Cognitive Processing Therapy
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.
Cognitive processing therapy 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.
What Is CPT?
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.
Cognitive processing therapy 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.
The first phase of cognitive processing therapy can involve cooperation between therapist and client to establish an understanding of events 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.
The second phase of cognitive processing therapy may start as soon as the next session, or may take more time, depending on the client. Phase Two involves helping clients process traumatic events and 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.
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.
Final Sessions Of Cognitive Processing
When the therapist and client have determined that enough sessions have been completed, they may review learned adaptive 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 cognitive processing therapy 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 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, 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 cognitive processing therapy 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.
Types Of Cognitive Processes
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 and processing of experiences before reacting to them.
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 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 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 is communication. By communicating, the client and therapist can foster a better understanding of the trauma or why the individual is attending treatment.
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.
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. The therapist can help clients identify this inner voice or force and how to use it.
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.
However, many people report feeling relief 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.
Frequently Asked Questions (FAQs)
Below are several frequently asked questions on the topic of cognitive processing therapy.
How Does CPT Work?
Cognitive processing therapy (CPT) is a specific type of cognitive-behavioral counseling focused on challenging and modifying unhelpful beliefs related to traumatic events or symptoms of PTSD. Developed to treat posttraumatic stress disorder (PTSD) in the 1980s, CPT has proven effective and may build self-esteem and intimacy. Throughout approximately 12 sessions, a client may gain a new conceptualization of thoughts and feelings related to a traumatic event. This form of therapy can be conducted in a group or individual setting.
Is CPT Part Of CBT?
CPT is a specific CBT technique often used to treat PTSD or other mental health conditions. CPT for PTSD involves addressing the unconscious and conscious thoughts that may lead to distressing symptoms. The therapist may aim to help clients break unwanted patterns.
What Is Exposure Therapy?
Prolonged exposure therapy is another CBT technique that might be used for PTSD. In this modality, a trained psychologist creates an environment of safety, trust, and calm to expose individuals to what they fear or avoid. The fears could be surrounding objects, activities, situations, or ideas. Exposing clients to these fears in a safe environment may build tolerance and acceptance to face them at home.
How Long Does Treatment Take To Work?
Often, clients may not begin by being exposed to the worst fear they could imagine. Instead, they may start slowly and begin to build a tolerance for their fears.
What Causes Desensitization?
Desensitization may be caused by an abundant exposure to a stimulus that, over time, causes a lesser fear reaction when a person is exposed to it. Desensitization may fall under the category of exposure therapy or CPT.
What Are The Three Steps Involved In Systematic Desensitization?
First, a client may be taught a specific type of breathing and deep muscle relaxation technique to utilize during desensitization. Next, they may be asked to create a fear hierarchy, starting with the stimuli that cause the slightest fear and building up to the most provoking causes.
Finally, they may work their way up the personal fear hierarchy to be exposed to each stimulus. However, if they struggle with one, they might return to a previous hierarchy stage and discuss their concerns with their therapist. Systematic desensitization can benefit those who experience significant phobias or obsessive-compulsive disorder (OCD) as well.
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