It was very fitting that between Veterans' Day, when we recognize our veterans and all they have done for our country, and Thanksgiving, when we show our gratitude for so many and for so much, the creation of a music therapy program at Walter Reed Army Medical Center and at the National Intrepid Center of Excellence (NICoE) was announced. What an appropriate way to honor and provide assistance to those who serve our country!
This expansion of the landmark partnership between the National Endowment for the Arts (NEA) and Department of Defense was discussed at a recent media teleconference. NEA chair Rocco Landesman mentioned that Walter Reed is the first "point of care in the U.S. for the wounded, ill and injured from global conflicts" and that many troops are now returning with traumatic brain injury and psychological health issues, "complex diagnoses that call for a new level of care."
Walter Reed's NICoE has the first state-of-the-art research center to test treatment plans integrating creative arts therapies alongside traditional rehabilitative treatments for patients in military settings. In November 2012, music therapy was added to healing art efforts at NICoE and throughout Walter Reed with the hiring of music therapist Julie Garrison and music therapy consultant Meagan Morrow, who worked with Congresswoman Gabrielle Giffords. Music therapy will be a part of the groundbreaking, interdisciplinary approach to working with patients and their families, according to Melissa Walker, creative arts therapist and the NICoE's Healing Arts Program Coordinator. Ms. Garrison will work with military patients, active duty troops with TBIs and psychological health issues at the NICoE and with patients throughout Walter Reed, including active duty, veterans, and their beneficiaries.
The formal discipline of music therapy has a rich, long history in providing services for our American heroes. It began after World Wars I and II, when community musicians performed in veterans' hospitals and medical professionals noticed patients' positive and emotional responses to music. In 1944, when it became evident that these hospital musicians required special training, the first music therapy degree program was founded. Currently, approximately 50 qualified music therapists work in VA hospitals throughout the U.S., according to Al Bumanis, director of communications at the American Music Therapy Association.
Articles specifically related to music therapy and the military included a 1990 pilot study using drumming with six Veterans Affairs Medical Center patients diagnosed with late stage dementias.  Results revealed the group could imitate rhythm patterns they heard and saw demonstrated, match tempos during group playing, respond to a leader, increase duration of their playing, and fit their playing more readily with others' rhythm patterns.
Burt (1995) used drumming with Vietnam veterans diagnosed with PTSD.  Music therapy utilizing improvisation on hand drums helped veterans modulate their "often misdirected, exaggerated, and unrecognized emotions," with the goal being generalization of these skills to everyday life. Drumming provided an opportunity for the men to express and control their feelings and helped build a sense of connectedness and group mission.
Blake (1994) described a project with inpatient Vietnam veterans with combat-related PTSD, who reported they were able to reconnect with feelings, increase self-understanding, improve concentration, and/or achieve a sense of relaxation during Guided Imagery and Music (GIM) sessions.  "The GIM process was significant in allowing the veterans to experience memories and emotions with the therapist as witness."
I recently spoke with Tina Haynes, MT-BC, LCAT, creative arts therapist in music, for the Tennessee Valley Healthcare System, York Campus, in Murfreesboro, Tenn. Ms. Haynes commented on trends she has recently observed in her clinical practice: She is seeing younger veterans and many more female veterans. Rather than being dependent on drugs, they request alternatives to pharmacologic intervention. They want healthy coping skills and tools to help them return to their lives and make life as normal as possible.
Recent veterans are part of the millennial generation. Pew social trends research found particular reasons leading "millennials" to feel distinctive: "In response to an open-ended follow-up question, 24 percent say it's because of their use of technology." Second in line were the 11 percent who said it's because of their music and pop culture. No other generation cited music and pop culture as a distinctive characteristic, making this generation unique. Haynes commented, "Music is just such a normal part of their life, and we can get them engaged more quickly through its use."
Another trend in today's military is the high incidence of "polytrauma," with individuals being subjected to multiple traumatic injuries. This term is common among U.S. military doctors describing seriously-injured soldiers returning from Iraq and Afghanistan.
A recent look at an outpatient music therapy group of veterans of current conflicts at the York Campus in Murfreesboro revealed all had PTSD and several had TBIs, both diagnoses considered "signature wounds" for veterans of our current conflicts, according to Haynes. The majority of group members were in their late 20s to early 30s. A music therapist and a speech and language pathologist co-led the group, the purpose of which was to provide a really intense, saturated experience in addressing attention and cognitive endurance. Standard traditional cognitive attention training and music attention control training were used. The group met twice weekly for eight weeks, with four sessions focusing on each type of attention.
To address sustained attention, the ability to focus on a specific task for a continual amount of time, veterans might be asked to match a rhythm played by the therapist on their instruments, listen for changes in the therapist's rhythm, and match the new rhythm each time a change was made.
An example to practice selective attention, the ability to focus on certain stimuli while ignoring distractions, involved veterans being given a rhythm to sustain on a percussion instrument while someone else played a different rhythm to intentionally try to disrupt their original rhythm.
To rehearse alternating attention, being able to shift focus between two different tasks with different cognitive demands, two leaders might create their own unique rhythms to play simultaneously. The group starts by following one leader and, at a predetermined cue, switches to the other leader's rhythm.
For divided attention, being able to respond simultaneously to multiple tasks, veterans were sometimes given times to track, without using a clock, while they played percussion instruments along with therapist accompaniment. One task was to play for 20 seconds, rest for 20, then play for 20 and to continue on for the remainder of the exercise.
At end of the pilot group, patients were so impressed with how the training affected their lives that they requested additional sessions and offered positive comments, such as: "This group helps you feel focused. It helps you feel good about yourself," or "This group helps with your independence." Comparisons of scores on pre- and post-standard attention tests were promising.
Much more attention is being drawn to what music therapy can accomplish in military circles. We need more music therapists to work with veterans, caregivers, and family members. We need more research, so it is great that this new partnership is very focused on research. In the Nov. 15 media teleconference, Landesman stated: "To reap long-term benefits from this collaboration, so that service people now and in the future might gain from what we learn, we will conduct research as we go along."
Health and Human Services Secretary Kathleen Sebelius applauded the NEA/Department of Defense partnership, noting NEA created an Interagency Task Force, bringing together multiple federal departments and agencies and encouraging "more and better research on how the arts can help people reach their full potential at all stages of life." Sebelius remarked:
Better research can inform future policy and practices nationwide ... The neurologic music therapy programs and creative and expressive writing programs being tested at Walter Reed may lead to more effective and widespread use of creative arts therapy as a treatment option, both for patients in military settings and within the larger health care system.
Rear Admiral Stocks, commander at Walter Reed, stated: "Time and time again, troops, their families, military and medical professionals tell us that art can make a difference in the quality of life for troops and their families." He shared his excitement "to examine those claims through research and practice."
Melissa Walker summed it up this way:
Through the creative arts therapies, service members come to a better understanding of themselves and are able to express this in a way that can help them heal and help their caregivers understand their experiences.
Feel free to visit the AMTA website, http://www.musictherapy.org, where you can find selected references and key findings on music therapy interventions for those dealing with trauma or traumatic brain injuries, although not specifically related to military participants.
(1) Clair, A. C., & Bernstein, B. (1990). A preliminary study of music therapy programming for severely regressed persons with Alzheimer's type dementia. Journal of Applied Gerontology, 9, 299-311.
(2) Burt, J. W. (1995). Distant Thunder: Drumming with Vietnam Veterans. Music Therapy Perspectives, 13, 110-112.
(3) Blake, R. L. (1994). Vietnam veterans with post traumatic stress disorder: Findings from a
music and imagery project. Journal of the Association for Music and Imagery, 3, 5-18.
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