Ukwelashwa ngokulutha kwe-intanethi, ukulutha ngokocansi nokuthenga okuphoqelela: Ukuhlaziywa kwe-meta (2020)

Umthamo / Inkinga: umqulu 9: Ukukhishwa 1

Ababhali: UMartina Goslar¹, UMax Leibetseder¹, UHannah M. Muench², UStefan G. Hofmann³ futhi U-Anton-Rupert Laireiter^{1 , 4}

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

abstract

Ingemuva futhi ihlose

Umlutha we-Intanethi, umlutha wobulili nokuthenga okuphoqayo kuyizinkinga zokuziphatha ezivamile, ezabelana ngokufana nokuphazamiseka kokugembula kanye nokuphazamiseka kokusebenzisa izidakamizwa. Kodwa-ke, kuncane okwaziwayo ngempumelelo yezindlela zokwelapha zabo. Inhloso yalokhu kuhlaziya kwe-meta kwakuwukubheka ukusebenza kahle kwezindlela zokwelapha zalezi zinkinga zokuziphatha, kanye nokuthola ukufana kokuphazamiseka kwezokugembula kanye nokuphazamiseka kokusebenzisa izidakamizwa ngokuya ngempendulo yokwelashwa.

izindlela

Ukusesha okwenziwe ngezincwadi kuveze izifundo ezingama-91 ezingenela abahlanganyeli abangama-3,531 ukuhlinzeka ngokuhlola okuphelele kokusebenza kwesikhashana nokwesikhathi eside kokusebenza kwengqondo, ekhemisi futhi okuhlanganisiwe kokulutha kwe-inthanethi, umlutha wobulili, nokuthenga okuphoqayo.

Imiphumela

Ukwelashwa ngokwengqondo, ukwelashwa, kanye nokuhlanganiswa kuhlotshaniswa nokuthuthuka okuqinile kwangaphambi kokuthunyelwa kubukhali bomhlaba bokubheja kwe-inthanethi (i-Hedges's g: 1.51, 1.13, no-2.51, ngokulandelana) nokulutha ngokocansi (Hedges's g: 1.09, 1.21, no-1.91, ngokulandelana ). Ngokuthenga okuphoqelekile, ukwelashwa ngokwengqondo nangokwemithi nakho kwahlotshaniswa nokwehliswa okukhulu kwangaphambi kokuthunyelwa kokuqina ebukhali bomhlaba (Hedges's g: 1.00 no 1.52, ngokulandelana). Amasayizi womphumela wokulandelela wangaphambi kokuthunyelwa naphakathi kweqembu abekade ebangeni elifanayo, ngaphandle kokumbalwa. Ukuhlaziywa kweModerator kuphakamisa ukuthi ukungenelela kwengqondo kuyasebenza ekwehliseni isimilo sokucindezela, ikakhulukazi lapho silethwa ubuso nobuso futhi siqhutshwa isikhathi eside. Inhlanganisela yezindlela zokuqonda nezokuziphatha ngemithi ikhombise inzuzo kunama-monotherapies.

Ingxoxo Neziphetho

Imiphumela isikisela ukuthi ukwelashwa kokulutha okuvamile kokuziphatha kuyasebenza esikhathini esifushane, kufana nalezo ezisetshenziselwa ukuphazamiseka kokugembula kanye nokuphazamiseka kokusebenzisa izidakamizwa, kepha kuyadingeka izivivinyo ezinzima kakhulu zomtholampilo.

Ucwaningo lwakamuva lukhombe ukufana phakathi kokuphazamiseka kokusetshenziswa kwezidakamizwa (ama-SUDs) nokuluthwa kokuziphatha (ama-BA; isib, UGrant, Potenza, Weinstein, & Gorelick, 2010). Ngakho-ke, ukuluthwa kokuziphatha okuhlobene nezinto ezingekho ezidakazini bekuchaziwe ngokuya ngezinqubo zokusetshenziswa kwezidakamizwa ezichazwe ku-Diagnostic and Statistical Manual of Mental Disorders (DSM IV; I-American Psychiatric Association, i-1994) kufaka phakathi ukuzibandakanya ekuziphatheni okuthile, ukungakwazi ukulawula indlela yokuziphatha, ukubekezelela, ukuhoxa, nokuziphatha okuqhubekayo naphezu kwemiphumela emibi (isib. U-Grant et al., I-2010). Njengamanje, yinkinga yokugembula kuphela (i-GD), ebiqhubeka ngaphansi kwe- “Impulse-Control Disrupt Not Not Elsewhere Classified” kwi-DSM IV (I-American Psychiatric Association, i-1994), ihlukaniswe ngaphansi kwesigaba esisha “Izinkinga ezihlobene nokudla izidakamizwa kanye nokulutha”Kwe-DSM-5 (I-American Psychiatric Association, i-2013). Lokhu kuhlangana kabusha kuvuse impikiswano enkulu yokuthi ngabe ezinye izindlela zokuziphatha ezinesimilo esinciphile sokulinganisa kufanele zibhekwe njengabavoti abangaba khona kuma-BA (isb. U-Grant et al., I-2010; UMueller et al., 2019).

Ngaphandle kwe-GD, i-inthanethi yemidlalo yokudlala (IGD) okuwukuphela kwesimo esibekwe ku-DSM-5 ngaphansi kwesigaba III ngesincomo sokwenza olunye ucwaningo (I-American Psychiatric Association, i-2013). Ixhaswe ngochwepheshe abavela ezizindeni ezahlukahlukene zezempilo nezomphakathi (isib. Rumpf et al., 2018; Saunders et al., 2017), inkinga yokudlala ibuye ibhekwe kusalungiswa kwe-ICD-11 (I-World Health Organization, i-2018). Kubalulekile ukuqaphela ukuthi i-IGD kufanele ihlukaniswe ekuluthweni kwe-inthanethi yokuqanjwa kwe-inthanethi (i-IA), njengoba bobabili bemele ukwakhiwa okuhlukile (isib. IGriffiths namaPonti, ngo-2014; UKiraly et al., 2014). Kodwa-ke, njengoba izincwadi eziningi zibhekisela kwi-IA yomhlaba wonke, leli gama selamukelwe kuleli phepha. Ngaphezu kwalokho, umehluko kufanele wenziwe phakathi "kokudlala" kanye "nokugembula": Ngenkathi "ukugembula kuchazwa ngokuyinhloko ngokusebenzelana kwawo, ukudlala ngokususelwa kumakhono, kanye nezinkomba zokuthuthuka nempumelelo, ... ukugembula kuchazwa ngokubheja kanye nokukhanda imishini, imiphumela elungiselelwe ithuba, kanye nezici zokwenza imali ezibandakanya ubungozi nokukhokha kumdlali. ” (INkosi, iGainsbury, iDelfabbro, iHing, ne-Abarbanel, 2015, iphe. I-216).

Yize ukufakwa kwe-IGD emabhukwini okuxilonga kuxoxwa ngokuphikisana ezincwadini zesayensi (King et al., 2019; UPetry, uRehbein, uKo, no-O'Brien, 2015; Rumpf et al., 2018; Saunders et al., 2017), ucwaningo oluningi seluvele lwenziwe ku-IA ne-IGD, ikakhulukazi ngezindlela ze-neurobiological eziphakamisa ukufana kwama-SUD (ukubuyekezwa bheka UFauth-Buhler noMann, 2017; I-Kuss, iPontes, neGriffiths, i-2018). Ngaphandle kokufana phakathi kwama-SUDs nama-BA ngokuya ngezici ezinkulu kanye nezomtholampilo, ukuqina komlando womndeni, ikakhulukazi okutholakele ocwaningweni lwe-neuroscience kubonakala kubalulekile ekuboniseni izinkomba zokuziphatha okuluthayo (isib, U-Grant et al., I-2010; IPotenza, iSofuoglu, iCarroll, neRounsaville, 2011).

Ngokuhambisana nalokhu kucatshangelwa, inqubekelaphambili ethile ekuhlolweni kokujwayeleka kwe-neurobiological ne-SUDs izuzwe muva nje emikhakheni yokuluthwa ngokocansi (i-SA) nokuthenga okuphoqelekile (i-CB) ngokuhlaziya izehlakalo zesiko eziphenywe kuma-SUD ezinjengezinqubo zokubeka isimo (isib. UHoffmann, Goodrich, Wilson, noJanssen, 2014; ISnagowski, iLaier, iDuka, neBrand, ngo-2016), ukusebenza kabusha kwe-cue, ukukhetha okubonakalayo nokusebenza kwenethiwekhi okuhlobene (isib, Umkhiqizo, uSnagowski, uLaier, noMaderwald, 2016; I-Gola et al., 2017; Jiang, Zhao, & Li, 2017; ILaier, iPawlikowski, neBrand, 2014; ILaier, iSchulte, neBrand, 2013; ULawrence, uCiorciari, noKyrios, ngo-2014; I-Mechelmans et al., 2014; I-Pekal, i-Laier, i-Snagowski, i-Stark, ne-Brand, i-2018; Schmidt et al., 2017; Seok & Sohn, 2015; I-Starcke, Schlereth, Domass, Schöler, neBrand, 2012; I-Trotzke, i-Starcke, i-Pedersen, ne-Brand, i-2014; UTrotzke, uStarcke, uPedersen, uMüller, noBrand, 2015; I-Voon et al., I-2014), noma ukusebenza okuphezulu (UDerbyshire, uChamberlain, u-Odlaug, uSchreiber, noGrant, ngo-2014; I-Messina, iFuentes, iTavares, i-Abdo, ne-Scanavino, i-2017; URaab, Elger, Neuner, noWeber, 2011; I-Trotzke et al., 2015). Lezi zifundo zikhombisile ukuthi phakathi kwalezo zimo ezingakamukelwa ngokusemthethweni eDSM-5 njengama-BA, ubufakazi obukhona njengamanje mayelana nezinkomba ze-neurobiological zokufana phakathi kokuziphatha okuhlobene nokuhlobene nokuphathelene nezidakamizwa ikakhulukazi kuvela ezindaweni ze-IA, SA kanye ne-CB, okuyizinto ezigxile ephepheni elikhona njengamanje. Njengoba lezi zinkinga zingokuhlobana kwemitholampilo, futhi zivame ukuhlotshaniswa nemiphumela elimazayo kubantu abathintekile (isib, Amaponti, uKuss, & Griffiths, 2015), izinketho zokwelashwa ezisebenzayo zidinga ukuphenywa (isib. U-Grant et al., I-2010). Kuze kube manje, ukucwaningwa kwe-meta-eshicilelwe kwenziwe ikakhulu maqondana ne-IA okufakazela ukusebenza kwezindlela ezahlukahlukene zokwelashwa (UChun, Shim, noKim, 2017; Liu, Liao, & Smith, 2012; Winkler, Doersing, Rief, Shen, & Glombiewski, 2013). Ukuhlaziywa okubili kwe-meta kuhlolisise ukungenelela kwengqondo, ukwakheka kwemithi kanye nokuhlanganiswa kwalezi zinhlelo zombili zokungenelela, kepha ubufakazi bukhawulelwe ezifundweni zemiphumela yokwelashwa eChina (Liu et al., 2012), ne-Korea (UChun et al., 2017). Ukubuyekezwa okuphelele kwe-meta-analytic kusekele ubufakazi bokuthi impumelelo ye-psychotherapy kanye nokwelashwa yezokwelapha ukunciphisa izimpawu ze-IA kubandakanya izivivinyo ezivela emazweni ase-Asia kanye nasentshonalanga (I-Winkler et al., I-2013). Ukungenelela okuhlanganisiwe, noma kunjalo, akuzange kubhekwe. Ngaphezu kwalokho, ukuhlaziywa kwe-meta UWinkler et al. (2013) alufakwanga ucwaningo lwakamuva.

Imiphumela emihle yokungenelela kwengqondo nokwelashwa ekwehliseni ubunzima bomhlaba wonke we-CB nayo yatholakala kolunye uhlaziyo lwamuva lwe-meta (IHague, iHholo, neKellett, 2016). Kodwa-ke, umthelela wekhwalithi yokutadisha nabanye omengameli emiphumeleni yokwelashwa awuzange uhlolwe. Ngenxa yalokho, kusalindwe uphenyo olunzulu lwezindlela zokwelashwa ze-IA ne-CB. Yize iSA ibhekwa ku-ICD-11 ngegama elithi "impoqo yokuziphatha kwezocansi" (I-World Health Organization, i-2018), kanye "nemizwa yokubikwa yokulutha kwezithombe zobulili ezingcolile ayijwayelekile" (IGrubbs, iKraus, nePerry, 2019, k. I-93), ukwelashwa kwe-SA akukakahlolwa izindlela ze-meta-analytic. Ngokwengeziwe, akukho ukuqhathanisa okwenziwe phakathi kwe-IA, noma i-IGD — ukhetho lesigaba “Izinkinga ezihlobene nokudla izidakamizwa kanye nokulutha”Ye-DSM-nezinye izindlela zokulutha ezinjenge-SA ne-CB, ngokusekelwe ekuphenduleni kwezempilo, okubhekwa njengesinkomba esibalulekile sokufana phakathi kwama-SUDs nama-BA (isib. U-Grant et al., I-2010).

Ngakho-ke inhloso eyinhloko yokuhlaziywa kwe-meta manje, bekuwukuphenya ukusebenza kokungenelela kwengqondo, kwezokwelapha kanye nokungenelela kwengqondo kanye nokwelashwa kwe-IA, SA, ne-CB ukunciphisa (a) ubukhulu bomhlaba kanye (b) nokuvama kokuphoqelela Ukuziphatha ngemuva kokuyeka ukwelashwa (imiphumela yesikhashana) nangesikhathi sokugcina sokulandela (imiphumela yesikhathi eside). Kususelwa kokutholakele kuzibuyekezo zakamuva (IHague et al., 2016; I-Winkler et al., I-2013), besilindele ukuthi izindlela zokwelapha ezingokwengqondo nezekhemisi zizosebenza ngokufana kuzo zonke izigaba ezintathu zokulutha. Silindele nokuthi imiphumela yokwelashwa iyafana naleyo ebikwe ukusetshenziswa kwezidakamizwa nokugembula (U-Grant et al., I-2010; Potenza et al., 2011). Ngaphezu kwalokho, inhloso yethu bekuwukubona omengameli abangahle basebenze ngosayizi ngamunye ophakathi kokulutha. Ukuhlaziywa kwe-meta kwenziwa ngokwezincomo zesitatimende se-PRISMA (Moher, Liberati, Tetzlaff, & Altman, 2009).

izindlela

Indlela yokufaneleka

Ucwaningo lwalubhekelwa ukufakwa uma (1) lusebenzisa noma yiluphi uhlobo lokungenelela kwengqondo, ekhemisi, noma kokungenelela okuhlangene (isib. Ukungenelela kwengqondo nokwenziwa kosokhemisi okwasetshenziswa ngasikhathi sinye); (2) Kusetshenziswe ngaphakathi kweqembu, okwenziwe ngokungahleliwe, noma okwenziwe ngokungahleliwe okwenziwa ngokungahleliwe kufaka phakathi izilawuli zohlu lokulinda, ababambiqhaza abangakutholi ukwelashwa, okunye ukwelashwa okusebenzayo, noma ukungenelela kwe-placebo; (3) baphatha abahlanganyeli ngokuxilongwa kwe-IA, SA, noma i-CB; (4) kulinganise okungenani eyodwa kokuguquguqukayo kwemiphumela (ie, ubulukhuni bomhlaba noma imvamisa); futhi (5) ibike idatha eyanele yezibalo yokubala usayizi wokusebenza. Izifundo azikhishwa uma (1) ucwaningo lungahlolisisa icala elilodwa; (2) isampula lokufunda limbozwe ngokuphelele ngesampula yolunye ucwaningo olufakwe ekuhlaziyeni kwe-meta; (3) ukwelashwa bekungachazwanga, noma (4) awukho umbhalo oyimfihlo noma ophelele ocwaningweni owatholakala. Mayelana ne-SA, sifake kuphela ucwaningo oluphenya ngokuziphatha ngokweqile kobulili kulandela incazelo ehlongozwe yi I-Kafka (2010), futhi kungafakwanga izifundo ezigxila ekwelapheni kwama-paraphilias ahlukile e-SA ngokuya ngezindlela “ezingekho emiphakathini noma 'zokuphambuka' zokuthanda ucansi” (I-Kafka, i-2010, iphe. I-392).

Imithombo yolwazi nokusesha izincwadi

Siqhube usesho lwezincwadi ze-multilevel sisebenzisa imininingwane yolwazi i-PsycInfo, iMedline, i-PubMed, i-Psyndex, ne-ISI Web yolwazi. Ukusesha kumboze konke okushicilelwe okusebenzayo kusuka onyakeni wokuqala otholakalayo kuze kube nguJuni 30, 2019 kusetshenziswa amagama alandelayo ahlobene nokuphazamiseka okuphathelene nokuphazamiseka: umlutha we-Intanethi, umlutha we-inthanethi ∗, i-inthanethi yokudlala umdlalo we-inthanethi, umlutha wevidiyo ∗, umlutha wevidiyo ∗, umlutha wevidiyo ∗, umlutha womdlalo wekhompyutha ∗, umlutha we-smartphone ∗, umlutha wefoni mobile, umlutha wezokuxhumana ∗, umlutha we-facebook ∗, inkinga phone umakhalekhukhwini ucansi ∗ umlutha ∗, ucansi ∗ uyaphoqelelwa sex, ucansi ∗ ukuphoqelelwa hyp, i-hypersex sex, ubulili obungenakuqhathaniswa ∗, ukuphazamiseka okuhlobene nesehlakalo ∗; ukuthenga okuphoqayo, ukuthenga okungaphoqeleli ∗, i-oniomania, i-shopaholic ∗, ukusaphaza ngokweqile kuhlangene nokwelashwa okuhlobene nokuhlobene kwamagama asemqoka, ukungenelela, ukwelashwa, i-psychotherapy. Amagama afanayo okusesha asetshenziselwe ukubhekabheka i-ProQuest Digital Dissertations yezincwadi ezingashicilelwe, ezingwevu. Ngemuva kwalokho, senze ukuhlolwa okugcwele kwezhlu zezethenjwa zezindatshana zokubukeza, ukucutshungulwa kwe-meta, kanye nezifundo zangempela ezitholwe emikhakheni yolwazi. Ngaphezu kwalokho, ababhali bezindatshana ezifanele bathintwa ukuze bacele imininingwane elahlekile kanye / noma amaphepha angashicilelwanga afanelekile ukufakwa ekuhlaziyeni kwe-meta. Izincwadi zesiShayina zahunyushwa izikhulumi ezimbili zomdabu ezinesizinda semfundo.

Imiphumela yokwenza

Ngemuva kwezinyathelo zokubika ezivame ukubikwa kakhulu ezifundweni zokuqala, sichaze imiphumela emibili ehlukahlukene yokunquma ukuncipha kwezimpawu ze-pathological: (1) ubukhulu bembulunga yonke, obunqunywe ukusetshenziswa kwamathuluzi afanele wokuhlola, kanye (2) nokuvama (isib. inani lamahora asetshenziswe online, ukubukwa kwezithombe zobulili ezingcolile, noma inombolo yokuthenga iziqephu ngesonto eledlule noma ngenyanga), kuchazwe ngamakhadi edayari noma imibiko yokuzazisa.

Ukukhetha okufundwayo

Ukukhetha okukhethiwe kwenziwa ngababuyekezi abazimele ababili (owokuqala nowesibili abalobi, i-MG ne-ML), futhi kwaqondiswa ngumbhali wokugcina waleli phepha (AL). Ukungaboni ngaso linye phakathi kwababhali kwaxazululwa ngengxoxo.

Inqubo yokuqoqa idatha nokukhipha idatha

Sikhiqize ifomu elihlelekile lokukhishwa kwedatha esilicwengisisile futhi saliguqula ngemuva kokuhlola isampula yezifundo eziyi-10. Ukubalwa kokulandelwa kokulandela nokulandela-isilinganiselo ngaphakathi kweqembu, imininingwane yezinombolo ikhishwe ngesimo ngasinye sokwelashwa kanye nomphumela ngokuhlukile. Uma izindlela zokwelapha ezahlukahlukene ezingokwengqondo noma ze-pharmacological bezihloliwe esifundweni esisodwa, idatha yesimo ngasinye yaqoshwa ngokwahlukile futhi yafakwa kumasayizi weqembu elingaphakathi lokuhlaziya kwezibalo. Ukubala usayizi wethonya lokulawulwa kwangaphambi kokuthunyelwa, imininingwane evela kuhlu lokulinda, akukho ukwelashwa, namaqembu okulawulwa kwe-placebo afakiwe. Ngaphezu kwalokho, sikhiphe idatha yezinombolo neyezigaba esifundweni ngasinye ukuze senze ukuhlaziya kongqondongqondo. Ukukhishwa kwedatha kwenziwa ngumlobi wokuqala (MG), kwaqinisekiswa ngumbhali wesibili (ML). Ukulinganisa kwalawa makhodi amabili azimele kugxile ezinhlotsheni zokwelapha, isilinganiso sokuguquguquka kwemiphumela, nokwethenjwa nokuba semthethweni kokuxilongwa okuqondene nokugula. Kodwa-ke, ocwaningweni, kusetshenziswe amathuluzi afanayo wokuhlonza ukutholakala kokuthikamezeka kwesilinganiso kanye nokulinganisa komphumela oguquguqukayo “wobulukhuni bembulunga yonke” ngesikhathi sokwelashwa. Ngoba ukukalwa kokwethenjwa nokweqiniso kwamathuluzi asetshenziselwe ukukalwa kokuguquguqukayo kwemiphumela nakho bekuyingxenye yesilinganiso sobungozi bebandakuko ezifundweni ngazinye (bona ngezansi), ukuthembeka kwangaphakathi kwe-interrater okuchazwe ngezibalo ze-kappa kwenziwa kuphela Izinhlobo zokwelashwa.

Ubungozi bokukhetha ezifundweni ngazinye

Sihlole ubuqiniso bangaphakathi besifundo ngasinye sisebenzisa iThuluzi Lokuhlola Ikhwalithi Yezifundo Ezincishisiwe, lakhiwa yiProjekthi Esebenzayo Yomphakathi Yezempilo (i-EPHPP) (UThomas, uCiliska, uDobbins, noMicucci, 2004). Leli thuluzi likhombise okuqukethwe nokwakha ubuqiniso (Thomas et al., 2004) futhi kunconyelwa ukubuyekezwa okuhlelekile nokuhlaziywa kwe-meta (I-Deeks et al., 2003). Ucwaningo ngalunye lwalulinganiswe ngendlela ezimele ezizindeni eziyisithupha: ukukhetha okokukhetha, ukwakheka kokutadisha, ukukhonjwa nokulawulwa kwama-confounders, izimpumputhe, ukuthembeka nokuba sematheni kwamathuluzi wokuqoqa idatha, nokubika namaphesenti okukhishwa nawokuyeka. Isizinda ngasinye sasihlolwa njengesiqinile, silinganisele, noma singenamandla Isilinganiso somhlaba wonke sabalwa ngemuva kokuhlolwa kwezizinda eziyisithupha. Ababhali ababili bokuqala (i-MG ne-ML) bahlola ngokuzimela isifundo ngasinye futhi banquma inani lomhlaba wonke lesivivinyo ngasinye. Ukuthenjwa kwe-Interrater kwahlatshwa amandla kusetshenziswa ukubalwa kwe-kappa. Ukungaboni ngaso linye phakathi kwababhali kwaxazululwa ngengxoxo kuze kube yilapho kufinyelelwe esivumelwaneni.

Ukubala usayizi womthelela kanye nokuqanjwa kwedatha yokulinganisa

Ukuhlaziywa kwezibalo kwenziwa kusetshenziswa uhlelo lwesoftware lwe-Comprehensive Meta-Analysis (CMA) version 2.2.064 (IBorenstein, iHedges, iHiggins, neRothstein, ngo-2005). Esigabeni ngasinye somlutha, sibala osayizi bomphumela wokuguquguquka komphumela okubikwe ezifundweni ezingokwengqondo, ezemithi, nezihlanganisiwe ngokwehlukana kwemiklamo yokufunda ngaphakathi kweqembu nokulawulwa (bheka iSithasiselo samafomula). Ngenxa yobukhulu besampula encane, osayizi bomphumela balungiswa ngokuchema kusetshenziswa amaHedges's g nesikhathi sokuvumelana sokuzithemba esihambisanayo sama-95% (i-CI; IHedges & Olkin, ngo-1984). Uma izindlela nokuphambuka okujwayelekile bekungekho, osayizi bemphumela babalwa ngokususelwa kwinqubo yokulinganisa efanayo (isib, t amanani, noma amazinga aqondile okungenzeka). Uma ukuhluka komphumela kulinganiswa ngethuluzi elilodwa, idatha evela kulamathuluzi ifakwa ngokuhlukile futhi ifakwe ndawonye ukuze kuhlanganiswe umphumela othile (I-Lipsey & Wilson, 2000). Yezifundo zokubika idatha ngokususelwa kubo bobabili abaqedile kanye nokuhlaziywa kwenhloso yokuphatha (i-ITT), idatha ye-ITT yacatshangelwa. Ukuqondiswa komphumela kwalungiswa ngokuya "ngempumelelo": usayizi womphumela wawumuhle uma iqembu elaphathwayo lenza kangcono kuneqembu elilawulayo. Ngokwezincomo zikaCohen (1977), usayizi wokusebenza ongu-0.20 kuya ku-0.30 ungahlukaniswa njengento encane, leyo eduzane ne-0.50 njengephakathi, futhi leyo engenhla eyi-0.80 enkulu.

Sicabanga i-heterogeneity phakathi kwezifundo, sanquma ukusebenzisa imodeli yemiphumela engahleliwe ukuhlanganiswa kwamasayizi wokusebenza. I-Heterogeneity yamasayizi wokuphenya iphenywe kusetshenziswa isibalo se-Q ngokuhambisana nayo p inani, kanye I² izibalo, okubonisa ukuthi kungakanani umehluko wangempela osayizi womphumela oboniswe yingxenye yokuhluka (IBorenstein, iHedges, iHiggins, neRothstein, ngo-2009; IHiggins, Thompson, Deeks, & Altman, 2003); I² amanani ka-25%, 50%, no-75% ahlukaniswe ngamanani aphansi, olinganiselayo, futhi aphezulu, ngokulandelana (IHiggins et al., 2003).

Ubungozi bokukhetha kuzo zonke izifundo

Ukulawula ukuthambekela kokushicilelwa, senze uphenyo olunzulu ngezincwadi futhi sabala ukuthi i-Rosenthal iphephile N (I-Rosenthal, 1979) futhi yahlola neziza zokuhlanza (UDuval noTweedie, 2000). Ngokusho I-Rosenthal (i-1991), osayizi womphumela kubhekwa njengamandla kakhulu uma inani lezifundo ezidingekayo ukuthola umphumela ongabalulekile omkhulu ungaphezulu kuka-5k + 10, kuphi k imelela inani lezifundo. Ngaphezu kwalokho, sisebenzise indlela yokusika-nokugcwalisa (UDuval noTweedie, 2000) ukulinganisa izifundo ezingekho kanye nomthelela wazo kosayizi bemphumela obonisiwe. Le ndlela isuselwa kumqondo wobuhle be-funnel futhi ithola ukusatshalaliswa ngokulingana kwamasayizi womphumela wokuguquguquka komphumela ngaphandle kokukhetha kokushicilelwa. Endabeni yokusatshalaliswa kwe-asymmetrical, indlela ye-trim-and -gcwalisa ilungisa futhi ilungisa osayizi womphumela (Borenstein et al., 2009); sisebenzise le ndlela kuphela uma izifundo eziyi-10 bezikhonaSterne, Egger, & Moher, 2011). I-asymmetry yesakhiwo somsebenzi ihlolwe ngokusebenzisa isivivinyo sika-Egger (U-Egger, uSmith, uSchneider, noMinder, ngo-1997). Njengamaveji asayizi okwedlulele okwedlula onke akhiqiza ukutolika okwedukisayo kwemiphumela yokwelashwa (I-Lipsey & Wilson, 2000), sisebenzise indlela “yokususa isifundo esisodwa” enikezwa yi-CMA ukuhlola umthelela wosayizi womphumela wesifundo ngasinye kumphumela ophelele (Borenstein et al., 2005). Uma imiphumela ephindwaphindwayo ayizange ibe nomthelela omkhulu usayizi womphumela futhi ihlala ngaphakathi kwe-95% CI, izifundo bezigcinwa ocwaningweni.

Ukuhlaziywa komengameli

Ukucacisa i-heterogeneity phakathi kwamasayizi wokusebenza, sihlolisise uhlobo lokuhlaziywa kwedatha (i-ITT vs. isihlanganisi sokuhlaziywa), kanye nekhwalithi yezifundo (Izikolo zomhlaba wonke ze-EPHPP) njengabongameli abangabakhona. Ngoba ukudangala nokukhathazeka kutholakele kuhlotshaniswa nama-BA (isb. UGonzález-Bueso et al., 2018; I-Starcevic neKhazaal, 2017), sihlole ukuthi ngabe amasayizi womphumela ahlukahluka njengomsebenzi walezi zinto ezenzeka ngokuhlangana (ukufakwa dhidi Njengoba izinkinga ezenzeka kanye kanye, ikakhulukazi ukudana nokukhathazeka, zivame kakhulu phakathi kwabantu abathinteka ama-BA (I-Starcevic neKhazaal, 2017), izifundo ezihlulekile ukubika idatha ngezimo ze-comorbid zithathwa njengezibandakanya ababambiqhaza ekucindezelekeni okwenzeka kanye nokukhathazeka okwenzeka kanye. Ezifundweni zokusebenza kwengqondo, siphinde saphenya ngemodi yokwelashwa (ukulungiselelwa kweqembu vs ukwelulekwa komuntu ngamunye ngokuchasene nezinye izinhlobo zezilungiselelo [isib., Ukulungiswa komuntu ngamunye neqembu, ukuhlelwa komndeni]), indlela yokulethwa (kobuso nobuso [FTFTs] vs. izindlela zokuzisebenzisa eziqondiswa nguwe uqobo (SGTs]), kanye nohlobo lokungenelela kwengqondo. Uhlobo lokungenelela kwengqondo luhlaziywe ngokuhlukanisa amasu okusebenza kwengqondo kwezigatshana ezilandelayo: (1) i-CBT, emboza ukwelashwa kokuqonda kanye / noma zokuziphatha; (2) ukwelashwa okuhlanganayo okubandakanya izindlela ezahlukahlukene zokwelashwa ezingekho, kanye (3) nezindlela zokwelapha eziphathelene nezinye izifo, ezifana nokwelashwa komndeni, ukwelashwa okungokoqobo, ukwamukela nokwelashwa kokuzibophezela, noma ukwelashwa kobuciko. Sicabanga ukuthi izifundo eziningi zenziwe emazweni angewona awasentshonalanga, ikakhulukazi i-IA, silandele ukuhlaziywa okwedlule kwe-meta (I-Winkler et al., I-2013) futhi kwahlolwa ukuthi ngabe isizinda samasiko (i-Asia kanye namanye amazwe) sibe ngumengameli. Njengoba i-IA yomhlaba kanye ne-IGD yomhlaba wonke imele ukwakhiwa okuhlukile (isib, IGriffiths namaPonti, ngo-2014), siphinde sahlola umehluko phakathi kwezifundo ezisuselwa ku-IA yomhlaba kanye nalezo, ezaziphenya nge-IGD neminye imisebenzi enikwe amandla i-inthanethi (isib. umlutha we-smartphone, umlutha we-videogame).

Ezokwelapha ezitholwa ngamakhemikhali, sihlole ukuthi ngabe ama-antidepressants enza kahle yini kunezinye izinhlobo zemithi noma emithini exubile (isib, ama-antidepressants ahlanganiswe ne-methylphenidate). Ezifundweni ezihlanganisiwe, sihlole umthelela wezinhlobo zokungenelela kwengqondo nokwelashwa. Ngaphezu kwalokho, siphenye ukuthi ngabe enye yezinhlobo zokwelashwa (ukungenelela okubandakanya ukuvela kosokhemisi kanye nokungenelela okuhlangene) esigabeni ngasinye somlutha kukhombise ithuba ngaphezulu kwezinye. Ekugcineni, siqhathanisa ubukhulu bokungenelela kokungenelela kwengqondo nokwelashwa kwemikhakha yezigaba ezehlukile zokulutha. Ukubalwa kweqiniso lokuthi "i-intanethi isiteshi nje abantu abangangena ngaso kunoma yikuphi okuqukethwe abakufunayo (isib. Ukugembula, ukuthenga, ukuxoxa, ubulili)" (IGriffiths namaPonti, ngo-2014, k. 2), siqale izifundo ezibandakanya abantu abanokuziphatha okuthe xaxa kocansi noma okuthenga ngaphansi kwezigaba "umlutha wobulili" kanye "nokuthenga okuphoqayo", noma ngabe i-inthanethi yayisetshenziswa noma cha.

Ukuhlaziya umengameli ngokuguquguquka kwesigaba kwenziwa kusetshenziswa imodeli yemiphumela exubekile enezilinganiso ezihlanganisiwe ze T² kanye nokuhlolwa kwe-Q okususelwa ekuhlaziyweni kokuhluka nokuhambelana p inani lokuhunyushwa komehluko phakathi kwamaqembu amancane (Borenstein et al., 2009). Ngokwesimo okungenani kwezifundo eziyi-10 (Ama-Deeks, ama-Higgins, no-Altman, ngo-2011), siphinde saqhubeka nokuhlaziya i-meta-regression sisebenzisa unyaka wokushicilela kanye nesikhathi sokwelashwa (okuhlolwe ngenani eliphelele lamahora asetshenziswa ekwelashweni esivivinyweni kwengqondo, noma ngenani lamaviki ezivivinyweni ze-pharmacological). Uma inani elanele lezifundo zengqondo libonisa inani lamahora achithwe ekwelashweni, inani lamasonto lalisetshenziselwa ukukala ubude besikhathi sokwelashwa. Ukuhlaziywa kwe-Meta kuhlaziya ngeminyaka yobudala kanye nephesenti labahlanganyeli besilisa / nabesifazane akuzange kwenziwe ngoba ubudala nobulili ezifundweni zonke buyahlukahluka kulolo ngaphakathi kwezifundo eziphazamisa ukutolika okuthembekile (UThompson noHiggins, 2002).

Imiphumela

Ukukhetha okufundwayo

Umdwebo wokugeleza kwenqubo yokukhethwa kwesifundo uboniswa ku I-Fig. 1. Akubanga khona ukungezwani phakathi kwe-interrater maqondana nezinhlobo zokwelashwa.

Izici zokucwaninga, zokwelapha, kanye nababambiqhaza

Kuzo zonke izigaba zokuluthwa umlutha, isampula yamanje yezifundo ehlukahlukene ngohlobo lwesimo sokulawula: Isigamu sazo sasebenza alikho iqembu lokulawula (50%) kanye nezifundo eziningi ezisetshenziswe ohlwini lokulinda, akukho ukwelashwa, izilawuli ezinempilo, noma amaqembu okulawula i-placebo (30%), noma okunye ukuqhathanisa ukwelashwa okusebenzayo (20%). Imiphumela ibisuselwa kakhulu kubahlanganisi (80%). Imininingwane yokulandela inikezwe izifundo ezingama-32 zengqondo (IA: k = Izifundo eziyi-16 ezinezikhathi ezisukela ezinyangeni ezi-1 kuye kweziyi-6; M = 3.53, SD = 2.13; SA: k = Izifundo eziyi-11 ezinezikhathi ezisukela ezinyangeni ezi-1.5 kuye kweziyi-6; M = 4.27, SD = 1.88; I-CB: k = Izifundo eziyi-5 ezinezikhathi ezisukela ezinyangeni ezi-3 kuye kweziyi-6; M = 5.4, SD = 1.34), ngesifundo esisodwa samakhemikhali esigabeni se-CB esilandelwa izinyanga eziyi-12, nangezifundo ezimbili kusigaba se-IA esasisebenzisa ukungenelela okuhlangene, ngamunye waqoqa idatha ngokulandela inyanga eyodwa.

Iningi lezifundo zezengqondo zahlola i-CBT (58%), yathunyelwa ekwelashweni ngokulungiswa kweqembu (i-71%), nangefomethi yobuso (92%). Inani eliphelele lamahora achithwe ekungeneleleni kwengqondo lisuka kumaminithi ayi-15 laya kwangama-54 h (M = 12.55 h, SD = 10.49), kusuka ngesonto elilodwa kuya kumaviki angama-26 (M = 10.44, SD = 6.12), futhi kusuka kumaviki awu-8 kuya kumaviki angama-20 (M = 11.71, SD = 3.90) ekwelashweni kwe-IA, SA, ne-CB, ngokulandelana. Iningi lezifundo zamakhemikhali zahlola ama-antidepressants (85%); iningi lezivivinyo ezihlanganisiwe zisebenzisa i-CBT ngokuhambisana nama-antidepressants (71%). Isikhathi sokulashwa kwemithi sisuka emavikini ayisithupha kuya kwangama-6 (M = 15.67, SD = 17.95), kusuka kumaviki ayi-12 kuye kwangama-72 (M = 24.83, SD = 23.58), futhi kusuka kumaviki awu-7 kuye kwayi-12 (M = 9.50, SD = 2.20) ekwelashweni kwe-IA, SA, ne-CB, ngokulandelana.

Kuzo zonke izigaba zokuluthwa umlutha, ingqikithi yababambiqhaza abangama-3,531 bahlaziywa (IA: n = 2,427; SA: n = 771; I-CB: n = 333). Iningi lezi zifundo lifake ababambiqhaza ekucindezelekeni okwenzeka kanye nokukhathazeka okukhona (ama-77%). Izilingo ezigxile ku-IA zenziwa ikakhulukazi emazweni ase-Asia (75%). Isampula lilonke laliliduna ikakhulu ezifundweni ezihlola i-IA (76%) elinomuntu ophakathi kweminyaka engama-21, kanye neSA (98%) elinomuntu ophakathi kweminyaka engama-37, kodwa ezesifazane ezifundweni ezihlola i-CB (92.45%) zinesilinganiso seminyaka engu-42 Imininingwane eningilizayo ephathelene nezimpawu zezifundo ivezwe Amathebula 1-3.

Ithebula 1.Izici zokufunda zokulutha kwe-inthanethi

Isifundo / unyaka	N^a	Iqembu lokwelashwa (N) / Imodi yokwelashwa / Imodi yokulethwa^b	Iqembu lokulawula (N) / Imodi yokwelashwa / Imodi yokulethwa^b	Isiko / D / A (+/−) / IA uhlobo	Ubude besikhathi t / c^c	I-FU (izinyanga)	Imiphumela (ukuhlolwa)	ukuhlaziywa kolwazi	I-EPHPP
Ukwelashwa kwengqondo
I-Anuradha ne-Singh (2018)	28	I-CBT (28) / I / FTFT	None	I-Eshiya / - / IA	NA	None	I-GS (IADQ)	CO	3
UBai noFan (2007)	48	I-IT (CBT; ukuzithiba; ikhono kwezenhlalo) (24) / G / FTFT	I-NT (24)	I-Asia / + / IA	16	1.5	I-GS (CIAS-R)	CO	3
UCao et al. (2007)	57	I-CBT (26) / G / FTFT	I-NT (31)	I-Asia / + / IA	10	None	I-GS (YDQ, CIAS)	CO	2
UCelik (2016)	30	I-EDU (15) / G / FTFT	I-NT (15)	I-Turkey / + / IA	10	6	I-GS (PIUS) I-FR (% yomdlalo we-Intanethi odlalwa ngokusetshenziswa kwe-inthanethi / w)^d	NA	3
UDeng et al. (2017)	63	I-CBI (44) / G / FTFT	I-WL (19)	I-Asia / + / IGD	18	6	I-GS (CIAS)	CO	2
UDu et al. (2010)	56	I-IT (CBT; ukuqeqeshwa kwabazali; i-EDU yothisha) (32) / G / FTFT	I-NT (24)	I-Asia / + / IA	14	6	I-GS (IOSRS)	CO	2
UGonzález-Bueso et al. (2018)	30	1) I-CBT (15) / I / FTFT 2) IT (CBT + EDU yabazali) (15) / I / FTFT	I-HC (30)^e	ISpain / - / IGD	I-1) i-9 I-2) i-9	None	I-GS (DQVMIA)	CO	3
UGeo et al. (2008)	28	1) I-CBT (14) / G / FTFT	2) I-SUPP (isib. Yabelana ngolwazi nge-IA; ukukhuthaza ukuzethemba nezinsizakusebenza) (14) / G / FTFT^f	I-Asia / + / IA	I-1) i-8 2) NA	None	I-GS (CIAS)	CO	2
UHan et al. (2012)	14	FT (14) / F / FTFT	None	I-Asia / - / IGD	NA	None	I-GS (YIAS) I-FR (h / w)	CO	3
UHan et al. (2018)	26	I-CBT (26) / G / FTFT	None	I-Asia / - / IGD	24	None	I-GS (CIAS) I-FR (h / w)	CO	3
UHui et al. (2017)	73	1) I-CBT (37) / G / FTFT	2) IT (CBT + EA) (36) / I + G / FTFT^f	I-Asia / - / IGD	I-1) i-5 I-2) i-10	None	I-GS (IAD)	CO	2
UKe noWong (2018)	157	I-CBT (157) G / FTFT	None	I-Asia / + / IA	12	1	I-GS (PIUQ)	CO	3
Khazaei et al. (2017)	48	I-PI (24) / G / FTFT	I-WL (24)	I-Iran / + / IA	NA	None	I-GS (IAT) I-FR (h / w)	NA	3
I-Kim (2008)	25	I-RT (13) / G / FTFT	I-NT (12)	I-Asia / + / IA	12.5	None	I-GS (K-IAS)	NA	3
King et al. (2017)^g		I-CBT (i-84 h yokuyeka) (9) / I / NA	None	I-Australia / + / IGD	NA	1	I-GS (uhlu lokuhlola lwe-IGD) I-FR (h / w)	CO	3
ULan et al. (2018)	54	1) I-CBT (27) / G / FTFT	2) I-EDU (27) / G / FTFT^f	I-Asia / + / SMA	I-1) i-8 I-2) i-1	3	I-GS (MPIAS) I-FR (h / w)	CO	2
U-Lee et al. (I-2016)	46	I-CBT (okwabhalwa ekhaya nsuku zonke) (46) / FTFT / I	None	I-Asia / + / SMA	NA	None	I-GS (KSAPS)	CO
U-Li no-Dai (2009)	76	I-CBT (38) / I / FTFT	I-WL (38)	I-Asia / + / IA	14	None	I-GS (CIAS)	CO	3
U-Li, uGarland et al. (2017)	30	1) OKWENGEZIWE (15) / G / FTFT	2) SUPP (15) / G / FTFT^f	I-USA / - / IGD	I-1) i-16 I-2) i-16	3	I-GS (inqubo ye-DSM-5)	LAPHA	2
U-Li, Jin et al. (2017)	73	1) I-CBT (36) / G / FTFT	2) I-CBT + EA (37) / I + G / FTFT^f	I-Asia / + / IGD	I-1) i-5 I-2) i-10	None	I-GS (IAT)	CO	3
Liu et al. (2013)	31	1) I-CBT (16) / G / FTFT	2) I-SM (isb. Amarekhodi abhaliwe wemvamisa yokugembula; ukuzimisela kwezimpawu zokuziphatha) (15) / G / SGT^f	I-Eshiya / - / IA	I-1) i-54 I-2) i-24	None	I-GS (IAT) FR (h / d)	CO	3
Liu et al. (2015)	46	FT (21) / G / FTFT	I-WL (25)	I-Eshiya / - / IA	12	3	I-GS (APIUS) I-FR (h / w)	CO	2
Pallesen et al. (2015)	12	I-IT (CBT; FT; SFT; MI) (12) / G / FTFT	None	INorway / + / VGA	NA	None	I-GS (GASA; PVP)	CO	3
Ipaki, uKim et al. (2016)	24	1) I-CBT (12) / G / FTFT	2) VRT (12) / G / SGT^f	I-Asia / - / IGD	I-1) i-16 I-2) i-4	None	I-GS (YIAS)	CO	3
I-Pornnoppadol et al. (2018)	54	1) IT (CBT + amakhono + ezemidlalo) (24) / G / FTFT	2) I-EDU (30) / G / FTFT^f	I-Asia / - / IGD	NA I-2) i-1	6	I-GS (GAST)	CO	2
USakuma et al. (2017)^g	10	I-IT (SDiC kufaka ne-CBT; ukupheka kwangaphandle; ukuhamba ngezinyawo; ukuhamba ngezinyawo; ukwenza izinkuni) (10) G / FTFT	None	I-Asia / - / IGD	NA	3	I-FR (imidlalo ye-h / d; h / w; d / w)	CO	3
UShek et al. (2009)	22	I-IT (ukwelulekwa umuntu ngamunye nomndeni; ukuxhaswa kontanga) (22) / I / FTFT	None	I-Asia / + / IA	NA	None	I-GS (CIA-Y; CIA-G)	CO	3
Se et al. (2018)	46	I-MI (PFB) (46) / I / SGT	None	I-Asia / + / IA	NA	None	I-GS (IAT)	CO	3
USu et al. (2011)	59	I-CBT (uhlelo lokwelashwa online) 1) LE (17) / I / SGT 2) NE (12) / I / SGT 3) NI (14) / I / SGT	I-NT (16)	I-Asia / + / IA	I-1) i-0.48 I-2) i-0.48 I-3) i-0.26	None	I-GS (YDQ) I-FR (h / w)	CO	2
van Rooij et al. (2012)	7	I-CBT (7) / I / FTFT	None	I-Netherlands / + / IA	7.5	None	I-GS (CIUS) FR (d / w; h / d)	CO	3
UWartberg et al. (2014)	18	I-CBT (18) / G / FTFT	None	EJalimane / + / IA	12	None	I-GS (CIUS) U-FR (h / izinsuku zeviki; h / ngezimpelasonto)	CO	3
Woelfling et al. (2014)	42	I-CBT (42) / G + I / FTFT	None	EJalimane / - / IA	32	None	I-GS (AICA-S) U-FR (h / usuku lwangempelasonto)	LAPHA	3
UYang noWo (2005)	52	I-IT (SFBT; FT; CT) (52) / I / FTFT	None	I-Asia / + / IA	NA	None	I-GS (YDQ)	CO	3
UYang et al. (2017)	14	1) I-CBT (14) / G + I / FTFT 2) EA (16)^h	I-HC (16)^e	I-Eshiya / - / IA	20	None	I-GS (IAT)	CO	2
Yao et al. (I-2017)	37	I-IT (RT; MFM) (18) G / FTFT	I-NT (19)	I-Asia / + / IGD	12	None	I-GS (CIAS)	CO	3
Omncane (2007)	114	I-CBT (114) / I / FTFT	None	I-USA / + / IA	NA	6	I-GS (APA; CCU; MSA; SF) U-FR (OA)	CO	3
Omncane (2013)	128	I-CBT modified (128) / I / FTFT	None	I-USA / + / IA	NA	6	I-GS (IADQ)	CO	3
I-Zhang (i-2009)	70	I-IT (CBT; ezemidlalo) (35) / G / FTFT	I-NT (35)	I-Asia / + / IA	24	None	I-GS (IAT)	CO	3
UZhang et al. (2009)	11	I-CBT (11) / G / FTFT	None	I-Asia / + / IA	NA	None	I-GS (IAT)	CO	2
UZhang et al. (2016)	36	I-IT (CBI + MFTR) (20) / G / FTFT	I-NT (16)	I-Asia / + / IGD	17	None	I-GS (CIAS) I-FR (h / w)	CO	2
UZhong et al. (2011)	57	1) FT (28) / G / FTFT	2) IT (ukuqeqeshwa kwezempi; ezemidlalo; ukwelashwa okuqondiswe ekuziphatheni okuluthayo) (29) / G / FTFT^f	I-Eshiya / - / IA	24.5 2) NA	3	I-GS (OCS)	CO	2
UZhu et al. (2009)	45	1) I-CBT (22) / G / FTFT	2) IT (CBT + EA) (23) / I + G / FTFT^f	I-Asia / + / IA	5 I-2) i-10	None	I-GS (ISS)	CO	2
UZhu et al. (2012)	73	1) I-CBT (36) / G / FTFT	2) IT (CBT + EA) (37) / I + G / FTFT^f	I-Asia / + / IA	5 I-2) i-10	None	I-GS (IAT)	CO	2
Ukwelashwa ngamakhemikhali
UBipeta et al. (2015)	11	Ama-antidepressants ahlukahlukene (ngemuva kokuba i-clonazepam icishiwe emavikini ama-3) (11) (ababambiqhaza nge-IA ne-OCD)	2) Ama-antidepressants ahlukahlukene (ngemuva kokuthi i-clonazepam icishiwe emavikini ama-3) (27) (ababambiqhaza nge-OCD kuphela)^e	India / - / IA	52	None	I-GS (YBOCS; IAT)	NA	3
UDell'Osso et al. (2008)	17	I-Escitalopram (17)	None	I-USA / + / IA	10	None	I-GS (IC-IUD-YBOCS) I-FR (h / w)	CO	3
UHan et al. (2009)	21	I-Methylphenidate (21) (IConserta)	None	I-Asia / - / IGD	8	None	I-GS (YIAS-K) FR (h / d)	CO	3
UHan et al. (2010)	11	I-Bupropion SR (11)	None	I-Asia / - / IGD	6	None	I-GS (YIAS) FR (h / d)	CO	3
Ipaki, uLee et al. (2016)	86	1) IMethylphenidate (44)	2) I-Atomoxetine (42)^f 10-60 mg / d	I-Asia / - / IGD	12	None	I-GS (YIAS)	CO	3
Iculo et al. (2016)	119	1) I-Bupropion SR (44) 2) I-Escitalopram (42)	I-NT (33)	I-Asia / - / IGD	6	None	I-GS (YIAS)	CO	2
Ukwelapha okuhlanganisiwe
UHan noRenshaw (2012)	25	1) Ama-Bupropion + ama-8 ama-EDU (25)	2) Isikhathi se-placebo + 8 se-EDU (25)^e	I-Asia / + / IGD	8	1	I-GS (YIAS) I-FR (h / w)	CO	2
UKim et al. (2012)	32	1) Amanqamu weBupropion + 8 we-CBT (32)	2) I-Bupropion + 10 amaminithi. izingxoxo ezenziwa njalo ngeviki (33)^e	I-Asia / + / IGD	8	1	I-GS (YIAS) I-FR (h / w)	CO	2
Li et al. (2008)	48	Ama-antidepressants ahlukahlukene + I-CBT + FT (48)	None	I-Asia / + / IA	4	None	I-GS (IRQ)	CO	3
Nam et al. (2017)	30	1) I-Bupropion + EDU (15)	2) I-Escitalopram + EDU (15)^f	I-Asia / + / IGD	12	None	I-GS (YIAS)	CO	2
ISantos et al. (2016)	39	Imithi exubile + izikhathi eziyi-10 eziguquliwe ze-CBT (39)	None	EBrazil / + / IA	10	None	I-GS (IAT)	CO	3
UYang et al. (2005)	18	I-CBT + ukuqeqeshwa kwabazali + iFluoxetine (18)	None	I-Asia / + / IA	10.5	None	I-GS (CIUS)	CO	3

Note.

^aInani lezifundo ezifakiwe ekuhlaziyeni.

^bAma-moderator “mode of therapy” kanye “nemodi yokulethwa” asetshenziselwa ukwelashwa kwengqondo kuphela.

^cEzifundweni zokusebenza kwengqondo, isikhathi sokwelashwa silinganiswa kusetshenziswa inani eliphelele lamahora asetshenziswa ekwelashweni kokwelashwa (t) namaqembu okulawula (c). Ezifundweni zamakhemikhali nezihlanganisiwe, isikhathi sokwelashwa silinganiswa kusetshenziswa inani lamasonto.

^dImininingwane ye “frequency” eguquguqukayo yemiphumela ibitholakala kuphela eqenjini lokwelashwa.

^eIsimo sokulawula sikhishwe ngaphandle kokuhlaziywa ngenxa yokungahambelani nenqubo yokukhetha.

^fIsimo sokulawula sithathwe njengengalo yokwelashwa ehlukile.

^gUcwaningo lubike idatha kusuka ekuzilandeleni kuya ekulandeleni kuphela.

^hIsimo sokwelashwa sikhishwe ngaphandle kokuhlaziywa ngenxa yokungahambelani nenqubo yokukhetha.

Ithebula 2.Izici zokucwaninga kwezidakamizwa zocansi

Isifundo / unyaka	Ubude N^a	Iqembu lokwelashwa (N) / Imodi yokwelashwa / Imodi yokulethwa^b	Iqembu lokulawula (N) Imodi yokwelashwa / Imodi yokulethwa^b	Ubude besikhathi t / c^c/ D / A (+/−)	I-FU (izinyanga)	Imiphumela (ukuhlolwa)	ukuhlaziywa kolwazi	I-EPHPP
Ukwelashwa kwengqondo
UCrosby (2012)	27	UMTHETHO (14) / I / FTFT	I-WL (13)	12 / +	5^d	I-GS (SCS) I-FR (amahora wokubuka izithombe zocansi / w; inguqulo eguquliwe ye-DDQ)	CO	2
IHellberg et al. (2017)	10	I-CBT (10) / G / FTFT	None	8 / -	6	I-GS (HD: CAS; HDSI)	LAPHA	3
IHellberg et al. (2019)	137	I-CBT (70) / G / FTFT	I-WL (67)	8 / -	6	I-GS (HD: CAS; SCS)	LAPHA	2
UHardy et al. (2010)	138	I-CBT (Uhlelo lwe-online lwe-Candeo) (138) / I / SGT	None	26 / +	None	I-GS (PDR) I-FR (ukusetshenziswa kocansi / m; ukushaya indlwabu / m)	CO	3
UHart et al. (2016)	49	I-MI (49) / G / FTFT	None	7 / +	3	I-GS (SCS)	CO	3
UHartman et al. (2012)^e	57	I-IT (uhlelo lweSA neSA-SUD) / I + G / FTFT (57)	None	13 / +	6	I-GS (CSBI)	CO	3
UKlontz et al. (2005)	38	1) IT (EXPT; CBT; EDU; M-Medit.), Abesilisa (28) / G / FTFT 2) IT (EXPT; CBT; EDU; M-Medit.), Izintokazi (10) / G / FTFT	None	1) 1 / + 2) 1 / +	6	I-GS (GSBI; CGI)	CO	3
ULevin et al. (2017)	11	UMSEBENZI (SHWB) (11) / I / SGT	None	8 / +	1.5	I-GS (CPUI) I-FR (ukubuka izithombe zocansi) / w)	CO	3
IMinarcik (2016)	12	I-CBT (12) / I / FTFT	None	12 / +	None	I-GS (CLAPS; HBI; SCS) I-FR (ukubuka izithombe zocansi min./w)	CO	3
U-Orzack et al. (2006)	35	I-IT (RtC; CBT; MI) (35) / G / FTFT	None	16 / +	None	I-FR (ukubuka izithombe zocansi / w; OTIS)	CO	3
UPachankis et al. (2015)	63	I-CBT (ESTEEM-SC esekwe kwi-UP) (32) / I / FTFT	I-WL (31)	12 / +	3	I-GS (SCS)	LAPHA	2
AmaParsons et al. (2017)	11	I-CBT (ESTEEM-SC esekwe kwi-UP) (11) / I / FTFT	None	12 / +	None	I-GS (SCS)	CO	3
I-Quadland (1985)^e	15	1) GPT / G / FTFT (15)	2) I-PT yababambiqhaza abathinteka ezinye izinkinga / I / FTFT (14)^f	20 / +	6	U-FR (n wabalingani abahlukene bocansi / izinyanga ezi-3 zokugcina;% yabalingani bezothando ababonwa kanye kuphela;% wokuya ocansini nomlingani oyedwa;% wokuya ocansini kuzilungiselelo zomphakathi)	CO	3
USadiza et al. (2011)	10	I-CBT (10) / G / FTFT	None	12 / +	None	I-GS (SCS)	CO	3
I-Twohig ne-Crosby (2010)	6	UMTHETHO (6) / I / FTFT	None	8 / +	3	I-FR (ukubuka izithombe zocansi)	CO	3
UWilson (2010)	54	1) Ukwelashwa kobuciko (27) / G / FTFT	2) i-CBT eguquliwe (TCA) (27) / G / FTFT^g	1) 6 / + 2) 6 / +	1.5	I-GS (HBI-19)	CO	2
Ukwelashwa ngamakhemikhali
I-Kafka (1991)	10	Ama-antidepressants ahlukahlukene + I-Lithium (10)	None	12 / +	None	I-GS (SOI)	CO	3
U-Kafka no-Prentky (1992)	16	I-Fluoxetine (16)	None	12 / +	None	I-GS (SOI)	CO	3
I-Kafka (1994)	11^h	I-Sertraline (11)	None	17 / +	None	I-GS (SOI) U-FR (ngicabanga, unxusa, imisebenzi yezocansi min./d)	CO	3
UKafka noHennen (2000)	26	Ama-antidepressants ahlukahlukene + methylphenidate (26)	None	72 / +	None	I-GS (TSO) U-FR (ngicabanga, unxusa, imisebenzi yezocansi min./w)	LAPHA	3
UWainberg et al. (2006)	28	I-Citalopram (13)	I-PLA (15)	12 / -	None	I-GS (YBOCS-CSB; CSBI; CGI-CSB) I-FR (ukushaya indlwabu, ukusetshenziswa kwe-inthanethi, ukusetshenziswa kwe-porn / h)	LAPHA	2
Ukwelapha okuhlanganisiwe
UGola noPotenza (2016)	3	I-CBT + Paroxetine (3)	None	10 / +	None	I-FR (ukusetshenziswa kwezithombe zocansi / w)	CO	3
Scanavino et al. (2013)	4	STPGP + imithi ehlukahlukene (4)	None	16 / +	None	I-GS (SCS)	CO	3

Note. A = ukukhathazeka; UMthetho = Ukwamukela nokwelashwa kokuzibophezela; I-BSI = Okumfishane kwezimpawu zezimpawu; I-CBT = ukwelashwa kokuqonda; I-CGI-CSB = I-Clinical Global Impression Scale eyamukelwa ekuziphatheni okubi ngokobulili; I-CLAPS = Ukususa umugqa weLwandle eliyi-pornogale; CO = kuphela; I-CPUI = I-cyber-Pornography Sebenzisa I-Inventory; CSBI = Inventory Yokuziphatha Kokuziphatha Okucasulayo Okucindezelayo; D = ukudangala; d = usuku; I-DDQ = Uhlu lwemibuzo yokuphuza nsuku zonke; I-EdU = i-psychoedfundo; I-EPHPP = Iphrojekthi Yokuzivivinya Yezempilo Yomphakathi ephumelelayo (1 = eqinile, 2 = okulinganiselayo, 3 = isilinganiso esibuthakathaka); I-ESTEEM = Amakhono Anempumelelo Okunikeza Abesilisa Abasebenza Ngokuphumelelayo; I-EXPT = ukwelashwa okubonakalayo; FR = imvamisa; I-FTFT = ukwelashwa kobuso nobuso; FU = ukulandela; G = ukuhlelwa kweqembu; I-GPT = i-psychotherapy yeqembu; GS = ubulukhuni bembulunga yonke; I-GSBI = I-Garos yezocansi iBeavior Inventory; h = amahora; I-HBI = I-Hypersexual Behavior Inventory; I-HD: i-CAS = Isiphazamiso se-Hypersexual: Isikali Samanje Sokuhlola; I-HDSI = I-Inthanethi ye-Hypersexual Disorder Screening Inventory; I = ukwelulekwa umuntu ngamunye; I-IT = ukwelashwa okuhlanganisa; I-ITT = inhloso-yokwelapha; m = inyanga; I-M-Medit. = ukuzindla kokucabanga; MI = Ingxoxo Yesisusa; NA = ayitholakali; I-OTIS = i-Orzack Isikhathi Sokuqina Kwamandla; PDR = ubukhulu bezengqondo bokululama (imicabango ecashile ebonakalayo, ukusabela okwakhayo kokuthola ukululama, umthelela omuhle, umthelela omubi, imibono ye-ejensi phezu kokulutha, ukuthambekela kokuphika umthwalo wemfanelo wokulutha, okushiwo empilweni, ukuxhumana nabanye, imizwa yokuthethelelwa, Ukuqwashisa ngemicabango nezimo ezilingayo, izitolo ezinenjabulo ezinempilo); I-PLA = i-placebo; I-PT = i-psychotherapy; I-RtC = Ukulungela Ukushintsha; SA = umlutha wobulili; I-SA-SUD = umlutha wobulili nowama-comorbid; I-SC = ukucindezelwa ngokocansi; I-SCS = Isikali Sokucindezela Kobulili; I-SGT = ukwelashwa okuqondiswa ngokwakho; I-SHWB = incwadi yomsebenzi wokuzisiza; I-SOI = I-Inventory Yobulili; I-STPGP = i-psychodynamic group psychotherapy yesikhashana; I-TCA = Indlela Esebenzayo Yomsebenzi; TSO = Ingqikithi yokuphuma kocansi; I-UP = I-Protocol Ehlanganisiwe Yokwelashwa kweTransdiagnostic Yezinkinga Zomzwelo; W = uhlu lokulinda; w = isonto; I-YBOCS-CSB = I-Yale-Brown Obsessive Compaleive Scale eguqulwe ngokuziphatha kocansi okuphoqayo.

^aInani lezifundo ezifakiwe ekuhlaziyeni.

^b"Imodi yokwelashwa" yomengameli kanye "nemodi yokubeletha" ibisetshenziswa kuphela ekwelashweni kwengqondo.

^cIsikhathi sokwelashwa silinganiswa kusetshenziswa inani lamasonto.

^dIdatha kusuka kokuzilandelanisa kuya kokulandelayo ibitholakala kuphela “kumvamisa” oguquguqukayo womphumela.

^eUcwaningo lubike idatha kusuka ekuzilandeleni kuya ekulandeleni kuphela.

^fIsimo sokulawula sikhishwe ngaphandle kokuhlaziywa ngenxa yokungahambelani nenqubo yokukhetha.

^gIsimo sokulawula sithathwe njengengalo yokwelashwa.

^hAbahlanganyeli kuphela abatholwe benkinga yokuhlaselwa yipharafesi abafakiwe kulokuhlaziya.

Ithebula 3.Izici zokucwaninga kokuthenga okuphoqelekile

Isifundo / unyaka	Ubude N^a	Iqembu lokwelashwa (N) / Imodi yokwelashwa / Imodi yokulethwa^b	Iqembu lokulawula (N)	Ubude besikhathi t / c^c/ D / A (+/−)	I-FU (izinyanga)	Imiphumela (ukuhlolwa)	ukuhlaziywa kolwazi	I-EPHPP
Ukwelashwa kwengqondo
U-Armstrong (2012)	10	MBSR (4) / G / FTFT	I-NT (6)	8 / +	3	I-GS (CBS; YBOCS-SV; IBS)	CO	2
UBenson et al. (2014)	11	IT (i-CBT, i-PSYDYN, i-PSYEDU, i-MI, UMthetho, izinto eziqondayo) (6) / G / FTFT	I-WL (5)	12 / +	6	I-GS (mod. VCBS; RCBS; CBS; I-YBOCS-SV) U-FR (min./w osetshenziselwe ukuthenga; ukuthenga iziqephu / w)^d	CO	2
I-Filomensky & Tavares (2009)	9	I-CBT (9) / G / FTFT	None	20 / +	None	I-GS (YBOCS-SV)	CO	3
UMitchell et al. (2006)	35	I-CBT (28) / G / FTFT	I-WL (7)	10 / +	6^e	I-GS (YBOCS-SV; CBS) U-FR (ukuthenga iziqephu / w; h uchithe ukuthenga / w)	LAPHA	2
UMueller et al. (2008)	60	I-CBT (31) / G / FTFT	I-WL (29)	12 / +	6^e	I-GS (CBS; YBOCS-SV; G-CBS)	LAPHA	2
UMueller et al. (2013)	56	1) I-CBT (22) / G / FTFT 2) Uhlelo lwe-GSH-(i-CBT WB + izikhathi eziyi-5 zocingo) (20) / I / SGT	I-WL (14)	1) 10 / + 2) 10 / +	6	I-GS (CBS; YBOCS-SV)	LAPHA	2
Ukwelashwa ngamakhemikhali
Imnyama et al. (1997)	10	I-Fluvoxamine (10)	None	9 / -	None	I-GS (YBOCS-SV)	CO	2
Imnyama et al. (2000)	23	I-Fluvoxamine (12)	I-PLA (11)	9 / -	None	I-GS (YBOCS-SV)	LAPHA	2
UGrant et al. (2012)	9	I-Memantine (9)	None	8 / -	None	I-GS (YBOCS-SV; mod. CB-SAS)	CO	2
Koran et al. (2002)	24	I-Citalopram (24)	None	12 / +	None	I-GS (YBOCS-SV)	LAPHA	2
Koran et al. (2003)	23	I-Citalopram (23)	None	7 / +	None	I-GS (YBOCS-SV; CBS; IBTS)	LAPHA	2
Koran et al. (2007)	26	I-Escitalopram (26)	None	7 / +	None	I-GS (YBOCS-SV)	LAPHA	3
UNinan et al. (2000)	37	I-Fluvoxamine (20)	I-PLA (17)	12 / +	None	I-GS (YBOCS-SV)	LAPHA	3

Note. A = ukukhathazeka; UMthetho = Ukwamukela nokwelashwa kokuzibophezela; I-CBS = Isilinganiso sokuthenga esiphoqayo; I-CB-SAS = Ukuthengela Ukuthengwa Kwezimpawu Zokuqonda (i-modified modified of the Gossip Symb Scale Scale; i-CBT = Ukwelashwa kokuqonda; CO = kugcwalisa kuphela; D = ukudangala; I-EPHPP = Iprojekthi Esebenzayo Yomphakathi Wempilo Yezempilo) (1 = eqinile, 2 = ngokulinganisela , 3 = isilinganiso esibuthakathaka); FTFT = ukuphathwa kobuso ngobuso; i-FR = imvamisa; i-FU = ukulandela ngokulandelayo; i-G = ukusetwa kweqembu; i-G-CBS = iCanada yokuthenga okulinganiselwe eCanada, inguqulo yaseJalimane; i-GS = ukwehla komhlaba; i-GSH = ukuqondiswa kokuzisiza; h = amahora; I = ukwelulekwa umuntu ngamunye; IBS = Isilinganiso Sokuthenga Esicindezelayo; IBTS = Isilinganiso Sokuthengela Ukuthenga; ITT = inhloso yokuhlaziya ukuhlaziya; MBSR = Ukuncipha kwengqondo okususelwa ekucindezelekeni; i-MI = Ukuxoxisana okushukumisayo; NA = ayitholakali; I-NT = akukho ukwelashwa; I-PLA = iqembu elilawula i-placebo; i-PSYDYN = i-psychodynamic; i-PSYEDU = i-psycho-yemfundo; i-RCBS = iRichmond Compulsive Buying Scale; SGT = ukwelashwa kokuzimela; i-VCBS = i-Valence Compulsive Buying Scale; WB = workbook; WL = uhlu lokulinda; w = isonto; I-YBOCS-SV = Yale-Brown Obsessive Com pulsive Scale-Shopping Version.

^aInani lezifundo ezifakiwe ekuhlaziyeni.

^b"Imodi yokwelashwa" yomengameli kanye "nemodi yokubeletha" ibisetshenziswa kuphela ekwelashweni kwengqondo.

^cIsikhathi sokwelashwa silinganiswa kusetshenziswa inani lamasonto.

^dImininingwane ye “frequency” eguquguqukayo yemiphumela ibitholakala kuphela eqenjini lokwelashwa.

^eLezi zifundo bezingafakwanga ekuhlaziyweni kwe-FU, ngoba yidatha kuphela evela ekuthumeleni iFU ibikiwe.

Ubungozi bokukhetha ngaphakathi kwezifundo

Izikolo zomhlaba wonke ze-EPHPP ezifundweni ezifakwe ezigabeni ezahlukahlukene zokulutha zichaziwe ku Amathebula 1-3. Ukuhlolwa kokuqinisekiswa kwenziwa yizilinganiso ezimbili ezizimele eziveza ukuthembeka kwe-interrater kwe κ = 0.73 wezifundo ezigabeni ze-IA neSA, futhi κ = 0.75 wezifundo kusigaba se-CB.

Ukuqondaniswa kwemiphumela kanye nengozi yokucashelwa kuzo zonke izifundo

Usayizi womphumela ohlanganisiwe wazo zonke izinhlobo zemilutha nokwelashwa ngokwahlukana kweqembu kanye nemiklamo yokutadisha elawulwayo kuyo yonke imiphumela yokudla nokulandela, i-95% CI, kanye nokuhlolwa okubalulekile kuchaziwe Ithebula 4. Ukuhlelwa kwamahlathi ezinhlwini zomphumela weqembu ngaphakathi kwesimo ngasinye, ukwelashwa, kanye nomphumela wokunakekelwa kwasemuva kokubeletha kwethulwa I-Fig. 2.

Ithebula 4.Sayizi osayizi wazo zonke izinhlobo zemilutha, imiphumela kanye namiklamo yokutadisha lapho unikezwa usizo futhi ulandela

wesifundo	Uhlobo lomphumela	k	g	95% CI	z	p	I²	FS N
Ukulutha kwe-intanethi
Ukwelashwa kwengqondo
Ubulukhuni bembulunga yonke	ngaphakathi kweqembu (okuthunyelwe)	54	1.51	[1.29, 1.72]	13.79		93.66	18,317
	kulawulwa (okuthunyelwe)	15	1.84	[1.37, 2.31]	7.268		83.56	1,254
	ngaphakathi kweqembu (FU)	17	1.48	[1.11, 1.85]	7.92		94.61	4,221
imvamisa	ngaphakathi kweqembu (okuthunyelwe)	17	1.09	[0.73, 1.49]	6.02		92.54	1,801
	kulawulwa (okuthunyelwe)	6	1.12	[0.41, 1.83]	3.08		78.05	69
	ngaphakathi kweqembu (FU)	6	1.06	[0.12, 2.00]	2.21		97.30	259
Ukwelashwa Ngokhemisi
Ubulukhuni bembulunga yonke	ngaphakathi kweqembu (okuthunyelwe)	8	1.13	[0.85, 1.42]	7.78		78.76	564
	kulawulwa (okuthunyelwe)	2	1.28	[0.85, 1.71]	5.85		0.00	-^a
	ngaphakathi kweqembu (FU)	NA
imvamisa	ngaphakathi kweqembu (okuthunyelwe)	3	0.72	[0.49, 0.96]	6.01		0.00	27
	kulawulwa (okuthunyelwe)	NA
	ngaphakathi kweqembu (FU)	NA
Ukwelapha Okuhlanganisiwe
Ubulukhuni bembulunga yonke	ngaphakathi kweqembu (okuthunyelwe)	7	2.51	[1.70, 3.33]	6.03		92.99	756
	kulawulwa (okuthunyelwe)	NA
	ngaphakathi kweqembu (FU)	2	2.15	[0.66, 3.65]	2.82		93.55	-^a
imvamisa	ngaphakathi kweqembu (okuthunyelwe)	2	2.77	[2.29, 3.24]	11.39		14.43	-^a
	kulawulwa (okuthunyelwe)	NA
	ngaphakathi kweqembu (FU)	2	2.69	[2.06, 3.32]	8.43		49.72	-^a
Isiyaluyalu socansi
Ukwelashwa Ngengqondo
Ubulukhuni bembulunga yonke	ngaphakathi kweqembu (okuthunyelwe)	14	1.09	[0.74, 1.45]	6.03		92.54	1,311
	kulawulwa (okuthunyelwe)	3	0.70	[0.42, 0.99]	4.87		7.02	19
	ngaphakathi kweqembu (FU)	10	1.00	[0.67, 1.32]	6.02		90.02	760
imvamisa	ngaphakathi kweqembu (okuthunyelwe)	6	0.75	[0.46, 1.03]	5.10		70.96	177
	kulawulwa (okuthunyelwe)	1	1.67	[0.82, 2.53]	3.83		0.00	-^a
	ngaphakathi kweqembu (FU)	4	0.83	[0.37, 1.29]	3.57		71.59	45
Ukwelashwa ngamakhemikhali
Ubulukhuni bembulunga yonke	ngaphakathi kweqembu (okuthunyelwe)	5	1.21	[0.88, 1.54]	7.12		50.42	134
	kulawulwa (okuthunyelwe)	1	0.14	[−0.58, 0.87]	0.38	0.70	0.00	-^a
	ngaphakathi kweqembu (FU)	NA
imvamisa	ngaphakathi kweqembu (okuthunyelwe)	3	0.87	[0.63, 1.12]	6.92		0.00	33
	kulawulwa (okuthunyelwe)	1	0.79	[0.04, 1.55]	2.06		0.00	-^a
	ngaphakathi kweqembu (FU)	NA
Ukwelapha okuhlanganisiwe
Ubulukhuni bembulunga yonke	ngaphakathi kweqembu (okuthunyelwe)	1	1.91	[0.75, 3.08]	3.22		0.00	-^a
	kulawulwa (okuthunyelwe)	NA
	ngaphakathi kweqembu (FU)	NA
imvamisa	ngaphakathi kweqembu (okuthunyelwe)	1	1.04	[0.22,1.85]	2.49		0.00	-^a
	kulawulwa (okuthunyelwe)	NA
	ngaphakathi kweqembu (FU)	NA
Ukuthenga okuphoqayo
Ukwelashwa kwengqondo
Ubulukhuni bembulunga yonke	ngaphakathi kweqembu (okuthunyelwe)	7	1.00	[0.75, 1.25]	7.88		46.43	210
	kulawulwa (okuthunyelwe)	6	0.75	[0.42, 1.08]	4.45		0.00	27
	ngaphakathi kweqembu (FU)	4	1.36	[0.88, 1.84]	5.57		53.65	66
imvamisa	ngaphakathi kweqembu (okuthunyelwe)	2	0.97	[0.68; 1.26]	6.55		0.00	-^a
	kulawulwa (okuthunyelwe)	1	2.48	[1.46, 3.49]	4.76		0.00	-^a
	ngaphakathi kweqembu (FU)	1	1.01	[0.47, 1.55]	3.68		0.00	-^a
Ukwelashwa ngamakhemikhali
Ubulukhuni bembulunga yonke	ngaphakathi kweqembu (okuthunyelwe)	7	1.52	[1.18, 1.86]	8.84		63.17	386
	kulawulwa (okuthunyelwe)	2	-0.13	[−0.82, 0.57]	-0.35	0.724	0.00	-^a
	ngaphakathi kweqembu (FU)	1	-0.49	[−1.00, 0.03]	-1.86	0.063	0.00	-^a
imvamisa	ngaphakathi kweqembu (okuthunyelwe)	NA
	kulawulwa (okuthunyelwe)	NA
	ngaphakathi kweqembu (FU)	NA

Qaphela. k = inombolo yezimo zokwelashwa; g = AmaHedges's g; CI = isikhathi sokuzethemba; I² = iphesenti lokuhluka okuphelele kuzo zonke izifundo; I-FS N = Yehlulekile-iphephile N (inani lezifundo ezidingekayo ukuthola umphumela wokuphathwa ongabalulekile); NA = ayitholakali.

^aIphephile-ephephile N ibingabalwa ngoba zimbalwa izifundo ezi-3.

Sayizi osayizi bezindlela zokwelapha ezingokwengqondo ngemuva kokulashwa nokulandela

Izindlela zokwelapha ngokwengqondo kuzo zonke izigaba zokulutha ziveze osayizi wesikhathi esifushane esukela kokuphakathi kuya kokukhulu kuzindlela zombili zokutadisha. Ubungako bomphumela wesikhathi eside kuzo zonke izigaba zokulutha kubonise ukuthi imiphumela yokwelashwa igcinwa. Njengoba kuboniswe ku Ithebula 4, ubukhulu be-heterogeneity ephakeme kakhulu kuzo zonke izifundo yabonwa ngokuhlukahluka kwemiphumela ngaphakathi kwezigaba ze-IA neSA, futhi i-heterogeneity noma i-homogeneity ngokulinganayo yabonwa esigabeni se-CB.

Ngaphakathi komkhakha we-IA, indlela enqume ukugcwalisa ihlolwe ngezifundo eziyi-17 ezibanga ubuqili bezinhlaka zabasebenzi ukuncipha kobunzima bomhlaba kanye nesifundo esisodwa sokwehlisa imvamisa kumiklamo yokutadisha yeqembu. Ukuhlaziya ngalezi zifundo ezigcwalisiwe kuphakamise ukuncishiswa okuncane komphumela (ubukhulu bezwe: g = 0.87; I-95% CI [0.82, 0.92]; Ukuhlolwa kuka-Egger p <0.001; imvamisa: g = 0.93; I-95% CI [0.84, 1.03]; Ukuhlolwa kuka-Egger p = 0.282) iphakamisa umthelela ongabalulekile wokuchema kokushicilelwa. Akukho zinkomba zokuthambekela kokushicilelwa ezitholakele ekwehliseni ubunzima bomhlaba wonke ngokuya ngemiklamo yokufunda elawulwayo (Ukuhlolwa kuka-Egger p = 0.067). Ngaphakathi kwesigaba se-SA, indlela enciphisayo nokugcwalisa ikhombe ucwaningo olulodwa olwabangela ukwakheka kwe-funnel asymmetry ukuncishiswa kobunzima bomhlaba okuholela kusayizi wethonya elincishisiwe kulokhu kuguquguquka komphumela (g = 0.88; I-95% CI [0.79; 0.97], isivivinyo sika-Egger p = 0.318) .Noma yikuphi ukwehluleka-kuphephile N Kwenziwa ucwaningo, osayizi bezomphumela kuzo zonke izigaba zokuluthwa babhekwa njengabanamandla emiphumeleni yomphumela, ngaphandle kosayizi womphumela olawulwayo mayelana nokuncishiswa kobunzima bomhlaba wonke ezigabeni zeSA kanye ne-CB, ezazinamandla.

Umphumela osayizi bezindlela zokwelapha ezilandela ukwelashwa lapho ululama futhi ulandela

Ekuqothulweni kokudla, ubungako beqembu elingaphakathi kweqembu kuzo zonke izigaba zokuluthwa babuphakathi futhi bukhulu. Amasayizi womphumela olawuliwe ikakhulukazi asuselwa ekulingweni okukodwa okusuka kokukhulu kusigaba se-IA kuya kokuncane nokubi kusigaba seSA ne-CB. Ukuntuleka kwemininingwane yokulandelela kunqande ukuhunyushwa kosayizi bemphumela wesikhathi eside. I-heterogeneity ephezulu futhi elinganiselayo kuzo zonke izifundo yabonwa ngokuhlukahluka kwemiphumela ezigabeni zokuluthwa. Ukwehluleka-kuphephile N Ukuhlaziya okwenzelwe idatha etholakalayo kuphakamise ukuqina kwamasayizi womphumela.

Sayizi osayizi bezindlela zokwelapha ezihlangene ekuphulukiseni nasekulandeleni

Ukungenelela okuhlanganisiwe kwaqaliswa kuphela ekwelapheni i-IA neSA ngokusekelwe kumiklamo yokufunda yeqembu engaphakathi enikela ngosayizi omkhulu wesikhathi esifushane. Imininingwane yokulandelela ibitholakala kuphela kusigaba se-IA ekhiqiza usayizi omkhulu womphumela olinganayo. Ukuphakama kwe-heterogeneity kuzo zonke izifundo kwaqaphelelwa ukuncishiswa kobunzima bomhlaba wonke esigabeni se-IA; kepha ukwehluleka kuphephile N kubonise ukuqina kwesayizi womphumela.

Ukukhonjwa kwangaphandle ngenqubo esuswe esifundweni esisodwa kukhombisile ukuthi akukho mthelela wanoma yiluphi ucwaningo olulodwa emiphumeleni ephelele yokwelashwa kwengqondo, ekhemisi, nokwelashwa okuhlangene.

Kuhlolisisa umengameli

Ukuhlaziywa komengameli kwenziwa Imiphumela yokuhluka ngokwezigaba ekwakhiweni kwempilo yethulwe Ithebula 5.

Ithebula 5.Umengameli uhlaziya ngokuhlukahluka kwezigaba zazo zonke izinhlobo zemilutha, nemiphumela

		IA		SA		CB
Moderator	Umphumela wokuhluka	Qbet	p (Q)	Qbet	p (Q)	Qbet	p (Q)
Ukwelashwa kwengqondo
Uhlobo lokwelashwa kwengqondo (i-CBT vs. IT vs. enye)
	GS	4.24	0.120	4.50	0.105	0.34	0.945
	FR	0.11	0.947	15.67	^a	-	-
Imodi yokwelashwa (iqembu vs umuntu ngamunye vs.)
	GS	0.47	0.792	0.11	0.741^b	0.44	0.508^b
	FR	0.55	0.761	14.55	^b
Imodi yokulethwa (FTFT vs. SGT)
	GS	9.15		0.56	0.453	0.44	0.508
	FR	2.03	0.154	0.76	0.384	-	-
I-Comorbidity (D / A ifakiwe vs. ayifakiwe)
	GS	0.02	0.898	0.84	0.360	0.00	1.00
	FR	1.13	0.289	0.00	1.00	-	-
Ukuhlaziywa kwedatha (umphelelisi 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	-	-
I-EPHPP (1 = eqinile vs 2 = ngokulinganayo iqonde 3 = ukuqina kwangaphakathi okubuthakathaka)^d
	GS	1.14	0.285	2.24	0.134	0.02	0.903
	FR	1.94	0.164	0.53	0.466	-	-
Isiko (Amazwe aseAsia vs Western Western)
	GS	0.54	0.461	-	-	-	-
	FR	0.58	0.447	-	-	-	-
Uhlobo lwe-IA (global IA vs. IGD vs.)
	GS	1.63	0.653	-	-	-	-
	FR	4.21	0.122	-	-	-	-
Ukwelashwa ngamakhemikhali^e
Uhlobo lokwelashwa kwemithi (AD vs. exubekile noma okunye)
	GS	5.62	^f	0.09	0.765	0.65	0.421^g
I-Comorbidity (D / A ifakiwe vs. ayifakiwe)
	GS	0.73	0.392	-^h	-^h	0.22	0.642
Ukuhlaziywa kwedatha (umphelelisi vs. ITT)
	GS	0.00	1.00	0.76	0.383	4.89
I-EPHPP (1 = eqinile vs 2 = ngokulinganayo iqonde 3 = ukuqina kwangaphakathi okubuthakathaka)^d
	GS	0.47	0.493	-^h	-^h	2.52	0.112
Isiko (Amazwe aseAsia vs Western Western)
	GS	7.32		-	-	-	-
Uhlobo lwe-IA (global IA vs. IGD vs.)
	GS	7.32	ⁱ	-	-	-	-
Ukwelapha okuhlanganisiwe^e
Uhlobo lokwelashwa kwemithi (AD vs. exubekile noma okunye)
	GS	0.83	0.362^j	-	-	-	-
Uhlobo lokwelashwa kwengqondo (i-CBT vs. IT vs. enye)
	GS	20.81	^k	-	-	-	-
Imodi yokwelashwa kwengqondo (iqembu dhidi yomuntu ngamunye vs.)
	GS	0.29	0.592^b	-	-	-	-
I-Comorbidity (D / A ifakiwe vs. ayifakiwe)
	GS	0.00	1.00	-	-	-	-
Ukuhlaziywa kwedatha (umphelelisi vs. ITT)
	GS	0.00	1.00	-	-	-	-
I-EPHPP (1 = eqinile vs 2 = ngokulinganayo iqonde 3 = ukuqina kwangaphakathi okubuthakathaka)^d
	GS	6.06		-	-	-	-
Isiko (Amazwe aseAsia vs Western Western)
	GS	0.83	0.362	-	-	-	-
Uhlobo lwe-IA (global IA vs. IGD vs.)
	GS	6.06	ⁱ	-	-	-	-

Note. A = ukukhathazeka; I-AD = antidepressants; I-CB = ukuthenga okuphoqayo; I-CBT = ukwelashwa kokuziphatha kwengqondo; D = ukudangala; I-EPHPP = Iphrojekthi Yokuzijwayeza Impilo Yomphakathi esebenzayo (ithuluzi lokuhlola ikhwalithi lezifundo zobungako); GS = ubulukhuni bembulunga yonke; FR = imvamisa; I-FTFT = ukwelashwa kobuso nobuso; IA = umlutha we-inthanethi; IGD = ukuphazamiseka kwemidlalo ye-inthanethi; I-IT = ukwelashwa okuhlanganisa; I-ITT = inhloso yokuphatha ukuhlaziywa; I-Qbet = i-homogeneity yezibalo ngomehluko phakathi kwamaqembu amancane; SA = umlutha wobulili; I-SGT = ukwelashwa okuqondiswa ngokwakho.

^aI-CBT: g = 0.98; I-95% CI [0.83, 1.13]; p ≤ 0.001; IT: g = 0.25; I-95% CI [−0.08, 0.58]; p = 0.132; Ezinye izindlela zokwelapha (ie, zokwamukela nokwelashwa kokuzibophezela): g = 0.80; I-95% CI [0.51, 1.10]; p ≤ 0.001.

^bUkuhlaziywa komengameli kufake amaqoqo amancane amabili kuphela (iqembu vs umuntu ngamunye).

^cIzifundo kuphela ezazikhombisa uhlobo lokuhlaziywa kwedatha ezifakiwe kulokuhlaziya (bheka Ithebula 1).

^dUkuhlaziywa komengameli kufake ama-subgroups amabili kuphela (2 = ngokulinganisela; 3 = abuthakathaka).

^eUmengameli uhlaziya nge-“frequency” eguquguqukayo yemiphumela ayizange iqhutshwe ngenxa yenani elanele lezifundo.

^fUkuhlaziywa komengameli kufake phakathi ama-subgroups amabili kuphela (i-AD vs. eminye imithi [ie, methylphenidate, atomoxetine]).

^gUkuhlaziywa komengameli kufake phakathi ama-subgroups amabili kuphela (i-AD vs. eminye imithi [ie, memantine]).

^hImiphumela yokuhlaziywa komengameli ayizange ihunyushwe, ngoba isifundo esisodwa kuphela esisele kwelinye lamaqembu amancane amabili.

ⁱUkuhlaziywa komengameli kufake ama-subgroups amabili kuphela (IA vs. IGD).

^jUkuhlaziywa komengameli kufake ama-subgroups amabili kuphela (i-AD vs. exubile).

^kUkuhlaziywa komengameli kufake kuphela ama-subgroups amabili (i-CBT kanye nezinye izindlela zokwelapha [ie, uhlelo lwemfundo]).

Ubungako bemiphumela kuzo zonke izinhlobo zokuluthwa kanye nokungenelela buhlala bungasasebenzi ngekhwalithi yezifundo, ukubonakala kokudangala kanye nokukhathazeka, kanye nonyaka wokushicilelwa (IA: ubulukhuni bembulunga yonke: β = -0.02; SE = 0.03; p = 0.417; imvamisa: β = -0.09; SE = 0.05; p = 0.075; SA: ubulukhuni bembulunga yonke: β = -0.03; SE = 0.04; p = 0.519).

Ngokuqondene ne-IA, kutholakale amasayizi amakhulu womphumela we-FTFTs ngokuqhathaniswa ne-SGTs, nokungenelela kufaka inani eliphakeme lamahora ekwelashweni ukwehliswa kobunzima bomhlaba (β = 0.04; SE = 0.01; p <0.01) nobuningi (β = 0.03; SE = 0.009; p <0.01). Ekwehliseni ubunzima bembulunga yonke ezifundweni zemithi, ubukhulu obukhulu bomphumela buqhamuka kuma-anti-depressants uma kuqhathaniswa namanye ama-ejenti amakhemikhali (okungukuthi, i-methylphenidate, i-atomoxetine), kulabo abasebenza kwamanye amazwe uma kuqhathaniswa namazwe ase-Asia, nokuhlola i-IA yomhlaba jikelele kuqhathaniswa ne-IGD ne-smart phone umlutha.

Ngokuphathelene ne-SA, i-CBT nokunye ukwelashwa kwengqondo (ie, ukwamukelwa nokwelashwa kokuzibophezela) kukhombise ithuba ngaphezulu kokungenelela okuhlanganayo nokwelulekwa ngakunye ngezilungiselelo zeqembu zokunciphisa imvamisa. Ngaphakathi kwesigaba se-CB, izivivinyo zamakhemikhali kusetshenziswa ukuhlaziya komhlanganisi kukhiqize osayizi omkhulu womphumela kunalezo ezincike ekuhlaziyweni kwe-ITT maqondana nokwehliswa kobunzima bomhlaba.

Ukuhlaziywa komengameli ezindleleni zokwelapha ezihlangene kwenziwa kuphela kwesigaba se-IA. Imiphumela ikhombisile ukuthi amasayizi amakhulu womphumela ahambisana nezinhlanganisela ze-CBT, izivivinyo ezisezingeni eliphansi, kanye nalabo abahlola i-IA yomhlaba.

Ukwelashwa okuhambisana nokukhubazeka kwengqondo vs.

Ngokuphathelene ne-IA, ukwelashwa okuhlangene kukhiqize amasayizi amakhulu womphumela kuqhathaniswa nokungenelela kwengqondo nokwelashwa ekwehliseni ukudonsa kobukhulu bomhlaba (ngokwengqondo nangokwengqondo kuhlangene: Q_Phakathi = 7.80, p <0.01; kwemithi vs. kuhlangene: Q_Phakathi = 14.69, p <0.001), kanye nemvamisa (ngokwengqondo uma kuqhathaniswa: Q_Phakathi = 8.73, p <0.01; kwemithi vs. kuhlangene: Q_Phakathi = 63.02, p <0.001). Imiphumela engabalulekile yatholakala phakathi kobukhulu bomphumela wokwelashwa okumsulwa ngokwengqondo nangokwemithi (ubunzima bomhlaba jikelele: p = 0.173; imvamisa: p = 0.492). Uma kucatshangelwa i-CB, ukwelashwa ngamakhemikhali kukhombise ukuthi kunenzuzo ngaphezulu kwezindlela zokwelapha zokwehliswa kobunzima bomhlaba (Q_Phakathi = 5.45, p <0.05). Awukho omunye umehluko ophawulekayo phakathi kwezinhlobo zokwelashwa obonwayo.

Umehluko phakathi kwezigaba zokulutha

Ukuqhathaniswa kwesayizi womphumela kuzo zonke izigaba zomlutha kuveze imiphumela engemihle maqondana nokungenelela kwengqondo (ubulukhuni bembulunga yonke: p = 0.174; imvamisa: p = 0.559) nokungenelela kukhemithi (ubulukhuni bembulunga yonke: p = 0.203; imvamisa: p = 0.389).

Ingxoxo

Inhloso yaleli phepha bekuwukuphenya ukusebenza kwezokwelapha okuphathelene nokwelashwa, ubuchopho kanye nokuhlangene kwe-IA, SA ne-CB kanye nokukhomba ababikezeli bezomphumela ongaba khona. Ngaphezu kwalokho, ukuqhathanisa phakathi kwezinhlobo ezintathu zama-BAs ngokusekelwe osayizi womphumela wokwelashwa kwengqondo nokwelashwa kuye kwenziwa okokuqala, ngenhloso eyengeziwe yokudweba ukufana kokugembula okungahambisani nama-SUD ngokuya ngempendulo yokwelashwa.

Sithole ukuthi ukwelashwa kwengqondo kwehlise ngempumelelo ubulukhuni bomhlaba kanye nokuvama kwe-IA neSA ngokuphendula kokulashwa kugcinwa isikhathi eside. Kwa-CB, ukwelashwa kwengqondo kubuye kuhlotshaniswe nokwehliswa okukhulu kwesilinganiso sangaphambi kokulandela nokulandelwa kokulandelana kobunzima bomhlaba. Izinzuzo ezinkulu nezilinganiselwe zesikhashana esifushane ngokuya ngazo zombili izinto eziguquguqukayo zaqinisekiswa kumiklamo yokutadisha elawulwayo, ikakhulukazi maqondana ne-IA nasezifundweni ngazinye ezigabeni zaseSA nase-CB. Le miphumela isebangeni elifanayo nalelo elitholakala kuma-meta-ukuhlaziywa ahlola ukwelashwa kwengqondo kokugembula okuphazamisekile (UCowlishaw et al., 2012; IGooding & Tarrier, ngo-2009; IGoslar, Leibetseder, Muench, Hofmann, & Laireiter, 2017; I-Leibetseder, i-Laireiter, i-Vierhauser, ne-Hittenberger, ngo-2011; UPallesen, uMitsem, uKvale, uJohnsen, noMolde, 2005) nama-SUD (I-Dutra et al., 2008; I-Tripodi, iBender, iLitschge, neVaughn, ngo-2010).

Yize i-CBT yayisetshenziswa kakhulu kuzo zozimbili izigaba zokulutha, izindlela ezahlukahlukene zengqondo zibonakale zisebenza ngokulinganayo ekunciphiseni indlela yokuziphatha enenkinga ngokungafani nangendlela yempatho futhi-ikakhulukazi maqondana ne-IA - isiko lesiko. Lokhu okutholakele kwehlukile kulokho okubikwe ekuhlolweni kwe-meta-yakamuva, okuthole ithuba le-CBT ngaphezu kwezinye izindlela zokwelapha zokunciphisa isikhathi esisetshenziswe online, ukwelulekwa umuntu ngamunye, kanye nezifundo ezenziwa e-US (I-Winkler et al., I-2013). Ukungafani, noma kunjalo, kungahle kubangelwe ukuthi ukucubungula komengameli kwenziwa lapho kufakwe phakathi kweqembu nokulawulwa kwemiphumela yosayizi kanye nokungezwa kwemiphumela yocwaningo lwakamuva kuhlaziyo lwethu lwe-meta. Kulezi, izindlela ezisetshenziswa kakhulu zazihlanganisa ukwelashwa komndeni, okuthe uma kubhekwa izimo ezahlukahlukene zokungasebenzi komndeni (isib. Schneider, King, & Delfabbro, 2017) avele anenzuzo hhayi kubadlali be-inthanethi abasebasha abayinkinga (isib, UHan, uKim, uLee, noRenshaw, 2012), kepha futhi nentsha ene-SUDs (isibuyekezo siyabona Amahlunga, Andersen, & Jørgensen, 2018). Ngokufanayo, izinhlelo zokucabanga ngokusetshenziselwa ukucabanga zifake isicelo ngempumelelo kwizimpawu ezithandekayo ze-IA (Li, Garland, et al., 2017) ne-CB (U-Armstrong, 2012), nokwelashwa nokwamukela ukuzinikela okwenzelwe ukwelapha i-SA (isib. ICrosby, 2012) zifakazelwe zibalulekile ukunciphisa izimpawu zokugembula okukhohlakele nama-SUDs (I-A-tjak et al., 2015; Li, Howard, Garland, McGovern, & Lazar, 2017; IMaynard, iWilson, iLabuzienski, neWhiting, i-2018). Izinhlelo ezihlanganayo, eziqukethe kakhulu izakhi ze-CBT, zikhiqize ngokufana usayizi omkhulu womkhawulo kuzo zontathu izigaba zokulutha, ngaphandle kokunciphisa imvamisa yezindlela zokuziphatha zocansi eziphoqelekile. Lo mphumela, noma kunjalo, wawususelwe esivivinyweni esisodwa esasihlukile kwabanye ngokusebenzisa i-Orzack Time Inventory Survey (OTIS; I-Orzack, 1999) avele "angahlanganisi ngokwanele" (I-Orzack, Voluse, Wolf, noHennen, 2006, k. 354) ukukala imvamisa yokusebenzisa kabi amakhompyutha. Ngoba U-Orzack et al. (2006) ukulethwa ukuphathwa kuzilungiselelo zeqembu, usayizi womphumela ophansi walolu cwaningo ubuye wabangela ukungahambi kahle kokusethwa kweqembu kuqhathaniswa nokwelulekwa umuntu ngamunye okugcizelela ukubaluleka kokusebenzisa amathuluzi wokulinganisa athembekile nasebenza (bheka futhi I-Hook, i-Reid, i-Penberthy, i-Davis, ne-Jennings, ngo-2014). Ngaphezu kwalokho, impendulo yokwelashwa ibonakala izimele kohlobo lokulethwa, ngaphandle kokukodwa: Ama-IA athintekile abantu abathola i-FTFTs babonakala sengathi bazuza kakhulu ekwelashweni kunalawo afakwe kuma-SGTs. Ama-SGTs asetshenziswa ekwelapheni i-IA, noma kunjalo, afaka inani eliphansi kakhulu lamaseshini kune-FTFTs. Ngakho-ke, ubude besikhathi sohlobo lokulethwa kungenzeka buvele kulokhu umehluko ophakathi kweqembu, kusekela imiphumela yokuhlaziywa kwe-meta kwakamuva (UGoslar et al., 2017) okukhombise ukuthi ama-SGTs amafushane angakhiqiza amazinga aphansi wokwenza ngcono kunokuqina okukhulu, nezinhlelo zokuzisiza ezihlelekile. Ubufakazi balokhu kutholwa bunikezwe ama-SGTs aqine kakhulu asetshenziswa ekwelapheni i-SA (UHardy, Ruchty, Hull, noHyde, 2010; ULevin, uHeninger, uPierce, noTwohig, 2017) ne-CB (UMueller, u-Arikian, de Zwaan, noMitchell, 2013), usayizi wokukhipha amandla uqhathaniswa nalawo atholakala kuma-FTFTs. Ngenxa yalokho, impumelelo yokwelashwa inyuke ngesikhathi sokusebenza kwengqondo, ikakhulukazi mayelana nokuncipha kobunzima bomhlaba kanye nobuningi be-IA. Umphumela ofanayo, kodwa ongasho lutho waphinde wabonwa ukuncishiswa kobunzima beNingizimu Afrika. Lokhu okutholakele kuhambelana nalokho okuvela ocwaningweni lwe-IA lwase-Asia (UChun et al., 2017), kanye nalokhu okutholakele kusuka ekugembeni okuchithiweUGoslar et al., 2017; I-Leibetseder et al., 2011; Pallesen et al., 2005), kuphakamisa ukuthi ukubonakaliswa kokuziphatha okuluthayo kudinga ukwelashwa okukhulu ukuze kufinyelelwe ukuthuthuka.

Njengokwelashwa kwengqondo, ukwelashwa ngamakhemikhali kukhombise ukwehla okukhulu kwangaphambi kokuthunyelwa kwezimpawu zempilo ezigabeni ezintathu zomlutha. Azikho iziphetho, noma kunjalo, ezingadonswa maqondana nokuqina kwempendulo yokwelashwa kanye nezinzuzo zesikhashana zemithi ngaphezulu kwe-placebo ngenxa yenani ledatha. Ngaphezu kwalokho, izivivinyo ezilawulwa yi-placebo ezenzelwe ukwelashwa kwe-SA ne-CB zazishayelwa uxhaso olwengeziwe njengokuxhumana nabantu bezokwelapha abajwayelekile kubandakanya ukubonakaliswa kokuziphatha okuyinkinga (Okumnyama, uGabel, uHansen, noSchlosser, 2000; UWainberg et al., 2006) noma amasu wokuhlangana njengokugcina idayari yezitolo (isib. I-Black et al., I-2000; UNinan et al., 2000) ukufaka isandla kokungafani okuncane phakathi kweqembu, nokufihla umphumela wabaphatheli bamakhemikhali (I-Black et al., I-2000; UNinan et al., 2000; UWainberg et al., 2006). Ukuqhathanisa, izinzuzo zesikhashana zesikhashana zemithi yokwelashwa ngamakhemikhali ngaphezulu kwe-placebo yokulwa nokugembula zazisezingeni eliphakathi (IGoslar, Leibetseder, Muench, Hofmann, & Laireiter, 2018), efana naleyo ebikwe inkinga yokusebenzisa kabi utshwala, nangezifo ezahlukahlukene zokwelapha kanye nokuphazamiseka kwempilo yengqondo (isib. UJonas et al., 2014; ULeucht, uHierl, uKissling, uDold, noDavis, ngo-2012).

Ukuhlaziywa komengameli akubonisanga umehluko obonakalayo phakathi kwezigaba zokwelashwa, kepha inzuzo yokwelashwa yokuncipha kobunzima bomhlaba wonke we-CB ibonakale idluliwe ngenxa yobukhulu bomthelela omkhulu osuselwa kubahlanganisi ababonwa kuzivivinyo ezimbili (Omnyama, Monahan, noGabel, 1997; UGrant, u-Odlaug, uMooney, u-O'Brien, noKim, ngo-2012) kuqhathaniswa nalezo ezitholakele kuhlaziyo lwe-ITT. Lezi zivivinyo ziphinde zanquma ukuphakama kwe-pharmacological ngaphezu kokwelashwa kwengqondo okwehliswa kokusekelwa kobunzima bomhlaba jikelele okusekela ukusetshenziswa kwe-ITT ukuhlaziywa, okubonisa indlela yezibalo ekhombisa izimo ezingokoqobo kumongo wezokwelapha (isib. ISedgwick, 2015). Ngaphakathi kwesigaba se-IA, abasebenza ngokudambisa izidakamizwa babonakala bephakeme kuneminye imithi. Ukuhlolisiswa kwale datha, nokho, kuveze ukuthi iqembu elingaphansi elithola ukwelashwa okuphezulu lithola abahlanganyeli abadala imbandezelo yokudangala, kanye nokuphazamiseka okubonakalayo okuphathwa nge-antidepressants, futhi kufaka phakathi isivivinyo ngosayizi omkhulu womphumela (g = 2.54; UDell'Osso et al., 2008). Iqembu elingaphansi ngenzuzo yokwehliswa yokwehliselwa, ifaka phakathi nentsha ene-comorbid ukunakwa kokungasebenzi kahle kwe-hyperactivity disorder (ADHD) ephathwe nge-psychostimulants (methylphenidate), futhi yayiqukethe isivivinyo ngosayizi womphumela ophansi kakhulu ohlola abantu abanobunzima obusezingeni eliphansi be-IA (g = 0.57; Han et al., 2009). Lokhu kwehluka kuthinte nabaphathi “amasiko” kanye no “IA hlobo”. Uma lezi zifundo ezimbili zisuswe ekuhlaziyeni komongameli, inzuzo yabasebenza ngokudambisa izidakamizwa, kanye nemiphumela ebalulekile yamomengameli "isiko", kanye nohlobo lwe-"IA". Yize ukwelashwa kuwo womabili la maqembu kube nemiphumela emihle, umehluko ubonakale uqhutshwa uvivinyo olulodwa. Ngakho-ke, ukusebenzisana phakathi kwe-ADHD eyenzeka ngokubambisana, ukwelashwa ngemithi, iminyaka, namasiko kudinga ukuphenywa uma kutholakala inani eliphakeme lezifundo. Ngaphandle kwe-comorbid ADHD, noma kunjalo, ukuthuthukiswa okucacile kokuphazamiseka kwakuzimele ekucindezelekeni kwe-comorbid nokukhathazeka, kusekela okutholakele ku-IA yangaphambilini (isib, UHan noRenshaw, ngo-2012) kanye nocwaningo lokugembula oluhlakazekile (ukubuyekeza ukubona IDowling, Merkouris, & Lorains, 2016).

Ngaphesheya kwezigaba ezintathu zokulutha, ikakhulukazi i-serotonin selectional reuptake inhibitors (ama-SSRIs) ihlolwe ngokuya ngobuningi obukhulu bokuphazamiseka kwemizwa ye-comorbid (isib, I-Kafka, i-1991) futhi-ikakhulukazi maqondana ne-SA — izakhiwo ezivimbelayo ze-serotonin ezenzweni zokuziphatha zocansi (isib. IKafka & Prentky, 1992). Abaphikisi be-opioid (isb, i-naltrexone) kanye nemithi ye-glutamatergic (isb., Topiramate) babebhekwa kuphela uma kwenziwa izifundo zokwelapha i-SA (isib. UGrant & Kim, 2001; IKhazaal neZullino, 2006) ne-CB (isb. Isibonelelo, 2003; IGuzman, Filomensky, & Tavares, 2007) okukhombisa imiphumela ezuzisayo Ngoba ama-opioid antagonists kanye nama-ejenti we-glutamatergic abonise izindlela ezinhle zokwelashwa zama-SUDs (UGuglielmo et al., 2015; UJonas et al., 2014; UMinarini et al., 2017) nokugembula okuhlakazekile (IBartley neBloch, 2013; UGoslar et al., 2018), lezi zinhlobo zezidakamizwa zibonakala zithembisa ukuthi ziphenywe ngemiklamo yokutadisha enkulukazi futhi elawulwayo, ikakhulukazi ekukhanyeni kwamanani aphezulu ama-SUDs we-comorbid abonwa kuma-BA (isb. U-Grant et al., I-2010).

Izindlela zokwelapha ezihlanganisiwe ze-IA, ikakhulukazi umuthi ohambisana ne-CBT, zikhiqize imiphumela yokuqeqeshwa ethuthukisiwe uma kuqhathaniswa nokungenelela okumsulwa kwengqondo nokwenziwa kosokhemikhali okusekela ukuncoma kokubuyekezwa kwakamuva kwezifundo zomphumela wokwelashwa kwe-IA (IPrzepiorka, iBlachnio, iMiziak, neCzuczwar, 2014). Ukuphakama kwenhlanganisela ye-CBT ngaphezu kwaleyo ehlanganiswe namanye amasu wengqondo bekucatshangwa ukuthi kususelwa esivivinyweni esisodwa esinikeza usayizi womphumela omkhulu kakhulu (g = 5.31; UYang, Shao, noZheng, 2005), okuthinta futhi omengameli "ikhwalithi" kanye "nohlobo lwe-IA". Ngalolu cwaningo olususwe ekuhlolweni kweqembu elingaphansi, noma kunjalo, inzuzo yezinhlanganisela ze-CBT kuphela esele ibalulekile.

Yize ulwazi oluningi lunikezwe yizifundo zokuphathwa kokulashwa kwe-IA, futhi imininingwane evela ekuvivinyweni okulawulwayo isanqunyelwe, izindlela ezingokwengqondo nezekhemisi zibonise imiphumela emihle yesikhathi esifushane kuzo zontathu izimo, okuqhathaniswa nalokho okusetshenziselwe ukusetshenziswa kwezidakamizwa nokugembula okuphazamisekile (isib, UGoslar et al., 2017; U-Grant et al., I-2010) ukusekela imibono yethu. Lokhu okutholakele akwanele ukucacisa ukuhlukaniswa kwe-IA, SA ne-CB ngaphakathi kwesibalo sokuphazamiseka kwengqondo ngenxa yokushoda kokuqinisekiswa kwemibandela yokuxilonga, kanye nemininingwane yokulinganiselwa yezifo, ufuzo kanye ne-neurobiological (isib. U-Grant et al., I-2010). Kodwa-ke, baphakamisa ukuthi, abantu ngabanye baphendula ngendlela efanayo ekwelashweni kungakhathalekile ukuthi hlobo luni lomlutha. Le miphumela ifanelana kahle namamodeli wokuqagela wokuphazamiseka umlutha osungula izindlela ezivamile zokucekeleka kuzo zombili izifo ezihlobene nezinto kanye nama-BA (Griffiths, i-2005; UJacobs, 1986; I-Orford, 2001; Shaffer et al., 2004), ezingashintshwa ngokusebenzisa ukwelashwa kwengqondo nokwelapha (Potenza et al., 2011). Ekukhanyisweni kokusebenza kokuphazamiseka kokuqala kanye nemibuthano yomvuzo ngesikhathi sokusetshenziswa okungapheli kwezidakamizwa nokuziphatha (isib. I-Nestler, i-2005), ukwelashwa kwengqondo, ikakhulukazi izinketho ezenzelwe i-CBT, zinamandla okuguqula ukuqonda okungasebenzi kahle nokuziphatha okungahambi kahle (UKim noHodgins, 2018), kanye nokuqinisa izindlela zokuzithiba ngokuqondisa izindawo zobuchopho bangaphambili (Potenza et al., 2011). Ukwelapha ngamakhemikhali, nakho, kuhlose ukunciphisa izimpawu zokufisa nokuhoxisa ngokuqondisa izindlela zomvuzo nezinhlelo ze-neurotransmitter (Potenza et al., 2011). Ngaphezu kwalokho, njengoba kubhekelwa ekwelashweni kwe-IA, inhlanganisela ye-CBT kanye nokwelashwa kwemithi kungenzeka ibe nomphumela wokungezelela, yize ukusebenzisana phakathi kwalaba bobabili kungakacaci (Potenza et al., 2011).

Ukulinganiselwa okulandelayo kufanele kuqashelwe: Okokuqala, njengoba kunjalo ngokubuyekezwa okuningi kwe-meta-anal, izifundo ezifakiwe ziyehluka ngekhwalithi yendlela yazo, yize ngenkathi zibhekelelwa ngokwezibalo, asizange siwubone umbandela ohleliwe osayizi wokuphumela ngenxa yokungafani kwekhwalithi wezifundo. Akekho noyedwa ocwaningweni, owathola isilinganiso esiphakeme kakhulu sibonisa ikhwalithi ekhawulelwe yobufakazi maqondana nokukhethwa kokukhetha futhi-ngenxa yokulungiswa kwemiklamo yokutadisha yeqembu-ekuboneni nasekulawuleni kwabangqungqa, kanye nokuphuphuthekisa. Ngakho-ke, ama-RCT enzelwe ngokuqinile ayadingeka, kufaka phakathi ukuqapha ukwesekelwa okwengeziwe kwengqondo kanye nemininingwane yokulandela, ikakhulukazi maqondana novivinyo lwe-pharmacological. Ngaphezu kwalokho, izifundo eziningi ze-IA zifaka phakathi izindlela zokuziphatha ezahlukahlukene ezenziwa nge-inthanethi (isib. Imidlalo yokudlala online, ukubukwa kwezithombe zocansi), yize ucwaningo lukhombisa umehluko phakathi komqondo ojwayelekile we-IA nezinhlobo ezithile zokuziphatha okuluthayo okuqhutshwa yi-inthanethi (I-Montag et al., 2015). Kodwa-ke, sizamile ukunqoba le nkinga ngokuhlela izifundo ngokwezifiso ezithile, kungakhathalekile ukuthi isetshenziswa kanjani. Ngokuphathelene nokuphazamiseka okwenzeka ngokubambisana, umengameli ongumkhawulo uhlaziya ukudana nokukhathazeka hhayi kuphela ngenxa yokuxhaphaka kwabo phakathi kokulutha kokuziphatha (isib. I-Starcevic neKhazaal, 2017), kodwa futhi ngoba le datha ibikhonjwa ngokusobala kusuka kumbandela wokukhishwa kwezifundo zokuqala. Njengoba ezinye izimo zivame ukuhlangana nama-BA (isib, U-Grant et al., I-2010), futhi impendulo yokwelashwa ingathonywa uhlobo lwe-comorbidity (I-Dowling et al., 2016), ezinye izifundo ziyagqugquzelwa ukuthi zibike ngokuhlelekile izinhlobo namazinga wokuphazamiseka okwenzeka ndawonye ukuze kuhlaziywe lolu lwazi ekuhlaziyeni kweMeta okuzayo. Iningi lezifundo liphinde lahluleka ukuhlinzeka ngemininingwane yokuthi ukutholwa kutholakale kanjani. Imodi yokunquma ukutholwa, noma kunjalo, ingaba nomthelela ekuvumeni kwabo (UCarlbring et al., 2002; bona futhi I-Andersson & Titov, 2014). Ucwaningo lwekusasa kufanele-ke lubike ukuthi ngabe ukutholwa kutholwe yini odokotela, ukuzichaza ngokwakho, ubuso nobuso, noma i-inthanethi. Ngaphezu kwalokho, izifundo zesikhathi esizayo zikhuthazwa ukuthi ziqhathanise ngqo umthelela wokwelashwa kwabantu abane-BAs ne-SUDs ukuze kuphenywe ukufana kanye nomehluko phakathi kwama-BA ahlobene nezidakamizwa nokuhlobene nezidakamizwa ngokuya ngempendulo yokwelashwa.

Ngaphandle kwalokhu kukhawulelwa, imiphumela yokuhlaziywa kwe-meta yamanje iphakamisa ukuthi ukungenelela okuningi kwengqondo kuyasebenza ukunciphisa izimpawu ze-IA, ikakhulukazi lapho zilethwe ubuso nobuso futhi ziqhutshwa isikhathi eside. Yize ama-antidepressants kanye nama-psychostimulants abantu abane-ADHD eyenzeka ngokubonakalayo bethuthukisa izimpawu ze-IA, i-CBT ehlanganiswe nama-antidepressants ikhombisile ithuba ngaphezulu kwezikhathi zokuphathwa kabi. Ngokusekelwe esimweni sokucwaninga samanje, i-CBT kanye nama-antidepressants abonakala ephumelela ekwelapheni i-SA ne-CB. Ngokunikezwa kwesidingo sokwelashwa, ucwaningo lwe-neurobiological kufanele luqhubeke ukuze kubonakale ukufana phakathi kokuphazamiseka okuhlobene nezinto nokuziphatha okungaba umlutha, futhi kuthuthukiswe nokwelashwa kwalezi zimo zokukhubazeka (U-Grant et al., I-2010; Potenza et al., 2011).

Imithombo yokuxhasa ngezimali

Lolu cwaningo aluzange luthole ukuxhaswa okuqondile kwezezimali kunoma yiziphi izinhlangano ezixhasa ngemali zomphakathi, ezentengiso, noma ezingenzi inzuzo.

Umnikelo wombhali

UMartina Goslar waphenya ngezincwadi, wakhipha imininingwane futhi wenza lokho okuhlaziya. Amaphepha okufakwa ekuhlaziyeni kwe-meta ahlolwe nguMartina Goslar noMax Leibetseder naye okuqinisekisile ukukhishwa kwedatha. U-Anton-Rupert Laireiter waqondisa lezi zinqubo. UMartina Goslar noMax Leibetseder balinganisele iqiniso lezifundo. UHannah M. Muench wasekela ukuhlanganiswa kwemininingwane futhi wanikeza izeluleko zezibalo. Umbhalo wesandla wabhalwa nguMartina Goslar ngamazwana anikezwe nguHana M. Muench, u-Anton-Rupert Laireiter, noStefan G. Hofmann. Bonke ababhali bafake isandla futhi bavumela umbhalo wesandla wokugcina.

Ukungqubuzana kwesithakazelo

UMartina Goslar umemezela ukuthi akukho kungqubuzana kwezintshisekelo. UMax Leibetseder umemezela ukuthi akanakho ukungqubuzana kwenzalo. UHana M. Muench umemezela ukuthi akanangxabano yezintshisekelo. UDkt Hofmann uthola ukwesekwa ngokwezimali yi-Alexander von Humboldt Foundation (njengengxenye yomklomelo kaHumboldt), NIH / NCCIH (R01AT007257), NIH / NIMH (R01MH099021, U01MH108168), kanye neJames S. McDonnell Foundation 21^st I-Century Science Initiative ekuqondeni ukuqonda komuntu - Initiative Special. Uthola isinxephezelo ngomsebenzi wakhe njengomhleli weSpringer Nature kanye ne-Association for Psychological Science, nanjengomeluleki ovela kuPalo Alto Health Sciences kanye nomsebenzi wakhe wokuba yi-Subject Matter Expert ovela kuJohn Wiley & Sons, Inc. kanye naseSilverCloud Health, Inc Uthola nemali etholakalayo kanye nezinkokhelo zomsebenzi wakhe wokuhlela kubashicileli abehlukahlukene. U-Anton-Rupert Laireiter umemezela ukuthi akanakho ukungqubuzana kwezintshisekelo.

Ukuvuma

Abalobi bafisa ukubonga uNkk. Xuan Wang noNkk Yang Zhang ohumushe izincwadi zesiShayina.

isithasiseloAmafomula Wokubalwa Kwezinsuku Zokusebenza Kwemphumela

Ukubala usayizi weqembu lamaqembu angaphakathi, kusetshenziswe amafomula alandelayo (UBorenstein et al., 2005, 2009):

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

kanjalo Y¯¯¯1 khombisa isisho sokuzenzisa, Y¯¯¯2 kukhombisa inchazelo yangemva kokulashwa, S_Umehluko kukhombisa ukuphambuka okujwayelekile komehluko, futhi r kukhombisa ukuhlangana phakathi kwezikolo zangaphambi kokuthola nokwelashwa. Ngenxa yobukhulu besampula encane, bonke osayizi bomphumela balungiswa ngokuchema kusetshenziswa amaHedges's g okwakukhonjwe ngokuphindaphindeka d ngesici sokulungiswa

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

kanjalo df imele amabanga wenkululeko ukulinganisa ukuphambuka okujwayelekile kweqembu. Lawa mafomula asetshenziselwa futhi ekubalweni kwamasayizi wemiphumela ukusuka ku-pretreatment kuya ekulandelweni kwamuva. Amasayizi womphumela olawulwayo ahlanganiswe kusetshenziswa ifomula elandelayo:

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

kanjalo Δ ¯¯¯¯ yilokho okusho ukuthi ngaphambi koshintsho lwangemva kokulashwa, SD ukuchezuka okujwayelekile kwezikolo zokwelashwa ngemuva, n usayizi wesampula, i-TREAT ibhekisa esimweni sokwelashwa esisebenzayo, futhi i-CONT ibhekisa esimweni sokulawula. Ukulandela I-Rosenthal (i-1991), silinganise ukuthi ukuhlangana kwangaphambi kokuthunyelwe kufanele kube r = 0.70.

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Ukwelashwa komlutha we-inthanethi, umlutha wobulili nokuthenga okuphoqayo: Ukuhlaziywa kwe-meta (2020)

abstract

Ingemuva futhi ihlose

izindlela

Imiphumela

Ingxoxo Neziphetho

izindlela

Indlela yokufaneleka

Imithombo yolwazi nokusesha izincwadi

Imiphumela yokwenza

Ukukhetha okufundwayo

Inqubo yokuqoqa idatha nokukhipha idatha

Ubungozi bokukhetha ezifundweni ngazinye

Ukubala usayizi womthelela kanye nokuqanjwa kwedatha yokulinganisa

Ubungozi bokukhetha kuzo zonke izifundo

Ukuhlaziywa komengameli

Imiphumela

Ukukhetha okufundwayo

Izici zokucwaninga, zokwelapha, kanye nababambiqhaza

Ubungozi bokukhetha ngaphakathi kwezifundo

Ukuqondaniswa kwemiphumela kanye nengozi yokucashelwa kuzo zonke izifundo

Sayizi osayizi bezindlela zokwelapha ezingokwengqondo ngemuva kokulashwa nokulandela

Umphumela osayizi bezindlela zokwelapha ezilandela ukwelashwa lapho ululama futhi ulandela

Sayizi osayizi bezindlela zokwelapha ezihlangene ekuphulukiseni nasekulandeleni

Kuhlolisisa umengameli

Ukwelashwa okuhambisana nokukhubazeka kwengqondo vs.

Umehluko phakathi kwezigaba zokulutha

Ingxoxo

Imithombo yokuxhasa ngezimali

Umnikelo wombhali

Ukungqubuzana kwesithakazelo

Ukuvuma

Okubhekwayo

Izinkomba ezifakwe ku-Meta-Analysis

ezisheshayo