Maybe you heard about it in a university lecture, maybe you've been through it yourself, or maybe you simply caught a glimpse of it on social media — either way, most readers who follow Treehole have probably come across CBT (cognitive behavioural therapy) in one form or another. In some people's eyes, CBT is the gold standard of modern psychotherapy, yet for others it just doesn't seem to work. So here's the question: is CBT really all that effective? And is it genuinely better than other forms of therapy?
What is cognitive behavioural therapy?
CBT emerged in the 1960s, when behaviourists merged the thought-focused cognitive therapy with behavioural therapy into a single approach, which later evolved into the CBT we know today. Strictly speaking, CBT isn't a single "therapy". It's more like Doraemon's magic pocket — full of different "therapeutic gadgets" for a therapist to choose from. To take a simple example, when treating a fear of vegetables (lachanophobia), a therapist might:
- draw out the patient's beliefs about vegetables in general, and help them reflect on the qualities of vegetables that they find frightening (this is the "cognitive" part);
- have the patient try interacting with different fruits and vegetables (this is the "behavioural" part)
In other words, the therapist works to change certain unhelpful thinking and behaviour patterns, reducing the patient's fear of vegetables. Of course, CBT in actual practice is far more involved than this.
The effectiveness and popularity of cognitive behavioural therapy
As far as effectiveness goes, CBT really is quite good [1]. As a psychotherapy built on rigorous, evidence-based scientific research, it has a fair number of randomised controlled trials behind it, finding that CBT can effectively treat common mood disorders (such as depression and anxiety) [2], psychiatric illnesses [3], and help with managing stress as well as resolving insomnia [4]. CBT is especially good at improving the symptoms of anxiety disorders — so much so that it can even outperform medication [1] [5]. With the literature on its side, it's only natural that more people come to trust CBT.
Another reason for CBT's popularity is that it's built on clear therapeutic techniques and principles, making it easier to standardise than psychotherapy in general [6]. This quality not only helps with researching CBT, it also benefits the training institutions that teach psychotherapy, along with insurance companies looking to keep medical reimbursements in check. So beyond its effectiveness, it's these additional factors that have driven CBT's spread.
But that's not the whole story. Bear in mind that saying CBT is "effective" doesn't mean it's the best choice. On effectiveness alone, some studies have found that CBT's results in treating depression are comparable to other psychotherapies (such as psychodynamic therapy) [7], while other studies have found that when treating certain mental illnesses, CBT falls short of other psychotherapies and medication.
Beyond effectiveness, we always need to take the individual therapist's ability into account too. Just as with the same magic pocket, the results are worlds apart in the hands of Gian versus Doraemon. So sometimes we can learn from Mr Miyagi and "pull the picture wider" — paying attention to a therapist's other qualities, such as whether they can build a good relationship with us and work alongside us towards our therapeutic goals. We believe this perspective will give you a more complete view of psychotherapy.
If you're interested in learning about mental health and picking up some practical knowledge, do look out for Treehole's upcoming online guided programmes. We'll be announcing them across our social media channels, so anyone who's interested, don't miss out~
*"Effective" means that participants in the relevant studies, after receiving the cognitive behavioural therapy required by that study, showed better treatment outcomes than the control group (for example, reduced symptoms or being assessed as recovered), and that the outcome reached statistical significance.
References
[1] 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
[2] Hofmann, S. G., & Smits, J. A. (2008). Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. The Journal of clinical psychiatry, 69(4), 621–632. https://doi.org/10.4088/jcp.v69n0415
[3] Zimmermann, G., Favrod, J., Trieu, V. H., & Pomini, V. (2005). The effect of cognitive behavioral treatment on the positive symptoms of schizophrenia spectrum disorders: a meta-analysis. Schizophrenia research, 77(1), 1–9. https://doi.org/10.1016/j.schres.2005.02.018
[4] Okajima, I., Komada, Y. & Inoue, Y. A meta-analysis on the treatment effectiveness of cognitive behavioral therapy for primary insomnia. Sleep Biol. Rhythms 9, 24–34 (2011). https://doi.org/10.1111/j.1479-8425.2010.00481.x
[5] https://www.apa.org/ptsd-guideline/patients-and-families/medication-or-therapy
[6] Gaudiano B. A. (2008). Cognitive-behavioural therapies: achievements and challenges. Evidence-based mental health, 11(1), 5–7. https://doi.org/10.1136/ebmh.11.1.5
[7] Beltman, M., Voshaar, R., & Speckens, A. (2010). Cognitive–behavioural therapy for depression in people with a somatic disease: Meta-analysis of randomised controlled trials. British Journal of Psychiatry, 197(1), 11-19. doi:10.1192/bjp.bp.109.064675
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