认知行为疗法治疗躯体形式障碍和医学无法解释的躯体症状的疗效：随机对照试验的荟萃分析。

The efficacy of cognitive behavioural therapy in somatoform disorders and medically unexplained physical symptoms: A meta-analysis of randomized controlled trials.

机构信息

The Department of Clinical Psychology & National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.

School of Medicine, Griffith University, Queensland, Australia; Gold Coast University Hospital, Southport, Queensland, Australia.

出版信息

J Affect Disord. 2019 Feb 15;245:98-112. doi: 10.1016/j.jad.2018.10.114. Epub 2018 Oct 22.

DOI:10.1016/j.jad.2018.10.114

PMID:30368076

Abstract

BACKGROUND

This systematic review and meta-analysis aimed to update and give an overview of the evidence from published literature that focused on the efficacy of cognitive behaviour therapy (CBT) in the management of somatoform disorders and medically unexplained physical symptoms (MUPS).

METHODS

A comprehensive literature search was carried out through an electronic search of various databases on randomized controlled trials (RCTs). Primary outcome was the severity of somatic symptoms. Secondary outcomes were also measured based on severity of anxiety symptoms, severity of depressive symptoms, social functioning, physical functioning, doctor visits and the compliance with CBT, as well as follow-up visits. Effects were summarized by a random effects model using mean differences or odds ratio with 95% confidence intervals (CIs).

RESULTS

A total of 15 RCTs comprising 1671 patients with somatoform disorders or MUPS were enrolled in our systematic review and meta-analysis. The main analysis revealed that CBT could alleviate somatic symptoms: -1.31 (95% CI: -2.23 to -0.39, p = 0.005); anxiety symptoms: -1.89 (95% CI: -2.91 to -0.86; p < 0.001); depressive symptoms: -1.93 (95% CI: -3.56 to -0.31; p = 0.020); improve physical functioning: 4.19 (95% CI: 1.90 to 6.49; p < 0.001). The efficacy of CBT on alleviating somatic symptoms, anxiety and depressive symptoms were sustained on follow-up. CBT may not be effective in reducing the number of doctor visits: -1.23 (95% CI: -2.97 to 0.51; p = 0.166); and improving social functioning: 3.27 (95% CI: -0.08 to 6.63; p = 0.056). The results of subgroup analysis indicated that CBT was particularly beneficial when the duration of session was more than 50 min to reduce the severity of somatic symptoms from pre to post treatment time, when it was group based and applied affective and developed good interpersonal strategy during the treatment. Longer duration and frequency such as more than 10 sessions and 12 weeks treatments had significant effect on reduction of the comorbid symptoms including depression and anxiety, but they may underpin low level of compliance of CBT based treatments.

CONCLUSIONS

CBT is effective for the treatment of somatoform disorders and MUPS by reducing physical symptoms, psychological distress and disability.

摘要

背景

本系统评价和荟萃分析旨在更新和概述已发表文献中关于认知行为疗法（CBT）治疗躯体形式障碍和医学无法解释的躯体症状（MUPS）疗效的证据。

方法

通过对各种数据库进行电子检索，进行了全面的文献搜索，以查找随机对照试验（RCT）。主要结局是躯体症状的严重程度。次要结局还根据焦虑症状严重程度、抑郁症状严重程度、社会功能、身体功能、就诊次数以及 CBT 的依从性和随访就诊次数进行测量。使用均数差值或比值比及其 95%置信区间（CI），采用随机效应模型汇总效应。

结果

我们的系统评价和荟萃分析共纳入了 15 项 RCT，共纳入了 1671 例躯体形式障碍或 MUPS 患者。主要分析结果显示，CBT 可减轻躯体症状：-1.31（95%CI：-2.23 至-0.39，p=0.005）；焦虑症状：-1.89（95%CI：-2.91 至-0.86；p<0.001）；抑郁症状：-1.93（95%CI：-3.56 至-0.31；p=0.020）；改善身体功能：4.19（95%CI：1.90 至 6.49；p<0.001）。CBT 缓解躯体症状、焦虑和抑郁症状的疗效在随访中持续存在。CBT 可能无法有效减少就诊次数：-1.23（95%CI：-2.97 至 0.51；p=0.166）；改善社会功能：3.27（95%CI：-0.08 至 6.63；p=0.056）。亚组分析结果表明，当疗程超过 50 分钟时，CBT 对减轻躯体症状的严重程度具有特别的益处，当采用小组形式并在治疗过程中应用情感和制定良好的人际策略时，CBT 具有特别的益处。治疗时间超过 10 次和 12 周时，疗程和频率更长会对减轻抑郁和焦虑等共病症状有显著效果，但可能会降低 CBT 基于治疗的依从性。