Clinical Peer-Reviewed
Publications Inventory

Military families are resilient but are impacted by service member’s deployments, combat exposure, injuries, and other stressors such as frequent moves. These factors affect the entire family, and in turn family dynamics influence injured service members’ capacity to heal. Art therapy is a regulated mental health profession that incorporates the use of visual art to address psychological and rehabilitation treatment goals provided by qualified art therapists and has been used with military families in health settings for over 70 years. Through art therapy, military families can find new ways to communicate with one another in developmentally appropriate ways. This article describes the process of the Animal Strengths and Family Environment (ASFE), an art therapy directive designed to meet the needs of families of service members recovering from effects of traumatic brain injuries (TBI) and post-traumatic stress disorder (PTSD). Case vignettes are presented illustrating the use of the ASFE, describing how two military families identified character strengths through animal metaphors, and created visual artwork to discover and express these strengths, roles, and needs. The authors contend that this process is useful in mapping family dynamics to increase communication which ultimately fosters family resiliency. Continued research is needed to better understand possible outcomes of art therapy directives with military families.

Art therapy has traditionally been used as a treatment approach, but it can also be applied successfully as a clinical behavioral health assessment tool in the care of military service members suffering from the effects of traumatic brain injury (TBI) and operational stressors. This observational study examined patterns of associations between visual imagery (mask and montage paintings) and clinical symptoms among 240 active-duty military service members with TBI and associated psychological health conditions to include posttraumatic stress disorder (PTSD). The service members had participated in a 4-week intensive outpatient assessment and treatment program at the Walter Reed National Military Medical Center in the United States. Themes seen in the visual imagery were examined in correlation with standardized measures of PTSD (Posttraumatic Stress Disorder Checklist: Military Version) and depressive symptoms (Patient Health Questionnaire-9). The analysis showed that certain themes, like the use of color symbolism to depict psychological states, were associated with greater PTSD and depressive symptoms at the beginning of the program. In addition, patients who depicted themes like physical injury, psychological injury, and memories of deployment in Week 1 of the program were more likely to continue to represent them in Week 4. Depiction of themes like color metaphors and duality was associated with lower depressive symptoms at the end of the program. The findings indicate the potential clinical and prognostic value of tracking the content of visual imagery created by military service members with TBI and associated psychological health conditions. Clinical applications include the recognition that certain visual themes could indicate higher or lower levels of distress and may help guide targeted care.

Chronic pain and access to care are identified as critical needs of the Veterans Health Administration. Music imagery and music listening interventions have shown promise as effective nonpharmacological options for pain management. However, most studies have focused on acute pain, passive music experiences, and in-person delivery. This study aimed to examine the feasibility and acceptability of 2 music interventions delivered through telehealth for chronic musculoskeletal pain, trial design, and theoretical model before conducting a fully powered efficacy or comparative effectiveness trial.

Telehealth provides access to psychotherapeutic interventions and psychoeducation for remote populations that may have limited access to in-person rehabilitation treatments. This paper explores the use of telehealth to facilitate music therapy with service members and veterans living in rural areas across the U.S. and reviews research regarding creative arts therapies delivered through telehealth. The existing evidence base is predominantly focused on art and dance movement therapies and includes little information about music therapy. However, music therapists have begun to use telehealth in clinical and community environments to increase access for remote patients. This article reports on the integration of telehealth and music therapy and presents facilitation techniques of didactic and applied clinical music experiences. This is accomplished through the review of current research, addressing knowledge gaps, and reviewing the evolving models of creative arts therapies delivered through telehealth for military populations.

Military service members (SMs) have an increased risk of developing posttraumatic stress symptoms. Art therapy is a promising intervention that allows SMs with posttraumatic stress to explore their trauma through art-making and reflection in a psychotherapeutic relationship. Thematic analysis of art products may lend itself as a description of visual indicators of an internal state of the brain. We hypothesized that specific neurobiological markers are associated with the theme of psychological closure and/or healing of traumatic memories as represented in the masks created during art therapy. Resting state fMRIs of a convenience sample of 104 SMs who received art therapy as part of the interdisciplinary Intensive Outpatient Program (IOP) at the National Intrepid Center of Excellence were examined. SMs depicting psychological closure and/or healing within their art therapy masks demonstrated greater resting state functional connectivity between regions associated with attention, memory, language, and pain processing. These findings are preliminary in nature therefore causal relationships cannot be assumed between art therapy and neuroimaging metrics, as both art therapy and neuroimaging measures were collected as part of a larger integrative IOP. Future work collecting neuroimaging metrics pre and post an art therapy intervention is warranted to further evaluate these associations.

The use of musical performance in music therapy with active duty military service members is discussed as a vehicle for social transformation and re-integration. The use of musical performance in music therapy is not without controversy. Therapy is considered a process, not a product, and essential components of this therapeutic process are confidentiality and privacy. However, others have argued that public performances can validate therapeutic changes in clients, give voice to clients’ experiences, raise awareness of social issues within their community, transform perceptions of disability or illness in audience members, and provide opportunities to receive support and validation from the community. We discuss the potential of musical performances to contribute to individual development and rehabilitation in active duty service members as well as facilitate change at the community level. We illustrate this through three brief case reports of active duty service members who received music therapy services at the National Intrepid Center of Excellence on base at Walter Reed National Military Medical Center in the USA as part of their treatment of Post-Traumatic Stress Disorder, Traumatic Brain Injury, and other psychological health concerns. The service members selected, learned and refined songs over multiple music therapy sessions, created introductions to each song to share with the audience the meaning of each song and the benefits gained from working with these songs in therapy. The case reports also include excerpts of interviews conducted with these service members several months following their performances about their experiences of the performances themselves and the perceived impact on the community.

Chronic pain and access to care are identified as critical needs of the Veterans Health Administration. Music imagery and music listening interventions have shown promise as effective nonpharmacological options for pain management. However, most studies have focused on acute pain, passive music experiences, and in-person delivery. This study aimed to examine the feasibility and acceptability of 2 music interventions delivered through telehealth for chronic musculoskeletal pain, trial design, and theoretical model before conducting a fully powered efficacy or comparative effectiveness trial.

Telehealth provides access to psychotherapeutic interventions and psychoeducation for remote populations that may have limited access to in-person rehabilitation treatments. This paper explores the use of telehealth to facilitate music therapy with service members and veterans living in rural areas across the U.S. and reviews research regarding creative arts therapies delivered through telehealth. The existing evidence base is predominantly focused on art and dance movement therapies and includes little information about music therapy. However, music therapists have begun to use telehealth in clinical and community environments to increase access for remote patients. This article reports on the integration of telehealth and music therapy and presents facilitation techniques of didactic and applied clinical music experiences. This is accomplished through the review of current research, addressing knowledge gaps, and reviewing the evolving models of creative arts therapies delivered through telehealth for military populations.

Purpose: Music therapy has a long history of treating the physiological, psychological, and neurological injuries of war. Recently, there has been an increase in the use of music therapy and other creative arts therapies in the care of combat injured service members returning to the United States from Iraq and Afghanistan, especially those with complex blast-related injuries. This case report describes the role of music therapy in the interdisciplinary rehabilitation of a severely injured service member. Methods: Music therapy was provided as stand-alone treatment and in co-treatment with speech language pathology, physical therapy, and occupational therapy. The report is based on clinical notes, self-reports by the patient and his wife, and interviews with rehabilitation team members. Results: In collaboration with other treatment disciplines, music therapy contributed to improvements in range of motion, functional use of bilateral upper extremities, strength endurance, breath support, articulation, task-attention, compensatory strategies, social integration, quality of life, and overall motivation in the recovery process. The inclusion of music therapy in rehabilitation was highly valued by the patient, his family, and the treatment team. Conclusions: Music therapy has optimized the rehabilitation of a service member through assisting the recovery process on a continuum from clinic to community.

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 therapist 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.

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 structured specifically 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 suggests 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 treatment benefits of music therapy in an interdisciplinary care setting. 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 and inform subsequent treatment.

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.

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.

Music therapy is becoming increasingly prevalent in rehabilitation programs serving military and Veteran populations in the United States. Music therapy is integrated into interdisciplinary models and positioned to treat brain injury, post-traumatic stress disorder, and other psychological health conditions at military installations and Veteran medical centers nationwide. Phased group music therapy is delivered in a longitudinal treatment model to assist in the rehabilitation of service members and Veterans. Different phases of group music therapy are aligned with a treatment trajectory that exists on a clinic to community continuum to support recovery and reintegration. This article provides a description and case presentations of clinical programming. Information was accessed from patients’ electronic medical records, clinical documentation, therapist observation, and patient interviews. Interviews were transcribed and a content analysis was conducted by the authors. Emergent themes from the patient interviews included social relationships, community reintegration and transition, and post-military occupational success. Patients reported that group music therapy provided skill-building opportunities that were helpful for them during military service transitions, specifically active duty to Veteran status. Support skills included rapport-building and enhanced camaraderie. Furthermore, music therapy appeared to bolster peer connections through shared experiences, which decreased isolation, increased socialization, and supported reintegration.