MODULE 2

ART THERPAY and CLINICAL NEUROSCIENCE

Clinical neuroscience is the application of the science of neurobiology to human psychology. It is the
interplay of the nervous system, particularly the brain, with a person’s environment.

In art therapy, the artwork is a concrete representation of such mind-body connectivity, which
contributes to internal feelings of mastery and control. It is a visual reiteration of the interplay
between the person and their environment.

Mind Body Connectivity

 The interplay of experiences, emotions, behavior and physical health characterize the study
of mind-body connections
 Mind-body approaches link nervous, endocrine and immune systems with physiological and
psychological changes
 Understanding the neurobiological connections between the mind and body furthers
therapeutic utility rendering the dualistic separation of mind and body a futile Cartesian
endeavor
 Mind-body connectivity manifests in the nervous system’s organization. The central nervous
system consists of the brain and the spinal cord, which innervates the body organs and their
extremities through the peripheral nervous system


Central nervous system and the peripheral nervous system. The central nervous system
includes the brain and spinal cord. The peripheral nervous system divides into the autonomic
and somatic nervous systems. The autonomic nervous system contains the sympathetic (SNS)
and parasympathetic (PNS) nervous systems. The sympathetic system is excitatory and the
“para” (meaning over) sympathetic attempts to restore normal function by counterbalancing
the sympathetic. The somatic/sensory nervous system responds to incoming afferent sensory
messages and carries efferent messages to the major voluntary muscle groups
  Initially, the strain of a novel demand, such as art-making, can be experienced as a SNS
excitement and emotionally anticipated. However, if the task is not mastered and the client’s
sense of control is challenged, the SNS stress response might increase.
 In order to regain a measure of safety and control, art therapists encourage clients to
practice taking action in session. Actions such as drawing or sculpting in the face of difficult
issues can express the voluntary function of the somatic nervous system and provide clients
with the opportunity to participate in pleasurable kinesthetic experiences. Doing so can
bring the somatic nervous system’s afferent and efferent nerves into play
o Afferent nerves carry incoming sensory information from touching the art materials
(soft or sharp, warm or cold), which may elicit emotional reactions such as pleasure,
discomfort or distaste. At the same time, efferent nerves cause the necessary muscle
contraction needed for drawing, painting and sculpting
 Art therapy activities, grounded in affective-sensory experiences, assist in keeping clients in
touch with their therapeutic surroundings and can also provide relief through the expression
of emotions and the kinesthetic and voluntary actions required to make and complete the
art. Art therapy experiences may help provide a sense of control and mastery, which is
mediated by sympathetic-parasympathetic balance
 It is important to share with art therapy clients how a person’s response to stress may be
affected by how he/she perceives, emotes and thinks about the situation (Barlow 2001).
 Art therapy is recognized as an intervention that facilitates the expression of mind-body
connectivity through the remediation of acute and chronic stress
 Mind-body-based interventions are also characteristic of health psychology, medical arts,
sports psychology and shamanic practice
 Most mind-body approaches are intrapersonally oriented. They focus on the remediation of
stress and restoring a sympathetic-parasympathetic balance by teaching clients experiential
practices.
 Art therapy differs in that it includes expressive and relational foci. At the same time that art
therapists assist clients in reducing the effects of stressors, they also encourage self-
expression and promote a sense of intra/interpersonal connectivity through the therapeutic
relationship.

Establishing connectivity: Development and Learning

 The earliest therapeutic relationship between the primary caregiver and infant directly
shapes the infant’s emotional brain
 From birth, the subcortical regions of the central brain, responsible for emotional processing,
are actively making neural connections.
 The basic building blocks of relational connectivity are neurons, which are electrically
excitable cells
 The basic structure of a neuron includes the cell body and nucleus axon, axon terminals and
dendrites. Some neurons are covered by myelin sheathing which facilitates faster
communication
 How neuron communication works?
 repeated sequences of neuronal firing establish learning and memory formation (Bishop
1995), which thickens dendritic connections.
  Repeated sensory art experiences contribute to the formation and strengthening of
memories (Vance and Wahlin 2008). Creating art about how our brains learn and change
assists in retaining complex information in memory
 Synaptic pruning and myelination : synaptic shaping and myelination contribute directly to
brain maturation and growth. Expereintial brain matures in first two years.
 non-verbal communications between mother and infant organize neurobiological systems
(Schore 1994). Art therapists working with mothers and caregivers may want to share how
somatosensory regulatory experiences of holding, touching and gazing help organize their
child’s nervous system. The interactive brain is social (Cozolino 2002; Perry 2001) as mothers
and babies continue to soothe each other and grow in shared contexts of emotion and
behavior
 Relational art activities can increase mother-child trust and attachment
 The pleasure associated with therapeutic art-making may also help mitigate postpartum
and/or clinical depression
 The brain continues to develop during the adolescent years and young adulthood as the
frontal lobes, areas responsible for attention, concentration and sophisticated decision-
making, myelinate and reorganize. These extensive synaptic changes contribute to the social-
emotional turmoil characteristic of the preadolescent and adolescent age.

Connectivity throughout the lifespan: brain plasticity

 Brain plasticity is the ability of the brain to strengthen, renew and, to a certain degree,
rewire to compensate for developmental, learning and traumatic brain deficits (
 Greater brain usage increases neuronal activity, which increases dendrites and synaptic
activity, thickening brain gray matter and resulting in heavier brains (Mechelli et al. 2004;
Stein et al. 2006). Heavier brains are less vulnerable to neurogenerative diseases, such as
Alzheimer’s, and can better compensate for brain injury
 Perhaps the repeated practices involved in making art and consistently communicating with
others through art forms may have similar, positive effects.
 Hippocampal neurogenesis occurs during physical exercise in an enriched environment and
while learning new memory-dependent tasks, transfers stm to ltm
 Hippocampal neurons respond poorly to long-term, chronic stress (Bremner 2006) yet
pharmacological and non-pharmacological treatments for depression can successfully
enhance hippocampal neurogenesis and help in mood disorders
 At the core of mood disorders, such as depression and anxiety, are problems with the
regulation of affect.
 Art therapy practices provide a unique opportunity for expression of emotions and practicing
the regulation of affect. Colors and textures easily arouse affectively laden limbic memories
while purposeful art-making provides a here and now opportunity to express, understand
and integrate emotional reactions.
Affect expression

 The ascending order of brainstem to central brain to right hemisphere and then across to the
left hemisphere (Figure 1.3) is associated with increased integration of emotions with
cognitive functions resulting in complex social function.
 he basic core emotions associated with pleasure and discomfort are happiness, surprise,
fear, anger, disgust and sadness (Tamietto et al. 2007).
 Basic emotions categorized as unpleasant or pleasant inform the person that his or her
environment is “helpful or harmful, rewarding or threatening, calling for acceptance or
rejection
 Crisis puts the higher verbal regulatory functions in the cerebral cortex out of reach, possibly
rendering a person without words (Hull 2002) and making it necessary to work directly with
non-verbal, emotional systems
 As emotionally salient information emerges in color and shapes, art therapy provides the
advantages of accessing non-verbal emotions through the art
 Understanding the social and emotional role of the limbic brain underscores the applicability
of non-verbal therapies: “Art expression could be useful in the treatment of trauma,
particularly for individuals who were unable to communicate their experiences with words
alone. Art therapy can arouse amygdala fear response too.
 One of the advantages of art therapy is that it can provide relief by pairing fear-arousing
emotions with positive, new sensory experiences.

Affect regulation and integration

 Affective neuroscience (Panksepp 1998) emphasizes the importance of connecting limbic

emotions with right prefrontal cortex communication.
 common significant area of activation for both core and social affects is the orbital frontal
cortex.
 “Art as therapy” activities have the potential to activate neural pathways related to tactile
and kinesthetic sensations associated with the primary somatosensory cortex
 Sensory experiences include touch, movement, visual and sound.
 junctures where different areas in the brain meet, such as the superior temporal gyrus
(Figure 1.7), are areas of polymodal integration.
 experiencing and learning how to regulate affects can perhaps happen more easily through
sensory integration activities and kinesthetic movement associated with art therapy
activities.
 sensory art-making processes can encourage vertical integration of brain function and result
in complex feelings such as authorship.
 The non-verbal exploration and expression of emotions may entrain the expression of more
complex cortical feelings such as a determination to problem-solve or the anticipation of
pride or shame if the task is or is not completed according to expectations
 Achieving stable mental states also requires integrating left and right hemispheres function
(Schore 2007), which can potentially be facilitated by therapeutic art-making (McNamee
2003). T
 he connections between the left and right hemispheres are facilitated by the corpus
callosum, a broad band of neural fiber
  a neurologically based bilateral art protocol can possibly facilitate a systemic integration of
hemispheric right-left functions.
 The protocol assists clients in exploring conflicting choices, cognitions or emotions.
 Art therapy practices can assist in regulating limbic affects by engaging left cortical functions.
rt therapists may be able to do so by asking clients to title the artwork and talk about their
feelings with the therapist.
 Talking about the art seems to engage cortical shifts: “Putting feelings into words is an
effective strategy for regulating negative emotional responses – Reduce amygdala activity
and increase prefrontal activiation.

Expressions of relational empathy and mindfulness

 Interpersonal relationships can arouse as well as alleviate stressful emotions and humans are
more likely to turn to others at times of distress
 As people respond to each other, networks from similar brain areas respond and fire,
evoking empathic resonance
 Facilitated by mirror neurons, humans can learn through empathic imitation and observation
of another’s actions, observing and recognizing that someone else’s action is something that
we can do also. Therapist’s empathetic actions.
 The impact of recognizing that I can do what you can do, and make what you make, reflects
an emotional resonance that can be experienced by art therapy clients and art therapists.
Artists learning from the masters also report a similar reaction as they are inspired by works
of art.
 When looking at the client’s artwork, the therapist’s empathy is aroused by recognizing how
she could have made what the client made.
 The planning and execution of purposeful choices, decisions and actions requires controlling
affective response and self-regulation
 The prefrontal lobes are associated with executive functions such as perceiving, verbalizing,
motivating, attending and coordinating (Faw 2003) and they mediate a higher order of
control used in willed actions such as making art.
 Carefully made media choices help regulate essential expressivity and integrate affect with
willful action. However, the use of very structured media, such as pencil, may stifle affective
expressivity. more mindful efforts with change in media

CREATE PRINCIPLE: Art Therapy Relational Neuroscience Principles

six proposed art therapy relational neuroscience (ATR-N) principles emerge: Creativity in action;
Relational resonance; Expressive communication; Adaptive responses: Transformation; and Empathy
(CREATE).

The CREATE framework makes available to art therapy valuable information from the interpersonal
neurobiology of emotion, cognition and action that are expressed in the dynamic interplay of bodily
systems during art therapy.

CREATE principles can help art therapists understand the neurological underpinnings of
psychopathology and allows for the fine-tuning of art therapy interventions and theories of change

CREATE emerged from the search for an understanding of how the functional entrainment and
synchronization of the bodily systems—the nervous, immune, endocrine, sensory, visual and motor
systems—express in art therapy processe

CREATE principle is connected with the function of specific brain structures

Creativity in Action

 The expressive arts therapies are characterized by the inclusion of movement and action,
from deliberately large movements to fine motor actions.
 Understanding of stress responses supports the significance of including action and
movement in a therapeutic environment
 The physical dimensions of art-making directly contribute to the therapeutic value. Art
therapy provides an opportunity to reduce defensive avoidant states and instead engage
adaptive action systems
 We encourage clients to take action by creating tangible art that expresses their inner state
 when clients are unable to match expectations of creating realistic and representative art
with appropriate art-making actions, they may also feel overwhelmed by a rush of self-
judgment and frustration. Art therapy facilitates the expression and regulation of these
urgent emotions and corporeal surges in a therapeutic and controlled environment,
 Art therapy provides an outlet for unspoken feelings through non-verbal action, bringing
about a felt sense of control and mastery (Malchiodi 1998) that assists in calming the body
for people with PTSD, creating a sense of action and the ability to control that action may
engender increased energy, a felt sense of accomplishment and personal creative agency
 Inputs to the motor control system depend on the thalamic processing of sensory stimuli,
such as those found in art-making and on the cerebellum’s coordination of motions that are
required for making art
 The main neurotransmitters involved are serotonin, associated with a sense of well-being;
norepinephrine, associated with a sense of arousal; and dopamine, associated with a sense
of reward and pleasure and enhanced positive mood. As clients create the art with their
hands, it is therefore a good idea to encourage them to draw by standing up and or adding
body movements
 Many of the therapeutic exchanges in the expressive arts happen through mirrored actions
between the client-artist and artist-therapist. Within a couple of sessions, most clients will
associate the therapist’s reaching out for the art media with a purpose
  The expressive arts therapies rely upon a full spectrum of purposeful actions. In the face of
adversity, simple purposeful activities, such as reaching out for media, washing brushes and
hands and moving between media centers, may be shown to have relieving effects.

Relational Resonance

 Processes involved in art-making assist therapist-client interpersonal resonance and can

positively impact attachment. Art-making and art products can act as regulatory mechanisms
that mimic the reiterative dynamics of approach
 Art therapy provides client and art therapist with opportunities for mutually dependent
communication that builds contingent attachment
 Paying attention to the art helps facilitate attunement as it allows for contained pauses that
assist in self-regulation. If eye contact becomes overwhelming, the client and the art
therapist can focus on the art-making and look at the messages in the art
 the art and the art-making, afford an opportunity to modify how client and therapist
resonate and individuate, yet stay connected (Robbins 1999). Layers of resonance allow the
art therapist to be interpersonally sensitive during art directives and interpretive moment
 therapeutic relationship builds coherent attachment as the client can count on the art
therapist and the media to be there for him or her.
 allowing the clients’ own imagery and understanding to surface rather than imposing
prescribed directives contributes to better attunement.
 Asking the client to make art in the presence of the art therapist is an invitation to take a
relational risk as art-making is culturally more associated with privacy
 Sharing intimate moments helps clients experience and regain a felt sense of coherent and
contingent attachment. Art therapy provides clients and therapists with unique opportunities
for intimate resonance.
 The art directive, the shared art-making and the discussion of the art product, offers an
opportunity for the expression of the person’s life story. The sharing of life stories with a
significant other is self-informative, develops relational connectivity and elicits further
resonances

Expressive Communication and Emotional Processing

 Emotional processing involves arousal, regulation, transformation, awareness and meaning-

making (Greenberg and Pascual-Leone 2006). Likened to a vertical ladder within the brain,
emotional processing ascends and descends through the brainstem, basal ganglia, the limbic
system and the right cerebral cortex.
 Art therapy calls emotions into the room by asking clients to make art about difficult life
circumstances in the presence of another. The novel situation invites arousal as well as
curiosity, which can balance emotional reactivity. Emotions are heightened by less structured
media, such as paint and clay (Riley 2004), whereas pencils and markers, which are more
structured media, modulate arousal.
 The use of chromatic or achromatic color also puts emotional processing in the center of art
therapy practices. Color invites the expression of basic core emotions.
  The processing of positive and negative emotions has been associated with left and right
hemispheric function. Both right and left hemispheric activation most likely work with the
art.
 the fearful, right hemisphere-activated client is encouraged to approach art-making, the left
hemisphere is engaged to modulate emotional avoidance. The artwork may also provide
clues to hemispheric lateralization of emotion.
 Dividing the page into two and inviting opposites on each side is a common art therapy
directive, an activity that may encourage inter-hemispheric engagement
 Vague art imagery may stimulate a stronger amygdala than a cortical response. Art therapy
helps clients discover the nature of hidden or unconscious feelings through working with
their reactions to vague stimuli.
 The transformation of a negative response into a positive or assertive response can result in
a shift from neuroendocrine-mediated feeling of loss of control, to a sympathetic nervous
system-based feeling of being in control. he pleasures of art-making in the face of adverse
emotions may very well assist in this transformation.
 Expressive communication includes transformation, awareness and meaning-making.
 rather than reasoning or assigning a new cognitive meaning to an emotion, one can use the
art to transform one emotion directly into another. Art-making results in positive and joyful
responses facilitated by the brain’s natural reward systems. Positive emotions have been
found to facilitate physical well-being and mental health changes

Adaptive Responses

 Presenting personal difficulties through art-making is a novel, unexpected task for most
people. Just as art-making in the presence of another invites expressivity and intimacy, it also
invites stress.
 The art therapist and client have the joint opportunity to look at the individual’s adaptation
to the unexpected request.
 Adaptive responses to new demands, such as drawing about health issues, require emotional
flexibility as well as sympathetic and parasympathetic autonomic nervous system balance.
 Initially, there is a beneficial arousal of the sympathetic response that helps the client cope
with the stressor, followed by protective dampening, mediated by the parasympathetic
relaxation response
 Stress in art is frequently expressed as quick scribbles, spills and/or small, withdrawn
representations.
 The art therapist’s invitation to use clear and simple forms, or structured media, can help
mitigate the stress response. While the request to draw a problem can arouse stress and
anxiety.
 Structured art interventions can calm fear-based, survival-based stress responses.\
 Art imagery can provide symbolic clues about immune system function that is affected by
chronic stress (HPA axis ). These clues can assist in medical arts therapy practices
 The art therapist is called upon to find creative ways to inform clients about the damage
caused by stress.

Transformation and Empathy

  Art visuals and narratives provide a window to the relational mind and the opportunity to
understand one another through narratives, participation and art
 There is an opportunity for knowing that another person means to connect through thinking,
emoting and intuiting.
 In the art therapy room, we can see the ability to make dual drawing connections and links
between ideas, feelings and events. Their increased ability to give form to feelings through
symbolic representations allowed them to share interpersonally
 Mentalizing emerges from the desire to foresee, know, understand and move the other in
relationship to the self. Figuring out what and how people think, intend and believe
represent unique human abilities
Art therapy practices may enhance mentalizing when shared knowing of shapes and
figurative marks emerge. Similar to comprehending conceptual art, the interpretation and
understanding of art therapy expressions is socially constructed by therapists and clients
who collaborate about relevant internal mental representations
 art therapy expressions serve to transfer communication between minds. The sharing of
symbolic meaning approximates real-life mind-reading of a metaphoric cultural language.
Symbolic art metaphors require a second order level of reading others’ mental states
 Shared internal mental representations reflect shared social cognitions, whereas empathic
representations evolve from experientially shared social resonances (Gallese 2006) that are
crucial for therapeutic success.
 Experiential simulation is a functional process that provides a window to the possible states
of others. heightened sensitivity to how hands pick up the media and to the specific sounds
the first tentative scratches and the ensuing bold marks make on the paper.
 strive to attune to what tone of voice accompanies an art directive and how I ask for the title
of the artwork. Whether I touch the client’s art or not, my facial and my bodily expressions
convey a sense of optimism that distress can be alleviated

Summary
Creativity in action highlights how movement and action are art therapy therapeutic factors. The
experience of actively matching inner states with corresponding visual expressions relieves stress.
Creativity in action brings this concrete visual expression to the shared space of the art therapy table.
The creative, action-oriented context uniquely shapes the therapist-client relational resonance.

Relational studio art therapy experiences and concretized art-making call forth memories, emotions
and cognitions, and have the potential to mend attachment ruptures. The inherent safety of the art-
making context increases the capacity to tolerate emotional frustration and regulate ambiguity in
one’s art and life.

Expressive communication reflects on the duality of simultaneously expressing avoidant feelings such
as fear while at the same time experiencing the positive affects of art-making. The experience of
these two states helps therapists and clients contain the tangible art representation of their
problems and let a new solution incubate through the art.

Adaptability is increased and the stress response reduced as expressive pleasure increases.

Transformations occur through interactive art therapy feedback loops that promote more flexible
and stable responses.

Art therapy experiences contribute to integrating both the mentalizing and empathic capacities
necessary for the emergent relational sel