Investigating art therapy for emotional regulation among service members with traumatic brain injury

Background Enhancing an individual’s emotion regulation strategies may help them improve functioning across multiple biopsychosocial domains.Aims This study aimed to investigate the use of emotion regulation strategies among service members and veterans receiving Art Therapy (AT) treatment for mild traumatic brain injury (mTBI) at an outpatient brain health clinic within the United States Military Health System.Methods This exploratory study involved a retrospective analysis of data collected during routine clinical care. The study sample included 79 patients (service members and recently separated veterans) who completed from 8 to 24 sessions of art therapy to treat mTBI. At the end of the art therapy programme, patients completed the Emotion Regulation Strategies for Artistic Creative Activities Scale (ERS-ACA), as adapted for art therapy settings.Results Of the three ERS-ACA emotion regulation strategy categories, approach strategies, such as reappraisal, problem-solving, and emotional acceptance, were used more than the other strategies for emotion regulation. The ERS-ACA scale was found to have good internal consistency.Conclusions This study built on prior programme evaluations by providing suggestive evidence that art therapy treatment may enhance emotion regulation strategy use among this population. It yielded preliminary evidence supporting the use of ERS-ACA in service members and recently separated veteran populations engaged in art therapy.Implications for practice/policy/future research Future validation studies are needed to confirm that the ERS-ACA is a valid and reliable measure in this population and setting. Overall, this study provides foundational support for future studies investigating whether art therapy helps military personnel with mTBI develop emotion regulation strategies.Plain-language summaryCould Art Therapy be a useful tool to heal the invisible wounds of war? This study explores how Art Therapy might help military service members and recently separated veterans manage their emotions after experiencing a mild traumatic brain injury (mTBI). For individuals who may find traditional talk-based therapies challenging, creative approaches offer an alternative. In the study, individuals received one-on-one sessions with an art therapist – a trained mental health professional who helps patients create visual art within a psychotherapeutic relationship – as a treatment for conditions like mTBI. As part of the Creative Forces®: NEA Military Healing Arts Network in the United States, researchers wanted to understand which emotion regulation strategies participants used. These are the different ways people manage their feelings, from distracting themselves from stress, to reflecting on their feelings in a new light. After completing their Art Therapy programme, 79 service members and recently separated veterans answered questions about their experience. The questions focused on three emotion regulation strategy categories; avoidance strategies (i.e. distraction, suppression, or detachment from stressful emotions), approach strategies (i.e. acceptance, reappraisal, or problem solving), and self-development strategies (i.e. enhanced self-identity, self-esteem, or agency). The findings point in an interesting direction. Participants reported using several strategies, but most frequently used approach strategies, which involve using the creative process to actively explore their emotions. A large number of participants specifically reported that making art helped them to ‘reflect on my emotions’. This study does not draw final conclusions but provides preliminary support for the idea that service members and recently separated veterans use emotion regulation strategies, particularly approach strategies, in Art Therapy. Overall, the authors suggest that more research is needed to build on these findings, providing a foundation for future work exploring how Art Therapy can best support service members and recently separated veterans on their journey to recovery.