The provision of Cognitive Behavioral Therapy in Japan: an analysis using insurance claims data

Purpose Cognitive Behavioral Therapy (CBT) is a first-line treatment for many mental health conditions. In Japan, patients can receive insurance coverage for CBT treatment of Major Depressive Disorder (MDD), social anxiety disorder (SAD), panic disorder (PD), Obsessive Compulsive Disorder (OCD), post-traumatic stress disorder (PTSD), and bulimia nervosa; however, utilization of CBT remains insufficient. This study investigated CBT provision for these disorders using Japanese health insurance claim data. Methods Data were from Detroit Employment Solutions Corporation (DeSC), spanning April 2015 to March 2022. The dataset included “Kempo” (salaried workers’ insurance; large companies) and “Kokuho” (national health insurance; self-employed and their dependents), representing 2.8% and 12% of each insured population, respectively. Patients with the aforementioned mental health conditions were identified, and analyses explored demographic characteristics, session frequencies, intervals, and prescription details. Results Overall, 0.50% of Kempo, and 0.24% of Kokuho, clients who were diagnosed with the relevant mental conditions claimed insurance for CBT. Among Kempo clients, CBT was claimed by 322 (89.2%) with MDD, 8 (2.2%) SAD, 13 (3.6%) PD, 11 (3.1%) OCD, 5 (1.4%) PTSD, and 2 (0.5%) unspecified conditions. Among Kokuho clients, CBT was claimed by 1037 (92.0%) with MDD, 11 (1.0%) SAD, 23 (2.0%) PD, 25 (2.2%) OCD, 13 (1.2%) PTSD, and 18 (1.6%) unspecified conditions. Average intervals between sessions for MDD were 34.2 days under Kempo and 71.9 days under Kokuho. Conclusion Few patients claimed insurance for CBT, and most session intervals exceeded one month. Findings underscore significant unmet medical needs in CBT provision in Japan. Medical environments that support and integrate regular CBT must be established.