Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.
Sci Rep. 2021 Oct 14;11(1):20385. doi: 10.1038/s41598-021-99882-w.
This meta-analysis systematically reviewed the evidence on standardized acceptance-/mindfulness-based interventions in DSM-5 anxiety disorders. Randomized controlled trials examining Acceptance and Commitment Therapy (ACT), Mindfulness-Based Cognitive Therapy (MBCT), and Mindfulness-Based Stress Reduction (MBSR) were searched via PubMed, Central, PsycInfo, and Scopus until June 2021. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for primary outcomes (anxiety) and secondary ones (depression and quality of life). Risk of bias was assessed using the Cochrane tool. We found 23 studies, mostly of unclear risk of bias, including 1815 adults with different DSM-5 anxiety disorders. ACT, MBCT and MBSR led to short-term effects on clinician- and patient-rated anxiety in addition to treatment as usual (TAU) versus TAU alone. In comparison to Cognitive Behavioral Therapy (CBT), ACT and MBCT showed comparable effects on both anxiety outcomes, while MBSR showed significantly lower effects. Analyses up to 6 and 12 months did not reveal significant differences compared to TAU or CBT. Effects on depression and quality of life showed similar trends. Statistical heterogeneity was moderate to considerable. Adverse events were reported insufficiently. The evidence suggests short-term anxiolytic effects of acceptance- and mindfulness-based interventions. Specific treatment effects exceeding those of placebo mechanisms remain unclear. Protocol registry: Registered at Prospero on November 3rd, 2017 (CRD42017076810).
这项荟萃分析系统地回顾了基于接受和正念的标准化干预措施在 DSM-5 焦虑障碍中的证据。通过 PubMed、Central、PsycInfo 和 Scopus 搜索了接受和承诺疗法 (ACT)、正念认知疗法 (MBCT) 和正念减压疗法 (MBSR) 的随机对照试验，截至 2021 年 6 月。计算了主要结局（焦虑）和次要结局（抑郁和生活质量）的标准化均数差 (SMD) 和 95%置信区间 (CI)。使用 Cochrane 工具评估偏倚风险。我们发现了 23 项研究，主要为偏倚风险不明确，包括 1815 名患有不同 DSM-5 焦虑障碍的成年人。ACT、MBCT 和 MBSR 在单独接受常规治疗 (TAU) 之外，在短期治疗时，对临床医生和患者评定的焦虑有效果。与认知行为疗法 (CBT) 相比，ACT 和 MBCT 在两种焦虑结局上显示出相当的效果，而 MBSR 的效果明显较低。与 TAU 或 CBT 相比，在 6 个月和 12 个月的分析中未显示出显著差异。对抑郁和生活质量的影响也显示出类似的趋势。统计异质性为中度到高度。不良反应报告不足。证据表明，接受和正念干预措施在短期内有抗焦虑作用。特定的治疗效果是否超过安慰剂机制仍不清楚。方案注册：2017 年 11 月 3 日在 Prospéro 注册（CRD42017076810）。
