Response rates for CBT for anxiety disorders: Need for standardized criteria
Response rates for CBT for anxiety disorders: Need for standardized criteria
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DOI：
10.1016/j.cpr.2015.08.004
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发表时间：
2015-12-01
影响因子：
12.8
通讯作者：
Craske, Michelle G.
中科院分区：
文献类型：
--
作者：
Loerinc, Amanda G.;Meuret, Alicia E.;Craske, Michelle G.
充分评价认知行为疗法(CBT)的有效性需要有效的大小数据和个体的阳性反应率。应答率对临床医生在选择治疗方案时特别有帮助。然而，尚未对交叉研究的应答率进行系统审查，这可能是由于缺乏计算应答率的标准化指标。我们对治疗结果文献进行了系统的回顾，以确定焦虑症患者对CBT的总体应答率，以及当前定义治疗应答率的方法是否会影响总应答率。我们的数据库搜索(2000-2014)导致了87项研究，报告了应答率，并包括至少一种CBT条件。结果显示，焦虑症的总体治疗反应率在治疗后平均为49.5%，在随访时为53.6%。回应率随着用于定义它们的属性的不同而显著不同。包含一个以上标准的措施，可靠的变化指数与临床截止点(临床上显著的变化)的组合，以及意向治疗样本在治疗后产生较低的应答率。盲法独立评价者比非盲法评价者有更高的应答率。基于以前的经验和理论工作，我们建议未来的研究在意向治疗分析(使用混合模型方法)中使用临床显著变化指数，反映多种模式，并由独立的盲法评估者进行评估。我们的结果表明，这些措施可能会降低答复率，但可能会减少偏见，更准确地反映改进和实现规范运作的情况。(C)2015爱思唯尔有限公司。保留所有权利。
Full appreciation of the effectiveness of cognitive behavioral therapy (CBT) requires both effect size data and individual rates of positive response. Response rates are particularly helpful for clinicians when choosing among treatment options. However, systematic reviews on cross-study response rates have not been conducted, possibly due to the absence of a standardized metric for calculating response rates. We conducted a systematic review of the treatment outcome literature to determine overall response rates to CBT for anxiety disorders and whether current methods of defining treatment response influence overall response rates. Our database search (2000-2014) resulted in 87 studies that reported response rates and included at least one CBT condition. Results showed that overall treatment response rates across anxiety disorders averaged 49.5% at post-treatment and 53.6% at follow-up. Response rates varied significantly as a function of the properties used to define them. Measures that incorporated more than one criterion, the combination of a reliable change index with a clinical cutoff (a clinically significant change), and intent-to-treat samples yielded lower response rates at post-treatment. Blinded independent assessors yielded higher response rates than unblinded assessors. Based on previous empirical and theoretical work, we recommend that future studies use a clinically significant change index, in an intent-to-treat analysis (using a mixed-model approach), reflecting multiple modalities, and assessed by independent blinded assessors. Our results indicate that such measures are likely to reduce response rates, but may result in a less biased and more accurate representation of improvement and achievement of normative functioning. (C) 2015 Elsevier Ltd. All rights reserved.