Schefft Cora, Heinitz Christian, Guhn Anne, Brakemeier Eva-Lotta, Sterzer Philipp, Köhler Stephan
Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Department of Clinical Psychology and Psychotherapy, University of Greifswald, Greifswald, Germany.
Front Psychiatry. 2023 Oct 5;14:1189970. doi: 10.3389/fpsyt.2023.1189970. eCollection 2023.
In recent decades, various new psychotherapy approaches have been developed in an effort to overcome issues of non-response, referred to as "third-wave psychotherapies." How third-wave therapies perform in comparison to each other, to classical CBT, or other common comparators in the treatment of depression has not yet been systematically assessed.
We firstly determined the scope of the term "third-wave" by conducting a systematic search. The identified approaches were then used as search terms for the systematic review and network meta-analysis (NMA). We searched MEDLINE, CENTRAL, PsychINFO and Web of Science from inception until 31 July 2022. We assessed randomized controlled trials comparing third-wave psychotherapies to each other, CBT, treatment as usual (TAU), medication management, active control conditions, or waitlist (WL) in adult populations with depressive disorders. The treatments included were acceptance and commitment therapy, behavioral activation, cognitive behavioral analysis system of psychotherapy, dialectical behavioral therapy, mindfulness-based cognitive therapy, meta-cognitive therapy, positive psychotherapy and schema therapy. The primary outcome was depression severity (efficacy) at study endpoint, and the secondary outcome was all-cause discontinuation (acceptability). This review was registered in PROSPERO, identifier CRD42020147535.
Of 7,971 search results, 55 trials were included in our NMA (5,827 patients). None of the third-wave therapies were more efficacious than CBT but most were superior to TAU [standardized mean differences (SMD) ranging between 0.42 (95% CI -0.37; 1.19) and 1.25 (0.48; 2.04)]. Meta-cognitive therapy (MCT) was more efficacious than three other third-wave therapy approaches. None of the third-wave treatments were more acceptable than WL or CBT. Twenty-seven percent of the trials were rated as low risk of bias. Confidence in the evidence was largely low according to GRADE. Inconsistency emerged for a small number of comparisons.
Third-wave therapies are largely efficacious and acceptable alternatives to CBT when compared to TAU, with few differences between them. The evidence so far does not point toward superiority or inferiority over CBT. Patient-level research may offer possibilities for tailoring individual psychotherapies to the needs of individual patients and future trials should make this data available. The evidence base needs to be broadened by sufficiently powered trials.
近几十年来，为克服无反应问题开发了各种新的心理治疗方法，即 “第三波心理治疗”。第三波疗法与经典认知行为疗法（CBT）或其他常见对照疗法相比，在治疗抑郁症方面的表现尚未得到系统评估。
我们首先通过系统检索确定 “第三波” 一词的范围。然后将确定的方法用作系统评价和网状Meta分析（NMA）的检索词。我们检索了MEDLINE、CENTRAL、PsychINFO和Web of Science数据库，检索时间从建库至2022年7月31日。我们评估了比较第三波心理治疗方法之间、与CBT、常规治疗（TAU）、药物管理、积极对照条件或等待名单（WL）在成年抑郁症患者中的随机对照试验。纳入的治疗方法包括接纳与承诺疗法、行为激活、认知行为分析心理治疗系统、辩证行为疗法、基于正念的认知疗法、元认知疗法、积极心理治疗和图式疗法。主要结局是研究终点时的抑郁严重程度（疗效），次要结局是全因停药（可接受性）。本综述已在PROSPERO注册，标识符为CRD42020147535。
在7971条检索结果中，55项试验纳入我们的NMA（5827例患者）。没有一种第三波疗法比CBT更有效，但大多数优于TAU [标准化均数差（SMD）在0.42（95%CI -0.37；1.19）至1.25（0.48；2.04）之间]。元认知疗法（MCT）比其他三种第三波疗法更有效。没有一种第三波治疗方法比WL或CBT更可接受。27% 的试验被评为低偏倚风险。根据GRADE，证据的可信度大多较低。少数比较出现了不一致。
与TAU相比，第三波疗法在很大程度上是CBT的有效且可接受的替代方法，它们之间差异不大。目前的证据并未表明其优于或劣于CBT。患者层面的研究可能为根据个体患者需求定制个体心理治疗提供可能，未来的试验应提供此类数据。需要通过足够有力的试验来拓宽证据基础。
