How Effective Is Cognitive Behavioral Therapy for Depression? The Latest Scientific Answers from the Largest Meta-Analysis to Date

What Patients Should Know About Cognitive Behavioral Therapy for Depression – The Latest Expert Evaluation 

Depression affects hundreds of millions of people around the world and is among the leading causes of reduced quality of life, premature death, and economic burden. Treatment often includes medication, psychotherapy, or a combination of both—but one of the most widely discussed methods remains Cognitive Behavioral Therapy (CBT). In 2023, a large and authoritative meta-analysis was published (“Cognitive behavior therapy vs. control conditions, other psychotherapies, pharmacotherapies and combined treatment for depression”), which pooled results from 409 randomized clinical trials with over 52,000 patients. This analysis provides comprehensive answers to some of the most important questions patients and their loved ones may have.

In the following expert insights, drawn from and commented on based on this meta-analysis, you’ll find answers to key questions: How effective is CBT? Is it comparable to medication? How does it compare with other types of therapy? What are the outcomes for different groups—children, adults, people with other medical conditions? Does it matter if it’s delivered online or as a self-help intervention? Here’s what the researchers say.

Expert Insights

1. How effective is Cognitive Behavioral Therapy for depression?

“CBT had moderate to large effects compared to control conditions such as care as usual and waitlist (g=0.79; 95% CI: 0.70–0.89), which remained similar in sensitivity analyses and were still significant at 6–12 month follow-up.”

“The response rate was 0.42 (95% CI: 0.39–0.45) in CBT and 0.19 (95% CI: 0.18–0.21) in the control conditions, which resulted in a RR of 2.13 (95% CI: 1.96–2.32) and a NNT of 4.7 (95% CI: 4.0–5.5) in favor of CBT.”

Explanation: CBT proves to be significantly more effective than standard care or being on a waitlist: nearly twice as many patients respond positively to the treatment. This means that for every 4 to 5 patients treated with CBT, one will see significant improvement as a direct result of the therapy.

2. Is CBT better than other types of psychotherapy?

“CBT was significantly more effective than other psychotherapies, but the difference was small (g=0.06; 95% CI: 0–0.12) and became non-significant in most sensitivity analyses.”

“The superiority of CBT over other psychotherapies for depression does not emerge clearly from this meta-analysis.”

Explanation: While CBT showed a slight advantage over other types of therapy (such as interpersonal therapy, psychodynamic therapy, behavioral activation, etc.), the difference wasn’t statistically robust. According to the authors, it’s not possible to definitively say CBT is better. This suggests that the choice of therapy can often depend on individual preferences, previous experiences, and accessibility.

3. CBT or medication – which is more effective?

“The effects of CBT did not differ significantly from those of pharmacotherapies at the short term, but were significantly larger at 6–12 month follow-up (g=0.34; 95% CI: 0.09–0.58), although the number of trials was small, and the difference was not significant in all sensitivity analyses.”

Explanation: In the short term (right after treatment ends), CBT is as effective as antidepressants. Interestingly, between 6 and 12 months post-treatment, CBT effects last longer, while there’s a higher relapse risk with medication. This is important for people seeking long-term stability.

4. Is there value in combining CBT and medication?

“Combined treatment was more effective than pharmacotherapies alone at the short (g=0.51; 95% CI: 0.19–0.84) and long term (g=0.32; 95% CI: 0.09–0.55), but it was not more effective than CBT alone at either time point.”

Explanation: Combining medication with CBT is more effective than medication alone—but not more effective than CBT alone. This suggests that in moderate to severe cases, a combined approach may offer some benefit, but when high-quality CBT is accessible, it is effective on its own.

5. Does CBT work for kids, adults, online, and as self-help?

“CBT was also effective as unguided self-help intervention (g=0.45; 95% CI: 0.31–0.60), in institutional settings (g=0.65; 95% CI: 0.21–1.08), and in children and adolescents (g=0.41; 95% CI: 0.25–0.57). We can conclude that the efficacy of CBT in depression is documented across different formats, ages, target groups, and settings.”

Explanation: CBT is proven effective not only for adults, but also for children and teens, and across a variety of formats—individual, group, online, and self-help. This makes the therapy extremely accessible and flexible for diverse needs.

Takeaway for Patients and Families

Modern science shows that Cognitive Behavioral Therapy is one of the most effective approaches to treating depression, with lasting results over time, suitable for a wide range of patients, and adaptable across various delivery formats. When choosing a treatment, it’s best to discuss options with a healthcare provider while considering personal needs, preferences, and availability of therapy.

Questions & Answers

1. How long-lasting are the effects of CBT—do the benefits remain after therapy ends? 

Answer: The study shows that CBT’s effects are sustained over time. At 6–9 months post-treatment, the effect remains significant (g=0.74), and at 10–12 months there is still a positive effect (g=0.49). The effect only starts to diminish after a year; at 13–24 months it is no longer statistically significant—likely due to fewer studies covering this time frame. This means most patients can expect sustained benefits for at least a year after therapy ends.

2. What if I can’t attend regular therapy—does self-help CBT (like online programs) work? 

Answer: Yes, results show that even CBT conducted as a self-guided intervention (including online programs) has a significant positive effect (g=0.45; 95% CI: 0.31–0.60). So patients who can’t attend therapy in person can still benefit from working with specialized materials or platforms on their own.

3. Does it matter how many CBT sessions I have or what format I receive (individual, group, guided or not)? 

Answer: The article shows that different formats of CBT—individual, group, guided (with a therapist), and unguided (self-help)—yield similar results. Even the number of sessions has decreased over time, without significantly affecting effectiveness. This allows therapy to be tailored to the patient’s needs and available resources.

4. What’s the chance I’ll respond to CBT or reach remission? 

Answer: About 42% of patients who undergo CBT show significant improvement (response rate), and 36% reach remission (i.e., very low or no depressive symptoms). These rates are much higher than those for standard care or waitlist, where remission is around 15%.

5. Are there differences in CBT effectiveness based on age, gender, comorbid conditions, or setting (e.g., hospital vs. home)? 

Answer: CBT is effective across various patient groups—adults, children and adolescents (g=0.41), older adults, people with other medical conditions, and even for patients in hospitals or institutions (g=0.65). Age, gender, and comorbidities do not diminish therapy effectiveness. This makes CBT broadly applicable to a wide range of patients.

Conclusion

Current scientific evidence is clear—Cognitive Behavioral Therapy is a highly effective, flexible, and widely applicable treatment for depression. It works across different age groups, treatment settings, and delivery formats, with proven durability over time. Whether applied individually, in groups, online, or as self-help, CBT offers a real chance for improvement and recovery. Many patients seeking help can benefit from this approach, with or without additional treatments depending on their needs. The findings presented here come from the international research team led by Pim Cuijpers and colleagues, published in World Psychiatry in 2023. The hope is that this information will support informed decision-making and offer greater confidence to anyone facing depression—whether as a patient or a loved one.

Source Cuijpers, P., Miguel, C., Harrer, M., Plessen, C.Y., Ciharova, M., Ebert, D., & Karyotaki, E. (2023). Cognitive behavior therapy vs. control conditions, other psychotherapies, pharmacotherapies and combined treatment for depression: a comprehensive meta-analysis including 409 trials with 52,702 patients. World Psychiatry, 22(1), 105-115. https://doi.org/10.1002/wps.21069