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Cue-Centered Treatment (CCT) - Promising Futures
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Programs

Cue-Centered Treatment (CCT)

Overview

Delivery Approach:
  • Individual
Delivery Format:
  • In-Person
  • Virtual
  • Hybrid
Provider Requirements:
  • Licensed/Certified Professional Led
Type of Experience Addressed:
  • Domestic Violence
  • Child Abuse 
  • Sexual Abuse
  • Community Violence
  • Neglect 
  • Family Separation
  • Homicide/Familicide 
  • Substance Abusing Caregiver 
  • Natural Disasters 
  • Grief/Bereavement 
  • Criminal Victimization 
  • Refugee/Immigration
  • Reunification
  • Medical Trauma
  • Homelessness
  • Verbal/Emotional abuse
  • Mental Health Issues/Concerns
  • Mass shootings
  • Hate Crimes
  • Systemic/Interpersonal Racism
  • Historical trauma
  • Homophobia/Transphobia
Engagement Methods:
  • Talk-Based
Level of Intervention:
  • Tertiary Prevention
  • Intervention
Length:
  • Greater than 12 weeks
Setting:
  • Residential
  • School
  • Family Service Agencies
  • Health Services
  • Foster Care
  • Community Based Agency
  • Mental Health Services
Program Details:
Type of services provided:

Four phase individual treatment that is designed to help youth and caregivers to understand how exposure to trauma may be related to current emotional experiences and how these experiences can be linked to maladaptive behaviors. Combines elements from cognitive, behavioral, psychodynamic, expressive and family therapies to help youth and caregivers learn about the importance of traumatic stress, how responses that are initially adaptive can become maladaptive and how to manage maladaptive responses to traumatic reminders (cue), how to cope with stress, and express emotions.

Program setting:

Clinic, school, residential care, community agencies

Length of program/number of sessions:

15 sessions that are 45-50 minutes in length

Type(s) of trauma/concerns addressed:

Suitable for any trauma type

Symptoms addressed:

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

Education level of providers:

Therapists (At least Masters level trained)

Additional information:

None

Unique/Innovative Characteristics:

CCT focuses on the allostatic load (accumulation of stress over time) rather than processing traumatic events in isolation. In addition, it is a more insight-oriented approach than traditional cognitive behavioral interventions, providing youth with knowledge about how trauma cues develop through classical conditioning and the link between these cues and their trauma responses.

Date Added/Updated:

7/13/22

Population Served

Age:
  • 6-12 (Childhood)
  • 13-17 (Adolescent)
Population Language:
  • English
  • Spanish
Ethnic Racial Group:
  • Black or African American
  • Hispanic or Latino
  • Asian
  • Indigenous – American Indian/Native American, Alaska Native
  • Native Hawaiian or other Pacific Islander
  • White
Client/Audience
  • Child and Non-abusive Parent/Caregiver
Population Adaptations:
Age range of children served:

Youth ages 7-18 years old with chronic exposure to violence/trauma and ongoing stress

Are parent/adult caregiver(s) included in intervention?

Yes, parents/caregivers of children ages 7-18 years old

Ethnic/racial and other groups served:

Evaluation studies included African American, Asian, Hispanic/Latino, mixed ethnicity, Native, and Pacific Islander youth.

Specific cultural adaptations:

The principles of CCT apply across diverse groups and the treatment has been used with a wide range of minority groups. The clinical trials have been conducted predominantly with ethnic minority samples indicating the efficacy of the intervention for these groups.

Languages that service/resource is available:

English

Evaluation

Foundation:
Goals of the program/services:

Reduce posttraumatic stress, and associated symptoms in children exposed to violence and other trauma. Goals of CCT include building children’s strength and resilience by empowering them to become their own agents of change through awareness and knowledge of the relationship between their history of trauma and current affective, cognitive, behavioral and physiological responses. CTT also seeks to strengthen the relationships between youth and their parents/caregivers.

Evaluation Studies:
Has there been any evaluation?

Yes

Key evaluation results:

Two randomized controlled trials have been completed with CCT. The first examined CCT compared to a wait list control group in 65 youth ages 8-17 from low-income, high risk schools in the San Francisco and Ravenswood (East Palo Alto) school districts. The CCT group was found to have greater reduction in PTSD (by child and caregiver report), anxiety and depression as well as overall improvement in functioning compared to the wait list group. In addition, caregivers in the CCT group had greater reductions of their own anxiety. These gains were maintained at three month follow up. The second trial examined 73 youths ages 7-17 in a community based mental health agency randomly assigned to one of three treatment conditions: CCT, TF-CBT, or treatment as usual. Results showed that both CCT and TF-CBT were more efficacious than treatment as usual in reduction of PTSD and anxiety symptoms.  In addition, functional near-infrared spectroscopy (fNIRS) neuroimaging found that PTSD symptom improvement was predicted by cortical activation patterns.

Is there an evaluation currently in progress or planned?

We are currently planning a randomized controlled trial in Puerto Rican youth. All youth will receive a mindfulness-based intervention and those screened to be at higher risk will then be referred to receive CCT. We will also be examining epigenetic changes in response to these interventions.

Publications about the program:

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 trial. Journal of Traumatic Stress, 26, 654-662.

Espil, FM, Balters, SC, Li, R, McCurdy, BH, Kletter, H, Piccirilli, A, Cohen, JA, Weems, CF, Reiss, AL, & Carrion, VG (submitted). Brain function predicts posttraumatic improvement in youth treated with TF-CBT or CCT. Journal of Psychiatric Research.

Rated/Reviewed by Evidence Based Registries:

California Evidence-Based Clearinghouse for Child Welfare

Training & Resources

Training Language:
  • English
  • Spanish
Training Availability:
  • Yes
Training Details:
Training manuals/protocols:

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

Spanish therapist manual: Carrion V.G. (2018). Terapia de claves traumáticas: Manual de intervención para niños y adolscentes con síntomas postraumáticos. Barcelona: Editorial Gedisa.

Availability of Training:

An online course consisting of 8 self-paced modules covering the fundamentals of CCT is available.

The course offers 6 continuing education credits. English version of the course: https://mededucation.stanford.edu/courses/cue-centered-therapy/

Spanish version of course: https://mededucation.stanford.edu/courses/cue-centered-therapy-spanish/

In addition, we will soon be rolling out additional steps for becoming rostered as a CCT therapist which include live training and case consultation. Please contact the program for further information on these.

Training Contact:

Hilit Kletter, PhD
Stanford University Early Life Stress and Pediatric Anxiety Program
hkletter@stanford.edu
https://med.stanford.edu/elspap/about

Program Contact

Hilit Kletter, PhD
Stanford University Early Life Stress and Pediatric Anxiety Program
(650) 721-3582
hkletter@stanford.edu
https://med.stanford.edu/elspap/about