CBT guided self-help (CBTgsh) can produce treatment outcomes comparable to therapist-administered CBT (CBTta) for the treatment of anxiety and depression. The efficacy of CBTgsh compared to gold standard CBTta, however, remains to be examined. The current article addresses this issue, as well as how CBTgsh may have unique benefits over CBTta. It further highlights ways in which CBTgsh may be used for disorders of increasing severity, using eating disorders and personality pathology for illustrative purposes. A literature review of PsycINFO, PsyARTICLES, and PubMED was conducted to identify relevant studies published since 1990. Studies directly comparing CBTgsh to gold standard CBTta for anxiety and depression, as well as bulimia nervosa, revealed no significant differences between the two interventions. Furthermore, CBTgsh may have unique benefits by encouraging continued improvement over time. Innovative eating disorder studies also show that CBTgsh can be used for more severe disorders as a supplementary treatment, and produces treatment outcomes superior to CBTta or treatment as usual alone. Based on these findings, CBTgsh applications to personality pathology are suggested. Traditional stepped care models, as they pertain to CBTgsh, may gain to be broadened both in their focus and methods of delivery.