Abstract Text: Introduction Posttraumatic stress (PTS) symptoms and sequela of mild traumatic brain injury (mTBI) are persistent and frequently comorbid complications of combat that remain a challenge in providing healthcare. In these complex cases, traditional treatments often fail to provide complete relief from associated symptoms, leading the military healthcare system to seek complementary and integrative treatments. Art therapy is one promising therapy that helps service members (SMs) develop a “visual voice,” using imagery, symbolism, and metaphor to externalize emotions and experiences that they may not be able to express in words [1, 2]. The National Intrepid Center of Excellence (NICoE) has a robust clinical creative arts therapy program with support of the National Endowment for the Arts (NEA) Creative Forces Network that provides art, dance/movement, and music therapy to both the four-week intensive outpatient program and traditional outpatients through the use of diverse standardized interventions. To date, few studies have used neuroimaging techniques to investigate brain network changes during creation of artwork. NICoE researchers provided preliminary evidence suggesting an association between recurring themes represented within masks created during art therapy and psychological health symptoms [3, 4]. However, the neurobiological mechanisms underlying this clinical intervention remain obscure. This abstract describes a prospective research study currently recruiting at the NICoE that uses neuroimaging techniques to investigate the neurobiological correlates of art therapy.
Materials and Methods Population: The study plans to recruit 25 active-duty service members and recently separated veterans, aged 18-64, with PTS (PCL-5 score ≥ 31) and no prior art therapy exposure.
Study
Design: This is a pilot, interventional clinical trial in which SMs with PTS symptoms will participate in 10 study sessions: one pre-therapy assessment, 8 art therapy sessions, and one post-therapy assessment. The pre- and post-therapy sessions will include a series of questionnaires and interviews measuring self-reported symptoms as well as an MRI. The MRI scan will include anatomical images as well as resting state and task based functional MRI (fMRI). The task completed during the fMRI will assess emotional regulation through asking participants to respond to emotionally negative and neutral visual stimuli and will be instructed to either enhance, maintain, or diminish their emotional response. The art therapy intervention will include altering a paper mache mask as well as other directives such as pour painting, bridge to path, and box project. Planned analysis includes investigating alterations in network connectivity and activation metrics extracted from the resting state and task-based fMRI. In addition, various network analyses of behavior will be conducted using art products and writing samples collected during art therapy sessions.
Study Status This study has recruited six participants thus far. We predict that the therapeutic effects of art therapy will be manifest in changes in behavioral measures, network measures based on written and art products as well as changes in brain network patterns. Additional information can be found at https://clinicaltrials.gov/ct2/show/NCT04776304 .
References
1. Jones, J.P., et al., Art therapy interventions for active duty military service members with post-traumatic stress disorder and traumatic brain injury. International Journal of Art Therapy, 2018. 23(2): p. 70-85. 2. Stone, A., How Art Heals the Wounds of War. National Geographics, 2015. 3. Berberian, M., M.S. Walker, and G. Kaimal, 'Master My Demons': art therapy montage paintings by active-duty military service members with traumatic brain injury and post-traumatic stress. Med Humanit, 2018. 4. Kaimal, G.W., MS; Herres, J; French, LM; DeGraba, TJ, Observational study of associations between visual imagery and measures of depression, anxiety and posttraumatic stress among active-duty military service members with traumatic brain injury at the Walter Reed National Military Medical Center. BMJ Open, 2018. 8(:e021448).
Funding: This study is funded by Creative Forces®: NEA Military Healing Arts Network. Creative Forces is an initiative of the National Endowment for the Arts in partnership with the U.S. Departments of Defense and Veterans Affairs and the state and local arts agencies.
Disclaimer: The authors have no conflicts of interest to disclose. The views expressed in this abstract are those of the author(s) and do not necessarily reflect the official policy of the Department of Defense or the U.S. Government.