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Paper

The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses

Also known as Hofmann et al. (2012), Hofmann et al., 2012, The Efficacy of CBT: A Review of Meta-analyses

Hofmann and colleagues' 2012 survey of 106 meta-analyses of CBT, problem by problem

At a glance

Also on this page: Key facts · Links · Sources · Related pages

Why it matters

Key facts

Authors
Stefan G. Hofmann, Anu Asnaani, Imke J. J. Vonk, Alice T. Sawyer, Angela Fang (Boston University)2
Published
2012 (online 31 July 2012)2
Journal
Cognitive Therapy and Research, 36(5): 427–4402
DOI
10.1007/s10608-012-9476-11
PubMed / PMC
PMID 23459093; PMC35845801
Design
Review of meta-analyses: PubMed, PsycInfo and Cochrane searched; 269 meta-analyses since 2000 found, 106 reviewed2
Main result
CBT had higher response rates than comparison conditions in 7 of 11 reviews; lower in only one (personality disorders)1
Response rates
CBT 38% (OCD) to 82% (body dysmorphic disorder); waitlist 2% to 14%2
Cited by
1,514 articles indexed by Europe PMC1

What it found

  1. Anxiety: a reliable first-line approach2

    Medium to large effects for social anxiety, moderate for panic, large for specific phobia and OCD; for PTSD, equal to EMDR.

  2. Depression: clearly better than nothing2

    Medium effect against waitlist or no treatment; against other active treatments CBT was often equivalent, sometimes better.

  3. Somatoform disorders and insomnia2

    Large effects for hypochondriasis and body dysmorphic disorder; CBT for insomnia long shown better than control treatments.

  4. Weaker areas2

    Small effects against other psychosocial treatments in substance use; little effect on relapse or hospitalisation in psychosis.

  5. Personality disorders2

    Psychodynamic therapy had a larger overall effect, with response rates of 59% against CBT's 47%, though self-report measures favoured CBT.

  6. Children and older adults2

    Large effects for childhood anxiety; mixed for externalising problems and ADHD, where CBT was not better than medication.

Key ideas

  1. A review of reviews1

    Instead of single trials, it summarises meta-analyses, so each finding already pools many studies.

  2. Efficacy differs by problem2

    The evidence is very strong overall but questionable for some problems, so CBT strategies still need improving.

  3. Policy argument2

    The authors argue for wider use of CBT as a first-line treatment, citing England's Improving Access to Psychological Therapies programme.

Criticism and limits

  1. Weak underlying studies2

    Many included meta-analyses had small samples or inadequate control groups, and some lumped CBT with other therapies.

  2. Possible overestimates2

    Publication bias may inflate effects; long-term follow-up data are scarce.

  3. Few head-to-head comparisons2

    Relative efficacy against other active treatments remains uncertain for several disorders.

  4. Missing groups1

    Apart from children and older adults, no meta-analyses looked at subgroups such as ethnic minorities or low-income samples.

Connections

Written by

  • Stefan G. Hofmann
  • Anu Asnaani
  • Imke J. J. Vonk
  • Alice T. Sawyer
  • Angela Fang

Related

Sources

  1. Europe PMC: The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses (record and abstract) (opens europepmc.org)
  2. PMC full text: Hofmann et al. (2012), The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses (opens pmc.ncbi.nlm.nih.gov)

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