Bipolar disorder (BD) is associated with cognitive and functional difficulties, persistent beyond mood episodes. Cognitive remediation (CR) is a psychological therapy targeting cognitive and functioning difficulties. Recent evidence suggests that CR may enhance long-term functioning but transfer mechanisms on functional outcomes have not been explored. We aim to investigate whether and how cognitive gains after CR transfer to functional improvement.

We considered data from a randomized controlled trial comparing CR (n = 40) to treatment-as-usual (TAU; n = 40) in euthymic people with BD. Treatment outcomes included individual cognitive domains and global cognition, psychosocial functioning, and goal attainment. Regression-based mediation and moderation modelling were used to assess whether and how post-treatment cognitive changes translate into functional improvement at follow-up, three months after treatment end.

Cognitive gains after CR transferred to functional changes three months later: improvement in post-treatment global cognition partially mediated the effect of CR on psychosocial functioning (standardized indirect effect: −0.23, 95% CI −0.51 to −0.04). Goal attainment was not significantly mediated by changes in cognition, but post-treatment cognitive performance moderated the effect of CR on the GAS at follow-up (interaction effect: 0.78, 95% CI 0.08–1.55).

Our findings suggest that cognitive improvements contribute to functional improvement but transfer mechanisms differ between psychosocial functioning and idiosyncratic recovery goals. Cognition accounted for only a proportion of the total CR effect on functional outcomes. Future studies should consider other variables, such as metacognition, that may drive the transfer of CR effects to functional outcomes.

双相情感障碍 (BD) 与认知和功能困难有关，持续存在于情绪发作之后。认知矫正 (CR) 是一种针对认知和功能障碍的心理疗法。最近的证据表明，CR 可能会增强长期功能，但尚未探索功能结果的转移机制。我们的目的是调查 CR 后的认知增益是否以及如何转移到功能改善。

我们考虑了一项随机对照试验的数据，该试验将 CR（n = 40）与正常治疗（TAU；n = 40）在情绪正常的 BD 患者中进行了比较。治疗结果包括个体认知领域和整体认知、社会心理功能和目标实现。基于回归的调解和调节模型用于评估治疗后认知变化是否以及如何在治疗结束后三个月的随访中转化为功能改善。

三个月后 CR 后的认知增益转移到功能变化：治疗后整体认知的改善部分介导了 CR 对社会心理功能的影响（标准化间接效应：-0.23，95% CI -0.51 至 -0.04）。目标的实现并没有被认知的变化显着调节，但治疗后的认知表现调节了 CR 对后续 GAS 的影响（交互作用：0.78，95% CI 0.08-1.55）。

我们的研究结果表明，认知改善有助于功能改善，但心理社会功能和特殊恢复目标之间的转移机制不同。认知只占 CR 对功能结果的总影响的一部分。未来的研究应该考虑其他变量，例如元认知，它们可能会推动 CR 效应向功能结果的转移。