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Patterns of risk, resilience evident in art created by service members

Study findings revealed that military service members with history of traumatic brain injuries who depicted psychological injuries in their artwork tended to have more acute posttraumatic stress symptoms than those who used symbols of their military units.

"Few studies in art therapy have linked visual symbols with existing standardized clinical measures," Girija Kaimal, EdD, assistant professor in the creative arts therapies department at Drexel University College of Nursing and Health Professions, said in a press release. “This helps us see if there are patterns of visual representations that relate to psychological states.”

In this systematic observational study, researchers examined the correlations between visual self-expression and clinical symptoms of posttraumatic stress, depression and anxiety among 370 active-duty military at the National Intrepid Center of Excellence at the Walter Reed National Military Medical Center.

Patients with a history of traumatic brain injury, PTSD symptoms and related psychological health conditions participated in group art therapy mask-making sessions in week 1 of a 4-week integrative treatment program. The investigators examined whether the visual themes expressed in the participants’ art depicted aspects of individual identity — psychological injury, military symbols, military identity and visual metaphors.

Results of the visual and clinical data comparisons showed that service members who depicted psychological injury through their art had higher scores for posttraumatic stress and depression, Kaimal and colleagues found.

Participants who depicted their military unit identity, nature metaphors, sociocultural metaphors and cultural/historical characteristics were more likely to have lower posttraumatic stress, depression and anxiety scores. In comparison, participants who depicted color-related symbolism and fragmented military symbols were more likely to have higher posttraumatic stress, depression and anxiety scores.

Approximately 10% of participants’ masks showed fragmented representations of military symbols, including faded flags, pieces of camouflage and weapons, which were linked to elevated anxiety scores, whereas more than 10% of the masks portrayed symbols relating to their military units, such as logos or unit patches, which were linked to reduced levels of PTSD, according to the press release. Furthermore, over 25% of the masks depicted images of psychological injury, which were linked to higher PTSD symptom levels, and over 30% depicted metaphors, which were linked to lower symptoms of anxiety, per the release.

“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 in the release. “There is a subtle difference here between identification with military branch and the use of fragmented imagery associated with the military symbols. 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.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.