Study Shows TEMAS Psychological Diagnostic Test Can Treat Anxiety and Depression in Minority Children

TEMAS Touro College Graduate School Psychology Giuseppe Costantino

Giuseppe Costantino, Ph.D., holds TEMAS cards used to treat post-traumatic stress disorder in children following 9/11 terrorist attacks

Graduate School of Psychology Professor Giuseppe Costantino  has co-authored a book chapter that will be published later this year on the results of a study showing that TEMAS, a multicultural picture-based psychological diagnostic test that he developed, actually helped reduce anxiety and depression in Latino children presenting post-traumatic stress disorder following the 9/11 terrorist attacks within three months of treatment.

The study demonstrated that TEMAS (an acronym for ‘Tell Me a Story’), traditionally used as a multicultural diagnostic tool, could also be used as a therapeutic treatment modality. The book chapter as well as a presentation at the American Psychological Association (APA) Convention in San Diego in August 2010 were based on a new statistical analysis of the study’s findings by Graduate School of Psychology Dean Louis H. Primavera, Ph.D.

The chapter, written by Dr. Costantino, Dr. Primavera and Touro Professor of Educational Administration and Leadership Dr. Robert Malgady, is entitled, “Culturally Competent, Evidence-Based Treatment for Post-Traumatic Disaster Trauma Symptoms in Latino Children.” It will appear in the book, Cultural Competence in Assessment, Diagnosis and Psychotherapy with Ethnic Minorities, edited by Dr. Malgady and published both in print and electronically by Bentham Science Publishers.

The TEMAS study was part of a consortium of research conducted at 10 different sites in New York City that participated in the Child/Adolescent Trauma Study (CATS) focusing on the traumatic effects of the 9/11 terrorist attacks. The original TEMAS research was conducted at P.S. 24 in Sunset Park, Brooklyn, from 2002 to 2005 and was presented at various national and international conferences. The initial research and the new statistical analysis by Dr. Primavera, which demonstrated that the reduction in depression and anxiety took place within three months after treatment began, were presented at the 118th Annual APA convention in San Diego. Presentation co-author Erminia Costantino added a new element to the APA presentation as well with each section of the study being paired with a child’s drawing of the 9/11 attacks.

“The importance of this study is that it shows the utility and effectiveness of TEMAS as a culturally competent evidence-based treatment modality for minority children,” said Dr. Costantino. “The results show that both the TEMAS treatment and cognitive behavior therapy (CBT) were equally successful in reducing post-traumatic stress disorder symptoms but TEMAS was superior to CBT in reducing anxiety and depression symptoms in this case. Dr. Primavera conducted some additional analysis to clarify that the reduction of symptoms occurred within the first three months.”

The original study was funded by FEMA (Federal Emergency Management Agency) with a competitive grant administered by the New York State Office of Mental Health. The focus of the grant was to find children who were affected by the 9/11 terrorist attacks on the World Trade Center and to offer them therapeutic treatment to reduce the symptoms of anxiety, depression and post-traumatic stress disorder. The grant—$250,000 a year for three years—was awarded to the Lutheran Medical Center in Brooklyn, where Dr. Costantino worked at the time.

In the TEMAS study, Dr. Costantino and his colleagues compared individual cognitive behavioral therapy treatment, which involves talking to a therapist about traumatic experiences, with the TEMAS narrative group treatment modality in which pictures are used as a therapeutic technique to motivate patients to tell stories about their traumatic experiences. The study involved 172 mostly Latino children in grades 4 and 5 at P.S. 24, where on a clear day students could see the Twin Towers from the school. “We realized that the TEMAS cards could be used as therapeutic stimuli. The children still told stories but from a therapeutic point of view instead of a diagnostic point of view,” Dr. Costantino said.

In his poster presentation at the APA conference attended by more than 12,000 psychologists and mental health professionals last August, Dr. Costantino wrote, “Additional research is needed to further establish TEMAS as an evidence-based treatment with Hispanic/Latino as well other minority youngsters. However, in this study, TEMAS, a group therapy, showed to be a more valid modality and more cost effective in reducing symptoms within a brief treatment format of three months than the TF-CBT (trauma-focused cognitive behavior therapy), conducted as an individual treatment modality.”

TEMAS Touro College Graduate School Psychology Dr. Louis Primavera Giuseppe Costantino APA

Dr. Costantino, left, with Graduate School of Psychology Dean Louis H. Primavera, Ph.D., at APA Convention in San Diego

The initial findings of the study were published in 2009 in the Italian psychological journal Link Rivista Scientifica di Psicologia. As a result, Dr. Costantino was invited to present the TEMAS therapeutic modality at a psychology conference in Teramo, Italy, so it could be utilized with children affected by the 2009 earthquake in L’Aquila, Italy. “They are in the process of using the TEMAS therapeutic techniques that I used here with children affected by 9/11 to reduce depression, anxiety and post-traumatic stress disorder symptoms in hundreds, if not thousands, of children impacted by the earthquake in L’Aquila.”

TEMAS was initially developed by Dr. Costantino in the late 1970s as a psychological testing instrument. The standardization of the TEMAS test was conducted in collaboration with Dr. Malgady and Dr. Lloyd Rogler at the Hispanic Research Center at Fordham University. In the field of psychological testing in both the United States and internationally, TEMAS is widely seen as the first valid multicultural test to assess culturally and linguistically diverse children between the ages of five to 18, Dr. Costantino said.

The test consists of color picture cards (either nine in the short form or 23 in the complete version) depicting characters and settings specific to different cultural groups. There are two different versions of TEMAS—a minority-focused test for Hispanic/Latino and African-American children and adolescents, and a non-minority test for white children and teens.

Currently, Dr. Costantino is developing a third version of the test—a Jewish-themed TEMAS that will provide an accurate psychological assessment of Jewish children and adolescents based on the religious denominations and ethnic diversities of Jews living in the United States and Israel. Dr. Primavera is supervising the development of the new Jewish TEMAS. Dr. Costantino is working closely with Dr. Richard Waxman, associate dean of the Graduate School of Psychology, and Dr. Yair Maman, chair of Touro’s Master of Science in Mental Health Counseling Program, on the content of the cards, and Dr. Malgady is writing the research design for the new Jewish TEMAS test. Artist Phil Jacobs, who did the artwork for the original TEMAS, is designing the illustrations for the new Jewish-themed cards, and Dr. Anthony J. Polemeni, vice president of the Division of Graduate Studies, is providing financial support for the artwork from the division.

Originally from Calabria, Italy, Dr. Costantino came to New York to study psychology in his 20s. He earned a BS in industrial psychology from Baruch College, an MS in school psychology from City College and a doctorate in clinical community psychology from New York University. Following his studies at NYU, he became chief psychologist at the Sunset Park Mental Health Center at the Lutheran Medical Center in Brooklyn in 1977. In 1984, he became clinical director of the Sunset Park Mental Health Center and in 2005 he took on the role of director of research and training. He worked concurrently as research associate for the Hispanic Research Center at Fordham University from 1978 to 2000. In 2008, Dr. Costantino joined Touro’s Graduate School of Psychology as a professor of psychology.

Dr. Costantino said that in addition to TEMAS, the majority of his published work in the field of psychology is based on storytelling such as Cuento Therapy—the use of folktales as a therapy modality with Latino children and their mothers—and Hero/Heroine Modeling Therapy—the use of biographies of historical and contemporary political and sports figures from Puerto Rican culture who serve as symbolic role models in the treatment of Latino adolescents.

Dr. Costantino attributes his focus on storytelling as a diagnostic and therapeutic modality to the influence of his mother. “I’ll tell you why my research work revolves around storytelling. My mother was a very clever woman who taught me by telling me stories since my early childhood. Every time I did something wrong, she told me a story with a character who did the right thing, and every time I did something right, she told me a story of someone who got rewarded for doing the right thing. She was a master storyteller and used that as a teaching and upbringing technique.”

He even credits his mother’s storytelling for inspiring him to seek an education and become the very first professional from a very poor family from southern Italy.  “My mother was a woman who only had an elementary school education. But she had this intelligence of using stories to educate a little kid, which I think is unique. I was the first person in my family to earn a doctorate degree. I humbly concluded that this was due to my mother who really trained and motivated me to achieve by using fairly tales. It also worked with my younger brother Mario who became a medical doctor.”

Dr. Costantino noted that he had another important article published in the Journal of Consulting and Clinical Psychology in October 2009 based on a new theoretical construct called “Cultural Congruence.” The article entitled, “Congruence between Culturally Competent Treatment and Cultural Needs of Older Latinos,” was written at Touro by Drs. Costantino, Primavera and Malgady based on research conducted from 1998 to 2003 at the Lutheran Medical Center. The initial study was funded by SAMHSA (Substance Abuse and Mental Health Services Administration), a branch of the National Institutes of Health. The October 2009 article is based on a new analysis of the study’s findings and the newly developed cultural congruence theoretical construct.

“Cultural congruence is a construct that takes into consideration two factors: the cultural competence of organizations such as hospitals, outpatient clinics and medical and/or mental health centers which provide the services, and the cultural needs of the patient,” Dr. Costantino said. “If the cultural competence of the organization meets the cultural needs of the patient, then the services and the treatment are effective. If these two factors diverge, then the services and the treatment are not effective.

“The importance of this study is that it introduced a novel concept in cultural competence and actually demonstrated the importance of providing effective services to culturally diverse individuals,” he added. “Cultural congruence tends to reduce barriers to healthcare and reduce health disparities among minority patients. Other psychologists and psychiatrists had written about this construct theoretically but it was never previously linked to outcome treatment. No one had conducted a study linking cultural congruence to treatment service outcome and we did.”

This article was written by Gail Schiller

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