In recent years, cognitive behavioral therapy (CBT) has emerged as a cornerstone of treatment for numerous mental health disorders globally, thanks to its evidence-based approach and effectiveness. However, despite its recognized efficacy, access to CBT in Japan remains markedly limited, with a significant gap between clinical need and therapy utilization. A recent study published in BMC Psychiatry provides a data-driven insight into the current landscape of CBT provision in Japan by examining health insurance claims data. This detailed analysis reveals systemic barriers and highlights the pressing unmet needs within Japanese mental healthcare.
CBT is widely endorsed as a first-line treatment for several psychiatric conditions including major depressive disorder (MDD), social anxiety disorder (SAD), panic disorder (PD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and bulimia nervosa. In Japan, these illnesses qualify for health insurance coverage when treated through CBT, suggesting an institutional support framework exists to facilitate access. Nevertheless, the utilization rates uncovered by this study indicate that insurance claims for CBT are strikingly rare, exposing a disparity between policy and practice.
The investigation utilized the Detroit Employment Solutions Corporation (DeSC) database, which spans from April 2015 to March 2022 and incorporates insurance data from “Kempo” and “Kokuho” schemes. Kempo covers salaried employees in large companies while Kokuho serves self-employed individuals and their dependents. Together, these insurance entities represent significant demographic segments. Specifically, the data encompass approximately 2.8% of the salaried workforce and 12% of the self-employed populations, providing a substantial sample for analysis of CBT delivery patterns.
Quantitatively, only 0.50% of Kempo and 0.24% of Kokuho policyholders diagnosed with the specified mental health disorders filed insurance claims for CBT treatment within the study period. This minuscule fraction underscores the underutilization of what is clinically considered an effective treatment. The severe discrepancy raises critical questions about the systemic, cultural, or financial obstacles deterring broader CBT adoption despite coverage availability.
Delving into diagnostic specifics, the overwhelming majority of CBT claims were for major depressive disorder. Among Kempo clients, 89.2% receiving CBT had MDD, with the remainder spread thinly among other disorders such as SAD, PD, OCD, and PTSD. Similarly, Kokuho insurance data showed that 92.0% of CBT claims belonged to patients with MDD. This disparity among mental health conditions suggests a concentration of CBT application on depression, possibly reflecting prioritization or differential barriers affecting other conditions.
Another major finding pertained to treatment frequency and session intervals. For patients with MDD, the average interval between CBT sessions under Kempo was 34.2 days, while under Kokuho coverage, it stretched to an alarming 71.9 days. Considering that effective CBT typically requires weekly or biweekly sessions, these extended intervals imply that patients are receiving therapy at suboptimal frequencies, potentially diminishing therapeutic outcomes.
These findings collectively illuminate critical shortcomings in Japan’s mental healthcare infrastructure related to CBT. The incredibly low claim rates and prolonged intervals between sessions indicate systemic inadequacies, such as shortage of certified CBT practitioners, insufficient integration of CBT into routine care, or administrative and regulatory obstacles impeding frequent therapy provision. Cultural stigmatization of mental health treatment and patient reluctance might also contribute to the low uptake.
International comparisons provide context for these alarming figures. In many Western countries, CBT is widely accessible and integrated into public and private healthcare settings, with dedicated training programs ensuring a steady supply of qualified therapists. Contrarily, Japan’s mental health system appears to lag in these dimensions, despite epidemiological evidence pointing to a high burden of disorders eminently responsive to CBT.
Addressing these gaps requires multifaceted intervention strategies. Policymakers and healthcare administrators must work to increase the availability of trained CBT practitioners and streamline reimbursement processes to facilitate more frequent therapy sessions. Educating healthcare providers and the public about the benefits of CBT, while dismantling the stigma associated with mental illness, can also enhance patient engagement and demand.
The study’s reliance on insurance claims data offers objective measures of CBT utilization but may underrepresent actual therapy delivery if some patients pay out-of-pocket or receive CBT in non-insured contexts. Nonetheless, claims remain a robust proxy for formalized CBT provision in Japan and have illuminated patterns invisible in prior research relying on self-report or clinical trial data.
Ultimately, the research serves as a clarion call to reform the Japanese mental health system’s approach to CBT. As the global mental health crisis intensifies, countries must optimize access to evidence-based treatments like CBT. Japan’s current underutilization and irregular delivery of CBT represent critical missed opportunities for alleviating suffering and reducing the societal burden of mental disorders.
Innovative solutions may include integrating CBT into primary care, expanding teletherapy options to overcome geographical barriers, incentivizing therapist training and retention, and enhancing insurance policies to cover more flexible, frequent CBT sessions. If implemented thoughtfully, these changes could transform access to mental healthcare throughout Japan.
In conclusion, the analysis of Japanese health insurance claims finds that CBT remains an underutilized resource in treating major mental health disorders. Despite insurance coverage for several conditions, actual claims remain negligible and therapy scheduling does not adhere to recommended standards. This research highlights a profound unmet need and underscores the urgency for systemic reforms. Japan’s healthcare system must evolve to support regular, accessible, and adequately paced CBT, ensuring that patients receive the full benefits of this gold-standard psychological treatment.
Subject of Research: Utilization and provision of cognitive behavioral therapy in Japan analyzed through health insurance claims data.
Article Title: The provision of cognitive behavioral therapy in Japan: an analysis using insurance claims data.
Article References:
Mukai, K., Hosoi, Y., Yamanishi, K. et al. The provision of cognitive behavioral therapy in Japan: an analysis using insurance claims data. BMC Psychiatry 25, 878 (2025). https://doi.org/10.1186/s12888-025-07316-y
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