Cognitive behavior therapy for schizophrenia: Effect sizes, clinical models, and methodological rigor
Cognitive behavior therapy for schizophrenia: Effect sizes, clinical models, and methodological rigor
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DOI：
10.1093/schbul/sbm114
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发表时间：
2008-05-01
影响因子：
6.6
通讯作者：
Tarrier, Nicholas
中科院分区：
文献类型：
--
作者：
Wykes, Til;Steel, Craig;Tarrier, Nicholas
背景：美国和英国的指南已将认知行为疗法（CBTp）作为首选治疗方法。但最近的进展已将CBTp的靶点扩大到其他症状，并有不同的提供方法，例如在群体中。目的：探讨当前CBTp试验的效应大小，包括靶向和非靶向症状、作用方式和方法学严谨性的影响。方法：采用34项CBTp试验的公开数据作为源数据，采用临床试验评估量表（CTAM）对试验方法学的影响进行meta分析和调查。结果：对目标症状有总体有益效果（33项研究，效应值= 0.400[95%可信区间{CI} = 0.252, 0.548]），对阳性症状（32项研究）、阴性症状（23项研究）、功能（15项研究）、情绪（13项研究）和社交焦虑（2项研究）有显著效果，效应范围为0.35 ~ 0.44。然而，这对绝望感没有影响。一个领域的进步与其他领域的进步是相关的。在评价者意识到分组分配的试验中，其效应大小约为50%-100%。但是严格的CBTp研究显示了益处（估计效应值= 0.223;95% CI = 0.017, 0.428），尽管应该注意到CI的下限。次要结果（如阴性症状）也受到影响，因此在方法学上充分的研究组中，效应量不显著。结论：与其他荟萃分析一样，CBTp对阳性症状有有益作用。然而，没有试图掩盖群体分配的心理治疗试验可能有夸大的效应值。作为心理治疗指导的证据应该考虑到具体的方法学细节。
Background: Guidance in the United States and United Kingdom has included cognitive behavior therapy for psychosis (CBTp) as a preferred therapy. But recent advances have widened the CBTp targets to other symptoms and have different methods of provision, eg, in groups. Aim: To explore the effect sizes of current CBTp trials including targeted and nontargeted symptoms, modes of action, and effect of methodological rigor. Method: Thirty-four CBTp trials with data in the public domain were used as source data for a meta-analysis and investigation of the effects of trial methodology using the Clinical Trial Assessment Measure (CTAM). Results: There were overall beneficial effects for the target symptom (33 studies; effect size = 0.400 [95% confidence interval {CI} = 0.252, 0.548]) as well as significant effects for positive symptoms (32 studies), negative symptoms (23 studies), functioning (15 studies), mood (13 studies), and social anxiety (2 studies) with effects ranging from 0.35 to 0.44. However, there was no effect on hopelessness. Improvements in one domain were correlated with improvements in others. Trials in which raters were aware of group allocation had an inflated effect size of approximately 50%-100%. But rigorous CBTp studies showed benefit (estimated effect size = 0.223; 95% CI = 0.017, 0.428) although the lower end of the CI should be noted. Secondary outcomes (eg, negative symptoms) were also affected such that in the group of methodologically adequate studies the effect sizes were not significant. Conclusions: As in other meta-analyses, CBTp had beneficial effect on positive symptoms. However, psychological treatment trials that make no attempt to mask the group allocation are likely to have inflated effect sizes. Evidence considered for psychological treatment guidance should take into account specific methodological detail.