Cognitive Processing Therapy is a type of cognitive behaviour therapy that has been found to be very effective for Post-Traumatic Stress Disorder (PTSD). It involves 12 structured sessions. It works by changing thoughts that are preventing people from healing from their trauma.
What is Cognitive Processing Therapy?
Cognitive processing therapy (CPT) is a structured type of cognitive behavioural therapy developed for PTSD. It that has been effective in reducing symptoms of PTSD. It is usually delivered over about 12 sessions. Moreover, it helps individuals learn how to challenge and modify unhelpful beliefs related to the trauma. In so doing, the person creates a new understanding and conceptualization of the traumatic event so that it reduces its ongoing negative effects on current life.
Theory Behind Cognitive Processing Therapy
The theory behind Cognitive Processing Therapy is that individuals organize information into schemas (cognitive shortcuts) to make sense of the world, interpret new information, and exert some level of prediction and control over their experiences. Traumatic events can disrupt schemas, particularly around beliefs related to safety, trust, power/control, esteem, and intimacy. PTSD can result when disruptions in these schemas manifest in inaccurate statements about self or the world, called “stuck points,” that interrupt normal recovery from the traumatic experience.
Assimilation and over-accommodation are the 2 primary types of stuck points that can maintain PTSD. During the process of assimilation, trauma information is altered to fit within the existing belief system. For example, if the existing belief is, “good things happen to good people and bad things happen to bad people,” then an abused child may believe they were abused because they were bad. On the other hand, the process of over-accommodation involves extreme alteration of existing belief systems based on the new trauma information. For example, a person who was abused by a doctor may believe that no doctor can be trusted.
These processes are contrary to accommodation which involves a more balanced modification of an existing belief system to integrate the new information from the traumatic experience. For example, “Sometimes bad things happen to good people” or “This happened despite my reasonable effort to prevent it.” The process of accommodation promotes recovery from the traumatic event. Correcting inaccurate assimilated and over-accommodated stuck points and developing more accommodated, balanced beliefs is a primary goal of CPT.
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What is Cognitive Processing Therapy Like?
Cognitive Processing Therapy (CPT) is typically delivered over about 12 sessions and starts with psychoeducation regarding PTSD, thoughts, and emotions. The client writes an impact statement that details the current understanding of why the traumatic event occurred and its impact on beliefs about self, others, and the world. Next, the individual begins more formal processing of the trauma(s), by identifying stuck points and learning skills through worksheets on how to change those stuck points into more adaptive thoughts.
Finally, once the person has developed skills to identify and address unhelpful thinking, she or he uses those skills to continue evaluating and modifying beliefs related to traumatic events. At this point, the therapist is helping the patient develop the ability to use these adaptive strategies outside of treatment to improve overall functioning and quality of life. Additionally, focus is brought to the areas of life that are commonly affected by traumatic experiences, such as safety, trust, power, control, esteem and intimacy.
There are individual, group, or combined individual and group formats for Cognitive Processing Therapy. Although research suggests that the individual format is the most effective. CPT can be effectively delivered on a weekly basis or more often as long as all the homework is completed between sessions. This includes times where the client had 2 sessions a day for 5 days (in total 10 sessions). It has also been effective when delivered through an interpreter and telehealth.
Research on Cognitive Processing Therapy
Cognitive Processing Therapy (CPT) is one of the most researched treatments for PTSD. CPT has the strongest recommendation as a treatment for PTSD from a number of sources. CPT produces large treatment effects in regard to PTSD symptom reduction. Treatment gains were found to be maintained 5-10 years after the completion of treatment.
Additionally, CPT has also been shown to improve common comorbid symptoms and clinical correlates of PTSD such as:
- Depression
- Suicidal ideation
- Health-related concerns
- Sleep
- Physiological reactivity
- Dissociation
- Functioning across important life domains
- Personality disorders
- Traumatic brain injury (TBI)
In Summary
Cognitive Processing Therapy is a powerful structured therapy for PTSD that has been successful for most that put in the work. It can provide healing in less time than other forms of therapy for trauma.
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