Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: A meta-analysis of randomized controlled trials

Abstract

BackgroundAlthough cognitive behavioral therapy (CBT) is considered a promising adjuvant to pharmacotherapy for treating bipolar disorder (BD), its efficacy is unproven. The present review and meta-analysis evaluated the treatment outcomes of patients with BD treated with CBT plus medication and compared these data with the outcomes of those who received standard care alone.MethodsElectronic searches from inception to July 31, 2016, were performed using PubMed, Medline OVID, Cochrane Library, EMBASE, CINAHL plus, and PsycINFO. In the extensive electronic literature search, keywords such as “bipolar disorder,” “manic-depressive psychosis,” “bipolar affective disorder,” “bipolar depression,” “cognitive therapy,” “cognitive-behavioral therapy,” and “psychotherapy” were transformed into MeSH terms, and only randomized controlled trials (RCTs) were included. The pooled odds ratios (ORs) of relapse rates and Hedges’s g, along with 95% confidence intervals (CIs), for the mean differences in the levels of depression, mania, and psychosocial functioning were calculated. Further subgroup analyses were conducted according to the characteristics of the CBT approaches, patients, and therapists, if the data were available.ResultA total of 19 RCTs comprising 1384 patients with type I or II BD were enrolled in our systematic review and meta-analysis. The main analysis revealed that CBT could lower the relapse rate (pooled OR = 0.506; 95% CI = 0.278 −0.921) and improve depressive symptoms (g = −0.494; 95% CI = −0.963 to −0.026), mania severity (g = −0.581; 95% CI = −1.127 to −0.035), and psychosocial functioning (g = 0.457; 95% CI = 0.106–0.809).ConclusionsCBT is effective in decreasing the relapse rate and improving depressive symptoms, mania severity, and psychosocial functioning, with a mild-to-moderate effect size. Subgroup analyses indicated that improvements in depression or mania are more potent with a CBT treatment duration of ≥90 min per session, and the relapse rate is much lower among patients with type I BD.

Current understanding of bipolar disorder: Toward integration of biological basis and treatment strategies

“…A meta‐analysis of 19 RCTs of cognitive behavioral therapy (CBT) in 1384 bipolar patients showed that CBT decreased relapse rate, decreased the severity of depression and mania, and improved psychosocial function . The analysis showed that CBT programs with sessions of 90 min or more are most effective, and the efficacy is more enhanced for bipolar I disorder than bipolar II disorder.…”

“…242 A meta-analysis of 19 RCTs of cognitive behavioral therapy (CBT) in 1384 bipolar patients showed that CBT decreased relapse rate, decreased the severity of depression and mania, and improved psychosocial function. 243 The analysis showed that CBT programs with sessions of 90 min or more are most effective, and the efficacy is more enhanced for bipolar I disorder than bipolar II disorder. In the era of information technology, the efficacy of computerized CBT or smartphone-based activity monitoring 244 on treatment of BD is an issue that urgently requires study.…”

<p>Comorbid Premenstrual Dysphoric Disorder in Women with Bipolar Disorder: Management Challenges</p>

“…Results indicate that CBT could lower the relapse rate and improve manic and depressive symptoms, and psychosocial functioning, with a mild-to-moderate effect size. 93 Even though we could not find any paper focused on the treatment of comorbid PMDD/BD by means of psychotherapies, we can hypothesize their effectiveness as adjunctive treatments, based on their good proven efficacy on BD and PMDD separately, in accordance with Smith and Frey's recommendations. 47 Several research papers explored the effect of other treatments (ie, neither pharmacological nor psychotherapeutic approaches) on PMDD.…”

Effectiveness of outpatient-based group cognitive-behavioral therapy in Japanese patients with mood disorders and neurotic disorders

“…This diagnosis, which was made by the psychiatrist with over five years of clinical experience, was based on the ICD-10 classification system provided by the World Health Organization (WHO). Patients having bipolar disorder and exhibiting no signs of mania were included in the F3 group because a previous study has demonstrated that CBT is also effective in preventing the recurrence of bipolar depression in patients with bipolar disorder 10 .…”

“…Furthermore, because there are no established criteria for GCBT, individual medical facilities create their own protocols and programs but the validity of such protocols and programs has not yet been verified. Although GCBT could be effective in treating not only major depressive disorder but also anxiety disorder and bipolar disorder (particularly, bipolar depression) 10 , no study has yet been conducted in Japan to evaluate the effectiveness of GCBT on psychiatric disorders other than major depression disorder.…”