How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence
How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence
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DOI：
10.1002/wps.20346
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发表时间：
2016-10-01
期刊：
影响因子：
73.3
通讯作者：
Huibers, Marcus J. H.
中科院分区：
文献类型：
--
作者：
Cuijpers, Pim;Cristea, Ioana A.;Huibers, Marcus J. H.
我们报告了目前对认知行为疗法（CBT）治疗重度抑郁症（MDD）、广泛性焦虑症（GAD）、恐慌症（PAD）和社交焦虑症（SAD）效果的最佳估计，同时考虑了发表偏倚、试验质量和等候名单对照组对结果的影响。在我们的荟萃分析中，我们纳入了随机试验，比较CBT与对照条件（等候名单、照旧护理或药丸安慰剂）在重度抑郁症、广泛性焦虑症、PAD或SAD的急性治疗中，基于结构化访谈诊断。我们发现144个纳入的试验（184个比较）对所有四种疾病的总体影响都很大，从MDD的g=0.75到GAD的g=0.80， PAD的g=0.81， SAD的g=0.88。发表偏倚主要影响GAD（调整g=0.59）和MDD（调整g=0.65）的CBT结果，但对PAD和SAD没有影响。只有17.4%的纳入试验被认为是高质量的，这主要影响PAD （g=0.61）和SAD （g=0.76）的结果。超过80%的焦虑障碍试验使用了等候名单控制组，少数使用其他控制组的研究表明，CBT的效果要小得多。我们的结论是，CBT可能有效治疗重度抑郁症、广泛性焦虑症、PAD和SAD；当对照条件是等待名单时，效果很大，但当常规护理或药丸安慰剂时，效果很小到中等；而且，由于高质量的试验数量较少，这些影响仍然不确定，应该谨慎考虑。
We report the current best estimate of the effects of cognitive behavior therapy (CBT) in the treatment of major depression (MDD), generalized anxiety disorder (GAD), panic disorder (PAD) and social anxiety disorder (SAD), taking into account publication bias, the quality of trials, and the influence of waiting list control groups on the outcomes. In our meta-analyses, we included randomized trials comparing CBT with a control condition (waiting list, care-as-usual or pill placebo) in the acute treatment of MDD, GAD, PAD or SAD, diagnosed on the basis of a structured interview. We found that the overall effects in the 144 included trials (184 comparisons) for all four disorders were large, ranging from g=0.75 for MDD to g=0.80 for GAD, g=0.81 for PAD, and g=0.88 for SAD. Publication bias mostly affected the outcomes of CBT in GAD (adjusted g=0.59) and MDD (adjusted g=0.65), but not those in PAD and SAD. Only 17.4% of the included trials were considered to be high-quality, and this mostly affected the outcomes for PAD (g=0.61) and SAD (g=0.76). More than 80% of trials in anxiety disorders used waiting list control groups, and the few studies using other control groups pointed at much smaller effect sizes for CBT. We conclude that CBT is probably effective in the treatment of MDD, GAD, PAD and SAD; that the effects are large when the control condition is waiting list, but small to moderate when it is care-as-usual or pill placebo; and that, because of the small number of high-quality trials, these effects are still uncertain and should be considered with caution.