期刊
JOURNAL OF PSYCHIATRIC RESEARCH
卷 168, 期 -, 页码 140-148出版社
PERGAMON-ELSEVIER SCIENCE LTD
DOI: 10.1016/j.jpsychires.2023.10.025
关键词
Cognitive behavioral therapy; Obsessive-compulsive disorder; Internet-based; Network meta-analysis; Systematic review
类别
Internet-based cognitive behavioral therapy (ICBT) is an effective alternative to traditional cognitive behavioral therapy (CBT) for treating obsessive-compulsive disorder (OCD). The study found that CBT was more effective than therapist-guided ICBT (TG-ICBT), but the difference between CBT and unguided ICBT (UG-ICBT) was not significant. In terms of efficacy, all three interventions (CBT, TG-ICBT, and UG-ICBT) were superior to psychological placebo, waiting list, and pill placebo. Combination therapy of CBT with medication was more effective than the individual interventions.
Cognitive behavioral therapy (CBT) is widely recognized as an effective treatment for obsessive-compulsive disorder (OCD). However, few patients are able to receive CBT. Internet-based CBT (ICBT) may be able to overcome this problem. In this study, we aimed to compare the efficacy of CBT, therapist-guided ICBT (TG-ICBT), unguided ICBT (UG-ICBT), and none therapist-guided ICBT (NTG-ICBT) by a network meta-analysis. The primary outcome was the mean change in OCD severity measured by the Yale-Brown Obsessive Compulsive Scale (Y -BOCS) or the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). The secondary outcomes included the severity of depressive symptoms, side effects, and cost-effectiveness. A total of 25 trials with 1642 participants were included. We found that the efficacy of CBT was superior to that of TG-ICBT. The mean improvement in Y-BOCS/CY-BOCS scores was higher in CBT group than in UG-ICBT group, but this difference was not sta-tistically significant. The efficacy did not differ significantly between TG-ICBT and UG-ICBT. CBT, TG-ICBT, and UG-ICBT were all more effective than the psychological placebo, waiting list, and pill placebo. In terms of ef-ficacy, CBT combined with drug therapy was better than CBT, TG-ICBT, and UG-ICBT. Sensitivity analyses supported these findings. Based on the current evidence, we recommend TG-ICBT when CBT is not available. However, it is undeniable that UG-ICBT also has the potential to be an effective alternative to CBT. More evidence is needed to support this possibility.
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