Cognitive behavior therapy is an evidence-based, time-limited psychotherapy that uses goal-oriented interventions to treat various mental and physical health conditions across the lifespan. It is used alone or with pharmacologic interventions to help patients modify problematic thoughts, behaviors, and emotions that maintain functional impairment. It is a primary treatment for tinnitus, fatigue, and trauma, somatic symptom, tic, insomnia, and borderline personality disorders. Cognitive behavior therapy or medication is the primary treatment for sexual dysfunction, anxiety, depressive, and obsessive-compulsive and related diagnoses. Cognitive behavior therapy can be a primary treatment or combined with medication-assisted treatment for substance-related and addictive disorders. It is an adjunctive treatment for attention-deficit/hyperactivity disorder, bipolar disorder, chronic pain conditions, irritable bowel syndrome, weight management, and menopause. Telehealth and digital interventions have demonstrated clinical benefits. Efficacy of cognitive behavior therapy ranges from small to large effect sizes compared with control conditions or treatment as usual. Integrated behavioral health teams may administer brief cognitive behavior interventions in the primary care setting.
Cognitive behavior therapy (CBT) is an evidence-based, time-limited psychological treatment with six decades of proven efficacy for numerous mental and physical health conditions.1–4 Core components involve interventions targeting modification or acceptance of problematic thoughts, memories, or beliefs that maintain functional impairment and distress (Figure 13); increased engagement in intentional behaviors that enhance functioning and reduce distress; increased beneficial emotional responses; and reduced avoidance of emotional responses. CBT may be implemented across the lifespan, with variability in treatment recommendations from childhood to adulthood. CBT is most effective when there is a collaborative and supportive patient-clinician relationship.5
WHAT'S NEW ON THIS TOPIC
| Digital CBT delivered via synchronous telehealth modalities (eg, telephone, video conferencing) has been found as effective as in-person CBT delivered by licensed behavioral health clinicians for a range of mental and physical health concerns. |
| Studies of stand-alone CBT smartphone apps show minimal effects on mental health symptoms, but they may be a suitable first-step intervention for patients with limited access to care. |
CBT = cognitive behavior therapy.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comments |
|---|---|---|
| CBT is recommended as primary treatment for tinnitus, fatigue, and insomnia, trauma, somatic symptom, tic, and borderline personality disorders.17,18,25,26,34–39,45–47,53,55,56,58,60,64,66,70 | A | Consistent evidence from randomized controlled trials, evidence-based practice guidelines, and systematic reviews |
| CBT is recommended as an adjunctive treatment for attention-deficit/hyperactivity disorder, bipolar disorder, chronic pain conditions, irritable bowel syndrome, weight management, and menopause.15,16,23,24,51,52,54,57,59,61–63,65,68,69,71 | B | Systematic reviews and a limited number of randomized controlled trials |
| CBT or medication is the primary treatment for sexual dysfunction, anxiety, nonsevere depressive, and nonsevere obsessive-compulsive and related diagnoses.12–14,19,20,27–33 | C | Practice guidelines, randomized controlled trials, and systematic reviews |
| CBT combined with medication is recommended for severe, recurrent, or persistent depressive disorders, bulimia nervosa, binge-eating disorder, and severe obsessive-compulsive and related disorders.19–22,27,28 | C | Practice guidelines, randomized controlled trials, and systematic reviews |
| CBT can be the primary treatment for substance use disorders or combined with medication-assisted treatment.40–44 | A | Consistent evidence from randomized controlled trials, evidence-based practice guidelines, and systematic reviews |
CBT = cognitive behavior therapy.
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.
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