Is cognitive behavior therapy the gold standard of psychotherapy?

By Sarah Handzel, BSN, RN | Medically reviewed by Kevin Kennedy, MD
Published August 5, 2022

Key Takeaways

  • Cognitive behavior therapy (CBT) helps patients recognize negative or abnormal thinking patterns in response to the world around them.

  • Research indicates that CBT is the gold standard of psychotherapeutic treatment.

  • New technologies like smartphone apps may help bring CBT to more people, but patients and clinicians should be cautious about relying solely on these interventions.

Developed in the 1960s, cognitive behavioral therapy (CBT) helps many people who live with mental illness, substance issues, and eating, sleep, or sexual disorders change negative patterns of thought to better manage stressful life situations. Many physicians have combined this form of talk therapy with other treatments to promote positive outcomes.[]

Unlike many other forms of therapy, CBT can be adapted to serve people of all ages, including adolescents and children. CBT may also be used when counseling couples and families; the treatment’s versatility is part of what makes it an effective tool for many patients.

Basics of CBT

CBT is a form of talk therapy in which patients learn to identify and respond to inaccurate or negative thinking.

It helps patients recognize the relationships between three separate aspects of cognition: automatic thoughts, underlying beliefs, and cognitive distortions.

Automatic thoughts refer to a person’s immediate, unplanned interpretations of events happening in the world around them. These thoughts provoke an emotional response while directing an individual’s response to the event. Within the context of CBT, automatic thoughts may be dysfunctional—that is, they may be mistaken, distorted, unrealistic, or exaggerated.

Cognitive distortions are also common among patients with mental illnesses and other disorders. These patients may arrive at incorrect conclusions due to errors in logic. Individuals may present with one or more cognitive distortions, such as:

  • Catastrophizing

  • Dichotomous thinking

  • Disqualifying the positive

  • Emotional reasoning

  • Fortune-telling or mind-reading

  • Overgeneralization

CBT also addresses the patient’s underlying belief structure.

These beliefs may be viewed as the templates for information processing underlying layers of automatic thoughts. Consisting of both core and intermediate beliefs, CBT helps patients understand how their underlying beliefs shape their perception of the world and its events.

Commonly administered by psychologists, psychiatrists, counselors, and other mental health experts, CBT enables patients to learn more about their condition and practice coping mechanisms such as assertiveness, relaxation, and stress management.[] During treatment, patients are encouraged to discuss their thoughts and feelings, especially situations viewed as troubling.

In many cases, CBT focuses on one specific problem at a time, establishing treatment goals that patients can meet incrementally. Treatment length varies according to the patient’s individual needs, but most treatment courses range from 5 to 20 sessions.

Comparing CBT to other treatments

As a form of psychotherapy, many providers view CBT as the “gold standard” in treatment.

A 2018 paper published in Frontiers in Psychiatry concluded that “if gold standard is defined as [the] best standard we have in the field at the moment, then we argue that CBT is, indeed, the gold standard.”[] The authors attributed this conclusion to the following factors:

  • No other psychotherapy has been shown to be systematically superior.

  • CBT is researched more than any other psychotherapy.

  • The theoretical models of CBT line up with current mainstream human mind and behavior paradigms.

A 2018 study published in Psychology Research compared CBT with other forms of treatment including dialectical behavior therapy (DBT), eye movement desensitization and reprocessing (EMDR), and hypnosis.[] According to that research, CBT resulted in a final success rate of 40.5% after reviewing data from 4,085 subjects. DBT success rates hovered around 22% (217 subjects), while the final success rate of EDMR was 49.4% (689 subjects). The success rate for hypnosis, which used information from 1,504 study subjects, was 39.2%.

Expanding CBT’s role in the digital age

According to a 2020 paper, 59% of individuals meeting diagnostic criteria for psychiatric illness have not received treatment in the past year.[] Barriers to receiving mental health treatment often include cost, transportation issues, inability to take time off work, lack of child care, and the stigma surrounding mental illness.

The internet now provides the opportunity for providers to connect with patients who may not have access to traditional treatment modalities.

For example, a psychiatrist may engage with a patient in person and supplement their treatment using smartphone apps.

Thousands of mental health-related smartphone apps are currently available, and many apply the principles of CBT to help patients make positive changes. Some apps focus on single skills, such as mindfulness, to restructure negative thought patterns. Others provide a convenient method of monitoring symptoms, while still more are designed as standalone therapies.

This type of intervention can help patients—but there are limitations.

Patients may not be as engaged as they would be during in-person therapy sessions. More intensive support may be necessary to help CBT be truly effective. Additionally, some apps may not be user-friendly or include core features that support the patient’s goals. And the lack of an evidence base may mean some of these apps are not actually benefiting patients; in some cases, they could contain misinformation and actually be unsafe.

What this means for you

CBT can help patients living with a variety of disorders including mental health issues, substance use issues, and eating or sleeping disorders. CBT is considered by many providers to be the gold standard in psychotherapy; emerging technologies like smartphone apps could help connect more patients with therapeutic treatment, but their limitations may support the need for continued in-person treatment until further research can clarify the effectiveness of app-based treatments.

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