After a trauma, your mind tries hard to make sense of what happened. Sometimes the answers it lands on keep you stuck. "It was my fault." "I can't trust anyone." "The world isn't safe." Cognitive processing therapy is a talk therapy that helps you look at those beliefs, gently and step by step, so they loosen their grip. This post explains what CPT is, how stuck points work, what a course looks like and how to start, in person or online.
This post is general information, not a diagnosis or medical advice. Only a qualified professional can assess what you're going through.
What cognitive processing therapy is
Cognitive processing therapy is a structured, trauma-focused talk therapy for post-traumatic stress disorder (PTSD). So, what is CPT therapy in plain words? It's a way of working with a therapist to spot the beliefs a trauma left behind, test how true and helpful they are, and build more balanced ones.
CPT is one of several trauma therapies. Others include prolonged exposure, trauma-focused cognitive behavioural therapy (CBT) and eye movement desensitization and reprocessing (EMDR). A 2018 review found that two major sets of PTSD treatment guidelines strongly recommended CPT. A large 2020 review of many trials found that CPT was among the trauma-focused therapies with the strongest evidence for adults with PTSD.
How a trauma can leave you stuck
When something terrible happens, the mind tries to fit it into what you already believed about yourself and the world. Researchers describe two common ways this can go wrong.
Bending the event to fit old beliefs. If you believed bad things only happen to people who make mistakes, you may decide it must have been your fault. A common example is "If I had fought harder, it wouldn't have happened."
Over-correcting your beliefs. You may swing to a rule that feels protective but shrinks your life, such as "Because this happened, I can't trust anyone."
Both are understandable. They're the mind's way of trying to feel safe again. But over time, these beliefs can keep fear, guilt, shame and anger going long after the danger has passed.
CPT stuck points, with everyday examples
In CPT, these beliefs are called stuck points. A stuck point is a thought that keeps you from recovering. It's often short, firm and full of "should," "always" or "never." Some everyday examples:
"I should have known it would happen."
"If I let people get close, I'll get hurt."
"I can't handle being in a crowd."
"I'm weak because I still think about it."
Early in CPT, you may write a short piece about how the trauma has affected the way you see yourself, others and the world. Then you and your therapist list your stuck points. Using questions and simple worksheets, you look at each one. What's the evidence? What else was going on at the time? What did you actually know then? The goal is not to talk you out of your feelings. It's to help you see the event more fully and fairly.
Between sessions, you practise with short worksheets. CPT researchers describe this practice between sessions as an important part of the therapy.
The five themes CPT works through
Once the beliefs about the event itself start to shift, CPT looks at five areas of life that trauma often touches:
Safety. Beliefs about danger to yourself and others.
Trust. Trusting your own judgment, and trusting other people.
Power and control. Feeling helpless, or needing control over everything.
Esteem. How you see your own worth, and the worth of others.
Intimacy. Closeness with others, and caring for yourself.
You don't need to have problems in all five. Your therapist helps you focus on the ones that matter most to you.
What a course of CPT therapy looks like
CPT therapy follows a clear structure. It usually starts with learning about trauma and PTSD. Then you work on stuck points about the event, and later on the five themes. The last session looks back at your progress and ahead to your goals.
How many sessions is CPT? It was first developed as a 12-session course. Research shows that some people need fewer sessions and some need more. With us, the length of your course depends on you, your goals and how things are going. Your therapist will check in with you along the way.
Do you have to talk about the trauma in detail? Not always. CPT focuses mostly on your thoughts and beliefs about what happened. Some versions include writing a detailed account of the event, and some don't. Your therapist will explain the options and help you choose what fits.
It's normal for CPT to feel hard at times. Looking at painful beliefs can stir up strong feelings, and some weeks may feel heavier than others. That doesn't mean it isn't working. Tell your therapist how you're doing. If a crisis comes up in your life during the course, CPT guidance allows for a session that focuses on the crisis, and then you return to the plan. You stay in charge of the pace, and you can always ask questions about why a step matters.
Cognitive processing therapy for PTSD, who it may suit
CPT has been studied with people who've lived through many kinds of trauma, such as assault, combat, accidents and abuse. It may suit you if:
You keep blaming yourself for what happened
Your world has shrunk because nowhere feels safe
You find it hard to trust others, or yourself
You'd like a clear, structured approach with practice between sessions
CPT isn't the only option. Some people do better starting with skills to feel steadier first. Others prefer EMDR or another trauma-focused approach. Choosing a therapy is something you decide together with your therapist. Our guide on how to choose a trauma therapist in Ontario can help you think through what matters to you.
If you're thinking about suicide, call or text 9-8-8 now. If you or someone else is in immediate danger, call 911.
Cognitive processing therapy online
Cognitive processing therapy online can work well. A 2020 paper by CPT researchers reviewed studies showing that CPT by video reduced PTSD symptoms, with results similar to in-person care. Worksheets can be shared on screen or sent securely between sessions.
With us, online sessions happen over a secure video link we email to you. There's nothing to download. You can join from home, or anywhere private, across Ontario.
Therapists who offer CPT here
Two of our therapists list CPT on their own profiles:
Natalia Munive, RSW, sees adults and older teens (16 and up) at our 188 Main Street office in Cambridge and online. Learn more about Natalia Munive.
Sam Mohan, RP, sees adults (18 and up) online across Ontario. Learn more about Sam Mohan.
Not sure who's the right fit? Our admin team can help you choose during a free consultation.
You can see us in Kitchener, Waterloo, Cambridge or Ottawa, or by secure video from anywhere in Ontario.
Cost, billing and your first step
Sessions with our therapists range from $130 to $200, depending on the clinician.
We accept Health Spending Accounts (HSAs).
We can direct bill many insurers. Coverage depends on your plan, so check with your insurer before you start.
Book a free 15-minute consultation with our admin team. Let them know you're interested in cognitive processing therapy, and they'll help you find a good fit.
If you're in crisis: if you or someone you love is in immediate danger, call 911. If you're thinking about suicide, call or text 9-8-8 any time, day or night.
Last reviewed: October 2026
Sources
Treating PTSD: a review of evidence-based psychotherapy interventions, Watkins, Sprang and Rothbaum, Frontiers in Behavioral Neuroscience, 2018
Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis, Lewis and colleagues, European Journal of Psychotraumatology, 2020
Cognitive processing therapy for posttraumatic stress disorder via telehealth: practical considerations during the COVID-19 pandemic, Moring and colleagues, Journal of Traumatic Stress, 2020