Cognitive Behavioral Therapy (CBT) is an effective and accessible method for supporting your mental health. CBT helps you notice thought patterns that are negative or harmful to you so that you can change the way you respond to them. This clinically-reviewed blog explains what CBT is and how it can help you get relief from symptoms of anxiety and depression. For folks who cope with mental health issues, CBT can be a helpful tool. It is recognized as one of the most evidence-based and effective therapeutic treatments available to patients. 


TABLE OF CONTENTS


What is CBT?

Cognitive Behavioral Therapy (CBT) is a type of therapy that works to reduce symptoms of depression, anxiety, and other mental health issues, such as substance use disorder (SUD), post-traumatic stress disorder (PTSD), relationship challenges, stressful life situations, and many other clinical conditions. 


CBT can be used on its own, with a professional therapist or counselor, with other treatment modalities, and/or with medication. Research shows that CBT has similar effects to medication used for depression. It is effective when used on its own, but research has indicated that combining prescribed medications with CBT is often better.


How does CBT work?

There are four basic steps to using CBT to support your mental wellness. 

  1. Identify what is bothering you. First, figure out what conditions, situations, relationships, or experiences are troubling you. These issues might be outside your control, such as a mental health disorder or family member. They may also include issues such as a medical condition, relationship change, loss of a loved one, addiction, or intense emotional struggles. Choose which issue is the most important to you, and which one you would like to work on first.

  2. Notice how you’re thinking about your issues. After you’ve identified what is bothering you, write down or talk about your feelings and thoughts about them. This might look like making notes in a journal, sharing your feelings with your therapist, talking to your support group, or talking with your friend. Pay attention to not only how you interpret a specific situation, but also how you talk to yourself about it.  Notice your beliefs about yourself, other people, and your experiences. 

  3. Are your thoughts helping you or hurting you? Review how your body, emotions, and behavior changes when you are in a challenging situation. For example, your shoulders may feel tight every time you have to interact with a particular family member. Or you may notice that you say negative things to yourself every time you scroll through a friend’s social media. These patterns might actually be making your issue worse! Notice where you feel your stress and what actions—conscious or unconscious—you might be taking in response to it.


Change thought patterns that don’t serve you. This is the biggest challenge many of us take on. Working with a group, individual counselor or therapist, or friend will support you as you take on this step.  Accept that your way of thinking or behaving may not have been the best, although it was the best you could do at the time. Review your thought patterns, especially your thoughts toward yourself and your life. How can you redirect your thinking to be healthier and more loving? With practice, you can grow toward better thought patterns that feel nourishing and good to you.


How do I use CBT?

Working with a therapist, counselor, Plume Support Group, or caring friend may be helpful to getting the most from your CBT. While CBT can be effective as an individual practice, you can gain more perspective by sharing what you’re learning about yourself with someone you trust. 

We strongly recommend working with a trained licensed therapist when deciding to move forward with engaging in CBT to help manage symptoms of mental illness. We recognize that for many people, therapy may not be accessible—but you may be able to connect with a support group through your local clinic, LGBTQ center, or hospital or choose to use CBT self-directed resources.

Here are some free and low cost self-directed CBT resources you can find at the library, on your phone, or online. Each of these resources is self-directed and low-cost (or free)! 

  • Retrain Your Brain: Cognitive Behavioral Therapy in 7 Weeks: A Workbook for Managing Depression and Anxiety – This helpful workbook will support you as you practice using CBT for specific issues of depression and anxiety.

  • What’s Up? A Mental Health App – This free app includes in-app purchase ads. What’s Up? uses CBT along with acceptance and commitment therapy (ACT) to help redirect negative thoughts and feelings.

  • Free CBT worksheets – Therapist Aid provides free CBT worksheets that provide psychoeducation on the topic of CBT and worksheets designed to help individuals identify and defuse unhelpful thoughts associated with anxiety and depression. Many therapists use these worksheets, so they’re a great resource to bring to therapy if you have someone you’re working with.


If you have symptoms of mental illness, or if your mental health issues are interfering with your daily life, please seek support beyond self-guided CBT.


What is Transgender-Affirmative CBT (TA-CBT)?

To support our community, there is a special modality called transgender-affirmative CBT (TA-CBT). This type of behavioral therapy is an evidence-informed intervention developed to address the specific mental health needs of gender-diverse, gender non-conforming, trans, and/or nonbinary people. Finding a gender-affirming therapist is the first step to ensuring that your therapist is familiar with TA-CBT or would be an appropriate clinician to use TA-CBT with you. If you want to know if your therapist can help you with TA-CBT, you should ask!


TA-CBT works by helping people develop adaptive coping skills. It reduces distress that trans people may struggle with as part of their gender identity.Some of these stressors may include experiencing transphobia, discrimination, and microaggressions; navigating challenging healthcare situations; coming out to friends, family, and in the workplace; and more.


Changing your core beliefs with CBT

CBT is shown to be effective on its own, without medication. It works by identifying, monitoring, and changing or challenging what are called “core beliefs.” A core belief is an idea or belief that is so deeply ingrained that it can feel like a fact. Over time, the thoughts we have can evolve into  core beliefs, which then manifest themselves in our actions. For example, being hard on yourself for forgetting a friend’s birthday might lead to believing you are a bad friend. Then, your thoughts and actions might align with that belief, such as isolating yourself from your friends and thinking to yourself, “I’m such a bad friend that they don’t want to talk to me.”


It may sound simple when you read about it, but it’s surprisingly hard to stop thinking a certain way using only your mind! Even very intelligent people can’t magically control their own thought patterns. All people have their own unique core beliefs. Our minds accept them as the truth, although they are often far from reality—and often, we can’t even tell the difference, because we are so used to thinking in a certain way. Although we can’t always control our thoughts, CBT teaches us how to control our thinking—how we respond to our thoughts!


Harmful patterns of thoughts, beliefs, and behaviors

Negative self-talk or negative core beliefs are called “cognitive distortions.” This is a type of core belief that can cause or worsen anxiety and depression. It is bigger than simple self-criticism or accountability and can be destructive. Cognitive distortions are patterns or ways of thinking that can be maladaptive or even harmful. Examples of cognitive distortions can include magical thinking, mind reading, and all-or-nothing thinking. (This worksheet can help you identify whether you’re struggling with this type of mental stress.) 


Some examples of negative core beliefs are:

  • I’m worthless.

  • I have nothing to offer.

  • Nobody likes me.

  • I’ll never get where I want to be.

  • I don’t deserve to be happy.


Over time, these types of beliefs turn toxic. Although you may not consciously be telling yourself negative things about your worth, your core beliefs can affect your emotions and actions. Think about it: someone who believes they are worthless will behave very differently from someone who loves themselves unconditionally. A person who doesn’t trust in their own worth may put themselves at risk, waste time in dead-end or unhealthy relationships, and make choices that don’t serve their long-term happiness. 


You’re worth the work of getting well

Although it can be uncomfortable, it’s important to dig deep and work to understand our negative core beliefs and where they come from. Once we gain that self awareness, it is through applying CBT skills that we may be able to deconstruct harmful core beliefs and defuse unhelpful patterns of thought or cognitive distortions.

A person with healthy core beliefs, believes:

  • I am valuable and special.

  • I have my own set of gifts, strengths, and talents.

  • The people close to me cherish me.

  • It might be hard, but I can accomplish my dreams.

  • I deserve to experience all the abundance life has to offer.


Positive core beliefs are just as powerful as negative ones. For trans and nonbinary people, honing in on core beliefs is important for our mental wellness. Nobody should walk around feeling like they have no worth, or that they deserve to be unhappy. Every trans person is worthy, including you! However, getting to the place where you believe that—not just in the moment, but all the time, all the way down to your toes—takes time and effort. That’s where CBT comes in.


Using CBT to transform your thinking

One popular type of CBT exercise is called “Socratic Questioning.” This is an exercise that you can use on your own or with support. In this exercise, you’ll break down your thoughts, beliefs, and actions and decide how they serve you. All you need is a journal or private place to write down your responses. Some people choose to do this verbally, by talking through their emotions. That is helpful, but having some notes can help you identify patterns more clearly—and also see how you’re healing from negative core beliefs.


First, write a list of your core beliefs in your journal. Maybe you can only identify one or two at first. After all, for most people—even very smart, sensitive, and self-aware people—thinking is an unconscious process. Our thoughts just move through our minds, like background noise. If you are going through your day and you catch yourself thinking a certain way, write it down! Collect these thoughts without judgment. Remember, you are just observing how you think, when certain thoughts pop up, and how they make you feel.


When you have a list of core beliefs you’d like to address, choose one. Bear in mind that processing your core beliefs and the emotions that come with them is hard work. Like training a muscle, it does get easier with time and practice—but if you’re starting out, you may feel tired, anxious, defeated, or even angry. This is normal. Our minds don’t like being poked and prodded, especially when we’re already dealing with anxiety and depression! Give yourself the space you need to examine your core beliefs. There is no deadline and you don’t have to “hurry up and heal.” 


Write down the core belief you’d like to work on at the top of your journal page. Sit with it for a minute. Say it in your mind. Say it out loud. Then, take your time and respond to some questions:

  • Where did I first hear this belief expressed? Who taught me to feel this way?

  • Is there any proof that this belief is true? Is there any proof that it is false?

  • Do other people agree with this belief, or not? What proof do they have that supports this belief?

  • Would someone who loves me say it is true?

  • Is this core belief an exaggeration of what happened? Is it minimizing or making less of the real situation? Or does it accurately reflect reality?

  • How does my body feel when I say this core belief out loud or in my mind?

  • Would I ever say this statement to someone I deeply cared about?

  • What would my life be like, if I didn’t have this core belief?


As you do this exercise, remember that it’s better to really focus on a few answers. Don’t just speed through the questions. This isn’t a quiz or a timed test, it’s about you. Give yourself grace as you work on this. Many people feel overwhelmed when they try this, so be gentle with yourself. You can pause if you need to, call or text a friend, cry, get a snack, take a nap, or put your journal away and come back to it. When you’re ready, you can consider sharing what you’ve written with someone you trust.