Cognitive processing therapy, or CPT, is a research-supported treatment used to help individuals with trauma histories. It emphasizes how negative or incorrect thoughts about past trauma can fuel powerful secondary emotions that keep clients trapped in a negative spiral. This guide shares what you need to know about how CPT works, what studies show about its effectiveness, and how you can get certified if you’re interested in incorporating the techniques into your practice.
This form of therapy was initially designed to help victims of sexual assault and other forms of violent crime to more effectively manage their PTSD-related symptoms. Since then, the use of this intervention has broadened to include a wide range of trauma sufferers, most notably military service members struggling to process events that occurred during deployment.
Currently, CPT is considered an effective form of therapy for anyone with a diagnosis of PTSD. Since the goal of CPT is to shift the way trauma is interpreted and processed, it may be especially useful for individuals who are likely to incur additional trauma in the future, such as first responders or active military personnel. Although most commonly used in individual therapy, CPT can also be adapted for group therapy settings.
CPT has its foundations in P. J. Lang’s information processing theory and the social cognitive theory of PTSD. Information processing theory holds that when a person who has experienced trauma encounters a stimulus that reminds them of that experience, a fear reaction is triggered in their memory. As a result, the person attempts to escape the fear. This effort reinforces the fear response, making it more likely the cycle will repeat itself.
Social cognitive theory advances the idea that after a traumatic event, the primary feelings of fear or anger can be complicated by secondary emotions. Secondary emotions develop based on how an individual interprets their role in the traumatic event. For example, a rape survivor may come to believe that she, in some way, shares responsibility for the attack. This belief can create secondary emotions of guilt or shame. Challenging inaccurate perceptions around trauma can reduce troublesome secondary emotions and lessen the recurrence of intrusive thoughts.
A typical treatment course lasts twelve weeks, but it can be adjusted based on an individual client’s needs. CPT occurs in four distinct stages.
CPT begins with the therapist educating the client about their PTSD diagnosis and reviewing some of the most common ways people react when they’ve gone through a traumatic event. The therapist will ask the client to describe how the symptoms of PTSD show up in their life and help them identify thought patterns that may be causing the PTSD symptoms to recur. This stage concludes with the therapist sharing how CPT works and collaborating with the client on treatment goals.
In the second stage of CPT, the client processes the traumatic event. Typically, this involves the client writing a trauma account of the event and reading it aloud during a session. This exercise aims to help the client feel the emotions that the original trauma created while not attempting to run away or avoid them. This process serves to identify the stuck points or problematic interpretations of the event itself.
Through Socratic questioning or other techniques, the therapist engages the patient to question their maladaptive thoughts to help them modify potentially unhelpful ways of thinking about their trauma. Exercises that enable clients to recognize and investigate unhelpful thought patterns can feature in sessions and as homework.
People who’ve been diagnosed with PTSD often struggle in one or more of the following five areas: safety, trust, power and control, esteem, and intimacy. The final sessions are dedicated to helping the client apply the adaptive strategies learned earlier to everyday life situations that fall into one of these areas.
The power of CPT lies in its emphasis on how negative or incorrect thoughts about past trauma can increase the symptoms of PTSD and fuel powerful secondary emotions. These secondary emotions can make it more difficult for someone who has experienced trauma to process memories in a healthy way. CPT provides a framework for challenging negative thought patterns and replacing them with healthier, more productive ones. Also, CPT equips individuals with coping skills they can use to process past trauma. These coping skills can also be accessed if they experience additional trauma in the future.
CPT is an evidence-based treatment that has been the subject of several research studies. We’ll highlight two of them here.
A study published in Addictive Behaviors, a monthly peer-reviewed journal, involved 536 military veterans who received CPT therapy at a veterans hospital in the Midwest. Participants attended an average of nine sessions. A significant reduction in the symptoms of both PTSD and depression was reported across all groups who received a course of CPT therapy.
Another study published in the Journal of Consulting and Clinical Psychology sought to compare CPT’s effectiveness against prolonged exposure therapy and a control group. Study participants included 171 female rape victims. The study concluded that both CPT and prolonged exposure therapy were highly effective treatments and their results were very similar. However, participants who had received CPT therapy scored higher on two of the four guilt subtests designed to determine the effects of therapy outcomes in study participants.
Becoming certified as a CPT trainer is an in-depth process. The CPT training program involves participating in a self-paced, web-based training, a live online workshop, and group consultations. Before becoming fully certified, you’ll need to submit a series of redacted supporting documentation from your first few CPT clients to CPT-sanctioned evaluators for review. Full details on CPT certification can be found here.
CPT provides therapists with a powerful intervention for working with clients struggling with PTSD. This form of therapy helps those who’ve experienced traumatic life events to challenge faulty interpretations and replace them with healthier cognitions.