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Cited by 27Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and ApplicationsPsychological Treatments and Assessments

Effect sizes of randomized-controlled studies of cognitive behavioral therapy for anxiety disorders over the past 30 years

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Hofmann, Stefan G., Kasch, Chantal, Reis, Andreas·2025·Clinical Psychology Review
DOI 10.1016/j.cpr.2025.102553
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Abstract

BACKGROUND: Cognitive-behavioral therapy (CBT) is an effective treatment for the range of anxiety disorders as demonstrated in many randomized controlled trials (RCTs) conducted over the past 30 years. OBJECTIVE: To examine the change of CBT effect sizes over time, we tested whether publication year was a significant moderator. DATA SOURCES: We pooled studies from three previously published meta-analyses and searched three electronic databases (PubMed, PsychINFO, Web of Science) to identify any additional studies published from February 1, 2022 to January 24, 2025. The final analysis included 49 studies comprising a total of 3645 participants. STUDY SELECTION: We selected RCTs comparing CBT for anxiety disorders with psychological or pill control conditions. DATA EXTRACTION: Two independent raters used predefined data fields, including study quality indicators. DATA SYNTHESIS: The mean effect size of all RCTs comparing CBT vs. controls revealed a Hedges' g of 0.51, 95 % CI [0.40, 0.62], with significant differences in effect sizes between the diagnostic groups. Uncontrolled pre-post effect size calculations revealed a large effect for CBT, Hedges' g = 1.18, 95 % CI [1.01, 1.34], and a medium effect for the control conditions, Hedges' g = 0.59, 95 % CI [0.47, 0.70]. A linear meta-regression of publication year on effect sizes (Hedges g) showed no significant change in effect sizes as compared to the control conditions over the span of the last 30 years (B = -0.008, SE = 0.006, t(47) = -1.18, p = 0.24). CONCLUSION: Although CBT is an effective treatment for anxiety disorders, the effect sizes did not increase over the last 3 decades. This calls for studies on the processes of treatment change to improve the efficacy of CBT.

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  • Emerging evidence from RCTs demonstrates sustained improvements in sleep efficiency, daytime functioning, and affective regulation with ACT, positioning it as a viable adjunct or alternative to CBT-I for patients with high anxiety sensitivity or emotional dysregulation.

    “Emerging evidence from RCTs further demonstrates sustained improvements in sleep efficiency, daytime functioning, and affective regulation, positioning ACT as a viable adjunct or alternative to traditional CBT-I for patients with high anxiety sensitivity or emotional dysregulation [81].”

    From Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice. (2026) · cites this paper as [81]

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Research works printed but not linked: 2

  1. Lucas, 1994, A comparative treatment outcome study of social phobia, Dissertation Abstracts International, 54, 6465
  2. Sterne, 2019, RoB2: A revised tool for assessing risk of bias in randomized trials, BMJ, 366, 14898

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Authors
Hofmann, S. G., Kasch, C., & Reis, A.
Affiliations
Philipps University of Marburg (DE)
Corresponding author
Hofmann, Stefan G.
ORCID
Venue
Clinical Psychology Review
Publisher
Elsevier BV
Published
2025-04
Volume
117
Pages
102553
ISSN
0272-7358 (ISSN-L)
DOI
10.1016/j.cpr.2025.102553
OpenAlex
W4407318881
Semantic Scholar
f514800e1eb469f012ad1f7c2e8725d9085255ad
Cited by
27
References
78
Citations by year
2026: 18 · 2025: 9
FWCI
3.50
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Psychology Review (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • Deutsche Forschungsgemeinschaft (521379614 \u2013 TRR 393SFB/Transregio 393)
  • Ministry for Science and Art Hessen
  • Alexander von Humboldt Foundation
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, anxiety disorders, effect size, publication year, treatment modification, psychotherapy efficacy, control conditions
MeSH terms
Anxiety Disorders, Humans, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Outcome Assessment, Health Care

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