Rewriting the Narrative
Cognitive Processing Therapy (CPT)
Cognitive Processing Therapy (CPT) is a specific type of Cognitive Behavioral Therapy (CBT) that is highly effective and evidence-based for treating Post-Traumatic Stress Disorder (PTSD). It focuses on how an individual thinks about their trauma and its aftermath. The goal of CPT is to challenge and modify unhelpful stuck points—dysfunctional beliefs about the self, others, and the world—that prevent emotional recovery following a traumatic event.
Who Created CPT?
CPT was developed by American clinical psychologist Dr. Patricia A. Resick in the late 1980s and early 1990s. Initially designed for female victims of sexual assault, it grew out of the cognitive model of PTSD and rapidly expanded as a standardized, manualized treatment. It utilizes a combination of written exposure and cognitive restructuring to help the individual integrate the traumatic event into their overall life narrative (Resick & Schnicke, 1992).
Perspectives in CPT
The Therapist's Perspective
The CPT therapist views PTSD symptoms not as a failure to cope, but as a result of the trauma victim’s natural attempt to make sense of an event that shattered their core beliefs (e.g., "The world is safe," "I am competent"). When the trauma doesn't make sense, the brain creates stuck points (cognitive distortions) to fill the gaps, which ultimately keep the person emotionally trapped.
The therapist acts as a guide and educator, specifically using the Socratic method to help the client discover the flaws in their stuck points. They focus on five key areas often impacted by trauma: Safety, Trust, Power/Control, Esteem, and Intimacy. The therapist's goal is to help the client move from a state of emotional numbing and avoidance to cognitive flexibility and accurate risk assessment.
The Client's Perspective
The client shifts from believing that the trauma dictates their entire life to realizing that the way they are thinking about the trauma is what keeps them suffering. The client learns that their emotional pain is perpetuated by avoidingthinking about the event and holding onto unhelpful beliefs (e.g., "I should have prevented it," "I can't trust anyone").
The client's main tasks involve:
Writing: Completing structured written assignments to confront and process the traumatic memory and its meaning.
Challenging: Actively engaging with the therapist to question the logic and evidence supporting their stuck points.
Disseminating: Learning to apply the skills of cognitive restructuring to new, day-to-day problems, not just the original trauma.
What to Expect in a CPT Session
CPT is typically delivered in 12 highly structured sessions (though this can vary). It has two main tracks: CPT with a written trauma account, or CPT without a written account. CPT is often completed in the following phases:
Psychoeducation: The therapist teaches the client about PTSD, the cognitive model, and the concept of "stuck points."
The Impact Statement: The client writes a statement detailing why they think the trauma occurred and how it has affected their beliefs. This reveals the key stuck points.
Written Trauma Account (Core Processing): The client writes a detailed, first-person account of the trauma. They read this account aloud in session and review it daily. The purpose is not to relive the emotion, but to provide material for cognitive restructuring. This is the exposure element of the therapy.
Cognitive Restructuring: Using structured worksheets (e.g., the Challenging Questions and Patterns of Problematic Thinking worksheets), the client systematically disputes their stuck points related to the five key themes (Safety, Trust, Power/Control, Esteem, Intimacy).
Final Summary: The client writes a new, integrating final impact statement that reflects their modified, balanced beliefs, demonstrating successful processing of the event (Resick et al., 2017).
How CPT Can Help a Person
CPT is highly effective at reducing the core symptoms of PTSD by:
Challenging Self-Blame: By confronting the written account and questioning "shoulds," clients reduce excessive self-blame and guilt.
Restoring Function: Clients replace overly restrictive, trauma-driven safety behaviors with realistic, balanced behaviors, restoring a sense of control and reducing avoidance.
Creating Integration: The written component helps move the memory from being a fragmented, emotionally raw "hot flash" to a narrative that is integrated into the client's past, reducing intrusive symptoms like flashbacks.
Common Uses and Applications (DSM-5 Disorders and Life Problems)
CPT is specifically and strongly recommended as a first-line treatment for:
Post-Traumatic Stress Disorder (PTSD): Resulting from single or multiple traumas (e.g., combat, sexual assault, domestic violence, accidents).
Acute Stress Disorder
Because it is a cognitive restructuring treatment, it can also be beneficial as an adjunct for trauma-related symptoms in:
Comorbid Major Depressive Disorder
Substance Use Disorder (when trauma is a significant factor)
Persistent Difficulties with Trust and Intimacy rooted in trauma.
References
Resick, P. A., Monson, C. M., & Chard, K. M. (2017). Cognitive processing therapy for PTSD: A comprehensive manual. The Guilford Press.
Resick, P. A., & Schnicke, M. K. (1992). Cognitive processing therapy for sexual assault victims. Journal of Consulting and Clinical Psychology, 60(5), 748–756.
Ready to Process Your Past and Reclaim Your Future?
If you are struggling with the symptoms of trauma and are ready to change the story you tell yourself about what happened, CPT offers a clear, effective path to recovery.
Connect with one of our therapists trained in CPT and begin the evidence-based work of cognitive restructuring and healing.
