Cognitive processing therapy

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Cognitive processing therapy (CPT) is a manualized therapy used by clinicians to help people recover from posttraumatic stress disorder (PTSD) and related conditions. [1] [2] It includes elements of cognitive behavioral therapy (CBT) treatments, one of the most widely used evidence-based therapies. [3] A typical 12-session run of CPT has proven effective in treating PTSD across a variety of populations, including combat veterans, [4] [5] [6] sexual assault victims, [7] [8] [9] and refugees. [10] CPT can be provided in individual and group treatment formats and is considered one of the most effective treatments for PTSD. [11] [12]

Contents

The theory behind CPT conceptualizes PTSD as a disorder of non-recovery, in which a sufferer's beliefs about the causes and consequences of traumatic events produce strong negative emotions, which prevent accurate processing of the traumatic memory and the emotions resulting from the events. [13] Because the emotions are often overwhelmingly negative and difficult to cope with, PTSD sufferers can block the natural recovery process by using avoidance of traumatic triggers as a strategy to function in day-to-day living. Unfortunately, this limits their opportunities to process the traumatic experience and gain a more adaptive understanding of it. CPT incorporates trauma-specific cognitive techniques to help individuals with PTSD more accurately appraise these "stuck points" and progress toward recovery. [14]

History

Development of CPT began in 1988 with work by Patricia Resick. [15] Initial randomized controlled trials for treatment of PTSD were conducted by Candice M. Monson. [15]

Phases of treatment

The primary focus of the treatment is to help the client understand and reconceptualize their traumatic event in a way that reduces its ongoing negative effects on their current life. Decreasing avoidance of the trauma is crucial to this, since it is necessary for the client to examine and evaluate their meta-emotions and beliefs generated by the trauma.

The first phase consists of education regarding PTSD, thoughts, and emotions. [16] The therapist seeks to develop rapport with, and gain the co-operation of, the client by establishing a common understanding of the client's problems and outlining the cognitive theory of PTSD development and maintenance. The therapist asks the client to write an impact statement to establish a current baseline of the client's understanding of why the event occurred and the impact that it has had on their beliefs about themselves, others, and the world. This phase focuses on identifying automatic thoughts and increasing awareness of the relationship between a person's thoughts and feelings. A specific focus is on teaching the client to identify maladaptive beliefs ("stuck points") that interfere with recovery from traumatic experiences. [17]

The next phase involves formal processing of the trauma. [16] The therapist asks the client to write a detailed account of their worst traumatic experience, which the client then reads to the therapist in session. This is intended to break the pattern of avoidance and enable emotional processing to take place, with the ultimate goal being for the client to clarify and modify their cognitive distortions. Clinicians often use Socratic questioning to gently prompt the client, based on the idea that the client's own arrival at new cognitions about their trauma, as opposed to unquestioning acceptance of the clinician's interpretations, which is critical to recovery. Alternatively, CPT can be conducted without the use of written accounts (in a variant known as CPT-Cognitive, or CPT-C), which some clinicians have found to be equally effective and perhaps more efficient. [7] This alternative method relies almost entirely on Socratic dialogue between the therapist and client.

The final phase of treatment focuses on helping the client reinforce the skills they learned in the previous phase, with the intent that they can use those skills to further identify, evaluate, and modify their beliefs concerning their traumatic events. [16] The intent is to allow the clients to exit treatment with the confidence and ability to use adaptive coping strategies in their post-treatment lives. This phase focuses on five conceptual areas that traumatic experiences most frequently cause damage to: [18] safety, trust, power/control, esteem, and intimacy. Clients practice recognizing how their traumatic experiences resulted in over-generalized beliefs, as well as the impact of these beliefs on current functioning and quality of life.

Therapy elements

Four essential parts

Structure of CPT individual sessions

  1. CPT includes a brief written trauma account component, along with ongoing practice of cognitive techniques
  2. CPT-C omits the written trauma account, and includes more practice of cognitive techniques [19]

Structure of CPT group sessions

  1. CPT includes a brief written trauma account component, along with ongoing practice of cognitive techniques. The details of the written accounts are not shared during sessions, but the emotional and cognitive reactions identified while writing the account are processed by the group.
  2. CPT-C omits the written trauma account, and includes more practice of cognitive techniques.
  3. Individual and Group Combined includes practice assignments and the written trauma account, which are processed in additional individual therapy sessions. [19]

See also

Related Research Articles

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

<span class="mw-page-title-main">Dialectical behavior therapy</span> Psychotherapy for emotional dysregulation

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that began with efforts to treat personality disorders and interpersonal conflicts. Evidence suggests that DBT can be useful in treating mood disorders and suicidal ideation, as well as for changing behavioral patterns such as self-harm and substance use. DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies, and ultimately balance and synthesize them—comparable to the philosophical dialectical process of thesis and antithesis followed by synthesis.

Psychological trauma is an emotional response caused by severe distressing events such as accidents, violence, rape, or sensory overload. Short-term reactions such as psychological shock and psychological denial are typically followed. Long-term reactions include bi-polar disorder, uncontrollable flashbacks, panic attacks, nightmare disorder, difficulties with interpersonal relationships, post traumatic stress disorder (PTSD), or physical symptoms including migraines and nausea are often developed.

Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy devised by Francine Shapiro in the 1980s that was originally designed to alleviate the distress associated with traumatic memories such as post-traumatic stress disorder (PTSD). EMDR involves focusing on traumatic memories in a manner similar to exposure therapy while engaging in side-to-side eye movements. These eye movements have been criticized as having no scientific basis. The founder promoted the therapy for the treatment of PTSD and proponents employed untestable hypotheses to explain negative results in controlled studies. EMDR has been characterized as a pseudoscientific purple hat therapy.

<span class="mw-page-title-main">Art therapy</span> Creation of art to improve mental health

Art therapy is a distinct discipline that incorporates creative methods of expression through visual art media. Art therapy, as a creative arts therapy profession, originated in the fields of art and psychotherapy and may vary in definition.

Somatic experiencing (SE) is a form of alternative therapy aimed at treating trauma and stress-related disorders, such as PTSD. The primary goal of SE is to modify the trauma-related stress response through bottom-up processing. The Clients’ attention is directed toward internal sensations,, rather than to cognitive or emotional experiences. The method was developed by Peter A. Levine.

<span class="mw-page-title-main">Complex post-traumatic stress disorder</span> Psychological disorder

Complex post-traumatic stress disorder (CPTSD) is a stress-related mental disorder generally occurring in response to complex traumas, i.e. commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive few or no chance to escape.

Exposure therapy is a technique in behavior therapy to treat anxiety disorders. Exposure therapy involves exposing the target patient to the anxiety source or its context without the intention to cause any danger (desensitization). Doing so is thought to help them overcome their anxiety or distress. Procedurally, it is similar to the fear extinction paradigm developed for studying laboratory rodents. Numerous studies have demonstrated its effectiveness in the treatment of disorders such as generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder (PTSD), and specific phobias.

Prolonged exposure therapy (PE) is a form of behavior therapy and cognitive behavioral therapy designed to treat post-traumatic stress disorder. It is characterized by two main treatment procedures – imaginal and in vivo exposures. Imaginal exposure is repeated 'on-purpose' retelling of the trauma memory. In vivo exposure is gradually confronting situations, places, and things that are reminders of the trauma or feel dangerous. Additional procedures include processing of the trauma memory and breathing retraining.

Memory and trauma is the deleterious effects that physical or psychological trauma has on memory.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

Trauma focused cognitive behavioral therapy (TF-CBT) is an evidence-based psychotherapy or counselling that aims at addressing the needs of children and adolescents with post traumatic stress disorder (PTSD) and other difficulties related to traumatic life events. This treatment was developed and proposed by Drs. Anthony Mannarino, Judith Cohen, and Esther Deblinger in 2006. The goal of TF-CBT is to provide psychoeducation to both the child and non-offending caregivers, then help them identify, cope, and re-regulate maladaptive emotions, thoughts, and behaviors. Research has shown TF-CBT to be effective in treating childhood PTSD and with children who have experienced or witnessed traumatic events, including but not limited to physical or sexual victimization, child maltreatment, domestic violence, community violence, accidents, natural disasters, and war.

Internet interventions for post-traumatic stress have grown in popularity due to the limits that many patients face in their ability to seek therapy to treat their symptoms. These limits include lack of resources and residing in small towns or in the countryside. These patients may find it difficult to seek treatment because they do not have geographical access to treatment, and this can also limit the time they have to seek help. Additionally, those who live in rural areas may experience more stigma related to mental health issues. Internet interventions can increase the possibility that those who suffer from PTSD can seek help by eliminating these barriers to treatment.

<span class="mw-page-title-main">MDMA-assisted psychotherapy</span> Controlled administration of psychoactive drug MDMA to facilitate psychotherapy efficacy

MDMA-assisted psychotherapy is the use of prescribed doses of MDMA as an adjunct to psychotherapy sessions. Research suggests that MDMA-assisted psychotherapy for post-traumatic stress disorder (PTSD), including Complex PTSD, might improve treatment effectiveness. In 2017, a Phase II clinical trial led to "breakthrough therapy" designation by the US Food and Drug Administration (FDA).

Patricia A. Resick is an American researcher in the field of post traumatic stress disorder. She is known for developing cognitive processing therapy.

<span class="mw-page-title-main">Internet-based treatments for trauma survivors</span>

Internet-based treatments for trauma survivors is a growing class of online treatments that allow for an individual who has experienced trauma to seek and receive treatment without needing to attend psychotherapy in person. The progressive movement to online resources and the need for more accessible mental health services has given rise to the creation of online-based interventions aimed to help those who have experienced traumatic events. Cognitive behavioral therapy (CBT) has shown to be particularly effective in the treatment of trauma-related disorders and adapting CBT to an online format has been shown to be as effective as in-person CBT in the treatment of trauma. Due to its positive outcomes, CBT-based internet treatment options for trauma survivors has been an expanding field in both research and clinical settings.

<span class="mw-page-title-main">Narrative exposure therapy</span>

Narrative Exposure Therapy (NET) is a short-term psychotherapy used for the treatment of post-traumatic stress disorder and other trauma-related mental disorders. It creates a written account of the traumatic experiences of a patient or group of patients, with the aim of recapturing self-respect and acknowledging the patient's value. NET is an individual treatment, NETfacts is a format for communities.

In psychology, Trauma-informed feminist therapy is a model of trauma for both men and women that incorporates the client's sociopolitical context.

Psychedelic treatments for trauma-related disorders are the use of psychedelic substances, either alone or used in conjunction with psychotherapy, to treat trauma-related disorders. Trauma-related disorders, such as post-traumatic stress disorder (PTSD), have a lifetime prevalence of around 8% in the US population. However, even though trauma-related disorders can hinder the everyday life of individuals with them, less than 50% of patients who meet criteria for PTSD diagnosis receive proper treatment. Psychotherapy is an effective treatment for trauma-related disorders. A meta-analysis of treatment outcomes has shown that 67% of patients who completed treatment for PTSD no longer met diagnostic criteria for PTSD. For those seeking evidence-based psychotherapy treatment, it is estimated that 22-24% will drop out of their treatment. In addition to psychotherapy, pharmacotherapy (medication) is an option for treating PTSD; however, research has found that pharmacotherapy is only effective for about 59% of patients. Although both forms of treatment are effective for many patients, high dropout rates of psychotherapy and treatment-resistant forms of PTSD have led to increased research in other possible forms of treatment. One such form is the use of psychedelics.

Imagery Rescripting is an experiential therapeutic technique that uses imagery and imagination to intervene in traumatic memories. The process is guided by a therapist who works with the client to define ways to work with particular traumatic memories, images, or nightmares.

References

  1. ↑ Resick, P. A., & Schnicke, M. K. (1993). Cognitive processing therapy for rape victims: A treatment manual. Newbury Park, CA: Sage.
  2. ↑ Forman-Hoffman, Valerie; Cook Middleton, Jennifer; Feltner, Cynthia; Gaynes, Bradley N.; Palmieri Weber, Rachel; Bann, Carla; Viswanathan, Meera; Lohr, Kathleen N.; Baker, Claire; Green, Joshua (2018-05-17). "Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder: A Systematic Review Update". doi:10.23970/ahrqepccer207.{{cite journal}}: Cite journal requires |journal= (help)
  3. ↑ "What Is the Difference Between Talk Therapy and Cognitive Behaviour Therapy? | CBT Toronto". Cognitive Behaviour Therapy Toronto. 2021-04-13. Retrieved 2021-06-08.
  4. ↑ Monson, C.M. Schnurr, P.P., Resick, P.A., Friedman, M.J., Young-Xu, y., & Stevens, S.P. (2006). Cognitive processing therapy for veterans with military-related posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 74, 898-907.
  5. ↑ Monson, C.M., Price. J.L., Ranslow, E. (2005, October). Treating combat PTSD through cognitive processing therapy. Federal Practitioner, 75-83.
  6. ↑ Chard, K.M., Schumm, J.A., Owens, G.P., & Cottingham, S.M. (2010). A comparison of OEF and OIF veterans[ definition needed ] and Vietnam veterans receiving cognitive processing therapy. Journal of Traumatic Stress, 23, 25-32.
  7. 1 2 Resick, P. A., Galovski, T. E., Uhlmansiek, M. O., Scher, C. D., Clum, G. A., & Young-Xu, Y. (2008). A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence. Journal of Consulting and Clinical Psychology, 76, 243–258.
  8. ↑ Resick, P. A., Nishith, P., Weaver, T. L., Astin, M. C., & Feuer, C. A. (2002). A comparison of cognitive processing therapy with prolonged exposure therapy and a waiting list condition for the treatment of chronic posttraumatic stress disorder in female rape victims. Journal of Consulting and Clinical Psychology, 70, 867–879.
  9. ↑ Chard, K.M. (2005). An evaluation of cognitive processing therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse. Journal of Consulting and Clinical Psychology, 73, 965–971.
  10. ↑ Schulz, P. M., Resick, P.A., Huber, L.C., Griffin, M.G. (2006). The effectiveness of cognitive processing therapy for PTSD with refugees in a community setting. Cognitive and Behavioral Practice, 13, 322-331.
  11. ↑ Lewis, Catrin; Roberts, Neil P.; Andrew, Martin; Starling, Elise; Bisson, Jonathan I. (2020). "Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis". European Journal of Psychotraumatology. 11 (1): 1729633. doi:10.1080/20008198.2020.1729633. ISSN   2000-8066. PMC   7144187 . PMID   32284821.
  12. ↑ Tran, Khai; Moulton, Kristen; Santesso, Nancy; Rabb, Danielle (2016). Cognitive Processing Therapy for Post-Traumatic Stress Disorder: A Systematic Review and Meta-Analysis. CADTH Health Technology Assessments. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health. PMID   27227199.
  13. ↑ "Cognitive Processing Therapy (CPT)". American Psychological Association. Retrieved 4 October 2017.
  14. ↑ Kadosh, Joshua. "CBT Treatment in adults". experts-il.com. Archived from the original on 2020-08-08.
  15. 1 2 "About Us | Cognitive Processing Therapy". About Us | Cognitive Processing Therapy. 15 October 2012. Retrieved 27 August 2019.
  16. 1 2 3 "Cognitive Processing Therapy (CPT)". www.apa.org. Retrieved 2017-10-02.
  17. ↑ Resick, Patricia (2008). Cognitive Processing Therapy Veteran/Military Version: Therapist Manual. Boston, MA: Department of Veterans Affairs. pp. 1–24.
  18. ↑ Owens, G.P. & Chard, K.M. (2001). Cognitive distortions among women reporting childhood sexual abuse. Journal of Interpersonal Violence, 16, 178-191.
  19. 1 2 3 "Cognitive Processing Therapy". National Center for PTSD. ptsd.va.gov. Retrieved 15 February 2016.
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