Why CBT Doesn’t Work Very Well |
There’s a lot of evidence showing that cognitive-behavioral therapy (CBT) works if by “works,” you mean it provides statistically significantly more symptom relief than is provided by doing nothing (Shedler, 2015, 2025). The catch is that statistical significance can mean almost no relief at all, the difference of a couple of points on a 45-point scale. It’s like saying a weight-loss program works if the average participant goes from 100 pounds overweight to 97 pounds overweight. With enough participants, that will be a statistically significant difference.
What matters, of course, is clinical significance. With CBT, most depressed people are still depressed at the end of treatment. The same holds for PTSD, anxiety disorders, and so on.
CBT makes so much sense on its surface that it seems worthwhile to explore why it doesn’t work so well in practice. Shedler (2025) points out that it doesn’t typically last long enough, especially in the versions studied by researchers, to work. CBT makes sense because we often change our behavior when we change our beliefs. For example, if you are looking for the mustard at the grocery store among the salad dressings, it may be said that you believe the mustard is in Aisle........