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Summary
- Cognitive Processing Therapy (CPT) is a specific type of cognitive behavioral therapy that helps patients deal with traumatic events and reduce symptoms of post-traumatic stress disorder (PTSD).
- It focuses on altering maladaptive beliefs and thought patterns related to the trauma.
- In CPT, patients are taught to overcome negative thought patterns which contribute to their symptoms of PTSD and to replace them with more adaptive, realistic ways of thinking.
- CPT consists of 12, 50-minute sessions spread out over three months. CPT also includes at-home worksheets and exercises to continue what one learned in the session.
- CPT is evidence-based and can be extremely effective for those with PTSD. This includes victims of sexual assault, childhood trauma, military personnel, first responders, and more.
- Successful completion of CPT therapy helps decrease negative emotions and become unstuck from their past trauma, freeing them to enjoy day-to-day life more.
What is Cognitive Processing Therapy?
Cognitive processing therapy (CPT) is a type of cognitive behavior therapy (CBT) that is specially designed to treat post-traumatic stress disorder (PTSD) or other forms of trauma (Greene, 2022).
CBT is a type of psychotherapy in which negative thought patterns are challenged to change unwanted behavior or thinking, and it is often used to treat depression and anxiety.
Cognitive processing therapy (CPT) uses the tools of CBT to help patients evaluate and change the upsetting thoughts they”ve had since their trauma.
CPT generally consists of 12 sessions, lasting about 60 to 90 minutes. Unlike other therapies, CPT can either be done individually, where you meet one-to-one with a provider, or it can be done in a group of about 6-10 other people with one or two providers (Va.gov, 2018)
During these sessions, therapists will guide patients through understanding their thoughts and feelings and changing their harmful beliefs. This way, CPT teaches the patient to evaluate and change their upsetting thoughts since their trauma and, therefore, how they feel.
CPT was developed by psychologists in the Department of Veterans Affairs and has since been designated by the American Psychological Association (APA) as a first-line treatment for those suffering from PTSD— even more effective than medication (Greene, 2022).
CPT vs. Exposure Therapy
CPT is very similar to another form of therapy called “exposure therapy,” which is used to treat anxiety disorders. Exposure therapy involves exposing patients to the source of their anxiety and showing no real danger.
In doing so, providers help patients to overcome their fears and anxieties by training the patients’ brains to recognize that their distress is irrational.
Prolonged exposure therapy for PTSD helps people to gradually approach trauma-related memories, feelings, and situations they have been avoiding since their trauma.
By asking people to repeatedly recall and describe details of their traumatic experience, exposure therapy for PTSD encourages patients to confront their trauma head-on.
In contrast, CPT focuses on helping people with PTSD evaluate upsetting thoughts that have existed since their trauma.
More specifically, CPT is interested in changing the way these patients look at themselves and the world and challenging their trauma-related beliefs through critical thinking (Richman, 2022).
What Are the Unique Challenges of PTSD?
PTSD is a disorder in which a person has difficulty recovering from a traumatic event for months or even years. “Triggers” can bring back physical and emotional memories of the trauma, and symptoms include nightmares, panic attacks, intrusive thoughts, anxiety, and depression (Greene, 2021).
The difficulty of treating people with PTSD is that many times, people are neither aware they have the condition nor that there are treatment options available. People might experience opinions from loved ones that say, “It will pass” or “You’ve just gotta tough it out.”
Furthermore, negative self-talk is very common among those afflicted with PTSD. Labeling oneself as damaged or weak for not being able to move on can be extremely damaging.
As a result, CPT’s focus on changing how people think about a traumatic event can be extremely effective if one overcomes the stigma (Greene, 2022).
How Does CPT Therapy Work?
Psychoeducation
CPT falls under the larger category of psychoeducational therapy. Psychoeducation refers to a broad range of interventions that combine educating a patient while also providing counseling and support activities.
Many psychotherapeutic interventions are based on traditional models of treating pathology and illness. In contrast, the psychoeducation model offers a more holistic approach to therapy that stresses collaboration, coping, and empowerment for the patient and their support system (Lukens et al., 2004).
In psychoeducational therapy, the patient and the patient’s support system are considered partners with the provider in treatment. This design is built on the premise that the more knowledgeable the patient and their support system are about their mental health condition, the better health outcomes are for the patient.
To build this knowledge, providers focus on removing barriers to comprehending mental health conditions and developing strategies for the patients to be proactive in their treatment.
In CPT, this might be done by teaching patients about the reality of a PTSD diagnosis, overcoming stigma and self-blame, and assigning writing assignments that encourage practicing real-life skills learned in therapy (Va.gov, 2018).
Understanding Your Thoughts and Feelings (Processing the Trauma)
At its base, CPT is built on the premise that what we think influences how we feel. For example, after a traumatic event, one’s thought patterns might change to cope and keep oneself safe in the future (Greene, 2022).
These thought patterns might lead to over-negativity, feelings of uncertainty, and even feelings of danger.
Through CPT, people are taught how to think differently or reprocess a traumatic event. In doing so, patients are encouraged to challenge their long-held assumptions about these events to progress emotionally.
For people with PTSD, it can be extremely difficult to talk or even think about the traumatic event(s) which changed their lives. What’s more, it can be even harder to change their long-held beliefs about those particular events to move on.
CPT helps reshape patients’ long-held beliefs and destructive thought patterns by retraining their automatic tendency to think negatively. By learning to challenge initial thought processing, patients effectively “rewire” their brains over time.
Learning New Skills
As CPT teaches, small changes in thinking can greatly impact how you feel. By helping you get “unstuck” from your past, CPT can free you to enjoy the parts of life you have been missing out on.
In CPT, the provider leads the client through exercises that help them to recognize and investigate unhelpful thought patterns. This includes regular out-of-session practice assignments to apply what has been discussed in therapy sessions.
Through Socratic questioning or other techniques, patients learn how to challenge and modify unhelpful beliefs related to the trauma and learn new thinking skills.
Changing Your Beliefs
People diagnosed with PTSD often struggle in one or more of the following five areas: safety, trust, power and control, esteem, and intimacy (My Clients Plus). Therefore, the final sessions of CPT are dedicated to helping clients apply the adaptive strategies they learned in therapy to everyday life situations that fall into one of these areas.
In doing so, providers aim to replace their client’s faultier interpretations with healthier cognitions. CPT emphasizes how negative or incorrect thoughts of past trauma can increase symptoms of PTSD and fuel powerful emotions.
Since these emotions can make it more difficult for someone with PTSD to process memories in a healthy way, CPT encourages a framework for challenging negative thoughts and replacing them with new, productive ones (My Clients Plus).
Finally, CPT provides clients with coping skills they can use on their own to continue to process past trauma. These coping strategies can also be used in the future if clients experience additional trauma, helping them to stop negative thoughts in their wake.
What Is the Role of Self-Blame in PTSD?
Self-blame plays a strong role in keeping people stuck in the memory of their trauma. Therefore, reducing self-blame is a key focus of CPT.
Self-blame is a cognitive process in which an individual attributes the occurrence of a stressful event to oneself. To those who experienced a traumatic event, self-blame might feel useful as a way to make one feel control over what happened.
However, self-blame can be a corrosive and dangerous coping mechanism. If one blames oneself for a traumatic event, the result can be an increase in symptoms of PTSD. Therefore, self-blame blocks one’s natural capacity for healing after a traumatic event (Greene, 2022).
Importantly, some traumatic events tend to cause more self-blame than others. For instance, survivors of sexual assault often blame themselves for what happened to them due to the personal nature of the crime as well as societal judgment.
Furthermore, childhood abuse can lead to self-blame as children are likely to assume the trauma they experience is a result of something they did. Even as these children become adults, they typically do not re-examine these memories.
Is CPT a “Cure” for PTSD?
For some, CPT can effectively treat PTSD. Of course, they do not forget the traumatic event, but the trauma no longer perpetuates the same PTSD symptoms that existed before treatment.
Research has shown that most people who complete CPT treatment experience significantly reduced symptoms. For some, they can overcome all symptoms of their PTSD entirely. For others, they might continue to experience symptoms of PTSD but to a lesser degree than before (Greene, 2022).
To a strong degree, the effectiveness of PTSD is impacted by the client’s commitment to the treatment. Some patients find it especially difficult to complete the take-home homework assignments or to do the difficult job of confronting and analyzing their trauma.
CPT will unlikely be helpful without the client completing these important tasks of following through with all sessions. Through these important exercises and sessions, clients examine their thoughts and emotions in a way that reduces PTSD symptoms.
How to Get Started (Where to go for Help)
To find a therapist in your area, you can use the find-a-therapist directory from the Association for Behavioral and Cognitive Therapies (ABCT) or this clinical directory of CPT therapy providers (Greene, 2022).
Furthermore, if you are a veteran suffering from PTSD, almost all VA Medical Centers offer CPT in their specialized PTSD programs, and more than 2,000 VA providers are trained in CPT (VA.gov, 2018).
Finally, CPT coach is a mobile app that you can use with a provider during CPT. CPT Coach can help you learn more about CPT and PTSD symptoms and help you keep track of homework and assignments. This app is free and can be downloaded on most mobile devices (VA.gov, 2018).
FAQs
How long does cognitive processing therapy take?
CPT generally consists of 12 sessions, lasting about 60 to 90 minutes. This means it takes about three months to complete the therapy adequately.
Patients may start to feel better after just a few sessions, and the benefits of CPT can last long past the final session. The effectiveness of CPT therapy is also strongly influenced by engagement.
Is cognitive processing therapy evidence-based?
CPT is evidenced-based, meaning it has been shown to work in multiple research studies. For instance, a study in the Journal of Addictive Behaviors studied the effectiveness of CPT for veterans with comorbid PTSD and alcohol use disorders (Kaysen et al., 2014).
Participants attended an average of nine sessions, and there was a significant reduction in the symptoms of PTSD across all groups who received a course of CPT therapy.
Another study published in the Journal of Consulting and Clinical Psychology compared CPT’s effectiveness against prolonged exposure therapy for victims of sexual assault.
The study concluded that both CPT and prolonged exposure therapy were highly effective treatments, but participants who had received CPT therapy had better outcomes (Resick et al., 2002).
Who benefits from CPT?
CPT is an effective form of therapy for people diagnosed with PTSD or coping with past trauma.
Furthermore, since CPT aims to reshape the way a traumatic experience is interpreted and processed, it is especially useful for people who may endure future trauma, including active military personnel or first responders (My Clients Plus).
What are the goals of CPT therapy?
The goals of CPT therapy are to increase understanding of PTSD and how it affects life; feel the emotions of a traumatic event and reduce its avoidance; develop more realistic beliefs about the world; decrease negative emotions created by maladaptive thought patterns; and simply improve the day to day living of those stuck in their trauma (CEBC).
Who developed cognitive processing therapy?
CPT was developed by Patricia Resick, a clinical psychologist, in the 1980s. Resick initially designed CPT as a treatment for individuals who had experienced sexual assault, and it has since been expanded to address various types of trauma, such as combat-related trauma and PTSD resulting from other traumatic events.
Further Information
- Chard, K. M., Ricksecker, E. G., Healy, E. T., Karlin, B. E., & Resick, P. A. (2012). Dissemination and experience with cognitive processing therapy. Journal of Rehabilitation Research & Development, 49 (5).
- U.S. Department of Veterans Affairs (VA) PTSD: National Center for PTSD. Cognitive processing therapy for PTSD.
- Gallagher, M. W., & Resick, P. A. (2012). Mechanisms of change in cognitive processing therapy and prolonged exposure therapy for PTSD: Preliminary evidence for the differential effects of hopelessness and habituation. Cognitive therapy and research, 36 (6), 750-755.
References
Asmundson, G. J., Thorisdottir, A. S., Roden-Foreman, J. W., Baird, S. O., Witcraft, S. M., Stein, A. T., … & Powers, M. B. (2019). A meta-analytic review of cognitive processing therapy for adults with posttraumatic stress disorder. Cognitive Behaviour Therapy, 48 (1), 1-14.
CEBC. CEBC ” Cognitive Processing Therapy Cpt ” Program ” Detailed. (n.d.). Retrieved July 4, 2022, from https://www.cebc4cw.org/program/cognitive-processing-therapy-cpt/detailed
Gallagher, M. W., & Resick, P. A. (2012). Mechanisms of change in cognitive processing therapy and prolonged exposure therapy for PTSD: Preliminary evidence for the differential effects of hopelessness and habituation. Cognitive therapy and research, 36 (6), 750-755.
Greene, D. P. (2022, May 20). Cognitive processing therapy (CPT) for PTSD and trauma. Manhattan Center for Cognitive Behavioral Therapy. Retrieved June 29, 2022, from https://www.manhattancbt.com/archives/840/cognitive-processing-therapy-cpt/
Greene, D. P. (2021, November 12). Posttraumatic stress disorder (PTSD). Manhattan Center for Cognitive Behavioral Therapy. Retrieved June 29, 2022, from https://www.manhattancbt.com/ptsd-posttraumatic-stress-disorder/
Holliday, R., Holder, N., & Surís, A. (2018). A single-arm meta-analysis of cognitive processing therapy in addressing trauma-related negative cognitions. Journal of Aggression, Maltreatment & Trauma, 27 (10), 1145-1153.
Kaysen, D., Schumm, J., Pedersen, E. R., Seim, R. W., Bedard-Gilligan, M., & Chard, K. (2014). Cognitive processing therapy for veterans with comorbid PTSD and alcohol use disorders. Addictive behaviors, 39 (2), 420-427.
Lukens, E. P., & McFarlane, W. R. (2004). Psychoeducation as Evidence-Based Practice: Considerations for Practice, Research, and Policy. Brief Treatment & Crisis Intervention, 4(3).Chicago
My Clients Plus. (n.d.). Cognitive processing therapy 101 for therapists. Retrieved July 3, 2022, from https://myclientsplus.com/cognitive-processing-therapy-101-for-therapists/
Price, J. L., MacDonald, H. Z., Adair, K. C., Koerner, N., & Monson, C. M. (2016). Changing beliefs about trauma: A qualitative study of cognitive processing therapy. Behavioural and cognitive psychotherapy, 44 (2), 156-167.
Resick, P. A., Nishith, P., Weaver, T. L., Astin, M. C., & Feuer, C. A. (2002). A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. Journal of consulting and clinical psychology, 70 (4), 867.
Richman, M (2022, January 19). Prolonged exposure or cognitive processing therapy? va.gov. Retrieved June 29, 2022, from https://www.research.va.gov/currents/0122-Prolonged-exposure-or-cognitive-processing-therapy.cfm
Va.gov: Veterans Affairs. Cognitive Processing Therapy for PTSD. (2018, August 10). Retrieved June 29, 2022, from https://www.ptsd.va.gov/understand_tx/cognitive_processing.asp
