How the Creative Arts Therapies Treat PTSD
Having PTSD means you’re more likely to have Coronary Heart Disease1, dementia2, and TBI, at least for civilians3. But, veterans with PTSD are more likely to have more disabilities, pain, depression, catastrophizing beliefs, and sleep disturbances than veterans without PTSD and are also likely to have lower functioning4.
Interestingly, creative arts therapists have treated PTSD since the 70s, before it was even listed as a diagnosis5,6,7. Creative arts therapies can help improve PTSD and are thought to be effective on it by
- reducing hyperarousal through a relaxing experience,
- using nonverbal mediums to express difficult memories and emotions that are not easily verbalized,
- containing trauma within a creative product (to provide a sense of control, empowerment, and accomplishment),
- making exposure to trauma tolerable through symbolism (reducing avoidance),
- finding pleasure in creating (which helps activate the reward system and reduce emotional numbness),
- and processing emotions and behaviors to activate parts of the brain related to posttraumatic expression 7,8,9,10
Music therapy can help improve PTSD symptoms8,13 through group improvisation and verbally talking out thoughts and feelings in only 10 weeks10. Interventions like group drumming9,10 and music and progressive relaxation11 can also help patients who have PTSD improve their self-worth and isolation9, sleep quality11, and anxiety11,12. Listening to music as a distraction and using it to ground (or emotionally regulate) can help with the intrusive thoughts. Group music making and group improvisation can help reduce the avoidance of people and triggers while encouraging positive social engagement. In regards to negative cognition and mood, music can also alter your perspective, activate the reward centers in the brain, and reduce cortisol and stress13.
To put this in perspective in a case study, Jake, who grew up in Colorado and earned a Bachelor’s degree, witnessed the death of many of his friends and family. He developed suicidal ideation and depresion and started cutting himself. He turned to music to help prevent him from cutting, saying
“If there is a song or a melody that meets me where I’m at emotionally, I could listen to it on repeat for hours and hours. In some ways, this can magnify a potentially “harmful” emotion, but for me, even if it intensifies my sadness, it feels more like a comforting dark corner where I can just channel and truly feel the emotion without having to resort to self-harm”
and
“Often times, music would be the only thing that kept me from cutting”.
He was avoiding his feelings, but music was the only thing that allowed him to express himself, to cry and release. At one point, he was ready to kill himself, but Elliot Smith’s “Miss Misery” started playing. This song met him where he was and despite feeding his depression at times, the music saved his life and preserved his mental health14.
It’s important to remember that Jake’s experience shows the power and benefits of music, but not music therapy. Thankfully, Jake was able to capitalize on the music’s benefits accidentally, but trained music therapists help guide their patients through the healing process through music intentionally and purposefully.
Art therapy also reduces PTSD symptoms but through drawing and creative writing15 in addition to other techniques like collages and mask-making16 for both civilians15 and veterans16. To put this in perspective with a case study, Chief Echo was a Chief Petty Officer in the Navy and served for 23 years and experienced several traumatic events. For four weeks in 90-minute group sessions, Chief Echo made a paper-maché mask and decorated it with items that had meaning to him:
On the outside:
- a small dowel under the nose, which he associated with a childhood memory
- white glued that dried giving the appearance of peeling skin, which represented a shedding process.
On the inside:
- a small cotton ball over blue pain to represent “tranquility and peace within” at the inside of the forehead of the mask, which to him meant a goal he was constantly trying to achieve
- clay and collage materials in the form of TNT barrels located at the bottom inside of the mask around the mouth to represent his emotional triggers. In week 5, he verbally processed the artwork.
At the end of treatment, he self-reported improvement in functioning and in coping and even successfully returned to duty17.
Despite all of this compelling evidence, there is very little research on music therapy13 or the creative arts therapies in general8 and their efficacy on treating PTSD. Even the research on non-creative arts therapy approaches is stating that, at least for children and adolescents, no intervention could be strongly recommended18. The research isn’t even strongly recommending EMDR because of low evidence in both children and adolescents18 and combat-related PTSD19 despite the evidence for its effectiveness in both18,20,21. Instead, it recommends Trauma-Focused Cognitive Behavioral Therapy as the standard, first treatment to try18,19. Even if Trauma-Focused Cognitive Behavioral Therapy should be the first strategy, music therapy22 and art therapy23 can take that approach.
Finally, there is evidence suggesting that 30–40% of people drop out in treatment that is not creative arts therapies when compared to creative arts therapy treatment9, 16, 24, which suggests that the creative arts therapies can maintain engagement in treatment8. When you put all of this together, you find that the creative arts therapies like music therapy and art therapy can and do treat PTSD, and they do so in a way that the patients find tolerable and engaging.
1. Akosile, Colquhoun, Young, Lawford, & Voisey (2018); 2. Günak, Billings, Carratu, Marchant, Favarato, & Orgeta (2020); 3. Iljazio et al. (2020); 4. Benedict, Keenan, Nitz, & Moeller-Bertram (2020); 5. Dieterich-Hartwell (2017); 6. Johnson (2009); 7. Spiegel, Malchiodi, Backos, & Collie (2006); 8. Baker, Metcalf, Varker, & O’Donnell (2018); 9. Bensimon, Amir, & Wolf (2012); 10. Carr et al. (2012); 11. Hernandez-Ruiz (2005); 12. Gold et al. (2014); 13. Landis-Shack, Heinz, & Bonn-Miller (2017); 14. Hereld (2019); 15. Wang et al. (2015); 16. Campbell, Decker, Kruk, & Deaver (2016); 17. Matlz, Uomoto, & Herodes (2020); 18. Bastien, Jongsma, Kabadayi, & Billings (2020); 19. Kitchiner, Lewis, Roberts, & Bisson (2019); 20. Frappell-Cooke & McCauley (2018); 21. Kitchiner et al. (2012); 22. Kurtsman (2019); 23. Schouten, van Hooren, Knipscheer, Kleber, & Hutschemaekers (2019); 24. Vibe Jespersen & Vuust (2012)
