NEW YORK – When art therapy is adjunctively combined with cognitive processing therapy in combat veterans with posttraumatic stress disorder, there is a trend for improvement in the Beck Depression Inventory–II score and greater reported patient satisfaction with the therapy, according to interim results from the first known randomized trial to evaluate the addition of art therapy in this setting.
“There are several case studies suggesting a benefit from art therapy in veterans with PTSD, but we believe this is the first controlled study,” reported Dr. Kathleen P. Decker, a psychiatrist with the Hampton (Va.) VA Medical Center, and the Eastern Virginia Medical School, Norfolk. These preliminary data were presented at the American Psychiatric Association’s Institute on Psychiatric Services.
In this ongoing study, 20 veterans with combat PTSD who were undergoing cognitive processing therapy (CPT) in a residential treatment center have so far been randomized to receive art therapy or no art therapy. The hypothesis is that art therapy would improve cognitive processing and thereby further reduce symptoms.
In addition to “engaging the senses,” art therapy “has been hypothesized to assist with externalization and emotional distance,” Dr. Decker explained. “It has also been hypothesized to assist patients [in processing] traumatic memories by creating links between verbal and nonverbal memories, and may organize disassociated memories.”
The data have been encouraging but not definitive, he said. On the basis of the PTSD Checklist Military, symptoms declined significantly from baseline in both groups (P less than.001), but no significant advantage of art therapy was found over CPT alone (P = .5). However, in addition to the more rapid decline in symptoms of depression on the Beck Depression Inventory–II (BDI-II) in those who received adjunctive art therapy, which approached significance (P = .07), high rates of patient satisfaction were recorded in the art therapy group relative to baseline on a semistructured interview with a Likert scale.
“Subjects who received art therapy were more satisfied with their experience of CPT when they received both treatments. Most reported that they would like to continue,” Dr. Decker reported. She noted that no patient reported an increase in distress in the art therapy group, and all patients in the art therapy group completed the protocol. In contrast, two of the patients receiving CPT alone left the program early.
The absence of significant benefit from art therapy across objective measures might be an issue of sample size, according to Dr. Decker, who said a plan is underway to expand the study. It also was emphasized that this study was conducted in a subpopulation of combat veterans with severe PTSD symptoms (although without traumatic brain injury or active psychosis). Dr. Decker suggested it might be appropriate to consider objective tools other than those used in this study to evaluate the impact of art therapy.
Also, he said it might be possible to improve the structure of the art therapy protocol, which remains incompletely validated. In the protocol outlined by Dr. Decker, patients receiving art therapy were encouraged to set goals and identify symptom triggers early in the sequence of sessions. In the final sessions, patients were encouraged to work on reconstructing self-concepts and review the trauma narrative in the context of the artwork.
“Research has shown that art therapy has been a successful tool in symptom reduction and recovery in civilian populations [with] childhood trauma, rape, or other sources of PTSD,” noted Dr. Decker, citing published studies. For the participants in this trial “art therapy was perceived as useful and satisfying,” encouraging additional studies to further objectively evaluate this approach.
Dr. Decker reported no relevant financial relationships.