CPT Stuck Points Worksheet: Reframing Trauma-Driven Beliefs

The CPT Stuck Points Worksheet operationalizes the reframing process across three pages of targeted clinical examples. It presents common trauma-related beliefs—such as “I am damaged forever,” “I deserved to have been abused,” and “I must be on guard at all times”—and provides an adjacent column for the client to construct a more realistic and evidence-based alternative. This side-by-side format allows for a direct comparison between trauma-driven logic and “more reasonable” interpretations, helping the client see the difference between emotional reasoning and factual reality.

The worksheet covers a wide range of CPT themes, including safety (“I must be in control of everything”), trust (“Other people should not be trusted”), power/control (“I have no control over my future”), and esteem (“I am unloveable”). By requiring the client to explicitly rewrite these statements, the tool moves the client from passive recognition to active cognitive restructuring, an essential skill for long-term PTSD maintenance and relapse prevention.

How This Worksheet Can Be Used

During sessions:
Clinicians use the worksheet to review common themes in trauma-related thinking. It serves as an excellent psychoeducational tool to help clients understand what a stuck point is by seeing examples they might relate to, which can normalize their experience and reduce shame.

Between sessions:
Clients complete the worksheet as a homework assignment to practice the skill of reframing. This builds the cognitive “muscle” needed to challenge their own unique stuck points that arise in daily life.

To identify core themes:
By observing which examples the client struggles to reframe, the clinician can identify which CPT modules (Safety, Trust, Power, Esteem, or Intimacy) require the most intensive focus and Socratic challenging.

Benefits of the CPT Stuck Points Worksheet

• Provides 30+ specific examples of common trauma-related “stuck points” to facilitate client recognition.
• Encourages the practice of developing “more reasonable thoughts” to increase cognitive flexibility.
• Targets core trauma themes: blame, safety, trust, power, control, and esteem.
• Helps clients identify and interrupt “if-then” logic and absolute language (always, never).
• Reduces emotional reactivity by providing more balanced alternatives to distressing thoughts.
• Directly supports the “cognitive processing” phase of the CPT treatment protocol.

Integrating This Tool into Clinical Work

Integrating the CPT Stuck Points Worksheet is most effective when the clinician emphasizes that “more reasonable” does not mean “perfectly happy.” The goal is to move from an extreme, inaccurate thought to one that is more grounded in evidence. For instance, shifting from “I am damaged forever” to “I have been hurt, but I am currently in the process of healing.” Clinicians should guide clients through the worksheet by asking, “Is that thought 100% true for everyone, all the time?” When a client finds a specific stuck point difficult to reframe, the therapist can use Socratic questioning to find the “middle ground.” By the time the client completes these three pages, they will have a much clearer understanding of how their trauma has skewed their thinking and will be better prepared to tackle the more individualized stuck points on their own log.

References

• Resick, P. A., Monson, C. M., & Chard, K. M. (2016). Cognitive Processing Therapy for PTSD: A Comprehensive Manual. Guilford Press.
• American Psychological Association (APA). (2017). Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults.
• Chard, K. M., et al. (2012). Cognitive Processing Therapy: Veteran/Military Version. Department of Veterans Affairs.
• Monson, C. M., & Shnaider, P. (2014). Cognitive-Behavioral Conjoint Therapy for PTSD. (Principles of identifying stuck points).