Clinician Concerns About Cognitive Processing Therapy: A Review of the Evidence

Cognitive processing therapy (CPT) is recommended for the treatment of posttraumatic stress disorder (PTSD) but is infrequently delivered. Many clinicians have concerns about CPT that impact usage. Common concerns include (a) CPT's effectiveness in "real-world" settings, (b) whether CPT can be individualized, (c) the possibility of making clients worse, (d) CPT's effectiveness for clients with comorbidities, (e) CPT's effectiveness for clients with childhood trauma, (f) the appropriateness of CPT for moral injury, (g) delivering CPT to culturally diverse populations, (h) initiating CPT without first stabilizing clients with preparatory treatment, (i) the effects of CPT's structure on rapport, (j) whether and when CPT should be stopped, and (k) whether clients will maintain their gains long term. To inform clinical decision-making, findings from the psychological literature are presented for each concern. The evidence provides support for CPT's safety, tolerability, acceptability, and effectiveness across populations and settings, as well as for delivery of CPT without preparatory treatment and across a range of secondary outcomes. Although symptom exacerbations occur, evidence suggests they are typically temporary and occur at similar rates as in control conditions. Findings highlight the role of fidelity in symptom outcome. The evidence may aid providers in making informed decisions about training in or delivering CPT.