Introduction: Understanding Your Therapy Options for PTSD and Trauma
When most people think of trauma therapy, they often jump right to EMDR. In popular culture and media, EMDR (Eye Movement Desensitization and Reprocessing) has become almost synonymous with trauma treatment. While EMDR is certainly effective for many, it’s just one of several approaches that can treat trauma and PTSD effectively. Knowing your options helps you choose what best fits your individual needs.
This blog compares EMDR with Cognitive Processing Therapy (CPT), an equally powerful but often lesser-known therapy for trauma. We’ll dive into what each therapy is, how they’re similar, and where they differ so that you can make an informed choice.
What is EMDR?
EMDR, or Eye Movement Desensitization and Reprocessing, is a therapy that was initially developed to treat trauma and PTSD. It’s now also used for other anxiety disorders. EMDR centers on a technique called bilateral stimulation, where sensory methods—like eye movements, tapping, or auditory cues—stimulate both sides of the brain as you recall traumatic memories. This process is designed to reprocess traumatic memories, reducing their emotional intensity over time. Because of its reliance on recalling the event, EMDR is considered a form of exposure therapy, which means clients actively recall and talk through their traumatic experiences. But, it’s also considered a form of somatic therapy because of its use of sensory cues to reduce stress and anxiety.
What is CPT?
CPT, or Cognitive Processing Therapy, is a form of cognitive-behavioral therapy (CBT) specifically developed to address trauma and PTSD, particularly among survivors of domestic violence. CPT focuses on identifying and challenging unhelpful beliefs that may have formed due to trauma (e.g. “I shouldn’t have trusted them”; “No one can be trusted”, “The world isn’t safe”, etc); these beliefs often keep people in a pattern of anxiety, worry, and unease. CPT helps people undo the effects of trauma by helping them gain more control over their thinking patterns. Unlike EMDR, CPT doesn’t require you to discuss traumatic details if you’re not comfortable doing so. Instead, it focuses on helping you reshape how you understand yourself, others, and the world in the wake of trauma.
What Do EMDR and CPT Have in Common?
- Both are Evidence-Based Practices (EBP) for PTSD: EMDR and CPT have both gone through extensive research trials, proving effective for PTSD treatment. Rigorous studies have confirmed their efficacy, setting them apart from other therapies that lack evidence-based support.
- Shared Goal: The main objective of both EMDR and CPT is to reduce or eliminate the symptoms of PTSD, helping clients find relief from past trauma.
- Highly Regarded: Both therapies are respected within the mental health field, recognized for their effectiveness.
Client-Therapist Collaboration: Both approaches rely on a high degree of interaction between client and therapist, requiring active participation from both sides for successful outcomes.
The Benefits of CPT Over EMDR
Here’s a detailed look at the differences between EMDR and CPT, organized into an easy-to-read chart:
|
Feature |
EMDR |
CPT |
|
Approach |
Uses bilateral stimulation to process traumatic memories by stimulating both brain hemispheres during trauma recall. |
Focuses on cognitive restructuring and developing cognitive flexibility. CPT emphasizes understanding and updating unhelpful beliefs formed during trauma, without requiring detailed trauma discussions. Engages the Prefrontal Cortex to mediate the Limbic System. |
|
Treatment Length |
Varies based on individual needs; can range from 6 sessions to ongoing, depending on progress. |
A manualized treatment with an average length of 12 sessions, providing a predictable structure for clients. |
|
Structured vs. Unstructured |
Less structured, sessions are tailored to the client’s week-by-week experiences. |
Highly structured, with a set format for each session, including activities, homework, and a workbook. |
|
In-Session Focus |
Focuses on discussing trauma in detail repeatedly, paired with bilateral stimulation. |
Helps clients understand and update thoughts related to their trauma, with an emphasis on building skills for self-management. |
|
Between Sessions |
Minimal homework or exercises between sessions, primarily focusing on in-session processing. |
Involves weekly homework and worksheets, allowing clients to practice cognitive skills between sessions and reinforce learning. |
|
Long-Term Results |
Limited research on long-term effects, though some studies indicate a need for follow-up over time. |
Proven long-term efficacy; studies show lasting symptom relief up to 10 years post-treatment, with CPT often considered a “cure” for PTSD in terms of symptom remission. |
|
Particularly Effective For |
Helps reduce the physical symptoms of trauma, such as hyperarousal and improving sleep. |
Especially effective at reducing shame, guilt, and self-blame related to trauma, which are often deeply rooted in PTSD. |
|
Discussing Trauma |
Requires detailed discussion of traumatic events repeatedly. |
Trauma details are optional; the focus is on addressing how trauma has impacted beliefs, rather than reliving the trauma itself. |
|
Women’s Issues |
Effective for both men and women. |
Created with women’s trauma in mind; CPT was designed by women working with survivors of domestic violence, making it particularly sensitive to women’s trauma and PTSD needs. |
|
Other Applications |
Useful for anxiety disorders and obsessive-compulsive disorder (OCD) alongside PTSD. |
Can improve overall anxiety management and emotional regulation; currently being researched for applications in treating symptoms of borderline personality disorder (BPD). |
The Benefits of CPT Over EMDR
- Long-Term Efficacy: Studies on CPT have shown that it offers long-lasting relief, with clients often reporting reduced PTSD symptoms even 10 years post-treatment. EMDR, while effective, has limited data supporting its long-term efficacy.
- Effective for Shame, Guilt, and Self-Blame: Trauma can leave survivors with misplaced feelings of shame or guilt. CPT directly addresses these feelings, helping clients reframe their trauma and develop healthier self-perceptions. This makes CPT especially beneficial for trauma survivors who struggle with shame or self-blame.
Why Isn’t CPT as Well Known as EMDR?
- Academic and Military Coverage: CPT is well-known in academia and the military but has less visibility in mainstream media. Its focus on research and veterans’ support has limited its exposure outside these circles.
- Media and Celebrity Endorsements of EMDR: EMDR’s popularity has been bolstered by celebrity endorsements and mentions in pop culture. For instance, Prince Harry has publicly discussed his experience with EMDR, giving it a high-profile endorsement.
- Categorization Under CBT: CPT is often included under the umbrella of CBT, meaning it doesn’t always receive individual recognition. This has contributed to its underrepresentation in broader discussions about trauma therapy.
How to Choose Between EMDR and CPT
Choosing between EMDR and CPT is a highly personal decision. Here are some factors to consider:
- Therapy Experience: EMDR involves more unstructured sessions and requires discussing traumatic memories in detail, while CPT offers a structured, step-by-step program.
- Homework Preference: CPT has regular homework, which can reinforce skills learned in therapy, whereas EMDR typically focuses more on in-session processing.
- Trauma History: If shame, self-blame, or relational issues are primary concerns, CPT may be a better fit, as it’s designed to address these issues head-on.
- Gender-Specific Considerations: CPT was initially developed with women’s trauma in mind, which may make it a good choice for female survivors dealing with relational trauma.
To make an informed decision, you might consult with a therapist trained in both therapies or explore the VA’s Decision Aid tool, which provides guidance for selecting an evidence-based PTSD treatment.
Other Therapy Options Worth Exploring
If EMDR and CPT don’t feel like the right fit, other trauma therapies are also available:
- Prolonged Exposure Therapy (PE): Another evidence-based therapy where clients repeatedly discuss their trauma in detail until it loses its emotional intensity.
- Present-Centered Therapy (PCT): Focuses on helping clients stay in the present moment, though it’s generally less effective than PE, EMDR, or CPT for treating PTSD.
- Written Exposure Therapy (WET): Involves writing about trauma experiences as a form of exposure, helping desensitize clients to traumatic memories without in-person discussions.
- Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): Primarily used with children and adolescents, it mirrors CPT’s structured approach for young trauma survivors.
- Cognitive Therapy for PTSD (CT-PTSD): Utilizes cognitive skills similar to CPT but with less structure, making it an option for clients who prefer a more flexible approach.
Conclusion:
When it comes to trauma therapy, you have options. While EMDR is well-known and widely used, CPT offers a structured, skill-building approach that emphasizes cognitive restructuring. This approach can be especially beneficial for survivors who want to move past feelings of shame and guilt associated with their trauma.
Both therapies have their strengths, and your choice ultimately depends on what feels right for you. If you’re ready to explore your options or if you’re interested in trying CPT, reach out today. Taking the first step toward healing is a courageous move, and having the right tools makes all the difference in your journey to recovery.
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If you live in Massachusetts, Vermont, Virginia, Florida, or Illinois, you can begin feeling better today by scheduling a free phone consultation to learn more about the benefits of CPT.
References:
- U.S. Department of Veterans Affairs. Talk Therapy for PTSD: National Center for PTSD. https://www.ptsd.va.gov/understand_tx/talk_therapy.asp
