Sponsored by The Rhode Island Foundation

In Collaboration with Rhode Islanders Sponsoring Education




Robert M. Cicione, LICSW


Originator and Founder of T.R.U. Method

T.R.U. Treatment Provider

Project Director



Abbreviated Report:  For full report copy

Contact Robert M. Cicione, LICSW

(401) 941-2664



Report Submitted August, 2000




Project Outline and Development


            The treatment phase began in May.  Ten R.I.S.E. students took the Trauma Symptom Checklist for Children-Alternative Version (TSCC-A) a nationally recognized, standardized test for PTSD in children.  This “before test” established a clinical baseline for treatment.  Three other cross-checking tools were also instituted before treatment.  A Parent Questionnaire that consisted of ten questions about their child’s behavior was administered to parents of participating students.  A second questionnaire was given to teachers to record changes in student behavior.  Finally, a weekly inventory by the therapist was administered to each student monitoring changes in common symptoms of PTSD including flashbacks, nightmares, anxiety attacks, violent episodes and depression.  Each student was subsequently treated in three successive weekly sessions with the T.R.U. method.  Two weeks following the last treatment session the student took the “after test”, i.e. a second TSCC-A test.  Scores on the “before test” and “after test” were subsequently tabulated, compared and analyzed.  A second post test, approximately three months after the treatment, is planned.  This post test would add a longitudinal perspective to the project.


A Brief History



The Trauma Relief Unlimited method took nearly twenty years to develop.  The first fifteen years, I used a variety of art related exercises on myself as a form of my own self-therapy.  At a very early stage, I recognized the psychological value of art to bolster the human spirit and to cleanse those residuals from the self that tended to sap that spirit.  In effect, I observed that art was an incredibly powerful process for ridding oneself of excess anxiety and for raising one’s spirits.  In short, the incredible renewal, rejuvenation and revitalization power of art was recognized and acknowledged.


            The convergence of the recognition of the revitalization power of art and the need to find a more effective way to treat trauma survivors resulted in the birth of the T.R.U. method.  Six years ago, I began using what I knew about art to treat others.  I began developing a right-brain, non-verbal protocol to treat patients.  After many changes and refinements, the T.R.U. method was developed into what it is today.  (Note attached T.R.U. brochure and Description of Treatment).  In effect, the T.R.U. method is a streamlined version of traditional Art Therapy.  Whereas Art Therapy takes several months to get results, T.R.U. takes one to six weeks.  In the case of a one-episode trauma consistent and reliable results occur in one 45-minute application.  Unlike traditional Art Therapy that has historically been used almost exclusively with children under 12 years old, the T.R.U. method is user friendly for all ages.  In short, the T.R.U. method represents a major breakthrough in treating trauma survivors surpassing in effectiveness both traditional Art Therapy and more commonly used left-brain, talk therapies.


Design of Pilot Project



            The first design objective was to treat a significant number of actual trauma survivors from the general population of 110 R.I.S.E. students.  A significant sample of ten students was ultimately selected from the general population.  All ten students participating had experienced other traumatic episodes in addition to the separation trauma of incarceration noted above.  All ten had experienced at least one episode of physical abuse, sexual abuse, rape, or the death of a close family member.  Thus, the first objective of selecting actual trauma survivors for this pilot was achieved.


A second objective was to provide a sufficient number of applications of the T.R.U. method to provide necessary scientific data of observable change.  Three such T.R.U. treatment applications were provided by Robert M. Cicione, L.I.C.S.W.  This series of three weekly treatment sessions was preceded by a Psycho-Social Evaluation of each student.  This was a fairly standard Psycho-Social Evaluation commonly used for initial intake in the psychotherapy field.  It served to summarize the psychosocial experience of each student and to provide an overview for the therapist.  A particular emphasis was placed on significant trauma experiences reported by each student.  In all cases, at least three major trauma episodes were identified for treatment.  In some instances, more than three were reported. 


            A third objective of the pilot design was to provide more than one series of observations of change in student behavior.  In actuality, four series of data were tracked adding to scientific validity and reliability.  In addition to those observations of the therapist noted above, there were three others.  A second series of data came from the standardized test, the TSCC-A.  Note the “before and after” data graph attached and the report of the Psychometrist attached.  Both the tool itself and Dr. Willis’ interpretation of results are valuable measures of the power and effectiveness of the T.R.U. method.  A third data stream was produced by a questionnaire given to parents.  (Note attached graph that indicates parent observations of change).

            From a design perspective, it is important to note that multiple observation and data collection streams add to scientific validity and reliability.  Important for our purposes, all four data collections support the direction, if not the degree, of positive changes.  In short, the therapist, the parents, the teachers, and the standardized testing device all point to the power and effectiveness of the T.R.U. method.


Pilot Project Conclusions and Recommendations



            This Trauma Relief Unlimited (T.R.U.) Pilot Project presents scientific data to support the breakthrough impact of this new and innovative methodology.  The data speaks for itself. 


            From a need standpoint, with the growing concern about violence, especially in schools, there seems to be little doubt about the potential of the T.R.U. Program to meet the challenge of safety.  And this is but one possible application.  Concerns about the growing incidence of domestic violence would seem to offer another obvious application.  The violence reduction and elimination data of the project would seem to overwhelmingly support T.R.U. effectiveness in violence prevention and elimination.  The possible applications in this connection would seem to be virtually unlimited.



Trauma Relief Unlimited (T.R.U.) Method Effectiveness Report



Compiled and written by Dr. Christopher S. Willis, Ph.D. with assistance from Robert M. Cicione, LICSW, the treating clinician and data collector.



            This pilot project examines the effectiveness of the T.R.U. method in reducing the psychological symptoms commonly associated with post-traumatic stress disorder in children; specifically anger, anxiety, depression, dissociation, and post-traumatic stress.  It is hypothesized that the T.R.U. method will reduce the frequency of these symptoms.




          Each subject completed the Trauma Symptom Checklist for Children-Alternate Version (TSCC-A) as a pre-treatment and post-treatment measure.   The TSCC-A is a self-report measure of post-traumatic distress and related psychological symptomatology.  Forty-four items yield five clinical scales (anger, anxiety, depression, dissociation, and post-traumatic stress) and two validity scales (under-response and hyper-response).  Reliability analysis of the TSCC-A scales in the normative sample (N=3008) demonstrated high internal consistency (alphas range from .82 to .89).  Convergent, discriminant, and construct validity data are provided in the TSCC Professional Manual (Briere, 1996).



            A clinical interview was conducted as part of an initial intake evaluation and prior to each treatment session.  Subjects responded to regular therapist inquiries regarding the frequency of violence, angry outbursts, nightmares, flashbacks, and anxiety attacks.  Subjects also indicated a level of depression (1-5) at each session.  Frequencies were reported in terms of the number of times per week they experienced the particular category.


            The mothers of nine subjects responded to a parent questionnaire as a pre- and post-treatment measure.  Mothers indicated the frequency (1=Never to 4=Almost Always) with which they observed their children engaged in ten types of behavior/feelings (e.g., “I observe my child getting into fights”).




            Prior to treatment, subjects reported significantly higher frequency of anger (M = 52.5, SD = 10.4) than they did following the treatment (M = 43.5, SD = 6.8), t (9) = 3.55, p < .01.  Subjects reported significantly greater pre-treatment depression (M = 54.2, SD = 11.6) than they did post-treatment (M = 42.4, SD = 5.8), t (9) = 3.15, p < .05.  Pre-treatment levels of post-traumatic stress were reported at a significantly higher level (M = 54.0, SD = 9.9) than they were following the treatment protocol (M = 40.8, SD = 6.0) t (9) = 3.67, p < .01.


            The difference between the pre-treatment levels of anxiety reported on the TSCC (M = 52.4, SD = 10.8) and the post-treatment levels (M = 42.5, SD = 6.4) approached statistical significance, t (9) = 2.18 p < .058).  (See table 1 next page)



Table 1. Pre – and Post – Treatment Scores for TSCC Factors


   Pre Treatment

  Post Treatment






















































            A marked decrease in dissociation from pre-treatment levels (M = 54.0, SD = 13.2) to post-treatment levels (M = 46.7, SD = 14.7), was not statistically significant, t (9) = 1.38, p = .200.  However, one subject indicated a significant increase in dissociation following an assault that occurred near the end of his treatment.


            The total frequency of post-traumatic symptoms reported also showed a marked decrease over the course of the treatment.  (See figure 2).  The total number of symptoms (violence, angry outbursts, nightmares, flashbacks, and anxiety attacks) reported by the subject to the therapist dropped from a mean of 8.58 per week (Evaluation Session) to 0.4 per week (Third Treatment Session).


            The frequency of observed behaviors and feelings that the mothers of the subjects reported also decreased as a result of the treatment.  The mean pre-treatment score for the Parent Questionnaire was 8.22 (N=9).  The mean post-treatment score was 3.67.  (See figure 3).




            The findings of this pilot project indicate that the T.R.U. method effectively reduces psychological symptoms associated with post-traumatic distress.  Improvement in functioning was noted via self-report measures, clinician interview, parent report, and teacher report.



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