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.

Why it works

Trauma disrupts beliefs systematically across a predictable set of domains because it fundamentally challenges our assumptions about how the world works. By organizing stuck points into these five domains, CPT ensures that the most common patterns of trauma-related cognitive disruption are examined rather than addressed only where they are most obvious (typically self-blame, which is salient, while trust disruptions may be less consciously attributed to the trauma).

How to do it

1. Review each domain and generate at least one stuck point per domain: Safety ("The world is dangerous"), Trust ("No one can be trusted"), Power/Control ("I have no control"), Esteem ("I am damaged/worthless"), Intimacy ("I cannot be close to anyone").
2. Notice which domains generated the most stuck points — those are the cognitive territory most disrupted by your particular experience.
3. Prioritize the domains where your stuck points are strongest for the challenging beliefs worksheet.
4. Return to all five domains at the end of a CPT course to assess which have shifted.

Evidence

The five-domain model is drawn from McCann & Pearlman’s constructivist self-development theory and has been used as the organizing framework across all CPT research. Domain-level cognitive change has been tracked in CPT outcome studies and is associated with symptom improvement. McCann, Sakheim & Abrahamson (1988) laid out the underlying model of how trauma disrupts core psychological need areas, which is the theoretical source of the five-domain framework. (clinical)

The five domains are a clinical organizing framework; the evidence supports CPT using this framework, not the framework as an independently validated classification system.

Sources

• McCann & Pearlman (1990), constructivist self-development theory
• McCann, I. L., Sakheim, D. K., & Abrahamson, D. J. (1988). Trauma and victimization: A model of psychological adaptation. The Counseling Psychologist, 16(4), 531-594.

Common mistake

Focusing only on the domain that feels most obvious (usually self-blame or safety) and not examining the subtler disruptions in trust and intimacy, which may be equally active in maintaining PTSD.