Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190 - Santa Efigênia, CEP: 30130-100 Belo Horizonte, MG, Brazil.
Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6.627, CEP: 31270-901 Belo Horizonte, MG, Brazil.
J Affect Disord. 2022 Jul 15;309:297-308. doi: 10.1016/j.jad.2022.04.134. Epub 2022 Apr 27.
A comprehensive meta-analysis quantitatively examining the effects of group Acceptance and Commitment Therapy (ACT) on anxiety and depressive symptoms is required to advance our understanding of its efficacy and moderating factors.
Four electronic databases were searched in August 2018. An update search was conducted in November 2021. Forty-eight randomised controlled trials (RCTs) were included in this review (3292 participants: anxiety = 34 RCTs, depression = 40 RCTs).
The overall effect size for anxiety symptoms was medium-to-large (g = 0.52, p < 0.001; 95% CI = 0.30-0.73), while the overall effect size was small-to-medium for depressive symptoms (g = 0.47, p < 0.001; 95% CI = 0.31-0.64). Subgroup analyses demonstrated that group ACT was significantly superior to non-active controls (e.g., waiting list) in reducing anxiety and depressive symptoms. Group ACT was only significantly superior to active controls (e.g., CBT) in reducing depressive symptoms. Subgroup analyses also demonstrated that the effect size can vary depending on the number of sessions provided and the primary condition of participants recruited.
The number of studies included in each category of subgroup analyses was small and the risk of bias varied across studies. There was high heterogeneity among the included studies, and this might have affected the results.
The current evidence suggests that group ACT may be effective in treating anxiety and depressive symptoms, perhaps more so for depressive symptoms when compared to other well-established treatments. The intensity of treatment and the targeted population may need to be considered when delivering group ACT.
为了深入了解团体接纳与承诺疗法（ACT）的疗效及其调节因素，需要进行一项综合的荟萃分析，定量评估团体 ACT 对焦虑和抑郁症状的影响。
本研究于 2018 年 8 月检索了四个电子数据库，并于 2021 年 11 月进行了更新检索。本综述共纳入 48 项随机对照试验（RCT）（3292 名参与者：焦虑症=34 项 RCT，抑郁症=40 项 RCT）。
焦虑症状的总体效应量为中到大（g=0.52，p<0.001；95%置信区间[CI]：0.30-0.73），而抑郁症状的总体效应量为小到中（g=0.47，p<0.001；95%CI：0.31-0.64）。亚组分析表明，团体 ACT 显著优于非活动对照（如等待名单），能减轻焦虑和抑郁症状。团体 ACT 仅在降低抑郁症状方面显著优于活性对照（如 CBT）。亚组分析还表明，效应量可能因提供的疗程数和招募的参与者的主要疾病而异。
每个亚组分析类别的研究数量较少，且研究间偏倚风险存在差异。纳入的研究之间存在高度异质性，这可能影响了结果。
目前的证据表明，团体 ACT 可能对治疗焦虑和抑郁症状有效，与其他已确立的治疗方法相比，对抑郁症状的疗效可能更为显著。在提供团体 ACT 时，需要考虑治疗强度和目标人群。
