Evidence


It has been shown in large-scale analyses of analyses (known as meta-analysis) that the evidence base for CBT for a range of disorders is ‘very strong’(Hoffman, Asnaani, Vonk, Sawyer & Fang; 2012). Hoffman and his colleagues showed that from the 106 studies considered (vetted from 269), there was support for the treatment of a large range of conditions. These included: ‘depression and dysthymia, bipolar disorder, anxiety disorders, somatoform disorder, eating disorders, insomnia, personality disorder, anger and aggression, criminal behaviours, general stress, distress due to medical conditions, chronic pain and fatigue, distress related to pregnancy complications and female hormonal conditions.’

Earlier studies have shown from analysing the data that CBT is effective (there are large effect sizes) for the treatment of: ‘unipolar depression, generalized anxiety disorder, panic disorder with or without agoraphobia, social phobia, post-traumatic stress disorder, and childhood depressive and anxiety disorders’ (Butler, Chapman, Forman & Beck; 2006)

CBT is the most widely evidenced psychological therapy and we believe it is important to deliver applications that are ethical and that are consistent with the evidence base. We thought that it would be helpful to show how effective CBT is. We have done this in the table below:

Condition Evidence Summary  
Depression The National Institute for Health and Care Excellence, a body independent from the government in England, recommends CBT as either a first line or combination treatment for depression (CG 90). The intensity of the treatment varies based upon the severity of the depressive symptoms. Link
Cuijpers et al (2013) stated from their analysis of 115 studies, that there ‘is no doubt that CBT is an effective treatment for adult depression’. However, they did wish to emphasise that it did not differ greatly from other psychotherapeutic interventions nor medication, this is important, because it highlights the importance of undertaking the intervention. Link
It is increasingly recommended that we utilise computerised CBT to support the treatment of depression. Link
It was found that CBT is more effective for reducing depression than relaxation techniques alone. Link
When psychological therapies were compared, it was found that they were as effective as one another in the treatment of depression. They reviewed 25 studies in this analysis. Link
Seven small trials were reviewed (totalling 153 participants); showed CBT was more effective than the control group for older adults. However, it may not be helpful to generalise to specific populations. Link
Anxiety This meta-analysis (looking at 41 studies) demonstrates the efficacy of CBT with young people when compared with no treatment. There is no difference between any active therapy with children, whether this is self-help or with a therapist. Link
This meta-analysis identified 92 studies, the analysis showed that CBT was moderately helpful and was more helpful than no treatment. Self-help appeared to still be effective but is more helpful with the support of a therapist. Link
NICE introduced public health guidance (PH 19) recommending that in relation to long-term sickness absence from work, CBT can be helpful and should be considered in line with the recommendations for depression (CG 90) and anxiety (CG 113). Link
Social Phobia (Social Anxiety Disorder) Cognitive Behavioural Therapy is the treatment of choice as recommended by NICE (CG159) and guidelines state that CBT should be offered as a first line treatment. Offer adults with social anxiety disorder individual CBT that has been specifically developed to treat social anxiety disorder, based on the Clark and Wells model or the Heimberg model. Link
Systematic review of 27 studies indicated that CBT is efficacious in the treatment for people with Social Anxiety; however, they noted that there was room for improvement. Link
This systematic review showed the CBT had a large effect size (was effective) when summarising 16 meta-analyses (analyses of analyses). This included Social Phobia. Link
The BBC recently reported on a large-scale analysis of 101 clinical trials which found that “cognitive behaviour therapy (CBT) on a one-to-one basis was the most effective”. Link
Generalised Anxiety Disorder CBT is recommended in varying intensity as a treatment approach for Generalised Anxiety Disorder: Link
This meta-analysis (looking at 25 studies) reported the efficacy of CBT with people who suffer from Generalised Anxiety Disorder. “People attending for psychological therapy based on a CBT approach were more likely to have reduced anxiety at the end of treatment than people who received treatment as usual or were on a waiting list for therapy.” Link
Obsessive Compulsive Disorder (OCD) NICE (National Institute for Health and Care Excellence), recommend within their guidelines (CG 31) that Cognitive Behavioural Therapy (comprising of Exposure and Response Prevention; ERP) is effective in reducing the impact of OCD and is a recommended treatment. Link
This provides support for the use of CBT to treat OCD in adolescents and children. This meta-analysis (looking at 8 studies) showed that CBT was as effective as medication in reducing symptoms and when they were both combined, they were even more effective. Link
Panic Disorder (with or without Agoraphobia) CBT is considered the most effective form of intervention for Panic Disorder by NICE (CG113): Link
Post-Traumatic Stress Disorder (PTSD) The National Institute of Health and Care Excellence has identified that Trauma-focused CBT or EMDR are the best approaches (CG 26). Link
This meta-analysis (looking at 70 studies) continues to support the efficacy of Trauma-focused CBT. The study showed that non-trauma focused CBT (generic) is as effective in the first one to four months following treatment. But for long-term gains, trauma focused CBT and EMDR (eye movement desensitisation and reprocessing) are most effective. Link
Can be helpful in debriefing from traumatic incidents, but treat with caution due to the biases inherent in the studies. Link
Health Anxiety/Hypochondriasis A review of 6 studies showed that CBT was more effective for the reduction of hypochondriasis than no treatment. However, there were relatively few studies in this case and there may be other factors that facilitate this reduction. Link
Chronic Fatigue Syndrome The this meta-analysis (which reviewed 15 studies), this showed that people who completed CBT were more likely to have less fatigue at the end of treatment when compared with no treatment, or other techniques (such as relaxation, counselling and support/education). However, it is also suggested that we don’t know enough at present to draw firm conclusions. Link
Disordered Eating CBT for bulimia nervosa was found to be better than other forms of psychotherapy and it was better than no treatment at all for the reduction of binge eating. However, more trials are likely to be beneficial. Link
This shows a reduction in absolute risk when using Cognitive Behavioural Therapy and/or medication; at the moment there are not enough studies to tease out the differences between them. But it was clear that psychological therapy was more acceptable for the people involved. Link