Department of Psychology, University of California, Los Angeles, United States.
Department of Psychology, Southern Methodist University, United States.
Clin Psychol Rev. 2015 Dec;42:72-82. doi: 10.1016/j.cpr.2015.08.004. Epub 2015 Aug 14.
Full appreciation of the effectiveness of cognitive behavioral therapy (CBT) requires both effect size data and individual rates of positive response. Response rates are particularly helpful for clinicians when choosing among treatment options. However, systematic reviews on cross-study response rates have not been conducted, possibly due to the absence of a standardized metric for calculating response rates. We conducted a systematic review of the treatment outcome literature to determine overall response rates to CBT for anxiety disorders and whether current methods of defining treatment response influence overall response rates. Our database search (2000-2014) resulted in 87 studies that reported response rates and included at least one CBT condition. Results showed that overall treatment response rates across anxiety disorders averaged 49.5% at post-treatment and 53.6% at follow-up. Response rates varied significantly as a function of the properties used to define them. Measures that incorporated more than one criterion, the combination of a reliable change index with a clinical cutoff (a clinically significant change), and intent-to-treat samples yielded lower response rates at post-treatment. Blinded independent assessors yielded higher response rates than unblinded assessors. Based on previous empirical and theoretical work, we recommend that future studies use a clinically significant change index, in an intent-to-treat analysis (using a mixed-model approach), reflecting multiple modalities, and assessed by independent blinded assessors. Our results indicate that such measures are likely to reduce response rates, but may result in a less biased and more accurate representation of improvement and achievement of normative functioning.
全面评估认知行为疗法（CBT）的疗效需要考虑效应量数据和积极反应的个体比例。反应率对于临床医生在选择治疗方案时特别有帮助。然而，尚未对跨研究反应率进行系统评价，这可能是因为缺乏计算反应率的标准化指标。我们对治疗结果文献进行了系统回顾，以确定焦虑障碍的 CBT 总体反应率，以及当前定义治疗反应的方法是否会影响总体反应率。我们的数据库搜索（2000-2014 年）产生了 87 项报告反应率的研究，并包含至少一种 CBT 条件。结果表明，焦虑障碍的总体治疗反应率在治疗后平均为 49.5%，随访时为 53.6%。反应率因用于定义它们的特性而有显著差异。将多个标准结合起来的方法，如可靠变化指数与临床截止值（临床显著变化）的结合，以及意向治疗样本，在治疗后会导致较低的反应率。盲法独立评估者比非盲法评估者产生更高的反应率。基于先前的实证和理论工作，我们建议未来的研究使用意向治疗分析中的临床显著变化指数（采用混合模型方法），反映多种模式，并由独立的盲法评估者进行评估。我们的结果表明，这些措施可能会降低反应率，但可能会以更少的偏差和更准确地反映改善和达到正常功能。
