(PS3-C53) Psychological Interventions for Anxiety Disorders Comorbid with Bipolar Disorder: A Systematic Review and Meta-analysis

Introduction: Anxiety disorders (AD) are the most prevalent comorbidity in Bipolar Disorders (BD), being encountered in up to 75% of cases. Since pharmacotherapy for AD may be harmful for BD patients, the use of psychological interventions such as cognitive behavioral therapy (CBT) appears to be a promising complementary approach. Despite our current knowledge about the effectiveness of psychological interventions to treat each condition, the need to establish guidelines for the treatment of anxiety disorders comorbid with bipolar disorder (ADBD) remains urgent. Although two systematic reviews have been published on the subject (Provencher et al., 2011; Stratford et al., 2015), the increased interest in the treatment of ADBD in the last few years, and the publication of several randomized controlled trials with promising results, highlight the importance of conducting a new systematic review and the first meta-analysis on the subject (Couillard Larocque et al., 2023).

Methods: Studies on psychological interventions targeting ADBD were assessed regarding their impacts on symptoms of anxiety. Two authors independently screened the titles and abstracts retrieved from PsycInfo, Medline, Web of Science, Psychology and Behavioral Sciences Collection, Cumulative Index to Nursing & Allied Health Literature and the Cochrane Library for potentially eligible articles. Any study identified as being potentially eligible underwent a full-text assessment against the eligibility criteria. Data was extracted from the studies selected for inclusion using Covidence and the risk of bias assessment of the selected studies was conducted using the Joanna Briggs Institute critical appraisal tool (2020).

Results: A PRISMA flow diagram was developed to gather the records included in the final sample. A total of 15 473 records were identified from databases and manual research. After removing duplicates, 10 336 were screened based on the title and abstract and 368 were assessed for eligibility based on the full text. The final sample includes 47 studies of psychological interventions. The reports are divided in one of two categories, 20 specifically addressing ADBD while 27 measured anxiety as a secondary outcome. Results of the metanalysis based on 11 eligible RCTs show that psychological interventions lead to a significant decrease of anxiety symptoms in patients with BD (T (14) = 2,19, p = 0,046, d = 0,20 (IC at 95% = 0,005 to 0,404)).

Discussion: Two previous reviews found respectively 14 and 22 studies on ADBD. The present systematic review includes 47 studies, which is more than double the studies reported in the previous review (Stratford et al., 2015). CBT is the most supported therapy for anxiety symptoms and disorders comorbid with BD. Transdiagnostic and imagery-based interventions seem promising, but further controlled studies need to be conducted. Detailed findings will be discussed during the presentation.