Art therapy may be a viable approach in aiding the recovery of trauma survivors. Art therapy may exist as a solitary treatment or in conjunction with other therapies. Studies have shown the benefits art therapy may have on the mental health of those who have undergone traumatic experiences.

Introduction

Art therapy may serve as a coping strategy to help process traumatic events one has experienced in their lifetime. Individuals suffering from traumatic memories may find it helpful to convey the complicated feelings and emotions often associated with trauma through the act of art-making, which can take various forms. This allows for the release of trauma at a comfortable pace, which is entirely up to the individual. Art therapy can be undertaken along with cognitive processing therapy, a psychotherapy for post-traumatic stress disorder (PTSD), to maximise the beneficial effects of art therapy through reflection and evaluation. 

Art therapy can be defined as the integration of sensory memories as well as declarative memories. It may be useful for those struggling to verbalise their thoughts that may aid them in their recovery or simply the processing and understanding of their traumas. The neuroscience behind art therapy involves bilateral stimulation ( both hemispheres of the brain) to allow the complete processing and storage of trauma in long-term memory, via externalisation and emotional distance (the use of art or in conjunction with talking therapies) through materials such as paintbrushes and pencils.¹ 

Art therapy has been demonstrated to reduce PTSD in various populations and has previously been applied in the treatment of traumatised adults with promising results.² This highlights the usefulness of exploring art modes to help combat traumatic memories.

Neuroscience

The bilateral stimulation of the brain is involved in art therapy. The sequencing of narratives using the left hemisphere of the brain and the integration with the right side of the brain plays a role in both the processing and storage of traumatic memories in long-term memory.^1,4

Types of art therapy

Art therapy involves the creation of a visual trauma narrative. This allows individuals to reconceptualise their current beliefs about the concepts of themselves and other people, as well as the environment and world in which they live.¹ The benefits of visual trauma narrative reduce the occurrence of emotional numbing, which is commonly seen following a traumatic memory. It can be interpreted as a form of repression, as well as avoidance behaviours (to avoid reliving the uncomfortable feelings associated with said traumatic memories). It is worth noticing that the therapist involved in this concept will strive to create a safe and comfortable environment for the trauma-affected individual to help “contain” these powerful memories. 

There are multiple steps involved in the processing of trauma. Studies have shown that the noticing of body sensations is the first. Trauma survivors are often in a state of fight-or-flight when reminded of their traumatic experiences. Monitoring of this sensation associated with this fearful state will allow recognition of triggers and treatment can be targetted. This is supported by studies that suggest trauma is associated with an increase in heart rates.

Art therapy for trauma survivors

Studies have shown that the creation of art led to an improvement in mood in comparison with the simple viewing of art. This supports the theory that art therapy could be an effective way of coming to terms with traumatic memories. Further support has demonstrated art therapy in the treatment of trauma with 89% of participants meeting the criteria for improvement or fully recovered.¹ 

Furthermore, the combination of art therapy with cognitive behavioural therapy (CBT) led to significant improvements in trauma-related symptoms of children suffering from PTSD following sexual abuse.¹ Art therapy is also useful in the treatment of PTSD and reduction in depression in combat veterans.¹

Visual trauma narrative 

Visual trauma narrative involves the creation of a series of images.³ The first image could represent a peaceful moment for the individual before the traumatic experience that they had encountered. The second image may be the moment recalled just before the traumatic event occurred. The third image could be the traumatic event itself. The fourth image may be an image of what happened directly after the traumatic experience. The fifth, possibly the final image could be one following the unfortunate experience.

To allow healthy distancing between the individual and the traumatic experience, the individual may take a step back and narrate these images from a third-person perspective, which can then be paraphrased back to the individual by the art therapist leading the session. These sessions can last around 70-80 minutes and maybe multiple sessions.¹

Mask-making and mind-mapping

Mask-making is a technique that may be used during art therapy to help participants identify and express emotions that they find difficult to express verbally. Mind mapping is another approach used in the recovery of trauma survivors, that allows patients to explore their internal feelings and how they present themselves to the world.

It can involve the creation of a web with the patient’s name in the middle of a small circle, with core emotions stemming from the centre of the circle. This will allow further exploration of internal and external triggers of their traumas, also considering contributors to said emotions.¹

Assessing treatment 

Therapists may review the trauma survivors’ work after each session to determine whether art therapy is beneficial to the patients. They may compare and discuss the artwork before and after treatment with patients. It is said that when analysing artwork before treatment, themes of avoidance and regression were often noted and, the artwork was described as being sketchy.^1,5 

Engagement and satisfaction

Patients’ engagement with art therapy is as important as their satisfaction levels, which are monitored following art therapy sessions to determine whether any changes need to be made. 

Studies have found that patients found a significant improvement when their traumatic experiences were described back to them during the visual trauma narrative viewing. Additionally, each review of this phase led to a reduction in anxiety as gaps with memory were slowly filled, as each review of the visual trauma narrative was built on the previous one, allowing close monitoring.¹ 

One of the most significant effects of this treatment was improved trauma processing via the externalisation of trauma and its associated emotions, allowing the creation of an external reflection of the trauma survivor’s internal self. 

It may be difficult for people to verbalise the thoughts and feelings that come with recalling traumatic memories, so it is worth noting that the sensory modalities associated with this treatment could be an alternative way of deconditioning the threat that comes with recounting traumatic memories, without having to resort to talking therapies.

Studies have shown a significant reduction in psychological trauma in the art therapy treatment groups, showing the potential effectiveness of art therapy as a treatment for trauma survivors.^2,6

Trauma and depression scores

Another way of determining whether art therapy has the intended effects is via monitoring of depression scores, whereby less depression is indicative of a better ability to process trauma healthily. However, this evaluation may come in conjunction with other measures. 

Studies have shown a significant decrease in depression following art therapy, showing its potential use as a more regular treatment for traumatic experiences in the future.²

Limitations

Many studies assessing the benefits of art therapy have a small sample size of patients, meaning it is hard to generalise results.  There is also a lack of long-term follow-up of the treatments, making it difficult to determine whether the effects of art therapy are long-lasting or if they require further intervention.^1,7 

Furthermore, there is a general lack of art therapists, suggesting that art therapy is not the most accessible form of treatment. This goes in hand with the potential costs associated with the materials required for art therapy to go ahead. The use of self-rating scales following art therapy sessions is subjective and may result in either the exaggeration or underreporting of symptoms. 

Future research

Future studies could involve more male and female participants. Additional art therapist researchers should be involved to reduce experimenter bias. More studies on art therapy alone for trauma survivors rather than in conjunction with other therapies may also yield helpful and applicable findings.^7,8

Summary

Art therapy can take on many different forms and can involve different components. Some of these include the creation of a visual trauma narrative, mask-making, and mind mapping. Some of the aims of art therapy help convey, and process complicated feelings involved in trauma. 

Art therapy has yielded promising results in trauma survivors, with decreased depression scores as well as a reduction in psychological trauma symptoms as seen in studies that assess the effectiveness of art therapy. 

Art therapy can be undertaken as a singular therapy or alongside other therapies. However, some limitations involve sample size, generalisation and methodological quality. However, with the promising results seen in studies, further research into art therapy and the treatment of trauma is an area that needs exploration to hopefully aid towards the improvement of one’s quality of life.