Your Brain on Art: A Promising Path to Healing War Trauma

Paintings by military service members

Seven service members, all diagnosed with Post-Traumatic Stress Disorder (PTSD) from combat, sat at the psychotherapy group table, creating symbols of themselves out of clay on a fabric placemat to keep their workspace clean. During the verbal processing part of the group, each participant described what he made; symbols that ranged from flat hearts to Swiss cheese to flags to animals. When describing his horse, AJ explained to the group that the horse itself represented the part of him that everyone could see—he was strong and had purpose. Then, in a quieter voice, while moving the fabric placemat to the side, he showed what remained: a morass of wet clay, pieces stuck to the table. He explained to the group, “This is really who I am…..a total mess.” The safety of the group and the distance of the art helped AJ take ownership for authentic and painful feelings. After processing with the members, he joyfully exclaimed “Man, this is a metaphor for my life!” indicating an ability to connect his thoughts, feelings and behaviors in a way that promoted his growth.

Some systems of the brain and body can be characterized by precise measurable phenomena, easily labeled and quantified: Endocrine glands secrete hormones, the kidneys expel toxins from the body and the heart pumps blood to deliver oxygen to cells. Other systems are more difficult to define, such as those that deal with thoughts, feelings, and behaviors. When exploring the more ambiguous concepts of the human psyche, we tend to speak the universal language of symbolism. For example, a profound loss may have nothing to do with the cardiac system, yet describing grief with the image of a broken heart is commonplace when words fail.

Symbolic mental representations of one’s thoughts and feelings are formed from various sources of interacting data generated through sensory processes, movement, feelings, perception, and cognition. (Lusebrink, 2010). These symbols range from very concrete to dynamic and complex and are an innate pathway for humans to express their experiences of self and other. Symbols emerge naturally before language. We typically experience a sensation or a mental image prior to attaching language to verbally articulate its meaning. This imagery is the language of memory and holds rich information within which to communicate our experiences.

Trauma Impairs Language Processing and Communication

When a person endures trauma, whether from combat, sexual assault or a terrible accident, the ability to verbally communicate experiences becomes limited. Trauma elicits a sympathetic nervous system response that is part of our evolutionary heritage of fight, flight or freeze. The response to danger is healthy and adaptive. However, when a person is faced with cumulative and enduring traumatic stress, such is often the case with combat and deployment experiences, these adaptive responses that promote survival in the stressful environment can persist after the experience is over, thus becoming maladaptive and problematic. This can present as intrusive memories, emotional numbing, avoidance, irritable behavior, sleep disruption, difficulty concentrating, risk taking behaviors, emotional dysregulation and an overall sense of isolation and disconnectedness. In other words, what is at first a common and healthy reaction to stress impacts the lens within which we view our selves and the world around us. Our cognitive processes become more prone to the rigidity of negative thinking, essentially aligning with an overactive physiological response in an attempt to create a sense of control and safety.

When a person is faced with cumulative and enduring traumatic stress, such is often the case with combat and deployment experiences, these adaptive responses that promote survival in the stressful environment can persist after the experience is over, thus becoming maladaptive and problematic.

In a state of ongoing emotional arousal, the language areas of the brain are compromised. This makes already difficult memories and experiences even more challenging to process verbally and emotionally. In her work in the PTSD clinic at the West Palm Beach VA, Clinical Psychologist Dr. Julia Stone says that one of the most challenging aspects of treating combat trauma is the inability of service members to access and share their internal experience, be it memories, feelings or physical sensations. She finds great value in the use of metaphor when working with veterans who have a diagnosis of PTSD, explaining “….metaphor helps a person understand their subjective sequelae of trauma and how it maintains itself within. For example, if I ask my patient to tell me the best way to keep a knife sharp, the most obvious answer would be not to use it. This opens up a dialogue to demonstrate how avoidance of all types becomes a barrier to trauma recovery. If the person avoids internal and external reminder cues, the knife remains sharp, and new learning is limited. But when exposed to difficult trauma cues repeatedly and cumulatively, associations they currently have with what is essentially limbic system messages becomes dulled and they are able to gain new perspectives.”

Art Making Bridges Communication Gaps

Dr. Stone goes on to say how her expertise as a verbal psychotherapist has its limitations, in that not all of her patients are readily engaged in the process. “…having complementary avenues to tap into less conscious aspects of the self and promote personal expression through art making can be extremely helpful for those less conducive to verbal processing.” Stone works collaboratively with credentialed art therapists at the VA and finds these partnerships to be highly effective. Veterans who have been reluctant to or who have had challenges engaging in evidence-based trauma processing therapies are often referred to art therapy first. This type of transdisciplinary collaboration lends itself to expansive, holistic and integrative approaches which are necessary and important as we seek to address the complexity of trauma and the many ways it is manifested in society as a whole.

Veterans who have been reluctant to or who have had challenges engaging in evidence-based trauma processing therapies are often referred to art therapy first.

Art Therapy Accelerates Healing in Military Service Members

Research Psychologist Dr. Brandi Luedtke has been an active advocate in bringing art therapy to the veteran population. In her work, she integrates mindfulness and cognitive behavioral therapy approaches and with this author, developed a Mindfulness Based Art Therapy Intervention that was implemented at the Roudebush VA in Indianapolis, IN. Two pilot studies yielded significant qualitative and quantitative data that attests to the value of this intervention to alleviate stress and anxiety. All participants indicated a desire to participate in this type of programming should it be offered in the future.

Artistic symbolic expression offers the potential to make unexpected connections and discover new insights. This is essentially an isomorphic principle; through the process of making artwork and discussing the art in the context of the therapeutic relationship, we create a different way of seeing ourselves. What we make on the outside has similar properties as to what is happening on the inside—it just looks different. Ramachandran & Hirstein (1999) note the human capacities to tap into reward systems through the arts. This neuroaesthetic perspective lends credence to the value of art making that offers engagement and even enjoyment by reawakening positive emotions and offer healthier coping mechanisms through the arts. Art therapy offers a way to circumvent defenses and essentially ‘say’ what words cannot. When working with an art therapist in treatment, the therapist and patient have more opportunities to explore and investigate the multidimensionality of self, which contributes to healing and may even speed up the meeting of therapeutic goals.

Art therapy offers a way to circumvent defenses and essentially ‘say’ what words cannot.

More Translational Research Required to Secure Funding for Therapeutic Arts

Art therapy researcher Dr. Girija Kaimal has been prolific in her work to understand and articulate the value of art therapy with the evidence. Kaimal states that “Art therapy is uniquely positioned to address the psycho-social challenges of military service members affected by deployment related trauma. The visual externalization helps to unlock blocks to verbal expression and relational connection which in turn helps service members better understand their interpersonal experiences and better integrate and manage triggers related to trauma.”

Using neuroscience to help explain what Kaimal is describing will offer further opportunities to fund therapeutic arts and art therapy programming for veterans throughout the VA system. Great strides are being made to understand how the scientific method can be applied to explore the value of the arts in healing. A tricky challenge is in the development of testable hypotheses that can capture data that contributes to the value of arts interventions inherently reliant upon the subjective experiences of the individual. Through translational collaborations between neuroscientists, psychologists, artists and therapists, there is vast potential for innovative discovery to promote health and healing amongst military service members and all those affected by trauma.

Written and reported by IAM Lab Contributor Juliet King ATR-BC, LPC, LMHC.  Juliet King is currently an Associate Professor of Art Therapy at The George Washington University in Washington, DC and Adjunct Associate Professor and Research Scientist at the IU School of Medicine Department of Neurology in Indianapolis, IN.

REFERENCES

Kaimal, G., Jones, J.P., Dieterich-Hartwell, R.,*Acharya, B.*, Wang, Xi.* (in press). Evaluation of art therapy programs for Active Duty Military service with TBI and post-traumatic stress. The Arts in Psychotherapy. 10.1016/j.aip.2018.10.003

King, J. L. (Ed.). (2016). Art therapy, trauma, and neuroscience: Theoretical and practical perspectives. Routledge.

Lusebrink, V. B. (2010). Assessment and therapeutic application of the expressive therapy continuum: Implications for brain structures and functions. Art Therapy: Journal of the  American Art Therapy Association, 27(4). 168-177.

Ramachandran, V. S., & Hirstein, W. (1999). The science of art: A neurological theory of aesthetic experience. Journal Of Consciousness Studies, 6(6-7), 15-51

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