Background and objectives : A previous study stated that cognitive-behavioral therapy (CBT) is not sufficiently disseminated and that Japan exhibits considerable regional disparities in this regard. Thus, in the present study, we aimed to determine the current status of CBT in Japan.

Methods : We used CBT data from the National Database of Health Insurance Claims and Specific Health Checkups from the fiscal year (FY) 2014 (FY2014) to FY2022. We analyzed the number of CBT sessions stratified by year, month, sex, five-year age group, 47 prefectures, and eight regions. Additionally, we calculated the standardized claim ratio (SCR) for the number of sessions to account for age variations among prefectures.

Results : The number of annual CBT sessions decreased from 44,999 in FY2014 to 35,231 in FY2022. In FY2022, the vast majority of CBT sessions were administered by physicians, with only 239 sessions being co-provided by nurses in collaboration with physicians. In FY2022, 63％ of CBT sessions were conducted for female patients, with the therapy being provided more frequently for women than for men in the age groups ≥15 years. Additionally, 64％ of the CBT sessions were administered to patients aged 20-49 years. CBT sessions for patients aged ＜20 and ≥65 years accounted for 13％ and 7％ of sessions, respectively. The highest number of CBT sessions per million members of the general population was observed among women aged 20-24 years (n＝864) and men aged 25-29 years (n＝490). In 14 prefectures, Aomori, Akita, Yamagata, Niigata, Toyama, Fukui, Nara, Yamaguchi, Kagawa, Kochi, Saga, Nagasaki, Oita, and Okinawa, ＜10 CBT sessions were conducted. In FY2022, the highest number of CBT sessions per million individuals of the general population was observed in Okayama (n＝2,834). Among the eight regions, the highest CBT sessions per million of the general population was observed in Chugoku (n＝595) and Hokkaido (n＝37), respectively. The SCR for Tokyo, Osaka, and Miyagi were close to the national average. The SCR was the highest in Okayama (1,029). During FY2020, the number of sessions was the lowest in May (n＝2,509) and highest in March (n＝3,263). Notably, the coronavirus disease 2019 pandemic led to a decrease in the number of monthly CBT sessions.

Conclusions : Although various health policies promoting CBT, including broadening the spectrum of diseases covered by health insurance and delegating CBT to nurses, have been implemented, concerns raised by previous studies persist. Improving the environment and providing physicians and nurses with adequate training are crucial for the widespread dissemination of CBT.