Roberge Pasquale, Provencher Martin D, Gaboury Isabelle, Gosselin Patrick, Vasiliadis Helen-Maria, Benoît Annie, Carrier Nathalie, Antony Martin M, Chaillet Nils, Houle Janie, Hudon Catherine, Norton Peter J
Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke (Québec), Canada.
Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke (Québec), Canada.
Psychol Med. 2020 Dec 2;52(13):1-11. doi: 10.1017/S0033291720004316.
Transdiagnostic group cognitive-behavioral therapy (tCBT) is a delivery model that could help overcome barriers to large-scale implementation of evidence-based psychotherapy for anxiety disorders. The aim of this study was to assess the effectiveness of combining group tCBT with treatment-as-usual (TAU), compared to TAU, for the treatment of anxiety disorders in community-based mental health care.
In a multicenter single-blind, two-arm pragmatic superiority randomized trial, we recruited participants aged 18-65 who met DSM-5 criteria for principal diagnoses of generalized anxiety disorder, social anxiety disorder, panic disorder, or agoraphobia. Group tCBT consisted of 12 weekly 2 h sessions. There were no restrictions for TAU. The primary outcome measures were the Beck Anxiety Inventory (BAI) and clinician severity rating from the Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5) for the principal anxiety disorder at post-treatment, with intention-to-treat analysis.
A total of 231 participants were randomized to either tCBT + TAU (117) or TAU (114), with outcome data available for, respectively, 95 and 106. Results of the mixed-effects regression models showed superior improvement at post-treatment for participants in tCBT + TAU, compared to TAU, for BAI [p < 0.001; unadjusted post-treatment mean (s.d.): 13.20 (9.13) v. 20.85 (10.96), Cohen's d = 0.76] and ADIS-5 [p < 0.001; 3.27 (2.19) v. 4.93 (2.00), Cohen's d = 0.79].
Our findings suggest that the addition of group tCBT into usual care can reduce symptom severity in patients with anxiety disorders, and support tCBT dissemination in routine community-based care.
跨诊断团体认知行为疗法（tCBT）是一种治疗模式，有助于克服焦虑症循证心理治疗大规模实施过程中的障碍。本研究旨在评估在社区心理健康护理中，团体tCBT联合常规治疗（TAU）相较于单纯TAU治疗焦虑症的有效性。
在一项多中心单盲、双臂实用性优效性随机试验中，我们招募了年龄在18至65岁之间、符合《精神疾病诊断与统计手册》第5版（DSM-5）中广泛性焦虑症、社交焦虑症、惊恐障碍或场所恐惧症主要诊断标准的参与者。团体tCBT包括12次每周2小时的课程。对TAU没有限制。主要结局指标为治疗后主要焦虑症的贝克焦虑量表（BAI）和来自DSM-5焦虑及相关障碍访谈量表（ADIS-5）的临床医生严重程度评分，并采用意向性分析。
共有231名参与者被随机分为tCBT + TAU组（117名）或TAU组（114名）（分别有95名和106名参与者可获得结局数据）。混合效应回归模型结果显示，与TAU组相比，tCBT + TAU组参与者在治疗后BAI改善更显著[p < 0.001；治疗后未调整均值（标准差）：13.20（9.13）对20.85（10.96），Cohen's d = 0.76]，ADIS-5评分改善也更显著[p < 0.001；3.27（2.19）对4.93（2.00），Cohen's d = 0.79]。
我们的研究结果表明，在常规护理中加入团体tCBT可降低焦虑症患者的症状严重程度，并支持tCBT在常规社区护理中的推广。
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