Skip to main content

Verified by Psychology Today

Cognitive Behavioral Therapy

Major Meta-Analysis Finds CBT Effective But Not Superior

The finding contrasts with popular notions of depression treatment.

Key points

  • A meta-analysis found that CBT was effective in treating depression but not superior to other psychotherapies.
  • CBT became a favored treatment due to its time-limited and structured nature.
  • CBT is a manualized treatment, so it's more readily amenable to scientific research than other therapies.

A massive meta-analysis of over 50,000 patients published recently in the journal World Psychiatry found cognitive-behavioral therapy (CBT) to be effective but not superior to other psychotherapies in the treatment of depression. The study, authored by Pim Cuijpers and colleagues, is the largest meta-analysis ever for a specific type of psychotherapy for a particular mental disorder.

Mohamed Hassan / Pixabay
Source: Mohamed Hassan / Pixabay

In the paper, which is available via open access, the authors write, "The superiority of CBT over other psychotherapies for depression does not emerge clearly from this meta-analysis." When the authors limited studies to those with a low risk of bias, excluded outliers, or adjusted for publication bias, they found no difference between CBT and other forms of psychotherapy.

This is not the first study to find that CBT is not superior to other psychotherapies for depression (see Cuijpers et al., 2021). These findings contrast sharply with the common assumption that CBT is the "gold standard" psychotherapy for depression, a position propagated by many CBT researchers and therapists for decades.

CBT is often compared to psychodynamic psychotherapy, a form of talk therapy and the major alternative to the symptom-focused, manualized CBT approach. In psychodynamic therapies, the therapist assists the patient in an introspective and exploratory process, examining the patient's inner conflicts, motivations, and patterns of behavior.

It should be noted that there are around 300 randomized controlled trials of psychodynamic therapies and multiple meta-analyses and systematic reviews. This includes one of the most cited papers of the past decade, “The Efficacy of Psychodynamic Psychotherapy,” authored by psychologist Jonathan Shedler.

CBT was originally developed by the late psychiatrist Aaron Beck in the 1960s at the University of Pennsylvania. Beck, who studied psychoanalysis but was denied membership in the American Psychoanalytic Association, believed that depression results from faulty and distorted thinking. Thus, the focus of CBT is on identifying and changing irrational patterns of thought and behavior.

Beginning in the 1980s, with the increased influence of managed care on the practice of psychotherapy, CBT became a favored treatment due to its time-limited and structured nature. Since CBT is a manualized treatment, it is more readily amenable to scientific research than some other forms of psychotherapy, including psychodynamic therapy. Soon, CBT researchers began to tout its superiority in the treatment of depression and other disorders.

Now, it has become clear that CBT’s effectiveness has been exaggerated; its popularity may have been driven in part by forces other than its utility as a form of psychotherapy.

The recent Cuijpers et al. paper highlights the importance of unbiased empirical research in evaluating the effectiveness of psychiatric and psychological treatments. It reveals most clearly the risk of bias in shaping the narrative around psychotherapy for generations of mental health professionals—and patients.

References

Cuijpers, P., Quero, S., Noma, H., Ciharova, M., Miguel, C., Karyotaki, E., Cipriani, A., Cristea, I. A., & Furukawa, T. A. (2021). Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 20(2), 283–293. https://doi.org/10.1002/wps.20860

Cuijpers, P., Miguel, C., Harrer, M., Plessen, C. Y., Ciharova, M., Ebert, D., & Karyotaki, E. (2023). 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: Official Journal of the World Psychiatric Association (WPA), 22(1), 105–115. https://doi.org/10.1002/wps.21069

Shedler J. (2010). The efficacy of psychodynamic psychotherapy. The American Psychologist, 65(2), 98–109. https://doi.org/10.1037/a0018378

advertisement
More from Mark L. Ruffalo M.S.W., D.Psa.
More from Psychology Today