Dismantling cognitive-behaviour therapy for panic disorder: a systematic review and component network meta-analysis.

Pompoli, Alessandro; Furukawa, Toshi A; Efthimiou, Orestis; Imai, Hissei; Tajika, Aran; Salanti, Georgia (2018). Dismantling cognitive-behaviour therapy for panic disorder: a systematic review and component network meta-analysis. Psychological medicine, 48(12), pp. 1945-1953. Cambridge University Press 10.1017/S0033291717003919

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Cognitive-behaviour therapy (CBT) for panic disorder may consist of different combinations of several therapeutic components such as relaxation, breathing retraining, cognitive restructuring, interoceptive exposure and/or in vivo exposure. It is therefore important both theoretically and clinically to examine whether specific components of CBT or their combinations are superior to others in the treatment of panic disorder. Component network meta-analysis (NMA) is an extension of standard NMA that can be used to disentangle the treatment effects of different components included in composite interventions. We searched MEDLINE, EMBASE, PsycINFO and Cochrane Central, with supplementary searches of reference lists and clinical trial registries, for all randomized controlled trials comparing different CBT-based psychological therapies for panic disorder with each other or with control interventions. We applied component NMA to disentangle the treatment effects of different components included in these interventions. After reviewing 2526 references, we included 72 studies with 4064 participants. Interoceptive exposure and face-to-face setting were associated with better treatment efficacy and acceptability. Muscle relaxation and virtual-reality exposure were associated with significantly lower efficacy. Components such as breathing retraining and in vivo exposure appeared to improve treatment acceptability while having small effects on efficacy. The comparison of the most v. the least efficacious combination, both of which may be provided as 'evidence-based CBT,' yielded an odds ratio for the remission of 7.69 (95% credible interval: 1.75 to 33.33). Effective CBT packages for panic disorder would include face-to-face and interoceptive exposure components, while excluding muscle relaxation and virtual-reality exposure.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Efthimiou, Orestis and Salanti, Georgia

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0033-2917

Publisher:

Cambridge University Press

Language:

English

Submitter:

Tanya Karrer

Date Deposited:

15 Feb 2018 14:12

Last Modified:

01 Nov 2019 06:44

Publisher DOI:

10.1017/S0033291717003919

PubMed ID:

29368665

Uncontrolled Keywords:

Cognitive-behaviour therapy component network meta-analysis panic disorders

BORIS DOI:

10.7892/boris.110766

URI:

https://boris.unibe.ch/id/eprint/110766

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