| Objectives1.Analyse the efficacy of Cognitive-behavior therapy(CBT) in the treatment of Generalized anxiety disorders(GAD) by Systematic review/Meta-analysis.2.Observe the effectiveness of CBT and Sandplay therapy(SP) in the treatment of prisoners’ GAD by an RCT.3.Find out the evidence by applying Evidence-based Psychotherapy(EBP) in the treatment of prisoners’ anxiety. Methods1.Evaluate the treatment of GAD by using Systematic reviews. Firstly, consult the existing Meta-analysis in the treatment of GAD. Secondly, search the articles about RCT which are embodied in the databases such as CNKI, VIP, WANFANG DATA till Oct. 30, 2014. Thirdly, search the firsthand research literature in the prison.Use Endnote x6 for literature management, Jadad and Cochrance Handbook(2008) in the assessment of the study’s quality, and use Review Manage 5.3 for statistical analysis.2.Clinical RCT of CBT and SP for GAD. Divide the 132 subjects that accord condition into 4 groups according to SPSS, namely the CBT group, SP group, Waiting list(WL) group and Psychological placebo(PP) group. Subjects in the CBT and SP group accept psychological treatment 20 times, and subjects in the WL group accept no treatment, and the PP group accept comfort talk. In the first month, treatment are conducted for 3 times every week. During the second and third month for 1 time every week. And each time, the treatment lasts for 60 minutes. Make evaluation according SCL-90 and SAS at 5 time points: the first evaluation is made before the experiment, the second to the fourth evaluation is made every month during the treatment, and the last evaluation is made one month after the treatment is finished. Use SPSS 18.0 to conduct descriptive analysis, X2 test, t test and F test. Results1. The result of Systematic review/Meta-analysis.A total of 10 RCTs, including 1109 cases. The result of Meta-analysis of CBT and non CBT psychotherapy for anxiety disorder shows that both of the two groups make statistically significant difference in [SMD =-0.84,95%CI(-1.37,-0.30)], which proves that CBT is better in the treatment of anxiety. GRADE evidence for quality evaluation is middle, whichi means that the evidence needs to be confirmed by higher quality studies.2. The result of clinical RCT.(1) Baseline comparison: all of the subjects are male, in somatic health status, without family history and treatment history; there is no significant difference in the four groups in their time staying in prison(F =2.365, p =0.07) and their age(F =2.023, p =0.109).(2)Efficacy: when treatment for 3 months, 19 persons are cured in the CBT group(57.6%), 8 persons are cured in the SP group(24.2%) with a significant statistical difference [Χ2(1)=7.584,p <0.01] when the standard is SAS points. 33 persons(100%)are cured in the CBT group, 26 persons(75.8%)are cured in the SP group with a significant statistical difference [Χ2(1)=9.103,p <0.01] when the standard is SCL-90 anxiety factor points. The result indicates that CBT is better than SP in the treatment of anxiety.Make random follow-up one month after the treatment is finished, 16 persons(48.5%) are cured in the CBT group, 10 persons(30.3%) are cured in the SP group with no significant statistical difference [Χ2(1)=2.285,p =0.131] when the standard is SAS points. 27 persons(81.8%) are cured in the CBT group, 24 persons(72.7%)are cured in the SP group with no significant statistical difference [Χ2(1)=0.776,p =0.378] when the standard is SCL-90 anxiety factor points. The result showed no significant difference between CBT and SP in the treatment of anxiety.(3) Recurrence rate: SP is lower than CBT.(4)The comparison between SAS and SCL-90 scores: when treatment for 1 month, both the experimental group(CBT and SP) and the control group(WL and PP) shows a significant statistical difference in the SAS score(F =11.31, p <0.01) and SCL-90 anxiety factor points(F =0.46,p <0.01). It means that both CBT and SP can make a therapeutic effect.When treatment for 3 months, all of the four groups shows a significant statistical difference in the total score of SAS(F =71.39, p <0.01)and SCL-90 anxiety factor points(F =82.91, p <0.01), of which the score arranged from low to high is CBT, SP, PP, WL.It shows that the efficacy of CBT group is significantly higher than that of sandplay therapy when for treatment 3 months.1 months after the treatment is finished, all of the four groups shows a significant statistical difference in the total score of SAS(F =36.18,p <0.01)and SCL-90 anxiety factor points(F =40.66,p <0.01), of which the score arranged from low to high is CBT, SP, PP, WL. It means that the curative effect of both CBT and SP group could maintain well. Conclusions 1. It shows that CBT is the best psychological treatment for anxiety through the Systematic review/Meta-analysis. 2. CBT is superior to SP in the treatment of GAD for prisoners. 3. Since the recurrence rate of CBT is higher than that of SP in the treatment of GAD, it needs to be further studied whether CBT is the best in the treatment of GAD. |
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