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Trauma & Expressive Arts Therapy

Neurobiology, creative interventions, and childhood trauma.

This chapter provides an overview of trauma from a neurobiological view and a foundation for understanding why sensory-based, creative interventions such as arts therapies and expressive methods are effective and often necessary in work with traumatized children. For therapists who are not familiar with these modalities, a brief description of creative arts therapies and expressive therapies is offered along with general information on the nature of traumatic events and their impact on children. (PsycInfo Database Record (c) 2020 APA, all rights reserved) 

Malchiodi, C. A. (2015). Neurobiology, creative interventions, and childhood trauma. In C. A. Malchiodi (Ed.), Creative arts and play therapy. Creative interventions with traumatized children (p. 3–23). The Guilford Press.

Avenues of Hope: Art Therapy and the Resolution of Trauma

This paper describes a method for using art therapy with adolescents in crisis. A model developed for the study defines four trauma stages and associated art therapy goals. They are Stage I, Impact—Creating Continuity; Stage II, Retreat—Building Therapeutic Alliance; Stage III, Acknowledgment—Overcoming Social Stigma and Isolation Through Mastery; and Stage IV, Reconstruction—Fostering Meaning. An example of the application of the paradigm is presented through a case study, including the art therapy approaches and method for assessing the artwork and art processes across the continuum of these stages. It is found that hope is experienced through art and generative processes. The author draws on research conducted on an intensive care burn unit to develop a new paradigm for understanding crisis and trauma through art therapy (Appleton, 1990).

Valerie Appleton EdD, ATR, MFCC, NCC (2001) Avenues of Hope: Art Therapy and the Resolution of Trauma, Art Therapy, 18:1, 6-13, DOI: 10.1080/07421656.2001.10129454

Using Creative Arts in Trauma Therapy: The Neuroscience of Healing 

Knowledge about the brain and the impact of trauma has increased significantly in recent years. Counselors must understand brain functioning and the effects of trauma in order to choose the most effective methods for working with clients. Creative arts therapies offer a nonthreatening way for clients to access and express their trauma, creating a corrective experience in the brain. Activities that incorporate body movement can be particularly helpful by providing a corrective emotional experience for those clients with an immobilized response to a traumatic event. This article offers a model for the assessment and treatment of trauma through the use of creative arts.

Kristi Perryman, Paul Blisard, Rochelle Moss; Using Creative Arts in Trauma Therapy: The Neuroscience of Healing. Journal of Mental Health Counseling 1 January 2019; 41 (1): 80–94. doi: https://doi.org/10.17744/mehc.41.1.07

A Review of Art Therapy Among Military Service Members and Veterans with Post-Traumatic Stress Disorder

Every day in the United States approximately 22 veterans, and one active duty service member, reservist, or national guardsman commits suicide and the rate is climbing.1-2 In 2008, there were 197 reported suicides; 2009, 238; 2010, 301; 2011, 283; 2012, 325.3 In addition to fighting the Global War on Terror, current service members and veterans
are left to battle postwar symptoms related to post traumatic stress disorder, otherwise known as PTSD. As the wars in Iraq and Afghanistan have come to a close, there is growing concern over the efficacy of postwar treatment, which will be needed for the increasing number of veterans returning home. Veterans Affairs (VA) healthcare is the largest
healthcare delivery system in the United States and  according to a U.S. Congressional Research Service report for Congress, the prevalence of PTSD among Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans receiving VA healthcare in FY2002-2012 was 29%.4 It is important to note that although combat exposure is a leading cause of PTSD among males, military sexual trauma (MST) is the leading cause of PTSD among females.5 Although treatment for PTSD is widely researched among past and present military service members, little
is known about the potential therapeutic benefits art therapy could offer this population. Existing research indicates that art therapy shows promising treatment results among service members.6 This project aims to provide a review of why art therapy programs should be implemented among current military service members and veterans diagnosed with PTSD.

By Jeremy Ramirez, BS, MPH-C In Review Article  Issue Volume 24 No.2 .

Mental Health & Expressive Arts Therapy

A Story of a Healing Relationship: The Person-Centered Approach in Expressive Arts Therapy

In expressive arts therapy, visual art, movement, music, poetry, and creative writing offer clients opportunities to explore their hidden feelings expressed in the art forms. The colors, lines, motions, or sounds expressed during the therapy session promote better understanding of the self with support of the therapist. It is crucial to have a creative connection, not only between the self and its inner world but also between the client and the therapist for the healing process to unfold. This article presents a story of a healing relationship using Rogers's person-centered approach in expressive arts therapy.

Sunhee Kim (2010) A Story of a Healing Relationship: The Person-Centered Approach in Expressive Arts Therapy, Journal of Creativity in Mental Health, 5:1, 93-98, DOI: 10.1080/15401381003627350

Expressive Arts and Mindfulness: Aiding Adolescents in Understanding and Managing Their Stress

This study contains an exploration of the use of mask-making and mindfulness training as components of an expressive arts group intervention designed to help youth understand and manage their stress. With the assistance of a school counselor, six eighth-grade students, who were having difficulty managing stress, were identified and participated in a 12-hour group intervention over the course of six weeks. Participants were assessed pre- and post-intervention and at a three-week follow-up on measures of self-efficacy, depression, anxiety, and stress. The group intervention resulted in significant self-reported reductions of anxiety and stress at the three-week follow-up.

Laura Lindsey, Phyllis Robertson & Beth Lindsey (2018) Expressive Arts and Mindfulness: Aiding Adolescents in Understanding and Managing Their Stress, Journal of Creativity in Mental Health, 13:3, 288-297, DOI: 10.1080/15401383.2018.1427167

‘Painting a path to wellness’: correlations between participating in a creative activity group and improved measured mental health outcome

Responding to a call for quantitative outcome evidence about the therapeutic relationship between creative activity and mental health, this study examined the mental health outcomes of inpatients participating in art‐ and craft‐based creative therapies at a private psychiatric hospital over a 5‐year period. The creative activity group sample (n= 403) improved from admission to discharge across four different psychometric measures with moderate to strong mean effect sizes. Reductions from pre‐ to post‐treatment in both self‐reported and clinician‐rated symptoms are clearly demonstrated for the creative activity group participant sample. Research findings establish that participation in creative activity has potential benefits for people experiencing mental health problems.

CADDY, L., CRAWFORD, F. and PAGE, A.C. (2012), ‘Painting a path to wellness’: correlations between participating in a creative activity group and improved measured mental health outcome. Journal of Psychiatric and Mental Health Nursing, 19: 327-333. https://doi.org/10.1111/j.1365-2850.2011.01785.x

Art Making as a Mental Health Recovery Tool for Change and Coping

The intrinsic benefits of art making may be implicated in how and why people with mental illness turn to art therapy to aid their recovery. In this longitudinal multiple case study adult participants (N = 12) with severe and ongoing mental illness were recruited through their involvement in diverse community mental health art therapy programs. An interpretive phenomenological data analysis revealed that participants utilized art making as a change mechanism and coping tool that encouraged development of flexible and adaptable approaches toward overcoming barriers in their recovery process.

Theresa Van Lith (2015) Art Making as a Mental Health Recovery Tool for Change and Coping, Art Therapy, 32:1, 5-12, DOI: 10.1080/07421656.2015.992826

Grief & Expressive Arts Therapy

Grief and the Expressive Arts: Practices for Creating Meaning. Barbara E. Thompson and Robert A. Neimeyer (Eds.). New York, NY: Routledge, 2014, 312 pp.

Grief is a universal experience, yet is insufficiently understood in counselling and psychotherapy. Loss is not an experience to be solved or resolved. Grieving has no clear end, and fostering acceptance does not reduce the suffering of loss. There is a dearth of services in Australia for bereaved and grieving people, and there is far greater attention paid to trauma than to grief and loss.

https://pacja.org.au/2017/08/grief-and-the-expressive-arts-practices-for-creating-meaning-barbara-e-thompson-and-robert-a-neimeyer-eds-new-york-ny-routledge-2014-312-pp/

The therapeutic effectiveness of using visual art modalities with the bereaved: a systematic review

Bereaved individuals are increasingly considered at risk for negative psychological and physiological outcomes. Visual art modalities are often incorporated into grief therapy interventions, and clinical application of art therapy techniques with the bereaved has been widely documented. Although clinicians and recipients of these interventions advocate for their helpfulness in adapting to bereavement, research investigating the efficacy of visual art modalities has produced equivocal results and has not yet been synthesized to establish empirical support across settings. Accordingly, this review critically evaluates the existent literature on the effectiveness of visual art modalities with the bereaved and offers suggestions for future avenues of research. A total of 27 studies were included in the current review. Meta-analysis was not possible because of clinical heterogeneity and insufficient comparable data on outcome measures across studies. A narrative synthesis reports that therapeutic application of visual art modalities was associated with positive changes such as continuing bonds with the deceased and meaning making. Modest and conflicting preliminary evidence was found to support treatment effectiveness in alleviating negative grief symptoms such as general distress, functional impairment, and symptoms of depression and anxiety.

Weiskittle, R. E., & Gramling, S. E. (2018). The therapeutic effectiveness of using visual art modalities with the bereaved: a systematic review. Psychology research and behavior management, 11, 9–24. https://doi.org/10.2147/PRBM.S131993

Towards Healing Ambiguous Grief with Nature-Based Expressive Arts Therapy, Embodiment, and Mindfulness: A Literature Review

There is an emerging trend of nature-based expressive arts therapy with a developing body of research. The current literature indicates that there are numerous nature-based approaches and that they can be effectively applied to many populations. Some of the benefits of nature-based therapy are shifts in physiology such as lowered blood pressure, heart rate, and decrease in stress, anxiety and depressive symptoms. The approaches of nature-based therapeutic work include mindfulness and meditation, animal-assisted therapies, farm and work-based therapies, horticulture therapy, and nature-based expressive arts therapy. There are many effective applications of these frameworks that have been studied and some that have not been explored yet. There is a small but growing body of research in nature-based expressive arts therapy approaches for dealing with grief and loss. This literature review suggests that nature-based therapies might be effective for healing ambiguous loss. This thesis will explore some of the current research on nature-based expressive arts therapy, research on ambiguous grief and some suggested areas for exploration of nature-based interventions for grief and loss.

Piper, E. (2019). Towards Healing Ambiguous Grief with Nature-Based Expressive Arts Therapy, Embodiment, and Mindfulness: A Literature Review.

Honoring Choice in Grief Through Expressive Arts With Long-Term Care Residents 

Death in long-term residential care homes is a common occurrence, yet it is often taboo and strongly avoided. Staff and residents often express deep connections to one another in these settings, but when death occurs, there is often little to no support, training or space to share these feelings. This session will discuss the findings of Dr. Olson’s multi-case, arts-based research from the elder voices of those who face these losses. Perceptions such as disenfranchised grief and ageism were revealed in this study as well as positive expressions such as love, kindness and acceptance. The shared findings will include poetry and artwork that was created within this research study. Utilizing the creative arts can assist in the expression of these complex and abstract human emotions, instill a sense of comfort and community and empower honor these lives and friendships.

Michelle Olson, Honoring Choice in Grief Through Expressive Arts With Long-Term Care Residents, Innovation in Aging, Volume 4, Issue Supplement_1, 2020, Page 676, https://doi.org/10.1093/geroni/igaa057.2348

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