Cognitive Processing Therapy (CPT)

Theory of change

A person changes when they transform rigid trauma-related beliefs into meanings that are more specific, more flexible and compatible with a safe life in the present.

Core ideas

1. Trauma alters fundamental cognitive schemas

   CPT holds that traumatic events can distort core schemas about safety, trust, power/control, esteem and intimacy, generating rigid and global interpretations that organise emotional and behavioural experience after the trauma. (Resick & Schnicke, 1993; Resick et al., 2016).

2. Stuck points maintain post-traumatic distress

   The maintenance of PTSD is explained by the presence of rigid or distorted trauma-related beliefs — stuck points — that prevent a functional integration of the traumatic memory and sustain emotions such as fear, guilt, shame and anger. (Resick et al., 2016).

3. Assimilation and over-accommodation are maladaptive processes

   CPT distinguishes between assimilation, in which the trauma is interpreted in a self-blaming or distorted way in order to preserve prior beliefs, and over-accommodation, in which the traumatic event leads to extreme and negative generalisations about oneself, others or the world. (Resick & Schnicke, 1993).

4. Cognitive content is the main focus of change

   Unlike other models centred on processes or on the relationship with one's thoughts, CPT places the therapeutic focus on identifying and directly modifying the content of trauma-related beliefs, using a structured and focused cognitive approach. (Resick et al., 2016).

5. Written exposure facilitates access to and integration of the trauma

   The model uses the impact statement and the trauma account as a controlled form of narrative exposure that reduces cognitive and emotional avoidance, allowing implicit meanings to be accessed and subsequently processed cognitively. (Resick & Schnicke, 1993; Resick et al., 2016).

6. Cognitive questioning must be structured and functional

   CPT emphasises the use of Socratic questions and specific worksheets to evaluate the evidence for, usefulness of and consequences of stuck points, avoiding abstract debates and prioritising the functionality of beliefs in the patient's current life. (Resick et al., 2016).

7. Narrative integration reduces the organising power of the trauma

   Therapeutic change is consolidated when the traumatic memory is integrated into the autobiographical narrative as a past, contextualised and bounded event, instead of functioning as a central organiser of identity and of the present. (Resick et al., 2016).

8. The therapeutic aim is a flexible cognitive accommodation

   The ultimate aim of CPT is to promote a flexible cognitive accommodation in which beliefs about oneself, others and the world incorporate the trauma without absolutist generalisations, allowing safer and more adaptive psychological functioning. (Resick et al., 2016).

Influences

• Cognitive therapy
• Trauma
• Psychoeducation
• Written exposure

Key references

• Resick, P. A., & Schnicke, M. K. (1992). Cognitive processing therapy for sexual assault victims. Journal of Consulting and Clinical Psychology, 60(5), 748–756.
• Resick, P. A., & Schnicke, M. K. (1993). Cognitive Processing Therapy for Rape Victims: A Treatment Manual. Sage.
• Resick, P. A., Monson, C. M., & Chard, K. M. (2014). Cognitive Processing Therapy: Veteran/Military Version. Department of Veterans Affairs.
• Resick, P. A., Monson, C. M., & Chard, K. M. (2016/2017). Cognitive Processing Therapy for PTSD: A Comprehensive Manual. Guilford Press.