4 Ways That Cognitive Processing Therapy Can Help Heal PTSD

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Going through a traumatic experience is, by definition, horrific. As you try to make sense of what happened, your belief system may be impacted, which, in turn, can change your day-to-day thinking. Thinking patterns that are rooted in trauma can generate painful emotions and hold you back from living the life that you want for yourself. Cognitive processing therapy (CPT) is focused on changing unhelpful, trauma-related thoughts and beliefs that have prevented you from recovering from posttraumatic stress disorder (PTSD).

CPT is considered a first-line, recommended treatment for PTSD by major treatment guidelines, such as those produced by the American Psychological Association, the International Society for Traumatic Stress Studies, and the World Health Organization. It has a substantial research base to support its effectiveness for treating PTSD. At least 35 randomized controlled trials have included CPT as one of the treatment arms. Meta-analyses of these studies suggest that CPT is among the most effective treatments for PTSD, has a high strength of evidence, and demonstrates large effect sizes for reducing PTSD symptoms.

A standard course of CPT treatment consists of 12 sessions. It is most common to conduct sessions weekly over the course of approximately three months, but some providers may offer daily sessions over a period of a few weeks. If you choose CPT as your treatment for PTSD, here are four major components that will aid in your recovery:

1. Distinguishing between changeable and unchangeable emotion: Because traumatic events are inherently painful, CPT distinguishes between “natural” and “manufactured” emotions. “Natural” emotions are hard-wired into humans and are therefore not always possible to change. For example, nearly anyone who loses a beloved family member to an unexpected death is going to feel a sense of sadness when the memory arises. Natural emotions emerge quickly and automatically in response to a traumatic memory, but they also fade quickly. “Manufactured” emotions, on the other hand, are linked to extreme or inaccurate thoughts about the traumatic event. For example, the thought “I should have been able to prevent her death” would likely lead to guilt or shame. Unlike natural emotions, manufactured emotions do not pass quickly with time–they stick around as long as the extreme thought remains. The good news is that changing the thoughts will alleviate the emotion, often quite quickly.
2. Identifying “stuck points,” or unhelpful beliefs: A stuck point is a thought that causes one to get “stuck” in the trauma. Stuck points prevent recovery from PTSD because they continuously produce negative emotions. Stuck points are concise statements that are unhelpful, not fully accurate, or use extreme language. They can be about the trauma (e.g., “I should have prevented it”), oneself (e.g., “I am permanently damaged”), other people (e.g., “If I open up to someone else I will be betrayed”), or the world (e.g., “The world is a dangerous place”). Starting in the second session and lasting throughout the course of therapy, you would create a “stuck point log,” which is essentially a master list of your trauma-related stuck points.
3. Learning tools to change your stuck points: After identifying stuck points, the first half of therapy focuses on teaching skills for evaluating and changing these thoughts. You would practice applying the skills through using a series of worksheets provided by the therapist. You would learn to connect a trauma-related thought to the negative emotions that it produces, evaluate how accurate and/or helpful the trauma-related thought is, and determine how it may fit into a larger pattern of problematic thinking. Most importantly, you would learn how to develop helpful, accurate, balanced thoughts to replace your stuck points.
4. Exploring trauma-related themes: The second half of therapy encourages you to apply your new cognitive skills to address five themes that are frequently impacted by trauma: (1) safety, (2) trust, (3) power and control, (4) esteem, and (5) intimacy. This provides the opportunity to explore how trauma may be impacting your life through areas such as relationship issues, safety concerns, difficulty self-soothing, or fear of not being in control. You would be given special assignments for some of these themes, such as doing nice things for yourself, mapping your levels of trust for a specific friend or loved one, or practicing receiving compliments well.

Although you cannot change what has happened in the past, you can absolutely recover from the distressing, often debilitating symptoms of PTSD. A wealth of scientific evidence suggests that CPT can be integral in that process by helping you change unhelpful, trauma-related beliefs.