Bandelow Borwin, Seidler-Brandler Ulrich, Becker Andreas, Wedekind Dirk, Rüther Eckart
Department of Psychiatry and Psychotherapy, The University of Göttingen, Göttingen, Germany.
World J Biol Psychiatry. 2007;8(3):175-87. doi: 10.1080/15622970601110273.
A number of meta-analyses have led to contradictory results regarding the efficacy of the psychological and pharmacological treatment of anxiety disorders. The main reasons for these inconsistent results seem to be the inclusion of heterogeneous studies and influences of selection biases. We performed a meta-analysis, which only included studies using a direct comparison of pharmacological, psychological, or combined treatments.
Sixteen studies on panic disorder, six studies on social anxiety disorder, and two studies on generalized anxiety disorder have been analyzed. Effect sizes for differences between the different treatment modalities were calculated. Also, the effect sizes of the pre-post differences were calculated.
Pharmacological treatment, cognitive-behavioural treatment, and the combination of both treatment modalities all led to substantial improvement between pre- and post-treatment. Combined pharmacological and psychological treatment was superior to the monotherapies for panic disorder. For social anxiety disorder, there is only preliminary support for combined treatment. Due to lack of sufficient data, no final conclusions can be drawn for generalized anxiety disorder.
While drug treatment and CBT showed equal efficacy, only in panic disorder the combination of pharmacological and psychological treatment was superior to either treatment alone. For the other anxiety disorders, the evidence for greater efficacy of combination treatment is still not sufficient due to lack of studies.
多项荟萃分析在焦虑症心理治疗和药物治疗的疗效方面得出了相互矛盾的结果。这些结果不一致的主要原因似乎是纳入了异质性研究以及选择偏倚的影响。我们进行了一项荟萃分析，该分析仅纳入了对药物治疗、心理治疗或联合治疗进行直接比较的研究。
分析了16项关于惊恐障碍的研究、6项关于社交焦虑障碍的研究以及2项关于广泛性焦虑障碍的研究。计算了不同治疗方式之间差异的效应量。此外，还计算了治疗前后差异的效应量。
药物治疗、认知行为治疗以及两种治疗方式的联合应用均使治疗前后有显著改善。药物与心理联合治疗对惊恐障碍优于单一疗法。对于社交焦虑障碍，联合治疗仅有初步支持证据。由于缺乏足够数据，无法对广泛性焦虑障碍得出最终结论。
虽然药物治疗和认知行为疗法显示出同等疗效，但仅在惊恐障碍中，药物与心理联合治疗优于单独的任何一种治疗。对于其他焦虑症，由于缺乏研究，联合治疗疗效更佳的证据仍不充分。
