What is Cognitive Processing Therapy?

Cognitive Processing Therapy, usually shortened to CPT, is a structured treatment for post-traumatic stress developed in the late 1980s and refined over three decades of research. It sits alongside Prolonged Exposure as one of the two treatments the VA and Department of Defense clinical practice guideline recommends most strongly for PTSD. It is an approach Dr. Thaxter trained in through the VA. She completed the training and consultation the developers require and is listed on their national CPT Provider Roster, and it is one of several approaches she draws on in this practice.

The idea underneath it

When something terrible happens, people draw conclusions from it. “I should have known.” “I can’t trust my own judgment.” “If I let my guard down, it happens again.” These are not irrational. They were reasonable conclusions drawn from real evidence at the worst moment of your life. The problem is that they were formed under extreme conditions and have never been re-examined with everything you know now.

CPT calls these stuck points. The treatment is a systematic way of finding them and questioning them, not with positive thinking, and not by arguing with yourself, but by looking at the actual evidence the way you would look at any other claim.

What the sessions look like

A standard course runs around twelve sessions, though the number varies with the person, and it is never applied rigidly. The early sessions explain how trauma changes belief rather than just mood, and you write a short impact statement: what you currently believe the event says about you, about other people, and about the world. The middle sessions identify the specific beliefs doing the most work and teach a structured set of questions to apply to them. The later sessions work through the five areas trauma most reliably distorts: safety, trust, power and control, esteem, and intimacy. Near the end you write the impact statement again and read the first one. Most people do not need that moment explained to them.

The homework matters

There is written work between sessions, usually twenty to forty minutes. This is the part people underestimate. The hour with the psychologist is where you learn the tool; the week is where it changes anything. People who do the practice tend to get better, and people who skip it tend to get less out of it. It’s better to know that at the start than at session six.

What CPT does not ask of you

You are not asked to retell the event over and over. CPT focuses on the beliefs rather than on repeated exposure to the memory. You write about it once, and after that most of the work is on what you concluded from it. For many people this is the difference between a treatment they can face and one they cannot.

An emotion changing is not an emotion shrinking

This distinction does most of the work. Some feelings are manufactured by a belief that does not hold up. Guilt produced by “I should have known” is guilt about something that was not, in fact, knowable, and when the belief is examined, that guilt tends to ease, because it was never accurate. Other feelings are entirely accurate. Grief at losing someone is not a symptom and not a target. CPT does not try to talk you out of it. Much of what treatment does is separate the two, so that you stop fighting the grief and stop carrying the guilt.

Who it is for, and who it is not

CPT is for adults with post-traumatic stress, whether from a single event or from years of cumulative exposure. It is used with Veterans, Service Members, first responders, survivors of assault, and people whose trauma has nothing to do with any of those. It works over telehealth, live and one on one, and has been studied that way extensively across the VA system.

It is not the right first step if you are in acute crisis, actively suicidal, or in the middle of untreated substance dependence. Those need stabilizing first, and a responsible clinician will help you find that rather than start a protocol that assumes stability you do not have. It is also not the right fit if what you want is open-ended supportive therapy, which is a legitimate thing to want and a different thing.

Where it sits in this practice

CPT is one of several evidence-based approaches Dr. Thaxter draws on, alongside CBT, ACT and DBT. Whether it is the right one for you comes out of a full intake. It is offered individually and as a group. How therapy works here →