You Can Change Your Thinking and Still Feel Lost

Cognitive behavioral therapy (CBT), arguably the most common approach to psychotherapy, rests on the powerful premise that “how we think about a problem affects how we feel about it.”

And that premise makes sense. Change how you interpret a problem, and you will change how you feel about it.

But what happens when the distressing thoughts are actually true? What happens when recognizing reality also means accepting something negative about reality?

Here’s an example. Someone thinks other people do not like them. CBT might emphasize that the person could be misinterpreting this situation. Maybe they are misinterpreting cues as evidence that people do not like them. Or maybe there is little likelihood that people are thinking about them at all.

Not bad alternatives. But what if the reality is that people do not actually like them? Or what if the reality of people not even thinking about them is by itself distressing?

These are truths about life that can cause their own level of difficulty. Because what do you do with that information? What do you do when evidence suggests that people do not like you? Or that you are not important enough for them to even think about you?

If the way we interpret things contributes to our emotional problems, then changing how we think about those things should help us respond differently. But what happens when you learn to think about things differently and still don’t know what to do with that information?

Here’s another example. A person may reach the point where they are able to think differently about work situations and draw a different conclusion: “I know that my boss’s criticism doesn’t mean I’m a worthless person.”

And that is helpful. But then the multiple other questions come up, like “Should I stay at this job or leave it?” “Should I confront my boss?” “Am I only staying at this job because it provides security?”

CBT focuses on asking, “Is this thought accurate?” But living a full life also requires asking, “Given what is true, what should I do?” Answering that question is important for moving beyond just the basics of what CBT offers.

Thinking more rationally helps us get closer to seeing reality as it actually is. But that actually creates another problem. What do we do with that reality once we see it more clearly?

Knowing what is true does not by itself help us know what to do next. Other factors, gathered from animal and human psychology research, that impact what an individual does with new information include motivation, prior learning, and change avoidance (Pisula, 2025).

Here are some examples of other factors that impact how we act even when we are able to think differently about situations:

• “I know why change would help here; it just isn’t worth the effort” (motivation)
• “Things are OK right now. Not great, but OK. Why risk changing that?” (change avoidance)
• “I have tried to change before, but nothing happened. Why would I think this time would be any different?” (prior learning)
• “What I learned helps me see reality more clearly. But that doesn’t mean I can change it.” (acceptance)

Notice that each of these statements reflects a strong recognition of reality. And notice that they are not necessarily bad. In fact, the issue of acceptance can be a big part of moving forward in CBT. “Radical acceptance” in therapy is often very useful for helping a person recognize reality and live with it, even if it is not positive.

What each of these factors has in common is that they require the person to take another step beyond changing their thinking. This requires them to address not only how they view what is happening around them but what that reality says about how they want to live their life.

Doing this requires asking questions deeper than just “What do I think about this?” These questions include:

Cognitive Behavioral Therapy Essential Reads

5 Signs That Now Is a Good Time to Start Cognitive Behavioral Therapy for Insomnia

Why People Keep Making the Same Mistakes

• “Do I really want to change, or am I saying I want to change because I think that I’m supposed to want to change?”
• “Does how I am now fit with the sort of person I want to be? If it does, then why do I need to change even if other people are not happy with it?”
• “What do I really find meaningful in life? Is making a change going to move me in that direction? If not, is it really that important?”
• “Do I know anything about why my prior attempts to change didn’t help? What does that say about what I am really looking for from changing?”

These are questions that are less about how the person sees specific situations and more about understanding what the person wants from life. They are still in the realm of CBT but just in a deeper realm. Here, change moves from asking questions about specific situations to asking questions about meaning and purpose. These are questions that help a person move from just living a more positive life to living a more meaningful life.