Barriers and Facilitators of Implementing Cognitive Behavioral Therapy: A Systematic Review Based on the Consolidated Framework for Implementation

Cognitive behavioral therapy (CBT) is currently considered the gold standard of treatment, with its evidence-based framework widely used in healthcare. However, its implementation in real-world settings faces numerous challenges. Understanding the barriers and facilitators of CBT implementation is essential to improving its accessibility and effectiveness. A systematic search was conducted across multiple databases from 20/9/2024 to 10/10/2024, including PubMed, CINAHL, ProQuest, and Web of Science. Studies published in English from 1994 to 2024 were included. This systematic review was reported using the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and registered at the International Prospective Register of Systematic Reviews (Registered No. CRD42024570477). Qualitative, quantitative, and mixed-method studies were analyzed to identify key implementation challenges and enablers. Data extraction and quality assessments were performed using the Mixed Methods Appraisal Tool (MMAT) and the JBI critical appraisal tools. A total of 32 studies with 2082 participants were included in this review. Common barriers to CBT implementation included limited training opportunities for clinicians, high caseloads, organizational constraints, resistance to change, and inadequate funding. Digital literacy challenges and technical issues further hindered the adoption of internet-based CBT (iCBT). Facilitators included strong leadership support, structured training programs, stakeholder engagement, and the integration of digital and step-care approaches to enhance accessibility. The findings highlight the importance of addressing systemic, organizational, and individual-level barriers to improve the implementation of CBT. Strengthening clinician training, increasing institutional support, and leveraging digital solutions can enhance the accessibility and sustainability of CBT interventions. This review provides practical insights for policymakers, mental health professionals, and researchers working toward optimizing CBT implementation in diverse settings.