The Art of Healing

Trading FoursColoring in or sculpting to heal the injured brain or psyche might sound like pseudoscience, but it has a longer history than you think and scientists are starting to take it very seriously.

In the late 18th century painting, sculpting and sketching were used in what was called the ‘moral treatment’ of psychiatric patients, but it wasn’t until the mid 20th century that the practice became more widespread. The term ‘art therapy’ was first coined in 1942 – not by a doctor, but by an artist recovering from tuberculosis in a sanatorium when he noticed the therapeutic effects of drawing and painting.

Today the art therapy field is gaining respect fast among clinicians and even neuroscientists as a possible treatment for injury and illness of the brain, but it’s still a slippery subject. As any scientist can tell you, a gene or a flu virus is a pretty absolute quantity.

Creativity (along with concepts like love, speech or altruism) is a very subjective term for a collection of mental behaviors and activities we can’t even pin down as they happen in the brain, let alone measure objectively.

But something we don’t need doctors to explain is the therapeutic effects of relaxing with a good book or making love to an attractive partner. Is art just another social construct we happen to find pleasurable, or can it offer something particular to brain health?

The mechanics of art therapy

The Wikipedia page for art therapy call it ‘any type of visual art and art medium can be employed within the therapeutic process including painting, drawing, sculpting, photography, and digital art.’

At the most basic level, we understand that art (along with every other thought, dream, fear, desire, plan and memory we have) is rewiring the physical brain in a quite literal sense – the machinery from which neuroscience tells us mind, self and consciousness arise.

Called long-term potentiation, synapses are strengthened based on specific activity, so as you take part in behaviors or thoughts, make new habits or break old ones and excite new synaptic pathways, you’re changing your brain according to the principles of neuroplasticity.

The question is, can encouraging people to express themselves through art make those changes to enough of a degree that it provides therapeutic benefits? Again, we don’t need a scientist to tell us happiness promotes overall health – according to research by the American Psychosomatic Society’s Journal of Biobehavioral Medicine; ‘possessing a high sense of purpose in life is associated with a reduced risk for all-cause mortality and cardiovascular events’.

Some studies claim art therapy has shown desired results in Alzheimer’s, traumatic brain injury, PTSD, depression and dealing with chronic pain. Sound far-fetched? Not to clinical psychologist Dr Bart Rossi. “Art therapy does work in a variety of settings as with Alzheimer’s,” he says. “Thinking in line with art helps delay dementia as it develops in the Alzheimer’s stages.”

Professor Lukasz Konopka, executive director at Spectrum Center for Integrative Neuroscience, wrote a 2014 paper for the Croatian Medical Journal called ‘Where art meets neuroscience: a new horizon of art therapy’, and he adds that letting patients express themselves through art rather that more traditional means lets them circumvent feelings normally oppressed by ‘guilt, shame, fear, self-doubt and any other negative constructs of self’, recruiting novel brain processes or regions into the effort. “When used properly art therapy provides for exploration and expression of [mental] processes that were unreachable through conversation and conventional psychotherapy.”

Of course, art therapy has twin aims. To most therapists the content of patients’ output reveals what they’re facing. Nobody claims that drawing a picture of yourself in a coffin means you’re at risk of stroke or brain lesions – most clinical art therapy is around the expression of emotional trauma (although one doctor contacted by Brain World claimed a patient’s drawings ‘turned dark’ when their cancer returned).

But new research in art therapy aspires to investigate the effect on brain structure of the act of creation itself – as Dr Bart Rossi puts it, ‘the output is a distant second to the process. The process of helping brain function is key.’

Art and the changing brain

So what can we do to gain a deeper understanding of the neuroscience of art therapy after the success of the treatment in clinical psychology? Jim Lebret, a neuroscientist and assistant professor of medicine at New York University Medical Center has practised reflective writing (where patients write down thoughts and how they did or might deal with something, revealing personal insight in the process) for four years and admits his program is called Deliberate Practice ‘to come in under the radar with the predominantly science-minded doctors’.

The reason for that might be that even though many patients report feelings better, art therapy isn’t like most medicine where a chemical reaction prompts a change in physiology and enacts a fairly straightforward outcome.

Although as Rossi reminds us, even that’s putting it too simplistically. “Some outcomes – especially as with Alzheimer’s and brain injuries – are difficult to measure,” he agrees. “Art therapy may be effective and tough to measure, [but so are] many approaches in medicine or science.”

Art therapy was also designed and developed by artists who realised creating art influenced the way they feel and view the world, finding its way into therapy from there. There are several associations and accreditation bodies for art therapists in the US, and art therapists are licensed under the general license of counseling clinicians rather than medicine or science, but Professor Konopka thinks everyone would benefit by coming together.

“It’d be beneficial to the field to provide potential therapists with unified understanding of applied and clinical neuroscience and subsequent specialization in art therapy,” he says. “It’s being talked about and slowly developed, but there’s significant opposition to this evolution from ‘old-timers’ in the field.”

Still, we have some working models for how art therapy affects the neurology of the brain, which is a start. Rachel Sikorski, LCAT, ATR-BC is a state-licensed and nationally certified art therapist experienced with trauma. She integrates EMDR (eye movement desensitization and reprocessing) therapy into art therapy treatment and believes the marriage of the two disciplines give her particular insight.

Based on a model called Adaptive Information Processing (AIP), EMDR explains how maladaptive patterns can become encoded in the brain when adverse or traumatic experiences are incompletely processed. Sufferers then repeatedly fall victim to triggers when traumatic memories get ‘stuck’ in the emotional memory center of the brain, activating the body’s fight or flight stress response.

The amygdala looks for a threat and the short-term memory center of the hippocampus links the response to the context of the threatening stimulus. When past experiences haven’t been processed and filed as ‘over’, it can reduce the prefrontal cortex’s power to appropriately interpret the context.

“[People] can talk about their experiences for years, but sometimes patterns never change because the nervous system still reacts to events that should have been digested long before,” Sikorski says. “The level of disturbance or reaction to triggers may not change. Art therapy can provide the physical and emotional distance to properly process, helping the client resolve internal conflicts.”

Making it work

Whatever it’s doing to the brains of trauma, injury or illness patients, art therapy has plenty of supporters and success stories. A 2009 study of prison inmates done by David Gussak – PhD and the chairperson for The Florida State University’s department of art education – discovered art therapy improved of mood within prison inmates.

The theory was that prison inmates experience external control and thus don’t feel in control of their lives, experiencing higher instances of depression and poor mood as a consequence. Gussak’s experiments might have proved art therapy moved the locus of control and allowed inmates to feel they had some control over themselves, leading to an improvement of mood and the associated depression (although it should be noted it was more helpful to female than male inmates).

There are even examples of art therapy working outside scientific or even clinical studies. Artist and author Bruce Katlin had been searching for a solution to anxiety and depression for years when he says he came across something unique.

“I found that by combining high intensity, high-altitude trail running and landscape painting, the artist’s passion and pragmatic thinking became linked on a subconscious level, creating the perfect triple-decker sandwich of mind, body and soul,” Katlin says. He claims creative performance and divergent thinking have been intertwined and enhanced, but whatever spiritual or emotional dimension is involved, Katlin’s anxiety and depression levels have been reduced dramatically.

That art changes the structure of the brain is beyond debate because we understand all other human cultural and emotional artifacts do just that. The question is how well we can direct and measure it to provide responsible therapy that changes real people’s lives. The answer is starting to emerge, but it will take research, collaboration and a whole lot of art supplies.

Sidebar – In living color

In case you haven’t heard, coloring books for adults is one of the hottest new trends. With designs far more elaborate than those found in kids coloring books, coloring book proponents claim they work wonders for settling and quieting the mind. In the ever-increasing pace of today’s demanding world, adult coloring books have found armies of eager devotees, with coloring books appearing on the Amazon bestseller lists around this time last year.

So might coloring in constitute art therapy, or share some of its effects on trauma or even brain injury? As Prof Lukasz Konopka of the Spectrum Center for Integrative Neuroscience points out, coloring in – however relaxing to the conscious mind – involves a lot of detailed processing under the hood. “The rhythmicity of the brain while engaged in coloring allows for synchronization of the networks that resets or modulates a variety of other functions,” he says.

According to Konopka, our bodies are very rhythmic systems (you only have to observe heartbeat, sleep/wake patterns or breathing to see that) and the brain oversees and responds to a huge amount of parallel processing from disparate systems to perform even the most seemingly simple action.

“Becoming engaged in the process that involves two main systems of the brain such as integration of the visual and a motor systems [both critical in coloring in] provides for a tremendous amount of brain activity,” he says.

The key is that generally, anxiety is viewed as an arrhythmic mental process, whereas the rhythmic quality of something like coloring in allows for what he called a ‘meditative state’.

“A patient can engage in coloring while processing significant emotional trauma, and the experience facilitates the patient’s ability to be present during the therapeutic process and gain insight that wouldn’t be available otherwise,” he says. Though far more complex and designed, art therapy offers the same activity framework.