周一开营|这张图是三万人选择暂停的理由

自助/线上/线下不同干预方式的效果比较：

1 美国线上情绪干预数字产品「Happify」效应量约为 0.5（焦虑抑郁）

Parks, A. C., Williams, A. L., Tugade, M. M., Hokes, K. E., Honomichl, R. D., & Zilca, R. D. (2018). Testing a scalable web and smartphone based intervention to improve depression, anxiety, and resilience: A randomized controlled trial. International Journal of Wellbeing, 8(2).

2 澳洲线上自助情绪干预产品「Moodgym」的改善效应量约为 0.34（抑郁）-0.57（焦虑）

Twomey, C., & O’Reilly, G. (2017). Effectiveness of a freely available computerised cognitive behavioural therapy programme (MoodGYM) for depression: Meta-analysis. Australian & New Zealand Journal of Psychiatry, 51(3), 260-269.

3 AI 驱动的CBT聊天机器人「woebot」的效应量约为 0.14（焦虑）和0.44（抑郁）

Fitzpatrick, K. K., Darcy, A., & Vierhile, M. (2017). Delivering cognitive behavior therapy to young adults with symptoms of depression and anxiety using a fully automated conversational agent (Woebot): a randomized controlled trial. JMIR mental health, 4(2), e19.

4 瑞典Orexo制药公司研发的一款抗抑郁数字疗法「deprexis」的效应量约为0.57

Meyer, B., Bierbrodt, J., Schröder, J., Berger, T., Beevers, C. G., Weiss, M., ... & Klein, J. P. (2015). Effects of an Internet intervention (Deprexis) on severe depression symptoms: Randomized controlled trial. Internet Interventions, 2(1), 48-59.

5 一篇对 CBT疗法效应量的元分析表明，对于抑郁、广泛性焦虑、惊恐发作、社交焦虑、强迫症、PTSD 等各种情绪障碍，CBT 治疗都有大的效应量（0.95）。

Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clinical psychology review, 26(1), 17-31.

6 对线上 CBT 疗法的效应量元分析表明，在线实施的 CBT 治疗（通常为有治疗师带领的类型）对焦虑和抑郁治疗的效应量 0.8 左右。

Arnberg, F. K., Linton, S. J., Hultcrantz, M., Heintz, E., & Jonsson, U. (2014). Internet-delivered psychological treatments for mood and anxiety disorders: a systematic review of their efficacy, safety, and cost-effectiveness. PloS one, 9(5), e98118.

Josephine K, Josefine L, Philipp D, David E, Harald B. Internet- and mobile-based depression interventions for people with diagnosed depression: A systematic review and meta-analysis. J Affect Disord. 2017 Dec 1;223:28-40. doi: 10.1016/j.jad.2017.07.021. Epub 2017 Jul 10. PMID: 28715726.

7 WHO世界卫生组织联合ACT专家团队为难民设计的线下减压干预项目(guided self-help) 效应量约为 0.75（抑郁）。

Tol, W. A., Leku, M. R., Lakin, D. P., Carswell, K., Augustinavicius, J., Adaku, A., ... & van Ommeren, M. (2020). Guided self-help to reduce psychological distress in South Sudanese female refugees in Uganda: a cluster randomised trial. The Lancet Global Health, 8(2), e254-e263.

8 八周正念训练（MBCT和MBSR）的干预效应量为0.5-0.6。

Khoury B, Lecomte T, Fortin G, Masse M, Therien P, Bouchard V, Chapleau MA, Paquin K, Hofmann SG. Mindfulness-based therapy: a comprehensive meta-analysis. Clin Psychol Rev. 2013 Aug;33(6):763-71. doi: 10.1016/j.cpr.2013.05.005. Epub 2013 Jun 7. PMID: 23796855.

9 来自mayo诊所的研究，线上三周视频团体的效应量约为0.4-0.5。

Puspitasari, A. J., Heredia, D., Coombes, B. J., Geske, J. R., Gentry, M. T., Moore, W. R., … Schak, K. M. (2021). Feasibility and initial outcomes of a group-based teletherapy psychiatric day program for adults with serious mental illness: Open, nonrandomized trial in the context of covid-19. JMIR Mental Health, 8(3), 1–11.

10 guided self-help 半自助疗效优于纯自助的证据研究：

Cuijpers, P., Noma, H., Karyotaki, E., Cipriani, A., & Furukawa, T. A. (2019). Effectiveness and Acceptability of Cognitive Behavior Therapy Delivery Formats in Adults with Depression: A Network Meta-analysis. JAMA Psychiatry, 76(7), 700–707.

这篇发在精神病学顶刊JAMA psychiatry上的元分析发现，一对一咨询，电话咨询和半自助线上工具都显著有效，而纯自助则效果较差。从性价比来看，guided self help 最优。

从有效性和便利性两方面考虑，Guided self-help 可以作为CBT咨询的替代方案。