Are the benefits of cognitive-behavioral therapy massively oversold? That was the claim in a recent article in the Mail Online bearing the provocative title “CBT is a scam and a waste of money” featuring psychologist Oliver James (http://www.dailymail.co.uk/health/article-2828509/CBT-scam-waste-money-Popular-talking-therapy-not-long-term-solution-says-leading-psychologist.html). Because the article was intended for the general public and advances extremely strong assertions, it warrants a closer look. Let’s look at the evidence.
Cognitive-behavior therapy (CBT) is a structured psychotherapy. In contrast to some treatments, which can go on indefinitely, CBT tends to be time-limited. The approach has benefited countless clients suffering from a diverse array of problems, including major depression, anxiety disorders, posttraumatic stress disorder, psychological adjustment following medical procedures, eating disorders such as bulimia, and addictions; it can also be useful in general stress management. The scientific evidence for CBT is extensive, with hundreds of trials conducted over the past five decades that document the effectiveness of this approach for many of the disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). In two-year (or longer) follow-up studies for treatment trials for many forms of mental illness, clients treated with CBT remain as well as, or in some cases better, than they were when treatment ended. Indeed, data suggest that in contrast to medication, CBT has lasting benefits that extend beyond the intervention itself. Further, when compared with some traditional psychotherapies, such as psychodynamic therapies (treatments influenced by the theories and techniques of Freud and his followers), CBT is consistently associated with better outcomes for mood, anxiety, and eating disorders. Finally, because CBT is a short-term treatment, sufferers of psychological distress can enjoy relief far more rapidly than with most other psychotherapies.
Some proponents of traditional psychotherapies have long asserted that CBT merely provides a ‘quick fix,’ because the root causes of the illness are not resolved, clients supposedly remain at risk for re-developing the same mental illness, or related problems. This criticism overlooks a critical point: CBT is based on theories of mental illness that emphasize different causes than those depicted in traditional psychotherapies. As a result, the components of mental illness targeted in treatment with CBT are the root causes, but these are not the same as those targeted in other treatments, such as psychodynamic therapy. For example, a client seeking CBT for depression may be assisted in identifying and changing specific patterns of thinking that promote depressed mood. That is because the theory underlying CBT suggests that thinking style itself is a root cause of depression. In contrast, this same client might begin a quest to identify specific unconscious conflicts that give rise to depression while undergoing psychodynamic therapy. The difference in these root causes is also the difference in the time for treatment: With CBT treatment, relief would typically require three to four months, whereas treatment with psychodynamic psychotherapies would commonly require one or more years. Further, research has consistently failed to support the assertion that failure to address the root causes proposed by psychodynamic psychotherapies will lead to a re-emergence of symptoms, or the development of other symptoms.
When we consider the best research evidence, rather than which theory ‘feels right,’ the findings are compellingly in favor of CBT. As with all treatments, psychological or otherwise, some individuals will not benefit fully. On balance, however, CBT has been found to be superior to traditional psychotherapies, at least for mood, anxiety, and eating disorders.
Let’s now return to James’ strong criticisms of CBT. Contrary to Mr. James’ claim, extensive evidence shows clearly that children and adults treated with CBT for anxiety and depression typically remain well at 2-year follow-up, and several studies demonstrate that improvement is maintained as long as six years after treatment. Moreover, contrary to Mr. James’ assertion, CBT is consistently superior to placebo in treating anxiety and depression.
The Mail Online article leaves readers with the unsupported impression that the root causes posited by psychodynamic therapy are unquestionably valid, that CBT merely glosses over problems associated with mental illnesses rather than addresses their true causes, and that the benefits of CBT are only temporary. As we have seen, these criticisms are contradicted by research.
The Society for a Science of Clinical Psychology (SSCP) believes that conclusions regarding treatment effectiveness must be based on research evidence rather than opinions. Specifically, SSCP believes that the unsupported criticisms voiced in the Mail Online article, which neglect large bodies of data, can mislead the public into seeking ineffective or untested therapies, some of which may inadvertently prolong psychological distress. We believe that the public will be better served by the understanding that CBT is based on a fundamentally different model of mental illness than most traditional psychotherapies, and that the research evidence for CBT’s long-term effectiveness is compelling.
Ginsberg, G.S., Becker, E.M., Keeton, C.P., Sakolsky, D., Piacentini, J., Albano, A.M., Compton, S.N., …, & Kendall, P.C. (2014). Naturalistic follow-up of youths treated for pediatric anxiety disorders. JAMA Psychiatry, 71, 310-318.
Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36, 427-440.
The authors, including lead author Dr. Dean McKay, are members of the Public Education and Media Committee, which is part of the Society for a Science of Clinical Psychology (SSCP). SSCP is Section III of Division 12 of the American Psychological Association (APA), and an organizational affiliate of the Association of Psychological Science (APS), but we are writing on behalf of SSCP, not APA or APS.