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“第三波”认知行为疗法与其他治疗抑郁症的心理疗法对比

'Third wave' cognitive and behavioural therapies versus other psychological therapies for depression.

作者信息

Hunot Vivien, Moore Theresa H M, Caldwell Deborah M, Furukawa Toshi A, Davies Philippa, Jones Hannah, Honyashiki Mina, Chen Peiyao, Lewis Glyn, Churchill Rachel

机构信息

Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol, Avon, UK, BS8 2BN.

出版信息

Cochrane Database Syst Rev. 2013 Oct 18;2013(10):CD008704. doi: 10.1002/14651858.CD008704.pub2.


DOI:10.1002/14651858.CD008704.pub2
PMID:24142844
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12107518/
Abstract

BACKGROUND: So-called 'third wave' cognitive and behavioural therapies represents a new generation of psychological therapies that are increasingly being used in the treatment of psychological problems. However, the effectiveness and acceptability of third wave cognitive and behavioural therapy (CBT) approaches as a treatment for depression compared with other psychological therapies remain unclear. OBJECTIVES: 1. To examine the effects of all third wave CBT approaches compared with all other psychological therapy approaches for acute depression.2. To examine the effects of different third wave CBT approaches (ACT, compassionate mind training, functional analytic psychotherapy, extended behavioural activation and metacognitive therapy) compared with all other psychological therapy approaches for acute depression.3. To examine the effects of all third wave CBT approaches compared with different psychological therapy approaches (psychodynamic, behavioural, humanistic, integrative, cognitive-behavioural) for acute depression. SEARCH METHODS: We searched the Cochrane Depression, Anxiety and Neurosis Group Specialised Register (CCDANCTR to 01/01/12), which includes relevant randomised controlled trials from The Cochrane Library (all years), EMBASE (1974-), MEDLINE (1950-) and PsycINFO (1967-). We also searched CINAHL (May 2010) and PSYNDEX (June 2010) and reference lists of the included studies and relevant reviews for additional published and unpublished studies. An updated search of CCDANCTR restricted to search terms relevant to third wave CBT was conducted in March 2013 (CCDANCTR to 01/02/13). SELECTION CRITERIA: Randomised controlled trials that compared various third wave CBT with other psychological therapies for acute depression in adults. DATA COLLECTION AND ANALYSIS: Two review authors independently identified studies, assessed trial quality and extracted data. Study authors were contacted for additional information where required. We rated the quality of evidence using GRADE methods. MAIN RESULTS: A total of three studies involving 144 eligible participants were included in the review. Two of the studies (56 participants) compared an early version of acceptance and commitment therapy (ACT) with CBT, and one study (88 eligible participants) compared extended behavioural activation with CBT. No other studies of third wave CBT were identified. The two ACT studies were assessed as being at high risk of performance bias and researcher allegiance. Post-treatment results, which were based on dropout rates, showed no evidence of any difference between third wave CBT and other psychological therapies for the primary outcomes of efficacy (risk ratio (RR) of clinical response 1.14, 95% confidence interval (CI) 0.79 to 1.64; very low quality) and acceptability. Results at two-month follow-up showed no evidence of any difference between third wave CBT and other psychological therapies for clinical response (2 studies, 56 participants, RR 0.22, 95% CI 0.04 to 1.15). Moderate statistical heterogeneity was indicated in the acceptability analyses (I(2) = 41%). AUTHORS' CONCLUSIONS: Very low quality evidence suggests that third wave CBT and CBT approaches are equally effective and acceptable in the treatment of acute depression. Evidence is limited in quantity, quality and breadth of available studies, precluding us from drawing any conclusions as to their short- or longer-term equivalence. The increasing popularity of third wave CBT approaches in clinical practice underscores the importance of completing further studies to compare various third wave CBT approaches with other psychological therapy approaches to inform clinicians and policymakers on the most effective forms of psychological therapy in treating depression.

摘要

背景:所谓的“第三波”认知行为疗法代表了新一代心理疗法,越来越多地用于治疗心理问题。然而,与其他心理疗法相比,第三波认知行为疗法(CBT)作为抑郁症治疗方法的有效性和可接受性仍不明确。 目的:1. 考察所有第三波CBT方法与所有其他心理疗法治疗急性抑郁症的效果。2. 考察不同的第三波CBT方法(接纳与承诺疗法、慈悲心训练、功能分析心理治疗、扩展行为激活和元认知治疗)与所有其他心理疗法治疗急性抑郁症的效果。3. 考察所有第三波CBT方法与不同心理疗法(心理动力疗法、行为疗法、人本主义疗法、整合疗法、认知行为疗法)治疗急性抑郁症的效果。 检索方法:我们检索了Cochrane抑郁、焦虑和神经症小组专业注册库(截至2012年1月1日的CCDANCTR),其中包括来自Cochrane图书馆(所有年份)、EMBASE(1974年起)、MEDLINE(1950年起)和PsycINFO(1967年起)的相关随机对照试验。我们还检索了CINAHL(2010年5月)和PSYNDEX(2010年6月)以及纳入研究和相关综述的参考文献列表,以查找其他已发表和未发表的研究。2013年3月对CCDANCTR进行了更新检索,仅限于与第三波CBT相关的检索词(截至2013年2月1日的CCDANCTR)。 入选标准:比较各种第三波CBT与其他心理疗法治疗成人急性抑郁症的随机对照试验。 数据收集与分析:两位综述作者独立识别研究、评估试验质量并提取数据。必要时与研究作者联系以获取更多信息。我们使用GRADE方法对证据质量进行评级。 主要结果:本综述共纳入3项研究,涉及144名符合条件的参与者。其中2项研究(56名参与者)将早期版本的接纳与承诺疗法(ACT)与CBT进行了比较,1项研究(88名符合条件的参与者)将扩展行为激活与CBT进行了比较。未识别到其他关于第三波CBT的研究。这2项ACT研究被评估为存在执行偏倚和研究者偏倚的高风险。基于脱落率的治疗后结果显示,在疗效(临床反应的风险比(RR)为1.14,95%置信区间(CI)为0.79至1.64;极低质量)和可接受性的主要结局方面,没有证据表明第三波CBT与其他心理疗法之间存在任何差异。两个月随访结果显示,在临床反应方面,没有证据表明第三波CBT与其他心理疗法之间存在任何差异(2项研究,56名参与者,RR为0.22,95%CI为0.04至1.15)。可接受性分析显示存在中度统计学异质性(I² = 41%)。 作者结论:极低质量的证据表明,第三波CBT和CBT方法在治疗急性抑郁症方面同样有效且可接受。现有研究在数量、质量和广度上的证据有限,使我们无法就它们的短期或长期等效性得出任何结论。第三波CBT方法在临床实践中越来越受欢迎,这凸显了开展进一步研究以比较各种第三波CBT方法与其他心理疗法的重要性,以便为临床医生和政策制定者提供关于治疗抑郁症最有效心理治疗形式的信息。

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