Cognitive-behavioral therapy (CBT) is a powerful tool for supporting your mental wellness. You can use CBT on your own, with a therapist or counselor, in a support group, or with a trusted friend. 

Understanding how to use CBT on your own can help you identify and change destructive or disturbing thought patterns that have a negative influence on our behaviors and emotions. This can help significantly with managing symptoms of anxiety and depression. For trans and nonbinary folks, stress, anxiety, panic attacks, and general discomfort can be an everyday experience. But it doesn’t have to be that way! You can learn to lower your anxiety by using CBT as a helpful tool for changing how you respond to stress.

Obviously, if you need anxiety or depression medications, you should absolutely reach out to your Care Team for help. Never try to handle a mental health crisis on your own, especially if self-harm or risky behaviors are part of your experience. You can always call emergency services or contact Trans Lifeline if you’re having a mental health crisis. To talk about longer-term care options, reach out to your Care Team to talk to a provider about your mental health options.


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.