Cognitive processing therapy (CPT) is a particular branch of cognitive-behavioral therapy (CBT) that supports trauma recovery. CPT teaches clients how to identify, challenge, and change maladaptive thoughts about their trauma. This modification can facilitate positive emotional and behavioral changes. CPT is a structured treatment that consists of approximately 12 sessions designed to help reduce unwanted PTSD symptoms.1
What Is Cognitive Processing Therapy?
CPT teaches clients how to challenge and reframe certain beliefs about their trauma. The overarching premise of this kind of healing has roots in CBT and believes that by changing how you think, you can, subsequently, change how you react and feel.
CPT often consists of psychoeducation, where your therapist will teach you how trauma impacts your thoughts and feelings. You’ll also learn cognitive coping skills, such as “finding the evidence,” using change of thought records, or practicing cognitive restructuring. These techniques can help you ultimately challenge and change rigid beliefs.
“It is recommended to have a diagnosis of PTSD to receive CPT as it is based on the social cognitive theory of PTSD. 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 Therapy8
How Does CPT Therapy Treat PTSD?
Ideally, CPT therapy helps people feel less stuck in trauma. The theory assumes that PTSD symptoms emerge from existing beliefs coupled with post-trauma information. For example, let’s say you once believed in giving people the benefit of the doubt. If someone hurts you, you may get “stuck” in the idea that people are dangerous. A CPT therapist would support you in feeling more capable and empowered to get “unstuck.”
Because PTSD often entails a pervasive sense of feeling unsafe, unloved, or dysregulated, it’s important to learn how to change the thought patterns exacerbating those emotions. Cognitive processing therapy introduces numerous skills designed to help you identify (and embrace) new perspectives for recovery.2
Chaves states, “PTSD can lead to negative emotions like fear, anxiety, guilt, shame, and anger, which are connected to unhelpful thoughts and beliefs pertaining to self, others, and the world, all which interfere with a journey to recovery. If you experience any of the above, CPT can be a helpful tool for you.”
CPT vs. CBT
CPT therapy is a derivative of CBT. Both theories assume that you can understand and change thought patterns. They also assume that you can apply practical coping skills to improve your overall functioning.
Unlike CBT, which was initially developed for treating depression, CPT is specifically trauma-focused, meaning a CPT therapist is highly trauma-informed. As a result, CPT therapists will be more attuned to understanding trauma-based triggers and reactions. They may be more likely to work with certain populations, like veterans, victims of sexual assault, or people coping with acute natural disasters.
Is CPT for PTSD Effective?
Research shows that cognitive processing therapy can be highly effective in treating PTSD symptoms. For example, one current meta-analysis showed that CPT outperforms control groups not receiving therapy for relieving PTSD symptoms. It also showed lasting benefits in follow-up studies.3
In reviewing participants’ written impact statements, CPT correlates with people shifting into a more positive framework about their traumatic events. For example, participants were more likely to report higher levels of self-esteem, a greater ability to trust others, and enhanced intimacy within relationships.4
When treating trauma, most mental health professionals adamantly advocate for utilizing evidence-based care approaches. Evidence-based care ensures a high-quality of standard care coupled with current research about the model’s efficacy. CPT is currently endorsed as a PTSD best practice by the U.S Department of Veterans Affairs and Defense and the International Society of Traumatic Stress Disorder. Presently, the CPT treatment manual is available in six different languages.5
Risks of CPT
Generally speaking, participating in any therapy carries some inherent risk, but the risks of CPT are limited. Research shows that 5-20% of all psychotherapy clients experience issues related to symptom deterioration, the emergence of new symptoms, suicidal ideation, problems with work, relationship issues, or struggles with therapy dependence.6 However, it’s impossible to discern whether therapy causes these symptoms or whether it’s due to a mix of factors, one of which potentially being the difficult emotions that are brought up during therapy sessions.
The following complications may increase the risk of unwanted side effects:
- Premature withdrawal or dropping out of treatment
- Poor mismatch of a therapist with a client
- Financial stressors impacting consistency of treatment
- Co-occurring untreated mental health issues
- Active substance use
CPT therapy requires an active level of participation. In other words, you need a vested interest in your treatment and recovery. It’s normal to feel some discomfort when you first begin the work. Confronting trauma can invariably feel traumatic, which is why it’s crucial to have an open and forthcoming relationship with your therapist.
Criticisms of CPT Therapy
As cognitive-behavioral therapies become more popular, it’s important to recognize potential limitations before beginning this treatment. Some opponents of behavioral-based therapies argue that such models are too restrictive and fail to address the needs of the “whole” person.7 Even some original theorists have expressed concerns that specific cognitive components fail to outperform the “stripped-down” segments of cognitive treatments.
With that in mind, there isn’t much research criticizing cognitive processing therapy exclusively. However, as a general rule of thumb, educating yourself on various trauma treatment options is helpful before choosing a provider.
How to Find a Cognitive Processing Therapist
Choosing the right therapist isn’t always a straightforward task, especially if you’re in an acute crisis. You can find a good CPT therapist by asking friends, family, or your medical provider, or by starting your search on a reputable directory. If you’re struggling, it’s essential to reach out for help before things continue escalating. Preventing distressing symptoms can be much easier than treating them after they have fully unraveled.
Chavez encourages, “It can be helpful for someone seeking CPT support to inquire if a practitioner has received training or a certification for CPT. A practitioner may have acquired some training or become certified through a university, workplace or designed training curriculum. You can always ask a practitioner if they have a training background or experience working with CPT.”
Most therapists offer either in-person or video-based treatment. Some therapists focus on CPT exclusively, while others blend CPT techniques with interventions from other theories. Keep in mind that you may need to meet with a few different providers before finding the right match. Therapy relationships are intimate and evolving, and it’s OK if you don’t mesh with the first person you meet.
Cost of Cognitive Processing Therapy
The cost of treatment will depend on your region, session frequency, and how you intend to pay. For instance, paying a private provider out-of-pocket will almost always cost more than meeting a therapist at a nonprofit clinic.
On average, therapy sessions may range from $60-$250. Obviously, this is an extensive range, but the median cost is around $130 per session. Most people in metropolitan areas will pay more per session than those living in rural areas. Online therapy platforms with membership plans may cost anywhere from $40-$70 per week.
When using health insurance, co-pays typically range between $20-$50 per session. Your insurance may cover treatment if you have a mental health diagnosis, like PTSD or major depression. Depending on your insurance, you may receive an allocated number of sessions per year.
Keep in mind that many therapists offer a sliding scale. With a sliding scale, you pay a subsidized rate based on your income level. Finally, if you are a veteran, you may have access to free or low-cost treatment through the VA Mental Health Services.
What to Expect at Your First Appointment
The first session may feel more formal and administrative than subsequent sessions. Your therapist will likely have you fill out paperwork before arriving. During your first session, they will obtain your informed consent. Informed consent means that you understand and consent to the benefits of risks of therapy. It also means you agree to the terms and conditions of your process.
Your therapist may ask questions about your:
- Mental health
- Physical health
- Family demographics
- Previous therapy experiences
- Goals for treatment
Your therapist may spend a good amount of time reviewing your paperwork and clarifying any information about your mental health. These details help them better understand your current situation, and it supports them in formulating an appropriate treatment plan for your care.
Final Thoughts on CPT
Trauma can be incredibly challenging, and unwanted trauma symptoms often feel disturbing, frustrating, and shameful. That said, you don’t have to suffer alone. Speaking to a trusted CPT professional can make a tremendous difference. While trauma may be part of your story, it does not need to compromise your well-being or jeopardize your entire identity.
