Cuijpers Pim, Quero Soledad, Noma Hisashi, Ciharova Marketa, Miguel Clara, Karyotaki Eirini, Cipriani Andrea, Cristea Ioana A, Furukawa Toshi A
Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain.
World Psychiatry. 2021 Jun;20(2):283-293. doi: 10.1002/wps.20860.
The effects of psychotherapies for depression have been examined in several hundreds of randomized trials, but no recent network meta-analysis (NMA) has integrated the results of these studies. We conducted an NMA of trials comparing cognitive behavioural, interpersonal, psychodynamic, problem-solving, behavioural activation, life-review and "third wave" therapies and non-directive supportive counseling with each other and with care-as-usual, waiting list and pill placebo control conditions. Response (50% reduction in symptoms) was the primary outcome, but we also assessed remission, standardized mean difference, and acceptability (all-cause dropout rate). Random-effects pairwise and network meta-analyses were conducted on 331 randomized trials with 34,285 patients. All therapies were more efficacious than care-as-usual and waiting list control conditions, and all therapies - except non-directive supportive counseling and psychodynamic therapy - were more efficacious than pill placebo. Standardized mean differences compared with care-as-usual ranged from -0.81 for life-review therapy to -0.32 for non-directive supportive counseling. Individual psychotherapies did not differ significantly from each other, with the only exception of non-directive supportive counseling, which was less efficacious than all other therapies. The results were similar when only studies with low risk of bias were included. Most therapies still had significant effects at 12-month follow-up compared to care-as-usual, and problem-solving therapy was found to have a somewhat higher long-term efficacy than some other therapies. No consistent differences in acceptability were found. Our conclusion is that the most important types of psychotherapy are efficacious and acceptable in the acute treatment of adult depression, with few significant differences between them. Patient preference and availability of each treatment type may play a larger role in the choice between types of psychotherapy, although it is possible that a more detailed characterization of patients with a diagnosis of depression may lead to a more precise matching between individual patients and individual psychotherapies.
数百项随机试验对抑郁症心理治疗的效果进行了检验，但最近尚无网络荟萃分析（NMA）整合这些研究的结果。我们开展了一项NMA，纳入比较认知行为疗法、人际疗法、心理动力疗法、问题解决疗法、行为激活疗法、生活回顾疗法和“第三波”疗法以及非指导性支持性咨询，彼此之间以及与常规护理、等候名单和药物安慰剂对照条件的试验。缓解（症状减轻50%）是主要结局，但我们也评估了痊愈、标准化均数差和可接受性（全因脱落率）。对331项涉及34285例患者的随机试验进行了随机效应成对和网络荟萃分析。所有疗法均比常规护理和等候名单对照条件更有效，除非指导性支持性咨询和心理动力疗法外，所有疗法均比药物安慰剂更有效。与常规护理相比，标准化均数差范围从生活回顾疗法的-0.81至非指导性支持性咨询的-0.32。个别心理疗法之间无显著差异，唯一例外是非指导性支持性咨询，其效果低于所有其他疗法。仅纳入低偏倚风险研究时结果相似。与常规护理相比，大多数疗法在12个月随访时仍有显著效果，且发现问题解决疗法的长期疗效略高于其他一些疗法。未发现可接受性方面的一致差异。我们的结论是，最重要类型的心理治疗在成人抑郁症急性治疗中有效且可接受，它们之间差异不大。患者偏好和每种治疗类型的可及性在心理治疗类型选择中可能起更大作用，尽管有可能对抑郁症诊断患者进行更详细的特征描述可使个体患者与个体心理治疗更精确匹配。
