Cognitive Processing Therapy (CPT): An Introduction to Treating PTSD in Therapy

Introduction

Cognitive Processing Therapy (CPT) is a specialized form of cognitive-behavioural therapy designed to support individuals who are struggling with post-traumatic stress disorder (PTSD) and related symptoms. It is particularly effective in addressing the distressing thoughts and beliefs that often follow traumatic experiences. As a therapist, my approach typically focuses on somatic practices, which involve tuning into and working with the body’s sensations, movements, and physiological responses to aid healing. However, I’ve noticed that for many clients—especially those from the 2SLGBTQIA+ community—there are moments when negative thinking patterns can become deeply entrenched, creating barriers to progress in somatic work. In such instances, CPT can serve as a valuable bridge, helping to untangle these harmful thoughts and beliefs, which in turn creates a more stable foundation for further exploration of the body and emotions.

CPT provides a structured way to examine how our thoughts impact our emotions and behaviours, which is crucial when working with the layered traumas that 2SLGBTQIA+ clients often face. Many clients within our community experience not just isolated traumatic events but ongoing, systemic stressors such as discrimination, microaggressions, and social rejection. This adds layers of complexity to their healing process. By focusing on cognitive restructuring—challenging and reframing the unhelpful beliefs that stem from trauma—CPT allows clients to break free from rigid, negative patterns that might otherwise keep them stuck. This process can be particularly empowering for those who have been told repeatedly, either explicitly or implicitly, that their identities are invalid or dangerous. CPT helps clients reclaim control over their narratives, moving towards self-compassion and resilience. When clients can clear these cognitive obstacles, they often find engaging in deeper, more embodied therapeutic practices easier.

The Origins and History of CPT

Cognitive Processing Therapy (CPT) was developed in the late 1980s by Dr. Patricia Resick and her colleagues as a targeted treatment for PTSD, rooted in cognitive-behavioural therapy principles (Resick, Monson, & Chard, 2024). This modality emerged during a period when trauma-focused therapies were gaining recognition for their efficacy in addressing the complex ways that trauma impacts cognition and emotion. Dr. Resick’s work was pivotal in recognizing that individuals who experience trauma often develop maladaptive beliefs about themselves, others, and the world. These beliefs—termed “stuck points” in CPT—can perpetuate distress and inhibit recovery by reinforcing cycles of shame, self-blame, and fear.

Initially developed for survivors of sexual assault, CPT’s structured and evidence-based approach quickly showed promise for a broader range of trauma survivors, including military veterans, survivors of childhood abuse, and those who have experienced natural disasters. The therapy involves identifying these stuck points, challenging them through evidence-based questioning, and reframing them to align more closely with reality. Over the decades, the modality has evolved to incorporate adaptations for diverse populations and varying contexts, such as group therapy formats and telehealth applications.

Importantly, CPT has also been adapted to be more inclusive and sensitive to the needs of marginalized communities, including the 2SLGBTQIA+ population. Research has shown that trauma can have unique impacts on individuals who face ongoing systemic oppression, such as transphobia, homophobia, racism, and ableism (Resick, Monson, & Chard, 2024). Traditional trauma therapies sometimes overlook these intersecting factors, but CPT offers flexibility through its focus on individualized cognitive restructuring. By helping clients process not only the primary trauma but also the secondary trauma of discrimination and exclusion, CPT becomes a powerful tool for healing within a social justice framework. This inclusivity makes CPT an appealing option for 2SLGBTQIA+ clients who seek to understand and challenge both personal and systemic factors contributing to their trauma responses.

These historical developments reflect a growing understanding within the field of psychology that effective trauma treatment must be both evidence-based and responsive to the social contexts in which clients live. CPT’s adaptability ensures that it remains relevant and effective for all clients, including those whose identities and experiences challenge normative assumptions. As therapists, our job is to leverage such tools to empower clients to reclaim their narratives, heal, and thrive in a world that often does not validate their full humanity.

Core Components of CPT

Cognitive Processing Therapy (CPT) consists of several key components that structure the therapeutic process, guiding clients through identifying, challenging, and transforming the negative cognitions and beliefs that have resulted from trauma. These components work synergistically to help clients move from feeling trapped in their trauma to finding new, healthier ways of understanding themselves and their experiences.

1. Identifying Stuck Points: At the heart of CPT is the identification of “Stuck Points,” which are unhelpful beliefs or interpretations that keep clients mired in trauma-related distress. These could range from self-blame (“I should have done more”) to overgeneralizations (“No one can be trusted”) and are often developed as a way of making sense of traumatic events. The therapeutic process begins by helping clients articulate these beliefs, which can be hidden beneath layers of shame, fear, or guilt. By bringing these stuck points into conscious awareness, clients can start to see how these thoughts are impacting their emotional well-being and everyday functioning.

2. Challenging and Reframing Thoughts: Once stuck points are identified, the next step is to challenge these negative thoughts and reframe them in a way that aligns more closely with reality and the client’s values. Tools like the Alternative Thoughts Worksheets are central to this process, encouraging clients to examine the evidence for and against their beliefs, consider alternative perspectives, and develop more balanced ways of thinking (Resick, Monson, & Chard, 2024). This cognitive restructuring helps clients break free from rigid, distressing thought patterns and opens up space for new emotional and behavioural responses.

3. Engaging in Socratic Dialogue: A critical aspect of CPT is the use of Socratic dialogue, where the therapist and client engage in a structured, collaborative discussion to examine the evidence and logic behind the client’s beliefs. This process involves asking open-ended questions that encourage clients to think deeply about their “Stuck Points” and explore alternative interpretations. The goal is not for the therapist to provide answers but to guide clients in discovering insights themselves, fostering a sense of agency and self-efficacy.

4. Exploring Themes Related to Safety, Trust, Power/Control, Esteem, and Intimacy: As clients become more adept at recognizing and challenging their stuck points, CPT shifts focus to exploring how trauma has impacted fundamental beliefs about safety, trust, power/control, self-esteem, and intimacy. Trauma can significantly distort these core beliefs, leading to hypervigilance, mistrust, disempowerment, low self-worth, and difficulties in forming close relationships. Through targeted exercises and discussions, clients are supported in rebuilding healthier, more realistic frameworks for these concepts, which are essential for establishing a sense of safety and connection in their lives.

5. Impact Statements: Early in CPT, clients are asked to write an Impact Statement—a brief account of how they believe the traumatic event has affected them and their worldviews. This exercise serves as a baseline for understanding the client’s current beliefs and provides a reference point throughout therapy. Revisiting and rewriting the Impact Statement later in therapy allows clients to see their progress in shifting from trauma-informed beliefs to more adaptive, empowering ones.

6. Worksheets and Practice Assignments: Throughout CPT, clients are encouraged to use various worksheets, such as the Exploring Questions Worksheet and the Thinking Patterns Worksheet, to help structure their thinking and practice the skills they are learning in therapy (Resick, Monson, & Chard, 2024). These worksheets provide a practical, hands-on way for clients to engage with the material outside of sessions, fostering continued growth and reflection. Practice assignments also allow clients to apply new ways of thinking to real-life situations, helping them solidify their cognitive and emotional shifts.

7. Gradual Exposure Through Written Accounts: For some clients, especially those who have experienced severe or multiple traumas, a modified version of CPT called CPT+A incorporates written accounts of their trauma as part of the therapeutic process. Clients are guided to write about their traumatic experience in detail, often more than once, and to discuss these writings with their therapist. This gradual exposure allows clients to confront and process their trauma memories in a safe, structured environment, reducing avoidance and fostering desensitization to trauma cues.

8. Skill Generalization and Maintenance: Towards the end of the CPT protocol, the focus shifts to consolidating skills and ensuring clients can generalize what they’ve learned to new situations. This includes helping clients identify potential future challenges, develop coping strategies, and build a strong support system to maintain progress. Clients are encouraged to continue using the tools and techniques from CPT in their everyday lives, helping them navigate stressors and triggers that may arise after therapy ends.

9. Supportive Therapeutic Relationship: A core component of CPT, as with any therapeutic approach, is the establishment of a strong, supportive relationship between the client and therapist. In CPT, this relationship is particularly important for fostering trust and collaboration, which are essential when delving into challenging and often painful cognitive work. The therapist acts not as an authority but as a guide and partner in the client’s journey toward healing, which aligns well with feminist and anti-oppressive frameworks.

10. Flexibility and Cultural Sensitivity: While CPT follows a structured protocol, it is also flexible and adaptable to meet the unique needs of each client. For 2SLGBTQIA+ clients, this might mean explicitly incorporating discussions about how their trauma is intertwined with experiences of discrimination, social marginalization, and internalized stigma. Therapists can work with clients to tailor the content of CPT to reflect their lived experiences, ensuring the therapy is culturally sensitive, inclusive, and affirming.

By integrating these core components, CPT offers a comprehensive and adaptable framework for trauma recovery that empowers clients to reclaim their narratives, rebuild trust in themselves and others, and foster resilience in the face of ongoing challenges.

How is CPT Used in Therapy?

Cognitive Processing Therapy (CPT) is a structured, evidence-based approach typically conducted over 12 sessions, although the length can be adjusted based on individual needs and progress. Each session follows a clear and predictable format, which can be incredibly grounding for clients who might feel overwhelmed by their trauma and its aftermath. By providing a roadmap for the therapeutic process, CPT helps clients know what to expect, making the journey of healing feel more manageable and organized.

The Structure of CPT Sessions

The 12 sessions of CPT are carefully designed to build upon each other, guiding clients from initial identification of trauma-related beliefs to the development of healthier, more adaptive ways of thinking. Here is a breakdown of the general flow of CPT therapy:

1. Session 1: Introduction to CPT and PTSD

The first session focuses on establishing a safe and collaborative therapeutic environment. The therapist provides an overview of CPT, explains the cognitive model of PTSD, and discusses how thoughts, feelings, and behaviours are interconnected. Clients are introduced to the concept of “Stuck Points” and begin to identify how their trauma has impacted their thinking patterns. They may be given an Impact Statement assignment, where they write about how the trauma has affected their beliefs about themselves, others, and the world.

2. Session 2: Writing and Reviewing the Impact Statement

Clients share their Impact Statement, and the therapist helps them identify any cognitive distortions or “Stuck Points” that emerge. This session sets the stage for cognitive restructuring, where clients begin to learn how their thoughts are related to their emotional and behavioural reactions.

3. Sessions 3-6: Developing Cognitive Skills and Using Worksheets

These sessions are dedicated to building cognitive skills that help clients challenge their “Stuck Points.” Using tools like the ABC Worksheets and Exploring Questions Worksheet, clients learn to break down their thoughts and feelings into manageable parts, evaluate evidence for and against their beliefs, and consider alternative, more balanced perspectives. Homework assignments, such as completing the Alternative Thoughts Worksheets, are crucial components. Clients review these assignments with their therapist to refine their skills and discuss any difficulties they encountered, receiving guidance and feedback to deepen their understanding.

4. Sessions 7-8: Introducing Trauma Themes and Deeper Cognitive Restructuring

In these sessions, therapy delves into core themes affected by trauma—Safety, Trust, Power/Control, Esteem, and Intimacy. Each theme represents a different area where trauma can create distorted beliefs. For example, a client may struggle with trust due to betrayal or violence, or with self-esteem if they internalize blame for their trauma. Through focused discussion and continued use of cognitive tools, clients explore how their trauma has shaped these beliefs and work towards developing healthier frameworks.

5. Sessions 9-10: Applying Skills to Future Scenarios

As clients become more comfortable with the cognitive restructuring process, they begin to apply their skills to hypothetical future scenarios. This phase helps clients generalize their new ways of thinking beyond their trauma, equipping them to handle everyday stressors and challenges with resilience and confidence. This is particularly helpful for those who have had chronic or complex trauma, where ongoing life events may trigger past trauma responses.

6. Sessions 11-12: Consolidation and Planning for the Future

The final sessions focus on consolidating the gains made throughout therapy and planning for the future. Clients revisit their original Impact Statement and rewrite it, reflecting any changes in their beliefs and perspectives. This exercise helps them recognize the progress they’ve made and reinforces the cognitive tools they’ve learned. The therapist and client collaboratively develop a maintenance plan to ensure the client feels equipped to continue using these skills after therapy ends, identifying potential triggers and coping strategies to manage future distress.

What Happens in a Typical CPT Session?

Each session in CPT follows a predictable structure, which includes several core elements:

•Review of Homework Assignments: At the beginning of each session, the therapist and client review the homework assignments from the previous session, such as the Alternative Thoughts Worksheets or the Exploring Questions Worksheet. This review helps the therapist assess the client’s understanding and ability to apply cognitive restructuring techniques and provides an opportunity to address any challenges or refine the skills further.

•Discussion of Stuck Points and Cognitive Restructuring: A significant portion of each session is dedicated to discussing specific “Stuck Points” that the client has identified. Through guided questioning, the therapist encourages the client to critically examine these thoughts and consider alternative perspectives. This process, known as Socratic dialogue, helps clients explore their beliefs in depth, identify cognitive distortions, and develop more balanced and adaptive thoughts.

•Introduction of New Concepts or Tools: Depending on the session, the therapist may introduce new concepts or cognitive tools. For instance, when exploring the theme of Safety, the therapist might discuss how trauma can distort one’s sense of safety and security and introduce exercises to help the client rebuild this fundamental belief. New worksheets or exercises are provided as practice assignments for the client to complete between sessions.

•Collaborative Planning for Future Practice: At the end of each session, the therapist and client collaboratively plan the homework assignments and practice exercises for the upcoming week. These assignments are tailored to the client’s progress and focus on reinforcing newly learned skills, applying them to everyday situations, and preparing for potential challenges.

•Check-In on Emotional Reactions: Before concluding, the therapist checks in with the client about their emotional reactions to the session. This is important for ensuring the client leaves the session feeling supported and not overwhelmed by the content discussed.

Benefits of a Structured Approach in CPT

The structured nature of CPT provides several benefits for clients:

•Predictability and Safety: Knowing what to expect each session helps create a sense of safety and predictability, which is crucial when working through trauma. This consistency can be particularly comforting for clients who have experienced chaos or unpredictability in their lives.

•Skill-Building and Empowerment: By systematically teaching and reinforcing cognitive restructuring skills, CPT empowers clients to become their own “cognitive therapists.” This self-efficacy is vital for sustaining progress after therapy ends.

•Grounding and Organization: The organized flow of sessions helps clients feel more grounded in their healing journey. The clear roadmap of CPT, combined with its practical tools, provides clients with concrete steps to take, reducing the feeling of being overwhelmed by their trauma.

•Integration with Other Therapeutic Approaches: CPT can also serve as a precursor to other therapeutic modalities, such as somatic therapy. By helping clients cognitively process and reframe their trauma-related beliefs, CPT can create a more stable foundation for deeper somatic work, where clients explore how trauma has affected their bodies and emotional regulation.

By following these structured sessions, clients participating in CPT can expect a focused and systematic approach to addressing trauma. Each step is designed to build on the previous one, fostering a sense of mastery, resilience, and hope as clients move forward in their healing journey.

Integrating CPT in Anti-Oppressive and Feminist Theoretical Orientations

For 2SLGBTQIA+ clients, therapy must address not only the trauma itself but also the broader contexts of marginalization, discrimination, and systemic oppression that often compound mental health struggles. When used thoughtfully, CPT can be adapted to an anti-oppressive, feminist framework that recognizes the complexities of intersecting identities and power dynamics. This involves being deeply attuned to each client’s reality, understanding how their lived experiences of systemic harm influence their beliefs, and reframing our approach to “stuck points” to be more culturally sensitive.

1. Addressing Cultural and Contextual Factors: Traditional CPT focuses on identifying and challenging unhelpful beliefs or “stuck points.” However, it is essential to recognize that some beliefs that seem unhelpful on the surface may actually reflect the reality of discrimination or systemic harm a client faces. For instance, a belief like “I can’t trust anyone” may not be a cognitive distortion but a realistic assessment for a person who has repeatedly experienced betrayal or violence due to their gender identity, race, or sexual orientation. In these cases, it is not about “removing” the thought but understanding its context and validating the client’s lived experience. The therapist’s role is to explore with the client how these realities impact their sense of safety, trust, and self-esteem, and to support them in developing coping strategies that acknowledge these truths while still fostering hope, agency, and resilience.

2. Empowering Clients Through Collaboration: A feminist approach to CPT involves viewing the client as an expert on their own life, rather than positioning the therapist as the authority. This collaborative stance aligns well with the use of Socratic dialogue in CPT, where the therapist and client work together to explore the evidence for and against certain beliefs. Instead of directing the client to simply change their thoughts, the therapist encourages them to critically evaluate how their experiences, social identities, and systemic factors shape their thinking. This collaborative approach helps clients feel empowered to make sense of their experiences and to determine what feels authentic and helpful for them in reframing their beliefs.

3. Critiquing Dominant Narratives: In an anti-oppressive framework, therapists support clients in critiquing and challenging dominant societal narratives that may reinforce their “stuck points.” For example, heteronormative, cisnormative, and white supremacist ideologies can perpetuate beliefs that a client is “not enough” or “unworthy” due to their identity. Instead of viewing these thoughts as irrational or maladaptive, therapists work with clients to unpack these beliefs as responses to systemic oppression and societal invalidation. The focus shifts from simply “correcting” cognitive distortions to understanding how these beliefs are shaped by broader cultural forces, allowing clients to challenge and resist these narratives on their terms.

4. Balancing Reframing with Validation: While cognitive restructuring is a core component of CPT, there must be a balance between encouraging clients to reframe their thoughts and validating the reality of systemic harm. For clients who live with multiple marginalized identities, the process of reframing can sometimes feel like gaslighting if it does not fully acknowledge their lived experience. Therapists need to validate the pain and frustration that come from living in an oppressive society, while also exploring how clients can hold on to beliefs that serve their healing and well-being, even when those beliefs may include a healthy skepticism of the systems around them.

5. Understanding the Intersection of Trauma and Identity: For many 2SLGBTQIA+ clients, trauma is not just an isolated event but an ongoing experience linked to their identities. This might include microaggressions, threats to safety, healthcare discrimination, or family rejection. An intersectional approach in CPT considers how these cumulative traumas impact the client’s cognitive and emotional world. It also means recognizing that clients may need to navigate spaces that are not safe or affirming, and that their thoughts and beliefs may be protective in these contexts. The therapist’s role is to help clients navigate these realities in a way that feels empowering rather than diminishing their lived experiences.

6. Trauma-Informed Practice and Cultural Sensitivity: Being trauma-informed is essential in anti-oppressive CPT. This involves creating a therapeutic environment that emphasizes safety, choice, collaboration, and empowerment. For 2SLGBTQIA+ clients, this also means being aware of cultural nuances and historical traumas, such as the legacy of colonization, slavery, and forced assimilation, and how these intersect with contemporary experiences of discrimination. Therapists should approach each session with curiosity and humility, understanding that every client brings a unique story shaped by their intersecting identities.

7. Expanding the Concept of “Stuck Points”: The idea of “stuck points” in CPT can be expanded in an anti-oppressive context to include not only personal beliefs but also the systemic and structural factors that keep clients feeling trapped. Therapists can help clients identify not only internalized beliefs that are unhelpful but also external “stuck points” like ongoing discrimination, lack of access to affirming care, or unsafe environments. This expanded view allows for a more holistic approach to healing that acknowledges both internal and external barriers to recovery.

8. Building Collective Resilience: An anti-oppressive approach also recognizes the importance of collective healing and resilience. This could mean encouraging clients to connect with supportive communities or engage in activism as a form of healing. For many 2SLGBTQIA+ clients, finding solidarity and strength within their communities is crucial for challenging oppressive systems and finding joy and meaning beyond the trauma.

9. Continual Reflection and Therapist Accountability: Therapists must continually reflect on their own biases, power dynamics in the therapeutic relationship, and how they may unintentionally reinforce dominant narratives. Incorporating regular supervision, seeking out anti-oppressive training, and engaging in self-reflection are all critical for maintaining a culturally sensitive and intersectional practice.

By integrating these principles, CPT becomes not just a tool for cognitive restructuring but a framework for deeper, systemic healing that respects each client’s unique context and lived reality. In this way, therapy can support not just individual recovery but also collective liberation and empowerment.

Moving Forward with CPT

If you’re considering Cognitive Processing Therapy (CPT), it’s essential to have a conversation with your therapist about whether it aligns with your therapeutic goals and lived experiences. While CPT is a powerful tool for addressing negative thought patterns and developing new ways of thinking, it is also a flexible framework that can be adapted to suit your needs as a whole person, especially within an anti-oppressive, culturally sensitive, and feminist context.

CPT can help you understand and challenge the thoughts and beliefs that keep you feeling stuck, particularly when those thoughts are shaped by trauma and systemic oppression. However, it also respects the reality that some beliefs may be protective responses to ongoing discrimination or harm. In working with your therapist, you can explore these complexities together, ensuring that the approach is both validating and empowering.

By providing a structured, yet adaptable foundation for reframing harmful thoughts and beliefs, CPT can complement other therapeutic modalities, including somatic approaches that foster a deeper connection with your body and emotions. It is not just about changing thoughts but about holding space for the full spectrum of your experiences—acknowledging pain, reclaiming power, and building resilience.

Whether you’re just beginning your healing journey or looking to deepen your existing therapeutic work, CPT offers a way to explore your narrative in a context that honours your unique identity and lived experience. The goal is not merely to “fix” or “correct” thoughts but to create a path toward healing that is inclusive, liberating, and aligned with your truth.

Your story, your voice, and your experiences matter. Therapy should be a space where you feel seen, heard, and valued in all your intersections. If CPT feels like the right step for you, know that it can be a powerful tool in moving forward—helping you navigate not only the internal terrain of thoughts and beliefs but also the external realities of the world you live in, with greater strength and clarity.

References

Resick, P. A., Monson, C. M., & Chard, K. M. (2024). Cognitive Processing Therapy for PTSD: A Comprehensive Therapist Manual (2nd ed.). The Guilford Press.