Media-delivered cognitive behavioural therapy and behavioural therapy (self-help) for anxiety disorders in adults.

摘要: Background Anxiety disorders are the most common mental health problems. They chronic and unremitting. Effective treatments available, but access to services is limited. Media-delivered behavioural cognitive interventions (self-help) aim deliver treatment with less input from professionals compared traditional therapies. Objectives To assess effects of media-delivered therapies for anxiety in adults. Search methods Published unpublished studies were considered without restriction by language or date. The Cochrane Depression, Anxiety Neurosis Review Group's Specialized Register (CCDANCTR) was searched all years 1 January 2013. CCDANCTR includes relevant randomised controlled trials following bibliographic databases: Library (all years), EMBASE (1974 date), MEDLINE (1950 date) PsycINFO (1967 date). Complementary searches carried out on Ovid 23 February 2013) (1987 February, Week 2, 2013), together International trial registries (the portal World Health Organization (ICTRP) ClinicalTrials.gov). Reference lists previous meta-analyses reports checked, authors contacted data. Selection criteria Randomised therapy adults (other than post-traumatic stress disorder) no intervention (including attention/relaxation controls) face-to-face therapy. Data collection analysis Both review independently screened titles abstracts. Study characteristics outcomes extracted duplicate. Outcomes combined using random-effects models, tests heterogeneity small study bias conducted. We examined subgroup differences type disorder, provided, media, recruitment methods used. Main results One hundred one 8403 participants included; 92 included quantitative synthesis. These several types (with varying levels support) interventions. Inconsistency risk reduced our confidence overall results. For primary outcome symptoms anxiety, moderate-quality evidence showed medium (standardised mean difference (SMD) 0.67, 95% interval (CI) 0.55 0.80; 72 studies, 4537 participants), low-quality favoured (SMD -0.23, CI -0.36 -0.09; 24 1360 participants). associated greater response seen (risk ratio (RR) 2.34, 1.81 3.03; 21 1547 participants) not significantly inferior these (RR 0.78, 95 % 0.56 1.09; 10 575 latter comparison versions that as comprehensive those provided routine clinical practice. Evidence suggested benefit secondary measures (depression, mental-health related disability, quality life dropout), this low moderate quality. regarding harm lacking. Authors' conclusions Self-help may be useful people who able willing use other disorders; can it, probably clinically superior. Economic analyses beyond scope review. Important noted across trials. Recent specific problems incorporate clinician support more effective transdiagnostic (i.e. multiple disorders) guidance, issues confounded available trials. Although many have been conducted, generalisability their findings limited. Most tested consumers. Self-help has recommended first step some disorders, short-term long-term effectiveness established. Large, pragmatic needed evaluate maximise benefits self-help