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How Cognitive Processing Therapy has changed the landscape of trauma care.

“This has been my life’s work: to demonstrate that Post-traumatic Stress Disorder (PTSD) is treatable. You don't have to have your life revolve around the trauma and judge everything through that lens,” said Dr. Patricia Resick, a professor of Psychiatry and Behavioral Sciences at Duke University Medical Center.

In 1988, Resick began developing a new short-term, trauma-focused method for the treatment of PTSD, naming it Cognitive Processing Therapy (CPT). Over the past 32 years, Resick and colleagues have conducted intensive research on the effectiveness of CPT, otherwise known as an evidence-based therapy, with participants from a range of backgrounds and have proven it to be an excellent means of treatment for individuals with PTSD.

This method has changed the landscape of trauma care. In only 12 therapy sessions, lasting 50 minutes each, patients can experience a sharp reduction in symptoms or even recovery from PTSD.

CPT: How It Works

“The basis of CPT is that if you can change your thought, it can change your feelings,” shared Resick. To tackle such a challenge, Resick created a manual for CPT treatment that would be more conceptual and structured than traditional talk therapy, and it would be based on Socratic (meaning, focused and probing) questioning. In a nonjudgmental and confidential setting, the CPT psychologist follows the manual and asks the patient to conduct progressive daily written assignments. The patient fills out worksheets to practice new skills on topics including trust, safety, esteem, intimacy, power, and control.

CPT has three main goals: to reflect on what PTSD is and how trauma can be impactful; to redefine thoughts about the trauma by considering alternative thoughts while evaluating one’s thinking; and to recover from the trauma by reducing negative emotions and focusing on how one’s life can be improved in the future. An important component of CPT is the identification of “stuck points,” or the thoughts that people develop because of the PTSD that stops their recovery (for example, the patient thinking that he/she is “worthless”).

While patients have the option to also write an account of their traumatic experience, the patient does not need to go into an in-depth retelling of the trauma narrative, a bonus for individuals who are triggered by sharing their experience.

With patients ranging from survivors of sexual assault, childhood traumas, combat, or natural disasters, CPT has repeatedly delivered significant results in various populations. Resick and colleagues have repeatedly demonstrated how this treatment can make a difference. In all, Resick has co-authored nine books and more than 300 articles and book chapters.

Resick’s close collaborator, Dr. Candice Monson of Ryerson University in Canada, said, “Professor Resick is one of the most influential pioneers in the traumatic stress field, fearlessly conducting research on interpersonal violence survivors before they received their due attention, offering up treatment that was alternative to prevailing models of trauma processing, and expanding our understanding of the range of post-traumatic sequelae that survivors experience.”

Courtesy of Patricia Resick
Prof. Patricia Resick
Source: Courtesy of Patricia Resick

CPT: The Early Years

When Resick was finishing graduate school in 1976, PTSD was four years away from having its first diagnostic criteria in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), a widely used publication to classify and diagnose mental disorders. During her internship, Resick was asked to be a counselor at one of the first rape crisis centers, while simultaneously co-writing two grants about longitudinal outcomes and treatment in the aftermath of rape. Resick was astounded to see how little research and clinical support existed for survivors of assault and began thinking of a way to assist her patients.

Resick noticed a pattern in her clinical work with survivors of sexual assault: the prevalence of feelings of shame. Based on the work of the famed cognitive-behavioral therapist Dr. Aaron Beck, Resick began to develop a manualized protocol tailored to the trauma of sexual assault which evolved into the CPT manual that she would publish in 1993.

CPT and the Department of Veterans Affairs

In 2007, Resick further expanded the reach of CPT when the United States Department of Veterans Affairs (VA) began to use the protocol to treat veterans and active-duty military members as part of a VA dissemination project. Dr. Kathleen M. Chard, the Director of the Trauma Recovery Center at the Cincinnati VA Medical Center, oversees the dissemination of CPT to VA clinicians across the U.S.

Chard said, “Prof. Resick’s impact has been unquantifiable on civilians and veterans. We did not have ready access to evidenced-based care within the VA for veterans until Prof. Resick suggested the training of clinicians in evidence-based treatments. She changed the outcomes for many veterans who up to that point had not received evidence-based treatment for PTSD.” In 2011, Resick joined the Strong Star consortium and began testing CPT among active-duty military with a number of studies.

Since the beginning of the VA CPT Training Program, 5,297 VA and Vet Center clinicians have completed training. There are currently 76 CPT trainers across the VA system who offer training sessions regionally. In 2019 alone, 722 clinicians attended a CPT training. In the last 12 months, 26,515 veterans in the VA have completed at least two CPT sessions.

One of these veterans is 48-year-old Jane Doe (name changed), who was raped during her service and who shared that for a long time she blamed herself for the assault. Yet with CPT, having “someone talk through my stuck points helped me move towards being a better me.” Ultimately, “CPT has helped me realize that I have a purpose in life.”

Civilian CPT

While Resick’s work began with civilians, due to the lack of universal healthcare in the U.S, CPT is harder to disseminate. Resick and her colleagues created and provide workshops and consultation for community providers. Currently, there are over 700 qualified CPT providers in seven countries. CPT has also been tested in developing countries such as the Democratic Republic of Congo and Cambodia.

Civilians who have completed CPT include Becky Wohlfrom, a 35-year-old mother of three who was diagnosed with PTSD in the aftermath of leaving an abusive marriage. She shared that CPT led to a decline in her symptoms, saying, “I absolutely love CPT, and it has definitely changed my life for the better. I continue to utilize CPT on a daily basis. Now my PTSD does not seem like a hopeless situation: I have been given the tools, and I have empowered myself with the worksheets and sessions.”

The CPT Manual
Source: CptForPtsd

CPT: The Future

Going forward, Resick envisions facilitating CPT with online materials, over smartphone apps such as CPTCoach, text message, or to complete the treatment in an even shorter time span, as seen in "Ten Sessions" on This American Life. Studies have found that CPT can be equally effective whether done over telehealth, in groups, or individually.

Resick also wants to focus more on how to overlay the protocol with co-morbid disorders, such as substance abuse, personality disorders, or insomnia, which have already begun. Yet, no matter which of these projects she concentrates on in the future, Resick’s passion for working with traumatized populations remains strong. She is motivated by “how gratifying it is to work with trauma because people can get better.” And she adds, “I am still hearing, ‘You are stuck with PTSD for life’, and no, you are not!”

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