Staff Perspective: Changes in the new CPT treatment manual

Staff Perspective: Changes in the new CPT treatment manual

As both a therapist using Cognitive Processing Therapy (CPT) with my PTSD patients and a CPT Trainer, I was eagerly awaiting the revision of the treatment manual.  And my wait was finally over in May 2014!  But then I found I was faced with a dilemma - do I throw out my old manual along with notes and reprint the new one?  Or can I simply keep the old manual and replace a few pages here and there.  It seems others were wondering also given the number of times during trainings and within my own clinic I've been asked this.  So, I did an in-depth comparison of the two manuals, and here is what I found along with my suggestions.

The wait for the new Cognitive Processing Therapy (CPT) Manual is over!  In May 2014 the new resources were finally published.  Specifically, there is a new Therapist Manual, Group Therapist Manual and a new CPT Materials Manual.  (For those with logins for the Provider Community on the CDP website, these can be found under “Member Resources” –> “Provider Resources and EBP Tools” –> “Cognitive Processing Therapy” or click here while logged in.)  In regards to what I am going to discuss here, I am focusing specifically on the individual CPT format, not the group format. 

There have been many questions about what specific changes were going to happen with this update.  I’m happy to say that there weren’t a ton, so you don’t need to throw out what you already have.  But there were some key changes that you do need to be aware of.  After watching our students stress about this issue, I actually went through each manual page-by-page and documented the changes.  That information can be found here.  But honestly, there are only a few key changes in the Therapist Manual that you need to focus on. 

The first is the change from the PCL-C to the PCL-5.  This is throughout the manual, and the Materials Manual does have a page regarding the new scoring of this tool.  Another key change is the removal of the optional session 2a on bereavement.  This was removed because it was found to be redundant.  When patients were giving their standard trauma account, they usually included bereavement issues and stuck points.  If they didn’t, this would be fleshed out when the trauma account was discussed. 

Other key changes to take note of are the revisions in the Challenging Questions Worksheet, Patterns of Problematic Thinking Worksheet, and Challenging Beliefs Worksheet.  Given these are key in the therapy process, I definitely recommend reprinting these items.  Changes to these worksheets are not dramatic and still reflect the original questions.  But some of the specific questions are reworded to be more user friendly, which is a huge plus in my book! 

There are obviously other changes in the new manual, such as waiting to introduce the Stuck Point Log until session 2, and the emphasis on not using psychobabble with patients to include the words “over-accommodation” and “assimilation”.  All of these can be found in the attachment to this blog.  In fact, you will see in the list of changes things so minor you may think I have lost my mind.  While some may argue I was having an OCD moment, I actually wanted to put people at ease who are really concerned that there are significant changes that they will miss.  So while I included every change I found, I did asterisk changes so significant you will want to reprint those pages, so if you don’t care about details you can skip to those. 

Regarding the new “CPT Materials Manual”, I absolutely love what they have done.  They have combined the previous resource manuals into one, and added things that you will find helpful.  The Materials Manual is divided in to two parts – Therapist Materials and Patient Materials.  The Therapist Materials section gives a very helpful overview of CPT and CPT-C, and the forms you have previously seen for your use if you so choose.  They have added a section for supplementary materials which includes the Stuck Point Help Sheet.  This sheet wasn’t in the previous therapist or materials manuals, but has been circulating, so you may already have it. 

Take note that although the new Therapist Manual does recommend you use it in session 1, the handouts in the Therapist Manual do not include the Stuck Point Help Sheet, but you can find it in the Materials Manual.   I personally use it with every patient and it seems to help explain this concept.  They have also included in the updated Materials Manual the revised forms if you are doing CPT with a patient who has a cognitive impairment that makes using the standard forms difficult.  In the Patient Materials section there is the full patient workbook for CPT as well as the workbook for CPT-C.  The introduction to this manual also lets you know which form sections to use for Group CPT.  Overall, I love the new layout and inclusions in the Materials Manual.  Every single form you need is there and easy to find.

So to summarize what I suggest you do to catch up with the updates in the new CPT materials:

  1.  Download the new materials.  You do not need to fully reprint everything.
  2. Review the attached document to see what the changes are between the manuals.
  3. Definitely print the new worksheets and PCL5.
  4. Spend time going through the new Materials Manual.  I think you will be pleased with what you find.
  5. And Don’t Panic!  The concepts of what you are doing with patients has not changed.  Trust what you know and enjoy the updated information and tools.

Dr. Debra Nofziger is a Cognitive Processing Therapy for PTSD trainer with the Center for Deployment Psychology.  She currently holds the CDP position at Brooke Army Medical Center in San Antonio Texas.