A roundup of recent research on cognitive behavioral therapy
CBT is one of the most studied forms of psychotherapy, and the research keeps coming. Here are some of the findings from this year that I think are worth knowing about, starting with a new study on insomnia and aging.
CBT for Insomnia and Biological Aging
A UCLA Health study published in The Lancet Healthy Longevity in September found that treating insomnia with cognitive behavioral therapy for insomnia (CBT-I) slowed the pace of biological aging in older adults.
Nearly 100 older adults with insomnia were randomly assigned to eight weeks of either CBT-I or sleep education. Sleep education covered general information about healthy sleep habits, without the behavioral techniques. The researchers measured biological aging with epigenetic clocks, which estimate how fast the body is aging from changes in DNA. They took blood samples before treatment and at follow-up visits over the next two years.
The adults who received CBT-I were nearly three times as likely to have their insomnia go into remission. Their pace of biological aging was also significantly slower on one of the three clocks the researchers used, DunedinPACE.
The study was small and took place at a single site in Los Angeles. The authors say a larger study with more diverse participants is needed to confirm the results. Still, the lead author, Dr. Judith Carroll, put it well: insomnia in older adults “is often treated as a quality-of-life issue, but these findings suggest it may also be a modifiable risk factor for how the body ages.”
Other Recent Updates
New insomnia guidelines: start with CBT-I
In April, the American Academy of Sleep Medicine published a new guideline in the Journal of Clinical Sleep Medicine on combining CBT-I with sleep medication. It suggests CBT-I plus medication over medication alone. It also suggests against routinely adding medication to CBT-I. Both recommendations are conditional and based on low-certainty evidence, so treatment should still be a shared decision. The practical takeaway for most adults with chronic insomnia is to start with CBT-I.
Therapist-led CBT by instant messaging helps depression
A UK trial in The Lancet Primary Care randomly assigned 334 adults with depression to usual care or nine sessions of CBT delivered by instant message with an accredited CBT therapist, plus online resources. At six months, the CBT group had significantly lower depression scores. The key word here is therapist. This was a real clinician delivering CBT through a different channel, not an app.
CBT for menopausal insomnia and hot flashes
A pilot trial in Menopause found that CBT produced short-term improvements in insomnia severity, hot flash interference, sleep confidence and depressive symptoms in perimenopausal and postmenopausal women. The benefits faded after three months. This is a small early study, but it is a promising option for women who cannot use or do not want hormone therapy.
CBT and fluoxetine for youth anxiety
A trial in The American Journal of Psychiatry followed 316 youths ages 8 to 17 with severe anxiety. Starting with exposure-based CBT or with fluoxetine led to similar improvement, with a small, nonsignificant edge for CBT. For youths who were not in remission after 12 weeks, adding the second treatment did not do better overall than continuing the first. The lead author suggests the choice can rest on family preference and access to care.
AI-delivered CBT falls short so far
A systematic review in npj Digital Medicine looked at 16 randomized trials of AI-delivered CBT for anxiety and depression. Only 1 of 14 studies found a significant improvement in anxiety, and only 4 of 16 found one in depression. The authors also raised concerns about study quality. AI tools may still have a role, but right now the evidence does not show that they work as well as CBT with a therapist.
If you are struggling with insomnia, anxiety or depression, CBT is a well-researched place to start. You can find additional resources on our site.