Using art therapy to overcome avoidance in veterans with chronic post-traumatic stress disorder

Exploring the impact of expressive therapies on military veterans with PTSD: A systematic review

BACKGROUND

Post-traumatic stress disorder (PTSD) is common in military veterans and presents as distress, anxiety, or depression due to a traumatic event. Expressive therapies are an emerging intervention used to enhance the quality of life by addressing the cognitive, emotional, and behavioral aspects of individuals.

METHODS

Five databases were searched from 2014 to 2022 with search terms addressing the expressive therapies of art, dance, drama, music, and writing, and military veterans with PTSD.

RESULTS

One hundred eighty-seven articles were screened and 16 articles qualified for review. Articles were categorized based on the following results: decrease in PTSD symptoms, veterans' triggered responses, participants recommending expressive therapy/finding it helpful, and increased well-being and/or quality of life.

CONCLUSIONS

Results found that expressive therapies are effective in reducing PTSD symptoms in military veterans. However, more research is recommended to fully support the use of expressive therapies in PTSD treatment.

Exploring the Role of Social Connection in Interventions With Military Veterans Diagnosed With Post-traumatic Stress Disorder: Systematic Narrative Review

Background

It has been identified that military veterans have distinct experiences of loneliness and social isolation and, when comparing this community to other client groups with a PTSD diagnosis, veterans respond less favorably to treatment. However, the link between PTSD and loneliness for veterans remains insufficiently researched and it is unclear if there are effective interventions tackling this distinct experience of loneliness.

Aims

This systematic narrative review aimed to synthesize existing evidence incorporating elements of social connection, social isolation, and loneliness within interventions for military veterans with a diagnosis of PTSD, consequently aiming to examine the impact of such interventions upon this community.

Methods

Six databases were searched, utilizing relevant search criteria, with no date restrictions. Articles were included if they involved intervention or treatment for military veterans with PTSD and considered elements of social connection, social isolation, and/or loneliness. The initial search returned 202 papers. After exclusions, removal of duplications, and a reference/citation search, 28 papers remained and were included in this review.

Results

From the 28 studies, 11 directly addressed social isolation and two studies directly addressed loneliness. Six themes were generated: (i) rethinking the diagnosis of PTSD, (ii) holistic interventions, (iii) peer support, (iv) social reintegration, (v) empowerment through purpose and community, and (vi) building trust.

Conclusions

A direct focus upon social reintegration and engagement, psychosocial functioning, building trust, peer support, group cohesiveness and empowerment through a sense of purpose and learning new skills may mitigate experiential loneliness and social isolation for veterans with PTSD. Future research and practice should further explore the needs of the PTSD-diagnosed veteran community, seek to explore and identify potential common routes toward the development of PTSD within this community and consider bespoke interventions for tackling loneliness.

Imagery Rehearsal Based Art Therapy: Treatment of Post-traumatic Nightmares in Art Therapy

Imagery Rehearsal Therapy (IRT) is effective for trauma-related nightmares and is also a challenge to patients in finding access to their traumatic memories, because these are saved in non-verbal, visual, or audiovisual language. Art therapy (AT) is an experiential treatment that addresses images rather than words. This study investigates the possibility of an IRT-AT combination. Systematic literature review and field research was conducted, and the integration of theoretical and practice-based knowledge resulted in a framework for Imagery Rehearsal-based Art Therapy (IR-AT). The added value of AT in IRT appears to be more readily gaining access to traumatic experiences, living through feelings, and breaking through avoidance. Exposure and re-scripting take place more indirectly, experientially and sometimes in a playlike manner using art assignments and materials. In the artwork, imagination, play and fantasy offer creative space to stop the vicious circle of nightmares by changing theme, story line, ending, or any part of the dream into a more positive and acceptable one. IR-AT emerges as a promising method for treatment, and could be especially useful for patients who benefit least from verbal exposure techniques. This description of IR-AT offers a base for further research.

A case analysis of service-member trauma processing related to art therapy within a military-intensive outpatient program

Objectives

Art therapy has been widely used in clinical settings and has shown preliminary success in military trauma. This case study describes a mask‐making art therapy directive facilitated by a board‐certified art therapist as an adjunct to group posttraumatic stress disorder (PTSD) treatment in a military‐intensive outpatient program.

Methods

Described are clinical outcome measures, linguistic analysis of a personal journal, evaluation of this service‐member's artwork, and experiences in the program.

Results

Mask‐making, as a trauma‐focused group‐art therapy directive, expanded the understanding of treatment progress 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. He reported improvement in coping and successfully returned to full military duty following treatment.

Conclusions

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.