Cognitive Processing Therapy
Using an evidence based intervention for trauma, while treating individuals experiencing Substance Use Disorders with co-occurring PTSD.
What is trauma informed care? Facilities all over the country are working feverishly to add the trauma informed care tag to their programs. This is true of more than drug treatment programs, but behavioral health care organizations everywhere.
“Trauma-informed care (TIC) takes a trauma-informed approach to the delivery of behavioral health services that includes an understanding of trauma and an awareness of the impact it can have across settings, services, and populations.” (SAMHSA, 2014)
SAMHSA has done significant work toward educating practitioners and to be trauma informed is great, but does the definition above mention actually treating trauma or the effects of trauma? The way that I read it, it doesn’t.
As a practitioner, I struggled with navigating around trauma, but not through it. Trauma informed doesn’t mean that an agency is providing treatment for trauma. Many, if not most, of our patients at Transitions have a trauma history. Substance misuse can be both an avoidance symptom of (Resick et. al. 2017) and a contributor to trauma. Ethically, I had to balance between the fact that substance use disorder can be fatal, but after just a few weeks, these clients need to be capable of coping with multiple life stressors outside of a controlled environment. This has meant that making a conscious effort to intervene with trauma has always been a bit taboo due to the potential fragility of people while working through trauma.
This is where a supportive and invested leadership team arrives. I reached out to the president and vice president of the agency and with next to no convincing they agreed to send me to training for Cognitive Processing Therapy. There is, and continues to be, an economic investment that the agency has taken on. As a result of this, Transitions now offers an evidenced based intervention specifically designed for PTSD. This intervention, developed initially for the VA by Patricia Resick, Candace Monson, and Kathleen Chard, has been around for more than thirty years (Resick, et. al. 2017). Now we can provide an even more holistic approach to person centered care.
PTSD is a common co-occuring diagnosis people with substance use disorders often experience. I believe it is the responsibility of agencies like ours to do everything possible to offer clients opportunities to live healthy happy lives. This goes hand in hand with the Transitions, Inc. mission. “Transitions provides evidenced-based, person-centered Substance Use Disorder treatment and recovery services so individuals can lead their most meaningful and healthy lives.”
What is Cognitive Processing Therapy? “CPT is a cognitive-behavioral treatment for Posttraumatic Stress Disorder (PTSD). CPT was developed in the late 1980s and has been shown to be effective in reducing PTSD symptoms related to a variety of traumatic events including child abuse, combat, rape and natural disasters,” (Resick, et. al. 2023). CPT only takes 12 sessions for most clients. That means that in as few as 12 weeks clients can learn the skills to challenge the beliefs that can cause non-recovery from trauma. In CPT these beliefs are called stuck points.
“Cognitive theories are characterized by their focus on the idea that how and what people think leads to the arousal of emotions and that certain thoughts and beliefs lead to disturbed emotions and behaviors and others lead to healthy emotions and adaptive behavior,” (DiGiuseppe, et. al. 2016).
CPT focuses on thoughts from this perspective and works to challenge maladaptive thoughts and beliefs to help develop more adaptive patterns of thinking which improves mood and emotions.
Now, at Transitions, Inc. individuals have the choice to engage in residential treatment for SUD and transition directly to outpatient treatment for SUD and PTSD, without any gap in the continuum of care. I am proud to be a part of an agency that is willing to invest in its employees and the clients that it serves. Combining PTSD treatment and SUD treatment, I believe, will be considered cutting edge as we continue to learn more about how trauma predisposes individuals to substance use disorders. By offering this evidenced based intervention for PTSD, Transitions, Inc. is no longer just trauma informed, but trauma integrated.
Sources
DiGiuseppe, R., David, D., & Venezia, R. (2016). Cognitive theories. In J. C. Norcross, G. R. VandenBos, D. K. Freedheim, & B. O. Olatunji (Eds.), APA handbook of clinical psychology: Theory and research (pp. 145–182). American Psychological Association. https://doi.org/10.1037/14773-006
Resick, P. A., Monson, C. M., & Chard, K. M. (2017). Cognitive processing therapy for Ptsd: A comprehensive manual. The Guilford Press.
Resick, P., Chard, K., & Monson, C. (2023). Cognitive Processing Therapy For Post Traumatic Stress Disorder. Cptforptsd.com. https://cptforptsd.com/
Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration.
