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Section 5: Thinking about trauma

How to think about trauma

Luke Lamprecht

Child Protection and Development Specialist

Trauma debriefing is a particular skill and requires specific training. We have included a description of the CATT process in this module for your information and further training should you want to move in this direction. It is a safe and tested CBT technique to work with prolonged PTSD symptoms and may be useful in your tool box. The presentation video that goes with this section is given by Luke Lamprecht who helps us to think about trauma and potential creative ways to provide support. Please note there are restrictions on training CATT - visit LUNA’s website to find out more http://www.lunachildren.org.uk/CATT.html.

A CBT technique for prolonged PTSD symptoms: Children’s Accelerated Trauma Training

Watch this

Luna Children’s Charity is a child-centred voluntary organisation, which exists to advance the rights, education and health of children and young people affected by conflict and trauma. This video explains a little more about who they are, and what they do.

Children’s Accelerated Trauma Therapy (CATT) is a cognitive therapeutic protocol that utilises specific child-centred and play/arts based techniques, in order to help children, process and re-script traumatic memories in ways that are comfortable for them and age appropriate. CATT has been used with children from the age of three up to adults. The benefit of this approach is that it does not rely heavily on language and/or cognitive ability of the recipient, and has therefore been widely accepted cross-culturally and by services supporting children with a wide range of needs.

To ensure that CATT targets children and young people who are suffering with the symptoms of Post-Traumatic Stress Disorder (PTSD), Luna uses the “CRIES-8" or the Children's Impact of Events Scale (8). This was originally developed by Horowitz et al (1979) and subsequently modified to monitor the main phenomena of re-experiencing the traumatic event and of avoidance of that event and the feelings to which it gave rise.

(Taken from: http://www.lunachildren.org.uk/CATT.html)

Structure of CATT process

Holistic CATT protocol


CATT Phase one:

  • Conducive environment
  • Acknowledge the purpose of the session – child chooses event/trauma
  • Allow a short time to think of the event, but not too much so that they don’t get overloaded
  • Create a list of characters/people
  • Create a list of things and senses
  • Choose materials
  • Create characters and people who were there and key objects
  • Name a safe place at the start
  • Name a safe place at the end
  • Give this story a title
  • Ask the child to tell the story from the 1st safe place to the 2nd safe place and explain that you were not there, so it would be helpful if they add as much detail as possible. Ask them to describe all of the senses: sight, sound, tastes, smells, touch and how they moved.
  • Tell the story all the way through without stopping, starting from the safe place right through to the safe place at the end
    • Remember not to touch the characters or to comment or interpret - just listen
    • Prompt them to tell the story if they slow to much, stop using the characters or start making eye contact. This is protective and will lower the risk of flooding
  • Give lots of praise at the end of the first stage and tell them that they have now done the hardest part
  • Then say now I am going to ask you to do something a bit strange - tell the story backward.
    • If the child struggles with the sequence, you can help them to remember the order by prompting which event happened next
  • When they finish backwards, give lots of praise again
  • Repeat the process of telling forward and backwards three times, getting quicker and quicker

CATT Phase two:

  • Acknowledging that something difficult has happened to them and that they have now told you about this story, which we can’t do anything about
  • Having used CATT will now help them to be able to cope better
  • Now we are going to tell a different story that couldn’t have happened
  • Imagine a new character, who couldn’t possibly have been there
    • Offer prompts such as: other children have imagined a superhero; animal; imaginary creature
  • This new character can come into the story at any point and make the story different, in a way that will make them feel better or think differently about what happened. There’s no right or wrong way to do this
    • You may ask about the character to check that it is helpful and that it is indeed an imaginary character (i.e. not someone who could have been there)
  • Ask if this character has a name
  • Make this new character using the art materials
  • Give a new title for this make-believe story
  • Take your time to tell me this new story using the old props and the new character that you’ve made
  • After they’ve finished, ask if there is something they want to add
  • Thank them and praise them for having done this
  • Tell them that they can keep this new character and take it with them; it might remind them about the story that they made up which helped them to feel better or think differently

POST-CATT Protocol take-home technique for symptom reduction if triggered.

E. Theme: Technique to manage triggers once back in the world


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