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Using Human and Computer-Based text Analysis of Clinical Notes to Understand Military Service Members' Experience with Therapeutic Writing

Description

Article authored by Creative Forces creative arts therapists. Open access provided by Creative Forces.

"Background: Therapeutic writing has been shown to improve both physical health and emotional well-being. This paper examines the usefulness of clinical notes as a data source, and presents two different analyses of individual clinical notes of therapeutic writing group sessions: analysis performed by a person and analysis by a computer-based program (Pennebaker et al., 2015). The therapeutic writing sessions were offered during the second week of treatment at the National Intrepid Center of Excellence (NICoE) as part of an integrative care model for service members (SMs) with traumatic brain injury and underlying psychological conditions to include post-traumatic stress disorder (PTSD).

Method: Therapeutic writing sessions were facilitated in the art therapy studio at the NICoE. The sessions were documented in the military healthcare system’s patient record application by the art therapist and art therapy interns at the NICoE. Clinical notes were informed by SM self-report surveys and clinician observations. Notes from May 2012 to 2015 and were pulled and coded manually for emerging themes, then separately analyzed by a computer software text content analysis program (Pennebaker et al., 2015).

Results: Overall, SMs reported more positive than negative, neutral, or mixed emotions during and after the therapeutic writing experience. Some reported a change from negative to positive emotions through the writing process, and many described experiencing relief during and after sessions. SMs wrote on a wide range of topics. Most SMs kept their writing pieces, although some destroyed them or shared them with others, and a few SMs gifted the pieces. Computerized-based analysis (Pennebaker et al., 2015) indicated that work and social were the most prominent content theme areas. It also showed that positive emotions were more evident than negative emotions in the clinical notes and that the focus of the writing pieces was primarily on the present rather than on the past or the future.

Implications: Many SMs perceived the therapeutic writing experience as therapeutic, a relevant coping skill, and enjoyable. Some, however, preferred to work on art therapy projects they had begun in previous sessions (such as mask-making) during the writing sessions. The computer-based analysis of the clinical notes took much less time than the human analysis, but it did not produce results of comparable richness or nuance. Computer-based analysis of the actual therapeutic writing pieces may provide deeper insights into the content and themes that emerged during this therapeutic intervention."

Authors
Landless, B. M.
Walker, M. S.
Kaimal, G.
Publisher
Topic
Creative Forces Clinical Research
Therapeutic Writing
Vol/Issue
Volume 62, February 2019, Pages 77-84
Posted
Media Types
Journal Article
2

Using Distance Technology to Deliver the Creative Arts Therapies to Veterans: Case Studies in Art, Dance/Movement and Music Therapy

Description

"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."

Authors
Spooner, H.
Lee, J. B.
Langston, D. G.
Sonke, J.
Myers, K. J.
Levy, C. E.
Publisher
Topic
Art Therapy
Creative Forces Clinical Research
Telearts and Telehealth Engagement
Vol/Issue
Volume 62, February 2019, Pages 12-18
Posted
Media Types
Publications and Presentations
Journal Article
3

Songs Created by Military Service Members in Music Therapy: A Retrospective Analysis

Description

Article authored by Creative Forces creative arts therapists. Open access provided by Creative Forces.

"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."

Authors
Bradt, J.
Biondo, J.
Vaudreuil, R.
Publisher
Topic
Creative Forces Clinical Research
Music Therapy
Vol/Issue
Volume 62, February 2019, Pages 19-27
Posted
Media Types
Journal Article
4

Music Therapy Applied to Complex Blast Injury in an Interdisciplinary Model: A Case Report

Description

Open access provided by Creative Forces.

"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."

Authors
Vaudreuil, R.
Avila, L
Bradt, J.
Pasquina, P.
Publisher
Topic
Creative Forces Clinical Research
Music Therapy
Vol/Issue
Volume 41, 2019 - Issue 19
Posted
Media Types
Journal Article
5
6

Art Therapy Interventions for Active Duty Military Service Members with Post-Traumatic Stress Disorder and Traumatic Brain Injury

Description

Article authored by Creative Forces creative arts therapists. Open access provided by Creative Forces.

"This paper provides an overview of short and long-term art therapy treatment approaches, used in the USA, for military service members with post-traumatic stress disorder and traumatic brain injury. The described clinical approaches are based on the theoretical foundations and the art therapists’ experiences in providing individualised care for the unique needs of the patient population. The art therapy models and directives are designed to be more therapist-led in the short-term model, moving on to an increasingly patient-led format in the long-term treatment model. The overall objectives of art therapy are: to support identity integration, externalisation, and authentic self-expression; to promote group cohesion; and to process grief, loss, and trauma. In addition, programme evaluation is used in both settings as a means to understand participants’ experiences and the perceived value of art therapy."

Authors
Jones, J. P.
Walker, M. S.
Drass, J. M.
Kaimal, G.
Publisher
Topic
Art Therapy
Creative Forces Clinical Research
Vol/Issue
23/2
Posted
Media Types
Journal Article
7

Art Therapy for PTSD and TBI: A Senior Active Duty Military Service Member’s Therapeutic Journey

Description

Article authored by Creative Forces creative arts therapists. Open access provided by Creative Forces.

"Art therapy is increasingly being accepted as a form of complementary and integrative care for military veterans affected by trauma and injuries in the line of duty. Less is known, however, about the applications of art therapy for co-morbid traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). In addition, most studies to date have focused on art therapy with veterans (former military service members) rather than with active duty service members; furthermore, there are no studies that have examined the unique context of PTSD in senior military personnel. This case study presents the therapeutic process through art therapy in the case of a senior active duty military service member (with chronic PTSD and TBI), in the context of an integrated model of care that included medical and complementary therapies."

Authors
Walker, M.
Kaimal, G.
Koffman, R.
DeGraba, T. J.
Publisher
Topic
Art Therapy
Creative Forces Clinical Research
Vol/Issue
Volume 49, July 2016, Pages 10-18
Posted
Media Types
Journal Article
8

Advances in Creative Forces® Clinical Research and Applications of the Creative Arts Therapies for Treating PTSD and TBI in Military-Connected Populations

Description

Compelling preliminary evidence put forth by Creative Forces research supports use of the creative arts therapies in promoting rehabilitation and recovery for military and veteran populations exposed to trauma. To date, the 19 studies published by Creative Forces Network-affiliated researchers provide preliminary support for using creative arts therapies. Together, the findings justify continued growth of the program so that the nation’s military personnel, and families and caregivers, receive greater access to these therapies, as informed by best practices. This article was prepared for and published on the Creative Forces National Resource Center on July 15, 2020. Individual sections on: I. Creative Arts Therapies PTSD and TBI Research, II. Creative Forces Clinical Research, III. Arts Therapy, IV. Music Therapy, V. Telehealth, and VI. Conclusion can be found under Insights.

Topic
Art Therapy
Creative Arts Therapies
Creative Forces Clinical Research
Dance/Movement Therapy
Music Therapy
Telearts and Telehealth Engagement
Therapeutic Writing
Posted
Media Types
Lit Review
White Papers
9

Active-Duty Military Service Members’ Visual Representations of PTSD and TBI in Masks

Description

Article authored by Creative Forces creative arts therapists. Open access provided by Creative Forces.

"Active-duty military service members have a significant risk of sustaining physical and psychological trauma resulting in traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). Within an interdisciplinary treatment approach at the National Intrepid Center of Excellence, service members participated in mask making during art therapy sessions. This study presents an analysis of the mask-making experiences of service members (n = 370) with persistent symptoms from combat- and mission-related TBI, PTSD, and other concurrent mood issues. Data sources included mask images and therapist notes collected over a five-year period. The data were coded and analyzed using grounded theory methods. Findings indicated that mask making offered visual representations of the self related to individual personhood, relationships, community, and society. Imagery themes referenced the injury, relational supports/losses, identity transitions/questions, cultural metaphors, existential reflections, and conflicted sense of self. These visual insights provided an increased understanding of the experiences of service members, facilitating their recovery."

Authors
Walker, M.
Kaimal, G.
Gonzaga, A. M. L.
Myers-Coffman, K. A.
DeGraba, T. J.
Publisher
Topic
Art Therapy
Creative Forces Clinical Research
Vol/Issue
12/1
Posted
Media Types
Journal Article
10

A Case Analysis of Service-Member Trauma Processing Related to Art Therapy within a Military-Intensive Outpatient Program

Description

Article authored by Creative Forces creative arts therapists. Open access provided by Creative Forces.

This case study describes a mask-making art therapy directive facilitated by a board-certified art therapist as an adjunct to group post traumatic stress disorder (PTSD) treatment in a military-intensive outpatient program.  Described in the study are clinical outcome measures, linguistic analysis of a personal journal, evaluation of this service-member's artwork, and his experiences in the program.  Mask-making—as a trauma-focused group-art therapy directive—expanded the understanding of the service member’s treatment progress as reflected in journal notes, mask imagery, and by a change in linguistic indices of trauma processing, despite an overall increase in PTSD symptoms as he confronted his traumatic experiences. The service member reported improvement in coping and successfully returned to full military duty following treatment.  This case study suggests that art therapy and written narrative, combined with standardized self-report assessments, may more accurately indicate improvement in overall PTSD treatment.

Authors
Maltz, B.
Hoyt, T.
Uomoto, J.
Herodes, M.
Publisher
Topic
Art Therapy
Creative Forces Clinical Research
Posted
Media Types
Journal Article