What's Cognitive Processing Therapy?

Updated October 18, 2022 by BetterHelp Editorial Team

Many patients who struggle with Post Traumatic Stress Disorder (PTSD) don't have a set treatment that works on its own. In fact, because the range of symptoms and triggers for PTSD are so varied, it's understandable that the solutions will differ. Almost every PTSD patient practices some form of CBT or cognitive behavioral therapy. One of the individual treatments that may be considered alongside CBT is cognitive processing therapy or CPT. So, what is CPT? CPT, or Cognitive Processing Therapy, is similar to CBT and is usually done using a 12-session format.

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Cognitive Processing Therapy works on the principle that PTSD isn't "cured," but is instead manageable. This can be refreshing for those with PTSD and trauma to hear, as repeated tries at healing and being "fixed" sometimes results in feelings of failure. People who have PTSD have strong feelings about their traumatic memories, and the strong emotional response often makes the memories difficult to cope with. People with PTSD often block recovery by avoiding triggers that cause pain, which stops their ability and opportunity to respond with different behavior in triggering situations.

How To Learn CPT

Clinicians who want to study Cognitive Processing Therapy need to take an accredited course from a professional organization like the APA, CA BBS or NBCC. CPT training is a two-day course module in addition to graduate level education in a mental health field. Students of CPT may also choose to do specialized modules like CPT for Military PTSD which may be completed as an online course lasting around 9 hours. These courses alone are not for certification but for better understanding specific PTSD environments and the patients who experience it.

If you are a patient who is going through or has been prescribed Cognitive Processing Therapy, you may be directed to an app to help organize worksheets during treatment.

How CPT Works

Cognitive Processing Therapy works by giving the patient an understanding of the event and their negative emotion or behavior attached to it. It's necessary for the patient to understand both the behavioral and emotional response to the event. The focus of Cognitive Processing Therapy is to create this deeper understanding of their behavior and their reaction to trigger stimuli from it through examination of the way that past traumatic events may have changed their worldviews.

The first phase of Cognitive Processing Therapy is a cooperation between the therapist and patient to establish what the patient understands about the event and their behaviors. What comes out are usually automatic responses - things that they feel they cannot control, and often a detailed explanation of their negative behavioral response. It also helps identify the things that are causing them to get stuck in the loop rather than recovering from the experience.

The second phase of Cognitive Processing Therapy requires the patient to process the traumatic event that caused the PTSD. The therapist will ask the patient to write a statement about it and then read it back to the therapist. By being forced to confront the event in a safe environment rather than avoid it, they are better able to process what has happened emotionally. The process involves something called Socratic questioning, which prompts the patient to explain further and challenge anything they have assumed about the experience, so they can better understand it. The method also prompts them to look for alternative perspectives and conflicts within their thinking.

After the patient has begun to question their experience and how they have processed the trauma, they will write another account of the events. This shows the difference between their initial perception in the first phase and whether they have started to break the cycle using the thinking processes of the second phase. Some therapists prefer to do this step without a written record using only Socratic questioning, and both methods are considered equally effective. This is known as the CPT-C method.

Finally, the patient is taught new coping skills and processes so that when they are confronted with a situation where their PTSD is triggered, they can use those coping strategies to modify their behavior by evaluating what is going on at the time. People who experience PTSD often have generalized reactions, which is why Cognitive Processing Therapy is so specific at pinpointing the exact trauma and thinking associated with it.

What To Expect With CPT

Individual CPT sessions are usually done once or twice a week for a total of 12 sessions that last approximately 50 minutes each. In addition to this, patients are also given homework assignments for outside of session time. The main written piece, where patients write about their traumatic experiences, is typically done after the third session as a homework assignment. Therapy may include written accounts or may be purely verbal, depending on the therapist's technique.

Understanding the different techniques is helpful if you're looking for a therapist. You will want to find someone that works with a method you think you can connect best with. If you're not keen on writing essays or on writing at all, then choosing a therapist who uses the verbal method may be more successful. Websites like BetterHelp can help you identify a therapist who works with your preferred method.

In addition to individual sessions, a patient will also go through group therapy. There are also 12 sessions for group therapy, which are normally 90-120 minutes long. Group therapy is done in small groups of about eight patients with two clinicians to a group. Depending on the method the clinicians prefer, you will either be working with the same written or verbal processing choices except the experience will be analyzed by the whole group.

Talking About Trauma

Since Cognitive Processing Therapy is verbally based, you will be expected to talk about your trauma, even in a group environment. You do not have to be specific in the details, but you will need to have your feelings and beliefs that relate to the experience examined.

Some people find it easier to write their feelings than to verbalize them, and there is an option to use writing for this in CPT. Your therapist may encourage you to use verbal discussion if they believe it will be more clinically helpful to you. CPT requires you to discuss and evaluate your written statements.

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Different Cognitive Processes

There are six recognized cognitive processes which are used during CPT to identify the reaction in the patient and how to change it. The six processes are attention, higher reasoning, language, memory, perception, and learning. They each play a role in how we understand and process experiences before reacting to them.

  • Attention: Used to select the stimulus to which we react to, e.g., loud noise vs. the book we are reading. For PTSD, patients are often hyper-aware and overstimulated, which is why it's important to have them hone their attention down.
  • Perception: Used to understand the objects in the world around us using the sensory organs. For patients with PTSD, their perception can often be suddenly taken away during a flashback, and one of the goals of PTSD treatment is to reconnect with the world around them.
  • Memory: It allows us to recall experiences and react accordingly. In PTSD patients, the memory process is often flawed because the reaction that has been linked to the traumatic event is triggered by similar experiences that are mundane. By filtering the new information of the mundane situation and understanding that it is not the same as the memory, the patient can avoid being pulled into a flashback.
  • Language: Communication is language. By being able to communicate, the patient and therapist can foster a better understanding of the trauma.
  • Learning: By learning new coping methods to replace the negative ones, patients can use this knowledge in situations which would otherwise have been triggering. Learning how to better deal with trauma will also serve them in the future if they experience any additional trauma which could set them back.
  • Higher Reasoning: This process brings together the other cognitive processes by using reasoning and decision-making so that the patient has better problem-solving skills when it comes to their reaction to negative stimuli. The more the patient uses their higher reasoning to consciously process their trauma and reactions to it, the more likely they are to be able to consciously react appropriately when dealing with a triggering situation in the future.

Are There Risks?

While CPT itself doesn't present any risks, it is likely to be uncomfortable. Patients will encounter the past traumas, experiences, and triggers that they typically avoid. Most patients will feel better after completing CPT, and the discomfort or emotional pain experienced poses no serious risk. Receiving CPT from a trained, licensed clinician is an important part of the process so that crises and emotional pain can be addressed during treatment.

The idea of talking about past trauma can be scary, and it is something that many will avoid because of its difficulty. The important consideration in CPT is its helpfulness in achieving a positive outcome, which is essential in learning to live well with PTSD.

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