Cognitive Processing Therapy (CPT)

Cognitive processing therapy (CPT) addresses self-defeating thoughts and beliefs about trauma. Learn more about the process and goals of CPT.

Traumatic experiences are common, and most people will experience or witness trauma at some point in their lives. However, military personnel who experience war are at the highest risk for experiencing serious trauma and developing post-traumatic stress disorder (PTSD).

PTSD can impair a veteran’s ability to return to their usual life and activities following active service. The effects of trauma can present as anxiety, avoidance, anger or fear. Addressing PTSD symptoms can be difficult, but treatment options can help improve a person’s quality of life and allow them to return to their regular activities.

Cognitive processing therapy (CPT) is a type of treatment for PTSD. As a type of cognitive-behavioral therapy, cognitive processing therapy for PTSD can help a person confront their thoughts and feelings about trauma to reduce its impact on their life.

What Is Cognitive Processing Therapy?

Most professionals would define cognitive processing therapy as a 12-session therapy process that helps individuals process thoughts and feelings surrounding a traumatic experience.

The process of CPT follows a series of concrete steps, where each session has a specific focus or goal. For example, early CPT sessions focus on retelling the trauma, and later sessions focus on challenging problematic thinking about the trauma.

Cognitive processing therapy helps address the emotions surrounding a trauma, like anxiety, shame or anger. CPT aims to help a person understand how they have processed a traumatic experience, and works to challenge problematic thinking surrounding trauma.

History and Development

CPT was originally developed for women who had been victims of sexual assault. CPT has been trialed for other types of trauma by Dr. Patricia Resick, who developed cognitive processing therapy in the late 1980s. Dr. Resick went on to research the effectiveness of CPT and has since published therapist manuals on the therapy.

CPT is based on psychological theories about how the brain processes traumatic information. Like most treatments for PTSD, it targets the brain’s fear response, which is usually activated in PTSD. There is now a cognitive processing manual specifically for veterans and military personnel, and CPT has been trialed and researched in groups with varying types of trauma, different backgrounds and diverse levels of education.

How Does Cognitive Processing Therapy Work?

The cognitive-behavioral therapy process follows a manual that includes 12 sessions in total. These sessions last approximately 60–90 minutes, and are usually held once or twice a week. CPT sessions follow a process that includes three phases:

• First Phase – Psychoeducation: This stage is about learning about thoughts, feelings, and PTSD in general. A patient learns about the link between trauma-related thoughts and feelings and PTSD symptoms. This phase also allows clients to identify unhelpful thoughts that might contribute to PTSD symptoms.
• Second Phase – Processing of Trauma: This stage includes writing about the trauma. A patient reads their trauma discussion for the group or therapist in the next session, which helps them face a trauma they might otherwise avoid discussing. A therapist then uses questioning techniques to help the person with PTSD examine how they think about the trauma, which can help highlight unhelpful beliefs about the trauma, such as self-blame.
• Third Phase – Modify Beliefs Related to Traumatic Events: Questioning skills are used on an ongoing basis to examine thoughts and beliefs about trauma. The therapist and patient work together to change beliefs about trust, safety and other concepts that are often impacted by trauma. This phase helps set a patient up to use these skills and strategies after treatment is complete.

What to Expect from CPT Sessions

Cognitive processing therapy techniques are designed to help give exposure to traumatic experiences and to change thought patterns surrounding those experiences. There are several methods and strategies used in CPT sessions. Some techniques can be challenging or for those living with PTSD in the short-term but are demonstrated to be effective in improving PTSD symptoms.

Some of the techniques that can be expected in a CPT session include:

• Writing the details of a traumatic experience
• Reading and retelling the details of trauma to a group to reduce avoidance of trauma
• Having a therapist ask questions about the experience and beliefs about the experience
• Learning to identify unhelpful thoughts, like self-blame or lack of trust

A therapist will help a patient develop skills to identify and change thoughts that are harmful to their recovery. Learning to identify and change thoughts and beliefs is a skill that patients with PTSD can use throughout their recovery.

Goals of CPT

The goals of cognitive processing therapy are to change thoughts, feelings, and processing of trauma. By changing these, CBT aims to help reduce PTSD symptoms and improve the patient’s quality of life.

Some of the specific goals of CBT include reducing levels of distress and encouraging a therapy process called “cognitive restructuring.” Cognitive restructuring involves learning to identify, challenge and change thoughts and beliefs that are inaccurate about a trauma. Learning these skills is particularly helpful in the initial treatment phase, but they can also be utilized on an ongoing basis.

By changing how a person thinks and feels about their traumatic experience, CPT helps a person with PTSD reinterpret their trauma or understand their experiences differently. By reinterpreting trauma, a patient can reduce the distress they feel about their experience. Reduced stress and symptoms can improve patient quality of life and allow a person with PTSD to return to their regular activities.

Effectiveness and Limitations

The effectiveness of cognitive processing therapy has been well researched, and CPT has been shown to be effective at reducing PTSD symptoms.

Cognitive processing therapy is strongly recommended by the American Psychiatric Association for the treatment of PTSD. Research has shown that military veterans receiving cognitive processing therapy had significant improvement in their PTSD symptoms compared to veterans who received community counseling services. There were also significant improvements in conditions that are often related to PTSD, such as depression, anxiety, and relationships.

A main challenge of CPT can be the process of writing or sharing details of a traumatic experience with a group. This can be an emotionally challenging process for many people with PTSD. While this is considered an important part of therapy, there may be some therapists that are able to modify this phase.

Finding a CPT Therapist

Seeking therapy for PTSD can be an important first step in managing symptoms and returning to regular life. Finding a therapist for the treatment of PTSD should include looking out for several key criteria. To begin, a therapist must be licensed and should have experience treating those who have experienced trauma. Therapists should also have specific training in cognitive processing therapy.

Referrals to trained and qualified therapists can be accessed through a general practitioner, or through psychiatry registers such as the American Psychological Association’s Psychologist Locator. Patients may also wish to consider whether insurance will cover the full duration of twelve CPT sessions.

If you or a loved one are suffering from PTSD and a co-occurring substance use disorder, The Recovery Village offers a broad range of evidence-based treatments. Reach out to a representative today for more information.

Editor – Megan Hull

Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more

Medically Reviewed By – Dr. Sarah Dash, PHD

Dr. Sarah Dash is a postdoctoral research fellow based in Toronto. Sarah completed her PhD in Nutritional Psychiatry at the Food and Mood Centre at Deakin University in 2017. Read more