Cognitive processing therapy (CPT) is a structured, trauma-focused talk therapy for PTSD that teaches you to notice and change upsetting thoughts about your trauma. It usually takes 12 weekly sessions, about three months in total, and it is considered one of the most effective treatments for PTSD. CPT can be done one-on-one or in a group.
If trauma has left you with thoughts like “It was my fault,” “I can’t trust anyone” or “The world is completely dangerous,” cognitive processing therapy is designed to help you work through them. This article explains how CPT works, what sessions look like and what results you can expect. For background on the condition itself, see our overview of PTSD signs, effects and treatment.
What Is Cognitive Processing Therapy?
The VA’s National Center for PTSD describes CPT as an individual or group therapy for PTSD in which you learn ways to evaluate and change the upsetting thoughts you have had since your trauma. It is a type of cognitive behavioral therapy. The National Institute of Mental Health notes that CBT for PTSD can include cognitive restructuring, which helps people make sense of the traumatic event.
The core idea is simple: trauma can change the way you think about yourself, other people and the world. Some of those changes keep you stuck in PTSD. CPT helps you look at whether those thoughts are supported by the facts and find more balanced ways of thinking.
What are “stuck points”?
In CPT, beliefs that keep PTSD going are called stuck points. According to the VA’s clinical overview of CPT, they often show up in two ways:
- Bending the facts to fit old beliefs. For example, someone who believes that bad things only happen to bad people may decide they deserved what happened. This often leads to self-blame and guilt.
- Swinging to extreme new beliefs. For example, a person assaulted by a man might come to believe that all men are dangerous.
CPT helps you move toward balanced beliefs that take the trauma into account without letting it define everything.
How CPT Works: Session by Session
CPT follows a clear structure, which many people find reassuring. The VA explains that treatment usually involves 12 weekly sessions. Individual sessions last about 60 minutes, and group sessions last about 90 minutes. The VA’s guide for families supporting someone in CPT describes treatment in roughly four phases.
1. Learning about PTSD
Early sessions give an overview of PTSD and how your thoughts about the trauma affect your feelings. According to the VA’s CPT protocol summary, CPT also includes a writing exercise called an impact statement, along with guided questions from your therapist and worksheets.
2. Processing the trauma
You and your therapist identify your stuck points and start questioning them. At around the third session, you have the option of writing a detailed account of your trauma. The VA notes that research found this written account is not required for CPT to work, so it can be included or left out based on your preference.
3. Practicing new skills
You will use worksheets in session and at home to practice looking at the evidence for and against your thoughts, the VA says. The VA’s PTSD decision aid notes that the more effort you put into these practice assignments, the more you tend to get out of CPT.
4. Working through key themes
Later sessions focus on five areas that the VA notes trauma often disrupts: safety, trust, power and control, esteem and intimacy. You look at how your beliefs in each area have changed and work toward more balanced views.
How Effective Is CPT?
CPT has strong research support. The VA’s provider guidance states that CPT has the strongest recommendation as a treatment for PTSD in every clinical practice guideline, including the VA/DoD guideline. The VA’s PTSD treatment basics lists CPT alongside prolonged exposure (PE) and eye movement desensitization and reprocessing (EMDR) as the trauma-focused therapies that work best.
The VA’s decision aid reports that about 57 out of every 100 people who receive CPT, PE or EMDR have meaningful symptom improvement after about three months, compared with about 8 out of 100 people who do not get treatment. It also notes that the benefits of CPT often last long after the final session.
What Does CPT Feel Like? Common Concerns
It is normal to feel nervous about starting trauma therapy. According to the VA, the main risk of CPT is mild to moderate discomfort when talking or writing about trauma-related memories or beliefs. These feelings are usually brief, and people tend to feel better as they continue.
Feeling upset during treatment does not mean CPT is failing. The VA’s guide for family members supporting someone in CPT points out that being upset does not mean the treatment is not working. Loved ones can help by learning the basics of PTSD and CPT, giving you private time to complete assignments and encouraging you as you become more involved in daily life. You can also read about managing PTSD triggers between sessions.
Who Can Benefit From CPT?
CPT has been studied in many different groups of people. The VA reports that CPT has been shown to improve common related problems such as depression, suicidal thoughts, sleep problems and alcohol use disorder, and that it works when delivered through telehealth. It may be a good fit if you:
- Blame yourself for what happened
- Feel guilt or shame tied to the trauma
- Struggle to trust others or feel safe
- Prefer a structured therapy with a clear plan
People with long-lasting or repeated trauma may also benefit. Learn more in our article on complex PTSD. If you also use alcohol or drugs to cope, it is important to address both conditions. Our guide to PTSD and addiction explains how integrated care works.
Frequently Asked Questions
How long does cognitive processing therapy take?
CPT typically involves 12 weekly sessions, so treatment lasts about three months. Sessions are usually about 60 minutes for individual therapy and about 90 minutes for group therapy.
Do I have to talk about every detail of my trauma?
No. Writing a detailed trauma account is optional in CPT. Much of the work focuses on your thoughts and beliefs about the trauma rather than retelling every detail.
What is the difference between CPT and CBT?
CPT is a specific type of cognitive behavioral therapy designed for PTSD. General CBT is used for many conditions, while CPT focuses on the beliefs that keep trauma symptoms going. Read more about CBT for addiction.
Can CPT be combined with medication?
Yes. Some people take medication for PTSD symptoms while doing therapy. A psychiatric provider can help you decide whether medication is right for you.
Get Cognitive Processing Therapy in Lancaster, PA
The Ranch Pennsylvania Outpatient Services offers cognitive processing therapy as part of trauma-informed care, along with CBT, DBT, individual, group and family therapy, and psychiatric evaluation and medication management. You can receive care in our mental health partial hospitalization program, with full-day programming five days a week, or our intensive outpatient program, with three-hour sessions three days a week while you live at home. Explore our PTSD treatment in Pennsylvania, then verify your insurance or contact our admissions team. We are available 24/7, and calls are free and confidential.
