Cognitive Processing Therapy (CPT)
If you are interested in counseling using CPT, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.
What is Cognitive Processing Therapy?Cognitive Processing Therapy, usually shortened to CPT, is a specific, structured form of cognitive behavioral therapy developed to treat posttraumatic stress disorder. It was created by Dr. Patricia Resick, who began building and testing the approach in 1988 and first studied it with survivors of sexual assault (Resick & Schnicke, 1992). In the decades since, CPT has been tested across a wide range of trauma types, including combat, childhood abuse, physical and sexual assault, serious accidents, and disasters. It now carries the strongest level of recommendation in every major clinical practice guideline for PTSD.
CPT rests on a fairly direct observation. Most people who live through a traumatic event recover from it over time without formal treatment. PTSD develops when that natural recovery gets interrupted, and one of the most common things that interrupts it is the way a person comes to make sense of what happened. Trauma can change how you see yourself, other people, and the world, and some of those changed beliefs are what keep the distress locked in place. CPT is built to find those beliefs and examine them directly. How CPT Understands PTSDAfter a trauma, the mind tries to make sense of an experience that usually does not fit what a person believed beforehand about safety, trust, fairness, control, or their own judgment. Resick's model describes two common ways that sense-making goes wrong and keeps someone stuck.
The first is assimilation, where a person changes their understanding of the event itself in order to protect their prior beliefs. Self-blame is the clearest example. "If I had done something differently, it would not have happened," or "It was my fault." Holding onto that kind of belief preserves the sense that the world is predictable and that the person was in control, but it does so at a real cost. The second is over-accommodation, where a person swings their beliefs about themselves and the world too far in the opposite direction. "I cannot trust my own judgment about anything." "The world is completely dangerous." "I am permanently broken." These beliefs feel protective, and they made sense as an immediate response to something terrible, but over time they tend to shrink a person's life and keep the nervous system on constant alert. CPT refers to these extreme or conflicting beliefs as stuck points. The work of therapy is to identify them and hold them up against the actual evidence. This is not forced positivity, and a good CPT therapist will never push a client toward a cheerful interpretation that the facts do not support. The goal is accommodation, which means adjusting beliefs so they account for what genuinely happened while staying balanced and accurate. Someone finishing CPT is more likely to arrive at something like "I did the best I could with what I knew at the time" or "some situations carry risk, and most of my life is safe enough," because that is where the evidence leads, not because a therapist told them to think it. |
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What Does the Evidence Say?
CPT is among the most thoroughly researched psychological treatments in existence. It is strongly recommended as a first-line treatment for PTSD by the American Psychological Association's 2017 Clinical Practice Guideline, by the Department of Veterans Affairs and Department of Defense, by the International Society for Traumatic Stress Studies, and by the United Kingdom's National Institute for Health and Care Excellence (NICE).
The research base spans many kinds of trauma and many populations, and it includes individuals with complicated presentations such as co-occurring depression, substance use concerns, and personality disorders. Studies also show that the gains people make in CPT tend to hold up well after treatment ends, which is consistent with the nature of the work. CPT teaches a skill, the ability to examine your own thinking and weigh it against evidence, and that skill stays with you.
The research base spans many kinds of trauma and many populations, and it includes individuals with complicated presentations such as co-occurring depression, substance use concerns, and personality disorders. Studies also show that the gains people make in CPT tend to hold up well after treatment ends, which is consistent with the nature of the work. CPT teaches a skill, the ability to examine your own thinking and weigh it against evidence, and that skill stays with you.
What CPT Looks Like in Practice
CPT is structured and time-limited. A standard course typically runs about 12-16 weekly sessions although this can vary depending on a client's needs and symptoms. Many people notice some improvement within the first several sessions.
Treatment moves through three broad phases. It begins with education about PTSD and about the connection between thoughts and feelings, so the model makes sense before the harder work starts. Early on, your therapist will ask you to write an Impact Statement, a short piece about why you think the trauma happened and how it has affected your beliefs about yourself, others, and the world. That statement helps the two of you locate your specific stuck points.
The middle phase is where most of the work happens. Using a series of worksheets, you and your therapist examine the stuck points you have identified, one at a time. The method is Socratic, which means your therapist asks questions rather than handing you conclusions. You learn to ask those same questions of yourself: What is the evidence for this thought? Is there another way to see it? Am I confusing a feeling with a fact? Over time the worksheets build on each other, moving from examining a single belief to recognizing the broader patterns in your thinking.
The final phase applies these skills to five areas that trauma commonly disrupts: safety, trust, power and control, esteem, and intimacy. By the end, the aim is for you to be able to do this work on your own, without the therapist and without the worksheets.
Homework is central to CPT. The skills only become useful when they are practiced in your actual life between sessions, and the research consistently shows that people who engage with the practice assignments get more out of the treatment.
Treatment moves through three broad phases. It begins with education about PTSD and about the connection between thoughts and feelings, so the model makes sense before the harder work starts. Early on, your therapist will ask you to write an Impact Statement, a short piece about why you think the trauma happened and how it has affected your beliefs about yourself, others, and the world. That statement helps the two of you locate your specific stuck points.
The middle phase is where most of the work happens. Using a series of worksheets, you and your therapist examine the stuck points you have identified, one at a time. The method is Socratic, which means your therapist asks questions rather than handing you conclusions. You learn to ask those same questions of yourself: What is the evidence for this thought? Is there another way to see it? Am I confusing a feeling with a fact? Over time the worksheets build on each other, moving from examining a single belief to recognizing the broader patterns in your thinking.
The final phase applies these skills to five areas that trauma commonly disrupts: safety, trust, power and control, esteem, and intimacy. By the end, the aim is for you to be able to do this work on your own, without the therapist and without the worksheets.
Homework is central to CPT. The skills only become useful when they are practiced in your actual life between sessions, and the research consistently shows that people who engage with the practice assignments get more out of the treatment.
The Written Trauma Account: Optional, and Decided Together
A common worry about trauma therapy is the fear of being made to relive the event in detail. It is worth being clear about how CPT handles this.
CPT does involve talking and writing about your thoughts regarding why the trauma happened and how it changed your beliefs. Whether you write out a detailed account of the event itself is a separate question, and it is optional. Some versions of CPT include a written trauma account that you write at home, read to yourself, and read aloud in session. Research that examined the protocol piece by piece found that the version without the detailed written account is also effective, which is why the account is now a choice you and your therapist make together rather than a requirement. If you do choose it, it typically comes in around the third session, and your therapist will prepare you for it carefully. Plenty of people complete CPT and benefit from it without ever writing a detailed account of the trauma.
CPT does involve talking and writing about your thoughts regarding why the trauma happened and how it changed your beliefs. Whether you write out a detailed account of the event itself is a separate question, and it is optional. Some versions of CPT include a written trauma account that you write at home, read to yourself, and read aloud in session. Research that examined the protocol piece by piece found that the version without the detailed written account is also effective, which is why the account is now a choice you and your therapist make together rather than a requirement. If you do choose it, it typically comes in around the third session, and your therapist will prepare you for it carefully. Plenty of people complete CPT and benefit from it without ever writing a detailed account of the trauma.
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CPT at OakHeartMost of our trauma clinicians are formally trained in CPT and deliver the full protocol. Others draw on CPT's cognitive methods, the stuck point work, Socratic questioning, and the theme modules, as part of a broader and more individualized course of trauma treatment rather than the standard protocol. Both can be appropriate depending on the person, the nature of the trauma, and what someone is looking for. In addition, many of our trauma specialists attend a Trauma/PTSD specific professional consultation group alongside their formal training, to ensure their work stays faithful to the model, continues to sharpen over time, and that complicated cases get the benefit of experienced peer input.
During your assessment, your clinician will talk with you about which approach fits your situation. That conversation also covers whether CPT is the right trauma-focused therapy for you at all, or whether something like Prolonged Exposure or a combination of approaches makes more sense given your history and preferences. You can read more about the conditions this work addresses on our PTSD and Trauma pages. CPT can be delivered individually or in a group format. At OakHeart, we provide CPT in individual sessions. |
How CPT Differs from Other Trauma Treatments
PT is one of several trauma-focused therapies with strong research support, and the differences between them come down to mechanism and emphasis.
Prolonged Exposure (PE) is also strongly recommended for PTSD. It works primarily by helping you approach trauma memories and avoided situations gradually and repeatedly, so that the fear and other emotions attached to them decreases and you learn that the memory itself is not dangerous. CPT works primarily through the meaning side of things (cognition), examining and shifting the beliefs you have formed about the trauma. Both are effective, and the better choice often depends on what fits the person.
EMDR (Eye Movement Desensitization and Reprocessing) is another trauma-focused approach that the APA suggests and the VA/DoD recommends. It involves processing trauma memories while engaging in guided eye movements or other forms of bilateral stimulation.
CPT also differs from general Cognitive Behavioral Therapy in that it is a specific, manualized protocol built for trauma, rather than the broad family of cognitive and behavioral techniques that CBT refers to. CPT is a member of that family, refined and tested for one job.
Prolonged Exposure (PE) is also strongly recommended for PTSD. It works primarily by helping you approach trauma memories and avoided situations gradually and repeatedly, so that the fear and other emotions attached to them decreases and you learn that the memory itself is not dangerous. CPT works primarily through the meaning side of things (cognition), examining and shifting the beliefs you have formed about the trauma. Both are effective, and the better choice often depends on what fits the person.
EMDR (Eye Movement Desensitization and Reprocessing) is another trauma-focused approach that the APA suggests and the VA/DoD recommends. It involves processing trauma memories while engaging in guided eye movements or other forms of bilateral stimulation.
CPT also differs from general Cognitive Behavioral Therapy in that it is a specific, manualized protocol built for trauma, rather than the broad family of cognitive and behavioral techniques that CBT refers to. CPT is a member of that family, refined and tested for one job.
Frequently Asked Questions
Will I have to describe my trauma in detail?
Not necessarily. CPT always involves examining your thoughts and beliefs about the trauma, but writing a detailed account of the event itself is optional and is something you decide together with your therapist. Many people complete CPT without ever writing one.
How long does CPT take?
A standard course is around 12-16 weekly sessions. Some people need somewhat more time, particularly with multiple traumas or co-occurring concerns, and your therapist will track your progress with you throughout.
Is CPT going to make me feel worse?
The most common risk is mild to moderate discomfort when discussing or writing about trauma-related thoughts and memories. That discomfort is usually brief, and for most people it eases as treatment continues. The large majority of people who complete CPT find the benefits well worth the initial difficulty. If something feels like too much, that is information to bring to your therapist, who will adjust the pace with you.
My trauma happened a long time ago. Can CPT still help?
Yes. CPT does not depend on the trauma being recent. People who have lived with PTSD for many years can and do respond to it.
What is the difference between CPT and EMDR or Prolonged Exposure?
All three are evidence-based, trauma-focused therapies. CPT works mainly by examining and changing the beliefs you have formed about the trauma. Prolonged Exposure works mainly by helping you approach trauma reminders until the fear subsides. EMDR processes trauma memories alongside guided bilateral stimulation. Your clinician can help you think through which is the best fit for you.
Is CPT available via telehealth?
Yes. CPT translates well to telehealth, and there is research supporting its delivery in that format. OakHeart offers CPT via telehealth throughout Illinois, in addition to in-person sessions at our North Aurora and Sycamore locations.
Can children or adolescents do CPT?
Yes, for adolescents there is good evidence behind it. A developmentally adapted version of CPT has been tested in randomized trials with teens and young adults who have abuse-related PTSD, with gains that held up at follow-up. For younger children, other trauma-focused treatments are usually the better-studied place to start. If you are seeking trauma treatment for a young person, we will talk through the most appropriate, evidence-based option for their age during the assessment.
Our team of licensed psychologists, counselors, and social workers in North Aurora and Sycamore, Illinois provides evidence-based trauma treatment, including CPT, to clients throughout Kane County, DeKalb County, DuPage County, and the surrounding Chicago suburbs, with in-person and telehealth options throughout Illinois.
Not necessarily. CPT always involves examining your thoughts and beliefs about the trauma, but writing a detailed account of the event itself is optional and is something you decide together with your therapist. Many people complete CPT without ever writing one.
How long does CPT take?
A standard course is around 12-16 weekly sessions. Some people need somewhat more time, particularly with multiple traumas or co-occurring concerns, and your therapist will track your progress with you throughout.
Is CPT going to make me feel worse?
The most common risk is mild to moderate discomfort when discussing or writing about trauma-related thoughts and memories. That discomfort is usually brief, and for most people it eases as treatment continues. The large majority of people who complete CPT find the benefits well worth the initial difficulty. If something feels like too much, that is information to bring to your therapist, who will adjust the pace with you.
My trauma happened a long time ago. Can CPT still help?
Yes. CPT does not depend on the trauma being recent. People who have lived with PTSD for many years can and do respond to it.
What is the difference between CPT and EMDR or Prolonged Exposure?
All three are evidence-based, trauma-focused therapies. CPT works mainly by examining and changing the beliefs you have formed about the trauma. Prolonged Exposure works mainly by helping you approach trauma reminders until the fear subsides. EMDR processes trauma memories alongside guided bilateral stimulation. Your clinician can help you think through which is the best fit for you.
Is CPT available via telehealth?
Yes. CPT translates well to telehealth, and there is research supporting its delivery in that format. OakHeart offers CPT via telehealth throughout Illinois, in addition to in-person sessions at our North Aurora and Sycamore locations.
Can children or adolescents do CPT?
Yes, for adolescents there is good evidence behind it. A developmentally adapted version of CPT has been tested in randomized trials with teens and young adults who have abuse-related PTSD, with gains that held up at follow-up. For younger children, other trauma-focused treatments are usually the better-studied place to start. If you are seeking trauma treatment for a young person, we will talk through the most appropriate, evidence-based option for their age during the assessment.
Our team of licensed psychologists, counselors, and social workers in North Aurora and Sycamore, Illinois provides evidence-based trauma treatment, including CPT, to clients throughout Kane County, DeKalb County, DuPage County, and the surrounding Chicago suburbs, with in-person and telehealth options throughout Illinois.
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References
American Psychological Association. (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. American Psychological Association.
Resick, P. A., Monson, C. M., & Chard, K. M. (2017). Cognitive processing therapy for PTSD: A comprehensive manual. Guilford Press.
Resick, P. A., & Schnicke, M. K. (1992). Cognitive processing therapy for sexual assault victims. Journal of Consulting and Clinical Psychology, 60(5), 748-756.
Resick, P. A., Wachen, J. S., Dondanville, K. A., Pruiksma, K. E., Yarvis, J. S., Peterson, A. L., & Mintz, J. (2017). Effect of group vs individual cognitive processing therapy in active-duty military seeking treatment for posttraumatic stress disorder: A randomized clinical trial. JAMA Psychiatry, 74(1), 28-36.
U.S. Department of Veterans Affairs, National Center for PTSD. Cognitive Processing Therapy (CPT) for PTSD. https://www.ptsd.va.gov/understand_tx/cognitive_processing.asp
Resick, P. A., Monson, C. M., & Chard, K. M. (2017). Cognitive processing therapy for PTSD: A comprehensive manual. Guilford Press.
Resick, P. A., & Schnicke, M. K. (1992). Cognitive processing therapy for sexual assault victims. Journal of Consulting and Clinical Psychology, 60(5), 748-756.
Resick, P. A., Wachen, J. S., Dondanville, K. A., Pruiksma, K. E., Yarvis, J. S., Peterson, A. L., & Mintz, J. (2017). Effect of group vs individual cognitive processing therapy in active-duty military seeking treatment for posttraumatic stress disorder: A randomized clinical trial. JAMA Psychiatry, 74(1), 28-36.
U.S. Department of Veterans Affairs, National Center for PTSD. Cognitive Processing Therapy (CPT) for PTSD. https://www.ptsd.va.gov/understand_tx/cognitive_processing.asp
