While cognitive behavioral therapy (CBT) is an effective treatment for a range of mental health disorders, a meta-analysis issued this week in JAMA Psychiatry found that it is most effective for posttraumatic stress disorder (PTSD) and specific phobias, and potentially least effective for bipolar and psychotic disorders.
Pim Cuijpers, Ph.D., of Amsterdam Public Health Research Institute, and colleagues analyzed data from 375 randomized clinical trials comparing CBT with a control treatment such as a waiting list, usual care, or a placebo pill. The trials included 32,968 adults (average age 43 years, 68% female) who were diagnosed with one of the following: depressive disorder, PTSD, obsessive-compulsive disorder, psychotic disorder, bipolar disorder, an anxiety disorder (including panic disorder, generalized anxiety disorder, social anxiety disorder, and specific phobia), or an eating disorder (including anorexia nervosa, bulimia nervosa, and binge eating disorder).
While CBT was effective for all disorders, it was particularly effective for PTSD and specific phobias, which had effect sizes of 1.27 and 1.17, respectively. (Effect sizes are standardized values used to quantify changes such as symptom improvements, with values over 1 generally reflecting a very large change.) Bipolar disorder and psychotic disorders had the lowest effect sizes at .31 and .43, respectively. Effect sizes for the other disorders ranged from .84 for depressive disorder to .98 for obsessive-compulsive disorder.
The authors found that using waitlist control groups resulted in larger effect sizes than a control of usual care. This was an important distinction because most of the trials assessing bipolar and psychotic disorders employed usual care as the control group, which tended to vary from trial to trial and had a higher dropout rate than a waitlist control. This could potentially lead to an overestimation of the effect sizes for some disorders, the authors wrote.
“Although these findings confirm that CBT is effective in treating mental disorders, caution is needed because of considerable risk of bias, high levels of heterogeneity, and potential publication bias in several disorders,” the authors wrote.
For related information, see the Psychiatric News article “Brief CBT Interventions May Stop Depression Before It Starts.”
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