How Effective is Cognitive Behavior Therapy?

CBT is widely used but how well it works is not clear

/ Author:  / Reviewed by: Joseph V. Madia, MD

In contrast to fancy intellectual European talk-therapy like psychoanalysis, Cognitive Behavior Therapy (CBT) has a practical, fairly straightforward, All-American flavor.

What are your problems? How do your thoughts affect your actions? Can you act more effectively by noticing how your thinking is related to your behavior and vice versa? CBT might help you, but the only way to find out is to try it.

CBT is among the most common-sense, easy to understand types of therapy in widespread use. No knowledge of biology or physiology is required to understand it. It's helpfulness does not depend on murky theories about unconscious motivations and drives.

Is it science? That depends on how one defines "science". Battles have raged for years about the scientific validity of various talk therapies. The question of how it fits in with our scientific understanding of the mind, brain and behavior should be regarded as distinct from how useful it is in clinical or medical contexts.

The discerning consumer wants to know: does it work?

What is Cognitive Behavior Therapy?

Patients have a "presenting complaint" that is the reason they are coming to visit the clinician. CBT sessions have the therapist and patient jointly explore this issue as well as other thoughts, feelings, emotions, worries, behavior, and activity. 

The therapist and the patient look at how the problem may be affected by or is a product of the result of unhelpful attitudes, thinking, actions and reactions to other's behavior. The patient hopefully gains self-knowledge and considers better and more practical ways to think feel and act. Dysfunctional, unhealthy thinking and actions can hopefully be improved in this fashion.

There are doubtless many contributors to CBT, but as a myth of origin, likely none involve a more compelling story that that of Albert Ellis.

As a young man growing up in the Depression, he found himself shy and insecure around women. While this is a common enough situation, his response was unusual.

Elllis resolved he would defeat his insecurities,  and steeled himself through willpower to ask female passersby in the park for a date. While one hundred women supposedly turned him down, he is said to have gotten over his insecurities in this fashion. He eventually married, and it was apparently a happy union.

Ellis used rationality to change his behavior and eventually got better results. His "experiment" with the ladies may not be science in a strict sense, yet it owes something to the tradition of scientists and philosophers who try to use reason to get better empirical results.

The Cognitive Behavior therapy developed by Ellis and others focuses on how thoughts and action affect our lives. While we cannot control every aspect of our lives to suit our preferences, nonetheless how we think and how we behave has real-world impact. Over time, this school of psychology and counseling has drawn adherents around the world. CBT has become one of medicine's primary talk-therapies.

CBT can complement the use of pharmaceuticals and other therapeutic options. Some patients may prefer the use of the combination of an antidepressant or anti-anxiety medication with a series of counseling sessions than either one alone.

Does it work? Should I use it?

How well does this style of talk therapy actually work? This is a matter of some controversy. There are a series of measurements and metrics that attempt to gauge the effectiveness of this method.

Dr. Andrew Butler and his team examined 16 "methodologically rigorous" review studies which had aggregated previous findings. Writing in the journal Clinical Psychology Review, they report that these and other data "support the efficacy of CBT for many disorders". Compared to control groups which received no treatments, they found that CBT had large beneficial effects on people suffering from the following:

-unipolar depression

-generalized anxiety disorder

-panic disorder with or without agoraphobia

-social phobia

-posttraumatic stress disorder

-childhood depressive and anxiety disorders.

The authors claim that multiple studies show moderately beneficial effect sizes when CBT is employed to treat marital distress, anger, childhood somatic disorders, and chronic pain. They also report data that shows CBT was "somewhat superior to antidepressants in the treatment of adult depression".

A complementary review published at the Cochrane Institute website, which specializes in evidence-based medicine and systematic reviews, found that "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. CBT was also very effective in reducing secondary symptoms of worry and depression."

A contrary perspective: CBT is not particularly useful

There are contrary voices on the subject. It is worth noting only one of the more recent and high-profile critiques of CBT.

At a 2008 conference organized by the "World Association for Person- Centered and Experiential Psychotherapy and Counselling", Professor Mick Cooper announced the following:

"The accumulated scientific evidence clearly points to three facts: 1) People show large changes over the course of psychotherapy, changes that are generally maintained after the end of therapy. 2) People who get therapy show substantially more change than people who don't get therapy, regardless of the type of therapy they get. 3) When established therapies are compared to one another in scientifically valid studies, the most common result is that both therapies are equally effective."

They go on to say that "In view of these and other data, it is scientifically irresponsible to continue to imply and act as though CBT's are more effective".

These are far from the only voices questioning the effectiveness of CBT as better than other talk therapies. Other researchers maintain that CBT is less effective than drugs. Those who want to make the most informed judgment can read through the back-and-forth. However, the discerning consumer should focus not on the technical disputes about data interpretation by experts (or "experts") but on whether they themselves can benefit. The only way to find this out is by trying. Unlike drugs, there are no side effects of talk therapy, though there is money and time involved.

Conclusion

Therapists working with the CBT method try to use the patient's own reflections on attitudes, beliefs, experiences, choices, feelings, emotions, life situations and problems to open up a range of options.

Informed consumers should take all of the above as only data points. Any individual person may respond better with a Jungian analysts' exploration of how a dream reveals humanity's "collective unconscious",  or drugs prescribed by a psychiatrist, or from supposedly "discredited" therapies like Freudian psychoanalysis or something else entirely.

Evidence based medicine and systematic reviews apply to groups but the particular client may very well find that they respond better to one therapist because of their demeanor, patience and intuition, regardless of what methodological framework or school of psychology they subscribe to.

Cognitive Behavior therapies do seem effective for quite a number of people. They do have the advantage of being non-pharmaceutical and not involving side-effects. Some patients may find combining CBT and drugs works the best.

Overall, a patient should take a critical, but not skeptical approach to talk therapies such as CBT or any other type of treatment. There is no way to no for sure whether or how well it might work without trying it.

That there is evidence showing this style of therapy is effective for many does not make it so for any one person. When it works, it might do so for reasons only partially understood by medical science theory. Each individual must decide whether this approach makes sense for them.

Reviewed by: 
Review Date: 
June 29, 2012