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.
Ford and colleagues (2008) used a randomized control trial to study the effect of Trauma Affect Regulation: Guide for Education and Therapy (TARGET) on posttraumatic stress disorder (PTSD) symptoms and on stress management. A group of 147 low-income, multiethnic mothers, ages 18 to 45, were drawn from the Hartford, Conn., area and randomly assigned to one of three groups: waitlist treatment as usual (TAU, n=45); Present Centered Therapy (PCT, n=53); or TARGET (n=49). Exclusion criteria included substantial cognitive impairment, being on suicide watch, and being younger than 18. Inclusion criteria included parenting a child younger than 5 and a current diagnosis of partial or full PTSD.
Participants in the study were 39 percent European American, 33 percent African/Caribbean American, and 28 percent Latina or mixed race. Most participants lived alone; 30 percent had not completed high school, 27 percent were high school graduates, 21 percent had attended some college, and 22 percent were college graduates. Seventy-two percent had a comorbid anxiety or affective disorder with PTSD. Participants showed extensive exposure to psychological trauma; all demonstrated either full or partial PTSD. All participants in the study were female.
PCT provides psychoeducation about the link between trauma experience and PTSD, and focuses on the development of social problem-solving to enhance relationships. Individuals in the PCT received 12 sessions of supportive therapy. TARGET participants received individual counseling in 12 weekly sessions. The TAU individuals received no treatment.
Instruments used to assess measures of interest included the Traumatic Events Screening Inventory; the Clinician Administered PTSD Scale; the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (DSM–IV–TR); the Beck Depression Inventory; State–Trait Anxiety Inventory, State Version; the Posttraumatic Cognitions Inventory; the Interpretation of PTSD Symptoms Inventory; the Generalized Expectancies for Negative Mood Regulation; and Health-Related Functioning. Symptoms were assessed prior to treatment and at posttreatment; the treatment groups (but not the waitlist control group) were assessed again at 3- and 6-month follow-ups.
Therapy was delivered by eight female therapists with either doctoral degrees in clinical psychology or psychiatry or master’s degrees in social work, counseling, or marriage and family therapy. Therapists received 40 hours of training in TARGET and PCT.
Intent-to-treat analyses used mixed method regression. Covariates included age, marital status, education, ethnicity, and comorbid psychiatric disorders. Attrition was low in both treatment groups (between 6 percent and 10 percent).
Ford and colleagues (2012) conducted a randomized controlled trial involving delinquent girls (ages 13–17) who met the following criteria: a) self-reported delinquency (based on national Delinquency Study criteria) and b) full or partial posttraumatic stress disorder (based on the Clinician-Administered PTSD Scale for Children/Adolescent [CAPS–CA] structured diagnostic interview). Study participants were recruited from November 2006 to April 2008 in Hartford, Conn., from school, health clinics, protective services offices, and residential treatment centers.
The 59 delinquent girls were randomized to either the treatment group, which received TARGET (n=33) or to Enhanced Treatment as Usual (ETAU) (n=26). The ETAU was designed to provide relational support in dealing with current life problems. The female study participants were 59 percent Latina or mixed race, 25 percent white (European American), and 16 percent black (African/Caribbean American). More than one third (37.5 percent) of the study group were in Department of Children and Families guardianship, and that same percentage had prior arrests for violent crimes. There were no significant differences between the groups on demographic or outcome measures, except on one measure: TARGET participants had greater symptoms of PTSD according to Criterion B on CAPS–CA, compared with ETAU group participants.
The primary outcome of interest was diagnoses for PTSD and partial PTSD using the CAPS–CA, which is a structured interview that assesses DSM–IV–TR categorical diagnoses for PTSD. The items assessed the intensity (from none to extreme distress) and frequency (from never to daily or almost every day) of each PTSD symptom. Ordinal symptom severity scores were calculated for PTSD overall and for Criteria B (intrusive reexperiencing), Criteria C (avoidance and emotional numbing), and Criteria D (hyperarousal) from the CAPS–CA. In addition, the Generalized Expectancies for Negative Mood Regulation Scale, a 30-item scale, was used to measure self-perceived ability to identify, manage, and utilize adaptively a variety of negative emotion states using a 1-5 scale (from strongly agree to strongly disagree). Subscales from the Trauma Symptom Checklist for Children, a 54-item questionnaire, were used to measure anxiety, depression, and anger. The items were rated from 0 (never) to 3 (almost all the time). The Posttraumatic Cognitions Inventory, a 36-item questionnaire, measured self-reported measures of posttraumatic beliefs related to the world, self, and self-blame. Finally, the Hope Scale, a six-item questionnaire, assessed dispositional hope (self-efficacy and optimism).
The baseline assessment interviews were conducted 14 to 21 days before the girls began treatment. A posttest interview was conducted about 4 months after the baseline interview. To examine the collected data, intent-to-treat analyses were done with all participants regardless of missing data, using mixed-modal regression.
These sources were used in the development of the program profile:Study 1
Ford, Julian D., Karen L. Steinberg, Kathie Halback Moffitt, and Wanli Zhang. 2008. Breaking the Cycle of Trauma and Criminal Justice Involvement: The Mothers Overcoming and Managing Stress (MOMS) Study. Final Report to the U.S. Department of Justice
. Farmington, Conn.: University of Connecticut Health Center.http://www.ncjrs.gov/pdffiles1/nij/grants/222910.pdfStudy 2
Ford, Julian D., Karen L. Steinberg, Josephine M. Hawke, Joan Levine, and Wanli Zhang. 2012. “Randomized Trial Comparison of Emotion Regulation and Relational Psychotherapies for PTSD With Girls Involved in Delinquency.” Journal of Clinical Child & Adolescent Psychology
These sources were used in the development of the program profile:
Ford, Julian D., and Eileen Russo. 2006. “Trauma-Focused, Present-Centered, Emotional Self-Regulation Approach to Integrated Treatment for Posttraumatic Stress and Addiction: Trauma Adaptive Recovery Group Education and Therapy (TARGET).” American Journal of Psychotherapy
Ford, Julian D., Karen L. Steinberg, Josephine Hawke, Joan Levine, and Wanli Zhang. 2012. “Randomized Trial Comparison of Emotion Regulation and Relational Psychotherapies for PTSD with Girls Involved in Delinquency.” Journal of Clinical Child and Adolescent Psychology
Ford, Julian D. Karen L. Steinberg, and Wanli Zhang. 2011. “A Randomized Clinical Trial Comparing Affect Regulation and Social Problem-Solving Psychotherapies for Mother With Victimization-Related PTSD.” Behavior Therapy
Ford, Julian D. and Josephine Hawke. 2012. “Trauma Affect Regulation Psychoeducation Group and Milieu Intervention Outcomes in Juvenile Detention Facilities.” Journal of Aggression, Maltreatment & Trauma
21(4):365–84. (This study was reviewed but did not meet CrimeSolutions.gov criteria for inclusion in the overall program rating.)
Frisman, Linda K., Julian D. Ford, Hsiu–Ju Lin, Sharon Mallon, and Rocio Chang. 2008. “Outcomes of Trauma Treatment Using the TARGET Model.” Journal of Groups in Addiction and Recovery
Knudsen, Kraig. 2008. “TARGET Evaluation.” Columbus, Ohio: Ohio Department of Mental Health, Office of Program Evaluation and Research. (This study was reviewed but did not meet CrimeSolutions.gov criteria for inclusion in the overall program rating.)http://mha.ohio.gov/Portals/0/assets/Funding/research-evaluation/tsig-evaluation/target-program-evaluation.pdf
Marrow, Monique T., Kraig Knudsen, Erna Olafson, and Sarah E. Bucher. 2012. “The Value of Implementing TARGET Within a Trauma-Informed Juvenile Justice Setting.” Journal of Child and Adolescent Trauma