Journal of Anxiety Disorders最新文献_第8页

Psychological interventions for adult posttraumatic stress disorder: A systematic review of published meta-analyses 成人创伤后应激障碍的心理干预：已发表的荟萃分析的系统回顾

IF 4.8 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-04-08 DOI: 10.1016/j.janxdis.2025.103017

Ahlke Kip , Linnea Ritter , Thole H. Hoppen , Davide Papola , Giovanni Ostuzzi , Corrado Barbui , Nexhmedin Morina

Objective

A large and growing number of published meta-analyses have examined the efficacy of psychological interventions for post-traumatic stress disorder (PTSD). Conclusions drawn from these meta-analyses on treatment efficacy greatly influence clinical practice. This study aimed to provide a comprehensive review of meta-analyses of randomized controlled trials (RCTs) on psychological interventions for adult PTSD, focusing on their content, methodology, and reporting quality.

Method

Systematic database searches were conducted in March 2024 using MEDLINE, PsycInfo, PTSDpubs, Web of Science, and the Cochrane Database of Systematic Reviews. The quality of meta-analyses was assessed using AMSTAR 2. The systematic review was registered on PROSPERO (CRD42020151234).

Results

Overall, 55 meta-analyses with 93 meta-analytic comparisons at treatment endpoint and 28 comparisons at follow-up were included. Meta-analyses most consistently showed superiority of psychological interventions over control conditions. However, beneficial long-term effects exceeding one-month post-treatment were limited to trauma-focused cognitive behavior interventions (TF-CBT) and eye movement desensitization and reprocessing (EMDR). There was a substantial overlap of primary RCTs, indicating redundancy between meta-analyses. Furthermore, the quality of meta-analyses varied substantially.

Conclusions

There is a need to enhance the methodological and reporting quality of meta-analyses, avoid the production of redundant meta-analyses, and conduct more high-quality, large RCTs with long-term assessments.

目的：越来越多已发表的荟萃分析研究了心理干预对创伤后应激障碍（PTSD）的疗效。这些荟萃分析得出的疗效结论对临床实践有很大影响。本研究旨在对成人创伤后应激障碍心理干预的随机对照试验（RCTs）的荟萃分析进行全面回顾，重点关注其内容、方法和报告质量。方法于2024年3月使用MEDLINE、PsycInfo、PTSDpubs、Web of Science和Cochrane系统综述数据库进行系统检索。采用AMSTAR 2评估meta分析的质量。该系统评价已在PROSPERO注册（CRD42020151234）。结果共纳入55项荟萃分析，其中治疗终点荟萃分析比较93项，随访期荟萃分析比较28项。荟萃分析最一致地显示心理干预优于对照条件。然而，治疗后超过一个月的有益长期效果仅限于以创伤为重点的认知行为干预（TF-CBT）和眼动脱敏和再加工（EMDR）。主要随机对照试验存在大量重叠，表明meta分析之间存在冗余。此外，meta分析的质量差异很大。结论需要提高meta分析的方法学和报告质量，避免产生冗余的meta分析，开展更多高质量的大型随机对照试验，并进行长期评估。

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引用次数: 0

Early hypervigilance and sustained attention for the eye region in adolescents with social anxiety disorder 社交焦虑障碍青少年眼区早期高警觉性和持续注意

IF 4.8 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-04-05 DOI: 10.1016/j.janxdis.2025.103016

Vera Hauffe , Anna-Lina Rauschenbach , Eva-Maria Fassot , Julian Schmitz , Brunna Tuschen-Caffier

Social anxiety disorder (SAD) is a highly prevalent and debilitating affliction that typically manifests during childhood and adolescence. While theoretical models of adult SAD emphasize the role of attentional biases, little is known about maintaining factors during childhood and adolescence. The objective of our eye-tracking study was to determine whether youth with SAD exhibit a hypervigilance-avoidance pattern of visual attention for faces. To this end, we used a free-viewing paradigm to present angry, happy, and neutral faces, and non-social object stimuli to three groups of adolescents aged 10–15 years: SAD (n = 57), specific phobia (SP; n = 41), and healthy controls (HC; n = 65). A screen-based eye tracker recorded gaze behavior and pupil dilation. Among participants, only older adolescents with SAD exhibited shorter latencies of first fixation to the eye region compared to HC. Contrary to our expectations, there were no differences in duration of first fixation to the eye region among the groups. Instead, compared to HC, older adolescents with SAD showed longer dwell times on the eye region during the first 1000 – 3000 ms of stimulus presentation. No significant differences among the groups were found regarding scanpath length or pupillary reactivity. Taken together, our findings suggest early hypervigilance followed by sustained attention to the eye region in older adolescents with SAD, which may indicate difficulties in disengaging attention. We discuss the theoretical and practical implications in detail.

社交焦虑障碍（SAD）是一种非常普遍和令人衰弱的痛苦，通常表现在儿童和青少年时期。虽然成人SAD的理论模型强调注意偏差的作用，但对儿童期和青春期的维持因素知之甚少。我们的眼动追踪研究的目的是确定患有SAD的青少年是否表现出对面部视觉注意的过度警惕-回避模式。为此，我们使用自由观看范式向三组10-15岁的青少年呈现愤怒，快乐和中立的面孔以及非社会物体刺激：SAD (n = 57)，特定恐惧症(SP；n = 41)，健康对照组(HC；n = 65)。基于屏幕的眼动仪记录了凝视行为和瞳孔扩张。在参与者中，与HC相比，只有年龄较大的SAD青少年表现出较短的首次注视延迟。与我们的预期相反，各组之间首次注视眼睛区域的时间没有差异。相反，与HC相比，患有SAD的年龄较大的青少年在刺激呈现的前1000 - 3000 ms期间在眼睛区域停留的时间更长。各组之间在扫描路径长度和瞳孔反应性方面没有显著差异。综上所述，我们的研究结果表明，患有SAD的大龄青少年早期过度警觉，随后持续关注眼部区域，这可能表明难以摆脱注意力。我们详细讨论了理论和实践意义。

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引用次数: 0

"And then one day you find ten years have got behind you": Reflections on a Decade as Editor-in-Chief “然后有一天，你发现十年已经过去了”：《十年总编辑的反思》。

IF 4.8 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-04-01 DOI: 10.1016/j.janxdis.2025.103007

Gordon J.G. Asmundson

引用次数: 0

“To die, to sleep”: A systematic review and meta-analysis of the relationship between death anxiety and sleep “去死，去睡”：对死亡焦虑和睡眠之间关系的系统回顾和荟萃分析

IF 4.8 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-03-28 DOI: 10.1016/j.janxdis.2025.103001

Rachel E. Menzies, Jessie Brown, Jye Marchant

Poor sleep has long been established as both a symptom and cause of psychopathology. Similarly, death anxiety has attracted growing attention for its transdiagnostic role in mental illnesses, particularly anxiety-related disorders. However, the relationship between death anxiety and sleep has not been systematically explored. This systematic review and meta-analysis examined the relationship between sleep and death anxiety. In total, 15 studies were included in this review, representing a total sample size of 2786 participants. A review of these studies revealed that death anxiety was significantly associated with a number of sleep outcomes, particularly insomnia and poor sleep quality. Mixed results were found regarding the relationship between death anxiety and nightmare frequency. A meta-analysis of seven studies revealed a significant but small relationship between death anxiety and sleep problems (r = .225). Neither gender nor age emerged as a significant moderator of this relationship. These studies were generally of moderate quality, and there was limited evidence of publication bias. The current findings support the relationship between death anxiety and sleep. Further research is needed to clarify the direction of this effect, and whether targeting one in treatment may produce direct improvements in the other.

长期以来，睡眠不足一直被认为是精神病理的症状和原因。同样，死亡焦虑因其在精神疾病，特别是焦虑相关疾病中的跨诊断作用而引起越来越多的关注。然而，死亡焦虑与睡眠之间的关系尚未得到系统的探讨。这项系统回顾和荟萃分析研究了睡眠和死亡焦虑之间的关系。本综述共纳入15项研究，总样本量为2786名参与者。对这些研究的回顾显示，死亡焦虑与许多睡眠结果显著相关，尤其是失眠和睡眠质量差。关于死亡焦虑和噩梦频率之间的关系，发现了不同的结果。对七项研究的荟萃分析显示，死亡焦虑与睡眠问题之间存在显著但很小的关系（r = .225）。性别和年龄都不是这种关系的重要调节因素。这些研究一般质量中等，发表偏倚的证据有限。目前的研究结果支持死亡焦虑和睡眠之间的关系。需要进一步的研究来阐明这种效应的方向，以及针对其中一种治疗是否会对另一种产生直接的改善。

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引用次数: 0

Find your rhythm and regulate: Breath-synced vibration feedback during breath-focused mindfulness reduces respiration variability in trauma-exposed adults 找到你的节奏和调节：呼吸同步振动反馈在呼吸集中正念减少呼吸变异性创伤暴露的成年人

IF 4.8 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-03-23 DOI: 10.1016/j.janxdis.2025.103008

Timothy J. McDermott , Greg J. Siegle , Alfonsina Guelfo , Kayla Huynh , Maya C. Karkare , Rebecca Krawczak , Amanda Johnston , Aziz Elbasheir , Travis M. Fulton , Jacob Semerod , Divya Jagadeesh , Emma C. Lathan , Robert T. Krafty , Negar Fani

Stress and anxiety are associated with increased autonomic arousal, including altered respiration. Breath-focused mindfulness meditation can reduce stress and anxiety, but trauma-exposed adults with dissociation have difficulty engaging in this practice. Our ongoing clinical trial examines if vibration-augmented breath-focused mindfulness (VABF) can improve outcomes and increase engagement. Here, we tested if VABF reduces respiration rate (RR) or respiration variability (RV), and examined associations between RR, RV, and emotion ratings. 128 trauma-exposed adults (mean age = 30.21 years) with elevated dissociation volunteered and completed at least 50 % of intervention visits. Participants were randomized to one of four mindfulness meditation interventions: VABF (n = 34); breath-focus only (n = 33); vibration only (n = 34); open awareness (no vibration or breath-focus, n = 27). Results from linear mixed-effects models showed that VABF decreased RV across visits while all the other interventions showed increased RV across visits (p = .008; η_p² = .014), and RV was positively associated with both anxiety and anger ratings (ps < .001; rs > .125). Findings suggest RV is a meaningful metric for examining regulatory processes in clinical populations with elevated autonomic arousal and negative emotionality. They also show that RV is modifiable through VABF, which holds significant promise as an intervention to improve regulatory processes in trauma-exposed populations.

压力和焦虑与包括呼吸改变在内的自律神经唤醒增加有关。以呼吸为重点的正念冥想可以减轻压力和焦虑，但受到创伤的成人解离症患者很难参与这种练习。我们正在进行的临床试验将研究振动增强呼吸正念冥想（VABF）能否改善疗效并提高参与度。在此，我们测试了 VABF 是否会降低呼吸频率（RR）或呼吸变异性（RV），并研究了 RR、RV 和情绪评级之间的关联。128名受到创伤的成年人（平均年龄=30.21岁）自愿参加并完成了至少50%的干预访问。参与者被随机分配到四种正念冥想干预中的一种：VABF (n = 34)；仅呼吸聚焦 (n = 33)；仅振动 (n = 34)；开放意识（无振动或呼吸聚焦，n = 27）。线性混合效应模型的结果表明，VABF 降低了各次就诊的 RV，而所有其他干预措施都提高了各次就诊的 RV（P = .008；ηP2 = .014），RV 与焦虑和愤怒评分呈正相关（PS < .001；RS > .125）。研究结果表明，在自律神经唤醒和负性情绪升高的临床人群中，RV 是一种有意义的调节过程指标。研究还表明，RV 可通过 VABF 进行调节，这为改善创伤暴露人群的调节过程提供了重要的干预手段。

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引用次数: 0

What is the internal structure of intolerance of uncertainty? A network analysis approach 对不确定性的不容忍的内部结构是什么？网络分析方法

IF 4.8 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-03-22 DOI: 10.1016/j.janxdis.2025.102999

Igor Marchetti , Lavinia Miriam Pedretti , Sara Iannattone , Ilaria Colpizzi , Alessandra Farina , Lisa Di Blas , Marta Ghisi , Gioia Bottesi

Background

Intolerance of uncertainty (IU) is a well-established risk factor for anxiety disorders, as higher levels of IU increase the likelihood of future maladaptive outcomes. However, the presence of low levels of IU does not imply that maladaptive outcomes will not occur, as other risk factors can still lead to the onset of anxiety symptoms. Currently, it is unknown whether IU also serves as a necessary cause for anxiety symptoms, meaning that its absence would ensure the absence of these symptoms.

Methods

A sample of 186 adolescents (58.6 % boys) between 14 and 18 years of age (M = 16.58 ± 1.01) was followed for six months, with evaluations every three months. Several self-reports were administered to measure IU and general anxiety problems, derived from the Youth Self Report 11–18, and anxiety-specific symptoms, derived from the Self-Administered Psychiatric Scales for Children and Adolescents. The Necessary Condition Analysis approach was applied to determine the extent to which IU is a necessary condition for anxiety.

Findings

The analyses revealed that IU is a necessary condition for anxiety problems (d =.23 −.24), generalized anxiety disorder symptoms (d =.18 −.19), social anxiety disorder symptoms (d =.19 −.29), and school-related anxiety symptoms (d =.19 −.23) after three and six months. However, IU was not a statistically significant necessary condition for separation anxiety disorder symptoms. At baseline, between 29 % and 70 % of the sample exhibited the necessary levels of IU to potentially experience subclinical anxiety symptoms at subsequent follow-ups.

Discussion

IU is a necessary condition for the potential development of anxiety symptoms during adolescence. Recognizing necessary conditions for anxiety symptoms and mental disorders, in general, could lead to substantial progress, given its impact on enhancing our theoretical understanding and improving prevention strategies and clinical treatments.

不确定性耐受性（IU）是焦虑症的一个公认的危险因素，因为较高的IU水平增加了未来适应不良结果的可能性。然而，低水平IU的存在并不意味着不会发生适应不良的结果，因为其他风险因素仍然可以导致焦虑症状的发作。目前，尚不清楚IU是否也是焦虑症状的必要原因，这意味着它的缺失将确保这些症状的消失。方法对186名14 ~ 18岁青少年（M = 16.58 ± 1.01）进行为期6个月的随访，其中男生占58.6% %)，每3个月进行一次评估。一些自我报告被用于测量IU和一般焦虑问题，来自青年自我报告11-18，以及焦虑特异性症状，来自儿童和青少年自我管理精神病学量表。必要条件分析方法被用于确定IU在多大程度上是焦虑的必要条件。结果：分析显示IU是焦虑问题的必要条件(d =。23−.24)，广泛性焦虑障碍症状(d =。18−0.19)，社交焦虑障碍症状(d =。19−.29)，学校相关焦虑症状(d =。3个月和6个月后分别为19 - 0.23。然而，IU并不是分离焦虑障碍症状的有统计学意义的必要条件。在基线时，29% %至70% %的样本在随后的随访中表现出必要的IU水平，可能出现亚临床焦虑症状。iu是青春期焦虑症状潜在发展的必要条件。认识到焦虑症状和精神障碍的必要条件，一般来说，可以带来实质性的进展，因为它对增强我们的理论认识和改进预防策略和临床治疗有影响。

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引用次数: 0

Comparing structural models for internalizing pathology: Latent dimensions, classes, or a mix of both? 比较内化病理的结构模型：潜在维度，类别，还是两者的混合？

IF 4.8 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-03-16 DOI: 10.1016/j.janxdis.2025.103006

Ana De la Rosa-Cáceres , Leon P. Wendt , Johannes Zimmermann , Carmen Díaz-Batanero

In recent decades, the conceptualization of internalizing problems has changed from categorical to dimensional and hybrid approaches. However, most studies have analyzed the structure of internalizing problems at the disorder level using categorical or dimensional approaches, with only a few studies examining the structure at the symptom level, or considering a hybrid approach. This study aimed to compare categorical (latent class analysis), dimensional (confirmatory factor analysis), and hybrid models (semi-parametric factor analysis) of internalizing constructs at the symptom level regarding model fit (structural validity) and prediction (concurrent validity) in four samples: community adults (n = 1072; n = 620), students (n = 378), and patients (n = 485). All participants completed the Inventory of Depression and Anxiety Symptoms-II to assess internalizing symptoms. In two samples, participants completed additional measures to test concurrent validity regarding disability, externalizing symptoms, personality traits, impairments in personality functioning, and quality of life. Dimensional models, particularly those allowing for non-normal distributions, outperformed categorical and hybrid models in terms of structural and concurrent validity (median _adjR² for dimensional models =.18–.16). Our results suggest that future studies should prefer dimensional models to better describe internalizing constructs and predict external variables. The consistent application of dimensional models of internalizing pathology would facilitate the integration of empirical findings in clinical science and enable a more valid and fine-grained assessment of individual mental health problems in clinical practice, thereby enhancing the potential to guide effective personalized interventions.

近几十年来，内化问题的概念化已经从分类方法转变为维度和混合方法。然而，大多数研究使用分类或维度方法在障碍水平上分析内化问题的结构，只有少数研究在症状水平上检查结构，或者考虑混合方法。本研究旨在比较症状水平内化构构的分类（潜类分析）、维度（验证性因子分析）和混合模型（半参数因子分析）对模型拟合（结构效度）和预测（并发效度）的影响：社区成年人(n = 1072；n = 620),学生(n = 378),和病人(n = 485)。所有参与者完成抑郁和焦虑症状量表ii以评估内化症状。在两个样本中，参与者完成了额外的测量，以测试有关残疾、外化症状、人格特征、人格功能障碍和生活质量的并发效度。维度模型，特别是那些允许非正态分布的模型，在结构有效性和并发有效性方面优于分类模型和混合模型（维度模型的中位数adjR2 = 0.18 - 0.16）。我们的研究结果表明，未来的研究应该更倾向于维度模型，以更好地描述内化结构和预测外部变量。内化病理学维度模型的持续应用将促进临床科学中经验发现的整合，并使临床实践中对个体心理健康问题进行更有效和更细致的评估，从而增强指导有效个性化干预的潜力。

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引用次数: 0

Does intolerance of uncertainty predict child generalised anxiety? A longitudinal study 对不确定性的不耐受是否预示着儿童的广泛性焦虑？纵向研究

IF 4.8 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-03-15 DOI: 10.1016/j.janxdis.2025.103004

Zoe J. Ryan , Holly Rayson , Jayne Morriss , Helen F. Dodd

Intolerance of uncertainty (IU) is the tendency to find uncertainty distressing. IU is related to anxiety in adults and youth but it is unclear whether IU plays a maintenance or causal role, particularly across childhood. Our research examined whether: (1) IU is associated with generalised anxiety in preschool-aged children; (2) IU in preschool-aged children is associated with the trajectory of generalised anxiety into middle childhood; and (3) IU is associated with the trajectory of internalising symptoms and externalising symptoms over time. Parents completed questionnaires (child anxiety, IU, internalising and externalising symptoms) about their children at three timepoints when their child was: 3–4 years old (n = 180); 5–7 years old (n = 162); and 8–10 years old (n = 148). Those with higher IU had higher concurrent generalised anxiety, internalising and externalising symptoms at each measurement point. Preschoolers with higher IU, relative to lower IU, had, on average, higher generalised anxiety across childhood. Unexpectedly though, children who were higher in IU as preschoolers were more likely to show a decrease in generalised anxiety over time. These findings indicate that IU is a consistent correlate of generalised anxiety, internalising and externalising symptoms, but that it may not play a causal role in the onset of generalised anxiety in children.

对不确定性的不容忍（IU）是一种对不确定性感到痛苦的倾向。IU与成人和青少年的焦虑有关，但目前尚不清楚IU是否起到维持或因果作用，特别是在儿童期。我们的研究考察了：(1)IU是否与学龄前儿童的广泛性焦虑有关；(2)学龄前儿童IU水平与儿童中期广泛性焦虑的发展轨迹相关；(3) IU与内化症状和外化症状随时间的变化轨迹有关。父母在孩子3-4岁时完成了关于孩子的问卷调查（儿童焦虑、IU、内化和外化症状）：n = 180；5-7岁（n = 162）；8-10岁（n = 148）。在每个测量点上，高IU的患者有更高的并发广泛性焦虑、内化和外化症状。相对于较低的IU，较高IU的学龄前儿童在整个儿童期平均有较高的广泛性焦虑。然而出乎意料的是，随着时间的推移，学龄前IU较高的儿童更有可能表现出广泛性焦虑的减少。这些发现表明，IU与广泛性焦虑、内化和外化症状有一致的相关性，但它可能在儿童广泛性焦虑的发病中不起因果作用。

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引用次数: 0

Emotion regulation difficulties in children and adolescents with obsessive-compulsive disorder: A multi-informant and multi-method study 儿童和青少年强迫症的情绪调节困难：一项多信息和多方法的研究

IF 4.8 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-03-14 DOI: 10.1016/j.janxdis.2025.103002

Christine Lykke Thoustrup , Robert James Blair , Sofie Heidenheim Christensen , Valdemar Uhre , Linea Pretzmann , Nicoline Løcke Jepsen Korsbjerg , Camilla Uhre , Anna-Rosa Cecilie Mora-Jensen , Melanie Ritter , Nicole Nadine Lønfeldt , Emilie Damløv Thorsen , Daniel S. Quintana , Ahmad Sajadieh , Jakob Hartvig Thomsen , Kerstin Jessica Plessen , Signe Vangkilde , Anne Katrine Pagsberg , Julie Hagstrøm

Pediatric obsessive-compulsive disorder (OCD) is associated with emotion regulation (ER) difficulties. Most studies are based on self-reports, while few have examined how these difficulties are expressed across modalities, which may hold important diagnostic and therapeutic information. We applied a multi-informant and multi-method approach to examine ER difficulties in 211 children aged 8–17 years: 121 with OCD and 90 non-clinical controls. Child ER difficulties were assessed with The Difficulties in Emotion Regulation Scale (self-report and parent-report) and a Tangram frustration task with investigator-rated behavior, self-rated frustration, and heart rate variability (HRV). Children with OCD differed significantly from non-clinical controls in showing: (i) elevated child ER difficulties on self-report (partial eta squared =.068–.165) and parent-report (partial eta squared =.207–.369); (ii) more investigator-rated ER difficulties during the task (Cohen’s d = −.33); (iii) increased levels of self-rated frustration before and after the task (partial eta squared =.089); notably, the magnitude of this increase did not differ between children with and without OCD. Finally, (iv) all children, regardless of group, demonstrated significant HRV changes during the frustration task, with no discernible group differences in the magnitude of these changes. Results suggest the OCD-related experience of ER difficulties may not impact autonomic functioning.

儿童强迫症（OCD）与情绪调节（ER）困难有关。大多数研究都是基于自我报告，而很少有人研究这些困难是如何通过各种方式表达的，这可能是重要的诊断和治疗信息。我们采用多信息和多方法研究了211名8-17岁儿童的ER困难：121名患有强迫症，90名非临床对照。采用情绪调节困难量表（自我报告和父母报告）和由调查者评定行为、自我评定挫折和心率变异性（HRV）组成的七巧板挫折任务评估儿童急诊室困难。与非临床对照相比，强迫症儿童在以下方面表现出显著差异：(i)自我报告（偏平方= 0.068 - 0.165）和父母报告（偏平方= 0.207 - 0.369）中儿童ER困难程度升高；（ii）在任务期间，研究者认为更多的急诊困难（Cohen’s d = - 0.33）；（iii）任务前后自评挫败感水平增加（偏平方= 0.089）；值得注意的是，这种增加的幅度在有强迫症和没有强迫症的儿童之间没有差异。最后，（iv）所有儿童，无论分组，在挫折任务中表现出显著的HRV变化，在这些变化的幅度上没有明显的分组差异。结果表明，与强迫症相关的急诊室困难经历可能不会影响自主功能。

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引用次数: 0

Using machine learning methods to predict the outcome of psychological therapies for post-traumatic stress disorder: A systematic review 使用机器学习方法预测创伤后应激障碍心理治疗的结果：系统回顾

IF 4.8 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-03-11 DOI: 10.1016/j.janxdis.2025.103003

James Tait , Stephen Kellett , Jaime Delgadillo

Background

A number of treatments are available for post-traumatic stress disorder (PTSD), however, there is currently a lack of data-driven treatment selection and adaptation methods for this condition. Machine learning (ML) could potentially help to improve the prediction of treatment outcomes and enable precision mental healthcare in practice.

Objectives

To systematically review studies that applied ML methods to predict outcomes of psychological therapy for PTSD in adults (e.g., change in symptoms, dropout rate), and evaluate their methodological rigour.

Methods

This was a pre-registered systematic review (CRD42022325021), which synthesised eligible clinical prediction studies found across four research databases. Risk of bias was assessed using the PROBAST tool. Study methods and findings were narratively synthesised, and adherence to ML best practice evaluated.

Results

Seventeen studies met the inclusion criteria, including samples derived from experimental and observational study designs. All studies were assessed as having a high risk of bias, notably due to inadequately powered samples and a lack of sample size calculations. Training sample size ranged from N < 36–397. The studies applied a diverse range of ML methods such as decision trees, ensembling and boosting techniques. Five studies used unsupervised ML methods, while others used supervised ML. There was an inconsistency in the reporting of hyperparameter tuning and cross-validation methods. Only one study performed external validation.

Conclusions

ML has the potential to advance precision psychotherapy for PTSD, but to enable this, ML methods must be applied with greater adherence to best practice guidelines.

创伤后应激障碍（PTSD）有许多治疗方法，然而，目前缺乏数据驱动的治疗选择和适应方法。机器学习（ML）可能有助于改善对治疗结果的预测，并在实践中实现精确的精神卫生保健。目的系统回顾应用ML方法预测成人PTSD心理治疗结果（如症状改变、辍学率）的研究，并评价其方法的严谨性。方法：这是一项预注册系统评价（CRD42022325021），综合了四个研究数据库中符合条件的临床预测研究。使用PROBAST工具评估偏倚风险。对研究方法和结果进行叙述综合，并对ML最佳实践的依从性进行评估。结果17项研究符合纳入标准，包括来自实验和观察性研究设计的样本。所有研究都被评估为具有高偏倚风险，特别是由于样本不足和缺乏样本量计算。训练样本量为N <； 36-397。这些研究应用了各种各样的机器学习方法，如决策树、集成和增强技术。五项研究使用无监督机器学习方法，而其他研究使用监督机器学习。在超参数调整和交叉验证方法的报告中存在不一致。只有一项研究进行了外部验证。结论：sml有潜力推进PTSD的精确心理治疗，但要实现这一点，ML方法必须更严格地遵守最佳实践指南。

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