What is Cognitive Processing Therapy for PTSD?

Apr 8

Cognitive processing therapy is one of the top three treatments recommended by the American Psychological Association for the treatment of post-traumatic stress disorder (PTSD). It is considered a first-line treatment protocol, meaning it has the most research supporting its effectiveness and therefore comes with the highest recommendation.

After many years in practice, I decided to pursue further training in a dedicated treatment modality for PTSD. I chose to do this in order to be able to best help my clients experiencing post-traumatic stress disorder, including people with complex post-traumatic stress disorder, often called C-PTSD. After a careful review of all the options, I decided on CPT because of how it targets the issues I saw my clients experiencing. I wanted an approach that helped people process their trauma, face their real emotions, and find a way to help people overcome the barriers they were encountering to healing. For many people, the aftermath of the traumatic event can cause disruptions in many areas of their lives and lead to people experiencing severe anxiety, emotional distress, relationship problems, and difficulty at school or work.

In short, CPT for PTSD helps people experience their national emotions, develop more helpful beliefs, and accept and integrate what happened as they move on with their lives. After implementing CPT with several clients, I’ve seen firsthand how transformative it is in helping people overcome the effects of trauma and reclaim their lives and identities.

CPT has been extensively researched. For those interested, this paper provides an overview of the current research. Several studies have found that improvements made in CPT are evident in follow-up studies with clients 5-10 years later. It’s also been found to be effective in diverse populations and for clients who also have other mental health concerns. I’m a bit of a skeptic, and what won me over with CPT was the depth and breadth of research showing not only that it is safe but also that it shows the most promise for improving outcomes compared to other treatment approaches.

Cognitive processing therapy, like other trauma treatments, is for people who have experienced a traumatic event and who meet criteria for the diagnosis of post-traumatic stress disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders. It can also be used with trauma survivors who are experiencing sub-threshold symptoms of PTSD, meaning that they may not meet the full criteria, but their quality of life and functioning are impacted to the point where therapy focused on their trauma is warranted.

It’s important to note that not everyone who experiences trauma will develop PTSD. Many will experience shorter-lived acute stress symptoms that resolve after about a month. For those who do experience PTSD, treatment can be life-changing. Many people often experience more than one traumatic event, and their symptoms and struggles compound over time. Cognitive processing therapy for PTSD can help people who have had multiple traumatic experiences. It can also help people who have experienced trauma recently, or even decades ago.

The treatment itself is structured; however, its implementation is highly individualized. The most common number of sessions is 12, but some clients may complete sooner, or others may need additional sessions. Assessments are used at every session to track the severity of both PTSD and depression symptoms, and this helps the therapist and client know what progress has been made as well as what symptoms and issues still need to be addressed. Sessions must occur at least once a week. Depending on the client’s availability and preference, multiple sessions per week are also an option.

Clients are assigned practice assignments to do outside of sessions. These assignments are where the magic happens. Doing the assignments and bringing them to sessions allows the clients to process their trauma and gain new skills. This mix of support in sessions from one’s therapist and independent practice outside sessions has been shown to be the most effective for people’s recovery.

In the beginning sessions, CPT focuses on one “impact trauma” event, as this helps to reduce overwhelm. Focusing on the most distressing event first helps people get better as quickly and efficiently as possible. Other traumatic events are also often addressed as needed, depending on the client’s history.

Clients are given two options: either to do the regular CPT version or the alternative written account version. Both forms process the index trauma, but the written version does so in a more focused way. The client chooses which version they would like to do, after the therapist explains the rationale for doing one or the other. For example, people with high levels of dissociation often do better with the written account version, and people with high levels of emotional reactivity do better with the regular version.

In CPT, clients learn a process that helps them examine their thoughts and beliefs and identify new, more helpful ways of thinking and seeing themselves, others, and the world. This allows people to process the traumatic event and its impact. It also teaches clients a set of skills that they can use not only to manage their trauma-related symptoms, but also other stressors and problems in their lives as well. I reiterate with my clients all the time that the goal isn’t “positive thinking” or “toxic positivity.” We aren’t trying to deny reality or the facts of how the world works. What this process does is help people stop focusing on what isn’t true or helpful. It frees people to face what they need to face, feel what they need to feel, and to think and process difficult situations more effectively. CPT aims to empower people with the skills they need to recover.

The latter part of the therapy focuses on how the traumatic event impacted their sense of safety, their ability to trust others and themselves, issues related to power and control, their sense of self-esteem, and their ability to have intimacy with others and a positive relationship with themself. Clients explore the unique ways that experiencing trauma disrupted their lives and learn ways to reclaim what’s been lost and gain what they’ve been missing.

For people who want to learn about CPT in depth, I highly recommend listening to the mini-series from This American Life: CPT Treatment Story. The story features a journalist going through CPT for a sexual assault that happened during her childhood, and includes clips from therapy and a chronicle of her experience and recovery from PTSD. This is a great resource for anyone wanting to know more about CPT for PTSD. Additionally, the VA offers a PTSD Treatment Decision Aid and an overview of Cognitive Processing Therapy (CPT) for PTSD on their website.

People often ask how therapists like me can “handle” working with people who have experienced trauma. I’ve worked with many clients who have gone through hell on earth, and after receiving therapy, they come out the other side with a newfound sense of freedom, peace, and purpose. That’s how we therapists do what we do. We get to see people recover, and that is a beautiful thing to be a part of.

If you are in Tennessee or California and are interested in cognitive processing therapy for PTSD, I would love to explore the possibility of us working together. I offer a free 15-minute phone consultation to all potential clients to ensure I’m the best fit for what you are looking for in a therapist. You are also welcome to reach out if you have any questions about CPT or my practice.