untitled UCLA UCLA Previously Published Works Title Art appreciation for veterans with severe mental illness in a VA Psychosocial Rehabilitation and Recovery Center Permalink https://escholarship.org/uc/item/9cp2281c Journal ARTS & HEALTH, 7(2) ISSN 1753-3015 Authors Ketch, Robert A Rubin, Robert T Baker, Matthew R et al. Publication Date 2015 DOI 10.1080/17533015.2015.1019700 Peer reviewed eScholarship.org Powered by the California Digital Library University of California https://escholarship.org/uc/item/9cp2281c https://escholarship.org/uc/item/9cp2281c#author https://escholarship.org http://www.cdlib.org/ This article was downloaded by: [VA Medical Center 673], [Robert Rubin] On: 18 March 2015, At: 12:00 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Click for updates Arts & Health: An International Journal for Research, Policy and Practice Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/rahe20 Art appreciation for veterans with severe mental illness in a VA Psychosocial Rehabilitation and Recovery Center Robert A. Ketcha, Robert T. Rubinb, Matthew R. Bakera, Alexander C. Sonesa & Donna Amesa a VA Greater Los Angeles Healthcare System – West L.A. Psychosocial Rehabilitation and Recovery Center, Los Angeles, CA, USA b Psychiatry Department, VA Greater Los Angeles Healthcare System, and David Geffen School of Medicine at UCLA – Psychiatry and Biobehavioral Sciences, Los Angeles, CA, USA Published online: 16 Mar 2015. To cite this article: Robert A. Ketch, Robert T. Rubin, Matthew R. Baker, Alexander C. Sones & Donna Ames (2015): Art appreciation for veterans with severe mental illness in a VA Psychosocial Rehabilitation and Recovery Center, Arts & Health: An International Journal for Research, Policy and Practice, DOI: 10.1080/17533015.2015.1019700 To link to this article: http://dx.doi.org/10.1080/17533015.2015.1019700 PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. 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Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms- and-conditions D ow nl oa de d by [ V A M ed ic al C en te r 67 3] , [ R ob er t R ub in ] at 1 2: 00 1 8 M ar ch 2 01 5 http://www.tandfonline.com/page/terms-and-conditions http://www.tandfonline.com/page/terms-and-conditions Art appreciation for veterans with severe mental illness in a VA Psychosocial Rehabilitation and Recovery Center Robert A. Ketch a , Robert T. Rubin b *, Matthew R. Baker a , Alexander C. Sones a and Donna Ames a a VA Greater Los Angeles Healthcare System – West L.A. Psychosocial Rehabilitation and Recovery Center, Los Angeles, CA, USA; b Psychiatry Department, VA Greater Los Angeles Healthcare System, and David Geffen School of Medicine at UCLA – Psychiatry and Biobehavioral Sciences, Los Angeles, CA, USA (Received 27 June 2014; accepted 20 November 2014) Considerable research has shown the positive effects of art, music and drama therapy on mental health and well-being. In September 2012, a weekly Art Appreciation class was initiated at the Veterans Affairs (VA) West Los Angeles (WLA) Psychosocial Rehabilitation and Recovery Center (PRRC) for veterans with severe mental illness. There are 106 VA PRRCs throughout the USA, designed to be transitional learning centers with curriculum-based interventions to help veterans re-integrate into the community and develop meaningful activities independent of the hospital setting. The VA WLA PRRC Art Appreciation class includes classroom sessions and community outings to local museums and other institutions holding art works of interest. It is taught at a college level and designed to lack the stigma of being a therapy group. Preliminary evidence from self-report measures indicates positive effects on mood, self-esteem, socialization and community participation among the veteran participants and recognition among staff that the course aids the veterans’ recovery process. Appreciating art thus appears to promote both subjective and objective improvement in recovery and community re-integration for veterans who are experiencing chronic and disabling emotional distress. Keywords: veterans; mental health; art appreciation Introduction Art appreciation as a tool for enhancing mental health in the military California has the nation’s largest population of veterans (Blanton, 2013), and the Veterans Affairs (VA) Greater Los Angeles Healthcare System cares for about 20,000 veterans in its mental health programs. Many veterans recovering from severe mental illness are served by the VA West Los Angeles (WLA) Psychosocial Rehabilitation and Recovery Center (PRRC), whose mission is to stimulate hope and promote mental health recovery by offering support, education and opportunities so that individuals can successfully achieve their goals in the community. There currently are 106 VA PRRCs throughout the USA (Veterans Health Administration Handbook 1163.03, 2011), and all are seeking innovations in their programming. With its flourishing art scene, Los Angeles is considered a major art center supporting a vibrant gallery culture, world-class art education and some of the most This work was authored as part of the Contributor’s official duties as an Employee of the United States Government and is therefore a work of the United States Government. In accordance with 17 U.S.C. 105, no copyright protection is available for such works under U.S. Law *Corresponding author. Email: rtrubin@yahoo.com Arts and Health, 2015 http://dx.doi.org/10.1080/17533015.2015.1019700 D ow nl oa de d by [ V A M ed ic al C en te r 67 3] , [ R ob er t R ub in ] at 1 2: 00 1 8 M ar ch 2 01 5 mailto:rtrubin@yahoo.com mailto:rtrubin@yahoo.com http://dx.doi.org/10.1080/17533015.2015.1019700 respected art museums in the world. Consistent with the WLA PRRC mission, in September 2012 an Art Appreciation class was established with three goals: (a) appreciating art, (b) building positive relationships among class participants and (c) integrating participants into the community. The classes are led by the one of the authors, RAK, a licensed clinical social worker and experienced group facilitator with a long- standing interest in art appreciation. This report discusses the evidence on art appreciation as a vehicle for mental health recovery, how the art appreciation class fits into the recovery philosophy of the WLA PRRC, and the operation of the class, including examples of art discussed and preliminary evidence on effectiveness, based on individual veteran survey responses. The report, “Arts, Health and Well-Being across the Military Continuum: White Paper and Framing a National Plan for Action” (Americans for the Arts, 2013) identifies the positive effects of art on the mental health of veterans and advocates for advancing the policy, practice and quality use of arts and creativity as tools for health in the military. It further refers to the work of the National Endowment of the Arts that culminated in a theory of how art works as a system in America: “When people engage in art, they themselves may change and ‘grow,’ . . . Art contributes to and enriches the overall quality of life” (National Endowment for the Arts, 2012, p. 9). According to the 2009 Management of Major Depressive Disorders Working Group (cited in Americans for the Arts, 2013, p. 24), arts interventions can be a form of behavioral activation – the systematic scheduling and monitoring of pleasurable or reinforcing activities – which can have significant antidepressant effects. Expressive art therapies can help individuals have improved sleep and impulse control, greater concentration, and less depression and anxiety (Americans for the Arts, 2013). Visual art has been shown to alleviate stress and anxiety in patients in healthcare settings (Nanda, Eisen, & Baladandayuthapani, 2008; Ulrich, 2009; Ulrich & Gilpin, 2003; Wissing, 2009). When we look at things that we consider beautiful, the activity in the pleasure and reward centers of the brain is increased (Kawabata & Zeki, 2004). Chatterjee (2014) also contended that the pleasure we derive from viewing objects we find beautiful correlates with activation of our brain’s reward circuitry (i.e., different kinds of pleasures, including music, visual art and even architectural spaces, are accompanied by increased neuronal activity in the orbitofrontal cortex). Expressionist theories claim that the function of art is to communicate on the emotional level (Chatterjee, 2014); for veterans who are experiencing disabling emotional distress, appreciating art and learning about artists thus could have positive effects on mood, self-esteem, socialization and community participation and may be a protective factor in suicide prevention. Method Program rationale, goals and process In The Artist’s Way, Cameron (2002) identified elements of recovery to a healthy life, one of which is “The Artist Date . . . opening yourself to insight, inspiration, guidance” (p. 18). Cameron defined an Artist Date as “a block of time, perhaps two hours weekly, especially set aside and committed to nurturing the creative consciousness, [one’s] inner artist” (p. 18), leading to a sense of well-being. An Artist Date may be bowling, a walk on the beach, listening to music or a visit to an art gallery. It was this joyful experience that encouraged RAK, in September 2012, to share with veterans his appreciation of the artistic creations of others by beginning an Art Appreciation class for one hour each week at the WLA PRRC. 2 R.A. Ketch et al. D ow nl oa de d by [ V A M ed ic al C en te r 67 3] , [ R ob er t R ub in ] at 1 2: 00 1 8 M ar ch 2 01 5 Frederickson (2002) indicated that we should cultivate positive emotions in ourselves and in those around us, not just as end states in themselves, but also to achieve improved psychological and physical health. The WLA PRRC is a holistic program, centered on the recovery model (Warner 2010), that provides evidence-based treatments, wellness classes and creative arts experiences for veterans with severe mental illness. Therapeutic lifestyle changes (TLCs) are elements of the WLA PRRC’s holistic wellness programming. Walsh (2011) reviewed research on the effectiveness of eight TLCs for mental health: exercise; nutrition and diet; time in nature; relationships; recreation and enjoyable activities; relaxation and stress management; religious/spiritual involvement; and service and helping others. Class participants are encouraged to complete the Lifestyle Practices Diary: The eight Ways to Practice TLCs. For some veterans, the Art Appreciation class is part of the fifth practice, recreation and enjoyable activities. Veterans in the WLA PRRC are considered students who take classes, an orientation meant to be destigmatizing and which is part of the recovery model. Each veteran develops a personal recovery plan and engages in activities based upon his or her recovery goals. Community integration, as opposed to institutionalization, is the goal of recovery, and the Art Appreciation class includes both classroom sessions and community outings. The class is taught at the level of a college art history class. It is not designed as “therapy” and is meant to avoid the stigma associated with participation in a therapy group. Veterans participate as if they were in a college classroom and thus are transformed from patients to students. Dimming of the lights while appreciating art projected on the screen is conducive to a pervasive sense of peace and calm. Classes begin with participants sharing art experiences they have had during the previous week, which may include having viewed art or having read something about art. The leader (RAK) then shares his art experiences during the previous week, which may include projecting on a large screen photos from a laptop computer of art from a gallery, museum or sculpture garden visit. The veterans are encouraged to share their observations and perceptions of the projected art. This sharing not only provides information about a particular artist or artists, but it also informs members about art-experience opportunities in the community. When members express an interest in a particular artist or style of art, the leader researches the topic and brings information about the artist to the next class. For example, when a group member asked about Salvador Dali, the leader made a full presentation on the artist the next week. Every two months, the class leader and a VA recreation staff member accompany the class to a local museum to view art that has been discussed in class. This experience introduces veterans to museums to view original art first-hand and to consider the museums as community resources for further exploration on their own. The leader serves as the guide and may engage the museum to provide a docent to further explain the exhibits. Museums visited in the Los Angeles area include the Armand Hammer Museum, Getty Villa, Getty Center, Los Angeles County Museum of Art, Norton Simon Museum, California African American Museum, Autry Museum of Western Art, UCLA Franklin Murphy Sculpture Garden, UCLA Fowler Museum and the Huntington Library, Gardens, and Museums. The leader contacts the museums ahead of time to secure free passes, and the recreation staff member arranges packed lunches from the VA. Some veterans who have been unable to participate in the group outings have visited the museums with family members. Although the weekly meetings are conducted as art appreciation classes, as a Licensed Clinical Social Worker, the leader seeks to develop a positive group environment and relationships with members through expressions of concern, acceptance, genuineness and Arts and Health 3 D ow nl oa de d by [ V A M ed ic al C en te r 67 3] , [ R ob er t R ub in ] at 1 2: 00 1 8 M ar ch 2 01 5 empathy, as well as nonjudgmental acceptance and appreciation (Yalom, 1995). The leader seeks to engage members in the discussion of art, artistic styles and artists, to evoke positive and recovery-oriented thoughts and feelings. For example, a viewing and discussion of the paintings of cakes and pies by Wayne Thiebaud led to discussions of positive memories of family members’ gathering and baking. It has been important to follow the suggestions and interests of class participants, who often ask about a particular artist or type of art. Veterans have asked about Dali, Rembrandt, Picasso, Munch (painter of The Scream) and others, which has led to interesting reviews of their art and lives. Other veterans have asked about Aztec and Egyptian art, which has led to the discussion of historical aspects of artistic creations. The topics thus are often directed by the class members’ interests. The leader sometimes shares an overview of art seen on a recent museum or gallery visit, and members sometimes ask to learn about the life of an artist whose work has been shown. Prior to the museum field trips, the leader presents information on the museum and the art to be seen. For example, before visiting the Armand Hammer museum, the group viewed photos and a brochure of the museum collection, including works by Gustave Moreau and Vincent Van Gogh. This led to discussions of the artists and their subjects. Van Gogh’s painting, Trees in the Garden of the Hospital Saint-Paul (Figure 1; Van Gogh, 1889), led to a discussion of the mental health challenges in Van Gogh’s life, of which they were already aware. The recovery principle in this discussion was to learn that one is not alone in facing mental health challenges, and that some of the most famous and productive people throughout history have faced similar challenges. Figure 1. Trees in the Garden of the Hospital Saint-Paul (Van Gogh, 1889). The work of art depicted in this image and the reproduction thereof are in the public domain in the USA. 4 R.A. Ketch et al. D ow nl oa de d by [ V A M ed ic al C en te r 67 3] , [ R ob er t R ub in ] at 1 2: 00 1 8 M ar ch 2 01 5 The paintings of King David and Salome Dancing before Herod by Moreau led to class members’ discussing the history depicted by the paintings, as some of the class members were very knowledgeable about the bible stories. Supporting spiritual health also is part of a recovery-oriented approach to the treatment of mental illness. Prior to visiting the John Paul Getty Museum in Malibu (The Villa), the leader presented information on the eruption of Mt. Vesuvius and the burying of Pompeii and Herculaneum, because the museum is a replica of a villa in Herculaneum. The museum houses many sculptures and artifacts from ancient Greece, Rome and Egypt. The class was very interested in the history and artifacts from Pompeii. They viewed videos that dramatized the time of the eruption, and some already had watched television programs on the subject. Students were very keenly aware of how this tragedy helped preserve the details of everyday life 2,000 years ago. Certain artists have fascinated the class members. Caravaggio, the pioneer Baroque painter, painted real people in action, with dirty fingernails and all, to depict bible stories for Catholic churches. Some of his work was rejected by church leaders, because his subjects did not look saintly enough. Figure 2 illustrates the down-to-earth style of this early Baroque painter (Caravaggio, 1606). The veterans were interested in Caravaggio’s life struggles, stemming from the loss of most of his family to bubonic plague. Learning about how famous artists endured their life difficulties has been part of teaching the veterans about resilience and recovery – how to endure great troubles and still move forward with their lives. Figure 2. Death of the Virgin (Caravaggio, 1606). The work of art depicted in this image and the reproduction thereof are in the public domain worldwide. Arts and Health 5 D ow nl oa de d by [ V A M ed ic al C en te r 67 3] , [ R ob er t R ub in ] at 1 2: 00 1 8 M ar ch 2 01 5 The veterans also identified with artists who had other challenges. Although Norman Rockwell created idealistic views of America for over 40 years while illustrating for The Saturday Evening Post magazine, he left there to illustrate for Look magazine, so he could express his social concerns by portraying some of the problems afflicting American society. He painted The Problem We All Live With, which depicts a six-year-old African- American girl in the 1960’s being escorted to her class by federal marshals, a tomato- stained wall with degrading graffiti behind her (Figure 3; Rockwell, 1964). This illustrated the 1960 forced integration of New Orleans public schools. The class members compared Caravaggio and Rockwell in the ways they painted reality. Many individuals with severe mental illness face discrimination because of their illness, and this Rockwell painting conveyed the importance of being resilient under adverse societal circumstances. The sculptures of Auguste Rodin were introduced prior to visiting the Norton Simon Museum, where The Thinker and The Burghers of Calais were viewed. The class members were interested in the expressions of the statues and discussed interpretations of the faces and body language. This gave the opportunity to learn about Rodin’s life, which was not without tumult, and the class related to the challenges Rodin faced and appreciated the greatness of his work. They also learned about the bronze casting process Rodin used to create his sculptures. In this class, veterans have been exposed to a wide range of cultures in their exploration of art. One of the most important aspects of the recovery model is the support of cultural diversity and lifelong learning. Prior to a visit to the Autry Museum of Art, the class viewed and discussed the works of American artists, especially those who have portrayed the West, including N.C. Wyeth, Frederic Remington, and Allan Houser. The veterans were interested in learning about these artists’ lives. For example, Allan Houser, born in 1914, one of the most renowned Native American painters and Modernist sculptors, was the son of Sam Haozous, who was a translator for Geronimo, the leader of the Apache Nation. Houser was the first member of his family tribe born outside of captivity since Geronimo’s 1886 surrender and the tribe’s imprisonment by the US government. The class was quite moved by Houser’s sculptures of Native Americans. Figure 3. The Problem We All Live With (Rockwell, 1964). Copyright 1964 by Look Magazine. Reproduction of this image complies with fair use under US copyright law. The image is one of the subjects of this educational article and makes an irreplaceable contribution to the reader’s understanding of the article, where it is accompanied by background and commentary, and is of sufficiently low resolution to avoid competition for commercial purposes with the original image. 6 R.A. Ketch et al. D ow nl oa de d by [ V A M ed ic al C en te r 67 3] , [ R ob er t R ub in ] at 1 2: 00 1 8 M ar ch 2 01 5 While preparing for a trip to the California African American Museum, the works of African-American artists collected by the Golden State Mutual Life Insurance Company were studied, including the murals by Hale Woodruff and Charles Aston and works by Jacob Lawrence, Charles White and Romare Bearden. Also considered was the Harlem Renaissance, leading to the production of much fine African-American art. The class members were impressed by the important contributions of these and other African- American artists. The class learned about Henri Matisse and Pablo Picasso before visiting the Los Angeles County Museum of Art, which has many art objects from Picasso’s various periods (blue, rose, cubism and others), as well as several important works by Matisse. The impact of these painters on modern art was a topic for class discussion. Other artists featured in the class have included Richard Diebenkorn, Sam Francis, Mary Cassatt, Winslow Homer, Thomas Eakins, Frederic Edwin Church and the glass sculptures of Dale Chihuly, giving the class opportunities to discuss the artists’ talents and psychosocial challenges, how the artists dealt with them and how they expressed them in their art. One of the goals of a holistic approach to the treatment of mental illness is to help overcome the narrowing of world view that often comes with retreating into an internal world of isolation. The students taught themselves to see the world more fully through the artists’ creativity. For example, David Hockney’s works encourage the viewer to look more fully at a scene. He used photography with multiple cameras to record the English Yorkshire countryside, as well as painting on multiple large canvases in order to portray the details of landscapes. Through his art, he helps the viewer learn to see more and in greater detail. The class members have repeatedly recalled this lesson in viewing scenery. Andrew Wyeth taught us to appreciate the beauty around us. He mostly painted what he saw in and near his home. He wandered around his neighborhood, into people’s attics and cellars, and out in the fields, where he saw things that interested him. This led to a discussion of how the class members could look for and find beauty in their daily lives. The class learned that artists express their feelings and emotions through their art. Vincent Van Gogh saw his paintings as a way not to copy nature but to improve on it. He said that paintings come from the painter’s soul, and Picasso wrote that art washes away the dust of everyday life. While this lesson in creativity is helpful to everyone, it is especially useful to veterans confronting life’s major challenges. In addition to the Art Appreciation class, the advancement of art experiences by the WLA PRRC is achieved through creative arts classes (painting, ceramics, silk screening, mosaics), art shows created by veterans, and displays of art prints. Veterans are encouraged to enroll in outside adult education classes, and, as mentioned earlier, some veterans have returned to school in the community as part of their recovery goals. Results Program staff have emphasized the serenity the veterans experience as they view the images and absorb knowledge, and that their social skills have been enhanced by the gentle encouragement to participate provided by the discussion facilitator. It has been remarkable to the program staff just how fluent these veterans with severe mental illnesses have become in the language of art. Of particular importance, gaining confidence from this class and others in the WLA PRRC has aided veterans’ transition to the community and helped stimulate their lifelong learning. For example, some of our veterans in late middle age, following years of mental illness, have begun to pursue college educations. Arts and Health 7 D ow nl oa de d by [ V A M ed ic al C en te r 67 3] , [ R ob er t R ub in ] at 1 2: 00 1 8 M ar ch 2 01 5 Veterans in all WLA PRRC classes are asked to complete surveys to assess the classes for effectiveness and areas of improvement. For the Art Appreciation class, five veterans completed surveys after about eight months’ attendance (36 weekly sessions). (Other veterans, who attended less frequently, were not surveyed.) On a five-point Likert scale (1 ¼ extremely negative, 3 ¼ neutral, 5 ¼ very positive) asking, “How do you feel about attending this class?” all five participants indicated “very positive”. Comments about what they liked most included, “the slides,” “information concerning the artist,” and “talks about the impressionists.” To the question, “Do you feel this class has helped you develop in your own recovery?” all five participants answered “yes.” Responses to the question, “How has it helped you develop in your recovery?” included, “opens my mind,” “opens my mind to the beauty around me,” “by watching the artist” (slide presentations), and “go to museums to see art by the artist.” Responses to the question, “How could it better help you in your recovery?” included, “more videos,” “keep the class going,” and “by doing it.” Two veterans indicated the class was fine as it is. All the veterans answered “yes” to the questions, “Do you find the information and supplementary materials provided in the class helpful?” and “Do you feel that the information given in the class has helped in your recovery?” Responses to the request to “explain how course materials and information have helped in your recovery” included, “learning about the arts,” “I like art and going to the museum to see paintings,” and “helped me to think about art.” With regard to the question, “What additional suggestions or comments do you have that would assist in making this a better class?” two participants indicated, “nothing at this time,” and one indicated, “more movies about art.” Discussion The above-mentioned responses provide preliminary data on the effectiveness of the Art Appreciation class, and they point to its ability to support participants’ subjective beliefs about their progress toward recovery. The data also provide a rationale for continuation of the class, with more detailed evaluations of both its subjective impact, through measures of psychological functioning, and its objective impact, through measures of socialization, community participation and progress toward independent living. Continued assessment of the Art Appreciation class, with ongoing improvements as suggested by veterans and staff, will determine its ultimate place in the armamentarium of recovery-oriented mental health programs. We need to learn more about how identifying with an artist or being immersed in beauty impacts our brain’s reward circuitry. The Art Appreciation class offers the opportunity to further investigate art appreciation as a vehicle for psychological growth and improved mental health. Future plans include hypothesis-based collection of both structured self-report measures and narrative comments from class participants, and structured evaluations from WLA PRRC staff, to further elucidate the Art Appreciation class as a vehicle for psychological growth and improved mental health in veterans. Development of a manual, with links to images and video clips of suggested artists and recovery-themed discussion points, also will be undertaken, so that others can institute and evaluate similar classes in their own clinical settings. Conclusion The WLA PRRC Art Appreciation class embraces many aspects of the recovery model for the treatment of severe mental illness in veterans, providing a unique learning adventure 8 R.A. Ketch et al. D ow nl oa de d by [ V A M ed ic al C en te r 67 3] , [ R ob er t R ub in ] at 1 2: 00 1 8 M ar ch 2 01 5 for the participants. The class enhances their psychological resiliency by fostering their love for learning and their ability to rise above the stigma of mental illness. Participants learn that some of the greatest artists faced similar challenges. The class emphasizes cultural diversity and supports community integration, combining didactics with community outings to provide places to go to appreciate art, a deeper awareness of the lives of artists, and, in turn, deeper insight into the veterans’ own life stories. Of importance, the class format of didactic sessions and outings to local cultural institutions is easily adaptable to many mental health recovery-oriented programs. Acknowledgements The authors are grateful to the veterans and staff of the WLA PRRC who have contributed to the success of the Art Appreciation class. Disclosure statement None of the authors has any financial or other conflict of interest with respect to this work. 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(2011). Lifestyle and mental health. American Psychologist, 66, 579–592. doi:10:1037/ a0021769 Warner, R. (2010). Does the scientific evidence support the recovery model? Psychiatric Bulletin, 34, 3–5. doi:10.1192/pb.bp.109.025643 Wissing, K. (2009). Expressive arts and traumatic brain injury: Therapeutic arts for head trauma survivors. Retrieved from http://suite101.com/a/expressive-arts-and-traumatic-brain-injury- a120778 Yalom, I. (1995). The theory and practice of group psychotherapy. New York, NY: Basic Books. 10 R.A. Ketch et al. D ow nl oa de d by [ V A M ed ic al C en te r 67 3] , [ R ob er t R ub in ] at 1 2: 00 1 8 M ar ch 2 01 5 http://dx.doi.org/doi:10:1037/a0021769 http://dx.doi.org/doi:10:1037/a0021769 http://dx.doi.org/doi:10:1037/a0021769 http://dx.doi.org/doi:10:1037/a0021769 http://dx.doi.org/doi:10.1192/pb.bp.109.025643 http://dx.doi.org/doi:10.1192/pb.bp.109.025643 http://suite101.com/a/expressive-arts-and-traumatic-brain-injury-a120778 http://suite101.com/a/expressive-arts-and-traumatic-brain-injury-a120778 Abstract Introduction Art appreciation as a tool for enhancing mental health in the military Method Program rationale, goals and process Results Discussion Conclusion Acknowledgements Disclosure statement References