第三波认知行为疗法对儿童和青少年的有效性：系统评价和荟萃分析

The effectiveness of third wave cognitive behavioural therapies for children and adolescents: A systematic review and meta-analysis

——原载《英国临床心理学杂志》2023年第62卷第1期——

<British Journal of Clinical Psychology> 2023, 62 (1)

【摘要】目的：第三波认知行为疗法越来越多地用于儿童和青少年。这项荟萃分析旨在确定四种第三波干预措施（接受和承诺疗法、同情聚焦疗法、正念认知疗法和元认知疗法）对青少年的有效性。方法：四个电子数据库被用来识别随机对照试验，这些试验测试了与健康、福祉和功能相关的影响。 进行了考虑研究质量的敏感性分析，并探索了调节剂。结果：基于 50 项符合纳入标准的随机对照试验的结果表明情绪症状/内化问题（g=−.68，95% CI −.98 至 −.37，k=43，N=3265），行为困难/外化问题（g=−.62，95% CI −1.01 至 −.22，k=23，N=1659），困难的干扰（g=−.46，95% CI −.87 至 −.05，k=21，N=1786），第三波过程（g= .39，95% CI .17 至 .62，k=22，N=1900），幸福/繁荣（g= .76，95% CI .35 至 1.17，k=21 , N=1303) 和身体健康/疼痛 (g= .72, 95% CI .01 to 1.44, k=9, N=1171) 产生显着影响。 对生活质量的影响（g= .62，95% CI −.08 至 1.31，k=12，N=1271）不显著。 当仅分析那些评级为中等质量的研究时，与对照组相比，第三波干预在情绪症状/内化问题方面产生了显着的优势效应（g= −.55，95% CI −.82 至 −.27，k=28，N= 110），来自困难的干扰（g= −.48，95% CI −.90 至 −.05，k=21，N=1605），第三波过程（g= .27，95% CI .11 至 . 43，k=18，N=1692），幸福感/幸福感（g= .50，95% CI 0.18 至 .81，k=16，N=1063），以及生活质量（g= .32， 95% CI 0.04 至 0.60，k=10，N=1212）。行为困难/外化问题（g= −.38，95% CI −.86 至 .10，k=15，N=1351）和身体健康/疼痛（g= .52，95% CI −.14 至 1.17， k=8, N=1139) 不再显著。广泛的异质性引起了对普遍性的担忧，后续数据相对稀少。结论：尽管该综述存在局限性，但该荟萃分析发现对青年人使用第三波 CBT 有希望的结果。

【关键词】青少年心理健康，儿童心理健康，荟萃分析，第三波，认知行为疗法

[Abstract] Objectives: Third wave cognitive behavioural therapies are increasingly used with children and adolescents. This meta-analysis aimed to determine the effectiveness of four third-wave interventions (acceptance and commitment therapy, compassion focused therapy, mindfulness-based cognitive therapy, and metacognitive therapy) for youth. Methods: Four electronic databases were used to identify randomized controlled trials, which tested effects related to health, well-being and functioning. Sensitivity analyses considering study quality were conducted and moderators were explored. Results: The results based on 50 RCTs meeting inclusion criteria indicated emotional symptoms/internalizing problems (g = −.68, 95% CI −.98 to −.37, k = 43, N = 3265), behavioural difficulties/externalizing problems (g = −.62, 95% CI −1.01 to −.22, k = 23, N = 1659), interference from difficulties (g = −.46, 95% CI −.87 to −.05, k = 21, N = 1786), third wave processes (g = .39, 95% CI .17 to .62, k = 22, N = 1900), wellbeing/flourishing (g = .76, 95% CI .35 to 1.17, k = 21, N = 1303) and physical health/pain (g = .72, 95% CI .01 to 1.44, k = 9, N = 1171) yielded significant effects. Effect for quality of life (g = .62, 95% CI −.08 to 1.31, k = 12, N = 1271) was non-significant. When analysing only those studies rated moderate-high quality, third wave interventions yielded significant superiority effects compared to controls for emotional symptoms/internalizing problems (g = −.55, 95% CI −.82 to −.27, k = 28, N = 2110), interference from difficulties (g = −.48, 95% CI −.90 to −.05, k = 21, N = 1605), third wave processes (g = .27, 95% CI .11 to .43, k = 18, N = 1692), well-being/flourishing (g = .50, 95% CI .18 to .81, k = 16, N = 1063), and quality of life (g = .32, 95% CI .04 to .60, k = 10, N = 1212). Behavioural difficulties/externalizing problems (g = −.38, 95% CI −.86 to .10, k = 15, N = 1351) and physical health/pain (g = .52, 95% CI −.14 to 1.17, k = 8, N = 1139) ceased to be significant. Widespread heterogeneity raised concerns about generalizability and follow-up data was relatively sparse. Conclusions:  This meta-analysis finds promising results for use of third wave CBT with youth, though the review has limitations.

【Key Words] adolescent mental health, child mental health, meta-analysis, third wave, cognitive behavioural therapy

论文原文：Amorette M. Perkins, Richard Meiser-Stedman, Samuel W. Spaul, Gemma Bowers, Abigail G. Perkins, Laura Pass (2023). The effectiveness of third wave cognitive behavioural therapies for children and adolescents: A systematic review and meta-analysis. British Journal of Clinical Psychology, 62 (1): 209-227

https://doi.org/10.1111/bjc.12404

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