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Running head: CPT for PTSD

Assignment #1: Cognitive Processing Therapy (CPT) for Post Traumatic Stress Disorder
Daniel R. Gaita, MA
September 8th, 2016
University of Southern California
School of Social Work
SOWK 587B
Professor Jan Reisch, LICSW, CEAP

CPT FOR PTSD

Population and Psychosocial Problem Selected

General Information
Post Traumatic Stress Disorder (PTSD) is a condition experienced by some people after
traumatic experiences such as warfare or domestic violence. People with PTSD experience
symptoms of intense fear, helplessness and horror (Amos, Stein, & Ipser, 2014; Hetrick, Purcell,
Garner & Parslow, 2010). We have also learned that PTSD symptoms such as negative
alterations in cognition, irritable behavior, angry outburst, recklessness, self-destructive behavior,
sleep disturbances, impairment in social functions are commonly observed in combat veterans
exposed to traumatic environments. Additionally, there are the accompanying symptoms of
avoidance of social functions, people, conversations, or even interpersonal situations that arouse
recollections of the trauma/abuse (American Psychiatric Association, 2013, pp. 274-275).
PTSD is also associated with high levels of physical, social, and economic disability and
these tend to result in higher levels of medical utilization. Furthermore, the associated impaired
functions exhibited by those suffering from PTSD transcend social, interpersonal,
developmental, educational, physical health, and occupational domains (American Psychiatric
Association, 2013, pp. 278-279).
Equally as worrisome is the high probability (80%), that individuals with PTSD are more
likely to develop at least one other mental disorder, such as depression, bipolar, anxiety, or
substance abuse, with comorbid substance use disorder and conduct disorder more common
among males than females. There is also considerable comorbidity between PTSD and major

CPT FOR PTSD

neurocognitive disorders with symptoms overlapping between these and other disorders
(American Psychiatric Association, 2013, pp. 280).
Current Intervention Practice
Evidence based treatments, such as Cognitive Behavioral Therapy (CBT), Trauma
Focused Therapy (TFT), Cognitive Processing Therapy, (CPT), Eye Movement Desensitization
and Repossessing (EMDR) as well as other standard and individualized psychotherapy
techniques are being widely used today by mental health professionals to free victims of combat
trauma from the long-term and lingering symptoms suffered as a result of traumatic exposure
(Institute of Medicine, 2008; Kuehn, 2008; Cahill, & Foa, 2007; Rausch, & Foa, 2005).
Our extensive literature search demonstrates that Trauma Focused Psychotherapy that
included components of exposure, and / or cognitive restructuring; or Stress Inoculation training
showed significant benefit when compared to the wide array of various modalities including both
utilization of medications and or combinations of psychotherapy and medication utilization
(Amos, Stein, & Ipser, 2014; Bisson, Roberts, Andrew, Cooper, & Lewis, 2013; Chard, 2005&
2009; Hetrick, Et. Al., 2010; Kattar, 2009; Monson, Schnurr, Resick, Friedman,Young-Xu, &
Stevens 2006; Ori, Amos, Bergman, Soares-Weiser, Ipser, & Stein D.J., 2015; Resick, 2010;
Resick, Galovski, OBrien, Scher, Clum, & Young- Xu, 2008; Resick, Monson, & Chard, 2008;
Resick, Monson, Galovski, Chard, & Kattar, 2010; Resick, Pallavi, Weaver, Astin, & Feuer,
2002; Roberts, Kitchiner, Kenardy, & Bisson 2009; Roberts, Roberts, Jones, & Bisson, 2016;
Stein, Ipser, & Seedat, 2006).

Selected Evidence Based Model

CPT FOR PTSD

Following the extensive evaluation of literature and meta-analysis available we selected
Cognitive Processing Therapy (CPT), as our best evidence based model for the treatment of
Combat PTSD. Additionally we provide the following link, (http://alrest.org/pdf/CPT_Manual__Modified_for_PRRP(2).pdf) to the actual Veterans and Military manual (Resick, Monson, &
Chard, 2008), being implemented in providing CPT treatment for PTSD through the United
States Veterans Affairs healthcare system as well as a very helpful instructional video series
provided by the National Center for PTSD and the U.S. Department of Veterans Affairs here,
(http://www.ptsd.va.gov/professional/continuing_ed/flash-files/CPT/Player/launchPlayer.html?
courseID=1568&courseCode=PTSD101_cpt) specific to CPT implementation guidelines
currently in effect.
CPT was initially developed in 1998 and uses a twelve-session protocol, which can be
implemented individually, in-group, or combined format. It may or may not include trauma
focused cognitive therapy and can be implemented without traumatic accounts. CPT is a
recovery-focused therapy which works off both collaboration and informed choice (Resick,
Monson, & Chard, 2008).
Evidence of Intervention Efficacy
Cognitive Processing Therapy (CPT) has been found effective for both PTSD and other
corollary symptoms following traumatic events (Bisson, et al. 2013; Monson et al., 2006;
Roberts, Jones, & Bisson, 2016; Resick et al., 2002; Resick & Schnicke, 1992 &1993). The
research was initially conducted on CPT and its use with rape victims. It has since been used
successfully with a range of other traumatic events, including military-related traumas (Resick,
Monson, & Chard, 2008).

CPT FOR PTSD

In four primary studies: Resick et al. 2002; Chard, 2005; Monson et al. 2006; and Resick
et al. 2008, CPT treatments were compared with their outcomes specific to the Clinician
Administered PTSD Scale (CAPS) severity scores. In all four studies, CPT treatment outcomes
were significantly better. Additionally, those that participated in and completed all treatment
sessions did better than participants that dropped out early. Each of these four studies also
utilized the Beck Depression Inventory (BDI) and in each case CPT also had significant and
beneficial impact on depression scale scores.
In another study the various components of CPT for PTSD were dismantled by separating
PTSD diagnostic scale scores specific to: written accounts without cognitive restructuring; with
both written accounts and cognitive restructuring; and cognitive restructuring only. The results
indicated that all three groups got better but the combination of both written accounts and
cognitive processing therapy was more effective both long term and short (Resick, Galovski,
Uhlmansiek, Schier, Clum & Young-Xu, 2008).
A five-year follow up study demonstrated that CPT has effective long-term post treatment
success. (Resick et al., in press, 2011).
Implementation into Agencies
This EBI could easily be implemented into any practice that serves traumatized
individuals such as and not limited to combat veterans. Implementation should include patient
and provider dyads that share decision-making (Implementation of Evidence-Based Treatment
for PTSD.n.d). Given the substantial variability in the way EBT treatment decisions are likely
made, current evidence indicates that a briefly shared decision-making intervention to assist
providers in explaining the treatment to their clients along with a framework for their decisions

CPT FOR PTSD

about treatment could positively impact preference for and better engagement in an EBT for
PTSD (Implementation of Evidence-Based Treatment for PTSD.n.d).
Challenges of Implementation
Although CPT us a highly used and respected form of treatment to use for adults who
have experienced trauma there could be some problems with implementing this into a group.
One of the issues could be that this type of therapy it is necessary for people to do homework and
actively participate with homework. Some clients may not like that aspect of treatment due to
time constraints or have to write about their trauma may cause the client temporary discomfort
(PTSD: National Center for PTSD 2016). The other issue in implementing this would be that it
would not always be appropriate to use in a group therapy setting (PTSD: National Center for
PTSD,2016). The trauma that a client may have experienced, they may not feel comfortable
discussing in a group. This treatment might be more beneficial if the organization had the
capability to do this on a one on one basis with the client.

References:

CPT FOR PTSD

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Washington, DC: Author.
Amos T, Stein D.J., Ipser J.C. (2014). Pharmacological interventions for preventing
post-traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews
2014, Issue 7. Art. No.: CD006239. DOI: 10.1002/14651858.CD006239.pub2.
Retrieved from: http://www.cochrane.org/CD002795/DEPRESSN_medication-posttraumatic-stress-disorder.
Cahill, S. P. & Foa, E. B. (2007). PTSD: Treatment efficacy and future directions.
Psychiatric Times, 24(3), 32 34.
Bisson J.I., Roberts N.P., Andrew M., Cooper R., & Lewis C., (2013) Psychological
therapies for chronic post-traumatic stress disorder (PTSD) in adults. Retrieved
from: http://www.cochrane.org/CD003388/DEPRESSN_psychological-therapieschronic-post-traumatic-stress-disorder-ptsd-adults
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(5), 965-971.
Chard, K. M., Resick, P.A., Monson, C.M., & Kattar, K. (2009). Cognitive Processing
Therapy: Group Manual. Veterans Administration
Hetrick S.E., Purcell R., Garner B., & Parslow R. (2010). Combined pharmacotherapy
and psychological therapies for post traumatic stress disorder (PTSD). Cochrane
Database of Systematic Reviews 2010, Issue 7. Art. No.: CD007316. DOI:
10.1002/14651858.CD007316.pub2. Retrieved from:

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http://www.cochrane.org/CD007316/DEPRESSN_combined-pharmacotherapy-andpsychological-therapies-for-post-traumatic-stress-disorder-ptsd
Institute of Medicine (IOM). (2008). Treatment of post-traumatic stress disorder: An
assessment of the evidence. Washington, D. C.: The National Academies Press.
Implementation of Evidence-Based Treatment for PTSD.(n.d.).Retrieved from
http://www.ptsd.va.gov/professional/newsletters/researchquarterly/V26N4.pdf
Kattar, K. (2009). Examining Change in Cognitions and Mental Health Service
Utilization. Symposium, Annual Conference of the International Society of
Traumatic Stress Studies, Atlanta, Georgia.
Kuehn, B. M. (2008). Scientists probe PTSD effects, treatments. Journal of the
American Medical Association (JAMA), 299(1), 23 26.
Monson, C. M., Schnurr, P. S., Resick, P. A., Friedman, M. J., & Young-Xu, Y., &
Stevens, S. (2006). Cognitive Processing Therapy for Veterans with military-related
posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 1074,
898-908.
Ori R., Amos T., Bergman H., Soares-Weiser K., Ipser J.C., & Stein D.J. (2015).
Augmentation of cognitive and behavioral therapies (CBT) with d-cycloserine for
anxiety and related disorders. Cochrane Database of Systematic Reviews 2015, Issue
5. Art. No.: CD007803. DOI: 10.1002/14651858.CD007803.pub2. Retrieved from:
http://www.cochrane.org/CD007803/DEPRESSN_addition-of-d-cycloserine-tocognitive-and-behavioural-therapies-for-the-treatment-of-anxiety-and-relateddisorders.

CPT FOR PTSD

PTSD: National Center for PTSD. (2016). Retrieved from
http://www.ptsd.va.gov/public/treatment/therapymed/cognitive_processing_therapy.
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Rausch, S. & Foa, E. (2005). Encyclopedia of cognitive behavior therapy. New York,
NY: Springer Science +Business Media, Inc. doi: 10.1007/0-306-48581-8_86.
Resick, P.A., Nishith, P., Weaver, T.L., Astin, M.C., & Feuer, C.A. (2002). A comparison
of cognitive processing therapy, prolonged exposure and a waiting condition for the
treatment of posttraumatic stress disorder in female rape victims. Journal of
Consulting and Clinical Psychology, 70, 867-879.
Resick, P. A., & Schnicke, M. K. (1992). Cognitive processing therapy for sexual assault
victims. Journal of Consulting and Clinical Psychology, 60, 748-756.
Resick, P. A., & Schnicke, M. K. (1993). Cognitive processing therapy for rape victims:
A treatment manual. Newbury Park, CA: Sage Publications.
Resick, P.A. (2010, March). Improvement over the long term: CPT and PE on PTSD,
depression, health, and guilt. In M. Powers (chair), How do treatments for anxiety
disorders benefit patients in the long run? Symposium conducted at the 30th annual
meeting of the Anxiety Disorders Association of America, Baltimore, MD.
Resick. P. A., Galovski, T. E., OBrien Uhlmansiek, M., 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.

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Resick, P.A., Monson, C.M., & Chard, K. M. (2008). Cognitive Processing Therapy:
Veteran/Military Manual. Veterans Administration. Retrieved from:
http://alrest.org/pdf/CPT_Manual_-_Modified_for_PRRP(2).pdf
Resick, P.A., Monson, C. M., Galovski, T. E., Chard, K.M. & Kattar, K. A. (2010).
Cognitive Processing Therapy: Veteran Military Consultants Manual. Veteran's
Administration
Resick, P.A., Galovski, T., Uhlmansiek, M., Scher, C., Clum, G., & Young-Xu, Y., (2008)
A Randomized clinical trial to dismantle components of CPT for PTSD in female
victims of Interpersonal violence. Journal of Clinical and Consulting Psychology.
Resick, P. A., Pallavi, N., Weaver, T. L., Astin, M. C., Feuer, C. A. (2002). A comparison
of Cognitive Processing Therapy with Prolonged Exposure and a waiting condition
for the treatment of chronic posttraumatic stress disorder in female rape victims.
Journal of Consulting and Clinical Psychology, 70, 867-879.
Roberts N.P., Kitchiner N.J., Kenardy J., & Bisson J.I., (2009). Multiple session early
psychological interventions for the prevention of post-traumatic stress disorder.
Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD006869. DOI:
10.1002/14651858.CD006869.pub2. Retrieved from:
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Roberts N.P., Roberts P.A., Jones N., Bisson J.I. (2016) Psychological therapies for posttraumatic stress disorder and comorbid substance use disorder. Cochrane Database
of Systematic Reviews 2016, Issue 4. Art. No.: CD010204. DOI:
10.1002/14651858.CD010204.pub2. Retrieved from:

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http://www.cochrane.org/CD010204/DEPRESSN_psychological-therapies-posttraumatic-stress-disorder-and-substance-use-disorder
Stein D.J., Ipser J.C., Seedat S. (2006) Pharmacotherapy for post traumatic stress
disorder (PTSD). Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.:
CD002795. DOI: 10.1002/14651858.CD002795.pub2. Retrieved from:
http://www.cochrane.org/CD002795/DEPRESSN_medication-post-traumatic-stressdisorder
Thompson, C., (2016). VA Suicide Prevention Program, Facts about Veteran Suicide,
Suicide. Prevention and Community Engagement. Retrieved from:
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