Cognitive Processing Therapy
Cognitive processing therapy (CPT) is a specific type of cognitive-behavioral therapy found to be effective for treating post-traumatic stress disorder (PTSD) in people who have experienced violence, abuse, natural disasters, or other traumatic events. CPT is short-term, typically conducted over the course of 12 sessions.
In CPT, the therapist will help a patient who has undergone significant trauma to evaluate his or her thoughts surrounding the trauma, particularly maladaptive or self-blaming thoughts that may be exacerbating PTSD symptoms, and conditions including anxiety and depression that set on in the wake of the experience. The patient will then learn to challenge those thoughts and take a new perspective when appropriate. Like some other forms of CBT, at-home work is important for CPT; for example, patients will likely be asked to write an account of their trauma between sessions, to be read aloud in a later session.
CPT was first developed in the late 1980s, and numerous studies since then have demonstrated that it is highly effective for the treatment of PTSD. One large meta-analysis, for example, found that CPT was significantly more effective than a placebo, both immediately after treatment and at follow-up, regardless of a patient's age and whether CPT was administered individually or in a group. The APA strongly recommends it for the treatment of post-traumatic stress disorder.
CPT is a viable treatment option for most adults who have received a diagnosis of PTSD; it may also be used to treat older adolescents. Some researchers and clinicians believe that CPT might be particularly beneficial for those who anticipate encountering additional traumatic events—say, in the military or as an emergency worker, such as a firefighter, police officer, or EMT—as it aims to alter the way patients interpret and process trauma on an ongoing basis.
CPT is not recommended for those who have not received a diagnosis of PTSD or those with literacy difficulties, as it involves written homework. It may also not be an ideal treatment for individuals struggling with substance abuse or suicidal ideation, or individuals with comorbid bipolar disorder. In these instances, another research-supported trauma treatment, such as prolonged exposure therapy (PET), is often recommended over CPT.
CPT can be conducted in individual or group therapy sessions, or a combination of the two. A full course of CPT typically involves 12 weekly sessions, each about 60 to 90 minutes long, though this can vary slightly depending on the client’s specific needs.
Initial sessions are typically focused on psychoeducation that helps the patient learn about PTSD and what they can expect from treatment. In subsequent sessions, the patient will work with their therapist to identify and explore the ways that trauma may have altered the patient’s thoughts and beliefs, affecting both the way they feel and how they act. Specifically, the therapist will help the patient pick out thoughts that create barriers to recovery. The patient will learn a set of strategies to challenge and modify thoughts that are inaccurate and/or unhelpful and will practice these strategies with the therapist and on their own with worksheets and exercises.
Patients may be asked to write about the specific events of their traumatic experience, including any sensory details that they remember, or they may be asked to write more broadly about how their experience makes them feel and how they tend to think about what occurred. If the patient is in individual therapy, they may read these statements aloud during a session; the same is usually not required for group therapy.
CPT can be cognitively or emotionally intense, especially when the patient is writing or talking about the experience itself. Feeling discomfort during CPT is normal, though many patients report that their discomfort was brief and was outweighed by the benefits they gained from completing the full course of treatment.
Someone who has experienced significant trauma and has developed PTSD as a result may notice that they think very differently about themselves or their environment than they did prior to the trauma. This is often particularly noticeable in the following five areas:
- Safety: They may doubt their ability to protect themselves and others.
- Trust: They may question their judgment and/or the judgment and intentions of others.
- Control: They may feel unable to control their own life or influence the lives of those they care about.
- Esteem: They may view themselves and/or others differently, perhaps seeing themselves as “broken” or others as “evil.”
- Intimacy: They may feel incapable of connecting with or being understood by and accepted by others.
These thoughts tend to lead to negative emotions—fear, anxiety, guilt, and anger—and can halt the person's recovery from PTSD. CPT focuses on teaching a set of skills that will help the person challenge these negative thoughts.
CPT is based on the social cognitive theory of PTSD, which posits that incorporating a traumatic event into one’s worldview is often counterproductive and may lead to maladaptive beliefs. CPT, therefore, focuses on repairing the damage done by a traumatic event to someone’s beliefs about themselves and the world. By offering specific cognitive restructuring skills, CPT allows an individual to challenge these negative thoughts and interpretations (known as stuck points), gain a healthier perspective about the trauma (for example, “While I can’t trust my abuser, I can still trust other people”), cope better with any future trauma, and move forward with their lives.
It’s important to find a provider who is trained in CPT, or who has received a certification in it; you can search for such therapists on the Psychology Today therapy directory or ask your doctor or mental healthcare provider for a referral. Many hospitals run by the Department of Veteran’s Affairs also offer CPT treatment programs specially designed for military veterans.