Internet and computer-based cognitive behavioral therapy for anxiety and depression in youth: a meta-analysis of randomized controlled outcome trials.
Internet and computer-based cognitive behavioral therapy for anxiety and depression in youth: a meta-analysis of randomized controlled outcome trials.
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DOI：
10.1371/journal.pone.0119895
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Riper H
中科院分区：
文献类型：
--
作者：
Ebert DD;Zarski AC;Christensen H;Stikkelbroek Y;Cuijpers P;Berking M;Riper H
儿童和青少年的焦虑和抑郁症治疗不足。基于计算机和互联网的认知行为治疗（cCBT）可能是一个有吸引力的治疗替代定期面对面的治疗。这项荟萃分析旨在评估cCBT是否是有效的治疗青年焦虑和抑郁症状。我们在文献数据库（Pubmed、科克伦对照试验注册库、PsychInfo）中进行了系统检索，检索截止日期为2013年12月4日。仅选择了随机对照试验，其中将针对25岁以下儿童或青少年的抑郁、焦虑或两者的基于计算机、互联网或移动的认知行为干预与对照条件进行比较。我们采用随机效应合并模型进行总体效应分析，采用混合效应模型进行亚组分析。结果确定了13项随机试验，包括796名符合纳入标准的儿童和青少年。七项研究针对治疗焦虑，四项研究针对抑郁，两项研究具有跨诊断性质，针对焦虑和抑郁。cCBT对后测焦虑或抑郁症状的总体平均效应量（Hedges' g）为g=0.72（95%CI：0.55-0.90，需要治疗的人数（NNT）=2.56）。异质性较低（I²= 20.14%，95%CI：0-58%）。对于针对焦虑的干预措施，cCBT优于对照组（g=0.68; 95% CI：0.45-0.92; p <0.001; NNT=2.70）和针对抑郁症的干预措施（g=0.76; 95%CI：0.41-0.12; p < .001; NNT=2.44）以及跨诊断干预（g=0.94; 95%CI：0.23-2.66; p < .001; NNT=2.60）。结果为cCBT治疗青少年焦虑和抑郁症状的有效性提供了证据。因此，当基于证据的面对面治疗不可行时，这种干预措施可能是一种有希望的治疗替代方案。未来的研究应检查治疗的长期效果，并应侧重于从现有研究中获得患者水平的数据，以进行个体患者数据荟萃分析。
Anxiety and depression in children and adolescents are undertreated. Computer- and Internet-based cognitive behavioral treatments (cCBT) may be an attractive treatment alternative to regular face-to-face treatment.This meta-analysis aims to evaluate whether cCBT is effective for treating symptoms of anxiety and depression in youth. We conducted systematic searches in bibliographical databases (Pubmed, Cochrane controlled trial register, PsychInfo) up to December 4, 2013. Only randomized controlled trials in which a computer-, Internet- or mobile-based cognitive behavioral intervention targeting either depression, anxiety or both in children or adolescents up to the age of 25 were compared to a control condition were selected. We employed a random-effects pooling model in overall effect analyses and a mixed effect model for sub-group analyses. Searches resulted in identifying 13 randomized trials, including 796 children and adolescents that met inclusion criteria. Seven studies were directed at treating anxiety, four studies at depression, and two were of a transdiagnostic nature, targeting both anxiety and depression. The overall mean effect size (Hedges’ g) of cCBT on symptoms of anxiety or depression at post-test was g=0.72 (95% CI:0.55-0.90, numbers needed to be treated (NNT)=2.56). Heterogeneity was low (I²=20.14%, 95% CI: 0-58%). The superiority of cCBT over controls was evident for interventions targeting anxiety (g=0.68; 95% CI: 0.45-0.92; p < .001; NNT=2.70) and for interventions targeting depression (g=0.76; 95% CI: 0.41-0.12; p < .001; NNT=2.44) as well as for transdiagnostic interventions (g=0.94; 95% CI: 0.23-2.66; p < .001; NNT=2.60). Results provide evidence for the efficacy of cCBT in the treatment of anxiety and depressive symptoms in youth. Hence, such interventions may be a promising treatment alternative when evidence based face-to-face treatment is not feasible. Future studies should examine long-term effects of treatments and should focus on obtaining patient-level data from existing studies, to perform an individual patient data meta-analysis.
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