Cognitive Processing Therapy (CPT) for PTSD

This was the first therapy treatment I went through with the VA. I will say it did not go well. I ended up quitting four weeks into my first attempt. It was just too tough, to raw and emotional to get through it. Several years later, I went through a group version of the treatment and was able to get through it. However, I would recommend going through the SGB process first, then go through this treatment process once you’ve numbed the emotional response this therapy is going to bring out.

Cognitive Processing Therapy (CPT) is a popular trauma-centered psychotherapy used to treat Post-Traumatic Stress Disorder (PTSD). It was developed in the late 1980s by Drs. Patricia Resick, Kate Chard & Candice Monson, according to their website, CPTforPTSD.com. It was designed for survivors of sexual assault but is also used for veterans and others with the disorder.

The American Psychological Association (APA)’s Clinical Practice Guideline explains that it is just one of several specialized treatments that fall under the category of Cognitive Behavioral Therapy (CBT) and is strongly recommended for treating PTSD. CBT focuses on the relationships between thoughts, feelings, and behaviors, and works to change the patterns between them that lead to problems in functioning. Changes in any one of these three areas can improve functioning in another area. For example, changing a person’s unhealthy thinking can lead to better behaviors and emotional regulation. CPT focuses on the unhealthy thoughts.

How CPT Helps

A trauma that results in PTSD changes the way an individual thinks about him or herself, the world, and other people, affecting five areas in particular: safety, trust, control, self-esteem and intimacy, according to Psychology Today. A person with PTSD may blame himself or herself for what happened, feel like they don’t deserve to be happy, or feel like the world is a dangerous place. Such negative thoughts can lead to negative emotions such as anger, anxiety, fear, and guilt. They can also make someone feel “stuck” and halt the recovery process. A person may miss out on things that were once enjoyable.

Cognitive Processing Therapy focuses on repairing the damage done to thoughts and beliefs because of the trauma. It teaches an individual to examine the negative thoughts and challenge them (look at whether or not the facts support them). Once thoughts are changed, then feelings can change. A person can gain a healthier perspective about the trauma so that the negative effects from it are reduced, then the person can move forward with his or her life and handle any future trauma better.

What to Expect

According to the U.S. Department of Veterans Affairs’ National Center for PTSD, this therapy usually involves 12 weekly sessions, though this can vary depending on the person’s needs. Each session is typically 60-90 minutes long. A person can begin to feel better after just a couple of sessions, and the benefits can last long after the therapy ends. Sessions are either done individually, as in one on one with a provider, or in a group with one or two providers and up to 10 individuals.

First, the provider will discuss the therapy and ask briefly about the type of trauma experienced. The client may do some writing about how the trauma has affected him or her. Talking or writing about any memories or beliefs associated with the trauma may lead to some discomfort, but usually, it’s brief, and clients feel better as they continue with the therapy. Several sessions are spent discussing any negative or unhelpful thoughts about the trauma, as well as other ways of thinking about it. There’s also some homework involved in CPT; a client may be asked to write about the details of the trauma at home and share it at the next session. (There is another type of CPT that does not ask the client to write about the trauma.) The homework also includes some worksheets to help practice real life skills in between sessions. At the end of therapy, the client may discuss the specific areas of life affected by the trauma, such as safety, trust, control, self-esteem, and intimacy.

A 2014 case study of a soldier who served in Iraq shows how CPT can help change a person’s thoughts and perspective. At the end of treatment, he wrote that in terms of safety, he used to believe that people were out to get him, but after the therapy, he realized that isn’t likely. He said he was still a little anxious about himself or his family getting hurt, but not by a sniper.

Therapy Effectiveness

Trauma-focused psychotherapies, like CPT, are some of the most effective treatments for PTSD. CPT is one of four interventions strongly recommended by the APA’s clinical practice guideline. Veterans Affairs and the Department of Defense also recommend it as one of three trauma-focused psychotherapies offered. These therapies provide greater improvement in symptoms compared to medications, the improvements last longer, and there is a lower risk for negative side effects, as found in a 2016 systemic review and meta-analysis published in the journal Depression and Anxiety.

Other studies show that CPT is effective in reducing symptoms from a variety of traumatic events, such as child abuse, combat, rape and natural disasters. A 2006 study published in the Journal of Consulting and Clinical Psychologyincluded 60 veterans with military-related PTSD. After treatment, 40% of those receiving CPT no longer met the criteria for a PTSD diagnosis and 50% had a reliable change in their symptoms.

A 2019 review published in the Journal of Evidence-Based Social Work summarized outcome studies examining CPT for the treatment of PTSD related to Military Sexual Trauma. It found that the therapy is an effective intervention for the reduction of symptoms, compared to Present-Centered therapy, which is a non-trauma focused therapy. Results were stable at a 6-month follow up.

Some researchers believe this therapy may be even more beneficial for those who may experience trauma again in the future, such as military members or emergency workers. This is because it aims to change the way the person interprets and processes trauma.

To see a list of other studies involving CPT, visit the resources page at CPTforPTSD.com. The page also features a radio episode called “Ten Sessions,” with a sexual assault survivor’s first-hand account, sharing recorded sessions and progress made over a two-week CPT intensive.

CPT Availability

This therapy is available at almost all VA medical centers within the PTSD programs. More than 2,000 VA providers are trained in CPT. Even smaller facilities that don’t offer CPT may be able to do video conferencing so that a patient can receive the therapy from a provider at another location. Veterans can contact their closest VA medical center to find a therapist.

Many other clinicians outside of the VA that treat PTSD may be trained in CPT/CBT. To search for such a therapist, visit PsychologyToday.com and CPTforPTSD.com.

For more information about Cognitive Processing Therapy, visit PTSD.VA.gov and APA.org.

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