Outcomes of Art Therapy Treatment for Military Service Members with Traumatic Brain Injury and Post-traumatic Stress at the National Intrepid Center of Excellence

Abstract

2.77 million US military service members (SMs) served on more than 5.4 million deployments. Notably , over 20% of those SMs deployed three or more times [1]. Factors such as frequency and duration of deployments lead to compounding injuries, specifically traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) which are referred to as the signature and invisible wounds of the post-911, Global War on Terror conflicts. TBI has been found to be a significant predictor in the development of PTSD [2, 3] often with an overlap of symptoms such as anxiety, depression, cognitive deficits, irritability, sleep disruptions, and embodied memory experiences [4, 5]. A recent study also found that the co-occurrence of PTSD with mild TBI (mTBI) worsens post-concussive symptoms in post-9/11 veterans, including greater pain catastrophizing and intensity, worse recall, and greater illness-focused coping than in veterans with mTBI alone [6]. It is estimated that 19.5-22.8% of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) SMs and veterans have sustained a TBI, with 383, 941 diagnoses as of the first quarter of 2018 [7], and 7-20% of SMs and veterans who served in OEF and OIF are living with or at some point met the criteria for PTSD diagnosis [8]. While experiencing symptoms associated with post-traumatic stress is natural following an event and often resolve on their own, the criteria for the diagnosis of a disorder include re-experiencing, avoidance, thought/mood disturbance, and hyperarousal which impair life functioning for longer than a month [9, 10]. Chronic PTSD in our veterans can span a lifetime if left untreated. Due to the complex and unique nature of SMs overcoming comorbidity of TBI and underlying psychological health (PH) conditions including PTSD, specialized treatment facilities have begun operating within both the Departments of Defense (DoD) and Veterans Affairs (VA). utilizes a holistic, interdisciplinary approach to clinical care for military SMs whose comorbid TBI and PH conditions have not responded to traditional treatment. At the NICoE (Fig. 1), a facility designed to be a healing environment, SMs receive behav-ioral health and rehabilitation treatments which target the mind, body, and spirit, and foster and encourage resilience, well-being, and self-management through active engagement in their care [11]. Since 2010, the NICoE has developed and implemented a four-week intensive outpatient program (IOP) which employs 17 medical and integrative health disciplines, such as neurology, neuropsychology, psychiatry, family therapy, physical therapy, and speech-language pathology, which offer an array of recovery techniques and tools for active-duty SMs with mTBI. The NICoE also offers long-term outpatient programming in which SMs whose TBIs range from mild to severe are referred to various treatments based on their individual recovery goals. As part of interdisciplinary programming under the behavioral health umbrella, each SM is scheduled to partake in creative arts therapies treatment delivered by trained and certified art, music, and dance/movement therapists.