The provision of cognitive behavioral therapy in Japan: an analysis using insurance claims data

Cognitive behavioral therapy (CBT) is a first-line treatment for many mental health conditions. In Japan, patients can receive health 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 aimed to examine the status of CBT provision for these disorders using Japanese health insurance claims data.

Data for April 2015-March 2022 from the Detroit Employment Solutions Corporation (DeSC) database were analyzed. The dataset included "Kempo" (salaried workers' insurance; large companies) and "Kokuho" (national health insurance; self-employed and their dependents) insurance, representing 2.8% and 12% of each insured population, respectively. Patients diagnosed with the above mental health conditions were identified, and their demographic characteristics, CBT session frequencies, session intervals, and psychotropic prescription status were evaluated.

Overall, 0.50% of Kempo and 0.24% of Kokuho clients diagnosed with the relevant mental health conditions claimed insurance for CBT. Among Kempo clients, CBT was claimed by 322 (89.2%) with MDD, 8 (2.2%) with SAD, 13 (3.6%) with PD, 11 (3.1%) with OCD, 5 (1.4%) with PTSD, and 2 (0.5%) with unspecified conditions. Among Kokuho clients, CBT was claimed by 1037 (92.0%) with MDD, 11 (1.0%) with SAD, 23 (2.0%) with PD, 25 (2.2%) with OCD, 13 (1.2%) with PTSD, and 18 (1.6%) with unspecified conditions. Average intervals between MDD sessions were 34.2 days under Kempo and 71.9 days under Kokuho.

Few patients claimed insurance for CBT, and most session intervals exceeded 1 month. The findings highlight substantial unmet medical needs in CBT provision in Japan. Medical environments that support and integrate regular CBT must be established.