No. 37 Republicii St 400015, Cluj-Napoca, Romania.
J Clin Psychiatry. 2010 Jan;71(1):66-72. doi: 10.4088/JCP.08r04559yel. Epub 2009 Oct 20.
The goal of the current study was to conduct a quantitative meta-analysis investigating the role of cognitive-behavioral therapy (CBT) as adjunctive treatment to medication for patients diagnosed with bipolar disorder.
Studies included in the sample were identified through a computer search of articles in English in the MEDLINE database from January 1980 to March 2008. Key terms entered were cognitive and bipolar disorder, cognitive therapy and bipolar disorder, cognitive behavioral therapy and bipolar disorder, psychotherapy and bipolar disorder, and psychosocial and bipolar disorder.
Inclusion criteria were (1) randomized clinical trial investigating the role of adjunctive CBT in patients diagnosed with bipolar disorder, (2) clearly defined CBT intervention, (3) the inclusion of a control group, and (4) sufficient data reported to allow calculation of effect sizes. Twelve randomized clinical trials were selected for analysis on the basis of these criteria.
Effect sizes (Cohen d) were calculated according to published procedures.
We found a low to medium overall effect size of CBT at posttreatment (d = -0.42, P < .05) and follow-up (d = -0.27, P < .05), and we found a positive impact of CBT on clinical symptoms (posttreatment d = -0.44, P < .05), cognitive-behavioral etiopathogenetic mechanisms (posttreatment d = -0.49, P < .05), treatment adherence (posttreatment d = -0.53, P < .05), and quality of life (posttreatment d = -0.36, P < .05). The impact was less evident in the case of relapse and/or recurrence (posttreatment d = -0.28). These effects on outcome categories were more evident at posttreatment compared to follow-up.
Cognitive-behavioral therapy can be used as an adjunctive treatment to medication for patients with bipolar disorder, but new CBT strategies are needed to increase and enrich the impact of CBT at posttreatment and to maintain its benefits during follow-up.
本研究的目的是进行一项定量荟萃分析，以调查认知行为疗法（CBT）作为辅助治疗双相情感障碍患者药物治疗的作用。
通过在 MEDLINE 数据库中以英语搜索文章，对 1980 年 1 月至 2008 年 3 月期间的文章进行计算机检索，确定纳入研究中的文献。输入的关键词是认知和双相情感障碍、认知疗法和双相情感障碍、认知行为疗法和双相情感障碍、心理疗法和双相情感障碍以及心理社会和双相情感障碍。
纳入标准为（1）调查辅助 CBT 在双相情感障碍患者中的作用的随机临床试验，（2）明确界定的 CBT 干预措施，（3）包括对照组，以及（4）报告了足够的数据以计算效应大小。根据这些标准，选择了 12 项随机临床试验进行分析。
根据已发表的程序计算效应大小（Cohen d）。
我们发现 CBT 在治疗后（d = -0.42，P <.05）和随访时（d = -0.27，P <.05）的总体效应大小为低至中等，并且我们发现 CBT 对临床症状（治疗后 d = -0.44，P <.05）、认知-行为病因机制（治疗后 d = -0.49，P <.05）、治疗依从性（治疗后 d = -0.53，P <.05）和生活质量（治疗后 d = -0.36，P <.05）有积极影响。在复发和/或复发的情况下，影响不太明显（治疗后 d = -0.28）。与随访相比，这些对结局类别的影响在治疗后更为明显。
认知行为疗法可以作为双相情感障碍患者药物治疗的辅助治疗方法，但需要新的 CBT 策略来增加和丰富 CBT 在治疗后的影响，并在随访期间维持其益处。
