Cognitive Processing Therapy
See Cognitive Processing Therapy: Effective Treatment for Veterans with PTSD
Trauma
often causes people to struggle with their memories and thoughts about
the event. You may have a hard time making sense of what happened. You
may find yourself getting "stuck" in your thoughts about the trauma and
how it affects your life. This feeling of being unable to make sense of
the trauma can make you want to avoid thinking about or dealing with
your memories.
How Cognitive Processing Therapy can help
Cognitive
Processing Therapy (CPT) helps you by giving you a new way to handle
these distressing thoughts and to gain an understanding of these events.
By using the skills learned in this therapy, you can learn why recovery
from traumatic events has been hard for you. CPT helps you learn how
going through a trauma changed the way you look at the world, yourself,
and others. The way we think and look at things directly affects how we
feel and act.
The four main parts of CPT
- Learning about your PTSD symptoms.
CPT begins with education about your specific PTSD symptoms and how the
treatment can help. The therapy plan will be reviewed and the reasons
for each part of the therapy will be explained. You will be able to ask
questions and to know exactly what you are going to be doing in this
therapy. You will also learn why these skills may help.
- Becoming aware of thoughts and feelings.
Next, CPT focuses on helping you become more aware of your thoughts and
feelings. When bad things happen, we want to make sense of why they
happened. An example would be a Veteran who thinks to himself or
herself, "I should have known that this would happen." Sometimes we get
stuck on these thoughts. In CPT you will learn how to pay attention to
your thoughts about the trauma and how they make you feel. You'll then
be asked to step back and think about how your trauma is affecting you
now. This will help you think about your trauma in a different way than
you did before. It can be done either by writing or by talking to your
therapist about it.
- Learning skills.
After you become more aware of your thoughts and feelings, you will
learn skills to help you question or challenge your thoughts. You will
do this with the help of worksheets. You will be able to use these
skills to decide the way YOU want to think and feel about your trauma.
These skills can also help you deal with other problems in your
day-to-day life.
- Understanding changes in beliefs.
Finally, you will learn about the common changes in beliefs that occur
after going through trauma. Many people have problems understanding how
to live in the world after trauma. Your beliefs about safety, trust,
control, self-esteem, other people, and relationships can change after
trauma. In CPT you will get to talk about your beliefs in these
different areas. You will learn to find a better balance between the
beliefs you had before and after your trauma.
Learning new ways to deal with your trauma
You
and your therapist will work together to help you learn a new way of
dealing with your trauma. In CPT you will work closely with your
therapist to reach your goals. You will be meeting with him or her on a
regular basis for 12 sessions. During your therapy you will also have
the chance to practice your new skills outside of your therapy meetings.
The more you practice your new skills, the sooner they will begin
working for you. By choosing to approach your experiences in a new and
different way, you will be able to decide how your past affects your
future.
CPT for Veterans 
CPT
has been shown to be one of the most effective treatments for PTSD. For
this reason, the VA's Office of Mental Health Services has rolled out a
national therapist training program. VA therapists throughout the
country will be trained in how to use CPT treatment. These therapists
will also consult with CPT experts to learn how to best provide this
therapy. Then they will be asked to use CPT in their routine clinical
care.
How can I get help?
Ask your VA healthcare provider about getting CPT. A list of VA facilities can be found online at: VA Facilities Locator.
Prolonged Exposure Therapy
§ See In-Context Exposure Therapy Helps Bring Closure to Veterans
After
a traumatic event, many individuals experience distress and symptoms of
posttraumatic stress disorder (PTSD). This distress may be highest when
dealing with memories, thoughts, feelings, and situations that are
related to the trauma. Exposure therapy is a type of therapy that helps
you decrease distress about your trauma. This therapy works by helping
you approach trauma-related thoughts, feelings, and situations that you
have been avoiding due to the distress they cause. Repeated exposure to
these thoughts, feelings, and situations helps reduce the power they
have to cause distress.
Prolonged Exposure (PE) is one exposure therapy that works for many people who have experienced trauma. It has four main parts:
- Education:
PE starts with education about the treatment. You will learn as well
about common trauma reactions and PTSD. Education allows you to learn
more about your symptoms. It also helps you understand the goals of the
treatment. This education provides the basis for the next sessions.
- Breathing:
Breathing retraining is a skill that helps you relax. When people
become anxious or scared, their breathing often changes. Learning how to
control your breathing can help in the short-term to manage immediate
distress.
- Real world practice:
Exposure practice with real-world situations is called in vivo
exposure. You practice approaching situations that are safe but which
you may have been avoiding because they are related to the trauma. An
example would be a Veteran who avoids driving since he experienced a
roadside bomb while deployed. In the same way, a sexual trauma survivor
may avoid getting close to others. This type of exposure practice helps
your trauma-related distress to lessen over time. When distress goes
down, you can gain more control over your life.
- Talking through the trauma:
Talking about your trauma memory over and over with your therapist is
called imaginal exposure. Talking through the trauma will help you get
more control of your thoughts and feelings about the trauma. You will
learn that you do not have to be afraid of your memories. This may be
hard at first and it might seem strange to think about stressful things
on purpose. Many people feel better over time, though, as they do this.
Talking through the trauma helps you make sense of what happened and
have fewer negative thoughts about the trauma.
 With
the help of your therapist, you can change how you react to stressful
memories. In PE, you work with your therapist to approach trauma-related
situations and memories at a comfortable pace. Usually, you start with
things that are less distressing and move towards things that are more
distressing. A round of PE therapy most often involves meeting alone
with a therapist for about 8 to 15 sessions. Most therapy sessions last
90 minutes.
With
time and practice, you will be able to see that you can master
stressful situations. The goal is that YOU, not your memories, can
control what you do in your life and how you feel. Therapy helps you to
get your life back after you have been through a trauma.
PE therapy for Veterans
PE
has been shown to be one of the most effective treatments for PTSD. For
this reason, the VA's Office of Mental Health Services has rolled out a
national PE training program. VA providers throughout the country will
be trained in how to use PE treatment. The providers will at first be
supervised as they use these treatments in actual cases. Then they will
be asked to use PE in their routine clinical care. Others will be
selected and trained as consultants.
See this video describing how In-Context Exposure Therapy Helps Bring Closure to Veterans.
How can I get help?
Ask your VA healthcare provider about getting PE therapy. A list of VA facilities can be found online at: VA Facilities Locator.
Finding and Choosing a Therapist
These resources can help you locate and choose a therapist who is right for you. A special section for Veterans is included.
Finding a therapist
There
are many ways to find a therapist. You can start by asking friends and
family if they can recommend anyone. Make sure the therapist has skills
in treating trauma survivors.
On the phone
One
way to locate a therapist is to make some phone calls. When you call,
say that you are trying to find a therapist who specializes in effective
treatment for PTSD, such as cognitive behavioral therapy (CBT) or Eye
Movement Desensitization and Reprocessing (EMDR).
- Contact your local mental health agency or family doctor.
- Call your state psychological association.
- Call the psychology department at a local college or university.
- Call the Anxiety Disorders Association of America at (240) 485-1001 to access their referral network
- Call the National Center for Victims of Crime's toll-free information and referral service at 1-800-FYI-CALL.
- Call the Sidran Institute’s Help Desk at 410-825-8888 for help finding a therapist who specializes in trauma treatment. You can also email Sidran at help@sidran.org.
- If you work for a large company, call the human resources office or employee assistance plan to see if they make referrals.
- If you have health insurance, call to find out about mental health providers the insurance company will cover.
Some
mental health services are listed in the phone book. In the Government
pages, look in the "County Government Offices" section. In that section,
look for "Health Services (Dept. of)" or "Department of Health
Services." Then in that section, look under "Mental Health."
In
the yellow pages, therapists are listed under "counseling,"
"psychologists," "social workers," "psychotherapists," "social and human
services," or "mental health."
Online
Information
can also be found using the Internet. Some organizations have databases
that allow you to search for therapists near you. These databases
include profiles of therapists with their areas of expertise and the
types of therapy they provide. Search online for “find a therapist.”
Websites you can try are:
Help for Veterans
All VA Medical Centers provide PTSD care. Or you can use this online VA PTSD Program Locator to find a VA PTSD Treatment program at a VA facility near you. You can also go online to read more about services at Vet Centers.
Other resources include:
VA
Medical Centers and Vet Centers are listed in the phone book. In the
Government pages, look under "United States Government Offices." Then
look for "Veterans Affairs, Dept of." In that section, look under
"Medical Care" and "Vet Centers - Counseling and Guidance."
Finding a support group
Many
VA Medical Centers and Vet Centers have various types of support
groups. Use the information in the “Help for Veterans” section above to
find out more.
Choosing a therapist
There
are a many things to consider in choosing a therapist. Some practical
issues are location, cost, and what insurance the therapist accepts.
Other issues include the therapist's background, training, and the way
he or she works with people.
Here is a list of questions you may want to ask a possible therapist.
- What is your education? Are you licensed? How many years have you been practicing?
- What are your special areas of practice?
- Have you ever worked with people who have been through trauma? Do you have any special training in PTSD treatment?
- What kinds of PTSD treatments do you use? Have they been proven effective for dealing with my kind of problem or issue?
- What
are your fees? (Fees are usually based on a 45-minute to 50-minute
session.) Do you have any discounted fees? How much therapy would you
recommend?
- What types of insurance do you accept? Do you file insurance claims? Do you accept Medicare or Medicaid insurance?
These
questions are just guidelines. In the end, your choice of a therapist
will come down to many factors. Think about your comfort with the person
as well as his or her qualifications and experience treating PTSD. And
keep in mind the importance of evidence-based, trauma-focused treatments like Cognitive Processing Therapy, Prolonged Exposure, and Eye Movement Desensitization and Reprocessing.
Paying for therapy
If
you have health insurance, check to see what mental health services are
covered. Medicare, Medicaid, and most major health plans typically
cover a certain number of mental health counseling sessions per year,
though you may have a small additional amount you will have to pay
called a co-pay. Call your insurance company to see what they cover so
you won’t be surprised by a big bill.
If
you don’t have health insurance that will cover your therapy, you may
still be able to get counseling, even if you can’t afford to pay full
price. Many community mental health centers have sliding scales that
base your fee on what you are able to pay.
Who is available to provide therapy?
There are many types of professionals who can provide therapy for trauma issues.
Clinical Psychologists
Clinical
psychologists focus on mental health assessment and treatment. Licensed
psychologists have doctoral degrees (PhD, PsyD, EdD). Their graduate
training is in clinical, counseling, or school psychology. In addition
to their graduate study, licensed psychologists must have another 1 to 2
years of supervised clinical experience. Psychologists have the title
of "doctor," but in most states they cannot prescribe medicine.
Clinical Social Workers
The
purpose of social work is to enhance human well-being. Social workers
help meet the basic human needs of all people. They help people manage
the forces around them that contribute to problems in living. Certified
social workers have a master's degree or doctoral degree in social work
(MSW, DSW, or PhD).
Master's Level Clinicians
Master's
Level Clinicians have a master's degree in counseling, psychology, or
marriage and family therapy (MA, MFT). They have at least 2 years of
training beyond the 4-year college degree. To be licensed, master's
level clinicians must meet requirements that vary by state.
Psychiatrists
Psychiatrists
have a Doctor of Medicine degree (MD). After they complete 4 years of
medical school, they must have 3 to 4 years of residency training. Board
certified psychiatrists have also passed written and oral exams given
by the American Board of Psychiatry and Neurology. Since they are
medical doctors, psychiatrists can prescribe medicine. Some also provide
psychotherapy.
For more information on the training and qualifications of therapists, go to Psychology Today’s glossary of professionals* and glossary of credentials*.
Date Created: 01/01/2007 See last Reviewed/Updated Date below.
*****VET CENTERS ARE A GREAT PLACE TO GET COUNSELING SERVICE – YOU CAN BE SEEN MORE OFTEN ******
 Located outside medical facilities
Many workers are Veterans
Provide a mix of counseling and help with accessing other programs
No information about your treatment will be given to any person or agency (including the VA) without your consent
Veterans and Military: Web Resource Links
GO TO: www.ptsd.va.gov to click on to the links below………..
§ Self-Care and Treatment
§ Disaster Relief
§ Trauma Organizations
§ Veterans and Military
§ Veterans Service Organizations
§ Families
§ Children and Teens
This section contains links to resources for military personnel and Veterans and webpages for the U.S. military branches.
§ afterdeployment.org*
A mental wellness resource for service members, Veterans, and military families.
§ America's Heroes at Work
A
US Department of Labor project to help returning service members
affected by Traumatic Brain Injury (TBI) and/or PTSD succeed in the
workplace. Designed for employers and the workforce development system.
§ Ameriforce Publishing*
As
a leading publisher of military magazines, AmeriForce Publishing
focuses on four very important aspects of military life: relocation,
military family life, service in the Reserve or National Guard, and
deployment issues.
§ Compensation and Pension Benefits: VA
Information on how to submit a VA compensation claim for PTSD.
§ Courage To Care Campaign
Courage
to Care is an electronic health campaign for professionals serving the
military community, as well as for military and families. Content is
developed by military health experts from Uniformed Services University
of the Health Sciences.
§ Defenselink
The U.S. Department of Defense military website.
§ DoD Outreach Center for Psychological Health and Traumatic Brain Injury
Call 1-866-966-1020 or email resources@dcoeoutreach.org. Provides authoritative information and resources 24/7 to Service Members, Veterans, and families, and those who support them.
§ Employer Support of the Guard and Reserve*
This
Department of Defense staff group is within the Office of the Assistant
Secretary of Defense for Reserve Affairs (OASD/RA).
§ Give an Hour*
A
nonprofit group providing free mental health services to US military
personnel and families affected by the current conflicts in Iraq and
Afghanistan.
§ Hooah4Health.com*
The US Army health promotion and wellness website.
§ Institute of Medicine: Veterans Health*
The IOM website includes information about a variety of military-related health issues.
§ Joining Forces
Joinging
Forces is a National initiative that mobilizes all sectors of society
to give our Service Members and their families the opportunities and
support they have earned - find out how you can get involved today.
§ Lifelines
Navy
Lifelines services network provides sailors, marines, and their
families with answers to questions about before, during, and after
deployment.
§ MilitaryHOMEFRONT
The
official DoD site for reliable quality of life information designed to
help troops and their families, leaders, and service providers. Includes
links to all Active Duty Family Program Support centers on military
installations.
§ My HealtheVet
My
HealtheVet is the VHA Health Portal created for you, the Veteran, and
your family, and for VA employees. This new health portal will enable
you to access health information, tools and services anywhere in the
world you can access the Internet.
§ My PAY
An
innovative, automated system allows military members to process certain
discretionary pay data items without using paper forms. You can also
get pay statements, tax forms and travel advice.
§ National Call Center for Homeless Veterans
Homeless
Veterans, family members and service providers can now use the National
Call Center for Homeless Veterans to find help and resources. Call to
speak to trained VA staff available 24 hours a day, 7 days a week.
1-877-4AID VET (1-877-424-3838).
§ National Resource Directory
The
NRD links to over 10,000 services and resources that support recovery,
rehabilitation and reintegration for wounded, ill and injured Service
Members, Veterans, their families, and those who support them.
§ PD Health
This
site was developed by the Department of Defense's Deployment Health
Clinical Center as a resource for clinicians, Veterans, and their
families.
§ Returning Service Members (OEF/OIF)
The
Department of Veterans Affairs (VA) has created this website for
returning Active Duty, National Guard and Reserve service members of
Operations Enduring Freedom and Iraqi Freedom.
§ SAMHSA Veteran Resources
The Substance Abuse and Mental Health Services Administration provides resources for returning Veterans and their families.
§ VA Facilities Locator
Use this tool to find a VA facility close to you.
§ Vet Centers
Vet
Centers provide readjustment counseling, a wide range of services
provided to combat Veterans to help them make a satisfying transition
from military to civilian life.
§ Vet Success*
The
purpose of this website is to present information about the services
that the Vocational Rehabilitation and Employment (VRE) program provides
to Veterans with service-connected disabilities.
§ Veterans' Employment & Training Service (VETS)
This U.S. Department of Labor program helps Veterans to maximize their job opportunities and protect their employment rights.
§ Veterans Suicide Prevention Hotline and Online Chat*
If you are in crisis, you may call the hotline any time to speak with someone who can help: 1-800-273-TALK (1-800-273-8255) (en Español 1-888-628-9454). Veterans, press "1" after you call. You can also chat live online with a crisis counselor at any time of day or night.
§ Vietnam Veterans of America's Guide to PTSD Benefits*
A helpful site for information on how to submit a compensation claim for PTSD.
§ Wounded Warrior Project*
The mission of this project is to provide direct programs and services to meet the needs of severely injured service members.
US Military Branches
§ US Air Force
Home page for the US Air Force.
§ US Air Force Reserve
Home page for the US Air Force Reserve.
§ US Air National Guard
Home page for the US Air National Guard.
§ US Army
Home page for the US Army.
§ US Army National Guard
Home
page of the Army National Guard: composed of civilians who serve their
country, state and community on a part-time basis. The Guard takes on
both State and Federal roles.
§ US Army Reserve
Home page of the US Army Reserve: a community-based federal military force that is skill based.
§ US Coast Guard
Home page for the US Coast Guard.
§ US Coast Guard Reserve
Home page for the Coast Guard Reserve.
§ US Marines
Home page for the US Marines.
§ US Navy
Home page for the US Navy.
§ US Navy Reserve
Home page for the US Navy Reserve.
Veterans Service Organizations: Web Resource Links
GO TO: www.ptsd.va.gov to click on these links
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