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How Cognitive Processing Therapy (CPT) Treats Trauma and PTSD

Updated: Jan 11

CPT is one of the most-used and effective therapies for post-traumatic stress disorder (PTSD). Learn why.

Cognitive processing therapy is a structured treatment for post traumatic stress disorder (PTSD).

Many types of therapy strive to heal post-traumatic stress disorder (PTSD). One of them works particularly well, taking a targeted yet gradual approach.

Cognitive processing therapy (CPT) is one of the most tested and proven therapies used to treat PTSD. It targets and treats harmful thoughts that fuel the condition, allowing survivors to gain confidence so they can feel safe in the world again.

This helps relieve the symptoms caused by past trauma.

(CPT is not to be confused with CBT, which is a related therapy. We’ll get more into that below.)

Looking for resources for yourself or your clients right away? Check out our tools for anxiety, PTSD, and self-care.

Ready to learn more about this groundbreaking treatment? Below is a look at CPT, and how it might help you or those you work with.

Article Highlights

How CPT Was Developed

How and Why it Works

How Long Does it Take?

CPT Techniques

Similar Therapies

Find a CPT Therapist

Become a CPT Therapist

Tools and Worksheets

How CPT Was Developed

CPT was developed in 1988 by Dr. Patricia Resick when she was at the University of Missouri in St. Louis. She worked with rape victims at the time, and was looking for a cognitive therapy to help her clients who were suffering from PTSD.

Over time, she developed an approach that built on the ideas from cognitive behavioral therapy (CBT). She adapted the basics of CBT to help her clients work through the unhelpful thoughts relating to their trauma (Resick, 2019).

An early study of CPT showed that this method indeed helped decrease symptoms of PTSD and depression among survivors. Over time, the therapy has been modified and refined, as more was learned about CPT and how to best use it with clients (Resick & Schnicke, 1992; Resick, 2019).

The main difference at the time between Resick’s approach and other PTSD treatments was that it worked from the “top-down,” meaning it targeted the thoughts about the trauma first, rather than targeting the resulting symptoms (Resick, 2019).

CPT therapy targets the thoughts and beliefs relating to your trauma that are contributing to PTSD symptoms.

CPT is now applied to post-traumatic stress disorder (PTSD) in many settings. It’s used with those who’ve survived all types of trauma, including sexual assault, physical assault, accidents, combat exposure, and much more.

Since the initial development of CPT, repeated studies have shown it to be effective across a range of traumas, age groups, and backgrounds (Asmundson, et al., 2019).

How it Works

CPT targets negative thoughts that make people feel unsafe following a trauma. In my experience, these thoughts typically fall within just a few broad categories. They include:

  • Guilt and self-blame. It seems a natural trait for many people to blame themselves after something bad happens. Thoughts such as, “I shouldn’t have done that,” “I should have handled it differently,” or “I didn’t fight back hard enough,” are common beliefs I hear.

  • Beliefs about poor self-worth. Sometimes trauma triggers underlying negative beliefs. Examples include, “I deserve bad things to happen to me,” or “I’m a person unworthy of love or a happy life.”

  • Fear-based thoughts about safety in the world. Following a trauma, humans instinctively try to figure out what’s safe and what’s not. Those who develop PTSD haven’t yet returned to that feeling of safety.

A person with PTSD may think, “Everywhere in the world is unsafe,” or “I will feel out of control in certain situations.” They may also believe people who resemble or are similar to someone who harmed them will be unsafe, ie: “All tall men will harm me.”

These aren’t all of the possible negative beliefs people with PTSD experience, however these categories cover the majority of the thoughts my clients have experienced.

Such thoughts continue to send signals to the survival part of the brain that the world is unsafe. Even months or years following a trauma, someone with PTSD may still feel instinctively in danger.

This often happens even when the individual is in an obviously safe, harmless environment. They may know on the surface-level that nothing bad is likely to happen, but their body still reacts in defensive, self-protective ways. This leads to problems like hypervigilance in public settings, and frequent anxiety.

CPT targets the underlying thoughts, like those above, that are fueling the PTSD. Within this particular therapy, these thoughts are called “stuck points.”

For example, a CPT therapist may guide their client to reconsider thoughts of self-blame. This is often done through the Socratic method.

Rather than “telling” someone what they should believe, the therapist guides them to challenge their own thoughts about the trauma. A set of worksheets are often used to teach this method, which were created for CPT.

I’ve also developed a user-friendly set of PTSD worksheets consistent with treatments like CPT. You can check them out here.

The CPT worksheets, which clients complete both inside and outside of sessions, cover specific skills that help people challenge their negative beliefs.