What Is Cognitive Processing Therapy (CPT)?

Cognitive processing therapy for PTSD

Verywell / Lara Antal

What Is Cognitive Processing Therapy?

Cognitive processing therapy (CPT) is a cognitive behavioral treatment focused on helping people who are "stuck" in their thoughts about a trauma. It was developed by Patricia Resick, PhD, and other psychologists to treat post-traumatic stress disorder (PTSD).

CPT is based on the idea that PTSD symptoms stem from a conflict between pre-trauma beliefs about the self and world and post-trauma information. For example, a pre-trauma belief could be The world is a safe place, and nothing bad will happen to me, while post-trauma information may suggest that the world is, in fact, dangerous and hazardous. These conflicts are called "stuck points" and are addressed through various techniques such as writing about the traumatic event.

Your therapist will help you identify and address stuck points and ​errors in thinking, including thoughts like I am a bad person or I did something to deserve this, for example. Your therapist may help you address these errors or stuck points by having you gather evidence for and against those thoughts.

CPT vs. Exposure Therapy

Similar to exposure therapy for PTSD, CPT provides people with information on PTSD and helps them confront unpleasant memories and thoughts associated with a traumatic event. However, unlike CPT, exposure therapy doesn't always assist people in addressing these errors in thinking.

In CPT, your therapist will help you confront your feared thoughts and memories associated with a traumatic event. They will also assist as you learn to correct the maladaptive, unrealistic, or problematic thoughts that may be driving your PTSD symptoms.

Techniques

CPT is a highly structured treatment approach. It consists of 12 weekly sessions, each around an hour in length. These sessions can take place in a group setting, one-on-one, or in a combined group and individual format, and they may be offered in-person or online. Sessions are divided into separate phases that deal with different components of therapy.

Psychoeducation

Your initial sessions will deal with psychoeducation about PTSD and the CPT approach. Your therapist will likely ask about your symptoms and talk about your goals for treatment. They will go over the ways in which your thoughts about your trauma impact your emotions and daily experience.

Understanding Your Thoughts and Feelings

Next, you'll learn to become more aware of what you think and feel about your trauma and how you may be stuck in beliefs that are hurting you. You'll work with your therapist to identify and analyze your stuck points.

You may be asked to write an impact statement that explores your thoughts and beliefs about the trauma. This statement will talk about why you think the trauma occurred and the ways you believe it has affected your life. Not every CPT therapist will ask you to write an impact statement, but they will ask you to think about your trauma and its effects.

If you're engaging in group therapy, you won't have to read your impact statement aloud in front of everyone. You may share it with your therapist individually, or they may only ask that you revisit it yourself in private throughout treatment.

In addition to your impact statement, your therapist may also ask you to write down detailed accounts of your traumatic experience. These accounts will include sensory details that you remember, in addition to your thoughts and feelings.

Learning New Skills

In this phase, you'll learn how to question and challenge your thoughts and feelings and explore how you would prefer to think about the trauma. Your therapist will go over common thought patterns that people with PTSD experience and will teach you cognitive coping skills.

They may ask you to look for evidence for or against your beliefs about your trauma. You will likely fill out worksheets during this part of treatment, either in therapy or afterward as homework.

Changing Your Beliefs

Finally, you'll learn about how it's common for a person's thoughts and beliefs about the world to change after a trauma, and you'll learn how to balance the way you saw the world before and the way you see it now. Your therapy will focus on helping you in five areas in your life where people with PTSD commonly encounter issues:

  • Esteem
  • Intimacy
  • Power or control
  • Safety
  • Trust

Before concluding treatment, you'll rewrite your impact statement and compare it with your original version. You and your therapist may also discuss future areas that may pose problems and together you'll develop a plan for managing those possibilities if they occur.

What CPT Can Help With

CPT is focused on helping people with PTSD and symptoms related to trauma, like:

CPT may be helpful for people who have experienced trauma in a variety of situations, including combat veterans, survivors of sexual violence, and survivors of childhood abuse.

Benefits of CPT

CPT may help you learn how to change negative and unhelpful thoughts associated with PTSD and trauma. Through addressing these stuck points, you can reduce your symptoms and learn healthier ways to cope.

Research shows that CPT does impact negative cognitions related to PTSD, and it's able to reduce those thoughts even after treatment. By targeting negative cognitions and encouraging new ways of thinking about trauma, CPT therapists may help their clients change the way they think overall.

CPT may even create positive impacts in areas that weren't specifically targeted during therapy. For example, people who undergo CPT may experience fewer feelings of hopelessness compared to people who go through other forms of therapy. This is true even if addressing hopelessness isn't a specific goal of treatment.

Effectiveness

CPT is considered an effective treatment for PTSD. Research shows that people who undergo CPT experience fewer symptoms associated with PTSD and that those positive effects appear to be lasting. CPT also appears to reduce the severity of PTSD symptoms, including trauma-related depression, even compared to other forms of therapy.

These positive effects are often visible in clients' written impact statements. One 2014 study looked at statements written at the beginning and end of treatment and found that people reported a shift to a more positive perspective about their trauma, and saw improvements in their:

  • Ability to trust themselves and others
  • Feelings of safety
  • Happiness levels
  • Intimacy and relationships
  • Self-esteem
  • Sense of personal power and ability to control their environments
  • Tolerance of negative emotions

Things to Consider

CPT may not be recommended for people with certain conditions. If you are experiencing one or more of the following, check with your primary care provider or mental health care provider before beginning CPT:

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

How to Get Started

If you are interested in CPT, search for a trained treatment provider in your area. You can also learn more about CPT from the National Center for PTSD and the International Society for Traumatic Stress Studies.

If you're an American veteran, CPT services are available through the Department of Veterans Affairs (VA). The VA's Office of Mental Health Services has CPT-trained therapists nationwide. Talk to your VA healthcare provider about incorporating CPT into your PTSD treatment plan.

Once you begin treatment, your therapist will explain their process and let you know what to expect. CPT commonly includes homework assignments, handouts, and writing assignments, so you'll need to be prepared to put in work inside and outside of your sessions.

Because CPT involves exposure to your trauma, either through writing about it or discussing it with your therapist, it can be an emotional experience. Your therapist can help provide a safe environment for you to process these emotions while helping you learn to address your stuck points and move forward.

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