PTSD: National Center for PTSD

Cognitive Processing Therapy (CPT): Helping During Treatment

Available en Español

What is Cognitive Processing Therapy (CPT)?

Cognitive Processing Therapy (CPT) is an evidence-based treatment for posttraumatic stress disorder (PTSD). This means that it has been studied by researchers and found to be effective in treating PTSD. Most people who complete CPT show a noticeable improvement in PTSD symptoms. CPT typically takes 12 weekly sessions, but this can vary from person to person.

CPT helps people recognize how trauma has changed their view about themselves, others, and the world. CPT teaches people to recognize the negative thoughts that are created by the trauma. These thoughts are called "stuck points" in CPT because they keep people stuck and get in the way of recovery from PTSD. Stuck points are less than 100% accurate and CPT works by teaching people how to think through their stuck points and consider new, more balanced perspectives.

What happens in CPT?

CPT has 4 main parts:

1. Education about PTSD and CPT
2. Processing the trauma
3. Learning to evaluate and change thoughts about the trauma
4. Addressing the impact of the trauma on current life themes

1. Education about PTSD and CPT

CPT starts with education about PTSD and common ways people respond to trauma. The therapist will ask about the symptoms your loved one has, explain how CPT works, and discuss the goals of treatment. Most importantly, your loved one will learn about the ways their thoughts about the trauma, themself, the world, and others can affect emotions.

You can help by:

• Learning about trauma, PTSD, and CPT. Knowing the basics is a great place to start. The resources listed at the end of this page can help.
• Asking your loved one if they want to talk about treatment and respecting their answer. You are providing support by asking to talk even if your loved one is not ready to do so.

2. Processing the trauma

The therapist and your loved one will focus on thinking through parts of the trauma memory. Depending on the type of CPT, the therapist may ask them to write a description of the trauma, called a trauma account. Writing and re-reading this trauma account helps many people feel their feelings related to the trauma and identify stuck points created by the event.

You can help by:

• Understanding that many people may prefer to keep the details of their trauma private.
• Allowing your loved one time to read and write the trauma account privately.
• Reminding yourself it is ok if your loved one gets upset when thinking about the trauma. Being upset does not mean that the treatment is not working. With treatment, thinking about the trauma will get easier over time. Many people were not able to feel their feelings (such as sadness or fear) during the traumatic event. Reading the account often allows people to experience these feelings now that the trauma is over and they are in a safe place.
• Encouraging your loved one to face the difficult or uncomfortable feelings may help them stick with and finish the treatment.

3. Learning to evaluate and change thoughts about the trauma

An important part of CPT is identifying thoughts that get in the way of recovery from PTSD. In addition to the work done during therapy sessions, your loved one will complete worksheets between sessions. These worksheets help people identify and examine their thoughts about the trauma.

You can help by:

• Providing support if your loved one is nervous about doing the worksheets.
• Giving your loved one space to complete assignments privately.
• Recognizing that your loved one may be more interested in doing things that were avoided before treatment began. If so, support your loved one in becoming more involved in daily life.

4. Current life themes

During the last several sessions of CPT, your loved one will focus on 5 themes: safety, trust, power and control, esteem, and intimacy. Often, people with PTSD have problems in one or more of these areas. For example, they may think that they are never safe, or that no one can be trusted. Your loved one will complete worksheets on each of these themes and will talk about thoughts related to these themes with their therapist. They will also be asked to complete assignments to increase their engagement in daily life.

You can help by

• Being aware that your loved one will be thinking more about these themes.
• Making yourself available to talk about the themes if your loved one wants to.
• Providing support and encouragement for increased engagement in life activities.

Wrap Up

Cognitive Processing Therapy (CPT) is effective in treating PTSD. Your loved one's decision to think about or start CPT is a great first step in recovery. Understanding the basics of CPT will help you support your loved one during the treatment process.

Printable Handout

Cognitive Processing Therapy: Helping During Treatment

Download a PDF of this page (PDF) which discusses what to expect and how you can support your loved one during Cognitive Process Therapy treatment.

Additional Resources

There are videos and programs to support family members or help you learn about trauma, PTSD, and PTSD treatments like Cognitive Processing Therapy. We recommend:

• Read more about Cognitive Processing Therapy (CPT) for PTSD.
• PTSD Treatment Decision Aid: An online tool to explore and compare effective treatment options for PTSD. The decision aid includes a section For Loved Ones to learn about more tips to offer support to someone with PTSD.
• Understanding PTSD: A Guide for Family and Friends (PDF) | Available en Español (PDF): Booklet that includes what you need to know to help yourself and your loved one with PTSD.
• PTSD Family Coach App: Mobile app designed to provide support for concerned family members of those with PTSD.
• Animated Videos: Short videos that describe PTSD and effective treatments, including CPT.
• AboutFace: Learn about PTSD from Veterans who've experienced it. Listen to their stories and find out how treatment turned their lives around. Hear from family members and clinicians as well.
• VA Caregiver Support: Program to help you care for the Veteran you love and for yourself.