Awarefy Inc. (Headquarters: Shinjuku-ku, Tokyo; CEO: Shinichiro Ogawa, hereinafter "Awarefy") and the "Mental Health Research Institute" (Director: Hikari Takashina, hereinafter "Kokoro Soken"), operated by Awarefy, have released the analysis results of the "Cognitive Behavioral Therapy Awareness Survey (May 2026)" conducted on approximately 950 individuals residing in Japan.

This survey was conducted to understand the current state of awareness, access, and system recognition of Cognitive Behavioral Therapy (CBT) as of the end of May 2026, ahead of the medical fee revision (hereinafter referred to as "this revision") concerning CBT and psychological support premiums, which will be implemented in June 2026.

Survey Results Summary

Over 70% experienced mental distress in the past year, but less than 20% utilized specialized institutions.

CBT is the least "well-known" among mental healthcare methods. Compared to mindfulness, approximately 50% are "not well-informed" about CBT (around 30% for mindfulness/meditation), indicating a significant difference in awareness.

CBT's intention to "receive treatment" does not easily translate into actual use. While 14.5% have thought about wanting to receive it, only 3.5% have actually done so.

As a background, 9.2% stated "wanted to receive it but couldn't," suggesting that a considerable number of people are unable to access treatment despite their intention.

The barriers to accessing CBT identified in this survey are: 1st place "Don't know where to receive it," 2nd place "Expensive/financially difficult," and 3rd place "Uncertain about effectiveness/suitability."

Over 90% responded they were "unaware" of this revision. On the other hand, upon learning about the revision, over 60% showed increased interest in receiving CBT.

Background and Purpose of This Survey

Cognitive Behavioral Therapy (CBT) (*1) is a psychotherapy that addresses patterns of "thinking" and "behavior" that affect mood and actions, and has demonstrated therapeutic effects for a wide range of mental disorders such as depression and anxiety disorders. In recent years, its approach has been increasingly used not only for treatment in medical institutions but also for self-care and behavioral change in response to daily stress.

Furthermore, with the medical fee revision for Reiwa 8 (2026) (*2), "Certified Public Psychologists" have been newly added to the practitioners eligible for CBT under insurance coverage, which was previously limited to doctors and nurses. The scope of diseases covered by psychological support premiums has also been expanded. This has broadened the possibility of receiving specialized psychological support at a lower cost. This is a significant step towards establishing a system for the widespread adoption of mental healthcare in Japan.

However, the extent to which these systemic advancements are reflected in the awareness and behavioral choices of individuals experiencing mental distress has not been previously understood. To observe how new systems reach society, it is considered important to acquire and track data over time regarding the literacy of Japanese people concerning mental care, their actual coping behaviors when experiencing distress, and the awareness and usage status of the "CBT" approach.

Therefore, as a first step, we conducted a current status survey on awareness, intention to use, usage status, and barriers to use of CBT at the time of May 2026, prior to the implementation of the revision.

*1 Cognitive Behavioral Therapy (CBT) is a psychological approach (psychotherapy) that alleviates distress related to mood and life by addressing patterns of "thinking" and "behavior" that influence mood and actions. It has shown therapeutic effects and relapse prevention effects for a wide range of mental disorders including depression, anxiety disorders, obsessive-compulsive disorder, and PTSD, and is recommended as a standard treatment in clinical guidelines. In recent years, it has been utilized not only in medicine but also in a wide range of fields such as occupational health, education, and lifestyle improvement.

*2 The Reiwa 8 (2026) Medical Fee Revision (implemented in June 2026) newly includes Certified Public Psychologists among practitioners eligible for CBT under insurance coverage, which was previously limited to doctors and nurses. Additionally, the scope of diseases covered by psychological support premiums has been expanded from post-traumatic stress disorder (PTSD) to include neurotic disorders, stress-related disorders, and somatoform disorders. In medical institutions that meet specific conditions, there is an increased possibility of receiving CBT and psychological support for stress-related disorders etc. provided by Certified Public Psychologists at a lower cost.

https://www.mhlw.go.jp/content/12400000/001706379.pdf

Survey Results

1. Over 70% Experienced Mental Distress in the Past Year, but Less Than 20% Utilized Specialized Institutions

Out of all survey respondents, 72.9% reported experiencing mental distress in the past year. On the other hand, only 17.3% visited or used psychiatric clinics, mental health clinics, or psychological counseling services in the past year, revealing a significant gap between the proportion experiencing distress and the proportion actually using specialized institutions.

Did not receive treatment: 761 cases

Visited psychiatric/mental health/mental clinics: 145 cases

Received specialized support such as psychological counseling (not a medical institution): 21 cases

*Multiple selections possible

2. About Half Know CBT; However, "Have Used It" is Last Among 7 Methods.

2-1. Awareness of CBT

Regarding the extent to which people are aware of CBT, 37.4% had "heard the name but don't know the details," and 16.3% "know the details." Thus, approximately half (53.7%) recognize CBT, regardless of the level of knowledge.

Never heard of it: 425 people (46.3%)

Heard the name but don't know the details: 343 people (37.4%)

Know the details of CBT: 150 people (16.3%)

Furthermore, when analyzed by dividing respondents into those who experienced distress in the past year and those who did not, individuals who have not experienced distress showed lower CBT awareness rates compared to those who have experienced distress within the past year (response of "Never heard of it": 62.7% for those without distress, 40.2% for those with distress), suggesting that experiencing distress in the past year may influence CBT awareness.

2-2. Recognition of CBT as a Mental Care Method

Respondents were asked about their awareness of seven different mental care methods on a four-point scale from "not well-informed" to "have used it." The results for "have used it" were as follows:

Results for "Have Used It" (in order of most respondents)

- Lifestyle improvements such as exercise and sleep: 563 people (61.3%)

- Gathering information through books and online articles: 505 people (55.0%)

- Treatment using medication prescribed by a doctor (antidepressants, anti-anxiety drugs, etc.): 196 people (21.4%)

- Mindfulness/meditation: 154 people (16.8%)

- Use of over-the-counter herbal medicines and supplements: 122 people (13.3%)

- Mental health apps (self-care type): 100 people (10.9%)

- Cognitive Behavioral Therapy (CBT): 62 people (6.8%)

CBT had the lowest usage experience among the seven mental care methods, with "have used it" at 6.8%, "want to use it next" at 15.0%, "do not want to use it/no plans to use it" at 28.1%, and "not well-informed" at 50.1%, with "not well-informed" accounting for half of the respondents.

There was a significant difference compared to mindfulness and meditation (16.8% "have used it," 32.4% "not well-informed"), which are also categorized as psychological approaches, revealing it to be the least familiar method among mental care options.

2-3. Intention to Use and Actions Towards Use

To the question "Have you ever wanted to receive CBT?", 14.5% responded yes, and 85.5% responded no (*3).

Furthermore, to the question "Have you ever taken action, such as inquiring with a medical institution, to actually receive CBT?", 2.8% answered "yes," and 97.2% answered "no."

2-4. Experience with CBT Use

To the question "Have you actually received CBT?", the following results were obtained:

Never wanted to receive it (*3): 802 people (87.4%)

Wanted to receive it but couldn't: 84 people (9.2%)

Have received it: 32 people (3.5%)

9.2% of respondents reported having the experience of "wanted to receive it but couldn't," indicating that some individuals were unable to access treatment despite having a high intention and taking action, due to various barriers.

*3 The response "Never wanted to receive CBT" appears in both the question asking about intention to use (85.5%) and the options for the question asking about usage experience (87.4%). These were asked as independent questions, and slight differences in percentages may occur even for responses with the same intent due to differences in question context and the order of options. This release presents the response results for each question as they are.

3. Barriers to CBT Use are Information, Cost, and Anxiety About Effectiveness

When asked about the reasons for "wanted to receive it but couldn't" (n=84), the top reasons were: 1st place "Don't know where to receive it," 2nd place "Expensive/financially difficult," and 3rd place "Uncertain about effectiveness/suitability."

Free-text responses included comments such as:

I don't understand the content well, and I don't know which hospital to go to.

It requires multiple sessions, and I have the impression it's expensive.

I was worried if it would be effective for me, and where to get it, and by the time I thought about it, I couldn't take action.

Among those who have actually received CBT (n=32), the forms of implementation included "in-person sessions with a psychologist/counselor" and "in-person sessions with a doctor," followed by "self-administered using books" in third place.

Among the forms of CBT implementation, the most helpful were professional support as mentioned above, followed by "learning through YouTube, TV, social media, websites, etc., and self-administering" ranking third, indicating that CBT is practiced in diverse ways, not limited to provision by professionals.

4. Awareness of System Revision is Approximately 5.8%. However, "Once Informed," Interest Rises to 62%.

In light of this current situation, how is the recently implemented public health insurance system revision being received?

First, regarding this revision, approximately 94.2% responded they "did not know." Awareness for both the provision of CBT by Certified Public Psychologists and the expansion of target diseases for psychological support was at an extremely low level of around 5-9%.

On the other hand, when asked about changes in the expectation of receiving CBT at medical institutions after being informed about the revision's content during the survey, 6.2% responded "I definitely want to try it," and 55.8% responded "I don't need it now, but I would like to try it if I encounter problems." This indicates that 62.0% of people showed increased interest in CBT after learning about the system change.

Definitely want to try it: 57 people (6.2%)

Don't need it now, but would like to try it if I encounter problems: 512 people (55.8%)

No particular change: 336 people (36.6%)

Began to feel I don't want to receive it: 10 people (1.1%)

Other: 3 people (0.3%)

Considering that "cost" was the second reason for not being able to receive treatment, this revision may serve to lower that barrier. However, barriers such as "don't know where to receive it" and "don't know what it entails or who it's suitable for" continue to exist.

Expert Comment (Professor Hiroaki Kumano, Faculty of Human Sciences, Waseda University)

The most striking finding from this survey is the clear visualization through data that Cognitive Behavioral Therapy (CBT) is still "hardly known." Mindfulness, though a relatively new approach, has been gaining attention for about 20 years and is already widely known and used. In contrast, despite 50 years of practice and research, CBT had the highest percentage of respondents who were "not well-informed" among mental care options, and it was also shown to have hurdles to utilization.

Therefore, the first priority is to disseminate accurate information to society so that people can think, "CBT might be helpful for me," and to make CBT feel more accessible to as many people as possible. In that sense, inclusion in health insurance will increase opportunities to receive it at major hospitals, and awareness will gradually rise from now on. Following that, it is hoped that a society will emerge where individuals can choose the method that suits their situation and preferences, as the options for where and in what form to receive CBT expand.

This survey also indicated that while cost and resistance to face-to-face interaction are barriers to use, a certain number of people have been practicing CBT on their own through books and videos. It is considered important to provide diverse entry points, including not only face-to-face CBT by professionals but also online CBT and more easily accessible apps, to reach those who need CBT.

The Thickness of the "Information Barrier" Revealed: To Deliver CBT to Those Who Need It (Hikari Takashina, Director/Senior Researcher, Kokoro Soken; Yuki Takei, Researcher)

"Two Barriers to CBT Use" Revealed

From the results of this survey, it is clear that there are significant gaps at each stage from awareness (people who know) to intention to use (people who want to receive it) to actual use: CBT awareness is 53.7%, intention to use is 14.5%, and actual use is 3.5%. Furthermore, 9.2% of respondents had the experience of "wanted to receive CBT but couldn't," indicating that a certain number of people are unable to translate their intention into actual use. This calculates to approximately 0.65 people out of every 10 who know CBT ultimately being able to access it, which is less than one person. The primary factors creating these gaps are the "information barrier" and the "cost/psychological barrier."

The first "information barrier" is that the CBT approach itself is not sufficiently known. Many people were found to be in a state of "having heard the name but not knowing what it is, and not yet feeling interest or need."

The second "cost/psychological barrier" is faced by those who become interested in CBT and attempt to receive it. Specifically, the top reasons cited were "don't know where to receive it," "expensive," and "uncertain about effectiveness/suitability." Free-text responses also included comments such as "I didn't know how to choose," "I couldn't receive it at local medical institutions or my regular clinic," and "I couldn't imagine the effects and couldn't proceed," indicating a lack of clarity in the path to utilization.

It is also important to note that this "cost/psychological barrier" is likely to stem from a lack of information. When one's energy is depleted due to mental or physical distress, it is not easy to search for and evaluate information independently, making the barrier even higher.

What is Needed Now to Overcome the Two Barriers

In the widespread adoption and practice of mental healthcare, it is crucial for each individual to recognize when they need care at the appropriate time, to know what options are available, and to be able to choose the option that suits them. These individual recognitions and choices cannot be solely supported by personal effort. What enables them is a societal system where options are known, accessible, and selectable. To achieve this, it is essential to establish such a system through system revisions like the one in question and appropriate information dissemination.

For example, the current medical fee revision can be said to be a change that directly reduces some of the "cost barrier" and "anxiety about effectiveness," thereby lowering the barriers to accessing CBT. In fact, this survey showed that approximately 62% of people showed increased interest in CBT after learning about the revision, stating "I definitely want to try it" or "I would like to try it if I encounter problems in the future."

On the other hand, this survey also highlighted the significant thickness of the information barrier, with CBT being largely unknown as a mental healthcare method and people not knowing where to receive it. Even if the system is in place, if CBT and the resources for receiving CBT are not known, those who need them cannot access them when they need them. Therefore, in parallel with establishing the system, it is crucial to continue efforts in appropriate information dissemination.

Kokoro Soken will continue to monitor the process by which systemic advancements reach individuals and change people's awareness and behavior regarding mental healthcare through initiatives like this survey, and will strive to provide information that supports such changes. Furthermore, we will work to improve our services to contribute to the creation of a society where those in need can access CBT when they need it.

Details of Survey Respondents

Target Area: Nationwide

Respondent Conditions: 18 years or older, residing in Japan

Sample

- Sample Size: 959 (of which 918 who responded appropriately to IMC items were analyzed)

- Gender: Female 573 (62.4%), Male 329 (35.8%), Did not answer 15 (1.6%), Other 1 (0.1%)

- Age: Average 40.9 years (SD=11.5)

Survey Method: Internet survey, etc. *This is not a survey targeting Awarefy users.

Survey Period: May 25 - May 31, 2026

Implementing Body: Awarefy Inc. "Awarefy Mental Health Research Institute"

*Reference Links

[Latest Survey 2026] AI as a "Mental Support" Enters the Stabilization Phase. A Half-Year Review of Expanding Consultation Needs and Deepening Awareness of Dependence.

AI Mental Partner "Awarefy"

AI Mental Partner App "Awarefy"

Official Character "Fai-san"

This is a smartphone application that combines approaches based on scientifically evidenced methods such as "Cognitive Behavioral Therapy" with AI and other technologies. It has supported over 1 million people to date. It offers over 300 types of content useful for mental healthcare, including a dialogue function with the AI character "Fai-san," a function to reflect on one's own mental condition, and audio guides for mindfulness meditation and learning courses by topic.

Download the app here.

Awarefy Inc.

We are engaged in business centered on the development and operation of the AI mental partner "Awarefy" app, which combines cutting-edge AI technology with approaches based on scientifically evidenced methods such as "Cognitive Behavioral Therapy." To realize a society where people can face their "cherished values," we aim to contribute to the field of mental healthcare not only through expanding app features but also by operating "Awarefy Rework," a facility that supports individuals aiming for return to work.

Location: Shinjuku Sumitomo Building 24F GROWTH Shinjuku ROOM-4, 2-6-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo

Representative Director & CEO: Shinichiro Ogawa

Business Activities: Planning, development, and operation of the app "Awarefy," operation of the welfare rework facility "Awarefy Rework," etc.

Company HP: https://www.awarefy.com/

[Contact for Inquiries Regarding This Matter]

Awarefy Public Relations

Email: press@awarefy.com

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