About cognitive processing therapy

Cognitive processing therapy and post traumatic stress disorder

Those experiencing posttraumatic stress disorder (PTSD) may struggle to find a treatment for their symptoms. Because ranges of PTSD symptoms and triggers can be varied, PTSD treatment may also vary. Many individuals with PTSD find cognitive-behavioral therapy (CBT), also called cognitive processing therapy (CPT), to be helpful.  

CPT is often carried out using a 12-session format to treat PTSD. Cognitive techniques may also benefit several other mental health conditions and symptoms. Learning about this modality could help you make an informed decision about your care.

Cognitive processing therapy was originally developed by psychology professor Dr. Patricia Resick and was further refined through her collaborations with Dr. Candice Monson and Dr. Kate Chard. The authors have continued to conduct research on CPT specifically for PTSD, with collaborations with the International Society for Traumatic Stress Studies and the Association for Behavioral and Cognitive Therapies.

Those living with PTSD may experience intense feelings, negative thoughts, and distressing memories concerning traumatic events and triggers. They may try to avoid triggers or distressing situations to avoid confronting or experiencing these feelings and memories. Counseling can help these individuals find emotional control and a sense of safety, and learn skills to practice self-care. 

CPT methodology after a traumatic event

Cognitive processing therapy is a type of cognitive behavioral treatment that often aims to help clients address past adverse events and unhelpful thoughts or behavioral patterns attached to them. The focus is often to create a deeper understanding of an individual's reaction to trauma triggers through an examination of how past traumatic events may have changed their world view.

Phase one 

The first phase of CPT can involve cooperation between therapist and client to establish an understanding of events or traumatic experiences that occurred and connections between them and the client's thoughts, behaviors, and emotions. Clients may find that their responses to trauma are automatic responses that they struggle to control. Therapists will use these insights to draft a treatment plan and help clients identify initial factors potentially prompting a behavioral loop, such as self blaming thoughts. 

Phase two 

The second phase of cognitive processing therapy may start as soon as the next session, or may take more time, depending on the client. In the treatment manual, Phase Two involves helping clients process traumatic events, their ongoing negative effects, and the potential symptoms of PTSD. Therapist may ask individuals to write an impact statement about trauma and read it back. By confronting events in a safe environment rather than avoiding it, clients may feel better able to process their emotional responses. 

The process may also involve Socratic dialogue or questioning, which prompts clients to delve into their motives, core beliefs, and values to challenge unwanted thoughts or behaviors. The method may also prompt them to look for a new perspective and conflicts within their thinking.

Future phases 

After the individual has begun questioning their experience and how they have processed trauma, therapists may ask them to write another account of the events, often many sessions after the first account. The client can compare their first account with their second to see how their perception of the event has changed with treatment. Some therapists may complete this step without a written record, using only Socratic questioning. This method is referred to as the CPT-C method.

When the therapist and client have determined that enough sessions have been completed, they may review learned adaptive strategies, resources, and processes that clients can use in their daily life to help them cope with symptoms. They may discuss generalizations, thought patterns, and emotional responses. If clients do not feel in control or are not ready to end treatment, CPT may be extended. 

What to expect

Individual CPT sessions are often conducted once or twice a week for 12 sessions that last approximately 50 minutes each. In addition to these factors, individuals may be given homework assignments. The main written piece, where they write a detailed account about their traumatic experience, might be completed after the third session as a homework assignment or with the therapist and added to their patient materials. Counseling may include a written trauma account or may be verbal, depending on the therapist's technique.

Understanding the techniques could prove helpful if you're looking for a therapist. If you're interested in CPT work, you can reach out to a therapist in your area or online. In addition to individual sessions, an individual might participate in support groups for PTSD. 

If you participate in CPT in a group setting, you may attend 12 sessions, around 90 to 120 minutes long. Group sessions are often conducted in small groups of about eight patients with two clinicians in a group. However, this may vary depending on the method the clinicians prefer.  

There are six recognized cognitive processes often used during cognitive processing therapy to identify a client's reactions. They can each play a role in individuals' understanding of experiences before reacting to them.

Attention 

Attention is used to select the stimulus to which we react. For example, you might choose to focus on a book instead of the noises around you. With PTSD, a patient may feel hyper-aware and overstimulated, which can cause challenges with attention. CPT can help clients refocus and utilize attention strategies. 

Perception 

Perception is used to understand your environment using sensory organs. For clients with PTSD, perception may be harder during a flashback or distressing memory. Cognitive processing therapy can teach mindfulness and grounding skills to help individuals feel "in their body." 

Memory 

Memory can allow individuals to recall experiences and react accordingly. For people experiencing PTSD, the memory process may be altered, and the brain may be impacted. By filtering information on daily occurrences and triggers, an individual may be able to avoid flashbacks or painful memories. 

Language 

Language is communication. By communicating, the client and therapist can foster a better understanding of the trauma or why the individual is attending treatment. 

Learning

Individuals can make informed choices and practice self-care by learning new coping methods to replace unwanted mechanisms. They may feel more equipped to handle stress or future challenges. 

Higher reasoning 

The higher reasoning process connects other cognitive processes using reasoning and decision-making. It can help an individual cultivate more effective problem-solving skills when facing a reaction to certain stimuli or automatic thoughts. The therapist can help clients identify this inner voice or force and how to use it. 

Risks

While cognitive processing therapy may not present any risks, it might sometimes feel uncomfortable. People who receive CPT may profoundly discuss past traumas, experiences, and triggers. Reliving a traumatic event such as child abuse or surviving natural disasters can be challenging for some clients. 

If you or a loved one is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.

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However, many people report feeling relief in their current life after sessions. The US Department of Veterans Affairs’ (VA) National Center for PTSD states that over 40% of veterans utilizing this treatment had no symptoms of PTSD when it was completed. The National Center for PTSD recommends CPT treatment as a course of treatment for PTSD. 

Receiving CPT from a trained, licensed clinician may make this treatment effective for you. If it is not helpful, other treatments are available for PTSD. 

Clinicians who want to study CPT can take an accredited course from a professional organization like the American Psychological Association (APA) or the National Board for Certified Counselors (NBCC). CPT training may be an extended course module in addition to a graduate-level education in the mental health field. 

Students of CPT may also choose to participate in specialized modules like CPT for Military PTSD, which may be completed as an online course. These courses alone are not for certification but for a better understanding of specific methods of treatment for PTSD. 

If you are experiencing challenges related to trauma, you might benefit from talking to a therapist about CPT. There are many options for using this therapeutic modality, and you do not necessarily need to do it in person. Many clients who struggle to leave home or set appointments may benefit from online CPT. 

Research has shown that online counseling is as effective as in-person care, and you can try it from the comfort of your home. With a platform like BetterHelp, you can be matched with a therapist experienced in CPT and contact your therapist via in-app messaging in between sessions. You can also choose between phone, video, or live chat session formats.