Evaluating the Impact of Cognitive Behavioral Therapy on Stress Severity Transitions among University Students: A Multi-Group Analysis

Background: University students often encounter considerable stress arising from academic demands, social expectations, and personal responsibilities. Cognitive Behavioral Therapy (CBT) is widely recognized as an effective psychological intervention for alleviating emotional distress; however, limited attention has been given to its comparative effects across students from different academic disciplines. The present study aimed to examine changes in stress severity before and after a CBT-based intervention among university students enrolled in medical, para-medical, and non-medical programs. Methods: The study involved 600 participants representing the three academic streams. The Stress subscale of the Depression Anxiety Stress Scales (DASS-21) was administered both prior to and following the intervention. Data analyses comprised internal consistency estimation, descriptive statistics, paired-samples t -tests, and categorical transition evaluations using McNemar and McNemar–Bowker tests. Results: The Stress subscale demonstrated high internal reliability (α = .95–.96). No significant differences were observed in mean stress scores across time points or academic groups (all p > .25, d < 0.10). Distributional analysis revealed stable stress severity patterns (χ² = 8.57, p = .57), with nearly half of the respondents classified within the Normal range. Medical students exhibited a marginally higher normalization rate (60%) compared with para-medical (52.5%) and non-medical (49.5%) students. Conclusion: While CBT did not produce statistically significant group-level reductions in stress, individual-level improvements were evident among participants initially presenting with elevated stress levels. These findings emphasize the enduring nature of stress among university students and underscore the necessity for sustained, discipline-specific mental-health interventions.