What Is Cognitive Processing Therapy (CPT)?

Cognitive processing therapy (CPT) is a cognitive behavioral treatment focused on helping people who are "stuck" in their thoughts about a trauma. It was developed to treat post-traumatic stress disorder (PTSD).

If you're considering CPT, it helps to know how this therapy works and the techniques used. Here's who cognitive processing therapy can help, the benefits it provides, and what you need to know before getting started.

How Cognitive Processing Therapy Works

CPT is a highly structured treatment approach consisting of 12 weekly sessions, each around an hour in length. Sessions can take place in a group setting, one-on-one, or in a combined group and individual format. They may be offered in-person or online.

Cognitive processing therapy is based on the idea that PTSD symptoms stem from a conflict between pre-trauma beliefs about the self and world and post-trauma information. When the two aren't aligned, issues can result.

For example, a pre-trauma belief could be The world is a safe place, and nothing bad will happen to me, while post-trauma information may suggest that the world is, in fact, dangerous. These conflicts are called "stuck points" and are addressed through various techniques, such as writing about the traumatic event.

A therapist specializing in CPT helps identify stuck points and ​errors in thinking, including thoughts like I am a bad person or I did something to deserve this, for example. They then work to address these errors or stuck points by helping gather evidence for and against those thoughts.

CPT vs. Exposure Therapy

Similar to exposure therapy for PTSD, cognitive processing therapy provides people with information on PTSD and helps them confront unpleasant memories and thoughts associated with a traumatic event. However, unlike CPT, exposure therapy doesn't always assist people in addressing these errors in thinking.

In CPT, a therapist helps confront feared thoughts and memories associated with a traumatic event. They also assist with learning to correct the maladaptive, unrealistic, or problematic thoughts that may be driving your PTSD symptoms.

Cognitive Processing Therapy Phases

Cognitive processing therapy is divided into separate phases that each deal with different components of therapy. Here's what each phase involves and what you can expect.

Psychoeducation

Initial sessions involve education about PTSD and the CPT approach. The therapist goes over how your thoughts about the trauma can impact your emotions and daily experience, as well as how CPT can help. They also ask about your symptoms and talk about goals for treatment.

Understanding Thoughts and Feelings

Next, you learn to become more aware of what you think and feel about your trauma and how you may be stuck in beliefs that are hurting you. During this phase, you work with your therapist to identify and analyze your stuck points. To assist with this, you may be asked to write an impact statement.

An impact statement explores your thoughts and beliefs about the trauma. In it, you talk about why you think the trauma occurred and the ways you believe it has affected your life.

If you're engaging in group therapy, you won't have to read your impact statement aloud in front of everyone. You may share it with your therapist individually, or they may only ask that you revisit it yourself in private throughout treatment.

In addition to an impact statement, your therapist may also ask you to write down detailed accounts of your traumatic experience. These accounts will include sensory details that you remember, in addition to your thoughts and feelings.

Learning New Skills

In the next phase of cognitive processing therapy, you learn how to question and challenge your thoughts and feelings and explore how you would prefer to think about the trauma. The therapist goes over common thought patterns that people with PTSD experience and teaches you cognitive coping skills.

They may also ask you to look for evidence for or against your beliefs about your trauma. You will likely fill out worksheets during this part of treatment, either in therapy or afterward as homework.

Changing Beliefs

In the final phase of CPT, you learn how it's common for a person's thoughts and beliefs about the world to change after a trauma. You also learn how to balance the way you saw the world before and the way you see it now.

At this point, CPT therapy focuses on helping you in five areas in your life where people with PTSD commonly encounter issues:

• Esteem
• Intimacy
• Power or control
• Safety
• Trust

Before concluding treatment, you'll rewrite your impact statement and compare it with your original version. You and your therapist may also discuss future areas that may pose problems and together develop a plan for managing those possibilities should they occur.

Who CPT Can Help

CPT may be helpful for people who have experienced trauma in a variety of situations, including combat veterans, survivors of sexual assault, and survivors of childhood abuse. It is focused on reducing symptoms related to the trauma, some of which can include:

• Anger
• Fear
• Feeling overwhelmed
• Feeling numb
• Sadness
• Shame
• Trouble regulating emotions

Benefits of Cognitive Processing Therapy

Research shows that CPT impacts negative cognitions related to PTSD, and it's able to reduce those thoughts even after treatment. By targeting negative cognitions and encouraging new ways of thinking about trauma, CPT therapists can help change the way you think overall.

CPT may even create positive impacts in areas not specifically targeted during therapy. For example, one study found that adults engaged in cognitive processing therapy had a greater reduction in heavy drinking than those in a different type of cognitive behavioral therapy. This can make CPT useful when trauma co-occurs with substance use issues.

Cognitive Processing Therapy Effectiveness

CPT is considered an effective treatment for PTSD. Research shows that people who undergo CPT experience fewer symptoms associated with PTSD and these positive effects appear to be lasting. It also reduces the severity of PTSD symptoms, including trauma-related depression, more so than other forms of therapy.

These positive effects are often visible in clients' written impact statements. One study looked at statements written at the beginning and end of CPT treatment and found that people reported a shift to a more positive perspective about their trauma, also seeing improvements in their:

• Ability to trust themselves and others
• Feelings of safety
• Happiness levels
• Intimacy and relationships
• Self-esteem
• Sense of personal power and ability to control their environments
• Tolerance of negative emotions

Things to Consider Before Beginning CPT

A 2022 review of the evidence suggests that CPT can be effective for many different types of trauma and a diverse set of clients, providing relief from symptoms experienced. However, it may also make some symptoms worse, especially in the initial stages.

If you're concerned about how cognitive processing therapy may affect you, talk to your mental health provider. Ask them any questions you may have and what you can expect during treatment. They can help determine whether CPT is appropriate for your condition and symptoms.

How to Get Started With CPT

If you are interested in CPT, search for a trained PTSD treatment provider in your area. You can also learn more about CPT from the National Center for PTSD and the International Society for Traumatic Stress Studies.

If you're an American veteran, CPT services are available through the Department of Veterans Affairs (VA). The VA's Office of Mental Health Services has CPT-trained therapists nationwide. Talk to your VA healthcare provider about incorporating CPT into your PTSD treatment plan.

Once you begin treatment, your therapist will explain their process and let you know what to expect. CPT commonly includes homework assignments, handouts, and writing assignments, so you'll need to be prepared to put in work inside and outside of your sessions.

Because CPT involves exposure to your trauma, either through writing about it or discussing it with your therapist, it can be an emotional experience. Your therapist can help provide a safe environment for you to process these emotions while helping you learn to address your stuck points so you can move forward.