Cognitive Processing Therapy
What is CPT?
CPT is an approach to treating the psychological impact of trauma- the thoughts, feelings, and behaviors that, for many, last long after the trauma has ended. The exercises and interventions used in CPT are designed to improve critical thinking and allow for exploration of the beliefs and thoughts that developed or changed as a result of the trauma.
During CPT sessions we look at the way the traumatic incident (or incidents) shifted thinking patterns and identify the thoughts or beliefs that are keeping you stuck. This includes both new beliefs that began after the traumatic event, and how previous beliefs may have changed after the event. People with PTSD often experience changes in their thoughts related to.
CPT takes into account not only the anxiety / fear response that accompanies PTSD, but also the errors in thinking that lead to feelings of guilt, shame, disgust, and sadness following a traumatic incident.
The theory behind CPT takes into account how the brain works and focuses intervention on the brain changes that occur as a result of PTSD.
Studies have identified biological differences in the brain of a person with PTSD when compared to a person without. For those with PTSD, the fight-or-flight mechanism (the part of the brain that reacts when faced with danger) is activated quicker, and stays activated longer, than in the brain of someone without PTSD. This means a person who has PTSD is more often operating from a fight or flight mentality, and the part of the brain responsible for more complex thinking takes longer to recognize there is no danger and calm down the body down. Specific activities in CPT are designed to activate the part of the brain that helps us respond, plan, and pay attention. These activities help reduce the over activation of the fight or flight response and allow for cognitive flexibility- which in turn allows for resolution of trauma symptoms to begin.
The standard CPT protocol consists of 12 sessions, most commonly delivered over 6-24 individual therapy sessions. Research on CPT has shown that resolution of PTSD and trauma response symptoms can be achieved in as few as 8 sessions. Each CPT session has specific interventions and goals that allow movement forward in the treatment. For some, additional time is needed in specific areas and the pace of treatment can be individualized based on the client’s unique needs.
Who can benefit from CPT?
Cognitive Processing Therapy focuses on identifying and changing the thoughts or beliefs that have been altered as a result of a person experiencing trauma.
A formal or full diagnosis of PTSD is not necessary to be a candidate for this treatment approach, though there must be at least some PTSD symptoms present. Symptoms of depression, anxiety, alcohol or substance use, or personality disorders may also be present; however, the primary treatment goal should be addressing the PTSD symptoms.
CPT has shown to be effective in clients of all ages and backgrounds. Minimal formal education is needed to fully participate in the CPT activities though some reading and writing skills are needed to complete assignments.
CPT has been effective in resolving trauma symptoms related to both single episode and recurrent traumatic events, as well as various types of trauma (sexual, physical, emotional, environmental, natural disasters, or being witness to traumatic events).
The primary factor influencing whether or not a person will benefit from CPT is the client’s motivation to address and resolve their PTSD symptoms.
Who should not participate in CPT?
If symptoms of another disorder interfere with the ability to fully participate and engage in the CPT sessions, the other symptoms need to be addressed before beginning CPT. If dissociation is present, grounding skills may be needed before beginning this treatment to help the client remain engaged during CPT sessions.
If there are safety concerns such as suicidal intent, self-injury, or other high-risk behavior, CPT should not be initiated until the client is stabilized and not an immediate danger to themselves or others. Additionally, if alcohol or substance use is present, detoxification from these substances may be needed before beginning CPT.
CPT should not be initiated with clients who are experiencing psychosis or mania and should be considered only once the client is stabilized on medication.
Are you ready?
If you answer TRUE to the statements below, CPT therapy may be right for you.
TRUE OR FALSE: I am able to stay grounded/ I have the skills to manage dissociation and remain present during CPT sessions.
TRUE OR FALSE: I am not actively suicidal, engaging in self harm, or engaging in other high risk behaviors.
TRUE OR FALSE: I am willing to identify and work on what has been keeping me stuck/preventing resolution of PTSD symptoms.
TRUE OR FALSE: I am compliant with taking medication as prescribed (if applicable) and not experiencing psychosis, mania, or other symptoms that would interfere with my ability to fully participate in CPT sessions.
TRUE OR FALSE: Avoidance based behaviors such as alcohol use, substance use, or eating disorder behaviors are currently controlled and I commit to not using these (behaviors?) to numb out.
TRUE OR FALSE: I am ready to feel better.
Overall, CPT has been shown to be effective in many clients with PTSD or other trauma related problems, even when symptoms other disorders (anxiety, depression, personality disorders) are present. Success with this treatment requires the client to be an active participant in therapy sessions and be motivated to address the PTSD symptoms. Resolution of PTSD symptoms requires participation in therapy sessions, completing the assignments between sessions, and willingness to practice the skills learned in CPT outside of the therapy sessions. To be a candidate for CPT, you must be able and willing to work towards resolving the issues keeping you stuck.