Cognitive Behavioral Therapy for LGBTQ+

Table of Contents

Members of the LGBTQ+ community often find it challenging to locate care providers that will provide compassionate support. They will likely need support that is specifically geared toward their needs. Members of the LGBTQ+ community may struggle with mental health and substance abuse issues at a higher rate than other people. 

Higher rates of trauma for LGBTQ+ are likely due to the trauma they often face when coming out. They may struggle to find suitable treatment methods for their specific needs. The right provider can make a huge difference as one discovers different treatment methods. 

One commonly-used tactic that can prove incredibly beneficial to many patients is cognitive behavioral therapy, also known as CBT. A CBT provider with specialized training to treat members of the LGBTQ+ community can help many people receive the support they need.

What is Cognitive Behavioral Therapy (CBT)?

Cognitive behavioral therapy is a psychological strategy that focuses on changing thinking patterns to improve psychological conditions. It starts with the idea that those thinking patterns are partially responsible for many people’s responses and psychological challenges. By addressing those thinking patterns, many people can better manage symptoms of mental health conditions and move toward more positive outcomes. 

Cognitive behavioral therapy may address several vital concerns based on several key questions. 

Working with a qualified therapist as you go through CBT can make it easier to identify potential negative thinking patterns. Then, the person can work to change those negative thinking patterns and approach those everyday situations more positively. In some cases, cognitive behavioral therapy can also help patients take control over situations that they might have considered hopeless in the past. Or they may find more favorable outcomes or possibilities for problems they cannot otherwise avoid. 

Cognitive behavioral therapy relies on the concept that much of your mental health is impacted by your thinking patterns. By addressing those thinking patterns head-on, it is often possible to achieve substantial results.

Is Cognitive Behavioral Therapy Used Alone?

CBT can be used alone or with other types of mental health services. For example, a patient suffering from high levels of depression, anxiety, or PTSD might take medications to help deal with those symptoms. 

They can also receive cognitive behavioral therapy that helps address underlying negative thought patterns. In other cases, cognitive behavioral therapy may be used with different types of therapy. A therapist can help determine what kind of treatment is most needed in each case. 

What is CBT Used For?

Cognitive behavior therapy is often used alongside other treatment methods. CBT is used to help alleviate symptoms and make it easier to deal with many potential problems. Through comprehensive cognitive behavior therapy, many people notice long-term changes in their symptoms.

How Can CBT Help the LGBTQ+ Community?

68% of young people3 in the LGBTQ+ community note symptoms of anxiety or generalized anxiety disorder within the past two weeks. This is compared to around 19% of adults2 across America and 7% of children under 18.

48% of LGBTQ youth reported engaging in self-harm within a month of the period surveyed. This number is compared to around 17-18% of the general population in the same age group. 

Older adults who are members of the LGBTQ+ community may suffer from anxiety and depression at higher rates than their peers. 

Members of the LGBTQ+ community also struggle more with substance abuse6 than their heterosexual, cisgender peers. Types of substance abuse may depend on gender and other underlying mental health conditions. 

Cognitive behavioral therapy1 for the LGBTQ+ community may not help remove all those potential symptoms. It can, however, help address many of those psychological concerns.

Cognitive behavioral therapy can help identify the situations and challenges that may be causing symptoms of mental health issues.

Many members of the LGBTQ+ community face much condemnation, both from strangers and friends and family members. Often, they may struggle to fully identify which situations contribute most to some of the symptoms they may be feeling.

For example, a gay patient may suffer from immense depression due to his family’s refusal to accept his partner. If, however, he has never taken the time to identify where those symptoms might be coming from and why that sadness has deepened over time, he might not recognize the source of the anxiety. As a result, this person may struggle to overcome their anxiety and other mental health symptoms.

Cognitive behavioral therapy can help identify those specific situations that are still causing trauma. Including concerns that the patient may think that they had managed to “get past” years before.

Cognitive behavioral therapy can help identify the emotions associated with everyday events.

If a loved one had a negative reaction to someone coming out of the closet, there may be lingering emotions. Many people will try to shove down those emotions. They might cut off the people that caused the initial response and insist that they “don’t matter.”

In reality, however, many members of the LGBTQ+ community have feelings of emotional distress7 and abandonment. These feelings may stem from that initial disclosure moment. Shoving them aside, or pretending that they don’t exist, may cause them to simmer under the surface for a long time. This makes it much more challenging to deal with other, similar situations.

Consider, for example, a transgender woman whose sister initially reacted disgusted when she came out. Now, the transgender woman struggles to go home for the holidays. She may have a great deal of anxiety around the event or around other situations. Being around her family may be particularly triggering for her. 

After identifying where those feelings come from, she might start to deal with them more healthily. In many cases, it can even be possible to restore relationships once those challenges have been identified. This is particularly true if the other party’s thinking patterns have also changed over time.

Cognitive behavioral therapy can help identify negative thinking patterns contributing to mental health concerns.

Many members of the LGBTQ+ community struggle with negative thinking patterns4, including those imposed from the outside. There are many biases associated with the LGBTQ+ community. Some of these biases can create a deep sense of shame in its members even as they come out. 

These negative thoughts, which may come from without the LGBTQ+ community, can quickly become overpowering. Cognitive behavioral therapy can help address those concerns and improve overall mental health.

Furthermore, some members of the LGBTQ+ community may internalize negative thought patterns and cycles. They may, for example, get in the habit of thinking that no one will accept them. Or they may believe that they don’t belong in a particular group. As a result, they may struggle with negative thoughts and even negative self-concepts. 

Cognitive behavioral therapy takes a close look at those negative thought patterns and how they might impact the individual. Then helps address them and replace them with more positive thoughts. For example, a patient who constantly thinks, “No one accepts me for who I am, so I must be worthless.” 

Cognitive behavioral therapy might help replace those thoughts with more positive ones: “My friends love me for who I am. I have worth and meaning. I am important.” Those simple changes can, over time, help alleviate depression, social anxiety, or even self-harming behaviors.

Cognitive behavioral therapy can help identify inaccurate thinking patterns and replace them with more accurate, helpful thoughts.

Members of the LGBTQ+ community often struggle with condemnation, sometimes even from those closest to them. As a result, they may have developed several inaccurate thinking patterns. Sometimes, those things might be related to what others have said. 

For example, a transgender woman might think, “I am not a real woman.” Thanks to adverse coming-out reactions, gay or lesbian individuals might think, “I will never have a family.” 

Cognitive behavioral therapy can help identify those inaccurate thinking patterns and replace them with more positive, accurate thoughts: “I am a real woman, and other people see me that way,” for example, or, “I might have a different road to having a family, but there are plenty of ways that I can build the right family for me.”

In addition, members of the LGBTQ+ community might struggle with the overall lack of acceptance common for members of the community. As a result, they may develop negative thought patterns. 

For example, someone who lost friends or contact with family members after coming out might think, “No one accepts me, so I should never tell anyone else about who I am.” Cognitive behavioral therapy helps identify those inaccuracies and replace them: “The people who matter most to me accept me for who I am,” for example, or, “I can find people who will still want to be around me for who I am, even if I am honest about it.” 

Over time, replacing those negative thought patterns can help improve depression, anxiety, and social anxiety symptoms. CBT helps people

Cognitive behavioral therapy can help many members of the LGBTQ+ community move forward into the future.

Many members of the LGBTQ+ community struggle with the moment of transition between a past life and their present. They may have dramatically changed their lifestyles, social circles, or communities when they came out. Often, however, they may still be held back by the things that happened in the past. Which may leave them struggling with many psychological challenges. 

On the other hand, cognitive behavioral therapy focuses heavily on the present and the things under the individual’s control. It might help them realize that even though they were abandoned by members of their family, they have a new community around them that is much more accepting, loving, and willing to support them. 

Frequently, cognitive behavioral therapy can help patients move forward and have better, more fulfilling lives. It does address the issues in the past that may have caused those negative emotions in the first place. However, it may also help patients look at their present to see how they have improved.

CBT Treatment Programs for the LGBTQ+ Community

When seeking a treatment program for members of the LGBTQ+ community, it is essential to find therapists who specialize in helping this population. Intrinsic bias against members of the LGBTQ+ community is all too common.

Some therapists cannot set aside that bias to allow them to work more effectively with community members. Others may ignore the issues faced by members of the LGBTQ+ community, which may not create an effective treatment program. 

LGBTQ+-affirmative programs can lead to considerable increases in mental health.

Often, therapists require specialized training5 to deliver LGBTQ+-affirmative mental health services, including cognitive behavioral therapy. Once they have received that training, however, therapists can often provide much more extensive gains in overall mental health. When members of the LGBTQ+ community feel affirmed and supported, they can often make more effective gains in their mental health.

Intrinsic bias can interfere heavily with treatment.

Not only can intrinsic bias make a patient feel uncomfortable working with a therapist who is unable to affirm them and their needs. But it may also make it more difficult for patients to overcome the negative thought patterns that cognitive behavioral therapy is intended to address. 

Often, patients may find themselves stuck in the same negative spirals because of a therapist who is intrinsically biased against them. If this is the case, the therapist will not be able to identify the suitable thought patterns that will help them out of those cycles. Therapists who are biased against members of the LGBTQ+ community may even add to those negative thought patterns rather than helping to alleviate them.

Therapists may need training in the unique perspective of the LGBTQ+ community.

Members of the LGBTQ+ community may have unique experiences based on their sexuality and their journey during the “coming out” process. They may have a completely different perspective than cisgender, heterosexual individuals. Cisgender, heterosexual people may never have had that same experience and may not know how to identify with it. By receiving training focused on those issues and experiences, a therapist can better help members of the LGBTQ+ community.  

Treatment for mental health conditions, including substance abuse, should not mean that members of the LGBTQ+ community have to sacrifice their identity. Unfortunately, all too often, they may find themselves working with providers who fail to consider their unique needs. Working with a qualified therapist trained in delivering cognitive behavioral therapy LGBTQ+ people can yield better outcomes.

Do You Need Cognitive Behavioral Therapy Services as a Member of the LGBTQ+ Community?

Cognitive behavioral therapy, particularly when used with other behavioral health services, medication, and comprehensive mental health support, can help be incredibly beneficial. At No Matter What Recovery, we provide cognitive behavioral therapy that can help address addiction, mental health, and other common conditions. We have specialized training and experience treating members of the LGBTQ+ community. 

Contact us today to learn more about our services and how we can help.


  1. Safren, S. A., & Rogers, T. (2001). Cognitive-behavioral therapy with gay, lesbian, and bisexual clients. Journal of clinical psychology, (575), 629–643. https://doi.org/10.1002/jclp.1033
  2. National Alliance on Mental Illness.  Anxiety Disorders. December 2017. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Anxiety-Disorders#:~:text=Over%2040%20million%20adults%20in,develop%20symptoms%20before%20age%2021.
  3. Sage. Startling mental health statistics among LGBTQ+ are a wake-up call. August 21, 2020. https://www.sageusa.org/news-posts/startling-mental-health-statistics-among-lgbtq-are-a-wake-up-call/
  4. Higa D, Hoppe MJ, Lindhorst T, Mincer S, Beadnell B, Morrison DM, Wells EA, Todd A, Mountz S. Negative and Positive Factors Associated With the Well-Being of Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning (LGBTQ) Youth. Youth Soc. 2014 Sep;46(5):663-687. doi: 10.1177/0044118X12449630. PMID: 25722502; PMCID: PMC4337813.
  5. Pachankis, J. E., Soulliard, Z. A., Seager van Dyk, I., Layland, E. K., Clark, K. A., Levine, D. S., & Jackson, S. D. (2022). Training in LGBTQ-affirmative cognitive behavioral therapy: A randomized controlled trial across LGBTQ community centers. Journal of consulting and clinical psychology, 90(7), 582–599. https://doi.org/10.1037/ccp0000745
  6. Green, K. E., & Feinstein, B. A. (2012). Substance use in lesbian, gay, and bisexual populations: an update on empirical research and implications for treatment. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors, 26(2), 265–278. https://doi.org/10.1037/a0025424
  7. Almeida J, Johnson RM, Corliss HL, Molnar BE, Azrael D. Emotional distress among LGBT youth: the influence of perceived discrimination based on sexual orientation. J Youth Adolesc. 2009 Aug;38(7):1001-14. doi: 10.1007/s10964-009-9397-9. Epub 2009 Feb 24. PMID: 19636742; PMCID: PMC3707280.