针对高度恐针个体的干预措施：随机对照试验和半随机对照试验的系统评价
Interventions for Individuals With High Levels of Needle Fear: Systematic Review of Randomized Controlled Trials and Quasi-Randomized Controlled Trials.
作者信息
McMurtry C Meghan, Noel Melanie, Taddio Anna, Antony Martin M, Asmundson Gordon J G, Riddell Rebecca Pillai, Chambers Christine T, Shah Vibhuti
机构信息
*Department of Psychology, University of Guelph, Guelph †Children's Health Research Institute ‡Department of Paediatrics, Western University, London ∥Leslie Dan Faculty of Pharmacy ‡‡Department of Psychiatry ##Health Policy Management and Evaluation, Faculty of Medicine, University of Toronto ¶The Hospital for Sick Children #Department of Psychology, Ryerson University ††Department of Psychology, York University ¶¶Mount Sinai Hospital, Toronto, ON **Department of Psychology, University of Regina, Regina, SK §§Departments of Pediatrics, Psychology & Neuroscience, Dalhousie University ∥∥Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada §Department of Psychology, University of Calgary, AB, Canada.
出版信息
Clin J Pain. 2015 Oct;31(10 Suppl):S109-23. doi: 10.1097/AJP.0000000000000273.
BACKGROUND
This systematic review evaluated the effectiveness of exposure-based psychological and physical interventions for the management of high levels of needle fear and/or phobia and fainting in children and adults.
DESIGN/METHODS: A systematic review identified relevant randomized and quasi-randomized controlled trials of children, adults, or both with high levels of needle fear, including phobia (if not available, then populations with other specific phobias were included). Critically important outcomes were self-reported fear specific to the feared situation and stimulus (psychological interventions) or fainting (applied muscle tension). Data were pooled using standardized mean difference (SMD) or relative risk with 95% confidence intervals.
RESULTS
The systematic review included 11 trials. In vivo exposure-based therapy for children 7 years and above showed benefit on specific fear (n=234; SMD: -1.71 [95% CI: -2.72, -0.7]). In vivo exposure-based therapy with adults reduced fear of needles posttreatment (n=20; SMD: -1.09 [-2.04, -0.14]) but not at 1-year follow-up (n=20; SMD: -0.28 [-1.16, 0.6]). Compared with single session, a benefit was observed for multiple sessions of exposure-based therapy posttreatment (n=93; SMD: -0.66 [-1.08, -0.24]) but not after 1 year (n=83; SMD: -0.37 [-0.87, 0.13]). Non in vivo e.g., imaginal exposure-based therapy in children reduced specific fear posttreatment (n=41; SMD: -0.88 [-1.7, -0.05]) and at 3 months (n=24; SMD: -0.89 [-1.73, -0.04]). Non in vivo exposure-based therapy for adults showed benefit on specific fear (n=68; SMD: -0.62 [-1.11, -0.14]) but not procedural fear (n=17; SMD: 0.18 [-0.87, 1.23]). Applied tension showed benefit on fainting posttreatment (n=20; SMD: -1.16 [-2.12, -0.19]) and after 1 year (n=20; SMD: -0.97 [-1.91, -0.03]) compared with exposure alone.
CONCLUSIONS
Exposure-based psychological interventions and applied muscle tension show evidence of benefit in the reduction of fear in pediatric and adult populations.
背景
本系统评价评估了基于暴露的心理和物理干预措施对儿童和成人高度针恐惧和/或恐惧症及昏厥管理的有效性。
设计/方法：一项系统评价确定了针对有高度针恐惧（包括恐惧症，若没有相关研究，则纳入有其他特定恐惧症的人群）的儿童、成人或两者的相关随机和半随机对照试验。至关重要的结局是针对恐惧情境和刺激的自我报告恐惧（心理干预）或昏厥（应用肌肉紧张）。使用标准化均数差（SMD）或相对危险度及95%置信区间对数据进行合并。
结果
该系统评价纳入了11项试验。7岁及以上儿童的现场暴露疗法对特定恐惧有疗效（n = 234；SMD：-1.71 [95% CI：-2.72，-0.7]）。成人的现场暴露疗法在治疗后降低了对针的恐惧（n = 20；SMD：-1.09 [-2.04，-0.14]），但在1年随访时未降低（n = 20；SMD：-0.28 [-1.16，0.6]）。与单次治疗相比，多次暴露疗法在治疗后有疗效（n = 93；SMD：-0.66 [-1.08，-0.24]），但1年后无疗效（n = 83；SMD：-0.37 [-0.87，0.13]）。非现场暴露疗法，如儿童的想象暴露疗法在治疗后降低了特定恐惧（n = 41；SMD：-0.88 [-1.7，-0.05]），在3个月时也有降低（n = 24；SMD：-0.89 [-1.73，-0.04]）。成人的非现场暴露疗法对特定恐惧有疗效（n = 68；SMD：-0.62 [-1.11，-0.14]），但对操作恐惧无疗效（n = 17；SMD：0.18 [-0.87，1.23]）。与单纯暴露相比，应用紧张在治疗后及1年后对昏厥有疗效（n = 20；SMD：-1.16 [-2.12，-0.19]；n = 20；SMD：-0.97 [-1.91，-0.03]）。
结论
基于暴露的心理干预和应用肌肉紧张在降低儿童和成人恐惧方面显示出有益证据。
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