Comparison Of Intervention Efficacy Of Non-Pharmacological Treatment For Symptom Disorders:A Network Meta-analysis

Objective: To search for randomized controlled trials of Non-pharmacological therapy for symptom related disorders and explore the efficacy of non-drug therapy for symptom disorders.Methods: A comprehensive search was conducted on Embase,Pub Med,Cochrane Library and other foreign language databases,as well as CNKI,CBM,Wanfang,VIP and other databases.The retrieval date is November 2021.According to inclusion and exclusion criteria,two independent researchers screened,sorted out literature,extracted valid data,and conducted risk assessment.Stata15.1 software and Revman5.3 software were used for data analysis,graph drawing,and ranking of each efficacy,R 4.1.2 software was used for Network meta-regression analysis Results: A total of 6880 Chinese and English literatures were preliminarily searched.After eliminating duplicate literatures and reading the full text in detail,a total of 95 Chinese and English literatures were included in this study,including 8 intervention methods.Involving the Cognitive behavioral therapy(CBT)intervention with 40 references;involving psychodynamic therapy with 4 references,Morita therapy intervention with 7references,Mindfulness therapy intervention involving 6 references;repetitive transcranial magnetic stimulation(r TMS)with 13 references,with17 references involved in Acupuncture treatment intervention,involving the EEG biofeedback with 8 references.36 literatures reported the generation of random sequences.Due to the particularity of the studies,most of the studies lacked blind methods for participants,therapists and outcome evaluators,leading to a higher risk of bias in these projects.Follow-up data were reported in 35 literatures,safety data and adverse reactions were reported in 35 literatures,and the sample size of 25 literatures was less than 30,indicating the possibility of small sample publication bias.Results of mesh Meta-analysis: The cumulative area of SUCRA from high to low in terms of therapeutic effect of somatic symptoms was as follows:Mindfulness therapy(SUCRA=98.6%)> Psychodynamic therapy(SUCRA=57.8%)> cognitive behavioral therapy(CBT)(SUCRA=57.3%)> Morita therapy(SUCRA=55.6%)> EEG biofeedback treatment(SUCRA=53.4%)> repetitive transcranial magnetic stimulation(r TMS)(SUCRA=45.3%)> Usual care(SUCRA=29.4%)> Acupuncture treatment(SUCRA=2.5%);The cumulative area of SUCRA for pain treatment from high to low was ranked as follows: Repetitive transcranial magnetic stimulation(r TMS)(SUCRA=79.5%)>Acupuncture treatment(SUCRA=66.9%)> Mindfulness therapy(SUCRA=58.4%)> Usual care(SUCRA=47.1%)> Psychodynamic therapy(SUCRA=43.0%)> Cognitive behavioral therapy(CBT)(SUCRA=5.1%);The cumulative area of SUCRA for anxiety effect from high to low was ranked as follows: Cognitive behavioral therapy(CBT)(SUCRA=73.1%)> EEG biofeedback treatment(SUCRA=69.2%)> Acupuncture treatment(SUCRA=68.2%)> Repetitive transcranial magnetic stimulation(r TMS)(SUCRA=55.9%)> Mindfulness therapy(SUCRA=47.4%)> Psychodynamic therapy(SUCRA=37.5%)> Morita therapy(SUCRA=33.8%)>Usual care(SUCRA=14.9%)。The cumulative area of SUCRA from high to low in the therapeutic effect of depression was as follows: Repetitive transcranial magnetic stimulation(r TMS)(SUCRA=82.3%)> Acupuncture treatment(SUCRA=79.8%)> Cognitive behavioral therapy(CBT)(SUCRA=65.1%)> Mindfulness therapy(SUCRA=56.6%)> EEG biofeedback treatment(SUCRA=37.3%)> Psychodynamic therapy(SUCRA=36.3%)> Morita therapy(SUCRA=31.0%)> Usual care(SUCRA=11.6%).The cumulative area of SUCRA from high to low in terms of total clinical response rate was: Morita therapy(SUCRA=90.8%)> Acupuncture treatment(SUCRA=78%)> EEG biofeedback treatment(SUCRA=45.4%)> Cognitive behavioral therapy(CBT)(SUCRA=44.4%)> Repetitive transcranial magnetic stimulation(r TMS)(SUCRA=41.1%)> Usual care(SUCRA=0.2%).The results of regression analysis showed that the model with corrected year of publication,intervention course and male/female ratio had a good fit and low heterogeneity,and the confidence interval of regression coefficient was not statistically significant,indicating that it had little influence on the results of network meta-analysis.Conclusions: jCompared with conventional treatment,Non-pharmacological therapy combined with conventional treatment intervention can further improve physical symptoms and depression and anxiety in patients with somatic symptom disorder.kPsychotherapy such as mindfulness therapy,Morita therapy,and cognitive behavioral therapy can help improve the physical symptoms of patients with somatic symptom disorder.Comprehensive outcome indicators,cognitive behavioral therapy effect is balanced,no matter on physical symptoms or emotional intervention effect is better.lPhysical therapy,such as repetitive TRANSCranial magnetic stimulation(TMS),acupuncture and eeg biofeedback,has advantages in interfering with pain,depression and anxiety in patients with somatic symptom disorder,according to the Study.