Know that CPT-C (cognitive only) skips the trauma narrative
A cognitive-only version of CPT omits the written trauma account and may be more tolerable for some people.
Why it works
The original CPT included a written trauma account (a detailed narrative of the event) as a component alongside the cognitive work. Resick’s research group subsequently tested "CPT-C" — the cognitive-only version — and found it produced equivalent outcomes in most populations. This matters because the written trauma account is the most distressing element for many people, and knowing that an equally effective alternative exists increases the options for who can engage with and complete treatment.
How to do it
- When seeking CPT, ask prospective therapists whether they offer CPT-C (cognitive-only) as well as the full protocol.
- If avoidance of the written account is specifically blocking you from engaging, explicitly discuss CPT-C as an option.
- CPT-C follows the same stuck-point identification, Socratic questioning, and challenging beliefs process — it omits only the detailed narrative writing.
- For some clients (especially those with severe avoidance or writing difficulties), CPT-C is preferable; for others, the written account deepens the processing.
Evidence
CPT vs. CPT-C (without written account) has been directly compared in RCTs, with CPT-C showing equivalent outcomes in most populations. This is a robust finding with direct relevance for treatment selection. (rct)
Equivalence was found at the group level; individual response to the written account vs. cognitive-only format may vary. A CPT-trained therapist is best placed to make individualized recommendations.
Sources
- Resick et al. (2008), comparing CPT, CPT-C, and written account only for PTSD, Journal of Consulting and Clinical Psychology
Common mistake
Assuming the written trauma account is essential to CPT’s effectiveness and avoiding the treatment because that component feels intolerable. The cognitive-only version removes that barrier without sacrificing outcomes for most people.
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More practices for Cognitive Processing Therapy (CPT): Unsticking the Meanings That Maintain PTSD
- Identify your stuck points
Name the specific beliefs about safety, trust, control, esteem, or intimacy that the trauma has frozen.
- Write an impact statement — why the trauma happened and how it affected you
A written account of the meaning you made of the trauma is CPT’s starting point for finding stuck points.
- Use Socratic questions to examine stuck points
Challenge stuck points with specific questions that examine the evidence rather than argue against the belief.
- Use a challenging beliefs worksheet to work a stuck point completely
The CPT challenging beliefs worksheet is a structured, written process for examining one stuck point at a time.
- Examine stuck points across the five disrupted domains
CPT organizes trauma-disrupted beliefs into five domains — Safety, Trust, Power, Esteem, Intimacy — to ensure none are missed.
Related concepts
- Prolonged Exposure Therapy: Principles, Practices, and the Evidence
Extinction learning, avoidance reversal, and the most evidence-supported PTSD protocol
- EMDR: Eye Movement Desensitization and Reprocessing
A structured approach to processing traumatic memory — what works and what we still debate
- Exposure Therapy: Facing Fears to Shrink Them
The extinction mechanism, the hierarchy, and self-guided principles that hold up