Buschner Alexander, Makiol Christian, Huang Jue, Mauche Nicole, Strauß Maria
Department of Psychiatry and Psychotherapy, Faculty of Medicine, Leipzig University, Leipzig, Germany.
Department of Psychiatry and Psychotherapy, Faculty of Medicine, Leipzig University, Leipzig, Germany.
J Affect Disord. 2025 Jun 15;379:88-99. doi: 10.1016/j.jad.2025.02.104. Epub 2025 Mar 5.
Mindfulness-based therapies (MBT) are proposed as a "third wave" of cognitive-behavioral therapy (CBT). This network meta-analysis investigated this hypothesis by comparing the effectiveness of MBT and CBT for treating depression, measured by the Beck Depression Inventory-II (BDI-II).
An indirect comparison was made. Relevant databases were searched for studies comparing either CBT or MBT with treatment as usual (TAU). Mean differences (MD) between intervention and TAU were calculated using changes from baseline from both intervention (Me) and TAU-group (Mc). MDs of CBT and MBT were compared in a network meta-analysis. Results were reported for both the common-effects-model (CEM) and the random-effects-model (REM). Risk of Bias (RoB) was measured using the RoB-2-tool. Quality of evidence was investigated based on GRADE.
Eight MBT and ten CBT studies, meeting eligibility since 2006, were included. MBT studies included behavioral activation with mindfulness, mindfulness-based cognitive therapy, person-based cognitive therapy, and a newly developed meditation-based lifestyle modification program. Both CBT and MBT differed significantly from TAU. In the unweighted CEM network meta-analysis, MBT showed significantly better treatment effect, but this was below the clinically relevant threshold (MD:-1.81). For REM and weighted analysis, there were no significant differences between CBT and MBT.
Heterogeneity, high RoB, and low evidence quality were notable, with indirectness limiting this analysis.
CBT and MBT both showed significant and clinically important treatment effects for depression. However, an outstanding benefit of MBT in comparison to CBT could not be found in this analysis. Further research could include a direct comparison.
基于正念的疗法（MBT）被视为认知行为疗法（CBT）的“第三次浪潮”。本网状Meta分析通过比较MBT和CBT在治疗抑郁症方面的有效性（以贝克抑郁量表第二版（BDI-II）衡量）来研究这一假设。
进行间接比较。检索相关数据库以查找比较CBT或MBT与常规治疗（TAU）的研究。使用干预组（Me）和TAU组（Mc）相对于基线的变化计算干预与TAU之间的平均差异（MD）。在网状Meta分析中比较CBT和MBT的MD。报告了固定效应模型（CEM）和随机效应模型（REM）的结果。使用RoB-2工具测量偏倚风险（RoB）。基于GRADE调查证据质量。
纳入了自2006年以来符合纳入标准的8项MBT研究和10项CBT研究。MBT研究包括正念行为激活、基于正念的认知疗法、以人为本的认知疗法以及新开发的基于冥想的生活方式改变计划。CBT和MBT均与TAU有显著差异。在未加权的CEM网状Meta分析中，MBT显示出显著更好的治疗效果，但低于临床相关阈值（MD：-1.81）。对于REM和加权分析，CBT和MBT之间没有显著差异。
异质性、高RoB和低证据质量较为显著，间接性限制了本分析。
CBT和MBT对抑郁症均显示出显著且具有临床重要性的治疗效果。然而，本分析未发现MBT相对于CBT有突出优势。进一步的研究可包括直接比较。
