What kinds of anxiety and depression can it help with? Can it help manage pain? Can it help with Chronic Fatigue Syndrome? Does it still work if you’re older? How does it work and how can I access CBT if I need it?

So how effective is CBT? 

CBT is considered one of the most effective treatments for conditions which are anxiety or depression based. It can be as effective as medicine in treating depression and some other mental health problems. Depending on the condition, CBT can also be completed over a relatively short period of time (6 weeks to 6 months).

What kinds of anxiety and depression can CBT help with?

A 2012 review of the published evidence concluded the evidence was strongest for CBT helping with anxiety disorders, somatoform disorders (where mental factors such as stress cause physical symptoms), the eating disorder bulimia, anger control problems and general stress.

Further evidence for helping with eating disorders was indicated in an Australian study published in 2017.

A 2019 review of published evidence considered its use to treat depression in children and adolescents found that CBT was effective but that improvements were needed in the way CBT was provided, to enhance its effectiveness.

Work-focused CBT may also help people who are off work due to common mental health problems (such as anxiety and depression). That was the verdict of a study of 168 employees published in 2019.

Can it help manage pain?

‘Small to moderate benefits, more for disability, mood and catastrophic thinking than for pain, were found in trials which compared CBT with no treatment. Some of these were still positive six months later. ‘ That’s the verdict of a 2012 systematic review.

This suggests that CBT doesn’t significantly reduce the pain itself but can help provide useful coping skills and so help improve quality of life. For example during their treatment groups, individuals are taught to manage and cope with unexpected episodes of pain and how to deal with other challenging situations. 

Combining CBT with other approaches, such as physical exercise, appears to increase its effectiveness - according to a 10 year study published in 2016. 

Can it help with Insomnia?

It seems to be agreed that CBT can help with insomnia.  

Does it work if you’re older?

Most research has been conducted among working age adults. However, depression is a common problem facing older people and is often associated with loneliness, physical illness and pain - which may suggest some potential for CBT to help.

In 2009 a randomised control trial of 204 patients aged 65+ concluded, ‘Cognitive behavioural therapy is an effective treatment for older people with depressive disorder and appears to be associated with its specific effects.’

A 2011 review also noted, ‘many CBT programs for older adults do explicitly address physical health as well as spiritual and religious beliefs and behavior in the treatment.’

A 2014 review of published research concluded that CBT is likely to be efficacious in older people. And December 2014 saw the publication of CBT for Older People by Professor Ken Laidlaw.

It has even been suggested that CBT, by encouraging positive behaviour change, could reduce the risk of Alzheimer's - although this is a hypothesis that has yet to be tested. 

What does the most recent evidence suggest?

A 2016 analysis of the evidence suggests that the effectiveness of CBT for treating major depression, generalized anxiety disorder, panic disorder and social anxiety disorder may be small to moderate compared with care as usual or a pill placebo - but that the effect appears large compared with people on waiting lists for treatment.

Conversely, an earlier review of meta analyses, published in 2013, concluded, ‘In general the evidence base for CBT is very strong.’ It suggested the strongest evidence was for its effectiveness in treating anxiety disorders; mental illnesses that cause bodily symptoms, including pain; bulimia; anger control problems; and general stress. However, it noted one new point i.e. that more research is needed into specific subgroups, like ethnic minorities and people on low incomes. 

So how does CBT work and how can I access CBT if I need it? 

You can find out how CBT works and where it is available here.

Conclusions

• CBT is considered one of the most effective treatments for conditions which are anxiety or depression based, although the effects appear greatest when compared with people receiving no treatment rather than receiving other forms of treatment.
• In particular it appears to help with various forms of anxiety, depression, anger control, bulimia and general stress.
• Initial indications are that it can help even if you’re older.
• On its own it doesn’t seem to significantly reduce pain but it can make it easier to cope with pain - and combining CBT with other approaches, such as physical exercise, may increase its effectiveness.
• More research is needed into its effectiveness with people from ethnic minorities and people on low incomes.

Reviewed and updated by Miguel Rodrigues, March 2019.  Next review date February 2023.