The Structure of CPT

CPT is typically delivered in 12 weekly sessions, though it can be extended if needed. It follows a structured protocol with specific components in each session. The therapy can be delivered individually or in groups.

Sessions 1-2: Education and Impact Statement

The therapy begins with psychoeducation about PTSD symptoms and how trauma affects thoughts and feelings. You learn about the relationship between events, thoughts, and emotions, and how “stuck points” problematic beliefs about the trauma—maintain PTSD symptoms.

A crucial early assignment is writing an “impact statement” a narrative about what the trauma means to you and how it has affected your beliefs about yourself, others, and the world. This isn’t a detailed account of what happened, but rather your interpretation of its significance. This statement serves as a baseline that you’ll revise later as your understanding evolves.

Sessions 3-5: Identifying and Challenging Stuck Points

You learn to identify stuck points, specific beliefs that keep you from recovering. These often appear as self-blaming thoughts, overgenealized beliefs, or extreme conclusions about safety, trust, control, esteem, and intimacy.

You’re taught to use Socratic questioning to examine these beliefs systematically:

• What’s the evidence for and against this belief?
• Are you confusing something within your control with something outside your control?
• Are you thinking in all-or-nothing terms?
• Are you using your feelings as facts?
• Are you focusing only on certain aspects of the situation?

The therapist helps you practice challenging stuck points using worksheets that guide you through examining the evidence, considering alternative interpretations, and developing more balanced, accurate beliefs.
Sessions 6-7: Processing the Trauma

In traditional CPT, you write a detailed trauma account, a comprehensive narrative of the traumatic event including sensory details, thoughts, and feelings. You read this account aloud to your therapist, which serves as a form of exposure that helps process the traumatic memory.

You write this account at least twice, and with each reading and revision, the goal is to identify and challenge stuck points that emerge. The retelling helps you integrate the traumatic memory rather than avoiding it, and allows you to confront distortions about what happened.

Note: There’s also CPT-C (CPT-Cognitive only), a variant that omits the written trauma account and focuses exclusively on cognitive work. Research shows both versions are effective, giving therapists and clients flexibility based on preferences and needs.

Sessions 8-12: Challenging Beliefs in Specific Themes

The final sessions systematically address five key areas where trauma typically disrupts beliefs:

Safety: Trauma often shatters assumptions about safety. You might develop extreme beliefs like “Nowhere is safe” or “Danger is everywhere.” CPT helps you develop more nuanced, accurate assessments of actual risk versus perceived threat.

Trust: Trauma can destroy trust in others or even yourself. Stuck points might include “No one is trustworthy” or “I can’t trust my own judgment.” You learn to evaluate trustworthiness on a continuum and in specific contexts.

Power and Control: Trauma often creates feelings of helplessness. Stuck points include “I have no control over anything” or conversely, “I should have been able to control what happened” (inappropriate self-blame). CPT helps distinguish what was and wasn’t in your control.

Esteem: Trauma frequently damages self-worth. Common stuck points are “I’m damaged/worthless/dirty” or “It happened because there’s something wrong with me.” You learn to separate what happened to you from who you are.

Intimacy: Trauma can disrupt the ability to connect with others emotionally or physically. Beliefs like “Intimacy always leads to harm” or “I don’t deserve closeness” are examined and modified.

For each theme, you complete worksheets that help you identify stuck points, examine evidence, and develop more balanced perspectives.

Key Techniques and Tools

The ABC Worksheet helps you track the connection between Activating events, your Beliefs about those events, and the emotional and behavioral Consequences that follow. This makes the thought-emotion-behavior connection concrete.

Challenging Questions Worksheet provides a structured format for systematically questioning stuck points using specific prompts about evidence, alternative explanations, and realistic thinking.

Patterns of Problematic Thinking educates you about common cognitive distortions relevant to trauma, including:

• Jumping to conclusions without evidence
• Exaggerating or minimizing the importance of events
• Disregarding important aspects of situations
• Oversimplifying events as good/bad or right/wrong
• Overgeneralizing from single incidents
• Mind reading or assuming you know what others think
• Emotional reasoning (treating feelings as facts)

Challenging Beliefs Worksheets guide you through a systematic process of identifying a stuck point, examining evidence for and against it, considering whether it’s based on thinking errors, and generating more balanced alternative thoughts.

What Makes CPT Distinctive

Unlike prolonged exposure therapy (another evidence-based PTSD treatment), CPT therapy for PTSD Ontario doesn’t require extensive or repeated retelling of traumatic memories. The focus is primarily cognitive, on how you think about and interpret the trauma, rather than on emotional processing through repeated exposure.

CPT specifically targets the meaning and beliefs formed around trauma, not just the symptoms. It recognizes that trauma fundamentally challenges core assumptions about the world, and recovery requires rebuilding a coherent, realistic worldview.

The therapy is highly structured and manualized, with specific content for each session. This makes it replicable and trainable, contributing to its widespread adoption in VA hospitals, military settings, and trauma treatment centers.

The Role of Self-Blame

CPT pays particular attention to self-blame, which is extremely common after trauma. It distinguishes between:

Behavioral self-blame: “I did something wrong” (based on actions) Characterological self-blame: “I am something wrong” (based on identity)

Both types are addressed by helping you accurately assess what was and wasn’t in your control, and separating actions from character. The therapy also addresses “hindsight bias” the tendency to believe you should have known or prevented something that you couldn’t have predicted at the time.

Recovery Process

As therapy progresses, you rewrite your impact statement, incorporating new understandings. Comparing the initial and final versions often reveals dramatic shifts in how you view the trauma, yourself, and your future. The stuck points that once seemed like unquestionable truths become recognized as beliefs that can be examined and modified.

Research Support

CPT has extensive research validation and is recognized as a first-line treatment for PTSD by organizations including the American Psychological Association, the Department of Veterans Affairs, and the World Health Organization. Studies show significant reductions in PTSD symptoms, depression, and functional impairment, with effects maintained over time.

It’s been successfully adapted for various populations including combat veterans, sexual assault survivors, refugees, survivors of natural disasters, and people who experienced childhood abuse. It works across cultures and can be delivered in different formats including individual therapy, group therapy, and even intensive formats where sessions occur more frequently.

The Ultimate Goal

CPT aims to help you “get unstuck” from trauma by processing what happened in a way that’s both emotionally integrated and cognitively accurate. Rather than avoiding trauma-related thoughts and feelings or being controlled by distorted beliefs about the trauma, you develop a coherent understanding that acknowledges what happened while recognizing it doesn’t define your worth, your future, or the entire world around you. The goal is not just symptom reduction but reclaiming your life and moving forward with realistic, balanced beliefs that allow for safety, connection, and meaning.

Cognitive Processing Therapy FAQ’s

What types of trauma can Cognitive Processing Therapy in Ottawa treat?

Cognitive Processing Therapy in Ottawa is specifically designed to treat PTSD resulting from various types of trauma. Originally developed for sexual assault survivors, CPT has been extensively validated for treating combat-related PTSD in veterans, motor vehicle accidents, natural disasters, childhood abuse, physical assault, and witnessing traumatic events. Our Ottawa CPT therapists work with youth aged 16 and older and adults who struggle with intrusive memories, avoidance behaviors, negative beliefs about themselves, and hypervigilance following traumatic experiences. Whether your trauma occurred recently or decades ago, CPT helps you process the traumatic memory and challenge the stuck points, distorted beliefs that keep you from recovering. Research shows CPT is effective across different trauma types and cultural backgrounds, making it a versatile first-line treatment for PTSD in Ontario.

How is CPT different from other PTSD treatments like EMDR or prolonged exposure therapy?

Cognitive Processing Therapy in Ottawa differs significantly from other PTSD treatments in its approach and focus. Unlike prolonged exposure therapy that requires extensive repeated retelling of traumatic memories, CPT primarily focuses on how you think about and interpret the trauma rather than emotional processing through exposure. While EMDR uses bilateral stimulation and memory reprocessing, CPT uses structured cognitive techniques to identify and challenge stuck points—the problematic beliefs that maintain PTSD symptoms. CPT specifically addresses five key areas affected by trauma: safety, trust, power and control, esteem, and intimacy. The therapy is highly structured with a 12-session protocol, making it time-limited and predictable. CPT-C (cognitive only version) can even omit written trauma accounts entirely, focusing exclusively on belief modification. This makes CPT particularly suitable for clients who prefer a cognitive approach over exposure-based treatments.

What are “stuck points” and how does CPT therapy in Ottawa address them?

Stuck points are specific beliefs that develop after trauma and prevent natural recovery from PTSD. In CPT therapy in Ottawa, your therapist helps you identify two main types of stuck points: assimilation, where you distort the trauma to fit existing beliefs (like “I must have done something to deserve this”), and overaccommodation, where you overgeneralize from the trauma (such as “No one can ever be trusted again”). These stuck points typically affect beliefs about safety, trust, control, self-worth, and intimacy. Using structured worksheets and Socratic questioning, your Ottawa CPT therapist guides you through examining evidence for and against these beliefs, identifying thinking errors like emotional reasoning or all-or-nothing thinking, and developing more balanced, accurate perspectives. CPT recognizes that recovery requires rebuilding a coherent worldview that acknowledges what happened while recognizing it doesn’t define your worth or future.

How long does CPT therapy take and what happens in each session?

Cognitive Processing Therapy in Ottawa typically consists of 12 weekly sessions, though it can be extended based on individual needs. The structured protocol begins with psychoeducation about PTSD and writing an impact statement about what the trauma means to you. Sessions 3-5 focus on identifying and challenging stuck points using systematic questioning techniques. Sessions 6-7 involve processing the trauma through a written account (in traditional CPT) or continued cognitive work (in CPT-C). The final sessions systematically address beliefs about safety, trust, power and control, esteem, and intimacy. Each session includes homework assignments like completing worksheets to challenge stuck points between appointments. This structured approach ensures consistent progress and makes CPT one of the most researched and evidence-based PTSD treatments available. Most clients notice significant improvement in PTSD symptoms, with effects maintained long-term.

Is online CPT therapy effective for treating PTSD in Ontario?

Yes, online Cognitive Processing Therapy delivered across Ontario is highly effective for treating PTSD and offers several advantages. Research demonstrates that virtual CPT produces outcomes comparable to in-person treatment, with significant reductions in PTSD symptoms, depression, and functional impairment. The structured nature of CPT—including worksheets, impact statements, and systematic belief challenging—translates seamlessly to secure video platforms. Online CPT therapy allows you to access specialized trauma treatment from Ottawa-based therapists without travel, which is particularly important for those with PTSD-related avoidance or anxiety about leaving home. You can complete therapy in a safe, private environment where you feel most comfortable processing difficult material. Our Ontario CPT therapists use the same evidence-based protocol recognized by the American Psychological Association, Department of Veterans Affairs, and World Health Organization as a first-line PTSD treatment.

Will I have to repeatedly describe my trauma in detail during CPT therapy?

Not necessarily. While traditional Cognitive Processing Therapy in Ottawa includes writing a detailed trauma account once or twice as part of the protocol, there’s also CPT-C (cognitive only), which omits the written trauma account entirely and focuses exclusively on challenging beliefs and stuck points. Research shows both versions are equally effective, giving you and your therapist flexibility based on your preferences and comfort level. Even in traditional CPT, you’re not repeatedly retelling your trauma story throughout treatment—the written account occurs in just 2 sessions. The majority of CPT therapy focuses on identifying and modifying the distorted beliefs that developed after the trauma, not on exposure to traumatic memories. Your Ottawa therapist will discuss both options during your initial assessment and work collaboratively with you to determine which approach feels right for your recovery journey.