People suffering from Post-Traumatic Stress Disorder often turn to art therapy because the trauma they experienced is usually stored in the non-verbal parts of the brain, but with the help of art, it transfers to the verbal parts so they can start dealing with it. According to webmd.com, Post-Traumatic Stress Disorder is ” a disorder In which a person has difficulty recovering after experiencing or witnessing a terrifying event.” With this disorder, a few parts of the brain are affected. The amygdala is the first part of the brain to be affected. When trauma occurs the amygdala indicates danger and then sends out a fight or flight response. The amygdala stores stimulus from the trauma, and also calms you down. Once a person develops PTSD, the amygdala has stored the stimuli and if any stimuli is encounters, the fear and fight or flight response is triggered. The amygdala is very over active in those who suffer, making sleep difficult as well as letting their guard down. The next part of the brain to be affected is the hippocampus. When trauma occurs, the hippocampus ” creates and stores the memory, retrieves the memory and then calms down the amygdala.”(brainline.org) In those who suffer from ptsd the hippocampus becomes disoriented and confused. It causes nightmares and flashbacks. The hippocampus is so overactive in PTSD sufferers that the memories come and go very easily both when awake and asleep causing nightmares and flashbacks. The hippocampus is unable to calm the amygdala because the memories feel so real. The prefrontal cortex controls emotions, behaviors and impulses. In those who suffer from PTSD, the prefrontal cortex isn’t as active which is why avoidance, withdrawal and emotional numbing likely occur. As the hippocampus replays memories, the prefrontal cortex is unable to take control to tell the amygdala the danger isn’t real. The human body is a complex system of inner connections all working together. How is the body affected by ptsd? Those suffering with this find themselves feeling disconnected from their own body. Van der Kolk states, ” Traumatized people chronically feel unsafe inside their bodies.” Many of those suffering feel as though they have lost themselves and don’t know what to do. This is where art therapy comes into play. Talk therapy has been used in treatment of ptsd for many years but sometimes words are not sufficient enough. Art therapy works to trigger the sub conscious, through art the sub conscious comes out and heals things sometimes people didn’t even know needed healing.
To understand how art therapy heals those suffering from trauma we must first understand what exactly art therapy is and how it came to be. Art therapy was first referred to as art therapy by an English man named Adrian Hill. When he was being treated for tuberculosis, he suggested doing group art with the other patients. By the 20th century art therapy began spreading through hospitals and mental health facilities across the globe. Art therapy “is a form of expressive therapy that uses creative processes of making art to improve a persons physical, mental, and emotional well being.” (“What is Art Therapy”) The focus of this therapy is to help people understand and express their emotions through art techniques or activities combined with “traditional psychotherapeutic theories and techniques with an understanding of psychological aspects of the creative process, especially the affective properties of different art materials.” (“What is Art Therapy” Art Therapy is not limited to those suffering from trauma, anyone can see one. Despite the popular misconception, no you do not need to be good at art to participate either. Art therapists use a variety of techniques dependent upon the patient. Popular techniques include painting, scribbling, journaling, collages, line art, clay, drawing, finger painting, mandala drawings, self portraits, the list goes on and on. What techniques are used by art therapists in treatment of ptsd? Therapists find techniques can vary depending on the person. Although it is dependent upon the person, there are a few popular among those suffering including coloring, mask making, mind mapping, drawing and painting emotions, One client recounts, “When I color during therapy, it creates a safe place for me to express painful feelings from my past.”(Fabian, 2017)
Cognitive Processing Therapy is frequently paired with art therapy for those who suffer from PTSD. CPT is “a specific type of cognitive behavioral therapy that has been effective in reducing symptoms of PTSD that have developed after experiencing a variety of traumatic events including child abuse, combat, rape and natural disasters.”(Resick, 2017)This type of therapy usually last about 12 sessions. The goals of CPT are for those who suffer to be able to process natural emotions other than fear, understand the meaning of the content derived from the trauma, and finally for those who suffer to accept the trauma has occurred but doesn’t change who they are.
There is a vast number of literatures and studies proving the success of art therapy. A study was done by Melissa Campbell and others to see if art therapy when combined with cognitive processing therapy was more successful in treating symptoms of those who suffer from PTSD. Their study was done on veterans with combat related PTSD. It consisted of 8 75 minute sessions. The first session included the “Art Therapy Projective Imagery Assessment and an interview with semi structured interview questions.”(Campbell, 2016) The second session had “psychoeducational material about PTSD, goal setting and safety…”(Campbell, 2016) and they also discussed triggers and symptoms. The third session the veterans were asked to create 6 images and narrate them back in the third person. The images were as follows, the first image was a time they felt safe and peaceful before the trauma. The second image was the last moment they could remember directly before the trauma. The third image was what had happen during the trauma. The fourth image was the first moment they could recall after the trauma. The fifth image was when the veteran felt safe from physical harm of the trauma. The sixth and final image was a time he tried to “self soothe” (Campbell, 2016). Once they created these 6 images they were asked to narrate in third person to separate them from it. They repeated the narrations three times throughout their sessions. The fourth session involved mask making to help express and identify hard to talk about emotions and mind mapping. The fifth session was the narration in third person for the second time. The sixth session was about addressing their loss and grief by making an image of something lost during the trauma. The seventh session involved reconstructing self-conception and their world view. The eighth and final session included an interview, they would review their trauma, narrated in the third person for the third time, reflect on their artwork created throughout the session and finally ended with a reflective art piece creation. The results of their study found PTSD symptoms had decreased, depression had improved, satisfaction rating of 4.8 out of 5, and all participants who received art therapy said they had remembered blocked memories or “gained insights and realizations crucial to their healing process through art therapy.”(Campbell, 2016) Visual art therapy is also mentioned by Campbell. Visual Art Therapy helps those who suffer gain new insights, reconstruct their self-perception, world view and perception of others, and is hypothesized to reduce emotional numbing and avoidance.
The art therapies are often overlooked and under estimated in terms of efficiency. Felicity Baker, Olivia Metcalf and others from the University of Melbourne reviewed studies to see just how effective the creative art therapies are for those suffering from PTSD. The way they did this was by searching databases for peer reviewed published studies to test the “efficiency” of the creative art therapies for PTSD sufferers. The focused population was adults who suffer from PTSD. They categorized treatments into three different categories: ongoing therapist involvement, limited therapist involvement and unknown therapist involvement. Ongoing therapist involvement meant “during every therapy session a therapist was involved. For limited therapist involvement, “meant that the therapist was involved initially to set the task or activity, but did not have ongoing involvement.” Unknown therapist involvement meant that in the studies they reviewed, therapist involvement wasn’t mentioned. Results of their review showed those who had art therapy with ongoing therapist contact symptoms had decreased. They also reviewed the effectiveness of art therapy with motor vehicle accident survivors and found through art therapy, ” there was a significant reduction of PTSD symptoms.”(Baker, 2017) Limited therapist contact was investigated among students with “moderate levels of PTSD”(Baker, 2017) The students were to draw mandalas for 20 minutes a day. Results of that concluded, ” significant reduction of PTSD symptoms.”(Baker, 2017) Unknown therapist contact was reviewed through a study done on 200 German soldier “with recent stressful experiences compared to 60 soldiers who didn’t receive intervention.”(Baker, 2016) The treatment group had three weeks of painting as well as exercise and relaxation plus individual and group therapy. Results showed no significant change. “The quality of evidence for art therapy with unknown therapist contact was graded as ‘very low’.” Due to the grade of evidence, “we have very little confidence that there is no effect for art therapy with unknown therapist contact compared to a control group on PTSD symptoms post treatment.”(Baker, 2017) As their overall conclusion on this review, they concluded “Creative art therapies may offer the potential for people to creatively process, cope, and recover from PTSD…” but the acknowledged more research is needed.
While there is a lot of research on how art therapy is useful for veterans that have experienced trauma, there is less research available on how art therapy helps those suffering from a co-morbid traumatic brain injury and PTSD. The CDC defines a TBI “as a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury.”(Traumatic Brain Injury, 2017) This study is focused on a senior active duty military service member with chronic PTSD and TBI and long term art therapy. Although research is limited on art therapy and TBI, “Dodd found that art therapy helped a man with brain injury progress from empty and simplistic drawings to more unified and colorful images.”(Walker, 2016) The patient in this study is in his 50s, he is an active duty service member “who was referred for evaluation and treatment in an interdisciplinary patient centric intensive outpatient program …” (Walker, 2016) after his cognitive and emotional functioning had reduced significantly. The patient even began to recognize “an increasing inability to focus and sought treatment almost seven years after his traumatic experiences, including specific memories of an incident during one of his deployments in a war zone.”(Walker, 2016) The patient found acupuncture paired with art therapy aided him in managing and “partly overcome some of the recurring debilitating symptoms of PTSD and TBI.”(Walker, 2016) Before The patients deployments, he recounted having a normal life that included a long marriage with children. He also reported his history of deployments to be normal as well. He had a good childhood, did well in school, had successful career in military until “a series of incidents that occurred during wartime deployment.” (Walker, 2016) The patient claimed he hasn’t been well since a combat deployment around seven years ago. In the duration of his deployment he suffered a TBI from a “mortar barrage hit his base with several rounds impacting near him”(Walker, 2016). While he was taking cover, shrapnel hit him in the leg and he lost consciousness and had post traumatic amnesia for about 40 minutes. He can remember “being on one side of the bunker before the blast, and then returning to consciousness on the other side of the bunker with rescue personal attending to him. (Walker, 2016). That was one of several traumatic experiences the patient had endured during that deployment. The most traumatic The patient had recalled was one of his buddies lost his life in a convoy that had been hit by and IED. When he had returned home he reported feeling guilty about his decisions during deployment, and immersing himself into his work to keep his mind busy. At home he started abusing alcohol and became depressed. Instead of going to treatment, he redeployed in hopes of making amends for his through to be previous mistakes of his last deployment. During this deployment he received a promotion his resulting in less sleep. The patient developed major depression that went untreated. Soon he started having flashbacks, became forgetful and distant. He described his flashbacks as having a “bloody face of unknown identity in the bunker in which he was injured”(Walker, 2016). His mental health continued to get worse and worse in the following months. His coworkers reported the patient often made no sense when he would try to put sentences together. He also reported having conversations that he swore were real but later found out were actually all in his mind. The patient expressed he never felt suicidal but did however feel as though he should be out in a life or death situation in an effort to get rid of his unwanted thoughts for good. After being observed acting unusual his gun was taken from him then agreed to seek help. He reported feeling hopeless after getting his diagnosis. He heavily relied on alcohol to sleep although it did not deter his night terrors and flashbacks. Irritability, impulsiveness, libido decrease, interest decrease, 2-4 hours of sleep, and racing thoughts were all reported by the patient. He was put into a four week intensive out patient program for military service members with PTSD and TBI. His PTSD was considered so severe that they projected him to benefit most from non verbal therapies, art therapy. In an effort to reduce the amount of times the patient had to recall his history, a team developed a schedule specific to the patient. The patient was reluctant at first due to a lack of confidence in the therapies. Through acupuncture his anxiety symptoms had decreased. Once he realized the therapies were helping, he became more open minded and began his art therapy sessions. His first session was an hour long and he participated in mask making. The mask he made depicted the bloody face he had seen in his flashbacks. The patient described the experience as ” I thought I would paint one of myself… but as I started that subconscious piece of my psyche kicked in and I rapidly produced one of my haunting, I would see a bloody face lying on the ground next to me in the bunker where I was wounded during a mortar attack on our compound. I had seen it so often…I named him BFIB (Bee-Fib).” (Walker, 2016) The patient found the experience to be “incredibly therapeutic”. The next session the therapist provided a box to keep the mask in and the patient painted it yellow “to symbolize ‘shedding light'”(Walker, 2016) next he made a collage. The patient attributed this mask making and box process for him overcoming the images from the past. During his next few sessions, he continued work on his mask and was implemented into a group therapy session with others and they reflected on their sessions together. He continued to see the art therapist and reported not seeing the bloody face anymore. The next phase of their recovery plan was for the patient to dig deeper into his trauma. He still had flashbacks, so art therapists had him paint what he was seeing. He reported believing the creation of the painting had helped him. After more sessions like this one, he reported his flashbacks to be less intense and through art he was starting to view what had happened differently. The next phase was focused on self care. In these sessions, the patient wanted to “recreate the memory of his friend who was killed.”(Walker, 2016) He said, ” I felt utter failure for the first time in my life. I had horrific visions of past war scenes. I repeatedly saw the man I sent on a mission in my place, in my seat, doing part of my job so that I could attend another event… I would constantly see him looking at me as I watched him buckle up… and then gave me a thumbs up. Then I would see him after the IED destroyed the vehicle and killed him and others.”(Walker, 2016) the image he created was his buddy giving him the thumbs up. Soon, the patient expressed a desire to do art at home as well as in sessions. The patient credited the art therapy sessions for providing him with “the ability to gain a more comprehensive understanding of my memories, actions, and situations that have caused survivors guilt, shame, and depression.” (Walker, 2016) After two years, the patient “was hopeful for continued recovery and improved health. He continues to paint, engages in self expression at home, and visits the Medical Center for art therapy and acupuncture sessions regularly.”(Walker, 2016) This is one story of significant recovery in someone who felt hopeless about living with chronic PTSD and TBI.
There is a vast amount of research that leads u to believe that the art therapies are particularly useful in treatment of those suffering from PTSD. This is a study focused on five adult victims of childhood sexual abuse who developed PTSD due to their trauma. As in the first study I looked at, this study reviews the use of Cognitive Processing Therapy. For childhood sexual abuse victims, the appropriateness has been long debated for this population. In this population it is not uncommon for victims to report feeling unable to put words to their traumatic experiences. As stated before, art therapy works to transfer the trauma from the nonverbal parts of the brain to the verbal parts. That is why they find art therapy so successful in those suffering from trauma. When child abuse is experienced at a young age, “the developing limbic connections are exposed to prolonged high levels of excitotoxic neurotransmitters, which can ultimately lead to cell death in the limbic system.”(Becker, 2015) This helps to explain why survivors have a difficult time finding the words to describe their experiences. Survivors may feel too much anxiety surrounding their trauma, making conversations nearly impossible. It is different for people with combat related PTSD because they can usually talk about what happen and see images while these survivors have a particularly tough time doing so. The participants involved in this study were aged between 39 and 58 and were “adult male and female survivors of childhood sexual abuse who sought therapy at two outpatient community mental health psychiatric clinics in California.”(Becker, 2015) Five participants completed the study while six had started. Over the course of a 9 week period, these survivors attended 2 hour group therapy sessions every week. Their treatment plan was based off a study done by Karp and Butler (1996). In their study they “used art tasks to develop treatment strategies for children with a history of various kinds of abuse.”(Becker, 2015) For the purpose of this study, some of the tasks in the original study were modified for the specific participants involved. To do so, the authors implemented “psychoeducation, exposure, grounding, cognitive restructuring, and narrative therapy.”(Becker, 2015) paired with the art therapy techniques. The participants had directions for their tasks and were asked to reflect on their experiences. In those sessions, “paper and pastels, markers, paint, and crayons”(Becker, 2015) were used for their art therapy activities. After their refection, they would interact with one another and share their work with each other. The results of their studies were “After 9 weeks of treatment participants reported reduced PTSD symptoms and a stable reduction in some symptoms at the one-month follow-up, indicating that participation in the integrated treatment group may have helped to improve symptoms of PTSD.”(Becker, 2015)
Due to the growing number of research pointing to the success of art therapy in treatment for those who suffer from PTSD the only conclusion to be made is that art therapy is beneficial to those suffering and most continue to practice art even after their art therapy session. The studies included in the essay are about different populations to show the diversity and flexibility that art therapy has to offer. It really goes to show no matter what you’re going through there is something in art therapy that will work for