Clinical and Health Psychology, University of Edinburgh, UK.
Psychol Med. 2011 Nov;41(11):2239-52. doi: 10.1017/S0033291711000900. Epub 2011 Jun 15.
Cognitive-behavioural therapy (CBT)-based guided self-help (GSH) has been suggested to be an effective intervention for mild to moderate anxiety and depression, yet the evidence seems inconclusive, with some studies reporting that GSH is effective and others finding that GSH is ineffective. GSH differs in important respects from other levels of self-help, yet the literature regarding exclusively guided self-help interventions for anxiety and depression has not been reviewed systematically.
A literature search for randomized controlled trials (RCTs) examining CBT-based GSH interventions for anxiety and depressive disorders was conducted. Multiple electronic databases were searched; several journals spanning key disciplines were hand-searched; reference lists of included review articles were scanned and relevant first authors were contacted.
Thirteen studies met the inclusion criteria. Meta-analysis indicated the effectiveness of GSH at post-treatment, although GSH was found to have limited effectiveness at follow-up or among more clinically representative samples. Studies that reported greater effectiveness of GSH tended to be of lower methodological quality and generally involved participants who were self-selected rather than recruited through clinical referrals.
Although there is support for the effectiveness of CBT-based GSH among media-recruited individuals, the finding that the reviewed RCTs had limited effectiveness within routine clinical practice demonstrates that the evidence is not conclusive. Further rigorous evidence based on clinical populations that examines longer-term outcomes is required before CBT-based GSH interventions can be deemed effective for adults accessing primary care services for treatment of anxiety and depression.
认知行为疗法（CBT）为基础的自助指导（GSH）已被证明对轻度至中度焦虑和抑郁是一种有效的干预措施，但证据似乎并不明确，一些研究报告 GSH 是有效的，而其他研究则发现 GSH 是无效的。GSH 在重要方面与其他自助水平不同，但针对焦虑和抑郁的专门指导自助干预的文献尚未得到系统审查。
对针对焦虑和抑郁障碍的 CBT 为基础的 GSH 干预的随机对照试验（RCT）进行了文献检索。检索了多个电子数据库；对涵盖主要学科的几个期刊进行了手工检索；对纳入的综述文章的参考文献进行了扫描，并联系了相关的第一作者。
符合纳入标准的研究有 13 项。荟萃分析表明 GSH 在治疗后有效，但在随访或在更具临床代表性的样本中，GSH 的效果有限。报告 GSH 效果更好的研究往往方法学质量较低，通常涉及自我选择的参与者，而不是通过临床推荐招募的参与者。
虽然有证据支持基于 CBT 的 GSH 在媒体招募的个体中的有效性，但所审查的 RCT 在常规临床实践中的效果有限表明，证据并不明确。需要基于临床人群的更严格的证据来检查更长期的结果，然后才能认为基于 CBT 的 GSH 干预对接受初级保健服务治疗焦虑和抑郁的成年人有效。
