The effects of cognitive behavior therapy for adult depression on dysfunctional thinking: A meta-analysis
The effects of cognitive behavior therapy for adult depression on dysfunctional thinking: A meta-analysis
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DOI：
10.1016/j.cpr.2015.08.003
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发表时间：
2015-12-01
影响因子：
12.8
通讯作者：
Cuijpers, Pim
中科院分区：
文献类型：
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作者：
Cristea, Ioana A.;Huibers, Marcus J. H.;Cuijpers, Pim
背景：目前尚不清楚认知行为疗法（CBT）是否通过改变功能失调的思维而起作用。虽然有几项初步研究调查了CBT对功能障碍思维的影响，但尚未进行meta分析。方法：我们检索了比较CBT治疗成人抑郁症与对照组或其他治疗方法的随机试验，并报告了功能障碍思维的结果。我们分别计算了CBT与对照组的效应量，以及CBT与其他心理疗法和药物疗法的效应量。结果：26项研究共纳入2002例患者符合纳入标准。研究的质量并不理想。我们发现，与对照组相比，CBT对测试后功能障碍思维的影响中等（g = 0.50; 95% CI: 0.38-0.62），所使用的测量方法之间没有差异。这一结果在随访中保持不变（g = 0.46; 95% CI: 0.15-0.78）。对功能失调思维的影响和对抑郁症的影响之间有很强的联系。我们发现CBT和其他心理疗法之间没有显著差异（g = 0.17; p = 0.31），但功能失调态度量表的结果除外（g = 0.29）。CBT和药物治疗之间也没有差异（g = 0.04），尽管这一结果仅基于4项研究。讨论：虽然CBT对功能失调的想法有强大而稳定的影响，但这与其他心理疗法或药物疗法的效果没有显著差异。这一结果可以被解释为确认了认知变化在症状改变中的首要地位，无论它是如何获得的，以及支持功能失调思想只是治疗后改变的另一种症状的观点(C) 2015 Elsevier Ltd。版权所有。
Background: It is not clear whether cognitive behavior therapy (CBT) works through changing dysfunctional thinking. Although several primary studies have examined the effects of CBT on dysfunctional thinking, no meta-analysis has yet been conducted.Method: We searched for randomized trials comparing CBT for adult depression with control groups or with other therapies and reporting outcomes on dysfunctional thinking. We calculated effect sizes for CBT versus control groups, and separately for CBT versus other psychotherapies and respectively, pharmacotherapy.Results: 26 studies totalizing 2002 patients met inclusion criteria. The quality of the studies was less than optimal. We found a moderate effect of CBT compared to control groups on dysfunctional thinking at post-test (g = 0.50; 95% CI: 0.38-0.62), with no differences between the measures used. This result was maintained at follow-up (g = 0.46; 95% CI: 0.15-0.78). There was a strong association between the effects on dysfunctional thinking and those on depression. We found no significant differences between CBT and other psychotherapies (g = 0.17; p = 0.31), except when restrict in outcomes to the Dysfunctional Attitudes Scale (g = 0.29). There also was no difference between CBT and pharmacotherapy (g = 0.04), though this result was based on only 4 studies.Discussion: While CBT had a robust and stable effect on dysfunctional thoughts, this was not significantly different from what other psychotherapies or pharmacotherapy achieved. This result can be interpreted as confirming the primacy of cognitive change in symptom change, irrespective of how it is attained, as well as supporting the idea that dysfunctional thoughts are simply another symptom that changes subsequent to treatment (C) 2015 Elsevier Ltd. All rights reserved.