Efficacy of cognitive behavioral therapy for smoking cessation: A systematic review and meta-analysis.

INTRODUCTION

Tobacco use is a major preventable cause of morbidity and mortality, and Cognitive Behavioral Therapy (CBT) may address the cognitive, behavioral, and relapse-related mechanisms that sustain smoking. This review evaluated the efficacy of CBT for smoking cessation by synthesizing controlled studies reporting smoking abstinence and smoking reduction outcomes.

METHODS

Within this systematic review and meta-analysis, a search was performed in PubMed, Web of Science, Scopus, ScienceDirect, SpringerLink, ACM Digital Library, IEEE Xplore, and Google Scholar for studies published from 1 January 2000 to 15 January 2026. Eligible studies were randomized controlled trials or controlled quasi-experimental studies of people who smoked and compared CBT, delivered face-to-face or remotely, with a non-CBT control condition. Outcome data were extracted for smoking abstinence and smoking reduction. Risk-of-bias was assessed using RoB 2 for randomized trials and ROBINS-I for non-randomized controlled studies. Odds Ratios (ORs) were pooled using DerSimonian and Laird random-effects models, with fixed-effect estimates used only as sensitivity analyses.

RESULTS

Fourteen studies were included. Eleven studies contributed to the smoking abstinence meta-analysis, and five contributed to the smoking reduction meta-analysis. For smoking abstinence, the random-effects pooled OR was 1.60 (95% CI: 0.95-2.70; z=1.76; p=0.078; I2=83.70%). For smoking reduction, the random-effects pooled OR was 1.96 (95% CI: 0.66-5.81; z=1.21; p=0.226; I2=83.64%). Risk-of-bias assessments indicated low-risk, some-concerns, or moderate-risk ratings across included studies; no included study was judged to have a critical risk-of-bias.

CONCLUSIONS

CBT showed a favorable direction of effect for smoking abstinence, but the random-effects estimate was imprecise, and heterogeneity was substantial. Evidence for smoking reduction was also not statistically conclusive. The findings should therefore be interpreted cautiously, and future trials should clarify treatment moderators, standardize outcome definitions, and refine CBT protocols for different cessation goals.