Mandala and free-form drawing recreational therapy interventions for veterans with PTSD
DOI:
https://doi.org/10.5055/ajrt.2020.0204Keywords:
post-traumatic stress disorder, veterans, free-form drawing, recreational therapyAbstract
Post-traumatic stress disorder (PTSD) is an insidious mental disorder that brings about chaos and affects multiple life domains. Recreational therapy has provided interventions for PTSD and other disorders affecting veterans of the United States military throughout the decades. Recreational therapists search out effective interventions for veterans who will be in congruence with the military culture and allow for greatest impact on the related disorders. Mandala and free-form drawing are expressive interventions that fit within the military culture and have potential to bring about functional change for veterans living with PTSD. The findings of a recent study with veterans living with PTSD provides support for the inclusion and further exploration of both types of expressive interventions for veterans living with PTSD.
References
Department of Veterans Affairs: Report on VA facility specific Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) veterans diagnosed with potential or provisional PTSD. 1st ed. 2017. Available at http://www.publichealth.va.gov/docs/epidemiology/ptsd-report-fy2015-qrt3.pdf. Accessed May 1, 2019.
Taff B, Dattilo J, Davis K, et al.: Leisure perceptions of combat veterans of Operations Enduring Freedom and Iraqi Freedom. J Leisure Res. 2016; 48(4): 265-283.
Wilder A, Craig P, Sable J, et al.: The PATH-Way home: Promoting access, transition, and health for veterans with disabilities. Ther Recreat J. 2011; 45: 268–285.
Goldberg M: Death and injury rates of U.S. military personnel in Iraq. Military Med. 2010; 175(4): 220-226.
Tanielian T, Jaycox L, Adamson D, et al.: Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. 1st ed. pp. 3-17.
Santa Monica, California: RAND Center for Military Health Policy Research; 2008.
Van Puymbroeck M, Lundberg N: Introduction to veteran issues: The role of therapeutic recreation. Ther Recreat J. 2010; 45: 265-267.
American Psychiatric Association: Diagnostic and statistical manual of mental disorders 5th ed. Arlington, Virgina: American Psychiatric Publishing; 2013.
Dustin D, Bricker N, Arave J, et al.: The promise of river running as a therapeutic medium for veterans coping with Post-Traumatic Stress Disorder. Ther Recreat J. 2011; 45(4): 326-340.
Spiegel D, Malchiodi C, Backos A, et al.: Art therapy for combat-related PTSD: Recommendations for research and practice. Art Ther. 2006; 23(4): 157-164.
DiRamio D, Ackerman R, Mitchell R: From combat to campus: Voices of student-veterans. NASPA J. 2008; 45(1): 73-102.
Iwasaki Y, Coyle C, Shank J, et al.: Role of leisure in recovery from mental illness. Am J Psychiatric Rehabil. 2014; 17(2): 147-165.
Porter H: Recreational Therapy for Specific Diagnoses and Conditions. Enumclaw, Washington: Idyll Arbor, Inc.; 2015.
Assis M, Mello M, Scorza F, et al.: Evaluation of physical activity habits in patients with posttraumatic stress disorder. Clinics. 2008; 63(4): 473-478.
Crawford E, Elbogen E, Wagner H, et al.: Surveying treatment preferences in U.S. Iraq-Afghanistan veterans with PTSD symptoms: A step toward veteran-centered care. J Traum Stress. 2015; 28(2): 118-126.
Lake J: The integrative management of PTSD: A review of conventional and CAM approaches used to prevent and treat PTSD with emphasis on military personnel. Adv Integr Med. 2015; 2(1): 13-23. doi:10.1016/j.aimed.2014.10.002.
Poulsen D, Stigsdotter U, Djernis D, et al.: “Everything just seems much more right in nature”: How veterans with post-traumatic stress disorder experience nature-based activities in a forest therapy garden. Health Psychol Open. 2016; 3(1): 1-14. doi:10.1177/2055102916637090. 17. Weathers F, Litz B, Keane T, et al.: The PTSD checklist for DSM-5 (PCL-5). 2013. Available at http://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp. Accessed May 1, 2019.
Benish S, Imel Z, Wampold B: The relative efficacy of bona fide psychotherapies for treating post-traumatic stress disorder: A meta-analysis of direct comparisons. Clin Psychol Rev. 2008; 28(5): 746-758. doi:10.1016/j.cpr.2007.10.005.
Cusack K, Jonas D, Forneris C, et al.: Psychological treatments for adults with posttraumatic stress disorder: A systematic review and meta-analysis. Clin Psychol Rev. 2016; 43: 128-141. doi:10.1016/j.cpr.2015.10.003.
Tran U, Gregor B: The relative efficacy of bona fide psychotherapies for post-traumatic stress disorder: A meta-analytical evaluation of randomized controlled trials. BMC Psychiatry. 2016; 16(266): 1-21. doi:10.1186/s12888-016-0979-2.
Glaser D: Child abuse and neglect and the brain—A review. J Child Psychol Psychiatry. 2000; 41(1): 99-116.
Harris D: The paradox of expressing speechless terror: Ritual liminality in the creative arts therapies’ treatment of posttraumatic distress. Arts Psychother. 2009; 36(2): 94-104. doi:10.1016/j.aip.2009.01.006.
Klorer GP: Expressive therapy for severe maltreatment and attachment disorders: A neuroscience framework. In: Malchiodi CA, ed. Creative interventions with traumatized children. New York: Guilford; 2008: 43-61.
Newton P: Sourcing image formation in a depth psychological approach to posttraumatic stress disorder. [Master's thesis]. Santa Barbara, California: Pacifica Graduate Institute; 2015.
Gantt L, Tinnin L: Support for a neurobiological view of trauma with implications for art therapy. Arts Psychother. 2009; 36(3): 148-153. doi:10.1016/j.aip.2008.12.005.
Schore A: Dysregulation of the right brain: A fundamental mechanism of traumatic attachment and the psychopathogenesis of posttraumatic stress disorder. Aust New Zealand Journal Psychiatry. 2002; 36(1): 9-30. doi:10.1046/j.1440-1614.2002.00996.x.
Bremner J, Southwick L, Brett E, et al.: Dissociation and posttraumatic stress disorder in Vietnam combat veterans. Am J Psychiatry. 1992; 149(3): 328-332. doi:10.1176/ajp.149.3.328.
Talwar S: Accessing traumatic memory through art making: An art therapy trauma protocol (ATTP). Arts Psychother. 2007; 34(1): 22-35. doi:10.1016/j.aip.2006.09.001.
Brasile F, Skalko T, Burlingame J: Perspectives in Recreational Therapy. Ravensdale, Washington: Idyll Arbor; 1998.
Ida D: Cultural competency and recovery within diverse populations. Psychiatric Rehabil J. 2007; 31(1): 49-53. doi:10.2975/31.1.2007.49.53.
Iwasaki Y, Coyle C, Shank J: Leisure as a context for active living, recovery, health and life quality for persons with mental illness in a global context. Health Promot Int. 2010; 25(4): 483-494. doi:10.1093/heapro/daq037.
Resnick S, Rosenheck R: Recovery and positive psychology: Parallel themes and potential synergies. Psychiatric Services. 2006; 57(1): 120-122. doi:10.1176/appi.ps.57.1.120.
Slade M: Mental illness and well-being: the central importance of positive psychology and recovery approaches. BMC Health Services Res. 2010; 10(1). doi:10.1186/1472-6963-10-26.
Young A, Chinman M, Forquer S, et al.: Use of a consumer- led intervention to improve provider competencies. Psychiatric Services. 2005; 56(8): 967-975. doi:10.1176/appi.ps.56.8.967.
Arai S, Griffin J, Miatello A, et al.: Leisure and recreation involvement in the context of healing from trauma. Ther Recreat J. 2008; 42(1): 37-54.
Fullagar S: Leisure practices as counter-depressants: Emotion-Work and emotion-play within women's recovery from depression. Leisure Sci. 2008; 30(1): 35-52. doi:10.1080/01490400701756345.
Rudnick A: Psychiatric leisure rehabilitation: Conceptualization and illustration. Psychiatric Rehabil J. 2005; 29(1): 63-65. doi:10.2975/29.2005.63.65.
Nathan A, Mirviss S: Therapy techniques. Ravensdale, Washington: Idyll Arbor; 1998.
Naumburg M: Art therapy: Its scope and function. In: Hammer EF, The clinical application of projective drawings. Springfield, Illinois: Charles C. Thomas; 1980: 511–517.
Spring D. Thirty-Year study links neuroscience, specific trauma, PTSD, image conversion, and language translation. Art Ther. 2004; 21(4): 200-209. doi:10.1080/07421656.2004.10129690.
Tinnin, L: Biological processes in nonverbal communication and their role in the making and interpretation of art. Am J Art Ther. 1990; 29: 9-13.
Adamski A: Archetypes and collective unconscious compared to development quantum psychology. Neuroquantology. 2011; 9(3): 563-571. doi:10.14704/nq.2011.9.3.413.
Mann A: Pre-Drawn Mandalas versus constructed Mandalas versus unstructured Mandalas: Which creates a greater reduction in anxiety? [Unpublished Master's thesis]. Rochester, New York: Nazareth College; 2013.
Weathers F, Litz B, Keane T, et al.: The PTSD Checklist for DSM-5 (PCL-5)—Standard [measurement instrument]. 2013. Available at http://www.ptsd.va.gov/professional/assessment/documents/PCL-5_Standard.pdf. Accessed May 1, 2019.
Blevins C, Weather F, Davis M, et al.: The posttraumatic stress disorder checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. J Traumatic Stress. 2015; 28(6): 489-498. doi:10.1002/jts.22059.
Bovin M, Marx B, Weathers F, et al.: Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (PCL-5) in veterans. Psychol Assess. 2015; 28(11): 379-1391. doi:10.1037/pas0000254.
Wortmann J, Jordan A, Weathers F, et al.: Psychometric analysis of the PTSD Checklist-5 (PCL-5) among treatment-seeking military service members. Psychol Assess. 2016; 28(11): 1392-1403. doi:10.1037/pas0000260.
Henderson P: Creativity, expression, and healing: An empirical study using Mandalas within the written disclosure paradigm. [Unpublished Master's thesis]. College Station, Texas: Texas A&M University; 2007.
Frost J: Choosing between a nonparametric test and a parametric test. 2017. Available at http://blog.minitab.com/blog/adventures-in-statistics-2/choosing-between-a-nonparametric-test-and-a-parametric-test. Accessed May 1, 2019.
Unistat Software: Multiple comparisons. 2016. Available at https://www.unistat.com/guide/multiplecomparisons/#u7438. Accessed May 1, 2019.
Statistical Analysis System: About SAS. 2017. Available at https://www.sas.com/en_us/company-information.html#history. Accessed May 1, 2019.
Xue C, Ge Y, Tang B, et al.: A meta-analysis of risk factors for combat-related PTSD among military personnel and veterans. PLOS ONE. 2015; 10(3): 1. doi:10.1371/journal.pone.0120270.
Henderson P: Empirical study of the healing nature of artistic expression: Using Mandalas with the positive emotions of love and joy. [Doctor of Philosophy]. College Station, Texas: Texas A&M University; 2012.
MsShane B, Gal D, Robert C, et al.: Abandon statistical significance. Am Stat. 2019; 73(sup1); 235-245, doi:10.1080/00031305.2018.1527253.
Assel M, Sjober D, Elders, A, et al.: Guidelines for reporting of statistics for clinical research in urology. BJU Int (Br J Urol). 2019; 123(3): 401-410; doi:10.1111/bju.14640. wileyonlinelibrary.com.
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