Metaanalyse zur Wirksamkeit von achtsamkeitsbasierten Interventionen bei Angststörungen
Mindfulness-based interventions for DSM-5 anxiety disorders - a systematic review and meta-analysis Heidemarie Haller, Pascal Breilmann, Gustav Dobos, Holger Cramer Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Germany. Purpose: This meta-analysis aimed to systematically review the evidence on mindfulness-based interventions in patients with DSM-5 anxiety disorders. Methods: CENTRAL, PubMed, PsychInfo, and Scopus were searched until July 2017. Randomized controlled trials (RCT) on Acceptance and Commitment Therapy (ACT), Mindfulness-Based Cognitive Therapy (MBCT), and Mindfulness-Based Stress Reduction (MBSR) against wait list or treatment as usual (TAU) or other psychotherapeutic interventions were eligible. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for primary (anxiety severity) and secondary outcomes (depression and health-related quality of life). Risk of bias was assessed by the Cochrane risk of bias tool. Results: The literature search revealed 14 RCTs including 1159 patients with generalized or social anxiety disorder, panic, phobias, or anxiety disorder NOS. The overall risk of bias was unclear, except for mostly low detection bias, attrition bias and other bias. Compared to TAU, mindfulness-based interventions showed significant short-term effects on clinician-rated (3 RCTs; SMD=-2.51; 95%CI=[-4.24│-0.77]; I2=94%) and patient-rated anxiety (9 RCTs; SMD=-0.86; 95%CI=[-1.16│-0.55]; I2=71%). While clinician ratings all based on ACT studies, subgroup analyses of patients-rated effects revealed significant SMDs for ACT, MBCT as well as for MBSR with considerable heterogeneity only between the MBSR studies. Patient-rated depression (9 RCTs; SMD=-0.89; 95%CI=[-1.46│-0.50]; I2=87%) and quality of life (6 RCTs; SMD=0.67; 95%CI=[0.14│1.21]; I2=86%) also significantly improved in the short-term. In comparison to psychotherapeutic interventions such as Cognitive-Behavioral Therapy, education and relaxation, effects of ACT, MBCT, and MBSR were comparable for all outcomes in the short-term, 6 and 12 months after randomization. Adverse events were reported insufficiently. Conclusions: This meta-analysis suggested significant greater anxiolytic effects of mindfulness-based interventions against TAU and comparable effects in comparison to standard psychotherapeutic interventions up to 12 months. However, risk of bias was often unclear and heterogeneity considerable particular in MBCT and MBSR analyses, which limits the conclusions.
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