According to the United States Department of Veterans Affairs (VA), as of 30 September 2011, there were approximately 22.2 million living veterans. Veterans of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), those who participated in the Iraq and Afghanistan wars, represented 12% of that estimate, a total of 2.6 million veterans (U.S. Government Accountability Office, 2011). Technological advances, such as the use of improvised explosive devices, have changed the battlefield resulting in injuries of a more serious nature as well as a higher number of injuries sustained by military members. As of 23 May 2014, OIF, OEF, and Operation New Dawn, the last three major conflicts that the US military was involved with, have resulted in a total of 52,010 military personnel being wounded in action (U.S. Department of Defense, 2014). In addition to these visible wounds, many returning service members have what Tanielian, Jaycox, Adamson, and Metscher (2008) have deemed “invisible wounds.” Others, even close family members, friends, or other service members, are often unaware when a service member is struggling with posttraumatic stress disorder (PTSD), anxiety, depression, substance abuse, or traumatic brain injury (Tanielian et al., 2008).

Although many wounds may be invisible, it does not mean they have been less prevalent. Seal et al. (2009) found that from 2002 to 2008, 37% of Iraq and Afghanistan veterans who sought treatment at US health facilities were diagnosed with PTSD, depression, alcohol abuse, or other mental health issues. Of veterans who were diagnosed with mental health problems, 29% had two separate conditions and 33% had three or more conditions. PTSD prevalence increased most during the study, from 0.2% in 2002 to 21.8% in 2008. Depression was the second most increasing diagnosis.

In response to these issues, the Department of Veterans Affairs offers many evidence-based treatments, however, these treatments mostly rely on verbal processing and are not able to help those who have difficulty talking about their experience. Visual journaling offers a potential to fill this void and help those who would benefit from a nonverbal treatment. This led the author to develop a six-week visual journaling curriculum for use with military veterans. The journaling curriculum was focused on providing education and decreasing symptoms of stress, anxiety, depression, and trauma. A pilot study was conducted using the journaling curriculum to provide group art therapy at a therapeutic housing community for homeless veterans. The research questions this study sought to answer were:

• What is the lived experience of military veterans who have participated in a visual journaling art therapy group as part of their recovery process?
• Does the use of visual journaling impact subjective well-being, symptoms, life functioning, and risk as measured by the Clinical Outcomes in Routine Evaluation—Outcome Measure (CORE-OM)?

"This paper details a pilot study that used a six-week visual journaling art therapy group with military veterans in recovery in order to reduce symptoms of stress, anxiety, depression, and trauma. Two participants completed the journaling group, pre- and posttest Clinical Outcomes in Routine Evaluation—Outcome Measure (CORE-OM), and an individual interview. The data from the CORE-OM were analyzed to determine change in overall score as well as the domains of life functioning, risk/harm, problems/symptoms, and subjective well-being. The individual interviews were analyzed to determine themes. The following themes were identified: self-knowledge gained via the journaling process, therapist qualities, individual versus group therapy, art-making benefits, and art communicates the “real” me. Although the CORE-OM did not show clinically significant change, the interviews revealed that the participants benefited from their participation in the journaling group. Due to the small sample size and the fact that both participants were receiving other mental health treatment at the time of the study, the results cannot be generalized. However, the results indicate that further study is warranted."