Question: For adults with bipolar disorder who are either in a manic or depressive episode, how effective is Cognitive Behavioural Therapy, compared to any other intervention, for improving patient outcomes?

Answer:

There was evidence from one high-quality systematic review that CBT reduced the number of relapses compared to treatment as usual. However this was based on a small number of studies (up to five) and none of them reported other outcomes such as suicide or adverse events of treatment. Another, lower quality review, also found significant benefits across various outcomes for CBT, but this evidence was less reliable. In terms of clinical trial evidence, one poor quality trial found a longer time to the first episode of depression with CBT, but no differences when compared to treatment as usual for relapses or the number of depressive episodes. Two other trials (one poor and one moderate quality) did not find any evidence of a difference between CBT and supportive care or psychoeducation.

There was a small amount of evidence favouring CBT, however as stated by some of the authors, more research is needed. Ideally this should involve high-quality randomised controlled trials with a sufficiently large sample size to capture clinically relevant treatment differences and a long period of follow-up.

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