Modalities / Cognitive-Behavioral

CPT

Patricia Resick · 1992
Key text: Cognitive Processing Therapy (2007)
Cognitive-Behavioral Focus: Skill-building Short (12) Individual + Group

Core Mechanism

Identifying and challenging stuck points (distorted trauma-related beliefs) restores balanced appraisals of safety, trust, power, esteem, intimacy

Ontology

Trauma disrupts pre-existing beliefs or generates distorted accommodations about self and world

Therapeutic Voice

"You wrote that the assault was your fault because you didn't fight back. Let's look at that stuck point together."

View of the Person

A meaning-making being whose traumatic accommodations distort beliefs about safety, trust, power, esteem, and intimacy


Evidence

VA/DoD 2023: Recommended (strong). APA: Strongly recommended

25+ RCTs

Multiple meta-analyses

Gold standard for PTSD. Effective across trauma types.

PTSD & Acute Trauma
Effect: d = 0.83
~50-65% remission
Cusack et al., 2016 (2016)

Conditions

Epistemology

Empiricist

Blind Spots

Cognitive focus may underemphasize somatic and emotional processing; structured protocol can feel rigid

Contraindications

Active psychosis, imminent suicidality, active substance dependence requiring stabilization, severe dissociation, inability to engage with written cognitive exercises


Training

CPT workshop (2 days) + consultation calls. Well-manualized. VA dissemination

Official CPT trainers; VA credentialing

16 hrs + consultation

$1K-2.5K

Equity & Cultural Adaptations

Cross-cultural adaptationsRefugee/displacement populationsMilitary/veteran-specific adaptations

Philosophical Roots

Beck (cognitive model); Horowitz (stress response theory); Piaget (accommodation/assimilation); constructivism (meaning is actively constructed)

Related Modalities


Clinical Vignettes

See how CPT formulates these cases:

Test Yourself

What is a 'stuck point'?

Show answer

A belief about trauma keeping you stuck — often self-blame or distorted safety beliefs.


Sources