Review By:
Merdijana Kovacevic, M.A., and Elana Cewman, Ph.D.
Resick, P. A., Monson, C. M., & Chard, K. M. (2016). Cognitive Processing Therapy for PTSD: A comprehensive manual. New York, NY: Guilford Press. ISBN 9781462533725
Cognitive Processing Therapy for PTSD: A Comprehensive Manual contains everything a provider needs to deliver Cognitive Processing Therapy (CPT), an evidence-based treatment for posttraumatic stress disorder (PTSD). CPT aims to help clients acknowledge “stuck points”, thoughts that keep survivors from recovery after a traumatic experience. Clients are encouraged to accept the reality of what happened and develop balanced thoughts about themselves, others, and the world. An updated treatment manual was needed, as research determined a written account of the index trauma event, a critical component of previous manual versions (e.g., Resick, Monson, & Chard, 2014), is not essential for CPT’s efficacy (Resick et al., 2008). Hence CPT was reformulated to focus primarily on cognitive therapy addressing trauma-related thoughts about safety, trust, intimacy, power/control, and self-esteem. This new accessible manual describes the updated format in four sections providing: a) the theoretical underpinnings of CPT; b) treatment considerations; c) an in-depth guide of major treatment components; and d) helpful tips to adapt CPT to client needs.
In Part I, Resick provides an engaging autobiographical description of CPT theory development, evolution, and dissemination. Using both her clinical experience and scientific acumen, she describes how her team recognized serious treatment gaps for sexual assault survivors. Resick traces the theoretical underpinnings of CPT, including the influences of cognitive theory and the constructivist self-development theory of traumatic victimization. She notes the gradual development of CPT, which involved doubting the prevailing conceptualization of PTSD as solely a fear/anxiety disorder early on. She reported incorporating the biological model of PTSD to inform CPT techniques. Lastly, a concise review of research examining the efficacy and effectiveness of CPT is provided regarding primary outcomes, such as PTSD, and secondary mental and physical health outcomes, such as sleep changes. This section is likely to become outdated quickly as the database on CPT continues to grow.
The overall treatment approach and considerations are discussed in Part II including for whom CPT is appropriate and when and how to implement CPT. A plan to conduct a comprehensive pretreatment assessment of trauma history, PTSD symptoms, and other comorbid health conditions is provided. Easy-to-copy assessment tools, such as the PTSD Checklist-5 (PCL-5; Weathers et al., 2013) and the Patient Health Questionnaire-9 (PHQ-9; Kroenke & Spitzer, 2002), and charts to track client progress are included. The manual emphasizes how to conceptualize cases based on client’s stuck points to inform treatment planning. Specifically, the manual reviews the need to first identify and target client’s problematic assimilated thoughts, in which a client changes their interpretation of the event to fit existing beliefs (e.g., “I should have prevented the trauma”). Then, the manual suggests tackling problematic over-accommodated thoughts, or trauma-related changed beliefs about the self, others, or the world (e.g., “No one can be trusted”). In this section, information regarding trauma-informed ways to use general techniques is presented, such as using clarification to explore and challenge clients without invalidating their experiences.
Part III provides a detailed session-by-session guide to implementing CPT. For each session, there are new agendas, example scripts, and handouts (e.g., Trust Star Worksheet). The manual specifies indicators of progress throughout the protocol, which easily allows providers to concentrate on a primary focus for each session. Examples of critical CPT assignments and concepts are thoroughly described, which may be especially helpful to novice providers. For instance, this manual provides an annotated transcript of how to identify stuck points in clients’ accounts of their ideas about the causes and the impact of the trauma. Multiple solutions to deal with obstacles, such as non-adherence, are provided. Furthermore, specific advice on conceptualizing and reframing common themes for trauma survivors are discussed. For example, during the power/control module, compulsive behaviors (e.g., rechecking locks) may be conceptualized as behaviors leading to less control.
Part IV addresses special adaptations of CPT both in format (e.g., individual or group) and to different populations. Special considerations are discussed for individuals who are: active-duty service members and veterans, sexual assault survivors, intimate-partner violence survivors, disaster-accident survivors, and adolescents. Considerations on how to adapt CPT for those who have cognitive deficits, or PTSD complicated by grief also is reviewed. Session-by-session overviews are provided of different forms of CPT, including CPT for sexual abuse. While the basic tenants of CPT may be applied across cultures, current evidence for cultural adaptations is thoroughly reviewed. Considerations regarding racial/ethnic diversity, sexual orientation diversity, religion, morality, and other languages are directly addressed, which are often stumbling blocks for even the most proficient providers. A major strength of this manual is its consideration of diversity in delivering a standardized but flexible protocol.
Throughout the manual, considerations of client and provider’s most common concerns and difficulties in engaging with the CPT protocol are discussed. The manual helps providers anticipate how to respond to client concerns in a trauma-informed and sensitive manner. For instance, if a sexual assault survivor communicates self-blame, a provider can normalize this response and can help the survivor differentiate what was unforeseeable (i.e., an accident) and who played a role in the event with the intention of creating harm (i.e. fault). To help the provider, solutions to overcoming treatment providers own stuck points regarding CPT are presented in a helpful questions-and-answers section. This approach to addressing clinician internalized factors may be particularly appealing to psychodynamic providers.
This book is useful for Division 56 members and others who want to provide an empirically-supported treatment for PTSD. The authors took the opportunity to elaborate, offer hints, and guidance at every step of the way, given their expertise with CPT. This comprehensive manual would be helpful to both the novice CPT provider, as basic tenants of the treatment are thoroughly explained, along with advanced CPT providers, as technical nuances and potential adaptations of treatment delivery are detailed. This all-inclusive manual contains the necessary components required for clinicians to provide CPT, including new handouts that make the revised manual worth the purchase. Overall, Cognitive Processing Therapy for PTSD: A Comprehensive Manual is a must-have for the trauma provider.
References
Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: A new depression diagnostic and severity measure. Psychiatric Annals., 32(9), 509-515. https://doi.org/10.3928/0048-5713-20020901-06
Resick, P. A., Uhlmansiek, M. O., Clum, G. A., Galovski, T. E., Scher, C. D., & 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(2), 243–258. http://doi.org/10.1037/0022-006X.76.2.243
Resick, P. A., Monson, C. M., & Chard, K. M. (2014). Cognitive processing therapy: Veteran/military version: Therapist and patient materials manual. Washington, DC: Department of Veterans Affairs.
Weathers, F.W., Litz, B.T., Keane, T.M., Palmieri, P.A., Marx, B.P., & Schnurr, P.P. (2013). The PTSD Checklist for DSM-5 (PCL-5). Scale available from the National Center for PTSD at www.ptsd.va.gov.
Merdijana Kovacevic, M.A. is Doctoral Candidate at the University of Tulsa (TU) under the mentorship of Elana Newman, Ph.D. She is interested in elucidating effective programming and/or empirically supported treatments for populations at high risk for developing PTSD.
Elana Newman, Ph.D., McFarlin Professor of Psychology at the University of Tulsa, is the Research Director at the Dart Center for Journalism and Trauma and a Co-director of the Tulsa Institute of Trauma, Adversity, and Injustice. Her work focuses on assessing, understanding, and treating maladaptive responses to traumatic life events; Current projects focus on the intersection of journalism and traumatic stress studies and child disaster mental health.
