Cognitive Processing Therapy: One of the two best treatments for PTSD
If you or someone you love is living with Post-Traumatic Stress Disorder, you deserve to know what the research actually says about treatment. Not every therapy for PTSD is equally effective, and understanding the differences can help you make the best decision for your care.
On this page:
- The Two Best Treatments for PTSD
- Why We Use CPT
- What Is Cognitive Processing Therapy?
- What to Expect in CPT
- How Effective Is CPT?
- Frequently Asked Questions — including whether you have to relive your trauma, insurance coverage, and why we use CPT instead of EMDR
The Two Best Treatments for PTSD
Decades of rigorous clinical research have identified two treatments as the gold standard for PTSD: Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE). Both are specialized forms of Cognitive Behavioral Therapy (CBT) developed specifically for trauma. Both have been endorsed as first-line treatments by the American Psychological Association, the Department of Veterans Affairs, and the Department of Defense. Both have been studied in large, well-controlled trials across diverse populations — combat veterans, survivors of sexual assault, first responders, and civilians exposed to a wide range of traumatic events. The evidence supporting both is among the strongest in all of mental health treatment.
Why We Use CPT
We provide Cognitive Processing Therapy at our practice. Prolonged Exposure is equally effective but requires clients to revisit the traumatic memory in detail, repeatedly. If you are specifically looking for PE, two different Licensed Clinical Psychologists at the University of Virginia Health System provide it.
We chose CPT because it is remarkably gentle. CPT does not ask you to repeatedly relive or recount the details of what happened to you. We will only ask you to tell your story once, and even then, with relatively little detail. Many of our clients are surprised — and relieved — to discover that effective trauma treatment does not require going back through every painful moment of what they experienced.
What Is Cognitive Processing Therapy?
CPT was developed by Dr. Patricia Resick in the 1980s and has since become one of the most studied and widely used treatments for PTSD in the world. It is a structured therapy that targets the beliefs trauma leaves behind rather than the memories themselves. Most people experience significant improvement within 12 to 20 sessions, though treatment length is always tailored to the individual. If you still need support after working through PTSD, or if there are other concerns you want to address, you will not be asked to leave therapy. Our goal is simply to relieve your suffering as quickly as we can — not to end treatment on an arbitrary timeline.
CPT is based on a straightforward but powerful idea: trauma does not just leave painful memories. It leaves behind beliefs. About yourself. About others. About the world. Beliefs like “I should have done something to stop it,” “I can’t trust anyone,” “I am permanently damaged,” or “The world is completely dangerous.” These beliefs — what CPT calls “stuck points” — are what keep people trapped in PTSD long after the traumatic event itself has ended.
CPT does not focus on the trauma itself so much as it focuses on what the trauma taught you to believe. The goal is to examine those beliefs carefully, question whether they are accurate, and gradually replace them with a more balanced and realistic understanding of what happened and what it means.
What to Expect in CPT
CPT typically unfolds in three phases:
Learning about PTSD and how CPT works. In the early sessions your therapist will help you understand why PTSD develops and how stuck points keep it going. You will begin to identify the specific beliefs that have been most affected by your trauma — about safety, trust, power and control, esteem, and intimacy.
Working through stuck points. The heart of CPT involves learning to examine your stuck points systematically. Your therapist will teach you specific skills for identifying when a thought may not be entirely accurate, examining the evidence for and against it, and arriving at a more balanced conclusion. This is not about positive thinking — it is about thinking more accurately. Sessions are collaborative, and you will practice these skills between appointments.
Consolidating your gains. In the final phase you and your therapist will review the progress you have made, address any remaining stuck points, and make sure you have the skills to continue improving on your own after treatment ends.
Most clients report that CPT feels less like reliving a nightmare and more like finally making sense of one.
How Effective Is CPT?
The research on CPT is extensive and consistently positive. Studies have shown that the majority of people who complete CPT experience significant reductions in PTSD symptoms — and many no longer meet the criteria for a PTSD diagnosis by the time treatment ends. These gains have been shown to hold up over time, with clients continuing to improve even after therapy has concluded.
CPT has been shown to be effective across a wide range of trauma types, populations, and settings. It works for veterans and civilians, for recent trauma and trauma that occurred decades ago, and for people with complex trauma histories involving multiple events.
Frequently Asked Questions
Do you offer in-person PTSD treatment in Richmond and North Chesterfield?
Yes. All four of our therapists at the North Chesterfield office have training and experience treating PTSD and trauma. Our office is located at 701 North Courthouse Road, Suite 100, in Chesterfield County — near Chesterfield Town Center, minutes from Midlothian and Manchester, and easily accessible from the greater Richmond area. We also offer virtual appointments for clients throughout Virginia. You can learn more about our therapists on our home page.
Do you accept insurance for PTSD and trauma therapy?
Yes. We accept Anthem Blue Cross Blue Shield, Aetna, and Tricare East. If you have a different insurance plan, we will file out-of-network claims on your behalf, which may allow you to receive partial reimbursement depending on your plan. You can find more information on our fees and insurance page.
Will I have to relive my trauma in detail during treatment?
No — and this is one of the most important things to understand about Cognitive Processing Therapy. CPT does not ask you to repeatedly revisit or recount the details of what happened. You will be asked to write a brief account of the trauma once, early in treatment, but the focus of therapy is on the beliefs the trauma left behind — not on the event itself.
While the goal of CPT is to reduce or eliminate the painful emotions that PTSD produces, the method works primarily through your thoughts rather than your emotions directly. That does not mean your feelings will be dismissed or that you will be encouraged to stop feeling — quite the opposite. CPT recognizes that painful emotions are a natural and understandable response to trauma. What we work on are the thoughts and beliefs that keep those emotions stuck at an intensity that gets in the way of your life. When those beliefs shift, the emotions tend to follow.
Most clients are surprised to find that effective trauma treatment can feel much gentler than they expected.
Why do you use CPT instead of EMDR?
EMDR is widely promoted and many people have heard of it, but the research supporting it is less consistent and less rigorous than the research supporting CPT and Prolonged Exposure. A significant number of the studies supporting EMDR do not meet the standard criteria for research reliability and rigor — relying on subjective self-ratings of improvement, lacking placebo or waitlist control groups, using small sample sizes, or failing to account for the therapeutic relationship as a variable.
A number of better-controlled studies have found that when the eye movement component of EMDR is removed — leaving only the cognitive processing elements — outcomes are no different than with the full EMDR protocol. This has led many researchers to conclude that the eye movements themselves may not be the active ingredient, and that whatever benefits EMDR produces come from elements it shares with CPT. The difference is that in EMDR, those components — examining the meaning of the trauma, reducing avoidance, and restructuring unhelpful beliefs — are woven into a broader protocol in a way that can feel somewhat haphazard. They lack the defined structure, explicit purpose, and clear theoretical grounding that make CPT so effective.
We prefer CPT because, unlike EMDR, CPT’s active ingredients are applied deliberately and systematically, with a clear theoretical rationale for every step. EMDR also tends to involve more direct confrontation with the traumatic memory itself, which many people find more distressing. CPT focuses instead on the beliefs the trauma produced, allowing clients to make meaningful progress without repeatedly facing the most painful details of what happened. CPT has been endorsed as a first-line treatment by the American Psychological Association, the Department of Veterans Affairs, and the Department of Defense. We believe our clients deserve the most evidence-based care available.