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10 Cognitive Processing Therapy (CPT) Exercises and Activities to do with your Clients

Cognitive Processing Therapy (CPT) is a structured counseling approach that occurs over 12 sessions that typically last 50 minutes. Counselors who use Cognitive Processing Therapy work with their clients to improve their ability to learn to identify, modify, and challenge unhelpful beliefs that are associated with a trauma that they experienced. 

View all of our Cognitive Processing Therapy Worksheets

By learning to modify and challenge unhelpful beliefs, clients can develop a new understanding of their trauma. When this change occurs, clients find that they experience a decrease in the distress that they experience regarding their traumatic experience. Cognitive Processing Therapy begins by educating clients about their mental health concerns, thoughts, and emotions, and how they are all intertwined (American Psychological Association, 2017). Counselors work with their clients to identify automatic thoughts that contribute to their mental health symptoms.

 During the course of CPT therapy sessions, clients are asked to complete exercises that involve describing the traumatic event they experienced and speaking about details that they may try to avoid. The goal of this is to break the client’s pattern of avoiding thoughts and feelings that are associated with their trauma (American Psychological Association, 2017). 

Clients then use the skills they have learned in sessions in their everyday life, and they are asked to monitor their use of their learned skills. Counselors can focus on various areas of a client’s life that were impacted by their trauma including safety, trust, power, self-esteem, and intimacy (American Psychological Association, 2017). Continue reading to learn 10 Cognitive Processing Therapy Exercises and Activities you can do with your clients.

Mental Health Concerns That Can Benefit from Cognitive Processing Therapy

Cognitive Processing Therapy is primarily used for individuals who are living with post-traumatic stress disorder. This can include individuals who have experienced childhood abuse and neglect, combat, and rape (American Psychological Association, 2017). CPT would not be a good fit for individuals who are struggling with mental health disorders that are not associated with trauma, and individuals who would be unable to engage in the writing exercises assigned throughout the 12 sessions. 

Cognitive Processing Therapy Activities

Cognitive processing therapy activities can be used during individual and group therapy sessions to follow the flow of events for CPT. Exercises used in Cognitive Processing Therapy are consistent, as it is a structured therapeutic approach.

 Cognitive processing therapy exercises that can be used during therapy sessions can include:

  1. An important aspect of Cognitive Processing Therapy is gathering necessary and relevant information about the client’s experience, distress, and overall level of functioning. TherapyByPro offers Trauma History Questionnaire that can help Counselors gather this needed information as they begin developing their treatment plan. This includes the client’s childhood history, current functioning, target trauma, health since the traumatic experience, identity, substance use, and treatment plan. This form can then be used as a reference with clients as you discuss your treatment plan, goals, and objectives. It can also help your client tease out details of their history that could be addressed during their Cognitive Processing Therapy sessions.
  2. Before beginning your work with Cognitive Processing Therapy, you can speak with your client about the importance of showing kindness and compassion to themselves. When you are providing psychoeducation about post-traumatic stress disorder, you can take time to explore how they show themselves kindness and the impact it can have on our mental health, including self-esteem and depressive symptoms. Provide your client with a list of activities and behaviors that they could use to show themselves kindness, and ask them to identify 3-5 that they would be willing to try before their next session. Encourage your client to try engaging in one activity each day, and to keep track of their experience. TherapyByPro provides a Daily Self Kindness Worksheet that clients can complete as they practice showing themselves kindness.
  3. Writing an Impact Statement is a CPT exercise that clients are asked to complete twice during their 12-session CPT experience. You will ask your client to write about how they were impacted by their traumatic experience. Ask your client to focus on their thoughts, feelings, beliefs, and behaviors that were impacted by their trauma, rather than providing an account of what their traumatic experience entailed.

As you approach the final stages of CPT, you’ll ask your client to write a new impact statement with the knowledge they have gained in their sessions. With this opportunity to revisit their impact statement, they may have a different perspective on their trauma and how it impacts their thoughts, feelings, beliefs, and behaviors. 

In the final session, review the new impact statement and explore differences that can be observed in their first and second impact statement. Asking your client to complete their two impact statements is an example of a structured CPT exercise that you will use in your work. 

  1. The CPT ABC Worksheet be used to help guide you while providing psychoeducation to your client, or clients, about how a traumatic event impacts our thoughts and feelings. From here, you can work with your client to break down their experience into this ABC model. You can then work with your client to address their stuck point, and find healthier alternative thoughts they can use to replace their automatic thought or belief. Encourage your client to keep their worksheet as a reminder, and use it to keep track of their experience replacing their thought outside of therapy. 
  2. Counselors and Therapists can use Socratic Questioning while exploring unhealthy automatic thoughts that your client is experiencing. These questions aim to help Counselors and Therapists to understand the client’s perspective, and can gently work to help them see new aspects of their existing beliefs. Socratic questions encourage reflection and problem solving which can help facilitate some of the processes associated with Cognitive Processing Therapy. 
  3. You may find that some clients have difficulty identifying what emotions they are experiencing. This can be caused by a variety of factors including avoidance, and not being knowledgeable of different emotions, how they can impact us, and how they can cope when they experience distress. In this situation, you may find yourself focusing on exploring different emotions that your client experiences, and how your client is impacted by them. TherapyByPro offers an Identifying Emotions Worksheet that can guide your client in identifying what they are feeling and the overall intensity of their emotion. You can then guide a discussion about what feelings your client feels arise the most, and any that they find uncomfortable. This can help you narrow down coping skills that your client would benefit from.  
  4. Speak with your client about stuck points and how they can impact your client’s ability to move forward. Spend time exploring their experience with stuck points and any that they find themselves struggling with. This CPT Stuck Point Worksheet provides a list of common stuck points that can be used during sessions to aid your client in finding stuck points that they struggle with.
  5. Individuals who experience traumatic events and are living with post-traumatic stress disorder can struggle with different aspects of their life, including intimacy. If this is a concern that your client is struggling with, you may find that the CPT Esteem Worksheet available at TherapyByPro can help your client identify unhealthy beliefs that are impacting their ability to develop intimacy or closeness within their relationships.   
  6. Individuals who find themselves struggling with their self-esteem often struggle to accept compliments. Using a Compliments Worksheet can provide your client with a template that allows them to track compliments that they experience, and how they felt when they received the compliment. Allow for time to review this worksheet, and explore any stuck points that your client is experiencing regarding accepting the compliments that they receive.
  7. Individuals who experience trauma often find themselves struggling with power and control in their lives. This may mean that they try to control things in their life that are unrealistic or are simply out of anyone’s control. Exploring different aspects of clients’ life by using TherapyByPro’s  Power and Control Worksheet can help your client recognize areas of their life where they could work to let go of some of the control that they are holding onto. This change can have a positive impact on their mental health distress. 

Final Thoughts On Choosing Activities for CPT

Thank you for reading this resource about 10 Cognitive Processing Therapy Exercises and Activities you can do with your clients. Therapists who use Cognitive Processing Therapy follow a structured outline for therapy sessions that typically includes 12 fifty-minute sessions.  CPT can be effective in individual and group settings which provides clinicians with an opportunity to use it in either manner. CPT can be used in an inpatient and outpatient treatment setting, with the understanding that the client has the support and skills needed to cope with distress that they may experience while completing the assignments associated with Cognitive Processing Therapy.

CPT activities and exercises should be avoided unless you have the proper education and experience to use them. Each clinician is responsible for knowing the professional standards for their field, and their state. Continuing Education Courses and other training opportunities can provide you with the necessary training to utilize Cognitive Processing Therapy in your sessions.

TherapyByPro is an online mental health directory that connects mental health pros with clients in need. If you’re a mental health professional, you can Join our community and add your practice listing here. We have assessments, practice forms, and worksheet templates mental health professionals can use to streamline their practice. View all of our mental health worksheets here.

View all of our Cognitive Processing Therapy Worksheets

Resources:

American Psychological Association. (2017, July 31). Cognitive processing therapy (CPT). American Psychological Association. Retrieved March 30, 2023, from https://www.apa.org/ptsd-guideline/treatments/cognitive-processing-therapy 

Kayla Loibl, MA, LMHC
Author: Kayla Loibl, MA, LMHC

Kayla is a Mental Health Counselor who earned her degree from Niagara University in Lewiston, New York. She has provided psychotherapy in a residential treatment program and an outpatient addiction treatment facility in New York as well as an inpatient addiction rehab in Ontario, Canada. She has experience working with individuals living with a variety of mental health concerns including depression, anxiety, bipolar disorder, borderline personality disorder, and trauma.

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