基于互联网与传统的认知行为治疗对神经症性障碍疗效的meta分析
|
摘要
目的:采用系统综述的方法比较基于互联网的认知行为治疗(ICBT)和传统认知行为治疗(CBT)对神经症性障碍患者的治疗效果。方法:检索Medline网络数据库(MEDLINE),世界医学文献数据库(PubMed),荷兰医学文摘(EM-BASE),循证医学图书馆(Cochrane Library),中国期刊全文专题数据库(CNKI),美国科学引文索引网络版数据库(Web of science),中国生物医学文献数据库(Sinomed),维普全文电子期刊(VIP)。由2名研究人员根据纳入和排除标准独立筛选、评价文献。应用Cochrane协作网提供的RevMan5.1软件进行数据处理。结果:共纳入文献8篇,总计样本量n=569。对各研究的临床症状的变化值采用连续性变量的合并标准化平均差值及其95%CI表示,存在异质性的研究进行亚组分析。在神经症性障碍治疗中,基于互联网和传统的认知行为治疗差异无统计学意义[g=-0.07(-0.24～0.09),Pχ~2=0.52,I~2=0%]。结论:ICBT对神经症性障碍的治疗效果同传统CBT无明显差别,其有效性与优越性应引起国内精神卫生从业者的重视。
Objective:To compare therapeutic effects of internet-based cognitive behavioral therapy(ICBT)and traditional cognitive behavioral therapy(CBT)on patients with neurotic disorders systematic review and meta-analysis.Methods:We searched database including Medline Network Database(MEDLINE),PubMed,EM-BASE,Cochrane Library,CNKI,Web of Science Index,Sinomed,and Vip Full Text Electronic Journal(VIP).Literature was independently screened and evaluated with three researchers according to inclusion/exclusion criteria.RevMan 5.1 software provided by Cochrane Collaborative Network was used for data processing.Results:Eight articles were included with a total sample size of 569.The change values of psychological scales in each study were expressed by the combined standardized differences of means(SMD) values of continuous variables and 95% CI values.Subgroup analysis was carried out for heterogeneous studies.In the treatment of neurotic disorders,there was no significant difference between internet-based and traditional cognitive behavioral therapy[g=-0.07(-0.24-0.09),Pχ~2=0.52 I~2=0%].Conclusion:There is no significant difference between internet-based cognitive behavioral therapy and traditional cognitive behavior therapy.The application of internet-based cognitive behavioral therapy in neurotic disorders should arouse more attention.
Objective:To compare therapeutic effects of internet-based cognitive behavioral therapy(ICBT)and traditional cognitive behavioral therapy(CBT)on patients with neurotic disorders systematic review and meta-analysis.Methods:We searched database including Medline Network Database(MEDLINE),PubMed,EM-BASE,Cochrane Library,CNKI,Web of Science Index,Sinomed,and Vip Full Text Electronic Journal(VIP).Literature was independently screened and evaluated with three researchers according to inclusion/exclusion criteria.RevMan 5.1 software provided by Cochrane Collaborative Network was used for data processing.Results:Eight articles were included with a total sample size of 569.The change values of psychological scales in each study were expressed by the combined standardized differences of means(SMD) values of continuous variables and 95% CI values.Subgroup analysis was carried out for heterogeneous studies.In the treatment of neurotic disorders,there was no significant difference between internet-based and traditional cognitive behavioral therapy[g=-0.07(-0.24-0.09),Pχ~2=0.52 I~2=0%].Conclusion:There is no significant difference between internet-based cognitive behavioral therapy and traditional cognitive behavior therapy.The application of internet-based cognitive behavioral therapy in neurotic disorders should arouse more attention.
引文
[1] Thoma N,Pilecki B,McKay D.Contemporary cognitive behavior therapy:a review of theory,history,and evidence[J].Psychodyn Psychiatry,2015,43(3):423-461.
[2] Ebert DD,Zarski AC,Christensen H,et al.Internet and computer-based cognitive behavioral therapy for anxiety and depression in youth:a meta-analysis of randomized controlled outcome trials [J].PLoS One,2015,10(3):e0119895.doi:10.1371/journal.pone.0119895.
[3] Andrews G,Davies M,Titov N.Effectiveness randomized controlled trial of face to face versus Internet cognitive behaviour therapy for social phobia[J].Aust N Z J Psychiatry,2011,45(4):337-340.
[4] Botella C,Gallego MJ,Garcia-Palacios A,et al.An Internet-based self-help treatment for fear of public speaking:a controlled trial[J].Cyberpsychol Behav Soc Netw,2010,13(4):407-421.
[5] Hedman E,Andersson G,Ljótsson B,et al.Internet-based cognitive behavior therapy vs.cognitive behavioral group therapy for social anxiety disorder:a randomized controlled non-inferiority trial[J].PLoS One,2011,6(3):e18001.doi:10.1371/journal.pone.0018001.
[6] Bergstr?m J,Andersson G,Ljótsson B,et al.Internet-versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting:a randomised trial[J].BMC Psychiatry,2010,10:54.doi:10.1186/1471-244X-10-54.
[7] Carlbring P,Nilsson-Ihrfelt E,Waara J,et al.Treatment of panic disorder:live therapy vs.self-help via the Internet[J].Behav Res Ther,2005,43(10):1321-1333.
[8] Kiropoulos LA,Klein B,Austin DW,et al.Is internet-based CBT for panic disorder and agoraphobia as effective as face-to-face CBT?[J].J Anxiety Disord,2008,22(8):1273-1284.
[9] Andersson G,Waara J,Jonsson U,et al.Internet-based exposure treatment versus one-session exposure treatment of snake phobia:a randomized controlled trial[J].Cogn Behav Ther,2013,42(4):284-291.
[10]Andersson G,Waara J,Jonsson U,et al.Internet-based self-help versus one-session exposure in the treatment of spider phobia:a randomized controlled trial[J].Cogn Behav Ther,2009,38(2):114-120.
[11]McMain S,Newman MG,Segal ZV,et al.Cognitive behavioral therapy:current status and future research directions[J].Psychother Res,2015,25(3):321-329.
[12]Pǎsǎrelu CR,Andersson G,Bergman NL,et al.Internet-delivered transdiagnostic and tailored cognitive behavioral therapy for anxiety and depression:a systematic review and meta-analysis of randomized controlled trials[J].Cogn Behav Ther,2017,46(1):1-28.
[13]Karyotaki E,Riper H,Twisk J,et al.Efficacy of self-guided Internet-based cognitive behavioral therapy in the treatment of depressive symptoms:a meta-analysis of individual participant data[J].JAMA Psychiatry,2017,74(4):351-359.
[14]Andrews G,Basu A,Cuijpers P,et al.Computer therapy for the anxiety and depression disorders is effective,acceptable and practical health care:an updated meta-analysis[J].J Anxiety Disord,2018,55:70-78.doi:10.1016/j.janxdis.2018.01.001.
[15]Ivanova E,Lindner P,Ly KH,et al.Guided and unguided acceptance and commitment therapy for social anxiety disorder and/or panic disorder provided via the Internet and a smartphone application:a randomized controlled trial[J].J Anxiety Disord,2016,44:27-35.doi:10.1016/j.janxdis.2016.09.012.
[16]李金阳,张宁,张斌,等.网络版计算机化的认知行为治疗在中国人群的应用及有效性[J].中华行为医学与脑科学杂志,2018,27(2):115-120.
[17]Herbst N,Franzen G,Voderholzer U,et al.Working alliance in Internet-based cognitive-behavioral therapy for obsessive-compulsive disorder[J].Psychother Psychosom,2016,85(2):117-118.
[18]Diefenbach GJ,Wootton BM,Bragdon LB,et al.Treatment Outcome and Predictors of Internet Guided Self-Help for Obsessive-Compulsive Disorder[J].Behav Ther,2015,46(6):764-774.
[19]Andersson E,Enander J,Andrén P,et al.Internet-based cognitive behaviour therapy for obsessive-compulsive disorder:a randomized controlled trial[J].Psychol Med,2012,42(10):2193-2203.
[20]Rück C,Lundstr?m L,Flygare O,et al.Study protocol for a single-blind,randomised controlled,non-inferiority trial of internet-based versus face-to-face cognitive behaviour therapy for obsessive-compulsive disorder[J].BMJ Open,2018,8(9):e022254.doi:10.1136/bmjopen-2018-022254.
[21]Hedman E,Lekander M,Ljótsson B,et al.Sudden gains in internet-based cognitive behaviour therapy for severe health anxiety[J].Behav Res Ther,2014,54:22-29.doi:10.1016/j.brat.2013.12.007.
[22]Enander J,Andersson E,Mataix-Cols D,et al.Therapist guided internet based cognitive behavioural therapy for body dysmorphic disorder:single blind randomised controlled trial[J].BMJ,2016,352:i241.doi:10.1136/bmj.i241.
[23]Mayo-Wilson E,Dias S,Mavranezouli I,et al.Psychological and pharmacological interventions for social anxiety disorder in adults:a systematic review and network meta-analysis[J].Lancet Psychiatry,2014,1(5):368-376.
[24]Ciuca AM,Berger T,Cri?an LG,et al.Internet-based treatment for panic disorder:A three-arm randomized controlled trial comparing guided (via real-time video sessions) with unguided self-help treatment and a waitlist control.PAXPD study results[J].J Anxie-ty Disord,2018,56:43-55.doi:10:1016/j.janxdis.2018.03.009.
[25]Henriksen HH,Rahbar E,Baer LA,et al.Pre-hospital transfusion of plasma in hemorrhaging trauma patients independently improves hemostatic competence and acidosis[J].Scand J Trauma Resusc Emerg Med,2016,24(1):145.
[26]Olthuis JV,Watt MC,Bailey K,et al.Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults[J].Cochrane Database Syst Rev,2015,(3):CD011565.doi:10.1002/14651858.CD011565..Review.
[27]Milgrom J,Danaher BG,Gemmill AW,et al.Internet cognitive behavioral therapy for women with postnatal depression:a randomized controlled trial of MumMoodBooster[J].J Med Internet Res,2016,18(3):e54.
[28]Lau Y,Htun TP,Wong SN,et al.Therapist-supported Internet-based cognitive behavior therapy for stress,anxiety,and depressive symptoms among postpartum women:a systematic review and meta-analysis[J].J Med Internet Res,2017,19(4):e138.
[29]Hadjistavropoulos HD,Schneider LH,Klassen K,et al.Development and evaluation of a scale assessing therapist fidelity to guidelines for delivering therapist-assisted Internet-delivered cognitive behaviour therapy[J].Cogn Behav Ther,2018,47(6):447-461.doi:10.1080/16506073.2018.1457079.
[30]Berger T,Boettcher J,Caspar F.Internet-based guided self-help for several anxiety disorders:a randomized controlled trial comparing a tailored with a standardized disorder-specific approach[J].Psychotherapy (Chic),2014,51(2):207-219.
[2] Ebert DD,Zarski AC,Christensen H,et al.Internet and computer-based cognitive behavioral therapy for anxiety and depression in youth:a meta-analysis of randomized controlled outcome trials [J].PLoS One,2015,10(3):e0119895.doi:10.1371/journal.pone.0119895.
[3] Andrews G,Davies M,Titov N.Effectiveness randomized controlled trial of face to face versus Internet cognitive behaviour therapy for social phobia[J].Aust N Z J Psychiatry,2011,45(4):337-340.
[4] Botella C,Gallego MJ,Garcia-Palacios A,et al.An Internet-based self-help treatment for fear of public speaking:a controlled trial[J].Cyberpsychol Behav Soc Netw,2010,13(4):407-421.
[5] Hedman E,Andersson G,Ljótsson B,et al.Internet-based cognitive behavior therapy vs.cognitive behavioral group therapy for social anxiety disorder:a randomized controlled non-inferiority trial[J].PLoS One,2011,6(3):e18001.doi:10.1371/journal.pone.0018001.
[6] Bergstr?m J,Andersson G,Ljótsson B,et al.Internet-versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting:a randomised trial[J].BMC Psychiatry,2010,10:54.doi:10.1186/1471-244X-10-54.
[7] Carlbring P,Nilsson-Ihrfelt E,Waara J,et al.Treatment of panic disorder:live therapy vs.self-help via the Internet[J].Behav Res Ther,2005,43(10):1321-1333.
[8] Kiropoulos LA,Klein B,Austin DW,et al.Is internet-based CBT for panic disorder and agoraphobia as effective as face-to-face CBT?[J].J Anxiety Disord,2008,22(8):1273-1284.
[9] Andersson G,Waara J,Jonsson U,et al.Internet-based exposure treatment versus one-session exposure treatment of snake phobia:a randomized controlled trial[J].Cogn Behav Ther,2013,42(4):284-291.
[10]Andersson G,Waara J,Jonsson U,et al.Internet-based self-help versus one-session exposure in the treatment of spider phobia:a randomized controlled trial[J].Cogn Behav Ther,2009,38(2):114-120.
[11]McMain S,Newman MG,Segal ZV,et al.Cognitive behavioral therapy:current status and future research directions[J].Psychother Res,2015,25(3):321-329.
[12]Pǎsǎrelu CR,Andersson G,Bergman NL,et al.Internet-delivered transdiagnostic and tailored cognitive behavioral therapy for anxiety and depression:a systematic review and meta-analysis of randomized controlled trials[J].Cogn Behav Ther,2017,46(1):1-28.
[13]Karyotaki E,Riper H,Twisk J,et al.Efficacy of self-guided Internet-based cognitive behavioral therapy in the treatment of depressive symptoms:a meta-analysis of individual participant data[J].JAMA Psychiatry,2017,74(4):351-359.
[14]Andrews G,Basu A,Cuijpers P,et al.Computer therapy for the anxiety and depression disorders is effective,acceptable and practical health care:an updated meta-analysis[J].J Anxiety Disord,2018,55:70-78.doi:10.1016/j.janxdis.2018.01.001.
[15]Ivanova E,Lindner P,Ly KH,et al.Guided and unguided acceptance and commitment therapy for social anxiety disorder and/or panic disorder provided via the Internet and a smartphone application:a randomized controlled trial[J].J Anxiety Disord,2016,44:27-35.doi:10.1016/j.janxdis.2016.09.012.
[16]李金阳,张宁,张斌,等.网络版计算机化的认知行为治疗在中国人群的应用及有效性[J].中华行为医学与脑科学杂志,2018,27(2):115-120.
[17]Herbst N,Franzen G,Voderholzer U,et al.Working alliance in Internet-based cognitive-behavioral therapy for obsessive-compulsive disorder[J].Psychother Psychosom,2016,85(2):117-118.
[18]Diefenbach GJ,Wootton BM,Bragdon LB,et al.Treatment Outcome and Predictors of Internet Guided Self-Help for Obsessive-Compulsive Disorder[J].Behav Ther,2015,46(6):764-774.
[19]Andersson E,Enander J,Andrén P,et al.Internet-based cognitive behaviour therapy for obsessive-compulsive disorder:a randomized controlled trial[J].Psychol Med,2012,42(10):2193-2203.
[20]Rück C,Lundstr?m L,Flygare O,et al.Study protocol for a single-blind,randomised controlled,non-inferiority trial of internet-based versus face-to-face cognitive behaviour therapy for obsessive-compulsive disorder[J].BMJ Open,2018,8(9):e022254.doi:10.1136/bmjopen-2018-022254.
[21]Hedman E,Lekander M,Ljótsson B,et al.Sudden gains in internet-based cognitive behaviour therapy for severe health anxiety[J].Behav Res Ther,2014,54:22-29.doi:10.1016/j.brat.2013.12.007.
[22]Enander J,Andersson E,Mataix-Cols D,et al.Therapist guided internet based cognitive behavioural therapy for body dysmorphic disorder:single blind randomised controlled trial[J].BMJ,2016,352:i241.doi:10.1136/bmj.i241.
[23]Mayo-Wilson E,Dias S,Mavranezouli I,et al.Psychological and pharmacological interventions for social anxiety disorder in adults:a systematic review and network meta-analysis[J].Lancet Psychiatry,2014,1(5):368-376.
[24]Ciuca AM,Berger T,Cri?an LG,et al.Internet-based treatment for panic disorder:A three-arm randomized controlled trial comparing guided (via real-time video sessions) with unguided self-help treatment and a waitlist control.PAXPD study results[J].J Anxie-ty Disord,2018,56:43-55.doi:10:1016/j.janxdis.2018.03.009.
[25]Henriksen HH,Rahbar E,Baer LA,et al.Pre-hospital transfusion of plasma in hemorrhaging trauma patients independently improves hemostatic competence and acidosis[J].Scand J Trauma Resusc Emerg Med,2016,24(1):145.
[26]Olthuis JV,Watt MC,Bailey K,et al.Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults[J].Cochrane Database Syst Rev,2015,(3):CD011565.doi:10.1002/14651858.CD011565..Review.
[27]Milgrom J,Danaher BG,Gemmill AW,et al.Internet cognitive behavioral therapy for women with postnatal depression:a randomized controlled trial of MumMoodBooster[J].J Med Internet Res,2016,18(3):e54.
[28]Lau Y,Htun TP,Wong SN,et al.Therapist-supported Internet-based cognitive behavior therapy for stress,anxiety,and depressive symptoms among postpartum women:a systematic review and meta-analysis[J].J Med Internet Res,2017,19(4):e138.
[29]Hadjistavropoulos HD,Schneider LH,Klassen K,et al.Development and evaluation of a scale assessing therapist fidelity to guidelines for delivering therapist-assisted Internet-delivered cognitive behaviour therapy[J].Cogn Behav Ther,2018,47(6):447-461.doi:10.1080/16506073.2018.1457079.
[30]Berger T,Boettcher J,Caspar F.Internet-based guided self-help for several anxiety disorders:a randomized controlled trial comparing a tailored with a standardized disorder-specific approach[J].Psychotherapy (Chic),2014,51(2):207-219.