Skip to main content
SpringerLink
Log in

Cognitive Behavioral Therapy in China: Practices and Exploration

  • Published:
International Journal of Cognitive Therapy Aims and scope Submit manuscript

Abstract

The principles of CBT emphasize the interactions among cognition, emotion, and behavior. CBT’s origins lie in Stoicism philosophy and share similarities with the ideas of Confucianism, Taoism, and Traditional Chinese Medicine (TCM) in China. The idea of mind–body regulation in traditional Chinese culture has laid a cultural foundation for the promotion of CBT in China. This paper analyzes the applicability and challenges of CBT in China based on the current development of CBT in mainland China and the learning and practice of CBT therapists. It also explores the potential further development of CBT in China and the integration of CBT with the Chinese culture.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data Availability

The data that support the findings of this study are available from the corresponding author, JW, upon reasonable request.

References

  • Anik, E., West, R. M., Cardno, A. G., & Mir, G. (2021). Culturally adapted psychotherapies for depressed adults: A systematic review and meta-analysis. Journal of Affective Disorders, 278, 296–310. https://doi.org/10.1016/j.jad.2020.09.051

    Article  PubMed  Google Scholar 

  • Banerjee, P., Duggan, C., Huband, N., & Watson, N. (2006). Brief psychoeducation for people with personality disorder: A pilot study. Psychology and Psychotherapy: Theory, Research and Practice, 79(3), 385–394. https://doi.org/10.1348/147608305X57987

    Article  Google Scholar 

  • Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.

    Google Scholar 

  • Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy, 16(3), 252–260. https://doi.org/10.1037/h0085885

    Article  Google Scholar 

  • Braun, J. D., Strunk, D. R., Sasso, K. E., & Cooper, A. A. (2015). Therapist use of Socratic questioning predicts session-to-session symptom change in cognitive therapy for depression. Behaviour Research and Therapy, 70, 32–37. https://doi.org/10.1016/j.brat.2015.05.004

    Article  PubMed  PubMed Central  Google Scholar 

  • Cao, R., Yang, X., Luo, J., Wang, P., Meng, F., Xia, M., He, Y., Zhao, T., & Li, Z. (2021). The effects of cognitive behavioral therapy on the whole brain structural connectome in unmedicated patients with obsessive-compulsive disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 104, 110037. https://doi.org/10.1016/j.pnpbp.2020.110037

    Article  PubMed  Google Scholar 

  • Chang, D. F., Hung, T., Ng, N., Ling, A., Chen, T., Cao, Y., & Zhang, Y. (2016). Taoist cognitive therapy: Treatment of generalized anxiety disorder in a Chinese immigrant woman. Asian American Journal of Psychology, 7(3), 205–216. https://doi.org/10.1037/aap0000052

    Article  Google Scholar 

  • Chang, D. F., Ng, N., Chen, T., Hung, T., Miao, I. Y., Cao, Y., & Zhang, Y. (2020). Let nature take its course: Cultural adaptation and pilot test of Taoist cognitive therapy for Chinese American immigrants with generalized anxiety disorder. Frontiers in Psychology, 11, 547852. https://doi.org/10.3389/fpsyg.2020.547852

    Article  PubMed  PubMed Central  Google Scholar 

  • Chen, S.W.-H., & Davenport, D. S. (2005). Cognitive-behavioral therapy with Chinese American clients: Cautions and modifications. Psychotherapy: Theory, Research, Practice, Training, 42(1), 101–110. https://doi.org/10.1037/0033-3204.42.1.101

    Article  Google Scholar 

  • Chen, Y., Zhu, H., Cheng, L., & Lin, L. (2020). Exploring the feasibility of Chinese traditional emotion regulation theory and methods applied in colleges and universities-Taking Chinese Medicine emotion regulation as an example. Journal of Traditional Chinese Medicine Management, 28(10), 3–5. https://doi.org/10.16690/j.cnki.1007-9203.2020.10.002. (In Chinese).

    Article  Google Scholar 

  • Chen, Y., Lv, S., Duan, M., Shan, Y., & Jia, Y. (2023). Advances in cognitive processing therapy for posttraumatic stress disorder. Chinese Journal of Psychiatry, 56(1), 52–56. https://doi.org/10.3760/cma.j.cn113661-20220615-00154

    Article  CAS  Google Scholar 

  • Cheung, G., & Chan, C. (2002). The Satir model and cultural sensitivity: A Hong Kong reflection. Contemporary Family Therapy, 24(1), 199–215. https://doi.org/10.1023/A:1014338025464

    Article  Google Scholar 

  • Chi, Y., & Wang, D. (2005). A discussion on emotionality of Chinese archaic ideologist. Chinese Journal of Clinical Psychology, 03, 375–377. (In Chinese).

    Google Scholar 

  • Clarke, T., & Barwick, M. (2021). Editorial perspective: A call to collective action – improving the implementation of evidence in children and young people’s mental health. Child and Adolescent Mental Health, 26(1), 73–75. https://doi.org/10.1111/camh.12447

    Article  PubMed  Google Scholar 

  • Constantino, M. J., Arnow, B. A., Blasey, C., & Agras, W. S. (2005). The association between patient characteristics and the therapeutic alliance in cognitive-behavioral and interpersonal therapy for bulimia nervosa. Journal of Consulting and Clinical Psychology, 73(2), 203–211. https://doi.org/10.1037/0022-006X.73.2.203

    Article  PubMed  Google Scholar 

  • Dobson, K. S., & Kazantzis, N. (2023). Therapeutic relationships in cognitive behavioral therapy: Tailoring the therapeutic alliance. Psychotherapy Research, 33(1), 1–2. https://doi.org/10.1080/10503307.2023.2177942

    Article  PubMed  Google Scholar 

  • Dong, X., & Li, L. (2003). Foundation of Chinese Medicine Psychology. Beijing Science and Technology Publishing Co.

    Google Scholar 

  • Fan, Y., Shi, Y., Zhang, J., Sun, D., Wang, X., Fu, G., Mo, D., Wen, J., Xiao, X., & Kong, L. (2021). The effects of narrative exposure therapy on COVID-19 patients with post-traumatic stress symptoms: A randomized controlled trial. Journal of Affective Disorders, 293, 141–147. https://doi.org/10.1016/j.jad.2021.06.019

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Fang, F., Zhang, Y., Zhang, L., Jiang, M., Song, R., Wang, Y., Wang, Z., Li, B., Farrell, N., Cepeda, S. L., Schneider, S. C., Mcingvale, E., Shrestha, S., Goodman, W. K., Zhang, C., & Storch, E. A. (2019). Chinese therapists’ beliefs about exposure therapy for anxiety and obsessive-compulsive disorders. Journal of Psychiatric Practice®, 25(3), 179.

    Article  PubMed  Google Scholar 

  • Feng, Y. (2017). A short history of Chinese philosophy. Shanghai: Zhonghua Book Company.

    Google Scholar 

  • Fernández, I., Carrera, P., Sánchez, F., Paez, D., & Candia, L. (2000). Differences between cultures in emotional verbal and nonverbal reactions. Psicothema, 12(Supl1), 83–92.

    Google Scholar 

  • Foo, K. H., & Kazantzis, N. (2007). Integrating homework assignments based on culture: Working with Chinese patients. Cognitive and Behavioral Practice, 14(3), 333–340. https://doi.org/10.1016/j.cbpra.2006.08.005

    Article  Google Scholar 

  • Fu, F. (2017). Suitable for natural and inner peace: The wisdom of the Stoics’ philosophy therapy. Journal of Northwestern University (Philosophy and Social Science Edition in Chinese), 47(1), 91–99. (In Chinese).

    Google Scholar 

  • Geng, Z. (2018). The annotations of Guanzi. Shanghai: SDX Joint Publishing Company.

    Google Scholar 

  • Guo, X. (2007). About the psychological thought of the essence and adjustment of Zhuangzi’s mood and desire. Journal of Psychological Science, 01, 244–246. https://doi.org/10.16719/j.cnki.1671-6981.2007.01.064

    Article  Google Scholar 

  • Healthy China Action (2019-2030). (2019). General requirements, major actions and key indicators. Chinese Journal of Circulation, 34(9), 846–858. (In Chinese).

    Google Scholar 

  • Huang, F., Tang, Y., Zhao, M., Wang, Y., Pan, M., Wang, Y., & Qian, Q. (2019). Cognitive-behavioral therapy for adult ADHD: A randomized clinical trial in China. Journal of Attention Disorders, 23(9), 1035–1046. https://doi.org/10.1177/1087054717725874

    Article  PubMed  Google Scholar 

  • Jameel, S., Munivenkatappa, M., Arumugham, S. S., & Thennarasu, K. (2022). Cultural adaptation of cognitive behaviour therapy for depression: A qualitative study exploring views of patients and practitioners from India. The Cognitive Behaviour Therapist, 15, e16. https://doi.org/10.1017/S1754470X22000137

    Article  Google Scholar 

  • Jing, H. (2007). What confucianism can contribute to psychological counseling. Acta Psychologica Sinica, 02, 371–380. (In Chinese).

    Google Scholar 

  • Kürümlüoğlugil, R., & Tanrıverdi, D. (2022). The effects of the psychoeducation on cognitive distortions, negative automatic thoughts and dysfunctional attitudes of patients diagnosed with depression. Psychology, Health & Medicine, 27(10), 2085–2095. https://doi.org/10.1080/13548506.2021.1944654

    Article  Google Scholar 

  • Leong, F. T. (1986). Counseling and psychotherapy with Asian-Americans: Review of the literature. Journal of Counseling Psychology, 33(2), 196–206. https://doi.org/10.1037/0022-0167.33.2.196

    Article  MathSciNet  Google Scholar 

  • Li, B. (2016). Xunzi Commentary - fine translation. Shanghai: Classics Publishing House.

    Google Scholar 

  • Li, W.-W. (2000). The historical formation and future transformation of Confucianism’s form of existence. History of Chinese Philosophy, 4, 90–97. (In Chinese).

    Google Scholar 

  • Li, X.-M., Huang, F.-F., Cuijpers, P., Liu, H., Karyotaki, E., Li, Z.-J., Miguel, C., Ciharova, M., & Dobson, K. (2024). The efficacy of cognitive behavioral therapies for depression in China in comparison with the rest of the world: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 92(2), 105–117. https://doi.org/10.1037/ccp0000854

    Article  PubMed  Google Scholar 

  • Li, Y., Zhang, A. J., Meng, Y., Hofmann, S. G., Zhou, A. Y., & Liu, X. (2023). A randomized controlled trial of an online self-help mindfulness intervention for emotional distress: Serial mediating effects of mindfulness and experiential avoidance. Mindfulness, 14(3), 510–523. https://doi.org/10.1007/s12671-023-02083-x

    Article  Google Scholar 

  • Lin, Y. N. (2002). The application of cognitive-behavioral therapy to counseling Chinese. American Journal of Psychotherapy, 56(1), 46–58. https://doi.org/10.1176/appi.psychotherapy.2002.56.1.46

    Article  PubMed  Google Scholar 

  • Liu, Q. G. (2007). The exploration on Ardor Regulation Tradition of Confucian and Daoism. Medicine and Philosophy (Humanities and Social Medicine in Chinese), 11, 58–60. (In Chinese).

    Google Scholar 

  • Liu, W., Fang, F., Zhang, C., & Storch, E. A. (2017). Cognitive behavioral therapy practices in the treatment of obsessive-compulsive disorder in China. Annals of Translational Medicine, 5(1), 8–8. https://doi.org/10.21037/atm.2017.01.04

    Article  PubMed  PubMed Central  Google Scholar 

  • Luo, J. (2017). Utilizing the principle of emotional phasing to achieve emotion regulation. Proceedings of Abstracts of the Sixth Annual Academic Conference on Mental Health (p. 6). Beijing, China: Institute of Psychology, CAS; The CAS Key Laboratory of Mental Health.

    Google Scholar 

  • Masuda, A., & Boone, M. S. (2011). Mental health stigma, self-concealment, and help-seeking attitudes among Asian American and European American college students with no help-seeking experience. International Journal for the Advancement of Counselling, 33(4), 266–279. https://doi.org/10.1007/s10447-011-9129-1

    Article  Google Scholar 

  • Naeem, F., Khan, N., Sohani, N., Safa, F., Masud, M., Ahmed, S., Thandi, G., Mutta, B., Kasaam, A., Tello, K., Husain, M. I., Husain, M. O., Kidd, S. A., & McKenzie, K. (2024). Culturally adapted cognitive behaviour therapy (CaCBT) to improve community mental health services for canadians of south asian origin: A qualitative study. The Canadian Journal of Psychiatry, 69(1), 54–68. https://doi.org/10.1177/07067437231178958

    Article  PubMed  Google Scholar 

  • Ng, T. K., & Wong, D. F. K. (2018). The efficacy of cognitive behavioral therapy for Chinese people: A meta-analysis. Australian & New Zealand Journal of Psychiatry, 52(7), 620–637. https://doi.org/10.1177/0004867417741555

    Article  Google Scholar 

  • Ng, P., Tsun, A., Su, S., & Young, D. (2013). Cognitive behavioral intervention in the Chinese cultural context: A case report: CBI in Chinese cultural context. Asia-Pacific Psychiatry, 5(3), 205–211. https://doi.org/10.1111/appy.12092

    Article  PubMed  Google Scholar 

  • Okamoto, A., & Kazantzis, N. (2021). Alliance ruptures in cognitive-behavioral therapy: A cognitive conceptualization. Journal of Clinical Psychology, 77(2), 384–397. https://doi.org/10.1002/jclp.23116

    Article  PubMed  Google Scholar 

  • Peng, Y. (2002). Emotional model of the Confucian school and Taoists complementing each other: Exploration on traditional Chinesee motional psychological thoughts. Acta Psychologica Sinica, 05, 540–554. (In Chinese).

    Google Scholar 

  • Peng, X., & Cheng, Y. Q. (2004). Wujian (understanding and practice) psychotherapy and the indigenization of psychotherapy in China. International Journal of Psychology, 39(5–6), 407–407.

    Google Scholar 

  • Rathod, S., Phiri, P., & Naeem, F. (2019). An evidence-based framework to culturally adapt cognitive behaviour therapy. The Cognitive Behaviour Therapist, 12, e10. https://doi.org/10.1017/S1754470X18000247

    Article  Google Scholar 

  • Schöttke, H., Trame, L., & Sembill, A. (2014). Relevance of therapy goals in outpatient cognitive-behavioral and psychodynamic psychotherapy. Psychotherapy Research, 24(6), 711–723. https://doi.org/10.1080/10503307.2014.881578

    Article  PubMed  Google Scholar 

  • Şimşek, M. K., & Seçer, İ. (2022). Developing and examining the effectiveness of a cognitive behavioral therapy-based psychoeducation practice for reducing obsessive-compulsive symptoms in adolescents: A Mixed-methods study with a Turkish sample. Frontiers in Psychology, 13, 805035. https://doi.org/10.3389/fpsyg.2022.805035

    Article  PubMed  PubMed Central  Google Scholar 

  • Song, H., Guo, C. H., & Li, Z. (2018). Chinese cultural factors involved in the application of the cognitive behavioral therapy. Medicine and Philosophy (B), 39(2), 74–78. (In Chinese).

    Google Scholar 

  • Song, Y., & Liang, B. (2019). Therapeutic efficacy of zolpidem combined with cognitive-behavioral therapy on primary insomnia: A protocol for systematic review. Medicine, 98(39), e17122. https://doi.org/10.1097/MD.0000000000017122

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Sun, Y., & Zhang, N. (2018). Cognitive behavioral therapy in China: Reflections on current issues and the future development. Chinese Journal of Behavioral Medicine and Brain Science, 27(2), 97–101.

    ADS  Google Scholar 

  • Unschuld, P. U., & Tessenow, H. (2019). Comprehensive Discourse on Phenomena Corresponding to Yin and Yang. Huang Di Nei Jing Su Wen (pp. 95–126). University of California Press. https://doi.org/10.1525/9780520948181-007

  • Waltman, S., Hall, B. C., McFarr, L. M., Beck, A. T., & Creed, T. A. (2017). In-session stuck points and pitfalls of community clinicians learning CBT: Qualitative investigation. Cognitive and Behavioral Practice, 24(2), 256–267. https://doi.org/10.1016/j.cbpra.2016.04.002

    Article  Google Scholar 

  • Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work (2nd ed., p. Chapter x, 323). New York: Routledge/Taylor & Francis Group.

    Book  Google Scholar 

  • Xiong, N., Wei, J., Hong, X., Li, T., Jiang, J., Zhu, L.-M., Tian, G., Zhao, X., Zhang, L., & Kurt, F. (2017). Comorbidity of depression and anxiety disorders in Chinese outpatients with multiple somatic symptoms in different departments in general hospital: A multicenter cross-sectional study. Journal of Clinical Psychiatry, 27(2), 81–84. https://doi.org/10.3969/j.issn.1005-3220.2017.02.003

    Article  Google Scholar 

  • Xu, S.-M. (2020). The similarities and differences between Confucianism and Stoicism in the thought of benevolence. Jianghan Forum, 6, 11–21. (In Chinese).

    Google Scholar 

  • Yang, H., & Petrini, M. (2012). Effect of cognitive behavior therapy on sleep disorder in Parkinson’s disease in China: A pilot study. Nursing & Health Sciences, 14(4), 458–463. https://doi.org/10.1111/j.1442-2018.2012.00711.x

    Article  ADS  Google Scholar 

  • Yang, X., Zhang, P., Zhao, J., Zhao, J., Wang, J., Chen, Y., Ding, S., & Zhang, X. (2016). Confucian culture still matters: The benefits of Zhongyong thinking (Doctrine of the Mean) for mental health. Journal of Cross-Cultural Psychology, 47(8), 1097–1113. https://doi.org/10.1177/0022022116658260

    Article  Google Scholar 

  • Yu, X., & Liu, W. (2017). The cultivation of practical personality: The practical orientation of contemporary educational purpose from the perspective of Wang Yangming’s “Combining Knowledge with Practice.” Journal of Educational Science, Hunan Normal University, 16(3), 56–61.

    MathSciNet  Google Scholar 

  • Yu, F., Peng, K., Dong, R., Chai, F., & Han, T. (2013). The psychological research paradigms of moral personality. Advances in Psychological Science, 21(12), 2235–2244. (In Chinese).

    Article  Google Scholar 

  • Yu, H., Zhang, Y., Liu, Q., & Yan, R. (2021a). Efficacy of online and face-to-face cognitive behavioral therapy in the treatment of neurological insomnia: A systematic review and meta-analysis. Annals of Palliative Medicine, 10(10), 10684–10696. https://doi.org/10.21037/apm-21-2387

    Article  PubMed  Google Scholar 

  • Zang, Y., Hunt, N., & Cox, T. (2014). Adapting narrative exposure therapy for Chinese earthquake survivors: A pilot randomised controlled feasibility study. BMC Psychiatry, 14(1), 262. https://doi.org/10.1186/s12888-014-0262-3

    Article  PubMed  PubMed Central  Google Scholar 

  • Zhang, F. (2013). On Zhuang Zi’s happiness realm of “supreme happiness” and its modern revelation. Morality and Civilization, 2, 27–31. https://doi.org/10.13904/j.cnki.1007-1539.2013.02.009

    Article  Google Scholar 

  • Zhang, A. L., & Yang, D. S. (1998). The development of cognitive psychotherapy according to Taoism. Chinese Journal of Mental Health, 3, 61–63+65.

    Google Scholar 

  • Zhang, P., Ouyang, L., Liang, M., Wu, Y., Bao, C., Yang, K., Liu, Y., Long, J., Wang, X., Liu, G., Jiang, X., Sun, Y., Lv, H., Wu, X., Wang, S., Li, G., Zhao, B., Liu, Y., Hu, J., & Wang, C. (2023). A cross-sectional epidemiological study of non-suicidal self-injury prevalence in Chinese psychiatric patients. Nature Mental Health, 1(4), 266–272. https://doi.org/10.1038/s44220-023-00050-y

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge the participants enrolled in the survey and the Wechat group managers for data collection. The authors thank Wanjun Li for assisting the questionnaire design and distribution, and thank Jiedong Jiang for providing great help of article layout in LaTeX.

Author information

Author notes

  1. Ru Yan contributed equally to this work.

Authors and Affiliations

  1. Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal University, Haidian District, No. 19, Xinjiekouwai Street, 100875, Beijing, People’s Republic of China

    Jiao Man, Yuting Ouyang, Jun Sun & Jianping Wang

  2. Department of Mental Health, ChangZhi Medical College, No.161, East Jiefang Street, Changzhi, 046000, Shanxi, People’s Republic of China

    Jiao Man

  3. Mental Health Education and Counseling Center, Guangdong University of Foreign Studies, Baiyun District, 2 Baiyun Avenue, Guangzhou, 510420, Guangdong, People’s Republic of China

    Ru Yan

  4. Department of Psychology, Durham University, South Road, Durham, DH1 3LE, UK

    Kaidi Yang

  5. Mental Health Education and Research Center, Hohai University, No. 8, Fochengxi Street, Jiangning District, Nanjing, 210098, Jiangsu, People’s Republic of China

    Chenye Shu

  6. Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada

    Keith S. Dobson

Authors
  1. Jiao Man
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ru Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kaidi Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuting Ouyang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chenye Shu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jun Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jianping Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Keith S. Dobson
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JM, RY, KY, and JW: study design. JM: data collection. KY and YO: data analysis. JM, RY, KY, YO, and CS: manuscript writing. JW: study supervision. JS and KA polished the language of this manuscript. All authors contributed to the article and approved the submitted version.

Corresponding author

Correspondence to Jianping Wang.

Ethics declarations

Ethics Approval

All procedures performed in this study involving human participants were in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Consent to Participate

Informed consent was obtained from all individual participants.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Man, J., Yan, R., Yang, K. et al. Cognitive Behavioral Therapy in China: Practices and Exploration. J Cogn Ther (2024). https://doi.org/10.1007/s41811-024-00203-6

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s41811-024-00203-6

Keywords

Search

Navigation