Program Goals
Cognitive-Processing Therapy (CPT) was designed to treat posttraumatic stress disorder (PTSD) in victims of sexual assault. The overall goal of CPT is to restructure unbalanced thoughts directly related to the trauma. The therapy sessions focus on distorted beliefs (such as denial and self-blame), as well as over-generalized beliefs about oneself and the world. Clients are also exposed to their traumatic experience through writing detailed accounts of the incident, which they read aloud to their therapists. Therapists encourage clients to experience emotions while writing and reading the account in an effort to better determine areas of conflicting beliefs, logic, or assumptions that the client has in relation to the trauma.
Program Components
The therapeutic technique is a manualized, 12-session therapy developed by Resick and Schnicke (1993), which includes cognitive therapy and a writing/reading exercise to recall the traumatic event. Session one begins with an overview of PTSD and cognitive therapy. Clients are also assigned to write a statement about the impact the trauma had on their lives. During session two, the client and therapist discuss the meaning of trauma, and clients are taught how events, thoughts, and emotions are intertwined.
Following session three, clients are again asked to write about their trauma, but this time instructed to write a detailed account of the event, including emotions and thoughts. Clients are asked to experience their emotions when writing their statement, as well as read it back to themselves. This statement is read aloud to the therapist during session four, where the therapist begins incorporating cognitive therapy, through Socratic questioning, to challenge the client’s self-blame and distortions surrounding the event. In session five, clients write another account of their traumatic event and read it aloud to their therapist.
Beginning with session six and continuing for the remainder of the therapy, the therapist focuses on teaching clients to challenge and change their beliefs about the meaning of the event, as well as the impact of the trauma on their lives. Clients are first taught to challenge a single thought by asking themselves a series of questions. Clients then learn to identify problematic patterns of thinking that have come to represent their style of responding.
During sessions 7–12, clients use worksheets that incorporate their earlier responses and are asked to develop more balanced self-statements. Clients are asked to focus on a theme each week (e.g., safety, trust, esteem) and correct any over-generalized beliefs related to the themes for that week. To wrap up the therapy, during session eleven, clients are asked to rewrite their impact statements using their new beliefs. These new statements are then evaluated during session 12 to determine progress made during treatment, as well as areas where the clients should continue working.
Program Theory
CPT is based on a social cognitive theory and information processing theory of PTSD. The social cognitive theory focuses on how the traumatic event is constructed and handled by a person who is trying to regain a sense of mastery and control in their life (Resick, Monson, and Chard 2006). This theory centers on the content of cognitions and the impact that distorted cognitions have on emotional responses and behavior.
Alternatively, the information processing theory indicates that PTSD emerges as a result of the development of a fear network in memory that provokes avoidance behavior (Resick, Monson, and Chard 2006). It is believed that repetitive exposure to the traumatic memory in a safe environment can result in subsequent change in the fear structure.
Using these two theories as its framework, CPT aims to understand how the traumatic event has affected the individual, and to challenge distorted beliefs that develop as a result.
