Mothers Overcoming and Managing Stress
Condition: Posttraumatic Stress Disorder; PTSD
MeSH terms: Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic
Study type: Interventional
Phase: Phase 2

Summary: 
      The study is a randomized trial of two manualized 12-session one-to-one educational and
      therapeutic interventions for post-traumatic stress disorder (PTSD), to test and compare
      their efficacy for reducing PTSD symptoms as a means of prevention of intergenerational
      victimization by or involvement in criminal activities with at-risk mothers. The two
      therapies are (1) Trauma Affect Regulation: Guide for Education and Therapy (TARGET) and (2)
      Present Centered Therapy (PCT). The study also included a wait-list comparison condition in
      which participants were offered one of the two therapies following completion of baseline and
      posttest assessments.
    

Detailed description: 
      Hypotheses, Objectives and Aims:

      The study is a randomized clinical trial comparing two stress management counseling
      interventions with a wait-list comparison condition to determine their efficacy in addressing
      behavioral, cognitive, affective, and interpersonal effects of PTSD that often occurs for
      persons living in adverse socioeconomic circumstances and in violent families and
      communities. One goal of the study is to reduce the severity of or produce remission from
      PTSD, in order to reduce impulsivity, aggression, dissociation, and isolation by high-risk or
      previously incarcerated women. The long-term goal, which will be assessed in subsequent
      studies over time is to reduce the likelihood of their or their children becoming involved
      in, or victimized by other persons' involvement in, illegal activities. Children will not be
      involved in the present study, only women who are the mothers of young children.

      Aim #1: To test the efficacy of TARGET and PCT. TARGET (Frisman, L., Ford, J. D., Lin, H.,
      Mallon, S., & Chang, R., 2008) and PCT (McDonagh A, Friedman M, McHugo G, Ford J, Sengupta A,
      Mueser K, Demment CC, Fournier D, Schnurr PP, Descamps M., 2005) have demonstrated efficacy
      in randomized trial studies, but have not been tested specifically with mothers of young
      children. The study will assess outcomes that are of potential importance not only for the
      well being of the participating women but for their ability to develop secure attachments
      with their child which are protective against exposure to violence, crime, and victimization
      and associated with positive psychosocial development by children. Outcome measures reflect
      self-regulatory capacities compromised by trauma that are essential for effective caregiving
      by adults.

      Aim #2: To compare the efficacy of TARGET and PCT on theory-based differential outcomes.
      TARGET and PCT use similar but different therapeutic strategies. Each teaches skills for
      managing negative emotions and critical symptoms (e.g., inhibiting impulsivity). TARGET
      teaches a skill sequence for affect regulation and social/interoceptive information
      processing, while PCT teaches a skill sequence for recognizing and solving problems in
      relationships. We expect that TARGET and PCT will reduce stress-related avoidance and
      depression and enhance active coping with current stressors. TARGET should be superior to PCT
      in enhancing the ability to cope with trauma memories, stress reactivity, and anxiety, and
      therefore the ability to remain free from illegal activities or future or further involvement
      with criminal justice systems. PCT should be superior to TARGET in enhancing the
      participant's overall social adjustment.
    

Intervention name(s): Trauma Affect Regulation: Guide for Education and Therapy; Present Centered Therapy (PCT) - psychotherapy; No-treatment "waitlist" group
Intervention type(s): Behavioral; Behavioral; Other
Intervention description(s): Trauma Affect Regulation: Guide for Education and Therapy (TARGET; Ford & Russo, 2006) is a manualized gender-specific treatment for PTSD. TARGET teaches a practical 7-step sequence of skills for processing and managing trauma-related reactions to current stressful experiences, summarized by a mnemonic ("FREEDOM"), e.g., Focusing ("F"), Recognizing current triggers. TARGET also involves creative arts activities, i.e., personalized "lifelines" via collage, drawing, poetry, and writing that may include traumatic experiences but emphasize "life story" narrative reconstruction with no exposure therapy.; Present Centered Therapy (PCT) is a 12-session supportive therapy adapted a 14-session version co-developed by the first author (McDonagh-Coyle et al., 2005). Psychoeducation is provided about the link between traumatic events, PTSD symptoms, and problems in relationships, and social problem solving skills are taught to address the "traumagenic dynamics" of betrayal, stigma, powerlessness, and sexualization (Finkelhor, 1987). PCT focuses on addressing current problems rather than trauma memory-based exposure therapy, and uses a distinctive mnemonic to organize the skill set. PCT has clients keep a journal of relational stressors and responses as between-session homework.; After a 90 day wait-list period, participants were invited to choose one of the treatment approaches (PCT or TARGET) and engage in 12 sessions of therapy.
Other intervention name(s): Julian Ford; McDonagh-Coyle
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: women; posttraumatic stress disorder; PTSD; psychotherapy; clinical trial; emotion regulation