Creative arts therapy can be very beneficial for survivors of traumatic brain injury (TBI), because the nature of the injury often makes it difficult for patients to verbalize their thoughts and feelings.

In a new study, 370 active military service members were asked to create artistic masks as part of their TBI recovery treatment. Each mask began as a simple, blank human face that participants were encouraged to paint, cut, or add to with the objective of creating a representation of how they felt.

The researchers then analyzed the different themes present in the masks and linked the artwork to measures of depression, anxiety and PTSD.

The findings show that service members who depicted psychological injuries like depression or anxiety in their artwork tended to have more acute post-traumatic stress disorder (PTSD) than those who incorporated symbols of their military units.

The study is published in the journal BMJ Open.

“Few studies in art therapy have linked visual symbols with existing standardized clinical measures,” said Girija Kaimal, Ed.D., an assistant professor at Drexel University’s College of Nursing and Health Professions and study leader. “This helps us see if there are patterns of visual representations that relate to psychological states.”

Kaimal conducted the study with art therapist Melissa Walker of Walter Reed National Military Medical Center’s National Intrepid Center of Excellence (NICoE).

Once the masks were complete, the researchers categorized the themes they found in each, then matched the masks with mental health questionnaires previously taken by each participant. More than 10 percent of the masks had symbols relating to the participant’s military units, such as a logo or unit patch. Those kinds of masks were associated with lower levels of PTSD.

“We were surprised by how strongly references to a sense of belonging were associated with positive health outcomes,” Kaimal said.

However, another theme was depicted in the masks: fragmented representations of military symbols. These were present in around 10 percent of the masks and included items like faded flags or pieces of camouflage and weapons. These representations were tied to elevated anxiety in the service members.

“There is a subtle difference here between identification with military branch and the use of fragmented imagery associated with the military symbols,” Kaimal pointed out. “It might be that an integrated sense of belonging and identity are associated with resilience while use of fragmented images are associated with some ongoing struggles.”

More than a quarter of the masks had a representation of psychological injury, which was associated with greater levels of PTSD symptoms. Around a third of the masks depicted metaphors; these were linked to lower symptoms of anxiety.

“The main takeaway is that visual representations embed patterns of strengths and struggles that can help clinicians and researchers better serve this population in coping with their injuries and the psychological symptoms that accompany them,” Kaimal said.

Source: Drexel University