疗效和有效性研究中评估认知行为疗法治疗抑郁症的效果——排除标准如何影响治疗效果？
Benchmarking of cognitive-behavioral therapy for depression in efficacy and effectiveness studies--how do exclusion criteria affect treatment outcome?
机构信息
Department of Psychology, Johannes Gutenberg University of Mainz, Germany.
出版信息
Psychother Res. 2011 Nov;21(6):644-57. doi: 10.1080/10503307.2011.602750. Epub 2011 Jul 27.
OBJECTIVE
Little is known about how exclusion criteria applied in randomized controlled trials (RCTs) affect the transfer of psychotherapy outcome research to naturalistic settings. This study evaluated the effects of naturalistic depression therapies and benchmarked them with published RCTs.
METHOD
Commonly used exclusion criteria were applied to n=338 depressive patients receiving cognitive-behavioral therapy. Outcomes of the resulting subsample eligible for RCTs were compared to those reported in RCTs.
RESULTS
Treatment outcomes of the total sample (d=1.16) and the subsample eligible for RCTs (d=1.15) were highly similar. Therapy outcome was worse than in high-quality RCTs (d=1.39).
CONCLUSIONS
No systematic bias was demonstrated due to patient selection criteria that are typically applied in RCTs. The comparability of psychotherapies conducted in RCTs and in real-world settings might be underestimated. Conclusions concerning the improvement of therapies in naturalistic settings are discussed.
目的
关于随机对照试验（RCT）中应用的排除标准如何影响心理治疗结果研究在自然环境中的转化，目前知之甚少。本研究评估了自然主义抑郁症治疗的效果，并与已发表的 RCT 进行了基准比较。
方法
将常用的排除标准应用于 n=338 名接受认知行为疗法的抑郁患者。将符合 RCT 条件的亚组的治疗结果与 RCT 报告的结果进行比较。
结果
总样本（d=1.16）和符合 RCT 条件的亚组（d=1.15）的治疗结果非常相似。治疗结果比高质量 RCT 中的结果差（d=1.39）。
结论
由于通常应用于 RCT 的患者选择标准，没有显示出系统偏差。在 RCT 和真实环境中进行的心理治疗的可比性可能被低估。讨论了在自然环境中改善治疗的结论。
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