“I finally took the step to contact a therapist, because I have been struggling with depression for a while now and I do believe that talking about my problems can help me. The therapist I talked with said that they offer ‘cognitive behavior therapy’ and that this is the standard therapy for depression. I have searched the internet and I saw that there are all kinds of other therapies. Is this therapy the best option for me, or is it better to try to find another therapy?”
What CBT actually is
Cognitive behavior therapy (CBT) is indeed by many considered to be the ‘gold standard’ in the treatment of depression. It is not one very specific type of therapy but it is better to consider it as a ‘family’ of therapies with many subtypes. In all subtypes, a technique called ‘cognitive restructuring’ is used. In this technique, clients learn to identify, challenge and change negative or distorted thought patterns. People with depression typically have a negative view on themselves, the world and the future. Cognitive restructuring helps them to change this.
Apart from cognitive restructuring, CBT can include several other techniques. One important technique that is also included in most subtypes of CBT is ‘behavioral activation’. This is aimed at helping clients to identify meaningful and enjoyable activities and to stimulate them to engage in them. People with depression often have too few of such activities in their life and engaging in them has shown to be able to reduce depression. CBT often includes other components as well, including for example problem-solving techniques, social skills training and mindfulness.
Is it really the best?
Although CBT is indeed considered by many to be the best therapy for depression, there is no evidence that it is more effective than other therapies. There are several types of therapy that have been examined in more than 10 well-designed effect studies (randomized controlled trials), including:
- Behavioral activation as a stand-alone therapy (without the cognitive restructuring)
- Problem-solving therapy as a stand-alone therapy
- Interpersonal psychotherapy, which is focused on improving interpersonal relationships and social functioning
- Brief psychodynamic therapy, aimed at enhancing the patient’s understanding, awareness and insight about repetitive conflicts
- Non-directive counseling, in which clients can explore thoughts and feelings in a non-judgmental and supportive environment
- Life review, specifically developed for older adults, in which they systematically go through their life course and learn how to evaluate that in a more positive way
There is no evidence that CBT is more effective than these other therapies.
So why the reputation?
CBT is often considered to be the best therapy for depression, not because it is more effective than other therapies, but because it has been examined so extensively. About half of all well-designed effect studies have examined it, while other therapies have been examined much less. That means that we know very much about the effects of CBT, groups for whom it works, the format, the setting where it is delivered, the combination with pharmacotherapy and many other things. That is less so for other therapies.
Which one is right for you?
Unfortunately, it is not known who will benefit from CBT and who will benefit from another therapy. There is currently no solution for that, meaning that it will be trial and error which therapy will work for each individual. There is research on preference of clients for specific therapies, but that does not show that the preferred therapy has better effects than therapies that are offered as a standard.
This means that there is no evidence that CBT is a better treatment than other therapies, but it has been examined extensively, and it is a good choice to start a treatment with.
Pim Cuijpers is professor emeritus of clinical psychology and scientific director of Metapsy. He has been involved in more than 1,100 scientific studies, mostly on psychological treatments of mental health problems. This is one of a series of evidence summaries in which Prof. Cuijpers tries to answer questions from patients and clinicians, based on what is known in science about treatments. The knowledge is mostly drawn from collective work of the Metapsy collaboration of at least 15 years. Do you have other questions you would like Prof. Cuijpers to discuss? Feel free to contact us.
Literature
- Cuijpers P, Miguel C, Ciharova M, Harrer M, Basic D, Cristea IA, et al. (2024). Absolute and relative outcomes of psychotherapies for eight mental disorders: a systematic review and meta-analysis. World Psychiatry, 23, 267–275.
- Cuijpers P, Miguel C, Harrer M, Plessen CY, Ciharova M, Papola D, Ebert D, Karyotaki E. (2023). Psychological treatment of depression: A systematic overview of a ‘Meta-Analytic Research Domain’. Journal of Affective Disorders, 335, 141–151.
- Cuijpers P, Quero S, Noma H, et al. (2021). Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types. World Psychiatry, 20, 283–293.
- Cuijpers P, Karyotaki E, de Wit L, Ebert DD. (2020). The effects of fifteen evidence-supported therapies for adult depression: A meta-analytic review. Psychotherapy Research, 30, 279–293.