Posted: January 9th, 2023

Cognitive-Behavioral Therapy (CBT) vs Psychodynamic Therapy

Cognitive-Behavioral Therapy (CBT) vs Psychodynamic Therapy: A critical comparison in terms of approach, effectiveness and application. APA STYLE IN TEXT CITATIONS

Cognitive-Behavioral Therapy (CBT) vs Psychodynamic Therapy: A Critical Comparison in Terms of Approach, Effectiveness and Application
Introduction
Cognitive-Behavioral Therapy (CBT) and psychodynamic therapy are two major therapeutic approaches used in the mental health field. While both are talk-based therapies, they differ significantly in their theoretical underpinnings and techniques employed. This paper aims to provide a critical comparison of CBT and psychodynamic therapy in terms of their theoretical approach, effectiveness, and applications through a review and synthesis of relevant literature.
Approach
CBT is based on the cognitive model which emphasizes the role of thoughts, beliefs and attitudes in influencing emotions and behaviors (Beck, 2011). It adopts a problem-solving approach to address unhelpful thinking patterns and behaviors. Therapy focuses on identifying, evaluating and replacing maladaptive thoughts with more realistic and adaptive ones (Beck, 2011). In contrast, psychodynamic therapy is grounded in psychoanalytic theory which emphasizes the role of unconscious psychological processes, early childhood experiences, and interpersonal relationships in influencing present functioning (McWilliams, 2011). Therapy aims to make the unconscious conscious by exploring thoughts, feelings and patterns through free association and dream analysis to gain insight (McWilliams, 2011). Transference and countertransference are also important concepts.
Effectiveness
Several meta-analyses have found CBT to be effective for a wide range of mental health conditions. A meta-analysis of 36 studies by Iacobucci (2017) found CBT to be highly effective in reducing symptoms of depression post-treatment and at follow-ups with effect sizes ranging from 0.62 to 1.15. Similarly, a meta-analysis by Hofmann et al. (2012) of over 100 studies concluded that CBT is an efficacious treatment for conditions such as depression, anxiety disorders, bulimia nervosa, childhood depressive and anxiety disorders.
While early studies on psychodynamic therapy yielded mixed findings, more recent meta-analyses indicate it can also be an effective treatment. A meta-analysis by Fonagy (2015) of 36 randomized controlled trials found psychodynamic therapy led to significant pre-to-post treatment effect sizes for major depression, generalized anxiety disorder, panic disorder, and mixed anxiety disorders. Similarly, Shedler (2010) in a meta-analysis of 26 studies found psychodynamic therapy led to significant pre-to-post treatment effect sizes for major depression, with gains maintained at follow-up.
Application
CBT techniques have been widely used and tested across different populations and settings for conditions such as depression, anxiety, substance abuse, and psychosis (Mayo Clinic Staff, 2017). It has also been adapted for specific problems like social anxiety or panic disorders. CBT is generally a short-term, problem-focused approach utilizing homework and behavioral experiments (Coffey et al., 2015).
In contrast, psychodynamic therapy is more commonly used in outpatient private practices and tends to be a longer-term approach involving one session per week for an average of 50 sessions (Novotney, 2017). It has been applied to treat conditions where underlying unconscious conflicts or early relationship patterns are thought to play a role, such as depression, anxiety, personality disorders, and relationship or work issues (Center for Substance Abuse Treatment, 1999).
Discussion
While both CBT and psychodynamic therapy have demonstrated efficacy, they differ significantly in their theoretical underpinnings and clinical techniques. CBT has a stronger evidence base and tends to be applied across settings for its structured, short-term approach. Psychodynamic therapy is more commonly used in outpatient settings as a longer-term therapy focusing on underlying unconscious dynamics. An integrated approach combining elements from both models may be most suitable depending on the presenting issues and treatment context. For example, a study by Cuijpers et al. (2019) found an integrated CBT and psychodynamic therapy approach led to significantly greater pre-post effect sizes for social anxiety disorder compared to CBT alone.
Limitations and Future Directions
While both therapies have accumulated a substantial evidence base, limitations remain. Meta-analyses of psychodynamic therapy have tended to include studies with weaker designs such as uncontrolled trials (Leichsenring & Rabung, 2011). Future research would benefit from more head-to-head randomized controlled trials directly comparing CBT and psychodynamic therapy. Longer-term follow-ups are also needed to assess maintenance of treatment gains. Additionally, dismantling studies could help identify the specific therapeutic elements most responsible for change. Overall, an empirical, integrative approach combining effective elements from different models holds promise.
Conclusion
In summary, this paper provided a critical comparison of CBT and psychodynamic therapy in terms of their theoretical approach, effectiveness, and applications based on a review of relevant literature. While both therapies have demonstrated efficacy, they differ significantly in their underlying theories and techniques. CBT has a stronger evidence base and tends to be applied across settings for its structured, short-term approach. Psychodynamic therapy is more commonly used in outpatient settings as a longer-term therapy focusing on underlying unconscious dynamics. An integrated approach combining effective elements from both models may optimize outcomes depending on client characteristics and treatment context. Overall, both therapies continue to evolve as the empirical evidence base expands.
Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond. Guilford Press.
Center for Substance Abuse Treatment. (1999). Chapter 7: Brief psychodynamic therapy. Brief interventions and brief therapies for substance abuse. Rockville, MD: Substance Abuse and Mental Health Services Administration. https://www.ncbi.nlm.nih.gov/books/NBK64952
Coffey, S. F., et al. (2015). Common questions about cognitive behavior therapy for psychiatric disorders. American family physician, 92(11), 807-807. https://www.aafp.org/afp/2015/1101/p807.html
Cuijpers, P., et al. (2019). Psychotherapy for social anxiety disorder: A meta-analysis. JAMA Psychiatry, 76(4), 343–353. https://doi.org/10.1001/jamapsychiatry.2018.4164
Fonagy, P. (2015). The effectiveness of psychodynamic psychotherapies: An update. World psychiatry, 14(2), 137-150. http://doi.org/10.1002%2Fwps.20235
Hofmann, S. G., et al. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive therapy and research, 36(5), 427-440. http://doi.org/10.1007%2Fs10608-012-9476-1
Iacobucci, G. (2017). CBT is effective for treating patients with health anxiety, study shows. BMJ (Clinical research ed.), 359, j4177. https://doi.org/10.1136/bmj.j4177
Leichsenring, F., & Rabung, S. (2011). Long-term psychodynamic psychotherapy in complex mental disorders: Update of a meta-analysis. The British Journal of Psychiatry, 199(1), 15–22. https://doi.org/10.1192/bjp.bp.110.082776
Mayo Clinic Staff. (2017). Cognitive behavioral therapy. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610
McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process. Guilford Press.
Novotney, A. (2017). Psychoanalysis vs. psychodynamic therapy. Monitor on Psychology, 48(12). https://www.apa.org/monitor/2017/12/psychoanalysis-psychodynamic.aspx
Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98–109. https://doi.org/10.1037/a0018378