Question 1

How does Cognitive Processing Therapy differ from Prolonged Exposure Therapy (PE; Foa & Rothbaum) and Cognitive Therapy for PTSD (CT-PTSD; Ehlers & Clark)?

Patricia Resick · Accepted Answer

PE is an exposure therapy (imaginal and behavior exposure), CPT is a cognitive therapy.  The difference between CT-PTSD by Ehlers and Clark and CPT is that CPT is a more structured protocol.

Question 2

What elements of CBT does Cognitive Processing Therapy draw upon?

Patricia Resick · Accepted Answer

Cognitive therapy was influenced heavily by Aaron Beck. That is the bulk of the therapy, progressive worksheets and Socratic dialogue.  At the end of therapy there are two behavioral assignments, giving and receiving compliments and doing something nice/worthwhile for oneself each day. The goal of these assignments is increased self-esteem, finding out what they want to do when they aren't avoiding with their PTSD and to interact with other people more.

Question 3

What are the benefits of a manualized approach to PTSD intervention?

Patricia Resick · Accepted Answer

There are a number of benefits.  We have found that sticking to the protocol keeps both the therapist and patient from avoiding working with the PTSD trauma and wandering off to other topics. Fidelity to the manual has been shown to increase outcomes.  It is a systematic approach that teaches the patient a new way to think in a more balanced and fact-based way.  We want to stay on topic so that they can develop the skills of cognitive and emotional examination and they can get to the point where they can effectively come to more balanced fact-based alternative thoughts they can practice rather than the extreme statements they are accustomed to thinking.  Ultimately, we want them to take over as their own therapist.

Question 4

What are core themes in traumatized patients?

Patricia Resick · Accepted Answer

It depends on how you define a core theme.  As an example, if patients are taught when they are young that they are stupid or that everything that happens to them is their fault, that can become a core belief that is activated when they experience a traumatic event.  They will assume it happened because they are stupid or that it must be their fault.  Core beliefs generalize into habits to many events in everyday life and are underlying patients emotions and actions.  In CPT we talk about core beliefs when we hear patients having the same Stuck Points over and over across situations.  In the second half of treatment, any of the over-accommodated beliefs (safety, trust, power/control, esteem and intimacy) are focused on as common themes that are disrupted by traumatic events.  Some patients have more of some than others and any of them if generalized widely can become core beliefs.

Question 5

What are the rates of PTSD symptom relapse amongst patients who have completed Cognitive Processing Therapy?

Patricia Resick · Accepted Answer

In a follow-up that was conducted 5-10 year after completing CPT, we examined women who had recovered and then looked to see how many had PTSD at the long term follow-up.  For the whole sample who had CPT, 78% did not have PTSD at the follow-up.  Of those who did not have PTSD at the end of treatment, 20% met criteria for PTSD at the long term follow-up.  We only looked at relapse by diagnosis, not by decrease to a good end state and then relapsed to much higher scores.  The problem of diagnosis only could be changing just one answer to the criteria questions.  There is only so much you can put into a paper though.  I can't think of any other studies that we examined relapse per se.  the Larson 2016 article looked at exacerbations of specific symptoms during treatment (about 20% of those with CPT with written accounts and 15% of those who did CPT without accounts.  However, they seemed to do fine by the end of treatment with equal clinically significant improvements and no difference in drop-out.

Question 6

What are the core principles on which the CPT protocol is based?

Patricia Resick · Accepted Answer

Cognitive theory. Cognitive change not extinction of fear.  This question is too big for this venue.  I suggest that you read the manual or a chapter on CPT. Attached is a chapter on PTSD from a cognitive perspective.

Question 7

Would you endorse Written Expressive Therapy (WET) as part of a stepped care approach to treating PTSD?

Patricia Resick · Accepted Answer

I would give them a choice after describing the available therapies if therapists are trained in more than one treatment.  Some people would choose WET and some would choose PE or CPT.  It also depends on comorbidity.  We know that WET is noninferior to CPT with regard to PTSD, but we don't yet know about guilt, shame, anger, alcohol abuse etc.  It could be used as stepped care, if there are limited therapists, but the patients should know that there are other options also.

Question 8

How does CPT address intense self-loathing and shame?

Patricia Resick · Accepted Answer

Self-loathing and shame are a major focus in CPT.  Beyond self-blame, shame is a big predictor of who will have PTSD and we would conceptualize self-loathing and shame as core beliefs about one as a person.  Once we recognize a core belief, whenever we do in therapy, we explain it and don't try to challenge it as a large concept but do worksheets and notice whenever that is a theme.  If you can alter thoughts about one daily or trauma event at a time and they realize that it wasn't their fault or doesn't have to mean anything about them as a person, the core belief starts to fall under the weight of all of the evidence to the contrary.  Pointing out the pattern and noticing when it occurs and assigning worksheets on specific events works much better than trying to challenge it as a global concept. The patients need to come to understand that the traumatic events happened in spite of them, not because of them, and only means something about the perpetrator- the one who had the intent.

Question 9

What are the goals of Cognitive Processing Therapy?

Patricia Resick · Accepted Answer

To reduce the symptoms of PTSD and depression.  I suggest you watch the video on cptforptsd.com

Question 10

How does Cognitive Processing Therapy conceptualize PTSD?

Patricia Resick · Accepted Answer

Oh my, this is too big for a brief answer.  I suggest that you read the manual (Resick, Monson & Chard, 2017).  You can find it at cptforptsd.com or Guilford publishers.  I am attaching the draft of chapter I wrote on cognitive therapies.  I am working from home and can't make a copy because the book is at the office.  It is a cognitive model that does not assume PTSD to be only about fear and anxiety.  We see all different emotions based on how the person thinks about the cause of the event.  We help them to examine their thinking about the the causes and effects of the trauma and if their thoughts change, their emotions and other symptoms of PTSD change.

Ask World-Leading Experts

A cognitive approach to treating PTSD

SHARE TOPIC

Meet the expert answering questions

Discover other topics you may be interested in