Cognitive Processing Therapy (CPT)

For those experiencing trauma or post-traumatic stress disorder symptoms, support is available. Please see our Get Help Now page for more resources.

According to the National Center for PTSD (part of the U.S. Department of Veterans Affairs), cognitive processing therapy works by helping clients use rational thought to identify the ways that their traumatic experiences have distorted their thinking. Life-threatening or terrifying events may cause major disruptions to a person’s worldview, threatening their self-image or their understanding of the world. In trying to make sense of these experiences, the individual may internalize ideas that make it difficult for them to function in everyday life. CPT may help deconstruct these self-limiting beliefs. 

For example, someone with PTSD resulting from a traumatic event like sexual assault might have absorbed the idea that no one can be trusted. This can turn ordinary social interactions into terrifying experiences in which harmless behavior triggers a sense of alarm or panic. A therapist trained in cognitive processing therapy (CPT) might work with this person to help them recognize how this belief is shaping their emotional responses, assisting them in coming up with more constructive ways to assess risk.

The destructive thoughts and distressing emotions characteristic of PTSD may reinforce each other. Anger, disgust, shame, or fear resulting from traumatic experiences can prompt negative thoughts, and repetition of those thoughts may, in turn, strengthen the associated emotions. Cognitive processing therapy may help clients break this cycle by evaluating their thoughts logically rather than reacting instinctively.

CPT may also help people overcome avoidant behavior. Because the emotions surrounding trauma are often highly unpleasant, many people try not to think about them, often going to considerable lengths to steer clear of situations that might provoke traumatic memories. However, this avoidant behavior may play an important role in developing and reinforcing PTSD. CPT can provide a calm and safe environment in which a client can engage with their traumatic experiences to lessen their emotional impact. 

A course of cognitive processing therapy (CPT) or cognitive-behavioral therapy often consists of focused discussion with a trained therapist working from a treatment manual. These sessions can be one-on-one or involve groups of multiple clients. During the first session, the therapist typically explains what treatment will look like, what it’s intended to achieve, and why it’s expected to help. The therapist also usually asks clients to provide some basic information about themselves and the traumatic events that led to their condition.

Future sessions usually involve back-and-forth discussions between therapists and clients. The treatment provider may encourage clients to talk about:

• How they’re feeling
• What they’ve been thinking about
• Recent events in their lives and how they responded
• The symptoms they’ve experienced
• Their beliefs about themselves, other people, and the world
• Memories and life experiences

In CPT, therapists probe fixed ideas or emotional associations that are interfering with healthy recovery from trauma. Therapists often ask questions aimed at prompting clients to reconsider whether these mental habits are rational and constructive or whether they’ve been shaped by trauma in unhelpful ways.

Between sessions, clients are often encouraged to complete homework assignments. This can reinforce what they’re learning in therapy and bring it into the context of their day-to-day life, as well as increase the total amount of time spent working through their symptoms. Studies on CPT treatment outcomes indicate that completion of these assignments may be an important component of recovery. Homework assignments can include things like:

• Keeping a journal of thoughts, experiences, and symptoms
• Writing about traumatic experiences (this may not be required in all cases)
• Reading about trauma and post-traumatic stress disorder (PTSD)
• Completing written exercises that analyze thought patterns
• Practicing breathing or movement exercises
• Practicing healthy coping mechanisms

Cognitive processing therapy was originally developed to assist people with the psychological effects of rape and sexual assault. However, it has since shown effectiveness in adults with PTSD resulting from a wide range of traumatic events, including (but not limited to):

• Child abuse
• Military service
• Natural disasters

Most research on the effectiveness of CPT has focused on adult trauma survivors. However, research has found evidence that it can also be beneficial for adolescents. 

A 2019 meta-analysis found that CPT in adults was highly effective regardless of age or whether clients were treated individually or in groups. Outcomes were better for treatment recipients than members of control groups in more than 80% of cases. The authors concluded that CPT was an effective treatment for PTSD with lasting benefits.

The desired treatment outcomes for cognitive processing therapy can depend on the specific symptoms a person is experiencing. In general, though, treatment is intended to help clients better process their feelings and function in day-to-day life. 

Reducing emotional numbing can be an important part of this process. Survivors of trauma may suppress their emotions in an attempt to avoid the pain associated with their disturbing memories. However, this can lead to a wide variety of negative outcomes, including social isolation and difficulty enjoying the positive aspects of life. CPT often aims to help people feel comfortable experiencing appropriate emotions and processing them in healthy ways.

At the same time, CPT-trained therapists can work to help reduce the intense distress associated with traumatic memories. By helping clients let go of unhealthy beliefs about themselves and the world, this treatment method may decrease feelings that can affect people with PTSD, such as anger, shame, guilt, anxiety, and depression. Therapists may also seek to decrease tension and watchfulness, enabling clients to feel comfortable letting their guard down rather than being constantly alert for danger.

For many therapists, client education is another important goal of cognitive processing therapy. Helping individuals better understand PTSD and the factors that reinforce it may leave them better equipped to work toward further recovery after therapy ends. This can lead to better long-term treatment outcomes.

Numerous clinical trials have shown the effectiveness of cognitive processing therapy for PTSD, to the point that it’s now considered a gold standard treatment by organizations like the American Psychological Association. Other methods considered a gold standard include cognitive-behavioral therapy and dialectical behavioral therapy.⁴ As such, a great deal of recent research on this treatment has focused on how to deliver it as widely, consistently, and efficiently as possible. 

One study from 2022 focused on identifying the concerns that stop some clinicians from offering CPT despite awareness of its effectiveness in research trials. Common concerns included:

• CPT might not be effective in the real world.
• Clients might be retraumatized by the experience.
• The process may require someone with specialized training.
• CPT might not be individualized enough for specific clients.
• Clients with other mental illnesses might not respond well.

The authors noted that the existing research indicates that these concerns are not based on good evidence. For example, many studies of CPT show substantial improvements in PTSD symptoms even when the treatment is delivered by practitioners who’ve never employed this method before. Educating the broader clinical community about the effectiveness of CPT might help more people receive the help they need.

Other recent research has focused on the possible benefits of time-limited CPT. The fact that this therapy is delivered over a limited number of sessions may make it attractive to many clients and providers. Some researchers have found evidence that as little as two weeks of intensive CPT may be effective. This could be beneficial for clients who are feeling an urgent need for relief of their symptoms but who aren’t interested in long-term therapy.