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Updated 07/15/2020

Cognitive processing therapy is a form of cognitive-behavioral therapy used to treat PTSD. Learn how CPT is effective in treating PTSD co-occurring with substance use disorders.

Cognitive processing therapy (CPT) is a type of cognitive-behavioral therapy used for the treatment of post-traumatic stress disorder. A traumatic experience can influence a person’s beliefs regarding themselves and others, including an individual’s sense of self-esteem, safety, trust, and intimacy. These negative beliefs can impair the ability of the individual to function normally.

Cognitive processing therapy focuses on the causes behind the traumatic event and the impact of the traumatic event on the person’s beliefs. Cognitive processing therapy teaches individuals to evaluate the validity of these thoughts and modify inaccurate or negative thoughts. This cognitive restructuring, modification of thoughts related to the traumatic event, can help the individual move beyond the traumatic event.

What is Cognitive Processing Therapy?

Cognitive processing therapy is a form of cognitive-behavioral therapy that was initially developed to treat trauma in sexual assault victims. Cognitive processing therapy has been consequently adapted for the treatment of post-traumatic stress disorder due to combat, natural disasters, child abuse. Cognitive processing therapy involves helping the individual to identify negative beliefs that occur after a traumatic event and teaching them to challenge and modify these beliefs.

According to the theory underlying cognitive processing therapy, trauma leads to the formation of maladaptive beliefs regarding the traumatic event. These negative beliefs are also referred to as stuck points and prevent the individual from functioning normally. These stuck points lead to avoidance of memories related to the event and cause emotions such as guilt and shame. For example, an individual may be a victim of sexual assault but may assume responsibility for the event and experience guilt and shame. Cognitive processing therapy involves recognizing and restructuring or modifying these negative beliefs or thoughts

When is CPT Used?

Cognitive processing therapy is recommended for individuals who experienced a traumatic event and suffer from PTSD or depression because of the trauma. CPT is an evidence-based method (supported by scientific research) that is endorsed by the U.S. Department of Veterans Affairs for the treatment of symptoms of PTSD. CPT is, however, not suitable for the treatment of individuals who are suicidal or suffer from panic attacks. For CPT to be effective, the individual must be in a stable emotional state to discuss the traumatic event. CPT is also useful in the treatment of PTSD co-occurring with substance use disorder (addiction).

Cognitive Processing Therapy Phases

Cognitive processing therapy is delivered through 12 weekly sessions and the relatively shorter duration of treatment makes it a cost-effective approach. Each session lasts about 60 to 90 minutes and the number and duration of sessions may be adjusted according to the needs of the individual. Cognitive processing therapy may involve individual or group counseling or a combination of the two. CPT in a group setting may involve two counselors and 8 to 10 patients. The first session involves an overview of the treatment process, while subsequent sessions tend to focus on the traumatic memories and changing the negative thinking patterns that occur as a result of the traumatic event. There are three phases to the process.

Phase One: Psychoeducation

During the initial psychoeducation phase, the therapist provides an overview of the treatment process and the rationale behind CPT, along with information regarding the symptoms of PTSD. Psychoeducation involves making the individual aware of how beliefs about a traumatic event can have an impact on their feelings and ways to restructure these beliefs. Patients are asked to write an impact statement about how the traumatic event has impacted their beliefs.

Phase Two: Processing the Trauma

In the second phase of treatment, the individual is asked to write a detailed account of their traumatic experience and read the written assignment in the following session. The subsequent sessions involve the therapist and the patient discussing the meaning of the traumatic experience to identify stuck points or self-blame issues. Stuck points are negative thoughts about the traumatic event that prevents the individual from moving beyond the traumatic beliefs. The therapist then tries to modify these negative thinking patterns by using a Socratic-style of questioning. The patients also learn to independently identify and modify such negative or self-defeating thoughts with the help of worksheets.

Phase Three: Change Beliefs Surrounding Traumatic Events

The final phase involves the therapist providing guidance to the patient to help them independently practice the skills obtained over the course of the treatment. This guidance involves identifying stuck points and changing these thought patterns (i.e., cognitive restructuring). Initially, the focus of therapy is to change negative thoughts involving self-blame for the traumatic event. As the treatment progresses to the final phase, the focus of treatment moves to other beliefs affected by the traumatic event. This focus includes negative beliefs revolving around trust, power, intimacy, and self-esteem.

Cognitive Processing Therapy Techniques

Cognitive processing therapy involves focusing on traumatic memories through written accounts and counseling to help the individual modify negative thoughts related to the traumatic experience. Through the process of writing about their traumatic experience, individuals learn to identify negative thoughts or beliefs.

Counseling techniques used during cognitive processing therapy involve the use of the Socratic method that involves the therapist asking questions rather than providing guidance. In this way, the patients learn to challenge their own assumptions about the traumatic beliefs, aiding the restructuring of the negative beliefs related to the traumatic event. Therapy also involves the use of worksheets during therapy sessions and at home. These worksheets help individuals practice the skills they have learned during their therapy sessions.

CPT in Addiction Counseling

Substance use disorders are prevalent in individuals with PTSD. The co-occurrence of alcohol addiction is particularly common in military veterans with PTSD. In a study conducted on military veterans, being diagnosed with PTSD increased the chances of being diagnosed with alcohol addiction by four-fold. Veterans with PTSD were also three times more likely to be diagnosed with other substance use disorders. Cognitive processing therapy has been found to be equally effective in the treatment of PTSD in individuals with or without alcohol use disorder. Similarly, CPT can be used for the treatment of PTSD in individuals with substance use disorders.

Veteran Recovery Is Our Mission

Our facilities have helped thousands of veterans overcome a drug or alcohol addiction. At The Recovery Village at Baptist Health, our treatment programs offer veterans:

  • Veteran Advocates who can navigate the VA on your behalf to enter treatment faster
  • Experienced clinicians trained in military culture and trauma-informed care
  • Dual diagnosis to treat addiction and mental health disorders together  
  • EMDR, a revolutionary treatment that alleviates trauma symptoms

Finding a CPT Therapist

It can be overwhelming to have a friend or family member with PTSD. Besides being supportive, the best way to help the individual with PTSD is to obtain professional medical help.

While seeking treatment for mental health issues, it is essential to find a therapist who is licensed by the state board. Some therapists may also be certified to provide cognitive processing therapy. Besides finding a licensed trauma and PTSD therapist, it is also useful to ensure that therapy provided by a specific practitioner is covered by a health insurance plan.

All Veterans Affairs Medical Centers provide CPT and other forms of treatment for veterans with PTSD. Many drug rehabilitation centers also provide cognitive processing therapy for individuals with PTSD co-occurring with substance abuse.

If you or a loved one struggle with a substance use disorder that developed from attempting to manage PTSD,  The Recovery Village Palm Beach at Baptist Health can help. The Recovery Village Palm Beach at Baptist Health provides quality care and treatment for substance use disorders and co-occurring mental health disorders. Call today and take the first step toward a healthier future.

View Sources

US Department of Veteran Affairs. “Cognitive Processing Therapy for PTSD.” March 20, 2019. Accessed September 23, 2019.

American Psychological Association. “Cognitive Processing Therapy (CPT).” July 31, 2017.  Accessed September 23, 2019.

Seal, Karen H; et al. “Substance use disorders in Iraq and Afghanistan veterans in VA healthcare, 2001–2010: Implications for screening, diagnosis and treatment.” Drug and Alcohol Dependence, July 2011. Accessed September 23, 2019.

Kaysen, Debra; et al. “Cognitive processing therapy for veterans with comorbid PTSD and alcohol use disorders.” Addictive Behaviors, February 2014. Accessed September 23, 2019.