Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy.
Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Psychol Med. 2023 Feb;53(3):614-624. doi: 10.1017/S0033291722003683. Epub 2022 Dec 9.
Several in-person and remote delivery formats of cognitive-behavioural therapy (CBT) for panic disorder are available, but up-to-date and comprehensive evidence on their comparative efficacy and acceptability is lacking. Our aim was to evaluate the comparative efficacy and acceptability of all CBT delivery formats to treat panic disorder. To answer our question we performed a systematic review and network meta-analysis of randomised controlled trials. We searched MEDLINE, Embase, PsycINFO, and CENTRAL, from inception to 1st January 2022. Pairwise and network meta-analyses were conducted using a random-effects model. Confidence in the evidence was assessed using Confidence in Network Meta-Analysis (CINeMA). The protocol was published in a peer-reviewed journal and in PROSPERO. We found a total of 74 trials with 6699 participants. Evidence suggests that face-to-face group [standardised mean differences (s.m.d.) -0.47, 95% confidence interval (CI) -0.87 to -0.07; CINeMA = moderate], face-to-face individual (s.m.d. -0.43, 95% CI -0.70 to -0.15; CINeMA = Moderate), and guided self-help (SMD -0.42, 95% CI -0.77 to -0.07; CINeMA = low), are superior to treatment as usual in terms of efficacy, whilst unguided self-help is not (SMD -0.21, 95% CI -0.58 to -0.16; CINeMA = low). In terms of acceptability (i.e. all-cause discontinuation from the trial) CBT delivery formats did not differ significantly from each other. Our findings are clear in that there are no efficacy differences between CBT delivered as guided self-help, or in the face-to-face individual or group format in the treatment of panic disorder. No CBT delivery format provided high confidence in the evidence at the CINeMA evaluation.
有几种面对面和远程提供的认知行为疗法 (CBT) 可用于治疗惊恐障碍，但缺乏关于其相对疗效和可接受性的最新和全面的证据。我们的目的是评估所有 CBT 提供方式治疗惊恐障碍的相对疗效和可接受性。为了回答我们的问题，我们对随机对照试验进行了系统评价和网络荟萃分析。我们从 MEDLINE、Embase、PsycINFO 和 CENTRAL 数据库中检索了从成立到 2022 年 1 月 1 日的所有文献。使用随机效应模型进行了两两和网络荟萃分析。使用信心网络荟萃分析 (CINeMA) 评估证据的可信度。该方案已在同行评议期刊和 PROSPERO 上发表。我们共发现了 74 项试验，涉及 6699 名参与者。证据表明，面对面小组治疗 [标准化均数差 (s.m.d.) -0.47，95%置信区间 (CI) -0.87 至 -0.07；CINeMA = 中等]、面对面个体治疗 (s.m.d. -0.43，95% CI -0.70 至 -0.15；CINeMA = 中等) 和指导自助治疗 (s.m.d. -0.42，95% CI -0.77 至 -0.07；CINeMA = 低) 在疗效方面优于常规治疗，而无指导自助治疗则不然 (s.m.d. -0.21，95% CI -0.58 至 -0.16；CINeMA = 低)。在可接受性方面（即试验中所有原因的退出），CBT 提供方式彼此之间没有显著差异。我们的研究结果很明确，在治疗惊恐障碍方面，指导自助治疗或面对面个体或小组治疗方式之间没有疗效差异。在 CINeMA 评估中，没有任何一种 CBT 提供方式提供了高可信度的证据。
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