Cue Centered Therapy

Training and Implementation

CCT Essential Treatment Manual

English and Spanish versions

What is CCT

  • Cue-Centered Therapy, or CCT, is intended for pediatric mental health professionals who have experience with evidence-based interventions and treatment of trauma. CCT was developed by Dr. Victor Carrion, Dr. Hilit Kletter, and Dr. Ryan Matlow.
  • CCT is an evidence-based intervention for youth with chronic traumatic experiences. Rather than focus on traumatic events in isolation, the CCT framework emphasizes the impact of accumulating traumas and other stressors throughout a lifespan, otherwise known as allostatic load.
  • This intervention anchors in the fact that exposure to multiple forms of trauma and adversity in childhood leads to different psychological and developmental outcomes. CCT aims to address the diverse outcomes by promoting self-empowerment through increased knowledge and insight.
  • CCT is a hybrid approach that combines elements from cognitive behavioral, psychodynamic, interpersonal, expressive, and family therapies. The intervention is framed around the neurobiology of trauma beginning by teaching children the meaning of traumatic cues, natural reactions to stress, and how classical conditioning plays a role in our responses. In addition, CCT teaches how cues affect current emotions, cognitions, physiological reactions, and, ultimately, behaviors.
  • A central component of CCT is to help youth place their traumatic events in the greater context of their lives. Rather than “unlearn” conditioned maladaptive responses to cues, CCT focuses on building new responses, utilizing the strengths and adaptive coping mechanisms already present in the child. This principle empowers youth to be their own agents of change.

What to Expect

CCT is generally 15 sessions long with the flexibility of adding additional sessions to help the child understand the treatment concepts. Each weekly session is 45 - 60 minutes. During the first few sessions we will assess the child’s symptoms and determine if this treatment is appropriate to address the child’s needs. Caregivers and the child will also be asked to complete some self-report questionnaires to assist with the assessment.

Practicing the skills learned is an important part of treatment. Take-home assignments are provided, and caregivers are enlisted as coaches to help the child practice these skills outside the therapy setting.

CCT primarily focuses on individual treatment of the child with 3-4 joint sessions with the child and caregiver together.

CCT Training

This online course was designed by the creators of CCT, Dr. Victor Carrion, Dr. Ryan Matlow, and Dr. Hilit Kletter of the Early Life Stress and Resilience Program at Stanford University.

The Cue-Centered Therapy online training course is a self-paced course consisting of 10 modules that cover the fundamentals of CCT and is the first required step to be certified in the intervention (the other two steps are a 1.5 day in person training and consultation on at least 2 cases).

The course provides the theoretical rationale, goals, therapeutic techniques, and resources for each session of the intervention. Four vignettes that the created from the developers' own clinical experience are used throughout to demonstrate session goals.

The course is unique in that it incorporates different learning modalities including introduction of the vignettes in a graphic novel style, use of audio book format for the clinical scripts, illustrations/animations to teach key didactic concepts, and quizzes and interactive exercises to enhance learner knowledge. 

The course is approved for 6.00 continuing education AMA PRA category 1 credits: is why in this course we'll meet four different children across a series of short audiobook chapters. Join us as we observe their therapy sessions, and follow their journeys of self-knowledge and empowerment.

CCT Publications

Cue-Centered Therapy for Youth Experiencing Posttraumatic Symptoms

Recent findings Studies demonstrate promising outcomes indicating CCT effectiveness in reducing child and caregiver posttraumatic stress, and in improving child functioning. Further research, however, is needed to identify which clients are best-suited for CCT (versus other available child trauma treatments) and to identify which components of CCT are most critical for addressing complex developmental trauma.

Carrion, VG, Kletter, H, Weems, CF, Rialon Berry, R, & Rettger JP (2013). Cue-centered treatment protocol for children exposed to interpersonal violence: a school-based randomized controlled trial. Journal of Traumatic Stress, 26, 654-662.

Kletter, H (2019). Cue-Centered Therapy. In Victor G. Carrion (ed). Assessing and Treating Youth Exposed to Traumatic Stress (pp. 207-221). American Psychiatric Association Publishing.

Friedman, MA, & Kletter, H (2019). Parent-child informant discrepancy and treatment response among youth exposed to chronic adversity: Implications for childhood PTSD assessment and intervention. Poster presented at the 35th annual conference of the International Society for Traumatic Stress Studies: Boston, MA