In 2019, Special Interest Groups (SIGs) were selected by an International Association of Music Medicine review committee for inclusion at the 6th annual conference in 2020. Each leader was charged with assembling subject matter experts from different disciplines and across continents. These groups met virtually throughout the year to develop outcomes that included scholarly presentations and programming, white papers, research proposals, peer-reviewed journal articles, special editions, and clinical practice guidelines. On June 10th, the Special Interest Group on “Survivors of trauma: The use of music for resilience-building and healing in areas of conflict” led a webinar to report on their work.

In this blog post we would like to tell you about this initial virtual presentation and a follow-up webinar led by this SIG. 

The use of music for resilience-building and healing trauma

This SIG is a network of experts including medical professionals, music therapists, researchers, musicians, military personnel, and civilians who work with traumatized individuals and populations around the world and across a clinic-to-community continuum of music engagement. 

They share international perspectives of various applications of music including music therapy interventions and music-based experiences, music education and learning, and recreational music engagement to address trauma through professional facilitation, interactive and experiential learning, and performance informed by scholarly literature.

SIG Participants

This SIG is led by Rebecca Vaudreuil, EdM, MT-BC, who is the SIG Coordinator for IAMM. Rebecca serves as Lead Music Therapist for Creative Forces®: NEA Military Healing Arts Network, employed by the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. She is a board-certified music therapist who earned a music therapy degree at Berklee College of Music and master’s in education at Harvard University in the Mind, Brain, & Behavior program. She has a breadth and depth of experiences working with military-connected populations and has presented and published extensively on her work. She is currently studying at Fordham University’s Graduate School of Social Service in the Master of Social Work online program.

Creative Forces®: NEA Military Healing Arts Network is an initiative of the National Endowment for the Arts in partnership with the U.S. Departments of Defense and Veterans Affairs that seeks to improve the health, wellness, and quality of life for military and veteran populations exposed to trauma, as well as their families and caregivers. Creative Forces is managed in partnership with Americans for the Arts and the Henry M. Jackson Foundation for the Advancement of Military Medicine.

Chief Warrant Officer Two Jonathan Crane is a Research Analyst at the West Point Music Research Center. Chief Crane currently works for the U.S. Army Band program focused on the effects of music across all contexts. He has served in various roles from performer to commander in many locations across the globe, including a one-year deployment to Iraq in 2011. He holds degrees in music education and composition. 

Mark Ettenberger, PhD, MA, MT. Mark is an Ethno-Music Therapist trained in Austria with a PhD in Music Therapy from Anglia Ruskin University, UK. He holds a MA in Peace and Development Studies (Peace Culture, Security, International Cooperation and Conflict Resolution), UNESCO Chair of Philosophy for Peace, University Jaume I, Spain. Mark lives and works in Bogotá, Colombia, where he is the director of SONO – Centro de Musicoterapia and the coordinator for the music therapy services at the University Hospital Fundación Santa Fe de Bogotá, at the Clínica de la Mujer and at the Centro Policlínico del Olaya.

Sunil Iyengar directs the Office of Research & Analysis at the National Endowment for the Arts. Under his leadership, his office established research and data partnerships with the U.S Census Bureau and the Bureau of Economic Analysis, among others. Sunil and his team have created and pursued a long-term research agenda, founded a national data repository for the arts, and launched two awards programs for arts researchers, including the NEA Research Labs initiative. He chairs a federal Interagency Task Force on the Arts and Human Development and leads a research funding partnership with the National Institutes of Health as part of Sound Health. Sunil also leads the Sound Health Network, a partnership of the NEA with the University of California, San Francisco in collaboration with the National Institutes of Health, the John F. Kennedy Center for the Performing Arts, and Renée Fleming, the center’s artistic advisor. He writes a research blog (“Measure for Measure”) for the NEA website and the online news digest ArtsJournal.

Danielle Vetro-Kalseth, MM, MT-BC is a board-certified music therapist for Creative Forces at Joint Base Elmendorf-Richardson in Anchorage, Alaska, employed by the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. She earned a bachelor’s in fine arts at Shenandoah University and her master’s in music therapy at Florida State University. She provides music therapy services to active duty Air Force, Army, Alaska National Guard, and Alaska veterans. 

Technical Sergeant Craig Larimer is a Pianist and Vocalist in the United States Air Force Academy Band in Colorado Springs, CO, USA. TSgt Larimer travels throughout the world as a performer, educator, and music facilitator serving in the United States Air Force for the last 9 years.  He has served as a musical ambassador on multiple deployments to Afghanistan, Qatar, Kuwait and other parts of the Middle East promoting peaceful relationships with local populations. Currently he works for the United States Air Force Academy as a music director, producer and educator.  As a singer-songwriter TSgt Larimer continues to tap into his experiences, sparking conversations about the healing nature of music.

Diane G. Langston MM, MT-BC is a board-certified neurologic music therapist at the Malcom Randall VA Medical Center in Gainesville, Florida, USA. Diane graduated from Florida State University with bachelor’s and master’s degrees in music therapy. Her clinical practice, research, and advocacy focuses on music therapy with veterans and their families. Diane has presented on the delivery of music therapy via telehealth at conferences worldwide and is a published author. 

CAPT Moira G. McGuire, BSN, RN-BC, CSC is a nurse officer with the U.S. Public Health Service at Walter Reed National Military Medical Center where she serves as chief of their new Arts in Health Program. She has spoken extensively in military and community settings about the importance of creativity and expression in the treatment, healing, and prevention of illness and injury.

Karen Wacks, M.Ed, LMHC, MT-BC is a board-certified music therapist and a licensed mental health counselor. She earned her master’s in education at Harvard University and is a professor and Clinical Training Coordinator of the Music Therapy Department at Berklee College of Music in Boston, MA. The emphasis of her global work is community music therapy, specifically for peace and reconciliation for those experiencing war and conflict.

Samuel Gracida, MA, MT, is Chair of Communications and Outreach, International Association for Music and Medicine and the newest member of this SIG. Samuel Gracida is originally from Mexico but has lived in China, the USA, and Germany, where he currently resides. His interests include work with children, refugee and vulnerable populations, trauma, and more. He currently is working with refugee children in a community setting in Heidelberg, Germany. 

Learn more about this SIG here.

Disclaimer: The opinions contained herein represent the private views of the authors and are not to be construed as official or as reflecting the views, opinions, or policies of the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., the Department of Defense, the Department of Veterans Affairs, the National Endowment for the Arts, or the U.S. Government. Mention of trade names, commercial products, or organizations does not imply endorsement by the US Government. This document was created free of branding or market affiliations. The authors are operating solely as contributors. 

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Objectives for this SIG are to:

1. Understand aspects of trauma resulting from conflict; how knowledge, guidelines, and competencies inform treatment.
2. Distinguish a clinic to community continuum of music engagement.
3. Identify protocols and interventions that exist on a continuum and align with global healthcare models.
4. Gain insight into conflict areas through shared experiences of applied music and music therapy in clinic and community settings.
5. Explore stand-alone (individual) and collaborative research (team science) regarding music therapy and community music programming.
6. Engage in discussion/Q&A to inform continued learning and a white paper on the topic.

This SIG has accomplished two IAMM virtual engagements to date:

1. A presentation on June 10th, 2020, as part of the IAMM 2020 Virtual Conference
2. A discussion as part of IAMM Insights on September 11th, 2020, focused on music and trauma.

IAMM 2020 Conference Presentation

This presentation highlighted the work of the SIG members in their respective fields and provided key terminology, definitions, and concepts pertaining to the cycle of trauma and an arts spectrum of engagement facilitated by professionals across the areas of music, medicine, and music therapy. Read further about this presentation below.

Key Terminology & Concepts

The members of this SIG introduced and defined key terminology and concepts involved with their topic.

Conflict

Conflict can be looked at from two angles. 

1. Acute conflict occurs in a single event/location or over minimal time, although it may have long-term and pervasive effects. Examples of this type of conflict are mass shootings and protests. Additionally, Homer-Dixon (1991) wrote about the role of environment and resources to conflict and defined acute conflict as conflict with “substantial probability of violence.” 

1. Long-term conflict usually involves protracted and systemic issues such as deep-rooted moral or value differences. Examples may include power struggles for economic gains, religious discord, gender inequality, ethnic clashes, civil unrest, border/territory disputes, and economic/resource scarcity.

Additionally, the SIG presented a useful graphic by Karpman, S. (2014), displayed here:

The Drama Triangle (Karpman, 2014). 

The drama triangle is a social model of human interaction and maps a type of destructive interaction that can occur between people experiencing conflict. Initially this can arise when a person takes on the role of a victim or persecutor, and then as others enter or are enlisted into the conflict, roles can switch. For example, the victim may turn into the rescuer or the rescuer to the persecutor.

Defining the Trauma Cycle

Trauma arises from deeply distressing or disturbing experiences that can cause psychological, physical, and/or moral injuries as well as environmental or social disruptions. Trauma refers to the emotional shock following a stressful event or physical injury, which may be associated with physical and/or psychological experiences that may lead to long-term impact. 

Rebecca Vaudreuil presented this graphic, which offers a conceptual model of a trauma cycle that she created:

The SIG presented the following ways of conceptualizing trauma:

Trauma can be loud and abrasive or it can be silent…

Trauma can make you feel unheard

Trauma can manifest physically, psychologically, biologically

Trauma diagnoses are criteria-based, but the responses are often unique.

Resilience

The group proceeded to discuss resilience. 

Resilience is the capacity to recover from or adjust quickly from misfortune or change. It requires emotional strength and awareness of utilizing coping mechanisms to overcome obstacles and is related to adaptability and sustainability (Wu et al., 2013; Merriam-Webster, 2021). 

Resilience: Building Through the Arts

We as clinicians, musicians, artists, and mental health providers address resilience through professional and personal lenses and arts experiences. Resilience can be fostered from all of the aspects depicted in the graphic below:

And it includes aspects such as:

• Active use of creativity
• Creativity cultivates innovation
• Perspective
• Clinical and Community support
• Education
• Collaboration and Innovation
• Current and Future Opportunities

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Considerations in the Military Context

There are multiple aspects to consider when thinking about approaches to the arts and trauma, specifically working with military-connected populations.

Active conflict can occur in various environments and during occupational transitions. Military members receive non-clinical training that focuses on creating safe spaces and building relationships (positive socialization). The response time is immediate since they are also serving during conflict. 

Currently, there are no specific uniformed medical professionals who specialize in music-based health. Clinical interventions are more often delivered by civilian music and health professionals who must build rapport. The goal is to heal specific diagnoses with well-defined, targeted interventions. The response time is delayed as they usually engage with participants long after the trauma has occurred, sometimes years (Bronson et al., 2018).

Programs that promote music and health are now being developed as a result of individual commitment rather than formal organizational structure. For example, The Music Mentor Program (MMP) is a growing collaboration between military bands and Creative Forces music therapy programming at certain partnering military installations.

It is important in these cases to define roles within the MMP structure. Key players of the MMP include participants who are music therapy patients referred by music therapists at a point in their treatment where they are ready to learn self-sustaining musical knowledge. Mentors who are military band members who provide music instruction to the participants. 

Additionally, telehealth has been an incredible benefit for those long-suffering from trauma, as it allows access to music-based services from a comforting environment – their own home (Vaudreuil et al., 2020). Creative arts therapists and community artists leverage technology to provide therapy and non-clinical engagement through the arts. This has been an invaluable asset during the COVID-19 global pandemic.

During the question-and-answer section, the concept of ‘brave space’ to replace ‘safe space’ was discussed as a more empowering way to describe creating environments for the traumatized to express themselves. The poem, “Invitation to Brave Space” by Beth Strano was read by a participant of this SIG presentation. You can read the poem here: https://www.facinghistory.org/resource-library/untitled-poem-beth-strano

Arts Spectrum: Clinic to Community Continuum

The SIG members introduced a multi-directional arts spectrum that can inform facilitators about how music and the arts can be incorporated into the lives of those who have experienced trauma. They outlined the areas of work across the continuum:

Music Therapy is the clinical and evidence-based use of music interventions to accomplish individual or group goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy academic program (AMTA, 2005). Music therapists complete a clinical internship, and pass a board exam, earning the credential MT-BC, music therapist-board certified.   

Music for Wellness refers to engagement in musical experiences that support general wellbeing and enhances life functioning rather than addresses formalized clinical goals. 

Recreational Music is enjoyable, accessible, and fulfilling group-based activities that unite people of all ages regardless of their challenges, backgrounds, ethnicities, and abilities or prior experience.

Community Music is an approach to music making that engages collaboration between individuals to play, create, improvise, and perform music together. It is music making that simultaneously fosters individual growth and collective community development.

Photo Credits:

1. Clinical Creative Arts Therapies [Rehabilitative/Preventative]: Courtesy of National Endowment for the Arts
2. Arts in Health [Wellness]: Photo by Michael Conti
3. Recreational Arts [Expressive]: Courtesy of Creative Forces
4. Arts Education: Retrieved from: https://nmtsreno.org/news-and-notes/nmts-january-2017-newsletter/music-brain/
5. Community Arts: Photo By: Angelito F. Bautista

The SIG members span the arts spectrum from clinic to community in their respective roles, responsibilities, and service. They approached sharing their experiences drawing from five major considerations and perspectives. 

These included: 

1. Education & training,
2. Occupational considerations,
3. Health outcomes, 
4. Transitions and the importance and value of music to fluidly bridge the continuum, and
5. Considerations of music therapy telehealth and virtual arts engagement opportunities. 

Education and Training

TSgt Craig Larimer spoke about his use of music as a tool for opportunity-building, inspiration, working with schools in various communities (e.g., standard-setting, mobile education), respite, and self-care for cadets at the United States Air Force Academy. 

Afghanistan National Institute of Music clinic & Educational Programs in the 9th Ward

TSgt Larimer further spoke about the Afghanistan National Institute of Music clinic. Students use this organization as a gateway to studying and performing across the world. 

TSgt Larimer highlighted an example of his experience with educational outreach to a neighborhood heavily effected by Hurricane Katrina in 2005.  The area of New Orleans, LA known as the 9th Ward, has many organizations tapping into its musical heritage to rebuild their communities and military bands are a consistent presence as educators and performers. The Educational Programs in the 9th Ward reflect the importance of facilities geared towards the exploration of music and the arts. 

Music educational facilities provide security, food, and community in vulnerable populations. Facilities provide the conditions and atmosphere for healing in communities dealing with trauma. The United States Air Force provides training in resilience and a diverse team to connect with students. The United States Air Force Academy Band specifically seeks to reach populations in underrepresented areas of the country from the United States Air Force Academy and brings musical education and performances to communities that lack the resources to facilitate consistent programs (e.g., Detroit, Los Angeles, Miami, Atlanta, Native American communities, etc.).

West Point and the United States Air Force Academy

Another example of education and training can be seen at the United States Military Academy-West Point and the United States Air Force Academy. In this context, exploring songwriting to cope with stressful academic environments was one of the goals. Peer to peer mentorship is part of their model to build resiliency. It is important that musical experiences in the academies enhance lifelong strategies for coping with trauma as 80% of West Point Cadets will be officers in combat roles.

Educating on Global Health Models

Karen Wacks spoke about music therapy education and training in the Music Therapy Department at Berklee College of Music in Boston, MA. This information pertains to coursework, practicum experiences, internship programming, and telehealth competencies. 

She referenced the Compendium “Music as a Global Resource: Solutions for Cultural, Social, Health, Educational, Environmental, and Economic Issues.”  The compendium posits that:

• Music is a cornerstone of development and is central to the lives of people of all cultures around the world. Music and sound have the ability to unify people

• Music is a practical tool for dialogue amongst peoples must be used to enhance and promote solutions for social and economic challenges. 

• The power of music is immeasurable and filled with endless possibilities and a natural contributor to health and social/economic issues, as well as peace on earth.

The newest (5^th) edition can be found here. 

Defining global health models of community music therapy and approaches across multiple environments is relevant to this SIG topic. This includes providing telehealth music therapy services to those in remote areas, which provides accessibility as well as connection. 

Building community, resilience, reintegration, empowerment, assimilation through and with families, communities, and society is an essential component of the work of music and the arts to address trauma. 

Music Therapy: Clinic to Community Models

Bogotá, Colombia

Mark Ettenberger reported on clinical music therapy in Colombia, where a team of six music therapists working in three hospitals provide approx. 6,000-7,000 sessions/year. This work includes individualized care and self-care groups with patients and caregivers and it addresses well-being, coping and resilience in physiological, emotional, mental, and social areas. The concept of medical trauma related to injury, loss, treatment, environment, social isolation, and clinical outcomes is very important in this work.

Additionally, Mark led a sub-working group including other Colombian music therapists working in community music therapy settings. 

He shared about Andrés Salgado’s work on “Music therapy, coping and life projects for adolescent victims of the armed conflict: A pilot program.” In this work, he conducted 23 group and individual sessions with adolescents (13-18 years) over the course of 2 weeks. His aim was to develop coping strategies in relation to the adolescents’ life project.

Another project by Andrés Salgado entitled “Community music therapy and symbolic reparation in victims of forced displacement” focused on providing seven sessions over two months with six victims of forced displacement. The aims were: to work on group cohesion; adaptation to reality; coping strategies; and projecting the future.

The work of Carlos Gómez in Colombia focuses on “Community Music Therapy and the construction of memory for victims of the armed conflict.” It was a two-hour long workshop every two weeks for three months in different municipalities and it is a project in cooperation with the UN. Its aims were focused on memory, empowerment, and communication.

Another project is entitled “Community Music Therapy and indigenous rituality for improving quality of life in adolescents affected by the armed conflict.” It was one-hour long workshops twice a week for three months with adolescents from displaced families. The aims were focused on ancestral knowledge, indigenous rituals, and quality of life.

Diego Torres has led the project “To the rhythm of a pan,” focused on empowering women of indigenous groups, farmers, and Afro-Colombian origin. The aims of this project relate to making conscious and reconciling the women’s personal and collective history. During this project, 22 women from all over Colombia participated in two-hour long workshops once a week for two months. This project was carried out in cooperation with the National Association for Farmer, Black and Indigenous women. 

The project “Community MT for the construction of social fabric in the post-conflict in Colombia” was a project of the master’s program in Music Therapy, Universidad Nacional de Colombia. Professionals, ex-combatants, and the community worked in three stages:

• Psychosocial well-being for the professionals working with the ex-combatants
• Psychosocial well-being for ex-combatants
• Community integration and the construction of social fabric

Mark Ettenberger, Andrea Giraldo, Carolina Rosales Nicolás Soto, and Latin Latas worked on “One rhythm, one voice”, a three-day workshop in 2015 and 2016, done in cooperation with the diocese of Guaviare. About 70 teachers from extremely remote areas often affected by the armed conflict participated with the aims of developing strategies for teaching and relationship building with children and adolescents and self-care strategies for the teachers. It followed an integrated arts programming model with music, dance/movement, and building instruments with recycled materials.

To summarize this work, the following can be said about community music therapy engagement in Colombia:

• Influenced by community music therapy theories rather than trauma-oriented theories.
• Trauma happens and appears on multiple levels.
• People are affected directly or indirectly by the armed conflict, poverty (economic, social, cultural, educational), and an unequal distribution of opportunities and access to basic services.
• Collective nature of Colombian society favors community music making.
• Music as a salutogenic agent in groups and communities → relationship building, assertive communication, expression of emotions, thoughts or ideas are all important aspects when considering trauma.

Anchorage, Alaska

Danielle Vetro-Kalseth facilitates music therapy intervention and provides community engagement opportunities to support transitions and reintegration with active-duty service members and veterans with traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) in Anchorage, Alaska. She uses a phased music therapy outpatient group treatment model with patients to address clinical individual rehabilitation goals in a group setting (e.g., memory, pain, anxiety, motor, attention/focus). A publication in Military Psychology on Danielle’s phased music therapy treatment approach can be found here (Kalseth et al., 2021).

The treatment trajectory consists of (1) individual music therapy services, (2) group music therapy treatment, and (3) community engagement through performance. Sessions include stand-alone music therapy and/or co-treatments with other specialties such as speech language pathology and occupational therapy. Once patients have reached individualized goals they have the option to participate in a jam group. This group allows for socialization, communication, skill building, and teamwork (Bronson et al., 2018). Participation in jam group leads to community performance opportunities that empower patients to demonstrate what they have accomplished in music therapy (Vaudreuil et al., 2019). 

Performances take place at community locations such as a hospital for veterans with PTSD, the VA Domiciliary, the children’s hospital, and the military hospital. Another opportunity for community connection is with the Music Mentorship Program (MMP) through which appropriate patients who have reached their clinical goals and may benefit from advanced skills learning are paired with a band member for lessons on their selected instrument. 

Conclusion

The Special Interest Group on “The use of music for resilience-building and healing trauma” has presented a wide range of projects and important discussion topics about music, music therapy, and trauma. 

This blog post has provided a mere summary of the work done by this group. We want to reiterate that you can send us a message at sgracida@iammonline.com if you want to stay informed about the recordings of the past presentations.

Stay tuned for part 2 of this blog on the work by this SIG. The next report will focus on the inaugural session of the IAMM Insights series in 2020-2021. During this discussion, which took place on 9/11/20, the SIG built off the key concepts presented in their first presentation and addressed questions posed from the audience of their IAMM conference presentation 

This SIG is currently working on a white paper that you will be able to access in the future so make sure you subscribe to our blog through the form on the right! 

We look forward to hearing your thoughts and feedback about this post, which you can share in the comments section below.

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References

American Music Therapy Association. (2005). What is music therapy? Available from: https://www.musictherapy.org/about/musictherapy/

Bronson, H., Vaudreuil, R., & Bradt, J. (2018). Music therapy treatment of active duty military: An overview of intensive outpatient and longitudinal care programs. Music Therapy Perspectives, 36(2), 195-206. Available from: https://doi.org/10.1093/mtp/miy006 

Hesser, B., & Bartleet, B. L. (Eds.). (2020). Music as a global resource: Solutions for cultural, social, health, educational, environmental, and economic issues (5th Edition). New York: Music as a Global Resource. Available from: https://static1.squarespace.com/static/5f3998e232da833c870c255b/t/603a74da58b15d5dd4c3a4b0/1614443748998/MAGR_2020_Final.pdf 

Homer-Dixon, T. (1991). On the threshold: Environmental changes as causes of acute conflict. International Security, MIT Press. Vol. 16(2); 76-116. Available from: http://www.jstor.org/stable/2539061 

Kalseth, D., Vaudreuil, R., & Segall, L. (2021).Treatment description and case series report of a phased music therapy group to support Veteran reintegration, Military Psychology. DOI: 10.1080/08995605.2021.1962194

Karpman, S. (2014). A Game Free Life. USA: Drama Triangle Publications

Merriam-Webster (2021). Definition of resilience. Available from: https://www.merriam-webster.com/dictionary/resilience

Vaudreuil, R., Langston, D.G., Magee, W., Betts, D., Kass, S., & Levy, C. (2020). 

Implementing music therapy through telehealth: considerations for military populations. Disability and Rehabilitation: Assistive Technology. Available from: 10.1080/17483107.2020.1775312 

Vaudreuil, R., EdM, MT-BC, & Reuer, B., PhD, MT-BC. (2013). MusicWorx Toolbox Series. An Introduction to Military Music Therapy Programming: Working with Active Service Members and Veterans, 3^rd Edition. San Diego, CA: MusicWorx. ISBN: 978-0-9909673-0-9

Vaudreuil R., Bronson, H. & Bradt, J. (2019) Bridging the Clinic to Community: Music Performance as Social Transformation for Military Service Members. Frontiers in Psycholgy. 10:119. Available from: 10.3389/fpsyg.2019.00119   

Wu, G., Feder, A., Cohen, H., Kim, J. J., Calderon, S., Charney, D. S., & Mathé, A. A. (2013). Understanding resilience. Frontiers in behavioral neuroscience, 7, 10. Available from: https://doi.org/10.3389/fnbeh.2013.00010