CPT Session Outline

Thank you so much for your interest in Cognitive Processing Therapy (CPT).

I have sent clients enrollment forms and handouts through the client portal.

For people working on their own, a self-paced version of CPT is described in Self-Help Guide for Reducing Trauma Symptoms.

CPT terms are used below. Here is a glossary of CPT terms.

Contract

Please read the contract for engaging in CPT. If it is a fit for you, please sign it. Please complete the additional consents, questionnaires, and assessments.

Handouts and manual

Clients find CPT easier logistically if they have the manual in front of them, either in an electronic or print version.

Although the CPT manual is written for counselors, when we met in my office in-person, I had copies on hand for all of us so we could follow along together. I am sorry I am unable to provide copies for you.

If at all possible, please procure a print version of the manual. Here’s the publisher’s link to the manual. Here’s the Amazon link. You are welcome to purchase the manual from other vendors as well.

Through the client portal, I have provided a .pdf of the needed handouts and some particularly relevant sections of the manual.

Prior to Session 1

Part A

  1. Please be open to self-kindness.
  2. Consider that having experienced trauma can result in grief from losses. Here are the “Six Needs of the Grieving” from David Kessler‘s work:
    To have your pain witnessed
    To express your feelings
    To release the burden of guilt
    To be free of old wounds
    To integrate the pain and the loss
    To find meaning in life after loss
  3. Please examine this diagram entitled Approaching vs. Avoiding Reality.
  4. Prior to completing the task in #5, please make a list of 3 activities you find soothing and restorative. Plan for time to complete the task in #5, approximately 1 hour, and to complete at least one restorative activity, at least 30 minutes.
  5. Please draft a trauma timeline. Please begin to hypothesize about what might serve as the index trauma. Here is a handout that may be helpful: Preparing a trauma timeline and beginning to determine the index trauma.
  6. Engage in the restorative activities you identified in #3.

Part B

  1. Please take and score the PCL-5 Monthly and the PHQ-9 assessments. Copies of these assessments are included in the .pdf of handouts.
  2. Please open an email and entitle it “CPT Session 1.” Identify and list your scores. Please copy and paste this text in quotes into the body of the message: “Today, I learned __________. So far in CPT, I have learned _________. I think what I have learned will be of value to me because it will __________.”
  3. Please save this email in your drafts folder. At the end of each session, you will be asked to take two minutes to reflect on your experience, open this email, back over the underlines, and fill in the blanks. After sharing your insights aloud, you will email your scores and this statement of progress to me.
  4. Please enter your first PCL-5 score on the PCL-5 Score Sheet (Handout 3.1 p. 7 of 7)
  5. Please watch these videos:
    Cognitive Theory
    Recovery and Fight or Flight
    What Are Stuck Points?
    How Do I Identify Stuck Points?
    Types of Emotions

Brief summary, in first-person:

“If, without judgment, I can become aware of my feelings and thoughts and consciously shift my attention to facts rather than beliefs, I can engage my prefrontal cortex – the problem-solving portions of my brain – which, in turn, eases the emotion centers of my brain, further freeing my prefrontal cortex to aid me. I can then use the fullness of my heart and mind to help myself handle what’s happening. I can derive thoughtful next steps, based on my values and priorities, about what to say and do – or to not say and not do.”

Prior to each subsequent session

  1. Focusing on the index trauma rather than on current stressors, please take and score the PCL-5: Weekly (Handout 3.1).
  2. Please take and score the PHQ-9 (Handout 3.2)
  3. Please be ready to answer the questions in the Check-In/Check-Out Sheet.
  4. Please update your PCL-5 Score Sheet (Handout 3.1 p. 7 of 7) and prepare to display it to discuss.
  5. To “begin with the end in mind” and orient our work during the session, please turn to the homework assignment that will conclude the current session.

Prior to Session 2

  1. Please write an impact statement (Handout 5.3). The handout in the link in #2 may be helpful as you begin to jot down notes, organize your thoughts, and consider areas of your life affected by thoughts and beliefs about the index trauma.
  2. Here are sample notes for selecting the index trauma and writing an impact statement.
  3. After completing an impact statement, begin to become aware of, and track the interrelationship between events, feelings, thoughts, and words/actions. Begin to differentiate between thoughts that are beliefs vs. facts.

As soon as you can, and prior to Session 3, begin to compile a Stuck Point Log (Handout 6.1).

A “Stuck Point” is the CPT term for what is termed in cognitive theory a “cognitive distortion.” From page 95: “A Stuck Point is a thought that you probably formed during or shortly after the trauma about why the trauma happened or what it means about yourself, others, and the world. It serves to keep you stuck in place and stops your recovery and growth.”

Here are helpful readings about Stuck Points and cognitive distortions:

Stuck Points may appear in these forms and others:

  • “I should have/shouldn’t have done x.”
  • “It’s my fault because I did/didn’t do x.”
  • “[The event] happened because I did/didn’t do x.”
  • “If I had/hadn’t done x, [the event] would have never happened.”
  • If I had only been or done better, it wouldn’t have happened.

Reality is complex and we cannot know what may or may not have occurred if we or others had done differently. It’s possible that a change might have contributed to better outcomes. It’s also possible that a change might have contributed to worse outcomes. Causality is so difficult to identify or create. Acknowledging this reality may be painful, but it can free the heart and mind to consider one’s values and priorities, one’s meaning, and to move ahead.

Applying brain science and cognitive skills to intrusions

Symptoms of PTSD include intrusions, defined as “unwanted and upsetting memories, nightmares, flashbacks, and emotional distress and/or physical reactivity after exposure to reminders.” Intrusions may be experienced as panic attacks, a sense of dread, startled awakenings, or other forms of distress.

The well-intentioned may urge people with PTSD to “be present” and “stay in the moment.” Without knowledge of, and ability to use cognitive skills, intrusions can make the present moment feel akin to torture.

Many intrusions are preceded by an alarming or dire thought, often part of rumination, the understandable practice of playing the past over and over again in hopes that it, somehow, might change. Practice with CPT and other cognitive skills increases a person’s ability to catch the alarming thought quickly, examine and dispatch it, and return one’s attention to the task at hand.

Some intrusions are of unknown origin, occur involuntarily, or are preceded by a micro-thought too small to catch.

It’s very important to understand that the brain’s response to intrusions is an attempt to help. Indeed, the brain is warning the person of perceived threat or danger. This is a beautiful, necessary feature of the human brain, deserving of appreciation. If the intrusion is a misfiring and causes the equivalent of a false alarm, with compassion, we can help ourselves.

Intrusions are experienced as alarming. When dire thoughts – such as about having more intrusions, or being unable to function, love, parent, or work because of intrusions – are added to the current intrusions, alarm escalates and continues, prolonging distress.

Since we know from brain studies that engaging the prefrontal cortex eases the alarm and emotion centers of the brain, attempting to avoid intrusions delays restoration. To help ourselves, we need to engage the prefrontal cortex. Talking and writing engage the prefrontal cortex, so, to address intrusions, we begin an inner dialogue.

  1. Oh, my, I am experiencing an intrusion. I wish I weren’t, but I am. This one is particularly intense, almost painful. I am aware I feel quite frightened.
  2. What are the facts? Let me use my prefrontal cortex to assess the situation. Ah, I see I am at work/at home/in bed and I am as safe as I can be. I know there is no perfect safety, but right now, I see I am safe enough.
  3. I am here for me. No matter what, I am here for me. I can help myself with this. Okay, let’s return to what we were doing.

Often, engaging the prefrontal cortex in this direct way and muscularly shifting one’s attention eases intensity. The brain has evolved to stabilize and this reassuring inner dialogue is a means of using the mind to assist the brain in easing the emotion centers of the brain.

To help their brains help them, people need to approach, not avoid, reflect, not ruminate, and follow up awareness-fostering introspection with forward-looking prospection.

Doing ABC Worksheets and Challenging Beliefs Worksheets many times helps the brain learn how to handle challenging feelings, thoughts, and experiences skillfully and effectively.

Looking ahead

  • During Session 2, the ABC Worksheet is introduced (Handout 6.3).
    Under “Consequence / C / “I feel something,” to foster deeper awareness of your feelings, you are invited to subdivide that box with a horizontal line, label the top box “Primary feelings” (natural human feelings that occur without thought) and the bottom box “Secondary feelings” (feelings that result from thoughts).
  • With regard to identifying feelings, Handout 6.2 “Identifying Emotions Handout” is on page 125 in the manual.
  • You may find Dr. Gloria Willcox’s Feeling Wheel and Plutchik’s Wheel of Emotion of interest.
  • Important: Recovery and Nonrecovery from PTSD, Handout 5.1, page 98 in the manual, page 12 in the .pdf of handouts.
  • Important: Levels of Responsibility, Handout 7.1, page 152 in the manual, page 25 in the .pdf of handouts

Other resources

Inside look at an inner dialogue using CPT

Here is a plain language summary of the inner dialogue of a person using cognitive skills to ease emotion centers and activate cognitive centers. Most terms used are in the glossary.

“I am aware of an intense inner state. Let me take back my consciousness. What am I feeling? Which are my primary feelings and which are my secondary feelings? Let me feel my natural, human, primary feelings. My brain is designed to handle them. They will come and they will go. Now, what are my secondary feelings, caused by thoughts? What thoughts am I thinking to cause these feelings? Of those thoughts, which are beliefs? Which are facts? Let me follow the facts. Based on the facts, and my own values and priorities, what would be the most realistic and helpful thing to say or do next – or not say or not do?”

You are encouraged to spend 15-30 minutes per day on CPT homework assignments and/or reading and/or training.

For another view of CPT, here is a session outline from the founders of CPT.

Groups

If you will participate in a CPT group, here is our Group Protocol.

Here is the page of links to Zoom groups.

Here is our in-house CPT guide and glossary.

Here is our main CPT page which includes links to self-guided training.

In the CPT Enrichment Group, we practice and deepen insights using our in-house Expanded ABC Worksheet. We also consider relational effectiveness.

Related posts on this site that may be of interest 

Last updated 1/20/2023

This page is intended for clients’ use only. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.