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

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. [12] 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. [13]

History

Development of CPT began in 1988 with work by Patricia Resick. [14] Initial randomized controlled trials for treatment of PTSD were conducted by Candice M. Monson. [14]

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. [15] 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. [16]

The next phase involves formal processing of the trauma. [15] 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. [6] 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. [15] 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: [17] 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 [18]

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. [18]

See also

Related Research Articles

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Cognitive behavioral therapy (CBT) is a form of psychotherapy that aims to reduce symptoms of various mental health conditions, primarily depression, PTSD and anxiety disorders. Cognitive behavioral therapy focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include many issues and the treatment of many mental health and other conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

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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 client's attention is directed toward internal sensations,, rather than to cognitive or emotional experiences. The method was developed by Peter A. Levine.

Barbara Rothbaum is a psychologist at Emory University School of Medicine in Atlanta, Georgia, United States. She is a professor in the Psychiatry department and a pioneer in the treatment of anxiety-related disorders. Rothbaum is head of the Trauma and Anxiety Recovery Program (TARP) at Emory as well as the Emory Healthcare Veterans Program. In the mid-1990s she founded a virtual exposure therapy company called Virtually Better, Inc. This company treats patients with anxiety disorders, addictions, pain, and the like using virtual reality instead of the actual place or scenario. It also allows the therapist to control the environment. She also played a key role in the development of the treatment of posttraumatic stress disorder (PTSD).

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

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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.

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References

  1. ↑ Resick, P. A., & Schnicke, M. K. (1993). Cognitive processing therapy for rape victims: A treatment manual. Newbury Park, CA: Sage.
  2. ↑ "What Is the Difference Between Talk Therapy and Cognitive Behaviour Therapy? | CBT Toronto". Cognitive Behaviour Therapy Toronto. 2021-04-13. Retrieved 2021-06-08.
  3. ↑ 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.
  4. ↑ Monson, C.M., Price. J.L., Ranslow, E. (2005, October). Treating combat PTSD through cognitive processing therapy. Federal Practitioner, 75-83.
  5. ↑ 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.
  6. 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.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ "Cognitive Processing Therapy (CPT)". American Psychological Association. Retrieved 4 October 2017.
  13. ↑ Kadosh, Joshua. "CBT Treatment in adults". experts-il.com. Archived from the original on 2020-08-08.
  14. 1 2 "About Us | Cognitive Processing Therapy". About Us | Cognitive Processing Therapy. 15 October 2012. Retrieved 27 August 2019.
  15. 1 2 3 "Cognitive Processing Therapy (CPT)". www.apa.org. Retrieved 2017-10-02.
  16. ↑ Resick, Patricia (2008). Cognitive Processing Therapy Veteran/Military Version: Therapist Manual. Boston, MA: Department of Veterans Affairs. pp. 1–24.
  17. ↑ Owens, G.P. & Chard, K.M. (2001). Cognitive distortions among women reporting childhood sexual abuse. Journal of Interpersonal Violence, 16, 178-191.
  18. 1 2 3 "Cognitive Processing Therapy". National Center for PTSD. ptsd.va.gov. Retrieved 15 February 2016.
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