This paper reviews a series of research studies examining cognitive-behavioral therapy (CBT) as a treatment for a wide range of psychological disorders. Drawing on quantitative studies addressing substance abuse relapse, eating disorders, PTSD, and effect-size measurement; qualitative studies exploring physical activity, anger management, couples therapy, conduct disorders, and child sexual abuse; a mixed methods review of CBT for major depressive disorder; and a program evaluation of school-based CBT interventions, the paper synthesizes findings across research traditions. The review concludes that CBT is a broadly effective, evidence-based treatment suitable for diverse populations, while acknowledging implementation challenges and the need for further research on complex presentations.
Cognitive-behavioral therapy (CBT) has become the treatment of choice for a wide range of psychological disorders, and its efficacy has been demonstrated by numerous quantitative, qualitative, and mixed methods studies (Spates & Pagoto, 2010). In order to develop a thorough understanding of CBT and its applications, this paper provides a review of a series of quantitative and qualitative research articles as well as a mixed methods study and a program evaluation. A summary of the research and important findings concerning CBT and its implications for practitioners are presented in the conclusion.
A study by Shafiei and Hoseini (2016) evaluated the use of CBT-based treatment on the coping strategies used by young adults with substance abuse problems who subsequently relapsed. Using a descriptive cross-sectional design, the researchers developed a sample of 70 young adult addicts (aged 18–24 years) who were self-referred to substance abuse treatment centers in Iran (Shafiei & Hoseini, 2016). These researchers used the Adolescence Relapse Coping Questionnaire to analyze the efficacy of different relapse coping strategies, and descriptive statistics were used to analyze the resulting data (Shafiei & Hoseini, 2016). Based on their analysis, Shafiei and Hoseini (2016) determined that nearly three-quarters (71.2%) of the respondents suffered a total relapse and resumed substance-abusing behaviors.
The coping skills employed by the respondents were shown to be effective in helping them overcome this setback and regain some control over their circumstances (Shafiei & Hoseini, 2016). In this regard, Shafiei and Hoseini (2016) conclude that "coping cognitive behavioral therapy helps individuals to recognize the difficult situation, avoid them in the right time and apply effective coping mechanisms. Teaching coping skills, changing reinforcement contingencies, and fostering motivation are some of the basic tasks in this approach" (p. 46). In sum, CBT-based interventions have widespread application notwithstanding cross-cultural differences (Shafiei & Hoseini, 2016).
The overarching objective of a study by Zainal and Renwick (2016) was to evaluate the quantitative treatment acceptability and credibility ratings of outpatients in an eating disorder treatment program at 12 months. Almost all of the 142 adult participants were women (98%), recruited between June 2010 and November 2012 from four UK-based treatment centers (Zainal & Renwick, 2016). The inclusion criteria required a DSM-IV-TR diagnosis of anorexia nervosa (AN) or eating disorder not otherwise specified AN type (EDNOS-AN), a body mass index (BMI) below 18.5 kg/m², no major mental or physical comorbidities requiring separate treatment, and no lower BMI limit provided participants were otherwise healthy (Zainal & Renwick, 2016).
These researchers used quantitative data generated by the Eating Disorders Examination (EDE), a semi-structured diagnostic interview that produces four subscale scores; the mean of these four subscales provides an overall global score, with higher scores reflecting more severe eating disorder psychopathology (Zainal & Renwick, 2016). The EDE has demonstrated reliability and validity, instruments were completed by trained clinicians, and inter-rater reliability was established throughout the data analysis (Zainal & Renwick, 2016).
The credibility and acceptability of two CBT-based treatment programs were evaluated by participants using a visual analog scale based on the following questions: (a) how acceptable did you find the type of treatment you received from your therapist during this study? and (b) to what extent do you feel that the treatment you received has helped you to reduce your eating disorder behaviors? Responses ranged from "not at all" and "completely unacceptable" to "very much so" and "completely acceptable" for participants' perceptions of the treatment program's credibility and acceptability, respectively (Zainal & Renwick, 2016). To improve consistent interpretation, the researchers provided participants with the definition of credibility as "the reduction of eating disorder behaviors to assess how the treatment has been effective" (Zainal & Renwick, 2016, p. 37).
The results showed that at 12 months post-randomization — following the completion of both weekly and follow-up treatment sessions — participants who received the Maudsley Anorexia Treatment for Adults (MANTRA) rated their treatment significantly higher in both credibility and acceptability compared to participants who received Specialist Supportive Clinical Management (SSCM) (Zainal & Renwick, 2016). Based on the analysis of the data, Zainal and Renwick (2016) conclude that the MANTRA treatment can be recommended over the SSCM for the treatment of anorexia nervosa.
The purpose of a study by Vannesi and Ninci (2015) was to describe the application and interpretation of quantitative data for calculating effect size resulting from CBT interventions. According to Vannesi and Ninci (2015), effect size is a quantitative measure that provides useful estimates concerning the meaningfulness of any changes associated with a given intervention. An important point made by these researchers is that "determining that a functional relationship exists between the counseling treatment and the outcome variable is recommended prior to calculating an effect size" (p. 403). It is also important to note that, in order to improve validity and generalize the findings of time series data — and to determine whether interventions rather than extraneous factors caused the observed change — more than a single patient must be studied (Vannesi & Ninci, 2015). For instance, Vannesi and Ninci point out that "if a counselor investigates the effect of [CBT] on reported client anxiety, the counselor may begin by taking repeated measures during a baseline period. The counselor will then introduce the treatment and continue data collection" (p. 404). The aggregated time series data then allows clinicians to calculate an effect size, but it will remain unclear whether any change was caused by the CBT intervention or an unknown factor such as the patient taking undisclosed medication (Vannesi & Ninci, 2015).
These researchers describe four indices: (a) the percent of nonoverlapping data (PND), (b) percent of data exceeding the median (PEM), (c) nonoverlap of all pairs (NAP), and (d) Tau-U, along with step-by-step guidelines for using these four indices in clinical settings (Vannesi & Ninci, 2015). The first step involves determining functional relationships, internal validity, and experimental control; the second step involves calculating the effect size; and the third step involves interpreting the resulting quantitative data. The authors conclude with considerations that must be taken into account when interpreting data from each of these indices and recommend graphing the data to identify patterns and including a confidence interval and p-value if the results are intended for publication (Vannesi & Ninci, 2015).
Finally, a quantitative analysis by Dorrepaal and Thomaes (2010) identified a total of seven studies satisfying their inclusion criteria — treatments that specifically targeted child abuse-related post-traumatic stress disorder (PTSD) or complex PTSD. These seven studies were meta-analyzed based on effect size, dropout, recovery, and improvement rates. Six of the selected studies involved CBT-based treatments while the seventh involved a person-centered therapy approach. The results showed that subjects suffering from child abuse-related PTSD experienced modest recovery and improvement rates using exposure treatments, but no comparable outcomes were achieved for child abuse-related complex PTSD (Dorrepaal & Thomaes, 2010). In addition, these researchers concluded that "limited evidence suggests that predominantly CBT treatments are effective, but do not suffice to achieve satisfactory end states, especially in complex PTSD populations" (Dorrepaal & Thomaes, 2010, p. 37). Based on their results, Dorrepaal and Thomaes (2010) recommend additional research examining direct comparisons between types of treatment for patients with complex PTSD in order to improve the generalizability of these findings.
The purpose of a study by Hendry and Solman (2010) was to provide a qualitative analysis of women's perceptions of barriers to and facilitators of physical activity based on different interventions, including CBT. According to Hendry and Solman (2010), research to date indicates that women who suffer from panic disorder report experiencing less depression when treated with CBT in combination with a home-based walking program compared to those who received CBT only. Using this research as background, Hendry and Solman (2010) report the results of a case study design and semi-structured interviews to investigate perceived facilitators and barriers to physical activity among three African-American and 17 European-American middle-aged women living in Louisiana who were self-referred for physical fitness purposes. Most of the women were college educated and all were regarded as upper middle class (Hendry & Solman, 2010).
The results of this qualitative analysis identified three main themes: (a) negotiations of ideal weight with the conventional medical establishment; (b) perceptions of menopause as causing hormone deficiencies that functioned as a barrier to exercise; and (c) negotiations of the socially imposed self in relation to cultural norms (Hendry & Solman, 2010). The implications of these findings for practitioners include incorporating social support services into exercise regimens and helping women who respond to body image dissatisfaction in positive ways through CBT-based interventions (Hendry & Solman, 2010).
A study by Karahan and Yalcin (2014) used qualitative focus groups with the goal of reviewing the beliefs, attitudes, and views of 32 university students concerning their anger management strategies during eight focus group discussion sessions. The students in the study group were provided with a 90-minute CBT-based anger management skills training program lasting 11 sessions (Karahan & Yalcin, 2014). The study group also attended two enhancement sessions at 3 and 6 months post-program termination (Karahan & Yalcin, 2014). The results showed that participants reported decreased anxiety and anger levels following completion of the CBT-based intervention, findings that were confirmed during both follow-up sessions (Karahan & Yalcin, 2014). Based on their analysis, the authors conclude that "our results indicate that our program not only improved the anger control and anxiety management skills of the participants for the short-term, but that this effect continued beyond this" (Karahan & Yalcin, 2014, p. 2072).
A qualitative study by Rautiainen and Aaltonen (2010) used narrative analysis to examine the effects of a CBT-based intervention on couples experiencing marital difficulties. The overarching objective was to provide guidance for practitioners concerning CBT-based couples therapy, based on the following research question: "How does the spouse of a depressed person take part in constructing narratives of depression in couple therapy?" (p. 156). The participants were drawn from Rautiainen's professional practice at a psychiatric outpatient clinic in the Department of Psychiatry, Kuopio University Hospital, Finland.
The study's exclusion criteria were comorbid cognitive impairment or psychosis with substance abuse; inclusion criteria required that participants be adults experiencing moderate to major depressive disorder who were married or in a cohabitating relationship (Rautiainen & Aaltonen, 2010). The study included three couples who had been referred to the clinic, a sample regarded as adequate for developing a systematic qualitative narrative analysis. Of these three couples, one individual had been diagnosed with recurrent depression and two others were diagnosed with major depression and were prescribed an antidepressant medication regimen (Rautiainen & Aaltonen, 2010). Both researchers are practicing therapists — Rautiainen is a psychologist and Aaltonen is a psychiatrist.
In phase one of the qualitative data analysis, full transcripts of 12 video-taped treatment sessions were reviewed repeatedly by the first researcher to become familiar with the overall text and to identify emerging themes and ideas. The same approach was used by the second researcher, and the findings were analyzed for points of congruence, which were then used to organize the data into topic segments. In phase two, the researchers used Atlas-ti, a commercial software application designed for qualitative data analysis, to identify recurring themes that were then translated into narratives. In this regard, Rautiainen and Aaltonen (2010) report that "the term narrative refers here to reconstructed representations of the stories of depression" (p. 157). The researchers also used a standard structure to develop narratives concerning the interaction between couples and therapists (Rautiainen & Aaltonen, 2010). The results of this qualitative study showed that CBT-based couples therapy is a beneficial intervention for both members of a couple, even when only one member is experiencing depression, because the therapy can provide the non-depressed individual with coping skills and knowledge needed to understand the experience of depression (Rautiainen & Aaltonen, 2010).
A study by Fixsen and Blase (2013) examines best evidence-based practices for various psychological disorders, including conduct disorders among youth. These researchers define evidence-based practices as "collections of practices that are done within known parameters (philosophy, values, service delivery structure, and treatment components) and with accountability to the consumers and funders of those practices" (p. 213). For instance, some evidence-based programs incorporate a wide array of interventions, including CBT and behavioral parent training for children with severe conduct disorders (Fixsen & Blase, 2013). Using a literature review, Fixsen and Blase (2013) describe challenges involved in implementing integrated CBT interventions, provide several examples of how these challenges can be overcome, and cite the need to ensure that evidence exists confirming that an intervention is effective when used as intended.
Finally, a study by Foster and Hagedorn (2014) emphasizes that child sexual abuse (CSA) represents a serious societal problem, with estimates indicating that between one in four girls and one in six boys are sexually abused before reaching the age of 18, yet cites a dearth of timely and relevant research concerning the CSA experience from victims' perspectives (Foster & Hagedorn, 2014). The purpose of this qualitative analysis of 21 narratives written during CBT-based therapy was to help fill this gap in the body of knowledge. The results identified an overarching meta-theme described as "Fear and Safety." In this regard, Foster and Hagedorn report that "children's descriptions of past and current fears and concerns about their safety and the safety of others were evident in all 21 narratives" (p. 244). The authors also describe efficacious CBT-based strategies that practitioners can use to treat fear and enhance the perception of safety among young people (Foster & Hagedorn, 2014).
"Mixed methods review of CBT for depression"
"CBT implementation challenges in public schools"
The research was consistent in showing that the quantitative, qualitative, mixed methods, and program evaluation studies reviewed all indicated that cognitive-behavioral therapy has become the treatment of choice for a wide range of psychological disorders among people of all ages, genders, and nationalities. Although every individual's counseling needs are unique, these attributes make CBT-based interventions a useful tool for virtually any counselor, especially those treating young people with conduct disorders or anxiety. Finally, the research also showed that implementing and evaluating the efficacy of CBT interventions can be challenging, but step-by-step recommendations are available to help guide the process.
You’re 82% through this paper. Sign up to read the remaining 2 sections.
Sign Up Now — Instant Access Already a member? Log inAlways verify citation format against your institution’s current style guide requirements.