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

Pim Cuijpers^{1

2

3}, Mathias Harrer¹, Clara Miguel¹, Marketa Ciharova¹, Davide Papola⁴, Djordje Basic¹, Cristina Botella⁵, Ioana Cristea⁶, Nino de Ponti¹, Tara Donker^{1

7}, Ellen Driessen^{8

9}, Pamela Franco^{10

11}, Irene Gómez-Gómez¹², Jessica Hamblen^{13

14}, Noelia Jiménez-Orenga¹⁵, Eirini Karyotaki¹, Aaron Keshen¹⁶, Jake Linardon¹⁷, Emma Motrico¹⁸, Minoo Matbouriahi⁶, Olga M Panagiotopoulou¹, Rory A Pfund¹⁹, Constantin Yves Plessen^{20

21}, Heleen Riper^{1

22}, Paula P Schnurr^{13

14}, Marit Sijbrandij^{1

2}, Marieke B J Toffolo¹, Lingyao Tong¹, Wouter van Ballegooijen^{1

22}, Els van der Ven^{1

23}, Annemieke van Straten¹, Yingying Wang¹, Toshi A Furukawa²⁴

Affiliations

¹ Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
² WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
³ International Institute for Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania.
⁴ WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy.
⁵ Department of Basic, Clinical, and Psychobiological Psychology, Jaume I Universitat, Valencia, Spain.
⁶ Department of General Psychology, University of Padova, Padova, Italy.
⁷ Institute of Psychology, Department of Biological Psychology, Clinical Psychology and Psychotherapy, Albert Ludwigs-University of Freiburg, Freiburg im Breisgau, Baden-Württenberg, Germany.
⁸ Behavioural Science Institute, Department of Clinical Psychology, Radboud University, Nijmegen, the Netherlands.
⁹ Depression Expertise Center, Pro Persona Mental Health Care, Nijmegen, the Netherlands.
¹⁰ Department of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile.
¹¹ Millennium Institute for Research in Depression and Personality, Santiago, Chile.
¹² Department of Psychology, Universidad Loyola Andalucía, Seville, Spain.
¹³ National Center for PTSD, White River Junction, Vermont.
¹⁴ Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
¹⁵ Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain.
¹⁶ Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
¹⁷ SEED Lifespan Strategic Research Centre, School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
¹⁸ Department of Developmental and Educational Psychology, Universidad de Sevilla, Sevilla, Spain.
¹⁹ Department of Psychology, University of Memphis, Memphis, Tennessee.
²⁰ Department of Psychosomatic Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
²¹ Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
²² Department of Psychiatry, Amsterdam UMC, Amsterdam, the Netherlands.
²³ ARQ National Psychotrauma Centre, Diemen, the Netherlands.
²⁴ Office of Institutional Advancement and Communications, Kyoto University, Kyoto, Japan.

PMID: 40238104
PMCID: PMC12004241 (available on 2026-04-16)
DOI: 10.1001/jamapsychiatry.2025.0482

Meta-Analysis

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

Pim Cuijpers et al. JAMA Psychiatry. 2025.

. 2025 Jun 1;82(6):563-571.

doi: 10.1001/jamapsychiatry.2025.0482.

Authors

Affiliations

¹ Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
² WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
³ International Institute for Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania.
⁴ WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy.
⁵ Department of Basic, Clinical, and Psychobiological Psychology, Jaume I Universitat, Valencia, Spain.
⁶ Department of General Psychology, University of Padova, Padova, Italy.
⁷ Institute of Psychology, Department of Biological Psychology, Clinical Psychology and Psychotherapy, Albert Ludwigs-University of Freiburg, Freiburg im Breisgau, Baden-Württenberg, Germany.
⁸ Behavioural Science Institute, Department of Clinical Psychology, Radboud University, Nijmegen, the Netherlands.
⁹ Depression Expertise Center, Pro Persona Mental Health Care, Nijmegen, the Netherlands.
¹⁰ Department of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile.
¹¹ Millennium Institute for Research in Depression and Personality, Santiago, Chile.
¹² Department of Psychology, Universidad Loyola Andalucía, Seville, Spain.
¹³ National Center for PTSD, White River Junction, Vermont.
¹⁴ Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
¹⁵ Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain.
¹⁶ Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
¹⁷ SEED Lifespan Strategic Research Centre, School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
¹⁸ Department of Developmental and Educational Psychology, Universidad de Sevilla, Sevilla, Spain.
¹⁹ Department of Psychology, University of Memphis, Memphis, Tennessee.
²⁰ Department of Psychosomatic Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
²¹ Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
²² Department of Psychiatry, Amsterdam UMC, Amsterdam, the Netherlands.
²³ ARQ National Psychotrauma Centre, Diemen, the Netherlands.
²⁴ Office of Institutional Advancement and Communications, Kyoto University, Kyoto, Japan.

PMID: 40238104
PMCID: PMC12004241 (available on 2026-04-16)
DOI: 10.1001/jamapsychiatry.2025.0482

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.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Harrer reported being a part-time employee of Get.On Institut für 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 Investigación y Desarrollo (Chile) and postdoctoral funding from the Instituto de Investigación en Depresión y Personalidad MIDAP, Pontificia Universidad Católica 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.

References

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical