Changing the Conversation in Your Head: Understanding Cognitive Behavioral Therapy (CBT)

“I always mess things up.” “They probably think I’m annoying.” “If this goes wrong, everything falls apart.”

Most of us have an inner voice that narrates our day, and sometimes that voice isn’t very kind or very accurate. When those thoughts pile up, they can shape how we feel and what we do, often without our noticing. If that sounds familiar, you’re not alone. One approach many people ask about is cognitive behavioral therapy, or CBT, which Mayo Clinic describes as a common type of talk therapy.

What Is Cognitive Behavioral Therapy?

CBT is a form of talk therapy (psychotherapy) that focuses on the connection between your thoughts, feelings, and behaviors. According to the National Institute of Mental Health, CBT helps people examine how their thoughts affect their emotions and behavior, and change self-defeating behavior patterns.

The American Psychological Association (APA) describes a few core ideas behind CBT:

• Psychological problems are based, in part, on unhelpful ways of thinking.
• They’re also based, in part, on learned patterns of unhelpful behavior.
• People can learn better ways of coping, which can relieve symptoms and help them become more effective in their lives.

In other words, CBT isn’t about “just thinking positive.” The APA describes strategies such as learning to recognize distortions in thinking and reevaluate them in light of reality, and using problem-solving skills to cope with difficult situations.

What Is CBT Used For?

The APA notes that research has shown CBT to be effective for a range of problems, including depression, anxiety disorders, alcohol and drug use problems, marital problems, and eating disorders. Research findings describe groups of people, though, and individual results vary. Mayo Clinic notes that CBT doesn’t work for everyone.

Our cognitive behavioral therapy page lists a wide range of emotional challenges and mental health concerns CBT is used for, including:

• Anxiety
• Dependencies
• Depression
• Grief
• Phobias
• PTSD
• OCD
• Overcoming emotional trauma related to abuse or violence
• Resolving relational conflict

Mayo Clinic also points out that you don’t need to have a mental health condition to benefit from CBT, and that it can be an effective way to learn to better manage stressful life situations.

What Does a Cognitive Behavioral Therapist Do?

According to the APA, the therapist and client work together collaboratively to understand the problem and develop a treatment strategy. Our CBT page describes the process in these general steps. Every person’s experience is different.

1. Identifying What’s Troubling You

In CBT, the client works with their therapist to identify troubling or problematic situations or conditions in their life. Mayo Clinic notes these may include issues such as a medical condition, divorce, grief, anger, or symptoms of a mental health condition.

2. Noticing Your Self-Talk

Next, the client is asked to share about those areas, specifically the self-talk happening around those situations. Mayo Clinic notes your therapist may suggest keeping a journal of your thoughts.

3. Challenging Unhelpful Thoughts

The therapist then helps the client identify negative thinking that may be occurring, and encourages them to challenge those thoughts, asking whether they’re based on facts or inaccurate perceptions. As a simple illustration, a thought like “I always mess things up” might be reconsidered as “I made a mistake on this project, and I’ve also handled plenty of things well.” Mayo Clinic notes this step can be very hard because many thinking patterns are long-standing, and that with practice, more helpful thinking patterns can become a habit.

4. Building New Coping Skills

Finally, the therapist helps equip the client with new coping skills for stressful situations. Our CBT page notes there will likely be homework to help practice these skills, such as journaling, role-playing, and relaxation techniques. The APA notes that CBT places an emphasis on helping people learn to be their own therapists.

How Long Does CBT Take?

Our CBT page describes CBT as commonly used because of its highly specific goals and short-term length, usually 10 to 20 sessions. (Mayo Clinic gives a range of about 5 to 20 sessions.) Mayo Clinic notes that the right number for any person depends on factors like their situation, how severe and long-standing their symptoms are, how much they practice between sessions, and the support they have. That’s something to discuss with a therapist.

Mayo Clinic also notes that CBT can bring up painful feelings, that some people feel worse during the first part of therapy, and that it can take several sessions to build up new coping habits.

Can You Do CBT on Your Own?

This is a common question. Mayo Clinic notes that online resources are available that may make CBT possible even where local mental health resources are limited. Some people also find self-reflection tools like journaling helpful. At New Horizons, we often recommend journaling as a complementary practice to therapy (see our post on the power of journaling).

Mayo Clinic describes CBT as working with a mental health professional in a structured way, and notes that a therapist may also talk with you about whether other treatment might help. This article can’t tell you whether CBT is right for you. That’s a conversation to have with a qualified professional.

Is CBT Right for Me?

Our CBT page notes that CBT works well for individuals who are able to be introspective, and that it’s commonly used because of its highly specific goals. Some people explore CBT when they:

• Feel stuck in the same worries or negative thought loops
• Want to learn coping skills for stressful situations
• Are dealing with stress, worry, low mood, or a specific fear
• Are coping with a loss (we also offer grief counseling)
• Prefer a structured, goal-focused approach to therapy

Not sure? That’s okay. Our office staff can answer questions about our services.

If you are in crisis: If you are having thoughts of harming yourself or ending your life, please call or text 988 to reach the 988 Suicide & Crisis Lifeline, or chat at 988lifeline.org. It’s available 24/7, and conversations are free and confidential. If you are in immediate danger, call 911.

Ready to Learn More?

At New Horizons Center for Healing in McKinney, TX, several members of our team list CBT or cognitive-behavioral approaches among the methods they use, and we’re dedicated to working with individuals who are ready to be equipped with coping skills for positive change in their lives. Our facility is personal and welcoming, with programs specially tailored to fit our clients.

If you’d like to learn more, reach out to us today with your questions about cognitive behavioral therapy. You don’t have to navigate this journey alone.

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This article is for general educational purposes only. It is not a substitute for professional medical or mental health advice, diagnosis, or treatment, and reading it does not create a counselor-client or other provider relationship with New Horizons Center for Healing. If you are experiencing an emergency, call 911. If you are in crisis or having thoughts of suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline.

Sources

1. National Institute of Mental Health. Psychotherapies. https://www.nimh.nih.gov/health/topics/psychotherapies
2. American Psychological Association. What Is Cognitive Behavioral Therapy? https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
3. Mayo Clinic Staff. Cognitive behavioral therapy (updated Feb. 26, 2025). https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610
4. 988 Suicide & Crisis Lifeline. https://988lifeline.org/