Table 5 CPT Session Outlines

Pre-IOP

N/A

• Call client

• Introductions

• Program overview

• Cognitive Processing Therapy

 ○ 15 daily sessions

 ○ Trauma-focused

 ○ Can initially be challenging but we have found it to help with symptom reductions

• Questions?

• Motivation for treatment

• Barriers

• Needed support

• Check-in about reactions to call

• Call therapist if questions come up

Week 1 Monday

N/A

• Set agenda, make introductions and explain check-in process

• PTSD symptoms

 ○ Intrusions

 ○ Avoidance

 ○ Negative alterations in cognitions and mood

 ○ Hyperarousal

• Trauma recovery and Fight-Flight-Freeze response

• Cognitive theory

• Role of emotions in trauma recovery

• Brief review of most traumatic event

• Therapy rationale – stuck points

• Anticipating avoidance and increasing compliance

• Overview of treatment – structured

• Discuss group readiness

• Check-in about reactions to session

• Write Impact Statement

Week 1 Tuesday

• Agenda, introductions, and check-ins

• Group rules

• Provide treatment rationale

 ○ Cognitive theory

 ○ Types of emotions

 ○ Biological basis of PTSD

• Not everyone responds to trauma the same

• Importance of support among group members

• First Impact Statement

• Reminder: Impact Statement assignment and problem solve completion

• Check-in about reactions to session

• Brief check-in

• Complete practice assignment review and set agenda

• Patient to read Impact Statement

• Discuss meaning of Impact Statement

• Describe stuck points more fully

• Identify stuck points & generate Stuck Point Log

• Examine connections among events, thoughts, and feelings

• Introduce ABC Worksheets

• Check-in about reactions to session

• Complete 3 ABC Worksheets focused on assimilated stuck points

Week 1 Wednesday

• Agenda and check-ins

• Share Impact Statements

• Introduce connections between events, thoughts, and feelings

• Reminder: ABC Worksheet assignment and problem solve completion

• Check-in about reactions to session

• Brief check-in

• Complete practice assignment review and set agenda

• Review ABC Worksheets, further differentiating between thoughts and feelings

• Use Socratic questioning on ABC worksheets related to the index event to help patient identify alternative hypotheses

• Continue to add to Stuck Point Log

• Check-in about reactions to session

• Complete 3 ABC Worksheets focused on assimilated stuck points

• Write first Trauma Account

Week 1 Thursday

• Agenda and check-ins

• Continue to share Impact Statements

• Discuss ABC Worksheets

• Introduce Socratic questioning in group, practice challenging assimilated stuck points

 ○ Up to two patients share

• Reminder: ABC Worksheet assignment, Trauma Account assignment, and problem solve completion

• Check-in about reactions to session

• Brief check-in

• Complete practice assignment review and set agenda

• Patient to read full Trauma Account aloud with affective expression

• Identification of stuck points

• Use Socratic questioning to challenge assimilated stuck points

• Explain difference between responsibility and blame

• Continue to add to Stuck Point Log

• Check-in about reactions to session

• Complete 3 ABC Worksheets focused on assimilated stuck points

• Write second Trauma Account

Week 1 Friday

• Agenda and check-ins

• Share thoughts and feelings about writing Trauma Account

• Practice challenging assimilated stuck points

 ○ Up to two patients share

• Reminder: ABC Worksheet assignment, Trauma Account assignment, and problem solve completion

• Check-in about reactions to session

• Brief check-in

• Complete practice assignment review and set agenda

• Patient to read full Trauma Account aloud with affective expression; help identify differences between first and second account

• Introduce Challenging Questions Worksheet

• Use Socratic questioning to challenge assimilated stuck points

• Check-in about reactions to session

• Complete 3 Challenging Questions Worksheet

Week 2 Monday

• Agenda and check-ins

• Discuss re-writing Trauma Account

• Assess for and normalize strong emotions at this phase of therapy

• Practice challenging assimilated stuck points

 ○ Up to two patients share

• Reminder: Challenging Questions Worksheet assignment and problem solve completion

• Check-in about reactions to session

• Brief check-in

• Complete practice assignment review and set agenda

• Review Challenging Questions Worksheet

 ○ Focus on assimilated stuck points

• Continue cognitive therapy for stuck points

• Introduce Patterns of Problematic Thinking Worksheet

• Check-in about reactions to session

• Complete 1 Patterns of Problematic Thinking Worksheet

Week 2 Tuesday

• Agenda and check-ins

• Practice challenging assimilated stuck points

 ○ Up to two patients share

• Reminder: Patterns of Problematic Thinking Worksheet assignment and problem solve completion

• Check-in about reactions to session

• Brief check-in

• Complete practice assignment review and set agenda

• Review Patterns of Problematic Thinking Worksheet

 ○ Complete challenging Questions if patient is still struggling with content

• Continue cognitive therapy for stuck points

• Introduce Challenging Beliefs Worksheets

• Introduce first of five problem areas: Safety

• Check-in about reactions to session

• Complete 3 Challenging Beliefs Worksheets

• Review Safety Module

Week 2 Wednesday

• Agenda and check-ins

• Practice challenging assimilated stuck points

 ○ Up to two patients share

• Reminder: Challenging Beliefs Worksheet assignment and problem solve completion

• Check-in about reactions to session

• Brief check-in

• Complete practice assignment review and set agenda

• Review Challenging Beliefs Worksheet

 ○ Address remaining assimilated stuck points or Safety stuck points

• Help patient confront problematic cognitions and generate alternative beliefs using the Challenging Beliefs Worksheet

• Assign Challenging Beliefs Worksheets

• Introduce second of five problem areas: Trust

• Check-in about reactions to session

• Complete 3 Challenging Beliefs Worksheets

• Review Trust Module

Week 2 Thursday

• Agenda and check-ins

• Practice challenging assimilated stuck points

 ○ Up to two patients share

• Reminder: Challenging Beliefs Worksheet assignment and problem solve completion

• Check-in about reactions to session

• Brief check-in

• Complete practice assignment review and set agenda

• Review Challenging Beliefs Worksheet

 ○ Address remaining assimilated stuck points or Trust stuck points

• Help patient confront problematic cognitions and generate alternative beliefs using the Challenging Beliefs Worksheet

• Assign Challenging Beliefs Worksheets

• Introduce third of five problem areas: Power/Control

• Check-in about reactions to session

• Complete 3 Challenging Beliefs Worksheets

• Review Power / Control Module

Week 2 Friday

• Agenda and check-ins

• Practice challenging assimilated/over-accommodated stuck points

 ○ Up to two patients share

• Reminder: Challenging Beliefs Worksheet assignment and problem solve completion

• Check-in about reactions to session

• Brief check-in

• Complete practice assignment review and set agenda

• Review Challenging Beliefs Worksheet

 ○ Address remaining assimilated stuck points or Power/Control stuck points

• Help patient confront problematic cognitions and generate alternative beliefs using the Challenging Beliefs Worksheet

• Assign Challenging Beliefs Worksheets

• Introduce fourth of five problem areas: Esteem

• Check-in about reactions to session

• Complete 3 Challenging Beliefs Worksheets

• Review Esteem Module

Week 3 Monday

• Agenda and check-ins

• Practice challenging assimilated/over-accommodated stuck points

 ○ Up to two patients share

 ○ Focus on trauma themes

• Reminder: Challenging Beliefs Worksheet assignment and problem solve completion

• Check-in about reactions to session

• Brief check-in

• Complete practice assignment review and set agenda

• Review Challenging Beliefs Worksheet

 ○ Address remaining assimilated stuck points or Esteem stuck points

• Help patient confront problematic cognitions and generate alternative beliefs using the Challenging Beliefs Worksheet

• Assign Challenging Beliefs Worksheets

• Introduce fifth of five problem areas: Intimacy

• Initiate contact with community provider in patient’s area

• Check-in about reactions to session

• Complete 3 Challenging Beliefs Worksheets

• Review Intimacy Module

Week 3 Tuesday

• Agenda and check-ins

• Practice challenging assimilated/over-accommodated stuck points

 ○ Up to two patients share

 ○ Focus on trauma themes

• Reminder: Challenging Beliefs Worksheet assignment and problem solve completion

• Check-in about reactions to session

• Complete practice assignment review and set agenda

• Review Challenging Beliefs Worksheet

 ○ Address remaining stuck points

• Help patient confront problematic cognitions and generate alternative beliefs using the Challenging Beliefs Worksheet

• Assign Challenging Beliefs Worksheets

• Continue to establish contact with community provider in patient’s area

• Check-in about reactions to session

• Complete 3 Challenging Beliefs Worksheets

Week 3 Wednesday

• Agenda and check-ins

• Practice challenging assimilated/over-accommodated stuck points

 ○ Up to two patients share

 ○ Focus on trauma themes

• Reminder: Challenging Beliefs Worksheet assignment and problem solve completion

• Check-in about reactions to session

• Complete practice assignment review and set agenda

• Review Challenging Beliefs Worksheet

 ○ Address remaining stuck points

• Help patient confront problematic cognitions and generate alternative beliefs using the Challenging Beliefs Worksheet

• Assign Final Impact Statement

• Continue to establish contact with community provider in patient’s area

• Check-in about reactions to session

• Final Impact Statement

Week 3 Thursday

• Agenda and check-ins

• Discuss Final Impact Statement

• Involve patients in reviewing the course of treatment and patient’s progress

• Help identify goals for the future and delineate strategies for meeting them

• Check-in about reactions to session/program

• Complete practice assignment review and set agenda

• Review Challenging Beliefs Worksheet

 ○ Address remaining stuck points

• Help patient confront problematic cognitions and generate alternative beliefs using the Challenging Beliefs Worksheet

• Patient to read Final Impact Statement

• Involve patient in reviewing the course of treatment and patient’s progress

• Help identify goals for the future and delineate strategies for meeting them

• Continue to establish contact with community provider in patient’s area

• Check-in about reactions to session

N/A

Week 3 Friday

N/A - Graduation

• Review course of treatment and patient progress

• Go over discharge plan

• Assess patient goals for the future

• Continue to establish contact with community provider in patient’s area

• Review referrals and plan for aftercare

N/A - Graduation