Cognitive Processing Therapy (CPT)

CPT: A form of cognitive behavioral therapy

Those experiencing post-traumatic stress disorder (PTSD) may struggle to find a treatment for their symptoms. Because the range of symptoms and triggers for PTSD can be varied, the solutions may also vary. Many individuals with PTSD reach out to partake in the form of cognitive-behavioral therapy (CBT) called cognitive processing therapy (CPT). 

Cognitive processing therapy (CPT) is similar to cognitive-behavioral therapy and is often carried out using a 12-session format to treat PTSD symptoms. However, CPT may also benefit several other mental health conditions and symptoms. Learning about this therapy could help you make an informed decision about your care.

What is CPT for post-traumatic stress disorder (PTSD)? 

Those living with PTSD may experience intense feelings and distressing memories concerning traumatic events and triggers. They may try to avoid triggers or distressing situations to avoid confronting or experiencing these feelings and memories. Therapy can help these individuals emotionally control, feel safe, and practice self-care. 

How does CPT work for a person with trauma? 

Cognitive processing therapy often aims to help clients address past adverse events and unwanted emotions or behavioral patterns attached to them. The focus of cognitive processing therapy is often to create a deeper understanding of an individual's reaction to trauma triggers through an examination of the way that past traumatic events may have changed their worldview.

Phase one: Understanding the trauma response

The first phase of cognitive processing therapy (CPT) for post-traumatic stress disorder can involve cooperation between the therapist and client to establish an understanding of the events that occurred and the connection between them and the client's thoughts, behaviors, and emotions. Clients may find that their responses to trauma are automatic responses that they struggle to control. The therapist will use these insights to draft a treatment plan and help the client identify initial factors potentially prompting a behavioral loop rather than recovery or support. 

Phase two: Processing and confronting the traumatic experiences 

The second phase of CPT may involve helping the client process the traumatic event and potential symptoms of PTSD. The therapist may ask the individual to write a statement about the trauma and read it back. By confronting the event in a safe environment rather than avoiding it, the client may feel better able to process their emotional responses. 

The process may also involve Socratic dialogue or questioning, which prompts the client to delve into their motives, core beliefs, and values to challenge unwanted thoughts or behaviors. The method may also prompt them to look for alternative perspectives and conflicts within their thinking.

Future phases 

After the individual has begun questioning their experience and how they have processed the trauma, the therapist may ask them to write another account of the events, often many sessions after the first account. The client can compare their first account with their second to see how their perception of the event has changed with treatment. Some therapists may complete this step without a written record, using only Socratic questioning. The method is referred to as the CPT-C method.

Final sessions 

When the therapist and client have determined that enough sessions have been completed, they may review learned coping skills and processes that the client can use at home if confronted with symptoms. They may discuss generalizations, thought patterns, and emotional responses. If the client does not feel in control or is not ready to end therapy, cognitive processing therapy may be extended. 

What should you expect with CPT? 

Individual CPT sessions are often conducted once or twice a week for 12 sessions that last approximately 50 minutes each. In addition to these factors, individuals may be given homework assignments. The main written piece, where they write about their traumatic experiences, might be completed after the third treatment session as a homework assignment or with the therapist. Therapy may include written accounts or may be verbal, depending on the therapist's technique.

Understanding the techniques could prove helpful if you're looking for a therapist. If you're interested in CPT, you can reach out to a therapist in your area or online. In addition to individual sessions, an individual might partake in group therapy or support groups for PTSD. 

If you partake in CPT group therapy, you may attend 12 sessions, around 90 to 120 minutes long. Group therapy is often conducted in small groups of about eight patients with two clinicians in a group. However, this may vary depending on the method of cognitive processing therapy the clinicians prefer.   

What are the types of cognitive processes in therapy? 

Attention

Attention is used to select the stimulus to which we react. For example, you might choose to focus on a book instead of the noises around you. With PTSD, patients may feel hyper-aware and overstimulated, which can cause challenges with attention. CPT can help clients refocus and utilize attention strategies. 

Perception 

Perception is used to understand your environment using sensory organs. For clients with post-traumatic stress or PTSD, perception may be harder during a flashback or distressing memory. CPT can teach mindfulness and grounding skills to help individuals feel "in their body." 

Memory 

Memory can allow individuals to recall experiences and react accordingly. In those experiencing PTSD, the memory process may be altered, and the brain may be impacted. By filtering information on daily occurrences and triggers, an individual may be able to avoid flashbacks or painful memories. 

Language

Language is communication. By communicating, the client and therapist can foster a better understanding of the trauma or why the individual is attending therapy. 

Learning

Individuals can make informed choices and practice self-care by learning new coping methods to replace unwanted mechanisms. They may feel more equipped to handle stress or future challenges. 

Higher reasoning 

The higher reasoning process connects the other cognitive processes using reasoning and decision-making. It can help an individual cultivate more effective problem-solving skills when facing a reaction to certain stimuli. The therapist can help clients identify this inner voice or force and how to use it. 

Are there risks to CPT? 

While CPT may not present any risks, it might sometimes feel uncomfortable. People who receive CPT may profoundly discuss past traumas, experiences, and triggers. Facing a stressful memory can be challenging for some clients. However, many people report feeling relief after sessions. The US Veterans Affairs office states that over 40% of veterans utilizing this treatment had no symptoms of PTSD when it was completed. Receiving CPT from a trained, licensed clinician may make this treatment effective for you. 

How can therapists learn CPT?

Clinicians who want to study CPT can take an accredited course from a professional organization like the American Psychological Association (APA) or the National Board for Certified Counselors (NBCC). CPT training may be an extended course module in addition to a graduate-level education in the mental health field. Students of CPT may also choose to partake in specialized modules like CPT for Military PTSD, which may be completed as an online course. These courses alone are not for certification but for a better understanding of specific methods of treatment for PTSD. 

Counseling options in therapy

If you are experiencing challenges related to trauma, you might benefit from talking to a therapist about CPT. There are many options for using this therapy modality, and you do not necessarily need to do it in person. Many clients who struggle to leave home or set appointments may benefit from online CPT. Research has shown that online therapy is as effective as in-person therapy, and you can try it from the comfort of your home. With a platform like BetterHelp, you can be matched with a therapist experienced in CPT and contact your therapist via in-app messaging in between sessions. You can also choose between phone, video, or live chat session formats.