Psychotherapies are the treatment of choice for panic disorder, but which should be considered as first-line treatment is yet to be substantiated by evidence.

To examine the most effective and accepted psychotherapy for the acute phase of panic disorder with or without agoraphobia via a network meta-analysis.

We conducted a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the most effective and accepted psychotherapy for the acute phase of panic disorder. We searched MEDLINE, Embase, PsycInfo and CENTRAL, from inception to 1 Jan 2021 for RCTs. Cochrane and PRISMA guidelines were used. Pairwise and network meta-analyses were conducted using a random-effects model. Confidence in the evidence was assessed using Confidence in Network Meta-Analysis (CINeMA). The protocol was published in a peer-reviewed journal and in PROSPERO (CRD42020206258).

We included 136 RCTs in the systematic review. Taking into consideration efficacy (7352 participants), acceptability (6862 participants) and the CINeMA confidence in evidence appraisal, the best interventions in comparison with treatment as usual (TAU) were cognitive–behavioural therapy (CBT) (for efficacy: standardised mean differences s.m.d. = −0.67, 95% CI −0.95 to −0.39; CINeMA: moderate; for acceptability: relative risk RR = 1.21, 95% CI −0.94 to 1.56; CINeMA: moderate) and short-term psychodynamic therapy (for efficacy: s.m.d. = −0.61, 95% CI −1.15 to −0.07; CINeMA: low; for acceptability: RR = 0.92, 95% CI 0.54–1.54; CINeMA: moderate). After removing RCTs at high risk of bias only CBT remained more efficacious than TAU.

CBT and short-term psychodynamic therapy are reasonable first-line choices. Studies with high risk of bias tend to inflate the overall efficacy of treatments. Results from this systematic review and network meta-analysis should inform clinicians and guidelines.

心理治疗是恐慌症的首选治疗方法，但应被视为一线治疗尚待证据证实。

通过网络荟萃分析检查对伴有或不伴有广场恐惧症的恐慌症急性期最有效和被接受的心理治疗。

我们对随机对照试验 (RCT) 进行了系统评价和网络荟萃分析，以检查恐慌症急性期最有效和最被接受的心理疗法。我们搜索了 MEDLINE、Embase、PsycInfo 和 CENTRAL，从开始到 2021 年 1 月 1 日的 RCT。使用了 Cochrane 和 PRISMA 指南。使用随机效应模型进行配对和网络荟萃分析。使用网络元分析置信度（CINeMA）评估证据的置信度。该协议发表在同行评审期刊和 PROSPERO (CRD42020206258) 上。

我们在系统评价中纳入了 136 项 RCT。考虑到疗效（7352 名参与者）、可接受性（6862 名参与者）和 CINeMA 对证据评估的信心，与常规治疗 (TAU) 相比，最佳干预措施是认知行为疗法 (CBT)（疗效：标准化平均差 smd = -0.67, 95% CI -0.95 至 -0.39；CINeMA：中等；可接受性：相对风险 RR = 1.21, 95% CI -0.94 至 1.56；CINeMA：中等）和短期心理动力学治疗（疗效：smd = -0.61, 95% CI -1.15 至 -0.07；CINeMA：低；可接受性：RR = 0.92, 95% CI 0.54–1.54；CINeMA：中等）。在去除高偏倚风险的 RCT 后，只有 CBT 仍然比 TAU 更有效。

CBT 和短期心理动力学治疗是合理的一线选择。具有高偏倚风险的研究往往会夸大治疗的整体疗效。该系统评价和网络荟萃分析的结果应告知临床医生和指南。