Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont.
CMAJ. 2024 Mar 17;196(10):E327-E340. doi: 10.1503/cmaj.230274.
Cognitive behavioural therapy (CBT) has been shown to be effective for several psychiatric and somatic conditions; however, most randomized controlled trials (RCTs) have administered treatment in person and whether remote delivery is similarly effective remains uncertain. We sought to compare the effectiveness of therapist-guided remote CBT and in-person CBT.
We systematically searched MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials from inception to July 4, 2023, for RCTs that enrolled adults (aged ≥ 18 yr) presenting with any clinical condition and that randomized participants to either therapist-guided remote CBT (e.g., teleconference, videoconference) or in-person CBT. Paired reviewers assessed risk of bias and extracted data independently and in duplicate. We performed random-effects model meta-analyses to pool patient-important primary outcomes across eligible RCTs as standardized mean differences (SMDs). We used Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance to assess the certainty of evidence and used the Instrument to Assess the Credibility of Effect Modification Analyses (ICEMAN) to rate the credibility of subgroup effects.
We included 54 RCTs that enrolled a total of 5463 patients. Seventeen studies focused on treatment of anxiety and related disorders, 14 on depressive symptoms, 7 on insomnia, 6 on chronic pain or fatigue syndromes, 5 on body image or eating disorders, 3 on tinnitus, 1 on alcohol use disorder, and 1 on mood and anxiety disorders. Moderate-certainty evidence showed little to no difference in the effectiveness of therapist-guided remote and in-person CBT on primary outcomes (SMD -0.02, 95% confidence interval -0.12 to 0.07).
Moderate-certainty evidence showed little to no difference in the effectiveness of in-person and therapist-guided remote CBT across a range of mental health and somatic disorders, suggesting potential for the use of therapist-guided remote CBT to facilitate greater access to evidence-based care. Open Science Framework (https://osf.io/7asrc).
认知行为疗法（CBT）已被证明对多种精神和躯体疾病有效；然而，大多数随机对照试验（RCT）都是面对面进行治疗，远程治疗是否同样有效尚不确定。我们旨在比较治疗师指导的远程 CBT 和面对面 CBT 的有效性。
我们系统地检索了 MEDLINE、Embase、PsycINFO、CINAHL 和 Cochrane 对照试验中心注册库，从建库到 2023 年 7 月 4 日，纳入招募成年患者（年龄≥18 岁）并进行随机分组的 RCT，患者患有任何临床疾病，随机分组接受治疗师指导的远程 CBT（如电话会议、视频会议）或面对面 CBT。配对审查员独立并重复评估偏倚风险和提取数据。我们采用随机效应模型荟萃分析汇总合格 RCT 中的患者重要的主要结局作为标准化均数差（SMD）。我们使用推荐评估、制定与评价（GRADE）指南评估证据确定性，并使用效果修正分析可信度评估工具（ICEMAN）评估亚组效果的可信度。
我们纳入了 54 项 RCT，共纳入了 5463 名患者。17 项研究侧重于治疗焦虑和相关障碍，14 项研究侧重于抑郁症状，7 项研究侧重于失眠，6 项研究侧重于慢性疼痛或疲劳综合征，5 项研究侧重于身体形象或饮食障碍，3 项研究侧重于耳鸣，1 项研究侧重于酒精使用障碍，1 项研究侧重于情绪和焦虑障碍。中等确定性证据表明，治疗师指导的远程和面对面 CBT 在主要结局上的有效性几乎没有差异（SMD-0.02，95%置信区间-0.12 至 0.07）。
中等确定性证据表明，在一系列心理健康和躯体疾病中，面对面和治疗师指导的远程 CBT 的有效性几乎没有差异，这表明治疗师指导的远程 CBT 具有更大的潜力，可以促进更多的人获得循证治疗。开放科学框架（https://osf.io/7asrc）。
