Resource Results

"This study involved a thematic analysis of montage paintings and of related clinical records of 240 active-duty military service members collected during their art therapy treatment for traumatic brain injury and underlying psychological health concerns, including post-traumatic stress, at the National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA. Congruent with other research findings, the qualitative analyses of this study suggest that the group art therapy experiences fostered improvement in interpersonal relatedness, hopefulness and gratification for the service members in treatment, aiding in externalisation, progressive exposure and construction of a trauma narrative imperative for recovery. The mixed media nature of the montage painting supported the expression of a range of postcombat symptoms. Results from this study highlighted the complexity of military culture, necessitating a broader scope of analyses for how art therapy helps service members express and communicate their challenges to care providers, peers and family as well as regulate emotion in the short and long term."

"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."

"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."

Four domains across art therapy, music therapy, and dance/movement therapy were examined: (1) Practice/Clinical Intervention – treatment manual and training video development; (2) Clinical Assessment Protocols – implementation of discipline-specific individual and group assessment protocols based on validity and cultural appropriateness; (3) Documentation Procedures – integration of templated notes and standardization of symptoms and goals; (4) Program Evaluation – tools used to measure program effectiveness. Outcomes and observations from standardized practice allowed CATs to identify knowledge gaps and inform future research. Program evaluation was also bolstered by note standardization and the CF performance measurement tool, which captures clinician productivity.

"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."

Traumatic  brain  injury  (TBI)  and  posttraumatic  stress  (PTS) frequently occur in military populations. Art Therapy is one promising clinical therapy that may help service members to externalize emotions and experiences that they may not be able to express in words. To investigate the neurobiological correlates of art therapy, two prospective research studies are currently recruiting at NICoE using neuroimaging techniques:

1. Evaluation of Quantitative EEG During Art Therapy in Service Members with Co-Morbid TBI and PTS Symptoms (QEEG Study)
2. Art Therapy and Emotional Wellbeing in Military Populations with PTS Symptoms (fMRI Study)

"The study aimed tocompare recurring themes in the artistic expression of military service members (SMs) with post-traumatic stress disorder (PTSD), traumatic brain injury and psychological health (PH) conditions with measurable psychiatric diagnoses. Affective symptoms and struggles related to verbally expressing information can limit communication in individuals with symptoms of PTSD and deployment-related health conditions. Visual self-expression through art therapy is an alternative way for SMs with PTSD and other PH conditions to communicate their lived experiences. This study offers the first systematic examination of the associations between visual self-expression and standardised clinical self-report measures."

"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."

"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 specifically structured 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 suggest 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 benefits of music therapy in interdisciplinary treatment. 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 to inform subsequent treatment."

"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 therapists 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."