Believe it or not, it’s been nearly 25 years since Patricia Resick and Monica Schnicke published their groundbreaking treatment manual, Cognitive Processing Therapy for Rape Victims (1993). Since that time, the efficacy of Cognitive Processing Therapy (CPT) has been demonstrated time and time again in many high-quality studies. CPT is now considered a first-line treatment for PTSD according to VA/DOD Guideline: Management of Posttraumatic Stress (2010). CPT has proven to be a very robust treatment, applicable to both civilian and military populations in many different settings (individual therapy, group therapy, video-teleconferencing) and with different types of trauma histories.
The CPT manual, while maintaining its original structure and core interventions, has evolved over the years. In support of the Veterans Health Administration’s unprecedented efforts to disseminate evidence-based psychotherapy as described by Karlin & Cross (2011), the CPT manual was adapted for use with military populations by Drs. Resick, Monson, and Chard (2006). Detailed session agendas with suggested time frames, clinical vignettes demonstrating CPT interventions with Service members and Veterans, and example worksheets with military-themed content were all included to assist VA clinicians adapt CPT to the unique needs of their Veteran clients. The Veteran/Military version of the CPT manual was updated in 2010 and 2014 as new research became available.
Perhaps the most significant development regarding the CPT manual, reflected in the 2010 and 2014 revisions, was the inclusion of two versions of CPT: one that included a written trauma account (known then as “CPT”) and one that did not include a written trauma account (known then as “CPT-C”). Resick et. al (2008) compared these two versions of CPT and found that they were equally effective when compared to each other, although participants who received CPT-C, demonstrated more rapid decreases in symptoms. This finding suggested that the “active ingredient” in CPT seemed to be the cognitive therapy components of the treatment package and led to several other studies investigating the effectiveness of CPT-C (e.g., Chard, Schumm, Owens, & Cottingham, 2010). In light of this research, Drs. Resick and her colleagues concluded that CPT-C, a “purer” cognitive version of the protocol, should be the standard version of the therapy. Therefore, in the newest version of the CPT manual (Cognitive Processing Therapy for PTSD: A Comprehensive ManuaI, 2016), “CPT” now refers to the version of the protocol that does not include the written trauma account, and “CPT+A” refers to the version of the protocol that does include the written trauma account.
The new CPT manual really does live up to its name in that it is quite comprehensive. More than just a “how to” book for clinicians interested in providing CPT to their clients, Cognitive Processing Therapy for PTSD: A Comprehensive Manual provides the reader with a crash course on the history, key research findings, and important clinical consideration pertaining to CPT. In addition to providing session-by-session descriptions of the standard CPT protocol, variations of CPT (e.g., with an account, group CPT, CPT for survivors of childhood sexual abuse) are also discussed. Dr. Resick and her colleagues take care to address key clinical issues for civilian and military clients throughout the manual and provide additional insights into working with clients with different trauma histories and diverse backgrounds. Lastly, all worksheets included in the book can be downloaded in PDF format, making it easier for clinicians to prepare materials for session.
I find the newest version of the CPT manual to be a wonderful resource, but my fellow CPT trainers and I at CDP do miss some features of the older versions. First, the new manual doesn’t include suggested time frames for each item on session agendas unlike the three iterations of the Veteran/Military versions of the protocol. Many consultees have remarked that these “time stamps” helped them to manage their time. Second, the Veteran/Military versions of the protocol were produced in spiral bound format that included tabs for each section while the new manual comes in a standard, paperback format. The spiral bound manual opened flat and was a bit easier to sit in my lap while conducting sessions, and the tabs allowed me to quickly flip to the section of the manual that I wanted to consult. The good news is that the manual should sit flat with as the spine relaxes with use. Dr. Lefkowitz, my fellow CDP CPT trainer, also suggested using sticky page tabs to mark off the various sections and chapters of the manual.
But that’s enough from me! I encourage you to pick up the new CPT manual and judge for yourself. I think that you will be glad that you did. Please sign in and let us know what you like and don’t like about the new manual in the comments section.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Andrew Santanello, Psy.D is a licensed, clinical psychologist and CBT trainer at the Center for Deployment Psychology. Dr. Santanello joined CDP after over a decade of service in the Veterans Health Administration where he was a staff psychologist in the Trauma Recovery Program.
Bass, J. K., Annan, J., McIvor Murray, S., Kaysen, D., Griffiths, S., Cetinoglu, T., … Bolton, P.A. (2013) Controlled trial of psychotherapy for Congolese survivors of sexual violence. New England Journal of Medicine, 368, 2182–2191.
Chard, K.M., Schumm, J.A., Owens, G.P., & Cottingham, S.M. (2010). A comparison of OEF and OIF Veterans and Vietnam Veterans receiving cognitive processing therapy. Journal of Traumatic Stress. 23, 25–32.
Karlin, B.E. & Cross, G. (2010). From the laboratory to the therapy room: National dissemination and implementation of evidence-based psychotherapies in the U.S. Department of Veterans Affairs Health Care System. American Psychologist, 69, 19-33.
Resick, P.A., Galovski, T.A., Uhlmansiek, M. O., Scher, C.D., Clum, G. A., & Young-Xu, Y. (2008). A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence. Journal of Consulting and Clinical Psychology, 76, 243–258.
Resick, P. A., Monson, C.M., & Chard, K.M. (2006). Cognitive processing therapy veteran/military version: Therapist’s manual, Washington, DC: Department of Veterans Affairs.
Resick, P. A., Monson, C.M., & Chard, K.M. (2010). Cognitive processing therapy veteran/military version: Therapist’s manual, Washington, DC: Department of Veterans Affairs.
Resick, P. A., Monson, C.M., & Chard, K.M. (2014). Cognitive processing therapy veteran/military version: Therapist’s manual, Washington, DC: Department of Veterans Affairs.
Resick, P. A., Monson, C.M., & Chard, K.M. (2016). Cognitive Processing Therapy for PTSD: A Comprehensive Manual, New York, NY: The Guilford Press.
Resick, P. A., & Schnicke, M. K. (1993). Cognitive processing therapy for rape victims: A treatment manual. Newbury Park, CA: Sage Publications.
VA/DoD Clinical Practice Guideline: Management of Post-Traumatic Stress, 2010: Guideline Summary. Washington, DC, US Department of Veterans Affairs. Available at www.healthquality.va.gov/ptsd/ptsd-sum_2010a.pdf