Cue-Centered Therapy (CCT)

About This Program

Target Population: Youth ages 8-18 with a chronic history of trauma, adversity, and ongoing stress

For children/adolescents ages: 8 – 18

For parents/caregivers of children ages: 8 – 18

Program Overview

CCT is a manualized protocol consisting of 15 sessions. It is an integrative approach combining elements from cognitive, behavioral, psychodynamic, expressive, and family therapies to address four core domains: cognition, behavior, emotions, and physiology. The primary goal of CCT is to build strength and resilience by empowering the child through knowledge regarding the relationship between their history of trauma exposure and current affective, cognitive, behavioral, or physiological responses. Children and parents learn about the significance of traumatic stress, how adaptive responses become maladaptive, how to cope with rather than avoid ongoing stress, and the importance of verbalizing their life experiences. The treatment process is designed to help build overall competence, reduce physical symptoms of anxiety, modify cognitive distortions, and facilitate emotional expression. In CCT, youth and caregivers are taught how to recognize and effectively manage maladaptive responses that occur in response to traumatic reminders (cues).

Program Goals

The goals of Cue-Centered Therapy (CCT) are:

  • Build strength and resilience
  • Reduce negative cognitions
  • Foster emotional expression
  • Identify and change trauma-related responses
  • Empower youth to be their own agents of change
  • Strengthen the relationship between youth and their caregivers

Logic Model

The program representative did not provide information about a Logic Model for Cue-Centered Therapy (CCT).

Essential Components

The essential components of Cue-Centered Therapy (CCT) include:

  • CCT consists of 15 sessions divided into four phases:
    • Phase 1 (sessions 1-3) prepares youth and their caregivers for exposure through education and coping skills training.
    • Phase 2 (sessions 4-7) consists of the youth telling their life story highlighting both positive and negative events as a form of narrative exposure. The therapist identifies cognitions, emotions, cues, and memory gaps in the story and later works with the child to restructure cognitive distortions and misattributions.
    • Phase 3 (sessions 8-12) involves the therapist, youth, and caretaker working together to identify cues and reduce associated negative responses. The youth are exposed to the cues gradually in three stages: imaginary, in session, and in-vivo. Following exposure, the therapist helps youth find solutions to obstacles encountered when using the new coping strategies.
    • Phase 4 (sessions 13-15) has the youth use the skills learned to develop a coherent life narrative and the therapist, youth, and caregiver work to ensure that treatment gains are sustained after therapy.
  • Sessions generally occur weekly for 45 minutes; however the therapist may adapt the time to meet the child’s individual needs.
  • Up to two additional sessions may be added to each phase if the child is having difficulty grasping the concepts in that phase. Sessions are intended to build upon one another, therefore the therapist should not advance to a later session if the child has not mastered prior material
  • It is highly advisable that therapists wishing to use CCT receive training and supervision before using the intervention.

Program Delivery

Child/Adolescent Services

Cue-Centered Therapy (CCT) directly provides services to children/adolescents and addresses the following:

  • PTSD and associated symptoms, negative cognitions and self-attributions, emotional/behavioral dysregulation

Parent/Caregiver Services

Cue-Centered Therapy (CCT) directly provides services to parents/caregivers and addresses the following:

  • Poor caregiver-child relationship

Recommended Intensity:

Once a week sessions for 45 minutes

Recommended Duration:

15-19 sessions

Delivery Settings

This program is typically conducted in a(n):

  • Hospital
  • Outpatient Clinic
  • Community-based Agency / Organization / Provider
  • Group or Residential Care
  • School Setting (Including: Day Care, Day Treatment Programs, etc.)

Homework

Cue-Centered Therapy (CCT) includes a homework component:

Take-home activities are an essential component of CCT. Youth and their caregivers are given take-home activities during certain sessions to reinforce the skills learned in treatment and to allow caregivers practice in coaching the youth in using these skills.

Languages

Cue-Centered Therapy (CCT) has materials available in a language other than English:

Spanish

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Private space to conduct the sessions
  • Waiting area/supervision for children when caregivers are seen alone
  • Therapy manual and worksheets

Manuals and Training

Prerequisite/Minimum Provider Qualifications

Master’s level with experience working with traumatized youth and families and training on the treatment intervention

Manual Information

There is a manual that describes how to deliver this program.

Training Information

There is not training available for this program.

Implementation Information

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Cue-Centered Therapy (CCT).

Formal Support for Implementation

There is no formal support available for implementation of Cue-Centered Therapy (CCT).

Fidelity Measures

There are fidelity measures for Cue-Centered Therapy (CCT) as listed below:

A fidelity checklist outlining the goals of each session is available upon request by contacting Dr. Hilit Kletter at hkletter@stanford.edu.

Implementation Guides or Manuals

There are no implementation guides or manuals for Cue-Centered Therapy (CCT).

Research on How to Implement the Program

Research has not been conducted on how to implement Cue-Centered Therapy (CCT).

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Carrion, V. G., Kletter, H., Weems, C. F., Rialon Berry, R., & Rettger, J. P. (2013). Cue- Centered Treatment protocol for children exposed to interpersonal violence: A school-based randomized controlled trial. Journal of Traumatic Stress, 26, 654-662.

Type of Study: Randomized controlled trial
Number of Participants: 65

Population:

  • Age — Children: 8-17 years, Parents: Not specified
  • Race/Ethnicity — 33 African American, 26 Hispanic/Latino, 5 Mixed Ethnicity, and 1 Pacific Islander; Parents: Not specified
  • Gender — Children: 39 Male and 26 Female; Parents: Not specified
  • Status — Participants were youth with a history of exposure to violence.

Location/Institution: 13 Schools within San Francisco school district and Ravenswood school district in East Palo Alto.

Summary: (To include basic study design, measures, results, and notable limitations)
This study tested the efficacy of the Stanford Cue-Centered Treatment [now called Cue-Centered Treatment (CCT)] for reducing posttraumatic stress, depression, and anxiety in children chronically exposed to violence. Participants were randomly assigned to the Stanford Cue-Centered Treatment or a waitlist control group. Measures utilized include the UCLA PTSD Reaction Index for DSM-IV-Child Version (UCLA PTSD-RI), the Children’s Manifest Anxiety Scale (RCMAS), the Children’s Depression Inventory (CDI), the Beck Depression Inventory (BDI), the UCLA PTSD Reaction Index for DSM-IV-Parent Version (UCLA PTSD-RI), the Beck Anxiety Inventory (BAI), and the Children’s Global Assessment Scale. Results showed that compared to the waitlist group, the Stanford Cue-Centered Treatment group had greater reductions in posttraumatic stress disorder (PTSD) symptoms both by caregiver and child report, as well as caregiver anxiety. Limitations include reliability of small sample size, reliability of self-reported measures, and length of follow-up.

Length of postintervention follow-up: 3 months.

Additional References

Carrion, V. G. (2016). Cue-centered therapy for youth experiencing posttraumatic symptoms: A structured multimodal intervention, therapist guide. Oxford University Press.

Carrion, V. G. (2019). Terapia de claves traumáticas: Manual de intervención para niños y adolescents con sintomas postraumáticos. Gedisa Editorial.

Contact Information

Hilit Kletter, PhD
Agency/Affiliation: Stanford University Early Life Stress and Resilience Program
Website: med.stanford.edu/elspap
Email:
Phone: (650) 723-5511
Fax: (650) 724-7389

Date Research Evidence Last Reviewed by CEBC: February 2021

Date Program Content Last Reviewed by Program Staff: March 2020

Date Program Originally Loaded onto CEBC: June 2016