What Happens in Trauma Therapy? CPT & Prolonged Exposure
If you’re considering trauma therapy, you might wonder about options like trauma-focused CBT, Cognitive Processing Therapy (CPT), or Prolonged Exposure (PE). These treatments are highly recommended, but the names can sound intimidating. Many worry that trauma therapy means being overwhelmed or pushed too hard. We understand that it can feel daunting to start!
This post explains what happens in trauma therapy using CPT or PE, in simple terms—just like a therapist would with a client.
What are CPT and Prolonged Exposure?
Both Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) are proven treatments for post-traumatic stress and trauma-related symptoms (Resick et al., 2017; Foa et al., 2019). They help your brain and nervous system understand that the trauma is over, even if your body still reacts as if it isn’t.
Learn more about CPT vs PE: Which Therapy is Right for You? and EMDR vs CBT therapy.
We also offer Written Exposure Therapy (WET) for PTSD.
CPT focuses on:
how trauma affects beliefs and meaning
stuck points like guilt, shame, or self-blame
changing unhelpful trauma-based thinking
Discover “The Power of Cognitive Processing Therapy (CPT) for PTSD” and CPT trauma stuck points.
PE focuses on:
reducing fear through safe, gradual exposure
helping your brain learn that reminders aren’t dangerous
decreasing avoidance that keeps trauma alive
Both therapies are structured, collaborative, and time-limited. You won’t just “talk” without guidance.
What Trauma Therapy Using CPT or PE Is Not
Let's clear up common fears.
Trauma therapy using CPT or PE is not:
surprise exposure without preparation
forcing you to share details before you're ready
reliving trauma without support
blaming you for how you coped
telling you to “get over it”
These therapies work because they are careful, predictable, and grounded in safety (Resick et al., 2017).
What Happens in the First Sessions?
1. You Start With Education and Safety
Early sessions focus on understanding trauma and building trust.
Your therapist will explain:
how trauma affects the brain
why symptoms like panic, anger, or numbness occur
how avoidance keeps symptoms going
how CPT or PE helps reverse this pattern
You will also discuss current safety, stressors, and supports. This foundation is important. Trauma therapy works best when you know what to expect (Herman, 2015).
2. You Learn Skills to Stay Grounded
Before any trauma processing, you learn tools to help manage emotions.
These may include:
grounding strategies
breathing techniques
ways to handle dissociation
coping plans for after sessions
You practice these skills with your therapist. You won’t be sent home to figure it out alone.
What a Typical CPT or PE Session Looks Like
Most sessions follow a clear structure, which helps contain trauma.
Check-In
You review symptoms, reactions from the week, and any practice you did between sessions.
Core Therapy Work
This depends on whether you are doing CPT or PE, you and you therapist will create a plan together.
Wrap-Up
You reflect on what you learned, review coping strategies, and plan for after the session.
What Happens in Cognitive Processing Therapy (CPT)?
CPT focuses on how trauma changes your view of yourself, others, and the world.
Identifying “Stuck Points”
Stuck points are trauma-based beliefs that keep you feeling unsafe or ashamed, like:
“It was my fault”
“I should have known better”
“I can’t trust anyone”
“I’m permanently damaged”
These beliefs often develop to make sense of overwhelming experiences (Resick et al., 2017).
Challenging Trauma-Based Beliefs
In CPT, you learn to examine these beliefs closely:
What evidence supports or contradicts them?
Are you using hindsight or self-blame?
How would you talk to a friend in the same situation?
This process is thoughtful and respectful—not confrontational.
Making Meaning Without Blame
CPT helps you build beliefs that are:
more balanced
more accurate
less harmful
This reduces guilt, shame, anger, and fear over time.
What Happens in Prolonged Exposure (PE)?
PE helps your brain learn that trauma reminders aren’t dangerous.
Understanding Avoidance
Avoidance feels helpful at first, but it teaches the brain that reminders are threats. PE helps reverse this learning (Foa et al., 2019).
Imaginal Exposure
You may gradually talk through the trauma memory in session, with support.
This is done:
at a controlled pace
using grounding tools
while staying present in the room
The goal is not emotional flooding; it’s to help the memory lose its power.
In-Vivo Exposure
You may also practice facing avoided situations in real life—step by step.
For example:
driving again after a car accident
returning to certain places
engaging in previously avoided activities
You and your therapist plan this together.
Frequently Asked Questions
Do I Have to Describe Every Detail of the Trauma?
No. You share only what’s necessary for treatment. You control the pace (Resick et al., 2017).
Will CPT or PE Make Me Feel Worse?
Some discomfort is normal, but therapy should feel manageable. Therapists monitor distress closely and adjust as needed (Foa et al., 2019).
How Long Does CPT or PE Take?
Both treatments typically take about 8–15 sessions, depending on individual needs (Resick et al., 2017).
Can CPT or PE Be Done Online?
Yes. Research shows that trauma-focused CBT, including CPT and PE, can be effective when delivered online by trained clinicians (Morland et al., 2020).
What If I Shut Down or Dissociate?
That’s a trauma response—not a failure. Therapy slows down and focuses on regulation when this happens.
Signs CPT or PE Is Working
Over time, many clients notice:
fewer trauma triggers
reduced avoidance
less guilt or shame
improved sleep
a stronger sense of control
more confidence in daily life
Progress happens gradually—not all at once.
A Therapist’s Closing Thought
CPT and Prolonged Exposure are not about forcing you to relive trauma. They help your brain understand that the danger has passed.
You don’t need to carry this alone.
Ready to Get Started? Book a Free Consultation
If trauma symptoms interfere with your life, support can help.
At Virtual CBT, our therapists provide Cognitive Processing Therapy and Prolonged Exposure in a safe, structured, and compassionate online setting.
Learn more about our online trauma therapy. You can choose to work with a social worker, registered psychotherapist or online clinical psychologist.
Book a consultation to learn how we can help.
Finding a Trauma Therapist in Toronto, Ottawa, and Windsor (CPT & Prolonged Exposure)
If you are searching for trauma therapy in Toronto, Ottawa, Windsor, London, or any area in Ontario, or Nova Scotia it is important to find a therapist with specific training in evidence-based trauma treatments, not just general counselling experience.
Both Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) require advanced training and supervision. These therapies are structured, goal-oriented, and designed specifically to treat PTSD and trauma-related symptoms.
When looking for a trauma therapist in Toronto, Ottawa, or Windsor, consider asking:
Are you trained or certified in Cognitive Processing Therapy (CPT) or Prolonged Exposure (PE)?
Do you regularly treat trauma and PTSD?
Can you clearly explain how the therapy works and what sessions involve?
Do you offer online trauma therapy in Ontario?
Many people look locally first, but access to certified trauma therapists can be limited depending on the city. Because of this, many clients choose virtual trauma therapy, which allows them to work with a qualified CPT or PE therapist anywhere in Ontario.
Research shows that online trauma therapy, including CPT and Prolonged Exposure delivered via telehealth, can be just as effective as in-person treatment when provided by trained clinicians (Morland et al., 2020).
At Virtual CBT, we provide online trauma therapy across Ontario or Nova Scotia. Our therapists are trained in Cognitive Processing Therapy and Prolonged Exposure and offer structured, trauma-informed care designed to help clients feel safer, more grounded, and more in control.
If you are looking for a trauma therapist in Ontario or Nova Scotia, and want evidence-based treatment delivered online, a consultation can help you decide whether CPT or PE is the right fit.
Written by Melissa Lindstrom, MSW, RSW
References
Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2019). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences (2nd ed.). Oxford University Press.
Herman, J. L. (2015). Trauma and recovery (2nd ed.). Basic Books.
Morland, L. A., Wells, S. Y., Glassman, L. H., Greene, C. J., Hoffman, J. E., & Rosen, C. S. (2020). Advances in PTSD treatment delivery: Review of findings and clinical considerations for telehealth interventions. Current Treatment Options in Psychiatry, 7(3), 221–241. https://doi.org/10.1007/s40501-020-00207-x
Resick, P. A., Monson, C. M., & Chard, K. M. (2017). Cognitive processing therapy for PTSD: A comprehensive manual. Guilford Press.
