CBT for Depression: How Strong Is the Evidence Today?

There are now many psychosocial or talk therapies that effectively treat depression symptoms (Cuijpers et al., 2020). One of the most well-known treatments is cognitive behavioral therapy (CBT).

I was first exposed to CBT as a graduate student in the early 2000s. I remember learning the CBT model and appreciating the simplicity of the CBT triangle, where thoughts, behaviors, and feelings all interacted with one another. I felt empowered to have the tools to help my clients improve their mood by changing their thoughts and behaviors. At that time, CBT was the most studied psychosocial treatment for depression.

In the past 20 years, researchers have continued to test new iterations of CBT and tailor the core principles for various populations. This more recent research has focused on important questions: How does CBT work? Who does CBT work best for? Does CBT improve well-being (not just reduce depression symptoms)? And does CBT work for people from diverse backgrounds (Kunorubwe, 2023)?

A recent meta-analysis published in the Journal of Affective Disorders aimed to summarize the most recent studies of CBT for depression (O'Toole et al., 2025). They focused on randomized controlled trials published since 2019. In their search, they identified 62 different studies.

Here is what they found:

• Thirty-three percent of the studies tested classic CBT, 51 percent tested contemporary CBT (e.g., acceptance and commitment therapy, mindfulness-based cognitive therapy), and 16 percent used a combination. There was no difference in effects across the different types of CBT.
• Across all the studies, medium to large effects were observed on not only depression symptoms, but also other important outcomes like functioning, sleep, and quality of life.
• Many studies did not include a follow-up period, so it was difficult to determine how long effects last.
• The number of treatment sessions did not predict treatment response (e.g., depression symptom improvement).

It is important to interpret these results in the context of the meta-analysis's selection criteria. The authors only included studies that compared CBT to some kind of control condition—not another type of therapy—and they only included studies that formally diagnosed patients with major depressive disorder. Yet overall, this recent review of CBT aligns with current government and organizational recommendations for the treatment of depression (e.g., NICE guidelines) that include CBT as a gold standard treatment.