An Affective Cognitive Neuroscience-Based Approach to PTSD Psychotherapy: The TARGET Model.

Adaptations or alternative versions of cognitive psychotherapy for posttraumatic stress disorder (PTSD) are needed because even the most efficacious cognitive or cognitive-behavioral psychotherapies for PTSD do not retain or achieve sustained clinically significant benefits for a majority of recipients. Cognitive affective neuroscience research is reviewed which suggests that it is not just memory (or memories) of traumatic events and related core beliefs about self, the world, and relationships that are altered in PTSD but also memory (and affective information) processing. A cognitive psychotherapy is described that was designed to systematically make explicit these otherwise implicit trauma-related alterations in cognitive emotion regulation and its application to the treatment of complex variants of PTSD-Trauma Affect Regulation: Guide for Education and Therapy (TARGET). TARGET provides therapists and clients with (a) a neurobiologically informed strengths-based meta-model of stress-related cognitive processing in the brain and how this is altered by PTSD and (b) a practical algorithm for restoring the executive functions that are necessary to make implicit trauma-related cognitions explicit (i.e., experiential awareness) and modifiable (i.e., planful refocusing). Results of randomized clinical trial studies and quasi-experimental effectiveness evaluations of TARGET with adolescents and adults are reviewed.Keywords: posttraumatic stress disorder; complex trauma; psychotherapy; evidence-based practice; emotion regulation; translational scienceCognitive-behavioral approaches to psychotherapy have been the dominant paradigm for clinical practice and the most extensively empirically researched interventions for posttraumatic stress disorder (PTSD; James, James, Cowdrey, Soler, & Choke, 2013; Koucky, Dickstein, & Chard, 2013; Smith et al., 2013; Watts et al., 2013) since that syndrome was formally designated as a psychiatric diagnosis three decades ago in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed.; American Psychiatric Association, 1980). However, even the most efficacious cognitive or cognitive-behavioral psychotherapies for PTSD do not achieve clinically significant benefits for a sizeable minority of recipients (Imel, Laska, Jakupcak, & Simpson, 2013; Watts et al., 2013). Therefore, adaptations of existing cognitive psychotherapies for PTSD are needed to retain and effectively benefit treatment nonresponders. This article will describe an approach to developing enhanced cognitive psychotherapies for PTSD based on a translation of the growing research literature on cognitive and affective neuroscience. To show how this translational clinical neuroscience approach can be practically applied, a specific emotion regulation-focused intervention model for neuroscience-informed cognitive therapy of PTSD- Trauma Affect Regulation: Guide for Education and Therapy (TARGET) -will be described with a summary of the model's research evidence base and dissemination infrastructure.Cognitive Psychotherapy for PTS DBritish cognitive restructuring therapy models, the German Narrative Exposure Therapy model, and three American cognitive behavioral therapy models (cognitive processing therapy, eye movement desensitization and reprocessing, and prolonged exposure) have been found to be efficacious and safe with sustained benefits in randomized clinical trial studies with adults seeking treatment for PTSD related to a range of accidental and interpersonal/violent traumatic stressors (Adenauer et al., 2011; Bryant et al., 2008; Foa et al., 2005; Jayawickreme et al., 2014; Jeffreys et al., 2013; Koucky et al., 2013; Marks, Lovell, Noshirvani, Livanou, & Thrasher, 1998; Resick, Williams, Suvak, Monson, & Gradus, 2012; Robjant & Fazel, 2010; Tarrier, Sommerfield, Pilgrim, & Humphreys, 1999). Similarly, positive outcomes have been reported with traumatized children and adolescents in randomized controlled trial studies of therapies that emphasize cognitive restructuring (e. …