What Is CPT Therapy?
Many patients who struggle with 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 wide it's understandable that the solutions (and treatment options which work) will differ from patient to patient. That being said, almost every PTSD patient practices some form of CBT or cognitive behavioral therapy. Typically this is used in conjunction with individual and group treatments as well. One of the individual treatments that may be considered alongside CBT is CPT. Cognitive processing therapy is similar to CBT and is usually done as a 12 session format.
CPT works on the principal that PTSD cannot be cured, merely managed, something that is refreshing for many victims to hear since many will try to convince them they can be "fixed." People who have PTSD have strong feelings about their traumatic memories, and because of this, they can be difficult to cope with. The way PTSD works is that the sufferer often blocks their recovery by simply avoiding the triggers. This leaves them stuck in a loop where every time they are triggered they return to the same negative behavior instead of breaking the cycle using a different behavior which leaves them stuck.
How To Learn CPT
Clinicians who want to study CPT 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 professional psychiatric training to become qualified to practice. In addition to this, students may also choose to do specialized modules like CPT for Military PTSD which may be done as online courses 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 CPT, then there is also an app called the CPT Coach which will help organize your worksheets during treatment and help you learn more about it.
How CPT Works
CPT works by giving the patient an understanding of the event and their negative behavior attached to it. It's necessary for the patient to understand both and their emotions connected to it. The focus of CPT is to create this deeper understanding of their behavior and their reaction to trigger stimuli from it.
The first phase of CPT therapy is a cooperation between the therapist and patient to establish what the patient understands about the event and their behaviors. What comes out is mostly 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 CPT 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 rather than avoid it in a safe environment, 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 have to 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 are why CPT 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. In addition to this patients are also given homework assignments for outside of session time. The main written piece where you will write about your trauma is done after the third session as a homework assignment. The therapy may include written accounts or may be purely verbal depending on the therapist's technique.
This is important if you're looking to find a therapist you'll want someone who works with a method that you think you can connect to. If you're not keen on writing essays or in 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 the individual sessions, a patient will also go through group therapy. There are also 12 sessions for group therapy, but they are normally 90-120 minutes long. Group therapy is done in small groups of around 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 CPT is mostly verbal 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.
Because for some people it's easier to write their feelings than express them verbally there is an option to use writing for this in standard CPT. Just because you feel you would be better writing them it does not mean your therapist agrees and they may feel you will progress better with verbal discussion instead. Even if you prefer the written method, you will still have to discuss and evaluate the piece you have written.
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 is to reconnect with the world around them.
- Memory: Used to store and access knowledge or experiences. It allows us to recall experience 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 future if they experience any additional trauma which could set them back.
- Higher Reasoning: This process brings together the other cognition 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 future.
Are There Risks?
CPT itself isn't risky, it will likely be uncomfortable, and it can be difficult to talk about difficult memories, especially in the beginning. While most patients will feel better with CPT over time and eventually open up the results are the most important part. It may seem like there is some mental anguish, but there is no actual risk, especially when a trained, licensed clinician performs sessions.
The idea of talking about your trauma is scary, and it's something that many people will shy away from simply because it's difficult. The important thing if you're considering CPT or if you've been prescribed it is to remember that it's the outcome which is most important to learn better to live with PTSD.