Cognitive-Behavioral Therapy

by

Giovanbattista Andreoli, Stefan G. Hofmann

• LAST REVIEWED: 26 May 2023
• LAST MODIFIED: 26 May 2023
• DOI: 10.1093/obo/9780199828340-0186

Introduction

Cognitive-behavioral therapy (CBT) is an empirically based and short-term treatment that is based on the notion that maladaptive thought processes and behaviors are causally connected to emotional and physiological distress. CBT does not exclude biological, genetic, or cultural factors and recognizes the importance of certain pharmacological treatments. In CBT, the patient is involved as an active collaborator in the treatment process. In general, CBT is at least as effective as medication for treating phobias, panic, social anxiety, generalized anxiety, obsessive-compulsive disorder, posttraumatic stress disorder, depression, and substance abuse.

Empirical Support

The desire for scientific validity is part of the history and spirit of CBT. It comes as no surprise, therefore, that the American Psychological Association (APA) Division 12 website Research-Supported Psychological Treatments reports that CBT remains the most empirically supported school of psychotherapy. Hofmann, et al. 2012 reviews 106 meta-analyses and finds that CBT has strong support for treating anxiety disorders, somatoform disorders, bulimia, anger problems, and stress. Butler, et al. 2006 is a review of sixteen meta-analyses and finds large effect sizes of CBT for depression, generalized anxiety disorder, panic disorder, social anxiety disorder, and posttraumatic stress disorder. Hofmann and Smits 2008 reviews CBT specifically for anxiety disorders and finds CBT most effective in treating obsessive-compulsive disorder and acute stress disorder. Also, the article Kaczkurkin and Foa 2015 shows how CBT exposure and cognitive techniques are effective to treat anxiety disorders. Other studies specifically compared CBT to other active treatments. For example, Raue, et al. 1997 shows that CBT practitioners establish stronger therapeutic alliance than practitioners of psychodynamic-interpersonal therapy (PI), a treatment known for its client-therapist relationship. Agras, et al. 2000, a randomized controlled trial (RCT), establishes the effectiveness of CBT over interpersonal psychotherapy (IPT) in treating bulimia nervosa. Barrowclough, et al. 2001 finds that CBT also shows advantages over supportive counseling for anxiety symptoms. Tolin 2010, a meta-analysis, tempers these results by concluding that CBT is superior to alternative therapies only for anxiety and depressive disorders. Finally, Butler, et al. 2006 determines that CBT performed even better than pharmacotherapy for depression. Of note, the meta-analysis Bhattacharya, et al. 2023 considering placebo-controlled trials shows how the effect-size of CBT for anxiety-related disorders is having a standstill respect to past studies. Future studies should focus on finding approaches to help CBT to increase its efficacy.

• Agras, W. S., B. T. Walsh, C. G. Fairburn, G. T. Wilson, and H. C. Kraemer. 2000. A multicenter comparison of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa. Archives of General Psychiatry 57.5: 459–466.

  DOI: 10.1001/archpsyc.57.5.459

  A total of 220 patients with bulimia nervosa were allocated at random to nineteen sessions of CBT or IPT conducted over a twenty-week period. CBT resulted in significantly faster improvement than IPT in patients with bulimia nervosa, although there was no significant difference in symptoms at follow-up.

• APA Division 12. Research-Supported Psychological Treatments.

  A collection of treatments for a variety of disorders that meet APA criteria of strong, modest, or controversial empirical support. Several such studies are included in this article.

• Barrowclough, C., P. King, J. Colville, E. Russel, A. Burns, and N. Tarrier. 2001. A randomized trial of the effectiveness of cognitive-behavioral therapy and supportive counseling for anxiety symptoms in older adults. Journal of Consulting and Clinical Psychology 69.5: 756–762.

  DOI: 10.1037/0022-006X.69.5.756

  An RCT comparing CBT and supportive counseling in the treatment of anxiety symptoms. After treatment and at follow-up, the CBT group had significantly greater improvement in anxiety and depressive symptoms than the supportive-counseling group.

• Bhattacharya, S., C. Goicoechea, S. Heshmati, J. K. Carpenter, and S. G. Hofmann. 2023. Efficacy of cognitive behavioral therapy for anxiety-related disorders: A meta-analysis of recent literature. Current Psychiatry Reports 25.1: 19–30.

  DOI: 10.1007/s11920-022-01402-8

  This meta-analysis includes ten placebo-controlled trials on anxiety-related disorders published from 2017 to 2022. The resulting effect-size shows a reduction compared to prior meta-analysis on the topic.

• Butler, A. C., J. E. Chapman, E. M. Forman, and A. T. Beck. 2006. The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review 26.1: 17–31.

  DOI: 10.1016/j.cpr.2005.07.003

  This meta-analysis compared effect sizes of CBT to control groups. The authors found large effect sizes for anxiety disorders, bulimia nervosa, and schizophrenia.

• Hofmann, S. G., A. Asnaani, I. J. J. Vonk, A. T. Sawyer, and A. Fang. 2012. The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research 36.5: 427–440.

  DOI: 10.1007/s10608-012-9476-1

  The authors reviewed 106 meta-analyses examining the efficacy of CBT for a comprehensive range of psychological disorders. Eleven of the studies directly compared CBT with other treatments, only one of which outperformed CBT.

• Hofmann, S. G., and J. A. J. Smits. 2008. Cognitive-behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychiatry 69.4: 621–632.

  DOI: 10.4088/JCP.v69n0415

  The authors reviewed twenty-seven placebo-controlled studies. All effect sizes were significant, with the largest effects reported for obsessive-compulsive disorder and acute stress disorder.

• Kaczkurkin, A. N., and E. B. Foa. 2015. Cognitive-behavioral therapy for anxiety disorders: An update on the empirical evidence. Dialogues in Clinical Neuroscience 17.3: 337–346.

  DOI: 10.31887/DCNS.2015.17.3/akaczkurkin

  This article reviews the efficacy of two highly applied methods in CBT for anxiety disorders: exposure and cognitive therapy. The study supports the use of both techniques, underlying the importance for future research in understanding which specific components are linked to positive outcomes.

• Raue, P. J., M. R. Goldfried, and M. Barkham. 1997. The therapeutic alliance in psychodynamic-interpersonal and cognitive-behavioral therapy. Journal of Consulting and Clinical Psychology 65.4: 582–587.

  DOI: 10.1037/0022-006X.65.4.582

  This study used the Working Alliance Inventory to compare quality of therapeutic alliance between psychodynamic-interpersonal therapy and CBT in fifty-seven depressed patients. Results indicated significantly greater alliance scores for CBT on the whole. Furthermore, high-impact sessions were characterized by higher alliance.

• Tolin, D. F. 2010. Is cognitive-behavioral therapy more effective than other therapies? A meta-analytic review. Clinical Psychology Review 30.6: 710–720.

  DOI: 10.1016/j.cpr.2010.05.003

  This meta-analysis selected twenty-six studies comparing CBT with other well-established treatments. The advantage of CBT over other treatments was clearly evident only in patients with anxiety and depressive disorders.