Flexible Applications of Cognitive Processing Therapy: Evidence-based Treatment Methods

Chapter 1 - The face of PTSD
	Chapter outline
	What is PTSD?
	Clinical complexities
	The toll of PTSD
	Cognitive processing therapy
	Overview of the book
	Case studies
		Case 1: Anna’s story
			Immediate clinical considerations
			Potential challenges to optimal therapy outcomes
		Case 2: Steve’s story
			Immediate clinical considerations
			Potential challenges to optimal therapy outcomes
		Case 3: Julie’s story
			Immediate clinical considerations
			Potential challenges to optimal therapy outcomes
	Setting the stage
	References
Chapter 2 - Ancestral roots: The origins of CPT
	Chapter outline
	The role of avoidance
	Cognitive theory
	Cognitive theory in clinical practice
	The role of emotion
		Should we combine elements of other therapies to strengthen our outcomes?
	References
Chapter 3 - Treatment development: The early years
	Chapter outline
	CPT randomized clinical trials
		Random assignment
		Effect sizes
		Attrition
		Clinical relevance
		Long-term follow-ups
		Summary
	References
Chapter 4 - Emerging as an effective therapy: CPT is put to the test
	CPT is effective across a myriad of settings and diverse patient groups
	Why do patients get better?
	PTSD is not the only domain that improves after CPT
		Improvements on general well-being and interpersonal relationships
		Dissociation
		Health and somatic complaints
		Sexual functioning
		Reducing PTSD reduces suicidal ideation
		CPT in the context of violence
	References
Chapter 5 - Challenges to optimal therapy outcomes
	Chapter outline
	Walking the fine line between fidelity and flexibility
	The flexibility and fidelity balancing act
	The clinical value of continuous assessment
		Utilizing the PCL as a clinical tool
		Are the stars aligned?
		Leveraging the PCL to find stuck points and inform Socratic questions
			Case example
		Recovery beyond the core symptoms of PTSD
			Functioning
				Case example
			Comorbidity
			Physical health complications
		Challenges to optimal treatment outcomes (COTOs)
		Domains of challenges to optimal therapy outcomes
			Case example
		Case formulation approach and cognitive therapy
		Integrating case formulation into cognitive processing therapy
		Fitting a square peg in a round hole
		Integrating a case formulation approach to CPT for PTSD: Overarching goal
		Case formulation approach to CPT: The assessment
			Case formulation assessment
				Case example
				Monitor identified COTOs
				Expand CPT to specifically target COTO-related stuck points
				Diverging from the protocol
				Content of the divergence
				Resuming CPT
					Adjust length of CPT to address Criterion G of CPT as needed
	References
Chapter 6 - Therapy is hard: Improving patient engagement and working through avoidance
	Chapter outline
	Difficulty getting started: tenuous patient engagement
		Patient ambivalence or concern about beginning CPT
	Strategies to increase engagement at the outset of therapy
	Augmenting CPT at the outset of therapy
	Addressing CPT engagement during therapy: The brief session
		Brief session scenarios
	Finally, when to terminate therapy
	The importance of language
		Tweaking language
		Introducing out-of-session therapy
		Keep it real campaign
	Other issues that impact engagement
		Time management
			I cannot fit all of the information into one session
			Seamless delivery of therapy
			Finding time for continuous assessment
	CPT concepts are too complex for my patient
		The many faces of avoidance
			Case example
	References
Chapter 7 - Navigating rough waters: Managing common challenges across the four cornerstones of CPT
	Chapter outline
	Cornerstone 1: Emphasis on practice work between sessions
		The dog ate my homework and other sordid tales
		When the best intervention is not effective in increasing compliance with practice work
	Cornerstone 2: Promoting the expression of natural emotions
		The trauma narrative
		Eliciting emotion with Socratic dialogue
	Cornerstone 3: Prioritizing assimilated stuck points before over-accommodated stuck points
		Leverage the worksheets
		Platform dive
		Clock is ticking
	Cornerstone 4: Socratic questions
		Step 1: Identify the beliefs and Step 2: Decide if it is a stuck point
			Honing the stuck point
			The hunt for the elusive stuck point
			Enlarging the context
			Pulling at threads
		Step 3: Challenge the stuck point using Socratic questions
			Honing your Socratic questioning skills
				Arrow-down technique
					Clinical note
				Silver platter technique
				Grasping at straws
				Avoidance by trauma
		Step 4: Generate an alternative thought
			The recap
	Challenges in generating alternative thoughts
		Lip service
		Practice makes perfect
		Breaking the habit
	References
Chapter 8 - Complex trauma histories
	Chapter outline
	Complex trauma and complex PTSD
	Concerns, decision paths, and strategies
		Safety of CPT
		“Retraumatizing” patients
		Length of treatment and stabilization
		Therapeutic alliance
	The practical stuff
		Choosing an index trauma to get started
		So many traumas, so many stuck points
		Chasing the butterfly
		Get specific
		What’s different now?
		Keeping things on track
		It’s a crisis
		I do not have thoughts
		Therapist contact between sessions
		Therapy room setup
		Safety, the final frontier
	References
Chapter 9 - Managing emotional dysregulation
	Chapter outline
	Optimal levels of emotional engagement
	Managing over-arousal and big emotion in session
		Managing our own therapist beliefs and anxiety!
		Anger as an example
			Using the CPT framework
			Other possible strategies
			CPT “as normal” is an effective strategy
			A final comment on anger
		Sweet spot conversation
	My patient is just numb—managing lack of emotion in session
		Helping patients identify their feelings
		Avoidance by numbing
		Lack of emotion in a trauma account
		The role of alexithymia
	Managing dissociation in and out of session
	Dysregulation into regulation
	References
Chapter 10 - Addressing comorbid disorders and conditions
	Chapter outline
	The importance of a good history and good case conceptualization
	CPT for individuals with comorbid mood disorders
		Reasons to not do CPT or to prioritize the mood disorder
	CPT with comorbid panic disorder
		Targeting panic attacks in the context of CPT
	CPT with comorbid substance use disorders
		Reasons to not do CPT or prioritize the SUD
	Managing characterological features during CPT
	CPT with medical comorbidities
		CPT for traumatic brain injury
		CPT for PTSD and sleep disorders
		CPT with chronic pain
	References
Chapter 11 - Applications of CPT in diverse populations and across cultures
	Chapter outline
	Applications of CPT in diverse populations and across cultures
	Culture and evidence-based therapies
	The impact of gender, race, and ethnicity on CPT outcomes in the United States
	Use of adapted CPT within the United States
		Use of CPT with Bosnian refugees
		Adaptation of CPT with Latinos
		Adaptation of CPT with Native Americans
		Adaptation of CPT for sexual and gender minorities
	CPT hits the road: Applications of CPT outside of the United States
	CPT’s core features appear culturally robust
	References
Chapter 12 - Administering CPT across health care systems and clinical settings
	Chapter outline
	Strategies in disseminating and implementing CPT across systems
		Setting matters
			Delivering an effective schedule of CPT
			Coping with a high clinical caseload
			Difficulties in getting treatment to the patient
			Managing limited privacy
		Training and support make a difference
		Fidelity with flexibility
			New and shiny technique
			Reliance on previous techniques
			But they don’t get it yet
		How to get CPT into my service and make it work?
	References
Chapter 13 - Future frontiers
	Chapter outline
	Where to now?
	Treatment engagement, patient choice, and matching
	CPT and future innovations
		Increasing flexibility and personalization
		Stepped down models of care
		Adapting dose and delivery methods
		Combination, adjunctive, and novel therapy approaches
	Future clinical research
	Conclusion
	Resources
	References