Fodor Liviu A, Georgescu Raluca, Cuijpers Pim, Szamoskozi Ştefan, David Daniel, Furukawa Toshiaki A, Cristea Ioana A
International Institute for The Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania; Evidence Based Psychological Assessment and Interventions Doctoral School, Babeş-Bolyai University, Cluj-Napoca, Romania.
Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Lancet Psychiatry. 2020 Jun;7(6):506-514. doi: 10.1016/S2215-0366(20)30130-9. Epub 2020 May 20.
Cognitive bias modification (CBM) therapies, including attention bias modification, interpretation bias modification, or approach and avoidance training, are prototypical examples of mechanistically derived treatments, but their effectiveness is contentious. We aimed to assess the relative effectiveness of various CBM interventions for anxious and depressive symptomatology.
For this systematic review and network meta-analysis, we searched PubMed, PsycINFO, Embase, and Cochrane Central Register from database inception up until Feb 7, 2020. We included randomised controlled trials of CBM versus control conditions or other forms of CBM for adults aged 18 years and older with clinical or subclinical anxiety or depression measured with a diagnostic interview or a validated clinical scale. We excluded studies comparing CBM with a non-CBM active intervention. Two researchers independently selected studies and evaluated risk of bias with the Cochrane Collaboration tool. Primary outcomes encompassed anxiety and depressive symptoms measured with validated clinical scales. We computed standardised mean differences (SMDs) with a restricted maximum likelihood random effects model. This study is registered with PROSPERO, CRD42018086113.
From 2125 records we selected 85 trials, 65 (n=3897) on anxiety and 20 (n=1116) on depression. In a well connected network of anxiety trials, interpretation bias modification outperformed waitlist (SMD -0·55, 95% CI -0·91 to -0·19) and sham training (SMD -0·30, -0·50 to -0·10) for the primary outcome. Attention bias modification showed benefits only in post-hoc sensitivity analyses excluding post-traumatic stress disorder trials. Prediction intervals for all findings were large, including an SMD of 0. Networks of depression trials displayed evidence of inconsistency. Only four randomised controlled trials had low risk of bias on all six domains assessed.
CBM interventions showed consistent but small benefits; however heterogeneity and risk of bias undermine the reliability of these findings. Larger, definitive trials for interpretation bias modification for anxiety might be warranted, but insufficient evidence precludes conclusions for depression.
Romanian Ministry of Research and Innovation, The National Council for Scientific Research-The Executive Agency for Higher Education, Research, Development and Innovation Funding.
认知偏差矫正（CBM）疗法，包括注意力偏差矫正、解释偏差矫正或趋近与回避训练，是机制性衍生治疗的典型例子，但其有效性存在争议。我们旨在评估各种CBM干预措施对焦虑和抑郁症状的相对有效性。
对于这项系统评价和网状Meta分析，我们检索了从数据库建立至2020年2月7日的PubMed、PsycINFO、Embase和Cochrane中央对照试验注册库。我们纳入了针对18岁及以上成年人的CBM与对照条件或其他形式的CBM的随机对照试验，这些成年人患有临床或亚临床焦虑或抑郁，通过诊断访谈或经过验证的临床量表进行测量。我们排除了比较CBM与非CBM活性干预的研究。两名研究人员独立选择研究，并使用Cochrane协作工具评估偏倚风险。主要结局包括用经过验证的临床量表测量的焦虑和抑郁症状。我们使用限制最大似然随机效应模型计算标准化均数差（SMD）。本研究已在国际前瞻性系统评价注册库（PROSPERO）注册，注册号为CRD42018086113。
从2125条记录中，我们选择了85项试验，其中65项（n = 3897）针对焦虑，20项（n = 1116）针对抑郁。在一个连接良好的焦虑试验网络中，对于主要结局，解释偏差矫正优于等待名单（SMD -0·55，95%CI -0·91至 -0·19）和假训练（SMD -0·30，-0·50至 -0·10）。注意力偏差矫正仅在排除创伤后应激障碍试验的事后敏感性分析中显示出益处。所有结果的预测区间都很大，包括SMD为0的情况。抑郁试验网络显示出不一致的证据。在评估的所有六个领域中，只有四项随机对照试验的偏倚风险较低。
CBM干预措施显示出一致但较小的益处；然而，异质性和偏倚风险破坏了这些结果的可靠性。可能有必要进行更大规模、确定性的焦虑解释偏差矫正试验，但证据不足无法得出关于抑郁的结论。
罗马尼亚研究与创新部、国家科学研究委员会 - 高等教育、研究、发展和创新资助执行机构。
