Cognitive Processing Therapy (CPT) is an evidence-based brief therapy for Post-Traumatic Stress Disorder. CPT is a structured manualized therapy comprising of twelve sessions that occur weekly or bi-weekly, with regular practice assignments between sessions. In CPT it is not an expectation that clients talk about the details of their trauma in order to reduce their symptoms. Rather, the therapist and client work together to change unhelpful thoughts about the traumatic event, one’s self, others and the world that maintain symptoms.

CPT conceptualizes PTSD as a disorder of non-recovery. Accordingly, a person is not able to recover from their PTSD because the negative beliefs they developed after a trauma keeps them “stuck.” For instance, after a traumatic event it is common for the survivor to blame them self for the event, believe others cannot be trusted, or think that the world is a dangerous place. The premise behind CPT is that if you can change your thinking, you can change how you feel and behave. CPT teaches clients to become critical consumers of their own thinking. In CPT clients examine, evaluate and challenge unhelpful thoughts by looking for evidence for and against what they have been telling themselves about the trauma. Therapists ask clients questions about their thoughts to help to uncover underlying beliefs and assumptions. Clients generate and consider alternative ways to think about the traumatic event, themselves, others and the world. In so doing, clients can choose which alternative ways of thinking represent a more balance, accurate and context-sensitive perspective. As thinking becomes more flexible and balanced, the emotional state of the client improves.

A traumatic event can generate intense emotions and negative thinking and it is common for survivors to work hard to avoid any reminders of their trauma. Avoidance results in fewer opportunities to examine and make sense of a traumatic event and fewer opportunities to allow the expression of natural emotions related to the trauma. Consequently, avoidance stifles natural recovery and contributes to the development of PTSD. In the CPT approach, recovery from trauma is promoted by supporting clients to make sense of their traumatic experience by talking about their thinking and feelings related to the trauma and allowing room for the expression of natural emotions about the trauma when they arise.

There are three phases to CPT. In the first phase, education on PTSD and the cognitive theory of how PTSD is developed and maintained is provided. Clients write an impact statement about their worst trauma, to identify why they think the event happened and how it has affected their beliefs. The therapist helps the client identify “stuck points” from their impact statement, particular negative beliefs or assumptions that interfere with recovery and these are kept track of on a stuck point’s log. Prior to treatment starting, the client and therapist discuss if it makes sense for the client to write an account of their trauma as part of the treatment, in addition to the impact statement. In these early sessions, helping clients understand the relationship between their thoughts, feelings and behavior is the focus.

In the middle phase of treatment, clients learn skills to identify, evaluate and modify their unhelpful thoughts and feelings. Clients use worksheets to challenge and change their thinking in response to self-questioning and/or questions from the therapist. In the final phase of treatment, clients work through modules that help them consider and address how their traumatic experience has affected their quality of life, with respect to their sense of safety, trust, power/control, esteem and intimacy. Therapy ends with a final impact statement, which is compared to the original impact statement, to show how a client’s thinking has changed.