Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, VIC, Australia; Monash Alfred Psychiatry Research Centre (MAPrc), Central Clinical School, Monash University and The Alfred Hospital, Melbourne, VIC, Australia.
Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, VIC, Australia.
Schizophr Res. 2018 Feb;192:57-63. doi: 10.1016/j.schres.2017.05.023. Epub 2017 May 23.
In promoting optimal recovery in persons with psychosis, psychological interventions have become a key element of treatment, with cognitive behavioural therapy being widely recommended in clinical practice guidelines. One key area of development has been the trialling of "third wave" cognitive behavioural interventions, which promote mindfulness, acceptance and compassion as means of change. Trials to date have demonstrated encouraging findings, with beneficial effects observed on measures of psychotic symptoms. This meta-analysis evaluated the efficacy of third wave interventions for the treatment of psychosis in randomised controlled trials, with psychotic symptoms as the primary outcome. Overall, 10 studies were included. The primary outcome demonstrated a small but significant effect (g=0.29) for third wave interventions compared with control post-treatment. Trials of group format mindfulness-based interventions showed larger effects (g=0.46) than individual acceptance and commitment therapy based interventions (g=0.08), although methodological differences between trials were noted. Among secondary outcomes, a moderate, significant treatment effect (g=0.39) was found for depressive symptoms, but no significant effects were found on specific measures of positive and negative symptoms, hallucination distress, or functioning/disability. A moderate effect on mindfulness (g=0.56) was observed, but not on acceptance. Overall, findings indicate that third wave interventions show beneficial effects on symptoms in persons with psychotic disorders. However, further research is required to determine the efficacy of specific models of treatment.
在促进精神病患者的最佳康复方面，心理干预已成为治疗的关键要素，认知行为疗法在临床实践指南中得到广泛推荐。一个关键的发展领域是“第三波”认知行为干预的试验，这些干预措施提倡正念、接纳和同情作为改变的手段。迄今为止的试验结果令人鼓舞，观察到对精神病症状的测量有有益的影响。这项荟萃分析评估了第三波干预措施在随机对照试验中治疗精神病的疗效，以精神病症状为主要结果。总体而言，纳入了 10 项研究。与治疗后对照组相比，第三波干预的主要结果显示出较小但显著的效果（g=0.29）。小组格式的基于正念的干预试验显示出比个体接受和承诺疗法为基础的干预更大的效果（g=0.46），尽管试验之间存在方法学差异。在次要结果中，抑郁症状的治疗效果中等且显著（g=0.39），但阳性和阴性症状、幻觉困扰或功能/残疾的特定测量指标没有显著效果。观察到对正念的中等、显著的治疗效果（g=0.56），但对接受没有显著效果。总体而言，研究结果表明，第三波干预措施对精神病患者的症状有有益的影响。然而，需要进一步的研究来确定特定治疗模式的疗效。
