INTERVIEW WITH Patricia A. Resick, Ph.D. on Cognitive Processing Therapy

Anyone who has read the Candace Irving series Hidden Valor (https://www.militarypress.com/the-hidden-valor-military-veteran-k-9-series-by-candace-irving-is-one-of-the-best-series-to-come-along-in-quite-a-while/)

will learn about CPT.  Dr. Resick assisted Candace with the specific trauma treatments. The main character, Kate, and the psychologist, Dr. Manning, were based on her discussions with the renowned doctor. (https://store.candaceirving.com/)

The website (https://cptforptsd.com/) explains that “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. CPT is endorsed by the U.S. Departments of Veterans Affairs and Defense, as well as the International Society of Traumatic Stress Studies, as a best practice for the treatment of PTSD.”

Elise Cooper: What does the treatment entail? 

Dr. Patricia Resick: Cognitive Processing Therapy (CPT) is a short-term cognitive-behavioral treatment that consists of a progression of assignments to teach clients to examine first their worst traumatic event to change any inaccurate assumptions they have made about the causes and consequences of the event that have kept them stuck in their recovery. Through a series of questions by the therapist and then worksheets, they explore the actual facts of the event and develop more balanced thoughts that lead to different emotions.    

EC: Kate from the Hidden Valor Series had PTSD -can you explain her symptoms and are they accurate? 

DPR: Kate has very severe PTSD that includes flashbacks, nightmares (in her case even sleepwalking), avoidance of reminders, hypervigilance (keeping weapons at hand), self-blame and poor self-esteem. These are typical PTSD symptoms. She has more amnesia than is usually seen and is a form of avoidance to block out horrifying memories and even more unusual, waking up in various places without knowing how she got there. The symptoms are accurate but quite severe.

EC: Kate from the Hidden Valor series is an example of someone who went through CPT. Is what she went through accurate?

DPR: Yes, Candace Irving studied the CPT therapist manual and completed the worksheets from the perspective of Kate. She struggles with starting therapy which is not unusual but then engages and improves. Candace contacted me and asked me to read the therapy-related sections for accuracy and was very responsive to my feedback. 

EC: There is a questionnaire and worksheets. Why? 

DPR: The questionnaire is a measure of PTSD severity. We use it before, during and at the end of therapy to assess progress in therapy. The worksheets are practice assignments to bring the treatment of PTSD into the person’s life between sessions, where their PTSD is occurring. They are progressive and teach the client to identify and differentiate their thoughts from facts, to evaluate the accuracy of their thoughts and finally to develop alternative thoughts that are more fact-based and balanced. As a result of practice with the worksheets, the strong emotions that are triggered when reminded of the trauma(s) decrease over time and PTSD symptoms decrease. 

There are specific themes that are also explored regarding oneself or others: safety, trust, power/control, esteem and intimacy. Examining thoughts about these themes helps with recovering a normal life, work, self-worth and relationships. 

EC: Why CPT versus another type of treatment? 

DPR: There are several treatments for PTSD that are recommended by VA/DoD, and international organizations. CPT is highly recommended by all of these treatment guidelines. Candace Irving looked through the various treatments and chose CPT to include across her series of Hidden Valor novels. 

EC: Can you explain the manuals’ purpose?(https://a.co/d/40I6SHp) 

DPR: The therapist manual is used by qualified therapists as part of being trained in CPT and helps them to become more competent and conduct the therapy correctly. Qualified therapists also attend workshops and receive weekly consultation on their first cases to ensure that they are implementing it correctly. The manual helps therapists after training to refrain from drifting off protocol if they continue to use it.

EC: Can you explain the Self-Help Book process? (https://a.co/d/fT75632)

DPR: Because some people cannot find a therapist qualified to conduct CPT, do not have the time, or resources to attend therapy, we adapted the CPT manual to be self-directed. It includes all of the material that the therapist manual for CPT includes. This may be a good alternative but the person using the self-help CPT manual needs to be motivated and not so avoidant that they cannot do this alone. 

EC: How long is the treatment?

DPR: The standard protocol for most research projects is 12 sessions but it can be conducted more flexibly. Some people resolve their issues very quickly and don’t need a full 12 sessions. The average in the first study with civilian victims of interpersonal violence was 9 sessions. Some people need more sessions than 12 because they have a more complex histories like child sexual abuse, or comorbid disorders such as substance abuse or severe depression. Treatment typically runs from 7 – 20 sessions and get to a good place with few PTSD symptoms if they fully participate in treatment.

Unfortunately, veterans and active duty military members tend not to improve quite as much as civilians (although they do show significant improvements). We don’t know the reasons for this but it could have to do with stigma about admitting to symptoms or asking for help. It could have to do with the rigid training that prepared service members to go into combat but doesn’t undo that training when they return. It could be that those who go into combat and develop PTSD tend to be young. The reasoning part of the brain, the prefrontal cortex, does not finish developing until the mid-twenties and if there is no one around to help them think differently about the traumatic events they experienced, they may take on an over-abundance of guilt and suspicion of others.

EC: What is the goal? 

DPR: The goal of CPT is to reduce the symptoms of PTSD as well as other co-occurring symptoms such as suicidal ideation, hazardous drinking, panic and anxiety symptoms and to improve work and social functioning. The hope is to get the client back on track with their life and not be haunted any longer by traumatic life events.

EC: Anything else you want to add?

DPR: Although this is primarily a mystery series, Candace Irving has added the extra element of portraying therapy for PTSD as it actually exists and not as a therapist just sitting there listening. The therapy occurs over the course of several books and that makes it much more realistic than a television show in which the character is all better by the next episode or the character is never affected at all. Kate struggles with attending therapy to begin with but then buckles down and works the program. You can see her recovering over the course of the books and how it affects her work and relationships.  

For more information on CPT, finding a qualified provider or ordering the self-help book “Getting Unstuck from PTSD”. Veterans can go to their local VA and can learn more about PTSD and treatment options through the National Center for PTSD at (https://www.ptsd.va.gov).

THANK YOU!

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