Rethinking CBT as the ‘gold standard’ of mental health treatment
Cognitive behavioural therapy (CBT), frequently referred to as the “gold standard” of therapy, is rooted in evidence and offers a structured, measurable approach to mental health treatment. It was one of the first treatments shown to be as effective as prescription medication for depression — and unlike medications, it carries no risk of harmful side effects.
Yet, despite its popularity, some researchers and clinicians have begun advocating for increased access to alternative forms of therapy in Canada.
As mental health diagnoses continue to rise, the urgency to determine the most effective forms of treatment grows. And understanding whether CBT should continue to dominate the therapeutic landscape first requires a look at how it gained that reputation in the first place.
Allan Abbass and colleagues, in a 2020 article published in Psychoanalytic Psychotherapy, cite private insurance models as one of the reasons that CBT has become highly favoured in mental health care. Its structured format, clearly defined timelines and measurable outcomes align well with the requirements of insurance providers and public health systems. CBT protocols are relatively short, around 12 to 16 weeks, making it a more affordable private care option than long-term therapy.
“For sure cost is a factor,” says Karen Dougherty, a psychoanalyst and instructor at the Toronto Psychoanalytic Society, when discussing why people use CBT-based treatment over other forms of therapy.
CBT also aligns well with many North American cultural values, including swift productivity and progress. “We live in a culture that values quick fixes,” says Dougherty, adding she believes that long-term therapy is key to a patient’s success.
Developed by American psychiatrist Aaron Beck in the 1960s, CBT is praised for its scientific rigor and quantifiable outcomes. Beck was a psychoanalyst by training, and his method emerged from recognizing thought patterns in depressed patients that countered the understanding of depression. Thoughts such as: “I didn’t get that job; I’ll never get hired anywhere” or “They were just being nice; they don’t actually mean that compliment.”
Beck named these “cognitive distortions,” believing that by helping patients identify and change distorted thinking patterns, they could gain relief from mental illness.
Beck’s novel therapy took patients off the couch and into the chair. Previously, patients would have undergone years-long treatments exploring the unconscious through free association. Now, they would complete lessons and worksheets, practical strategies for identifying and modifying maladaptive thought patterns – all in a fraction of the treatment time by comparison.
No precise statistics cite how many Canadians receive CBT or how many CBT-trained therapists are practicing. However, most publicly available therapy programs appear to rely heavily on CBT-based treatments. The Canadian Mental Health Association’s BounceBack program, Saskatchewan’s Online Therapy Unit and Ontario’s Structured Psychotherapy Program are all grounded in CBT approaches. Access to other modalities in the public system appears far more limited.
Daniel Ellis, Director of Research at the Albert Ellis Institute, and colleagues state that CBT is one of the only therapies that has been rigorously tested against other forms of treatment, in a 2018 article in Frontiers in Psychiatry. They argued CBT has extremely strong backing in empirical support and that other forms of psychotherapy don’t measure up.
Others disagree. A 2017 American Journal of Psychiatry article argued that there is no compelling evidence that CBT is more effective than other psychotherapies for depression or anxiety. “CBT is probably the best empirically studied type of psychotherapy because for other forms of therapy … fewer high-quality studies are likely to exist.” But “more studies do not necessarily imply that a treatment is more efficacious.”
Many experts say therapy is rarely a binary choice between rigidly defined approaches. Dougherty’s own work echoes this, incorporating a range of methods. While primarily focused on psychoanalysis, she admits to borrowing from other methodologies, such as attachment-based therapy.
“In current practice, CBT often integrates techniques from a range of evidence-based treatments to support belief based, emotional and behavioural change,” Judith Beck, therapist and daughter of Aaron Beck, explained in a 2024 interview on the Psychiatry & Psychotherapy podcast. She added that one of the issues with CBT is that “too many practitioners work from a manual,” and not enough take an individualized approach when it comes to treating patients.
Though CBT, in some cases, is a fast-acting treatment that is exactly what’s needed to help a patient regain stability, other forms of therapy may offer deeper or longer-term benefits. Some Canadian psychotherapists have questioned whether a primary focus on short-term models like CBT is sufficient for all cases, as noted in a commentary published by the Canadian Counselling and Psychotherapy Association.
Dougherty says psychoanalysis has often been stigmatized as a treatment reserved for the upper class or highly educated. Through her work with patients in rural Ontario – and her involvement with the Conversations in Psychoanalysis Today podcast – she’s working to change that narrative.
As noted in the American Journal of Psychiatry article: “Only plurality allows for bridging the gap between different approaches and for learning from each other to further improve the treatment of patients with mental disorders.”
With mental health diagnoses on the rise, changes in treatment may be imminent with more emphasis placed on the importance of a pluralistic, rather than one-size-fits-all, approach to care – questioning CBT’s status as the “gold standard.”
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Charissa Egger is a journalist and writer covering topics at the intersection of neuroscience and health. She holds a BSc in Neurobiology and an MSc in Cognitive Neuroscience. In Fall 2025, Charissa will join the Dalla Lana Fellowship in Journalism and Health Impact at the University of Toronto. This piece was originally published in Healthy Debate.