Effectiveness of Art Therapy for PTSD Treatments

Abstract

Veterans are susceptible to suffering PTSD mainly because of the trauma they experience during combat duties. The serious nature of this mental illness advocates for establishing effective treatment options. Art therapy is an alternative therapeutic treatment option that is less evasive compared to traditional therapeutic methods. In this research, the study analyzes the effectiveness of art therapy in reducing symptoms of PTSD. The study involves observing a group of 50 veterans in group art therapy for two months. Results obtained from the study indicated positive reviews for art therapy from participants. This, therefore, showcases the effectiveness of art therapy in treating PTSD.

The effectiveness of art therapy in treating veterans with PTSD

Approximately 22 veterans are reported to commit suicide every day in the United States. Veterans are often left with memories of battles which in turn present postwar symptoms that are commonly known as a post-traumatic disorder or commonly referred to as PTSD. PTSD is one of the leading causes of the steady increase in suicide rates among veterans and this showcases the importance of finding effective treatment options. PTSD affects thousands of veterans in the United States especially from veterans from recent wars in Afghanistan and Iraq. According to the U.S. Department of Veterans Affairs. (n.d.), about 23 percent of veterans from the Iraq and Afghanistan wars are reported to suffer from PTSD. The numbers for other wars such as the Vietnam War accounts for 10 percent of veterans with PTSD while the Gulf War veterans with PTSD were estimated to make up 10 percent of the current veterans suffering from this psychological illness.

With the recent end of both Afghanistan and Iraq wars, there is a growing concern on the current efficacy of treatment options for postwar treatment. This comes from an increase in a number of veterans returning home which also correlates to increase in cases of PTSD. Veterans Affairs health care is without a doubt the largest healthcare system in America. The prevalence of PTSD among veterans has received significant funding from the federal government. What can be done to reduce the prevalence and most importantly the effects of PTSD among veterans in the United States? This is the main concern with the rise in the number of veterans there is the need to investigate on the efficiency of the existing treatment options to ascertain that the required help is availed to veterans with PTSD.

Combat exposure is the leading cause of PTSD especially among males but when it comes to female veterans, sexual trauma has been registered as the leading cause of PTSD. Treatment for PTSD widely varies as different research methods recommend the distinct therapeutic process. One of the treatment options which is fairly recent in the treatment of PTSD is art therapy.  The potential therapeutic and effectiveness of art therapy among veterans suffering from PTSD has not been widely researched hence limited knowledge is available on the treatment results of this option. To date, art therapy has not been considered to be effective in reducing or managing symptoms related to PTSD (Blankenship, 2017). 

This research looks into showing that art therapy is not only effective but at the same time an engaging form of treatment that offers diversity and improves participation during therapy. That is, this research would highlight the effectiveness of art therapy in ensuring that veterans with PTSD continuously attend therapy sessions. This originates from studies that showcase the ineffectiveness of cognitive processing therapy in motivating veterans with PTSD to continue with treatment session for a lengthy time (Campbell, Kurk, & Deaver, 2016). As a result, the main aim of this research paper would be to analyze the effectiveness of art therapy in the treatment of veterans with PTSD and consequently comment on its suitability and point out the potential therapeutic benefits.

Research Problem and Questions

The increasing number of suicide rates in veterans suffering from PTSD calls for review on current treatment options and analyze their effectiveness. Although cognitive processing therapy has long been preferred as the go-to treatment options, they have been seen to have some limitations. Art therapy is a relatively new method that has not been fully embraced in the psychology field. The research problem, in this case, revolves around debunking the belief that art therapy is not effective in reducing symptoms related to PTSD.

Questions that would be explored and answered in this study would include:

1. What are the different components of art therapy that showcase the positive impact on veterans with PTSD?
2. Is art therapy effective in the long term and how it does it cater for diversity among veterans with PTSD?
3. In the case where art therapy is combined with other forms of therapy in treating PTSD, does it remain effective as in the case where it is utilized as the primary form of treatment?

Literature Review

This section of the research paper will focus on three area. The first part of the literature will analyze or rather explain diagnosis for PTSD according to the current research data. At the same time, this section will analyze the current methods that are being utilized in treatment and the current view on their effectiveness. The second part of the literature review will analyze factors that influence engagement of art therapy in treating veterans with PTSD. The third part of the literature review will analyze and review the exploration of art therapy.

Understanding PTSD

The diagnosis for post-traumatic stress disorder commonly known as PTSD was first included in the DSM as early as 1980. Prior to official classification, research indicated that PTSD was called or described in different names and conditions including war neurosis, traumatic neurosis, shell shock, gross stress reaction and even combat fatigue. This research determined that although the diagnosis of PTSD is relatively new, the symptoms related to this mental illness have been experienced and at the same time documented for thousands of years.

Veterans with PTSD are reported to experience symptoms such as intrusive thoughts, flashbacks, and nightmares which allow the past to aggressively invade the present.

According to Mandic-Gajic & Spiric, (2016), individuals in this state of mind find it hard to differentiate or clearly define the past, the present and the future. The past is at all times increasing aggressively invading present moments with the main memories and thought involving traumatic events that took place in the past. This, therefore, implies that symptoms related to PTSD mainly involve relieving a traumatic event or simply constantly remembering the frightening elements of such an event. With this mind, Blankenship, (2017) recommends that the key element is considered in the treatment process if integration of an individual’s history and life experiences to allow for the harmonious coexistence of memories. Most importantly, ensuring that psychotherapy prevents or eliminates avoidance plays an instrumental role in minimizing symptoms related to PTSD. This is because avoidance has been found to be a major influence in a continual experience of reliving traumatic events.

Prevalence of PTSD among veterans and the extreme consequences of suffering from this mental illness is reason enough for mental practitioners to seek out treatment options that are effective. Different patients have been found to react differently to the various psychotherapy and medication treatments available. For instance, while certain medications such as antidepressants and SSRI’S have worked effectively in terms of reducing PTSD symptoms and improving quality of life for some patients, there are some who have seen little difference with this method of treatment. The ineffectiveness of a single form of treatment has resulted in the inclusion of the use of both psychotherapy and medication as the guideline for treating PTSD. Some of the common psychotherapy treatment utilized for the treatment of PTSD include Reprocessing and Stress Inoculation therapy (SIT), Virtual Reality Exposure (VRE), Eye Movement Desensitization, Prolonged Exposure Therapy and Cognitive Behavioral Therapy (CBT).

Art therapy and PTSD

Art therapy is a treatment option for patient combat-related PTSD that although has been utilized for many years is still not considered as a major psychotherapy treatment option. However, in recent years, art therapy has gained more spotlight based on case studies and research projects that have indicated and supported its effectiveness in reducing trauma-related symptoms and at the same time improving the lives of veterans suffering from PTSD. Research from Jones, Walker, Masino & Kaimal (2017), indicates that theorists have identified neurological and psychological mechanisms associated or rather thought to be operating in art therapy. These mechanisms are in turn indicated to have unique capabilities that promote the reduction of symptoms and subsequently recovery from PTSD.

There are various features that have made art therapy recommendable and considered highly effective at the same time. One of the features that have made art therapy a go-to form of treatment is the nature of its operation in the sense that it is undoubtedly the least physically and mentally invasive psychotherapy from of treatment. In this perspective, it has been reported that more veterans are opting and preferring to use this method of treatment because of its simple nature of treatment. Art therapy offers veterans with PTSD with a way to communicate in a visual language which is useful especially to individuals who cannot use words or find it hard to describe the trauma they experienced in words. Communication of any form is an important part of the healing process in treating PTSD. One of the major drawbacks to the existing psychotherapy treatments is avoidance and numbing which limit the effectiveness of various treatment options. However, when it comes to art therapy, patients are provided with an alternative form of communication hence expressing themselves in a much more effective manner through the art-making process.

Art therapy has been found to significantly reduce symptoms of PTSD such as emotional numbing, hyperarousal, intrusive thoughts, and avoidance. Considering that traumatic experiences are often difficult to express and externalize, patients often resort to generally trying to ignore and avoiding to talk about these episodes. At the same time, these experiences are often imprinted in visual areas of the brain which then makes it difficult to ignore of numb. However, art therapy offers a way for the patient to not only express but at the same release the tension associated with these traumatic experiences. Working through phase coding in art therapy enables patients to change the coding of the traumatic event and eventually integrate it with the personality while connecting or associating it with other thoughts and feelings which are under the control of the patient. Consequently, intrusive re-living of the traumatic event is transformed into merely remembering which has fewer impacts or effects.

Exploring art therapy

Art therapy is a form of treatment that explores creating a new trauma narrative that clearly defines the past, present, and future. Research data showcases that PTSD distorts traumatic memories that have invaded the present mindset. This allows for externalization and most importantly sharing of these traumatic memories that can easily become part of an individual’s story without necessarily representing the true being of this person. The mode of action that is important in art therapy and which is greatly associated with effectiveness in reducing PTSD related symptoms is the reintegration process which takes place when the present and the past of an individual’s history is joined through the creation of a new narrative. Additionally, different aspects such as self-esteem are boosted in the process which also facilitates the healing process.

Research and developments in neuroscience have provided useful information about different parts of the brain responsible for the verbal process of traumatic events. In this perspective, brain imaging has shown that when recounting traumatic events, victims experience two main processes that help to understand the effectiveness of art therapy in traumatic related therapy. That is, for such individuals when recounting the traumatic events that they underwent experience a shut down in the Broca area of the brain which is responsible for language and at the same time showcase arousal of the amygdala. This then helps to explain why individuals with PTSD find it relatively difficult to verbally express their emotions. However, art therapy initiates activation of the right brain which then promotes less reliance on verbal language (Lobban, 2016). This helps to explain or understand more on why art therapy is relatively more effective in treating trauma-related disorders.

Method

This study employed a cross-sectional design involving sampling from a single group of veterans who had undergone an art therapy block of treatment. There was a total of 50 veterans who took place in this experiment all of whom were part of various treatment programs. The inclusion criteria for this study was that the participants were to have been diagnosed with PTSD and also proven to be combat related. At the same time, participants in the program were required not to be currently using any drugs alcohol and also not experiencing active psychosis. All veterans in the selected group met at least one of the anxiety related disorders or PTSD.  All the veterans in the sample completed questionnaires, during and after the study to indicate their progress in dealing with or reducing symptoms of PTSD and their thoughts on the effectiveness of art therapy.

Participants

There was a total of 50 veterans who took place in this study and the total amount of time spent on art therapy was 2 months. Among the 50 veterans that took place in the study, 20 were female and 30 of them were male. The minimum age for participation in the study was 18 years but most of the participants were in their late in their late 30’s. The average age of the participants was 28 years old while the age ranged from 18 years to 4o years old. The participants came from different ethnic groups as the aim of this study was to showcase the effectiveness of art therapy for all veterans with PTSD regardless of ethnicity. Most of these individuals had served for more than 5 years in the military and had been involved in active combat duty during their active years. Recruitment was done through an online platform in collaboration with the local resource center. Participants were compensated by being provided with transport allowance that would cover for the expenses incurred to participate in the study.

Materials and Procedure

The PTSD checklist for DSM-5 (PCL-5) and the Beck’s Depression Inventory was used on the participants before, during and after starting the art therapy. These were used to measure the changes experienced by participants and to analyze the impact that art therapy had on the diagnosis of PTSD. There was two form of measures utilized in the study namely qualitative and quantitative sections. These were used in the questionnaire to determine the impact and attitude that participants have towards art therapy before and at the end of the study. Quantitative questions used a five-point Likert scale while the qualitative section allowed participants to provide free text comments about their experience and the changes they have undergone (Belkofer & Konopka, 2008).

The study included different forms of art therapy including but not limited to panting and music therapy. Participants were divided into different groups and given art-related assignments to complete and the required to present during the next meeting. There was a minimum of two sessions every week that lasted about 3 hours. In each session, participants would present their assignment and also comment on the presentations of other groups. Participating or presenting was on a voluntary basis and whenever a participant felt like he or she could not participate in group therapy for that session, he or she would be excused but required to complete individual art therapy. At the end of every session, participants would be required to fill out a questionnaire about progress made and changes noted or even state cases where they do not feel like there is any change.

There were two questions asked in the quantitative part of the questionnaires at the end of the study. The first question asked participants to rate the effectiveness of the sessions considering the statement “I found the art sessions useful”. The ratings in the questionnaire were from 1= strongly disagree to 5= strongly agree. The second question asked participants to consider the statement “I intend to continue with art therapy and would recommend it to other individuals with PTSD” with ratings varying from 1= definitely not to 5= definitely. The qualitative part of the questionnaire provided participants with free text comments to provide additional information guided with the question “Please tell us what you found most helpful or interesting about the art therapy sessions”. The data was collected over a span of 2 months which was the duration of the study.

Results

Quantitative findings

In total, 50 veterans which account for 100 percent of the sample completed the question of “I found the art sessions useful” where 1= strongly disagree and 5- strongly agree. The mean score of this question was 4.43 with a standard deviation of 0.0682. The table below showcases the distribution of the responses among the sample.

On the other question “I intend to continue with art therapy and would recommend it to other individuals with PTSD” with ratings varying from 1= definitely not to 5= definitely, a total of 49 veterans which caters for 99 percent of the sample completed the question. The mean score for this question was 4.15 and the standard deviation was 0.925. The table below shows the distribution of the ratings in the sample utilized.

Qualitative findings

The analysis method that was utilized to gather results in the qualitative part of the study was inductive content analysis. Three major themes were drawn out of the qualitative question “Please tell us what you found most helpful or interesting about the art therapy sessions”. The major theme drawn from this question were; improved ability to not only access but at the same time express difficult feelings and emotions; the experience of sharing and being with cohort; and the environmental aspect. Further analysis of the data indicated that within each of the above there themes were minor themes. The first major them form the data indicated that the experience or rather ability to share the experience with others is supplemented with minor themes of art facilitating communication within the group which in turn creates bonding and the second one being that listening to the experiences of others helped to normalize the issues faced.

The second major theme of exploring difficult feelings is described by minor themes of using art as a method of expressions emotions that are in normal context difficult to voice and also the fact that art therapy helps to unlock emotions and feelings that were previously deemed inaccessible. The final major theme is the environmental aspects and how it influences the therapy as well as adding value to the process. The minor theme described in this third theme is the calming and relaxing effects of the atmosphere and the effectiveness of using different materials.

Discussion

The aim of this research was to explore the effectiveness of art therapy for veterans suffering from PTSD. The study used mixed methods of the art design to view it suitability in helping to reduce the symptoms of PTSD and improve lives of participants. Veterans who took part in the study highly rated art therapy and its usefulness. According to the results obtained from the study, more than half of the veterans who took part in the study found that the art therapy sessions were useful. Most importantly, the majority of the veterans also not only certified that they would continue to apply the knowledge they gained from the art therapy sessions but at the same time extended that they would recommend this form of treatment to individual undergoing similar mental issues. These findings, therefore, imply that the veterans were not only engaged in the therapy sessions but at the same time found the process to be useful in improving the state of their mind and consequently reducing symptoms of their mental illness. This also has the implication that provides support for the effectiveness of art therapy for the treatment of this group of individuals.

The themes are drawn from the qualitative data also provide further insight into the perception and experience that the veterans had during the 2 months of art therapy. From the first theme, it is shown that one of the most useful aspects of art therapy is that it facilitates communication which helps in the formation of bonding relationships among participants. Implications associated with the formation of bonding relationships is that this improves on the ability of participants to connect with others and at the same time increasing the social support (Collie, Backos, Malchiodi & Spiegel, 2006). Secondly, shared perspectives during art therapy have a positive effect on normalizing mental health issues. Normalizing, in this case, has the implication of encouraging individuals to reach out and seek help when struggling. The second theme pointed out that art therapy was instrumental in helping the veterans to explore difficult feelings. One way through which this process helped to deal with the difficult feelings is by offering an alternative way of expression and also that it helped to unlock some emotions which the veterans were unaware existed within them.

These two major themes help to point out the importance of understanding the psychological mechanism that veterans suffering from PTSD undergo when they relive the atraumatic event. Understanding this mechanism plays a huge role in determining the suitable treatment options.     Most importantly, the fact that the veterans were able to recognize or under their needs indicates that art therapy is effective in its own way. this further suggests that veterans are indeed engaging and not undergoing a therapeutic experience in art therapy. This consequently supports the inclusion of art therapy as a reliable and effective treatment plan for PTSD in veterans. Additionally, the theme that describes the usefulness of art therapy in enabling veterans to express or even access difficult emotions suggests that art therapy may have a much more valuable role in cases where veterans with PTSD are finding it hard to engage in traditional viable therapeutic approaches. This supports the notion that art therapy accessed non-verbal processing of information which is as effective as the verbal processing of information (Ramirez, 2016).

The third major them from the analysis of the qualitative data is that the environment provided by art therapy plays a key role in the rehabilitation process. That is, the soothing atmosphere created has a positive impact. This comes from the fact that different forms of art utilize different environments which can be a relief from the normal setting that a patient is used to of often subjected to during other treatment forms. Additionally, the use of different materials provides creative and innovative ways for veterans to express their feelings. For instance, when drawing, a participant can communicate by sketching images that haunt him or her which can help others to understand their perspective. In the same way, music can be utilized to write lyrics that closely associate with what a person experiences hence finding an indirect way of communicating with others (American Art Therapy Association, 2016). This theme provides useful and practical implications for how art therapy can be presented to clients in a way that is acceptable to them.at the same time, this also provides information about how other therapeutic processes are different from art therapy in terms of the approaches utilized.

Further implications of this study fall on the analysis that group art therapy is more beneficial for the population with PTSD. This notion through research and this case study has been proven true among veterans. According to Lobban, 2016), utilizing group art therapy has been linked to positive results including reducing the feeling of isolation, negative uniqueness and most of all mistrust among PTSD population. At the same time, group art therapy is associated with reducing isolation amount veterans with PTSD and at the same time confronting avoidance issues that are a great hindrance to the treatment process. Generally, veterans have an appreciation for others who share the same military life experience. The utilization of group therapy, therefore, offers a mutual understanding and support to other veterans which facilitate coming to the aid of others and creation of a safe place where members of the group can express various emotions including fear, sadness, anger etc. most importantly, group dynamics provides an avenue for veterans with PTSD to give and receive feedback and most of all learn from each other hence creating an overall sense of encouragement and belonging

Limitations

This research employed a substantial sample from a group of veterans suffering from PTSD. The sample was homogeneous in the sense that it only included veterans with PTSD without any other mental problems and complications. Therefore, although the discussions offer a generalized conclusion about treatment options and suitability of art therapy to veterans with PTSD, this study is only limited to veterans suffering from PTSD exclusively. The sample is limited for the purpose of sampling. Therefore, it is possible that individuals with lower acceptability of compatibility with art therapy did not complete or were not part of the study conducted. Another limitation regards the fact that there is an instance where individuals may lie of offer responses that are not true and this could impact on the results.

Current and past research has shown that there is a significantly different or rather improvement in veterans with PTSD and undertaking art therapy as the treatment option. Art therapy offers a different or rather alternative way for an individual to cope up with events traumatizing them and most importantly to share them and transfer them to a place where they can control them. The study conducted on the 50 participants only solidified that art therapy is indeed effective in treating PTSD among veterans and should be listed officially as an alternative treatment for this mental illness.

References

• American Art Therapy Association . (2013). Retrieved from https://www.arttherapy.org/upload/whatisarttherapy.pdf
• Belkofer, C., & Konopka, L. (2008). Conducting art therapy research using quantitative EEG measures. Art Therapy, 25 (2), 56–63
• Blankenship, D. M. (2017, Oct). Five effeicacious treatments for posttraumatic stress disorder: An empirical review. Journal of Mental Health Counseling, 39(4), 275-255. doi:10.17744/mehc.39.4.01
• Campbell, M., P., D. K., Kurk, K., & Deaver, S. P. (2016). Art therapy and cognitive processing therapy for combat-related PTSD: A randomized controlled trail. Art Therapy: Journal of the American Art Therapy Association, 33(4), 169-177.
• Collie, K., Backos, A., Malchiodi, C., & Spiegel, D. (2006). Art therapy for combat-related PTSD: Recommendations for research and practice. Art Therapy: Journal of the American Art Therapy Association, 23(4), 157-164.
• Jones, J. P., Walker, M. S., Masino, D. J., & Kaimal, G. (2017, Nov 1). Art therapy interventions for active duty military service members with post-traumatic stress disorder an traumatic brain injury. International Journal of Art Therapy, 23(2), 70-85. doi:10.1080/17454832.2017.1388263
• Lobban, J. (2016). Factors that influence engagment in an inpatient art therapy group for veterans with post traumatic stress disorder. International Journal Of Art Therapy, 21(1), 15-22. doi:10.1080/17454832.2015.1124899
• Mandic-Gajic, G., & Spiric, Z. (2016). Posttraumatic stress disorder and art group therapy: self-sexpression of traumatic inner world war veterans. Vojnosanit Pregl, 73(8), 757-763. doi:10.2298/vsp150512083m
• Ramirez, J. (2016, April). A review of art therapy amoung military service members and veterans with post-traumatic stress disorder. Journal of Military and Veterans Health, 24(2), 40-51.
• U.S. Department of Veterans Affairs. (n.d.). Retrieved from PTSD: National Center for PTSD: https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp