What is Cognitive Processing Therapy?
Cognitive processing therapy (CPT) was developed by Patricia Resick in the late 1980s. CPT is a highly-structured, specific form of cognitive behavioral therapy (CBT), designed to reduce symptoms of post-traumatic stress disorder and related conditions, such as anxiety and depression. During its development, it was tested on sexual assault survivors in the United States, and in the following years was implemented when working with other trauma survivors, including veterans, refugees, torture survivors, rape victims, child abuse survivors, and those who have experienced natural disasters.
How does Cognitive Processing Therapy Work?
The core of CPT is that PTSD symptoms are a result of the conflict between an individual's pre-trauma beliefs and post-trauma beliefs about themselves and their world. Let’s say, for example, that before a traumatic event, you believed that the world is a safe place. After the traumatic event, you may believe that the world is incredibly dangerous and you are never safe. Another example could be that you believe you can trust your friends and family members, but then one day a friend or family member does something traumatic to you. Your belief may change from “I can trust my friends and family” to “no one, not even those closest to me, can be trusted”. The pre- and post-trauma thought conflicts are often referred to as “stuck points”. In CPT, your therapist will help you to identify stuck points and work with you to address them. For example, once a stuck point is identified, your therapist may ask you to gather evidence for and against that thought - what facts point to it being true, and what facts point to it being false.
Techniques & Process of CPT
CPT sessions are divided into separate phases, each dealing with a different component.
Psychoeducation: Psychoeducation refers to the process of teaching clients about mental, physical, and/or emotional health, including the nature of the illness or symptoms, its etiology, progression, consequences, prognosis, treatment, and alternatives. In your first few sessions of CPT, your therapist will provide psychoeducation about PTSD, thoughts, and emotions, such as how the thoughts you have about your trauma influence your emotions and current experiences. In this stage, your therapist will also discuss with you your symptoms and goals for therapy.
Understanding Thoughts & Feelings: You and your therapist will explore how you think and feel about the trauma you experienced, and how your current stuck points may be negatively impacting your life. During this process, you may be asked to write an impact statement about your trauma. In the impact statement, you will explore your thoughts and beliefs about the trauma, why you think the traumatic event took place, and the ways you see it currently influencing your life. While not every CPT therapist will ask you to write an impact statement, they will ask you about your trauma and its current effects. It is important to know that if you are doing group therapy, your therapist will not ask you to read the impact statement to the group. You may discuss it individually with your therapist, or they may ask you to read it in private throughout your time in therapy. Your therapist may also ask you to write down a detailed account of the traumatic event you experienced, including aspects such as sensory details.
Learning New Skills: During CPT, you will learn to question and challenge your thoughts and feelings and discuss how you would like to think about your trauma. Your therapist will go over common thought patterns that individuals with PTSD experience, and will teach you a number of cognitive coping skills. For example, they may ask you to look for evidence for and against your beliefs and thoughts about your trauma and ask you to fill out different worksheets.
Challenging Your Beliefs: In the last stage of CPT, you will learn how your thoughts and beliefs changed after your trauma, and how to reframe your thoughts in a more balanced way. Your therapist will work with you to address five areas of your life where individuals experiencing PTSD often have trouble: these are self-esteem, intimacy, power and control, safety, and trust. Before concluding your treatment, you will re-write your impact statement, and see how it has changed from the one you first wrote. Your therapist will collaborate with you to identify future areas that may present challenges and identify strategies to manage them if they occur.
How Long Does CPT Take to Work?
CPT is generally twelve sessions long, with each session being around an hour long. Sessions can take place in person, virtually, individually, in a group, or a combination of some/all of these.
Who Would Benefit From CPT?
CPT is often recommended for individuals with PTSD, as it helps them to deal with PTSD trauma symptoms, including anger, anxiety, depression, dissociation, guilt, hopelessness, distress, difficulty sleeping, and cognitive stuck points. It is effective in treating a number of traumatic experiences, including war-related trauma, sexual trauma, child abuse, assaults, and natural disasters.
One Thing to Keep in Mind
CPT may not be beneficial for everyone - if you are currently experiencing dementia, bipolar-induced mania, detox for a substance use disorder, suicidality, or symptoms of psychosis, check with your primary care provider and/or your mental health care provider before starting CPT.
Cognitive Processing Therapy (CPT). 2017. Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder. American Psychiatric Association. https://www.apa.org/ptsd-guideline/treatments/cognitive-processing-therapy
Cognitive Processing Therapy (CPT). 2022. Global Mental Health. John Hopkins Bloomberg School of Public Health. https://www.jhsph.edu/research/centers-and-institutes/global-mental-health/talk-therapies/cognitive-processing-therapy/
Sarkhel, S., Singh, O. P., & Arora, M. (2020). Clinical Practice Guidelines for Psychoeducation in Psychiatric Disorders General Principles of Psychoeducation. Indian journal of psychiatry, 62(Suppl 2), S319–S323. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_780_19
Tull, M. 2021. What is Cognitive Processing Therapy (CPT)? verywellmind. https://www.verywellmind.com/cognitive-processing-therapy-2797281