What is the TARGET model?
The following steps for regaining equilibrium when in a state of emotional alarm are drawn from the TARGET (Trauma Affect Regulation: Guide for Education and Therapy) model, developed by Ford and colleagues (2015). Based on a neuroscientific and clinically-grounded understanding of how traumatic experience leads to dysregulated emotional activity, they have developed a straightforward approach to re-establishing balance and reorienting one's inner compass when distress becomes overwhelming. This approach was developed to work with post-traumatic distress, but might also be useful for re-orienting when everyday distress threatens to overwhelm our usual coping mechanisms. By enabling us to stop using "experiential avoidance" to manage emotions by completely steering clear of them, approaches like TARGET can get us unstuck, and keep things moving even when the going gets tough.
When distress overwhelms development
In people with PTSD, especially those raised in an abusive and neglectful environment, the necessary skills required to maintain emotional equilibrium and clear-headed thoughtfulness may never have had the chance to develop fully. Basic survival takes priority, getting in the way of rounding out personal and interpersonal development.
In studies of brain networks, researchers (Teicher et al., 2014) have found that the dominant brain regions in adults with significant childhood mistreatment were different from those without significant mistreatment. Notably, maltreatment was associated with decreased involvement of areas related to emotion regulation, self-awareness, self-referential thinking, and the ability to correctly attribute motives and internal states to others. Along with other models to address dysregulated emotional states (e.g., DBT, STAIRS), the TARGET model is evidence-based, having been studied across different populations with a focus on treating PTSD, including in people suffering from developmental trauma. Among other things, the TARGET model has been shown to reduce violent and punitive behavior, improve self-perception, and foster active coping leading to greater self-efficacy. These are also factors associated with increased resilience.
The foundations of the TARGET model
The TARGET model draws upon approaches known as “focusing” and “mentalization,” in which people harness higher brain functions to recognize what is happening when they are caught in traumatic experiences. Over-learning a more adaptive response to distress leads to replacing old automatic habits with new flexible strategies grounded in one's core values and based on thoughtful consideration of choices. The approach is designed to be relatively simple to learn and practice, and has been used effectively with groups and individuals. The formal training is typically conducted over the course of several sessions, but the basic approach is easily grasped.
In providing education about how trauma affects our ability to remain calm and thoughtful, they describe the brain as having three basic areas, using metaphors for complex brain functions: the “alarm center,” the “filing center,” and the “thinking center” When we are caught up in traumatic experiences or high enough levels of distress that our coping mechanisms are overwhelmed, the alarm center takes over from the thinking center, and we go from normal function, or main mode, into survival mode. In survival mode, present experience is too overwhelming for the usual retrieval and processing of what is happening, and memories and response patterns developed in reaction to prior stressful experiences can hijack us and lead us into behaviors which do not fit the current situation.
The FREEDOM Mnemonic
The TARGET model uses seven steps to move from high levels of distress to calm, clear thinking, using the acronym “FREEDOM”:
These seven steps, starting with a basic grounding in what is most important to us, with practice may replace old habits with new. Being reminded of who we are and what is important to us can help to snap us out of the storm of distressing emotions, enough to consider alternatives. Noticing what is triggering us helps to further add context and a sense of self-efficacy, and moves us further away from the state of alarm, which at the time often seems to be our only reality. Taking stock of our emotions, and seeing which are related to alarm and which are not helps us to develop greater emotional awareness, and is additionally grounding. The additional steps further refine decision-making by identifying goals and options available, which are usually much broader than we initially thought. Finally, going through this process again and again until it becomes second nature goes a long way toward creating an overall positive sense of what we can do for ourselves, very different from the helplessness of being caught in traumatic triggers.
Ford, J. (2015). An Affective Cognitive Neuroscience-Based Approach to PTSD Psychotherapy: The TARGET Model. Journal of Cognitive Psychotherapy: An International Quarterly Volume 29, Number 1. http://dx.doi.org/10.1891/0889-8322.214.171.124
Teicher, M. H., Anderson, C. M., Ohashi, K., Polcari, A. (2014). Childhood Maltreatment: Altered Network Centrality of Cingulate, Precuneus, Temporal Pole and Insula. Biological Psychiatry, Aug. 15; 76(4): 297-305.