THE EFFECTIVENESS OF USING ART THERAPY INTERVENTIONS IN REDUCING POST TRAUMATIC STRESS DISORDER (PTSD) IN PEDIATRIC TRAUMA PATIENTS
Linda Chapman MA, ATR-BC,Diane Morabito RN, MPH,Chris Ladakakos PhD,Herbert Schreier MD &M. Margaret Knudson MD
Although post traumatic stress disorder (PTSD) in children has been extensively studied during the past 15 years, little research exists regarding the efficacy of treatment interventions. This report describes an outcome-based art therapy research project currently conducted at a large urban hospital trauma center. Included are the theoretical rationale and overview of an art therapy treatment intervention called the Chapman Art Therapy Treatment Intervention (CATTI) designed to reduce PTSD symptoms in pediatric trauma patients. Used in this study, the CATTI was evaluated for efficacy in measuring the reduction of PTSD symptoms at intervals of 1 week, 1 month, and 6 months after discharge from the hospital. An early analysis of the data does not indicate statistically significant differences in the reduction of PTSD symptoms between the experimental and control groups. However, there is evidence that the children receiving the art therapy intervention did show a reduction in acute stress symptoms.Previous articleView issue table of contents
This study utilized Linda Chapman’s Chapman Art Therapy Trauma Intervention (CATTI) for acute trauma, to monitor reduction of trauma symptoms in a pediatric medical unit. Although no statistically significant difference was determined, examination of individual symptom clusters revealed that intervention produced a reduction in all DSM-IV PTSD Criteria C (avoidance) symptoms at 1 week and sustained that decrease 1 month. This may indicate that the CATTI may be effective in reducing acute stress symptoms, and may allow children to discuss and process their traumatic experiences more effectively when compared to the standard therapy group.
Efficacy Study of The START UP!™ ART THERAPY TO REWIRE YOUR BRAIN School-Based Arts Intervention in American Indian Youth M. Mylant, Phd; C. MacCarthy, MA, ATR, LPCC; 2016-2018 This research study took place within two classrooms in 9-13 year old Native American students in a Tribal School on Pineridge Reservation, South Dakota, to monitor the reduction of PTSD symptoms utilizing the START UP! Art Therapy Program based on the Neurodevelopmental Art Therapy Four Stage Chronic Trauma Treatment model founded by Linda Chapman, ATR-BC. There were no significant differences between the treatment and comparison groups. The mean scores of the comparison group were higher than the treatment group. However, the mean scores on post-test for anxiety, depression, anger, post traumatic stress, sexual concerns, and dissociation all decreased for the treatment group on post-test. Whereas, the depression and dissociation post-test scores increased for the comparison group even though post-test scores for anxiety, anger, and post traumatic stress decreased.
Neurodevelopmental Art Therapy is a mind/body approach to trauma resolution that utilizes neuroplasticity and the integrative capacity of the brain. The dictionary definition of neuroplasticity is, “The ability of the brain to form and reorganize synaptic connections, especially in response to learning and experience or following injury.” Neuroplasticity is the brain's capacity to respond and adapt to changes over time by forming new neural pathways. The term "brain plasticity" is often used to describe neuroplasticity. Our brains are "plastic," which means they are adaptable and can change in response to environmental and/or structural changes. Neuroplasticity explains the ability of the human brain to readjust, learn new skills, capture memories, and store information, and to heal after traumatic neural damage caused by injury or psychological trauma. Neurodevelopmental Art Therapy utilizes neuroplasticity by applying neurobiologically informed trauma methodologies for acute and chronic trauma treatment, that facilitates information processing from the lower to higher structures of the brain, resulting in the reduction of prolonged stress response, (i.e., depression, anxiety, over-activity, hypersensitivity, hypervigilence, behavioral impulsivity, cognitive distortions, persistent fear response, and aggression), and improvement of: thinking, planning, judgment, consequences, wisdom, compassion, and empathy. Research in Traumatic Stress has proven that trauma is stored in the right hemisphere of the brain. Art is a right brain activity with the power to access traumatic memories and bodily based sensations stored in the right brain. When the right brain has been in a prolonged state of chronic stress response and constant state of activation, it may result in left brain inactivity, causing the left brain to atrophy, or “turn-off.” The left brain is responsible for language, new learning and memory retention, which explains the cognitive deficits during the chronic stress response in all ages. In school-age children we see inability to learn, retain information, low IQ’s, low test scores, low esteem, and high drop-out rates. In adults we see brain fog, poor concentration, and memory deficits. Combining art (right brain) and language (left brain) “turns on” the left brain again, facilitating communication between both hemispheres of the brain and allows the forming, re-forming, strengthening, and rewiring of neural pathways (neuroplasticity).
Neurodevelopmental Art Therapy is recognized by leading Neuroscientists and is gaining recognition and validity in the Neuroscience field. Our professional and scientificresearch has shown Neurodevelopmental Art Therapy to demonstrate a reduction in trauma symptoms: traumatic re-experiencing, avoidance and numbing, and increased arousal in children with trauma, as well as a reduction in anxiety, depression, anger, post traumatic stress, sexual concerns, and dissociation. Through this research Neurodevelopmental Art Therapy has earned the title of “Evidence-based.” Although Neurodevelopmental Art Therapy has been evidence-based with children, it is effective for ALL age groups: Children, Adolescents, Adults & Elders.
Art therapy is a proven-effective healing modality with the power to resolve psychological issues that can lead to; mental illness, PTSD, substance abuse, domestic violence, child abuse, unemployment, crime, incarceration, and suicide. Art Therapy is a highly effective means of self-discovery and communication in child and adolescent populations, as well as all ages. Art Therapy is a prevention strategy ideal for early detection and treatment of neurodevelopmental issues, and trauma, connected to present and future maladaptive behaviors; providing coping skills, community building, and healthy alternatives to ensure optimal mental, emotional, and social functioning throughout the lifespan. Art Therapy can improve: children’s classroom attendance, grades/test scores, IQs, peer relations, classroom behavior, and create hope for the future. Art Therapy fosters and promotes cultural continuity; preserving Spiritual and Cultural Heritage in ALL Cultures. Research and study clearly reveal Art Therapy’s efficacy with regards to early intervention and is consistently cited in literature, proving its positive impact on health, cognition, social interaction, trauma, stress reduction, anxiety, confidence, abuse, and many other of life’s challenges. Art Therapy provides important social and therapeutic benefits including: multi-dimensional healing of developmental, interpersonal, somatic, spiritual, and cultural trauma (American Art Therapy Association). Art Therapy is a culturally relevant, ethnocentric healing modality, which provides a clinical component, as well as a cultural continuity similar to traditional Native healing practices. Researchers at the University of British Columbia have found a distinct, positive relationship between “cultural continuity” and reduced suicide and suicidal behavior among Native youth (US Department of Health and Human Services, 2010). The START UP!™ Program utilizes our evidence-based & Neuroplasticity-based, culturally competent, Neurodevelopmental Art Therapy (NDAT) Trauma Treatment model to rewire the brain’s neural networks and relieve the maladapted stress response cycle, moving from a survival state to a state of repair and resilience, WHILE HAVING FUN!!! START UP!™ offers something for YOU…
I remember my second job out of graduate school, working in a sub-acute physical rehabilitation hospital as an adjunct therapist in an integrative therapy team of physical, occupational and speech therapists. No one understood how Art Therapy worked and I was always referred to as being the “Arts and Crafts Lady.” Their education deficit was very evident when my supervisor and hospital administrator actually called me to their office and told me that Art Therapy was “not counseling” and that I needed to stop counseling my patients! It took several educational in-services to help them understand what Art Therapy is. It wasn’t until I developed an Art Therapy technique for stroke rehabilitation and had stroke patients going from complete paralysis on one side of their bodies with no use of their arm nor hand, to full use of both arm and hand with the ability to use scissors and writing capability fully restored in 3 weeks, that the supervisor and administrator apologized and understood they were gravely mistaken about the power of Art Therapy.” Unfortunately, this issue is not uncommon within the Art Therapy field. Art Therapists have had to work very hard to educate the science world and all the misinformed supervisors and administrators out there, that Art Therapy is much more than crayons and coloring books. Evidently, from this story, there is a lot more to Art Therapy than just “arts and crafts.” Art Therapy works with the brains’ neuroplasticity to rewire damaged neural pathways, restoring optimal function in many areas of functioning. Art Therapy clearly has a basis in Neuroscience, which is why we call our program START UP!™; with its capacity to rewire and restart the brain. Research in Traumatic Stress has proven that trauma is stored in the right hemisphere of the brain. Art is a right brain activity with the power to access traumatic memories and bodily based sensations stored in the right brain. When the right brain has been in a prolonged state of chronic stress response and constant state of activation, it may result in left brain inactivity, causing the left brain to atrophy, or “turn-off.” The left brain is responsible for language, new learning and memory retention. Combining art (right brain) and language (left brain) “turns on” the left brain again, facilitating communication between both hemispheres of the brain through the corpus collosum and allows the forming, re-forming, strengthening, and rewiring of neural pathways (neuroplasticity).
START UP!’s own Linda Chapman, MA, ATR-BC, pioneered Neurodevelopmental Art Therapy (NDAT), a marriage of Art Therapy and Neuroscience, with her work in pediatric trauma at the University of California, San Francisco (UCSF). Linda conducted research with her pediatric patients with successful outcomes demonstrating her Neurodevelopmental Art Therapy models’ ability to reduce trauma symptoms, long-term. Linda’s research, teaching, and writing helped to further the field of Art Therapy. Carey MacCarthy, MA, ATR, LPCC, Founder of START UP!™ completed an outcome study through South Dakota State University (SDSU) using NDAT and making it Culturally competent to Native American youth. There have been many Art Therapists to research, write and educate, contributing very valuable information to the Art Therapy field. The following pages contain several links to Art Therapy resources and professional research, documenting important outcomes within the Art Therapy profession. Please copy and paste links to your browser to discover more about the efficacy of Art Therapy and its place in Neuroscience.
Art therapy is a profession grounded in assumptions of neuroplasticity and sensorimotor engagement and therefore aligns well with research protocols in neuroscience. It is however, a challenge to quantify subjective aspects of an individual's creative process and this is one of the reasons why it has been difficult to test art therapy interventions with the rigor and generalizability necessary to generate evidence on the effectiveness of an intervention. Creativity from a neuroscientific perspective is considered a compound construct in and of itself (Dietrich, 2019). Art therapy relies heavily on creative, symbolic self-expression as a method of engaging and objectifying less conscious cognition, emotion and memories, and in this way makes it easier for a person to “see” and eventually put words to psychic processes that are not otherwise readily attainable. In other words, art therapy can be a way of telling without talking (Cohen and Cox, 1995). Understanding and identifying the brain processes involved in this type of communication will help to explain with more certainty why and how art therapy works. In an attempt to conceptualize the theoretical underpinnings of neuroscience and art therapy and provide a framework to propel the systematic integration of the two fields, King (2016) developed three initial tenets within which to consider art therapy as neurotherapeutic. Although theoretical at this point, these tenets propose mechanisms of change through art therapy based on observations of clinical sessions: (1) The art-making process and the artwork itself are integral components of treatment that help to understand and elicit verbal and non-verbal communication within an attuned therapeutic relationship; (2) Creative expression is healing and life enhancing; and; (3) The materials and methods utilized affect self-expression, assist in emotional self-regulation, and are applied in specialized ways. These tenets help to distill and organize the multiple components of art therapy and provide a foundation from which to systematically research processes and outcomes. A key consideration in assessing brain function in the context of art therapy is the ability to track human functioning in natural ways, as action is involved in art making and movement is an integral part of the process. Although the mechanisms in our brain do not often map very well with what we experience (King, 2018), the introduction of Mobile Brain/Body Imaging (MoBI) (Makeig et al., 2009) to the range of contemporary imaging tools has increased these capacities. Art making and interpersonal interactions in an art therapy session are ideally suited for study using MoBI technologies in that they align with measurements in real world environments. For example, electroencephalography (EEG) and functional near infrared spectroscopy (fNIRS) are non-invasive tools that monitor participants brain activity while allowing for free movement and interpersonal interactions in the rest of the body. EEG measures brain wave activity while fNIRS is a hemodynamic activity-based neuroimaging technique that measures the relative changes in concentration of oxygenated and deoxygenated hemoglobin secondary to neuronal activity (Scholkmann et al., 2014). These MoBI set-ups allow a person to actively engage in the art-making process and to work with a range of art materials without being restricted by the technological equipment. Aligning scientific measurement with a natural therapeutic setting should enable the generation of findings that are relevant to clinical contexts. The use of EEG to understand brain processes connected to artistic self-expression is in the initial stages of exploratory research. King et al. (2017) found that art making resulted in overall increased power as measured by EEG compared with a rote motor task, highlighting the fact that there are differences in brain activation in a creative vs. a pure sensorimotor-based activity. This study provided initial support for the use of MoBI to assess the interaction of movement, cognition, and brain dynamics. Art therapy researchers have used EEG and fNIRS as imaging tools in a few pilot studies. Using quantitative electroencephalography (qEEG), Belkofer et al. (2014) investigated the differences in patterns of brain activity among artists and non-artists during the process of drawing. Results indicated that there was more activity in the left hemisphere of the brains of artists, whereas more activity was reflected in the frontal lobe of non-artists. This result may have been based on the fact that drawing was a new task for them and that stimulation in this area of the brain is a sign of learning. There was an increased presence of alpha waves for both the artists and the non-artists, indicating the potential for relaxation through creative opportunities generated by drawing tasks. Similarly, in a qEEG comparison of working with clay and drawing, activation was noted in regions of memory processes, meditative states, and spatiotemporal processing (Kruk et al., 2014). Kaimal et al. (2017a) examined the outcomes of three different drawing tasks on reward perception as measured using fNIRS. The underlying assumption in this study was that blood flow in the medial prefrontal cortex would indicate activation of one of the reward pathways in the brain. Participants were given three drawing tasks (coloring, doodling, and free drawing) spanning 3 min, each with intermittent rest periods of 2 min each. The findings indicated that all the drawing tasks activated this reward pathway of the brain compared with the no-activity rest conditions, with the doodling condition resulting in maximum activation. These studies highlight preliminary work in identifying mechanisms of change in art making that require further research: Art making within the therapeutic relationship elicits creativity, evokes positive emotional states of relaxation, and is influenced by specific differences in art media, art task and perceived skills. These are areas to explore further and might be organized according to the aforementioned tenets of art therapy (King, 2016). Doing so would help to clarify methods of systematically integrating art therapy and neuroscience theory, practice and research. For Full Article click on live link or copy and paste to your browser bar:
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How Art Works: A Psychological Exploration. New York, NY: Oxford University Press. Google Scholar Keywords: art therapy, neuroscience, mobile brain/body imaging, fNIRS (functional near infrared spectroscopy), EEG Citation: King JL and Kaimal G (2019) Approaches to Research in Art Therapy Using Imaging Technologies. Front. Hum. Neurosci. 13:159. doi: 10.3389/fnhum.2019.00159 Received: 17 January 2019; Accepted: 30 April 2019;Published: 17 May 2019. Edited by: Stephen Fairclough, Liverpool John Moores University, United Kingdom Reviewed by: Ute Kreplin, College of Health, Massey University, New Zealand Copyright © 2019 King and Kaimal. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. *Correspondence: Girija Kaimal, firstname.lastname@example.org Summary of Twenty-First Century Great Conversations in Art, Neuroscience and Related Therapeutics Juliet L. King A Perspective on Objective Measurement of the Perceived Challenge of Walking Sudeshna A. Chatterjee, Dorian K. Rose, Eric C. Porges, Dana M. Otzel and David J. Clark The Principles of Art Therapy in Virtual Reality Irit Hacmun, Dafna Regev and Roy Salomon Emotional Response and Changes in Heart Rate Variability Following Art-Making With Three Different Art Materials Shai Haiblum-Itskovitch, Johanna Czamanski-Cohen and Giora Galili [BOOK] Art therapy and the neuroscience of relationships, creativity, and resiliency: Skills and practices (norton series on interpersonal neurobiology) N Hass-Cohen, JC Findlay - 2015 - books.google.com Presenting a neuroscientifically aware approach to art therapy. Art Therapy and theNeuroscience of Relationships, Creativity, and Resiliency offers a comprehensiveintegration of art therapy and interpersonal neurobiology. It showcases the Art TherapyRelational Neuroscience (ATR-N) theoretical and clinical approach, and demonstrates howit can be used to help clients with autobiographical memory, reflecting and creating, touchand space, meaning-making, emotions, and dealing with long-term stress and trauma. The … Cited by 85 Related articles All 2 versions Resources https://digitalcommons.lesley.edu/cgi/viewcontent.cgi?article=1251&context=expressive_theses Rewiring the Nervous System with Art Therapy: Advocating for an Empirical, Interdisciplinary Neuroscience Approach to Art Therapy Treatment of Traumatized Children, A Literature Review Reid Dominie email@example.com ART THERAPY AND NEUROSCIENCE Hass-Cohen Art Therapy and Neuroscience Blend: Working with Patients Who Have Dementia Ellen Greene Stewart MARoxbury, NY Art Therapy, Trauma and Neuroscience Janet King (2016) PRACTICAL APPLICATIONS OF TRAUMA-INFORMED ART THERAPY Juliet King Art Therapy and Clinical Neuroscience Edited by Hass and Carr (2008) As you can see, Art Therapy is not about “arts and crafts” nor crayons and coloring books. Art Therapy is much more than that and there is plenty of empirical research to demonstrate that the Art Therapy profession has established itself over the decades. And yet, there is still further to go to distinguish this important profession within the scientific world. I wish to thank all Art Therapists who have worked so skillfully to put Art Therapy on the map!
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