Cognitive Behavioral Therapy (CBT) Efficacy:
Fact or Fiction?
Evidence on CBT in-effectiveness
These studies that show that in some cases CBT can be ineffective.
A systematic review of 6 RCTs in sleep disorders (particularly insomnia) for older adults, showed only a slight improvement for the CBT group (Montgomery & Dennis, 2003).
Goodyer et al. (2008) made an RCT for adolescents with major depression. The study compared treatment with SSRI (selective serotonin reuptake inhibitors) to treatment with SSRI + CBT. At 28 weeks after treatment, both groups showed significant improvement, but there was no significant difference between them. So CBT did not add any benefit to the drug treatment.
Trockel, Burg, Jaffe, Barbour, and Taylor (2008) conducted an RCT on myocardial infraction (MI) patients with depression, low perceived social support, or both, for smoking behavior. The study showed that CBT did not reduce smoking significantly in any of the groups.
Long term in-effectiveness of CBT
There are not many studies that examine the effectiveness of Cognitive Behavioral Therapy (CBT) 2-15 years after treatment. What we found is this:
Durham, Chambers, MacDonald, Power, and Major (2003) reviewed two RCTs in generalized anxiety disorder and found that people reported benefits from CBT at 8-14 years after treatment. But two years later, a team (consisting mostly of the same scientists) reviewed 8 RCTs on anxiety disorders and 2 RCTS on schizophrenia and found that the initial benefits of CBT disappeared at 2-14 years after treatment Durham et al. (2005).
An RCT on acute psychosis showed that, despite the initial benefits of CBT, when the researchers did a follow-up 4 years later, they found no difference between the CBT group and the control group, which had only received recreational activities and support (Drury, Birchwood, & Cochrane, 2000).
Westen D. and Novotny C., as cited in (Arkowitz & Lilienfeld, 2006), published an analysis on a number of efficacy studies for anxiety disorders and depression. Most of the therapies in these studies were CBT variants. 63% of anxiety patients and 51% of depression patients improved significantly. But many of those who improved still had symptoms, while others had not improved at all. The success rates dropped considerably when they included people who dropped out of therapy. Relapse rates were high, so 1-2 years after treatment, only 37% of the depressed patients remained improved.
CBT is not better than other forms of therapy
Many Studies show that CBT is not really more effective than other forms of therapy.
An RCT on chronic schizophrenia showed that people were improved at 2 years after treatment, but both the CBT and the SC (Supportive Counseling) group, had improved the same (Tarrier et al., 2000).
Tarrier et al. (2004) conducted an RCT on patients hospitalized for an acute episode of schizophrenia. The research showed that people had improved at 18 months after treatment. But again both the CBT and SC (Supportive Counseling) groups had the same improvement. Both SC and CBT failed to protect patients from re-hospitalization and relapse, as those groups performed essentially the same as the Treatment as Usual control group.
A systematic review of 6 RCTs on depression found no significant difference between CBT and Short Term Psychodynamic Psychotherapy (STPP) (Leichsenring 2001).
An RCT on myocardial infraction patients for depression showed that CBT was not better than Usual Care at 29 months after treatment (Berkman et al., 2003).
Beynon et al. (2008) published a systematic review of 5 RCTs for the prevention of relapse in bipolar disorder. In this study, 4 RCTs compared CBT with TAU (treatment as usual) and one RCT compared CBT with a waiting list control group. There was no significant benefit of CBT relative to TAU or waiting list control. One RCT showed that at 30 months follow-up, CBT was effective in preventing depressive relapses compared to TAU, but not effective in preventing manic relapses. Overall no evidence was found for the relative efficacy of CBT.
Price, Mitchell, Tidy, and Hunot (2008) made a systematic review of 15 RCTs on chronic fatigue syndrome. According to the study, CBT was more effective than UC (usual care) in reducing fatigue symptoms. At follow-ups 1-7 months after treatment, the CBT group continued to experience less fatigue. But when people who had dropped out of treatment were included, the CBT group showed no difference from the UC group. CBT was more effective than Relaxation Techniques, Counseling, and support/education at the end of treatment. But at follow-up, the results were inconsistent.A systematic review of 23 RCTs showed that Psychodynamic Psychotherapy is as effective as CBT, for specific psychiatric disorders (Leichsenring, & Leibing, 2007).
A. S. Petridis, Ph.D.
10 April 2009