CPT for PTSD: What It Is & How It Works

What Is Post-Traumatic Stress Disorder?

The Diagnostic Statistical Manual (DSM) defines post-traumatic stress disorder (PTSD) as a trauma-related disorder that occurs after exposure to actual or threatened death, serious injury, or sexual violence. PTSD often presents as a form of an anxiety disorder because there may be anxiety symptoms present in someone who has PTSD; however, there are differences.

A PTSD diagnosis is present when there are symptoms in the following domains: intrusion, persistent avoidance, negative alterations in mood and cognition, and alteration in arousal/reactivity. These symptoms are related to the traumatic experience(s) that occur for more than one month and cause significant impairment.¹

PTSD impacts the way our brains process information. Someone with PTSD experiences difficulty recognizing when a perceived danger has ended and cannot regulate their system. This happens because repeated traumatic experiences cause our brain’s alarm system, the amygdala, to be overactive.

Common symptoms of PTSD include:

• Vivid flashbacks related to the trauma
• Intrusive thoughts regarding the trauma
• Hypervigilance
• Numbness
• Dissociation 
• Anger/Irritability
• Depression
• Anxiety
• Increased startle response
• Difficulty Sleeping
• Suicidal thoughts

What Is Cognitive Processing Therapy for PTSD?

Cognitive processing therapy (CPT) is an evidence-based and highly recommended therapeutic intervention for PTSD. Over the course of treatment, the client will engage in psychoeducation about PTSD and learn how to challenge and modify unhelpful thinking patterns that developed due to the trauma. The idea is that by changing the thought patterns, healing can begin.³

Trauma survivors experience a shift in their perception of the world and themselves in an effort to understand the traumatic experiences. This can result in overgeneralizing, such as “I always make bad decisions,” “No one can be trusted,” or “I must control everything around me.”² CPT helps the client go back to where these thought distortions began in order to facilitate healing from the trauma.⁴

Three main goals of CPT are:

• Reflect: During CPT treatment, the client will be provided psychoeducation to help them improve their understanding of PTSD and how it impacts them.
• Redefine: Challenging negative cognitions known as “stuck points” will help the client to develop more helpful and realistic beliefs about themselves and the world.
• Recover: Over the course of treatment, the goal is also to see a decrease in PTSD symptoms and improvement in daily functioning.

“In CPT, an individual or group will work with their therapist to explore how traumatic events have altered their thoughts and beliefs, in relation to themselves, others, and the world. By identifying inaccurate and unhelpful thoughts and beliefs, individuals can develop awareness about the impact it plays on their feelings and actions.” – Iliana Chavez, AMFT, Associate Marriage and Family Therapist at My LA Therapy

What Is the Difference Between CBT for PTSD & Cognitive Processing Therapy?

Cognitive behavioral therapy (CBT) for PTSD and CPT are similar in focusing on challenging negative thoughts, increasing understanding of trauma, and decreasing PTSD symptoms. CPT, however, was created as a trauma-informed method to treat PTSD, while CBT was initially developed to treat depression and is also often used in the treatment of anxiety and borderline personality disorder. That said, while both can be effective, the CPT treatment plan is more specifically designed to treat PTSD.

CPT Therapy Vs. Exposure Therapy

Like exposure therapy for PTSD and related conditions, CPT can offer a person insight about PTSD and help them face the uncomfortable thoughts and memories related to a traumatic experience. Nonetheless, unlike CPT, exposure therapy does not usually work to target faulty thinking patterns.^5,6

With CPT, the therapist can help someone confront and challenge the thoughts and memories linked to the traumatic event. They often support the person through the process of correcting any unrealistic, dysfunctional, and troublesome thoughts that are likely fueling PTSD symptoms.^5,6

Is CPT Effective for PTSD?

CPT is one of the most studied PTSD treatment models. There have been 34 randomized controlled trials that have indicated CPT to be effective for treating PTSD.⁷ CPT studies have been conducted with various populations, such as female survivors of sexual assault and veterans experiencing war trauma. The American Psychological Association, the International Society for Traumatic Stress, the United Kingdom’s National Institute for Health and Care Excellence, and the Australian Guidelines identify CPT as a first-line treatment for PTSD.⁷

Cognitive Processing Therapy Techniques

CPT is a highly formatted approach that employs a variety of CBT-based techniques to address PTSD and related conditions, including:⁵

Psychoeducation

The initial phase of CPT often focuses on psychoeducation. The therapist will educate you about PTSD symptoms, explain how PTSD hinders recovery, how avoidance maintains symptoms, and give you an overview about how CPT works. Then, they’ll help you to develop your goals for therapy, and discuss ways CPT can help.

Understanding Thoughts & Feelings

As part of the CPT protocol, you will likely learn how to become more aware of your trauma-related thoughts, emotions, and their effects. You will also gain insight into how this can leave you stuck in beliefs that are self-destructive. From there, you’ll work with your therapist toward detecting and exploring your stuck points.

Learning New Skills

During this CPT stage, you’ll be taught how to question and dispute your thoughts and emotions triggering symptoms as well as ways to think about your trauma differently. Your psychotherapist will typically spend time discussing thought patterns commonly experienced with PTSD and provide you with a variety of coping skills that can diminish anxiety inducing thoughts.

Challenging & Changing Beliefs

In this phase, you’ll be prompted to examine, dispute, and alter faulty thoughts commonly experienced with PTSD, either in sessions or afterwards as homework. The goal is to understand that it’s normal for beliefs about the world to change after trauma and to find equilibrium between your previous thoughts and how you view things now.

What to Expect During CPT for PTSD Sessions

A CPT session will look different than a traditional talk therapy session as CPT offers a structured approach. You can expect to assess your current symptoms, review your weekly homework, and engage in psychoeducation. Your CPT sessions build off one another and incorporate the following themes: safety, trust, power/control, esteem, and intimacy.

During each session, the client will begin by completing an assessment of their current PTSD symptoms. This is an opportunity to explore any changes and discuss any difficulty an individual may have experienced between sessions. They will also review their homework assignments from the week. The CPT therapist will also introduce the next homework assignment and discuss how the client’s experience can be explored through the homework.

Talking About Trauma During CPT for PTSD

Over the course of treatment, there will be an exploration of the traumatic events the individual has experienced. In preparation, the client and the CPT therapist will discuss the person’s trauma history. This does not mean they must go into extensive details of each event. The goal in the history-taking and assessment phase of treatment is to establish what events the individuals are struggling with and to determine which one is causing the most distress.

CPT is a treatment model that heavily involves homework, which enables the client to explore the impact of their trauma and begin working towards behavioral and cognitive changes. The homework involves writing about their trauma in various ways, mostly about the impact of the trauma rather than details of what happened. If someone struggles with writing about their trauma, it is important to talk with their therapist about their concerns.

Will I Have Homework?

Homework is assigned with CPT to help you apply the strategies you have acquired during sessions in your everyday life. Although the content and purpose of the take-home assignments may vary over the course of treatment, it will usually consist of writing or completing worksheets. If you’re unable to finish the homework prior to your therapy session, the therapist will help you complete it during the next visit. Many people have found that the more they engage with homework exercises, the better outcomes they experience with CPT.⁵

How Long Does CPT for PTSD Treatment Last?

CPT is often completed over the courses of 12-15 sessions. CPT can be completed in an individual or group therapy setting. Sessions are typically 45-90 minutes. When undergoing CPT, some people begin to experience the benefits of therapy within the first few sessions, but everyone is different.

Depending on the person’s diagnosis, history, and the symptoms they are experiencing, progress will vary. In addition, the client will be provided homework in between sessions, which will also play a role in how much progress they make and how quickly that happens.

How to Find a CPT Therapist for PTSD

There are many ways you can go about finding a therapist who uses CPT to treat PTSD. Using an online therapist directory is a great place to start. If you have insurance, use your insurance directory to find someone in-network. Remember, not all therapists are trained in CPT. It is important to ask a potential therapist whether they provide trauma-informed treatment to ensure that you are working with someone competent in meeting your needs.

For individuals who do not have a CPT therapist in their area or who prefer to do therapy from home, CPT is available online via online therapy services. The key to successful online therapy is a strong internet connection, privacy, and the right therapist for the individual. That said, it is not the best choice for everyone, so remember to focus on what will be best for you or your loved one.

Remember that it is okay for you to ask as many questions as you need to before hiring a therapist. You can ask a therapist if they offer free consultations, as it can allow you to see if they are the right fit for you. If they don’t, you can do a deep dive into their website and directory listings to see if they feel like a good fit for you.

What About Group CPT Therapy?

CPT can be delivered in a group setting which may involve one or two facilitators and 6-10 members. CPT in group format has shown to be an efficient treatment, helping people better cope with their trauma via shared experiences with others who have also endured similar circumstances. Additionally, CPT groups can be a cost-effective option that provide moral support and facilitate a sense of normalization and universality regarding trauma-related symptoms.⁵

Alternative Treatment Options to CPT for PTSD

While CPT is a great treatment option for PTSD, it is not the only treatment model. It is important for every person to choose the right PTSD therapeutic intervention that is best for them.

Alternatives to CPT for PTSD include:

Eye Movement Desensitization & Reprocessing

Eye movement desensitization and reprocessing (EMDR) for PTSD is an evidence-based practice for treating PTSD. EMDR can help you process thoughts, memories, and feelings related to traumatic events you have experienced.⁸ EMDR therapy uses bilateral stimulation to help reprocess traumatic memories that have been maladaptively stored and are therefore causing PTSD symptoms. The client will focus on the traumatic memory while engaging in bilateral stimulation, which helps to reprocess and properly store the memory in the brain and reduce symptoms.

Narrative Exposure Therapy

Narrative exposure therapy (NET) is a treatment for trauma disorders, specifically for individuals who have experienced multiple traumatic events.⁹ Through guidance from the therapist, a client will narrate their life story, focusing on the trauma they experienced. They will work together to explore the harmful thoughts and feelings the individual may have developed about themselves and others due to their trauma. They will then recreate a coherent narrative that is healthier for the individual. and personal identity.

Prolonged Exposure

Prolonged exposure (PE) is a trauma-focused psychotherapy that works to modify fear/emotion through exposure.¹⁰ During prolonged exposure therapy, the client will engage in imaginal and in vivo exposure surrounding their trauma in order to modify the response to these exposures. Imaginal exposure will take place in the office, with the counselor guiding the client through a trauma-related scenario and helping them to process emotions connected to the exposure. In vivo exposure is interacting with trauma-related stimuli outside of the therapy room that will occur between sessions and will be discussed in the following appointment.

In My Experience

In my experience working with sexual assault survivors, I have seen my clients move from a place of guilt and shame into shifting responsibility onto their perpetrator. The powerful part of CPT is that you end the therapeutic process with lifelong skills and tools to process future issues. This doesn’t necessarily mean that you will never want to go back to therapy again. It means the homework you do during CPT can be applied in real time and used as a powerful and effective coping mechanism.

I remember working with someone who had symptoms of depression and anxiety symptoms that were disrupting their day-to-day life.  Through our work together, this person began to reclaim their life by challenging the stuck points they had been carrying for over 20 years. I saw this person transform into a confident and successful individual.