Clinical Peer-Reviewed
Publications Inventory

Post-traumatic stress disorder (PTSD) is a heterogeneous condition that affects many civilians and military service members. Lack of engagement, high dropout rate, and variable response to psychotherapy necessitates more compelling and accessible treatment options that are based on sound neuroscientific evidence-informed decision-making. Art therapy incorporates elements proven to be effective in psychotherapy, such as exposure, making it a potentially valuable treatment option. This conceptual paper aims to inform the neurophysiological rationale for the use of art therapy as a therapeutic approach for individuals with PTSD. A narrative synthesis was conducted using literature review of empirical research on the neurophysiological effects of art therapy, with supporting literature on neuroaesthetics and psychotherapies to identify art therapy factors most pertinent for PTSD. Findings were synthesized through a proposed framework based on the triple network model considering the network-based dysfunctions due to PTSD. Art therapy’s active components, such as concretization and metaphor, active art engagement, emotion processing and regulation, perspective taking and reframing, and therapeutic alliance, may improve symptoms of PTSD and prompt adaptive brain functioning. Given the scarcity of rigorous studies on art therapy’s effectiveness and mechanisms of alleviating PTSD symptoms, the suggested framework offers a neurophysiological rationale and a future research agenda to investigate the impact of art therapy as a therapeutic approach for individuals with PTSD.

Among disabling post-traumatic stress symptoms (PTSS) are irritability, aggressive behavior, distressing memories and general impaired cognition and negative mood. Art therapy interventions, including mask-making, can potentially alleviate these symptoms. We tested the hypothesis that art conveys emotions and predicted that blinded viewers would be able to perceive changes in theoretically derived emotional profiles expressed in art made by military personnel with PTSS from the onset to the end of therapy. Five service members and veterans exhibiting PTSS were enrolled in an 8-session art therapy protocol, during which they artistically transformed papier-mâché masks at the beginning and end of the protocol. We found that blinded viewers without knowledge of the masks’ creation stage (onset or end of therapy) read initial masks as conveying more negative emotions (e.g., angry, upset, and challenged) and later masks as conveying more positive emotions (calm and pleasure). Based on the assessments from the blinded evaluators, we infer the emotional transition experienced by the participants was expressed in the masks. In an exploratory arm of the study, we also found that viewers were better able to empathize with the negative emotions experienced by participants with PTSS when asked to explicitly take their perspective.

Appreciation for the utility of creative arts therapy in rehabilitation is on the rise. The limitations of conventional approaches to address posttraumatic stress disorder and co-occurring traumatic brain injury is spurring the development and increased use of creative arts therapies, especially in US military health care systems. However, emerging applications of creative arts therapies in rehabilitation extend well beyond posttraumatic stress disorder/traumatic brain injury and military populations to span the continuum of care, from the intensive care unit, postoperative recovery unit, acute inpatient medical and surgical wards, outpatient clinics, and home health, as well as in traditional long-term care and psychiatric settings. Critical steps to more fully integrating creative arts therapies in rehabilitation include the following: (1) incorporation of education about creative arts therapies into the curricula across rehabilitation disciplines; (2) alteration of national and state policies to promote greater inclusion of creative arts therapies as reimbursable treatments for a wide array of clinical diagnoses and conditions; and (3) significant expansion of creative arts therapies’ evidence base. This can be achieved by increasing funding levels to encourage rigorously designed and controlled studies to determine the efficacy, populations, diagnoses and conditions, cofactors, and the mechanisms of action of creative arts therapies. The time has come for a concentrated effort from the community of rehabilitation professional associations, advocacy organizations, and practitioners to promote the advancement and inclusion of creative arts therapies into appropriate clinical settings to optimize outcomes for patients.

Introduction: Studies suggest a relationship between the emotional evocativeness of visual imagery and viewer responses, however, there is limited understanding of these associations, especially as they relate to viewers’ personal experiences of adversities. Methods: In this exploratory study, we examined the relationship between the visual content of mask images and viewers’ responses. In an online survey 699 participants (of n = 1,010 total initial participants) rated 98 masks based on valence, arousal, and personal relevance and completed the Life Events Checklist. The masks included those created by service members (SMs) with traumatic brain injury (TBI), and post-traumatic stress disorder (PTSD), depicting physical, psychological, and moral injuries and matched neutral masks created by creative arts therapists and arts in health scholars. Findings: The findings indicated that responses to mask image content (traumatic versus neutral) were associated with viewers’ personal history of adversity and trauma. Specifically, images representing injury/trauma provoked stronger reactions on valence and arousal than neutral images. Moreover, participants with personal histories of trauma had heightened emotional responses to distressing imagery.

Background: Post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) have negative consequences on the health, rehabilitation, and quality of life for many United States (U.S.) military personnel. Digital technologies offer opportunities for the co-treatment of music therapy and occupational therapy to enhance the rehabilitation of injured service members. Objective: Case study to describe an interdisciplinary approach for comorbid symptoms of TBI and traumatic stress in an active duty service member. Both music therapy and occupational therapy approaches are highlighted. Methods: Case description Results: This intervention supported emotional state shifting from stress/anxiety to calm/regulated to stabilize their respiratory functioning and stress symptoms. Relaxation was further measured using heart rate variability (HRV) via biofeedback. Conclusions: Music technology played an essential role in the co-treatment space. Active music-making through traditional instrumentation and music listening to unaltered recorded songs did not comprehensively address the patient’s treatment goals. Combining a customized music listening tool, relaxation exercises, and HRV biofeedback demonstrated improvement in the service member’s physiological and psychological symptoms. Further investigation is needed to understand the impact of integrating digital music, health technologies, and a supportive co-treatment environment on rehabilitation success.

The use of musical performance in music therapy with active duty military service members is discussed as a vehicle for social transformation and re-integration. The use of musical performance in music therapy is not without controversy. Therapy is considered a process, not a product, and essential components of this therapeutic process are confidentiality and privacy. However, others have argued that public performances can validate therapeutic changes in clients, give voice to clients’ experiences, raise awareness of social issues within their community, transform perceptions of disability or illness in audience members, and provide opportunities to receive support and validation from the community. We discuss the potential of musical performances to contribute to individual development and rehabilitation in active duty service members as well as facilitate change at the community level. We illustrate this through three brief case reports of active duty service members who received music therapy services at the National Intrepid Center of Excellence on base at Walter Reed National Military Medical Center in the USA as part of their treatment of Post-Traumatic Stress Disorder, Traumatic Brain Injury, and other psychological health concerns. The service members selected, learned and refined songs over multiple music therapy sessions, created introductions to each song to share with the audience the meaning of each song and the benefits gained from working with these songs in therapy. The case reports also include excerpts of interviews conducted with these service members several months following their performances about their experiences of the performances themselves and the perceived impact on the community.

Creative arts therapists (art therapists, dance/movement therapists, and music therapists) administer assessments and interventions that support the holistic well-being of military families affected by traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD). Clinical examples illustrate methods used by creative arts therapists to address the neurological, physiological, and psychosocial needs of service members and their families. Creative arts therapists describe areas of need, identify common goals, and present creative arts therapy interventions used with military families. Three vignettes detail the application of creative arts therapy interventions with families, couples, and parent/child dyads. Art therapy, dance/movement therapy, and music therapy interventions were applied in discipline-specific sessions to promote familial bonding. As a result of these sessions, families were better able to identify challenges and discover strengths, improve intra-familial interactions, and create deeper mutual understanding and connectedness, all of which strengthened family resilience and encouraged motivation in other areas of rehabilitation. Creative arts therapies are an integral part of interdisciplinary care to address behavioural and rehabilitative conditions of military families impacted by TBI and PTSD. Future research should examine the efficacy of creative arts therapies in improving resilience in military families.

Chronic pain and access to care are identified as critical needs of the Veterans Health Administration. Music imagery and music listening interventions have shown promise as effective nonpharmacological options for pain management. However, most studies have focused on acute pain, passive music experiences, and in-person delivery. This study aimed to examine the feasibility and acceptability of 2 music interventions delivered through telehealth for chronic musculoskeletal pain, trial design, and theoretical model before conducting a fully powered efficacy or comparative effectiveness trial.

Telehealth provides access to psychotherapeutic interventions and psychoeducation for remote populations that may have limited access to in-person rehabilitation treatments. This paper explores the use of telehealth to facilitate music therapy with service members and veterans living in rural areas across the U.S. and reviews research regarding creative arts therapies delivered through telehealth. The existing evidence base is predominantly focused on art and dance movement therapies and includes little information about music therapy. However, music therapists have begun to use telehealth in clinical and community environments to increase access for remote patients. This article reports on the integration of telehealth and music therapy and presents facilitation techniques of didactic and applied clinical music experiences. This is accomplished through the review of current research, addressing knowledge gaps, and reviewing the evolving models of creative arts therapies delivered through telehealth for military populations.

Purpose: Music therapy has a long history of treating the physiological, psychological, and neurological injuries of war. Recently, there has been an increase in the use of music therapy and other creative arts therapies in the care of combat injured service members returning to the United States from Iraq and Afghanistan, especially those with complex blast-related injuries. This case report describes the role of music therapy in the interdisciplinary rehabilitation of a severely injured service member. Methods: Music therapy was provided as stand-alone treatment and in co-treatment with speech language pathology, physical therapy, and occupational therapy. The report is based on clinical notes, self-reports by the patient and his wife, and interviews with rehabilitation team members. Results: In collaboration with other treatment disciplines, music therapy contributed to improvements in range of motion, functional use of bilateral upper extremities, strength endurance, breath support, articulation, task-attention, compensatory strategies, social integration, quality of life, and overall motivation in the recovery process. The inclusion of music therapy in rehabilitation was highly valued by the patient, his family, and the treatment team. Conclusions: Music therapy has optimized the rehabilitation of a service member through assisting the recovery process on a continuum from clinic to community.

In recent years, there has been increased demand for music therapy services within military treatment facilities to treat combat-related injuries. This demand is partly due to increased research output related to music interventions in neuro-rehabilitation as well as an increased prevalence of signature injuries including traumatic brain injury and posttraumatic stress disorder for which interdisciplinary patient-centered care is recommended. The complexity of traumatic brain injury, posttraumatic stress, and military service itself presents challenges for music therapist when creating patient-centered program models. As military healthcare increases access to new treatments as a standard of care, it is important for music therapists to provide descriptions of effective treatment models in military settings. Outlining established music therapy models of care is essential to the successful addition of music therapy in the treatment of service members’ complex injuries. This paper outlines current program models at two facilities, the National Intrepid Center of Excellence at Walter Reed National Military Medical Center and Intrepid Spirit Center at Fort Belvoir.

Based on the growing need for music therapy programming at military treatment facilities and clinics that specialize in the rehabilitation of service members, this article describes a music therapy group protocol and the findings of 201 post-session evaluations. In addition, we present clinical perspectives and recommendations from three music therapists who have facilitated this group protocol on four military bases across the United States. The group session outlined in the protocol is intended as an introduction to music therapy. It familiarizes service members to various music therapy experiences structured specifically to enhance feelings of safety during emotional risk-taking. In addition, the protocol functions as an initial assessment of service members’ responses to the various receptive and interactive music experiences and includes psychoeducation regarding the role of music therapy in an interdisciplinary treatment model. The post-session evaluation data suggests that service members endorsed this introductory group as moderately to very helpful. Perceived benefits included the opportunity to express various emotions and increased awareness of somatic responses through music. A large number of requests for continued music therapy services following the introductory session suggest that the protocol is successful in facilitating understanding in service members regarding the potential treatment benefits of music therapy in an interdisciplinary care setting. Feedback from the music therapists indicated that the group protocol is a helpful initial experience for service members to acclimate to music therapy, and for music therapists to learn about their patients’ specific needs and inform subsequent treatment.

Music therapy treatment is increasingly being used to promote health, enhance quality of life, and improve functioning in military personnel, but evidence on the use of music interventions with military service members is still emerging. The purpose of this scoping review was to synthesize the available literature regarding music therapy treatment with military personnel by identifying the types of information available, key characteristics, and gaps in the knowledge base. The review was completed using the methodological framework proposed by Arksey and O’Malley. A total of 27 publications met the criteria for review. The results included anecdotal reports, white papers/ briefs, case studies, historical reviews, clinical program descriptions, and research studies. Both active duty and veteran service members were represented in the literature, and post-traumatic stress disorder and traumatic brain injury were the most commonly listed conditions among those served. Music therapy services were offered in both group and individual formats, and drumming was the most common music intervention cited. Most publications accurately represented music therapy, and the historical reviews highlighted the connection between the development of the field of music therapy and the use of music with military personnel. Several gaps were identified, including a lack of specificity in reporting, low levels of evidence, and limited inclusion of women service members.

A successful transition to civilian life is challenging for many service members returning from deployment. Psychological and physical injuries may hamper successful reintegration into home life and communities and, as a result, many service members report feeling lonely, isolated and misunderstood. This study analyzed 14 songs written by 11 active-duty service members with post-traumatic stress disorder, mild traumatic brain injury, and psychological health conditions, who received music therapy services at the National Intrepid Center of Excellence, a Directorate of Walter Reed National Military Medical Center in the United States of America. Service members wrote songs over the course of two or more individual music therapy sessions. Latent thematic analysis of the song lyrics yielded four main themes: (a) personal struggles and barriers to recovery, (b) moving forward, (c)relational challenges, and (d) positive relationships and support. The songs offer a window into service members’ lived experiences of military service, injury, recovery, homecoming, and transition from active-duty. Songwriting enabled service members to share their thoughts, emotions, fears, and hopes with family, friends, and other providers, often for the first time, and as such played an important role in their personal growth and recovery process. This is the first study to examine the therapeutic benefits of songwriting in a military population.

Background: Post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) have negative consequences on the health, rehabilitation, and quality of life for many United States (U.S.) military personnel. Digital technologies offer opportunities for the co-treatment of music therapy and occupational therapy to enhance the rehabilitation of injured service members. Objective: Case study to describe an interdisciplinary approach for comorbid symptoms of TBI and traumatic stress in an active duty service member. Both music therapy and occupational therapy approaches are highlighted. Methods: Case description Results: This intervention supported emotional state shifting from stress/anxiety to calm/regulated to stabilize their respiratory functioning and stress symptoms. Relaxation was further measured using heart rate variability (HRV) via biofeedback. Conclusions: Music technology played an essential role in the co-treatment space. Active music-making through traditional instrumentation and music listening to unaltered recorded songs did not comprehensively address the patient’s treatment goals. Combining a customized music listening tool, relaxation exercises, and HRV biofeedback demonstrated improvement in the service member’s physiological and psychological symptoms. Further investigation is needed to understand the impact of integrating digital music, health technologies, and a supportive co-treatment environment on rehabilitation success.

Appreciation for the utility of creative arts therapy in rehabilitation is on the rise. The limitations of conventional approaches to address posttraumatic stress disorder and co-occurring traumatic brain injury is spurring the development and increased use of creative arts therapies, especially in US military health care systems. However, emerging applications of creative arts therapies in rehabilitation extend well beyond posttraumatic stress disorder/traumatic brain injury and military populations to span the continuum of care, from the intensive care unit, postoperative recovery unit, acute inpatient medical and surgical wards, outpatient clinics, and home health, as well as in traditional long-term care and psychiatric settings. Critical steps to more fully integrating creative arts therapies in rehabilitation include the following: (1) incorporation of education about creative arts therapies into the curricula across rehabilitation disciplines; (2) alteration of national and state policies to promote greater inclusion of creative arts therapies as reimbursable treatments for a wide array of clinical diagnoses and conditions; and (3) significant expansion of creative arts therapies’ evidence base. This can be achieved by increasing funding levels to encourage rigorously designed and controlled studies to determine the efficacy, populations, diagnoses and conditions, cofactors, and the mechanisms of action of creative arts therapies. The time has come for a concentrated effort from the community of rehabilitation professional associations, advocacy organizations, and practitioners to promote the advancement and inclusion of creative arts therapies into appropriate clinical settings to optimize outcomes for patients.

Creative arts therapists (art therapists, dance/movement therapists, and music therapists) administer assessments and interventions that support the holistic well-being of military families affected by traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD). Clinical examples illustrate methods used by creative arts therapists to address the neurological, physiological, and psychosocial needs of service members and their families. Creative arts therapists describe areas of need, identify common goals, and present creative arts therapy interventions used with military families. Three vignettes detail the application of creative arts therapy interventions with families, couples, and parent/child dyads. Art therapy, dance/movement therapy, and music therapy interventions were applied in discipline-specific sessions to promote familial bonding. As a result of these sessions, families were better able to identify challenges and discover strengths, improve intra-familial interactions, and create deeper mutual understanding and connectedness, all of which strengthened family resilience and encouraged motivation in other areas of rehabilitation. Creative arts therapies are an integral part of interdisciplinary care to address behavioural and rehabilitative conditions of military families impacted by TBI and PTSD. Future research should examine the efficacy of creative arts therapies in improving resilience in military families.

Three case studies of veterans are presented who received either art therapy, dance/movement therapy or music therapy via in-home, synchronous clinical video telehealth through a VA medical center in the southeastern United States. As the use of distance technology becomes more widely implemented within healthcare, it becomes increasingly important for providers to receive adequate training and develop comfort and confidence in adapting their practices to distance delivery. Case studies are one way for creative arts therapists to conceptualize and demonstrate how their in-person practices can be adapted for distance delivery via telehealth.