Cognitive Processing Therapy

by

Kelli Godfrey, David L. Albright

• LAST REVIEWED: 24 February 2021
• LAST MODIFIED: 24 February 2021
• DOI: 10.1093/obo/9780195389678-0297

Introduction

Cognitive processing therapy (CPT) is a method of cognitive-behavioral treatment used for treatment of post-traumatic stress disorder (PTSD). This intervention was created in the 1980s and has been proven to be effective across differing populations such military veterans, sexual assault survivors, emergency service workers, survivors of child abuse, and others who suffer from PTSD or PTSD symptoms. CPT is typically a twelve-session therapy intervention where each session lasts fifty minutes. It can be used in individual therapy, a group setting, or a combination of the two. CPT is based on the social cognitive theory and focuses on repairing the negative experiences and thoughts stemming from the experienced trauma causing PTSD. CPT is evidence-based treatment that challenges cognitive distortions regarding trauma but also assists in dealing with any cognitive distortions, including future traumas. The Department of Veterans Affairs, the Department of Defense, and the International Society for Traumatic Stress Studies fully endorse CPT and suggest it as a first-line therapy for PTSD. However, further research is still needed for evaluation when patients who have co-occurring morbidities such as substance abuse disorders, which may prevent them from fully engaging in the treatment process, such as homework completion. The first phase of cognitive processing therapy is educational: providing education on PTSD as well as the thoughts and emotions that stem from their trauma. The second phase focuses on the formal processing of the trauma. During this phase, the therapist often uses Socratic questioning to explore complex issues and encourage the client to think differently about their trauma based upon their own conclusions and perspectives. Through this, the clinician is able to help the client focus on changing their beliefs of self-blame. The final phase focuses on fortifying the new thoughts from the previous phase and focuses on building upon safety, trust, power and control, esteem, and intimacy.

Introductory Works

Dr. Patricia Resick began developing and testing cognitive processing therapy in the late 1980s; however, research did not begin to appear in peer-reviewed journals until the early 1990s. In 1992, Resick and Schnicke published research conducted on the existing treatments for post-traumatic stress disorder (PTSD) stemming from sexual assault and suggested that previous therapies did not fully meet the needs of this population (see Resick, et al. 2016). This is the beginning of research literature on cognitive processing therapy for post-traumatic stress disorder. Dr. Resick continues to actively research, publish, and train professionals on CPT. The works in this section by Dr. Resick provide a context for some of her works within the field (see Larsen, et al. 2019; Sloan, et al. 2018; Stirman, et al. 2018; Thompson-Hollands, et al. 2018).

• Larsen, S. D. E., C. J. Fleming, and P. A. Resick. 2019. Residual symptoms following empirically supported treatment for PTSD. Psychological Trauma 11.2: 207–215.

  DOI: 10.1037/tra0000384

  This study examined evidence-based treatments and their effects on reducing symptoms of post-traumatic stress disorder. The findings were consistent with previous research and suggest evidence-based practices are effective in treating PTSD symptoms.

• Resick, P. A., C. M. Monson, and K. M. Chard. 2016. Cognitive processing therapy for PTSD: A comprehensive manual. New York: Guilford.

  Comprehensive guide on everything cognitive processing therapy for post-traumatic stress disorder with contributions from top experts, who developed the therapy. This guide is critical for clinicians using or wanting to utilize cognitive processing therapy for their patients. This manual discusses cognitive processing therapy with unique populations such as sexual assault survivors and combat veterans.

• Sloan, D. M., B. P. Marx, D. J. Lee, P. A. Resick. 2018. A brief exposure-based treatment vs cognitive processing therapy for posttraumatic stress disorder: A randomized noninferiority clinical trial. JAMA Psychiatry 75.3: 233–239.

  DOI: 10.1001/jamapsychiatry.2017.4249

  In this publication, the researchers seek to answer the question, “Is a brief, exposure-based treatment noninferior to the more time-intensive cognitive processing therapy in the treatment of posttraumatic stress disorder?” (p. 233) This randomized trial included veteran and nonveteran adults randomized to written exposure therapy (WET) and cognitive processing therapy (CPT). Results indicate that WET is noninferior to CPT in reducing PTSD symptoms.

• Stirman, S. W., C. A. Gutner, M. K. Suvak, A. Adler, A. Calloway, and P. Resick. 2018. Homework completion, patient characteristics, and symptom change in cognitive processing therapy for PTSD. Behavior Therapy 49.5: 741–755.

  DOI: 10.1016/j.beth.2017.12.001

  An approach that examines if homework completion has an association with behavior change and dropout rates in therapy. The researchers suggest that homework completion is associated with greater symptom change at certain time points associated with subsequent symptom change. Homework completion may be an indicator of engagement as patients were less likely to drop out.

• Thompson-Hollands, J., B. P. Marx, D. J. Lee, P. A. Resick, and D. M. Sloan. 2018. Long-term treatment gains of a brief exposure-based treatment for PTSD. Depression and Anxiety 35.10: 985–991.

  DOI: 10.1002/da.22825

  The authors examined written exposure therapy (WET) in comparison to cognitive processing therapy (CPT) for treatment of post-traumatic stress disorder. The outcome suggests that both WET and CPT were effective in treating post-traumatic stress disorder and had considerable long-term positive outcomes.