Telehealth delivered art therapy for post-traumatic stress disorder: A single-arm multi-modal feasibility pilot

Abstract

Post-traumatic stress disorder (PTSD) treatment efficacy varies in military Veterans, with reduced responsiveness to Prolonged Exposure Therapy (PE) and Cognitive Processing Therapy (CPT). Art therapy, leveraging non-verbal visual processing of trauma, offers a promising alternative. Additionally, teletherapy delivery is increasingly needed due to healthcare access challenges. This mixed methods pilot study presents findings from a single arm feasibility administration of a telehealth art therapy intervention in Veterans with PTSD, including preliminary efficacy and pre/post fMRI case data. Veterans were recruited from the North Florida/South Georgia VA Health System. An eight-week art therapy program was conducted via telehealth. Outcomes were measured using validated self-report scales, qualitative therapy notes, and resting-state fMRI to examine network changes and predictors of response. 18 Veterans were enrolled; one dropped out due to telehealth issues. Thirteen Veterans (ten men, three women; mean age 40.9) completed the protocol showing an average reliable change index (RCI) of 1.34 in PTSD symptoms (PCL-5 scores), with individual RCIs ranging from 0.11 to −2.92. Improvements were also seen in depression, sleep quality, and mindfulness. Seven Veterans had ' 30% reduction in PTSD severity. Case analyses of three strong responders and non-responders explored response differences. Telehealth art therapy was feasible and showed potential effectiveness in reducing PTSD symptoms and improving depression and sleep. Consistent with larger CBT studies, default mode and salience network connectivity appeared relevant to response, suggesting preliminary neural mechanisms. Future research should evaluate these findings in a fully powered randomized controlled trial.