Using Art Therapy to Overcome Avoidance in Veterans with Chronic Post-Traumatic Stress Disorder
Abstract: Avoidance can be a significant barrier to engaging in trauma-focused treatment for post-traumatic stress disorder (PTSD), as well as being a mechanism that creates restrictions that can seriously impact functioning and wellbeing. Following an outpatient study with veterans that indicated art therapy might assist the overcoming of avoidance, a group of veterans was offered an art therapy-focused, short-stay, inpatient admission at the veterans’ mental health charity Combat Stress to explore this potential outcome. Participants were able to use the art therapy process to express and tolerate painful thoughts and emotions, and to consider the effects of rigid perceptions. The group dynamic between the veterans created a strong container for this process. Consequently, this study suggests that art therapy can be constructively employed in assisting veterans to overcome avoidance PTSD symptoms and as a means of opening up new ways of perceiving, interpreting, and responding to situations. It is proposed that the non-verbal operations of art therapy enable this process through the use of imagination and creativity.
Abstract: Novel and automated means of opioid use and relapse risk detection are needed. Unstructured electronic medical record data, including written progress notes, can be mined for clinically relevant information, including the presence of substance use and relapse-critical markers of risk and recovery from opioid use disorder (OUD). In this study, we used natural language processing (NLP) to automate the extraction of opioid relapses, and the timing of these occurrences, from veteran patients' electronic medical record. We then demonstrated the utility of our NLP tool via analysis of pre-/post-COVID-19 opioid relapse trends among veterans with OUD. For this demonstration, we analyzed data from 107,606 veterans OUD enrolled in Veterans Health Administration, comparing a pandemic-exposed cohort (n = 53,803; January 2019-March 2021) to a matched prepandemic cohort (n = 53,803; October 2017-December 2019). The recall of our NLP tool was 75% and our precision was 94%, demonstrating moderate sensitivity and excellent specificity. Using the NLP tool, we found that the odds of opioid relapse postpandemic onset were proportionally higher compared to prepandemic trends, despite patients having fewer mental health encounters from which to derive instances of relapse postpandemic onset. In this research application of the tool, and as hypothesized, we found that opioid relapse risk was elevated postpandemic. The application of NLP Methods: to identify and monitor relapse risk holds promise for future surveillance, risk prevention, and clinical outcome research.