Cognitive therapy involves replacing negative, maladaptive thoughts with positive and realistic thoughts. Frequently, these thoughts occur automatically, without the awareness of the individual experiencing them.

Changing negative thought patterns often requires a process of identifying the undesirable beliefs an individual has about themselves and others. Once these thoughts have been identified, the individual learns to dispute them. Essentially, cognitive therapy requires developing new skills, including those involved in monitoring thought streams and subjecting attitudes and biases to more realistic reasoning. The goal is to make the use of these skills second nature.