Skip to main content
Erschienen in: Cognitive Therapy and Research 4/2018

15.05.2018 | Original Article

The Processes of Cognitive Behavioral Therapy: A Review of Meta-Analyses

verfasst von: Nikolaos Kazantzis, Hoang Kim Luong, Alexsandra S. Usatoff, Tara Impala, Rui Ying Yew, Stefan G. Hofmann

Erschienen in: Cognitive Therapy and Research | Ausgabe 4/2018

Einloggen, um Zugang zu erhalten

Abstract

Cognitive Behavioral Therapy (CBT) refers to a treatment approach with strong empirical support for its efficacy for various disorders and populations. The goal of the present review was to provide a comprehensive survey of meta-analyses examining the processes of CBT, namely: treatment processes (cognitive reappraisal, behavioral strategies, emotional regulation, motivation strategies, and psychoeducation) and in-session processes (alliance, goal consensus and collaboration, feedback, group cohesion, and homework). We identified 558 meta-analyses of CBT, and 30 meta-analyses met our inclusion criteria as reviews of process-outcome relations. For treatment processes, the strongest support currently exists for cognitive (n = 8 meta-analyses) and behavioral strategies (n = 3 meta-analyses) as change processes in CBT for anxiety disorders and depression. For in-session processes, the strongest support currently exists for the role of the alliance (n = 8 meta-analyses) and homework assignments (n = 6 meta-analyses) as predictors of outcome. Overall, the evidence base for process-outcome relations in CBT is just emerging. Additional research is needed to examine the range of treatment processes in various clinical contexts. Moreover, except for a meta-analysis on collaboration, no meta-analytic studies have been reported on CBT-specific elements of the therapeutic relationship, such as collaborative empiricism and Socratic dialogue.
Literatur
Zurück zum Zitat Beck, A. T., Rush, A. J., Shaw, B., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press. Beck, A. T., Rush, A. J., Shaw, B., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.
Zurück zum Zitat Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum.
Zurück zum Zitat *David, A. R., & Szamoskozi, S. (2011). A meta-analytical study on the effects of cognitive behavioral techniques for reducing distress in organizations. Journal of Cognitive and Behavioral Psychotherapies, 11(2), 221–236. *David, A. R., & Szamoskozi, S. (2011). A meta-analytical study on the effects of cognitive behavioral techniques for reducing distress in organizations. Journal of Cognitive and Behavioral Psychotherapies, 11(2), 221–236.
Zurück zum Zitat Ellis, A. (1970). The essence of rational psychotherapy: A comprehensive approach to treatment. New York: Institute for Rational Living. Ellis, A. (1970). The essence of rational psychotherapy: A comprehensive approach to treatment. New York: Institute for Rational Living.
Zurück zum Zitat Falkenstrom, F., Markowitz, J. C., Jonker, H., Philips, B., & Holmqvist, R. (2013). Can psychotherapists function as their own controls? Meta-analysis of the crossed therapist design in comparative psychotherapy trials. The Journal of Clinical Psychiatry, 74(5), 482–491. https://doi.org/10.4088/JCP.12r07848. doi.CrossRefPubMed Falkenstrom, F., Markowitz, J. C., Jonker, H., Philips, B., & Holmqvist, R. (2013). Can psychotherapists function as their own controls? Meta-analysis of the crossed therapist design in comparative psychotherapy trials. The Journal of Clinical Psychiatry, 74(5), 482–491. https://​doi.​org/​10.​4088/​JCP.​12r07848. doi.CrossRefPubMed
Zurück zum Zitat *Gil, P. J. M., Carrillo, F. X. M., & Sánchez-Meca, J. (2001). Effectiveness of cognitive-behavioural treatment in social phobia: A meta-analytic review. Psychology in Spain, 5, 17–25. *Gil, P. J. M., Carrillo, F. X. M., & Sánchez-Meca, J. (2001). Effectiveness of cognitive-behavioural treatment in social phobia: A meta-analytic review. Psychology in Spain, 5, 17–25.
Zurück zum Zitat Hayes, S. C., & Hofmann, S. G. (2018). Process-based CBT: The science and core clinical competencies of Cognitive Behavioral Therapy. Oakland:New Harbinger Publications Hayes, S. C., & Hofmann, S. G. (2018). Process-based CBT: The science and core clinical competencies of Cognitive Behavioral Therapy. Oakland:New Harbinger Publications
Zurück zum Zitat Hofmann, S. G. (2011). An introduction to modern CBT: Psychological solutions to mental health problems. Oxford: Wiley-Blackwell. Hofmann, S. G. (2011). An introduction to modern CBT: Psychological solutions to mental health problems. Oxford: Wiley-Blackwell.
Zurück zum Zitat Hofmann, S. G., & Hayes, S. C. (in press). The future of intervention science: Process-based therapy. Clinical Psychological Science. Hofmann, S. G., & Hayes, S. C. (in press). The future of intervention science: Process-based therapy. Clinical Psychological Science.
Zurück zum Zitat Kazantzis, N., Beck, J. S., Clark, D. A., Dobson, K. S., Hofmann, S. G., Leahy, R. L., & Wong, C. W. (in press). Socratic dialogue and guided discovery in cognitive behavioral therapy: A modified Delphi panel. International Journal of Cognitive Psychotherapy. Kazantzis, N., Beck, J. S., Clark, D. A., Dobson, K. S., Hofmann, S. G., Leahy, R. L., & Wong, C. W. (in press). Socratic dialogue and guided discovery in cognitive behavioral therapy: A modified Delphi panel. International Journal of Cognitive Psychotherapy.
Zurück zum Zitat Kazantzis, N., Beck, J. S., Dattilio, F. M., Dobson, K. S., & Rapee, R. (2013). Collaborative empiricism as the central therapeutic relationship element in cognitive behavior therapy: An expert panel discussion at the 7th International Congress of Cognitive Psychotherapy. International Journal of Cognitive Psychotherapy, 6(4), 386–399. https://doi.org/10.1521/ijct.2013.6.4.386.CrossRef Kazantzis, N., Beck, J. S., Dattilio, F. M., Dobson, K. S., & Rapee, R. (2013). Collaborative empiricism as the central therapeutic relationship element in cognitive behavior therapy: An expert panel discussion at the 7th International Congress of Cognitive Psychotherapy. International Journal of Cognitive Psychotherapy, 6(4), 386–399. https://​doi.​org/​10.​1521/​ijct.​2013.​6.​4.​386.CrossRef
Zurück zum Zitat Kazantzis, N., Cronin, T. J., Norton, P. J., Lai, J., & Hofmann, S. G. (2015). Reservations about the conclusions of the Interdivisional (APA Divisions 12 & 29) Task Force on Evidence-Based Therapy Relationships: What do we know, what don’t we know? Journal of Clinical Psychology, 71, 423–427. https://doi.org/10.1002/jclp.22178.CrossRefPubMed Kazantzis, N., Cronin, T. J., Norton, P. J., Lai, J., & Hofmann, S. G. (2015). Reservations about the conclusions of the Interdivisional (APA Divisions 12 & 29) Task Force on Evidence-Based Therapy Relationships: What do we know, what don’t we know? Journal of Clinical Psychology, 71, 423–427. https://​doi.​org/​10.​1002/​jclp.​22178.CrossRefPubMed
Zurück zum Zitat Kazantzis, N., Dattilio, F. M., & Dobson, K. S. (2017). The therapeutic relationship in cognitive behavior therapy: A clinician’s guide. New York: Guilford. Kazantzis, N., Dattilio, F. M., & Dobson, K. S. (2017). The therapeutic relationship in cognitive behavior therapy: A clinician’s guide. New York: Guilford.
Zurück zum Zitat Kazantzis, N., Reinecke, M. A., & Freeman, A. (2010). Cognitive and behavior theories in clinical practice. New York: Guilford. Kazantzis, N., Reinecke, M. A., & Freeman, A. (2010). Cognitive and behavior theories in clinical practice. New York: Guilford.
Zurück zum Zitat Klepac, R. K., Ronan, G. F., Andrasik, F., Arnold, K. D., Belar, C. D., Berry, S. L., et al. (2012). Guidelines for cognitive behavioral training within doctoral psychology programs in the United States: Report of the Inter-Organizational Task Force on Cognitive and Behavioral Psychology Doctoral Education. Behavior Therapy, 43(4), 687–697. https://doi.org/10.1016/j.beth.2012.05.002.CrossRefPubMed Klepac, R. K., Ronan, G. F., Andrasik, F., Arnold, K. D., Belar, C. D., Berry, S. L., et al. (2012). Guidelines for cognitive behavioral training within doctoral psychology programs in the United States: Report of the Inter-Organizational Task Force on Cognitive and Behavioral Psychology Doctoral Education. Behavior Therapy, 43(4), 687–697. https://​doi.​org/​10.​1016/​j.​beth.​2012.​05.​002.CrossRefPubMed
Zurück zum Zitat Lakens, D. (2013). Calculating and reporting effect sizes to facilitate cumulative science: A practical primer for t-tests and ANOVAs. Frontiers in Psychology, 4, 863.CrossRefPubMedPubMedCentral Lakens, D. (2013). Calculating and reporting effect sizes to facilitate cumulative science: A practical primer for t-tests and ANOVAs. Frontiers in Psychology, 4, 863.CrossRefPubMedPubMedCentral
Zurück zum Zitat Lambert, M. J., & Hill, C. E. (1994). Assessing psychotherapy outcomes and processes. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (pp. 72–113). Oxford: Wiley. Lambert, M. J., & Hill, C. E. (1994). Assessing psychotherapy outcomes and processes. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (pp. 72–113). Oxford: Wiley.
Zurück zum Zitat *Lambert, M. J., & Shimokawa, K. (2011). Collecting client feedback. Psychotherapy, 48, 72–79.CrossRefPubMed *Lambert, M. J., & Shimokawa, K. (2011). Collecting client feedback. Psychotherapy, 48, 72–79.CrossRefPubMed
Zurück zum Zitat Lorenzo-Luaces, L., & DeRubeis, R. J. (2018). Miles to go before we sleep: Advancing the understanding of psychotherapy by modeling complex processes. Cognitive Therapy & Research, 42(2), 212–217.CrossRef Lorenzo-Luaces, L., & DeRubeis, R. J. (2018). Miles to go before we sleep: Advancing the understanding of psychotherapy by modeling complex processes. Cognitive Therapy & Research, 42(2), 212–217.CrossRef
Zurück zum Zitat *Mausbach, B. T., Moore, R., Roesch, S., Cardenas, V., & Patterson, T. L. (2010). The relationship between homework compliance and therapy outcomes: An updated meta-analysis. Cognitive Therapy and Research, 34, 429–438.CrossRefPubMedPubMedCentral *Mausbach, B. T., Moore, R., Roesch, S., Cardenas, V., & Patterson, T. L. (2010). The relationship between homework compliance and therapy outcomes: An updated meta-analysis. Cognitive Therapy and Research, 34, 429–438.CrossRefPubMedPubMedCentral
Zurück zum Zitat *Murphy, R. H., & Hutton, P. (2017). Practitioner review: Therapist variability, patient-reported therapeutic alliance, and clinical outcomes in adolescents undergoing mental health treatment: A systematic review and meta-analysis. Journal of Child Psychology and Psychiatry, 59, 5–19. https://doi.org/10.1111/jcpp.12767.CrossRefPubMed *Murphy, R. H., & Hutton, P. (2017). Practitioner review: Therapist variability, patient-reported therapeutic alliance, and clinical outcomes in adolescents undergoing mental health treatment: A systematic review and meta-analysis. Journal of Child Psychology and Psychiatry, 59, 5–19. https://​doi.​org/​10.​1111/​jcpp.​12767.CrossRefPubMed
Zurück zum Zitat Newby, J. M., McKinnon, A., Kuyken, W., Gilbody, S., & Dalgleish, T. (2015). Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clinical Psychology Review, 40, 91–110.CrossRefPubMed Newby, J. M., McKinnon, A., Kuyken, W., Gilbody, S., & Dalgleish, T. (2015). Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clinical Psychology Review, 40, 91–110.CrossRefPubMed
Zurück zum Zitat Olejnik, S., & Algina, J. (2003). Generalized eta and omega squared statistics: Measures of effect size for some common research designs. Psychological Methods, 8(4), 434–437.CrossRefPubMed Olejnik, S., & Algina, J. (2003). Generalized eta and omega squared statistics: Measures of effect size for some common research designs. Psychological Methods, 8(4), 434–437.CrossRefPubMed
Zurück zum Zitat Orlinsky, D. E., Rønnestad, M. H., & Willutzki, U. (2004). Fifty years of psychotherapy process-outcomes research: Continuity and change. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (pp. 307–393). New York: Wiley. Orlinsky, D. E., Rønnestad, M. H., & Willutzki, U. (2004). Fifty years of psychotherapy process-outcomes research: Continuity and change. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (pp. 307–393). New York: Wiley.
Zurück zum Zitat Sauer-Zavala, S., Boswell, J. F., Bentley, K. H., Thompson-Hollands, J., Farchione, T. J., & Barlowa, D. H. (2018). Expectancies, working alliance, and outcome in transdiagnostic and single diagnosis treatment for anxiety disorders: An investigation of mediation. Cognitive Therapy & Research, 42(2), 135–145. https://doi.org/10.1007/s10608-017-9855-8.CrossRef Sauer-Zavala, S., Boswell, J. F., Bentley, K. H., Thompson-Hollands, J., Farchione, T. J., & Barlowa, D. H. (2018). Expectancies, working alliance, and outcome in transdiagnostic and single diagnosis treatment for anxiety disorders: An investigation of mediation. Cognitive Therapy & Research, 42(2), 135–145. https://​doi.​org/​10.​1007/​s10608-017-9855-8.CrossRef
Metadaten
Titel
The Processes of Cognitive Behavioral Therapy: A Review of Meta-Analyses
verfasst von
Nikolaos Kazantzis
Hoang Kim Luong
Alexsandra S. Usatoff
Tara Impala
Rui Ying Yew
Stefan G. Hofmann
Publikationsdatum
15.05.2018
Verlag
Springer US
Erschienen in
Cognitive Therapy and Research / Ausgabe 4/2018
Print ISSN: 0147-5916
Elektronische ISSN: 1573-2819
DOI
https://doi.org/10.1007/s10608-018-9920-y

Weitere Artikel der Ausgabe 4/2018

Cognitive Therapy and Research 4/2018 Zur Ausgabe

Update Psychiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.