Cognitive Processing Therapy (CPT)

Note: The Cognitive Processing Therapy (CPT) program is currently under re-review due to the availability of new research evidence. The Scientific Rating has been removed until it can be established based on the new research evidence.

Scientific Rating:
Not determined at this time
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Cognitive Processing Therapy (CPT) is in the process of being rated by the CEBC in the area of: Trauma Treatment (Adult).

Target Population: Adults who have experienced a traumatic event and are currently suffering from the symptoms of posttraumatic stress disorder (PTSD) and/or meet criteria for a diagnosis of PTSD

Brief Description

CPT was originally developed for use with rape and crime victims, but it is used with a variety of trauma populations, including both military and civilian samples. CPT focuses on identifying and challenging maladaptive beliefs that develop about, and as a result of, the traumatic event. The therapist helps the client to identify problem areas (i.e., stuck points) in their thinking about the traumatic event, which have impeded their recovery. Therapists then use Socratic dialogue, a form of questioning that encourages clients to examine and evaluate their own beliefs rather than being told in a directive way, to help clients challenge their stuck points. Throughout the treatment, worksheets and Socratic dialogue are used to help clients replace maladaptive beliefs with more balanced alternative statements. CPT can be delivered individually or in a group format. There is another form of CPT called CPT-C which does not include a written account of the traumatic event.

Program Goals:

The goals of Cognitive Processing Therapy (CPT) are:

  • Increase understanding of posttraumatic stress disorder (PTSD) and how it affects life
  • Accept the reality of the traumatic event
  • Feel emotions about the traumatic event and reduce avoidance
  • Develop balanced and realistic beliefs about the event, oneself, others, and the world
  • Decrease the emotions that emanate from maladaptive beliefs about the event (e.g., guilt, shame, anger)
  • Decrease symptoms of PTSD and depression
  • Improve day-to-day living

Essential Components

The essential components of Cognitive Processing Therapy (CPT) include:

  • Educating clients about the symptoms of PTSD
  • Assisting clients to identify and evaluate maladaptive beliefs that they have developed about the traumatic event, themselves, others, and the world
  • Using Socratic Questioning, a form of questioning that encourages clients to examine and evaluate their own beliefs
  • Teaching clients skills to modify their maladaptive thoughts and beliefs with the use of worksheets (e.g., ABC Worksheet, Challenging Beliefs Worksheet)
  • Assigning clients regular out-of-session practice assignments to learn and apply what has been discussed in therapy

Adult Services

Cognitive Processing Therapy (CPT) directly provides services to adults (regardless of whether they are parents or caregivers) and addresses the following:

  • Posttraumatic stress disorder (PTSD) and related symptoms

Delivery Settings

This program is typically conducted in a(n):

  • Community Agency
  • Hospital
  • Outpatient Clinic
  • Residential Care Facility

Homework

Cognitive Processing Therapy (CPT) includes a homework component:

Homework is assigned every week to expand upon what was learned/discussed in each therapy session. This includes a continuous stuck point log to be compiled by the patient outside of therapy, ABC Worksheets, Challenging Questions Worksheets, Patterns of Problematic Thinking Worksheets, and Challenging Beliefs Worksheets. A trauma impact statement is also assigned at the beginning and end of therapy. A written trauma account is also assigned.

Languages

Cognitive Processing Therapy (CPT) has materials available in languages other than English:

Arabic, Chinese, Finnish, German, Hebrew, Icelandic, Japanese, Spanish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

A quiet, private room for the session to be held in, the materials manual, the therapist manual, and the ability to copy worksheets

Minimum Provider Qualifications

Licensed mental health professionals or those working under the supervision of a licensed mental health professional. Psychology, social, work, and nursing staff can implement CPT in their respective roles. In third world countries, the protocol has been implemented successfully with therapists with high school education.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

Onsite, Regional, through the VA National Rollout, agency-arranged workshops with one of the trainers

Number of days/hours:

2 days/16 hours for individual CPT or 3 days/24 hours adding in a group therapy day followed by weekly telephone consultation for 6 months

Additional Resources:

There currently are additional qualified resources for training:

Online training is available at https://cpt.musc.edu/. Manuals as PDF documents are available upon request.

Implementation Information

Since Cognitive Processing Therapy (CPT) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Cognitive Processing Therapy (CPT) as listed below:

Pre-implementation assessments are given to training attendees prior to their first day of training and on the last day of training to assess their knowledge and level of comfort with CPT techniques. These are currently only used within VA trainings, and can be obtained from CPTforPTSD@gmail.com. Non-VA workshops require the online training prior to attending.

Formal Support for Implementation

There is formal support available for implementation of Cognitive Processing Therapy (CPT) as listed below:

Training and consultation is available for therapists who are conducting CPT. Refer to cptforptsd.com for more information.

Fidelity Measures

There are fidelity measures for Cognitive Processing Therapy (CPT) as listed below:

A fidelity checklist overviewing each session of CPT is available. Contact CPTforPTSD@gmail.com for a copy.

Implementation Guides or Manuals

There are implementation guides or manuals for Cognitive Processing Therapy (CPT) as listed below:

There are the following manuals: Therapist Manual, Materials Manual, and Group Manual. Contact CPTforPTSD@gmail.com for a PDF copy of the manuals.

Research on How to Implement the Program

Research has not been conducted on how to implement Cognitive Processing Therapy (CPT).

Relevant Published, Peer-Reviewed Research

Cognitive Processing Therapy (CPT) is in the process of being rated by the CEBC. Listed below are the research citations that the CPT program representative provided for the CEBC to review.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Resick, P.A., & Schnicke, M. A. (1992). Cognitive Processing Therapy for sexual assault victims. Journal of Consulting and Clinical Psychology, 60(5), 748-756.

Resick, P. A., Nishith, P., Weaver, T. L., Astin, M. C, & Feuer, C. A. (2002). A comparison of Cognitive-Processing Therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. Journal of Counseling and Clinical Psychology, 70(4), 867-879.

*Chard, K. (2005). An evaluation of Cognitive Processing Therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse. Journal of Counseling and Clinical Psychology, 73(5), 965-971.

Resick, P. A., Galovski, T. A., Uhlmansiek, M. O., Scher, C. D., Clum, G. A., & Young-Xu, Y. (2008). A randomized clinical trial to dismantle components of Cognitive Processing Therapy for posttraumatic stress disorder in female victims of interpersonal violence. Journal of Consulting and Clinical Psychology, 76, 243-258.

Forbes, D., Lloyd, D., Nixon, R. D. V., Elliott, P., Varkera, T., Perry, D.,...Creamer, M. (2012). A multisite randomized controlled effectiveness trial of Cognitive Processing Therapy for military-related posttraumatic stress disorder. Journal of Anxiety Disorders, 26(5), 442-452.

Iverson, K. A., Resick, P. A., Suvak, M. K., Walling, S., & Taft, C. T. (2012). Intimate partner violence exposure predicts PTSD treatment engagement and outcome in Cognitive Processing Therapy. Journal of Behavior Therapy, 42(2), 236-248.

*Resick, P. A., Williams, L. F., Suvak, M. K., Monson, C. M., & Gradus, J. L. (2012). Long-term outcomes of cognitive–behavioral treatments for posttraumatic stress disorder among female rape survivors. Journal of Consulting and Clinical Psychology, 80, 201-210.

Surís, A., Link-Malcolm, J., Chard, K., Ahn, C., & North, C. (2013). A randomized clinical trial of Cognitive Processing Therapy for veterans with PTSD related to military sexual trauma. Journal of Traumatic Stress, 26, 1-10.

Bass, J. K., Annan, J., Murray, S. M., Kaysen, D., Griffiths, S., Centinoglu, T.,...Bolton, P. (2013). Controlled trial of psychotherapy for Congolese Survivors of Sexual Violence. The New England Journal of Medicine, 368, 2182-2192.

The following studies were not included in rating CPT on the Scientific Rating Scale...

Galovski, T. E., Blain, L. M., Mott, J. M., Elwood, L., & Houle, T. (2012). Manualized therapy for PTSD: Flexing the structure of Cognitive Processing Therapy. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0030600

This study tested a modified cognitive processing therapy (MCPT) intervention designed to test the relative efficacy of the MCPT intervention compared with a symptom-monitoring delayed treatment (SMDT) condition and to assess within-group variation in change interpersonal trauma survivors with posttraumatic stress disorder (PTSD). After the conclusion of SMDT, participants crossed over to MCPT. Measures utilized include the Clinician-Administered PTSD Scale (CAPS), the Structured Clinical Interview for DSM–IV Axis I Disorders—Patient Edition (SCID), the Standardized Trauma Interview, the Posttraumatic Stress Diagnostic Scale (PDS), the Beck Depression Inventory-II (BDI-II), the Trauma-Related Guilt Inventory (TRGI), the Quality of Life Inventory (QOLI), and the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). Results revealed that MCPT evidenced greater improvement on all primary (PTSD and depression) and secondary (guilt, quality of life, general mental health, social functioning, and health perceptions) outcomes compared with SMDT. Limitations include high attrition rate. Note: This study was not used for rating Cognitive Processing Therapy (CPT) because it uses a modified version of CPT.

Resick, P. A., Wachen, J. S., Mintz, J., Young-McCaughan, S., Roache, J. D., Borah, A. M., ... Peterson, A. L. (2015). A randomized clinical trial of group cognitive processing therapy compared with group Present-Centered Therapy for PTSD among active duty military personnel. Journal of Consulting and Clinical Psychology. Advance online publication. doi:10.1037/ccp0000016

The purpose of this study was to determine whether group therapy improves symptoms of posttraumatic stress disorder (PTSD), by utilizing Cognitive Processing Therapy (cognitive-only version; CPT-C) with group present-centered therapy (PCT) for active duty military personnel. Measures utilized include the PTSD Checklist (Stressor Specific Version; PCL-S), Life Events Checklist (LEC), Beck Depression Inventory-II (BDI-II) and the Posttraumatic Stress Symptom Interview (PSS-I). Participants were randomized into CPT-C or PCT groups when 16 to 20 participants had been enrolled, resulting in 8 to 10 participants per group (two groups running simultaneously, with six cohorts total). Patients attended 90-minute groups twice weekly for 6 weeks. Independent assessments were administered at baseline, weekly before sessions, and 2 weeks, 6 months, and 12 months posttreatment. Results indicate that both treatments resulted in large reductions in PTSD severity, but improvement was greater in CPT-C. CPT-C also reduced depression, with gains remaining during follow-up. In PCT, depression only improved between baseline and before Session 1. There were few adverse events associated with either treatment. Limitations include small sample size, lower follow-up rates, and generalizability due to gender. Note: This study was not used for rating the program due to being a specialized version of Cognitive Processing Therapy (CPT) and not the entire protocol.

References

Chard, K. M., Resick, P. A., Monson, C. M., & Kattar, K. A. (2009). Cognitive Processing Therapy therapist group manual: Veteran/military version. Washington, DC: Department of Veterans’ Affairs.

Resick, P. A., Monson, C. M., & Chard, K. M. (2010). Cognitive Processing Therapy: Veteran/military version: Therapist and patient materials manual. Washington, DC: Department of Veterans’ Affairs.

Resick, P. A., Monson, C. M., & Chard, K. M. (2010). Cognitive Processing Therapy: Veteran/military version: Therapist’s manual. Washington, DC: Department of Veterans’ Affairs

Contact Information

Name: Patricia A. Resick, PhD, ABPP
Agency/Affiliation: Duke University
Email:

Date Research Evidence Compiled: July 2015 (currently being reviewed)

Date Program Content Last Reviewed by Program Staff: April 2016

Date Program Originally Loaded onto CEBC: June 2013