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Cognitive processing therapy (CPT): Treatment for PTSD

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A therapist comforting a patient.

What Is Cognitive Processing Therapy?

Cognitive processing therapy (CPT) is a specific type of cognitive behavioral therapy (CBT) developed to treat posttraumatic stress disorder (PTSD). CPT helps identify, address, and challenge any negative or unhelpful thoughts, feelings, and behaviors that may arise after a traumatic event. With CPT therapy, survivors of trauma can better understand and evaluate the underlying beliefs that motivate their feelings and behaviors.

What Is the Goal of CPT?

There are two main goals of cognitive processing therapy: reducing PTSD symptoms and getting “unstuck.”

1. Reducing PTSD Symptoms

Symptoms of PTSD generally fall into four categories:

  1. Intrusive memories: Unwillingly remembering or reliving the trauma via memories, flashbacks, or nightmares
  2. Avoidance: Purposefully avoiding triggers (people, places, thoughts, situations, and memories) associated with the trauma
  3. Cognition/mood changes: Struggling to remember the trauma and other, unrelated information; experiencing feelings of hopelessness, numbness, or detachment
  4. Arousal/reactivity: Constantly feeling on guard (hypervigilance) and struggling with greater reactions to stress (irritability, angry outbursts, intense guilt and shame, etc.)

Cognitive processing therapy can help reduce a person’s PTSD symptoms in all four categories.

2. Getting Unstuck

In CPT, stuck points are beliefs developed after a trauma that prevent recovery. They can be beliefs about yourself, others, or how the world works.

Stuck points are often rooted in shame, guilt, and fear. They are characterized by extreme beliefs, exaggeration, negativity, and black-and-white thinking. This makes them unreliable reflections of reality. An example of a stuck point may be a survivor of a car accident believing, “It’s my fault that other people died.”

CPT helps survivors of trauma identify their stuck points and learn how to challenge them. A cognitive processing therapist can also help survivors discover how these extreme beliefs are affecting specific areas of their life, such as their self-esteem, intimate relationships, and ability to trust.

How Does CPT Work?

Cognitive processing therapy can take place as either an individual therapy or group therapy. It follows a 12-week program divided into four distinct phases.

1. Education

In the first session, your cognitive processing therapist will explain the symptoms of PTSD as well as the body’s trauma response. They’ll give you a brief overview of cognitive theory and the 12-week treatment plan you’re about to go through.

Initial Disclosure

You’ll briefly discuss your trauma with your therapist. This initial disclosure is not meant to be detailed; instead, it’s to inform your therapist about the general overview of what you’ll be exploring together. Some people have experienced multiple traumas in their lives; the one you choose to tackle in your CPT treatment should be the one that is most distressing to you.

Impact Statement

At the end of your first session, your therapist will ask you to write about how you think the traumatic event has affected you. This is known as an impact statement. Keep in mind that you are not being asked to relive the trauma through writing. Instead, focus on the thoughts, feelings, behaviors, and beliefs you have that may have been affected or shaped by the traumatic event.

2. Processing

The next four sessions will focus on helping you process your trauma. Your therapist will help you review your impact statement and look for any stuck points. They will teach you how to identify your emotions and make connections between what you think and feel about the trauma and how you behave in your daily life.

First Trauma Account

During this time, your therapist will also ask you to write a trauma account. This is a more detailed disclosure of your trauma than your impact statement. Instead of writing about how your trauma affected you, you’ll be writing about the trauma itself: what happened, who was there, how you felt in the moment, etc.

This can be a difficult exercise and may require multiple attempts to get it all written down. You’ll also be asked to reread your account in the days leading up to your next session. Then, you’ll read the account out loud to your therapist.

Writing, reading, and sharing your trauma account is a critical step because it allows you to release extreme emotions that may have been inhibiting your ability to process what happened to you. Your therapist can also better assist you in identifying stuck points if they hear your trauma story from your perspective.

Second Trauma Account

After discussion with your therapist, you’ll then write a second trauma account, applying what you’ve learned to your recollection.

In this second trauma account, some of your initial stuck points may be resolved. For example, you may be able to write your second account without feeling the need to say, “I should have done something to prevent this.” Instead, you may write something like, “I wish I could have done something to prevent this.”

Although some stuck points will likely remain, you may be able to recognize them as such as you write them down. Being able to identify these unhelpful beliefs is a key component for your next stage of treatment.

It is important to note that a written trauma account is not required for everyone who undergoes cognitive processing therapy. While it can be helpful, there is evidence to suggest that people find relief from symptoms of PTSD without this component of treatment.

3. Questioning & Challenging

In your sixth and seventh sessions, you’ll learn how to question and challenge unhelpful thought patterns. Now that you’ve identified your stuck points, your therapist can help you learn how to question this black-and-white thinking in a way that has an impact.

Some survivors of trauma are already aware that their beliefs are unhelpful, but they don’t know what to do about them. A person may know logically that their assault wasn’t their fault, for example, but they feel and behave as if the opposite were true. The questioning and challenging sessions of cognitive processing therapy can help bridge that gap between what you know and what you truly believe.

Cognitive Distortions

People arrive at stuck points because of cognitive distortions. Cognitive distortions are shortcuts in our thinking that rely on extremes, stereotypes, or biases to provide an answer. Our minds are drawn to cognitive distortions because they supply simple narratives that make us feel safe and in control, even if those narratives offer a negative view of ourselves or others. Common types of cognitive distortions include:

  • Magnification: Overstating or exaggerating the significance of a shortcoming or failure
  • Minimization: Understating or discounting the significance of a success or achievement
  • Overgeneralization: Making broad conclusions based on an isolated event
  • Mind reading: Assuming you know what other people are thinking and feeling
  • Catastrophizing: Assuming the worst when you don’t know what will happen, often resulting in the prediction of cascading calamities
  • Labeling: Applying descriptors of events (e.g., “I failed my math test”) to your sense of self (e.g., “I am a failure”), typically in negative ways

4. Five Areas of Belief Affected by Trauma

In your final five sessions, your therapist will help you identify how the unhelpful beliefs you developed in response to your trauma are affecting you in five areas of life:

  1. Safety
  2. Trust
  3. Power and control
  4. Esteem
  5. Intimacy

Each of these areas will be discussed through the lens of yourself and others. For example, with trust, your therapist will help you explore both your ability to trust yourself and your ability to trust others, such as friends or family. You’ll also explore the area through the lens of the world, such as your ability to trust that most people in most circumstances are not intent on hurting you.

Second Impact Statement

At the end of your eleventh session, your therapist will ask you to write a new impact statement. This gives you the opportunity to rethink what your trauma means and how it affects you today in light of what you’ve learned during cognitive reprocessing therapy.

During your last session, you’ll share your new impact statement with your therapist. They will then go over your initial impact statement with you so you can see how much progress you’ve made over the course of your treatment. They’ll also help you identify any further treatment you may need as well as goals for you to set and work toward in the future.

Benefits of Cognitive Processing Therapy

CPT offers multiple benefits for people struggling with PTSD and other trauma-related conditions, including:

  • Getting “unstuck”: It’s difficult to move forward with your life after trauma, especially if you’re experiencing intrusive memories or other symptoms of PTSD. With cognitive processing therapy, you can learn more about why you feel stuck and how to get “unstuck.”
  • Putting words to what happened: It can be cathartic to express what happened to you in your own words and in a safe place. It can also be a clarifying experience and help you identify unhelpful beliefs you may not have realized you developed in response to trauma.
  • Learning to challenge unhelpful thoughts: Even if you know your thoughts aren’t helpful, it can be difficult to challenge them on your own. CPT gives you the tools to identify and challenge unhelpful thoughts in a productive way.
  • Applying what you’ve learned: Skills learned in CPT, such as identifying unhelpful thoughts or challenging beliefs, can be applied to many areas of life in a variety of contexts, including parts of life unaffected by your trauma. It can also help you if you ever go through a stressful or traumatic situation in the future.

Is CPT Effective?

Cognitive processing therapy has proven effective for PTSD of all kinds. It’s particularly effective for people struggling with complex PTSD, which means that they’ve endured either multiple forms of trauma, chronic trauma, or some combination of both.

CPT is effective for both military veterans and civilians who’ve never served. It’s generally not recommended for people who may struggle to complete weekly assignments or express themselves through writing, although modifications can be made to the typical treatment plan to accommodate certain clients.

PTSD Treatment Plans

If you’re struggling with trauma, there are multiple types of therapies that can help, including:

Get Help Now

If you are struggling with your mental health after experiencing trauma, help is available now:

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