Key Takeaways
Extended Takeaways
- The pooled posttreatment benefit of adjunctive cognitive-behavioral therapy in bipolar disorder was modest but statistically significant at d = -0.42 (95% CI, -0.51 to -0.34; P < .05), and remained significant after sample-size correction at D = -0.20 (95% CI, -0.29 to −0.11; P < .05).
- At posttreatment, the strongest domain-specific signal was for treatment adherence (d = -0.53, P < .05), which exceeded the effects seen for clinical symptoms (d = -0.44, P < .05) and quality of life (d = -0.36, P < .05).
- Benefits were more durable for symptom and mechanism measures than for functional outcomes: CBT showed significant effects on clinical symptoms and cognitive-behavioral etiopathogenetic mechanisms across follow-up intervals, while quality of life and life/social adjustment were not significant during follow-up.
- Adjunctive CBT did not show a significant effect on relapse and/or recurrence at posttreatment (d = -0.28), and relapse/recurrence remained nonsignificant at follow-up, so clinicians should not assume short-term symptom gains will translate into episode prevention.
- The apparent maintenance of benefit beyond 12 months was sensitive to analytic method: the uncorrected overall effect remained significant at d = -0.27 (95% CI, -0.40 to -0.13), but after sample-size correction it was no longer significant (D = -0.06, VAR D = 0.03, P > .05).
- This meta-analysis drew on 12 randomized clinical trials, but only 3 studies had over 100 patients; one large negative trial was influential enough that the authors specifically noted it affected the stability of follow-up findings.
