BRIEF RESEARCH REPORT article
Front. Psychiatry
Sec. Psychological Therapy and Psychosomatics
This article is part of the Research TopicExpanding the Reach of Evidence-Based Psychological Interventions for Mental Health: Innovation, Access, and Equity - volume 2View all articles
Predominant Polarity as a Potential Moderator of Group CBT Outcomes in Bipolar Disorder: An Exploratory Post-Hoc Analysis
Provisionally accepted
- 1Universidade de Sao Paulo, São Paulo, Brazil
- 2Universidade de Sao Paulo Departamento de Psiquiatria, São Paulo, Brazil
- 3Universidade Federal de Sao Paulo Departamento de Psiquiatria, São Paulo, Brazil
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Introduction: Bipolar disorder (BD) is a chronic and severe mood disorder, characterized by recurrent episodes of mania, hypomania, and depression. Adjacent to pharmacotherapy, positive evidence has been found for the benefit of adding cognitive behavioral therapy (CBT), family-focused therapy (FFT), interpersonal and social-rhythm therapy (IPSRT) and Group Psychoeducation for treating BD. Objective: CBT is well established as a form of psychotherapy for bipolar disorders, although variables that may affect its results are still poorly studied. The present study aimed to investigate Predominant Polarity (PP) as a possible moderator of response to group CBT for BD. Methods: The original controlled study included 50 bipolar patients, divided into two groups: one was maintained on treatment as usual (TAU) solely, and a second group was assigned to 18 weekly group CBT sessions as an add-on treatment to TAU. A 16-month follow-up was conducted after the sessions, as patients were evaluated by phone by two psychiatrists, blind to the patients' condition. We have conducted a post-hoc analysis including solely individuals assigned to group CBT, dividing patients according to predominant manic or depressive polarity. Results: Log-rank survival analysis revealed manic predominant polarity patients as maintaining an episode-free status for a longer amount of time in comparison to depressive predominant polarity patients. Conclusion: The results suggest predominant polarity may be an important moderator of CBT response in BD. Further studies should include larger samples.
Keywords: Bipolar Disorder, cognitive behavioral therapy, Group psychotherapy, moderator, Predominant polarity
Received: 01 Sep 2025; Accepted: 11 Feb 2026.
Copyright: © 2026 Khafif, Belizário, Lafer and Gomes. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Bernardo Carramão Gomes
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