Cognitive Behavioral Mental Health

Review Concepts of Cognitive Behavioral Therapy, Rational Emotive Behavior Therapy, Acceptance & Commitment Therapy & Coaching

1. Plan

Identify cognitive distortions leading to subsequent unhealthy negative emotions and poor coping strategies. Mental health screeners may help highlight areas on which to focus.
Cognitive Restructuring to replace distortions with new, non-distorted thoughts leading to subsequent healthy negative emotions & improved coping strategies.
Design Experiments reinforcing new, non-distorted thoughts and increase tolerance for healthy negative emotions and coping strategies

Medicines like Esketamine (Spravato), Racemic ketamine (by mouth, by iv or other route), and other psychedelic medicine and non-medicine practices (like meditation) have been studied and prescribed alongside psychotherapy for over 100 years.

Psychedelic coaching offers support for maintaining those new connections by practicing and applying what you began in psychotherapy.

2. ABC Model

"Within Existential Therapy, clinicians work with their clients to accept responsibility for their lives, which is something that REBT therapists do as well. Taking ownership of one’s thoughts, emotions and behaviors is first required in REBT, before any challenging or replacing of irrational beliefs can occur."

Smart Recovery is a recovery model based on Rational Emotive Behavior Therapy

How CBT Dismantles ADHD Negativity: Cognitive Behavioral Therapy Overview

Using CBT to Empower Black Patients (2025)

AFFIRM Youth – The California Evidence-Based Clearinghouse for Child Welfare

AFFIRM Youth is an eight-session, manualized affirmative cognitive-behavioral group intervention. It is designed to reduce depression and improve coping skills and self-efficacy for LGBTQ+ youth. Using a trauma-informed approach, AFFIRM Youth is tailored to the experiences of LGBTQ+ youth and provides them opportunities to develop identity cognition (e.g., self-awareness, identifying risk), mood (e.g., recognizing the link between thoughts and feelings), and behavior (e.g., identifying strengths and ways of coping), as well as equipping them with the tools to self-manage their mental health.

We have created and evaluated among the first LGBTQ-affirming psychotherapy programs with empirical evidence for improving LGBTQ people’s mental health. These treatments are developed in close consultation with community members and clinical experts and show associations with reduced depression, anxiety, substance use across several clinical trials. Most prominently, with $13M in NIH funding, we have developed and evaluated LGBTQ-affirmative CBT with gay and bisexual men, queer women, and transgender and non-binary individuals in clinical trials, community settings, and countries throughout the world. The treatment has been successfully delivered in-person, remotely, in groups, and online. Our LGBTQ-affirmative CBT program is considered a “treatment that works” and is cited in LGBTQ practice guidelines of the American Psychological Association.

Rational-emotive therapy (Bowins, 2021)

3. RAIN of Self Compassion

Unconditional Other-Acceptance

Albert Ellis Institutekdoyle

4. Cognitive Distortions & Meaning

After recognizing and allowing what is, we can start to investigate our thoughts & beliefs about our adversities and triggers. Our distorted thoughts (cognitive distortions) lead us to self-defeating beliefs about ourselves, others and life in general.

Types of Cognitive Distortions

All or Nothing Thinking You see things in black and white categories. If your performance falls short of perfect, you see yourself as a total failure.
Overgeneralization You see a single negative event as a never ending pattern of defeat.
Mental Filter You pick out a single negative detail and dwell on it exclusively so that your vision of all reality becomes darkened, like the drop of ink that discolors the entire beaker of water.
Disqualifying the Positive You reject positive experiences by insisting they “don’t count” for some reason or other. In this way you can maintain a negative belief that is contradicted by your everyday experiences. You make a negative interpretation even though there are no definite facts that convincingly support your conclusion.
Jumping to Conclusions You arbitrarily conclude that someone is reacting negatively to you and you don’t bother to check this out.
The Fortune Teller Error You anticipate that things will turn out badly, and you feel convinced that your prediction is an already established fact.
Magnification (Catastrophizing) or Minimization You exaggerate the importance of things (such as your goof up or someone else’s achievement), or you inappropriately shrink things until they appear tiny (your own desirable qualities or the other fellow’s imperfections). This is also called the“binocular trick”.
Emotional Reasoning You assume that your negative emotions necessarily reflect the way things really are– “I feel it; therefore, it must be true.”
Should Statements You try to motivate yourself with should and shouldn’ts, as if you had to be whipped and punished before you could be expected to do anything. “Musts” and “oughts” are also offenders. The emotional consequence is guilt. When you direct should statements toward others, you feel anger and resentment.
Labeling This is an extreme form of over generalization. Instead of describing your error, you attach a negative label to yourself: “I’m a loser.” When someone else’s behavior rubs you the wrong way, you attach a negative label to him: “He’s a jerk.”
Personalization and Blame With personalization, you see yourself as the cause of some negative external event which in fact you were not primarily responsible. With blame, you blame other people or your circumstances for problems, and overlook ways that you might be contributing to the problem.
Underestimating your Ability to Cope is where you doubt your ability to manage stressors you experience in the world.

In an Absolute State: Elevated Use of Absolutist Words Is a Marker Specific to Anxiety, Depression, and Suicidal Ideation (2018)

A three-level meta-analysis of the relationship between meaning in life and depression (2026)

Cognitive distortions in patients with social anxiety disorder: Comparison of a clinical group and healthy controls (2018)

APA PsycNet

Rational emotive behavior therapy, 2nd ed. (2019) "REBT is the founding cognitive, multimodal, and integrative therapy approach. Albert Ellis originated it in the 1950s, and other cognitive approaches followed. From its start, the approach included philosophical as well as experiential, emotional, and behavioral techniques."

5. Identifying & Investigating

Rumination: A Cycle of Negative Thinking

Rumination involves repetitive thinking or dwelling on negative feelings and distress and their causes and consequences. The repetitive, negative aspect of rumination can contribute to the development of depression or anxiety and can worsen existing conditions.

American Psychiatric Association home

"Research on unconditional self-acceptance found that a **low level of unconditional self-acceptance correlates with depression, anxiety, anger, and neuroticism** (Popov, 2019; Prihadi et al., 2019; Andronikos, 2021). High levels of unconditional self-acceptance were in general strongly related to mental health, happiness, self-esteem, life satisfaction, well-being, respect for the differences between individuals, and low levels of anxiety and depression (Vural-Batik, 2019; Bernard M. E., 2020). Unconditional self-acceptance **also correlates positively with dispositional forgiveness** (Porada et al., 2018), **self-compassion and flourishing** (Venet, 2019; Andronikos, 2021).

6. Stress Management, Inflammation

Chronic stress affects body and mind

Inflammation, stress and depression: An exploration of ketamine’s therapeutic profile (Johnston, et al, 2026)

This study found that in cases of PTSD, while clients make psychological improvements, underlying inflammation may remain. If left untreated, psychological symptoms could be expected to return.

Peripheral inflammation over the course of a cognitive behavioral intervention in PTSD (2023)

However, this review of 24 different studies found in cases of depression, there is a signal suggesting cognitive behavioral therapy affects certain biomarkers of stress.

Cognitive behaviour therapy and inflammation: A systematic review
of its relationship and the potential implications for the treatment of
depression (Lopresti, 2017).

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Cognitive-Behavioral Treatments for Anxiety and Stress-Related Disorders (Curtiss, et al, 2021)

Body Scan Meditation for Stress

The effect of slow breathing in regulating anxiety (2025) "The results of showed that: Slow breathing effectively reduced anxiety, the valence and arousal are lower under the slow breathing..."

2026: "Our study suggests that the brain's response to meditation can be rapid and varies with practitioners’ experience, potentially influencing cognitive and emotional processing in significant ways."

(2026):"psilocybin has achieved 60-80% long-term remission of cancer-related depression and anxiety and peri-palliative ketamine studies demonstrate rapid but short-lived symptom control. In preclinical models these agents appear to normalize hypothalamic-pituitary-adrenal (HPA) axis function while upregulating neurotrophic factors, mechanisms which putatively **promote stress reductions and resilience.**"

7. People Pleasing, Self Defeating Beliefs

On people pleasing / nice vs kind

Common Self-Defeating Beliefs

Perfectionism. I must never fail or make a mistake.
Perceived Perfectionism. People will not love and accept me as a flawed and vulnerable human being.
Achievement Addiction. My worthiness depends on my achievements, intelligence, talent, status, income, or looks.
Hopelessness. My problems could never be solved. I could never feel truly happy or fulfilled.
Worthlessness / Inferiority. I'm basically worthless, defective, and inferior to others.

6. Approval Addiction. I need everyone's approval to be worthwhile.

Love Addiction. I can't feel happy and fulfilled without being loved.
Fear of Rejection. If you reject me, it proves that there's something wrong with me. If I'm alone, I'm bound to feel miserable and worthless.
Pleasing Others. I should always try to please others, even if I make myself miserable in the process.
Conflict Phobia. People who love each other shouldn't fight.
Self-Blame. The problems in my relationships are bound to be my fault.
Emotional Perfectionism. I should always feel happy, confident, and in control.
Anger Phobia. Anger is dangerous and should be avoided at all costs.
Emotophobia. I should never feel sad, anxious, inadequate, jealous or vulnerable. I should sweep my feelings under the rug and not upset anyone.
Perceived Narcissism. The people I care about are demanding, manipulative, and powerful.
Brush fire Fallacy. People are clones who all think alike. If one person looks down on me, the word will spread like brush fire and soon everyone will look down on me.
Spotlight Fallacy. Talking to people feels like having to perform under a bright spotlight on a stage. If I don't impress people by being sophisticated, witty, or interesting, they won't like me.
Magical Thinking. If I worry enough, everything will turn out okay.
Other-Blame. The problems in my relationships are the other person's fault.
Entitlement. You should always treat me in the way I expect.
Truth. I'm right and you're wrong.
Low Frustration Tolerance. I should never be frustrated. Life should be easy.
Superman / Superwoman. I should always be strong and never be weak.

Common irrational assumptions that, if addressed, could alleviate distressing responses to negative events. Some of these include:

The idea that people should be completely competent at everything
The idea that it’s a disaster when things aren’t exactly how we want them to be
The idea that we have no control over our happiness
The idea that we need someone stronger than ourselves to depend on
The idea that our past holds a strong influence over our present life
The idea that all problems have a perfect and findable solution

(Source)

8. Cognitive Restructuring

Nourish with self compassion

Testing Thoughts (Beck Institute)

1. What is the situation? You might be having thoughts about something that just happened in the environment or something that happened inside of you (e.g., an intense emotion, a painful sensation, an image, a daydream, a flashback or a stream of thoughts, such as thinking about my future).

2. What am I thinking or imagining?

3. What is the cognitive distortion?

4. What makes me think the thought is true?

5. What makes me think the thought is not true or not completely true?

6. What’s another way to look at this?

7. If the worst happens, what could I do then?

8. What’s the best that could happen?

9. What will probably happen?

10. What will happen if I keep telling myself the same thought?

11. What could happen if I changed my thinking?

12. What would I tell my friend or family member [think of a specific person] if this happened to them?

13. What would be good to do now?

Untwisting Cognitive Distortions (Cognitive Restructuring)

"The Functional Dispute puts things in perspective, offering rational alternatives to think about the same problem. In REBT, it opens up doors for deeper introspection to our belief patterns. Not only that, but it tends to stop you on your worry and rumination tracks. So take a moment to reflect on your unhelpful beliefs. Are they helping or getting in the way of a goal we wish to achieve?"

9. 4 Ultimate Concerns

Your brain on nature: A scoping review of the neuroscience of nature exposure (Baquedano, et al, 2026)

4 Ultimate Concerns– On Meaning, Connection, Freedom, Life

Finding balance between meaning and meaninglessness, connection and isolation, freedom/free will and oppression/repression, and life and death may be Joy

How are your cognitive distortions and self-defeating beliefs affecting your ability to find balance?

(2026):"Researchers suspect that these positive psychological shifts rely heavily on the quality of a person’s initial experience while under the influence of the drug. People who report feelings of spiritual connection or a sense of ego dissolution often show the greatest long-term psychological changes. Ego dissolution refers to a temporary loss of one’s sense of self and a feeling of deep connection with the surrounding world. This temporary state may create opportunities for emotional healing."

10. Experimenting

Our emotions are neither good nor bad. They are only an indicator of where we are on any given subject. Imagine that each emotion below is a rung on a ladder. We have to climb the ladder rung by rung. Sometimes we can skip a rung or two but we usually can’t skip ten. So if you were jealous and now feel anger, acknowledge that you are moving in the right direction.

At first, just become familiar with what you are feeling. Identify any thoughts or beliefs that may have led up to the feeling.

Once you get skilled at identifying your self defeating beliefs and your cognitive distortions then you can begin to “reach for a better feeling thought.” First, identify where you are then identify where you want to be. Next, reach for a better feeling thought by changing the story you are telling yourself. If the thought makes sense to you, keep going. When you feel like the thought doesn’t make sense, or isn’t realistic, pause at that feeling for a bit. Once you feel ready, keep reaching for a better feeling thought.

Remember: beliefs contribute to thoughts and thoughts result in feelings and feelings shape experiences.

Beliefs/Thoughts–– >Feelings & Experiences

Emotional Spectrum Ladder - What would experimenting with new emotions look like? What would experimenting with new thoughts feel like?

1. Joy – Love – Passion - Transcendence – Awe

2. Compassion – Connectedness

3. Confident – Courageous

4. Curiosity – Creative

5. Optimism - Hopeful

6. Calm

7. Contentment – Clarity

8. Boredom

9. Pessimism

10. Frustration, Irritation, Impatience, Annoyance

11. Doubt, Concern, Caution

12. Disappointment, Sadness

13. Overwhelm

from here down, we're moving into unhealthy territory and suffering

Worry

15. Blame, Entitlement, Outrage

16. Discouragement, Unmotivated

17. Anger

18. Apathy

19. Hatred, Rage, Vindictive

20. Jealousy, Possessive

21. Insecurity, Guilt, Unworthiness, Shame

Anxiety, Fear, Nervous, Paranoid

23. Depression, Despair, Powerlessness, Helpless, Hopeless, Worthless

24. Isolation, Existential Dread, Panic

(variation on Source)

Rational vs Irrational Beliefs – Key Ideas by Albert Ellis (CBT/REBT)

(Source)

Goal: Replace irrational beliefs with rational, healthy perspectives. What feelings can you associate with each type of thought?

Need for Love from Others
Irrational: I must be loved by everyone to feel okay.
Rational: It’s more important to respect myself and love others, rather than needing their love all the time.
Judging People Harshly
Irrational: Bad acts mean people are bad and deserve punishment.
Rational: People may act harmfully, but that doesn’t make them evil. They can learn and grow.
Intolerance of Frustration
Irrational: It’s awful when things don’t go my way.
Rational: It’s not ideal, but I can cope and work to improve or accept the situation.
Blaming External Causes for Misery
Irrational: Others or events control my misery.
Rational: My feelings come from how I think about things, not just what happens to me.
Catastrophizing Fear
Irrational: If something is scary, I should panic or obsess.
Rational: It’s better to face fears calmly or accept what I can’t change.
Avoiding Responsibility
Irrational: Avoiding problems is easier than facing them.
Rational: Avoidance makes things worse long-term. Facing issues is healthier.
Dependence on Stronger Forces
Irrational: I must rely on something stronger than myself.
Rational: It’s better to take risks and manage life independently.
Perfectionism
Irrational: I must always be successful and smart.
Rational: I prefer doing well, but accept being imperfect and human.
Past Trauma Controls Me
Irrational: My past trauma defines me.
Rational: I can learn from the past but I don’t have to stay stuck in it.
Needing Total Control
Irrational: I must control everything perfectly.
Rational: Life is uncertain, and I can still enjoy it without total control.
Inaction Brings Happiness
Irrational: I’ll be happiest doing nothing.
Rational: True joy comes from meaningful work and connecting with others.
No Emotional Control
Irrational: I can’t help how I feel.
Rational: I can change my emotions by changing my thinking.

Rational Emotive Behavior Therapy (REBT), Irrational and Rational Beliefs, and the Mental Health of Athletes - PMC

In this article Rational Emotive Behavior Therapy (REBT) is proposed as a potentially important framework for the understanding and promotion of mental health in athletes. Cognitive-behavioral approaches predominate in the provision of sport…

NCBI home page

(2016) "far from being solely performance-focused, the cognitive-behavioral approach to sport psychology can restore, promote, and maintain mental health"

"REBT attempts to show you that (1) events do not automatically create your thoughts, (2) events do not cause your emotions, and (3) by changing your thinking, you will see things differently, and then your thoughts and emotions will aid you instead of interfering with your actions."

Cognitive-Behavioral Treatments for Anxiety and Stress-Related Disorders - PMC

Cognitive-behavioral therapy (CBT) is a first-line, empirically supported intervention for anxiety disorders. CBT refers to a family of techniques that are designed to target maladaptive thoughts and behaviors that maintain anxiety over time.…

NCBI home page✉Send correspondence to Dr. Curtiss (jcurtissmgh.harvard.edu). ✉Corresponding author.

How to deal with troubling thoughts (2024)

Intrusive thoughts are a common and disturbing symptom of anxiety. Cognitive behavioural techniques can help "...the most important question to ask yourself any time unwanted intrusive thoughts show up is this: What will my reaction to these thoughts teach my mind?"

11. Affirmations

Self-affirmations can boost well-being, study finds (2025)

(2026):"The findings suggest that self-compassion indirectly alleviates depressive symptoms by reducing ruminative thinking, even after accounting for baseline mental health. This supports the utility of self-compassion as a protective factor against depression during the school-to-work transition."

Self-affirmations can boost well-being, study finds (2025)

Quantum evidence of nonlocal consciousness during clinical death (2026) "If consciousness can operate under quantum principles, then the boundaries between life, death, and cognition are far more permeable than current science allows."

Savoring refers to the process by which individuals consciously notice, deeply experience, prolong, and amplify positive experiences. This process enhances individuals' sense of well‐being and their ability to regulate positive emotions (Bryant & Veroff, 2007).

12. Hierarchy of Needs

From Burnout through Transcendence to Joy

Experiences of Awe Mediate Ketamine’s Antidepressant Effects: Findings From a
Randomized Controlled Trial in Treatment-Resistant Depression (2024)

Air Quality & Suicide (2026)

Fluctuations in Sleep Duration and Timing and Cardiometabolic Risk (2026)

Examining the Evidence

Finding signal in the noise

Functional Connectivity of the Subcallosal Cingulate Cortex And Differential Outcomes to Treatment With Cognitive-Behavioral Therapy or Antidepressant Medication for Major Depressive Disorder (Dunlop, et al, 2023)

Brain Scans May Offer Clues About Depression Remission (Zagorski, 2023)

(2021): "Cognitive behavioural therapy (CBT) has more evidence supporting it than any other psychological therapy (David, Cristea, & Hofmann, 2018)."

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Cognitive–behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies (2021): "The results of several randomized controlled trials indicated that CBT was effective for a variety of mental problems (e.g., anxiety disorder, attention deficit hypersensitivity disorder, bulimia nervosa, depression, hypochondriasis), physical conditions (e.g., chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, breast cancer), and behavioral problems (e.g., antisocial behaviors, drug abuse, gambling, overweight, smoking), at least in the short term"

(2022):"The results revealed that the altered activation in the prefrontal cortex and precuneus were key regions related to the effects of CBT. Therefore, CBT may modulate the neural circuitry of emotion regulation. This finding provides recommendations for the rapidly developing literature."

Next-Generation Cognitive-Behavioral Therapy for Depression: Integrating Digital Tools, Teletherapy, and Personalization for Enhanced Mental Health Outcomes (2025)

Benefits of Cognitive Behavior Therapy with Neuroscience-informed Psychoeducation in Young Adult Patients: A Preliminary Study (2024) "Neuroscience-based psychoeducation has the potential of changing perception and enhancing the credibility of CBT and can bring better acceptance and outcome for the CBT process."

The Brain-Gut Connection "Psychological interventions like CBT may also help to 'improve communications' between the big brain and the brain in our gut."

Baseline Pain Variability is Linked to Neural Reappraisal and Catastrophizing Improvement Following Cognitive Behavioral Therapy in Fibromyalgia (2026) "Pain catastrophizing up-regulates chronic pain and is a central target of cognitive behavioral therapy (CBT)."

(2021): Preliminary study suggests "Ketamine seems to restore bacteria producing the anti-inflammatory substance, butyrate, and reduce the number of bacteria associated with inflammatory processes in the gut. It increases the abundance of bacteria, previously reported as reduced in depression, and reduces the amount of bacteria, previously reported as increased in MDD. It also increases the abundance of probiotic bacteria known to produce an antidepressant effect."