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People who experience significant trauma can develop long-term negative consequences as a result: when those consequences manifest as mental health symptoms and meet or exceed clinical criteria, people with a history of trauma may develop post-traumatic stress disorder (PTSD), which means they need the best possible, evidence-based PTSD treatment available.

New research shows a subtype of cognitive behavioral therapy (CBT) called cognitive processing therapy (CPT) is effective in reducing the disruptive symptoms of PTSD and is an effect modality for PTSD treatment.

In this article, we’ll provide an overview of CPT for PTSD treatment, including its primary goals, the overall process, and its benefits for people with PTSD. To learn more about PTSD, please navigate our website to our blog and read these articles.

This one offers a summary of PTSD and PTSD symptoms:

How Do You Recognize the Symptoms of PTSD?

This describes innovative new approaches to PTSD treatment available at Crownview Psychiatric Institute:

Psychedelics for Depression and PTSD Treatment

And this article reviews new evidence about the role of hormones and specific brain function in the development of PTSD:

Trauma and PTSD: The Role of Hormones and Brain Activity

Reading those articles will offer context for our discussion of cognitive processing therapy, which the American Psychological Association (APA) defines as follows:

“Cognitive processing therapy (CPT) is a specific type of cognitive behavioral therapy that has been effective in reducing symptoms of PTSD that have developed after experiencing a variety of traumatic events including child abuse, combat, rape, and natural disasters.”

Let’s take a closer look at CPT, starting with the treatment goals most commonly associated with the modality.

Cognitive Processing Therapy: Primary Goals

The Center for Cognitive Processing Therapy identifies three goals for CPT: reflect, redefine, recover. We’ll elaborate:

  1. CPT helps patients:
    • Understand PTSD
    • Examine the effect of trauma on thoughts and emotions
    • Reduce symptoms such as avoidance
    • Decrease emotional numbing
  1. CPT helps patients:
    • Develop effective tools to evaluate thoughts and thought processes
    • Establish new ideas and patterns of thought about trauma, about themselves, and about the world
  1. CPT helps patients:
    • Mitigate/reduce stressful and painful memories associated with related to trauma
    • Reduce symptoms of PTSD
    • Reduce intensity of emotions associated with PTSD, such as anxiety and anger
    • Decrease levels of shame and guilt associated with trauma
    • Improve ability to meet daily responsibilities/commitments

Those are the goals of CPT. It’s important for people with PTSD, as well as their families and friends, to understand that these goals are both realistic and achievable. It’s possible to recover from trauma, from PTSD, and live a life that’s not dominated by PTSD symptoms.

Now we’ll share how the CPT process works, and what a person engaging in CPT might experience, step-by-step.

How Does CPT Work for PTSD Treatment?

The core of CPT involves a patient and a clinician collaborating to examine the psychological and emotional consequences of a traumatic event, with the goal of challenging and changing disruptive, non-productive thoughts and patterns of thought, and reassessing/restructuring life-interrupting beliefs about themselves, other people, and the world.

The CPT process is slightly different for each patient and clinician. It’s a short-term approach that follows this general pattern:

CPT Overview: PTSD Treatment

  • 8-15 sessions total
  • Sessions may be one-on-one, once or twice a week for 50 minutes
  • Sessions may be in a group therapy setting, once or twice a week for 90 minutes
  • Some therapists may recommend a mix of individual and group sessions

CPT Details: PTSD Treatment

First Phase

  • The first phase involves the clinician offering education about PTSD and the science behind cognitive-behavioral therapies.
    • In some cases, the initial session may involve the patient writing a direct account of the trauma. In other cases, the clinician and patient decide against this, in order to avoid re-traumatization.
  • When the treatment pair – meaning patient and clinician – decide against a direct narrative account, the patient instead writes a statement about why the trauma happened and how they think the experience affects how they understand themselves and the world.
  • This statement focuses on the patients’ ideas about the trauma and its impact – not the details of the traumatic event itself
  • Next, the client and clinician identify stuck points. Stuck points are defined by CPT experts as follows:

“Stuck points are thoughts that keep us from recovering. Stuck points are concise statements that reflect a thought – not a feeling, behavior, or event.”

  • The patient records these thoughts in a stuck point journal/log, which the treatment pair use as a reference for the duration of the CPT treatment
  • To address and resolve these stuck points, clinician and patient engage in Socratic dialogue, wherein the clinician asks the patients questions that helps them clarify and restructure their thoughts. In some cases, patients use worksheets to facilitate this process, which focus on helping the patient identify and resolve cognitive distortions and/or problematic thinking.
  • Initial work on stuck points revolves around how the patient views, thinks about, and understands the traumatic event
  • Subsequent work on stuck points revolves around exploring and identifying beliefs that changed after the initial trauma – that’s the end of the first phase of CPT.

Second Phase

  • This phase shifts to address, process, and restructure areas of thought and emotion most often disturbed by severe trauma, including:
    • Safety
    • Trust
    • Power/control
    • Self-esteem
    • Intimacy/relationships

Conclusion/Consolidation Phase

  • This phase involves what may be best described as a debrief or summary.
  • The patent writes a final impact statement. The statement functions as a tool for growth and reflection, wherein the patient identifies how their thinking/thoughts/thought processes changed during the CPT process

Evidence shows the process above is effective for patients with a history of military combat, sexual trauma/abuse, childhood trauma/abuse, and multiple, complex traumatic experiences. In addition, research shows CPT is an effective treatment for the co-occurrence of PTSD with other mental and behavioral disorders such as alcohol/substance use disorders, depression, personality disorders, and traumatic brain injury.

The Benefits of CPT

The best source for understanding the benefits of CPT is people with PTSD who’ve engaged in the modality. A study published in 2014 examined the impact statements written by military veterans with severe combat-related PTSD.

Here’s what those veterans said about CPT. The therapeutic process improved their:

  • Sense of safety
  • Levels of happiness
  • Ability to form and maintain relationships
  • Intimacy/intimate relationships
  • Ability to tolerate negative emotions
  • Self-esteem

Cumulatively, those improvements lead in one crucial direction: the ability to rebuild their daily lives and meet the typical responsibilities associated with work, family, and school. That study examined impact statements from patients themselves. Now we’ll look at a more recent study that examined PTSD symptoms specifically. This research effort compared treatment with CPT to treatment as usual (TAU) with cognitive behavioral therapy (CBT) and medication (selective serotonin reuptake inhibitors, or SSRIs).

Here’s what they found.

The patients who received CPT and treatment-as-usual (CPT+TAU), compared to patients who received treatment-as-usual (TAU), showed significant improvement in:

  • PTSD symptoms
  • Depressive symptoms
  • Suicidal ideation
  • Quality of life

There are two things about this study we’d like to highlight. First, it was performed in Japan, making it the first random controlled trial on CPT for PTSD in East Asia. This demonstrates the efficacy of CPT across cultures, as previous studies involved patients in Europe and North America. Second, it shows the durability of the treatment: positive outcomes persisted for 34 weeks – roughly five and a half months – after the beginning of the study.

How This Information Helps Patients

That’s a big deal: treatment with benefits of longer duration are more valuable to patients than treatment with benefits of short duration. The goal is to equip patients with the skills to manage PTSD – if necessary – on an ongoing basis. While symptoms may gradually decrease until a person no longer meets the criteria for clinical PTSD, they may reappear during times of stress. Therefore, a treatment that’s long-lasting and includes practical skills is optimal for people with PTSD.

That’s why this approach can help people with PTSD: once a person learns these basic cognitive skills, they’re theirs for life. They can use them anytime, anywhere, in any way they like. And if they need to check in with a therapist, having their stuck journal and their final impact statement on hand can facilitate the treatment process, and remind them that they can effectively manage their PTSD symptoms.

We’ll close this article with five facts about PTSD we think everyone should know.

PTSD: Five Important Facts

  1. If someone you know and love has PTSD and you want to support them, the experts at the Chicago School of Professional Psychology indicate that in-person support in the form of shared activities or face-to-face conversations may be more effective than a phone call or video chat.
  2. More women have PTSD than men: roughly 10% compared to 4%.
  3. PTSD symptoms may take years to appear. They may be moderate at first, and escalate in frequency and severity over time.
  4. People with indirect exposure to trauma can develop PTSD. Symptoms can appear in people with friends or loved ones who experience traumatic events, or people who deal directly with traumatic circumstances but aren’t necessarily involved in the traumatic injury or event, such as first responders, emergency room medical staff, and mental health providers.
  5. Treatment for PTSD can work. People with severe PTSD may experience symptoms that are totally debilitating and prevent them from participating in basic activities we all take for granted. However, with time, commitment, effort, and evidence-based treatment, a person with PTSD can learn to manage their symptoms and life the life they choose, rather than one dominated by te symptoms of PTSD.