Cognitive Behavior Therapy for Mental Disorders in Adults: A Unified Series of Meta-Analyses

Pim Cuijpers; Mathias Harrer; Clara Miguel; Marketa Ciharova; Davide Papola; Djordje Basic; Cristina Botella; Ioana Cristea; Nino de Ponti; Tara Donker; Ellen Driessen; Pamela Franco; Irene Gómez-Gómez; Jessica Hamblen; Noelia Jiménez-Orenga; Eirini Karyotaki; Aaron Keshen; Jake Linardon; Emma Motrico; Minoo Matbouriahi; Olga M Panagiotopoulou; Rory A Pfund; Constantin Yves Plessen; Heleen Riper; Paula P Schnurr; Marit Sijbrandij; Marieke B J Toffolo; Lingyao Tong; Wouter van Ballegooijen; Els van der Ven; Annemieke van Straten; Yingying Wang; Toshi A Furukawa

doi:10.1001/jamapsychiatry.2025.0482

Cognitive Behavior Therapy for Mental Disorders in Adults: A Unified Series of Meta-Analyses

Pim Cuijpers, Mathias Harrer, Clara Miguel, Marketa Ciharova, Davide Papola, Djordje Basic, Cristina Botella, Ioana Cristea, Nino de Ponti, Tara Donker, Ellen Driessen, Pamela Franco, Irene Gómez-Gómez, Jessica Hamblen, Noelia Jiménez-Orenga, Eirini Karyotaki, Aaron Keshen, Jake Linardon, Emma Motrico, Minoo MatbouriahiOlga M Panagiotopoulou, Rory A Pfund, Constantin Yves Plessen, Heleen Riper, Paula P Schnurr, Marit Sijbrandij, Marieke B J Toffolo, Lingyao Tong, Wouter van Ballegooijen, Els van der Ven, Annemieke van Straten, Yingying Wang, Toshi A Furukawa

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

IMPORTANCE: Cognitive behavior therapy (CBT) is a first-line treatment for most mental disorders. However, no meta-analytic study has yet integrated the results of randomized clinical trials on CBT across different disorders, using uniform methodologies and providing a complete overview of the field.

OBJECTIVE: To examine the effect sizes of CBT for 4 anxiety disorders, 2 eating disorders, major depression, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and psychotic and bipolar disorders on symptoms of the respective disorders using uniform methodologies for data extraction, risk of bias (RoB) assessment, and meta-analytic techniques.

DATA SOURCES: Major bibliographical databases (PubMed, PsycINFO, and Embase for all disorders) were searched up to January 1, 2024, for each disorder separately. Data analysis was performed from August 2024 to January 2025.

STUDY SELECTION: Randomized clinical trials comparing CBT with inactive control conditions in adults with 1 of the mental disorders established through a clinical interview were included.

DATA EXTRACTION AND SYNTHESIS: Basic characteristics of patients, CBT, and studies were extracted. RoB was assessed with the Cochrane RoB tool 2. Meta-analyses were conducted using random-effects models.

MAIN OUTCOMES AND MEASURES: The primary outcome was the standardized mean difference (Hedges g) indicating the difference between CBT and controls at posttreatment on symptoms of the respective disorders.

RESULTS: A total of 375 trials (423 comparisons) between CBT and controls were included among 32 968 patients. The overall mean (SD) patient age was 43.4 (13.7) years, and the mean (SD) proportion of women was 0.68 (0.24). Effect sizes for CBT compared to all control conditions (g) were lower than 0.5 for bipolar and psychotic disorder; between 0.5 and 1.0 for panic, social anxiety, and generalized anxiety disorders, bulimia nervosa, binge eating disorders, depression, and OCD; and larger than 1.0 for PTSD and specific phobias (range of effect sizes: 0.31 for bipolar disorder to 1.27 for PTSD). Large effect sizes (g > 0.94) were observed in waitlist-controlled trials, a control condition mostly used in anxiety and eating disorders, PTSD, and OCD. Trials using care as usual showed more modest effect sizes (0.22-1.13). Study dropout rates within the CBT conditions ranged from 8% for specific phobia to 24% for PTSD.

CONCLUSIONS AND RELEVANCE: In this unified series of meta-analyses, CBT was probably effective in the treatment of mental disorders, including major depression, anxiety disorders, PTSD, OCD, and eating disorders, and possibly effective in psychotic and bipolar disorders. However, the effect sizes depended on the type of control condition.

Original language	English
Journal	JAMA Psychiatry
DOIs	https://doi.org/10.1001/jamapsychiatry.2025.0482
Publication status	E-pub ahead of print - 16 Apr 2025

Funding

Conflict of Interest Disclosures: Dr Harrer reported being a part-time employee of Get.On Institut f\u00FCr Gesundheitstrainings GmbH/HelloBetter, a company that provides digital therapeutics for mental health problems in routine care. Dr Papola reported grants from the European Union Horizon research program (Horizon-MSCA-2021-PF-01) under agreement N 101061648 outside the submitted work. Dr Driessen reported grants from the American Psychoanalytic Association and the Dutch Psychoanalytic Funds outside the submitted work. Dr Franco reported a PhD scholarship from the Agencia Nacional de Investigaci\u00F3n y Desarrollo (Chile) and postdoctoral funding from the Instituto de Investigaci\u00F3n en Depresi\u00F3n y Personalidad MIDAP, Pontificia Universidad Cat\u00F3lica de Chile, outside the submitted work. Dr Schnurr reported grants from Healing Breakthrough outside the submitted work. Dr Furukawa reported personal fees from Boehringer Ingelheim, Daiichi Sankyo, DT Axis, Micron Technology, Shionogi, SONY, and UpToDate; grants from DT Axis and Shionogi outside the submitted work; and a patent issued (7448125), a patent pending (2022-082495), and a patent for intellectual properties for Kokoro-app licensed to Mitsubishi Tanabe Pharma. No other disclosures were reported.

Funders	Funder number
American Psychoanalytic Association
Boehringer Ingelheim
Agencia Nacional de Investigación y Desarrollo
Daiichi
Pontificia Universidad Católica de Chile
Instituto de Investigación en Depresión y Personalidad MIDAP
European Union Horizon research program	Horizon-MSCA-2021-PF-01, 101061648
UpToDate	2022-082495, 7448125

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Cuijpers, P., Harrer, M., Miguel, C., Ciharova, M., Papola, D., Basic, D., Botella, C., Cristea, I., de Ponti, N., Donker, T., Driessen, E., Franco, P., Gómez-Gómez, I., Hamblen, J., Jiménez-Orenga, N., Karyotaki, E., Keshen, A., Linardon, J., Motrico, E., ... Furukawa, T. A. (2025). Cognitive Behavior Therapy for Mental Disorders in Adults: A Unified Series of Meta-Analyses. JAMA Psychiatry. Advance online publication. https://doi.org/10.1001/jamapsychiatry.2025.0482

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title = "Cognitive Behavior Therapy for Mental Disorders in Adults: A Unified Series of Meta-Analyses",

abstract = "IMPORTANCE: Cognitive behavior therapy (CBT) is a first-line treatment for most mental disorders. However, no meta-analytic study has yet integrated the results of randomized clinical trials on CBT across different disorders, using uniform methodologies and providing a complete overview of the field.OBJECTIVE: To examine the effect sizes of CBT for 4 anxiety disorders, 2 eating disorders, major depression, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and psychotic and bipolar disorders on symptoms of the respective disorders using uniform methodologies for data extraction, risk of bias (RoB) assessment, and meta-analytic techniques.DATA SOURCES: Major bibliographical databases (PubMed, PsycINFO, and Embase for all disorders) were searched up to January 1, 2024, for each disorder separately. Data analysis was performed from August 2024 to January 2025.STUDY SELECTION: Randomized clinical trials comparing CBT with inactive control conditions in adults with 1 of the mental disorders established through a clinical interview were included.DATA EXTRACTION AND SYNTHESIS: Basic characteristics of patients, CBT, and studies were extracted. RoB was assessed with the Cochrane RoB tool 2. Meta-analyses were conducted using random-effects models.MAIN OUTCOMES AND MEASURES: The primary outcome was the standardized mean difference (Hedges g) indicating the difference between CBT and controls at posttreatment on symptoms of the respective disorders.RESULTS: A total of 375 trials (423 comparisons) between CBT and controls were included among 32 968 patients. The overall mean (SD) patient age was 43.4 (13.7) years, and the mean (SD) proportion of women was 0.68 (0.24). Effect sizes for CBT compared to all control conditions (g) were lower than 0.5 for bipolar and psychotic disorder; between 0.5 and 1.0 for panic, social anxiety, and generalized anxiety disorders, bulimia nervosa, binge eating disorders, depression, and OCD; and larger than 1.0 for PTSD and specific phobias (range of effect sizes: 0.31 for bipolar disorder to 1.27 for PTSD). Large effect sizes (g > 0.94) were observed in waitlist-controlled trials, a control condition mostly used in anxiety and eating disorders, PTSD, and OCD. Trials using care as usual showed more modest effect sizes (0.22-1.13). Study dropout rates within the CBT conditions ranged from 8% for specific phobia to 24% for PTSD.CONCLUSIONS AND RELEVANCE: In this unified series of meta-analyses, CBT was probably effective in the treatment of mental disorders, including major depression, anxiety disorders, PTSD, OCD, and eating disorders, and possibly effective in psychotic and bipolar disorders. However, the effect sizes depended on the type of control condition.",

author = "Pim Cuijpers and Mathias Harrer and Clara Miguel and Marketa Ciharova and Davide Papola and Djordje Basic and Cristina Botella and Ioana Cristea and {de Ponti}, Nino and Tara Donker and Ellen Driessen and Pamela Franco and Irene G{\'o}mez-G{\'o}mez and Jessica Hamblen and Noelia Jim{\'e}nez-Orenga and Eirini Karyotaki and Aaron Keshen and Jake Linardon and Emma Motrico and Minoo Matbouriahi and Panagiotopoulou, {Olga M} and Pfund, {Rory A} and Plessen, {Constantin Yves} and Heleen Riper and Schnurr, {Paula P} and Marit Sijbrandij and Toffolo, {Marieke B J} and Lingyao Tong and {van Ballegooijen}, Wouter and {van der Ven}, Els and {van Straten}, Annemieke and Yingying Wang and Furukawa, {Toshi A}",

year = "2025",

month = apr,

day = "16",

doi = "10.1001/jamapsychiatry.2025.0482",

language = "English",

journal = "JAMA Psychiatry",

issn = "2168-622X",

publisher = "American Medical Association",

}

Cuijpers, P , Harrer, M , Miguel, C , Ciharova, M, Papola, D, Basic, D, Botella, C, Cristea, I, de Ponti, N , Donker, T, Driessen, E, Franco, P, Gómez-Gómez, I, Hamblen, J, Jiménez-Orenga, N, Karyotaki, E, Keshen, A, Linardon, J, Motrico, E, Matbouriahi, M, Panagiotopoulou, OM, Pfund, RA, Plessen, CY, Riper, H, Schnurr, PP, Sijbrandij, M , Toffolo, MBJ , Tong, L , van Ballegooijen, W , van der Ven, E , van Straten, A, Wang, Y & Furukawa, TA 2025, 'Cognitive Behavior Therapy for Mental Disorders in Adults: A Unified Series of Meta-Analyses', JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2025.0482

TY - JOUR

T1 - Cognitive Behavior Therapy for Mental Disorders in Adults

T2 - A Unified Series of Meta-Analyses

AU - Cuijpers, Pim

AU - Harrer, Mathias

AU - Miguel, Clara

AU - Ciharova, Marketa

AU - Papola, Davide

AU - Basic, Djordje

AU - Botella, Cristina

AU - Cristea, Ioana

AU - de Ponti, Nino

AU - Donker, Tara

AU - Driessen, Ellen

AU - Franco, Pamela

AU - Gómez-Gómez, Irene

AU - Hamblen, Jessica

AU - Jiménez-Orenga, Noelia

AU - Karyotaki, Eirini

AU - Keshen, Aaron

AU - Linardon, Jake

AU - Motrico, Emma

AU - Matbouriahi, Minoo

AU - Panagiotopoulou, Olga M

AU - Pfund, Rory A

AU - Plessen, Constantin Yves

AU - Riper, Heleen

AU - Schnurr, Paula P

AU - Sijbrandij, Marit

AU - Toffolo, Marieke B J

AU - Tong, Lingyao

AU - van Ballegooijen, Wouter

AU - van der Ven, Els

AU - van Straten, Annemieke

AU - Wang, Yingying

AU - Furukawa, Toshi A

PY - 2025/4/16

Y1 - 2025/4/16

N2 - IMPORTANCE: Cognitive behavior therapy (CBT) is a first-line treatment for most mental disorders. However, no meta-analytic study has yet integrated the results of randomized clinical trials on CBT across different disorders, using uniform methodologies and providing a complete overview of the field.OBJECTIVE: To examine the effect sizes of CBT for 4 anxiety disorders, 2 eating disorders, major depression, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and psychotic and bipolar disorders on symptoms of the respective disorders using uniform methodologies for data extraction, risk of bias (RoB) assessment, and meta-analytic techniques.DATA SOURCES: Major bibliographical databases (PubMed, PsycINFO, and Embase for all disorders) were searched up to January 1, 2024, for each disorder separately. Data analysis was performed from August 2024 to January 2025.STUDY SELECTION: Randomized clinical trials comparing CBT with inactive control conditions in adults with 1 of the mental disorders established through a clinical interview were included.DATA EXTRACTION AND SYNTHESIS: Basic characteristics of patients, CBT, and studies were extracted. RoB was assessed with the Cochrane RoB tool 2. Meta-analyses were conducted using random-effects models.MAIN OUTCOMES AND MEASURES: The primary outcome was the standardized mean difference (Hedges g) indicating the difference between CBT and controls at posttreatment on symptoms of the respective disorders.RESULTS: A total of 375 trials (423 comparisons) between CBT and controls were included among 32 968 patients. The overall mean (SD) patient age was 43.4 (13.7) years, and the mean (SD) proportion of women was 0.68 (0.24). Effect sizes for CBT compared to all control conditions (g) were lower than 0.5 for bipolar and psychotic disorder; between 0.5 and 1.0 for panic, social anxiety, and generalized anxiety disorders, bulimia nervosa, binge eating disorders, depression, and OCD; and larger than 1.0 for PTSD and specific phobias (range of effect sizes: 0.31 for bipolar disorder to 1.27 for PTSD). Large effect sizes (g > 0.94) were observed in waitlist-controlled trials, a control condition mostly used in anxiety and eating disorders, PTSD, and OCD. Trials using care as usual showed more modest effect sizes (0.22-1.13). Study dropout rates within the CBT conditions ranged from 8% for specific phobia to 24% for PTSD.CONCLUSIONS AND RELEVANCE: In this unified series of meta-analyses, CBT was probably effective in the treatment of mental disorders, including major depression, anxiety disorders, PTSD, OCD, and eating disorders, and possibly effective in psychotic and bipolar disorders. However, the effect sizes depended on the type of control condition.

AB - IMPORTANCE: Cognitive behavior therapy (CBT) is a first-line treatment for most mental disorders. However, no meta-analytic study has yet integrated the results of randomized clinical trials on CBT across different disorders, using uniform methodologies and providing a complete overview of the field.OBJECTIVE: To examine the effect sizes of CBT for 4 anxiety disorders, 2 eating disorders, major depression, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and psychotic and bipolar disorders on symptoms of the respective disorders using uniform methodologies for data extraction, risk of bias (RoB) assessment, and meta-analytic techniques.DATA SOURCES: Major bibliographical databases (PubMed, PsycINFO, and Embase for all disorders) were searched up to January 1, 2024, for each disorder separately. Data analysis was performed from August 2024 to January 2025.STUDY SELECTION: Randomized clinical trials comparing CBT with inactive control conditions in adults with 1 of the mental disorders established through a clinical interview were included.DATA EXTRACTION AND SYNTHESIS: Basic characteristics of patients, CBT, and studies were extracted. RoB was assessed with the Cochrane RoB tool 2. Meta-analyses were conducted using random-effects models.MAIN OUTCOMES AND MEASURES: The primary outcome was the standardized mean difference (Hedges g) indicating the difference between CBT and controls at posttreatment on symptoms of the respective disorders.RESULTS: A total of 375 trials (423 comparisons) between CBT and controls were included among 32 968 patients. The overall mean (SD) patient age was 43.4 (13.7) years, and the mean (SD) proportion of women was 0.68 (0.24). Effect sizes for CBT compared to all control conditions (g) were lower than 0.5 for bipolar and psychotic disorder; between 0.5 and 1.0 for panic, social anxiety, and generalized anxiety disorders, bulimia nervosa, binge eating disorders, depression, and OCD; and larger than 1.0 for PTSD and specific phobias (range of effect sizes: 0.31 for bipolar disorder to 1.27 for PTSD). Large effect sizes (g > 0.94) were observed in waitlist-controlled trials, a control condition mostly used in anxiety and eating disorders, PTSD, and OCD. Trials using care as usual showed more modest effect sizes (0.22-1.13). Study dropout rates within the CBT conditions ranged from 8% for specific phobia to 24% for PTSD.CONCLUSIONS AND RELEVANCE: In this unified series of meta-analyses, CBT was probably effective in the treatment of mental disorders, including major depression, anxiety disorders, PTSD, OCD, and eating disorders, and possibly effective in psychotic and bipolar disorders. However, the effect sizes depended on the type of control condition.

U2 - 10.1001/jamapsychiatry.2025.0482

DO - 10.1001/jamapsychiatry.2025.0482

M3 - Article

C2 - 40238104

SN - 2168-622X

JO - JAMA Psychiatry

JF - JAMA Psychiatry

ER -

Cognitive Behavior Therapy for Mental Disorders in Adults: A Unified Series of Meta-Analyses

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