Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan; Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.
WinShine Clinics in Specialty of Psychiatry, Kaohsiung City, Taiwan; Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung city, Taiwan; Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
J Affect Disord. 2021 Mar 1;282:786-794. doi: 10.1016/j.jad.2020.12.172. Epub 2020 Dec 30.
Currently, different psychological interventions have shown significant efficacy in the treatment of acrophobia. However, the superiority of these individual treatments remains unclear. This network meta-analysis (NMA) aimed to investigate the efficacy, acceptability, and superiority of different existing interventions for acrophobia.
We conducted a NMA of randomised controlled trials (RCTs) and compared the efficacy, acceptability, and superiority of different existing interventions for acrophobia.
In total, 17 RCTs (946 participants) were included in this study. The NMA demonstrated that virtual reality (VR) coach-delivered psychotherapy (standardised mean difference [SMD]=-2.08, 95% confidence interval [CI]: -3.22 to -0.93), in vivo exposure augmented with oppositional action (SMD=-1.66, 95% CI: -2.81 to -0.51), VR exposure therapy with 20 mg cortisol administration (SMD=-1.61, 95% CI: -3.14 to -0.09), VR based cognitive behavioural therapy (VRbasedCBT; SMD=-1.14, 95% CI: -2.22 to -0.05), and in vivo exposure (SMD=-1.02, 95% CI: -1.81 to -0.23) were significantly superior than the placebo/control interventions in improving the symptoms of patients with acrophobia. The NMA further indicated that VR coach-delivered psychotherapy was associated with the best improvement among all the 19 treatments for acrophobia. Furthermore, only VRbasedCBT (odds ratio=2.55, 95% CI: 1.09 to 5.96) was associated with higher dropout rate than the control/placebo.
Sample heterogeneity, non-standardised assessment tools, and limited RCTs in some of the treatment arms.
VR coach-delivered psychotherapy could be considered as a first-line intervention for treating acrophobia. However, because of the study limitations, the overall evidence was not sufficiently strong, which warrants future studies.
目前，不同的心理干预措施在治疗恐高症方面已显示出显著疗效。然而，这些单独治疗方法的优越性尚不清楚。本网络荟萃分析（NMA）旨在研究不同现有干预措施治疗恐高症的疗效、可接受性和优越性。
我们对随机对照试验（RCT）进行了 NMA，并比较了不同现有干预措施治疗恐高症的疗效、可接受性和优越性。
共有 17 项 RCT（946 名参与者）纳入本研究。NMA 显示，虚拟现实（VR）教练提供的心理治疗（标准化均数差 [SMD]=-2.08，95%置信区间 [CI]：-3.22 至-0.93）、结合对立动作的现场暴露治疗（SMD=-1.66，95% CI：-2.81 至-0.51）、20 毫克皮质醇给药的 VR 暴露治疗（SMD=-1.61，95% CI：-3.14 至-0.09）、基于 VR 的认知行为疗法（VRbasedCBT；SMD=-1.14，95% CI：-2.22 至-0.05）和现场暴露（SMD=-1.02，95% CI：-1.81 至-0.23）均显著优于安慰剂/对照干预措施，可改善恐高症患者的症状。NMA 进一步表明，在所有 19 种治疗恐高症的方法中，VR 教练提供的心理治疗效果最佳。此外，只有 VRbasedCBT（比值比=2.55，95% CI：1.09 至 5.96）与对照组相比，脱落率更高。
样本异质性、非标准化评估工具以及某些治疗组的 RCT 有限。
VR 教练提供的心理治疗可被视为治疗恐高症的一线干预措施。然而，由于研究的局限性，整体证据不够强，需要进一步研究。
