Cognitive Processing Therapy (CPT) is a structured counseling approach comprising 12 sessions, usually lasting 50 minutes each. Counselors proficient in Cognitive Processing Therapy collaborate with their clients to enhance their capacity to identify, modify, and challenge unhelpful beliefs associated with a past trauma they have experienced. The therapeutic goal is to assist clients in developing new cognitive skills and perspectives to promote healing and recovery. Keep reading to learn 10 CPT Therapy activities and exercises you can do with your clients in therapy.

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Through the process of modifying and challenging unhelpful beliefs, clients undergo a transformative shift in their understanding of their trauma. As this change takes place, clients often experience a significant reduction in distress related to their traumatic experiences. Cognitive Processing Therapy (CPT) commences by providing clients with education about their mental health concerns, thoughts, emotions, and their interconnected nature (American Psychological Association, 2017). Counselors collaborate with clients to identify automatic thoughts that contribute to their mental health symptoms.

Throughout CPT therapy sessions, clients engage in exercises that involve openly discussing the traumatic event they experienced, including details they may have previously avoided. This approach aims to disrupt the client’s pattern of avoiding thoughts and feelings associated with the trauma (American Psychological Association, 2017).

Clients are encouraged to apply the skills they learn in therapy to their daily lives, while also monitoring their utilization of these newly acquired skills. Counselors may focus on various areas of a client’s life that have been impacted by the trauma, such as safety, trust, power, self-esteem, and intimacy (American Psychological Association, 2017). To explore further, you can continue reading to discover 10 Cognitive Processing Therapy exercises and activities that can be incorporated into your sessions with clients.

Why Cognitive Processing Therapy?

Cognitive Processing Therapy (CPT) is a specialized form of cognitive-behavioral therapy (CBT) primarily designed to treat individuals who have experienced trauma, particularly those with post-traumatic stress disorder (PTSD). There are several compelling reasons why CPT may be chosen as a preferred treatment option:

1. Evidence-Based: CPT is a well-researched and evidence-based therapy, with numerous studies demonstrating its effectiveness in treating trauma-related conditions like PTSD.
2. Structured and Goal-Oriented: CPT is a structured therapy that focuses on specific treatment goals, including addressing and challenging maladaptive beliefs and thoughts related to the traumatic event.
3. Addressing Cognitive Distortions: CPT targets cognitive distortions and problematic thinking patterns that often result from trauma. It helps individuals reframe and reprocess these thoughts, leading to improved emotional well-being.
4. Processing Traumatic Memories: CPT provides a framework for processing traumatic memories and integrating them into a person’s overall narrative in a healthier way, reducing distress associated with those memories.
5. Holistic Approach: CPT recognizes the interplay between thoughts, emotions, and behaviors and addresses these aspects holistically to promote healing and recovery.
6. Long-Term Benefits: Many individuals who complete CPT report long-lasting improvements in their mental health, with a reduction in PTSD symptoms even after therapy has concluded.
7. Customized Treatment: CPT can be adapted to suit the individual needs and experiences of each client, ensuring that treatment is personalized and comprehensive.
8. Self-Empowerment: CPT empowers individuals by teaching them skills to challenge and change their thought patterns, helping them regain a sense of control over their lives.
9. Versatile Application: While CPT was initially developed for PTSD, it has been adapted to address a broader range of mental health issues, making it suitable for clients with comorbid conditions or those seeking treatment for other concerns in addition to trauma.
10. Trauma-Informed Care: CPT is a trauma-informed approach that emphasizes safety, trustworthiness, choice, collaboration, and empowerment—key principles that support individuals on their healing journey.
11. Resilience Building: CPT equips clients with tools to build resilience and cope effectively with stressors, not only related to the trauma but also in their daily lives.
12. Improved Quality of Life: By reducing the impact of trauma-related symptoms and distress, CPT can enhance an individual’s overall quality of life, including their relationships, work, and daily functioning.

While CPT is highly effective for trauma-related conditions, it is important to consider an individual’s unique needs and preferences when selecting a therapy approach. CPT may be particularly well-suited for those who have experienced trauma and are seeking structured, evidence-based treatment to alleviate distressing symptoms and improve their overall well-being. Keep reading to learn about CPT activities you can do with your clients.

Mental Health Concerns That Can Benefit from Cognitive Processing Therapy

Cognitive Processing Therapy is primarily used for individuals who are living with post-traumatic stress disorder. This can include individuals who have experienced childhood abuse and neglect, combat, and rape (American Psychological Association, 2017). CPT would not be a good fit for individuals who are struggling with mental health disorders that are not associated with trauma, and individuals who would be unable to engage in the writing exercises assigned throughout the 12 sessions. 

Cognitive Processing Therapy Activities

Cognitive processing therapy activities can be used during individual and group therapy sessions to follow the flow of events for CPT. Exercises used in Cognitive Processing Therapy are consistent, as it is a structured therapeutic approach.

 Cognitive processing therapy exercises that can be used during therapy sessions can include:

1. An important aspect of Cognitive Processing Therapy is gathering necessary and relevant information about the client’s experience, distress, and overall level of functioning. TherapPatron.com offers Trauma History Questionnaire that can help Counselors gather this needed information as they begin developing their treatment plan. This includes the client’s childhood history, current functioning, target trauma, health since the traumatic experience, identity, substance use, and treatment plan. This form can then be used as a reference with clients as you discuss your treatment plan, goals, and objectives. It can also help your client tease out details of their history that could be addressed during their Cognitive Processing Therapy sessions.
2. Before beginning your work with Cognitive Processing Therapy, you can speak with your client about the importance of showing kindness and compassion to themselves. When you are providing psychoeducation about post-traumatic stress disorder, you can take time to explore how they show themselves kindness and the impact it can have on our mental health, including self-esteem and depressive symptoms. Provide your client with a list of activities and behaviors that they could use to show themselves kindness, and ask them to identify 3-5 that they would be willing to try before their next session. Encourage your client to try engaging in one activity each day, and to keep track of their experience. TherapPatron.com provides a Daily Self Kindness Worksheet that clients can complete as they practice showing themselves kindness.
3. Writing an Impact Statement is a CPT exercise that clients are asked to complete twice during their 12-session CPT experience. You will ask your client to write about how they were impacted by their traumatic experience. Ask your client to focus on their thoughts, feelings, beliefs, and behaviors that were impacted by their trauma, rather than providing an account of what their traumatic experience entailed.

As you approach the final stages of CPT, you’ll ask your client to write a new impact statement with the knowledge they have gained in their sessions. With this opportunity to revisit their impact statement, they may have a different perspective on their trauma and how it impacts their thoughts, feelings, beliefs, and behaviors. 

In the final session, review the new impact statement and explore differences that can be observed in their first and second impact statement. Asking your client to complete their two impact statements is an example of a structured CPT exercise that you will use in your work. 

4. The CPT ABC Worksheet be used to help guide you while providing psychoeducation to your client, or clients, about how a traumatic event impacts our thoughts and feelings. From here, you can work with your client to break down their experience into this ABC model. You can then work with your client to address their stuck point, and find healthier alternative thoughts they can use to replace their automatic thought or belief. Encourage your client to keep their worksheet as a reminder, and use it to keep track of their experience replacing their thought outside of therapy.
5. Counselors and Therapists can use Socratic Questioning while exploring unhealthy automatic thoughts that your client is experiencing. These questions aim to help Counselors and Therapists to understand the client’s perspective, and can gently work to help them see new aspects of their existing beliefs. Socratic questions encourage reflection and problem solving which can help facilitate some of the processes associated with Cognitive Processing Therapy.
6. You may find that some clients have difficulty identifying what emotions they are experiencing. This can be caused by a variety of factors including avoidance, and not being knowledgeable of different emotions, how they can impact us, and how they can cope when they experience distress. In this situation, you may find yourself focusing on exploring different emotions that your client experiences, and how your client is impacted by them. TherapPatron.com offers an Identifying Emotions Worksheet that can guide your client in identifying what they are feeling and the overall intensity of their emotion. You can then guide a discussion about what feelings your client feels arise the most, and any that they find uncomfortable. This can help you narrow down coping skills that your client would benefit from.
7. Speak with your client about stuck points and how they can impact your client’s ability to move forward. Spend time exploring their experience with stuck points and any that they find themselves struggling with. This CPT Stuck Point Worksheet provides a list of common stuck points that can be used during sessions to aid your client in finding stuck points that they struggle with.
8. Individuals who experience traumatic events and are living with post-traumatic stress disorder can struggle with different aspects of their life, including intimacy. If this is a concern that your client is struggling with, you may find that the CPT Esteem Worksheet available at TherapPatron.com can help your client identify unhealthy beliefs that are impacting their ability to develop intimacy or closeness within their relationships.
9. Individuals who find themselves struggling with their self-esteem often struggle to accept compliments. Using a Compliments Worksheet can provide your client with a template that allows them to track compliments that they experience, and how they felt when they received the compliment. Allow for time to review this worksheet, and explore any stuck points that your client is experiencing regarding accepting the compliments that they receive.
10. Individuals who experience trauma often find themselves struggling with power and control in their lives. This may mean that they try to control things in their life that are unrealistic or are simply out of anyone’s control. Exploring different aspects of clients’ life by using TherapPatron.com’s  Power and Control Worksheet can help your client recognize areas of their life where they could work to let go of some of the control that they are holding onto. This change can have a positive impact on their mental health distress.

Final Thoughts On Choosing Activities for CPT

Thank you for reading this resource about 10 CPT Therapy activities and exercises you can do with your clients. Therapists who employ Cognitive Processing Therapy follow a structured framework consisting of 12 fifty-minute sessions. This approach can be effectively implemented in both individual and group settings, offering clinicians the flexibility to choose the most suitable format. Whether in an inpatient or outpatient treatment setting, it is crucial to ensure that clients have the necessary support and coping skills to manage any distress that may arise during the completion of Cognitive Processing Therapy assignments.

Please note that engaging in CPT activities and exercises requires proper education and experience. It is the responsibility of each clinician to be knowledgeable about the professional standards in their field and their state. To gain the necessary training for utilizing Cognitive Processing Therapy in your sessions, it is recommended to pursue Continuing Education Courses and other relevant training opportunities.

TherapyPatron.com helps mental health professionals better serve their clients. Our (editable, fillable, printable PDF) therapy worksheets can help you streamline your practice, effectively deliver different types of therapy, and support your clients be the best version of themselves.

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Resources:

American Psychological Association. (2017, July 31). Cognitive processing therapy (CPT). American Psychological Association. Retrieved March 30, 2023, from https://www.apa.org/ptsd-guideline/treatments/cognitive-processing-therapy 

Author: Kayla VanGuilder, MA, LCMHC

Kayla is a Mental Health Counselor who earned her degree from Niagara University in Lewiston, New York. She has provided psychotherapy in a residential treatment program and an outpatient addiction treatment facility in New York as well as an inpatient addiction rehab in Ontario, Canada. She has experience working with individuals living with a variety of mental health concerns including depression, anxiety, bipolar disorder, borderline personality disorder, and trauma.