What is CPT?
Cognitive Processing Therapy (CPT) is short-term, evidence-based therapy for Post-Traumatic Stress Disorder (PTSD). CPT was developed in the 1980s, derived from cognitive behavioral therapy (CBT). CPT is primarily a cognitive therapy, helping trauma survivors examine and challenge their beliefs surrounding a traumatic event, beliefs that serve to keep them stuck in trauma symptoms.
One of the unique features of CPT is that the treatment may or may not include a detailed narrative of the trauma. Individuals are free to choose whether they want to share their trauma narrative as part of the therapy; the treatment is just as effective without this component.
How Does CPT Work to Address PTSD Symptoms?
CPT views PTSD as a “failure” to recover from trauma. Most people experience a traumatic event at some point in their lives, and many will evidence PTSD symptoms following the event. What constitutes a PTSD diagnosis, though, is when you don’t “grow out” of these symptoms. About 80% of people will not develop PTSD after experiencing a traumatic event; they’ll naturally recover from the symptoms over time. The remaining 20% struggle because they are unable to process the trauma; their recovery is interrupted. They’re unable to make sense of the event in a way that quiets their overactive brains, particularly the area (amygdala) associated with fight-flight-freeze. Their amygdalas become chronically hyperactive, firing again and again to try to keep them safe; there’s a high level of activation and distress. So they start avoiding and using numbing behaviors (like alcohol/drugs, eating disorder symptoms, dissociation, and other means of avoidance) to cope with their trauma-related overwhelm. But this unfortunately, doesn’t solve the problem.
What CPT does is activate the “thinking” part of the brain, in particular, the prefrontal cortex. Activation of this region can help quiet the amygdala, resulting in reduced PTSD symptoms over time. With CPT, the 20% of trauma sufferers who develop PTSD are capable of recovery too; they just need more support in processing what happened, avoiding avoiding, and reworking some of their thought patterns around their experiences.
How Effective Is CPT?
A number of randomized controlled trials have demonstrated the efficacy of CPT, showing that CPT is one of the most effective trauma treatments available. In many cases, those undergoing CPT no longer meet criteria for PTSD after only six sessions. Treatment gains are often maintained for the 5-10 years participants are followed after intervention, and research shows no difference between outcomes for childhood and adult trauma. In addition to reducing symptoms of PTSD, CPT has been shown to be effective at reducing depression, guilt, anger, hopelessness, suicidal ideation, and with improving overall functioning. An additional benefit of CPT is that people can take the skills they’ve learned in this treatment and use them to address other concerns. CPT prepares clients to become their own cognitive therapist.
CPT can be conducted individually or in group settings, in person or online. Research shows that telehealth delivery of CPT has the same degree of efficacy as in-person interventions. CPT sessions generally occur weekly, though sessions can occur more frequently. The research shows that the more frequent the sessions are, the better the treatment outcome.
What Does CPT Entail?
CPT is generally a 12-session treatment but can involve more or fewer sessions, depending on the individual’s progress. The treatment involves identifying a specific traumatic event and then exploring and challenging cognitive “stuck points” around this event. A large part of the therapy involves reworking the thought patterns that keep people stuck, thoughts around guilt and blame and inferences around safety and trust. In fact, CPT looks at how trauma impacts our experience of safety, trust, power and control, esteem, and intimacy. Trauma can affect how we view the world, especially on these dimensions; we often become overly rigid in our belief systems as a result. Recovery involves coming up with a more flexible and realistic worldview.
At the end of each CPT session, homework is assigned. Homework is critical to the treatment’s success. In fact, the biggest predictors of treatment outcome is adherence to the protocol and completion of homework assignments. Review of the homework from the week prior is therefore a central part of each session. Following this, new topics are covered and related practice assignments are discussed.
If you’d like to get a feel for what CPT sessions are like, writer Jamie Lowe recorded her experience in CPT addressing sexual assault on This American Life. (Please note that this content might be triggering for some listeners.)
Who Is a Good Candidate for CPT?
If you’re wondering if you’re a good candidate for CPT, there are a few things to consider. Those who have a diagnosis of PTSD are candidates for CPT. It’s okay if you have another psychiatric diagnosis – those with depression, anxiety, eating disorders, personality disorders, and other related conditions can also benefit from CPT. The only time that CPT might be delayed is if you are in active need of alcohol/substance detox.
CPT is a wise choice if you’re interested in evidence-based therapy and you realize that you have certain stuck points around your trauma. Successful candidates are able to commit to 12 sessions and willing to complete daily homework assignments, as this practice represents the “bread and butter” of CPT. Finally, you’re a good candidate for CPT if you’re ready to recover – willing to look at thought patterns around your trauma and to stop avoiding trauma-related emotions – and if you’re tired of the symptoms of PTSD running your life. With CPT, healing and recovery are possible. Contact us to learn more about how CPT can work for you.