Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands.
Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan.
JAMA Psychiatry. 2019 Jul 1;76(7):700-707. doi: 10.1001/jamapsychiatry.2019.0268.
Cognitive behavior therapy (CBT) has been shown to be effective in the treatment of acute depression. However, whether CBT can be effectively delivered in individual, group, telephone-administered, guided self-help, and unguided self-help formats remains unclear.
To examine the most effective delivery format for CBT via a network meta-analysis.
A database updated yearly from PubMed, PsycINFO, Embase, and the Cochrane Library. Literature search dates encompassed January 1, 1966, to January 1, 2018.
Randomized clinical trials of CBT for adult depression. The 5 treatment formats were compared with each other and the control conditions (waiting list, care as usual, and pill placebo).
PRISMA guidelines were used when extracting data and assessing data quality. Data were pooled using a random-effects model. Pairwise and network meta-analyses were conducted.
Severity of depression and acceptability of the treatment formats.
A total of 155 trials with 15 191 participants compared 5 CBT delivery formats with 2 control conditions. In half of the studies (78 [50.3%]), patients met the criteria for a depressive disorder; in the other half (77 [49.7%]), participants scored above the cutoff point on a self-report measure. The effectiveness of individual, group, telephone, and guided self-help CBT did not differ statistically significantly from each other. These formats were statistically significantly more effective than the waiting list (standardized mean differences [SMDs], 0.87-1.02) and care as usual (SMDs, 0.47-0.72) control conditions as well as the unguided self-help CBT (SMDs, 0.34-0.59). In terms of acceptability (dropout for any reason), individual (relative risk [RR] = 1.44; 95% CI, 1.09-1.89) and group (RR = 1.38; 95% CI, 1.06-1.80) CBT were significantly better than guided self-help. Guided self-help was also less acceptable than being on a waiting list (RR = 0.63; 95% CI, 0.52-0.75) and care as usual (RR = 0.72; 95% CI, 0.57-0.90). Sensitivity analyses supported the overall findings.
For acute symptoms of depression, group, telephone, and guided self-help treatment formats appeared to be effective interventions, which may be considered as alternatives to individual CBT; although there were few indications of significant differences in efficacy between treatments with human support, guided self-help CBT may be less acceptable for patients than individual, group, or telephone formats.
认知行为疗法（CBT）已被证明对急性抑郁症的治疗有效。然而，CBT 是否可以有效地以个体、小组、电话管理、指导自助和非指导自助的形式提供，目前仍不清楚。
通过网络荟萃分析研究 CBT 最有效的提供形式。
从 PubMed、PsycINFO、Embase 和 Cochrane 图书馆每年更新的数据库。文献检索日期涵盖 1966 年 1 月 1 日至 2018 年 1 月 1 日。
针对成人抑郁症的 CBT 随机临床试验。将这 5 种治疗形式相互比较，并与对照条件（等候名单、常规护理和安慰剂）进行比较。
在提取数据和评估数据质量时使用 PRISMA 指南。使用随机效应模型汇总数据。进行了成对和网络荟萃分析。
抑郁严重程度和治疗形式的可接受性。
共有 155 项试验，涉及 15191 名参与者，将 5 种 CBT 提供形式与 2 种对照条件进行了比较。在一半的研究（78[50.3%]）中，患者符合抑郁障碍标准；在另一半研究（77[49.7%]）中，参与者在自我报告测量中得分高于临界值。个体、小组、电话和指导自助 CBT 的有效性彼此之间没有统计学上的显著差异。这些形式与等候名单（标准化均数差[SMD]，0.87-1.02）和常规护理（SMD，0.47-0.72）对照条件以及非指导自助 CBT（SMD，0.34-0.59）相比，在统计学上更有效。就可接受性（任何原因的辍学）而言，个体（相对风险[RR]，1.44；95%CI，1.09-1.89）和小组（RR，1.38；95%CI，1.06-1.80）CBT 明显优于指导自助。指导自助也比等候名单（RR，0.63；95%CI，0.52-0.75）和常规护理（RR，0.72；95%CI，0.57-0.90）更不可取。敏感性分析支持总体发现。
对于急性抑郁症状，小组、电话和指导自助治疗形式似乎是有效的干预措施，可考虑作为个体 CBT 的替代方法；尽管在有人支持的治疗效果方面没有明显差异的迹象，但与个体、小组或电话形式相比，指导自助 CBT 对患者的可接受性可能较低。
