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بررسی درمان‌های سایکولوژیکال برای اختلال پانیک با یا بدون آگورافوبیا در بزرگسالان: یک متاآنالیز شبکه‌ای

Información

DOI:
https://doi.org/10.1002/14651858.CD011004.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 13 abril 2016see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Trastornos mentales comunes

Copyright:
  1. Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Alessandro Pompoli

    Correspondencia a: Private practice, no academic affiliations, Malcesine, Italy

    [email protected]

  • Toshi A Furukawa

    Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan

  • Hissei Imai

    Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan

  • Aran Tajika

    Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan

  • Orestis Efthimiou

    Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece

  • Georgia Salanti

    Institute of Social and Preventive Medicine (ISPM) & Bern Institute of Primary Care (BIHAM), University of Bern, Bern, Switzerland

Contributions of authors

TAF and AP conceived the study.

AP led the project under TAF supervision.

AP, TAF and GS worked on the protocol; HI, AT and OE provided suggestions and input.

GS and OE performed the statistical analyses.

AP and TAF worked on the review; HI, AT, OE and GS provided suggestions and input.

All authors reviewed and approved the final version of the review.

Declarations of interest

AP has no competing interests.

TAF has received honoraria for speaking at CME meetings sponsored by Asahi Kasei, Eli Lilly, GlaxoSmithKline, Mochida, MSD, Otsuka, Pfizer, Shionogi and Tanabe‐Mitsubishi. He is a diplomate of the Academy of Cognitive Therapy. He has received royalties from Igaku‐Shoin, Seiwa‐Shoten and Nihon Bunka Kagaku‐sha. He is on the advisory board for Sekisui Chemicals and Takeda Science Foundation. The Japanese Ministry of Education, Science, and Technology, the Japanese Ministry of Health, Labor and Welfare, and the Japan Foundation for Neuroscience and Mental Health have funded his research projects.

HI has no competing interests.

AT has received honoraria for speaking at a meeting sponsored by Eli Lilly.

OE has no competing interests.

GS has no competing interests.

Version history

Published

Title

Stage

Authors

Version

2016 Apr 13

Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta‐analysis

Review

Alessandro Pompoli, Toshi A Furukawa, Hissei Imai, Aran Tajika, Orestis Efthimiou, Georgia Salanti

https://doi.org/10.1002/14651858.CD011004.pub2

2014 Feb 27

Psychological therapies for panic disorder with or without agoraphobia in adults

Protocol

Alessandro Pompoli, Toshi A Furukawa, Hissei Imai, Aran Tajika, Orestis Efthimiou, Georgia Salanti

https://doi.org/10.1002/14651858.CD011004

Differences between protocol and review

We first planned to use scale endpoint data, which typically cannot have negative values and are easier to interpret from a clinical point of view. However, as a post hoc decision, we decided to use change data in an attempt to reduce the amount of heterogeneity due to the baseline imbalance found across studies.

Keywords

MeSH

Medical Subject Headings Check Words

Adult; Humans;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Ideal network of included treatment and control conditions.
Figuras y tablas -
Figure 1

Ideal network of included treatment and control conditions.

Study selection process: PRISMA flow diagram
Figuras y tablas -
Figure 2

Study selection process: PRISMA flow diagram

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 3

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

'Risk of bias' summary. Note that we left the boxes empty when the RoB assessment was not applicable (e.g. in the case of incomplete outcome data in the long term when the study did not report any long term measure that could be included in the analyses).
Figuras y tablas -
Figure 4

'Risk of bias' summary. Note that we left the boxes empty when the RoB assessment was not applicable (e.g. in the case of incomplete outcome data in the long term when the study did not report any long term measure that could be included in the analyses).

Short‐term remission: network plot
Figuras y tablas -
Figure 5

Short‐term remission: network plot

Short‐term remission: forest plot for the comparison WL vs CBT
Figuras y tablas -
Figure 6

Short‐term remission: forest plot for the comparison WL vs CBT

Short‐term remission: forest plot for the comparison CBT vs BT
Figuras y tablas -
Figure 7

Short‐term remission: forest plot for the comparison CBT vs BT

Short‐term remission: funnel plot for the comparison CBT vs WL
Figuras y tablas -
Figure 8

Short‐term remission: funnel plot for the comparison CBT vs WL

Short‐term remission: funnel plot for the comparison CBT vs BT
Figuras y tablas -
Figure 9

Short‐term remission: funnel plot for the comparison CBT vs BT

Short‐term remission: contour‐enhanced funnel plot for the comparison CBT vs WL
Figuras y tablas -
Figure 10

Short‐term remission: contour‐enhanced funnel plot for the comparison CBT vs WL

Short‐term remission: inconsistency factors for the network
Figuras y tablas -
Figure 11

Short‐term remission: inconsistency factors for the network

Short‐term response: network plot
Figuras y tablas -
Figure 12

Short‐term response: network plot

Short‐term response: forest plot for the comparison WL vs CBT
Figuras y tablas -
Figure 13

Short‐term response: forest plot for the comparison WL vs CBT

Short‐term response: forest plot for the comparison CBT vs BT
Figuras y tablas -
Figure 14

Short‐term response: forest plot for the comparison CBT vs BT

Short‐term response: funnel plot for the comparison WL vs CBT
Figuras y tablas -
Figure 15

Short‐term response: funnel plot for the comparison WL vs CBT

Short‐term response: funnel plot for the comparison CBT vs BT
Figuras y tablas -
Figure 16

Short‐term response: funnel plot for the comparison CBT vs BT

Short‐term response: inconsistency factors for the network
Figuras y tablas -
Figure 17

Short‐term response: inconsistency factors for the network

Short‐term dropouts: network plot
Figuras y tablas -
Figure 18

Short‐term dropouts: network plot

Short‐term dropouts: forest plot for the comparison WL vs CBT
Figuras y tablas -
Figure 19

Short‐term dropouts: forest plot for the comparison WL vs CBT

Short‐term dropouts: forest plot for the comparison CBT vs BT
Figuras y tablas -
Figure 20

Short‐term dropouts: forest plot for the comparison CBT vs BT

Short‐term dropouts: funnel plot for the comparison WL vs CBT
Figuras y tablas -
Figure 21

Short‐term dropouts: funnel plot for the comparison WL vs CBT

Short‐term dropouts: funnel plot for the comparison CBT vs BT
Figuras y tablas -
Figure 22

Short‐term dropouts: funnel plot for the comparison CBT vs BT

Short‐term dropouts: inconsistency factors for the network
Figuras y tablas -
Figure 23

Short‐term dropouts: inconsistency factors for the network

Short‐term improvement: network plot
Figuras y tablas -
Figure 24

Short‐term improvement: network plot

Short‐term improvement: forest plot for the comparison WL vs CBT
Figuras y tablas -
Figure 25

Short‐term improvement: forest plot for the comparison WL vs CBT

Short‐term improvement: forest plot for the comparison CBT vs BT
Figuras y tablas -
Figure 26

Short‐term improvement: forest plot for the comparison CBT vs BT

Short‐term improvement: funnel plot for the comparison WL vs CBT
Figuras y tablas -
Figure 27

Short‐term improvement: funnel plot for the comparison WL vs CBT

Short‐term improvement: funnel plot for the comparison CBT vs BT
Figuras y tablas -
Figure 28

Short‐term improvement: funnel plot for the comparison CBT vs BT

Short‐term improvement: inconsistency factors for the network
Figuras y tablas -
Figure 29

Short‐term improvement: inconsistency factors for the network

Long‐term remission/response: network plot
Figuras y tablas -
Figure 30

Long‐term remission/response: network plot

Long‐term remission/response: inconsistency factors for the network
Figuras y tablas -
Figure 31

Long‐term remission/response: inconsistency factors for the network

Subgroup analysis: number of treatment sessions, forest plot for the comparison WL vs CBT
Figuras y tablas -
Figure 32

Subgroup analysis: number of treatment sessions, forest plot for the comparison WL vs CBT

Subgroup analysis: number of treatment sessions, regression line for the comparison WL vs CBT
Figuras y tablas -
Figure 33

Subgroup analysis: number of treatment sessions, regression line for the comparison WL vs CBT

Subgroup analysis: number of treatment sessions, forest plot for the comparison CBT vs BT
Figuras y tablas -
Figure 34

Subgroup analysis: number of treatment sessions, forest plot for the comparison CBT vs BT

Subgroup analysis: number of treatment sessions, regression line for the comparison CBT vs BT
Figuras y tablas -
Figure 35

Subgroup analysis: number of treatment sessions, regression line for the comparison CBT vs BT

Subgroup analysis: therapist training, forest plots for the comparison WL vs CBT
Figuras y tablas -
Figure 36

Subgroup analysis: therapist training, forest plots for the comparison WL vs CBT

Subgroup analysis: therapist training, forest plot for the comparison CBT vs BT
Figuras y tablas -
Figure 37

Subgroup analysis: therapist training, forest plot for the comparison CBT vs BT

Subgroup analysis: percentage of agoraphobic patients, regression line for the comparison WL vs CBT
Figuras y tablas -
Figure 38

Subgroup analysis: percentage of agoraphobic patients, regression line for the comparison WL vs CBT

Subgroup analysis: percentage of depressed patients, regression line for the comparison WL vs CBT
Figuras y tablas -
Figure 39

Subgroup analysis: percentage of depressed patients, regression line for the comparison WL vs CBT

Subgroup analysis: percentage of drug‐treated patients, regression line for the comparison WL vs CBT
Figuras y tablas -
Figure 40

Subgroup analysis: percentage of drug‐treated patients, regression line for the comparison WL vs CBT

Sensitivity analyses: network plot for short‐term remission excluding from the analyses group therapy trials
Figuras y tablas -
Figure 41

Sensitivity analyses: network plot for short‐term remission excluding from the analyses group therapy trials

Sensitivity analyses: forest plot for the comparison WL vs CBT excluding group therapy trials
Figuras y tablas -
Figure 42

Sensitivity analyses: forest plot for the comparison WL vs CBT excluding group therapy trials

Sensitivity analyses: forest plot for the comparison CBT vs BT excluding group therapy trials
Figuras y tablas -
Figure 43

Sensitivity analyses: forest plot for the comparison CBT vs BT excluding group therapy trials

Sensitivity analyses: funnel plot for the comparison WL vs CBT excluding group therapy trials
Figuras y tablas -
Figure 44

Sensitivity analyses: funnel plot for the comparison WL vs CBT excluding group therapy trials

Sensitivity analyses: forest plot for the comparison CBT vs BT excluding group therapy trials
Figuras y tablas -
Figure 45

Sensitivity analyses: forest plot for the comparison CBT vs BT excluding group therapy trials

Sensitivity analyses: inconsistency factors for the network of short‐term remission excluding from the analyses group therapy trials
Figuras y tablas -
Figure 46

Sensitivity analyses: inconsistency factors for the network of short‐term remission excluding from the analyses group therapy trials

Sensitivity analyses: network plot for short‐term remission excluding from the analyses trials in which a concomitant pharmacotherapy is allowed
Figuras y tablas -
Figure 47

Sensitivity analyses: network plot for short‐term remission excluding from the analyses trials in which a concomitant pharmacotherapy is allowed

Sensitivity analyses: network plot for short‐term remission excluding from the analyses trials in which pharmacotherapy stabilisation was not required
Figuras y tablas -
Figure 48

Sensitivity analyses: network plot for short‐term remission excluding from the analyses trials in which pharmacotherapy stabilisation was not required

Summary of findings for the main comparison. Cognitive behaviour therapy compared to no treatment for panic disorder with or without agoraphobia in adults

Cognitive behaviour therapy compared to no treatment for panic disorder with or without agoraphobia in adults

Patient or population: adult patients with panic disorder with or without agoraphobia

Setting: outpatients
Intervention: cognitive behaviour therapy (CBT)
Comparison: no treatment (NT)

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

No treatment (NT)

Cognitive‐behavioral therapy (CBT)

Short‐term remission

(follow‐up: mean 3 months)

Study population

OR 2.78
(0.54 to 14.29)

No direct evidence available: indirect evidence based on 357 participants (2 studies via CT; 5 studies via PT)a

⊕⊝⊝⊝
VERY LOW 1,2,3

36 per 100

61 per 100
(24 to 89)

Short‐term response

(follow‐up: mean 3 months)

Study population

OR 7.14
(1.25 to 50)

No direct evidence available: indirect evidence based on 357 participants (2 studies via CT; 5 studies via PT)a

⊕⊝⊝⊝
VERY LOW 1,2,3

36 per 100

80 per 100
(42 to 97)

Short‐term dropouts

(follow‐up: mean 3 months)

Study population

OR 6.25
(0.26 to 100)

No direct evidence available: indirect evidence based on 278 participants (4 studies via PT)a

⊕⊝⊝⊝
VERY LOW 1,2,3

1 per 100 (no events were observed in the available direct evidence: this percentage was assumed in order to calculate the corresponding risk)

6 per 100
(0 to 50)

Long‐term remission/response

(follow‐up: mean 12 months)

No data available for this comparison

Short‐term improvement as measured on a continuous scale

(follow‐up: mean 3 months)

The mean short‐term improvement as measured on a continuous scale in the control group was 0

The mean short‐term improvement, measured on a continuous scale as SMD (NMA results), was ‐0.83 (95% CI ‐1.5 to ‐0.16), indicating a large effect size in favour of CBT

27 participants
(1 RCT)

⊕⊕⊝⊝
LOW 4,5

Reported ORs are derived (as reciprocal values) from the results of network meta‐analyses presented in Table 1, Table 4 and Table 7 (for ST‐remission and ST‐response we used the results of NMA adjusted for SSE). Reported SMD is derived from the results of network meta‐analysis presented in Table 10.

aIndirect comparison is performed using all possible intermediate comparisons in the network. For brevity we report the number of studies contributing indirect evidence only via a single intermediate comparator.

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; NMA: network meta‐analysis; OR: odds ratio; RCT: randomised controlled trial; SMD: standardised mean difference

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

We downgraded the quality of the evidence one step at a time when one or more of the following criticisms was present:

1Only indirect evidence is available for this outcome.

2Wide 95% CI.

3The risk of bias of indirect evidence is often unclear.

4The risk of bias in the included study was unclear in almost every domain.

5Only one study, with a small sample size, available for direct comparison.

Figuras y tablas -
Summary of findings for the main comparison. Cognitive behaviour therapy compared to no treatment for panic disorder with or without agoraphobia in adults
Summary of findings 2. Cognitive behaviour therapy compared to supportive psychotherapy for panic disorder with or without agoraphobia in adults

Cognitive behaviour therapy compared to supportive psychotherapy for panic disorder with or without agoraphobia in adults

Patient or population: adult patients with panic disorder with or without agoraphobia

Setting: outpatients
Intervention: cognitive behaviour therapy (CBT)
Comparison: supportive psychotherapy (SP)

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

Supportive psychotherapy (SP)

Cognitive behaviour therapy (CBT)

Short‐term remission

(follow‐up: mean 3 months)

Study population

OR 0.67
(0.25 to 1.82)

176
(3 RCTs)

⊕⊕⊝⊝
LOW 1,2

38 per 100

29 per 100
(13 to 52)

Short‐term response

(follow‐up: mean 3 months)

Study population

OR 1.12
(0.4 to 3.26)

176
(3 RCTs)

⊕⊝⊝⊝
VERY LOW 1,2,3,4

32 per 100

34 per 100
(16 to 60)

Short‐term dropouts

(follow‐up: mean 3 months)

Study population

OR 0.64
(0.28 to 1.43)

176
(3 RCTs)

⊕⊝⊝⊝
VERY LOW 1,2,3

46 per 100

35 per 100
(19 to 55)

Long‐term remission/response

(follow‐up: mean 12 months)

Study population

OR 2.09
(0.73 to 5.98)

80
(1 RCT)

⊕⊕⊝⊝
LOW 1,5

24 per 100

40 per 100
(19 to 65)

Short‐term improvement as measured on a continuous scale

(follow‐up: mean 3 months)

The mean short‐term improvement as measured on a continuous scale in the control group was 0

The mean short‐term improvement, measured on a continuous scale as SMD (NMA results), was ‐0.05 (95% CI ‐0.56 to 0.47), indicating almost no difference between CBT and SP (the negative value of the point estimate indicates a slight trend in favour of CBT)

152
(3 RCTs)

⊕⊕⊝⊝
LOW 1,2

Reported ORs and SMD are derived from the network meta‐analyses.

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; NMA: network meta‐analysis; OR: odds ratio; RCT: randomised controlled trial; SMD: standardised mean difference

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

We downgraded the quality of the evidence one step at a time when one or more of the following criticisms was present:

1Risk of bias for the included studies was in many cases unclear.

2Only a few studies available for direct comparison. 95% CI still wide and non‐significant even after combining direct and indirect evidence.

3Results were inconsistent across studies, although with wide confidence intervals.

4ST‐response data were imputed from the continuous outcome for all the included studies.

5Only one study available for direct comparison. 95% CI still wide and non‐significant even after combining direct and indirect evidence.

Figuras y tablas -
Summary of findings 2. Cognitive behaviour therapy compared to supportive psychotherapy for panic disorder with or without agoraphobia in adults
Summary of findings 3. Cognitive behaviour therapy compared to psychodynamic psychotherapy for panic disorder with or without agoraphobia in adults

Cognitive behaviour therapy compared to psychodynamic psychotherapy for panic disorder with or without agoraphobia in adults

Patient or population: adult patients with panic disorder with or without agoraphobia

Setting: outpatients
Intervention: cognitive behaviour therapy (CBT)
Comparison: psychodynamic psychotherapy (PD)

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

Psychodynamic psychotherapy (PD)

Cognitive behaviour therapy (CBT)

Short‐term remission

(follow‐up: mean 3 months)

Study population

OR 0.94
(0.27 to 3.45)a

54
(1 RCT)

⊕⊝⊝⊝
VERY LOW 1,2,3,4

44 per 100

43 per 100
(18 to 73)

Short‐term response

(follow‐up: mean 3 months)

Study population

OR 1.05
(0.28 to 4)a

54
(1 RCT)

⊕⊝⊝⊝
VERY LOW 1,2,3,4

47 per 100

48 per 100
(20 to 78)

Short‐term dropouts

(follow‐up: mean 3 months)

Study population

OR 1.92
(0.56 to 6.67)a

54
(1 RCT)

⊕⊝⊝⊝
VERY LOW 1,2,3,4

19 per 100

32 per 100
(12 to 62)

Long‐term remission/response

(follow‐up: mean 12 months)

Study population

OR 1.25
(0.37 to 4.17)a

54
(1 RCT)

⊕⊕⊝⊝
LOW 1,4

50 per 100

56 per 100
(27 to 81)

Short‐term improvement as measured on a continuous scale

(follow‐up: mean 3 months)

The mean short‐term improvement as measured on a continuous scale in the control group was 0

The mean short‐term improvement as measured on a continuous scale in the intervention group was 0.17 standard deviations higher (0.5 lower to 0.83 higher), indicating a small effect size in favour of PDb

54
(1 RCT)

⊕⊝⊝⊝
VERY LOW 1,3,4,5

a Reported ORs are derived (as reciprocal values) from the results of network meta‐analyses presented in Table 1, Table 4, Table 7 and Table 13 (for ST‐remission and ST‐response we used the results of NMA adjusted for SSE).

b Reported SMD is derived from the results of network meta‐analysis presented in Table 10.

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CBT: cognitive behaviour therapy; CI: confidence interval; NMA: network meta‐analysis; OR: odds ratio; PD: psychodynamic psychotherapy; PT: physiological therapies; RCT: randomised controlled trial; SMD: standardised mean difference

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

We downgraded the quality of the evidence one step at a time when one or more of the following criticisms was present:

1The available direct evidence was affected by a high risk of bias in various important domains.

2Relevant (although non‐significant) inconsistency was found in the loop PD‐CBT‐PT.

3Indirect evidence importantly influences the NMA results.

4Only one study available for direct comparison. 95% CI still wide and non‐significant even after combining direct and indirect evidence.

5Statistically significant inconsistency was found in the loop PD‐CBT‐PT.

Figuras y tablas -
Summary of findings 3. Cognitive behaviour therapy compared to psychodynamic psychotherapy for panic disorder with or without agoraphobia in adults
Summary of findings 4. Network meta‐analysis rankings of psychological therapies for panic disorder with or without agoraphobia in adults

NMA Rankings of psychological therapies for panic disorder with or without agoraphobia in adults

Patient or population: adult patients with panic disorder with or without agoraphobia

Setting: outpatients
Intervention: psychoeducation (PE), supportive psychotherapy (SP), physiological therapies (PT), behaviour therapy (BT), cognitive therapy (CT), cognitive‐behaviour therapy (CBT), third‐wave CBT (3W), psychodynamic psychotherapy (PD)
Comparison: no treatment (NT), waiting list (WL), attention/psychological placebo (APP)

Outcomes

Treatment hierarchy (in descending order)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Short‐term remission
(follow up: mean 3 months)

(SP)‐CBT‐PD‐CT‐BT‐PT‐NT‐WL

2491
(40 RCTs)

⊕⊕⊝⊝
LOW 1 2

Short‐term response
(follow up: mean 3 months)

CBT‐PD‐(SP)‐BT‐PT‐WL‐CT‐NT

2240
(37 RCTs)

⊕⊕⊝⊝
LOW 1 2

Short‐term dropouts
(follow up: mean 3 months)

NT‐PD‐WL‐3W‐CBT‐APP‐PE‐PT‐CT‐BT‐SP

2535
(47 RCTs)

⊕⊕⊝⊝
LOW 1 3

Long‐term remission/response
(follow up: mean 12 months)

CBT‐PD‐PT‐BT‐SP‐CT

464
(9 RCTs)

⊕⊕⊝⊝
LOW 1 3

Short‐term improvement as measured on a continuous scale
(follow up: mean 3 months)

(PD)‐CBT‐SP‐CT‐3W‐BT‐PT‐NT‐WL

2318
(57 RCTs)

⊕⊕⊝⊝
LOW 1 3

Reported rankings are based on absolute SUCRA values, which are derived from network meta‐analyses (NMA).

The ranking of treatments reported in parenthesis must be interpreted with caution, because the evidence supporting those rankings is either too scarce or hampered by relevant inconsistency.

The assessment of quality of evidence has been made by adapting the GRADE tool, designed for pairwise meta‐analyses, to network meta‐analyses, as suggested in Salanti 2014.

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 Downgraded for study limitations because the risk of bias was unclear or high in more than one important domain for many of the included studies.

2 Downgraded for imprecision because too few comparisons remained clinically important after adjusting the results of NMA for SSE (See additional Table 1 and Table 4)

3 Downgraded for imprecision because too few comparisons showed clinically important results in NMA (See additional Table 7, Table 10 and Table 14)

Figuras y tablas -
Summary of findings 4. Network meta‐analysis rankings of psychological therapies for panic disorder with or without agoraphobia in adults
Table 1. Short‐term remission: pairwise meta‐analyses and NMA results

Comparison

(X vs Y)

Pairwise meta‐analyses

(common τ = 0.69)

Standard NMA

(τ = 0.64)

ΝΜΑ adjusted for SSE

(τ = 0.59)

# of studies

OR

CI (lower)

CI (upper)

OR

CI (lower)

CI (upper)

OR

CrI (lower)

CrI (upper)

PT vs SP

0.36

0.11

1.18

0.35

0.10

1.11

BT vs SP

0.37

0.12

1.15

0.38

0.12

1.19

BT vs PT

2

1.11

0.21

6.00

1.03

0.42

2.28

1.10

0.51

2.50

CT vs SP

0.47

0.11

2.07

0.44

0.10

1.90

CT vs PT

1

1.22

0.20

7.48

1.33

0.44

4.05

1.27

0.41

3.91

CT vs BT

1

0.95

0.12

7.47

1.29

0.41

4.07

1.15

0.37

3.61

CBT vs SP

3

0.68

0.24

1.91

0.68

0.25

1.83

0.67

0.25

1.82

CBT vs PT

4

1.56

0.62

3.94

1.90

0.98

3.69

1.95

1.02

3.97

CBT vs BT

10

2.09

1.10

3.97

1.84

1.06

3.22

1.77

1.02

3.11

CBT vs CT

1

1.69

0.21

13.47

1.43

0.48

4.23

1.53

0.52

4.68

WL vs SP

0.08

0.03

0.26

0.22

0.06

0.78

WL vs PT

4

0.21

0.06

0.70

0.23

0.12

0.48

0.64

0.27

1.65

WL vs BT

3

0.12

0.04

0.43

0.23

0.12

0.45

0.58

0.25

1.36

WL vs CT

2

0.12

0.02

0.61

0.18

0.06

0.52

0.50

0.15

1.77

WL vs CBT

18

0.13

0.07

0.22

0.12

0.07

0.21

0.33

0.16

0.69

NT vs SP

0.26

0.04

1.82

0.24

0.03

1.67

NT vs PT

1

0.70

0.11

4.33

0.73

0.14

3.68

0.70

0.14

3.48

NT vs BT

0.71

0.13

3.96

0.64

0.11

3.51

NT vs CT

1

0.57

0.09

3.48

0.55

0.11

2.73

0.55

0.11

2.71

NT vs CBT

0.38

0.07

2.05

0.36

0.07

1.85

NT vs WL

3.11

0.58

16.78

1.10

0.18

6.26

PD vs SP

0.71

0.14

3.52

0.71

0.14

3.42

PD vs PT

1

4.21

0.70

25.49

1.99

0.57

7.02

2.05

0.60

7.38

PD vs BT

1.94

0.50

7.48

1.88

0.48

7.17

PD vs CT

1.50

0.30

7.43

1.61

0.33

8.17

PD vs CBT

1

0.51

0.09

2.99

1.05

0.30

3.68

1.06

0.29

3.66

PD vs WL

8.50

2.27

31.84

3.21

0.75

12.87

PD vs NT

2.73

0.36

20.56

2.91

0.40

22.56

OR (X vs Y) is defined as (Odds X)/(Odds Y). For each comparison X vs Y, an OR greater than one favours treatment X, an OR less than one favours treatment Y. Note that in the main text, where necessary, we inverted the values presented in Table 4 for an easier presentation, in which an OR greater than 1 stands for a higher number of events (short‐term remissions) in the intervention group when compared to the control group. Statistically significant results are written in bold.

BT: behaviour therapy
CBT: cognitive behaviour therapy
CI: confidence interval
CrI: credible interval
CT: cognitive training
NMA: network meta‐analysis
NT: no treatment
PD: psychodynamic therapies
PT: physiological therapies
SP: supportive psychotherapy
SSE: small study effects
WL: wait list

Figuras y tablas -
Table 1. Short‐term remission: pairwise meta‐analyses and NMA results
Table 2. Short‐term remission: I2 values and their 95% confidence intervals

Comparison

I2(%)

95% CI

CBT vs SP

0

0 to 90

WL vs CBT

58

29 to 75

CBT vs BT

5

0 to 64

WL vs BT

34

0 to 78

WL vs PT

56

0 to 85

CBT vs PT

0

0 to 85

This values refer to standard meta‐analyses, where each comparison has its own heterogeneity variance.

BT: behaviour therapy
CBT: cognitive behaviour therapy
CI: confidence interval
CT: cognitive training
PT: physiological therapies
SP: supportive psychotherapy
WL: wait list

Figuras y tablas -
Table 2. Short‐term remission: I2 values and their 95% confidence intervals
Table 3. Short‐term remission: ranking of treatments

Treatment

SUCRA

SP

88

CBT

76

PD

73

CT

50

BT

41

PT

35

NT

25

WL

13

BT: behaviour therapy
CBT: cognitive behaviour therapy
CT: cognitive training
NT: no treatment
PD: psychodynamic therapies
PT: physiological therapies
SP: supportive psychotherapy
WL: wait list

Figuras y tablas -
Table 3. Short‐term remission: ranking of treatments
Table 4. Short‐term response: pairwise meta‐analyses and NMA results

Comparison

(X vs Y)

Pairwise meta‐analyses

(common τ = 0.55)

Standard NMA

(τ = 0.63)

NMA adjusted for SSE

(τ = 0.65)

# of studies

OR

CI (lower)

CI (upper)

OR

CI (lower)

CI (upper)

OR

CrI (lower)

CrI (upper)

PT vs SP

0.68

0.20

2.31

0.69

0.20

2.41

BT vs SP

0.589

0.18

1.93

0.69

0.21

2.33

BT vs PT

2

0.90

0.21

3.90

0.87

0.41

1.88

1.00

0.46

2.23

CT vs SP

0.39

0.07

2.07

0.36

0.07

1.96

CT vs PT

1

0.94

0.18

4.97

0.58

0.16

2.09

0.53

0.14

2.04

CT vs BT

1

0.20

0.03

1.46

0.66

0.18

2.51

0.53

0.13

2.07

CBT vs SP

3

1.02

0.38

2.73

1.04

0.36

2.99

1.12

0.40

3.26

CBT vs PT

4

1.23

0.56

2.71

1.54

0.81

2.94

1.62

0.84

3.17

CBT vs BT

10

1.78

1.00

3.18

1.77

1.02

3.04

1.61

0.92

2.86

CBT vs CT

1

2.92

0.43

19.98

2.65

0.73

9.62

3.08

0.81

12.26

WL vs SP

0.17

0.05

0.53

0.45

0.12

1.93

WL vs PT

4

0.15

0.05

0.44

0.25

0.12

0.50

0.65

0.24

1.91

WL vs BT

4

0.32

0.14

0.73

0.29

0.15

0.54

0.65

0.28

1.68

WL vs CT

1

0.31

0.02

4.27

0.43

0.12

1.61

1.24

0.26

6.42

WL vs CBT

17

0.19

0.05

0.31

0.16

0.10

0.26

0.40

0.18

1.00

NT vs SP

0.16

0.02

1.21

0.15

0.02

1.22

NT vs PT

1

0.31

0.06

1.62

0.24

0.05

1.25

0.22

0.04

1.25

NT vs BT

0.27

0.05

1.59

0.22

0.03

1.37

NT vs CT

1

0.33

0.06

1.68

0.41

0.08

2.13

0.42

0.07

2.31

NT vs CBT

0.16

0.03

0.87

0.14

0.02

0.80

NT vs WL

0.96

0.17

5.46

0.33

0.04

2.32

PD vs SP

1.02

0.20

5.28

1.07

0.20

5.70

PD vs PT

1

4.22

0.84

21.31

1.51

0.42

5.35

1.54

0.42

5.92

PD vs BT

1.73

0.44

6.70

1.54

0.37

6.41

PD vs CT

2.59

0.45

14.82

2.94

0.47

18.59

PD vs CBT

1

0.34

0.07

1.76

0.98

0.27

3.47

0.95

0.25

3.60

PD vs WL

6.02

1.60

22.61

2.37

0.49

10.75

PD vs NT

6.28

0.80

49.20

7.03

0.84

61.98

OR (X vs Y) is defined as (Odds X)/(Odds Y). For each comparison X vs Y, an OR greater than one favours treatment X, an OR less than one favours treatment Y. Note that in the main text, where necessary, we inverted the values presented in Table 4 for an easier presentation, in which an OR greater than 1 stands for a higher number of events (short‐term remissions) in the intervention group when compared to the control group. Statistically significant results are written in bold.

BT: behaviour therapy
CBT: cognitive behaviour therapy
CI: confidence interval
CrI: credible interval
CT: cognitive training
NMA: network meta‐analysis
NT: no treatment
PD: psychodynamic therapies
PT: physiological therapies
SP: supportive psychotherapy
SSE: small study effects
WL: wait list

Figuras y tablas -
Table 4. Short‐term response: pairwise meta‐analyses and NMA results
Table 5. Short‐term response: I2 values and their 95% confidence intervals

Comparison

I2(%)

95% CI

CBT vs SP

7

0 to 90

WL vs CBT

39

0 to 66

CBT vs BT

22

0 to 62

WL vs BT

26

0 to 72

WL vs PT

14

0 to 87

CBT vs PT

45

0 to 82

This values refer to standard meta‐analyses, where each comparison has its own heterogeneity variance.

BT: behaviour therapy
CBT: cognitive behaviour therapy
CI: confidence interval
CT: cognitive training
PT: physiological therapies
SP: supportive psychotherapy
WL: wait list

Figuras y tablas -
Table 5. Short‐term response: I2 values and their 95% confidence intervals
Table 6. Short‐term response: ranking of treatments

Treatment

SUCRA

CBT

84

PD

74

SP

72

BT

53

PT

52

WL

31

CT

27

NT

7

BT: behaviour therapy
CBT: cognitive behaviour therapy
CT: cognitive training
NT: no treatment
PD: psychodynamic therapies
PT: physiological therapies
SP: supportive psychotherapy
WL: wait list

Figuras y tablas -
Table 6. Short‐term response: ranking of treatments
Table 7. Short‐term dropouts: pairwise meta‐analyses and NMA results

Comparison

Pairwise meta‐analysis

Network meta‐analysis

(τ = 0.33)

# of studies

OR

CI (lower)

CI (upper)

OR

CI (lower)

CI (upper)

PT vs SP

0.76

0.28

2.08

BT vs SP

0.92

0.35

2.28

BT vs PT

2

2.19

0.46

10.38

1.20

0.60

2.40

CT vs SP

1.06

0.20

5.62

CT vs PT

1

5.59

0.59

52.73

1.38

0.33

5.86

CT vs BT

1.15

0.26

5.20

CBT vs SP

3

0.63

0.21

1.89

0.64

0.28

1.43

CBT vs PT

3

0.56

0.24

1.28

0.83

0.46

1.50

CBT vs BT

10

0.89

0.52

1.51

0.69

0.42

1.15

CBT vs CT

0.60

0.14

2.60

WL vs SP

0.48

0.19

1.22

WL vs PT

5

0.74

0.30

1.83

0.63

0.35

1.15

WL vs BT

4

0.34

0.16

0.69

0.52

0.30

0.93

WL vs CT

0.46

0.11

1.97

WL vs CBT

14

0.70

0.42

1.16

0.76

0.48

1.20

NT vs SP

0.10

0.00

2.18

NT vs PT

1

0.29

0.01

7.51

0.13

0.01

3.10

NT vs BT

0.11

0.00

2.69

NT vs CT

1

0.07

0.00

1.37

0.10

0.00

1.93

NT vs CBT

0.16

0.01

3.80

NT vs WL

0.21

0.09

5.01

PD vs SP

0.33

0.08

1.46

PD vs PT

1

0.16

0.03

0.84

0.44

0.12

1.52

PD vs BT

0.36

0.10

1.35

PD vs CT

0.32

0.05

2.04

PD vs CBT

1

1.21

0.27

5.35

0.52

0.15

1.80

PD vs WL

0.69

0.19

2.50

PD vs NT

3.31

0.11

97.03

APP vs SP

0.84

0.07

10.61

APP vs PT

1.10

0.10

12.30

APP vs BT

0.92

0.08

10.49

APP vs CT

1

0.97

0.08

11.51

0.80

0.09

7.21

APP vs CBT

1.32

0.12

14.61

APP vs WL

1.75

0.16

19.51

APP vs NT

8.37

0.21

333.81

APP vs PD

2.53

0.17

36.70

PE vs SP

0.84

0.01

97.42

PE vs PT

1.10

0.01

119.64

PE vs BT

0.92

0.01

100.89

PE vs CT

0.80

0.01

77.96

PE vs CBT

1.32

0.01

142.93

PE vs WL

1.75

0.02

189.75

PE vs NT

8.36

0.04

1954.05

PE vs PD

2.53

0.02

316.00

PE vs APP

1.00

0.02

55.66

3W vs SP

0.36

0.06

2.12

3W vs PT

0.47

0.08

2.65

3W vs BT

0.39

0.07

2.15

3W vs CT

0.34

0.04

3.03

3W vs CBT

1

0.56

0.13

2.51

0.56

0.11

2.88

3W vs WL

0.74

0.14

4.04

3W vs NT

3.55

0.10

126.65

3W vs PD

1.07

0.13

8.31

3W vs APP

0.42

0.02

7.74

3W vs PE

0.42

0.00

60.45

OR (X vs Y) is defined as (Odds X)/(Odds Y). Of course, since this is dropout outcome, an OR smaller than one favours treatment X. Statistically significant results are written in bold.

3W: third‐wave
APP: attention/psychological placebo
BT: behaviour therapy
CBT: cognitive behaviour therapy
CI: confidence interval
CrI: credible interval
CT: cognitive training
NMA: network meta‐analysis
NT: no treatment
PD: psychodynamic therapies
PE: psychoeducation
PT: physiological therapies
SP: supportive psychotherapy
SSE: small study effects
WL: wait list

Figuras y tablas -
Table 7. Short‐term dropouts: pairwise meta‐analyses and NMA results
Table 8. Short‐term dropouts: I2 values and their 95% confidence intervals

Comparison

I2(%)

95% CI

CBT vs SP

49

0 to 85

WL vs CBT

0

0 to 55

CBT vs BT

0

0 to 62

WL vs BT

0

0 to 85

WL vs PT

25

0 to 70

CBT vs PT

12

0 to 91

This values refer to standard meta‐analyses, where each comparison has its own heterogeneity variance.

BT: behaviour therapy
CBT: cognitive behaviour therapy
CI: confidence interval
CT: cognitive training
PT: physiological therapies
SP: supportive psychotherapy
WL: wait list

Figuras y tablas -
Table 8. Short‐term dropouts: I2 values and their 95% confidence intervals
Table 9. Short‐term dropouts: ranking of treatments

Treatment

SUCRA

NT

85

PD

75

WL

67

3W

67

CBT

51

APP

42

PE

42

PT

38

CT

29

BT

28

SP

26

Note that higher ranking treatments correspond to lower dropout rate.

3W: third‐wave
APP: attention/psychological placebo
BT: behaviour therapy
CBT: cognitive behaviour therapy
CT: cognitive training
NT: no treatment
PD: psychodynamic therapies
PE: psychoeducation
PT: physiological therapies
SP: supportive psychotherapy
WL: wait list

Figuras y tablas -
Table 9. Short‐term dropouts: ranking of treatments
Table 10. Short‐term improvement: pairwise meta‐analyses and NMA results

Comparison

(X vs Y)

Pairwise meta‐analysis

Network meta‐analysis

(τ = 0.34)

# of studies

SMD

CI (lower)

CI (upper)

SMD

CI (lower)

CI (upper)

PT vs SP

0.24

‐0.35

0.84

BT vs SP

0.16

‐0.42

0.74

BT vs PT

1

‐0.26

‐0.98

0.46

‐0.08

‐0.47

0.31

CT vs SP

0.17

‐0.56

0.90

CT vs PT

1

‐0.02

‐0.67

0.64

‐0.08

‐0.63

0.48

CT vs BT

1

0.65

‐0.16

1.46

0.00

‐0.56

0.57

CBT vs SP

3

‐0.08

‐0.40

0.24

‐0.05

‐0.56

0.47

CBT vs PT

5

‐0.05

‐0.30

0.19

‐0.29

‐0.60

0.02

CBT vs BT

10

‐0.24

‐0.45

‐0.03

‐0.21

‐0.48

0.07

CBT vs CT

2

0.03

‐0.88

0.94

‐0.21

‐0.73

0.31

WL vs SP

1.05

0.49

1.60

WL vs PT

4

0.87

0.09

1.65

0.80

0.47

1.13

WL vs BT

3

0.92

0.59

1.26

0.89

0.57

1.20

WL vs CT

1

0.60

‐0.27

1.47

0.88

0.34

1.42

WL vs CBT

17

1.14

0.87

1.41

1.09

0.88

1.31

NT vs SP

0.78

‐0.06

1.63

NT vs PT

1

0.36

‐0.26

0.98

‐0.46

‐1.12

0.21

NT vs BT

0.62

‐0.09

1.33

NT vs CT

1

0.39

‐0.25

1.03

0.61

‐0.11

1.34

NT vs CBT

1

1.30

0.46

2.14

0.83

0.16

1.50

NT vs WL

‐0.27

‐0.96

0.42

PD vs SP

‐0.21

‐1.05

0.63

PD vs PT

1

‐1.18

‐1.79

‐0.57

‐0.46

‐1.12

0.21

PD vs BT

‐0.38

‐1.09

0.34

PD vs CT

‐0.38

‐1.21

0.45

PD vs CBT

1

0.57

‐0.07

1.2

‐0.17

‐0.83

0.50

PD vs WL

‐1.26

‐1.95

‐0.57

PD vs NT

‐1.00

‐1.91

‐0.07

PE vs APP

1

‐0.25

‐0.87

0.38

3W vs SP

0.20

‐0.82

1.22

3W vs PT

‐0.04

‐0.98

0.90

3W vs BT

0.04

‐0.89

0.97

3W vs CT

0.04

‐0.99

1.07

3W vs CBT

1

0.26

‐0.33

0.84

0.25

‐0.64

1.14

3W vs WL

‐0.84

‐1.76

0.07

3W vs NT

‐0.58

‐1.69

0.53

3W vs PD

0.42

‐0.69

1.53

A positive SMD for Χ vs Y means treatment Y is better than X, the opposite for a negative SMD (this is because for the scales used a lower score corresponds to a better treatment). Statistically significant results are written in bold.

3W: third‐wave
APP: attention/psychological placebo
BT: behaviour therapy
CBT: cognitive behaviour therapy
CT: cognitive training
NT: no treatment
PD: psychodynamic therapies
PE: psychoeducation
PT: physiological therapies
SP: supportive psychotherapy
WL: wait list

Figuras y tablas -
Table 10. Short‐term improvement: pairwise meta‐analyses and NMA results
Table 11. Short‐term improvement: I2 values and their 95% confidence intervals

Comparison

I2(%)

95% CI

CBT vs SP

0

0 to 90

CBT vs PT

0

0 to 79

WL vs PT

79

45 to 92

CBT vs BT

0

0 to 62

WL vs BT

23

0 to 92

WL vs CBT

61

34 to 77

This values refer to standard meta‐analyses, where each comparison has its own heterogeneity variance.

BT: behaviour therapy
CBT: cognitive behaviour therapy
CI: confidence interval
CT: cognitive training
PT: physiological therapies
SP: supportive psychotherapy
WL: wait list

Figuras y tablas -
Table 11. Short‐term improvement: I2 values and their 95% confidence intervals
Table 12. Short‐term improvement: ranking of treatments

Treatment

SUCRA

PD

83

CBT

79

SP

69

CT

54

3W

53

BT

52

PT

43

NT

14

WL

4

3W: third‐wave
BT: behaviour therapy
CBT: cognitive behaviour therapy
CT: cognitive training
NT: no treatment
PD: psychodynamic therapies
PT: physiological therapies
SP: supportive psychotherapy
WL: wait list

Figuras y tablas -
Table 12. Short‐term improvement: ranking of treatments
Table 13. Long‐term remission/response: pairwise meta‐analyses and NMA results

Comparison

(X vs Y)

Pairwise meta‐analyses

Network meta‐analysis

# of studies

OR

CI (lower)

CI (upper)

OR

CI (lower)

CI (upper)

PT vs SP

1.31

0.33

5.25

BT vs SP

1.27

0.38

4.27

BT vs PT

1

1.17

0.28

4.87

0.97

0.37

2.57

CT vs SP

0.96

0.21

4.36

CT vs PT

1

0.83

0.25

2.80

0.74

0.26

2.06

CT vs BT

1

0.38

0.08

1.86

0.76

0.28

2.31

CBT vs SP

1

2.09

0.80

5.47

2.09

0.73

5.98

CBT vs PT

2

1.33

0.47

3.76

1.60

0.64

3.95

CBT vs BT

5

1.66

0.80

3.44

1.64

0.90

2.97

CBT vs CT

1

1.56

0.34

7.11

2.16

0.73

6.37

PD vs SP

1.67

0.33

8.33

PD vs PT

1.28

0.28

5.81

PD vs BT

1.31

0.34

5.07

PD vs CT

1.73

0.34

8.79

PD vs CBT

1

0.80

0.26

9.86

0.80

0.24

2.69

OR (X vs Y) is defined as (Odds X)/(Odds Y). For each comparison X vs Y, an OR greater than one favours treatment X, an OR less than one favours treatment Y. Note that in the main text, where necessary, we inverted the values presented in Table 4 for an easier presentation, in which an OR greater than 1 stands for a higher number of events (short‐term remissions) in the intervention group when compared to the control group.

BT: behaviour therapy
CBT: cognitive behaviour therapy
CT: cognitive training
PD: psychodynamic therapies
PT: physiological therapies
SP: supportive psychotherapy
WL: wait list

Figuras y tablas -
Table 13. Long‐term remission/response: pairwise meta‐analyses and NMA results
Table 14. Long‐term remission/response: ranking of treatments

Treatment

SUCRA

CBT

85

PD

64

PT

49

BT

43

SP

31

CT

27

BT: behaviour therapy
CBT: cognitive behaviour therapy
CT: cognitive training
PD: psychodynamic therapies
PT: physiological therapies
SP: supportive psychotherapy
WL: wait list

Figuras y tablas -
Table 14. Long‐term remission/response: ranking of treatments
Table 15. Sensitivity analyses: pairwise meta‐analyses and NMA results for short‐term remission excluding group therapy trials

Comparison

Pairwise meta‐analyses

(common τ 0.05)

Standard NMA

(τ ≅ 0)

NMA adjusted for SSE

(τ ≅ 0.60)

# of studies

OR

CI (lower)

CI (upper)

OR

CI (lower)

CI (upper)

OR

CrI (lower)

CrI (upper)

PT vs SP

0.27

0.11

0.64

0.34

0.10

1.08

BT vs SP

0.35

0.16

0.75

0.38

0.12

1.16

BT vs PT

2

0.98

0.26

3.74

1.29

0.69

2.42

1.10

0.51

2.52

CT vs SP

0.43

0.13

1.47

0.44

0.10

1.87

CT vs PT

1.60

0.51

4.96

1.27

0.41

3.90

CT vs BT

1

0.95

0.19

4.84

1.24

0.44

3.51

1.15

0.37

3.68

CBT vs SP

3

0.67

0.33

1.35

0.67

0.34

1.27

0.67

0.24

1.77

CBT vs PT

3

2.02

0.85

4.76

2.46

1.39

4.33

1.94

1.02

3.97

CBT vs BT

9

1.90

1.15

3.16

1.90

1.26

2.88

1.76

1.02

3.13

CBT vs CT

1

1.69

0.33

8.76

1.54

0.55

4.32

1.53

0.52

4.66

WL vs SP

0.07

0.03

0.15

0.22

0.06

0.76

WL vs PT

4

0.22

0.09

0.53

0.25

0.14

0.45

0.64

0.27

1.66

WL vs BT

3

0.17

0.08

0.36

0.19

0.12

0.31

0.58

0.26

1.36

WL vs CT

2

0.12

0.03

0.46

0.16

0.06

0.43

0.51

0.15

1.82

WL vs CBT

11

0.10

0.05

0.19

0.10

0.07

0.16

0.33

0.16

0.70

PD vs SP

0.61

0.21

1.80

0.24

0.03

1.64

PD vs PT

1

4.22

1.17

15.15

2.25

0.93

5.42

0.70

0.14

3.66

PD vs BT

1.74

0.68

4.47

0.64

0.11

3.60

PD vs CT

1.41

0.37

5.34

0.55

0.11

2.74

PD vs CBT

1

0.51

0.15

1.76

0.91

0.38

2.19

0.36

0.07

1.87

PD vs WL

8.97

3.50

22.95

1.09

0.18

6.45

OR (X vs Y) is defined as (Odds X)/(Odds Y). For each comparison X vs Y, an OR greater than one favours treatment X, an OR less than one favours treatment Y. Note that in the main text, where necessary, we inverted the values presented in Table 4 for an easier presentation, in which an OR greater than 1 stands for a higher number of events (short‐term remissions) in the intervention group when compared to the control group. Statistically significant results are written in bold.

BT: behaviour therapy
CBT: cognitive behaviour therapy
CI: confidence interval
CrI: credible interval
CT: cognitive training
NMA: network meta‐analysis
NT: no treatment
PD: psychodynamic therapies
PE: psychoeducation
PT: physiological therapies
SP: supportive psychotherapy
SSE: small study effects
WL: wait list

Figuras y tablas -
Table 15. Sensitivity analyses: pairwise meta‐analyses and NMA results for short‐term remission excluding group therapy trials
Table 16. Sensitivity analyses: I2 values and their 95% confidence intervals for short‐term remission excluding group therapy trials

Comparison

I2(%)

95% CI

WL vs PT

56

0 to 85

WL vs BT

34

0 to 78

WL vs CBT

21

0 to 60

CBT vs BT

6

0 to 67

CBT vs SP

0

0 to 90

CBT vs PT

0

0 to 90

This values refer to standard meta‐analyses, where each comparison has its own heterogeneity variance.

BT: behaviour therapy
CBT: cognitive behaviour therapy
PT: physiological therapies
SP: supportive psychotherapy
WL: wait list

Figuras y tablas -
Table 16. Sensitivity analyses: I2 values and their 95% confidence intervals for short‐term remission excluding group therapy trials
Table 17. Sensitivity analyses: ranking of treatments for short‐term remission excluding group therapy trials

Treatment

SUCRA

SP

89

CBT

76

PD

73

CT

50

BT

40

PT

35

NT

26

WL

13

BT: behaviour therapy
CBT: cognitive behaviour therapy
CT: cognitive training
NT: no treatment
PD: psychodynamic therapies
PT: physiological therapies
SP: supportive psychotherapy
WL: wait list

Figuras y tablas -
Table 17. Sensitivity analyses: ranking of treatments for short‐term remission excluding group therapy trials
Table 18. Sensitivity analyses: pairwise meta‐analyses and I2 for short‐term remission excluding trials in which a concomitant pharmacotherapy is allowed

Comparison (X vs Y)

Pairwise meta‐analyses

# of studies

OR

CI (lower)

CI (upper)

I2

WL vs CBT

3

0.07

0.01

0.30

0.0%

CBT vs BT

2

2.21

0.96

5.10

0.7%

CBT vs SP

2

0.51

0.22

1.23

0.0%

WL vs BT

1

0.22

0.11

0.44

NT vs CT

1

0.57

0.17

1.91

CT vs PT

1

1.22

0.36

4.12

NT vs PT

1

0.70

0.27

1.10

OR (X vs Y) is defined as (Odds X)/(Odds Y). For each comparison X vs Y, an OR greater than one favours treatment X, an OR less than one favours treatment Y. Note that in the main text, where necessary, we inverted the values presented in Table 4 for an easier presentation, in which an OR greater than 1 stands for a higher number of events (short‐term remissions) in the intervention group when compared to the control group. Statistically significant results are written in bold.

BT: behaviour therapy
CBT: cognitive behaviour therapy
CT: cognitive training
NT: no treatment
PT: physiological therapies
SP: supportive psychotherapy
WL: wait list

Figuras y tablas -
Table 18. Sensitivity analyses: pairwise meta‐analyses and I2 for short‐term remission excluding trials in which a concomitant pharmacotherapy is allowed
Table 19. Sensitivity analyses: pairwise meta‐analyses with their I2 and NMA results for short‐term remission excluding from the analyses trials in which pharmacotherapy stabilisation was not required

Comparison

(X vs Y)

Pairwise meta‐analyses

Network meta‐analysis

(tau = 0.63)

# of studies

OR

CI (lower)

CI (upper)

I2

OR

CI (lower)

CI (upper)

BT vs PT

0.56

0.12

2.67

CBT vs PT

3

1.56

0.69

3.55

30

1.80

0.69

4.67

CBT vs BT

2

4.04

0.73

22.52

72

3.16

0.93

10.71

WL vs PT

3

0.22

0.01

4.04

69

0.11

0.03

0.36

WL vs BT

1

0.02

0.00

0.32

0.19

0.04

0.87

WL vs CBT

6

0.06

0.03

0.014

0

0.06

0.02

0.16

OR (X vs Y) is defined as (Odds X)/(Odds Y). For each comparison X vs Y, an OR greater than one favours treatment X, an OR less than one favours treatment Y. Note that in the main text, where necessary, we inverted the values presented in Table 4 for an easier presentation, in which an OR greater than 1 stands for a higher number of events (short‐term remissions) in the intervention group when compared to the control group. Statistically significant results are written in bold.

BT: behaviour therapy
CBT: cognitive behaviour therapy
CT: cognitive training
PT: physiological therapies
SP: supportive psychotherapy
WL: wait list

Figuras y tablas -
Table 19. Sensitivity analyses: pairwise meta‐analyses with their I2 and NMA results for short‐term remission excluding from the analyses trials in which pharmacotherapy stabilisation was not required
Table 20. Sensitivity analyses: pairwise meta‐analyses for short‐term remission using a fixed‐effect rather than a random‐effects model

Comparison

(X vs Y)

# of studies

Random‐effects

pairwise meta‐analyses

Fixed‐effect

pairwise meta‐analyses

OR

CI (lower)

CI (upper)

OR

CI (lower)

CI (upper)

BT vs PT

2

1.09

0.22

5.52

0.96

0.27

3.46

CT vs PT

1

1.22

0.36

4.12

1.22

0.36

4.12

CT vs BT

1

0.95

0.20

4.54

0.95

0.20

4.54

CBT vs SP

3

0.67

0.35

1.27

0.67

0.35

1.27

CBT vs PT

4

1.43

0.78

2.62

1.43

0.78

2.62

CBT vs BT

10

2.05

1.29

3.27

2.05

1.30

3.22

CBT vs CT

1

1.69

0.35

8.22

1.69

0.35

8.22

PT vs WL

4

4.55

0.89

25.00

4.55

1.96

10.00

BT vs WL

3

8.33

2.33

25.00

5.56

2.94

11.11

CT vs WL

2

8.33

2.22

33.33

8.33

2.22

33.33

CBT vs WL

18

9.09

4.76

20.00

5.56

3.70

8.33

PT vs NT

1

1.43

0.41

5.00

1.43

0.41

5.00

CT vs NT

1

1.75

0.52

5.88

1.75

0.52

5.88

PD vs PT

1

4.22

1.27

13.95

4.22

1.27

13.95

PD vs CBT

1

0.51

0.16

1.613

0.51

0.16

1.613

OR (X vs Y) is defined as (Odds X)/(Odds Y). For each comparison X vs Y, an OR greater than one favours treatment X, an OR less than one favours treatment Y. Statistically significant results are written in bold.

BT: behaviour therapy
CBT: cognitive behaviour therapy
CT: cognitive training
NT: no treatment
PD: psychodynamic therapies
PT: physiological therapies
SP: supportive psychotherapy
WL: wait list

Figuras y tablas -
Table 20. Sensitivity analyses: pairwise meta‐analyses for short‐term remission using a fixed‐effect rather than a random‐effects model