Editing Cognitive behavioral therapy (section)

===Depression and anxiety disorders===
{{Further|Major depressive disorder#Talking therapies|Management of depression#Psychotherapy|Anxiety disorder#Treatment}}
Cognitive behavioral therapy has been shown as an effective treatment for clinical depression.<ref name="DriessenE" /> Among psychotherapeutic approaches for [[major depressive disorder]], cognitive behavioral therapy and [[interpersonal psychotherapy]] are recommended by clinical practice guidelines including The [[American Psychiatric Association]] Practice (APA) Guidelines (April 2000),<ref>{{cite book | vauthors = Hirschfeld RM |chapter = Guideline Watch: Practice Guideline for the Treatment of Patients With Bipolar Disorder, 2nd Edition|year = 2006|isbn = 978-0-89042-336-3|volume = 1|title=APA Practice Guidelines for the Treatment of Psychiatric Disorders: Comprehensive Guidelines and Guideline Watches| publisher=American Psychiatric Association |chapter-url=http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/bipolar-watch.pdf |archive-url=https://web.archive.org/web/20170712204621/http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/bipolar-watch.pdf |archive-date=2017-07-12 |url-status=live }}</ref> and the APA endorsed Veteran Affairs clinical practice guideline.<ref>{{Cite web |date=2022 |title=Veterans Affairs and Department of Defence Clinical Practice Guideline for the Management of Major Depressive Disorder |url=https://www.healthquality.va.gov/guidelines/MH/mdd/ |access-date=2025-01-01 |website=www.healthquality.va.gov |language=en}}</ref>

CBT has been shown to be effective in the treatment of adults with anxiety disorders.<ref>{{cite journal | vauthors = Hofmann SG, Smits JA | title = Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials | journal = The Journal of Clinical Psychiatry | volume = 69 | issue = 4 | pages = 621–632 | date = April 2008 | pmid = 18363421 | pmc = 2409267 | doi = 10.4088/JCP.v69n0415 }}</ref>  There is also evidence that using CBT to treat children and adolescents with anxiety disorders was probably more effective (in the short term) than wait list or no treatment and more effective than attention control treatment approaches.<ref>{{cite journal | vauthors = James AC, Reardon T, Soler A, James G, Creswell C | title = Cognitive behavioural therapy for anxiety disorders in children and adolescents | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | issue = 11 | pages = CD013162 | date = November 2020 | pmid = 33196111 | pmc = 8092480 | doi = 10.1002/14651858.CD013162.pub2 | collaboration = Cochrane Common Mental Disorders Group }}</ref><ref name=":3">{{cite journal | vauthors = Leichsenring F | title = Comparative effects of short-term psychodynamic psychotherapy and cognitive-behavioral therapy in depression: a meta-analytic approach | journal = Clinical Psychology Review | volume = 21 | issue = 3 | pages = 401–419 | date = April 2001 | pmid = 11288607 | doi = 10.1016/S0272-7358(99)00057-4 }}</ref> Some meta-analyses find CBT more effective than psychodynamic therapy and equal to other therapies in treating anxiety and depression.<ref name="Tolin_2010">{{cite journal |vauthors=Tolin DF |date=August 2010 |title=Is cognitive-behavioral therapy more effective than other therapies? A meta-analytic review |journal=Clinical Psychology Review |volume=30 |issue=6 |pages=710–720 |doi=10.1016/j.cpr.2010.05.003 |pmid=20547435}}</ref><ref name="Cuijpers_2008">{{cite journal |vauthors=Cuijpers P, van Straten A, Andersson G, van Oppen P |date=December 2008 |title=Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies |journal=Journal of Consulting and Clinical Psychology |volume=76 |issue=6 |pages=909–922 |doi=10.1037/a0013075 |pmid=19045960 |s2cid=23341989}}</ref><ref name=":3" /> A 2013 meta-analysis suggested that CBT, [[interpersonal therapy]], and [[problem-solving therapy]] outperformed psychodynamic psychotherapy and [[behavioral activation]] in the treatment of depression.<ref name="Barth_2013" /> According to a 2004 review by [[INSERM]] of three methods, cognitive behavioral therapy was either proven or presumed to be an effective therapy on several [[mental disorder]]s.<ref name="INSERM" /> This included [[Depression (mood)|depression]], [[panic disorder]], [[Post-traumatic stress disorder|post-traumatic stress]], and other anxiety disorders.<ref name="INSERM" />

A [[systematic review]] of CBT in depression and anxiety disorders concluded that "CBT delivered in primary care, especially including computer- or Internet-based self-help programs, is potentially more effective than usual care and could be delivered effectively by primary care therapists."<ref name="HoifodtRS">{{cite journal | vauthors = Høifødt RS, Strøm C, Kolstrup N, Eisemann M, Waterloo K | title = Effectiveness of cognitive behavioural therapy in primary health care: a review | journal = Family Practice | volume = 28 | issue = 5 | pages = 489–504 | date = October 2011 | pmid = 21555339 | doi = 10.1093/fampra/cmr017 | doi-access = free }}</ref>

A 2024 systematic review found that [[Exposure and response prevention (ERP) therapy|exposure and response prevention (ERP)]], a specific form of cognitive behavioral therapy, is considered a first-line treatment for pediatric obsessive–compulsive disorder (OCD). Research indicates that ERP is effective in both in-person and remote settings, providing flexibility in treatment delivery without compromising efficacy.<ref>{{Cite report |url=https://effectivehealthcare.ahrq.gov/products/obsessive-compulsive-disorder/research |title=Diagnosis and Management of Obsessive Compulsive Disorders in Children: A Systematic Review |last=Steele |first=Dale W. |last2=Caputo |first2=Eduardo L. |last3=Kanaan |first3=Ghid |last4=Zahradnik |first4=Michael L. |last5=Brannon |first5=Elizabeth |last6=Freeman |first6=Jennifer B. |last7=Balk |first7=Ethan M. |last8=Trikalinos |first8=Thomas A. |last9=Adam |first9=Gaelen P. |date=2024-12-06 |publisher=Agency for Healthcare Research and Quality (AHRQ) |doi=10.23970/ahrqepccer276}}</ref>

{{Quote2|In CBT you work on reducing fear by changing how you think and act. Instead of thinking of the fear object (for example, a spider) as an imminent threat or danger, you're taught to reevaluate the fear object as less threatening to your safety and well-being. Instead of avoiding or running from the fear, you're encouraged to face the fear.<ref>{{Cite book |last=Clark |first=David A. |url=https://www.goodreads.com/book/show/63223214-the-anxiety-and-worry-workbook |title=The anxiety and worry workbook: the cognitive behavioral solution |last2=Beck |first2=Aaron T. |date=2023 |publisher=The Guilford Press |isbn=978-1-4625-4616-9 |edition=Second |series=Psychology |location=New York London |pages=37 |language=en}}</ref>}}

====Theoretical approaches====
One [[Etiology|etiological]] theory of depression is [[Aaron T. Beck]]'s cognitive theory of depression. His theory states that depressed people think the way they do because their thinking is biased towards negative interpretations. Beck's theory rests on the aspect of cognitive behavioral therapy known as [[Schema (psychology)|schemata]].<ref name=":0">{{Cite journal |last1=Turk |first1=Dennis C. |last2=Salovey |first2=Peter |date=1985-02-01 |title=Cognitive structures, cognitive processes, and cognitive-behavior modification: I. client issues |url=https://doi.org/10.1007/BF01178747 |journal=Cognitive Therapy and Research |language=en |volume=9 |issue=1 |pages=1–17 |doi=10.1007/BF01178747 |issn=1573-2819}}</ref> Schemata are the mental maps used to integrate new information into memories and to organize existing information in the mind. An example of a [[Schema (psychology)|schema]] would be a person hearing the word "dog" and picturing different versions of the animal that they have grouped together in their mind.<ref name=":0" /> According to this theory, depressed people acquire a negative schema of the world in childhood and adolescence as an effect of stressful life events, and the negative schema is activated later in life when the person encounters similar situations.<ref name="Neale247">{{Cite book|vauthors = Neale JM, Davison GC|title = Abnormal psychology|edition = 8th|publisher = John Wiley & Sons|location = New York|year = 2001|page = [https://archive.org/details/abnormalpsycholo00gera/page/247 247]|isbn = 978-0-471-31811-8|url-access = registration|url = https://archive.org/details/abnormalpsycholo00gera/page/247}}</ref>

Beck also described a negative [[Beck's cognitive triad|cognitive triad]]. The cognitive triad is made up of the depressed individual's negative evaluations of themselves, the world, and the future. Beck suggested that these negative evaluations derive from the negative schemata and cognitive biases of the person. According to this theory, depressed people have views such as "I never do a good job", "It is impossible to have a good day", and "things will never get better". A negative schema helps give rise to the cognitive bias, and the cognitive bias helps fuel the negative schema. Beck further proposed that depressed people often have the following cognitive biases: [[arbitrary inference]], [[selective abstraction]], overgeneralization, magnification, and [[Minimisation (psychology)|minimization]]. These cognitive biases are quick to make negative, generalized, and personal inferences of the self, thus fueling the negative schema.<ref name="Neale247" />

On the other hand, a positive cognitive triad relates to a person's positive evaluations of themself, the world, and the future.<ref name=":1">{{Cite journal |last1=Mehta |first1=Mansi H. |last2=Grover |first2=Rachel L. |last3=DiDonato |first3=Theresa E. |last4=Kirkhart |first4=Matthew W. |date=June 2019 |title=Examining the Positive Cognitive Triad: A Link Between Resilience and Well-Being |url=http://journals.sagepub.com/doi/10.1177/0033294118773722 |journal=Psychological Reports |language=en |volume=122 |issue=3 |pages=776–788 |doi=10.1177/0033294118773722 |pmid=29708049 |issn=0033-2941}}</ref> More specifically, a positive cognitive triad requires [[self-esteem]] when viewing oneself and hope for the future. A person with a positive cognitive triad has a positive schema used for viewing themself in addition to a positive schema for the world and for the future. Cognitive behavioral research suggests a positive cognitive triad bolsters [[Psychological resilience|resilience]], or the ability to cope with stressful events. Increased levels of resilience is associated with greater resistance to [[Depression (mood)|depression]].<ref name=":1" />

Another major theoretical approach to cognitive behavioral therapy treatment is the concept of [[Locus of control|Locus of Control]] outlined in [[Social learning theory|Julian Rotter's Social Learning Theory]]. Locus of control refers to the degree to which an individual's sense of control is either internal or external.<ref name=":2">{{Cite journal |last1=Nowicki |first1=Stephen |last2=Iles-Caven |first2=Yasmin |last3=Kalechstein |first3=Ari |last4=Golding |first4=Jean |date=June 29, 2021 |title=Editorial: Locus of Control: Antecedents, Consequences and Interventions Using Rotter's Definition |journal=Frontiers in Psychology |volume=12 |doi=10.3389/fpsyg.2021.698917 |doi-access=free |pmid=34267714|pmc=8275955 }}</ref> An internal locus of control exists when an individual views an outcome of a particular action as being reliant on themselves and their personal attributes whereas an external locus of control exists when an individual views other's or some outside, intangible force such as luck or fate as being responsible for the outcome of a particular action.<ref name=":2" />

A basic concept in some CBT treatments used in anxiety disorders is ''in vivo'' [[Exposure therapy|exposure]]. CBT-exposure therapy refers to the direct confrontation of feared objects, activities, or situations by a patient. For example, a woman with PTSD who fears the location where she was assaulted may be assisted by her therapist in going to that location and directly confronting those fears.<ref>{{Cite web|url=https://www.div12.org/sites/default/files/WhatIsExposureTherapy.pdf |archive-url=https://ghostarchive.org/archive/20221010/https://www.div12.org/sites/default/files/WhatIsExposureTherapy.pdf |archive-date=2022-10-10 |url-status=live|title=What is Exposure Therapy?|author=((American Psychological Association {{!}} Division 12)) |website=div12.org/}}</ref> Likewise, a person with a social anxiety disorder who fears public speaking may be instructed to directly confront those fears by giving a speech.<ref>{{cite web|url = http://ptsd.about.com/od/glossary/g/invivo.htm|title = Definition of In Vivo Exposure|publisher = Ptsd.about.com|date = 9 June 2014|access-date = 14 August 2014|archive-date = 19 March 2016|archive-url = https://web.archive.org/web/20160319155913/http://ptsd.about.com/od/glossary/g/invivo.htm|url-status = dead}}</ref> This "two-factor" model is often credited to [[Orval Hobart Mowrer|O. Hobart Mowrer]].<ref>{{Cite book |publisher = Wiley|location = New York|author = Mowrer OH|title = Learning theory and behavior|year = 1960|isbn = 978-0-88275-127-6}}{{Page needed|date = April 2012}}</ref> Through exposure to the stimulus, this harmful conditioning can be "unlearned" (referred to as [[Extinction (psychology)|extinction]] and [[habituation]]).

CBT for children with phobias is normally delivered over multiple sessions, but one-session treatment has been shown to be equally effective and is cheaper.<ref>{{Cite journal |date=April 2023 |title=One-session treatment is as effective as multi-session therapy for young people with phobias |url=https://evidence.nihr.ac.uk/alert/one-session-cbt-treatment-effective-for-young-people-with-phobias/ |journal=NIHR Evidence|doi=10.3310/nihrevidence_57627 |s2cid=258149486 }}</ref><ref>{{cite journal | vauthors = Wright B, Tindall L, Scott AJ, Lee E, Biggs K, Cooper C, Bee P, Wang HI, Gega L, Hayward E, Solaiman K, Teare MD, Davis T, Lovell K, Wilson J, McMillan D, Barr A, Edwards H, Lomas J, Turtle C, Parrott S, Teige C, Chater T, Hargate R, Ali S, Parkinson S, Gilbody S, Marshall D | display-authors = 6 | title = One-session treatment compared with multisession CBT in children aged 7-16 years with specific phobias: the ASPECT non-inferiority RCT | language = EN | journal = Health Technology Assessment | volume = 26 | issue = 42 | pages = 1–174 | date = October 2022 | pmid = 36318050 | pmc = 9638885 | doi = 10.3310/IBCT0609 }}</ref>

====Specialized forms of CBT====
CBT-SP, an adaptation of CBT for suicide prevention (SP), was specifically designed for treating youths who are severely depressed and who have recently attempted suicide within the past 90 days, and was found to be effective, feasible, and acceptable.<ref>{{cite journal | vauthors = Stanley B, Brown G, Brent DA, Wells K, Poling K, Curry J, Kennard BD, Wagner A, Cwik MF, Klomek AB, Goldstein T, Vitiello B, Barnett S, Daniel S, Hughes J | display-authors = 6 | title = Cognitive-behavioral therapy for suicide prevention (CBT-SP): treatment model, feasibility, and acceptability | journal = Journal of the American Academy of Child and Adolescent Psychiatry | volume = 48 | issue = 10 | pages = 1005–1013 | date = October 2009 | pmid = 19730273 | pmc = 2888910 | doi = 10.1097/chi.0b013e3181b5dbfe }}</ref>

[[Acceptance and commitment therapy]] (ACT) is a specialist branch of CBT (sometimes referred to as contextual CBT).<ref>{{cite journal | vauthors = McCracken LM, Vowles KE | title = Acceptance and commitment therapy and mindfulness for chronic pain: model, process, and progress | journal = The American Psychologist | volume = 69 | issue = 2 | pages = 178–187 | year = 2014 | pmid = 24547803 | doi = 10.1037/a0035623 | s2cid = 16276904 | url = https://pure.qub.ac.uk/en/publications/acceptance-and-commitment-therapy-and-mindfulness-for-chronic-pain-model-process-and-progress(e4edf891-b582-4202-a4d6-ab8948539356).html }}</ref><ref>{{Cite web |title=Acceptance and Commitment Therapy {{!}} Psychology Today |url=https://www.psychologytoday.com/us/therapy-types/acceptance-and-commitment-therapy |access-date=2025-03-15 |website=www.psychologytoday.com |language=en-US}}</ref> ACT uses mindfulness and acceptance interventions and has been found to have a greater longevity in therapeutic outcomes. In a study with anxiety, CBT and ACT improved similarly across all outcomes from pre- to post-treatment. However, during a 12-month follow-up, ACT proved to be more effective, showing that it is a highly viable lasting treatment model for anxiety disorders.<ref>{{Cite web|title=Randomized Clinical Trial of Cognitive Behavioral Therapy (CBT) Versus Acceptance and Commitment Therapy (ACT) for Mixed Anxiety Disorders|url=http://thehappinesstrap.com/wp-content/uploads/2017/06/ACt-vs-CBT-for-Anxiety.pdf |archive-url=https://ghostarchive.org/archive/20221010/http://thehappinesstrap.com/wp-content/uploads/2017/06/ACt-vs-CBT-for-Anxiety.pdf |archive-date=2022-10-10 |url-status=live|website=The Happiness Trap}}</ref>

Computerized CBT (CCBT) has been proven to be effective by randomized controlled and other trials in treating depression and anxiety disorders,<ref name="plosone.org" /><ref name="biomedcentral.com" /><ref name="HoifodtRS" /><ref>{{cite web|title=MoodGYM|url=http://www.ehub.anu.edu.au/assist/about/research.php|archive-url=https://web.archive.org/web/20130221021730/http://www.ehub.anu.edu.au/assist/about/research.php|archive-date=21 February 2013|access-date=22 November 2012}}</ref><ref name="pmid20948835" /><ref>{{cite journal | vauthors = Williams AD, Andrews G | title = The effectiveness of Internet cognitive behavioural therapy (iCBT) for depression in primary care: a quality assurance study | journal = PLOS ONE | volume = 8 | issue = 2 | pages = e57447 | year = 2013 | pmid = 23451231 | pmc = 3579844 | doi = 10.1371/journal.pone.0057447 | bibcode = 2013PLoSO...857447W | veditors = Andersson G | doi-access = free }}</ref> including children.<ref>{{cite journal | vauthors = Khanna MS, Kendall PC | title = Computer-assisted cognitive behavioral therapy for child anxiety: results of a randomized clinical trial | journal = Journal of Consulting and Clinical Psychology | volume = 78 | issue = 5 | pages = 737–745 | date = October 2010 | pmid = 20873909 | doi = 10.1037/a0019739 | url = http://www.seattleimplementation.org/wp-content/uploads/2011/12/ccp-78-5-737.pdf | publisher = [[American Psychological Association]] | access-date = 1 December 2013 | archive-url = https://web.archive.org/web/20131203035310/http://www.seattleimplementation.org/wp-content/uploads/2011/12/ccp-78-5-737.pdf | archive-date = 3 December 2013 }}</ref> Some research has found similar effectiveness to an intervention of informational websites and weekly telephone calls.<ref name="Schneider">{{cite web| vauthors = Schneider J |title=Computerised CBT for Common Mental Disorders: RCT of a Workplace Intervention|url=http://www.bohrf.org.uk/downloads/Computerised_CBT-Sep2012.pdf|archive-url=https://web.archive.org/web/20131203020947/http://www.bohrf.org.uk/downloads/Computerised_CBT-Sep2012.pdf|archive-date=3 December 2013|access-date=29 January 2013}}</ref><ref name="MoodGym no better than informational websites_2012">{{cite web|date=20 September 2012|title=MoodGym no better than informational websites, according to new workplace RCT|url=http://www.thementalelf.net/mental-health-conditions/anxiety-disorders/moodgym-no-better-than-informational-websites-according-to-new-workplace-rct/|archive-url=https://web.archive.org/web/20121116020909/http://www.thementalelf.net/mental-health-conditions/anxiety-disorders/moodgym-no-better-than-informational-websites-according-to-new-workplace-rct|archive-date=16 November 2012|access-date=29 January 2013}}</ref> CCBT was found to be equally effective as face-to-face CBT in adolescent anxiety.<ref>{{cite journal | vauthors = Spence SH, Donovan CL, March S, Gamble A, Anderson RE, Prosser S, Kenardy J | title = A randomized controlled trial of online versus clinic-based CBT for adolescent anxiety | journal = Journal of Consulting and Clinical Psychology | volume = 79 | issue = 5 | pages = 629–642 | date = October 2011 | pmid = 21744945 | doi = 10.1037/a0024512 | hdl-access = free | s2cid = 19631532 | hdl = 10072/43516 }}</ref>

====Combined with other treatments====
Studies have provided evidence that when examining animals and humans, that [[glucocorticoid]]s may lead to a more successful extinction learning during exposure therapy for anxiety disorders.<ref>{{Cite journal |last=Bentz |first=Dorothée |last2=Michael |first2=Tanja |last3=de Quervain |first3=Dominique J.-F. |last4=Wilhelm |first4=Frank H. |date=2010-03-24 |title=Enhancing exposure therapy for anxiety disorders with glucocorticoids: from basic mechanisms of emotional learning to clinical applications |url=https://pubmed.ncbi.nlm.nih.gov/19962269/ |journal=Journal of Anxiety Disorders |volume=24 |issue=2 |pages=223–230 |doi=10.1016/j.janxdis.2009.10.011 |issn=1873-7897 |pmid=19962269}}</ref> For instance, glucocorticoids can prevent aversive learning episodes from being retrieved and heighten reinforcement of memory traces creating a non-fearful reaction in feared situations. A combination of glucocorticoids and exposure therapy may be a better-improved treatment for treating people with anxiety disorders.<ref>{{cite journal | vauthors = Bentz D, Michael T, de Quervain DJ, Wilhelm FH | title = Enhancing exposure therapy for anxiety disorders with glucocorticoids: from basic mechanisms of emotional learning to clinical applications | journal = Journal of Anxiety Disorders | volume = 24 | issue = 2 | pages = 223–230 | date = March 2010 | pmid = 19962269 | doi = 10.1016/j.janxdis.2009.10.011 }}</ref>

====Prevention====
For anxiety disorders, use of CBT with people at risk has significantly reduced the number of episodes of generalized anxiety disorder and other anxiety symptoms, and also given significant improvements in explanatory style, hopelessness, and dysfunctional attitudes.<ref name="pmid20948835" /><ref>{{cite journal| vauthors = Seligman M, Schulman P, DeRubeis R, Hollon S |year=1999|title=The prevention of depression and anxiety|journal=Prevention & Treatment|volume=2|issue=1|pages=1111–1126|citeseerx=10.1.1.421.9996|doi=10.1037/1522-3736.2.1.28a|s2cid=211577 }}</ref><ref>{{cite journal | vauthors = Schmidt NB, Eggleston AM, Woolaway-Bickel K, Fitzpatrick KK, Vasey MW, Richey JA | title = Anxiety Sensitivity Amelioration Training (ASAT): a longitudinal primary prevention program targeting cognitive vulnerability | journal = Journal of Anxiety Disorders | volume = 21 | issue = 3 | pages = 302–319 | year = 2007 | pmid = 16889931 | doi = 10.1016/j.janxdis.2006.06.002 }}</ref> In another study, 3% of the group receiving the CBT intervention developed generalized anxiety disorder by 12 months postintervention compared with 14% in the control group.<ref>{{cite journal | vauthors = Higgins DM, Hecker JE | title = A randomized trial of brief cognitive-behavioral therapy for prevention of generalized anxiety disorder | journal = The Journal of Clinical Psychiatry | volume = 69 | issue = 8 | page = 1336 | date = August 2008 | pmid = 18816156 | doi = 10.4088/JCP.v69n0819a | doi-access = free }}</ref> Individuals with subthreshold levels of panic disorder significantly benefitted from use of CBT.<ref>{{cite journal | vauthors = Meulenbeek P, Willemse G, Smit F, van Balkom A, Spinhoven P, Cuijpers P | title = Early intervention in panic: pragmatic randomised controlled trial | journal = The British Journal of Psychiatry | volume = 196 | issue = 4 | pages = 326–331 | date = April 2010 | pmid = 20357312 | doi = 10.1192/bjp.bp.109.072504 | doi-access = free }}</ref><ref>{{cite journal| vauthors = Gardenswartz CA, Craske MG |year=2001|title=Prevention of panic disorder|journal=Behavior Therapy|volume=32|issue=4|pages=725–737|doi=10.1016/S0005-7894(01)80017-4}}</ref> Use of CBT was found to significantly reduce social anxiety prevalence.<ref>{{cite journal | vauthors = Aune T, Stiles TC | title = Universal-based prevention of syndromal and subsyndromal social anxiety: A randomized controlled study | journal = Journal of Consulting and Clinical Psychology | volume = 77 | issue = 5 | pages = 867–879 | date = October 2009 | pmid = 19803567 | doi = 10.1037/a0015813 }}</ref>

For depressive disorders, a stepped-care intervention (watchful waiting, CBT and medication if appropriate) achieved a 50% lower incidence rate in a patient group aged 75 or older.<ref>{{cite journal | vauthors = van't Veer-Tazelaar PJ, van Marwijk HW, van Oppen P, van Hout HP, van der Horst HE, Cuijpers P, Smit F, Beekman AT | display-authors = 6 | title = Stepped-care prevention of anxiety and depression in late life: a randomized controlled trial | journal = Archives of General Psychiatry | volume = 66 | issue = 3 | pages = 297–304 | date = March 2009 | pmid = 19255379 | doi = 10.1001/archgenpsychiatry.2008.555 | doi-access = free | hdl = 1871/16425 }}</ref> Another depression study found a neutral effect compared to personal, social, and health education, and usual school provision, and included a comment on potential for increased depression scores from people who have received CBT due to greater self recognition and acknowledgement of existing symptoms of depression and negative thinking styles.<ref>{{cite journal | vauthors = Stallard P, Sayal K, Phillips R, Taylor JA, Spears M, Anderson R, Araya R, Lewis G, Millings A, Montgomery AA | display-authors = 6 | title = Classroom based cognitive behavioural therapy in reducing symptoms of depression in high risk adolescents: pragmatic cluster randomised controlled trial | journal = BMJ | volume = 345 | pages = e6058 | date = October 2012 | pmid = 23043090 | pmc = 3465253 | doi = 10.1136/bmj.e6058 }}</ref> A further study also saw a neutral result.<ref>{{cite journal|vauthors=Clarke GN, Hawkins W, Murphy M, Sheeber L|year=1993|title=School-Based Primary Prevention of Depressive Symptomatology in Adolescents: Findings from Two Studies|journal=Journal of Adolescent Research|volume=8|issue=2|pages=183–204|doi=10.1177/074355489382004|s2cid=143775884}}</ref> A meta-study of the Coping with Depression course, a cognitive behavioral intervention delivered by a psychoeducational method, saw a 38% reduction in risk of major depression.<ref>{{cite journal | vauthors = Cuijpers P, Muñoz RF, Clarke GN, Lewinsohn PM | title = Psychoeducational treatment and prevention of depression: the "Coping with Depression" course thirty years later | journal = Clinical Psychology Review | volume = 29 | issue = 5 | pages = 449–458 | date = July 2009 | pmid = 19450912 | doi = 10.1016/j.cpr.2009.04.005 }}</ref>