Cognitive Processing Therapy

Cognitive Processing Therapy for Post Traumatic Stress Disorder

Clinical guidelines and evidence based practice have established that specific interventions that are trauma-focused support the best outcomes for patients struggling with trauma and Post Traumatic Stress Disorder (PTSD). Cognitive Processing Therapy (CPT) is the trauma-focused psychotherapy proving most effective for long term improvements in overall functioning and quality of life for people with PTSD. EHN-Canada is committed to a standardized CPT approach in the trauma work we do with our patients across the country. CPT is a hallmark of our nationally recognized C-TAP Program (Concurrent Trauma and Addiction Program) that is offered in our residential treatment facility Edgewood Treatment Centre in Nanaimo, BC.

CPT essentially teaches patients how to evaluate and change the upsetting thoughts they have had since they experienced a traumatic event. Based on the principles of Cognitive Behavioral Therapy (CBT), the premise of CPT is that by changing your thoughts, you can change how you feel and behave.

How Does CPT Work?

Experiencing a traumatic event or prolonged exposure to chronic trauma can dramatically change and distort the way you think about yourself and the world. The impact of trauma in fact, can lead to actual changes in the chemistry and structure of the brain. Typical thought processes of trauma and PTSD include believing you are to blame for the traumatic event(s) or that the world is a dangerous place. These kinds of thoughts keep patients stuck in maladaptive behaviours, isolation, and avoidance leading to poor functioning, low quality of life and co-occurring depression and anxiety.

Cognitive Processing Therapy teaches patients new ways of coping and managing upsetting thoughts, images and senses described as “triggers” related to the trauma. In CPT, patients learn specific skills that can help them decide whether there are more helpful ways to think about the trauma. Patients learn how to examine and evaluate whether the facts at hand actually support their thoughts or do not support their thoughts. Ultimately the goal is to help patients take on a new perspective that is based in reality rather than on fear, avoidance and anxiety.

What Can be Expected from CPT?

The clinician (usually a doctorate level psychologist or licensed psychotherapist) will start by giving the patient an overview of the treatment process and the stages of CPT. They will review some information about PTSD to help the patient better understand their symptoms and related feelings of fear, anxiety and sadness. The therapist will ask about the type of trauma the patient experienced, and it will be up to their discretion how much detail is provided about the traumatic event or “index trauma.” Typically, the patient is asked to do some writing about how the trauma has affected their lives and their overall functioning.

Over the next several sessions, patients will be asked to describe in detail, the negative or unhelpful thoughts they have been having about the trauma and will work with their clinical team to consider other ways of thinking about the situation. Patients use specific worksheets in session and as “homework” that will help them learn this strategy. CPT can also include writing about the details of the trauma, if it is decided that providing graphic detail of the traumatic event is right for the patient. It may sound difficult at first, but writing about the trauma may help patients cope with emotions like anger, sadness and guilt. Towards the end of therapy, the patient will be supported to focus on some specific areas of their life that may have been affected by the trauma, including their sense of safety, trust, control, self-esteem, and intimacy.

How Long Does CPT Last?

Cognitive Processing Therapy usually involves 12 weekly sessions however, in C-TAP at EHN-Canada, we compress the work into 6-9 weeks because our patients are typically in residential care receiving these services.  Individual and group sessions are usually 60 to 90 minutes each.

Do Patients Talk in Detail about their Trauma in CPT?

While many patients feel the need to go into explicit and graphic description of their trauma, others avoid it. EHN-Canada is committed to starting where the patient is in this regard. In Cognitive Processing Therapy, patients may not need to talk about the specific details of their trauma, but they will be asked to talk about their beliefs and feelings related to the trauma. Patients may also choose the type of CPT that involves writing about the details of the trauma, but this is optional. If it is decided that writing about the trauma is right for the particular person, this writing assignment will be done outside of the therapy sessions after about the third CPT intervention. Sometimes this written trauma account is read out loud in the next session. If there is group CPT, a patient will read through their written trauma account with a therapist in an individual session — but typically not in front of the whole group.

Is There Homework in CPT?

CPT involves homework assignments aimed at helping patients solidify the gains they made in group or individual therapy. Patients will do some writing and complete worksheets between sessions that will help them practice the skills they learn during therapy. It is clear that the more effort and energy people put into these assignments, the more benefits they get out of Cognitive Processing Therapy.