Sponsored by
The Rhode Island Foundation
In
Collaboration with Rhode Islanders Sponsoring Education
T.R.U.
Treatment Provider
Project
Director
Contact Robert
M. Cicione, LICSW
(401) 941-2664
Report Submitted August,
2000
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.
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.
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.
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.
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.
METHOD
Measures
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”).
RESULTS
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 |
|
|
|||
|
Variable |
Mean |
SD |
Mean |
SD |
df |
t-value |
Signif. |
|
Anger |
52.5 |
10.4 |
43.5 |
6.9 |
9 |
3.55 |
.006 |
|
Anxiety |
52.4 |
10.8 |
42.5 |
6.4 |
9 |
2.18 |
.058 |
|
Depression |
54.2 |
11.6 |
42.4 |
5.8 |
9 |
3.15 |
.012 |
|
Dissociation |
54.0 |
13.2 |
46.7 |
14.7 |
9 |
1.38 |
.200 |
|
Posttraumatic Stress |
54.0 |
9.9 |
40.8 |
6.0 |
9 |
3.67 |
.005 |
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).
DISCUSSION
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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