How Effective is Cognitive Behavioral Therapy?
CBT provides lifelong skills that individuals can continue to apply long after their therapy sessions have ended.
If you have been experiencing mental health symptoms like depression, anxiety, or lingering effects of trauma, these may be impacting your ability to do the things you want or need to do in your life, and you might find yourself looking for treatment options to help. While there are many different kinds of treatments that are designed to help people improve their mental well-being, one of the most common treatment modalities used by mental health providers is cognitive behavioral therapy, or as it’s often called, CBT. CBT is a type of psychological treatment based on the idea that mental health issues and related distress are influenced by our thoughts, or how we think.
According to the American Psychological Association (APA)1, CBT is based on these core principles:
Psychological problems are partly based on faulty or unhelpful ways of thinking.
They may also be based on learned patterns of unhelpful behavior.
Through CBT, people suffering from psychological problems can learn better ways of coping with them, thereby relieving their symptoms and becoming more effective in their lives.
The History of Cognitive Behavioral Therapy
The CBT treatment model was founded by Dr. Aaron T. Beck, an American psychiatrist in the 1960s. Dr. Beck developed this theory when he noticed that his patients experiencing depression symptoms would often have “spontaneous, negative thoughts” during treatment sessions, and he coined these thoughts “automatic thoughts”2. He realized that if he worked with patients to analyze their thoughts and assess the validity or helpfulness of these thoughts, he could help them reframe their thinking to allow them to engage in more adaptive behaviors and this could improve how they feel. Dr. Beck studied the effectiveness of this method of treatment and found great results beginning in 1977. One particular clinical trial study compared CBT treatment to the use of antidepressant medication and found that CBT was just as effective at treating depression as medication and was twice as effective in preventing a relapse of depression symptoms. When additional trials began replicating the results, CBT became an internationally recognized treatment model that has since shown through over 2,000 studies that CBT is effective for many different kinds of mental health conditions and medical problems.
How does CBT Work?
CBT is a short-term, organized treatment that aims to change negative ways of thinking and behaving. CBT therapy sessions are usually somewhere between 30-60 minutes per week (sometimes more than once a week depending on symptom severity) for about 12-20 sessions. It works on the idea that our cognitions (or our thoughts), emotions, and actions are all linked, and if we want to see improvement in our emotions or our ability to make better choices with our actions, we often need to assess, challenge, and reframe our thinking to see improvements in these areas. Unlike therapies that just focus on talking about feelings, CBT is practical and goal-driven, helping people create real strategies to shift harmful thought patterns and behaviors. For example, patients are taught about unhelpful thinking traps like black and white thinking (such as, “I will never be good at this!”), jumping to conclusions (“I’m going to fail this test no matter how hard I study”), emotional reasoning (“I feel anxious, so I must be in real danger”), mind-reading (“They all think I’m weird and don’t want me around”), and many more. Once they learn about how their brains can get into these thinking traps, they are taught ways to challenge and reframe these thoughts to improve their ability to manage their emotions and the actions that follow. Then, after working to reframe the distorted or unhelpful thinking, therapists will also teach coping skills to manage emotions, like deep breathing, meditation, guided imagery, and many other active strategies to help them have something to do to reduce the emotional dysregulation they were experiencing as a result of these unhelpful thoughts. This dynamic method can often result in noticeable, effective improvements in symptoms after just a few sessions; many people report experiencing symptom improvement in just 5 sessions!
The Effectiveness of CBT for Depression
CBT is one of the most studied psychological treatments, particularly for depression, and this model of therapy is often recommended in treatment guidelines in combination with medication support for more severe cases. One particular article in World Psychiatry 3 in 2023 states that recently studies haven't fully compared CBT treatment’s stand-alone effectiveness against other therapies, medications, or combined treatments for depression. To address this, the researchers in this article conducted an extensive review, analyzing results from 409 studies involving 52,702 patients, making it the largest review of its kind for a therapy focused on a mental disorder. CBT showed moderate to large positive effects compared to “care as usual” or being placed on a waiting list, and these benefits lasted for 6-12 months after treatment. CBT was slightly more effective than other types of therapy, but it is important to note that the difference between other therapies and CBT was small and often not scientifically significant when analyzed.
This study went on to say that, when compared to medication, CBT was similarly effective in the short term but showed better results with longer treatment (over 6-12 months), but the writers of this article note that the number of studies was limited, and the findings were not consistent across all analyses. Many studies, including the ones in this article, suggest that combining CBT with medication was more effective than medication alone, both in the short-term and the long-term. This study also found that CBT also worked well as a self-help tool in institutional settings, and for children and teenagers. Overall, CBT is effective for depression across different formats, ages, and settings. However, this study did not clearly show that CBT is superior to other therapies for depression. It seems to be just as effective as medication in a short term treatment model but that it may be more effective over longer periods.
The Effectiveness of CBT for Other Conditions
As mentioned, CBT was originally developed as a treatment model to help patients experiencing depression, but throughout the years more studies have been conducted that have showed that CBT is incredibly effective in treating many other conditions as well. One National Institute of Health Public Access manuscript from 20124 indicated that they had looked at 269 studies that combined results from multiple research papers. From these, they closely examined 106 studies that focused on CBT for various issues, including addiction, schizophrenia and other severe mental illnesses, depression, bipolar disorder, anxiety, disorders related to physical symptoms without a clear medical cause, eating problems, sleep issues, personality problems, anger and aggression, criminal behavior, general stress, distress from medical conditions, long-term pain and tiredness, and distress related to pregnancy and women's hormonal issues. They also reviewed studies that looked at how effective CBT is for different issues in specific populations like children and older adults. Their findings suggest that CBT is most strongly supported for efficacy in treating for the following mental health conditions:
Anxiety
Disorders with physical symptoms
Bulimia
Anger management
General stress
Out of 11 studies that compared CBT to two conditions (other treatments or no treatment at all), 7 found that CBT worked better, while only one found it was less effective than other treatments. Overall, CBT has a very strong track record of success. However, more research is needed to test CBT in specific, controlled studies. Additionally, there aren't enough studies on how CBT works for specific groups like ethnic minorities and people with low income, aside from children and the elderly.
A therapist will help you to learn to slow down to recognize your thoughts or “self-talk” to ultimately help you to reframe your thinking before it leads to a behavior that causes you more harm than good.
How to Know if CBT is Right for You
Many people may wonder if CBT would be an effective treatment for the mental health symptoms they are experiencing, and as you can see from the studies above, CBT is often the gold standard treatment for many different kinds of mental health issues. So, how do you know if CBT is the right treatment for you? Because CBT is a treatment that helps a person recognize, challenge, and change unhelpful thoughts, CBT is great for those who experience problems with distorted or unhelpful thinking that leads to emotions that are hard to control or to problematic actions or behaviors. If you are someone who tends to be negative, or someone who expects the worst in most situations, you are likely experiencing distorted thinking, and a CBT therapist can help you figure out how to challenge these thoughts and reframe them into something more truthful and helpful to improve your mood. If you are someone who is struggling with engaging in behaviors that cause problems in your life and you don’t know why you keep doing these things in spite of the problems they are causing, you may be experiencing “automatic thoughts” that are leading to these behaviors. If so, CBT is a great treatment model to help with this as well! A therapist will help you to learn to slow down to recognize your thoughts or “self-talk” to ultimately help you to reframe your thinking before it leads to a behavior that causes you more harm than good. If you are someone who experiences high levels of stressful emotions such as panic, anger, or other forms of emotional distress, CBT can help you to connect the thoughts that may be attached to these emotions and teach you strategies to identify more productive thought patterns and coping skills to soothe your emotions as well.
The Takeaway
Cognitive Behavioral Therapy is a highly effective treatment for a range of mental health issues, including depression, anxiety, and trauma that focuses on identifying and changing negative thought patterns and behaviors. It's a structured, short-term therapy that empowers individuals to challenge and reframe unhelpful thoughts, leading to improved emotional regulation and behavior. Studies show that CBT is as effective as medication for depression and can sometimes be more beneficial over the long term. It also effectively addresses various conditions such as addiction, anxiety, and stress across different age groups and settings. If you find yourself struggling with negative thinking, emotional distress, or behaviors that impact your life, consider reaching out to a CBT therapist. They may be able to help you develop practical strategies to improve your mental well-being and lead a more fulfilling life!
References
American Psychological Association. (n.d.). American Psychological Association. https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
Dr. Aaron T. Beck. Beck Institute. (2024, June 14). https://beckinstitute.org/about/dr-aaron-t-beck/#developmentof
Cuijpers P, Miguel C, Harrer M, Plessen CY, Ciharova M, Ebert D, Karyotaki E. Cognitive behavior therapy vs. control conditions, other psychotherapies, pharmacotherapies and combined treatment for depression: a comprehensive meta-analysis including 409 trials with 52,702 patients. World Psychiatry. 2023 Feb;22(1):105-115. doi: 10.1002/wps.21069. PMID: 36640411; PMCID: PMC9840507.
Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440. https://doi.org/10.1007/s10608-012-9476-1