Early-life adversity has been associated with a life-long increased risk for psychopathology and chronic health problems. These long-term negative effects have been explained through stress sensitization, which may involve dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis through either increased or decreased reactivity. The present meta-analysis assessed for the first time the effect of early-life adversity on cortisol response to social stress. Thirty data sets were included in the meta-analysis, in which early-life adversity and salivary cortisol response to social stress were assessed in 4292 individuals of different ages. Results indicated a moderate effect size (g = −0.39) in overall cortisol levels across studies. Separate analyses of cortisol at different stages of response showed large effect sizes at peak and recovery, and a moderate effect at baseline. Heterogeneity was large in this sample of studies and several moderators were identified. The effect size was larger in studies that focused on maltreatment compared to those that included other adversities, and in adults compared to children and adolescents. Percent of women in each sample and methodological quality were positive predictors of the effect size. Publication bias may be present, but the analysis was hampered by the high heterogeneity. Therefore, these results support the association between early-life adversity and blunted cortisol response to social stress, and they suggest that the long-term negative effects of early-life adversity may reach maximum levels in adults.

The goal of the current study was to conduct a quantitative meta-analysis investigating the role of cognitive-behavioral therapy (CBT) as adjunctive treatment to medication for patients diagnosed with bipolar disorder. Studies included in the sample were identified through a computer search of articles in English in the MEDLINE database from January 1980 to March 2008. Key terms entered were cognitive and bipolar disorder, cognitive therapy and bipolar disorder, cognitive behavioral therapy and bipolar disorder, psychotherapy and bipolar disorder, and psychosocial and bipolar disorder. Inclusion criteria were (1) randomized clinical trial investigating the role of adjunctive CBT in patients diagnosed with bipolar disorder, (2) clearly defined CBT intervention, (3) the inclusion of a control group, and (4) sufficient data reported to allow calculation of effect sizes. Twelve randomized clinical trials were selected for analysis on the basis of these criteria. Effect sizes (Cohen d) were calculated according to published procedures. We found a low to medium overall effect size of CBT at posttreatment (d = -0.42, P < .05) and follow-up (d = -0.27, P < .05), and we found a positive impact of CBT on clinical symptoms (posttreatment d = -0.44, P < .05), cognitive-behavioral etiopathogenetic mechanisms (posttreatment d = -0.49, P < .05), treatment adherence (posttreatment d = -0.53, P < .05), and quality of life (posttreatment d = -0.36, P < .05). The impact was less evident in the case of relapse and/or recurrence (posttreatment d = -0.28). These effects on outcome categories were more evident at posttreatment compared to follow-up. Cognitive-behavioral therapy can be used as an adjunctive treatment to medication for patients with bipolar disorder, but new CBT strategies are needed to increase and enrich the impact of CBT at posttreatment and to maintain its benefits during follow-up.

Childhood maltreatment is a major risk factor for psychopathology, and increasing evidence suggests that emotion regulation is one of the underlying mechanisms. However, most of this evidence comes from single assessments of habitual emotion regulation, which may not overlap with spontaneous emotion regulation in daily life and which fail to account for within-individual variability in emotion regulation across multiple contexts. In the present study, we investigated the relation between history of childhood maltreatment, positive and negative affect, and multiple dimensions of spontaneous emotion regulation (strategy use, emotion regulation goals, emotion regulation success and effort) in everyday life, using experience sampling method (3 assessments/day, for 10 consecutive days), in a sample of healthy volunteers (N = 118). Multilevel modeling results indicated that childhood maltreatment was associated with lower positive affect and higher negative affect. Childhood maltreatment was also related to lower use of reappraisal and savoring (but not suppression, rumination and distraction), reduced emotion regulation success (but not effort), as well as lower levels of and higher within-individual variability of hedonic (but not instrumental) emotion regulation goals. These results provide ecological evidence for multiple differences in emotion regulation in individuals with a history of childhood maltreatment.