Using Cognitive Processing Therapy For PTSD

By: Patricia Oelze

Updated February 15, 2021

Medically Reviewed By: Melinda Santa

Content/Trigger Warning: Please be advised, the below article might mention trauma-related topics that include sexual assault & violence which could potentially be triggering.

While approximately 70% of the population in the United States have suffered some type of traumatic incident in their lives, not all of them will go on to have post-traumatic stress disorder or PTSD. However, 20% of these individuals will eventually develop PTSD, and that is approximately thirteen million people. In fact, about 8% of adults in the United States have PTSD at some point in their life. Although this may seem like a small number of people, it averages out to about one in every thirteen people. Luckily, many different types of therapy can help treat PTSD, but many individuals do not reach out for help.

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The Stigma Of Mental Health Care


One of the main reasons that some individuals do not get treatment is because of stigma. For example, many of those who have PTSD are combat veterans who were taught to be self-sufficient, brave, and to stand on their own feet and take care of themselves. They may have had it drilled into their head that mental illnesses or disorders only affect weak people so if they have a problem, they need to just "suck it up." This is a dangerous way to think and is why so many veterans end up as victims of suicide. Without an outlet for those thoughts and feelings, people with PTSD can become closed off, unable to work, and some cannot even leave the house.


PTSD, Anxiety, And Panic Attacks


Many people with PTSD suffer from flashbacks and panic attacks that can happen at any time so they are worried that if they go out in public, it may trigger an attack. Some people living with PTSD have such bad anxiety that they cannot be around others without having a panic attack. Others have so many triggers that it is worrisome for them to just go to the grocery store. A large group of people nearby or a car backfiring can cause an attack that may paralyze them or cause a violent episode. This can happen to anyone who has PTSD, not just veterans. In fact, there are high risks for developing PTSD for those who have experienced many different traumatic events. For example:


Rape victims are approximately 49% more susceptible

Severe physical assault victims are at a 32% increase

Any other type of sexual assault increases the chances by about 24%

A major accident such as a car or airplane accident typically affect about 17%

Stabbing or shooting victims are almost 16% more likely to have PTSD

Death of a loved one causes PTSD in approximately 15% of people


The Signs Of PTSD


How do you know if you or someone you love has PTSD or if they are just stressed out? There are many distinctions. Everyone has anxiety or gets stressed out occasionally, but if you are unable to perform your regular daily activities like going to work or school, visiting with loved ones, or doing chores like grocery shopping, you likely have PTSD. According to the American Psychiatric Association, you must have two or more of the following symptoms for at least one month following a traumatic incident:

  • Flashbacks of the traumatic event
  • Nightmares or night terrors
  • Going out of your way to avoid certain places or people
  • Negative thoughts such as "everyone is evil," or "I am bad."
  • Extreme fear of certain places, people, or things
  • Constant anxiety or stress over certain issues
  • Chronic fatigue
  • Trouble falling asleep or inability to stay asleep
  • Problems with self-esteem and intimacy
  • Chronic pain
  • Angry outbursts for no obvious reasons
  • Behaving recklessly or being self-destructive
  • Headaches and muscle pain
  • Heart palpitations or fast heart rate
  • Shaking or trembling
  • Dizziness or fainting
  • Irritable bowel problems
  • Avoiding loved ones
  • Panic attacks
  • Suicidal thoughts


This is not a comprehensive list, and there are many more signs and symptoms that you may have, or you may not experience some of those on the above list. Everyone with PTSD has their own experiences so it is important to note that if you think that you or someone you care about has PTSD; you should speak to a professional mental health expert as soon as you can. There are many treatments for PTSD, but one of the most effective is cognitive processing therapy.

Causes of PTSD

The symptoms of PTSD are most likely to develop after an extremely stressful event or a prolonged traumatic experience. The most common causes of the development of PTSD include:

  • physical or sexual assault
  • domestic abuse
  • events including child abuse
  • serious accidents
  • extreme childbirth experiences
  • torture
  • war and conflict

serious health problems that lead to being admitted to the hospital

The more common causes are accidents, rape and natural disasters.

Symptoms related to PTSD are prone to occur in people who are at risk, such as those who live with depression or anxiety, and experience some kind of traumatic event. Many scientists at the National Center for PTSD also believe that there may be a genetic link to PTSD, as having a parent with a mental health illness increases the chances of PTSD developing.

PTSD Developing in Children

Traumatic events including child abuse or sexual assault can be the most difficult to recover from because they occur during the time in a child’s life when their brain is still developing. To experience such stressful events can lead to a complete change in how the child’s brain works.

A child going through PTSD is likely to experience reliving the same event over and over again, having a lack of positive emotions, denying that the event happened, avoiding places or people associated with that event, or becoming extremely upset when someone asks about or causes the memories of the event.

PTSD Developing in Members of the Military

Service members of the military are also quite prone to experiencing PTSD because of the nature of their occupation, especially those who serve in a war or conflict. In a study conducted in 2016, out of 60,000 Iraq and Afghanistan deployed and non-deployed veterans, between 13.5% and 30% were screened positive for PTSD. Studies of PTSD in veterans is further complicated by the fact that depression is quite common in veterans, increasing the chances for PTSD symptoms to occur. The United States Department of Veterans Affairs does provide information of local facilities and services as well so that a person living with PTSD can receive the health care they need.

Military sexual trauma also plays a role, and refers to the psychological trauma associated with physical assault of a sexual nature, sexual harassment, or battery of a sexual nature while a veteran was serving on active duty, active duty for training, or inactive duty training.

If you are a veteran and believe you are experiencing symptoms of PTSD, please call the Veterans Crisis Line at 1-800-273-8255 (and press 1) or text 838255.

Treatment Options for Post-Traumatic Stress Disorder (PTSD)

The treatment of PTSD can be a complicated one, as there are many facets to tackle in the process. Medications and therapy are the two most common treatments, and increase success when they’re used together. When it comes to therapy, there are three main goals of the process: improving one’s symptoms, teaching them the skills they need to deal with their symptoms, and restoring their self-esteem.

The most common treatments for PTSD include cognitive processing therapy, prolonged exposure therapy, stress inoculation training, eye movement desensitization and reprocessing, and medication.

According to the National Center for PTSD, shared decision making brings about the best results. This is when you discuss your symptoms with your health care provider so that you can collectively choose a treatment option that makes the most sense and will work best for your needs.

What Is Cognitive Processing Therapy

Cognitive processing therapy is a form of cognitive behavioral treatment, and the two are similarly used in treating PTSD. If you are looking for therapy for PTSD, the first thing you should do is to talk to someone about it, usually a CPT coach. Whether it is a family member, your primary care doctor, or a friend, just talking about it with someone brings it to the forefront so that you and at least one other person is aware of the issue. Some therapists may recommend group or individual formats CPT, depending on what you’re comfortable with.

The reason that cognitive processing therapy for post-traumatic stress disorder is that it can be done from the comfort of your own home. Online therapy is an excellent solution for those who suffer from some of the signs of PTSD like panic attacks and flashbacks. We will talk more about that later.

The Four Steps Of Cognitive Processing Therapy

With cognitive processing therapy, there are four main steps which include education, information, developing skills, and changing beliefs. For example, the first step would be to help you to realize what your symptoms of PTSD are and how getting treatment can help. Continuing education in this area as you improve will prepare you for what’s next in the process. Then the CPT coach will help you realize your feelings and thoughts that are causing stress and anxiety. Once that is done, you will learn ways to question or challenge those thoughts so you can change them. And the last step is changing those beliefs about what happened and how you can deal with it without stress.

Of course, these four steps are not all going to be done in one day. In fact, cognitive processing therapy is usually done in 12 different sessions, depending on the individual and the severity of the PTSD. Challenging and managing your thoughts and feelings is difficult for some, and you will have to train your brain to think and feel in ways that are healthier than the ones you have been using. By doing so repeatedly with the help of a CPT coach and finding that it is working, you will find that you can and will automatically think and feel in a healthier way out of habit.

The History Of Cognitive Processing Therapy

Cognitive processing therapy was developed in the late 1980s by Patricia Resick and is designed to reduce symptoms of any type of traumatic issues such as combat, child abuse, terrorist attacks, natural disasters, rape or other sexual abuse, or serious accidents. Because it is so effective for veterans, it has been approved of and endorsed by the United States Department of Veteran's Affairs and Defense and the International Society of Traumatic Stress Studies.

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It was based on the idea that PTSD symptoms occur because of a conflict between a person's beliefs about the self and the world before the trauma compared to after the trauma. For instance, you may have felt safe going to the store or work on the bus before the incident, but after being in a serious bus accident, you may not feel safe on the bus anymore. Similar to exposure therapy, cognitive processing therapy helps patients learn to confront their fears and memories that are associated with that traumatic event rather than trying to avoid them.

CPT resources can provide you with a lot more information on what to expect before you consider CPT, such as the effectiveness of CPT, what each session will be like, and how CPT can be tailored to your needs to increase your rate of success. If you’re interested in continuing education on the top, please consider checking out this website for cognitive processing and the National Center for PTSD.

Prolonged Exposure Therapy

Workshop consultations involving prolonged exposure therapy can help a person overcome their PTSD by facing those stressful situations head on. When a person experiences PTSD, they’re likely to block out the event altogether in their memories and avoid talking about them. They may even resort to avoiding places or people that remind them of those events. This may seem harmful, forcing a person to confront their trauma, but studies have shown that prolonged exposure therapy is effective in reducing symptoms of PTSD.

Early in the treatment process, the therapist or health care provider will provide lessons in breathing techniques in order to minimize anxiety when the memory is brought up. The person living with PTSD is then asked to make a list of the things they’ve been avoiding or provide a written trauma account of an event so that they can come to terms with them. You may be asked to take your written trauma account home with you to read as “homework.” Finally, the PTSD survivor will recall the traumatic experience to their therapist and a recording of the session will be provided to them to listen to later.

By teaching a person living with PTSD how to cope with their emotions attached to these stressful events, it can restructure their brain so that they eventually learn to not consider them stressful any longer.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy is another option in the treatment of post-traumatic stress disorder (PTSD). Also called CBT, it has been shown to result in significant improvement in a person’s quality of life, helping them to cope with whatever psychological difficulties they may be facing. It will teach a person to recognize the distortions in their own thinking and to restructure that thinking process so that there is a more positive outcome.

There may be a specific type of cognitive behavioral therapy that is right for you, depending on which one suits your health care needs best. Clinical practice may recommend one or a combination of the four kinds of CBT:

cognitive: identification and changing distorted thinking patterns

dialectical:thoughts and behaviors are address in combination with mindfulness and emotional regulation.

multimodal: the seven modalities (imagery, sensation, behavior, affect, biological consideration, cognition, and interpersonal factors) are addressed to root out what the best solution may be

rational emotive: identification of irrational belief, challenging them, and learning to recognize and change those thought patterns.

It is through long discussions with a therapist to develop safety trust that the best choice can be arrived at.

Writing Your Story

You may be asked to write down the incident in detail and read it aloud over and over again to desensitize yourself to the event. The cognitive therapist will help the patient identify and change the negative thoughts and feelings you may have while writing or reading the story. Any thoughts about yourself such as "I deserved to be hurt," or "I didn't deserve to live when all my teammates died" will be discussed in detail to help you understand why they are not true.

Talking About Your Thoughts And Feelings

By discussing all these thoughts and feelings you are having, you will learn to be more aware of them and see how they are affecting you and hurting you. The therapist will teach you to change the way you think of the traumatic event so that you know that it was not your fault and that it is okay to feel afraid as long as you do not let it affect your daily life. You and the therapist will discuss how common your feelings are and that you are not alone so you can start to talk to others about what is going on with you.

You Can Do It Every day

Whether you have been in combat, were abused or neglected as a child, or have been exposed to some other traumatic episode, you can get help. If you do not have a therapist, there are many at BetterHelp who are available to help you right now. In fact, they have over a thousand licensed professionals experienced in all types of mental and emotional disorders and conditions. You do not need an appointment, and you do not even have to leave your home. You can just communicate with your therapist or counselor online or on the phone. However, you prefer. The more comfortable you are, the better the results will be.

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