What Is Cognitive Processing Therapy?

Cognitive processing therapy (CPT) is an evidence-based psychotherapy for post-traumatic stress disorder (PTSD). Its goal is to help people process traumatic events while challenging and changing unhelpful thoughts.

Trauma is an experience that overwhelms your ability to cope. It can occur through direct involvement or from witnessing an intense or dramatic event, and it often brings on feelings of helplessness, shock, or a loss of control.

For many people, the effects of trauma get better over a short period of time, but sometimes avoidance behaviors, hyperarousal, intrusive memories, and re-experiencing remain for years.

Cognitive processing therapy (CPT) is a talk therapy that addresses the mental health challenges resulting from experiencing trauma. The American Psychological Association (APA) recommends it for the management of post-traumatic stress disorder (PTSD).

What is cognitive processing therapy?

CPT is a type of cognitive behavioral therapy (CBT) used to treat PTSD and other mental health conditions associated with trauma . In CPT, a licensed mental health professional uses specific strategies during conversation-based sessions.

During CPT, a therapist asks you to write or speak in detail about the traumatic event or how you feel about it. You work together to identify problematic beliefs and unhelpful thoughts, like catastrophizing , that increase your levels of distress.

Once specific challenges have been identified during CPT sessions, you work on reframing your thinking to manage and prevent distress associated with the trauma. Homework between CPT sessions helps reinforce what you worked on with the therapist.

The phases of CPT

CPT typically involves 12 weekly sessions , and each session runs between 60 to 90 minutes .

Your therapist guides you through several phases , starting with an initial assessment to determine your mental health needs and if this type of therapy responds to them. Even if you’ve experienced trauma, individual factors like coexisting conditions and how ready you are to engage in trauma-focused work are considered.

Early CPT sessions focus on learning about trauma, how it affects your thoughts and emotions, what CPT is, and how it can help. A therapist will ask you more about the trauma you’ve experienced, and when you’re ready, they will request more details about the event.

You can go at your own pace and talk as much as you feel ready to.

During phases 2 and 3, the conversation with the therapist may focus on the impact of trauma in your life. You may explain how it makes you feel, what emotions you regularly experience, and what thoughts and behaviors you’ve noticed as a result.

Unhelpful thoughts and beliefs about yourself, others, and the world in general are identified and recognized as “stuck points,” or factors that prevent you from trauma recovery . These thoughts and beliefs are known as cognitive distortions . These are thoughts centered around your role in the event and typically lead to feelings of guilt and shame.

For example, “Had I left earlier that day, as I should have, the accident wouldn’t have happened.”

Once you’ve identified stuck points, the therapist may ask you strategic and open-ended questions to help you challenge obstructive thinking and trauma themes. You then start to learn actionable strategies to restructure your thoughts and manage unhelpful thinking that may be causing you distress.

Most phases of CPT focus on addressing stuck points across broader areas of function and building positive internal beliefs that promote healing. For example, you’ll work on overcoming challenges related to safety, trust, and self-esteem.

At the end of your CPT therapy program, you and the therapist create a plan for maintaining your progress moving on, generally starting with a follow-up session after 30 days of completing the initial four phases.

What are the 5 themes of cognitive processing therapy?

Toward the end of your CPT program, the therapist shifts focus to how trauma affects five key areas that steer your beliefs and perceptions about the world:

• Safety: How safe you feel and how safe you perceive others to be.
• Trust: How much you believe in the intentions and dependability of others.
• Power/control: The level of influence you feel you have in everyday outcomes.
• Self-esteem: Your perception of self-worth and self-efficacy.
• Intimacy: How willing and open you are to engage with and be close to others.

If the CPT therapist identifies any stuck points across these five realms, they may provide targeted approaches and strategies, like improving communication, practicing self-forgiveness, or setting achievable goals.

What is the difference between cognitive behavioral and cognitive processing therapy?

CBT is a broad psychotherapy framework that focuses on restructuring problematic thoughts and behaviors across a variety of settings. It can feature a wide array of techniques determined by an individual’s diagnosis or needs.

It’s typically used for:

• substance use disorder
• major depressive disorder (MDD)
• anxiety disorders
• adjustment disorders

CPT is a type of CBT that focuses specifically on trauma-related mental health challenges. Its techniques specifically involve detailed trauma exploration through written or verbal impact statements.

Who is cognitive processing therapy for?

CPT is for people who’ve experienced a traumatic event and may have been diagnosed with a related mental health condition, such as PTSD .

Not everyone experiencing a trauma-related condition is a candidate for CPT, and severe symptoms like psychosis and addiction may require other approaches before CPT is recommended.

Is cognitive processing therapy effective?

CPT is evidence-based, and experts consider it one of the most effective treatments for PTSD. APA highly recommends CPT in their PTSD treatment guidelines .

In 2018, a meta-analytic review found CPT was an effective treatment for PTSD symptoms with lasting benefits across a variety of outcomes.

A smaller 2024 study investigating the effectiveness of CPT for PTSD in severe mental health conditions resulted in statistically significant improvements in both PTSD and depression symptoms among study participants.

Will exploring trauma make my symptoms worse?

Some people may experience an increase in PTSD symptoms around the time trauma is detailed in CPT. These exacerbations are usually temporary , and your therapist will adjust your sessions to allow you time to adjust and process trauma gradually.

Read more about post-traumatic growth and how to start healing .

How long does CPT take to work?

CPT usually lasts for 12 sessions, and you may start to see improvement after the first few .

A CPT program may last longer than the expected 3 months. Trauma affects everyone differently, and additional sessions are added if your therapist feels you’ll benefit from more attention in a specific area.

Takeaway

CPT is a psychotherapy within the framework of CBT that addresses trauma-related mental health conditions. It’s primarily used in the management of PTSD, though it can be applied to other conditions involving trauma, like depression.

During CPT, your therapist guides you through your traumatic experience and helps you identify the thoughts and behaviors preventing you from coping and healing.

Although the therapy typically takes 12 weeks to complete, long-term success is achieved through follow-up planning and the ongoing application of CPT skills in daily life.