Veterans Use Creative Forces to Heal Invisible Wounds of War

On Aug. 30, 2021, the United States officially withdrew forces from Afghanistan, ending America’s longest war.

The two decades of continuous conflict resulted in the deaths of more than 2,400 American service members and 46,000 Afghanis. And for many returning military, the fight is not over as the battlefield follows them home.

The U.S. Department of Veterans Affairs estimates that 11-20% of veterans of the 1.9 million who served in Iraq and Afghanistan live with post-traumatic stress disorder (PTSD) while more than 400,000 service members have been diagnosed with traumatic brain injury (TBI) since 2000. Both debilitating disorders, PTSD and TBI are also often costly to treat. And traditional treatments, such as medication and therapy, are not always sufficient to manage the symptoms.

To help combat the increasing mental health needs of service members and their families, the military is turning to something different: creative arts therapies.

Sometimes Better Treatment Requires Creative Forces
Traumatic events activate our sympathetic nervous system, which through evolutionary adaptation compels us to respond with fight, flight, or freeze behavior to the danger at hand. While these responses can be healthy and help us survive, they can also become maladaptive—such as in the case of PTSD. People with PTSD can have intense, disruptive thoughts and emotions that last long after a traumatic event has ended. Many suffer from sleep disruption, irritable behavior, or emotional numbness.

For veterans coping with these psychological wounds, Creative Forces is a powerful ally. A partnership between the National Endowment for the Arts (NEA), the Department of Defense, and the Department of Veterans Affairs, Creative Forces provides a wide variety of creative arts therapies and community programs to military service members, including painting, music, dance, and expressive writing. These therapies are integrated into a larger treatment model at clinical sites throughout the United States, including telehealth services. The initiative seeks to improve the health, well-being, and quality of life for veterans, their family, and their caregivers.

“We look at using the arts to help in healing servicemen and women who have experienced the invisible wounds of war,” said Captain Sara Kass, a doctor who serves as the Senior Military and Medical Advisor for the organization during a November 2019 panel discussion hosted by the International Arts + Mind Lab.

Creative Forces began in 2012 when Kass’ team was struck by how effective creative arts therapies were for their patients at the Walter Reed National Military Medical Center. “It was one of the top things they wanted to continue when they left the [treatment facility],” Kass said.

The Art of Treating Trauma
Following traumatic events, the language and memory areas of the brain may become compromised; neuroimaging studies have found that trauma is linked to reduced size of the hippocampus, a brain area important for memory, and lowered activity in Broca’s area, a key language center. As a consequence, people affected by trauma may experience limitations in their ability to communicate verbally.

Art-making can help service members express themselves non-verbally, resulting in the activation of different brain circuits that can circumvent memory and language blocks.

For example, visual self-expression through mask-making may offer important clues into the creator’s state of mind and may help inform therapists of who needs treatment more urgently. In one study of 370 active-duty military service members, those who made masks with themes of psychological injury, such as a disfigured self-portrait, registered higher scores for post-traumatic stress and depression than those who made masks with nature metaphors or historical characters. The study’s authors believe the mask-making intervention could help therapists determine the level of dysfunction and most effective therapeutic approach for military members with PTSD or TBI.

One recent study found that service members who wrote songs as part of a music therapy program were able to express their struggles with PTSD, TBI, and other injuries. Their lyrics often centered on resilience, love for their family and friends, and motivating other service members. The study also suggested that music therapy may lower the threshold for seeking other forms of mental health therapies. Longer-term art therapy helped veterans develop a sense of self after injury and have higher satisfaction with treatment.

Art-making can also be a way for service members to connect with the community they return to after deployment. Patients in music therapy groups report that these sessions bolstered their social connections and helped with the tough transition between active service to veteran status. As part of their treatment for PTSD, TBI, or other psychological health issues, service members wrote and learned songs to share with audiences, a process that helped bridge their time in the clinic with the broader community. These creative arts therapies have also been found to promote bonding for military families and strengthen their resilience as a unit.

Research and Hope for Military and Civilians Alike
Over 20 published research studies associated with Creative Forces show that creative arts therapies provide service members with a range of benefits, such as improving their ability to make meaning and develop awareness and tolerance of PTSD/TBI symptoms like hypervigilance and pain. The arts also allow them to channel their aggressive behaviors and manage anger and anxiety into creative outlets, and cultivate feelings of hope and gratification.

“We are beginning to explore other trauma-exposed populations,” said Bill O’Brien, Director of Creative Forces and Senior Advisor for Innovation to the Chairman at the National Endowment for the Arts, in an interview with IAM Lab. The research and methods that Creative Forces are pioneering with combat veterans can provide hope for civilians who are dealing with other instances of trauma such as domestic violence or losses from natural disasters.

For our mental health, creative forces have the power to move us all.

Written and reported by IAM Lab Communications Specialist Richard Sima. Richard received his Ph.D. in neuroscience from Johns Hopkins University and is a science writer living in Baltimore, Maryland.

This post was featured on Psychology Today.

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