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PART ONE: IDEAS

CBT: From American Innovation to European Therapeutic “Monoculture”?—Transatlantic Transfer of Cognitive Behavioral Therapy and its British Afterlife

Paulina Grzęda

Abstract

This article critically examines the historical, philosophical, and socio-political trajectory of cognitive behavioral therapy (CBT), tracing its evolution from a distinctly American psychological innovation to its hegemonic institutionalization in the United Kingdom. It situates CBT within three successive “waves” and highlights its philosophical roots in American empiricism, pragmatism, and individualism. The analysis underscores CBT’s compatibility with neoliberal ideals, particularly its emphasis on personal responsibility, cost-effectiveness, and quantifiable outcomes. Through a socio-historical lens, the article explores CBT’s transatlantic transmission into the UK, detailing its development through academic institutions, government-backed initiatives such as IAPT, and policy frameworks like NICE. It further contrasts the British embrace of CBT with the more resistant reception in France, underscoring how national intellectual traditions and political cultures mediate therapeutic adoption. The article also assesses the philosophical and methodological critiques surrounding CBT’s dominance, including concerns about therapeutic monoculture, reductionism, and the marginalization of alternative approaches. Finally, it explores emerging trends such as third-wave and process-based therapies, arguing that CBT’s structured and protocol-driven nature makes it particularly adaptable to contemporary challenges, including the digitalization of mental healthcare. The study offers a timely reflection on how psychotherapy practices become entangled with broader epistemological, political, and cultural forces.

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1. Introduction

1Cognitive Behavioral Therapy (CBT) represents one of the most significant developments in modern psychotherapy, psychological and philosophical thought, embodying both therapeutic innovation and broader sociocultural transformations. Indeed, many claim that today, CBT has emerged as the “gold standard” in psychotherapy, gaining widespread global adoption due to its demonstrated transdiagnostic efficacy, supported by thousands of scientific studies (David et al.; Beck 19). Its widespread application was evidenced in a global survey conducted in 2015, which found CBT to be the most widely practiced therapeutic approach internationally (Knapp et al.). For instance, in the United Kingdom, CBT currently holds the position of the dominant therapeutic modality within the National Health Service’s (NHS) Improving Access to Psychological Therapies (IAPT) program. By year 2017, the IAPT program had begun annually assisting over 1 million individuals with various mental health concerns such as depression and anxiety disorders (Sharland et al. 7395). Such an institutionalization of CBT in Europe is further highlighted in Germany, where CBT is the dominant paradigm in most university clinical psychology institutes (Tripp et al. 209); in the Netherlands, with one of the largest CBT organizations globally and the highest global ratio of CBT therapists to population (van Emmerik and Prins 357); and in Spain, where a great majority of psychotherapists have a CBT orientation (Sorribes et al. 465).

2Although these developments collectively highlight CBT’s prominent and widely acknowledged role in contemporary European psychotherapeutic practice, the foundational origins of cognitive behavioral therapy remain distinctly American, deeply intertwined with a specific cultural and socio-political epoch in U.S. history. Indeed, long before CBT attained global prominence, its intellectual and methodological roots were firmly embedded within American psychological thought, reflecting distinctly behavioral and cognitive traditions originating in the United States. Thus, this article aims first to elaborate on the American socio-cultural foundations that shaped CBT’s evolution, before examining its subsequent hegemonic adoption within the United Kingdom, supplemented by comparative insights from France. This socio-historical and cultural analysis will draw on the “wave” model to trace CBT’s developmental trajectory, from its initial behavioral foundations, through cognitive integration, to the later emergence of increasingly eclectic, contextually responsive approaches, such as ACT, DBT, or mindfulness-based interventions.

2. The Early Origins of American Psychology

3Psychology in the United States initially developed as an academic field, with William James establishing the first informal psychology laboratory at Harvard University in the late 1870s (Wertheimer and Puente 94–95). James’s foundational impact is also reflected in his serving as the first president of the American Psychological Association, established in 1892. The first formal psychology laboratory in the USA, on the other hand, was founded by G. Stanley Hall, Wilhelm Wundt’s disciple. It opened at Johns Hopkins University in 1883, thus institutionalizing psychological research as a scientific discipline in the U.S. (Wertheimer and Puente 95). The term “clinical psychology” itself was first coined by Lightner Witmer, who pioneered the application of scientific research to real-world clinical settings. He also founded the first psychology clinic in 1896, which delivered both diagnostic assessments and therapeutic services for school-aged children with behavioral and learning challenges (Gerardi and McGinn 520). Although these initiatives represented only the initial stages in the broader development of American psychology, they established a robust scientific and empirical groundwork that would later contribute to the emergence of CBT in the U.S.

4As could be expected, early American psychological practice was soon notably influenced by psychoanalysis, a dominant paradigm of the early 20th century that foregrounded the significance of unconscious processes in shaping mental life with a goal of improving an individual’s self-awareness and understanding the influence of the past on present behaviors (Gerardi and McGinn 520–521). American psychoanalytic orientation emerged in parallel with similar intellectual currents in Europe, reflecting a marked transatlantic convergence in the conceptualization of the human psyche during that period. The psychodynamic approach, which soon evolved from psychoanalysis, dominated the field of personal change in the U.S. largely until the early 1950s (Bandura 163). However, importantly, in the United States of America, psychoanalysis was historically dominated by psychiatrists (Amouroux 10), which led psychologists either to primarily focus on assessment rather than therapeutic intervention or to explore other forms of psychotherapy, such as behavioral and humanistic approaches.

3. The American Tapestry of CBT’s Origins: CBT as An American Legacy and Its Evolving Waves

5It was within this specific historical context that behavior therapy (BT) emerged as a direct counter-movement to the prevailing psychodynamic approaches, seeking to apply empirically derived principles of learning to the treatment of psychological disorders (Franks 204). Interestingly, cognitive therapy (CT), a closely related development, also evolved in critical opposition to psychoanalytic theory. In the 1950s, Aaron T. Beck, then a young American psychiatrist aligned with psychoanalytic thought, set out to empirically validate its core constructs (Beck and Fleming). However, his research into Freud’s hypothesis that depression stems from self-directed anger revealed a different pattern. It turned out that individuals with depression frequently experienced automatic, negatively biased thoughts and maladaptive interpretations of the self, the world, and the future (Gerardi and McGinn 521). These findings led Beck to move his patients from the couch to a chair, where he collaboratively examined their automatic thoughts and cognitive distortions (Beck and Fleming 2). This transformation, grounded in the American emphasis on empirical observation and measurable outcomes, played a pivotal role in the development of CBT (Wertheimer and Puente). Consequently, by the close of the 20th century, psychodynamic treatment methods were largely supplanted by cognitive-behavioral and pharmacological techniques, and early behavior therapists effectively positioned themselves as rule-breakers and revolutionaries, challenging ineffective mainstream practices.

6Yet, the genesis of CBT lies in not just one, but two principal movements within American psychology, namely behaviorism and cognitive psychology. Since the evolution of CBT is frequently conceptualized through a developmental framework comprising three successive “waves,” the following section will outline the therapy’s historical trajectory in accordance with this model.

4. First Wave: Behavior Therapy

7The early foundations of BT can be traced to Ivan Pavlov’s work on classical conditioning in Russia, which served as the first animal model of learning (McGinn and Sanderson 23). In the United States, it was applications of conditioning principles to the study of emotional problems in humans that played a key role in the development of BT, as exemplified by Watson and Rayner’s (1920) account of conditioning phobia in Little Albert (Gerardi and McGinn 521). Watson, in particular, popularized the idea that psychology should focus exclusively on observable behavior rather than the mind. His “S-R associationism” sought to replace subjective psychological concepts with measurable behavioral equivalents (Wertheimer and Puente 130–131). Watson’s work explicitly aimed to establish psychology as a rigorous, objective science.

8Behavior modification evolved further from B.F. Skinner’s work on operant learning (1953). As arguably the most influential behaviorist of the late 20th century, Skinner championed a descriptive behaviorism focused on reinforcement and environmental control (Vargas). His research significantly influenced innovations such as “teaching machines” and programmed instruction (Wertheimer and Puente 135). In his utopian vision articulated in Walden Two (2005), Skinner proposed that carefully engineered environments could promote desirable social behavior. He consistently rejected internal constructs such as the mind or personality traits as explanatory tools, insisting that behavior must be understood exclusively through observable environmental contingencies. He even criticized emerging cognitive approaches, likening them to “creationism” for diverting attention from measurable behavioral factors (Vargas 71).

9This first wave of BTs was notably marked by American philosophical and scientific traditions. Key among these was scientific materialism, the belief that mental and behavioral phenomena can ultimately be described by the concepts of mathematical and physical sciences, adopting a mechanistic and deterministic view (Wertheimer and Puente 127–128). Such a perspective naturally favored objective study, moving away from subjective introspection, and aligning with the scientific method. Behaviorism, popularized by Watson, was perceived as “very characteristic of the United States at the time” and emerged from functionalism, again a “peculiarly American” system that focused on the adaptive functions of the mind and the underlying purposes of behavior (Wertheimer and Puente 127). This focus on pragmatism and utility, where “truth is measured by how well something works in the accomplishment of a particular goal,” became a hallmark of later CBT approaches (Hayes and Pierson 1).

10The early behavioral movement’s emphasis on rigorous empirical validation, in its commitment to “data, not faith or argument or authority,” is deeply grounded in American traditions of objectivism and experimentalism (Wertheimer and Puente 169). Such intellectual foundations reflect the broader Enlightenment ideals of empiricism, systematization, and the use of objectively verifiable methods. This philosophical embeddedness of behavior therapy within the American cultural and political landscape becomes particularly evident in its reception abroad, most notably in France. In the 1960s, behavior therapy encountered substantial resistance in France, where it was often perceived as a “typical product of American culture” and a “technique for mind control” that stood in direct opposition to the “libertarian ideals of postwar French intellectuals” (Amouroux 1). Apparently, this initial rejection of behaviorism and, by extension, CBT, was shaped less by a critique of its philosophical underpinnings than by a broader climate of anti-American sentiment and France’s assertion of its cultural exceptionalism (Amouroux 1).

11Last but not least, the emergence of the first wave of cognitive behavioural therapies coincided with the consolidation of neoliberal economic reforms in the United Kingdom and the United States. This socio-political shift, often referred to as the rise of “new capitalism,” emphasized individual responsibility over structural or collective explanations of psychic pain. Within such a framework, work-related stress and dissatisfaction came to be reframed as indicators of personal deficits in resilience, requiring resolution through individual psychological intervention. This ideological orientation is closely aligned with the principles of CBT (Rowland 5).

5. Second Wave: The Cognitive Revolution and Traditional CBT

12The “second wave,” or cognitive revolution of the 1960s and 1970s, marked the formal emergence of traditional CBT. This period witnessed the development of cognitively based interventions, most notably those introduced by Albert Ellis and Aaron T. Beck. Ellis’s rational emotive behavior therapy (REBT), first implemented in 1955, emphasized a “conscious, active ‘self-indoctrination’ process” in which individuals perpetuate maladaptive thoughts rooted in early childhood experiences (Marks 7). Subsequently, Beck, drawing on empirical research conducted in the 1960s and 1970s, formulated cognitive therapy (CT) as a short-term, symptom-focused approach to treating depression. CT posited that thoughts, emotions, and behaviors are fundamentally interconnected and that an individual’s response to a given situation is shaped not by the situation itself, but by their automatic negative thoughts about it (Beck and Fleming 1). Beck argued that dysfunctional cognitions are central to emotional distress, and, as such, they constitute a primary target for therapeutic intervention (Gerardi and McGinn 521).

13Although REBT and CT differed in terminology and technique, they emerged from comparable theoretical foundations (Beck and Ellis). This shared methodological orientation facilitated the integration of both approaches as well as their assimilation with behavioral therapies. Indeed, this marriage of cognitive and behavioral traditions was driven by a shared focus on targeting symptoms and problems and employing the experimental method to investigate, alleviate, and evaluate psychopathology (Gerardi and McGinn 522). From a cultural standpoint, the introduction of CT helped to mitigate the negative associations that some psychological milieus, such as France, held towards BT. It facilitated the hybridized adoption of cognitive and behavior therapies together (Amouroux 11). The integrated approach that soon emerged under the name of CBT posited a reciprocal determination among thoughts, behaviors, and emotions, meaning a change in one could influence the others. Core techniques included identifying, evaluating, and modifying maladaptive thinking through methods such as Socratic questioning (Türkçapar). The use of manualized, protocol-based treatments became popular to ensure fidelity in research studies and gain credibility within the medical profession (Wilson 105).

14Yet, a pivotal figure in the conceptual consolidation of CBT was Albert Bandura. His social learning theory, particularly the construct of self-efficacy, emphasized the importance of individuals’ beliefs in their capacity to perform behaviors necessary to achieve specific outcomes (Bandura 170–173). This cognitive emphasis highlighted how internal belief systems mediate behavioral change, reinforcing the role of cognition within behaviorally oriented interventions. Bandura’s framework was instrumental in integrating cognitive elements into the behavioral tradition, effectively bridging the cognitive-behavioral divide and supporting the emergence of CBT as a unified model. By the final quarter of the 20th century, this convergence gained momentum, rooted in a shared focus on symptom reduction and empirical validation. As a result, the term “cognitive behavior therapy” began appearing in the literature by the mid-1970s, with early clinical trials emerging toward the end of the decade (Clark and Fairburn IX)

15The development of second-wave cognitive behavioral therapies (CBT) in the United States in the 1960s–1970s was firmly grounded in the American intellectual tradition of empirical rigor and scientific pragmatism. Emerging from the behaviorist era, cognitive therapy’s emphasis on objective measurement and experimental validation mirrored a broader national ambition to establish psychology as a legitimate scientific discipline, “a true science” (Wertheimer and Puente 137). This shift was further institutionalized with the growing influence of the American Psychological Association (APA) and the National Institute of Mental Health (NIMH), which shaped the field by funding randomized controlled trials and advancing the “scientist-practitioner model,” the so-called Boulder model to formalize training in both research and clinical application (Gerardi and McGinn 530). These priorities coalesced in the rise of cognitive therapy as a short-term, structured, and evidence-based treatment model, which embodied a distinctly American blend of scientific empiricism, interventionist optimism, functionalist psychology, and neoliberalism. In particular, Beck’s CT, conceptualized as “brief, direct, and time-limited treatment” for very specific psychological disorders, resonated with neoliberal drive towards cost-effectiveness and efficiency (Gerardi and McGinn 522).

16This evolution was further supported by the context of the 1960s, often referred to as the “golden age” of clinical psychology in the U.S., marked by a significant expansion of psychological services and the increasing professionalization of clinical practice (Benjamin 22). As Capshew (1999) noted, by the 1960s, the notion of the U.S. as a “psychological society” had become widely accepted, reflecting the nation’s growing preoccupation with psychological well-being amidst broader social upheaval (241). Indeed, the reinforcement of the second-wave cognitive behavioral therapy in the United States of America can also be contextualized within the broader cultural transformation in modern Western societies that scholars have termed the rise of “therapy culture.” As Philip Rieff argues, the United States was among the first societies to transition from the “religious man” to the “psychological man,” reorganizing moral authority around the management of internal states and the pursuit of emotional self-regulation rather than adherence to religious principles (The Triumph of the Therapeutic). This cultural shift from external moral authority rooted in religion to an inward-oriented, self-governing subject seeking fulfillment through therapeutic means rather than communal or transcendent frameworks was, as Rieff argues, a global phenomenon initiated by Freud’s intellectual legacy. Yet it was in the United States that this transformation assumed a particularly distinctive and influential form. Within neoliberal contexts, the therapeutic ethos aligned seamlessly with political and economic systems that valorize self-responsibility, adaptability, and continuous self-optimization. Consequently, this cultural climate proved highly receptive to psychotherapies promising agency, self-regulation, and personal efficiency. In this sense, CBT’s focus on cognitive restructuring and self-observation was not merely clinically innovative but also profoundly attuned to broader socio-political narratives of self-improvement and psychological governance. This cultural foundation perhaps helps to explain why CBT emerged and flourished so decisively in the American context before its subsequent institutionalization abroad.

17Lastly, the swift embrace of CBT in the United States can be understood, in part, through its alignment with a broader cultural and ideological project centered on individual emancipation and personal empowerment (Amouroux 4). CBT promotes strategies aimed at self-control, self-monitoring, self-help, and personal optimization, which resonate deeply with the American ethos of individualism and the cultural ideal of personal agency and individual responsibility often encapsulated in the notion of the “American dream.” A core technique within cognitive therapy, cognitive reappraisal requires individuals to actively reinterpret distressing thoughts, thus appealing to personal agency and the capacity for self-directed change and psychological self-regulation (Siegle and Coan 166). Thus, CBT, emphasizing self-observation, cognitive restructuring, and the correction of maladaptive thought patterns, fits seamlessly into an individualist cultural environment, translating social and structural pressures into problems of individual cognition and resilience.

6. Eclectic and Contextually Responsive Approaches: The Third Wave

18Finally, the “third wave” of CBT, rooted in developments from the 1980s and gaining significant prominence in the 21st century, represents a reformulation and expansion of previous CBT generations. These latest approaches move beyond merely changing the content of thoughts or behaviors, marking a shift away from strictly mechanistic or symptom-focused models, and are “particularly sensitive to the context and functions of psychological phenomena” (Carona 214). Third-wave therapies emphasize experiential strategies such as mindfulness, acceptance, and emotional openness alongside more traditional didactic methods. Central to this approach is a focus on universal aspects of the human condition, including the ubiquity of suffering (Carona 214). In this respect, as well as in their acceptance-based strategies, third-wave CBT therapies draw inspiration from Eastern philosophies, particularly Buddhism or Taoism (Murguia and Díaz; Woolfolk 19). This wave broadens the scope of CBT, addressing common existential and human challenges, fostering more adaptive responses to the complexities of the modern world, and prioritizing psychological flexibility over symptom elimination.

19Prominent therapeutic approaches within the third wave include Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), Mindfulness-Based Cognitive Therapy (MBCT), Functional Analytic Psychotherapy (FAP), and Behavioral Activation (Gerardi and McGinn; Carona; Hayes and Hofmann, Process-based CBT).

20ACT is grounded in the pragmatic worldview of functional contextualism, which seeks to understand how psychological processes operate within specific contexts, rather than correcting irrational beliefs as in the traditional cognitive model (Carona 215). ACT thus prioritizes context over content, emphasizing processes such as acceptance, cognitive defusion, values-based action, and the cultivation of a flexible sense of self-as-context (Martin 1191; Hayes and Pierson 3). Cognitive defusion involves altering one’s relationship to thoughts so they are experienced as transient verbal events, mental representations rather than literal truths, thereby reducing their influence on behavior and emotion. Central to ACT is psychological flexibility, defined as the capacity to act in accordance with chosen values despite discomfort. Values themselves are conceived as “freely chosen, verbally constructed consequences of ongoing, dynamic, evolving patterns of activity” (Wilson and Dufrene 66). ACT’s philosophical foundations also parallel Buddhist thought in recognizing suffering as an inherent dimension of human existence (Marks 18). Finally, ACT views language as both a primary vehicle for therapeutic change and a source of psychological entanglement, given its role in producing and maintaining human distress (Hayes and Strosahl 4).

21In turn, DBT, another prominent third-wave approach developed by Marsha Linehan, integrates CBT techniques with mindfulness and acceptance strategies (Hayes and Hofmann, Process-based CBT). Initially designed for individuals with borderline personality disorder and suicidal behaviors, it has since been applied to various clinical populations. DBT emphasizes balancing acceptance with change, drawing on dialectical principles and promoting emotional regulation, interpersonal effectiveness, and distress tolerance (Linehan).

22Lastly, MBCT is arguably among the most extensively disseminated interventions associated with the so-called “third wave” of cognitive behavioral therapies, and its popularity has grown considerably in recent years. This approach draws from Buddhist philosophical traditions, enabling individuals to cultivate non-judgmental awareness of internal and external experiences as they unfold in the present moment (Marks 18). MBCT, alongside MBSR, represents a meaningful integration of mindfulness and acceptance-based strategies into psychological treatment, with robust academic and clinical research communities supporting both models in the U.S., the U.K., and beyond (Marchand; Emmerik and Prins 362).

23Originally developed by Jon Kabat-Zinn in the late 1970s, MBSR was initially designed as an 8-week program to assist with chronic pain, stress, and illness. Grounded in meditative and movement practices such as body scans and yoga, MBSR was conceived as a secular adaptation of Buddhist contemplative techniques, aimed at enhancing well-being through experiential learning and present-moment awareness (Kabat-Zinn). Both MBCT and MBSR emphasize the importance of decentering, observing thoughts and emotions as transient mental events rather than as accurate reflections of self or reality. This fosters psychological flexibility, emotional regulation, and a reduction in maladaptive rumination. Importantly, while these mindfulness-based programs are rooted in acceptance, they are not passive; rather, they enable individuals to make intentional and skillful responses to internal distress, thereby enhancing agency and psychological resilience.

7. Process-based Therapy: Towards an Interdisciplinary Approach

24Today, however, it is the process-based approach (PBA) that represents the latest direction within CBT in the U.S. and globally (Hayes and Hofmann, Process-based CBT). Shifting the focus from rigid, syndrome-specific protocols to targeting relevant, transdiagnostic psychopathological processes to promote individuals’ well-being and growth, it is process-based therapy (PBT) that is increasingly seen as the future of clinical science and the profession of psychotherapy (Hofmann 583).

25PBT has emerged in response to the limitations of traditional CBT models, which, under the auspices of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), have historically emphasized developing specific protocols for specific psychiatric syndromes. This syndrome-focused orientation has been increasingly critiqued for oversimplifying human suffering and leading to clinicians’ inflexibility (Hayes and Hofmann, Process-based CBT 15). In contrast, PBT seeks to transcend this “protocols-for-syndromes” framework by targeting core psychological processes, such as emotion dysregulation or rumination, transdiagnostically, rather than anchoring treatment within a single disorder (Hayes and Hofmann, Process-based CBT 428).

26This allows for greater clinical flexibility, adaptability, and individualization of psychotherapeutic practice. Indeed, PBA moves away from a purely top-down, protocol-based nomothetic system towards an idiographic, bottom-up approach that intensely analyzes the individual and their unique context (Hayes and Hofmann, Process-based CBT). Importantly, PBT also represents a paradigmatic shift in research emphasis. Whereas earlier CBT traditions prioritized outcome research, evaluating whether a treatment works, PBT seeks to understand how and why interventions work by investigating mediators and moderators of change. This emphasis on mechanisms of change, rather than on efficiency itself, aims to deepen understanding of how therapy exerts impact (Ong et al. 15).

27Far from proclaiming the advent of a “fourth wave” CBT, the PBA explicitly aims to bridge and integrate the diverse traditions and historical “waves” of behavioral and cognitive therapies, including third-wave developments such as Acceptance and Commitment Therapy (ACT) and Mindfulness-Based Cognitive Therapy (MBCT) (Ong et al. 2). While early behavioral therapies were often grounded in mechanistic models and classical conditioning, third-wave approaches emerged from functional contextualism and Eastern contemplative traditions. In this light, PBA does not propose a break with the past but rather advocates for a comprehensive understanding of the philosophical worldviews that underlie the full spectrum of CBT modalities (Hayes and Hofmann, “The Third Wave of Cognitive Behavioral Therapy” 245). Such an epistemological and ontological grounding fosters interdisciplinary communication and collaborative practice across the broader field of CBTs, perhaps also across a broader landscape of diverse cultures (Hayes and Hofmann, “The Third Wave of Cognitive Behavioral Therapy” 245).

28Truly, although the third-wave CBT and PBA remain undeniably grounded in the American cultural and socio-political context, their emergence reveals a distinctly broader set of cross-cultural philosophical and cultural foundations that may also cast some light on the reasons behind the contemporary hegemony of CBT in Europe, and more specifically in the UK.

8. The Third-Wave CBT and PBA: Evolution from the Distinctly American Cultural and Socio-Political Historical Landscape

29Undoubtedly, many foundational figures of the third wave of CBT, including Steven Hayes (ACT) and Marsha Linehan (DBT), are rooted in the American academic and clinical context. Their emphasis on contextualism and functional analysis, which, along with acceptance, are core elements of the PBA, emerged in response to the limitations of earlier, more mechanistic forms of CBT, yet remained ingrained in early American pragmatism and functionalism, an American school of psychology that preceded behaviorism (Wertheimer and Puente). Indeed, from its inception, American psychology diverged from its German roots by adopting a more functional orientation, emphasizing habit formation and the adaptive functions of the mind. This pragmatic and empirically driven focus, already evident in early BT, also laid the groundwork for subsequent developments in the field of CBT, including the third wave of CBT and the PBA. It was also American origins that might have fostered a preference for therapies that could demonstrate tangible results (David et al. 2) and, consequently, be rebranded as tools for self-betterment and empowerment (Amouroux 4).

30Last but not least, the shift towards PBA might have also been institutionally-driven and may have stemmed from an explicit American socio-historical landscape and the country’s specific research policies. Truly, the funding priorities of American government agencies such as the National Institute of Health (NIH) and National Institute of Mental Health (NIMH) played a crucial role here. It is important to note that the historical landscape of American mental healthcare, including phenomena such as deinstitutionalization (Community Mental Health Centers Act of 1963) and subsequent struggles to provide adequate care for mentally impaired Americans (Benjamin 4), fostered a strict demand for evidence-based practices and accountability from psychological interventions (Wertheimer and Puente 174). Consequently, following the introduction of DSM-III in 1980, the U.S. NIMH began to allocate substantial funding to randomized controlled trials evaluating specific treatment protocols for defined psychiatric syndromes (Hayes and Hofmann, Process-based CBT 428). This development contributed to what Hayes and Hofmann describe as the “biomedicalization of human suffering” (Process-based CBT 429), which regrettably narrowed the scope of CBT’s and, more broadly, clinical psychology research in the United States for decades, by prioritizing symptom reduction over holistic well-being. However, a later shift in funding from both the NIH and NIMH began to prioritize research into neurobiological mechanisms and processes of change, rather than merely demonstrating treatment efficacy (Gerardi and McGinn 528). This move directly propelled the field towards a process-based approach and a more holistic understanding of mental health and well-being.

31However, despite these distinctly American origins, the emergence of third-wave CBT and the subsequent development of the PBA mark a significant departure from a predominantly American-centric, critical rationalist orientation toward a more globally informed and cross-cultural framework. These newer approaches explicitly incorporate philosophical influences beyond the American context, including Stoicism and various Eastern traditions. Mindfulness-based therapies, for instance, draw extensively on Hindu and Buddhist movement therapies and contemplative practices such as yoga. Similarly, Acceptance and Commitment Therapy (ACT), while rooted in the pragmatic philosophy of functional contextualism, aligns closely with Eastern thought in its focus on accepting suffering as intrinsic to the human experience and fostering present-moment, non-judgmental awareness. The Stoic maxim attributed to Epictetus, “Men are disturbed not by things but by the views which they take of them,” reflects a core epistemological stance foundational to CBT (Carona 215).

32This broadened philosophical outlook encourages greater attention to contextual determinants of behavior, promotes the distinction between events and judgments, as advocated by stoicism, and underscores the acceptance of personal responsibility in living a valued life, a concept embraced by existentialism. Indeed, existential concerns outlined by Kierkegaard, Sartre, and de Beauvoir, such as death, responsibility, meaninglessness, and isolation, also seem to be at the core of third-wave CBT (Carona 215). The PBA further formalizes this integrative movement by grounding itself in evolution science, a global scientific framework that views psychopathology as a maladaptation of biopsychosocial processes within specific contexts (Ong et al. 3). This framework aims to unify diverse therapeutic techniques under a common, philosophically informed understanding of human adaptation and suffering, emphasizing that different philosophical assumptions can coexist and collaborate within a process-focused empirical approach. Such an assimilation of ancient wisdom and cross-cultural philosophical underpinnings into modern therapeutic models clearly marks a broadening of CBT’s theoretical framework beyond a solely Western scientific paradigm.

9. CBT’s Evolution in the UK

33Perhaps, such a broadening of the philosophical foundations underlying contemporary CBT approaches has played a significant role in the therapy’s global dissemination and international adoption. Notably, the worldwide expansion of CBT accelerated during the 1980s and 1990s, coinciding with the emergence of third-wave approaches and, subsequently, process-based therapy.

34This trajectory has been particularly pronounced in the United Kingdom, where CBT transitioned from an American innovation to the predominant form of psychological therapy within the NHS (Marks). Although CBT in Britain initially drew on American models, particularly those of Aaron Beck and Albert Ellis, it soon began developing independently, with strong local roots in behaviourist traditions (Rachman 4). Key figures such as Hans Eysenck, Isaac Marks, and David M. Clark were instrumental in this evolution, fostering a distinctively British model of CBT that combined scientific rigor with practical integration into public mental healthcare systems (Marks 3–4). It is therefore important to further examine the development of CBT in the UK, which reflects both the continuation of American theoretical foundations and a parallel trajectory shaped by distinctively British scientific traditions and institutional frameworks.

35It was already in post-World War II Britain that a distinct tradition of evidence-based psychotherapeutic interventions began to take shape, providing fertile ground for CBT’s subsequent development. The Maudsley Hospital and its associated Institute of Psychiatry in London became a pivotal center for the initial development of behavior therapies from the 1950s onwards. Under the leadership of Sir Aubrey Lewis, the institution fostered an environment of critical experimentalism and a rigorous training in the philosophy of science, setting itself apart from the dominant psychoanalytic paradigms of the time (Marks 2).

36Hans Eysenck played a pivotal role in the shift away from the psychoanalytic dominance that had been firmly established in Britain since the 1930s, following the relocation of Sigmund Freud and his daughter Anna Freud to London. Eysenck’s seminal paper “The Effects of Psychotherapy: An Evaluation” (1952) critically challenged the efficacy of psychoanalysis and stressed the crucial need for rigorous evaluation standards, including controlled treatment trials. This advocacy significantly influenced the adoption of contemporary standards for evidence-based treatments in mental health, not only in the UK but also in the U.S. and globally (Rachman 2).

37It can be argued that it was Eysenck’s early advocacy for empirically grounded, scientifically testable psychotherapy that laid the foundation for behavior therapy in the UK. The professional recognition of the behavioral approach was soon firmly established with the launch of the journal Behaviour Research and Therapy (BRAT) in 1963, founded by H. Eysenck and S. Rachman (Marks 5). While these early British developments were influenced by American innovations, they were equally grounded in the traditions of British empiricism and experimentalism, reflecting a broader commitment to evidence-based practice and scientific rationality (Pilgrim et al. 79).

38By the early 1970s, efforts were made to extend the reach of BT beyond traditional professions. Isaac Marks spearheaded initiatives to train nurse therapists, coining the term “barefoot therapists” to address the limited number of psychologists and widen access to behavioral treatments within the NHS (Marks 6). This expansion was also contextualized by the growth of community mental healthcare from the 1950s on, leading to more patients being treated as outpatients by multidisciplinary community mental health teams.

39The American “cognitive revolution” of the 1970s soon also marked a shift in psychotherapeutic approaches in the UK. In 1985, David Clark’s visit to Beck’s Center for Cognitive Therapy in Philadelphia catalyzed a cognitive shift in British CBT (Moorey 507). Clark’s subsequent development of a cognitive model of panic, alongside Paul Salkovskis’s work on inflated responsibility and safety-seeking behaviors in obsessive-compulsive disorder (OCD), played a central role in advancing evidence-based treatments for anxiety disorders in Great Britain (Moorey 507). In the wake of the visit, research groups were founded at the University of Oxford’s Department of Psychiatry (including Michael Gelder, David Clark, Paul Salkovskis, and Anke Ehlers). The University along with the Maudsley Hospital soon became key centers for CBT research and training. Simultaneously, Windy Dryden was instrumental in popularizing Ellis’s REBT for a British audience and establishing some of the first CBT training programs in the early 1980s (Marks 10–11). Such developments facilitated the expansion of CBT in the UK to an ever-broader range of conditions such as PTSD, anxiety disorders, and OCD.

40Similarly to the American context, the “third wave” of CBT in the United Kingdom emerged from the late 1980s through the 1990s and into the early 2000s, representing an equally significant evolution in psychotherapeutic approaches. Just as in the U.S., the third wave of CBT as it was embraced in the UK encompassed a very diverse set of practices and an eclectic integration of theoretical frameworks, moving beyond its earlier scientistic roots (Marks). Key third-wave therapies that gained prominence in the UK include: Mindfulness-Based Cognitive Therapy (MBCT), which has been accepted by the National Institute for Health and Care Excellence (NICE) as an approved treatment for recurrent depression (Moorey 512); Acceptance and Commitment Therapy (ACT), which challenged binary notions of health/illness and views language as both a therapeutic tool and a source of distress; and Dialectical Behavior Therapy (DBT), a structured approach encompassing mindfulness and emotion regulation, with growing popularity in the UK. In adjacent countries, for instance in the Republic of Ireland, training in DBT has even been extended to non-CBT trained mental health nurses (Butcher and Chigwedere 293).

41Interestingly, two of the third-wave CBT approaches emerged from within a distinctly British context: meta-cognitive therapy (MCT) and compassion-focused therapy (CFT). MCT, developed by Adrian Wells at the University of Manchester, shifts the therapeutic focus from the content of cognitions to the dysfunctional effects of thought processes and thinking styles (Marks 17). In contrast, CFT, developed by Paul Gilbert at the University of Derby, draws on evolutionary psychology and has gained influence as an adjunct to standard CBT. It has demonstrated effectiveness in enhancing self-compassion as a means of reducing maladaptive self-criticism (Moorey 512).

42CBT currently holds an undisputed position of dominance within the United Kingdom and remains the principal form of psychological intervention offered by the NHS. It is presently the unique therapy formally recommended by the NICE for the treatment of mild to moderate mental health conditions (Rowland 2). What is more, as of 2024, approximately 10 million individuals in the UK have been treated using CBT, and it has become the most extensively researched psychological treatment in British mental health services (Rowland 2). The institutional entrenchment of CBT has been solidified through the implementation of the Improving Access to Psychological Therapies (IAPT) program, launched in 2007–2008, which has systematically prioritised CBT within public mental health provision (Sharland et al. 7395).

43However, this dominance has not come without contestation. Much of the controversy surrounding CBT’s primacy arises from the specific socio-political and economic context of the United Kingdom. These include, among others, the broader neoliberal restructuring of the public sector, the medicalization of psychological distress, and an increasing emphasis on cost-efficiency and quantifiable outcomes in mental healthcare. In what follows, I will examine the key socio-political and economic drivers that underlie CBT’s rise to prominence in the UK.

10. Socio-Political and Economic Drivers of CBT’s Ascent in the UK: From Post-war Limitations, through Thatcherism to IAPT and 2008 Crisis

44Undoubtedly, already the financial limitations of the post-war nationalized healthcare system in the United Kingdom fostered a marked interest in the effectiveness rates of psychological and psychiatric treatments. Such an emphasis was viewed as a “rational consequence of the economics of healthcare,” more broadly characterizing the post-war period in Europe (Marks 5). Later, among the socio-political and economic transformations that fundamentally reshaped the British landscape, and in doing so laid the groundwork for CBT’s dynamic rise, was also Thatcherism. As a dominant ideological project in the UK between 1979 and 1990, Thatcherism challenged the principles of social democracy, promoted social mobility, and advanced a neoliberal agenda centered on individual responsibility and the retrenchment of the welfare state (ScottSamuel et al.). This political and economic environment created a fertile ground for the hegemonic appeal of CBT in Britain by aligning the therapeutic modality’s core tenets with the government’s drive for efficiency and economic pragmatism within public services, particularly the NHS and, from 1999, the NICE (Marks 13).

45This approach can be critically examined through the lens of Robert Alford’s theoretical political framework (1975), which identifies three dominant interest groups within health care systems: professional monopolists, corporate rationalizers, and the community population (Williamson 512). Of particular relevance here are the corporate rationalizers, a group encompassing policymakers, managers, civil servants, and academics, who are primarily concerned with systemic reform, sustainability, and the implementation of policy objectives designed to maximize efficiency and control within healthcare delivery (Williamson 513). During the Thatcher era, corporate rationalizers sought to realign the NHS with neoliberal principles by applying private-sector management techniques (ScottSamuel et al. 55, 58). CBT made a direct appeal to corporate rationalizers’ logic, as it was branded as evidence-based and quickly effective, offering short, forward-looking treatments that responded pragmatically to limited healthcare resources (Pilgrim, “The Hegemony of Cognitive-Behaviour Therapy” 120).

46Such a rationale was explicitly embodied in the promotion of CBT as a “back-to-work” intervention, notably championed by influential figures such as Lord Richard Layard and David Clark. The central aim was to reduce the fiscal burden of mental illness, most notably depression, by facilitating a rapid return to employment, thereby decreasing reliance on welfare benefits (Rowland 5). This project was outlined in Layard’s (2011) Happiness: Lessons from a New Science, which Dalal characterizes as the seismic event that triggered the CBT tsunami in the UK (Dalal). Within the “back-to-work” agenda, CBT was presented as a short-term, cost-effective, and efficient therapeutic solution capable of enabling individuals to regain control over their lives and re-enter the workforce (Rayberon 114).

47However, undoubtedly, it was the Labour Government’s “Improving Access to Psychological Therapies” (IAPT) program, launched in 2007, that marked a shifting moment in the widespread dissemination of CBT in the UK (Beck 19). The program received substantial political and economic backing, with over £300 million allocated in the first three years to train an additional 3600 psychological therapists specifically in “evidence-based treatments,” primarily CBT (Rachman 6). With a target of 50% recovery rates, the IAPT initiative aimed to increase access to psychotherapy for the approximately one in six people in Britain suffering from common mental disorders like depression and anxiety (Rabeyron 124). As Moorey put it, it was the IAPT initiative that has transformed psychotherapy in the UK from “a cottage industry to a systematically managed, target-driven enterprise” (510).

48The global economic recession in 2008 and subsequent fiscal constraints in the UK only further intensified the focus on evidence-based practices, increasing the legitimacy and funding for short-time therapies claiming to demonstrate efficacy, and delegitimizing those that did not (Pilgrim et al. 80). This economic imperative only reinforced CBT’s position due to its perceived efficiency and measurable outcomes.

11. Philosophical Underpinnings Facilitating Adoption of CBT in the UK

49Naturally, the transmission of CBT from the United States to the British socio-political and cultural context was not driven solely by economic incentives. Rather, a combination of economic, socio-political, but also philosophical and cultural influences created fertile ground for CBT’s adoption and institutionalisation in Great Britain.

50The cultural and intellectual traditions of the United Kingdom have historically drawn upon both Anglo-Saxon empiricism and German experimentalism (Pilgrim et al. 79). CBT’s emphasis on observable, measurable outcomes and its positioning as an “evidence-based” intervention, demonstrated through randomized controlled trials (RCTs) and meta-analyses, resonated strongly with this scientific orientation. The establishment of the NICE in 1999 further institutionalized this framework by issuing clinical guidelines that positioned CBT as the psychological treatment of choice for a range of conditions, including depression and anxiety (Moorey 507). This trajectory reflects what Rowland (2024) refers to as the scientification of mental health in the UK, a process through which quantitative research methodologies have been elevated as the principal route to psychological well-being (3).

51CBT’s appeal in the UK also stemmed from its alignment with modern rationalism, in its proposal that mental health problems are merely cognitive errors that can be managed through alterations in thought processes, thus entirely controlled by reason (Pilgrim, “The Hegemony of Cognitive-Behaviour Therapy” 120). This approach resonates with what Pilgrim terms a “techno-centric optimism” that seeks a quick, easily available, technological fix for human suffering (“CBT in the British NHS” 323).

52Moreover, CBT is also closely aligned with a broader global trend toward the individualization of psychological support, which tends to decontextualize human distress by separating it from its social and structural conditions and, instead, focusing on self-regulation and personal responsibility (Pilgrim, “The Hegemony of Cognitive-Behaviour Therapy” 120). In the UK, this orientation resonated strongly with the neoliberal ideology introduced under Thatcher, which advocated for a diminished role of the state and placed emphasis on individual agency in managing adversity. Within this ideological framework, the expansion of cognitive and behavioral approaches into wider public sectors, such as criminal justice and education, was promoted through political narratives of empowerment and self-management. As a result, CBT gained broad appeal across the political spectrum, including both New Labour and the New Right (Baistow 327).

12. Recent Criticisms of CBT

53Precisely because of its widespread implementation and institutional support, CBT in the UK has been increasingly criticized for its restrictive policy dominance and lack of therapeutic diversity, which has led to concerns about the homogenization of mental health care in the UK and the marginalization of non-CBT therapies (Leader; Pilgrim, “CBT in the British NHS”; Cooper & McLeod). Some critics have cautioned against the actual establishment of “therapeutic monoculture,” in which CBT remains the only available choice in the UK (Cooper & McLeod 11), while others have likened the impact of CBT on British mental healthcare to a destructive force of a tsunami (Dalal). Indeed, the prioritization of CBT within the NHS has been described as anti-democratic and limiting patients’ access to alternative therapeutic approaches that may be more congruent with their individual needs and preferences (Pilgrim, “CBT in the British NHS” 331). It has been repeatedly claimed that although there is variation tolerated within CBT modalities, especially among the third-wave approaches or in PBT, genuine choice on the part of service users remains constrained by funding structures and commissioning practices. This has led some to advocate for the open recognition of “the Cognitive Behavioural Therapy’s (CBT) complicity with contemporary power arrangements in, for example, legal, educational, psychiatric, psychological, political, even common sense institutions” (Guilfoyle 197). There seems to be a growing consensus that this entanglement with British power structures shall be addressed and, perhaps, counteracted (Guilfoyle).

54In addition to policy concerns, the scientific basis of CBT has also come under scrutiny. Although the dominance of CBT is attributed to its alignment with evidence-based therapeutic impact and scientific credibility, critics highlight methodological flaws in the research supporting CBT’s efficacy, such as the exclusion of complex cases, the lack of construct validity in outcome measures (Rowland 3–4), and the inconsistent quality across studies (David et al. 1). This has even led Rabeyron to conclude that CBT’s efficacy is actually a result of “scientific corruption” (Rabeyron 113). Meta-analyses are often opaque in their methods, and outcomes are frequently reported in relative rather than absolute terms, which can exaggerate therapeutic gains (Williams 348; Rabeyron 127; Rowland 3). Furthermore, there are indications of publication bias, where studies showing positive results for CBT are decisively more likely to be published (Marks 13), and concerns about the politicization of research, with claims that government funding for CBT-based programs like IAPT has shaped the evidence base to support economic rather than clinical priorities (Rowland 2). This has recently led to a widespread perception that CBT’s prominence is sustained as much by political and fiscal agendas as by scientific merit.

55At a conceptual level, CBT is also critiqued for individualizing and decontextualizing psychological distress, ignoring the social factors, and thus negating the perpetuation of psychopathology through social interrelations and diminishing a collective sense of social responsibility (Leader; Williams 348). Indeed, by focusing on correcting cognitive errors within the individual, many strands of CBT tend to overlook structural and socio-political contributors to mental health problems. Such an approach aligns with neoliberal values that emphasize personal responsibility while deflecting attention from social determinants of distress. Critical sociologists Frank Furedi and Eva Illouz have even extended this critique by showing how the modern Therapy Culture exemplified by CBT globally operates as a mode of social regulation that individualizes suffering and conceals its structural origins. Furedi argues that Therapy Culture cultivates a “vulnerable self,” framing ordinary difficulties as signs of fragility and encouraging dependence on expert intervention (Therapy Culture). Illouz similarly observes that therapeutic discourse has become the dominant cultural script through which individuals interpret both intimate life and public experience, producing a split responsibility that positions them as both victims of circumstances and agents solely responsible for their own repair (Saving the Modern Soul). Within such a framework, distress and dissatisfaction are primarily defined in psychological terms, redirecting moral and political energy away from collective critique toward private self-management. What might otherwise emerge as social protest or demands for reform is transformed into therapeutic self-work and consumption-driven self-optimization. In this way, the therapeutic ethos functions as a depoliticizing force: it dissolves collective agency into individualized projects of improvement, sustained by a market of emotional commodities. As Philip Rieff suggested in The Triumph of the Therapeutic, the modern self thus becomes governed not by moral or communal obligations but by the imperative to manage its own well-being. Through such a lens, CBT’s dominance can be read both as a symptom but also as a catalyst of this broader cultural order.

56Consequently, CBT has often been characterized as an “applied science” or a “psychotechnology” (Pilgrim, “CBT in the British NHS” 330), a label that is supposed to reflect its reductionist and mechanistic approach to human suffering that restricts complex psychosocial problems to medical symptoms that need to be treated individually, abstracted from their social context. Within the IAPT framework, CBT’s managerial implementation has also been associated with increased bureaucratization (Rabeyron 122), clinician burnout (Rabeyron 125), and diminished quality of care, with focus being placed on numerical outcomes rather than qualitative recovery or holistic approach to a patient (Dalal; Williams 345).

57Finally, deeper philosophical objections challenge CBT’s rationalist underpinnings, arguing that its reductionist view of suffering neglects unconscious processes, existential dimensions, and the diversity of moral perspectives in pluralistic societies (Pilgrim, “The Hegemony of Cognitive-Behaviour Therapy”). At an ideological level, CBT equally faces severe criticism for its alignment with neoliberal ideology and medicalization of mental distress (Rowland; Pilgrim, The Hegemony of Cognitive-Behaviour Therapy”; Dalal). In his widely discussed book, The Cognitive Behavioural Tsunami: Managerialism, Politics, and the Corruptions of Science (2018), Dalal even situates the rise of CBT within the broader political-economic context of neoliberalism and New Public Management. He critiques the influence of managerialist thinking on public mental health services, particularly through institutions such as NICE and IAPT, which have promoted CBT using performance metrics and claims of cost-effectiveness. According to Dalal, these narratives exaggerate CBT’s clinical effectiveness and obscure its limitations, particularly its focus on symptom reduction and neglect of deeper psychological or social dimensions of distress. The book argues that CBT has elevated quantification to an ideological imperative, resulting in an overreliance on measurement and a narrowing of what is considered therapeutically valid. This, Dalal contends, has given rise not merely to flawed methodologies but to a form of “corrupt science,” where political and institutional agendas compromise scientific integrity (145).

58Naturally, many of the therapies of the third wave of CBT, as well as the evolving concept of process-based therapy, actively respond to such philosophical and methodological objections leveled against CBT. Indeed, the latest approaches move beyond the previous focus on merely correcting cognitive errors or narrow, rationalistic interventions. For instance, Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), or Mindfulness-Based Cognitive Therapy (MBCT) adopt more contextual and experiential change strategies, viewing psychological events within their broader social context, which counters de-contextualization of psychological difficulties, and rejects the reductionist and medicalized view of suffering (Winter 225).

59Similarly, these latest trends within CBT incorporate elements from diverse philosophical traditions, including Buddhist and Taoist thought, and constructivist/ postmodernist perspectives, and in doing so, they address concerns about CBT’s singular rationalist underpinnings and promote pluralism in the supply of therapeutic options. These developments have also coincided with a broader global movement for integrative psychotherapy that postulates “rapprochement” between “competing” therapeutic currents and that has gained popularity in the UK as well (Marks 10). Undoubtedly, even within CBT’s framework itself, the shift towards transdiagnostic approaches and process-based work further demonstrates an effort to move away from rigid, diagnostic-focused, and potentially decontextualized interventions, instead emphasizing personalized care that considers the unique needs and broader context of the individual, including even culturally diverse perspectives (Terjesen et al. 4). This ongoing adaptation within CBT aims to provide a more comprehensive and client-centered approach to mental health, acknowledging its complex, multifactorial nature. Indeed, the recent openness to integrating diverse philosophical and cultural perspectives, alongside methodological innovations, may suggest that CBT is evolving towards greater inclusivity and responsiveness to contemporary challenges in mental healthcare.

13. Conclusions

60This analysis of the historical trajectory and contemporary position of CBT, tracing its expansion from its behavioral and cognitive roots to the contemporary Process-Based Approach (PBA) and third-wave therapies, reveals a dynamic evolution marked by growing philosophical diversity and cross-cultural synthesis. Yet, perhaps even more importantly, this examination of CBT’s journey from an American innovation to its hegemonic adoption in the European psychotherapeutic landscape, specifically in the United Kingdom, illustrates the complex interplay between socio-cultural, philosophical, and political-economic forces. Indeed, this transatlantic trajectory of CBT demonstrates that the adoption of therapeutic practices transcends clinical utility alone. Instead, it is intricately linked to culturally specific epistemologies, socio-political agendas, and the resultant institutional incentives. Indeed, CBT’s widespread embrace, particularly through initiatives such as the UK’s IAPT, underscores how psychological interventions become conduits for larger ideological currents, in this case, neoliberal ideals emphasizing efficiency, individual responsibility, and the depoliticization of psychological distress.

61This alignment with neoliberalism as well as other philosophical and epistemological foundations that the United States of America share with Great Britain may indeed be a reason behind CBT’s hegemonic position in both countries. Being deeply rooted in American empirical traditions, pragmatism, and individualistic philosophy, CBT found a uniquely receptive environment in Great Britain due to analogous cultural foundations, such as an emphasis on empiricism, scientific rationality, and practical effectiveness. The British intellectual and clinical milieu, shaped by empirical experimentalism and traditions of evidence-based practice, provided fertile ground for CBT’s swift and widespread acceptance. This has not been the case in all European countries. A counterexample may be provided by France, where CBT has not been received with matching zeal.

62Indeed, the adoption of CBT in France experienced a significant delay and was less smooth than in the United Kingdom, primarily due to France’s deeply entrenched psychoanalytic tradition and strong cultural and philosophical resistance, which led to early behavior therapy being perceived as a reductionist, mechanistic psychotechnology and a symbol of American cultural imperialism incompatible with French humanist values (Amouroux 13). In stark contrast to British promotion of CBT as a cost-effective, evidence-based “technological fix” for mental health issues (Pilgrim, “CBT in the British NHS” 323), in France CBT was rejected precisely for this neoliberal grounding. This resistance in France only began to wane in the 1990s with the introduction of cognitive therapy, which, through its hybridization with behavioral techniques, was viewed as a “synthetic product” better suited to French psychological culture. This eventually allowed CBT to gradually challenge the established psychoanalytic monopoly. Yet, the so-called “Psy Wars” in France continue to this day (Amouroux 11).

63At the same time, in the UK, CBT only kept on strengthening its position. From the 1980s on, CBT’s adoption was reinforced by socio-political and economic factors historically specific to the UK, particularly the neoliberal policies enacted under Thatcherism and subsequent governments, which emphasized individual responsibility, efficiency, and measurable outcomes. The institutionalization of CBT through the IAPT program epitomized this alignment, as CBT’s structured protocols and quantifiable outcomes suited governmental objectives of cost-effectiveness and accountability.

64Yet, as has been outlined, it was precisely this convergence that has raised concerns about the entanglement of mental health provision with political and economic agendas, most notably neoliberal managerialism, narrowing the spectrum of therapeutic approaches and calling into question the integrity of methodological standards. Indeed, critical voices highlight that CBT’s prominence has come at the expense of therapeutic pluralism, accompanied by methodological controversies and philosophical critiques concerning its narrow, individualistic conceptualization of suffering (Rowland).

65Perhaps, tracing CBT’s transatlantic transfer is of particular relevance today, as it may offer insights in the contemporary context of the rapid rise of the employment of artificial intelligence in mental healthcare. With recent reports, such as one from Harvard Business Review, identifying therapy and companionship as the most common application of generative AI in 2025 (ZaoSanders), surpassing even productivity and technical functions, the spread, popularization and adaptation of therapeutic modalities, including CBT, become especially pertinent. It is even more so when one considers that the second and third most common uses of generative AI were organizing one’s life (scheduling, planning, and task management) and finding purpose, including goal-setting, self-reflection, and personal development (ZaoSanders), both of which align closely with the psychoeducational and skills-based ethos of CBT.

66In another systematic review of the future of AI in mental healthcare, Fanarioti and Karpouzis (2025) identify several AI applications that already implement CBT primarily through conversational agents and chatbot-based interventions such as Woebot or Wysa, offering automated psychoeducation and support without human mediation. While these tools provide low-threshold, easily accessible self-help contexts that have become “increasingly integrated into workplace wellness programs and primary care settings” (Fanarioti and Karpouzis 6), they also raise serious concerns regarding safety, privacy, and equity. Specifically, such AI-driven therapeutic systems pose ethical and practical risks related to limited oversight, opaque data practices, and algorithmic bias, all of which may endanger vulnerable users, compromise sensitive information, and reinforce existing social and structural inequities in mental healthcare.

67Naturally, it may be claimed that the very characteristics that facilitated CBT’s international dominance—its structured, standardized, and protocol-driven approach that relies on quantifiable methods—are precisely what enable its seamless integration into digital and AI-driven platforms. Will AI-driven CBT shape the future landscape of psychotherapy on a global scale? This remains to be seen. However, such rankings underscore a clear shift in AI’s role, from primarily technical and productivity-driven tasks to support of emotional, organizational, and existential needs. CBT in cooperation with generative AI seems to be particularly well-suited to address these needs.

68It is my firm belief that understanding CBT’s trajectory from its American origins through its adaptation and institutionalization in Europe not only sheds light on the intersections between psychological therapies and broader socio-cultural dynamics but also serves as a critical lens through which future developments can be anticipated and examined. By critically exploring the past flows and current implications of CBT’s expansion, we can better address emerging challenges and seize opportunities in this rapidly evolving landscape of mental healthcare at the intersection between psychology, technology, and society.

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References

Electronic reference

Paulina Grzęda, CBT: From American Innovation to European Therapeutic “Monoculture”?—Transatlantic Transfer of Cognitive Behavioral Therapy and its British AfterlifeEuropean journal of American studies [Online], 20-3 | 2025, Online since 01 December 2025, connection on 24 January 2026. URL: http://journals.openedition.org/ejas/24529; DOI: https://doi.org/10.4000/15dm7

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About the author

Paulina Grzęda

An assistant professor at SWPS University, Dr. Paulina Grzęda is a triple philologist (English, Spanish and French philologies, University of Warsaw), cultural studies scholar, coach (Laboratorium Psychoedukacji, SWPS University), and psychologist in training. She holds a PhD in postcolonial trauma studies, and her research explores trauma theory, postcolonial forms of suffering, cultural dimensions of mental health, perceptions of otherness, and alternative conceptions of time. Her monograph Time and Alterity in South African Writing examines how post-traumatic societies conceptualize temporality and alterity. She has been a research fellow at the University of Cambridge and at the School of Oriental and African Studies (SOAS), University of London.

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