Written by Hyungjoo Shim, Ph.D., Licensed Clinical Psychologist
What is Cognitive Processing Therapy (CPT)?
CPT is a manualized treatment that helps people recover from post-traumatic stress disorder (PTSD) and related conditions. It includes elements of cognitive-behavioral therapy, a treatment that focuses on identifying and challenging unhelpful thoughts (and patterns) to address clinical conditions such as depression and anxiety. CPT was initially developed for and found to effectively help victims with sexual trauma to alleviate their PTSD symptoms, then also to help individuals with other trauma including combat, various child abuse/neglect, and domestic violence.
CPT has been effective for individuals with a range of different problems. Overall, sustained and consistent work put in will determine what comes out of CPT. Still, given my clinical experiences, individuals who like to process thoughts and feelings in writing and naturally prefer a structured and systematic way when it comes to learning, tend to respond well.
What is the structure of CPT?
CPT consists of approximately 12 units or modules in either individual or group therapy. It includes the following treatment components: a) Education about common reactions to trauma
towards enhanced understanding of a set of symptoms, b) Writing about the personal meaning of the trauma, c) Writing about detailed account of the trauma, in order to access to unprocessed emotions such as sadness, anger and guilt, d) Learning to identify, challenge, and change unhelpful beliefs about the meaning of the trauma, e) Applying a newly-learned way of thought-changing process to five areas (safety, trust, power/control, esteem, intimacy) that often are heavily impacted by traumatic experiences.
With every session, there is homework ranging from writing about painful material to learning how to systematically re-structure unhelpful thoughts that lead to emotional distress and avoidant behaviors. As much as what (e.g., important thought challenging skill) is being learned and practiced, how this therapy is conducted (e.g., approaching traumatic materials in a “safe” setting in validating and guided way ”together” with therapist) is therapeutically very important.
What are the goals of CPT?
CPT aims at improving one’s understanding of PTSD and its related issues, reducing the fear and distress tied to the memories of the trauma, decreasing emotional avoidance and numbing tied to empty and disconnected feelings, alleviating feeling of being intense and “on edge” all the time, decreasing depression, anxiety, and shame/guilt, restoring normal and content day-to-day living.
What predicts good outcomes in CPT?
Consistent attendance and homework completion outside of each session are the two most important factors in CPT. An individual with PTSD naturally feels fearful of and avoids revisiting traumatizing materials, and thus coming to therapy consistently can be very challenging. That is why, prior to the beginning of the treatment, heavy emphasis is placed on “showing up” for each session no matter what. In order to learn how to bring his/her attention to a more balanced and realistic way to triggering and distressing situations, not seeing the world through the lens of “danger,” the individual needs to keep practicing a new way of thinking about those situations more contextually. As such, completing homework assignments plays an important role in how much and fast PTSD symptoms are alleviated, and how long improved mood and behaviors are maintained, even after the treatment is over.
Common concerns among individuals with trauma when they consider CPT
Often, many individuals voice their worries about unbearably strong emotions that might arise while doing CPT. To address this concern, during the course of therapy, there will be a discussion to generate a specific self-care plan for those situations. Further, more specific emotion-regulation skills and/or distress-tolerance skills can be practiced, even before starting CPT treatment.
Another common concern is that the individuals may experience worsening symptoms especially at the beginning phase of CPT. As noted above, CPT involves “revisiting” emotionally distressing memories. Consequently, when they start approaching these memories, particularly writing about trauma account in detail, they are likely to experience increase in nightmare or intense fear, sadness and anger. However, this increase is going to be temporary. With continued confronting and approaching these materials in a safe and structured way, individuals will learn to take away the out-of-proportion emotional power of the materials. They will also learn to develop and apply an adaptive and healthy way of thinking about emotionally challenging situations.
In summary, CPT can be an effective form of treatment for individuals with trauma, especially if they are willing to commit to regular homework and sessions.
Are you interested in hearing more about CPT? Contact us, and we can shore more about this and our therapists that can help. All correspondence is confidential.