What is cognitive processing therapy?
Cognitive Processing Therapy (CPT) is a specific form of cognitive-behavioral therapy (CBT) that was developed by psychologists in the Veterans Administration. It was specifically designed to help people suffering from posttraumatic stress disorder (PTSD).
CPT was recently recommended by the American Psychological Association as a first-line treatment for PTSD. The APA’s treatment guidelines recommend CPT more highly than medication. It has been the subject of some recent media attention thanks to a wonderful in-depth report by NPR journalist Jaime Lowe who described her own experience with CPT on a recent podcast.
How does cognitive processing therapy work?
At a basic level, cognitive processing therapy is based on the notion that what we think affects how we feel. After a traumatic event, our thinking sometimes changes. This can be an effort to cope with the traumatic event, or an effort to keep ourselves safe going forward. For example, someone who was in a deadly car accident might think afterwards, “other drivers are mostly maniacs.” This change in his or her thinking would help them feel safer on the roads because it would lead them to drive much more defensively.
Another way in which our thinking is relevant to PTSD is when we blame ourselves for the traumatic event. Consider the example of a woman who was with her sister when the sister drowned. If the woman believed the drowning to have been caused by unusually strong currents that day, she would of course feel intense grief at the loss of her sister. However, she would be less likely to develop PTSD than if she believed that “if I had gone with her into the water, she wouldn’t have drowned.” Self-blame can play a very strong role in PTSD, and is something that is often a focus in CPT.
Some types of traumatic events tend to cause more self-blame than others. Abuse or assault that happens during childhood often leads to subtle but impactful forms of self-blame. This is because when we are children we think differently than when we are adults; we are quicker to assume that positive or negative events reflect on us. Sexual assault also lends itself to self-blame, because of 1) the personal nature of the crime and 2) the fact that the perpetrator is often known to the victim beforehand. Self-blame is a form of thinking (as mentioned above) that can feel helpful in the aftermath of a traumatic event; it can help us feel like we have total control over what happens to us. Unfortunately, self-blame can keep us stuck in PTSD and block our natural capacity for healing after an awful event.
CPT can help us learn to think differently about, or re-process, a traumatic event, even if that event was many years ago. For people with PTSD it can be very difficult to talk about or think about the events that changed their lives. It can be even harder to challenge assumptions we have had about these events for a long time. But CPT can help us do these things in a structured and focused way that is proven to reduce the severity of PTSD.
Is cognitive processing therapy a “cure” for PTSD?
For some people, CPT can indeed be a cure for PTSD. This doesn’t mean the traumatic event is forgotten, of course. It just means that the memory of the event no longer causes significant impairment for the person who endured the event.
Research shows that most people who complete a course of CPT do experience a significant reduction in symptoms of PTSD. However, many people continue to have PTSD after treatment, just milder than before. CPT is typically delivered in ten sessions, although sometimes it is adapted to particular situations and can take a bit longer. Some people with PTSD find it difficult to get through the sessions, or to do the homework that is a critical part of CPT. A certain amount of commitment is necessary to get complete the treatment.
It is unlikely that CPT will be significantly helpful without completing the sessions and/or doing the homework exercises. The exercises help you practice examining your thoughts and emotions in a specific way that has been shown to help healing from PTSD. Don’t be fooled by the word “homework,” though, CPT feels much more like therapy than like an academic class.
CPT helps address the ways in which a traumatic event has affected our beliefs about many aspects of our lives, including trust, intimacy, safety, self-esteem and others. The effects of trauma on self-esteem can be devastating. This is true for survivors of adult trauma but even more for survivors of childhood trauma.
What other treatment options are there?
CPT is certainly not the only treatment available for people with PTSD. There are other good options available that do not involve medication. There are many types of therapy that claim to treat trauma but many of these have been been proven through research. Fortunately, a few types of therapy for PTSD do have substantial research support. Medication can be part of a comprehensive treatment plan for PTSD but it is certainly not necessary for everyone.