{"title":"(第三波)成人广泛性焦虑障碍的认知行为疗法:系统回顾和贝叶斯网络荟萃分析","authors":"Xu Dai, Zhongming Zhang, Linghan Sun, Shunshun Zhu, Yunchou Wu, Junwei Lian, Xia Deng","doi":"10.1016/j.jpsychires.2025.05.010","DOIUrl":null,"url":null,"abstract":"<div><div>Generalized anxiety disorder (GAD) imposes a substantial burden on the patient and society. To manage GAD, cognitive behavioral therapy (CBT) is a widely recognized psychotherapeutic approach. Moreover, the third-wave CBTs expand the treatment options and have the potential to positively impact patient outcomes and preferences. However, which CBT protocols or third-wave CBTs are the most effective and appropriate for use in primary care settings remains uncertain. This study explored the short-and long-term relative efficacy of various CBT protocols and third-wave CBTs in reducing GAD symptom severity via a Bayesian network meta-analysis. The meta-analysis comprised 56 studies involving 4388 participants. Combining the initial analysis and sensitivity analysis, the results indicated that among the CBT protocols, Dugas's CBT protocol—which incorporates self-monitoring, education on uncertainty intolerance, assessment of worry beliefs, improvement of problem orientation, and dealing with core fears—demonstrated superior short- and long-term efficacy in reducing GAD symptom severity. Within the third-wave CBTs, the short- and long-term efficacy of acceptance-based therapy for GAD treatment is also notable. The Bayesian meta-regression analysis results showed that whether the therapies or protocols were guided by a clinician significantly moderated the effect size compared with the control group. These findings provide valuable insights for future GAD therapists in selecting appropriate therapies and protocols and a reference for updating GAD treatment guidelines.</div></div>","PeriodicalId":16868,"journal":{"name":"Journal of psychiatric research","volume":"187 ","pages":"Pages 134-143"},"PeriodicalIF":3.7000,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"(Third-wave) cognitive behavioral therapy for generalized anxiety disorder in adults: A systematic review and Bayesian network meta-analysis\",\"authors\":\"Xu Dai, Zhongming Zhang, Linghan Sun, Shunshun Zhu, Yunchou Wu, Junwei Lian, Xia Deng\",\"doi\":\"10.1016/j.jpsychires.2025.05.010\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><div>Generalized anxiety disorder (GAD) imposes a substantial burden on the patient and society. To manage GAD, cognitive behavioral therapy (CBT) is a widely recognized psychotherapeutic approach. Moreover, the third-wave CBTs expand the treatment options and have the potential to positively impact patient outcomes and preferences. However, which CBT protocols or third-wave CBTs are the most effective and appropriate for use in primary care settings remains uncertain. This study explored the short-and long-term relative efficacy of various CBT protocols and third-wave CBTs in reducing GAD symptom severity via a Bayesian network meta-analysis. The meta-analysis comprised 56 studies involving 4388 participants. Combining the initial analysis and sensitivity analysis, the results indicated that among the CBT protocols, Dugas's CBT protocol—which incorporates self-monitoring, education on uncertainty intolerance, assessment of worry beliefs, improvement of problem orientation, and dealing with core fears—demonstrated superior short- and long-term efficacy in reducing GAD symptom severity. Within the third-wave CBTs, the short- and long-term efficacy of acceptance-based therapy for GAD treatment is also notable. The Bayesian meta-regression analysis results showed that whether the therapies or protocols were guided by a clinician significantly moderated the effect size compared with the control group. These findings provide valuable insights for future GAD therapists in selecting appropriate therapies and protocols and a reference for updating GAD treatment guidelines.</div></div>\",\"PeriodicalId\":16868,\"journal\":{\"name\":\"Journal of psychiatric research\",\"volume\":\"187 \",\"pages\":\"Pages 134-143\"},\"PeriodicalIF\":3.7000,\"publicationDate\":\"2025-05-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of psychiatric research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0022395625003012\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PSYCHIATRY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of psychiatric research","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0022395625003012","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PSYCHIATRY","Score":null,"Total":0}
(Third-wave) cognitive behavioral therapy for generalized anxiety disorder in adults: A systematic review and Bayesian network meta-analysis
Generalized anxiety disorder (GAD) imposes a substantial burden on the patient and society. To manage GAD, cognitive behavioral therapy (CBT) is a widely recognized psychotherapeutic approach. Moreover, the third-wave CBTs expand the treatment options and have the potential to positively impact patient outcomes and preferences. However, which CBT protocols or third-wave CBTs are the most effective and appropriate for use in primary care settings remains uncertain. This study explored the short-and long-term relative efficacy of various CBT protocols and third-wave CBTs in reducing GAD symptom severity via a Bayesian network meta-analysis. The meta-analysis comprised 56 studies involving 4388 participants. Combining the initial analysis and sensitivity analysis, the results indicated that among the CBT protocols, Dugas's CBT protocol—which incorporates self-monitoring, education on uncertainty intolerance, assessment of worry beliefs, improvement of problem orientation, and dealing with core fears—demonstrated superior short- and long-term efficacy in reducing GAD symptom severity. Within the third-wave CBTs, the short- and long-term efficacy of acceptance-based therapy for GAD treatment is also notable. The Bayesian meta-regression analysis results showed that whether the therapies or protocols were guided by a clinician significantly moderated the effect size compared with the control group. These findings provide valuable insights for future GAD therapists in selecting appropriate therapies and protocols and a reference for updating GAD treatment guidelines.
期刊介绍:
Founded in 1961 to report on the latest work in psychiatry and cognate disciplines, the Journal of Psychiatric Research is dedicated to innovative and timely studies of four important areas of research:
(1) clinical studies of all disciplines relating to psychiatric illness, as well as normal human behaviour, including biochemical, physiological, genetic, environmental, social, psychological and epidemiological factors;
(2) basic studies pertaining to psychiatry in such fields as neuropsychopharmacology, neuroendocrinology, electrophysiology, genetics, experimental psychology and epidemiology;
(3) the growing application of clinical laboratory techniques in psychiatry, including imagery and spectroscopy of the brain, molecular biology and computer sciences;