The Effects of A Therapeutic Martial Arts Program on Youth in Residential
Psychiatric
Treatment
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.
Hypotheses
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.
Methodology
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
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).
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
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