School of Nursing, Peking University, Beijing, China.
Department of Epidemiology, School of Public Health, Johns Hopkins University, United States.
J Affect Disord. 2022 Sep 15;313:196-203. doi: 10.1016/j.jad.2022.06.017. Epub 2022 Jun 25.
Acceptance and Commitment Therapy (ACT) has been shown to be effective in the treatment of acute depression. However, whether ACT can be effectively delivered in individual, group, internet, and combined delivery format remain unclear. We aimed to examine the most effective delivery format for ACT via a network meta-analysis (NMA).
An electronic literature search was conducted by two reviewers in the Pubmed, Cochrane library, Embase, PsycINFO, CINAHL, CNKI, Wangfang databases to identify relevant studies that were published up to March 21th, 2021. We conducted pairwise and NMA to evaluate the relative effectiveness and rank the probability of different ACT delivery formats. A series of analyses and assessments, such as the risk of bias, and GRADE were performed concurrently.
A total of 23 studies were included in our analysis based on a series of rigorous screenings, which comprised 690 depressed patients. The effectiveness of individual, group, internet, and combine ACT did not differ statistically significantly from each other. Compared with control group, individual delivery format (standardized mean difference [SMD] = -1.44, confidence interval (CI) = -2.11 to -0.76 GRADE low), group delivery format (SMD = -1.34, 95 % CI = -1.91 to -0.78 GRADE moderate), and internet delivery format (SMD = -0.66, 95 % CI = -1.25 to -0.06 GRADE low) showed the largest improvement on depressive symptoms, whereas the combined group and individual ACT was less effective. In terms of acceptability (dropout for any reason), all delivery formats did not differ statistically significantly from each other.
For depression symptoms, individual, group, and internet treatment formats appeared to be effective interventions. Applying effective and acceptable ACT in a range of different formats will make ACT easier to implement, disseminate, and deliver across different settings and diverse patient populations. More research is needed to verify the ACT in telephone and combined formats for the management of depression.
接受和承诺疗法（ACT）已被证明在治疗急性抑郁症方面有效。然而，ACT 能否以个体、团体、互联网和联合的方式有效地实施尚不清楚。我们旨在通过网络荟萃分析（NMA）来检验 ACT 最有效的实施方式。
两名审查员在 Pubmed、Cochrane 图书馆、Embase、PsycINFO、CINAHL、CNKI、万方数据库中进行电子文献检索，以确定截至 2021 年 3 月 21 日发表的相关研究。我们进行了成对和 NMA 分析，以评估不同 ACT 实施方式的相对有效性，并对不同 ACT 实施方式的概率进行排序。同时进行了一系列分析和评估，如偏倚风险和 GRADE 分级。
根据一系列严格的筛选，共有 23 项研究纳入了我们的分析，共纳入 690 名抑郁症患者。个体、团体、互联网和联合 ACT 的有效性彼此之间无统计学差异。与对照组相比，个体实施方式（标准化均数差 [SMD] = -1.44，置信区间 [CI] = -2.11 至 -0.76 GRADE 低）、团体实施方式（SMD = -1.34，95%CI = -1.91 至 -0.78 GRADE 中）和互联网实施方式（SMD = -0.66，95%CI = -1.25 至 -0.06 GRADE 低）在抑郁症状方面显示出最大的改善，而联合组和个体 ACT 的效果较差。在可接受性（任何原因的脱落）方面，所有实施方式彼此之间无统计学差异。
对于抑郁症状，个体、团体和互联网治疗方式似乎是有效的干预措施。在各种不同的实施方式中应用有效且可接受的 ACT 将使 ACT 更容易在不同环境和不同患者群体中实施、推广和提供。需要更多的研究来验证电话和联合实施方式在抑郁症管理中的 ACT。
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