Cognitive processing therapy

cognitive behavioral therapy, CPT

Cognitive processing therapy (CPT) was developed by Patricia Resick, Ph.D. in the late 1980s. It was originally created to treat post-traumatic stress disorder (PTSD) in rape survivors. It has since been found to be an effective treatment for all types of trauma and has been used frequently to treat PTSD in the military. Here is everything you need to know about cognitive processing therapy.

What is Cognitive Processing Therapy?

Cognitive Processing Therapy is an offshoot of cognitive-behavioral therapy (CBT). It targets the dysfunctional beliefs that a person develops after experiencing a traumatic event. In short, CPT attempts to repair the damage done by trauma to someone’s thoughts about themselves and their environment. It does this by teaching clients how to overcome “stuck points”, where adaptive beliefs have been distorted due to the experience of the traumatic event. For example, a person might originally believe that the world is a generally safe place. But, due to witnessing a tragic death or injury, that same person might learn to question their everyday safety. As a result, they experience fear and arousal in situations that they previously would have felt secure.

Cognitive Processing Therapy is a brief manualized therapy, designed to be completed in 12 sessions of approximately 60 minutes. It can be adapted to group treatment as well. The American Psychological Association (APA) strongly recommends CPT as a treatment for PTSD and it is covered by insurance.

Cognitive Processing Therapy is geared toward adults and older adolescents. It relies on the client doing work outside the session. If homework isn’t your thing—or you have cognitive deficits that may cause you to struggle with its demands—you might prefer eye movement desensitization and reprocessing (EMDR) or accelerated resolution therapy (ART).

The four phases of Cognitive Processing Therapy

Psychoeducation

The first stage of Cognitive Processing Therapy is to educate the client about the basics of CPT. That is, how thoughts lead to feelings, how trauma influences our automatic thoughts (i.e, the thoughts that automatically jump into our heads) and how these thoughts cause and reinforce PTSD symptoms.

Identification

The second phase is where the client talks about their trauma and learns to identify their related automatic thoughts. In this step, many therapists will ask their clients to complete an impact statement, where a person describes how they feel their trauma has affected them.

Cognitive restructuring

In this next phase, therapists will teach clients how to challenge maladaptive thoughts that have developed as a result of trauma. This is commonly known in CBT as cognitive restructuring. Therapists will give clients homework to help them learn to perform this process on their own.

The therapist will likely focus on thoughts related to the following five areas, which are often impacted by trauma:
  • Esteem: They may suffer from a poor self-image and see others in an overly negative light. They may look at themselves as “damaged”.

  • Safety: They question their ability to protect themselves and others.

  • Intimacy: They may feel unable to form deep connections with others. In addition, they may believe that other people can’t understand their situation or want to be close to them.

  • Trust: They may wonder if other people have good intentions and if they can trust their own judgment.

  • Control: They feel out of control, like they have no control over their own life or the lives of others.

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Assessment

In the final phase, progress is assessed and gains are reinforced. Clients may be asked to rewrite their impact statement to see how they have changed their thinking and reduced PTSD symptoms since the beginning of treatment.

Does Cognitive Processing Therapy work?

In a nutshell, Cognitive Processing Therapy works. And it works in the way it says it does. It has been found to change negative thoughts related to trauma, which confirms the theory behind the treatment. What’s more, it significantly reduces feelings of hopelessness and overall depressive feelings related to PTSD. Most importantly, meta-analyses of relevant studies illustrate how it directly alleviates symptoms of PTSD.

The downside of Cognitive Processing Therapy is that it requires a thorough examination of traumatic events. Exposure to trauma can be quite upsetting and may derail treatment if it is too distressing for the client. That is why treatments like EMDR and ART are sometimes preferred when reliving trauma that is too overwhelming or painful.


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Cognitive Processing Therapy training and resources

There are two levels of official certification for CPT: CPT provider and Quality-Rated CPT Provider. You can find official training on the CPT website. The website is also chock-full of other essential information, such as a detailed summary of the session components a therapist would need to conduct CPT.

Although there is official certification training, it is not a stretch to say that any clinician with training in CBT and a little more specialized education can perform CPT. If you are a CBT therapist and you review the CPT manual, you can likely treat someone at an effective level. That being said, CPT-specific training or supervision from someone who has administered CPT would never be a bad thing.

Speaking of the manual, the official Cognitive Processing Therapy manual for clinicians can be purchased and includes access to worksheets.

A great self-help resource for clients, these CPT worksheets have everything they will need to implement CPT outside the therapy office.

Do you want to listen to how CPT is performed? This American Life has a podcast of actual CPT therapy sessions.



For another example of the treatment process, APA presents a case study of CPT for treating PTSD in a man who experienced trauma as a result of military service in Iraq.

If you would like more information about CPT and other cognitive-behavioral techniques, Theraplatform can be a valuable resource. Theraplatform is an all-in-one teletherapy, practice management, and electronic documentation software for clinicians. It also has CBT worksheets and other information that therapists can use to improve their practice. People interested in CPT will find the worksheet on challenging thoughts particularly relevant. To stay one step ahead, you need a reliable practice management platform. Don’t get left behind. Try a 30-day free trial of Theraplatform today.

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