Four Decades of Outcome Research on Psychotherapies for Adult Depression: An Overview of a Series of Meta-Analyses
Four Decades of Outcome Research on Psychotherapies for Adult Depression: An Overview of a Series of Meta-Analyses
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DOI：
10.1037/cap0000096
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发表时间：
2017-02-01
影响因子：
4.6
通讯作者：
Cuijpers, Pim
中科院分区：
文献类型：
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作者：
Cuijpers, Pim
在过去的40年里，大约有500项随机试验研究了心理治疗对成人抑郁症的影响。在这篇文章中，这些试验的一系列荟萃分析的结果进行了总结。几种类型的心理治疗已被审查，包括认知行为疗法，行为激活疗法，人际心理治疗，解决问题的治疗，非指导性支持治疗，短期心理动力学心理治疗。所有治疗均有效，治疗之间无显著差异。心理治疗与药物治疗效果相当，联合治疗比单独治疗更有效。治疗在特定目标群体中也有效，例如老年人，大学生，一般医学疾病患者，但在慢性抑郁症和患有共病物质使用障碍的患者中可能效果稍差。治疗是有效的，当提供个人，小组和指导自助格式。由于许多试验的低质量和发表偏倚，心理治疗的效果被高估了。未来的研究不应着眼于开发抑郁症的新心理疗法，针对特定的治疗形式或针对特定人群的治疗，因为证据表明，人类参与的所有类型和形式对所有特定的目标群体都有效。未来的研究应该集中在进一步减少抑郁症的疾病负担上。具体而言，它应侧重于预防抑郁症发作、治疗慢性和难治性抑郁症、预防复发和扩大治疗的可能性，例如通过使用更多指导性自助干预措施。
In the past 4 decades about 500 randomized trials have examined the effects of psychological treatments of adult depression. In this article the results of a series of metaanalyses of these trials are summarised. Several types of psychotherapy have been examined, including cognitive behaviour ther-apy, behavioural activation therapy, interpersonal psychotherapy, problem-solving therapy, nondirective supportive therapy, and short-term psychodynamic psychotherapy. All therapies are effective and there are no significant differences between treatments. Psychotherapies are about equally effective as pharmacotherapy, and combined treatments are more effective than either of these alone. Therapies are also effective in specific target groups, such as older adults, college students, patients with general medical disorders, but may be somewhat less effective in chronic depression, and in patients with comorbid substance use disorders. Treatments are effective when delivered in individual, group, and guided selfhelp format. The effects of psychotherapies have been overestimated because of the low quality of many trials and due to publication bias. Future research should not be aimed at the development of new psychotherapies for depression, on specific treatment formats or on therapies in specific populations, because the evidence indicates that all types and formats with human involvement are effective in all specific target groups. Future research should instead focus on a further reduction of the disease burden of depression. Specifically, it should focus on the possibilities of preventing the onset of depressive disorders, treatments of chronic and treatment-resistant depression, relapse prevention, and scaling up treatments, for example by using more guided self-help interventions.