Cue-Centered Therapy

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What is Cue-Centered Therapy?

Cue-Centered Therapy, or CCT, is an evidence-based intervention for youth with chronic traumatic experiences. It is appropriate for youth with a history of adverse childhood experiences or who are living in conditions that carry a risk of recurrence of trauma. Further, CCT is appropriate for youth with varied traumas, developmental levels, and backgrounds. Rather than focus on traumatic events in isolation, the CCT framework emphasizes the impact of accumulating stress throughout a lifespan, otherwise known as allostatic load.

What is the theory behind Cue-Centered Therapy?

CCT is a multi-modal intervention drawing from elements of cognitive behavioral, psychodynamic, interpersonal, expressive, and family therapies. It integrates an insight-oriented approach with these other modalities, providing youth with knowledge on how trauma cues develop through classical conditioning and the link between these cues and their trauma responses.

What makes Cue-Centered Therapy unique?

CCT places trauma in the context of the child’s life rather than examining the traumatic experience in isolation. Youth develop insight about their trauma and how trauma cues develop through conditioning to impact emotions, cognitions, physiology, and behaviors.

What are the components of Cue-Centered Therapy?

CCT has four phases of treatment:

  1. Assessment, psychoeducation, and coping toolbox
  2. Trauma History
  3. Gradual exposure to cues
  4. Integration of skills learned

What is allostatic load?

Allostatic load is the accumulation of stress (includes both traumatic events and other stressors) in the mind and body throughout the lifespan.

Who benefits from Cue-Centered Therapy?

CCT is appropriate for youth experiencing chronic traumatic stress. It is appropriate for any trauma type and has been applied in school, clinic, and community settings. CCT has been used with youth from diverse backgrounds including ethnic/racial minorities, LGBTQ+, and immigrant populations. Rather than focus on traumatic events in isolation, the CCT framework emphasizes the impact of accumulating stress throughout a lifespan, otherwise known as allostatic load.

What age range is Cue-Centered Therapy intended for?

CCT has been standardized for use with children ages 8-18, although it can be adapted for use with other age groups.

Is Cue-Centered Therapy right for me and my clients?

CCT is appropriate for youth with a history of adverse childhood experiences or who are at risk of recurrence of varied traumas. The practice of CCT is intended for mental health professionals who have experience with evidence-based interventions and treatment of trauma in youth.

What is the format of Cue-Centered Therapy? How long does it take to use Cue-Centered Therapy with clients?

CCT is an individual therapy consisting of 15 weekly sessions. Caregivers participate in 3-4 sessions. Extra sessions may be added to reinforce particular components of the intervention.

Can Cue-Centered Therapy be administered in a telehealth format?

CCT has been conducted successfully over telehealth. Some advantages of telehealth include making treatment more accessible, being able to observe the child/family in their natural environment, and facilitation of rapport building as for some children, the clinic/office setting may be a trauma cue. When considering telehealth for your individual client, it is important to consider their privacy and safety as well as to assess the appropriateness of the virtual format depending on their age, cognitive level, ability to engage, and other factors.

Is there evidence that Cue-Centered Therapy works?

Two randomized controlled trials of CCT have been completed to date. In the first, compared to a waitlist group, the CCT group had greater reductions in posttraumatic symptoms both by caregiver and child report, as well as caregiver anxiety (Carrión, Kletter, Weems, Rialon Berry, & Rettger, 2013). In addition, the CCT group had greater overall improvement in functioning as assessed by the study therapists. These gains were maintained at three month follow up. The second trial demonstrated that youth who received CCT and Trauma-Focused CBT reported significantly lower levels of both posttraumatic and anxiety symptoms by follow-up while those in the Treatment As Usual group had no significant differences across time (Espil, Balters, Li, McCurdy, Kletter, Piccirilli, Cohen, Weems, Reiss, Carrion, 2022). In addition, neuroimaging using functional near-infrared spectroscopy (fNIRS) showed that cortical responses predicted posttraumatic symptom improvement.

Visit the CCT Press and Publications webpage for additional articles on CCT.

Is there a manual for Cue-Centered Therapy?

The CCT therapist manual is available in both English and Spanish. You can purchase the English version here: Cue-Centered Therapy for Youth Experiencing Posttraumatic Symptoms. The Spanish version can be purchased here: Terapia de claves traumáticas.

Who developed Cue-Centered Therapy?

CCT was developed by Dr. Victor Carrión, Dr. Hilit Kletter, and Dr. Ryan Matlow of the Stanford Early Life Stress and Resilience Program. Read about the team that developed CCT here.

What kind of training or licensure do I need to have to enroll in Cue-Centered Therapy training? I live and work outside the United States and my license is in my home country, am I still eligible to enroll in Cue-Centered Therapy courses?

To be eligible to enroll in CCT training, you must have a minimum Master’s level degree in mental health or an associated profession and experience in evidence-based interventions and treatment of trauma in youth. For case consultation, you must provide proof of licensure in the location you reside. Those residing outside of the United States are eligible to register for CCT courses and will be required to provide proof of licensure in their home country.

What is included in the Cue-Centered Therapy training program?

We have created a sequenced educational program that blends theory, practice, and application to prepare mental health professionals to integrate CCT in their own practice. Available in either English or Spanish, the 3-course program includes:

  • Course 1: Foundations of Cue-Centered Therapy
  • Course 2: Advanced Theory and Practice of Cue-Centered Therapy
  • Course 3: Applications of Cue-Centered Therapy: Case Consultations
     

We offer open enrollment courses for individual or small group sign-ups. We also tailor programs for agencies wishing to create a customized group experience for their team.

Read about the courses here.

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