Blog and Musings

Sometimes when I lead trainings in CPT, I'm asked if it can work for people who experience complex trauma, which has been defined as exposure to multiple, interrelated trauma and the reactions that result from that trauma. My answer is that it can. While measures of complex trauma are still being developed and refined and were not often used in earlier studies, research has included individuals who would meet the definition above. Some examples are people who experienced repeated physical and/or sexual trauma as children, adults who experience intimate partner violence, and people exposed to war and/or ongoing violence. We've also seen a lot of examples in clinical practice. 

One of the reasons people may wonder about CPT and complex trauma is that CPT initially focuses on an "index trauma"---or an event that was experienced as either the earliest or the most difficult experience (one that was associated with the most guilt or shame, or one that is the most haunting). Having a single event to work on as a starting point helps us to make sure that we don't jump from memory to memory without ever fully processing any of them, or that we don't inadvertently avoid the one that is hardest to get "unstuck" from. However, that doesn't mean that you won't deal with other traumatic events or memories in CPT. There's room to work with multiple traumas, as long as you give yourself the time and focus to process the ones that are hardest to face first--after that, some of what you come to understand and realize can be applied to the other events.

Another reason that people wonder about CPT and complex trauma has to do with the fact that CPT doesn't integrate somatic work, which some have suggested is important for trauma work. Over many years, the treatment developers and the hundreds of therapists who now use CPT regularly in their practice and provide training and consultation have found that people can experience recovery without explicitly integrating somatic work. People we work with do sometimes use emotion regulation strategies that work for them such as grounding, mindful breathing, relaxation/body scans, or activities such as yoga in their daily lives. Others find that other forms of physical activity, creative activity, or spending time with their loved ones help them cope effectively with the emotions they are processing. However, these aren't the focus within the therapy sessions. Some studies have shown that the patterns and reactions that people with a history of multiple, interrelated, or complex trauma may experience do in fact change and improve as they go through the process of CPT. People also share their experiences of feeling calmer in general and reacting differently to situations that once would have been very triggering, or that would have provoked emotions that felt impossible to tolerate before. 

So CPT, or the work in our self-guided CPT book, can indeed be helpful and worth spending time on if you have experienced complex trauma.  And as always, what matters most is that people find what works for them, practice consistently, and see the benefits. 

June is PTSD awareness month. Many individuals experience trauma during their lifetimes. After a trauma, it's universal to experience some symptoms of PTSD, and often they diminish over time.  For some people, trauma recovery requires extra help. This may be because they didn't have a lot of support after the trauma and didn't feel they could talk about it or process the feelings that come up about the experience and/or memory.  It may be because they got messages that things happen for a reason, and that they somehow didn't do enough to prevent or stop what happened. Whatever the reason, there are still ways to move forward and recover. If you or someone you care about experiences PTSD, there's hope. We are learning more and more about ways to help people recover from PTSD, and there are many different forms of treatment that can help. Here are some good resources to learn more about PTSD and about treatment options:

PTSD: National Center for PTSD Home (va.gov) 

The National Child Traumatic Stress Network | (nctsn.org) 

Some examples of trauma-focused treatment in action

home - HERE. IS. BETTER. (hereisbetter.org) 

Ten Sessions - This American Life 

Finding a therapist

Get Help - ABCT - Association for Behavioral and Cognitive Therapies 

CPT Provider Roster | Cognitive Processing Therapy (cptforptsd.com) 

ISTSS - Find a Clinician 

Self help/self guided options

Pause A Moment (stanford.edu) 

Getting Unstuck from PTSD: Using Cognitive Processing Therapy to Guide Your Recovery (guilford.com) 

PTSD Coach - PTSD: National Center for PTSD (va.gov) 

Participate in research

Messaging-based trauma therapy: Many people have experienced worsening stress or traumatic events over the past few years. Stanford University is partnering with Talkspace to study how we can help. Qualified participants will receive free treatment through the study. If you’re interested in learning more, reach out to texting_study@stanford.edu. Or start screening at PTSD (Post-Traumatic Stress Disorder) Test - Mental Health America (mhanational.org) 

Clinical Trials Database: PTSD-Repository - PTSD: National Center for PTSD (va.gov) 

Search Results | Beta ClinicalTrials.gov