Over the past 40 years, considerable evidence has accumulated in support of cognitive behavioral therapy (CBT) for various mental health disorders. Cognitive behavioral therapy has demonstrated efficacy on par with medication, significantly augmenting it and surpassing its durability.1,2 Despite this strong record, efficacy may be weaker if refractory elements (eg, rumination in patients with major depression) are not specifically targeted,3 and although no other psychosocial treatment has been studied as rigorously as CBT, a number of trials failed to include important high-quality indicators reflecting this rigor (eg, randomization, an active comparator, fidelity and integrity analyses, consideration of participant dropouts), and those that do demonstrate smaller effect sizes.1
Mennin DS. Identifying Efficacious Treatment Elements for Refractory Conditions, Such as Body Dysmorphic Disorder. JAMA Psychiatry. Published online February 20, 201976(4):357–358. doi:10.1001/jamapsychiatry.2018.4084
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