Different Ways of Delivering CBT Therapy: What Works Best for Anxiety?
When it comes to treating generalized anxiety disorder, cognitive behavioural therapy (CBT) has long been considered one of the most effective approaches. But as mental health services evolve and technology advances, researchers are asking an important question: Does it matter how this therapy is delivered?
A new study examined data from 52 clinical trials involving over 4,300 people with generalized anxiety disorder to compare three main ways of receiving CBT: traditional one on one sessions with a therapist, group therapy sessions, and remote therapy delivered through digital platforms.
What the Research Revealed
Individual therapy sessions emerged as the most effective format, showing greater results compared to remote therapy, standard care, and waiting lists. This traditional approach appears to maintain its edge in helping people manage their anxiety symptoms.
Group therapy also demonstrated strong effectiveness, particularly when compared to no treatment at all. The researchers found that group sessions produced notably positive results, with effect sizes that were actually larger than individual therapy in some measures, though the direct comparison between individual and group therapy didn't show a significant difference.
Remote therapy, while still beneficial compared to no treatment in some analyses, showed the most mixed results. It did not prove superior to standard care or waiting lists in the main network analysis, though it did show benefits in direct comparisons with waiting lists.
Why These Differences Matter
The effectiveness of individual therapy likely stems from the personalized attention and strong therapeutic relationship that develops between patient and therapist. This one on one connection allows for tailored treatment approaches and immediate feedback, which can be particularly valuable for addressing the complex worry patterns characteristic of generalized anxiety disorder.
Group therapy's strong showing might surprise some people, but it offers unique advantages. Participants can learn from others facing similar challenges, provide mutual support, and practice new skills in a social setting. The group dynamic can create a sense of community and reduce the isolation often felt by those struggling with anxiety.
The more modest results for remote therapy highlight some current limitations of digital mental health approaches. While convenient and accessible, remote therapy may lack some of the interpersonal connection that makes therapy effective. The researchers suggest that future developments might focus on enhancing how therapists establish relationships with patients in digital settings or creating virtual group environments that promote more effective patient interaction.
For people seeking CBT for anxiety, these findings suggest several considerations. Individual therapy remains a gold standard option, particularly for those who can access it readily. However, group therapy emerges as a viable and potentially equally effective alternative that may also be more cost effective and accessible.
The research indicates that group CBT could help address the shortage of mental health services by allowing therapists to work with multiple patients simultaneously while maintaining effectiveness. This could be particularly valuable in areas where mental health professionals are scarce or where cost is a significant barrier to treatment.
Remote therapy, while showing promise, may work best as a supplement to other forms of treatment rather than a complete replacement, at least with current technology and approaches. As digital mental health tools continue to evolve, future versions may prove more effective.
The study involved participants ranging from children to older adults, providing a broad view of CBT effectiveness across age groups. However, the researchers note that responses to different therapy formats may vary among different patient populations, suggesting that personalized approaches to treatment selection could become increasingly important.
The research also underscores the importance of ongoing innovation in mental health service delivery. As demand for mental health services continues to rise, understanding how to deliver effective treatment in various formats becomes increasingly crucial for meeting population needs.
For mental health providers, these findings support maintaining individual therapy as a primary treatment option while considering group therapy as a valuable alternative. The results also suggest that improvements in remote therapy delivery methods could enhance their effectiveness in the future.
This research provides valuable guidance for anyone navigating anxiety treatment options, offering evidence based insights into what approaches are most likely to provide relief from the persistent worry and distress that characterize generalized anxiety disorder.
Liu, S., Xiao, H., Duan, Y., Shi, L., Wang, P., Cao, L., ... & Qiu, C. (2025). CBT treatment delivery formats for generalized anxiety disorder: a systematic review and network meta-analysis of randomized controlled trials. Translational Psychiatry, 15(1), 197.
