Hedman-Lagerlöf Erik, Carlbring Per, Svärdman Frank, Riper Heleen, Cuijpers Pim, Andersson Gerhard
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Department of Psychology, Stockholm University, Stockholm, Sweden.
World Psychiatry. 2023 Jun;22(2):305-314. doi: 10.1002/wps.21088.
Providing therapist-guided cognitive behaviour therapy via the Internet (ICBT) has advantages, but a central research question is to what extent similar clinical effects can be obtained as with gold-standard face-to-face cognitive behaviour therapy (CBT). In a previous meta-analysis published in this journal, which was updated in 2018, we found evidence that the pooled effects for the two formats were equivalent in the treatment of psychiatric and somatic disorders, but the number of published randomized trials was relatively low (n=20). As this is a field that moves rapidly, the aim of the current study was to conduct an update of our systematic review and meta-analysis of the clinical effects of ICBT vs. face-to-face CBT for psychiatric and somatic disorders in adults. We searched the PubMed database for relevant studies published from 2016 to 2022. The main inclusion criteria were that studies had to compare ICBT to face-to-face CBT using a randomized controlled design and targeting adult populations. Quality assessment was made using the Cochrane risk of bias criteria (Version 1), and the main outcome estimate was the pooled standardized effect size (Hedges' g) using a random effects model. We screened 5,601 records and included 11 new randomized trials, adding them to the 20 previously identified ones (total n=31). Sixteen different clinical conditions were targeted in the included studies. Half of the trials were in the fields of depression/depressive symptoms or some form of anxiety disorder. The pooled effect size across all disorders was g=0.02 (95% CI: -0.09 to 0.14) and the quality of the included studies was acceptable. This meta-analysis further supports the notion that therapist-supported ICBT yields similar effects as face-to-face CBT.
通过互联网提供治疗师指导的认知行为疗法(ICBT)具有诸多优势,但一个核心研究问题是,与金标准的面对面认知行为疗法(CBT)相比,能在多大程度上获得相似的临床效果。在本期刊此前发表并于2018年更新的一项荟萃分析中,我们发现有证据表明,两种形式在治疗精神疾病和躯体疾病方面的合并效应相当,但已发表的随机试验数量相对较少(n = 20)。鉴于这是一个快速发展的领域,本研究的目的是对我们关于ICBT与面对面CBT对成人精神疾病和躯体疾病临床效果的系统评价和荟萃分析进行更新。我们在PubMed数据库中检索了2016年至2022年发表的相关研究。主要纳入标准是,研究必须采用随机对照设计,将ICBT与面对面CBT进行比较,并针对成年人群。使用Cochrane偏倚风险标准(第1版)进行质量评估,主要结局估计是使用随机效应模型的合并标准化效应量(Hedges' g)。我们筛选了5601条记录,纳入了11项新的随机试验,并将它们添加到之前确定的20项试验中(总计n = 31)。纳入研究针对16种不同的临床情况。一半的试验涉及抑郁症/抑郁症状或某种形式的焦虑症领域。所有疾病的合并效应量为g = 0.02(95%CI:-0.09至0.14),纳入研究的质量可以接受。这项荟萃分析进一步支持了这样一种观点,即有治疗师支持的ICBT产生的效果与面对面CBT相似。