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


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.

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*Denotes inclusion in the review of meta-analyses

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Correspondence to Nikolaos Kazantzis.

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Conflict of Interest

Nikolaos Kazantzis, Hoang Kim Luong, Alexsandra S. Usatoff, Tara Impala, Rui Ying Yew, and Stefan G. Hofmann declare that they have no conflicts of interests to disclose in this submitted work to Cognitive Therapy and Research.

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The attribution of authorship on this manuscript has also been carefully considered and is being made in a manner that is consistent with ethical research practice. An authorship agreement outlining each author’s scientific contributions, prepared by Monash University’s legal office, was signed in determining the author listing.

Human and Animal Rights and Informed Consent

This article is a systematic review of previously published research and therefore does not contain any research with human participants performed by any of the authors. Sourcing informed consent from participants was not required as there were no research participants.

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Kazantzis, N., Luong, H.K., Usatoff, A.S. et al. The Processes of Cognitive Behavioral Therapy: A Review of Meta-Analyses. Cogn Ther Res 42, 349–357 (2018).

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  • Cognitive behavioral therapy
  • Process
  • Review