The Effects of A Therapeutic Martial Arts Program on Youth in Residential

Psychiatric Treatment


Submitted to the A.D. Williams Committee, February 1, 2003


Principle Investigator

Brian Hill, LCSW, Assistant Professor

Team Leader and Therapist for the Residential Treatment Program

The Virginia Treatment Center for Children



The efficacy of traditional martial arts programs applied toward mental health issues is well documented.  Over the course of the last twenty years, proliferating research into therapeutic martial arts programs has allowed an academic and professional exploration of alternatives to traditional psychotherapy. Therapeutic martial arts programs benefit difficult to reach, oppositional, seriously emotionally disturbed and delayed children and adolescents.  Evidence exists for effective adjunctive and alternative therapeutic martial arts programs as treatment modalities.  This study will add to the field by using objective behavioral evidence as well as psychometrics to explore the effects of therapeutic martial arts in a residential psychiatric treatment center.  Our goal is to show how this alternative treatment can reduce violence and increase emotional well-being in troubled youth.


Although the literature supports most assertions regarding the beneficial results of martial arts training (MAT) in adults, a much more limited base exists regarding children and adolescents.  These studies have focused primarily on school based programs, selecting students at-risk for behavioral problems, or those already identified with serious emotional disturbance or behavioral problems, as subjects.  The focus has been the effects of MAT on aggression, self-esteem, behavioral problems, and prevention.


Early research (Nosanchuk, 1981) indicated MAT increased self-control, assertiveness, self-esteem and self-confidence.  Importantly, Nosanchuk and MacNeil later (1989) determined that “modern” or non-traditional MAT which discounts meditation, values of peace, etc. was found to increase aggressive behavior. Further, increased dosage of treatment exposure (longer training time) created a heartier result.  The 1989 study also identified what the authors considered key elements in conducting therapeutic MAT, including instructor characteristics (restraint, parental figure, and faith in the student,) values and ethics, and finally techniques focusing on conflict resolution.


Numerous studies (Madden, 1995; Rothpearl, 1980; Kurian, Caterino & Kulhavy, 1993) have focused on the various personality characteristics found in martial artists, and how martial arts training can mediate these traits.  Self-esteem, self-concept, anxiety, hostility, assertiveness and aggressiveness were studied to determine what factors in MAT have greatest impact on personality traits.  Konzak and Boudreau (1984) pointed out the possibility for adults to use MAT as a means of self-help, moderating the above mentioned personality or emotional issues without the need for psychotherapy.  Reynes and Lorant (2001) studied personality characteristics of children in MAT programs and found that children choosing martial arts training were not more aggressive than their peers, of particular interest for researchers studying levels of aggression in children in MAT programs. 


Trulson (1986) studied the effects of traditional MAT in his important work with juvenile delinquent youth in a community setting, and also found significant benefits in decreased aggressiveness and anxiety, and increased self-esteem and social skills.  Of note, the youth’s MMPI scores for juvenile delinquency measured in the normal range post- treatment.  Again, those youths engaged in modern style MAT, which focuses on fighting and competition, showed no improvement.  Twemlow and Sacco’s  (1996) violence reduction, conflict resolution, and bully-victim studies in schools include using both concepts of martial arts as well as direct application of MAT classes.  Although the study does not focus on research involving a residential treatment setting, the authors cite a case study showing the efficacy such a program might hold, and make recommendations for program curricula and instructor qualifications.  Zivin, et al (2001) duplicated several school- and community-related MAT programs, and were able to again demonstrate the effectiveness on various dependent variables associated with violence and delinquency within as few as 30 sessions.


The work of Weiser, Kutz, Kutz, and Weiser (1995) argued that MAT should be used as an adjunctive psychotherapy due to its simultaneous intervention on physical, interpersonal, and intrapsychic levels.  MAT can foster and expose feelings through a physical mode, for example, which may then be addressed through other modes of therapy.  Gleser and Brown (1988) found that in their work with children of varying disabilities including mental retardation and attention deficits, the use of a martial arts program improved their levels of physical and psychosocial functioning.  The principles inherent in the martial art paralleled significantly with certain mainstream psychological constructs.   Fuller (1988) also points out the similarities between numerous psychological concepts and martial arts concepts.   Fuller advocated the use of aikido, a Japanese martial art, perhaps most suited to work with the mental health field.  He cited the work of Madenlian (1979) who compared an aikido MAT program with traditional group psychotherapy, finding gains on the Piers Harris Self Concept Scale greater for the MAT program than for the group therapy.


Fuller’s (1988) assertions that aikido matches the needs of psychotherapeutic programs are well taken.   The concepts of blending, non-violence, peaceful conflict resolution, centering, and non-competitiveness inherent in aikido practice make it an ideal modality to approach emotionally disturbed children and adolescents.  Fuller’s criticism of therapeutic martial arts research points out areas needing more thorough examination, especially regarding the ingredients of training and characteristics of instructors. 


The therapeutic MAT literature does not include research applied specifically to youth placed in long term mental health treatment settings.  The currently proposed study focuses on the effects of a therapeutic martial arts program on severely emotionally disturbed children and adolescents in an urban residential treatment program.  The subjects are residents within the program for significant time duration (6-12 months).  Measuring objective behavioral progress and incidents of aggression can be easily and accurately accomplished due to the high level of structure, supervision and ongoing documentation by nursing staff.  Psychometric investigation typical of prior research with community based MAT programs will focus on internal emotional or cognitive effects of the treatment.  It is hypothesized that incidents of behavioral acting out, aggression, and seclusion will decrease during and after participation in the MAT program.  In addition, we expect that rating of self-concept and self-control will increase.


Objectives of the proposed study:

1)      Examine the effects of a therapeutic martial arts program on youth placed in residential psychiatric treatment, specifically exploring aggression, self-concept, and self-control.

2)      Conducting research on the effects of therapeutic martial arts in a controlled, objectively measurable environment to further the field and provide more valid basis for the work.

3)      Provide the basis for externally funded research investigating alternative methods for treating aggression in the most treatment resistant populations. 

4)      Provide a seed program for the Virginia Treatment Center for Children to focus on special programs for violent children.



1)      Behavioral incidents requiring documentation (time out, aggression, seclusion) will decrease between the start of the therapeutic martial arts program and its end. 

2)       The therapeutic martial arts program will positively affect scores on measurements of self-concept (Piers-Harris Children’s Self-Concept Scale) and self-control (Children’s Perceived Self-Control Scale).

3)      Documentation of youths’ ability to demonstrate positive behavior (as measured by points earned) will increase as a result of the therapeutic martial arts program.

4)      Follow up (three months) will indicate that the effectiveness of the training will decrease over time.




The youth will be 40 randomly selected males and females from a children and adolescent residential psychiatric treatment program population.  The ages of the subjects may range from 8-17 years old.  Due to the nature of the treatment program, which is on average 6-8 months in duration, the patients typically have multiple Axis 1 DSM-IV diagnoses, as well as Axis II diagnoses including Learning Disorders and other developmental disabilities. Generally, most if not all have had serious issues with aggression, impulse control, oppositional and defiant behavior, and school problems. VTCC has 30 beds for residential treatment; consequently, we estimate that 12 months of data collection will yield 40 subjects.  A power analysis (Cohen, 1992) indicates this is a sufficient number of subjects for the planned analyses.



From the population of the residential program, twenty subjects will be randomly selected and divided into a treatment group (Group A) and a wait-list control group (Group B).  The treatment group will receive enhanced treatment in the form of a therapeutic martial arts program for ten weeks, twice weekly for 45-60 minutes each session, while the wait-list group will receive typical residential treatment services. Once group B moves into treatment phase, a new wait list (group C) group will be randomly selected from newly admitted residents.  This process will continue until Group D has completed treatment. Every group will be administered the measures pre- and post-treatment, as well as have behavioral progress tracked.


The martial arts groups will consist of stretching warm-up, followed by daily review of behavioral expectations including the philosophy of traditional martial arts training.  Same sex dyads will practice the physical techniques of self-defense to prevent the risk of inappropriate touching.  During the instruction, the subjects will also learn anger management and conflict resolution techniques.  Each class will end with a meditative relaxation exercise.  Follow-up measures will be completed at three-month periods for six months post-treatment.  Objective behavioral indexes will be tallied every month until the youth is discharged to follow behavioral progress post-treatment.  The instructor will be the principle investigator, who is a clinician as well as a qualified martial arts teacher.



Discrete behaviors are directly observed and documented on behavioral program point sheets every half-hour by 24 hour nursing staff and behavioral counselors.  The counselors are trained to recognize and provide consequences for negative behavior.  The following behaviors are tallied to determine progress on a monthly basis:

1)      Incidents of aggression towards peers or staff

2)      Time Out (to be used as an index of self-control, anger management, and use of coping skills)

3)   Out of control or dangerous behavior requiring seclusion or therapeutic holding


Self-Concept Measure

Piers Harris Children’s Self-Concept Scale (PHCSCS)

The PHCSCS is well known, written on a 3rd grade reading level, designed for 7-18 year olds.  The PHCSCS was on 1,183 students grade 4-12, and showed test-retest reliability coefficients from.42 to .96, with a median test-retest reliability of .73.  This test reported internal consistency coefficients ranging from .88 to .92 for the total score and from .73 to .81 for the cluster scales (Forgan, 2000).


Self-Control Measure

Children’s Perceived Self-Control Scale (CPSC)

This 11-item instrument was developed by Humphrey (1982) to measure children’s perceptions of their self-control from a cognitive-behavioral perspective.  The instrument measures three aspects of self-control: interpersonal, personal, and self-evaluation.  An overall measurement of self-control may be gleaned from the instrument, as well as the individual subscale indexes.  The CPSC has been reported (Humphrey, 1982) to have satisfactory (.71 for total scores, ISC=.63, PSC=.63, SE=.56) reliability, but no data on internal consistency is available.  Evidence for concurrent validity has been minimal, however naturalistic observations correlated highly with ISC.


Data Analysis

Data will be analyzed to provide summary statistics for the sample (e.g., ranges, means, standard deviations for key demographic and outcome variables).  Repeated Measures Analysis of Variance will be used to compare means on outcome variables measured across time.  These analyses will determine whether children have changed significantly over time in terms of self-control, self-concept, and aggression.  These analyses will also indicate whether specific groups of children (i.e. age groups or gender groups) differ in the magnitude of their change over time. In these analyses, the wait-list condition will be used to determine if the martial arts treatment is more or less effective in reducing aggression, improving self-concept, and improving self-control than standard treatment procedures in the residential treatment program.  All statistical analyses will be conducted using SPSS, version 11 (or updated versions, as needed).



The study is limited by a small pool of participants (n=40), which impacts the ability to provide a matched control group, due to the time constraints and small capacity of the residential treatment program being utilized.  Also, although the participants will be randomly selected, their ages will be quite varied, and the mixed gender construction of the group complicates the picture.  The control group although receiving the basic residential treatment, will not get any placebo treatment during the program, and they will not be matched with the treatment group.


The Therapeutic Martial Arts Program will be developed and implemented at the Virginia Treatment Center for Children.  Should the Committee fund the program, it will provide the seed for a research program which will be designed to study the many ways in which violence effects our youth, and the cutting edge means of treating those hardest to reach.  With this seed money, a program will be developed attracting federal and state funding for violence prevention and treatment that serves the converging needs of the academic, civic, and private communities.  Interest has already sparked in the community by requests for collaboration with our planned program, which will allow for a larger scale evaluation of violence prevention.



Month 1                       Submit IRB Proposal, Prepare Training Room

Months 2-10                Data Collection

Month 11                     Data Analysis and Interpretation

Month 12                     Report and manuscript preparation; prepare proposal for external funding