Kelson Joshua, Rollin Audrey, Ridout Brad, Campbell Andrew
Cyberpsychology Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.
J Med Internet Res. 2019 Jan 29;21(1):e12530. doi: 10.2196/12530.
Anxiety conditions are debilitating and prevalent throughout the world. Acceptance and Commitment Therapy (ACT) is an effective, acceptance-based behavioral therapy for anxiety. However, there are treatment barriers (eg, financial, geographical, and attitudinal), which prevent people from accessing it. To overcome these barriers, internet-delivered ACT (iACT) interventions have been developed in recent years. These interventions use websites to deliver ACT information and skill training exercises on the Web, either as pure self-help or with therapist guidance.
This systematic review aimed to examine the therapeutic impact of iACT on all anxiety conditions.
The EMBASE, MEDLINE, ProQuest Central, PsycINFO, Scopus, and Web of Science databases were searched up to September 2018. The titles and abstracts of remaining records after deduplication were screened by 2 authors with a total of 36 full-text articles being retained for closer inspection next to eligibility criteria. Empirical studies of all designs, population types, and comparator groups were included if they appraised the impact of iACT treatment on any standardized measure of anxiety. Included studies were appraised on methodological quality and had their data extracted into a standardized coding sheet. Findings were then tabulated, and a narrative synthesis was performed because of the heterogeneity found between studies.
A total of 20 studies met inclusion criteria. There were 11 randomized controlled trials (RCTs) and 9 uncontrolled pilot studies. Participants across all studies were adults. The anxiety conditions treated were as follows: generalized anxiety disorder (GAD), social anxiety disorder (SAD), illness anxiety disorder (IAD), and general anxiety symptoms, with or without comorbid physical and mental health problems. A total of 18 studies reported significant anxiety reduction after iACT treatment. This was observed in studies that delivered iACT with (n=13) or without (n=5) therapist guidance. The average attrition rate across all included studies during the active iACT treatment phase was 19.19%. In the 13 studies that assessed treatment satisfaction, participants on average rated their iACT experience with above average to high treatment satisfaction.
These findings indicate that iACT can be an efficacious and acceptable treatment for adults with GAD and general anxiety symptoms. More RCT studies are needed to corroborate these early iACT findings using empirical treatments in active control groups (eg, internet-delivered cognitive behavioral therapy). This would potentially validate the promising results found for SAD and IAD as well as address the full spectrum of anxiety disorders.
焦虑症在全球范围内普遍存在且使人衰弱。接纳与承诺疗法（ACT）是一种针对焦虑症的有效、基于接纳的行为疗法。然而，存在一些治疗障碍（如经济、地理和态度方面的障碍），阻碍人们获得这种治疗。为克服这些障碍，近年来已开发出互联网提供的接纳与承诺疗法（iACT）干预措施。这些干预措施利用网站在网络上提供ACT信息和技能训练练习，既可以是纯粹的自助形式，也可以在治疗师指导下进行。
本系统评价旨在研究iACT对所有焦虑症的治疗效果。
检索截至2018年9月的EMBASE、MEDLINE、ProQuest Central、PsycINFO、Scopus和Web of Science数据库。由2位作者对去重后剩余记录的标题和摘要进行筛选，共保留36篇全文文章以根据纳入标准进行更仔细的审查。如果评估了iACT治疗对任何标准化焦虑测量指标的影响，则纳入所有设计、人群类型和比较组的实证研究。对纳入研究的方法学质量进行评估，并将其数据提取到标准化编码表中。然后将结果制成表格，并由于研究之间发现的异质性进行叙述性综合分析。
共有20项研究符合纳入标准。其中有11项随机对照试验（RCT）和9项非对照试点研究。所有研究的参与者均为成年人。所治疗的焦虑症如下：广泛性焦虑症（GAD）、社交焦虑症（SAD）、疾病焦虑症（IAD）以及一般焦虑症状，伴有或不伴有合并的身心健康问题。共有18项研究报告iACT治疗后焦虑显著减轻。在有（n = 13）或没有（n = 5）治疗师指导下提供iACT的研究中均观察到这一点。在积极的iACT治疗阶段，所有纳入研究的平均脱落率为19.19%。在13项评估治疗满意度的研究中，参与者对iACT体验的平均评分是治疗满意度高于平均水平至较高。
这些发现表明，iACT对于患有GAD和一般焦虑症状的成年人可能是一种有效且可接受的治疗方法。需要更多的RCT研究，以使用积极对照组中的实证治疗方法（如互联网提供的认知行为疗法）来证实这些早期的iACT研究结果。这可能会验证在SAD和IAD中发现的有前景的结果，并解决整个焦虑症谱系问题。
