School of Health Sciences, University of East Anglia, United Kingdom.
Department of Clinical Psychology, Norwich Medical School, University of East Anglia, United Kingdom.
Clin Psychol Rev. 2017 Mar;52:124-136. doi: 10.1016/j.cpr.2017.01.003. Epub 2017 Jan 16.
The current meta-analysis compared the efficacy of CBT for GAD between adults of working age and older people. In addition, we conducted a qualitative content analysis of treatment protocols used in studies with older clients to explore potential factors that may enhance treatment outcomes with this particular client group. Applying the inclusion criteria resulted in the identification of 15 studies with 22 comparisons between CBT and control groups (770 patients). When examining overall effect sizes for CBT for GAD between older people and adults of working age there were no statistically significant differences in outcome. However, overall effect size of CBT for GAD was moderate for older people (g=0.55, 95% CI 0.22-0.88) and large for adults of working age (g=0.94, 95% CI 0.52-1.36), suggesting that there is still room for improvement in CBT with older people. The main difference in outcome between CBT for GAD between the two age groups was related to methodological quality in that no older people studies used an intention-to-treat design. The content analysis demonstrated that studies with older clients were conducted according to robust CBT protocols but did not take account of gerontological evidence to make them more age-appropriate.
本次荟萃分析比较了成人和老年人的广泛性焦虑障碍认知行为疗法（CBT）的疗效。此外，我们对针对老年患者的研究中使用的治疗方案进行了定性内容分析，以探讨可能增强该特定患者群体治疗效果的潜在因素。应用纳入标准确定了 15 项研究，其中包括 CBT 组和对照组（770 名患者）之间的 22 项比较。在检查老年人和成年工作年龄人群中广泛性焦虑障碍的 CBT 总体疗效时，两组之间的结果没有统计学上的显著差异。然而，老年人广泛性焦虑障碍 CBT 的总体疗效为中度（g=0.55，95%置信区间 0.22-0.88），成年工作年龄人群的疗效为显著（g=0.94，95%置信区间 0.52-1.36），这表明老年人的 CBT 仍有改进的空间。两组之间广泛性焦虑障碍 CBT 的结果主要差异与方法学质量有关，即没有老年人研究使用意向治疗设计。内容分析表明，针对老年患者的研究是根据强大的 CBT 方案进行的，但没有考虑老年学证据使治疗更适合他们的年龄。
