Program Goals/Target Populations
Trauma Affect Regulation: Guide for Education and Therapy (TARGET) is a trauma-focused psychotherapy for the concurrent treatment of posttraumatic stress disorder (PTSD) and substance use disorders (SUDs). The program, which has been used with adolescents and adults, is designed to serve individuals suffering from PTSD and SUDs. The goal of treatment is to help patients suffering from PTSD and SUDs to regulate intense emotions and solve social problems while simultaneously maintaining sobriety.
TARGET’s three main components can be delivered through group or individual therapy. These components include:
- Education about the biological and behavioral components of SUDs and PTSD
- Guided implementation of information/emotion processing and self-regulation skills (see information on the FREEDOM skill sequence below)
- Development of an autobiographical narrative that incorporates the trauma, PTSD, and SUD
Treatment can last between 6 months and several years. In its brief therapy form, individuals receive counseling in 12 weekly sessions.
Therapy focuses on the client’s core values and hopes, resilience, and client strengths. Therapists reframe PTSD symptoms as healthy reactions to abnormal circumstance; in other words, the symptoms are a sign that the individual has coped well with the trauma. Clients learn that they can reset this “biological alarm” (Ford and Russo 2006, 342), which does not serve the individual well in ordinary life.
The program introduces a seven-step skill sequence—known by the acronym FREEDOM—that helps individuals learn to process and manage trauma-related reactions to stressful current situations. These steps are:
- Focus. A step to reduce anxiety and increase mental alertness.
- Recognize. An activity to help individuals recognize specific stress triggers.
- Emotions. A step to identify primary feelings.
- Evaluate. A step in which individuals evaluate primary thoughts/self-statements.
- Define. An activity to help individuals determine and define their primary personal goal(s).
- Option. An activity where individuals identify one choice that represents a successful step toward the primary goal(s) that he or she actually accomplished during a current stressful experience.
- Make a contribution. An activity to help individuals recognize how that option reflected their core values and made a difference in others’ lives.
These skills are introduced through the three phases of treating PTSD. Phase 1 coincides with the “F” (Focus) skill; phase 2 primarily focuses on recognition skills, and includes the skills represented by “REEDOM”; and phase 3 involves the incorporation of these skills into the individual’s overarching goals.
TARGET draws on cognitive–behavioral therapy and self/relational models of treatment to define a set of steps for clients to learn how to regulate intense emotions and solve social problems while simultaneously maintaining sobriety. It provides a framework for understanding and managing trauma memories and affecting dysregulation.
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Posttraumatic Stress Disorder (PTSD) Symptoms
Compared to the waitlist control participants (classified as treatment as usual, or TAU), Ford and colleagues (2008) found that both Trauma Affect Regulation: Guide for Education and Therapy (TARGET) and Present Centered Therapy (PCT) participants experienced reductions in PTSD symptoms, with TARGET participants experiencing larger reductions. Absolute levels of PTSD symptoms were reduced by 33 percent for the TARGET participants, so that mean levels fell below the clinical range cut-off score. At both follow-up assessments, PTSD severity scores were reduced to a level more than 50 percent lower than baseline. Between posttherapy and the 6-month follow-up, the incidence of full or partial PTSD decreased significantly for TARGET participants compared to TAU participants.
Negative Mood Regulation
Both treatment conditions experienced decreased negative mood regulation compared to TAU participants. Compared to the TAU group, TARGET led to a statistically significant improvement in negative mood regulation. TARGET participants experienced greater improvements than PCT participants.
Compared to the TAU group, TARGET led to a statistically significant reduction in trauma-related beliefs. These improvements were sustained through the 6-month follow-up.
Distress Related to PTSD
Compared to the TAU group, TARGET led to a statistically significant reduction in distress related to PTSD. These improvements were sustained through the 6-month follow-up.
Compared to TAU, PCT led to larger statistically significant reductions in depression than TARGET. For the TARGET group, however, scores continued to decline through the 6-month follow-up. By the 6-month follow-up, TARGET was associated with equivalent sustained reductions in depressive symptoms compared to PCT.
Compared to the TAU group, TARGET led to a statistically significant reduction in anxiety. Scores remained low, below clinical cut-point, at the 6-month follow-up.
Overall, the study by Ford and colleagues (2012) found that TARGET was associated with significant reductions in measures of PTSD symptoms, anxiety, and posttraumatic cognitions compared with the Enhanced Treatment as Usual (ETAU) group. However, the ETAU group showed better improvements on measures of optimism/self-efficacy and reduced anger.
Compared with the ETAU group, participants in TARGET showed significantly greater reductions in PTSD symptoms as measured by the Clinician-Administered PTSD Scale for Children/Adolescent. Specifically, at the 4-month follow-up there were significant reductions for the TARGET in measures of PTSD Criteria B symptoms (intrusive reexperiencing) and Criteria C symptoms (avoidance and emotional numbing) compared with the ETAU group. There was also a significant reduction for the TARGET group in the measure of total PTSD symptoms. However, there was no difference between the groups on PTSD Criteria D symptoms (hyperarousal).
Negative Mood Regulation
There were no differences between the TARGET and ETAU groups on measures of negative mood regulation.
There were significant improvements for the TARGET group on measures of posttraumatic cognitions compared with the ETAU comparison group.
The ETAU comparison group showed significant gains in measures of optimism and self-efficacy compared with the TARGET group at the 4-month follow-up.
There were also no significant differences between the groups on measures of depression.
There were significant improvements on measures of anxiety for the TARGET group compared with the ETAU comparison group at the 4-month follow-up.
The ETAU comparison group showed better improvements on measures of anger compared with the TARGET group at the 4-month follow-up.