Cognitive Processing Therapy (CPT)
Definition
Cognitive Processing Therapy (CPT) is an evidence-based trauma-focused therapy developed by Dr. Patricia Resick and colleagues in the 1990s. CPT is a cognitive-behavioral treatment specifically designed for trauma survivors, focusing on identifying and challenging “stuck points” — maladaptive beliefs related to the trauma that maintain PTSD symptoms.
How It Works
CPT is based on the theory that PTSD is maintained by cognitive distortions related to the trauma. The core mechanism is cognitive restructuring of trauma-related beliefs across five domains:
- Safety: “The world is completely dangerous”
- Trust: “I can’t trust anyone”
- Power/Control: “I have no control over what happens to me”
- Self-Esteem: “I am worthless/bad”
- Intimacy: “I can’t form close relationships”
The 5-Session Structure
| Session | Focus | Key Activity |
|---|---|---|
| 1 | Rationale & Psychoeducation | Why thoughts matter; overview of CPT |
| 2 | Identifying Thoughts | Thoughts vs. feelings; identifying stuck points |
| 3-4 | Challenging Thoughts | Socratic questioning; challenge worksheets |
| 5 | Advanced Challenge | Overgeneralization; challenging multiple beliefs |
The A-B-C Worksheet
Clients learn to identify:
- A: Activating event (trauma-related situation)
- B: Beliefs/thoughts about the event
- C: Emotions and behaviors
The Impact Statement
Clients write about how the trauma has affected their beliefs about safety, trust, power/control, self-esteem, and intimacy — then systematically challenge these beliefs.
Evidence Base
PTSD — First-Line Treatment
CPT is recommended as first-line for PTSD by major clinical guidelines:
| Outcome | Evidence |
|---|---|
| PTSD symptom reduction | Large effect sizes (d = 1.0-1.5) |
| Depression comorbidity | Significant reductions |
| Guilt/shame | Primary target; strong evidence |
| Treatment adherence | Good (~75-80% completion rate) |
Comparative Evidence
- vs. EMDR: Equivalent outcomes for PTSD; CPT may be better for guilt/shame
- vs. Prolonged Exposure: Similar efficacy; CPT requires less detailed trauma narrative
- vs. Waitlist: Large superiority effects
Strengths
- Excellent for guilt, shame, and moral injury
- Less reliance on detailed trauma narrative than PE
- Highly structured and manualized
- Strong evidence base (200+ RCTs)
- Available in digital format (PTIR app, written protocol)
Limitations
- Homework-heavy (can reduce adherence)
- Requires cognitive engagement (may be challenging during acute distress)
- Less effective for severe dissociation
Key Parameters
- Duration: 12 sessions (typically weekly, 50-60 minutes)
- Format: Individual or group; written protocol option available
- Primary conditions: PTSD, moral injury, depression related to trauma
- Delivery: VA/DoD standard of care for PTSD
Relevant Concepts
Source Metadata
- Type: Concept
- Primary source: Resick, Monson & Chard (2017) “Cognitive Processing Therapy for PTSD”; VA/DoD guidelines
- Updated: 2025 evidence review