辩证行为疗法改善双相情感障碍情绪症状有效性的系统评价

A systematic review on the effectiveness of dialectical behavior therapy for improving mood symptoms in bipolar disorders

——原载《国际双相障碍杂志》2023年第11卷第1期——

<International Journal of Bipolar Disorders> 2023, 11 (1)

【摘要】背景：可用于治疗双相障碍 (BD) 患者的循证心理疗法是有限的。辩证行为疗法 (DBT) 可能针对 BD 的几种常见症状。我们对 DBT 对 BD 患者情绪症状的疗效进行了系统评价。系统搜索使用了从 1980 年到 2022 年 4 月 1 日期间在 Medline、Embase、PsycInfo、CINAHL 和 Cochrane 图书馆数据库中与 DBT 和 BD 相关的关键词。我们纳入了纳入诊断为 BD I 或 II（DSM 或 ICD）的患者的研究 、 12 岁及以上接受基于 DBT 的干预。 审查的研究是临床试验，包括报告至少一种与 BD 情绪症状或严重程度相关的结果的观察性研究。 我们没有排除基于精神病或身体合并症。结果：我们筛选了 848 篇摘要，审阅了 28 篇全文；10 篇出版物和 11 项研究符合我们预先确定的资格标准。 除了一项之外，其他都是可行性试点研究，大多数参与者都处于除躁狂症之外的所有情绪状态。这些研究提供了初步证据，表明这些干预措施可能有效改善 BD 的几个核心症状。 总的来说，所有研究一致支持基于 DBT 的干预对 BD 患者是可行和可接受的。结论：DBT 可能是 BD 的有效治疗方法； 然而，这一结论的可信度受到所有已发表试验中样本量小、异质性和高偏倚风险的限制。现在需要更大的精心设计的随机对照试验来确定 DBT 在 BD 中的有效性。

【关键词】双相障碍，辩证行为疗法，心理治疗，抑郁症

[Abstract] Background: Evidence-based psychotherapies available to treat patients with bipolar disorders (BD) are limited. Dialectical behavior therapy (DBT) may target several common symptoms of BD. We conducted a systematic review on the efficacy of DBT for mood symptoms in patients with BD. The systematic search used key words related to DBT and BD in Medline, Embase, PsycInfo, CINAHL, and Cochrane Library databases from 1980 to April 1st, 2022. We included studies that enrolled patients with a BD I or II diagnosis (DSM or ICD), age 12 and older who received a DBT-based intervention. Studies reviewed were clinical trials including observational studies that reported at least one outcome related to BD mood symptoms or severity. We did not exclude based upon psychiatric or physical co-morbidity. Results: We screened 848 abstracts and reviewed 28 full texts; 10 publications with 11 studies met our pre-determined eligibility criteria. All but one were feasibility pilot studies and most included participants in all mood states except for mania. The studies provided preliminary evidence suggesting these interventions may be effective for improving several core symptoms of BD. Overall, all the studies consistently supported that DBT-based interventions are feasible and acceptable for patients with BD. Conclusion: DBT may be an effective treatment for BD; however, the confidence in this conclusion is limited by the small sample sizes, heterogeneity, and high risk of bias in all published trials. Larger well-designed RCTs are now required to establish the effectiveness of DBT in BD.

[Key words] Bipolar disorder, DBT, Psychotherapy, Depression

论文原文：Brett D. M. Jones, Madeha Umer, Mary E. Kittur, Ofer Finkelstein, Siqi Xue, Mikaela K. Dimick, Abigail Ortiz, Benjamin I. Goldstein, Benoit H. Mulsant & Muhammad I. Husain (2023). A systematic review on the effectiveness of dialectical behavior therapy for improving mood symptoms in bipolar disorders. International Journal of Bipolar Disorders, 11(1): 6.

doi: 10.1186/s40345-023-00288-6

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