Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: A meta-analysis of randomized controlled trials
Open Access
- 4 May 2017
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 12 (5), e0176849
- https://doi.org/10.1371/journal.pone.0176849
Abstract
Although 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. Electronic 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. A 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). CBT 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.Keywords
Funding Information
- National Science Concil ((NSC)-NSC99-2627-B-038-001)
This publication has 49 references indexed in Scilit:
- An estimate of the minimum economic burden of bipolar I and II disorders in the United States: 2009Journal of Affective Disorders, 2011
- A Randomized Controlled Trial of Cognitive Behavioral Group Therapy for Bipolar DisorderPsychotherapy and Psychosomatics, 2011
- How effective is a psychological intervention program for patients with refractory bipolar disorder? A randomized controlled trialJournal of Affective Disorders, 2010
- Family‐focused treatment for caregivers of patients with bipolar disorderBipolar Disorders, 2010
- Cognitive-Behavioral Therapy for Depression in Bipolar Disorder: A Meta-AnalysisJournal of Evidence-Based Social Work, 2010
- The Efficacy of Cognitive-Behavioral Therapy in Bipolar DisorderPublished by Physicians Postgraduate Press, Inc ,2009
- A “community-friendly” version of integrated group therapy for patients with bipolar disorder and substance dependence: A randomized controlled trialDrug and Alcohol Dependence, 2009
- Adjunctive Psychotherapy for Bipolar Disorder: State of the EvidenceAmerican Journal of Psychiatry, 2008
- Mindfulness-based Cognitive Therapy (MBCT) in bipolar disorder: Preliminary evaluation of immediate effects on between-episode functioningJournal of Affective Disorders, 2008
- Intensive Psychosocial Intervention Enhances Functioning in Patients With Bipolar Depression: Results From a 9-Month Randomized Controlled TrialAmerican Journal of Psychiatry, 2007