Cognitive processing therapy helps veterans and service members understand how their experience of a traumatic event may have changed how they see themselves, others, and the world. CPT, in particular, targets beliefs around "what ifs" or "should haves," which are inherently toxic and can result in feelings of guilt and shame that often keep a person stuck in the symptoms of PTSD. CPT can't change what happened, but it can help that person construct a new narrative that helps change how that person feels about the trauma.
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In cognitive processing therapy, the gist of that treatment is that going through a traumatic experience is going to change how you see yourself, and other people, and maybe the world in general. And so, in cognitive processing therapy what we try to do is help a veteran understand how their experience of the traumatic event may have changed how they see themselves, other people, or the world. In CPT we particularly try to target beliefs like the “should have, could have, would have’s.” Right? Like, “If only I had gone left instead of right. If only I had fought back harder against my attacker. If only I had trained harder. If only I had done more.” That, from a CPT perspective, these kinds of beliefs about yourself and the situation are particularly toxic because they result in a lot of guilt and shame that we have found keeps people stuck in post-traumatic stress. The alternative narrative is I think it’s important as a clinician when you’re engaging in cognitive processing therapy with veterans, not to lapse into this mode of, you know, we’re teaching them the correct way to think or we’re giving them the right answer. Because, let me tell you something - these men and women know what they should think, they know what the right answer is. And if it were that simple, believe me, they would believe the alternative narrative. So, I think good practitioners of cognitive processing therapy are patient. Again, trauma’s about context. Right? So, it’s about kind of telling the story of the trauma in such a way that it allows the veteran to go back and take a hard look at it and kind of come to their own conclusions about, you know, “I did everything I could at the time. I kind of hit the limits of my training. I did the best I could with a bad situation.” And like, ultimately, that’s what we want because it’s not about changing what happened, but it’s about constructing a narrative that helps resolve some of the guilt and shame that a person feels about their trauma.
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Brian Klassen, Ph.D., is the Associate Clinical Director for The Road Home Program: The National Center of Excellence for Veterans and Their Families at Rush University in Chicago, Illinois. Brian spent his formative years training at the Jesse Brown VA Medical Center, completing rotations in chronic pain management, residential substance use disorder treatment, and PTSD. Brian has special expertise in providing front-line treatments for PTSD, including Prolonged Exposure and Cognitive Processing Therapy.