接纳承诺疗法治疗焦虑障碍随机对照试验的Meta分析

Meta-analysis of randomized controlled trials of acceptance commitment therapy for anxiety disorder

目的系统评价接纳承诺疗法(acceptance and commiment therapy,ACT)对焦虑障碍的干预效果。方法使用计算机检索Web of Science Core Collection、MEDLINE、KCI-Korean Journal Database、SciELO Citation Index、SpringerLink、Pubmed、EMBASE、Cochrane Library、中国知网、万方及维普全文数据库,搜集接纳承诺疗法治疗焦虑障碍患者相关的随机对照研究。纳入符合标准的随机对照研究,同时对纳入文献进行文献质量评价,选取焦虑指数、心理灵活性、生活质量指数等结局指标,使用RevMan 5.3软件对符合纳入标准的文献数据进行分析。结果共纳入12篇研究,共1062例患者,其中,ACT组513例,对照组549例。Meta分析显示ACT能够有效降低焦虑障碍患者焦虑水平(MD=-0.58,95%CI:-0.85~-0.32,P<0.001)及随访期的焦虑水平(MD=-0.42,95%CI:-0.75~-0.08,P=0.01),提高心理灵活性(MD=0.46,95%CI:0.24~0.68,P<0.0001),均差异有统计学意义;在对照组为认知行为疗法(cognitive behavioral therapy,CBT)的研究中,ACT组和对照组焦虑水平均差异无统计学意义(干预后:MD=-0.06,95%CI:-0.47~0.36,P=0.79;随访期:MD=0.17,95%CI:-0.07~0.41,P=0.16);在对照组为空白对照的研究中,ACT能降低焦虑障碍患者焦虑水平(MD=-0.76,95%CI:-0.97~-0.56,P<0.001),差异有统计学意义;剔除非空白对照研究,在女性占比大于或等于70%的研究中,ACT能降低焦虑障碍患者焦虑水平(MD=-0.82,95%CI:-1.09~-0.55,P<0.001)。在女性占比为50%~70%的研究中,ACT能够降低焦虑障碍患者焦虑水平(MD=-0.68,95%CI:-1.09~-0.28,P=0.01),均差异有统计学意义;ACT组对生活质量的干预效果与对照组之间差异无统计学意义(MD=0.24,95%CI:-0.01~0.49,P=0.06)。结论ACT对焦虑障碍患者有一定疗效,不仅改善了患者的焦虑水平,改善效果在随访期内也有较好的保持,心理灵活性的提高也得到了验证;ACT的即时疗效和长期疗效与CBT相近,进一步提高了ACT疗效的可靠性;性别差异对治疗效果的影响尚未得到印证;ACT对生活质量无明显改善,本研究结论尚需要更多大样本、高质量的随机对照研究予以验证。

Objective To systematically evaluate the intervention effect of acceptance commitment therapy on anxiety disorder.Methods The full-text databases of Web of Science Core Collection,MEDLINE,KCI-Korean Journal Database,SciELO Citation Index,SpringerLink,Pubmed,EMBASE,Cochrane Library,CNKI Wanfang and Weipu were searched and randomized controlled studies related to acceptance commitment therapy for patients with anxiety disorder were collected.All randomized controlled studies met the criterion were included.Meanwhile,the literature quality of the included literatures was evaluated.The outcome indicators such as anxiety index,psychological flexibility and quality of life index were selected,and RevMan 5.3 software was used to analyze the literature data that met the inclusion criteria.Results A total of 12 studies with 1062 patients were included,including 513 cases in ACT group and 549 cases in control group.Meta analysis showed that ACT can effectively reduce anxiety level of patients with anxiety disorder(MD=-0.58,95%CI:-0.85--0.32,P<0.001),anxiety level in follow-up period(MD=-0.42,95%CI:-0.75--0.08,P=0.01),improving psychological flexibility(MD=0.46,95%CI:0.24~0.68,P<0.001);In the study of CBT(cognitive behavioral therapy)as the control group,there was no significant difference between ACT group and control group,among which after intervention(MD=-0.06,95%CI:-0.47-0.36,P=0.79),follow-up period(MD=0.17,95%CI:-0.07-0.41,P=0.16).In the study with the control group as the blank control,ACT can reduce the anxiety level of patients with anxiety disorder(MD=-0.76,95%CI:-0.97--0.56,P<0.001),and the difference is statistically significant.Excluding the non-blank control study,ACT can reduce the anxiety level of patients with anxiety disorder(MD=-0.82,95%CI:-1.09--0.55,P<0.001)in the studies where the proportion of women is greater than or equal to 70%.In the study of 50%-70%females,ACT can reduce the anxiety level of patients with anxiety disorder(MD=-0.68,95%CI:-1.09--0.28,P=0.01).All the differences were statistically significant.There was no significant difference between ACT and the control group for quality of life(MD=0.24,95%CI:-0.01-0.49,P=0.06).Conclusion ACT has a certain effect on patients with anxiety disorder,which not only improves the anxiety level of patients,but also keeps the effect of anxiety improvement during the follow-up period,and the improvement of psychological flexibility has also been verified.The immediate and long-term efficacy of ACT is similar to that of CBT,which further improve the reliability of ACT curative effect.Gender difference has not been confirmed for the therapeutic effect.ACT has no obvious improvement on the quality of life,and the conclusion of this study needs more randomized controlled studies with large samples and high quality to verify it.