Trauma Affect Regulation: Guide for Education and Therapy (TARGET) is a manualized, trauma-focused psychotherapy for both female and male adolescents (and also adults) suffering from posttraumatic stress disorder (PTSD). TARGET teaches skills for processing and managing trauma-related reactions to stressful situations, such as PTSD symptoms, traumatic grief, survivor guilt, and shame. The goal of treatment is to help individuals regulate intense emotions and gain control of posttraumatic stress reactions. It provides a framework for understanding and managing trauma memories and affecting dysregulation. Therapy focuses on the client’s core values and hopes, resilience, and client strengths. 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.
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 main thoughts/self-statements.
- Define. An activity to help individuals determine and define their main personal goal(s).
- Option. An activity where individuals identify one choice that represents a successful step toward the main 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.
In a three-year randomized clinical trial study, funded by OJJDP, TARGET, delivered as a 12-session individual therapy for PTSD with sixty-one 13-17 year old delinquent girls, was superior to a gender-specific relational therapy in reducing PTSD avoidance/numbing and intrusive re-experiencing by more than 50%. In a 2-year study funded by OJJDP, each Target session attended (delivered as a systemic intervention to 12-17 year old boys and girls in juvenile detention centers) was associated with a 22% decrease in disciplinary incidents and 37 fewer minutes of seclusion in the first 14 days of stay. In addition, youth with severe trauma histories/symptoms had 50% greater benefits.
Developmental trauma exposure
Early and persistent noncompliant behavior
High alcohol/drug use
Broken home/changes in caretaker
Family history of problem behavior/criminal involvement
Poor parental supervision (control, monitoring, and child management)
Low school attachment/bonding/motivation/commitment to school
Poor school attitude/performance; academic failure
Association with antisocial/aggressive/delinquent peers; high peer delinquency
Crime Solutions: Effective
Ford, J. D., and Hawke, J. (2012). Trauma affect regulation psychoeducation group and milieu intervention outcomes in juvenile detention facilities. Journal of Aggression, Maltreatment & Trauma, 21, 365-384.
Ford, J. D., Steinberg, K.L., Moffitt, K.H., and Zhang, W. (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.
Ford, J. D., Steinberg, K.L., Hawke, J.M., Levine, J. and Zhang, W. (2012). Randomized trial comparison of emotion regulation and relational psychotherapies for PTSD with girls involved in delinquency. Journal of Clinical Child & Adolescent Psychology, 41, 27–37.