Staff Perspective: Want to improve your CPT or PE skills? Start with the fundamentals!

Staff Perspective: Want to improve your CPT or PE skills? Start with the fundamentals!

Dr. Jeffrey Mann

In working with Psychology Interns, Psychiatry Residents, Social Workers, and all other types of mental health providers from the most experienced to least, I’ve found that people often forget the basis of Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE). CPT is a form of Cognitive Behavioral Therapy (CBT) and PE is a form of Exposure Therapy. They are not unique theories. They adapt these types of treatment to address the theoretical understanding of what causes and maintains PTSD symptoms. For example, one of the main mechanisms that is believed to sustain PTSD is avoidance and these treatments are designed to address that mechanism. CPT addresses maladaptive thought patterns developed after the trauma with tried and true CBT methods. When treating depression with CBT, the goal is to address cognitive processes that support hopelessness, self-deprecation, etc. When treating panic disorder or some sort of phobic condition with Exposure Therapy, the goal is to perform systematic exposure to the avoided stimuli. All of these treatments adapt a basic theory to a specific situation and utilize core concepts to address specific problems.

There are many resources to reference. One of the most practical books I’ve used for myself and for teaching CBT is Judith Beck’s book “Cognitive Behavior Therapy: Basics and Beyond.” Having a reference like this will help you understand the basics of a cognitive conceptualization, identification of automatic thoughts, the use of Socratic questioning, and many other techniques.

When it comes to PE and learning to conduct imaginal and in-vivo exposure, understanding the basic principles and guidelines for exposure-based therapies (ET) will help you to construct an effective exposure hierarchy and use effective methods and parameters when conducting the exposure. A great resource in this area is “Exposure Therapy for Anxiety: Principles and Practice” by Abramowitz, Deacon, and Whiteside. There are also great disorder specific manuals in the “Treatments that work” series.

An important consideration is that it is highly likely that the individual you are treating will have a co-morbid condition such as Major Depression, Panic Disorder, Social Anxiety, or Agoraphobia. According to the DSM-5 there is an 80% likelihood that individuals diagnosed with PTSD will meet diagnostic criteria for at least one other disorder. My personal clinical experience has been that in working with individuals with multiple traumas, unstable or traumatic childhoods, and/or extensive time since the trauma, it is rare that I am not going to be treating another mental health disorder. If you are already engaged in PTSD treatment with PE or CPT, using a theoretically consistent model of treatment to address the co-morbid conditions can reduce confusion and re-inforce the learning achieved in the PTSD treatment while demonstrating the generalizability of the techniques being learned. For example, during the PE protocol the concept of using exposure rather than avoidance to reduce anxiety associated with feared situations can be applied to social situations and events, and not just traumatic memories. Thought Challenging techniques are helpful in addressing depression-related thoughts and experiences in addition to trauma related stuck points.

Learning to effectively apply these techniques to conditions other than PTSD will enhance your ability to adapt to the unique presentation of your patient. Using these techniques to address other co-morbid conditions such as depression, panic disorder, OCD, etc

When it comes to PE and CPT, they achieve the same end through slightly different means that converge on a state of adaptive thought and behavior with respect to experiencing one or more traumatic events.

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.

Jeffrey Mann, Psy.D., a Senior Military Internship Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) with the Uniformed Services University of the Health Sciences and is located at Naval Medical Center San Diego.