The Trauma Brain
First! What happens to the brain when there is a perceived threat of danger? Resick, Monson, and Chard (2017) describe that our “prefrontal cortex is the thinking center of the brain.” Then there is the amygdala, which “triggers strong emotions and sends neurotransmitters throughout the brain to activate the emergency response”, or the fight/flight/freeze response. The prefrontal cortex and amygdala talk to each other.
When the brain gets the message there is danger, the prefrontal cortex takes the back seat as the amygdala takes over the steering wheel. During this time, the amygdala drives the body while the prefrontal cortex is in the back seat searching for more danger. When the prefrontal cortex doesn’t see the danger anymore, it tells the amygdala thank you for driving and we can switch seats now, therefore returning to normal functioning.
However, in someone with PTSD, “the amygdala is too highly activated and the activity in the prefrontal cortex is diminished, taking much longer to recognize that the perceived danger has ended and to calm down” (Resick, Monson, and Chard, 2017). In other words, the amygdala takes the front seat as the prefrontal cortex goes in the back seat, the amygdala turns up the music and is in full control as the prefrontal cortex takes longer to realize there is no danger.
CPT: What Is It?
The trauma brain can be scary and looking at what our brain perceives as trauma can be scarier. Let’s face it, nobody likes a backseat driver. Because it’s frightening, it’s normal for someone to bottle up those traumatic emotions and thoughts and to not let those emotions run their course.
Cognitive Processing Therapy was developed by Patricia Resick, Candice Monson, and Kathleen Chard and is an evidence-based trauma treatment that focuses on “Stuck Points.” Resick (2017) explained that in treating trauma, clients needed to go back to where their thoughts originated and if they had processed the trauma experience. She stated: “I started conceptualizing that those who hadn’t been able to recover had been ‘stuck’ in their thinking since the time of the traumatic events” (2017), therefore creating the idea of Stuck Points.
If you think of a cozy fire in the living room fireplace, think of the fire as emotions and the logs as stuck points. What keeps the fire going? The logs. So, in CPT, the logs will be separated from the fire, examined for critters, so the fire, or the emotions can burn down naturally by changing the negative and inaccurate thoughts (Resick, Monson, and Chard, 2017).
How Does It Work?
By examining stuck points and looking at the traumatic event in different ways, those stuck points can be processed and changed into more realistic thoughts. The amygdala may try to take the front seat, but the prefrontal cortex is kept active while talking about the trauma and examining the stuck points, therefore telling the amygdala no more driving from the backseat. CPT is about 12 sessions, sometimes longer.
The first half of CPT is focusing on the trauma and determining what the thoughts are. Together with your therapist, questions will be asked to help you find the facts of that situation and if the thought is accurate. If the thoughts are indeed stuck points, you will find more factual statements you can learn to think (Resick, Monson, and Chard, 2017). A stuck point log is kept so every time a stuck point is challenged a changed, it gets crossed off the list. And let’s be real, who doesn’t like to cross things off a list?
The second half of CPT focuses on five themes of trauma: Safety, Trust, Power/Control, Esteem, and Intimacy. “These themes represent important negative core beliefs that can be confirmed by a traumatic event or can change as a result of a traumatic event” (Resick, Monson, and Chard, 2017). These beliefs are made into stuck points, challenged, and changed.
Is It Right For Me?
Resick, Monson, and Chard (2017) developed this trauma-focused evidence-based treatment so you can eventually become your own therapist. Meaning, you can process your trauma, challenge your stuck points, and learn how to engage in more factual, positive thinking. Talk with your therapist or make an appointment if you have questions and think CPT is right for you. Either way, there is recovery from trauma and you deserve to be unstuck.
At MCS Counseling, our specialist in Cognitive Processing is LICSWA Tarah Hipple-Thomas. Tarah works with individuals and uses the model of Cognitive Processing to reduce symptoms of anxiety, depression, and trauma. Tarah uses multiple tools, including mindfulness, to work with individuals in developing coping skills, increasing self-awareness, building mental fitness, and further promote healing. Tarah received her Master’s in Social Work from Capella University.