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

Nikolaos Kazantzis, Hoang Kim Luong, Alexsandra S. Usatoff, Tara Impala, Rui Ying Yew, Stefan G Hofmann

Research output: Contribution to journalReview ArticleResearchpeer-review

108 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)349-357
Number of pages9
JournalCognitive Therapy and Research
Issue number4
Publication statusPublished - Aug 2018


  • cognitive behavioral therapy
  • process
  • review

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