CPT: Cognitive Processing Therapy for PTSD

When Trauma Shatters Our Worldview

After a traumatic event, we are put in the terrible position of trying to put our shattered assumptions about the world back together. While the world may have once felt safe, suddenly we know how quickly things can change. Many individuals notice changes in the ways they think about themselves, the world, and others. These thoughts can then get them stuck.

What Are Stuck Points?

Stuck points are beliefs that keep us from recovering from our trauma. They keep us stuck in the past and make it hard to move forward. These beliefs often go to extremes to try to keep us safe. They also may have elements of unhelpful blame where we overly focus on what could have been done differently to prevent the trauma from happening.

Cognitive Processing Therapy (CPT) Can Help You Get Unstuck

CPT is a research-based therapy designed to help trauma survivors work through the impact of their trauma and process their natural emotions. CPT is considered one of the gold standard treatment for PTSD and is recommended by the American Psychological Association and the Department of Veteran Affairs.

In particular, CPT is very good at helping clients work through feelings of guilt or “would have, should have, could have” thinking. Research shows that clients who complete CPT show significant decreases in symptoms of PTSD, guilt, and depression. In fact, many individuals who complete CPT no longer meet criteria for PTSD.

Using skills they learn in individual therapy, clients do daily practice assignments to help them become “unstuck.” Clients start by tracking their thoughts to identify how their thoughts have shifted since the trauma. Clients then learn skills to evaluate whether these thoughts are helpful or even fit the facts (“what evidence do I have for this thought?”). With practice, clients are able to shift their thinking, which in turn helps to shift how they feel and what they do.

An Example of CPT in Action

After her trauma, Jennifer thought “I can’t trust anyone” and began pulling away from the people she loved. Jennifer was so afraid of depending on others she stopped asking for help at work and talking to her wife about what she was feeling. Even though she felt safer in the moment, in the long term she felt overwhelmed and alone.

With the skills she learned in CPT, Jennifer learned to take a step back from this thought. After careful consideration, Jennifer realized that while she couldn’t trust some people with some things, there were other people she could put her trust in. She knew she could trust her wife to take care of their kids. She also knew her wife would never intentionally hurt her. She also trusted her coworker Ryan to show up when he said he would. So it couldn’t be true that she couldn’t trust anyone!

After talking with her therapist, Jennifer also began to realize that there were many different dimensions to trust. While she could trust her brother to take care of her dog, she wouldn’t necessarily trust her brother with her money.

By working through these thoughts, Jennifer was better able to identify:

• who she wanted to trust
• what she wanted to trust them with

Changing her thoughts helped Jennifer feel comfortable asking for help and empowered to decide who to let in.

In addition to checking out their thoughts, clients also work through the emotions around the trauma. This is particularly important as clients often did not have a safe space to work through the emotions when the trauma happened. Just like a soda bottle that has been shaken, there are often a lot of emotions that come up in the beginning. Over time, however, the emotions are released and the client is able to reclaim a healthier relationship with their feelings.

In CPT, clients work with a therapist for about 12, 50-minute sessions. They also complete daily practice assignments that help them identify whether or not their thoughts fit the facts. Clients get to choose whether or not to write about the traumatic event. Research has shown both options are equally effective.

To learn more about PTSD and its treatment, see the following resources:

• What is PTSD?
• STAIR: Taking the First Step Towards Trauma Recovery
• PE: Prolonged Exposure for PTSD
• Cognitive Processing Therapy for PTSD by the Veterans Health Administration

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