title: Effectiveness of cognitive behavioral therapy in treating bipolar disorder: An updated meta-analysis with randomized controlled trials.
abstract: OBJECTIVE
  The aim of this updated meta-analysis was to further assess the effectiveness of cognitive behavioral therapy (CBT) in treating bipolar disorder (BD).
  
  
  METHODS
  We carried out a literature search on PubMed, Embase, and the Cochrane Library up to October 2015. We calculated the pooled relative risk of relapse rate and standard mean difference (SMD) of mean change (data at a follow-up time-point - baseline) of the Beck Depression Inventory, Beck Hopelessness Scale, Hamilton Rating Scale for Depression, Young Mania Rating Scale (YMRS) and Mania Rating Scale scores with their 95% confidence interval (95%CI). Subgroup analyses based on follow-up time were performed.
  
  
  RESULTS
  Nine randomized controlled trials with 520 bipolar I or II disorder patients were reanalyzed. Overall analysis showed that CBT did not significantly reduce the relapse rate of BD or improve the level of depression. However, significant efficacy of CBT in improving severity of mania was proved based on the YMRS (SMD = -0.54, 95%CI, -1.03 to -0.06, P  = 0.03) but not based on MRS. Subgroup analyses showed that CBT had short-term efficacy in reducing relapse rate of BD (at 6 months' follow-up: relative risk = 0.49, 95%CI: 0.29-0.81, P  = 0.006) and improving severity of mania based on YMRS score (post-treatment: SMD = -0.30, 95%CI, -0.59 to -0.01, P  = 0.04).
  
  
  CONCLUSIONS
  Short-term efficacy of CBT in reducing relapse rate of BD and improving the severity of mania was proved. But these effects could be weakened by time. In addition, there was no effect of CBT on level of depression in BD.
authors.affiliation: Department of Affective Disorders, Guangzhou Huiai Hospital (Guangzhou Psychiatric Hospital), The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
authors.forename: Bi-Yu
authors.initials: BY
authors.lastname: Ye
authors.affiliation: Department of Affective Disorders, Guangzhou Huiai Hospital (Guangzhou Psychiatric Hospital), The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
authors.forename: Ze-Yu
authors.initials: ZY
authors.lastname: Jiang
authors.affiliation: Department of Affective Disorders, Guangzhou Huiai Hospital (Guangzhou Psychiatric Hospital), The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
authors.forename: Xuan
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Medical School, The University of Texas Health Science Center, Houston, USA.
authors.forename: Bo
authors.initials: B
authors.lastname: Cao
authors.affiliation: Department of Affective Disorders, Guangzhou Huiai Hospital (Guangzhou Psychiatric Hospital), The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
authors.forename: Li-Ping
authors.initials: LP
authors.lastname: Cao
authors.affiliation: Department of Affective Disorders, Guangzhou Huiai Hospital (Guangzhou Psychiatric Hospital), The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
authors.forename: Yin
authors.initials: Y
authors.lastname: Lin
authors.affiliation: Department of Affective Disorders, Guangzhou Huiai Hospital (Guangzhou Psychiatric Hospital), The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
authors.forename: Gui-Yun
authors.initials: GY
authors.lastname: Xu
authors.affiliation: Department of Affective Disorders, Guangzhou Huiai Hospital (Guangzhou Psychiatric Hospital), The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
authors.forename: Guo-Dong
authors.initials: GD
authors.lastname: Miao
mesh_terms: D001714:Bipolar Disorder / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*
keywords: bipolar disorder; cognitive behavioral therapy; mania; meta-analysis; relapse