Treatment moderators of child- and family-focused cognitive-behavioral therapy for pediatric bipolar disorder

J Am Acad Child Adolesc Psychiatry. 2015 Feb;54(2):116-25. doi: 10.1016/j.jaac.2014.11.007. Epub 2014 Nov 22.


Objective: Prior work has demonstrated the efficacy of child- and family-focused cognitive-behavioral therapy (CFF-CBT) versus enhanced treatment as usual (TAU; unstructured psychotherapy) for pediatric bipolar disorder (PBD). The current study builds on primary findings by examining baseline child, parent, and family characteristics as moderators of symptom response trajectories.

Method: A total of 69 youth aged 7 to 13 years (mean = 9.19 years, SD = 1.61 years) with DSM-IV-TR bipolar I, II, or not otherwise specified (NOS) were randomly assigned, with family members, to CFF-CBT or TAU. Both treatments consisted of 12 weekly sessions and 6 monthly booster sessions. Participants were assessed at baseline, 4, 8, and 12 weeks, and 6-month follow-up on mania and depression symptoms and overall psychiatric severity. Parents and youth also provided self-report data on baseline characteristics.

Results: CFF-CBT demonstrated greater efficacy for youth depressive symptoms relative to TAU for parents with higher baseline depressive symptoms and lower income, and marginally for families with higher cohesion. In addition, youth with lower baseline depression and youth with higher self-esteem showed a poorer response to TAU versus CFF-CBT on mania symptom outcomes. Age, sex, baseline mania symptoms, comorbidity, and suicidality did not moderate treatment response.

Conclusion: Results indicate that CFF-CBT was relatively immune to the presence of treatment moderators. Findings suggest the need for specialized treatment to address symptoms of PBD in the context of parental symptomatology and financial stress.

Keywords: cognitive-behavioral therapy; family-focused intervention; pediatric bipolar disorder; randomized clinical trial; treatment moderators.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Bipolar Disorder / diagnosis*
  • Bipolar Disorder / therapy*
  • Child
  • Cognitive Behavioral Therapy / methods*
  • Comorbidity
  • Depression / therapy*
  • Diagnostic and Statistical Manual of Mental Disorders
  • Family Therapy / methods*
  • Female
  • Humans
  • Male
  • Parents / psychology*
  • Psychiatric Status Rating Scales
  • Regression Analysis
  • Severity of Illness Index
  • Treatment Outcome