Our Youtube Channel has videos introducing you to this line of therapy designed for PTSD. CPT is basically a structured 12-step CBT program that is focused on identifying your thinking in situations where you get stuck, choked up or in a rut, and evaluating from where they come. Then on the touchstone of reason, thoughts underlying these stuck points are tested to see if they actually hold water.
CPT is a standardized application of CBT that consists of a manual, worksheets, and analysis. A common strategy used in working through these stuck points is to write down an account of the trauma. Adding language especially helps when the patient continues to ‘re-experience’ the trauma through sensory impressions (e.g., a pattern of lighting, sounds) – rather than thoughts (e.g., “I’m terrified!”) triggering the symptoms of hyperarousal. Adding language to these situations helps contextualize the experience and slow down – and possibly stop – the automatic reaction the occurs in the face of these stimuli. This is because it changes the way the trauma is encoded in the memory. So, instead of the patient left with the experience of hyperarousal symptoms in the “here-and-now”, the experience is contextualized as having occurred at a different time under a different set of circumstances. Keep in mind that often these stuck points are natural feelings, e.g., “feeling like you’re going to die”. They are not secondary emotions, e.g., “I blame myself for what happened”, which are emotions that trick yourself into a distraction so you don’t have to go where you (consciously or subconsciously) don’t want to go. We are trying to get to the root – the “stuck points” – so that they are processed and then integrated.
are meant to focus on the meaning of the event; views of oneself, others and the world; and how it has affected themes of safety, trust and intimacy. It is not meant to focus on the details of the event in the way a police officer would write an accident report. Impact Statements
can cause patients to experience dissociations and/or dysregulation:
- Dissociation refers to an experience where patients disconnect with their awareness of themselves. They may blank out and not know what’s happening, who they are, etc. Patients may say, “After that, I don’t remember anything, next thing I know, I was home and in bed and I account for the 2 hours between when I called the tow-truck and got home.”
- Dysregulation refers to losing the ability to regulate your emotions.
The goal of the Impact Statement
is to get patients connected to their natural feelings associated with the trauma. So, if someone doesn’t know how to write, any technique that gets you there can be attempted – singing, drawing, speaking, etc.
Sample writing assignment
Write down exactly what happened with as many details as possible. Also write down your thoughts and feeling during the event. Use as many pages as you need. Once you have finished writing the account, you should read the account every day until the next session. Don’t be surprised if you feel your reactions almost as strongly as you did at the time of the incident. However, you need to remind yourself that this is a memory and that you are not actually in danger as you recall the event. Please bring your account to the next session.
“Stuck Points” are identified triggers for intrusive memories. It will help serve as a springboard to dive into the memory of the trauma and promotes better discrimination. They can take the form of:
- Single event or a series of events;
- Thoughts, images, memories, flashbacks;
- Physiological sensations.
Processing the Trauma
The writing assignment serves as a flywheel to processing the trauma using CBT and involves worksheets and analytical conversations with the therapist. Generally, the areas processed include:
- What it really meant to you on emotional, cognitive and lifestyle levels
- Learning to connect the dots between your thoughts and feelings
- Different feelings may be caused by different thoughts so all the dots have to be connected skillfully
- The difference between the event and the event’s memory
- Potential feelings of guilt and blame
- Why “stuck points” are “stuck points” and do they really need to be?
- Identifying and correcting cognitive distortions (problematic thinking)
- Rebuilding a sense of safety, trust and self-esteem
- Addressing power and control issues
Ultimately, the main goal is to process the memories of the event. Although many patients avoid memories of the event, ultimately, the memories need to be processed and integrated and to not be made to not feel conspicuous like a mustard stain on a white shirt.
The paradox in doing this is that many patients have a hard time remembering details of the trauma (i.e., avoidance strategy) but they have a high incidence of intrusive memories, emotions, sensory impressions spawned by the trauma.
Just talking about the memory in unemotional contexts doesn’t help integrate it, e.g., I had a bad childhood, I was in a car accident, etc.
Also, just dwelling on why something happened can prevent you from accessing the feelings that go along with the memories. See our article on Journaling
(section – “Be Descriptive”) for more information on how we encode memories; all these different aspects to a memory may need to be accessed and processed to successfully integrate them.
Why does CPT work?
- We don’t entirely why
- It identifies and addresses problematic thinking commonly seen in PTSD. See “Common things patients do that worsens their lot: Avoidance, Changed Core Beliefs and Secondary Emotions.”
- Links “unconnected” parts of PTSD (i.e., memories, emotions, thoughts, core beliefs, internal culture, coping strategies, etc.) to correct impressions and thoughts.
- It sounds strange at first, but science has shown that every time someone recalls a memory, it’s a chance to change it (Hardt et al., 2013).
- Facilitates discrimination between the then from the now
- So that when people have that PTSD reminder, they don’t experience it as if it was happening to them again right now.
- Verbalization of visual/sensory cues may make it more difficult to retrieve original sensory impressions from memory
- Often we don’t have the same degree of horror/terror we had before if we involve language parts of the cortex