A systematic review on the role of self-efficacy as an outcome, predictor or mediator variable in cognitive behavioral therapy for anxiety in adults, children and adolescents

Self-efficacy (SE) serves as a fundamental mechanism underlying cognitive behavioral therapy (CBT) for anxiety disorders (AD). Previous reviews and meta-analyses have primarily examined the role of SE within specific treatment methods and/or disorders, often viewing SE as just one aspect of broader cognitive mechanisms. Moreover, the existing evidence is based solely on studies in adult samples.This systematic review aims to provide a comprehensive, up-to-date overview on both specific (SSE) and general self-efficacy (GSE) as outcomes, predictors, or mediators of CBT for ADs, including data from both adult and child/adolescent samples. We identified N=104 studies with a total of 9707 participants. These studies employed a wide range of CBT interventions, including exposure therapy, cognitive restructuring (CR), systematic desensitization, and mindfulness-based approaches.Key findings indicate that CBT significantly enhances both GSE and SSE, particularly when exposure or CR are key components. Pre-and post-treatment levels of SE, as well as CBT-induced increases in SE, predicted or mediated treatment outcomes regardless of AD diagnoses. However, evidence linking SE gains to outcomes is weaker in studies with children/adolescents, interventions targeting general or subclinical anxiety, trauma-focused samples, and remote interventions especially when GSE measures were used.To conclude, while the evidence supports SE as both a treatment outcome and a mechanism of change in CBT, we identified various boundary conditions that significantly impact existing associations. Promising results from experimental studies suggest that interventions designed to bolster SE could be a valuable addition to enhance the efficacy of standard CBT protocols.