COMPLEX PTSD
COMPLEX PTSD
Trauma Affect Regulation: Guide for Education and Therapy (TARGET)
Some people have a difficult time finding relief from PTSD with other therapies, and have experience heightened emotional dysregulation such as aggression, impulsivity, self-harm, etc. Advocates for CBT have called for adaptions in the CBT model to more specifically address emotional regulation as a critical prerequisite to the successful use of other CBT treatment for coping and resilience.
Ford, et. al., (2018) state that TARGET teaches cognitive and behavior stills for mindfulness and the ability to adapt and modify stress reactions that are triggered by PTSD and C-PTSD.
According to Ford (2015), Target provides clinicians and clients with strengths-based model of stress-related information and how it is processed in the brain with a practical method for restoring the ability of the brain to process trauma-related thoughts in a manner that allows the client to access the trauma while regulating emotions. "TARGET provides therapists and clients with (a) a neurobiologically informed strengths-based meta-model of stress-related information processing in the brain and how this is altered by PTSD and (b) a practical algorithm for restoring executive functions that are needed to make implicit trauma-related cognitions explicit (i.e., experiential awareness) and modifiable (i.e., planful refocusing)" (pp. 73-74). Several studies have proven that TARGET has been associated with greater reductions in violent incidents and disciplinary sanctions, reductions in depression and anxiety, improvements in sense of hope and engagement, and reductions in drinking in those with drinking problems
"TARGET has been implemented in several statewide behavioral health, juvenile and adult criminal justice systems in the United States, and in multiprogram TARGET Model 83 agencies and organizations in North America and Europe providing mental health, child welfare, juvenile justice, substance abuse treatment, and homelessness services" (Ford, 2015, pp. 83-84).
TARGET is based upon a 10-12 session psychotherapy that is manual-based and has separate individual and group versions for both adults and adolescents as well as for family systems therapy and in-program treatment facilities.
TARGET begins with psychoeducation that explains how PTSD symptoms are processed as a result of how the brain responds to stress. When a person with PTSD is triggered, their brain goes straight into a survival mode with hypervigilance, This survival mode can exhaust the body and brain.
Once the client understand the brain's relation to PTSD symptoms, the clinical and the client will complete a seven step sequence over the course of several sessions that is known by the acronym 'FREEDOM.'
According to Ford (2015), the seven steps include:
Focusing on one thought that you choose based on your core values and self
Recognizing triggers for posttraumatic “alarm” reactions
Distinguishing alarm driven (reactive) vs adaptive (main) Emotions
Distinguishing alarm driven (reactive) vs adaptive (main) Evaluations
Defining adaptive (main) goals distinct from alarm-driven goals
Distinguishing alarm driven (reactive) vs adaptive (main) Options
Making a positive contribution by using these steps to reset the brain's alarm.
In other words, the client will first focus on defining who they are, recognize when their reactions are triggered by their PTSD, tell the difference between their normal emotions vs. their triggered emotions and thought patterns, create goals and find options for how they will act based upon their non-triggered selves, and make steps towards those goals and options.
One method for working on these steps is the SOS acronym:
Slow down and sweep your mind of all thoughts.
Orient yourself by choosing one thought or image that represents what is most important to you in that moment.
Self-check by using a 1-10 rating scale of your stress level and personal control.
TARGET also uses creative therapies and mindfulness to reinforce positive thoughts and reactions.