第三代认知行为疗法治疗强迫障碍的Meta分析

The Third Wave Cognitive Behavioral Therapies for Obsessive-Compulsive Disorder: A Meta-Analysis

目的:通过Meta分析评价第三代认知行为疗法(Third wave cognitive behavioral therapies, CBT)对强迫障碍(obsessive-compulsive disorder, OCD)的干预效果。方法:检索Cochrane Library、PubMed、Medline、PsycINFO、维普中文科技期刊数据库、中国知网和万方数据库,检索年限为建库至2023年4月1日,纳入第三代CBT治疗OCD的随机对照试验进行Meta分析,由2名研究者独立筛选文献及提取数据。根据Cochrane评价手册对文章进行质量评价,使用Rev Man5.3软件进行数据分析。采用耶鲁–布朗强迫量表(Yale-Brown Obsessive Compulsive Scale, Y-BOCS)评估强迫症状,接受与行动问卷(Acceptance and Action Questionnaire, AAQ)评估心理灵活性。结果:检索发现1604篇文献,9篇符合纳入排除条件,共808例患者。结果表明,第三代CBT (包括接受与承诺疗法、正念等)改善强迫症状相对优于常规疗法(包括心理健康教育、暴露反应预防、渐进式放松训练等);第三代CBT在改善心理灵活性方面较常规方法效果好,但差异无统计学意义[MD = 5.54, 95%CI (−0.83, 11.90), P = 0.09]。结论:第三代CBT治疗强迫障碍效果相对优于常规疗法。

Objective: Meta-analysis was conducted to evaluate the intervention effect of third wave cognitive behavioral therapies (CBT) on obsessive compulsive disorder (OCD). Methods: Cochrane Library, PubMed, Medline, PsycINFO, VIP ,CNKI and Wanfang database were searched, with the search year from the establishment of the database to April 1, 2023, and randomized controlled trials of third-generation CBT for the treatment of OCD were included in the Meta-analysis, with 2 investiga-tors independently screening the literature and extracting date. Data were analyzed using Rev Man 5.3 software, and the quality of articles was assessed in accordance with the Cochrane Evaluation manual. Obsessive-compulsive symptoms were evaluated utilizing the Yale-Brown Obsessive Com-pulsive Scale (Y-BOCS), and psychological flexibility was evaluated by the Acceptance and Action Questionnaire (AAQ). Results: The search yielded 1604 literatures, 9 RCT with a total of 808 pa-tients were included. The results showed that the third wave of CBT (e.g., Acceptance and Commit-ment Therapy, Mindfulness cognitive therapy, Dialectical behavior therapy) improved obses-sive-compulsive symptoms better than the routine therapies (e.g., Psychological Education, Expo-sure and Response Prevention, Progressive Muscle Relaxation). The third CBT showed greater gains in psychological flexibility than the routine therapies, although the difference was not statistically significant [MD = 5.54, 95%CI (−0.83, 11.90), P = 0.09]. Conclusion: In comparison to traditional therapies, third wave CBT for OCD is relatively effective.