Cognitive Processing Therapy for Trauma

Cognitive Processing Therapy (CPT) is an adaptation of evidence-based, Cognitive Behavioral Therapy (CBT) used by clinicians to help clients explore recovery from Post-Traumatic Stress Disorder (PTSD), and Complicated Grief. CPT typically consists of 12 sessions and has been shown to be effective in treating PTSD for a variety of traumas, including for victims of sexual assault, for combat veterans, and for refugees.

CPT conceptualizes PTSD as a disorder where erroneous beliefs about the causes and consequences of traumatic events produce strong negative emotions that subvert or distort accurate processing of the memory, and the expression of natural emotions.

People with PTSD may experience, “a range of emotions including horror, anger, shame, guilt and sadness as well as fear.” A significant obstacle to the natural recovery process is the ongoing use of avoidance as a coping strategy. By avoiding traumatic memories, and situations that trigger strong reactions, people with PTSD limit their opportunities to process the traumatic experience, and to cultivate adaptive understanding.

CPT incorporates trauma-specific, cognitive techniques to help individuals with PTSD accurately appraise ‘stuck points,’ and to progress toward a natural recovery. {Source: Wikipedia}

A primary focus of CPT is to help patients gain an understanding of, and an ability to modify the meaning attributed to a traumatic event. One goal of CPT is to decrease the pattern of avoiding the traumatic memory, so that beliefs and meanings can be further evaluated and understood within the original context.

CPT phases of treatment

The initial phase of treatment consists of PTSD education, and the identification of thoughts and emotions. By developing a therapeutic alliance with clients, the therapist establishes a common understanding of the problems being experienced. Here, the focus is on the identification of automatic thoughts and increasing awareness of the relationship between a person's thoughts and feelings.

Specifically, patients are taught to identify ‘stuck points,’ which are problematic beliefs that interfere with recovery from traumatic experiences (e.g., ‘It is all my fault;’ or, ‘I should have known that he would attack me;’ or, ‘I should have fought harder,’ etc.).

The middle phase of CPT involves formal processing of the trauma. Emotional processing occurs as patients discuss their traumatic experiences in efforts to clarify and modify maladaptive beliefs. Therapists use Socratic dialogue to encourage clients to gently challenge their thinking about the traumatic event, and to consider the context in which the event occurred. An important goal is to decrease self-blame and guilt, and to increase acceptance.

The final phase of treatment focuses on teaching the patient the cognitive skills necessary to identify, evaluate, and realistically modify their beliefs about the traumatic event. Patients focus on ‘stuck points’ and work to understand habitual, unrealistic beliefs about themselves in relation to the traumatic experience.

The skills learned are helpful in empowering patients to, ‘become their own therapist.’ The final phase focuses on five areas in which beliefs are altered by traumatic experiences: safety, trust, power/control, esteem, and intimacy.