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Cognitive Processing Therapy for PTSD

February 28, 2017

Man in civilian clothes comforts young man in military dress blues while sitting on a park bench.

Posttraumatic stress disorder (PTSD) belongs to a class of mental disorders known as trauma- and stressor-related disorders. This class of disorders includes disorders in which exposure to a traumatic or stressful event is listed explicitly as a diagnostic criterion, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

Treatments for PTSD include talk therapies (or psychotherapy) and medications, according to the U.S. Department for Veterans Affairs. Cognitive processing therapy is a specific type of cognitive behavioral therapy that is used for treating PTSD.

Overview of PTSD

Diagnostic Criteria

The following criteria from the DSM-5 apply to adults, adolescents and children older than 6 years.

A. Exposure to actual or threatened death, serious injury or sexual violence in one or more of the following ways.

  1. Directly experiencing the traumatic event(s).
  2. Witnessing, in person, the event(s) as it occurred to others.
  3. Learning that the traumatic event(s) occurred to a close family member or friend.
  4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s).

B. Presence of one or more of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred.

  1. Recurrent, involuntary and intrusive distressing memories of the traumatic event(s).
  2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s).
  3. Dissociative reactions in which the individual feels or acts as if the traumatic event(s) were recurring.
  4. Intense or prolonged psychological distresses at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
  5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following.

  1. Avoidance of or efforts to avoid distressing memories, thoughts or feelings about or closely associated with the traumatic event(s).
  2. Avoidance of or efforts to avoid external reminders that arouse distressing memories, thoughts or feelings about or closely associated with the traumatic event(s).

D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two or more of the following.

  1. Inability to remember an important aspect of the traumatic event(s).
  2. Persistent and exaggerated negative beliefs or expectations about oneself, others or the world.
  3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
  4. Persistent negative emotional state.
  5. Markedly diminished interest or participation in significant activities.
  6. Feelings of detachment or estrangement from others.
  7. Persistent inability to experience positive emotions.

E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two or more of the following.

  1. Irritable behavior and angry outbursts typically expressed as verbal or physical aggression toward people or objects.
  2. Reckless or self-destructive behavior.
  3. Hypervigilance.
  4. Exaggerated startle response.
  5. Problems with concentration.
  6. Sleep disturbance.

F. Duration of the disturbance (Criteria B, C, D and E) is more than 1 month.

G. The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.

H. The disturbance is not attributable to the physiological effects of a substance or another medical condition.


Other Features

  • Prevalence: Projected lifetime risk for PTSD using DSM-IV criteria at age 75 years in the United States is 8.7 percent. Rates of PTSD are higher among veterans and others whose vocation increases the risk of traumatic exposure. Highest rates (ranging from one-third to more than one-half of those exposed) are found among survivors of rape, military combat and captivity, and ethnically or politically motivated internment and genocide.
  • Onset: PTSD can occur at any age, beginning after the first year of life. Symptoms usually begin within the first 3 months after the trauma, although there may be a delay of months or even years before criteria for the diagnosis are met.
  • Differential Diagnosis: In adjustment disorders, the stressor can be of any severity or type rather than what is required by PTSD Criterion A. The DSM-5 includes differential diagnosis guidelines for several other disorders.
  • Comorbidity: Individuals with PTSD are 80 percent more likely than those without PTSD to have symptoms that meet diagnostic criteria for at least one other mental disorder, such as depressive, bipolar, anxiety or substance use disorders. Among U.S. military personnel and combat veterans who have been deployed to recent wars in Afghanistan and Iraq, co-occurrence of PTSD and mild traumatic brain injury is 48 percent.

Cognitive Processing Therapy for PTSD


Cognitive processing therapy (CPT) is a manualized (uses specific steps) therapy designed to help people with PTSD evaluate and change the thoughts they have had since their trauma. Treatment typically consists of 12 sessions that take place once or twice weekly. CPT can be done individually or in a group setting.

A person in CPT will begin by discussing PTSD to better understand the symptoms. Then the therapist will ask the individual to write down how trauma has affected the person. Using worksheets and through dialogue with the provider, the individual will write and talk about negative or unhelpful thoughts that he or she has had about the trauma. The individual will be able to talk through emotions like anger, sadness and guilt by discussing them with the therapist, who can provide insight into confronting these emotions and how they impact the individual’s personal life.

Effectiveness of Using CPT to Treat PTSD

The U.S. Department of Veterans Affairs and the International Society for Traumatic Stress Studies regard CPT as an effective treatment for PTSD in military and veteran populations as well as other groups.

A literature review from the Naval Center for Combat & Operational Stress Control concluded that “Evidence points to CPT’s efficacy as a psychological treatment for PTSD and has demonstrated potential to decrease symptoms of depression and guilt.” The authors identified that out of cognitive behavioral therapies (including CPT as well as stress inoculation training and prolonged exposure), CPT has the strongest support across a variety of populations. They added that CPT is one of two manualized therapies that adequately treats PTSD (the other is prolonged exposure).

Considerable research has focused on CPT for PTSD in veterans; veterans are one of the most common population groups affected by PTSD and CPT was specifically designed for veterans with PTSD. A trial in the Journal of Consulting and Clinical Psychology found that group CPT for active duty military personnel resulted in large reductions of PTSD severity and reduced depression, with these gains remaining during follow-up. The Journal of Clinical Psychiatry found significant reductions in PTSD symptoms for veterans who received CPT delivered via video teleconferencing, and these results were maintained at 3- and 6-month follow-up.

Time magazine notes some debate over the effectiveness of CPT. More research is needed to state conclusively how effective CPT is in treating PTSD.

Becoming a Mental Health Counselor

Employment of mental health counselors is projected to grow 20 percent by 2024, according to the Bureau of Labor Statistics. This is much faster than the average for all professions.

Grace College’s online M.A. in Clinical Mental Health Counseling prepares graduates for work in counseling environments. This faith-based program allows students to complete the majority of their coursework in a fully online format, while attending an annual seven- to 10-day residency on campus in scenic Winona Lake, Indiana. The program is accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP).