School of Psychology and Exercise Science, Murdoch University, Murdoch, WA, Australia.
Altrecht Academic Anxiety Centre, Utrecht, The Netherlands.
PLoS One. 2021 Jul 22;16(7):e0254778. doi: 10.1371/journal.pone.0254778. eCollection 2021.
BACKGROUND: Trauma-focused treatments (TFTs) have demonstrated efficacy at decreasing depressive symptoms in individuals with PTSD. This systematic review and meta-analysis evaluated the effectiveness of TFTs for individuals with depression as their primary concern.
METHODS: A systematic search was conducted for RCTs published before October 2019 in Cochrane CENTRAL, Pubmed, EMBASE, PsycInfo, and additional sources. Trials examining the impact of TFTs on participants with depression were included. Trials focusing on individuals with PTSD or another mental health condition were excluded. The primary outcome was the effect size for depression diagnosis or depressive symptoms. Heterogeneity, study quality, and publication bias were also explored.
RESULTS: Eleven RCTs were included (n = 567) with ten of these using EMDR as the TFT and one using imagery rescripting. Analysis suggested these TFTs were effective in reducing depressive symptoms post-treatment with a large effect size [d = 1.17 (95% CI: 0.58~ 1.75)]. Removal of an outlier saw the effect size remain large [d = 0.83 (95% CI: 0.48~ 1.17)], while the heterogeneity decreased (I2 = 66%). Analysis of the 10 studies that used EMDR also showed a large effect [d = 1.30 (95% CI: 0.671.91)]. EMDR was superior to non trauma-focused CBT [d = 0.66 (95% CI: 0.311.02)] and analysis of EMDR and imagery rescripting studies suggest superiority over inactive control conditions [d = 1.19 (95% CI: 0.53~ 1.86)]. Analysis of follow-up data also supported the use of EMDR with this population [d = 0.71 (95% CI: 1.04~0.38)]. No publication bias was identified.
CONCLUSIONS: Current evidence suggests that EMDR can be an effective treatment for depression. There were insufficient RCTs on other trauma-focused interventions to conclude whether TFTs in general were effective for treating depression. Larger studies with robust methodology using EMDR and other trauma-focused interventions are needed to build on these findings.
背景:创伤焦点治疗(TFT)已被证明能有效减少 PTSD 患者的抑郁症状。本系统评价和荟萃分析评估了 TFT 对以抑郁为主要关注点的个体的有效性。
方法:对 2019 年 10 月前在 Cochrane 中心、Pubmed、EMBASE、PsycInfo 和其他来源发表的 RCT 进行了系统检索。纳入了评估 TFT 对抑郁患者影响的试验。排除了专门针对 PTSD 或其他心理健康状况患者的试验。主要结局是抑郁诊断或抑郁症状的效应量。还探讨了异质性、研究质量和发表偏倚。
结果:纳入了 11 项 RCT(n = 567),其中 10 项使用 EMDR 作为 TFT,1 项使用意象重述。分析表明,这些 TFT 在治疗后减少抑郁症状方面是有效的,效应量较大[d = 1.17(95% CI:0.581.75)]。去除一个异常值后,效应量仍然较大[d = 0.83(95% CI:0.481.17)],同时异质性降低(I2 = 66%)。对使用 EMDR 的 10 项研究的分析也显示出较大的效应[d = 1.30(95% CI:0.671.91)]。EMDR 优于非创伤焦点认知行为疗法[d = 0.66(95% CI:0.311.02)],对 EMDR 和意象重述研究的分析表明,其优于非活动对照条件[d = 1.19(95% CI:0.531.86)]。对随访数据的分析也支持在该人群中使用 EMDR[d = 0.71(95% CI:1.040.38)]。未发现发表偏倚。
结论:目前的证据表明,EMDR 可能是治疗抑郁的有效方法。关于其他创伤焦点干预措施的 RCT 数量不足,无法得出 TFT 一般是否对治疗抑郁有效。需要进行更大规模、方法更稳健的研究,使用 EMDR 和其他创伤焦点干预措施,以进一步证实这些发现。
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