The Rationale for Treatment Copy

Cue-Centered Therapy’s mission is empowerment through knowledge. We help children and caregivers understand that the way they think, feel, and behave, as well as the physiological reactions they experience because of trauma cues, are all normal. It provides hope for the child and caregiver, and helps them know they are not alone in their experience.

Tasha and her mom outside their small suburban home
Tasha and her mom outside their small suburban home

But just because it is normal for the body’s stress response to become sensitized over time, doesn’t mean it’s healthy. When legitimately safe environments continue to cue the stress response over time, these become symptoms of posttraumatic stress.

If left untreated in a child, symptoms of posttraumatic stress can interfere with multiple domains of functioning. This can lead to various mental health conditions later in life—such as anxiety, depression, self-harm, and substance abuse—and affect physical health as well.

CCT Speech bubble - can symptoms of posttraumatic stress heal with time or can a child "grow out" of it?

It is important to emphasize to the child and the caregiver that in order to prevent detrimental consequences, symptoms must be adequately addressed using evidence-based interventions focused on trauma, such as CCT.

Posttraumatic Stress Disorder (PTSD)

Posttraumatic stress disorder (PTSD) is a clinical condition that might develop after exposure to trauma. For a diagnosis of PTSD, a person must be exposed to a traumatic event and have symptoms that last at least one month. There are four symptom categories required for PTSD: 

  • Re-experiencing (i.e., intrusive thoughts, flashbacks, nightmares, emotional or physiological distress to trauma reminders) 
  • Avoidance (i.e., avoidance of trauma-related emotions/thoughts or reminders) 
  • Negative cognitions and mood (i.e., negative affect, exaggerated blame of self or others, loss of interest in activities, isolation) 
  • Arousal and reactivity (i.e., irritability, risky behavior, hypervigilance, difficulty with sleep or concentration, and heightened startle response)

Many children who have experienced trauma do not meet the full criteria for PTSD, but they do exhibit similar difficulties across functional domains (social, emotional, cognitive, academic). Thus, especially for children, it is important to assess not only the severity of symptoms but also functional impairment. In addition, children with PTSD may have overlapping symptoms of anxiety, depression, attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder, and dissociative disorders.

Read more from the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) Criteria for PTSD. DSM 5: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub; 2013. 991 p.


In the psychoeducation session, it is crucial to explain the concept of “avoidance” and anticipate that it may be present during the therapy.

Avoidance is “the failure to address a traumatic experience,” such as when people emotionally, cognitively, physiologically, and behaviorally distance themselves from painful or threatening experiences.

Avoidance is a natural protective mechanism, but it can often drive and maintain trauma symptoms. Learning about cues and confronting them, after adequate preparation through Cue-Centered Therapy, is crucial to help reduce trauma symptoms.

Posttraumatic stress will not heal on its own with time nor will a child grow out of it without an evidenced-based trauma therapy. Posttraumatic stress feeds on avoidance, hence we must approach it with treatment.