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Global Mental Health

Cognitive Processing Therapy (CPT)


Cognitive processing therapy (CPT) is a manualized talk-therapy that has been used to reduce the burden of symptoms related to posttraumatic stress disorder (PTSD) and related conditions, including depression and anxiety. CPT was first developed in the late 80’s (Resick & Schnicke, 1993) and tested with sexual assault victims in the United States. It has since been implemented and studied with other trauma survivors, including combat veterans, refugees, torture survivors, and other traumatized populations.  

Resick, P. A., & Schnicke, M. K. (1993). Cognitive processing therapy for rape victims: A treatment manual. Newbury Park, CA: Sage.

How it Works

CPT is a cognitive behavioral treatment and can be provided in individual and group treatment formats. As a trauma-focused treatment, CPT is a model that provides the client with tools to process the trauma(s) they have experienced and gain skills to review their own emotions and thoughts as they lead to avoiding traumatic triggers which lead to impairments in day-to-day functioning. CPT teaches specific skills to help individuals with PTSD more accurately appraise these trauma-related beliefs to change their emotions and behavior to progress toward recovery.

Our Studies

Our global mental health group has led randomized controlled trials of CPT in the Democratic Republic of Congo and in Iraq in collaboration with colleagues at University of Washington who provided the training, supervision, and implementation monitoring of the CPT intervention in each context. Currently we are conducting a study with Congolese refugee women in Tanzania where we are combining CPT with an advocacy intervention for women who are facing intimate partner violence. We are also working with the University of Washington and IMA Worldwide to conduct focused scale-up activities in North and South Kivu, DRC.

Democratic Republic of Congo

In the Democratic Republic of Congo we completed a trial in 15 villages comparing group CPT with an existing individual support program. Study participants were adult female sexual violence survivors who reported having experienced or witnessed sexual violence (translated as rape locally) and presented with elevated mental distress symptoms and functional impairment as assessed by locally adapted measures. On average, women in both programs experienced significant improvements during treatment with effects maintained at 6-months. For depression/anxiety and PTSD symptoms, CPT participants showed significantly greater improvements compared with women in individual support villages post treatment and after 6 months. Approximately 70 percent of CPT participants met our criteria for probable depression/anxiety at baseline, with 10 percent or fewer meeting criteria at both follow-up assessments. CPT was also found to be effective at increasing social capital outcomes, including participating in community activities and emotional support seeking.


Kurdistan and Northern Iraq

In Kurdistan, Northern Iraq, we completed a trial with adult torture and trauma survivors who were randomly allocated to receive individual CPT or be in wait-control condition. Treatment was provided by 9 community mental health workers (CMHWs) working in rural health clinics; CMHWs were nurses, pharmacist assistants, or physician assistants employed by the clinics. All had completed high school and had varying amounts of post graduate and/or job specific training. Compared with participants in the wait-control condition, CPT participants experienced significantly greater reductions in depression and trauma symptoms and improved daily functioning. Estimated effect sizes for depression and dysfunction were 0.70 and 0.90 respectively comparing CPT participants to all controls and 0.44 and 0.63 respectively compared to CPT controls only. 



In Basra and Nassariyah Iraq, we completed a trial with adult survivors of systematic violence who were randomly allocated to receive CPT or be in a wait-control condition. CPT was provided by 17 community mental health workers (CMHWs) who were medics or nurses who worked in rural Ministry of Health primary health care centers. CPT supervisors were clinical staff located in Kurdistan who had participated in the prior trial described above. Compared with the wait-control condition, participants in CPT showed statistically significant improvements for trauma and depression symptoms; effect sizes were moderate (0.41 for trauma and 0.40 for depression). 



In Tanzania, we are currently conducting an evaluation of an integrated CPT and intimate partner violence advocacy intervention.

For more information about Cognitive Processing Therapy generally, please go to For questions specifically related to international application of CPT or for international adaptations or trainings, please contact Dr. Debra Kaysen at University of Washington.