Reviewhybrid2021

Comparative efficacy and acceptability of psychotherapies for panic disorder with or without agoraphobia: systematic review and network meta-analysis of randomised controlled trials

Davide Papola · Giovanni Ostuzzi · Federico Tedeschi · Chiara Gastaldon · Marianna Purgato · Cinzia Del Giovane +7 more

54 citations0/0 files storedThe British Journal of Psychiatry

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Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Psychotherapy Techniques and Applications Psychological Treatments and Assessments

Abstract

BACKGROUND: Psychotherapies are the treatment of choice for panic disorder, but which should be considered as first-line treatment is yet to be substantiated by evidence. AIMS: To examine the most effective and accepted psychotherapy for the acute phase of panic disorder with or without agoraphobia via a network meta-analysis. METHOD: We conducted a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the most effective and accepted psychotherapy for the acute phase of panic disorder. We searched MEDLINE, Embase, PsycInfo and CENTRAL, from inception to 1 Jan 2021 for RCTs. Cochrane and PRISMA guidelines were used. Pairwise and network meta-analyses were conducted using a random-effects model. Confidence in the evidence was assessed using Confidence in Network Meta-Analysis (CINeMA). The protocol was published in a peer-reviewed journal and in PROSPERO (CRD42020206258). RESULTS: We included 136 RCTs in the systematic review. Taking into consideration efficacy (7352 participants), acceptability (6862 participants) and the CINeMA confidence in evidence appraisal, the best interventions in comparison with treatment as usual (TAU) were cognitive-behavioural therapy (CBT) (for efficacy: standardised mean differences s.m.d. = -0.67, 95% CI -0.95 to -0.39; CINeMA: moderate; for acceptability: relative risk RR = 1.21, 95% CI -0.94 to 1.56; CINeMA: moderate) and short-term psychodynamic therapy (for efficacy: s.m.d. = -0.61, 95% CI -1.15 to -0.07; CINeMA: low; for acceptability: RR = 0.92, 95% CI 0.54-1.54; CINeMA: moderate). After removing RCTs at high risk of bias only CBT remained more efficacious than TAU. CONCLUSIONS: CBT and short-term psychodynamic therapy are reasonable first-line choices. Studies with high risk of bias tend to inflate the overall efficacy of treatments. Results from this systematic review and network meta-analysis should inform clinicians and guidelines.

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References

2021The PRISMA 2020 statement: an updated guideline for reporting systematic reviews 1997Bias in meta-analysis detected by a simple, graphical test 2019RoB 2: a revised tool for assessing risk of bias in randomised trials 2008Cochrane Handbook for Systematic Reviews of Interventions 2019Cochrane Handbook for Systematic Reviews of Interventions 2015The PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions: Checklist and Explanations 2011Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials 2010Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial

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