Johnsen, T. J., & Friborg, O. (2015, May 11). The Effects of Cognitive Behavioral Therapy as an Anti-Depressive Treatment is Falling: A Meta-Analysis. Psychological Bulletin. Advance online publication. http://dx.doi.org/10.1037/bul0000015 From the Abstract:
- A meta-analysis examining temporal changes (time trends) in the effects of cognitive behavioral therapy (CBT) as a treatment for unipolar depression was conducted. A comprehensive search of psychotherapy trials yielded 70 eligible studies from 1977 to 2014. … temporal trends indicated that the effects of CBT have declined linearly and steadily since its introduction, as measured by patients’ self-reports (the BDI, p _ .001), clinicians’ ratings (the HRSD, p _ .01) and rates of remission (p _ .01)… Thus, modern CBT clinical trials seemingly provided less relief from depressive symptoms as compared with the seminal trials.
The authors speculate that the placebo effect may be an important factor in the decline in CBT's efficacy. They note that the “placebo effect is typically stronger for newer treatments; however, as time passes and experience with therapy is gained, the strong initial expectations wane. One may question whether this is the case with CBT. In the initial phase of the cognitive era, CBT was frequently portrayed as the gold standard for the treatment of many disorders. In recent times, however, an increasing number of studies ...have not found this method to be superior to other techniques. Coupled with the increasing availability of such information to the public, including the Internet, it is not inconceivable that patients’ hope and faith in the efficacy of CBT has decreased somewhat, in recent decades. …CBT apparently reached a ceiling effect during its first few years.” (p. 16)
Bottom line: A lot of the promise of CBT may have been due to a placebo effect: high hopes and high expectations, plus a narrative that makes sense of one’s misery. Now that CBT is old hat and just about anyone who has been to a therapist has been exposed to CBT, it no longer has that je ne sais quoi that inspires optimism – or at least a better mood. Not feeling that great? It’s probably because of your irrational and inaccurate cognitions. That used to help – but less and less as time goes by.