The Effectiveness of Virtual Reality Exposure-Based Cognitive Behavioral Therapy for Severe Anxiety Disorders, Obsessive-Compulsive Disorder, and Posttraumatic Stress Disorder: Meta-analysis.
The Effectiveness of Virtual Reality Exposure-Based Cognitive Behavioral Therapy for Severe Anxiety Disorders, Obsessive-Compulsive Disorder, and Posttraumatic Stress Disorder: Meta-analysis.
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DOI：
10.2196/26736
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发表时间：
2022-02-10
影响因子：
7.4
通讯作者：
Batelaan N
中科院分区：
文献类型：
--
作者：
van Loenen I;Scholten W;Muntingh A;Smit J;Batelaan N
近年来，基于虚拟现实的认知行为疗法（VRE-CBT）在（亚临床）焦虑症中显示出良好的治疗效果，似乎是常规认知行为疗法（CBT）中体内暴露的良好替代方案。然而，之前关于VRE-CBT对焦虑症疗效的荟萃分析包括了对特定恐惧症和阈下焦虑的研究;因此，这些结果可能无法推广到更严重和致残性焦虑症患者。我们研究的目的是确定VRE-CBT对更严重的焦虑症的疗效，不包括特定恐惧症和阈下焦虑症。将进行荟萃分析，以检查VRE-CBT与等待名单和常规CBT相比的疗效。我们的次要目标是检查疗效是否因焦虑症类型、招募类型和VRE-CBT类型（有或无常规CBT的虚拟现实暴露）而异。此外，还将比较VRE-CBT和CBT的磨损情况。通过PubMed、PsycINFO和Embase中的系统性文献检索，检索了截至2020年8月20日发表的研究。我们在随机效应模型中计算了条件之间差异的效应量（Hedges g）及其后测和随访测量的95% CI。进行了单独的荟萃分析，以比较VRE-CBT和CBT条件之间的磨损。共纳入16项试验，817例受试者。我们确定了VRE-CBT和等待列表条件之间的10个比较，以及VRE-CBT和CBT条件之间的13个比较。关于偏倚风险，关于随机序列生成、分配隐藏和选择性结局报告偏倚风险的信息通常缺失或不清楚。VRE-CBT与waitlist（nco=10）相比的平均效应量为中等且显著，有利于VRE-CBT（Hedges g=-0.490，95%CI-0.82 to-0.16; P=.003）。与CBT相比，VRE-CBT的平均效应量（nco=13）较小且不显著，有利于CBT（Hedges g=0.083，95% CI −0.13至0.30; P= 0.45）。VRE-CBT和CBT之间的脱落率（nco=10）无显著差异（比值比0.79，95% CI 0.49-1.27; P= 0.32）。没有迹象表明存在小的研究效应或发表偏倚。我们的研究结果表明，VRE-CBT比waitlist更有效，在治疗更严重的焦虑症时与CBT一样有效。因此，VRE-CBT可能被认为是CBT的一种有前途的替代方案，用于更严重的焦虑症患者。需要更高质量的随机对照试验来验证这些发现的可靠性。
In recent years, virtual reality exposure–based cognitive behavioral therapy (VRE-CBT) has shown good treatment results in (subclinical) anxiety disorders and seems to be a good alternative to exposure in vivo in regular cognitive behavioral therapy (CBT). However, previous meta-analyses on the efficacy of VRE-CBT on anxiety disorders have included studies on specific phobias and subthreshold anxiety; therefore, these results may not be generalizable to patients with more severe and disabling anxiety disorders. The objective of our study is to determine the efficacy of VRE-CBT on more severe anxiety disorders, excluding specific phobias and subthreshold anxiety disorders. Meta-analyses will be conducted to examine the efficacy of VRE-CBT versus waitlist and regular CBT. Our secondary objectives are to examine whether the efficacy differs according to the type of anxiety disorder, type of recruitment, and type of VRE-CBT (virtual reality exposure either with or without regular CBT). Furthermore, attrition in VRE-CBT and CBT will be compared. Studies published until August 20, 2020, were retrieved through systematic literature searches in PubMed, PsycINFO, and Embase. We calculated the effect sizes (Hedges g) for the difference between the conditions and their 95% CIs for posttest and follow-up measurements in a random effects model. A separate meta-analysis was performed to compare attrition between the VRE-CBT and CBT conditions. A total of 16 trials with 817 participants were included. We identified 10 comparisons between VRE-CBT and a waitlist condition and 13 comparisons between VRE-CBT and a CBT condition. With regard to risk of bias, information on random sequence generation, allocation concealment, and risk of bias for selective outcome reporting was often absent or unclear. The mean effect size of VRE-CBT compared with waitlist (nco=10) was medium and significant, favoring VRE-CBT (Hedges g=−0.490, 95% CI −0.82 to −0.16; P=.003). The mean effect size of VRE-CBT compared with CBT (nco=13) was small and nonsignificant, favoring CBT (Hedges g=0.083, 95% CI −0.13 to 0.30; P=.45). The dropout rates between VRE-CBT and CBT (nco=10) showed no significant difference (odds ratio 0.79, 95% CI 0.49-1.27; P=.32). There were no indications of small study effects or publication bias. The results of our study show that VRE-CBT is more effective than waitlist and as effective as CBT in the treatment of more severe anxiety disorders. Therefore, VRE-CBT may be considered a promising alternative to CBT for patients with more severe anxiety disorders. Higher-quality randomized controlled trials are needed to verify the robustness of these findings.
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