Cognitive Processing Therapy: Everything You Need to Know
Medically reviewed by Steven Gans, MD
Many people may endure a traumatic event at some point in their lives. These situations and their aftermath can be debilitating and potentially life-altering. While some people can cope with traumatic events, others experience an acute stress response, adjustment, or post-traumatic stress disorder (PTSD).
Cognitive processing therapy (CPT) is a structured form of cognitive-behavioral therapy used to treat PTSD and trauma-related issues. CPT can be helpful for clients to challenge and modify unhealthy beliefs and behaviors that can arise when a traumatic event impacts their life.
This article discusses CPT, its uses, benefits, and what to expect.
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Uses
CPT helps clients process traumatic events and their reactions to them. Reactions to trauma might present as:
Intrusive symptoms (such as thoughts or nightmares) that feel like you are experiencing the event
Negative thoughts and feelings
Avoidance of people, places, or things that remind you of the trauma
Physical alterations in arousal and reactivity
The distress following traumatic situations can impact a person's mental and physical well-being and quality of life.
Therapists use CPT to treat trauma and stressor-related disorders. According to the American Psychological Association, this treatment approach is an effective form of psychotherapy (talk therapy) for people who have endured traumatic events such as child abuse, combat, sexual assault, and natural disasters.
Cognitive processing therapy has been shown to reduce symptoms of:
Related: The Difference Between Acute and Chronic Trauma
The Five Themes
One of CPT's assumptions is that after a traumatic event, a person does their best to try to make sense of what's occurred, potentially leading to distorted thinking regarding themselves, the world, and other people.
Cognitive processing therapy provides a way for people to process trauma in a safe environment, develop skills to identify and address distorted thinking, develop coping strategies to improve functioning, and empower them in five key areas of their lives.
Safety
People may view the world as relatively safe until they have experiences that show them otherwise. After a traumatic experience, people, places, or things may feel unsafe. In CPT, clients learn to identify and challenge these changed beliefs around safety.
Trust
Trust involves a belief in the reliability of others. Traumatic situations can impact a person's sense of trust.
During CPT, clients are encouraged to talk about how their perspectives on trust have changed and learn how to question these changes.
Power and Control
When a person's boundaries and sense of safety are violated, they can experience powerlessness.
For example, a person might feel that everything is out of their control. CPT explores a person's changed sense of control and examines ways of reconnecting with a healthier sense of one's power and control.
Esteem
Self-esteem refers to a person's thoughts and beliefs about their worth.
Traumatic events can lead to negative thinking about oneself. For instance, a person might describe themselves as bad or broken as a result of the trauma.
Through CPT, clients begin to identify their changed and distorted beliefs about themselves and their self-esteem.
Intimacy
Traumatic events often change our relationships with ourselves and others, which can impact our ability to be intimate with those close to us. In treatment, clients can focus on distorted thinking patterns related to the trauma that make this closeness challenging, and work to become more open to connecting with loved ones.
Techniques
CPT can uncover painful emotions, thoughts, and experiences. Before diving in, therapy starts with psychoeducation (process of providing information to people seeking treatment) about trauma, PTSD, thoughts, emotions, and what you can expect with CPT.
A therapist will want to get a sense of the traumatic experience, your symptoms, and how the event has impacted your life and functioning. It's also crucial for clients to understand what CPT is, how it's structured, and how treatment works.
Once the client understands CPT, they will identify thoughts, emotions, and the impact of the trauma. Bringing awareness to these things helps the client and therapist identify stuck points (thoughts that get in the way of recovery). Examining thinking patterns allows the client to challenge and restructure unhelpful thoughts related to the trauma.
Discussing various coping strategies that can be used outside of treatment is essential during CPT, especially as clients process a traumatic event. Ultimately, CPT is an effective way to help clients name, challenge, and change their beliefs, which impact their emotions and actions.
Benefits
Processing and working through trauma can sound overwhelming. However, there are many benefits to engaging in CPT. Clients learn to:
Challenge negative thoughts linked with trauma
Implement coping strategies
Develop problem-solving skills
Alleviate symptoms
One study explored the use of CPT delivered both in-home and through telehealth (using digital communication technologies to provide healthcare services) in military veterans with PTSD. Researchers found that CPT administered in these ways resulted in a significant reduction in PTSD-related symptoms.
Who Shouldn't Try CPT?
While CPT can be effective in treating PTSD and related disorders, it may not be recommended for everyone. There may be conditions in which the treatment is not effective or the patients require other types of psychiatric interventions around their symptoms or safety. These conditions include:
Cognitive impairment
Neurological conditions like dementia
Active substance use
What to Expect
Before starting therapy, it's helpful to have a conversation with a healthcare provider about what to expect from CPT. It's important to know that CPT can bring up distressing thoughts and emotions. However, a licensed and trained professional will strive to create a safe therapeutic environment.
With CPT, you can expect that your therapist will begin by providing education about therapy and how CPT works. This is an opportunity to ask your therapist questions so you can make the best choice about whether the therapist and approach are right for you.
You can anticipate attending weekly sessions for approximately 12 weeks. CPT can also be delivered in groups, but you can talk with your provider about the best way to participate.
The work you're doing will extend beyond the session. Your therapist may give you writing or homework assignments or ask you to utilize strategies outside of therapy. It's important to practice the skills and techniques you learn and update your therapist on what is and is not working.
The most distressing aspect of CPT can be discussing memories, thoughts, and feelings associated with the trauma. Keeping the lines of communication open with your therapist about your symptoms and the challenges you're facing allows you to collaborate and create a plan to manage difficult moments.
Resources
If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one is in immediate danger, call 911. For other mental health resources, see our National Helpline Database.
Effectiveness
Research demonstrates the effectiveness of CPT. According to one study, CPT is effective in treating PTSD, with participants seeing lasting benefits.
People who engage in CPT may note:
Decrease in intensity and severity of depressive, anxiety, and PTSD symptoms
Shifts in their perspective
Increased feelings of safety
Enhanced sense of trust in self and others
Enhanced sense of personal power and control in their environment
Ability to tolerate distressing emotions
CPT for PTSD and trauma-related responses can lead to improved daily functioning and quality of life.
Alternative Trauma Treatments
Other treatment methods have evidence to support their effectiveness. Researchers have identified prolonged exposure therapy and trauma-focused cognitive behavioral therapy as beneficial alternatives, which are:
Prolonged exposure therapy involves gradually and repeatedly exposing clients to situations, places, and people they have been avoiding because of the altered fear response related to PTSD. This diminishes distress over time.
Trauma-focused cognitive behavioral therapy aims to combat and restructure negative thoughts, appraisals, and memories and promote behaviors that support healing.
Summary
Cognitive processing therapy (CPT) is an effective treatment for trauma and PTSD-related symptoms. It is used to reduce anxiety, anger, and intrusive thoughts that occur as a result of the trauma. It can support people who've experienced combat, sexual assault, child abuse, and more.
In CPT, clients learn skills to manage distressing symptoms, challenge their thinking, and strengthen thoughts and feelings regarding safety, trust, power and control, esteem, and intimacy.
A Word From Verywell
Traumatic experiences can be life changing. They can impact how we feel about ourselves and how we navigate the world. It can be challenging to deal with the onslaught of negative and intrusive thoughts and feelings following a traumatic event. If you're struggling, know that effective treatment is available to help you feel safer.
Frequently Asked Questions
How long does it take to see the results of cognitive processing therapy?
Every person and the situation that's impacted them are unique. The first few sessions of CPT focus on learning about the thoughts, emotions, and trauma symptoms that are connected to the traumatic event. Then, the therapist and client may shift to examining the client's specific thoughts and feelings concerning the trauma. It may take several sessions to begin to experience improvement.
How effective is cognitive processing therapy?
Research shows that CPT is effective at helping people reduce PTSD-related symptoms.
What are the five primary themes of cognitive processing therapy?
There are five themes related to the impact of trauma that you will likely address in CPT. These include safety, trust, power and control, esteem, and intimacy. These aspects of our life often suffer from a traumatic event.
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