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Cognitive Processing Therapy (CPT) In Addiction: Definition And Benefits, Process And Usage, And Techniques

Cognitive Processing Therapy in addiction is a form of cognitive-behavioral therapy specifically adapted for treating psychological distress. It is used to treat particularly Post-Traumatic Stress Disorder in individuals with addiction. This therapy focuses on modifying and challenging unhelpful beliefs related to trauma, which often contribute to the maintenance of addictive behaviors. 

According to APA, 2023, “Cognitive Processing Therapy,” CPT focuses on how traumatic events are construed and the impact these perceptions have on an individual’s emotions and behaviors.

CPT in addiction aids individuals in addressing the often-overlooked emotional and cognitive aspects of addiction that are tied to traumatic experiences. By targeting the thoughts and feelings associated with trauma, CPT helps reduce symptoms of PTSD, which decreases the need for substances used by individuals as a form of self-medication.

APA, 2023, “Cognitive Processing Therapy,” states that CPT was initially developed for women with PTSD from sexual violence but has since been widely adapted to treat a variety of trauma types, including addiction.

The CPT process has over 12 to 16 sessions, each structured to help the individual understand and reinterpret traumatic events progressively. These processes improve emotional regulation, enhance personal relationships, and foster a greater sense of self-efficacy, all of which are critical for long-term recovery from addiction.

CPT is used in settings that include individual or group therapy environments within outpatient, residential, or inpatient treatment centers. 

Techniques in CPT include the use of written accounts of traumatic experiences, Socratic questioning, and worksheets for tracking and challenging their thoughts.

What Is Cognitive Processing Therapy?

what is cpt in addiction

Cognitive Processing Therapy (CPT) is a specific type of cognitive-behavioral therapy developed to treat symptoms of post-traumatic stress disorder (PTSD). According to the National Center for PTSD, the best treatments for PTSD are trauma-focused talk therapies; CPT is a trauma-focused therapy.

It focuses on how traumatic events are construed and the impact these perceptions have on an individual’s emotions and behaviors. 

The core of CPT lies in identifying and altering maladaptive beliefs related to trauma, such as feelings of guilt, shame, and fear, which obstruct emotional recovery. According to APA, 2023, “Cognitive Processing Therapy,” by systematically tackling these beliefs, CPT assists individuals in restructuring their thoughts in a way that reduces the distress caused by traumatic memories and promotes more adaptive coping strategies.

By systematically tackling these beliefs, CPT assists individuals in restructuring their thoughts to reduce the distress caused by traumatic memories and promote more adaptive coping strategies.

CPT was initially developed for women with PTSD from sexual violence but has since been widely adapted to treat a variety of trauma types, including addiction. The essence of CPT lies in its focus on the way individuals think about themselves, the world, and others after a traumatic event. 

Through CPT, patients learn to examine and challenge distorted thoughts, such as self-blame, which are referred to as ‘stuck points,’ and work towards restructuring these unbalanced thoughts associated with the trauma.

What Is The Role Of CPT In Addiction Treatment?

The primary role of CPT is to address PTSD symptoms that co-occur with substance use disorders. It also assists individuals in:

  • Modifying negative beliefs and thoughts that contribute to addiction
  • Targeting maladaptive cognitions and ‘stuck points’ that often accompany PTSD
  • Precipitating substance abuse as a response to trauma-related stress

The frequency of post-traumatic stress disorder (PTSD) coexisting with substance use disorders, especially among military veterans, reinforces the value of CPT in treating this demographic. 

Studies have demonstrated CPT’s effectiveness in reducing PTSD and depression symptoms in people with substance use disorders, whether in remission or active use. According to VA, 2023, “Cognitive Processing Therapy for PTSD,” CPT provides tailored therapy to address both PTSD and addiction concurrently.

What Are The Benefits Of CPT In Addiction Treatment?

benefits of cpt in addiction treatment

The six main benefits of cognitive Processing Therapy (CPT) in addiction treatment are PTSD symptom reduction, emotional regulation, trauma understanding, personal empowerment, better quality of life, and relapse prevention. 

In a 2019 review published by Asmundson et al. in the journal Cognitive Behaviour Therapy, it was discovered that, on average, individuals undergoing Cognitive Processing Therapy (CPT) showed greater improvement compared to 89% of individuals in the psychological placebo group.

  1. Reduction of PTSD Symptoms: CPT directly targets the symptoms of PTSD, such as intrusive thoughts, flashbacks, and emotional numbing. A clinical trial by Tracy L et al. 2022 ‘Cognitive Processing Therapy or Relapse Prevention for Comorbid Post Traumatic Stress Disorder and Alcohol Use Disorder’ shows that CPT has reduced PTSD and alcohol use frequency relative to waitlist control and was found to be a helpful follow-up treatment after group-based AUD treatment.
  2. Improved Emotional Regulation: Participants in CPT learn to identify and understand their emotional responses to trauma. The therapy guides them in developing skills to manage intense emotions, leading to improved emotional regulation and stability. According to APA, 2023, “Cognitive Processing Therapy,” CPT helps individuals manage intense emotions and achieve emotional stability.
  3. Enhanced Understanding of Trauma: CPT helps addicted individuals understand their traumatic experiences. It helps them shift their perspective from self-blame to recognizing external factors involved in the event. According to VA, 2023, “Cognitive Processing Therapy for PTSD,” CPT helps individuals reframe their traumatic experiences, reducing self-blame. This reevaluation often leads to a more balanced and less distressing view of the trauma and addiction recovery.
  4. Increased Personal Empowerment: CPT fosters a sense of personal empowerment by challenging and changing maladaptive beliefs. According to APA, 2023, “Cognitive Processing Therapy,” CPT empowers individuals by helping them challenge and change maladaptive beliefs. Individuals living with addiction gain confidence in their ability to cope with and control their emotional responses to memories of trauma.
  5. Better Quality of Life: As symptoms decrease and coping strategies improve, individuals struggling with substance abuse often experience an overall enhancement in their quality of life. Asmundson et al., 2019, “Cognitive Behaviour Therapy,” states that CPT improves the overall quality of life for individuals with PTSD and addiction. They find it easier to maintain relationships, engage in social activities, and perform daily tasks that were previously challenging.
  6. Prevention of Relapse: By equipping individuals recovering from addiction with practical tools to deal with thoughts and feelings associated with trauma, CPT helps prevent the recurrence of PTSD symptoms. Tracy L. et al., 2022, “Cognitive Processing Therapy or Relapse Prevention for Comorbid Post Traumatic Stress Disorder and Alcohol Use Disorder,” conclude that CPT provides practical tools for managing trauma-related thoughts and feelings, reducing the risk of relapse. This benefit makes it a robust therapeutic approach for long-term mental health stability and relapse prevention.

What Are The Processes Of CPT In Addiction Treatment?

Cognitive Processing Therapy (CPT) in addiction treatment comprises three significant processes: initial patient assessment and PTSD diagnosis, consistent education about coping with trauma, and the development of new coping strategies. CPT not only offers a therapeutic process but also equips individuals with the tools necessary to manage their addiction beyond the therapy sessions.

1. Assessment And Psychoeducation

Psychoeducation is the first step of Cognitive Processing Therapy in addiction treatment. During this phase, patients learn about PTSD and its impact on thoughts and emotions. They are educated on the interaction between thoughts and feelings and identify automatic thoughts contributing to PTSD symptoms.

According to SAMHSA, 2023, “Cognitive Processing Therapy for PTSD,” patients write an impact statement expressing their current understanding of the traumatic event, its reasons, and its effect on their beliefs about themselves, others, and the world.

This impact statement enables the assessment of changes in the patient’s beliefs post-trauma, laying the groundwork for further CPT interventions.

2. Processing Trauma

Processing trauma is the focal point of the next phase in CPT. It involves:

  • Identification of ‘thinking stuck points.’ These are persistently troublesome thoughts associated with the trauma.
  • Patients who have a substance use disorder are supported in writing about their traumatic events.
  • Patients then read their accounts aloud, which helps them confront and articulate their experiences.

According to APA, 2023, “Cognitive Processing Therapy,” patients reading their accounts aloud helps them confront and articulate their experiences.

The trauma account or processing trauma stage serves as a form of exposure therapy, helping patients to:

  • Repeatedly engage with their narrative in order to decrease emotional distress and avoidance behaviors
  • Challenge and examine beliefs and thoughts tied to the trauma, such as feelings of self-blame
  • Encourage cognitive restructuring

3. Consolidation And Skill-Building

Consolidation and skill-building are the final phases of Cognitive Processing Therapy. During this phase, individuals with substance use disorder learn to identify, challenge, and change harmful thoughts and beliefs. These skills are utilized throughout the patient’s recovery from addiction, providing them with lasting tools to manage their symptoms.

According to SAMHSA, 2023, “Cognitive Processing Therapy for PTSD,” consolidation in CPT equips people with addiction with lasting skills such as assertiveness and personal safety.

A summary document of learned material is created to help patients apply these strategies post-treatment. 

Role-play exercises and activities are integrated into the consolidation phase to help them solidify the coping strategies and skills they have acquired during therapy.

How Many Sessions Are Required For CPT?

Cognitive Processing Therapy (CPT) typically requires 12 to 16 sessions to complete. This structured format allows individuals to address and reinterpret their traumatic experiences progressively. According to APA, 2023, “Cognitive Processing Therapy,” CPT is usually delivered over 12 to 16 sessions, each focusing on specific components of the therapy process.

These sessions are designed to provide a comprehensive approach to managing PTSD symptoms and related issues, such as those connected to substance use disorders. The consistency and structure of the sessions help individuals gradually build coping skills, challenge maladaptive thoughts, and develop healthier perspectives on their trauma and addiction.

The number of sessions may vary based on individual needs and the severity of the trauma and addiction. For some, additional sessions may be necessary to address their issues and achieve sustained recovery fully. According to SAMHSA, 2023, “Cognitive Processing Therapy for PTSD,” the duration of CPT can be adjusted to meet the specific needs of the individual, with some requiring more sessions to benefit from the therapy fully.

This flexibility ensures that the therapy is tailored to each person’s unique circumstances, providing the necessary support for their journey towards healing and recovery.

What Are CPT Session Notes?

CPT session notes are detailed records maintained by therapists during and after each therapy session. These notes document the key points discussed, the progress made, and any significant observations about the patient’s behavior, thoughts, and emotions. According to APA, 2023, “Cognitive Processing Therapy,” session notes are essential for tracking the patient’s progress, identifying recurring issues, and planning future sessions. 

They serve as critical tools for therapists to monitor the effectiveness of therapy and adjust their approach as needed to meet the patient’s evolving needs. 

In addition to recording the session’s content, CPT session notes also include specific exercises and assignments given to the patient, such as writing impact statements or completing thought-tracking worksheets. 

According to VA, 2023, “Cognitive Processing Therapy for PTSD,” therapists use session notes to document assignments and exercises that patients need to complete between sessions. These notes help ensure continuity in treatment and allow therapists to review previous sessions to identify patterns and progress. 

By maintaining comprehensive session notes, therapists provide more effective and personalized care, ultimately enhancing the therapy’s overall impact on the patient’s recovery journey.

What Are Real Life Usage Of CPT In Addiction?

Cognitive Processing Therapy (CPT) is employed in 6 real-world settings to effectively address addiction, mainly where trauma underlies substance use disorders. Here’s how it is used across different environments:

  1. Residential Treatment Centers: CPT is a core component of many residential addiction treatment programs. It allows clients to work intensively on traumatic experiences while in a supportive, structured environment. This setting enables individuals to focus entirely on recovery, receiving constant support from professionals trained in trauma and addiction.
  2. Outpatient Clinics: Many outpatient facilities offer CPT as a treatment modality. Clients attend scheduled therapy sessions while maintaining their daily routines. This flexibility helps individuals integrate coping strategies learned in therapy into real-life situations, fostering resilience and ongoing recovery management.
  3. Veterans Affairs Services: Given its origins in treating PTSD, CPT is extensively used in services designed for military veterans. These programs cater specifically to veterans who often face co-occurring PTSD and addiction issues. It provides them with tailored therapy to address both conditions concurrently.
  4. Group Therapy Sessions: CPT is adaptable to group therapy contexts, where participants benefit from shared experiences and mutual support. Group settings allow individuals to see others work through similar issues, which normalizes their experiences and reinforces the application of new skills.
  5. Dual Diagnosis Treatment Programs: Facilities that specialize in treating dual diagnosis (co-occurring mental health and substance use disorders) utilize CPT. This approach ensures that the treatment handles both the trauma and the addiction simultaneously, recognizing that these issues are often deeply intertwined.
  6. Teletherapy Services: The expansion of online therapy services includes the provision of CPT via telehealth platforms. This method extends the reach of CPT, making it accessible to those who might not have in-person access to specialized trauma and addiction treatment services due to geographic or mobility constraints.

How Effective Is CPT?

Cognitive Processing Therapy (CPT) has demonstrated significant effectiveness in treating PTSD, particularly when it co-occurs with substance use disorders. According to Asmundson et al., 2019, “Cognitive Behaviour Therapy,” individuals undergoing CPT showed greater improvement compared to 89% of individuals in the psychological placebo group. 

Additionally, a clinical trial by Tracy L et al., 2022, “Cognitive Processing Therapy or Relapse Prevention for Comorbid Post Traumatic Stress Disorder and Alcohol Use Disorder,” found that CPT reduced both PTSD symptoms and alcohol use frequency. 

The VA, 2023, “Cognitive Processing Therapy for PTSD,” also notes that CPT is effective in decreasing PTSD symptoms and improving overall mental health in veterans with co-occurring PTSD and addiction. 

This combination of studies underscores CPT’s role in providing substantial therapeutic benefits and enhancing the recovery process for individuals dealing with both trauma and addiction.

What Is The Difference Between CPT And CBT Therapy?

CPT therapy tends to focus more on processing past trauma and its impact on current feelings and behaviors. At the same time, CBT covers a broader range of mental health concerns and empowers individuals to manage their thoughts and emotions.

What specific techniques are used in Cognitive Processing Therapy (CPT) for addiction, and how do they compare to those used in other therapeutic approaches like yoga therapy?

Cognitive Processing Therapy (CPT) for addiction utilizes specific techniques such as cognitive restructuring, challenging negative thoughts, and writing impact statements to process traumatic experiences and their influence on addictive behaviors. These techniques help individuals reframe their thoughts and develop healthier coping mechanisms. In contrast, yoga therapy employs techniques such as physical postures (asanas), breath control (pranayama), and meditation to enhance physical health, reduce stress, and improve emotional regulation. While CPT focuses on cognitive and psychological aspects of addiction, yoga therapy addresses the physical and emotional dimensions.

What Is CPT For CBT Therapy?

CPT is a type of cognitive-behavioral therapy (CBT) that is specifically designed to treat individuals who have experienced traumatic events. In CPT, the therapist helps the individual challenge and modify unhelpful beliefs and assumptions about the trauma, as well as the world and themselves.

How does Cognitive Processing Therapy (CPT) complement group therapy in treating addiction?

Cognitive Processing Therapy (CPT) complements group therapy in treating addiction by addressing individual cognitive distortions and trauma-related thoughts while providing a supportive group environment for shared experiences and social support. CPT focuses on helping individuals identify and change negative thought patterns related to their trauma and addiction, promoting healthier coping mechanisms. Group therapy, on the other hand, offers a sense of community and reduces feelings of isolation, which are common in addiction. By integrating CPT with group therapy, individuals can benefit from personalized cognitive restructuring and the collective strength of a supportive group, enhancing overall treatment outcomes.

How Does CPT Work In Addiction Treatment?

CPT works in addiction treatment by addressing PTSD symptoms that often co-occur with substance use disorders, helping individuals modify negative thoughts and beliefs that contribute to addiction. It targets maladaptive cognitions and ‘stuck points’ associated with PTSD.

Can Cognitive Processing Therapy (CPT) Be Used For All Types Of Addiction?

CPT is primarily designed to treat trauma-related conditions, such as PTSD, but it is also helpful for individuals with addiction and trauma. Other forms of therapy, such as cognitive-behavioral therapy (CBT) for addiction, are often recommended as the primary treatment approach.

How Long Does Cognitive Processing Therapy (CPT) Take To Show Results In Addiction Treatment?

The duration of therapy varies depending on individual factors, such as the severity of addiction and the presence of co-occurring conditions. CPT is typically delivered over a series of structured sessions, with noticeable improvements in symptoms occurring gradually over time.

Ryan Wakim MD
Author
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Dr. Wakim is a board-certified psychiatrist with a passion for and expertise in addiction, mood disorders, trauma-related disorders and the subspecialty of interventional psychiatry. He obtained his medical degree from West Virginia University where he also completed his residency training, finishing as chief resident. Dr. Wakim co-founded and served as the CEO of Transformations leading to a successful merger with Shore Capital in May 2021. He is purpose driven towards improving the standard of and removing stigma related to behavioral healthcare. Dr. Wakim enjoys golf, traveling and time spent with his two dogs, Lulu and Rayna.

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