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Cognitive Behavioral Therapy

CBT Can Work Beyond WEIRD Populations

Why it's important to modify cognitive-behavioral therapy for different people.

Research on cognitive-behavioral therapy is moving beyond select groups of people to see how it can help even more people.

In psychology, we have an acronym, WEIRD, that refers to the people psychologists tended to study for most of the twentieth century. WEIRD stands for "Westernized, Educated, Industrial, Rich, and Developed." This refers mostly to people from North America, Europe, and Australia who are educated and have a lot of resources. Cognitive-behavioral therapy has been criticized for focusing mostly on these groups of people when conducting clinical trials, rather than on other parts of the world, or on people with less education and resources.

Image by StockSnap from Pixabay
Source: Image by StockSnap from Pixabay

The criticism that cognitive-behavioral therapy was targeted towards WEIRD groups was warranted. Cognitive-behavioral therapy is very abstract, focused on thoughts and feelings that are not physical or easy to imagine. It would involve tracing long trains of thought, sometimes without a visual aid such as writing down each thought. Traditional cognitive-behavioral therapy was also very language heavy, creating further barriers. Nonetheless, the principles of cognitive-behavioral therapy have been adapted for wider use.

While there are several examples of adapting traditional cognitive-behavioral therapy for different groups, I’ll highlight two specific examples here. First, cognitive-behavioral therapy has been used to help reduce the stress from chronic pain and promote self-management of pain. Scientists at the University of Alabama have adapted cognitive-behavioral therapy for pain so it can be used with people of varying literacy levels. A lot of people do not have a college degree; in the United States, about 33 percent of adults have a bachelor’s degree or higher and another 9 percent have an associate’s degree. If we write all our workbooks and worksheets at a college level, more than half of adults could have difficulty using these resources. Therefore, adapting cognitive-behavioral therapy for pain so that people with any level of education can benefit has the potential to help even more people.

Another example of adapting a therapy similar to cognitive-behavioral therapy is cognitive processing therapy. Cognitive processing therapy has similar principles to cognitive-behavioral therapy. Both focus on negative thinking patterns and on working to make those thoughts more realistic. However, cognitive processing therapy specifically focuses on trauma and Post-Traumatic Stress Disorder. Scientists at the University of Washington have adapted cognitive processing therapy for use in a variety of settings, including the Democratic Republic of Congo.

I want to emphasize that just because cognitive-behavioral therapy and similar treatments have been effective for many different groups of people, this does not mean that cognitive-behavioral therapy is going to be effective for everyone. While psychologists are moving to expand cognitive behavioral therapy beyond WEIRD populations, there is still a lot we do not know about how to adapt cognitive-behavioral therapy for different people.


Murray, S.M., Augustinavicius, J., Kaysen, D. et al. The impact of Cognitive Processing Therapy on stigma among survivors of sexual violence in eastern Democratic Republic of Congo: results from a cluster randomized controlled trial. Confl Health 12, 1 (2018).

Thorn, B. E., Day, M. A., Burns, J., Kuhajda, M. C., Gaskins, S. W., Sweeney, K., ... & Cabbil, C. (2011). Randomized trial of group cognitive behavioral therapy compared with a pain education control for low-literacy rural people with chronic pain. Pain, 152(12), 2710-2720.