目的 采用Meta分析方法探究认知行为疗法(CBT)对孤独症谱系障碍(ASD)儿童焦虑症状的治疗效果,为ASD儿童焦虑症状的临床治疗提供循证学依据。方法 通过计算机检索中国知网、万方医学网、中国生物医学文献数据库、PubMed、Cochrane Library、Web of Science、Embase7个中外文数据库,检索文献的发表时间均为建库至2024年5月1日。2名研究人员按照Cochrane评价工具中的相关标准独立对纳入的文献进行质量评估,研究的结局指标包括斯宾塞儿童焦虑量表-儿童版/家长版(SCAS-C/P)、儿童焦虑评定量表(PARS)、焦虑障碍访谈量表(ADIS)、儿童多维焦虑量表-家长版(MASC-P)、状态特质焦虑量表(State-Trait Anxiety Inventory,STAI),采用RevMan 5.4和Stata 17.0软件对纳入的文献数据进行分析。结果 共11篇文献被纳入Meta分析,均为外文文献,样本量共计483例。Meta分析结果显示在治疗后实验组的焦虑症状相关评估量表评分优于对照组(SMD=-0.69,95%CI:-0.88~-0.50,P＜0.001),且实验组与对照组在治疗结果上的差异有统计学意义(P<0.05)。亚组分析结果显示,焦虑症状改善情况在PARS量表中最明显(SMD=-0.98,95%CI-1.30~-0.66,P＜0.001),适用于ASD的CBT(BIACA)较其他类型的CBT对焦虑症状改善效果最显著(SMD=-0.98,95%CI-1.30~-0.66,P＜0.001),14周以上对焦虑症状严重程度的改善效果最佳(SMD=-0.87,95%CI:-1.16~-0.58,P＜0.001。结论 CBT对改善ASD儿童焦虑症状有较好的疗效,但其疗效大小可能会受结局指标、CBT种类和疗程等因素的影响,通过BIACA进行适当疗程的治疗,能更好地改善ASD儿童的焦虑症状。
Abstract
Objective To analyze the therapeutic effect of cognitive behavioral therapy (CBT) on anxiety symptoms in patients with autism spectrum disorder by Meta-analysis. Methods Seven Chinese and foreign databases, including CNKI, Wanfang Data, China Biology Medicine (CBM), PubMed, Cochrane Library, Web of Science, and Embase, were searched for relevant literature published from the inception of the databases to May 1st, 2024. Two researchers independently assessed the quality of the included studies according to the relevant criteria in the Cochrane evaluation tool. The outcome indicators included the Spence Children's Anxiety Scale-Child/Parent version (SCAS-C/P), Pediatric Anxiety Rating Scale (PARS), Anxiety Disorders Interview Schedule (ADIS), Multidimensional Anxiety Scale for Children-Parent version (MASC-P), and State-Trait Anxiety Inventory (STAI). The included literature data were analyzed using RevMan 5.4 and Stata 17.0 software. Results A total of 11 foreign language articles were included in the Meta-analysis, with a total sample size of 483.Meta-analysis showed that the anxiety symptom-related assessment scale scores in the experimental group after treatment were better than those in the control group (SMD=-0.69,95%CI:-0.88~-0.50,P＜0.001), and there was a statistically significant difference in treatment outcomes between the experimental and control groups. The subgroup analysis results showed that the improvements in anxiety symptoms was the most obvious in PARS scale (SMD=-0.98, 95%CI:-1.30 to -0.66, P<0.001). CBT specifically tailored for ASD (BIACA) had the most significant effect on improving anxiety symptoms compared to other types of CBT (SMD=-0.98, 95%CI:-1.30 to -0.66, P<0.001). The best improvement in the severity of anxiety symptoms was observed with a treatment duration of over 14 weeks (SMD=-0.87, 95%CI:-1.16 to -0.58, P<0.001). Conclusions CBT has a good therapeutic effect on improving anxiety symptoms in children with ASD. However, its effectiveness may be influenced by factors such as outcome indicators, types of CBT, and treatment duration. Appropriate treatment duration with BIACA can better improve anxiety symptoms in patients with ASD.
关键词
认知行为疗法 /
孤独症谱系障碍 /
焦虑 /
Meta分析
Key words
cognitive behavioral therapy /
autism spectrum disorder /
anxiety /
Meta-analysis
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基金
佳木斯大学优秀学科团队项目(JDXKTD-2019006)
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