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



Report Submitted August, 2000






            As Director of the Trauma Relief Unlimited (T.R.U.) Pilot Project, I am pleased to acknowledge the many people who made this project possible.  First and foremost, I am deeply indebted to my wife, Joan McLaughlin, Director of Marketing and Training for the T.R.U. Program, for her unwavering support, valuable suggestions and constant faith in me and the T.R.U. method.


            I am grateful to Dr. Ronald Gallo, President of the Rhode Island Foundation, and his staff, for funding this project.  Dr. Gallo immediately recognized the “ breakthrough” potential of the T.R.U. method.


            Many thanks to Dr. Kevin Vigilante, Co-Founder of Rhode Islanders Sponsoring Education (R.I.S.E.), for offering the R.I.S.E. Program as a venue for the project.  Dr. Vigilante’s agreeing to guide and “mentor” me throughout the project was always helpful, if not critical, to the project’s development and completion.


            Particular thanks to Kristen Heffenreffer-Moran, Executive Director of R.I.S.E., for approving the project and offering administrative leadership and assistance throughout the project.


            The help of Anna Morales, M.S.W., Administrator at R.I.S.E. was invaluable, particularly during the implementation stages of the project.  Her skills in coordinating the various involved parties including R.I.S.E. students, their parents, school administrators, teachers and others was greatly appreciated.


            Many thanks to the four participating school administrators and their assistants.  At times, I was amazed at how smoothly the project went.  Without their help, the going would have been much more difficult, if not impossible.


            I am grateful for all the parents, students and teachers who gave their time and attention to the project, often “beyond the call of duty”.  Their participation in filling out questionnaires and giving attention to differences in student performance was valuable in giving validity and perspective to the project.


            Speaking of validity and reliability, many thanks to Dr. Christopher Willis for providing the necessary scientific perspective.  Dr. Willis was particularly helpful with data tabulation and analysis at the conclusion of the project.


            Many thanks to Dr. Vicki Moss, Dr. Tom Guilmette, Dr. Raymond Kilduff, Ms. Rebecca Silver and the folks at Western Psychological Services for their help in choosing an appropriate test for the project.


            Finally, I am very grateful to the ten R.I.S.E. students who participated in this study.  Ultimately, without their willingness and cooperation, this project would not have been possible.



Robert M. Cicione, L.I.C.S.W.


Project Outline and Development


The Trauma Relief Unlimited Pilot Project was truly a collaborative venture between The Trauma Relief Unlimited (T.R.U.) Program, Rhode Islanders Sponsoring Education (R.I.S.E.), and The Rhode Island Foundation.  T.R.U. provided the treatment methodology, application and overall design of the project.  R.I.S.E. and its associated schools provided the venue, support personnel, students and coordination of the various aspects of the project.  The Rhode Island Foundation provided the funding.


            The project commenced in February 2000 when the Rhode Island Foundation approved a $5,000 grant.  During the next two months, T.R.U. and R.I.S.E. worked together to design and organize the project.  Project participants were selected; the support and participation of parents/guardians and school authorities was solicited, and treatment schedules at four participating R.I.S.E. network schools were established.  Also, appropriate tools to measure change in student attitude, behavior and performance were selected.  A “before and after” format was chosen to demonstrate the power and effectiveness of the T.R.U. method.


            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.


            Approximately seven years ago, a professionally traumatic episode changed the course of my career.  I had been treating abuse survivors for years using traditional left-brain, talk therapies.  In this instance, it took nearly two years for this particular patient to access and to share one of the most disturbing and ghastly episodes of physical/sexual abuse I had heard before or since.  Within twenty-four hours of that disclosure, this person made a serious suicide attempt resulting in hospitalization.  I can recall sitting in the psychiatric hospital reflecting on this episode.  I knew then there had to be a better way.


            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.


            From the experience of the very first T.R.U. treated patient, I knew the power and effectiveness of this new methodology.  A one-episode molestation survivor was able to unload nearly fifty years of weekly flashbacks and nightmares with three applications of the treatment.  Today with refinements to the process, symptom extinction would likely occur in this case with one application of T.R.U.  After treating hundreds of similar patients during the past six years, the results are convincing.


            However, in this empirically/scientifically based culture of ours, there is a need to produce more than one’s own personal experiences or even one’s professional observations.  In January of this year, I began looking for a sponsor for a pilot project that would produce the first empirical evidence of the power and effectiveness of T.R.U. 


Design of Pilot Project



            The Rhode Islanders Sponsoring Education (R.I.S.E.) Program provided a valuable venue for observing the effects of the T.R.U. method.  R.I.S.E. is a network of 23 schools providing education to approximately 110 students.  All students are from “high risk”, inner city environments.  All had experienced at least one trauma through the incarceration of at least one parent, usually mother.  Of the ten participating students, most had experienced this separation trauma before the age of eight.


            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.  In this instance, the therapist, with student input, chose those three most significant for treatment.  Usually, the most severe were treated. One student for instance, had been raped three times in addition to multiple episodes of physical abuse and the aforementioned incarceration separation trauma.  Because the sexual episodes were most likely to cause the most psychological damage, they were given priority for treatment.


            The Psycho-Social Evaluation also provided a baseline for therapist observations of change in common trauma symptoms.  Accordingly, the therapist noted on a weekly basis the number of

common trauma symptoms including flashbacks, nightmares, anxiety attacks, violent episodes and depression.  In the later case, a five-point scale of depression was used to note changes in suicidal material and in vegetative signs.  (Note the graph and data sheets of therapist observations of symptom changes attached here: Graph 1  and Graph 2).

The  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).  Finally, a fourth collection of data came from the teacher reports.  An attempt was made to get quantitative teacher evaluations of the student behavior change.  Because of some teacher confusion in interpreting the form and in inconsistencies of reporting, quantitative data from teachers is not reported.  However, in more than one-half of all the cases, positive comments were noted by teachers about changes in student behavior.  This was quite significant in itself since one would expect academic changes to have many roots in addition to previous trauma experiences.  Moreover, positive teacher responses were remarkable since the study occurred at the end of the school year.  Although not an educator, I wonder if there isn’t a momentum – positive or negative – as the school year moves on.


            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.  The data warrants a more formal, more extensive, research project that would erase any lingering doubts about the power and effectiveness of T.R.U.  Perhaps a study with a larger sample, or one with a control group, would add to scientific validity and reliability.


            From a human standpoint, a more formal study, greater in scope, might also afford the opportunity to treat more people in need.  Perhaps all abuse survivors in the R.I.S.E. Program, for instance, could be treated under an expanded format.  Perhaps, other programs serving other populations of trauma survivors could be considered.


            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.


            From an economic perspective, T.R.U. offers a great opportunity to address problems of violence and abuse with “cost effectiveness”.  The brief intervention nature of the methodology could save both economic and human resources to address a variety of problems.  The fact that T.R.U. is transferable suggests that others could be trained in a relatively short period of time.  Moreover, comparisons to other methods seem to suggest that the method itself is “easier on the therapist” than other thought intensive methods.  The fact that symptoms, once eradicated do not recur, suggests the mounting tide of abuse and violence could be abated.  More importantly, “the cycle of abuse”, often generational, could be broken.


            There is a willingness to pursue any and all objections to T.R.U., including doing a more formal research project.  At some point, however, this method needs the support of all interested community members to meet even a fraction of some of the problems facing us as a society.  Once again, the pioneering support of the Rhode Island Foundation has been greatly valued and appreciated.


            For further information, contact Robert M. Cicione, LICSW at (401) 941-2664.


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”).


            Teachers of the subjects were also asked to respond to a pre- post-treatment Student Status Report.  Confusion with the form resulted in inconsistent quantitative data, however, qualitative data are reported.



            Eight males and two females, ranging in age from 8 to 14, were selected from nominations made by the administrative director of Rhode Islanders Sponsoring Education (RISE).  All subjects attended a non-public inner-city school.  Seven were African-American, two were Hispanic, and one was Caucasian.  All had a history of one parent being incarcerated at some point in time.



            Each subject was met by the T.R.U. therapist for an evaluation session prior to beginning treatment.  Demographic information and pre-treatment data were collected at that time.  Following the evaluation session, subjects were met by the therapist for three treatment sessions.  The intervention was time limited because it was felt that three treatment sessions were sufficient to significantly reduce the frequency of symptoms and provide relief from post-traumatic distress.  Financial limitations were also a consideration.  (An additional session was provided to one subject who was assaulted during the weeks he was in treatment.)  The mean time between the evaluation session and the collection of post-treatment data was 38.6 days (median = 35).  Post-treatment data was collected within two weeks of the final treatment session.




            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).



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 teachers of five subjects noted an improvement following the treatment.  Comments included; “(EL) shows many fewer incidents of crying and getting upset…better able to handle conflicts appropriately.”  “(TP) is “less argumentative,…improvement in making up work.”  “(AA) has had several days when he does all assigned work.  I have really noticed a change in a positive direction.”  “(SM’s) attendance has improved.”


            The teachers of two subjects reported no positive changes.  Three teachers provided no report of change following the treatment.




            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.


            Threats to the validity of these findings include the small sample size (N=10) and the fact that the treatment protocol was conducted by a single therapist.  Further research with larger samples of clients and additional therapists is recommended.  As the T.R.U. method purports to impact the non-verbal, right-brain imprinting of the traumatic experience, a non-verbal measure of effectiveness (e.g., Draw-A-Person) should be added to the pre- and post-treatment test battery.



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