Læknablaðið - 15.11.2011, Blaðsíða 38

Y F I R L I T
grein nema meðferðaraðilar mæti slíkum skilmerkjum. í annan
stað eru rannsóknir á samþættri meðferð komnar skammt á veg.
í þriðja lagi eru árangursrannsóknir gjarnan gerðar á fremur
einsleitum hópi sjúklinga sem endurspeglar ekki alltaf nægilega
klínískan raunveruleika þar sem vímugjafar, erfiðar félagslegar
aðstæður og persónuleikaröskun getur flækt myndina. Að lokum
er vert að nefna að í sumum samanburðarrannsóknum á HAM
og lyfjameðferð hefur verið notast við þríhringa þunglyndislyf
sem eru ekki lengur fyrsta lyfjameðferð við kvíða og þunglyndi
vegna aukaverkana og hættu á hjartsláttartruflunum, séu þau
tekin í of stórum skömmtum.
Af yfirlitinu má álykta að HAM sé gagnleg meðferð við lyndis-
og kvíðaröskunum. Aukaverkanir eru nær aldrei vandamál og
langtímaárangur að meðferð lokinni oft góður. í þessari grein
leyfir rýmið ekki að fjallað sé um árangur HAM við ýmsum
öðrum vandamálum sem sálfræðingar, geðlæknar, heimilislæknar,
lyflæknar og aðrir heilbrigðisstarfsmenn glíma við í starfi sínu.
Dæmi um slíkt eru persónuleikaraskanir, geðklofi, geðhvarfasýki,
fíknivandamál og átraskanir. Slík umfjöllun er efni í aðra grein.
ENGLISH SUMMARY
Efficacy of cognitive behavioral therapy in the treatment of mood and anxiety disorders in adults
Sighvatsson MB, Kristjánsdóttir H. Sigurðsson E, Sigurðsson JF
Cognitive behavioral therapy (CBT) represents that form of psychotherapy which has most research data to build on in the treatment of mood and
anxiety disorders for adults. In this review we will introduce CBT and present the results of pertinent outcome research. Efficacy at the end of treatment is
discussed, as well as long term effectiveness and the efficacy of combined treatment with medication and CBT. In addition, we discuss the pros and cons
of group CBT compared to CBT in individual format, and comorbidity of mental disorders. According to this review CBT is efficacious for major depressive
disorder, generalized anxiety disorder, panic disorder, post-traumatic stress disorder, obsessive compulsive disorder, social phobia and specific phobia.
Efficacy of CBT is equal to or better than efficacy of drugs in the treatment of the above disorders, but there is less access to CBT. Longterm effectiveness
of CBT appears to be good, but research on combined treatment is yet in its infancy and conclusions are premature on its place in treatment.
Key words: Cognitive behavioral therapy, psychotropic treatment, efíicacy, long-term efíects, combined treatment, mental disorders, adults.
Correspondence: Hafrún Kristjánsdóttir, hafrunkr@landspitali.is
Heimildir
1. Prochaska JM, Norcross JC. Systems of Psychotherapy:
A Transtheoretical Analysis. 7th ed. Brooks/Cole, Pacific
Grove Califomia 2010.
2. Beck AT. How an anomalous finding led to a new system
of psychotherapy. Nat Med 2006; 12:1139-41.
3. Butler AC, Chapman JE, Forman EM, Beck AT. The
empirical status of cognitive-behavioral therapy: a review
of meta-analyses. Clin Psychol Rev 2006; 26:17-31.
4. Beck AT. The current state of cognitive therapy: a 40-year
retrospective. Arch Gen Psychiatry 2005; 62: 953-9.
5. Beck AT. Cognitive Therapy and the Emotional Disorders.
Penguin Books, New York 1976.
6. Bennett-Levy J, Butler G, Fennell M, Hackmann A,
Mueller, M, Westbrook D. Oxford Guide to Behavioral
Experiments in Cognitive Therapy. Oxford University
Press, Oxford 2004.
7. Tolin DF. Is cognitive-behavioral therapy more effective
than other therapies? A meta-analytic review. Clin Psychol
Rev 2010; 30: 710-20.
8. National Institute for Clinical Exellence. Depression:
the treatment and management of depression in adults
(update). Clinical guideline 90. NICE, London 2009.
9. Cuijpers P, van Straten A, Andersson G, van Oppen P.
Psychotherapy for depression in adults: a meta-analysis of
comparative outcome studies. J Consult Clin Psychol 2008;
76:909-22.
10. Gloaguen V, Cottraux J, Cucherat M, Blackbum IM.
A meta-analysis of the effects of cognitive therapy in
depressed patients. J Affect Disord 1998; 49: 59-72.
11. Cuijpers P, van Straten A, van Oppen P, Anderson G. Are
psychological and pharmacological interventions equally
effective in the treatment of adult depressive disorders?
A meta analysis of comparative studies. J Clin Psychiatry
2008; 69:1675-85.
12. DeRubeis RJ, Hollon SD, Amsterdam JD, et al. Cognitive
therapy vs medications in the treatment of moderate to
severe depression. Arch Gen Psychiatry 2005; 62:409-16.
13. Hollon SD, DeRubeis RJ, Shelton RC, et al. Prevention
of relapse following cogntive therapy vs medications in
moderate to severe depression. Arch Gen Psychiatry 2005;
62:417-22
14. Hollon SD, Stewart MO, Stmnk D. Enduring effects for
cognitive behavior therapy in the treatment of depression
and anxiety. Ann Rev Psychol 2006; 57: 285-315.
15. Otto MW, Smits JAJ, Reese HE. Combined psychotherapy
and pharmacotherapy for mood and anxiety disorders in
adults: review and analysis. Clin Psychol: Sci Pract 2005;
12: 72-86.
16. Cuijpers P, van Straten A, Warmerdam L, Andersson G.
Psychological treatment versus combined treatment of
depression: A meta-analysis. Depress Anxiety 2009; 26:
279-88.
17. Murphy GE, Simons AD, Wetzel RD, Lustman PJ.
Cognitive therapy and pharmacotherapy. Singly and
together in the treatment of depression. Arch Gen
Psychiatry 1984; 41: 33-41.
18. Keller MB, McCullough JP, Klein DN, et al. A comparison
of nefazodone, the cogntive behavioral analysis system of
psychotherapy, and their combination for the treatment of
chronic depression. N Eng J Med 2000; 342:1462-70.
19. Paykel ES. Cognitive therapy in relapse prevention in
depression. Int J of Neuropsychopharmacol 2007; 10: 131-
6.
20. Dunner DL, Schmaling KB, Hendrickson H, Becker J,
Lehman A, Bea C. Cognitive therapy versus fluoxetine in
the treatment of dysthymic disorder. Depression 1996; 4:
34-41.
21. Stavinski A, Shahar A, Verreault R. A pilot study of
the cognitive treatment of dysthymic disorder. Behav
Psychother 1991; 19:369-72.
22. Cuipers P, van Straten A, Schuurmans J, van Oppen P,
HoIIon SD, Andersson G. Psychotherapy for chronic major
depression and dysthymia: a meta-analysis. Clin Psychol
Rev 2010; 30: 51-62.
23. Ravindran AV, Anisman H, Merali Z, et al. Treatment of
primary dysthymia with group cognitive therapy and
pharmacotherapy: clinical symptoms and functional
impairments. Am J Psychiatry 1999; 156,1608-17.
24. National Institute for Clinical Exellence. Generalised
anxiety disorder and panic disorder (with or without
agoraphobia) in adults. Clinical guidelines 113. NICE,
London 2011.
25. Robichaud M, Dugas MJ. Psychological treatments of
generalized anxiety disorder. In: Antony MM, Stein MB,
ed. Oxford Handbook of Anxiety and Related Disorders.
Oxford University Press, New York 2009: 364-75.
26. Mitte, K. Meta-analysis of cognitive-behavioral treatments
for generalized anxiety disorder: a comparison with
pharmacotherapy. Psychol Bull 2005; 131: 785-95.
27. Power KG, Simpson RJ, Swanson V, Wallace LA. A
controlled comparison of cognitive-behaviour therapy,
diazepam, and placebo, alone and in combination, for the
treatment of generalised anxiety disorder. J Anx Disord
1990; 4: 267-92.
28. Gould RA, Otto MW, Pollack MH. A meta analysis of
treatment outcome for panic disorder. Clin Psychol Rev
1995; 15: 819-44.
29. National Institute for Clinical Exellence. Anxiety:
Management of anxiety (panic disorder, with or without
agoraphobia, and generalised anxiety disorder) in adults
in primary, secondary and community care. Clinical
guideline 22. NICE, London 2004.
30. Wright J. Integrating cognitive behavioral therapy and
pharmacotherapy. In: Leahy RL, ed. Contemporary
Cognitive Therapy. Guilford, New York 2004:341-67.
31. Agnarsdóttir A, Eyþórsdóttir Á, Einarsson E, et al.
Þunglyndi og kvíði - klínískar leiðbeiningar. Land-
spítalinn 2011 www.Iandspitali.is - september 2011
32. Sánchez-Meca J, Rosa-AIcázar AI, Marín-Martínez F,
Gómez-Conesa A. Psychological treatment of panic
disorder with or without agoraphobia: A meta analysis.
Clin Psychol Rev 2010; 30: 37-50.
33. Barlow DH, Gorman JM, Shear MK, Woods SW. Cognitive-
behavioral therapy, imipramine, or their combination for
panic disorder: A randomized controlled trial. JAMA 2000;
283: 2529-36.
34. van Apeldoom, FJ, Timmerman ME, Merch PPA, et al.
A randomized trial of cognitive-behavioral therapy or
selective serotonin reuptake inhibitor or both combined
for panic disorder with or without agoraphobia: treatment
results through 1-year follow-up. J Clin Psychiatry 2010;
71:574-86.
618 LÆKNAblaðið 2011/97
i