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Why is CBT (Cognitive Behavioral Therapy) only Half as Effective as it Used to Be? Are We Ready for a New Paradigm?

by Craig Weiner

A recent meta-analysis (May 2015) by Johnsen, T. J., & Friborg, O. has raised quite a stir. Their research paper analyzed 70 studies conducted between 1977 and 2014, and concluded that CBT is roughly half as effective in treating depression as it used to be. Articles by Vaughan Bell in the blog, MindHacks, and by Olver Burkeman of The Guardian, recently offered some intriguing perspectives on the results of this large-scale analysis.

Cognitive Behavioral Therapy

The coalescing of cognitive and behavioral therapies formalized as CBT in the early 1970s. CBT, is characterized by a form of psychotherapy aimed at modifying not only overt behaviors but also beliefs, attitudes, cognitive styles and expectations of the client (Galeazzi & Meazzini, 2004). CBT has had hundreds if not thousands of studies performed evaluating its effectiveness and it has become the “workhorse” and most accepted model of emotional and psychological psychotherapeutic intervention, accepted ubiquitously in institutions and for insurance reimbursement.
This new study explores the effectiveness of CBT specifically for depression and finds its effectiveness to have significantly decreased over time. The big question is why. Vaughn Bell suggests that “the reasons for the declining treatment effects over time are also likely to include different types of patients selected into trials, more methodologically sound research practices meaning less chance of optimistic measuring and reporting.” In other words newer studies, with experience are able to more accurately measure an intervention’s effectiveness.

Other Explanations:

Burkeman raises the following points:
1. That as any therapy grows more popular, the proportion of inexperienced or incompetent therapists grows bigger.
2. The second is that there is often a strong placebo effect that is at play with a new intervention, subject to a lessening of effectiveness as its new “miraculous” capacities wear off over time.
3. Our expectations have become more realistic, so effectiveness has fallen, too. He mentions that the study authors even worry that their own paper will make matters worse by further lowering people’s expectations.
4. Finally, and most intriguing to me is his idea that perhaps CBT has served its purpose for a generation that it was effective for but that as an intervention it has begun to outlive its usefulness.

A Paradigm Shift

The idea that an intervention may have to adapt, as the population it is used on changes over time is a fascinating concept. As a chiropractor I have often heard it spoken that in the early 1900’s, chiropractic adjustments regularly had dramatic effects on altering patient’s health, finding often unheard of immediate resolution to hearing loss, angina, digestive disorders and auto-immune conditions. While I have seen and hear of sporadic miraculous cases, it no longer seems to occur at the frequency that it once did. Speculations have unofficially abounded as to the lessening of nutrients in our soil and alteration of our food and diet, the increase accumulated stress of our busy lifestyle, etc.
So what if….what if the paradigm of the general acceptance of a more mind-body-energy, inter-connected, integrated perspective of health and well-being has reached such a tipping point that interventions must know acknowledge and adapt to this new understanding to be effective? Is this a window of opportunity that suggests that innovations such as mindfulness and somato-emotional techniques like EFT (Emotional Freedom Techniques), other Energy Psychology Methods (like TFT, EMDR and others), TRE and others may prove to be the next most-effective “therapy”?
These are interesting times. Having just asked Robert Scaer, MD, author of The Body Bears the Burden, what was his degree of hopefulness in seeing a shift in the traditional medical and psychotherapeutic towards a more holistic and integrated body-mind approach, he responded that he is extremely encouraged by the attention that this paradigm is now receiving. So am I.

1. Bell, Vaughan, CBT is Becoming Less Effective, Like Everything Else. July 8, 2015 blog MindHacks, https://wp.me/ptsTD-8m8.
2. Burkeman, Oliver. Why CBT is Falling Out of Favor, July 3, 2015 The Guardian, US edition, https://www.theguardian.com/lifeandstyle/2015/jul/03/why-cbt-is-falling-out-of-favour-oliver-burkeman
3. Johnsen, T. J., & Friborg, O. (2015, May 11). The Effects of Cognitive Behavioral Therapy as an Anti-Depressive Treatment is Falling: A Meta-Analysis. Psychological Bulletin. Advance online publication. https://dx.doi.org/10.1037/bul0000015