisoa tse tšoanang bakeng sa tlhahlobo ea tšoaetso e amanang le ho senyeha le tekanyo ea phello e fapaneng ea "ho teba ha lefatše" nakong ea kalafo. Hobane tekanyetso ea ho ts'epahala le ho nepahala ha lisebelisoa tse sebelisitsoeng bakeng sa tekanyo ea liphetho tsa sephetho le tsona e ne e le karolo ea tekanyetso ea kotsi ea leeme lithutong ka bonngoe (bona ka tlase), ho ts'epahalla ha lipakeng ho hlalositsoeng ke lipalo tsa kappa ho entsoe feela bakeng sa mefuta ea kalafo.

Kotsi ea khethollo ho lithuto tsa motho ka mong

Re ile ra lekola bonnete ba kahare ba thuto e 'ngoe le e' ngoe re sebelisa Sesebelisoa sa Tlhahlobo ea Boleng bakeng sa Lithuto tsa Bohlokoa, se ntlafalitsoeng ke Morero o sebetsang oa Thupelo ea Bophelo ba Sechaba (EPHPP) (Thomas, Ciliska, Dobbins, & Micucci, 2004). Sesebelisoa sena se bontšitse litaba le ho aha bonnete (Thomas et al., 2004) hape e khothalelitsoe tlhahlobo e hlophisehileng le tlhahlobo ea meta (Deeks et al., 2003). Phuputso e 'ngoe le e' ngoe e ne e lekantsoe ka mokhoa o ts'oanang metseng e tšeletseng: khetho ea leeme, moralo oa ho ithuta, tlhahlobo le taolo ea li-confounders, ho foufatsa, ho ts'epahala le ho nepahala ha lisebelisoa tsa pokello ea data, le ho tlaleha le liperesente tsa ho ntshwa le ho tloheloa. Sebaka ka seng se ne se hlahlojoa e le se matla, se leka-lekaneng, kapa se fokolang. Tekanyetso ea lefatše ka bophara e baliloe kamora tlhahlobo ea libaka tse tšeletseng. Bangoli ba pele ba babeli (MG le ML) ba ile ba lekola thuto ka 'ngoe ka boikemelo mme ba tseba hore na teko e' ngoe le e 'ngoe ea lefatše ke efe. Ho ts'epahala ho kenelletseng ho ile ha qobelloa ho sebelisoa lipalo tsa kappa. Ho se lumellane pakeng tsa bangoli ho rarollotsoe ka puisano ho fihlela tumellano e fihletsoe.

Palo ea boholo ba phello le synthetative ea data

Ts'ebetso ea lipalopalo e entsoe ho sebelisoa lenaneo la software Comprehensive Meta-Analysis (CMA) version 2.2.064 (Borenstein, Hedges, Higgins, & Rothstein, 2005). Kahare ho sehlopha ka seng sa lithethefatsi, re balile boholo ba litlamorao bakeng sa liphetho tse tlalehiloeng lithutong tsa kelello, litlhare le lithuto tse kopaneng ka thoko bakeng sa meralo ea sehlopha le e laoloang ea ho ithuta (bona Sehlomathiso bakeng sa litlhahlobo). Ka lebaka la boholo ba mehlala e nyane, boholo ba litlamorao bo ile ba lokisoa bakeng sa leeme le sebelisang Hedges's g le nako e lumellanang ea 95% ea nako ea kholiseho (CI; Hedges & Olkin, 1984). Haeba mekhoa le mekhelo e ne e sa fumanehe, boholo ba phello bo ne bo baloa ho latela lits'ebetso tsa tekanyetso e tšoanang (mohlala, t litekanyetso, kapa maemo a ikhethang a monyetla). Haeba sephetho sa sephetho se lekantsoe ke sesebelisoa se fetang se le seng, data e tsoang ho lisebelisoa tsena e ne e kenngoa ka thoko 'me e ts'oaroe hammoho bakeng sa phapang e itseng (Lipsey le Wilson, 2000). Bakeng sa liphuputso tse fanang ka tlhaiso-leseling e ipapisitse le litlhahlobo tsa bobeli ba ho phethela le ho ikemisetsa ho phekola (ITT), ho ile ha tsotelloa lintlha tsa ITT. Tataiso ea phello e ile ea fetoloa ho latela "katleho": boholo ba phello bo ne bo le botle haeba sehlopha se tšoaroang se sebetsa hantle ho feta sehlopha sa taolo. Ho latela likhothaletso tsa Cohen (1977), boholo ba boholo ba 0.20 ho isa ho 0.30 bo ka khetholloa bo le bonyenyane, ba haufi le 0.50 e le bohareng, mme ba kaholimo ho 0.80 bo boholo.

Re nka heterogeneity har'a lithuto, re nkile qeto ea ho sebelisa mohlala oa litla-morao bakeng sa kopanyo ea boholo ba litlamorao. Heterogeneity ea boholo ba litlamorao e ile ea fuputsoa ho sebelisoa lipalo-palo tsa Q tse lumellanang p boleng, le I² lipalo, ho bonts'a hore na phapano ea 'nete ea boholo ba phello e bontšitsoe ke bokae ba phapang (Borenstein, Hedges, Higgins, & Rothstein, 2009; Higgins, Thompson, Deeks, & Altman, 2003); I² litekanyetso tsa 25%, 50%, le 75% li ne li thathamisitsoe e le tse tlase, tse itekanetseng le tse phahameng, ka ho latellana (Higgins et al., 2003).

Kotsi ea khethollo ho lithuto

Ho laola leeme la phatlalatso, re ile ra etsa lipatlisiso tse felletseng tsa lingoliloeng mme ra bala tšireletseho ea Rosenthal N (Rosenthal, 1979) hape le ho hlahloba merero ea funnel (Nako le Tweedie, 2000). Ho latela Rosenthal (1991), boholo ba phello bo nkoa bo le matla haeba palo ea lithuto e hlokahalang ho fumana phello e sa lekanang ka kakaretso e kholo ho feta 5k + 10, kae k e emela palo ea lithuto. Ntle le moo, re sebelisitse mokhoa oa ho fokotsa le ho tlatsa (Nako le Tweedie, 2000) ho hakanya lithuto tse sieo le phello ea tsona ho boholo bo felletseng ba phello. Mokhoa ona o ipapisitse le moelelo oa moralo oa tšebetso 'me o nka karolelano ea ho lekana ea boholo ba litlamorao bakeng sa ho feto-fetoha ha sephetho ha ho se na leeme. Tabeng ea kabo ea asymmetrical, mokhoa oa ho fokotsa le ho tlatsa o nchafatsa le ho lokisa boholo ba sephetho (Borenstein et al., 2009); re sebelisitse mokhoa ona feela haeba lithuto tse 10 li le teng bakeng sa tlhahlobo (Sterne, Egger, & Moher, 2011). Asymmetry ea funnel e ile ea hlahlojoa ka ho sebelisa teko ea Egger (Egger, Smith, Schneider, & Minder, 1997). Joalo ka ha litekanyo tse ngata tsa boholo bo hlahisang litlhaloso tse fosahetseng tsa litlamorao tsa kalafo (Lipsey le Wilson, 2000), re sebelisitse mokhoa oa "thuto-e tlositsoeng" e fanoang ke CMA ho lekola litlamorao tsa boholo ba phello ea phuputso ka kotlolloho (Borenstein et al., 2005). Haeba liphetho tse phetoang li sa ka tsa ama boholo ba phello mme tsa lula kahare ho 95% CI, lithuto li ile tsa bolokoa tlhahlobisong.

Ts'ebetso ea motsamaisi

Ho hlalosa heterogeneity har'a boholo ba phello, re ile ra hlahloba mofuta oa tlhahlobo ea data (tlhahlobo ea ITT vs.), le boleng ba lithuto (EPHPP scores global) ka ho ba bahlophisi ba ka khonehang. Hobane khatello ea maikutlo le matšoenyeho li fumanoe li amana le li-BA (mohlala, González-Bueso et al., 2018; Starcevic & Khazaal, 2017), re ile ra hlahloba hore na boholo ba litlamorao bo fapana joang e le ts'ebetso ea mathata ana a etsahalang (ho kenyelletsoa ha ho kenyeletsoa khatello ea maikutlo le / kapa matšoenyeho). Kaha mafu a hlahang a kopane, haholo khatello ea maikutlo le matšoenyeho, a atile haholo bathong ba anngoeng ke li-BA (Starcevic & Khazaal, 2017), lithuto tse ileng tsa sitoa ho tlaleha data ka maemo a comorbid ho nahanoa hore li kenyelletsa barupeluoa ba nang le khatello ea maikutlo le matšoenyeho a kopaneng. Bakeng sa lithuto tsa kelello, re boetse re fuputse mokhoa oa kalafo (tokiso ea sehlopha dhidi ea tlhabollo ea motho e mong le e mong ka mefuta e meng ea litlhophiso [mohlala, tokisetso ea motho ka mong le sehlopha, tokisetso ea lelapa]), mokhoa oa ho fana (sefahleho-le sefahleho [FTFTs] dhidi ea kalafo e itlhommeng pele [SGTs], le mofuta oa ho kenella kelellong. Mofuta oa ts'ebetso ea kelello o ile oa hlahlojoa ka ho arola maano a kelello likarolong tse latelang: (1) CBT, e koahelang litlhare tsa kalafo le / kapa tsa boits'oaro; . Ho nka hore lithuto tse 'maloa li entsoe linaheng tseo eseng tsa bophirimela, haholo bakeng sa IA, re ile ra latela tlhahlobo ea pejana ea meta (Winkler et al., 2013) mme a lekola hore na semelo sa setso (Asia le linaha tse ling) se ipakile e le mookameli. Kaha IA ea lefats'e le IGD ea lefats'e e emela li-construquer tse fapaneng (mohlala, Griffiths le Liponte, 2014), hape re hlahlobe liphapang lipakeng tsa lithuto tse ipapisitseng le IA ea lefats'e le tse ling, tse entseng lipatlisiso ka IGD le mesebetsi e meng e lumelletsoeng inthanete (mohlala, ho lemalla li-smartphone, ho lemalla videogame).

Bakeng sa kalafo ea pharmacological, re ile ra hlahloba hore na li-antidepressants li sebetsa kaholimo ho mefuta e meng ea meriana kapa meriana e tsoakaneng (mohlala, li-antidepressants tse kopantsoeng le methylphenidate). Bakeng sa lithuto tse kopaneng, re ithutile ka bobeli tsusumetso ea mefuta ea ts'ebetso ea kelello le ea meriana. Ho kenyelletsa moo, re fuputse hore na e 'ngoe ea mefuta ea kalafo (mahlale a kelello le litlatsetso tse kopaneng tsa meriana) e ne e le monyetla ho feta tse ling. Kamora nako, re bapisa boholo ba litlamorao tsa ho kenella maikutlong le kelellong ka mefuta e fapaneng ea bokhoba. Ho boloka tlaleho ea hore "marang-rang ke mocha feela oo batho ka bomong ba ka fumanang eng kapa eng eo ba e batlang (mohlala, ho becha, ho ea mabenkeleng, ho qoqa, ho etsa thobalano)" (Griffiths le Liponte, 2014, leq. 2), re qalile lithuto tse kenyeletsang batho ba nang le boits'oaro bo feteletseng ba ho reka kapa ho reka ka tlasa mekhahlelo ea "tlhekefetso ea thobalano" le "ho reka ka mokhoa o phehellang", ho sa tsotelehe hore na inthanete e ne e sebelisoa kapa che.

Tlhahlobo ea mookameli oa likarolo tsa mekhahlelo e entsoe ho sebelisoa mohlala o kopaneng oa litekanyetso ka litekanyetso tsa pooled T² le tlhahlobo ea Q e thehiloeng tlhahlobisong ea phapang le e tsamaisanang p boleng ba ho toloka liphapang lipakeng tsa subgroups (Borenstein et al., 2009). Maemong a bonyane lithuto tse 10 tse fumanehang (Deeks, Higgins, & Altman, 2011), re boetse re etsa tlhahlobo ea meta-regression re sebelisa selemo sa phatlalatso le nako ea kalafo (e lekantsoe le palo e felletseng ea lihora tse sebelisitsoeng kalafong litekong tsa kelello, kapa ka palo ea libeke litekong tsa meriana. Haeba palo e sa lekaneng ea lithuto tsa kelello e bonts'a palo ea lihora tse sebelisitsoeng kalafong, palo ea libeke e ne e sebelisoa ho lekanya nako ea kalafo. Litlhahlobo tsa "Meta-regression" li lekola lilemo tse bolelang tsa basali le basali, 'me liperesente tsa banna le basali ha lia ka tsa etsoa hobane lilemo le thobalano lithutong tsohle li fapana le tseo lithuto li sitisang ho toloka.Thompson & Higgins, 2002).

Results

Khetho ea thuto

Sekirine sa phallo ea mokhoa oa khetho ea lithuto se bonts'oa ho Feie. 1. Ho ne ho se na likhohlano lipakeng tsa lipotso mabapi le mefuta ea phekolo.

Litšobotsi tsa lithuto, kalafo le barupeluoa

Hoo e ka bang mefuta eohle ea bokhoba ba ho lemalla, sampole ea hona joale ea lithuto e fetohileng ka tsela e fapaneng ea maemo a taolo: Half ba bona ba sebelisitse sehlopha sa taolo (50%) le lithuto tse 'maloa tse sebelisitsoeng ho emela, ha ho na kalafo, taolo e ntle, kapa lihlopha tsa taolo ea placebo (30%), kapa lipapiso tse ling tse sebetsang tsa kalafo (20%). Liphetho li ne li thehiloe haholo ho lingoloa (80%). Lintlha tsa ho latela li fanoe ke lithuto tsa kelello tsa 32 (IA: k = Lithuto tse 16 tse nang le linako tse pakeng tsa likhoeli tse 1 ho isa ho tse tšeletseng; M = 3.53, SD = 2.13; SA: k = Lithuto tse 11 tse nang le linako tse pakeng tsa likhoeli tse 1.5 ho isa ho tse 6; M = 4.27, SD = 1.88; CB: k = Lithuto tse 5 tse nang le linako tse pakeng tsa likhoeli tse 3 ho isa ho tse tšeletseng; M = 5.4, SD = 1.34), ka tlhahlobo e le 'ngoe ea thuto ea meriana ho sehlopha sa CB se ileng sa latela ka mor'a likhoeli tse 12, le ka lithuto tse peli sehlopheng sa IA se sebelisitseng mehato e kopaneng, e' ngoe le e 'ngoe e bokella data ka mor'a khoeli e le' ngoe.

Boholo ba lithuto tsa kelello li ile tsa hlahloba CBT (58%), ea fana ka kalafo ka litlhophiso tsa sehlopha (71%), le sebopeho sa sefahleho (92%). Palo e felletseng ea lihora tse sebelisitsoeng ho kenella lipakeng tsa kelello ho tloha ho 15 min ho isa ho 54 h (M = 12.55 h, SD = 10.49), ho tloha bekeng e le 'ngoe ho isa ho libeke tse 26 (M = 10.44, SD = 6.12), le ho tloha libeke tse 8 ho isa ho libeke tse 20 (M = 11.71, SD = 3.90) bakeng sa kalafo ea IA, SA, le CB, ka ho latellana. Boholo ba lithuto tsa meriana bo ile ba hlahloba li-antidepressants (85%); boholo ba liteko tse kopaneng li sebelisitse CBT hammoho le li-antidepressants (71%). Nako ea kalafo ea pharmacological e qalile libekeng tse 6 ho isa ho tse 52 (M = 15.67, SD = 17.95), ho tloha libeke tse 12 ho isa ho tse 72 (M = 24.83, SD = 23.58), le ho tloha ho libeke tse 7 ho isa ho tse 12 (M = 9.50, SD = 2.20) bakeng sa kalafo ea IA, SA, le CB, ka ho latellana.

Hoo e ka bang likarolo tsohle tsa bokhoba ba ho lemalla, kakaretso ea barupeluoa ba 3,531 e ile ea hlahlojoa n = 2,427; SA: n = 771; CB: n = 333). Boholo ba lithuto li kenyellelitse barupeluoa ba nang le khatello ea maikutlo le ho tšoenyeha (77%) tse hlahang. Liteko tse lebisitsoeng ho IA li ne li etsoa haholo linaheng tsa Asia (75%). Mohlala oohle e ne e le banna haholo lithutong tse hlahlobang IA (76%) ea lilemo li 21, le SA (98%) ea nang le lilemo tse 37, empa basali lithutong tse hlahlobang CB (92.45%) o na le lilemo tse 42 Lintlha tse qaqileng mabapi le litšobotsi tsa lithuto li hlahisoa ho Matlapa a 1-3.

Tafole 1.Litšobotsi tsa lithuto tsa bokhoba ba marang-rang

Study / Selemo	N^a	Sehlopha sa kalafo (N) / Mode oa phekolo / Mokhoa oa ho fana^b	Sehlopha sa taolo (N) / Mode oa phekolo / Mokhoa oa ho fana^b	Moetlo / D / A (+/−) / Mofuta oa IA	Duration t / c^c	FU (likhoeli)	Liphetho (tekolo)	Tlhahlobo ea lintlha	EPHPP
Phekolo ea kelello
Anuradha le Singh (2018)	28	CBT (28) / I / FTFT	None	Asia / - / IA	NA	None	EA-GS (IADQ)	CO	3
Bai le Fan (2007)	48	IT (CBT; boits'oaro; boiphihlelo ba sechaba) (24) / G / FTFT	NT (24)	Asia / + / IA	16	1.5	EA-C (CIAS-R)	CO	3
Cao et al. (2007)	57	CBT (26) / G / FTFT	NT (31)	Asia / + / IA	10	None	EA (YDQ, CIAS)	CO	2
Sephetho (2016)	30	EDU (15) / G / FTFT	NT (15)	Turkey / + / IA	10	6	EA-PI (PIUS) FR (% ea papali ea inthanete e bapalang tšebeliso ea marang-rang / w)^d	NA	3
Deng et al. (2017)	63	CBI (44) / G / FTFT	WL (19)	Asia / + / IGD	18	6	EA-GS (CIAS)	CO	2
Ho latela al. (2010)	56	IT (CBT; koetliso ea batsoali; EDU bakeng sa matichere) (32) / G / FTFT	NT (24)	Asia / + / IA	14	6	EA-GS (IOSRS)	CO	2
González-Bueso et al. (2018)	30	1) CBT (15) / I / FTFT 2) IT (CBT + EDU ea batsoali) (15) / I / FTFT	HC (lintlha tse 30)^e	Spain / - / IGD	1) 9 2) 9	None	EA-DQVMIA	CO	3
Guo et al. (2008)	28	1) CBT (14) / G / FTFT	2) SUPP (mohlala, ho arolelana leseli ka IA; ho phahamisa boitšepo le lisebelisoa) (14) / G / FTFT^f	Asia / + / IA	1) 8 2) NA	None	EA-GS (CIAS)	CO	2
Han et al. (2012)	14	FT (14) / F / FTFT	None	Asia / - / IGD	NA	None	EA-GS (YIAS) FR (h / w)	CO	3
Han et al. (2018)	26	CBT (26) / G / FTFT	None	Asia / - / IGD	24	None	EA-GS (CIAS) 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	None	MONG (IAD)	CO	2
Ke le Wong (2018)	157	CBT (157) G / FTFT	None	Asia / + / IA	12	1	EA-PI (PIUQ)	CO	3
Khazaei et al. (2017)	48	PI (24) / G / FTFT	WL (24)	Iran / + / IA	NA	None	EA-GS (IAT) FR (h / w)	NA	3
Mofumahali Kim (2008)	25	RT (13) / G / FTFT	NT (12)	Asia / + / IA	12.5	None	EA-K-IAS	NA	3
King et al. (2017)^g		CBT (84 h abstinence) (9) / I / NA	None	Australia / + / IGD	NA	1	GS (lenane la tlhahlobo la IGD) 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 (ho ngolloa lapeng ka mehla) (46) / FTFT / I	None	Asia / + / SMA	NA	None	EA-KSAPS	CO
Li le Dai (2009)	76	CBT (38) / I / FTFT	WL (38)	Asia / + / IA	14	None	EA-GS (CIAS)	CO	3
Li, Garland le al. (2017)	30	1) TSOHLE (15) / G / FTFT	2) SUPP (15) / G / FTFT^f	USA / - / IGD	1) 16 2) 16	3	GS (mekhoa ea DSM-5)	MONA	2
Li, Jin le al. (2017)	73	1) CBT (36) / G / FTFT	2) CBT + EA (37) / I + G / FTFT^f	Asia / + / IGD	1) 5 2) 10	None	EA-GS (IAT)	CO	3
Liu et al. (2013)	31	1) CBT (16) / G / FTFT	2) SM (mohlala, litlaleho tse ngotsoeng tsa khafetsa tsa papali ea chelete; boikemisetso ba boitšoaro bo lebisitsoeng) (15) / G / SGT^f	Asia / - / IA	1) 54 2) 24	None	EA-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	None	Norway / + / VGA	NA	None	GS (GASA; PVP)	CO	3
Park, Kim le al. (2016)	24	1) CBT (12) / G / FTFT	2) VRT (12) / G / SGT^f	Asia / - / IGD	1) 16 2) 4	None	EA-GS (YIAS)	CO	3
Pornnoppadol le al. (2018)	54	1) IT (CBT + litsebo + lipapali +) (24) / G / FTFT	2) EDU (30) / G / FTFT^f	Asia / - / IGD	NA 2) 1	6	MONG (GAST)	CO	2
Sakuma et al. (2017)^g	10	IT (SDiC e kenyelletsa CBT; ho pheha ka ntle; ho tsamaea ka maoto; ho tsamaea ka maoto; ho betla patsi) (10) G / FTFT	None	Asia / - / IGD	NA	3	FR (libapali h / d; h / w; d / w)	CO	3
Shek et al. (2009)	22	IT (Keletso ea motho ka mong le lelapa; tšehetso ea lithaka) (22) / I / FTFT	None	Asia / + / IA	NA	None	EA-C (CIA-Y; CIA-G)	CO	3
Sei et al. (2018)	46	MI (PFB) (46) / I / SGT	None	Asia / + / IA	NA	None	EA-GS (IAT)	CO	3
Su et al. (2011)	59	CBT (lenaneo la kalafo la inthaneteng) 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	None	EA-GS (YDQ) FR (h / w)	CO	2
van Rooij et al. (2012)	7	CBT (7) / I / FTFT	None	Netherlands / + / IA	7.5	None	EA-CI (CIUS) FR (d / w; h / d)	CO	3
Wartberg le ba bang. (2014)	18	CBT (18) / G / FTFT	None	Jeremane / + / IA	12	None	EA-CI (CIUS) FR (h / matsatsi a beke; h / mafelo a beke)	CO	3
Woelfling et al. (2014)	42	CBT (42) / G + I / FTFT	None	Jeremane / - / IA	32	None	EA-GS (AICA-S) FR (h / letsatsi la beke)	MONA	3
Yang le Hao (2005)	52	IT (SFBT; FT; CT) (52) / I / FTFT	None	Asia / + / IA	NA	None	EA-GS (YDQ)	CO	3
Yang et al. (2017)	14	1) CBT (14) / G + I / FTFT 2) EA (16)^h	HC (lintlha tse 16)^e	Asia / - / IA	20	None	EA-GS (IAT)	CO	2
Yao et al. (2017)	37	IT (RT; MFM) (18) G / FTFT	NT (19)	Asia / + / IGD	12	None	EA-GS (CIAS)	CO	3
Bonyane (2007)	114	CBT (114) / I / FTFT	None	USA / + / IA	NA	6	EA-XNUMX-GS FR (OA)	CO	3
Bonyane (2013)	128	CBT e fetotsoe (128) / I / FTFT	None	USA / + / IA	NA	6	EA-GS (IADQ)	CO	3
Zhang (2009)	70	IT (CBT; lipapali) (35) / G / FTFT	NT (35)	Asia / + / IA	24	None	EA-GS (IAT)	CO	3
Zhang et al. (2009)	11	CBT (11) / G / FTFT	None	Asia / + / IA	NA	None	EA-GS (IAT)	CO	2
Zhang et al. (2016)	36	IT (CBI + MFTR) (20) / G / FTFT	NT (16)	Asia / + / IGD	17	None	EA-GS (CIAS) FR (h / w)	CO	2
Zhong et al. (2011)	57	1) FT (28) / G / FTFT	2) IT (Koetliso ea sesole; lipapali; pheko e lebisang boits'ebetso bo lemaletseng) (29) / G / FTFT^f	Asia / - / IA	24.5 2) NA	3	EA-GS (OCS)	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	None	EA-GS (ISS)	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	None	EA-GS (IAT)	CO	2
Litlhare tsa kalafo
Bipeta et al. (2015)	11	Li-antidepressants tse fapaneng (kamora hore Clonazepam a huleloa libekeng tse 3) (11) (bankakarolo ba IA le OCD)	2) Li-antidepressants tse fapaneng (kamora hore Clonazepam a huleloe libeke tse 3) (27) (bankakarolo ba nang le OCD feela)^e	India / - / IA	52	None	GS (YBOCS; IAT)	NA	3
Dell'Osso et al. (2008)	17	Escitalopram (lintlha tse 17)	None	USA / + / IA	10	None	EA (IC-IUD-YBOCS) FR (h / w)	CO	3
Han et al. (2009)	21	Methylphenidate (lintlha tse 21) (Konsarete)	None	Asia / - / IGD	8	None	EA-GS (YIAS-K) FR (h / d)	CO	3
Han et al. (2010)	11	Bupropion SR (lintlha tse 11)	None	Asia / - / IGD	6	None	EA-GS (YIAS) FR (h / d)	CO	3
Park, Lee et al. (2016)	86	1) Methylphenidate (tse 44)	2) Atomoxetine (lintlha tse 42)^f 10-60 mg / d	Asia / - / IGD	12	None	EA-GS (YIAS)	CO	3
Pina et al. (2016)	119	1) Bupropion SR (44) 2) Escitalopram (lintlha tse 42)	NT (33)	Asia / - / IGD	6	None	EA-GS (YIAS)	CO	2
Phekolo e kopaneng
Han le Renshaw (2012)	25	1) likarolo tsa 8 tsa Bupropion + tse 25 EdU (XNUMX)	2) Lisebelisoa tsa "placebo + tse 8 tsa EDU (25)^e	Asia / + / IGD	8	1	EA-GS (YIAS) FR (h / w)	CO	2
Kim et al. (2012)	32	1) likarolo tsa 8 tsa Bupropion + tse 32 (XNUMX)	2) Bupropion + 10 mets. lipuisano tsa beke le beke (33)^e	Asia / + / IGD	8	1	EA-GS (YIAS) FR (h / w)	CO	2
Li et al. (2008)	48	Li-antidepressants tse fapaneng + CBT + FT (48)	None	Asia / + / IA	4	None	Gs (IRQ)	CO	3
Nam et al. (2017)	30	1) Bupropion + EDU (15)	2) Escitalopram + EDU (15)^f	Asia / + / IGD	12	None	EA-GS (YIAS)	CO	2
Santos le al. (2016)	39	Motsoako o tsoakaneng + Liseshara tse 10 tse fetotsoeng CBT (39)	None	Brazil / + / IA	10	None	EA-GS (IAT)	CO	3
Yang et al. (2005)	18	Koetliso ea botsoali ea CBT + Fluoxetine (18)	None	Asia / + / IA	10.5	None	EA-CI (CIUS)	CO	3

Hlokomela.

^aPalo ea lithuto tse kenyelelitsoeng tlhahlobisong.

^b"Mokhoa oa phekolo" le "mokhoa oa ho pepa" li sebelisitsoe bakeng sa kalafo ea kelello feela.

^cBakeng sa lithuto tsa kelello, nako ea kalafo e lekantsoe ho sebelisoa palo e felletseng ea lihora tse sebelisitsoeng kalafo bakeng sa kalafo (t) le lihlopha tsa taolo (c). Bakeng sa lithuto tsa pharmacological le tse kopaneng, nako ea kalafo e lekantsoe ho sebelisoa palo ea libeke.

^dLintlha tsa "frequency" tse fapaneng tse hlahisitsoeng li ne li fumaneha feela bakeng sa sehlopha sa kalafo.

^eBoemo ba taolo bo ile ba behelloa ka thoko ho tlhahlobisiso ka lebaka la ho se lumellane le mekhoa ea khetho.

^fBoemo ba taolo bo ne bo nkuoa e le letsoho le arohaneng la kalafo.

^gPhuputso e tlaleha datha ho tloha ho boitlamo ho latela feela.

^hBoemo ba kalafo bo ile ba behelloa ka thoko ho tlhahlobo ka lebaka la ho se lumellane le mekhoa ea khetho.

Tafole 2.Litšobotsi tsa lithuto tsa bokhoba ba thobalano

Study / Selemo	Kakaretso N^a	Sehlopha sa kalafo (N) / Mode oa phekolo / Mokhoa oa ho fana^b	Sehlopha sa taolo (N) Mokhoa oa phekolo / Mokhoa oa ho tlisa^b	Duration t / c^c/ D / A (+/−)	FU (likhoeli)	Liphetho (tekolo)	Tlhahlobo ea lintlha	EPHPP
Phekolo ea kelello
Pula Tsa Lehlohonolo (2012)	27	Molao (14) / I / FTFT	WL (13)	12 / +	5^d	EA-GS (SCS) FR (lihora tsa ho shebella litšoantšo tsa bootsoa / w; mofuta o fetotsoeng oa DDQ)	CO	2
Hallberg le ba bang. (2017)	10	CBT (10) / G / FTFT	None	8 / -	6	GS (HD: CAS; HDSI)	MONA	3
Hallberg le ba bang. (2019)	137	CBT (70) / G / FTFT	WL (67)	8 / -	6	GS (HD: CAS; SCS)	MONA	2
Hardy le ba bang. (2010)	138	CBT (Lenaneo la inthanete la Candeo) (138) / I / SGT	None	26 / +	None	EA-GS (PDR) FR (sebelisa litšoantšo tsa bootsoa / m; ho ipholla litho tsa botona kapa botšehali / m)	CO	3
Hart et al. (2016)	49	MI (49) / G / FTFT	None	7 / +	3	EA-GS (SCS)	CO	3
Hartman le ba bang. (2012)^e	57	IT (lenaneo la SA le SA-SUD) / I + G / FTFT (57)	None	13 / +	6	EA-CS (CSBI)	CO	3
Klontz et al. (2005)	38	1) IT (EXPT; CBT; EDU; M-Medit.), Banna (28) / G / FTFT 2) IT (EXPT; CBT; EDU; M-Medit.), Basali (10) / G / FTFT	None	1) 1 / + 2) 1 / +	6	EA-GS (GSBI; CGI)	CO	3
Levin et al. (2017)	11	Molao (SHWB) (11) / I / SGT	None	8 / +	1.5	EA-GS (CPUI) FR (shebella litšoantšo tsa bootsoa h / w)	CO	3
Minarcik (2016)	12	CBT (12) / I / FTFT	None	12 / +	None	GS (LITLAPA; HBI; SCS) FR (shebella litšoantšo tse litšila tse tsosang takatso metsotso./w)	CO	3
Orzack le al. (2006)	35	IT (RtC; CBT; MI) (35) / G / FTFT	None	16 / +	None	FR (ho shebella litšoantšo tsa bootsoa / w; OTIS)	CO	3
Pachankis et al. (2015)	63	CBT (ESTEEM-SC e thehiloe ho UP) (32) / I / FTFT	WL (31)	12 / +	3	EA-GS (SCS)	MONA	2
Parsons le ba bang. (2017)	11	CBT (ESTEEM-SC e thehiloe ho UP) (11) / I / FTFT	None	12 / +	None	EA-GS (SCS)	CO	3
Quadland (1985)^e	15	1) GPT / G / FTFT (15)	2) PT ea barupeluoa ba anngoeng ke mathata a mang / I / FTFT (14)^f	20 / +	6	FR (n balekane ba fapaneng ba thobalano / likhoeli tse 3 tse fetileng;% ea balekane ba thobalano ba bone hanngoe;% ea thobalano le molekane a le mong;% ea thobalano maemong a sechaba)	CO	3
Sadiza et al. (2011)	10	CBT (10) / G / FTFT	None	12 / +	None	EA-GS (SCS)	CO	3
Twohig le Crosby (2010)	6	Molao (6) / I / FTFT	None	8 / +	3	FR (shebella litšoantšo tsa bootsoa h / d)	CO	3
Wilson (2010)	54	1) Litlhare tsa kalafo (27) / G / FTFT	2) CBT e fetotsoeng (TCA) (27) / G / FTFT^g	1) 6 / + 2) 6 / +	1.5	EA-HS (HBI-19)	CO	2
Litlhare tsa kalafo
Khafetsa (1991)	10	Li-antidepressants tse fapaneng + Lithium (10)	None	12 / +	None	EA-GS (SOI)	CO	3
Kafka le Prentky (1992)	16	Fluoxetine (lintlha tse 16)	None	12 / +	None	EA-GS (SOI)	CO	3
Khafetsa (1994)	11^h	Sertraline (11)	None	17 / +	None	EA-GS (SOI) FR (ho nahana, ho khothatsa, liketso tsa thobalano.m./d)	CO	3
Kafka le Hennen (2000)	26	Li-antidepressants tse fapaneng + methylphenidate (26)	None	72 / +	None	GS (TSO) FR (ho nahana, ho khothatsa, liketso tsa thobalano metsotso./w)	MONA	3
Wainberg le ba bang. (2006)	28	Citalopram (lintlha tse 13)	Pula (15)	12 / -	None	EA-GS (YBOCS-CSB; CSBI; CGI-CSB) FR (thobalano, ts'ebeliso ea marang-rang, litšoantšo tsa bootsoa li sebelisa h / w)	MONA	2
Phekolo e kopaneng
Gola le Potenza (2016)	3	CBT + Paroxetine (3)	None	10 / +	None	FR (sebelisa litšoantšo tsa bootsoa / w)	CO	3
Scanavino et al. (2013)	4	STPGP + meriana e fapaneng (4)	None	16 / +	None	EA-GS (SCS)	CO	3

Hlokomela. A = matšoenyeho; Molao = Kamohelo le kalafo ea boitlamo; BSI = Bokhutšoanyane ba Matšoao a Botsitso; CBT = phekolo ea kelello-boits'oaro; CGI-CSB = Claleical Global Impression Scale e amohetsoeng bakeng sa boitšoaro bo qobelloang ba thobalano; CLAPS = Thibelo e hlakileng ea Letša la Litšoantšo tsa Litšoantšo tsa Bootsoa; CO = li tsamaellana feela; CPUI = Ts'ebetso ea Litšoantšo tsa Bootsoa tsa Inthanete; CSBI = Qobello e Akarelletsang ea Boitšoaro ba ho Kopanela Liphate; D = khatello ea maikutlo; d = letsatsi; DDQ = Potso ea ka mehla ea ho noha; EDU = psychoedfundo; EPHPP = Morero o sebetsang oa Tloaelo ea Bophelo ba Sechaba (1 = o matla, 2 = tekano, 3 = tekanyetso e fokolang); ESTEEM = Tsebo e sebetsang ea ho Matlafatsa banna ba sebetsang; EXPT = kalafo ea boiphihlelo; FR = khafetsa; FTFT = kalafo ea sefahleho le sefahleho; FU = ho latela; G = tokiso ea sehlopha; GPT = psychotherapy ea sehlopha; GS = botebo ba lefatše; GSBI = Garos sex Beavior Inventory; h = lihora; HBI = Hypersexual Behaeve Inventory; HD: CAS = Khathatso ea Hypersexual: Tekanyetso ea hajoale ea Tekanyetso; HDSI = Hypersexual Disorder Screening Inventory; Ke = tlhabollo ea motho ka mong; IT = kalafo e kopanyang; ITT = morero oa ho-tšoara; m = khoeli; M-Medit. = ho thuisa ka kelello; MI = Puisano e susumetsang; NA = ha e fumanehe; OTIS = Patlisiso ea Matla a Nako ea Orzack; PDR = maemo a kelello a ho hlaphoheloa (menahano e shebileng ea thobalano, karabelo e hahang ea ho hlaphoheloa, tšusumetso e ntle, tšusumetso e mpe, maikutlo a mokhatlo mabapi le ts'ebeliso, tloaelo ea ho hana boikarabello, ho bolela bophelo, kgokelo ho ba bang, maikutlo a ho ts'oareloa, tlhokomeliso ea menahano le maemo a ho hohelang, libaka tse monate tsa boithabiso); PLA = placebo; PT = psychotherapy; RtC = Ho Ikemisetsa ho Fetoha; SA = tlhekefetso ea thobalano; SA-SUD = ho lemalla lithethefatsi tsa thobalano le lithethefatsi; SC = khatello ea thobalano; SCS = Tekanyo ea ho Hoelana ka Thobalano; SGT = kalafo e itaolang; SHWB = buka ea mosebetsi ea ho ithusa; SOI = Boqapi ba Litaba tsa Thobalano; STPGP = nakoana psychodynamic sehlopha psychotherapy; TCA = Tsela ea Ts'ebetso ea Mosebetsi; TSO = Kakaretso ea thobalano; UP = Protocol e Kopaneng ea Phekolo ea Transdiagnostic ea Mathata a Maikutlo; W = lenane la ho leta; w = beke; YBOCS-CSB = Yale-Brown Obsessive Compaleive Scale e fetotsoe bakeng sa boitšoaro bo qobelloang ba thobalano.

^aPalo ea lithuto tse kenyelelitsoeng tlhahlobisong.

^b"Mokhoa oa phekolo" le "mokhoa oa ho pepa" li sebelisitsoe feela bakeng sa kalafo ea kelello.

^cNako ea kalafo e lekantsoe ka ho sebelisa palo ea libeke.

^dTlhahiso-leseling ea ho nka khato ea morao-rao e ne e fumaneha "khafetsa" feela e fapaneng.

^ePhuputso e tlaleha datha ho tloha ho boitlamo ho latela feela.

^fBoemo ba taolo bo ile ba behelloa ka thoko ho tlhahlobisiso ka lebaka la ho se lumellane le mekhoa ea khetho.

^gBoemo ba taolo bo ne bo nkuoa e le letsoho la kalafo.

^hKe feela barupeluoa ba fumanoeng ba e-na le mathata a amanang le paraphilia ba ileng ba kenyelletsoa lipatlisiso.

Tafole 3.Litšobotsi tsa lithuto tsa ho reka ka mokhoa o qobelloang

Study / Selemo	Kakaretso N^a	Sehlopha sa kalafo (N) / Mode oa phekolo / Mokhoa oa ho fana^b	Sehlopha sa taolo (N)	Duration t / c^c/ D / A (+/−)	FU (likhoeli)	Liphetho (tekolo)	Tlhahlobo ea lintlha	EPHPP
Phekolo ea kelello
Armstrong (2012)	10	MBSR (4) / G / FTFT	NT (6)	8 / +	3	EA (CBS; YBOCS-SV; IBS)	CO	2
Benson et al. (2014)	11	E (CBT, PSYDYN, PSYEDU, MI, Molao, likarolo tsa kelello: (6) / G / FTFT	WL (5)	12 / +	6	GS (mod. VCBS; RCBS; CBS;) YBOCS-SV) FR (mets./w e sebelisitsoeng ho reka; ho reka likarolo / w)^d	CO	2
Filomensky & Tavares (2009)	9	CBT (9) / G / FTFT	None	20 / +	None	EA-YBOCS-SV	CO	3
Mitchell et al. (2006)	35	CBT (28) / G / FTFT	WL (7)	10 / +	6^e	EA-YBOCS-SV; CBS FR (ho reka likarolo / w; o qetile ho reka / w)	MONA	2
Mueller le ba bang. (2008)	60	CBT (31) / G / FTFT	WL (29)	12 / +	6^e	Gs (CBS; YBOCS-SV; G-CBS)	MONA	2
Mueller le ba bang. (2013)	56	1) CBT (22) / G / FTFT 2) Lenaneo la GSH-(CBT WB + makhetlo a 5 a mohala) (20) / I / SGT	WL (14)	1) 10 / + 2) 10 / +	6	EA (CBS; YBOCS-SV)	MONA	2
Litlhare tsa kalafo
Fekete et al. (1997)	10	Fluvoxamine (lintlha tse 10 tsa GS)	None	9 / -	None	EA-YBOCS-SV	CO	2
Fekete et al. (2000)	23	Fluvoxamine (lintlha tse 12 tsa GS)	Pula (11)	9 / -	None	EA-YBOCS-SV	MONA	2
Grant le al. (2012)	9	Memantine (9)	None	8 / -	None	EA (YBOCS-SV; mod. CB-SAS)	CO	2
Koran le al. (2002)	24	Citalopram (lintlha tse 24)	None	12 / +	None	EA-YBOCS-SV	MONA	2
Koran le al. (2003)	23	Citalopram (lintlha tse 23)	None	7 / +	None	EA-YBOCS-SV; CBS; IBTS	MONA	2
Koran le al. (2007)	26	Escitalopram (lintlha tse 26)	None	7 / +	None	EA-YBOCS-SV	MONA	3
Ninan le al. (2000)	37	Fluvoxamine (lintlha tse 20 tsa GS)	Pula (17)	12 / +	None	EA-YBOCS-SV	MONA	3

Hlokomela. A = matšoenyeho; Molao = Kamohelo le kalafo ea boitlamo; CBS = Tekanyo ea ho Reka ka Matla CB-SAS = Ho reka ka mokhoa o qobelloang oa ho reka matšoao a ho becha (mofuta o fetotsoeng oa sekhahla sa tlhahlobo ea Matšoao a Papali ea Chelete; , 1 = tekanyetso e fokolang); FTFT = kalafo ea sefahleho sefahleho; FR = khafetsa; FU = ho latela; G = sehlopha se hlophisitsoeng; G-CBS = Canadian Compulsive Buying Methalo Scale, mofuta oa Sejeremane; GS = botebo ba lefatše; GSH = tataiso ea ho ithusa fumaneha = lenane la ho emela; w = beke; YBOCS-SV = Yale-Brown Obsessive Com pulsive Scale-Shopping Version.

^aPalo ea lithuto tse kenyelelitsoeng tlhahlobisong.

^b"Mokhoa oa phekolo" le "mokhoa oa ho pepa" li sebelisitsoe feela bakeng sa kalafo ea kelello.

^cNako ea kalafo e lekantsoe ka ho sebelisa palo ea libeke.

^dLintlha tsa "frequency" tse fapaneng tse hlahisitsoeng li ne li fumaneha feela bakeng sa sehlopha sa kalafo.

^eLithuto tsena li ne li sa kenyelletsoe tlhahlobisong ea FU, hobane ho tlalehiloe data feela ho tloha ho fufuleloa ho FU.

Kotsi ea khethollo ka har'a lithuto

Lipalo tsa EPHPP tsa lefatše ka bophara bakeng sa lithuto tse kenyelelitsoeng mekhatlong e fapaneng ea bokhoba ba litheko li thathamisitsoe ho Matlapa a 1-3. Tlhahlobo ea netefatso e entsoe ke litekanyetso tse peli tse ikemetseng tse fanang ka ts'epo ea lipakeng tsa κ = 0.73 bakeng sa lithuto tsa mekhahlelo ea IA le SA, le κ = 0.75 bakeng sa lithuto sehlopheng sa CB.

Tekanyo ea liphetho le kotsi ea khethollo ho lithuto

Boemo ba pooled ba boholo ba mefuta eohle ea litlolo le kalafo ka thoko bakeng sa sehlopha le mekhabiso e laoloang ea lipatlisiso mabapi le liphetho tsohle ho latela kalafo le ho latella, 95% CI, le liteko tsa bohlokoa li hlalositsoe ho Lethathamo 4. Morero oa moru ka boholo ba phello ea sehlopha ka seng bakeng sa boemo bo bong le bo bong, kalafo, le sephetho sa ho khutla li hlahisoa Feie. 2.

Tafole 4.Sebelisa boholo ba mefuta eohle ea bokhoba ba ho lemalla, sephetho le meralo ea ho ithuta ka mora kalafo le ka ho latela

Phello	Mofuta oa phello	k	g	95% CI	z	p	I²	FS N
Inthaneteng e lemalla
Phekolo ea kelello
Botebo ba lefatše	kahare ho sehlopha (poso)	54	1.51	[1.29, 1.72]	13.79		93.66	18,317
	e laoloe (poso)	15	1.84	[1.37, 2.31]	7.268		83.56	1,254
	kahare-sehlopha (FU)	17	1.48	[1.11, 1.85]	7.92		94.61	4,221
maqhubu	kahare ho sehlopha (poso)	17	1.09	[0.73, 1.49]	6.02		92.54	1,801
	e laoloe (poso)	6	1.12	[0.41, 1.83]	3.08		78.05	69
	kahare-sehlopha (FU)	6	1.06	[0.12, 2.00]	2.21		97.30	259
Litlhare tsa kalafo
Botebo ba lefatše	kahare ho sehlopha (poso)	8	1.13	[0.85, 1.42]	7.78		78.76	564
	e laoloe (poso)	2	1.28	[0.85, 1.71]	5.85		0.00	-^a
	kahare-sehlopha (FU)	NA
maqhubu	kahare ho sehlopha (poso)	3	0.72	[0.49, 0.96]	6.01		0.00	27
	e laoloe (poso)	NA
	kahare-sehlopha (FU)	NA
Phekolo e Kopaneng
Botebo ba lefatše	kahare ho sehlopha (poso)	7	2.51	[1.70, 3.33]	6.03		92.99	756
	e laoloe (poso)	NA
	kahare-sehlopha (FU)	2	2.15	[0.66, 3.65]	2.82		93.55	-^a
maqhubu	kahare ho sehlopha (poso)	2	2.77	[2.29, 3.24]	11.39		14.43	-^a
	e laoloe (poso)	NA
	kahare-sehlopha (FU)	2	2.69	[2.06, 3.32]	8.43		49.72	-^a
Sex Addiction
Phekolo ea kelello
Botebo ba lefatše	kahare ho sehlopha (poso)	14	1.09	[0.74, 1.45]	6.03		92.54	1,311
	e laoloe (poso)	3	0.70	[0.42, 0.99]	4.87		7.02	19
	kahare-sehlopha (FU)	10	1.00	[0.67, 1.32]	6.02		90.02	760
maqhubu	kahare ho sehlopha (poso)	6	0.75	[0.46, 1.03]	5.10		70.96	177
	e laoloe (poso)	1	1.67	[0.82, 2.53]	3.83		0.00	-^a
	kahare-sehlopha (FU)	4	0.83	[0.37, 1.29]	3.57		71.59	45
Litlhare tsa kalafo
Botebo ba lefatše	kahare ho sehlopha (poso)	5	1.21	[0.88, 1.54]	7.12		50.42	134
	e laoloe (poso)	1	0.14	[−0.58, 0.87]	0.38	0.70	0.00	-^a
	kahare-sehlopha (FU)	NA
maqhubu	kahare ho sehlopha (poso)	3	0.87	[0.63, 1.12]	6.92		0.00	33
	e laoloe (poso)	1	0.79	[0.04, 1.55]	2.06		0.00	-^a
	kahare-sehlopha (FU)	NA
Phekolo e kopaneng
Botebo ba lefatše	kahare ho sehlopha (poso)	1	1.91	[0.75, 3.08]	3.22		0.00	-^a
	e laoloe (poso)	NA
	kahare-sehlopha (FU)	NA
maqhubu	kahare ho sehlopha (poso)	1	1.04	[0.22,1.85]	2.49		0.00	-^a
	e laoloe (poso)	NA
	kahare-sehlopha (FU)	NA
Ho reka ka mokhoa o qobelloang
Phekolo ea kelello
Botebo ba lefatše	kahare ho sehlopha (poso)	7	1.00	[0.75, 1.25]	7.88		46.43	210
	e laoloe (poso)	6	0.75	[0.42, 1.08]	4.45		0.00	27
	kahare-sehlopha (FU)	4	1.36	[0.88, 1.84]	5.57		53.65	66
maqhubu	kahare ho sehlopha (poso)	2	0.97	[0.68; 1.26]	6.55		0.00	-^a
	e laoloe (poso)	1	2.48	[1.46, 3.49]	4.76		0.00	-^a
	kahare-sehlopha (FU)	1	1.01	[0.47, 1.55]	3.68		0.00	-^a
Litlhare tsa kalafo
Botebo ba lefatše	kahare ho sehlopha (poso)	7	1.52	[1.18, 1.86]	8.84		63.17	386
	e laoloe (poso)	2	-0.13	[−0.82, 0.57]	-0.35	0.724	0.00	-^a
	kahare-sehlopha (FU)	1	-0.49	[−1.00, 0.03]	-1.86	0.063	0.00	-^a
maqhubu	kahare ho sehlopha (poso)	NA
	e laoloe (poso)	NA
	kahare-sehlopha (FU)	NA

Hlokomela. k = palo ea maemo a kalafo; g = Lirapa tsa g; CI = nako ea tšepo; I² = liperesente tsa phapang e felletseng lithutong tsohle; FS N = E sa sireletseha N (palo ea lithuto tse hlokahalang ho fumana phello e bohloko ea kalafo); NA = ha e fumanehe.

^aE bolokehile N e ne e sa baloe hobane lithuto tse fokolang ho 3 li ne li fumaneha.

Etsa boholo bo sa tloaelehang bakeng sa kalafo ea kelello ea ka mor'a ho phekola le ho latela

Phekolo ea kelello le mefuta eohle ea bokhoba ba litlatsetso e hlahisitse boholo ba nako e khuts'oanyane ho tloha ho bohareng ho isa ho bo boholo merarong ea thuto ka bobeli. Mefuta e meng ea nako e telele ea mefuta eohle ea bokhoba ba taolo e bonts'itse hore litlamorao tsa kalafo lia bolokeha. Joalokaha ho bontšoa ka Lethathamo 4, haholo heterogeneity e phahameng ho feta lithutong e ile ea bonoa bakeng sa phetoho ea sephetho kahare ho mekhahlelo ea IA le SA, mme heterogeneity e leka-lekaneng kapa homogeneity e ile ea bonoa sehlopheng sa CB.

Ka har'a sehlopha sa IA, mokhoa oa ho fokotsa le ho tlatsa lithuto tse 17 o ile oa etsa hore ho be le lithuto tse XNUMX tse etsang hore ho be thata ho lekana le thuto e le 'ngoe bakeng sa phokotso ea khafetsa meralo ea thuto ea sehlopha. Tlhahlobo le liphuputso tsena tse tlatsitsoeng li khothalelitse hore litla-morao tse fokotsoang (boholo ba lefatše: g = 0.87; 95% CI [0.82, 0.92]; Teko ea Egger p <0.001; maqhubu: g = 0.93; 95% CI [0.84, 1.03]; Teko ea Egger p = 0.282) e fana ka maikutlo a tšusumetso e sa reng letho ea leeme la phatlalatso Ha ho sesupo sa khethollo ea phatlalatso se fumanoeng bakeng sa phokotso ea bohale ba lefats'e ho ipapisitse le meralo ea thuto e laoloang (Teko ea Egger p = 0.067). Har'a sehlopha sa SA, mokhoa oa ho tlatsa le ho tlatsa o senotse phuputso e le 'ngoe e bakileng sebopeho sa Funnel bakeng sa phokotso ea boima ba lefats'e bo lebisang ho phello e fokolang ea sephetho bakeng sa phapang ena (g = 0.88; 95% CI [0.79; 0.97], teko ea Egger p = 0.318) .Na neng le neng ha o hloleha o bolokehile N tlhahlobo e entsoe, boholo ba litlamorao ho mefuta eohle ea bokhoba bo nkoe bo le matla bakeng sa phetoho ea sephetho, ntle le boholo ba sephetho se laoloang mabapi le phokotso ea khatello ea lefatše ho mekha ea SA le ea CB, e neng e se matla.

Phetoho ea boholo ba litlhare tsa kalafo ea meriana ka mora ho latela kalafo le ho latela

Boemong ba ho phekola, litekanyo tsa sehlopha sa lihlopha ka bongata li ne li le bohareng ebile li le kholo. Mefuta ea matla a laoloang e ne e thehiloe haholo litekong tse le 'ngoe ho tloha ho tse kholo ho sehlopha sa IA ho isa ho tse nyane le tse seng ntle ho mekha ea SA le ea CB. Ho haella ha tlhaiso-leseling ho tlatselitse ho hlalosoa ha boholo ba sephetho sa nako e telele. H henogenegeneity e phahameng le e leka-lekaneng lithutong tsohle e ile ea bonoa bakeng sa liphetho tse fapaneng lipakeng tsa mekhahlelo ea tlhekefetso. Ho hloleha ho bolokehile N tekolo e entsoeng bakeng sa data e fumanehang e khothalelitse matla a boholo ba litlamorao.

E thusa boholo ba liphekolo tse kopaneng nakong ea kalafo le ho latela

Ho kenelletse lintho tse kopanetsoeng ho sebelisitsoe feela bakeng sa kalafo ea IA le SA ho ipapisitse le meralo ea sehlopha sa boithuto sa sehlopha se fanang ka liphetho tse kholo tsa nako e khuts'oanyane. Lintlha tsa tlhahlobo-leseling li ne li fumaneha feela mokhahlelong oa IA o hlahisang boholo bo boholo bo lekanang. Boholo ba maemo a phahameng lithutong tsohle bo ile ba bonoa bakeng sa phokotso ea bokhopo ba lefatše ho sehlopha sa IA; leha ho le joalo ho hloleha ho bolokehile N e bonts'a ho tiea ha boholo ba phello.

Boitsebiso bo kantle ho ts'ebetso e tlositsoeng boithuto bo le bong ha bo supe phello ea thuto e le 'ngoe ho litlamorao tse akaretsang tsa kalafo ea kelello, ea meriana le ea kalafo e kopaneng.

Mohlophisi oa tlhahlobo

Bohlahlobuoa ba motsamaisi bo ile ba etsoa bakeng sa boholo ba phello ea sehlopha. Liphetho tsa tse fapaneng tsa mekhahlelo ea phallo ea kalafo li hlahisoa Lethathamo 5.

Tafole 5.Morekisi o sekaseka mefuta ea mefuta ka mefuta eohle ea likhothaletso le liphetho

		IA		SA		CB
molekanyetsi	Phello e fapaneng	Qbet	p (Q)	Qbet	p (Q)	Qbet	p (Q)
Phekolo ea kelello
Mofuta oa kalafo ea kelello (CBT vs. IT vs. e ngoe)
	GS	4.24	0.120	4.50	0.105	0.34	0.945
	FR	0.11	0.947	15.67	^a	-	-
Mokhoa oa kalafo (sehlopha vs. motho ka mong le e mong)
	GS	0.47	0.792	0.11	0.741^b	0.44	0.508^b
	FR	0.55	0.761	14.55	^b
Mokhoa oa ho tsamaisa (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 / E kenyellelitsoeng e qheletsoe ka thoko)
	GS	0.02	0.898	0.84	0.360	0.00	1.00
	FR	1.13	0.289	0.00	1.00	-	-
Tlhahlobo ea data (motlatsi 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 = e matla vs. 2 = e leka-lekaneng vs. 3 = ho se sebetse kahare hoa nnete)^d
	GS	1.14	0.285	2.24	0.134	0.02	0.903
	FR	1.94	0.164	0.53	0.466	-	-
Setso (Asia le linaha tsa Bophirimela)
	GS	0.54	0.461	-	-	-	-
	FR	0.58	0.447	-	-	-	-
Mofuta oa IA (IA vs. IGD ea lefatše le tse ling)
	GS	1.63	0.653	-	-	-	-
	FR	4.21	0.122	-	-	-	-
Litlhare tsa kalafo^e
Mofuta oa kalafo ea pharmacological (AD e bapisoa le kapa e meng)
	GS	5.62	^f	0.09	0.765	0.65	0.421^g
Comorbidity (D / E kenyellelitsoeng e qheletsoe ka thoko)
	GS	0.73	0.392	-^h	-^h	0.22	0.642
Tlhahlobo ea data (motlatsi vs. ITT)
	GS	0.00	1.00	0.76	0.383	4.89
EPHPP (1 = e matla vs. 2 = e leka-lekaneng vs. 3 = ho se sebetse kahare hoa nnete)^d
	GS	0.47	0.493	-^h	-^h	2.52	0.112
Setso (Asia le linaha tsa Bophirimela)
	GS	7.32		-	-	-	-
Mofuta oa IA (IA vs. IGD ea lefatše le tse ling)
	GS	7.32	ⁱ	-	-	-	-
Phekolo e kopaneng^e
Mofuta oa kalafo ea pharmacological (AD e bapisoa le kapa e meng)
	GS	0.83	0.362^j	-	-	-	-
Mofuta oa kalafo ea kelello (CBT vs. IT vs. e ngoe)
	GS	20.81	^k	-	-	-	-
Mokhoa oa kalafo ea kelello (sehlopha vs. motho ka mong le e mong)
	GS	0.29	0.592^b	-	-	-	-
Comorbidity (D / E kenyellelitsoeng e qheletsoe ka thoko)
	GS	0.00	1.00	-	-	-	-
Tlhahlobo ea data (motlatsi vs. ITT)
	GS	0.00	1.00	-	-	-	-
EPHPP (1 = e matla vs. 2 = e leka-lekaneng vs. 3 = ho se sebetse kahare hoa nnete)^d
	GS	6.06		-	-	-	-
Setso (Asia le linaha tsa Bophirimela)
	GS	0.83	0.362	-	-	-	-
Mofuta oa IA (IA vs. IGD ea lefatše le tse ling)
	GS	6.06	ⁱ	-	-	-	-

Hlokomela. A = matšoenyeho; AD = antidepressants; CB = ho qobella ho reka; CBT = kalafo ea boits'oaro ea kelello; D = khatello ea maikutlo; EPHPP = Morero o sebetsang oa Thupelo ea Bophelo ba Sechaba (sesebelisoa sa tlhahlobo ea boleng bakeng sa lithuto tsa bongata); GS = botebo ba lefatše; FR = khafetsa; FTFT = kalafo ea sefahleho le sefahleho; IA = ho lemalla marang-rang; IGD = marang-rang a lipapali tsa marang-rang; IT = kalafo e kopanyang; ITT = Morero oa ho phekola tlhahlobo; Qbet = homogeneity Statistics bakeng sa phapang lipakeng tsa subgroups; SA = tlhekefetso ea thobalano; SGT = kalafo e u tataisang.

^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; Litlhare tse ling (ke hore, ho amohela le ho itlama kalafo): g = 0.80; 95% CI [0.51, 1.10]; p ≤ 0.001.

^bTlhahlobo ea moderator e kenyelletsa lihlotšoana tse peli feela (sehlopha vs motho ka mong).

^cKe lithuto feela tse bonts'ang mofuta oa tlhahlobo ea data tse kenyellelitsoeng ho hlahlobisiso (bona Lethathamo 1).

^dTlhahlobo ea mookameli e kenyelletse likarolo tse peli feela (2 = e leka-lekaneng; 3 = e fokolang).

^eModerator e hlahlobisisa sephetho se feto-fetohang sa "frequency" ha e ea etsoa ka lebaka la palo e sa lekanang ea lithuto.

^fTlhahlobo ea moderator e kenyellelitse likarolo tse peli feela tsa tlatsetso (AD vs. meriana e meng hape [ke hore methylphenidate, atomoxetine]).

^gTlhahlobo ea moderator e kenyellelitse likarolo tse peli feela tsa tlhatlhobo (AD vs. meriana e meng hape [ke hore, memantine]).

^hLiphetho tsa tlhahlobisiso ea mookameli ha lia ka tsa hlalosoa, hobane ho ile ha sala thuto e le 'ngoe ho a le mong a maqhubu a mabeli.

ⁱTlhahlobo ea moderator e kenyelletsa lihlopha tse peli feela (IA vs. IGD).

^jTlhahlobo ea moderator e kenyelletsa lihlotšoana tse peli feela (AD vs. e kopaneng).

^kTlhahlobo ea moderator e kenyelletsa li-subgroups tse peli feela (CBT vs. kalafo tse ling [ke hore, lenaneo la thuto]).

Boholo ba boholo ka mefuta eohle ea bokhoba le litlatsetso bo lutse bo sa amangoe ke boleng ba lithuto, tse etsahalang khafetsa khatello ea maikutlo le matšoenyeho, le selemo sa phatlalatso (IA: botebo ba lefatše: β = -0.02; SE = 0.03; p = 0.417; khafetsa: β = -0.09; SE = 0.05; p = 0.075; SA: botebo ba lefats'e: β = -0.03; SE = 0.04; p = 0.519).

Mabapi le IA, boholo ba phello bo boholo bo ile ba fumanoa bakeng sa FTFTs ha bo bapisoa le SGTs, le bakeng sa mehato e kenyeletsang palo e phahameng ea lihora tsa kalafo bakeng sa ho fokotsa tsitsipano ea lefatše (β = 0.04; SE = 0.01; p <0.01) le khafetsa (β = 0.03; SE = 0.009; p <0.01). Bakeng sa phokotso ea ho tiea ha lefatše lithutong tsa meriana, boholo ba litlamorao bo ile ba hlaha bakeng sa ho imeloa kelellong ha bo bapisoa le tse ling tsa lik'hemik'hale (ke hore, methylphenidate, atomoxetine), bakeng sa tse kentsoeng ts'ebetsong linaheng tse ling ha li bapisoa le linaha tsa Asia, le ho hlahloba IA ea lefats'e ho bapisoa le IGD le mohala o bohlale ho lemalla.

Mabapi le SA, CBT le liphekolo tse ling tsa kelello (ke hore, tumello ea ho amohela le boitlamo) e bontšitse monyetla ho feta lipuisanong tse kopaneng le tlhabollo ea motho ka mong mabapi le litlhophiso tsa sehlopha bakeng sa phokotso ea khafetsa. Ka har'a sehlopha sa CB, liteko tsa bo-ramahlale tse sebelisang tlhahlobo ea litlatsetso li hlahisitse boholo bo boholo ho feta bo ipapisitseng le tlhahlobo ea ITT mabapi le phokotso ea khatello ea lefatše.

Bohlahlobisisi ba kalafo mabapi le kalafo e kopaneng bo ne bo etsetsoa sehlopha sa IA feela. Liphetho li bonts'itse hore boholo bo boholo ba phello bo ne bo amahanngoa le motsoako oa CBT, liteko tsa boleng bo tlase, le ba ileng ba hlahloba IA ea lefatše.

Psychological vs. pharmacological vs. meriana e kopaneng

Mabapi le IA, liphekolo tse kopaneng li hlahisitse boholo bo boholo ha bo bapisoa le ts'ebetso ea kelello le ea meriana bakeng sa phokotso ea boima ba lefatše (maikutlo a kelello le a kopaneng: Q_{Pakeng tsa} = 7.80, p <0.01; pharmacological vs. Q_{Pakeng tsa} = 14.69, p <0.001), le maqhubu (a kelello le a kopantsoeng: Q_{Pakeng tsa} = 8.73, p <0.01; pharmacological vs. Q_{Pakeng tsa} = 63.02, p <0.001). Liphetho tse sa reng letho li fumanoe lipakeng tsa boholo ba litlamorao tsa kalafo e hloekileng ea kelello le ea kalafo (ho teba ha lefatše: p = 0.173; khafetsa: p = 0.492). Ha re nahana ka CB, kalafo ea meriana e sebelisang merianaQ_{Pakeng tsa} = 5.45, p <0.05). Ha ho phapang e ngoe ea bohlokoa lipakeng tsa mefuta ea kalafo e bonoeng.

Phapang lipakeng tsa mekhahlelo ea bokhoba

Papiso ea boholo ba litlamorao ho mefuta eohle ea bokhoba e hlahisitse litholoana tse senang thuso mabapi le ts'ebetso ea kelello (botebo ba lefatše: p = 0.174; khafetsa: p = 0.559) le ho kenella hoa meriana p = 0.203; khafetsa: p = 0.389).

Puisano

Morero oa pampiri ena e ne e le ho etsa lipatlisiso tsa ho sebetsa hantle ha kalafo ea kelello, ea meriana le ea bongaka bakeng sa IA, SA le CB le ho bonts'a bokapele ba sephetho sa kalafo. Ho feta moo, papiso lipakeng tsa mefuta e meraro ea li-BA ho latela boholo ba litlamorao tsa kalafo ea kelello le ea bongaka li entsoe khetlo la pele, ka sepheo se seng sa ho hula ho ts'oana ho ts'oanang le li-SUDs mabapi le karabelo ea kalafo.

Re fumane hore kalafo ea kelello e fokotsehile ho tsitsipana ha lefatše le maqhubu a IA le SA ka karabelo ea kalafo e ntseng e bolokoa nako e telele ho feta. Bakeng sa CB, kalafo ea kelello e ne e boetse e amahanngoa le phokotso e kholo ea boholo ba pele le ea ho latela pele litekong tsa lefatše. Katleho e kholo le e itekanetseng ea nako e khuts'oane ho latela mefuta eohle ea sephetho e netefalitsoe meralo ea lithuto e laoloang, haholoholo mabapi le IA le lithutong ka bonngoe ho mekhahlelo ea SA le ea CB. Liphetho tsena li maemong a tšoanang le a fumanoeng tlhahlobisong ea meta e ileng ea hlahloba kalafo ea kelello bakeng sa papali ea chelete e sa sebetseng (Cowlishaw et al., 2012; Gooding & Tarrier, 2009; Goslar, Leibetseder, Muench, Hofmann, & Laireiter, 2017; Leibetseder, Laireiter, Vierhauser, & Hittenberger, 2011; Pallesen, Mitsem, Kvale, Johnsen, & Molde, 2005) le li-SUD (Dutra et al., 2008; Tripodi, Bender, Litschge, & Vaughn, 2010).

Le ha CBT e ne e sebelisoa haholo mekhahlelong e meraro ea bokhoba ba tahi, mekhoa e mengata e fapaneng ea kelello e ipakile e sebetsa hantle ho fokotsa boitšoaro bo sa tsotelleng mofuta oa kalafo, haholo-holo mabapi le IA. Liphumano tsena li fapane le tse tlalehiloeng tlhahlobisong ea morao-rao ea meta, e ileng ea fumana monyetla oa CBT holim'a mefuta e meng ea kalafo ea kelello bakeng sa phokotso ea nako e sebelisitsoeng inthaneteng, likeletso tsa motho ka mong, le bakeng sa lithuto tse entsoeng US.Winkler et al., 2013). Phapang, leha ho le joalo, e ka ba lebaka la hore tlhahlobo ea mookameli e entsoe ka tse fumanehang kahare ho sehlopha le taolo ea sephetho le ho kenyelletsa liphetho tsa moraorao tsa tlhahlobo ea rona ea meta. Har'a tsena, mekhoa e sebelisoang haholo e ne e kenyelletsa kalafo ea lelapa, eo ka lebaka la maemo a fapaneng a lelapa a sa sebetseng (mohlala, Schneider, King, & Delfabbro, 2017) bonahala e se na thuso ho libapali tsa marang-rang tse nang le mathata a marang-rang feela (mohlala, Han, Kim, Lee, & Renshaw, 2012), empa hape le bakeng sa bacha ba nang le li-SUD (bakeng sa tlhahlobo Litlhaku, Andersen, & Jørgensen, 2018). Ka mokhoa o ts'oanang, mananeo a kelello a thehiloeng monahanong a sebelisitse ka katleho matšoao a khahlisang a IA (Li, Garland, le al., 2017) le CB (Armstrong, 2012), le kalafo ea ho amohela le boitlamo e sebelisitsoeng bakeng sa kalafo ea SA (mohlala, Crosby, 2012) li ipakile li le bohlokoa ho fokotsa mats'oao a ho becha le likhathatso tsa SUDA-tjak et al., 2015; Li, Howard, Garland, McGovern, & Lazar, 2017; Maynard, Wilson, Labuzienski, & Whiting, 2018). Mananeo a kopaneng, ao boholo ba 'ona a neng a e-na le likarolo tsa CBT, a hlahisitse boholo bo lekanang ka bongata mekhahlelong e meraro ea bokhoba, ntle le phokotso ea khafetsa ea boits'oaro bo matla ba thobalano. Sephetho sena, leha ho le joalo, se ne se ipapisitse le teko e le 'ngoe e fapaneng le tse ling ka ho sebelisa Orzack Nako Inventory Survey (OTIS; Orzack, 1999) e hlahileng “e sa kenyeletse ka ho lekaneng” (Orzack, Voluse, Wolf, & Hennen, 2006, leq. 354) ho lekanya khafetsa tšebeliso e mpe ea ts'ebeliso ea komporo. Hobane Orzack le al. (2006) fana ka kalafo maemong a sehlopha, boholo bo tlase ba phuputso ena bo bile le boikarabello ba ho beha tikoloho ha sehlopha ha bo bapisoa le tlhabollo ea motho ka mong e totobatsang bohlokoa ba ho sebelisa lithulusi tsa mehato tse tšepahalang le tse sebetsang (bona hape Hook, Reid, Penberthy, Davis, & Jennings, 2014). Ntle le moo, karabelo ea kalafo e ne e bonahala e ikemetse ho tsoa mofuteng oa pelehi, ntle le karolelano e le 'ngoe: Batho ba IA ba anngoeng ke FTFTs ba ne ba bonahala ba fumana chelete e ngata ho kalafo ho feta e kenyelelitsoeng ho SGTs. SGTs e sebelisitsoeng bakeng sa kalafo ea IA, leha ho le joalo, e ne e kenyelletsa palo e tlase haholo ea lithuto ho feta FTFTs. Ka hona, nako ho fapana le mofuta oa nehelano e ka ikarabella bakeng sa liphapang tsena tse pakeng tsa sehlopha, e ts'ehetsang sephetho sa tlhahlobo ea morao-rao ea meta (Goslar et al., 2017) e bonts'ang hore SGTs e khutšoane e ka hlahisa maemo a tlase a ntlafatso ho feta matla a mananeo a ho thusa. Bopaki ba ho fumana sena bo fanoe ke SGTs tse matla haholo tse sebelisitsoeng bakeng sa kalafo ea SA (Hardy, Ruchty, Hull, & Hyde, 2010; Levin, Heninger, Pierce, & Twohig, 2017) le CB (Mueller, Arikian, de Zwaan, & Mitchell, 2013), boholo ba sephetho ba ho bapisoa ha bo bapisoa le bo fumanoeng bakeng sa FTFTs. Ka hona, katleho ea kalafo e eketsehile le nako ea kalafo ea kelello, haholoholo mabapi le phokotso ea ho teba ha lefatše le khafetsa ea IA. Sephetho se ts'oanang, empa se sa nahaneng se ile sa boela sa bonoa bakeng sa ho fokotsa botebo ba lefatše la SA. Liphumano tsena li tsamaellana le lipatlisiso tsa Asia IA (Chun et al., 2017), hammoho le tse fumanoeng papaling ea chelete e jeleng setsiGoslar et al., 2017; Leibetseder et al., 2011; Pallesen et al., 2005), ho fana ka maikutlo a hore ponahatso ea boitšoaro bo lematsang e hloka kalafo e matla haholoanyane ho fihlela ntlafatso.

Joalo ka kalafo ea kelello, kalafo ea meriana e bonts'itse liphokotso tse kholo le tse matla tsa pele ho matšoao a methapo ea methapo methating e meraro ea bokhoba. Ha ho na liqeto, leha ho le joalo, li ka huleloang mabapi le ho tšoarella ha karabelo ea kalafo le melemo ea nakoana ea meriana holim'a placebo ka lebaka la palo e fokolang ea data. Ho feta moo, liteko tse laoloang ke placebo tse entsoeng bakeng sa kalafo ea SA le CB li ne li fositse ke tšehetso e eketsehileng joalo ka mabitso a tloaelehileng a kalafo ho kenyeletsa ponts'o mabapi le boits'oaro bo nang le mathata (Mnyama, Gabel, Hansen, & Schlosser, 2000; Wainberg et al., 2006) kapa maano a kopanetsoeng a joaloka ho boloka lilulo tsa mabenkele (mohlala, Ntsu et al., 2000; Ninan et al., 2000) ho kenya letsoho karohanong e nyane pakeng tsa sehlopha, le ho patela phello ea li-chemical agents (Ntsu et al., 2000; Ninan et al., 2000; Wainberg et al., 2006). Ha ho bapisoa, melemo ea nakoana ea kalafo ea makhopo ka lebaka la bothata ba papali ea chelete ea ho becha e ne e le maemong a mahareng (Goslar, Leibetseder, Muench, Hofmann, & Laireiter, 2018), e ts'oanang le e tlalehiloeng bakeng sa bokuli ba tšebeliso ea joala, le maloetse a fapaneng a kalafo le mafu a kelello (mohlala, Jonas et al., 2014; Leucht, Hierl, Kissling, Dold, & Davis, 2012).

Bohlahlobisisi ba motsamaisi ha bo supe phapang e kholo lipakeng tsa lihlopha tsa bongaka, leha phaello ea kalafo bakeng sa phokotso ea ho teba ha lefatše bakeng sa CB e bonahala e phahame haholo ka lebaka la boholo bo boholo ba phello e thehiloeng ho bapalami ba hlokometsoeng litekong tse peli (Mnyama, Monahan, & Gabel, 1997; Grant, Odlaug, Mooney, O'Brien, & Kim, 2012) bapisoa le tse fumanoeng tlhahlobisong ea ITT. Liteko tsena li boetse li supile bophahamo ba phekolo ea bongaka maemong a kelello bakeng sa phokotso ea bokhopo ba lefatše bo ts'ehetsang ts'ebeliso ea tlhahlobo ea ITT, e emelang mokhoa o hlakileng oa lipalo o bonts'a maemo a nnete maemong a kalafo (mohlala, Sedgwick, 2015). Feela ka har'a sehlopha sa IA, lingaka tsa litlhare li ile tsa hlaha li phahame ho meriana e meng. Ha ho hlahlobisisoa lintlha, ho ile ha senola hore sehlotšoana se nang le kalafo e phahameng se fumana karolo ea batho ba baholo ba nang le khatello ea maikutlo le mathata a amang maikutlo a amanang le kalafo, 'me a kenyeletsa teko ka boholo bo boholo ba phello (g = 2.54; Dell'Osso et al., 2008). Sehlopha se ka tlase se nang le phaello e fokotsitsoeng ea kalafo, se ne se kenyelletsa bacha ba nang le comorbid hloko deficit hyperactivity disc (ADHD) e tšoaroang ka psychostimulants (methylphenidate), 'me e ne e na le nyeoe ka boholo bo tlase bo hlahlobang batho ba nang le botebo bo tlase ba IA (g = 0.57; Han et al., 2009). Liphapang tsena li amme hape "baokameli" le "mofuta oa" IA. Ka lithuto tse peli tse tlositsoeng tlhahlobisong ea mookameli, monyetla oa lithibela-mafu le litlamorao tse kholo tsa "moetapele" le "mofuta oa IA" li ile tsa nyamela. Le ha kalafo ka sehlotšoaneng ka bobeli e bile le litholoana tse ntle, phapang e ne e bonahala e tsamaisoa ke liteko tse le 'ngoe. Ka hona, lipuisano lipakeng tsa ADHD tse hlahang, kalafo ea meriana, lilemo le setso li hloka tlhahlobo haeba palo e phahameng ea lithuto e tla ba teng. Ntle le comorbid ADHD, leha ho le joalo, ntlafatso e tobileng ea pherekano e ne e ikemetse ho tloha ho tepelleng le ho tšoenyeha ka comorbid, e tšehetsang liphumano tse tsoang ho IA ea pele (mohlala, Han & Renshaw, 2012) le lipatlisiso tsa lipakeng tsa papali ea chelete (bakeng sa tlhahlobo Dowling, Merkouris, & Lorains, 2016).

Hoo e ka bang mekhahlelo e meraro ea bokhoba ba ho lemalla, haholo-holo serotonin khetha reuptake inhibitors (SSRIs) e se e hlahlobiloe ho latela mefuta e mengata ea mathata a maikutlo a maikutlo a komorbid (mohlala, Kafka, 1991) le - haholoholo mabapi le SA - thepa e thibelang serotonin ka boitšoaro ba thobalano (mohlala, Kafka & Prentky, 1992). Bahanyetsi ba opioid (mohlala, naltrexone) le meriana ea glutamatergic (mohlala, topiramate) li ne li nkuoa feela lithutong tsa ho phekola SA (mohlala, Grant & Kim, 2001; Khazaal le Zullino, 2006) le CB (mohlala, Grant, 2003; Guzman, Filomensky, le Tavares, 2007) ho bonts'a litholoana tse ntle. Hobane bahanyetsi ba opioid le li-agents tsa glutamatergic ba bontšitse likhetho tse ntle tsa kalafo bakeng sa li-SUD (Guglielmo et al., 2015; Jonas et al., 2014; Minarini et al., 2017) le papali ea chelete e felisitsoeng (Bartley & Bloch, 2013; Goslar et al., 2018), mefuta ena ea lithethefatsi e bonahala e ts'episa ho etsa patlisiso meqolong e meholo le e laoloang ea ho ithuta, haholo ka leseli la litheko tse phahameng tsa li-SUDs tse tšehetsang li-BA (mohlala, Grant et al., 2010).

Mekhoa ea phekolo e kopaneng ea IA, haholo meriana hammoho le CBT, e hlahisitse litlamorao tse ntlafalitsoeng ha e bapisoa le ts'ebetso e hlakileng ea kelello le ts'ebetso ea meriana e tšehetsang khothaletso ea tlhahlobo ea morao-rao mabapi le lithuto tsa sephetho sa kalafo tsa IA (Przepiorka, Blachnio, Miziak, & Czuczwar, 2014). Bophahamo ba motsoako oa CBT holim'a bao bo kopantsoeng le maano a mang a kelello bo ne bo nahanoa hore bo thehiloe tekong e le 'ngoe e hlahisang boholo bo boholo ba phello (g = 5.31; Yang, Shao, & Zheng, 2005), e amang le baokameli "boleng" le "mofuta oa IA". Ha boithuto bona bo tlositsoe tlhahlobisong ea sehlotšoana, leha ho le joalo, ke feela menyetla ea ho kopana ha CBT e ileng ea lula e le bohlokoa.

Leha tlhaiso-leseling e ne e fanoa ke lithuto tsa sephetho sa kalafo ea IA, 'me tlhaiso-leseling e tsoang litekong tse laoloang e ntse e lekantsoe, mekhoa ea kelello le ea meriana e bonts'itse litlamorao tse khutšoane maemong ohle a mararo, a ka bapisoang le a kentsoeng ts'ebeliso ea lithethefatsi le papali ea chelete e senyehileng (mohlala, Goslar et al., 2017; Grant et al., 2010) Ho ts'ehetsa maikutlo a rona. Liphumano tsena ha li na ho lekana ho hlakisa karohano ea IA, SA le CB kahara bongata ba mafu a kelello ka lebaka la tlhaelo-leseling ea tlhahlobo ea tlhahlobo le tlhaiso-leseling e fokolang ea mafu a tšoaetsanoang, liphatsa tsa lefutso le neurobiological (mohlala, Grant et al., 2010). Leha ho le joalo ba fana ka maikutlo a hore batho ka bomong ba arabela hantle ho kalafo ntle le mofuta oa bokhoba. Liphetho tsena li lumellana hantle le mehlala ea likhathatso tse lemalloang tse hlalosang mekhoa e tloaelehileng ea lisosa tse amanang le lithethefatsi le li-BA ((BA) (Griffiths, 2005; Jacobs, 1986; Orford, 2001; Shaffer et al., 2004), e ka fetoloang ka ho sebelisa kalafo ea kelello le ea meriana (Potenza et al., 2011). Ka lebaka la ts'ebetso ea likonopo tse sa sebetseng hantle le likarete tsa moputso nakong ea tšebeliso e mpe ea lithethefatsi le boits'oaro (mohlala, Nestler, 2005), kalafo ea kelello, haholo-holo likhetho tse thehiloeng ho CBT, li na le monyetla oa ho fetola ho se sebetse hantle le boits'oaro bo fosahetseng (LITLHAKU TSE KHOLO 2018), le ho matlafatsa mekhoa ea ho itaola ka ho lebisa libaka tsa bokapele ba pele (Potenza et al., 2011). Litlhare tsa kalafo ea meriana le tsona li ikemiselitse ho fokotsa matšoao a ho lakatsa le ho tlosa chelete ka ho ts'oara litsela tsa moputso le li-neurotransmitter system (Potenza et al., 2011). Ho feta moo, joalo ka ha ho bonoa kalafo ea IA, ho kopantsoe ha meriana ea CBT le kalafo ea meriana ho ka ba le phello e tlatsetsang, leha litšebelisano lipakeng tsa bobeli li ntse li sa hlaka (Potenza et al., 2011).

Lintlha tse latelang li lokela ho hlokomeloa: Pele, joalo ka litlhahlobo tse ngata tsa meta-anal, lithuto tse kenyelelitsoeng li fapana ka boleng ba tsona ba kemiso, leha li ne li sebetsoa ka lipalo, ha rea ka ra boloka leeme ka tatellano ka boholo ba phapang ka lebaka la phapang ea boleng tsa lithuto. Leha ho le joalo, ha ho le e 'ngoe ea lithuto e ileng ea fumana boleng bo phahameng ba bopaki bo mabapi le khetho e khethiloeng mme ka lebaka la tlhaiso ea meralo ea sehlopha sa thuto-ho khetholla le taolo ea batho ba ferekanyang le ho foufatsa. Ka hona, li-RCT tse entsoeng ka thata li hlokahala, ho kenyelletsa leihlo la tšehetso e eketsehileng ea kelello le tlhaiso-leseling, haholo-holo mabapi le liteko tsa meriana. Ntle le moo, lithuto tse ngata tsa IA li kenyeletsa boits'oaro bo fapaneng bo sebelisitsoeng marang-rang (mohlala, papali ea inthanete, ho shebella litšoantšo tsa bootsoa), leha lipatlisiso li bonts'itse phapang lipakeng tsa mohopolo o akaretsang oa IA le mefuta e ikhethileng ea boits'oaro bo tsamaisoang ke inthanete (Montag et al., 2015). Le ha ho le joalo, re lekile ho hlola bothata bona ka ho hlophisa lithuto ho latela boits'oaro bo fapaneng, ho sa tsotelehe mahareng a sebelisitsoeng. Mabapi le mathata a teng a kopaneng, re lekola mookameli a sekaseka khatello ea maikutlo le matšoenyeho eseng feela ka lebaka la ho ata ha bona bo phahameng hara litloaelo tsa boits'oaro (mohlala, Starcevic & Khazaal, 2017), empa hape hobane lintlha tsena li ne li tsebahala ka ho hlaka ho latela litheko tsa lithuto tsa mantlha. Kaha maemo a mang a hlaha hangata le li-BA (mohlala, Grant et al., 2010), mme karabelo ea kalafo e kanna ea susumetsoa ke mofuta oa comorbidity (Dowling et al., 2016), lithuto tse tsoelang pele li khothaletsoa ho tlaleha ka tatellano mefuta le litekanyetso tsa mafu a hlahang e le ho lekola leseli lena tlhahlobisong ea meta. Boithuto bo bongata bo boetse bo sitiloe ho fana ka tlhaiso-leseling ea hore na li fumanoe joang? Mokhoa oa ho khetholla tšoaetso, leha ho le joalo, o ka ba le tšusumetso ho nepahala ha bona (Carlbring et al., 2002;; bona hape Andersson & Titov, 2014). Lithuto tsa nako e tlang li lokela ho tlaleha hore na lipilisi li fumanoe ke lingaka, ho itlaleha, sefahleho, kapa marang-rang. Ntle le moo, lithuto tsa nako e tlang li khothaletsoa ho bapisa ka kotloloho phello ea kalafo bakeng sa batho ba nang le li-BA le li-SUD e le hore ho hlahlojoe ho tšoana le ho fapana lipakeng tsa li-BA tse amanang le lintho tse amanang le lithethefatsi mabapi le karabelo ea kalafo.

Leha ho na le mefokolo ena, liphetho tsa tlhahlobo ea hona joale ea meta li fana ka maikutlo a hore ho kena lipakeng tsa kelello ho sebetsa hantle ho fokotsa matšoao a IA, haholoholo ha ho fanoa ka sefahleho le ho tsamaisoa nako e telele. Le ha li-antidepressant le psychostimulants bakeng sa batho ba nang le li-ADHD tse hlahang li ntlafalitse matšoao a IA, li-CBT tse kopaneng le li-antidepressants li bonts'a monyetla ho feta monotherapies. Ho ipapisitsoe le boemo ba lipatlisiso ba hona joale, li-CBT le li-antidepressants li bonahala li sebetsa hantle bakeng sa kalafo ea SA le ea CB. Ha ho fanoa ka tlhoko ea kalafo, lipatlisiso tsa neurobiological li lokela ho tsoela pele e le hore li tsebe ho tšoana lipakeng tsa mafu a amanang le lintho tse amanang le lithethefatsi le boits'oaro bo bobebe, le ho ntlafatsa kalafo bakeng sa maemo ana a bohloko.Grant et al., 2010; Potenza et al., 2011).

Mehloli ea lichelete

Patlisiso ena ha e a ka ea fumana tšehetso e tobileng ea lichelete ho tsoa ho mekhatlo efe kapa efe ea lithuso tsa lichelete sechabeng, khoebong, kapa bakeng sa phaello.

Tlatsetso ea mongoli

Martina Goslar o ile a etsa patlisiso ea lingoliloeng, a fumana tlhaiso-leseling 'me a etsa tlhahlobo. Lipapatso tsa ho kenyelletsoa tlhahlobisong ea meta li netefalitsoe ke Martina Goslar le Max Leibetseder le bona ba netefalitseng tlhahlobo ea data. Anton-Rupert Laireiter o ile a hlokomela lits'ebetso tsena. Martina Goslar le Max Leibetseder ba hakantse bonnete ba lithuto. Hannah M. Muench o ile a tšehetsa tlhophiso ea data mme a fana ka likeletso mabapi le lipalo. Buka e ngotsoeng ka letsoho e ngotsoe ke Martina Goslar ka litlhaloso tse fanoeng ke Hannah M. Muench, Anton-Rupert Laireiter, le Stefan G. Hofmann. Bangoli bohle ba kentse letsoho ho tšehetsa buka e ngotsoeng ea ho qetela le ho e amohela.

Khohlano ea thahasello

Martina Goslar o phatlalatsa hore ha a na likhohlano tsa phaello. Max Leibetseder o phatlalatsa hore ha a na likhohlano tsa phaello. Hannah M. Muench o phatlalatsa hore ha a na likhohlano tsa phaello. Ngaka Hofmann o fumana tšehetso ea lichelete ho tsoa ho Alexander von Humboldt Foundation (e le karolo ea moputso oa Humboldt), NIH / NCCIH (R01AT007257), NIH / NIMH (R01MH099021, U01MH108168), le James S. McDonnell Foundation 21^st Boqapi ba Saense ea Lilemo Tse Lekholo ho Utloisisa Temoho ea Batho - Bohato bo Khethehileng. O fumana matšeliso bakeng sa mosebetsi oa hae oa ho ba mohlophisi ho tsoa ho Springer Nature le Association for Psychological Science, hape e le moeletsi ho tsoa Palo Alto Health Sciences le bakeng sa mosebetsi oa hae e le Setsebi sa Litaba ho tsoa ho John Wiley & Sons, Inc. le SilverCloud Health, Inc O boetse o fumana litefiso le litefo bakeng sa mosebetsi oa hae oa bohlophisi ho tsoa ho baphatlalatsi ba fapaneng. Anton-Rupert Laireiter o phatlalatsa hore ha a na khohlano ea lithahasello.

lumela hore baa fokola

Bangoli ba lakatsa ho leboha Mof. Xuan Wang le Mof. Yang Zhang ea fetoletseng lingoliloeng tsa China.

sehlomathisoLits'oants'o tsa Lipalo tsa Bohlokoa ba Phello

Ho etsa lipalo tsa boholo ba lihlopha tsa sehlopha, ho sebelisitsoe mekhoa e latelang (Borenstein le al, 2005, 2009):

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

joalo joalo Y¯¯¯1 e bonts'a moelelo oa boitlamo, Y¯¯¯2 e bonts'a moelelo oa kamora kalafo, S_Phapang e bontša ho kheloha ho tloaelehileng ha phapang, mme r e bonts'a kamano e teng lipakeng tsa kalafo ea kalafo ea kalafo ea kalafo le kalafo ea kamora 'kalafo. Ka lebaka la boholo ba mehlala e nyane, boholo bohle ba litlamorao bo ile ba lokisoa bakeng sa leeme le sebelisang Hedges's g e neng e kopantsoe ke ho ata d ka ntlha ya tokiso

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

joalo joalo df e emela li-degree tsa tokoloho ho hakanyetsa ho kheloha ho kahare ho sehlopha. Liforomo tsena li boetse li sebelisitsoe bakeng sa lipalo tsa boholo ba phello ho tloha pele ho ea pele ho latela tlhahlobo ea morao-rao. Mefuta ea boholo bo laoloang e kopantsoe ho sebelisoa foromo e latelang:

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

joalo joalo Δ ¯¯¯¯ Ke mokhoa oa ho fetola kalafo ea kamora kalafo, SD ke ho kheloha ho tloaelehileng ha lintlha tsa kamora kalafo, n ke sampole ea boholo, TELE e bua ka boemo bo sebetsang ba kalafo, 'me CONT e bua ka boemo ba taolo. Etsahala Rosenthal (1991), re hakantse hore khokahano ea pele ho poso e tla ba r = 0.70.

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Mekhoa ea kalafo ea ho lemalla lithethefatsi inthaneteng, ho lemalla ho kopanela liphate le ho reka ka thata: Tlhatlhobo ea meta-2020 (XNUMX)

inahaneloang

Ka morao le sepheo

mekhoa

Results

Puisano le Liphetho

mekhoa

Mekhoa e amohelehang

Mehloli ea tlhahisoleseling le patlo ea lingoliloeng

Liphello tsa liphello

Khetho ea thuto

Ts'ebetso ea ho bokella ya data le ho ntšoa ha data

Kotsi ea khethollo ho lithuto tsa motho ka mong

Palo ea boholo ba phello le synthetative ea data

Kotsi ea khethollo ho lithuto

Ts'ebetso ea motsamaisi

Results

Khetho ea thuto

Litšobotsi tsa lithuto, kalafo le barupeluoa

Kotsi ea khethollo ka har'a lithuto

Tekanyo ea liphetho le kotsi ea khethollo ho lithuto

Etsa boholo bo sa tloaelehang bakeng sa kalafo ea kelello ea ka mor'a ho phekola le ho latela

Phetoho ea boholo ba litlhare tsa kalafo ea meriana ka mora ho latela kalafo le ho latela

E thusa boholo ba liphekolo tse kopaneng nakong ea kalafo le ho latela

Mohlophisi oa tlhahlobo

Psychological vs. pharmacological vs. meriana e kopaneng

Phapang lipakeng tsa mekhahlelo ea bokhoba

Puisano

Mehloli ea lichelete

Tlatsetso ea mongoli

Khohlano ea thahasello

lumela hore baa fokola

References

Likarolo tse kenyelelitsoeng ho Meta-Analysis

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