Advances in Creative Forces® Clinical Research and Applications of the Creative Arts Therapies for Treating PTSD and TBI in Military-Connected Populations
Compelling preliminary evidence put forth by Creative Forces research supports use of the creative arts therapies in promoting rehabilitation and recoveryfor 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 published on the Creative Forces National Resource Center on July 15, 2020 and updated on December 22, 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.
Creative Forces Conceptual Frameworks Phase 2 Final Report
The Creative Forces®: NEA Military Healing Arts Network is committed to conducting and disseminating rigorous biomedical and behavioral research conducted in clinical settings, focusing on the biological, psycho-social, and comparative cost effectiveness of impacts and effectiveness of art therapy, music therapy, dance/movement therapy, and therapeutic writing on service members, veterans, families and social networks. The conceptual frameworks for art therapy, music therapy, dance/movement therapy, and therapeutic writing guide research proposals toward the clinical needs of military-connected patients served by Creative Forces patients and similar programs.
In 2021, Creative Forces is implementing a systematic research program. Findings will be used to further advance research and treatment for military-connected populations, as well as other clinical treatment groups. Creative Forces also aims to promote research collaboration across the partnering federal agencies, private foundations, state agencies, etc., to advance knowledge, leverage subject-matter expertise, and promote the use of best practices to benefit targeted patient populations. Specifically, the research will identify the optimal content, timing, frequency, duration, and candidates for these therapies. The conceptual frameworks establish a theoretical foundation for research activities, identify the intended outcomes for the creative arts therapies disciplines, and explain how the interventions achieve those outcomes. This is essential groundwork for theory-driven research. The conceptual frameworks reflect the differences in the level of development of clinical practice and research in art therapy, music therapy, dance/movement therapy, and therapeutic writing. For art therapy and music therapy, the proposed research questions included underlying hypotheses based on theory and research in the respective fields. Through stakeholder input and an iterative review process, one question was prioritized for each of the two disciplines and serves as the basis for the RCTs proposed in those conceptual frameworks. A progressive research program was designed for dance/movement therapy, leading to a conceptual framework. The proposal for therapeutic writing creates a foundation for using common protocols across Creative Forces sites and for exploratory research.
Music and Mind LIVE is a weekly webinar series with Renée Fleming, in conversation with scientists and practitioners exploring the powerful impact of music and arts on human health and the brain produced by the John F. Kennedy Center for the Performing Arts. This episode examines the impact of the music and arts therapy on veterans, highlighting the work of Creative Forces, the National Endowment for the Arts' Military Healing Arts Network. Partnering with the U.S. Departments of Defense and Veterans Affairs, this program works to improve the health of service members exposed to trauma, as well as their families and caregivers. Joining us will be three experts from Creative Forces, as well as world-famous ABC news correspondent Bob Woodruff, to discuss the work of the Bob Woodruff Foundation, which raises money to assist injured service members, veterans, and their families. Featured speakers include: Bill O'Brien (Project Director, Creative Forces) Donna Betts, PhD, ATR-BC (Clinical Research Advisor, Creative Forces) Sara Kass, MD (Senior Military and Medical Advisor, Creative Forces), and Bob Woodruff (ABC News/Bob Woodruff Foundation).
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.
"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."
"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."
"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."
"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."
"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."
"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."