CBT self-help: does it work without a therapist?
StressKey points
- Meta-analysis: guided self-help was as effective as face-to-face therapy.
- At least minimal professional support matters.
- Suitable for mild to moderate depression and anxiety.
- Severe conditions need in-person care.
What the research shows
Guided self-help. A meta-analysis of 21 studies directly comparing guided self-help with face-to-face psychotherapy for depression and anxiety disorders found no significant difference in effectiveness, and the results held at follow-up (Cuijpers et al., 2010).
Insomnia. CBT for insomnia also works in digital and self-help formats (Trauer et al., 2015).
Mindfulness. In a randomized trial of 276 adults with anxiety disorders, an 8-week mindfulness-based stress reduction program was noninferior to the antidepressant escitalopram (Hoge et al., 2023).
How to choose a program
- Look for programs based on CBT with research behind them.
- Prefer programs that include some contact with a professional.
- Check privacy policies for apps.
- Ask your doctor or health plan for recommendations.
- If you do not improve within several weeks, step up to in-person care.
Frequently asked questions
Where can I find guided CBT programs?
Ask your doctor or health plan; many offer digital CBT programs. The VA and university clinics also offer free resources.
Is mindfulness as good as medication for anxiety?
In a 2023 randomized trial, an 8-week mindfulness-based stress reduction program was as effective as the antidepressant escitalopram for anxiety disorders.
Sources
- Cuijpers et al. (2010). Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychological Medicine 40(12):1943-1957. doi:10.1017/S0033291710000772
- Trauer et al. (2015). Cognitive Behavioral Therapy for Chronic Insomnia. Annals of Internal Medicine 163(3):191-204. doi:10.7326/M14-2841
- Hoge et al. (2023). Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders. JAMA Psychiatry 80(1):13. doi:10.1001/jamapsychiatry.2022.3679
- World Health Organization. Doing What Matters in Times of Stress. www.who.int
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