What Is Cognitive Processing Therapy (CPT)?

By Erin Heaning, published July 06, 2022 | Fact Checked by Saul Mcleod, PhD


Summary

  • Cognitive processing therapy (CPT) is a psychological framework specifically designed to treat people with post traumatic stress disorder (PTSD) and other lasting trauma.
  • In CPT, patients are taught to overcome negative thought patterns which contribute to their symptoms of PTSD and to replace them with more adaptive, realistic ways of thinking.
  • CPT consists of 12, 50 minute sessions spread out over 3 months. CPT also includes at-home worksheets and exercises to continue what one learned in-session.
  • CPT is evidence-based, and it can be extremely effective for those with PTSD. This includes victims of sexual assault, childhood trauma, military personal, first responders, and more.
  • Successful completion of CPT therapy helps decrease negative emotions and become unstuck from the trauma of their past, freeing them to enjoy day-to-day life more.

What is Cognitive Processing Therapy?

Cognitive processing therapy (CPT) is a type of cognitive behavior therapy (CBT) which is specially designed to treat post-traumatic stress disorder (PTSD) or other forms of trauma (Greene, 2022).

CBT is a type of psychotherapy in which negative thought patterns are challenged in order to change unwanted behavior or thinking, and it is often used to treat depression and anxiety. Cognitive processing therapy (CPT) uses the tools of CBT to help patients evaluate and change the upsetting thoughts they've had since their trauma. 

CPT generally consists of 12-sessions with each session lasting about 60 to 90 minutes. Unlike other therapies, CPT can either be done individually, where you meet one-to-one with a provider, or it can be done in a group of about 6-10 other people with one or two providers (Va.gov, 2018)

During these sessions, therapists will guide patients through understanding their thoughts and feelings and changing their harmful beliefs. This way, CPT teaches the patient to evaluate and change the upsetting thoughts they’ve had since their trauma and therefore also how they feel. 

CPT was developed by psychologists in the Department of Veterans Affairs, and has since been designated by the American Psychological Association (APA) as a first-line treatment for those suffering from PTSD— even more effective than medication (Greene, 2022). 

CPT vs. Exposure Therapy

CPT is very similar to another form of therapy called “exposure therapy” which is used to treat anxiety disorders. Exposure therapy involves exposing patients to the source of their anxiety and showing there is no real danger.

In doing so, providers help patients to overcome their fears and anxieties by training the patient’s brain to recognize that their distress is irrational. 

Prolonged exposure therapy for PTSD helps people to gradually approach trauma-related memories, feelings, and situations they have been avoiding since their trauma.

By asking people to repeatedly recall and describe details of their traumatic experience, exposure therapy for PTSD encourages patients to confront their trauma head-on. 

In contrast, CPT focuses on helping people with PTSD evaluate upsetting thoughts that have existed since their trauma.

More specifically, CPT is interested in changing the way these patients look at themselves and the world and to challenge their trauma-related beliefs through critical thinking (Richman, 2022). 

What Are the Unique Challenges of PTSD?

PTSD is a disorder in which a person has difficulty recovering from a traumatic event for months or even years. “Triggers” can bring back physical and emotional memories of the trauma, and symptoms include nightmares, panic attacks, intrusive thoughts, anxiety, and depression (Greene, 2021). 

The difficulty of treating people with PTSD is that many times, people are neither aware they have the condition or that there are treatment options available. People might experience opinions from loved ones that say “it will pass” or “you’ve just gotta tough it out.” 

Furthermore, negative self-talk is very common amongst those afflicted with PTSD. Labeling oneself as damaged or weak for not being able to move on can be extremely damaging.

As a result, CPT’s focus on changing the way people think about a traumatic event can be extremely effective if one overcomes the stigma (Greene, 2022).

Psychoeducation

CPT falls under the larger category of psychoeducational therapy. Psychoeducation refers to a broad range of interventions which combine educating a patient while also providing counseling and support activities. 

Many forms of psychotherapeutic interventions are based on traditional models in treating pathology and illness. In contrast, the psychoeducation model offers a more holistic approach to therapy which stresses collaboration, coping, and empowerment for both the patient and their support system (Lukens et al., 2004). 

In psychoeducational therapy, the patient and the patient’s support system are considered partners with the provider in treatment. This design is built on the premise that the more knowledgeable the patient and their support system are about the mental health condition, the better health outcomes are for the patient. 

To build this knowledge, providers focus on removing barriers in comprehending mental health conditions and developing strategies for the patients to be proactive in their treatment. 

In CPT, this might be done through teaching patients about the reality of a PTSD diagnosis, overcoming stigma and self-blame, and assigning writing assignments which encourage practicing in real life skills learned in therapy (Va.gov, 2018). 

Understanding Your Thoughts and Feelings (Processing the Trauma)

At its base, CPT is built on the premise that what we think influences how we feel. For example, after a traumatic event, one’s thought patterns might change in an effort to cope and keep oneself safe in the future (Greene, 2022). These thought patterns might lead to over-negativity, feelings of uncertainty, and even feelings of danger. 

Through CPT, people are taught how to think differently, or reprocess, a traumatic event. In doing so, patients are encouraged to challenge their long-held assumptions about these events in an effort to progress emotionally. 

For people with PTSD, it can be extremely difficult to talk or even think about the traumatic event(s) which changed their lives. What’s more, it can be even harder to change their long-held beliefs about those particular events in order to move on. 

CPT helps to reshape those long-held beliefs and destructive thought patterns created by patients by retraining their automatic tendency to think negatively. By learning to challenge initial thought processing, patients effectively “rewire” their brains over time.

Learning New Skills 

As CPT teaches, small changes in thinking can have a big impact on how you feel. By helping you get “unstuck” from your past, CPT can free you to enjoy the parts of life you have been missing out on. 

In CPT, the provider leads the client through exercises which help them to recognize and investigate unhelpful thought patterns. This includes regular out-of-session practice assignments to apply what has been discussed in therapy sessions.

Through Socratic questioning or other techniques, patients learn how to challenge and modify unhelpful beliefs related to the trauma and learn new thinking skills.

Changing Your Beliefs

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 (My Clients Plus). Therefore, the final sessions of CPT  are dedicated to helping clients apply the adaptive strategies they learned in therapy to everyday life situations that fall into one of these areas. 

In doing so, providers above all aim to replace their client’s faultier interpretations with healthier cognitions. CPT emphasizes how negative or incorrect thoughts of past trauma can increase symptoms of PTSD and fuel powerful emotions. 

Since these emotions can make it more difficult for someone with PTSD to process memories in a healthy way, CPT encourages a framework for challenging negative thoughts and replacing them with new, productive ones (My Clients Plus).

Finally, CPT provides clients with coping skills they can use on their own to continue to process past trauma. These coping strategies can also be used in the future if clients experience additional trauma, helping them to stop negative thoughts in their wake. 

What Is the Role of Self-Blame in PTSD?

Self-blame plays a strong role in keeping people stuck in the memory of their trauma. Therefore, reducing self-blame is a key focus of CPT.

Self-blame is a cognitive process in which an individual attributes the occurrence of a stressful event to oneself. To those who experienced a traumatic event, self-blame might feel useful as a way to make one feel control over what happened. 

However, self-blame can be a corrosive and dangerous coping mechanism. If one blames oneself for a traumatic event, the result can be an increase in symptoms of PTSD. Therefore, self-blame blocks one’s natural capacity for healing after a traumatic event (Greene, 2022). 

Importantly, some traumatic events tend to cause more self-blame than others. For instance, survivors of sexual assult often blame themselves for what happen to them due to the personal nature of the crime as well as societal judgment. 

Furthemore, childhood abuse can lead to self-blame as children are likely to assume the trauma they experience is a result of something they did. Even as these children become adults, they typically do not re-examine these memories. 

Is CPT a “Cure” for PTSD?

For some, CPT can effectively cure PTSD. Of course, they do not forget the traumatic event, but the trauma no longer perpetuates the same PTSD symptoms that existed before treatment. 

In fact, research has shown that most people who complete CPT treatment experience a significant reduction in symptoms. For some, they are able to overcome all symptoms of their PTSD entirely. For others, they might continue to experience symptoms of PTSD but to a lesser degree than before (Greene, 2022). 

To a strong degree, the effectiveness of PTSD is impacted by the commitment of the client to the treatment. Some patients find it especially difficult to complete the take-home homework assignments, or to do the difficult job of confronting and analyzing their trauma. 

It is unlikely CPT will be helpful without the client completing these important tasks of following through with all sessions. Through these important exercises and sessions, clients do the important work of examining their thoughts and emotions in a way which reduces the PTSD symptoms. 

How to Get Started (Where to go for Help)

To find a therapist in your area, you can use the find-a-therapist directory from the Association for Behavioral and Cognitive Therapies (ABCT), or this clinical directory of CPT therapy providers (Greene, 2022).

Furthermore, if you are a veteran suffering from PTSD, almost all VA Medical Centers offer CPT in their specialized PTSD programs and more than 2,000 VA providers are trained in CPT (VA.gov, 2018). 

FInally, CPT coach is a mobile app that you can use with a provider during CPT. CPT Coach can help you learn more about CPT and PTSD symptoms, as well as help you to keep track of homework and assignments. This app is free and can be downloaded on most mobile devices (VA.gov, 2018).

How long does cognitive processing therapy take?

CPT generally consists of 12-sessions with each session lasting about 60 to 90 minutes. This means it takes about 3 months to adequately complete the therapy.

Patients may start to feel better after just a few sessions, and the benefits of CPT can last long past the final session. The effectiveness of CPT therapy is also strongly influenced by engagement. 

Is cognitive processing therapy evidence-based?

CPT is evidenced-based, meaning it has been shown to work in multiple research studies. For instance, a study in the journal of Addictive Behaviors studied the effectiveness of CPT for veterans with comorbid PTSD and alcohol use disorders (Kaysen et al., 2014).

Participants attended an average of nine sessions, and there was a significant reduction in the symptoms of PTSD across all groups who received a course of CPT therapy.

Another study published in the Journal of Consulting and Clinical Psychology compared CPT’s effectiveness against prolonged exposure therapy for victims of sexual assault.

The study concluded that both CPT and prolonged exposure therapy were highly effective treatments, but participants who had received CPT therapy had better outcomes (Resick et al., 2002).

Who benefits from CPT?

CPT is an effective form of therapy for people diagnosed with PTSD or coping with past trauma. Furthermore, since the goal of CPT is to re-shape the way a traumatic experience is interpreted and processed, it is especially useful for people who may endure future trauma, including active military personnel or first responders (My Clients Plus).

What are the goals of CPT therapy?

The goals of CPT therapy are to: increase understanding of PTSD and how it affects life; feel the emotions of a traumatic event and reduce its avoidance; develop more realistic beliefs about the world; decrease negative emotions created by maladaptive thought patterns; and to simply improve the day to day living of those stuck in their trauma (CEBC). 

Fact Checking

Content is rigorously reviewed by a team of qualified and experienced fact checkers. Fact checkers review articles for factual accuracy, relevance, and timeliness. We rely on the most current and reputable sources, which are cited in the text and listed at the bottom of each article. Content is fact checked after it has been edited and before publication.

This article has been fact checked by Saul Mcleod, PhD, a qualified psychology teacher with over 17 years' experience of working in further and higher education. He has been published in psychology journals including Clinical Psychology, Social and Personal Relationships, and Social Psychology.

About the Author

Erin Heaning is a member of the Class of 2023 at Princeton University. She studies psychology with a minor in neuroscience and works as a research assistant at the Princeton Baby Lab. Outside of school, she works for BMS Pharmaceuticals and as a writer for featurefemale.com. After graduation, she plans to study clinical psychology with a focus on women’s mental health.

Cite this Article (APA Style)

Heaning, E. (2022, July 06. What Is Cognitive Processing Therapy (CPT)?. Simply Psychology. www.simplypsychology.org/cognitive-processing-therapy.html

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