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The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses
Open accessAbstract
Cognitive behavioral therapy (CBT) refers to a popular therapeutic approach that has been applied to a variety of problems. The goal of this review was to provide a comprehensive survey of meta-analyses examining the efficacy of CBT. We identified 269 meta-analytic studies and reviewed of those a representative sample of 106 meta-analyses examining CBT for the following problems: substance use disorder, schizophrenia and other psychotic disorders, depression and dysthymia, bipolar disorder, anxiety disorders, somatoform disorders, eating disorders, insomnia, personality disorders, anger and aggression, criminal behaviors, general stress, distress due to general medical conditions, chronic pain and fatigue, distress related to pregnancy complications and female hormonal conditions. Additional meta-analytic reviews examined the efficacy of CBT for various problems in children and elderly adults. The strongest support exists for CBT of anxiety disorders, somatoform disorders, bulimia, anger control problems, and general stress. Eleven studies compared response rates between CBT and other treatments or control conditions. CBT showed higher response rates than the comparison conditions in 7 of these reviews and only one review reported that CBT had lower response rates than comparison treatments. In general, the evidence-base of CBT is very strong. However, additional research is needed to examine the efficacy of CBT for randomized-controlled studies. Moreover, except for children and elderly populations, no meta-analytic studies of CBT have been reported on specific subgroups, such as ethnic minorities and low income samples.
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“Cognitive behavioral therapies have been shown to increase success rates and may mitigate suicide risk during smoking cessation.22”
From Are smoking cessation treatments associated with suicidality risk? An overview (2016) · cites this paper as [22]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Through changing thoughts and behaviors, this treatment has been demonstrated to help improve mood symptoms and reduce cravings as well as facilitate smoking cessation.22,50”
From Are smoking cessation treatments associated with suicidality risk? An overview (2016) · cites this paper as [22]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“Cognitive behavioral therapies (CBTs) theorize that mental disorders, including mood and addiction disorders, are maintained by cognitive, emotional, and behavioral factors, although the etiology of such disorders may be multicausal, including genetic components.”
From Are smoking cessation treatments associated with suicidality risk? An overview (2016) · cites this paper as [22]
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In the citing paper
“Evidence-based psychological treatments for anxiety and depression (eg, cognitive behavioral therapy) are highly effective in reducing symptoms and improving functioning [1-3].”
From Clinical Effects of Asynchronous Provider-Guided Practice Sessions During Blended Care Therapy for Anxiety and Depression: Pragmatic Retrospective Cohort Study (2024) · cites this paper as [1]
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“while general anxiety is related with neuroticism72 and the stress caused by individuals’ maladaptive patterns of thinking, judging, and responding73.”
From Rational thinking as a mediator of the relationship between mindfulness and dental anxiety (2023) · cites this paper as [73]
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“A variety of evidence-based psychotherapeutic treatments for depression are available (American Psychiatric Association, 2000), chief among them being CBT, shown to help in several chronic conditions, including chronic pain, diabetes, irritable bowel syndrome, and polycystic ovarian syndrome [37,38].”
From Psychological and Psychiatric Comorbidities in Youth with Serious Physical Illness (2022) · cites this paper as [37]
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“Because of its clear research support, CBT as the gold-standard evolving psychological treatment dominates the international guidelines for psychosocial treatments, making it a first-line treatment for many disorders.”
From Effectiveness of a hybrid arts-based Cognitive Behavioral Therapy intervention for patients with non-malignant chronic pain (2022) · cites this paper as [9]
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“4 meta-analyses showed how CBT performed better than the other interventions in the treatment of occupational stress [25].”
From A conversational artificial intelligence agent for a mental health care app: Evaluation study of its participatory design (2021) · cites this paper as [25]
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“The gold standard intervention to treat anxiety is exposure-based CBT (Hofmann et al., 2012).”
From Targeting excessive avoidance behavior to reduce anxiety related to asthma: A feasibility study of an exposure-based treatment delivered online (2021) · cites this paper as Hofmann et al., 2012
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“Cognitive behavioural therapy (CBT) is widely accepted and has been repeatedly found to be effective for a wide range of psychological problems (Hofmann et al., 2012).”
From ICBT program for improving informal caregiver well-being: A qualitative study (2021) · cites this paper as Hofmann et al., 2012
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“The efficacy of this treatment is supported by The Task Force Report on Empirically Supported Treatments (ESTs; Chambless & Hollon, 1998) and the 12th Division of the APA.”
From Enhancing In Vivo Exposure in the Treatment of Panic Disorder and Agoraphobia Using Location-Based Technologies: A Case Study (2020) · cites this paper as Hofmann et al., 2012
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“The effects on antenatal depression are highly comparable to those found for ICBT-programs as well as traditional CBT for depression (Hedman et al., 2012;Hofmann et al., 2012;Cuijpers et al., 2013).”
From Internet delivered cognitive behavior therapy for antenatal depression: A randomised controlled trial (2017) · cites this paper as Hofmann et al., 2012
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“Cognitive Behav ioural Therapy (CBT) is the most well-established psychological treat ment for anxiety and depression (Hofmann et al., 2012).”
From Effects of group Acceptance and Commitment Therapy (ACT) on anxiety and depressive symptoms in adults: A meta-analysis. (2022) · cites this paper as Hofmann et al., 2012
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“Cognitive Behavioral Therapies (CBT) have been shown in recent decades to be broadly effective in reducing many forms of mental illness (Hofmann, Asnanni, Vonk, Sawyer, & Fang, 2012).”
From Trajectories of change in well-being during cognitive behavioral therapies for anxiety disorders: Quantifying the impact and covariation with improvements in anxiety (2020) · cites this paper as Hofmann, Asnanni, Vonk, Sawyer, & Fang, 2012
The cited source says what the claim attributes to it.
In the citing paper
“Decades of research have clearly demonstrated that CBT has robust effects on many different forms of mental illness, including anxiety disorders (Hofmann et al., 2012)”
From Trajectories of change in well-being during cognitive behavioral therapies for anxiety disorders: Quantifying the impact and covariation with improvements in anxiety (2020) · cites this paper as Hofmann et al., 2012
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In the citing paper
“Similarly, CBT, with its focus on modifying maladaptive thought patterns and behaviors, has been associated with reductions in stress-related symptoms and pain intensity [64].”
From The Role of Cortisol in Chronic Stress, Neurodegenerative Diseases, and Psychological Disorders (2023) · cites this paper as [64]
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In the citing paper
“Cognitive behavioral therapies (CBTs) have been found to be effective in treating individuals presenting with symptoms of anxiety and depression 20, 21 – common complaints of ICs – and hence it is likely an appropriate first choice treatment for ICs.”
From Cognitive behavioral therapies for informal caregivers of patients with cancer and cancer survivors: a systematic review and meta-analysis (2017) · cites this paper as [21]
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In the citing paper
“Interventions that integrate elements of cognitive behavioural therapy (CBT) have been shown to lead to positive outcomes in improving mental health (22).”
From Efficacy of eHealth interventions to reduce depression symptoms in individuals with obesity: a systematic review of randomized controlled trials (2024) · cites this paper as [22]
The cited source says what the claim attributes to it.
In the citing paper
“Changing cognitions and thoughts can help to reduce symptoms [25].”
From A conversational artificial intelligence agent for a mental health care app: Evaluation study of its participatory design (2021) · cites this paper as [25]
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In the citing paper
“Furthermore, panic patients who believed that they had control over the amount of CO 2 they inhaled by turning an inoperative dial were less likely to panic than individuals who knew that they had no control over it 26”
From “Third-wave” cognitive and behavioral therapies and the emergence of a process-based approach to intervention in psychiatry (2021) · cites this paper as [26]
Experimental — accuracy not yet measuredIn the citing paper
“During the past two decades, effective therapies have become available for the treatment of several PDs [14–16].”
From Personality disorders are important risk factors for disability pensioning (2014) · cites this paper as [15]
In the citing paper
“As PDs are relatively common in the community, and effective treatment is available for some, health care workers should be aware of the strong link between PDs and work force exclusion.”
From Personality disorders are important risk factors for disability pensioning (2014) · cites this paper as [15]
In the citing paper
“A recent review of the literature identified 269 meta-analytic studies examining CBT for nearly every DSM category (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012).”
From A process-based approach to psychological diagnosis and treatment:The conceptual and treatment utility of an extended evolutionary meta model (2020) · cites this paper as Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012
In the citing paper
“While medication and cognitive behaviour therapy (CBT) are effective for anxiety disorders (Bandelow et al., 2015;Olatunji, Cisler, & Deacon, 2010), these treatments have limitations, such as drug side-effects and drug dependence, and modest efficacy as only about half of anxiety sufferers respond successfully to CBT (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012).”
From Anxiety and attention to threat: cognitive mechanisms and treatment with attention bias modification (2016) · cites this paper as Hofmann et al., 2012
In the citing paper
“It is not surprising then that protocolized treatments for specific forms of psychopathology are only effective for a portion of patients [10].”
From Using person-specific networks in psychotherapy: challenges, limitations, and how we could use them anyway (2020) · cites this paper as [10]
In the citing paper
“Thus, although there is accumulating evidence for the efficacy of these approaches (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012; Kuyken et al., 2016), their wide-spread availability is currently limited.”
From Beneficial effects of training in self-distancing and perspective broadening for people with a history of recurrent depression (2017) · cites this paper as Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012
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Citations
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“…validated kind of behavioral treatment for neuropsychiatric disorders is CBT, meta-analyses of which indicate it to be effective for many disorders, including depression, generalized anxiety disorder, panic disorder, and social anxiety disorder (e.g., Butler et al., 2006; Hofmann et al., 2012).”
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“CBT is a type of psychotherapeutic treatment that helps people to identify and change destructive or disturbing thought patterns that have a negative influence on their behavior and emotions [1].”
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“1 3 moderate effects on depression (Hofmann et al. 2012; Zhou et al. 2015).”
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“Research on the efficacy of evidencebased approaches, such as cognitive behaviour therapy (CBT), suggest that a large number of patients improve thanks to the interventions they receive (Hofmann et al., 2012).”
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“8) for anger and aggression (Hofmann et al., 2012) and for gambling (Hedges’s g = .”
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Internet-based mindfulness treatment for anxiety disorders: a randomized controlled trial
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Immersive Virtual Reality and Virtual Embodiment for Pain Relief
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Reducing Crime and Violence: Experimental Evidence from Cognitive Behavioral Therapy in Liberia
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“est for two reasons: the program’s overwhelming focus on antisocial behaviors, with drug use seen by NEPI as only a modest factor; and the fact that systematic reviews of CBT do not find support for its effectiveness treating substance use disorder (Hofmann et al., 2012).”
Burgdorf, V., Szabó, M., & Abbott, M. J. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.01336 · Cited by 234
“Similarly, the effects of cognitive behavioral therapy for general stress are maintained at follow up, but not increased (Hofmann et al., 2012).”
BackgroundBrain circuits for pain and its treatment
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Cultures for mental health care of young people: an Australian blueprint for reform
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The processes of cognitive behavioral therapy: A review of meta-analyses
Kazantzis, N., Luong, H. K., Usatoff, A. S., Impala, T., Yew, R. Y., & Hofmann, S. G. (2018) · Cognitive Therapy and Research · doi:10.1007/s10608-018-9920-y · Cited by 218
“The first application of these ideas to psychotherapy are credited to Beck (1963) and Ellis (1970), in order to explain emotional and behavioral disturbance involved in psychiatric disorders (Hofmann et al. 2012).”
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“It is interesting to note that antidepressant actions, although likely expected to be different between escitalopram, duloxetine (Frampton and Plosker, 2007), and CBT (Hofmann et al., 2012), have similar effects on the immune response.”
InfluentialA cognitive account of belief: a tentative road map
Connors, M. H., & Halligan, P. W. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2014.01588 · Cited by 237
“Given this overarching influence of belief on our experience, beliefs that are considered dysfunctional or inaccurate are often the target of psychological interventions (Beck, 1976; Young et al., 2003; Hofmann et al., 2012; Kronemyer and Bystritsky, 2014).”
Alcohol, drugs, and violence: A meta-meta-analysis.
Duke, A. A., Smith, K. M. Z., Oberleitner, L., Westphal, A., & McKee, S. A. (2017) · Psychology of Violence · doi:10.1037/vio0000106 · Cited by 218
Virtual reality for supporting the treatment of depression and anxiety: scoping review
Baghaei, N., Chitale, V., Hlasnik, A., Stemmet, L., Liang, H.-N., & Porter, R. (2021) · JMIR Mental Health · doi:10.2196/29681 · Cited by 197
“CBT is a type of psychotherapeutic treatment that helps people learn how to identify and change destructive or disturbing thought patterns that have a negative influence on behavior and emotions [8].”
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Contemporary cognitive behavior therapy: A review of theory, history, and evidence
Thoma, N., Pilecki, B., & McKay, D. (2015) · Psychodynamic Psychiatry · doi:10.1521/pdps.2015.43.3.423 · Cited by 197
Common versus specific factors in psychotherapy: opening the black box
Mulder, R., Murray, G., & Rucklidge, J. (2017) · The Lancet Psychiatry · doi:10.1016/s2215-0366(17)30100-1 · Cited by 198
Craig, C., Hiskey, S., & Spector, A. (2020) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2020.1746184 · Cited by 201
“As CBT is the current treatment of choice for most psychological ailments due to its sizeable evidence-base [54] it is important that CFT is directly compared with CBT in terms of its effects.”
BackgroundChronic Pain and Cognitive Behavioral Therapy: An Integrative Review
Knoerl, R., Lavoie Smith, E. M., & Weisberg, J. (2016) · Western Journal of Nursing Research · doi:10.1177/0193945915615869 · Cited by 194
Chaves, C., Lopez-Gomez, I., Hervas, G., & Vazquez, C. (2017) · Cognitive Therapy and Research · doi:10.1007/s10608-016-9778-9 · Cited by 196
“treatments, including cognitive-behavioral therapy (CBT), problem-solving therapy, behavioral therapy, and interpersonal therapy (Barth et al. 2013; Cuijpers et al. 2011a; Hofmann et al. 2012; Hollon and Ponniah 2010).”
BackgroundForsell, E., Bendix, M., Holländare, F., Szymanska von Schultz, B., Nasiell, J., Blomdahl-Wetterholm, M., Eriksson, C., Kvarned, S., Lindau van der Linden, J., Söderberg, E., et al. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.06.013 · Cited by 175
“The effects on antenatal depression are highly comparable to those found for ICBT-programs as well as traditional CBT for depression (Hedman et al., 2012; Hofmann et al., 2012; Cuijpers et al., 2013).”
MethodReavell, J., Hopkinson, M., Clarkesmith, D., & Lane, D. A. (2018) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000626 · Cited by 189
Deep learning for small and big data in psychiatry
Koppe, G., Meyer-Lindenberg, A., & Durstewitz, D. (2021) · Neuropsychopharmacology · doi:10.1038/s41386-020-0767-z · Cited by 189
Effect of treatments for depression on quality of life: a meta-analysis
Hofmann, S. G., Curtiss, J., Carpenter, J. K., & Kind, S. (2017) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2017.1304445 · Cited by 189
“First, the number of clinical trials examining the efficacy of CBT for depression is very large (Hofmann et al., 2012), providing a large sample of potential studies.”
BackgroundSimon, N. M. (2013) · JAMA · doi:10.1001/jama.2013.8614 · Cited by 198
Moberg, C., Niles, A., & Beermann, D. (2019) · Journal of Medical Internet Research · doi:10.2196/12556 · Cited by 157
“CBT is among the best-researched nonpharmacological treatments for depression and anxiety [5,6].”
Sleep and Mental Health in Undergraduate Students with Generally Healthy Sleep Habits
Milojevich, H. M., & Lukowski, A. (2016) · PLoS ONE · doi:10.1371/journal.pone.0156372 · Cited by 172
“Cognitive behavioral therapy in particular has been effective at improving nighttime sleep [45–47] and mental health outcomes in individuals with [48] and without insomnia (for a review, see reference [49]).”
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Internet-Based Cognitive Behavior Therapy for Loneliness: A Pilot Randomized Controlled Trial
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Recognizing Psychiatric Comorbidity With Reading Disorders
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“No previous systematic review has established the effectiveness of CB interventions when delivered by physiotherapists in routine clinical practice.[8,11,16] Moreover, previous systematic reviews have not assessed whether CB interventions are reported in sufficient detail to allow replication in clinical practice.”
BackgroundSustained and “Sleeper” Effects of Group Metacognitive Training for Schizophrenia
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“to be effective in addressing several health conditions including adult and childhood obesity [17].”
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“CBT focuses on personal connotations added to situations and produces empowering psychological strategies to reevaluate the meanings attributed to situations, promoting learned practice for more positively altered behaviors, emotions, and thoughts [4].”
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CBT at the crossroads: the rise of transdiagnostic treatments.
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Critical Care Nurses’ Physical and Mental Health, Worksite Wellness Support, and Medical Errors
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“Despite the well-established efficacy of CBT for treating and preventing psychological disorders [5], barriers to the administration of CBT exist, which may include insufficient therapists, stigmatization, geographical remoteness, long waiting times, and high costs [6].”
Chapter 33. Neuroscience of Psychotherapy
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Emotion Regulation in Adolescent Well-Being and Positive Education
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Sleep Health Promotion Interventions and Their Effectiveness: An Umbrella Review
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“The most common example among the therapies was cognitive behavioral therapy, which aims to support patients in identifying and changing destructive or disturbing patterns of thoughts that negatively affect behavior and emotions [66].”
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“Psychological interventions (eg, cognitive behavioral therapy, CBT) have been shown to reduce psychological distress in chronic disease populations [12-14].”
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Metadata
- Authors
- Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A.
- Affiliations
- Boston University (US)
- Corresponding author
- Hofmann, Stefan G.
- Venue
- Cognitive Therapy and Research
- Published
- 2012-07-31
- Volume
- 36
- Issue
- 5
- Pages
- 427-440
- ISSN
- 0147-5916 (ISSN-L)
- 1573-2819
- PMC
- PMC3584580
- OpenAlex
- W2036735145
- Semantic Scholar
- 17c0a3ec0f066a90b84fa336daf8c55391b5254a
- Cited by
- 3,445
- References
- 130
- Citations by year
- 2026: 313 · 2025: 444 · 2024: 307 · 2023: 289 · 2022: 353 · 2021: 373 · 2020: 299 · 2019: 256 · 2018: 225 · 2017: 186 · 2016: 177 · 2015: 101 · 2014: 78 · 2013: 36 · 2012: 3
- FWCI
- 92.71
- Type
- journal article
- Language
- en
- Update notices
- correction (2014-01-08)
- Open access
- green
- europepmc.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Cognitive Therapy and Research (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R21MH073937, R01MH078308, R01MH081116)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- cognitive behavioral therapy, treatment efficacy, meta-analysis, anxiety disorders, somatoform disorders, bulimia nervosa, anger management, stress, substance use disorders, schizophrenia, depression, bipolar disorder, eating disorders, insomnia, personality disorders, criminal behavior, chronic pain, pregnancy complications, children, older adults, evidence base
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