Study 1
Ford and colleagues (2008) used a randomized controlled 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, Connecticut area. Exclusion criteria included having substantial cognitive impairment, being on suicide watch, and being younger than age 18. Inclusion criteria included parenting a child younger than age 5 and having a current diagnosis of partial or full PTSD. The 147 mothers were randomly assigned to one of three groups: 1) a waitlist, treatment-as-usual (TAU) comparison (n = 45); Present Centered Therapy (n = 53); or the trauma-focused psychotherapy program, TARGET (n = 49). The CrimeSolutions review of the study focused on the comparison between mothers in TARGET and mothers in the TAU group.
Participants in the study were 39 percent white, 33 percent Black (African/Caribbean American), and 28 percent Latina or mixed race. Most participants lived alone (42 percent had never married, and 22 percent were divorced, separated, or widowed). About 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. There were no statistically significant differences in baseline characteristics between mothers in the TARGET and TAU groups, except for emotion regulation and depression. The TARGET group had higher emotion regulation and lower depression scores, compared with TAU group mothers.
Outcomes of interest were PTSD symptoms, depression, anxiety, and emotion regulation. Symptoms were assessed prior to treatment and at posttreatment for the TARGET treatment and waitlist TAU comparison groups. PTSD was measured using the Clinician Administered PTSD Scale to assess diagnoses for full PTSD and partial PTSD. The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (i.e., the DSM–IV–TR) was administered to assess anxiety. A 21-item Beck Depression Inventory (BDI) measured depression: scores greater than or equal to 19 indicated clinical-level depression, and scores greater than or equal to 30 indicated severe depression. The State–Trait Anxiety Inventory measured symptoms of anxiety using a 0–4 scale. Scores greater than 40 were considered clinical range, and scores greater than 50 were considered severe. Emotion regulation was measured through a 30-item Generalized Expectancies for Negative Mood Regulation Scale. Participants’ self-perceived ability to identify, manage, and utilize adaptively a variety of negative emotion states was assessed using a 1–5 scale (from strongly agree to strongly disagree).
A mixed method regression was used with covariates such as age, marital status, education, ethnicity, and comorbid psychiatric disorders controlled for within the intent-to-treat analysis. The study authors did not conduct subgroup analyses.
Study 2
Ford and colleagues (2012) conducted a randomized controlled trial involving delinquent girls (ages 13–17) who met the following criteria: 1) self-reported delinquency, based on National Delinquency Study criteria; and 2) full or partial posttraumatic stress disorder, based on the Clinician-Administered PTSD Scale for Children/Adolescents (CAPS–CA) structured diagnostic interview. Study participants were recruited from November 2006 to April 2008 in Hartford, Connecticut, from schools, health clinics, protective services offices, and residential treatment centers.
There were 59 delinquent girls who were randomized to either the treatment group, which received TARGET (n = 33), or to the Enhanced Treatment as Usual (ETAU) group (n = 26). The ETAU provided the girls with relational support in dealing with current life problems through clinical observations and helped them build a sense of emotional connection in healthy relationships. The female study participants were 59 percent Latina or mixed race, 25 percent white, 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, 45 percent were living in residential treatment facilities due to severe behavioral problems, and 37.5 percent had prior arrests for violent crimes. There were no statistically significant differences between the groups on demographic or outcome measures, except in symptoms of PTSD for Criterion B, at baseline. The TARGET group had a greater number of symptoms, compared with the ETAU group.
Data were collected at baseline and at a posttest interview (approximately 4 months after the baseline interview). The baseline assessment interviews were conducted 14 to 21 days before the girls began treatment. The outcomes of interest were the scores for PTSD diagnoses; for three diagnoses for PTSD (Criteria B, C, and D); and for emotion regulation, posttraumatic cognitions, anxiety, depression, anger, and hope.
Full and partial PTSD diagnoses were measured through the CAPS–structured interview, which assesses DSM–IV–TR categorical diagnoses for PTSD and rates the intensity and frequency of each PTSD symptom on a 0–4 scale ([0 = none; 4 = extreme distress] and [0 = never; 4 = daily or almost every day]). Ordinal symptom severity scores were calculated for the categorial diagnosis of PTSD for Criterion B (intrusion), Criterion C (avoidance), and Criterion D (hyperarousal). The 30-item Generalized Expectancies for Negative Mood Regulation Scale measured emotion regulation. Subscales from the 54-item Trauma Symptom Checklist for Children questionnaire were used to measure anxiety, depression, and anger (0 = never; 3 = almost all the time). Experiences of posttraumatic cognition were measured through a 36-item questionnaire on self-reported measures of posttraumatic beliefs related to the world, self, and self-blame. Hope was measured through a 6-item scale that assessed self-efficacy and optimism. A mixed model regression was used to analyze differences between adolescents in the TARGET and ETAU groups (which included all participants regardless of missing data). The study authors did not conduct subgroup analyses.
