Is Online Cognitive Processing Therapy for Trauma a Fit for Me?

November 10, 2020 by

At essence, Cognitive Processing Therapy, CPT, is a way to use one’s own heart and mind to help reduce the impact on one’s brain of having experienced trauma. Designed to be a brief protocol, CPT has over 25 years of research to back it and is recommended by the Veterans Administration and the American Psychological Association (APA).

Cognitive Processing Therapy for PTSD ManualI experienced such significant trauma symptom reduction myself from being taken through the protocol by clinical psychologist Stephanie Fearer, Ph.D., that I trained in providing the CPT protocol so I could pass this relief forward to others. I provided individual and group sessions in CPT in my private practice’s counseling office until March, 2020. Since then, we have been conducting individual and group CPT sessions online.

Numerous research studies report the effectiveness of online vs. in-person counseling, including for CPT.

The CPT protocol includes 12 sessions. These can be scheduled weekly, twice weekly, or at other intervals. In this case study, a person received 10 sessions of Cognitive Processing Therapy delivered twice per day over a single, five-day work week.

The first 7 sessions are fundamental and the last 5 offer deeper insights. Some people experience noteworthy symptom reduction in a few sessions – “early responders” – and complete the protocol in fewer than 12 sessions.

Participants complete assessments prior to each session and plot them on a graph to track their progress. They complete daily homework between sessions.

Some people want to take their time and experience the comprehensive experience of the full protocol. Others, because of time and cost limitations, want to be early responders. In my professional experience, all who engage in CPT for any length of time are brave. Early responders tend to be those who 1) do the homework daily (not intermittently or all at once), and 2) do it thoroughly. In addition, women who identify as female and for whom attendance of our online CPT group is a fit may also respond quickly to the protocol.

The primary logistics challenge for conducting and participating in online CPT is distributing and using the handouts. When I had an office, I created a folder for each client and arranged a sequence of handouts in folders as if in a buffet line. Clients arrived, completed assessments, acquired the session’s handouts, and we were ready to begin in about 3 minutes.

Online, I have used a website page as a virtual table and made an ordered list of the materials participants need and the actions to take prior to each session. The give-and-take of quick questions that happens while seated in-person, side-by-side at a table doesn’t really happen in online sessions when one is, virtually, inches away from the other person’s face. There’s a focus and seriousness to it that, again in my opinion, might actually improve outcomes. That is hypothesis, not data. I’ve made a CPT glossary that covers the questions I was most often asked about terms and concepts.

Although a self-guided workbook is being developed, I encourage people to buy a copy of the CPT manual. I kept an in-house copy of the manual in my office so clients could follow along during each session. This was more efficient than attempting to page through copies of handouts in a folder or notebook.

If you’ve read this far, then you’ve answered the first question.

Is online Cognitive Processing Therapy (CPT) a fit for me?

1. Am I open to reading short passages of explanatory text at about the reading level of the text in this post?

2. Am I open to reading and following lists of directions primarily on my own and asking clarifying questions if I’m having trouble?

3. Am I open to doing daily homework? After the first homework assignment, which takes an hour, am I open to doing homework each day, maybe 20-30 minutes per day?

4. Am I aware that the primary symptom of trauma disorders is clinically – and somewhat uncharitably – termed “avoidance” but is my attempt to protect myself from emotional pain?

5. Am I aware that, paradoxically, the primary symptom of trauma disorders – avoidance – is the one that may get in the way of me getting help for it? If I do get help, am I aware I will, understandably, lean toward canceling sessions and not doing homework and lean away from attending appointments and doing homework? That I may find myself wanting to quit attending sessions at all?

6. Am I aware that a secret, fearful belief I have is that, if I engage in counseling for trauma, all my defenses and adaptations will shatter and I will be so raw and vulnerable that I will be unable to function?

7. Given all this, am I open to taking a chance on the protocol for about 20-30 minutes per day for up to 12 sessions, knowing I, truly, can stop at any time and use the manual on my own?

The start of any counseling process for any condition begins with self-kindness. Having questions and concerns like these makes complete sense. People who have trauma symptoms suffer. People who have been diagnosed with post-traumatic stress disorder (PTSD) have a condition considered a severe mental illness (SMI) for which they qualify to apply for disability benefits. This is serious business and deserves our attention and care.

If you are a Virginia resident and would like to consider Cognitive Processing Therapy facilitated by a counselor, please fill out this contact form. (If you are not a resident of Virginia, here is a roster of other CPT providers.)

I will use your email address to send you the CPT contract and the .pdf of CPT worksheets for your review. If you decide you would like to engage in the protocol, I’ll send you further enrollment information and we’ll schedule a meeting to answer any questions you may have.  When we meet, we’ll schedule a set of 12 appointments together. Then we’ll begin.

If you would like to consider engaging in CPT on your own, Self-Help Guide to Reducing Trauma Symptoms may be of assistance.

With any questions at all, please do contact me.

This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Filed Under: CPT, Trauma

Self-Soothing Statements for the Human Condition

December 6, 2019 by

People can be burdened with two fundamental, often unconscious, beliefs: “I am a bad person” and “I am an incapable person.” As global statements, they are untrue. Only a very few of us can be perceived as evil, lacking such empathy that we take action without thought of human consequence. The rest of us, as humans, have brains that have evolved for us to be primarily good to each other, if only for survival reasons. Even if we make mistakes often – which, again, most of us don’t or we wouldn’t survive – we don’t make them all of the time.

The troubling nature of these beliefs is multiplied when they are paired with the just-world belief.

“The just-world belief holds that good things happen to good people, that bad things happen to bad people, and that the world should be a fair and just place. This belief emanates from the desire to find an orderly, cause-effect association between an individual’s behavior and the consequences of that behavior…this is a hard-wired, evolutionary need of humans to predict and control events in order to survive.” (65)
– Resick, et al., Cognitive Processing Therapy for PTSD: A Comprehensive Manual, 2017.

Anne's ringLook at the permutations of thoughts that can arise from the “I am bad”/”I do badly”/just-world belief scenario:

  • Something good happened. I must have done something right and deserve credit.
  • Something bad happened. I must have done something wrong, I am to blame, and I deserve punishment.
  • If I had just done something different, this bad thing wouldn’t have happened.
  • If ________ had only done something else, this wouldn’t have happened. (“hindsight bias”)
  • If I just could figure out what would have made a difference, I would feel more certain about why it happened and I would feel better.
  • If I do this and say this, and don’t do that and don’t say that, I can keep bad things from happening.
  • Why me?
  • Why not me? (“survivor guilt”)

A few weeks ago, one or more people came into my home, ascended the stairs to my bedroom, opened my jewelry box, and took a selection of rings, primarily the most valuable and beautiful. I experienced very human shock, fear, and grief. But part of the human condition is having things we love taken from us. Adaptively, we usually grieve, practice self-care, seek out and receive support, accept sad, unfortunate facts, and move ahead.

Instead, I descended into a hell of suffering. I had the experience of watching myself slip and tumble, being baffled by how this was happening, but being unable to do anything about it. Finding life enriched by giving and receiving counseling, I sought care from my in-person counselor and from online counseling via Talkspace. I worked and worked to become aware of my primary and secondary feelings, to sort through my thoughts as facts vs. beliefs, and to access my inner wisdom for guidance. (That’s the essence of the counseling protocols CBT, DBT, and CPT rolled into one.)

I think realizations usually dawn on people, but I actually had a eureka moment. On Thanksgiving, I worked out at my gym, then spent the rest of the day alone. In a moment of deep reflection, I realized I was thinking, “If I were a better, more capable person, this wouldn’t have happened. I should be better and I should have done better. Shame on me.”

Good grief! Who wouldn’t suffer from being told these things?! And in my own head! I had no idea how mean I was being to myself! No wonder I was suffering!

It is the human condition to think thoughts like these. But it is within our human capability to transform them.

I was asked by my Talkspace therapist, “What feelings are you trying not to feel?”

Repeating those beliefs to myself helped me avoid the fact I reject most often – “I am helpless to change what happened” – and the feeling I reject most often: sorrow.

For helpless sorrow, there is only one human, humane response: self-soothing statements of kindness.

  • Some things happen for no discernible reason.
  • Some things happen to me – both good and bad – that have nothing to do with me, who I am, or what I’ve done.
  • Some things happen to other people – both good and bad – that have nothing to do with them, who they are, or what they’ve done.
  • Some things happen that cannot have been predicted, prevented, or controlled.
  • For some things that happen, an alternative action may have had an equally negative or worse outcome.
  • I know this is a difficult time for me.
  • I am so sorry I’m going through this.
  • This is hard.
  • I’ve been through hard things before and I made it. I can make it this time, too.
  • I am here for me.
  • I am not going to leave me.
  • I have the skills I need to take care of myself. I can ask for help from others when I need it.
  • I can comfort myself.
  • I can help myself through this.
  • I can help myself do what I need to do.
  • I can care for myself.
  • I have hope for myself and wish the very best for myself.
  • Above all, I am kind to myself.

Image is an enlargement of a photo taken in 2007 of one of my missing rings: 14 karat gold, heavy band; oval pink tourmaline, estimated 9 x 6 mm; small diamond on either side of stone; scrollwork wire around setting of stone; custom designed by Virginia artist Kirk ______ (unknown last name).

The views expressed are mine alone and do not necessarily reflect the positions of my colleagues, clients, family members, or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Filed Under: Addictions Treatment, CPT

Chanel Miller Is With Us

October 16, 2019 by

I am recommending Chanel Miller’s Know My Name: A Memoir to my clients who have experienced trauma, to their partners, parents, and family members, and to anyone who wants to better understand trauma and how to begin to heal from it.

I concur with Laura Norkin, Deputy Editor of InStyle, who posted on Twitter, “Very few stories, in this seemingly endless trauma vortex, are actually worth dipping back into your own PTSD spiral in order to read. This is one – because she talks about climbing back out.”

Know My Name by Chanel MillerAlthough I learned in 2016 that “Emily Doe’s” victim impact statement had been published on BuzzFeed, I was not one of the 15 million+ who read it.  While clinicians term the primary symptom of post-traumatic stress disorder (PTSD) “avoidance,” having experienced trauma myself, I was simply being merciful, willing to do anything to protect my broken heart and wild mind from further tragedy.

When I learned through The New York Times that “Emily Doe” had identified herself as Chanel Miller and written a memoir, again I hesitated.

I am so very sorry for what has happened to the narrators of trauma survivor stories. Many survivors can only record that miserably electrified, detailed memory set that comes with trauma. The narrator and the listener or reader re-experience the trauma in excruciating detail, became overwhelmed with horror, and stay stuck in anguish. “This shouldn’t have happened,” If only I had or hadn’t…,” and “I don’t know what to do except endure” are beliefs often underpinning many experiences of trauma.

They were part of mine as well. But these beliefs are so much less a part of how I think about the traumas I experienced. I was taken through Cognitive Processing Therapy (CPT) by a local psychologist about two years ago. Based on the findings of neuroscience about the traumatized brain, paired with cognitive theory, CPT helps people use their own tender hearts and wise minds to directly help themselves. Even today, I tear up with compassion for myself when I remember the dawning realization that how I was thinking about myself as a result of what happened was causing my suffering. My poor self! I was writhing and whimpering from my own mean thoughts! I had no idea I was doing to myself what I would never even consider doing to anyone else.

I rarely think in self-cruel ways now and can catch myself pretty quickly when I do. PTSD can be a tough disorder, but I have few symptoms because I treat myself kindly. As a counselor, I was eligible to train in CPT and became a rostered provider of CPT. I attempt to pass the kindness forward.

Still, I protect myself as much as I can from situations in which I feel helpless and sad. In sum, PTSD results from feeling unrelentingly overpowered and helpless. To quote CPT founder Dr. Patricia Resick at a seminar I attended, “At essence, PTSD is unfelt sadness.”

Wondering if her memoir might be helpful to clients, however, I listened to Chanel Miller tell her own story.

Chanel Miller states openly that she engaged in therapy and thanks her therapist in the acknowledgements. I don’t know if she engaged in CPT, but she takes herself through a similar restorative process.

Yes, as she recalls and recounts the details, downward trajectories threaten downward spirals. But she challenges what she’s telling herself about herself throughout her story.

As I listened to her memoir, I heard her record realities, feel feelings as a result, becomes aware of associated thoughts, and differentiate between thoughts that are about facts and thoughts that state beliefs. She then challenges those beliefs with the facts as she sees them and as those who love her see them. She comforts herself as she can, but even when she simply has to get back in bed, she continues to seek to affirm the reality of her own self.

Again, as I see it, it seems that the inner narrative she discovers, composed of facts and realities, revives and restores her to stability, even through the punishing experience of the trial and sentencing. It’s harrowing! But she uses the very skills that brain researchers – as currently formulated by CPT – reveal are helpful: have an on-going, compassionate, interested, inner conversation, feel and name feelings, become aware of thoughts associated with the feelings, identify the thoughts that are misbegotten beliefs, meticulously dismantle those beliefs with facts, and free yourself.

I felt and thought infinitudes while I listened to Chanel Miller’s story, but I only cried three times, once when she recounted something loving her mother said, once when she recounted something bold her father said, and finally when she was thanking the Swedes in her acknowledgements. I am so very sorry for her pain, but I am uplifted and strengthened by her compassion and bravery.

BuzzFeed published all 7,000 words of Emily Doe’s/Chanel Miller’s impact statement and, I too, cannot make a selection from her memoir to quote. William Zinsser asked writers to ask, “Is every word doing new work?” For those of us with trauma stories, perhaps as yet unspoken or unwritten, Chanel Miller’s words help do the work with us and for us.

CPT is the counseling protocol recently featured on This American LIfe. It is a recommended treatment for PTSD by the Veterans Administration and the American Psychological Association (APA).

The views expressed are mine alone and do not necessarily reflect the positions of my colleagues, clients, family members, or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Filed Under: CPT
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