任何情况下、人群或环境中认知行为疗法的证据:系统评价和全景式荟萃分析的元综述。
The evidence for cognitive behavioural therapy in any condition, population or context: a meta-review of systematic reviews and panoramic meta-analysis.
机构信息
Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Science (NDORMS) University of Oxford, Oxford, UK.
Nuffield Department of Population Health, University of Oxford, Oxford, UK.
出版信息
Psychol Med. 2021 Jan;51(1):21-29. doi: 10.1017/S0033291720005292. Epub 2021 Jan 18.
The majority of psychological treatment research is dedicated to investigating the effectiveness of cognitive behavioural therapy (CBT) across different conditions, population and contexts. We aimed to summarise the current systematic review evidence and evaluate the consistency of CBT's effect across different conditions. We included reviews of CBT randomised controlled trials in any: population, condition, format, context, with any type of comparator and published in English. We searched DARE, Cochrane, MEDLINE, EMBASE, PsycINFO, CINAHL, CDAS, and OpenGrey between 1992 and January 2019. Reviews were quality assessed, their data extracted and summarised. The effects upon health-related quality of life (HRQoL) were pooled, within-condition groups. If the across-condition heterogeneity was I2 < 75%, we pooled effects using a random-effect panoramic meta-analysis. We summarised 494 reviews (221 128 participants), representing 14/20 physical and 13/20 mental conditions (World Health Organisation's International Classification of Diseases). Most reviews were lower-quality (351/494), investigated face-to-face CBT (397/494), and in adults (378/494). Few reviews included trials conducted in Asia, South America or Africa (45/494). CBT produced a modest benefit across-conditions on HRQoL (standardised mean difference 0.23; 95% confidence intervals 0.14-0.33, I2 = 32%). The effect's associated prediction interval -0.05 to 0.50 suggested CBT will remain effective in conditions for which we do not currently have available evidence. While there remain some gaps in the completeness of the evidence base, we need to recognise the consistent evidence for the general benefit which CBT offers.
大多数心理治疗研究都致力于调查认知行为疗法(CBT)在不同条件、人群和环境下的有效性。我们旨在总结当前的系统评价证据,并评估 CBT 在不同条件下的效果一致性。我们纳入了 CBT 随机对照试验的综述,无论其人群、条件、形式、环境如何,以及任何类型的对照,并以英文发表。我们在 1992 年至 2019 年 1 月期间在 DARE、Cochrane、MEDLINE、EMBASE、PsycINFO、CINAHL、CDAS 和 OpenGrey 进行了检索。对综述进行了质量评估、数据提取和总结。在条件内组内,汇总了对健康相关生活质量(HRQoL)的影响。如果跨条件异质性 I2 < 75%,我们将使用随机效应全景荟萃分析来汇总效果。我们总结了 494 项综述(221 128 名参与者),涉及 14/20 种身体疾病和 13/20 种精神疾病(世界卫生组织的国际疾病分类)。大多数综述质量较低(351/494),调查了面对面的 CBT(397/494),并且针对成年人(378/494)。很少有综述包括在亚洲、南美洲或非洲进行的试验(45/494)。CBT 在 HRQoL 方面对各种疾病都有适度的益处(标准化均数差 0.23;95%置信区间 0.14-0.33,I2 = 32%)。效应的相关预测区间为-0.05 至 0.50,表明 CBT 在目前尚无证据的情况下仍将对某些疾病有效。尽管证据基础的完整性仍存在一些差距,但我们需要认识到 CBT 提供的普遍益处的一致证据。
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