See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/342224003

How Art Can Heal

Article in American Scientist · January 2020

DOI: 10.1511/2020.108.4.228

CITATION READS
1 1,928

1 author:

Girija Kaimal
Drexel University
85 PUBLICATIONS 1,150 CITATIONS

SEE PROFILE

All content following this page was uploaded by Girija Kaimal on 05 July 2020.

The user has requested enhancement of the downloaded file.

How Art Can Heal 7/5/20, 3)31 PM

American Scientist

How Art Can Heal

GIRIJA KAIMAL

Nonverbal therapy helps people work through trauma and

build resilience.

ART MEDICINE PSYCHOLOGY

One-fourth of the global population is at risk of developing a mental health

challenge in their lifetime, and one-fifth of children and adolescents could

develop mental health problems, according to a 2014 World Health

Organization report. Wars, adversity, discrimination, natural disasters, and

illnesses such as COVID-19 further exacerbate these unmet needs for

psychosocial support.

Oscar Wilde once said, “Man is least himself when he talks in his own person.

Give him a mask, and he will tell you the truth.” Art provides a way to

communicate experiences when individuals lack verbal skills or when words

are insufficient. Humans evolved artistic expression as an imaginative tool

for adapting to changing conditions and solving problems. Other scholars

https://www.americanscientist.org/print/4648 Page 1 of 15
How Art Can Heal 7/5/20, 3)31 PM

and I have asserted that art making is an integral part of human functioning,

and that it helps humans survive. As an art therapist, I have spent decades

trying to understand the role of art making as a therapeutic tool.

Art therapist Jacqueline Jones and Army Staff Sergeant Jonathan Meadows discuss his painting at Fort Belvoir Community
Hospital’s Traumatic Brain Injury Clinic in Virginia. Although art therapy has been used for decades, researchers still have more
to learn about how art making can help people grapple with complex emotions and work through life’s challenges to support
mental health and well-being.
Photo by Marc Barnes/courtesy of U.S. Department of Defense

https://www.americanscientist.org/print/4648 Page 2 of 15
How Art Can Heal 7/5/20, 3)31 PM

Professional art therapy began in the mid-20th century as a restorative

practice that allowed people to express themselves in nonverbal ways, such

as drawing and painting. Trauma affects the brain’s speech centers and can

limit the effectiveness of traditional talk-based therapies. The impetus

behind the creation of modern art therapy in the United States and Europe

was to serve the needs of veterans from the two World Wars who were

suffering from post-traumatic stress, and to address the development of

children and adolescents with special needs.

Despite the prominent application of art therapy programs and the

widespread belief that art supports mental health, many of the claims that

art and art making can help people have remained anecdotal. My colleagues

and I are among a growing group of art therapy researchers working to

strengthen the scientific evidence that art can heal and to better understand

how and why it does so.

Art as a Therapy Tool

Adults typically have complex, ambivalent feelings about art and art making;

common responses range from dismissal and derision to awe and

sometimes shame about their own lack of artistic skills. Young children, on

the other hand, typically draw and sing and dance without worrying about

their abilities. That freedom and joy is often lost as we grow and begin to

https://www.americanscientist.org/print/4648 Page 3 of 15
How Art Can Heal 7/5/20, 3)31 PM

self-consciously evaluate the quality of our art. Too often, we become

viewers of others’ art rather than being active creators, and we lose the

many benefits of creative self-expression. Art therapists guide people in

connecting or reconnecting with the creative practices that support mental

health, and that help people to grapple with life challenges and

uncertainties. The United States has more than 6,000 credentialed art

therapists, and the profession is growing in all parts of the world.

As a child, I used drawing and expressive writing to cope with boredom. (I

was home sick a lot.) In India, I started a career as a textile designer, working

in the vast and rich landscape of the artisanal traditions. But in the 1990s, as

markets were disappearing, many artisans were despairing and committing

suicide. I cherished working with them to adapt their exquisite craft to a

modern market.

My interest in the connection between artistic practices and human well-

being deepened, and I chose to pursue a master’s degree in art therapy and

clinical work. As I worked with clients, I continued to wonder how humans

can best work through traumatic experiences and grapple with adversity,

and I eventually pursued my current work studying creative expression in a

range of human populations.

https://www.americanscientist.org/print/4648 Page 4 of 15
How Art Can Heal 7/5/20, 3)31 PM

Art therapy is founded on the assumption that everyone is creative and

capable of self-expression. My job is to create a safe environment that allows

clients to express themselves and communicate without worrying about

whether they have great visual arts skills or whether their artwork is

technically brilliant. Art therapy clinicians focus on the process of making

rather than the artistic product, which allows our clients to gain insights

about their situations and develop inner emotional resilience. Therapy

sessions—in groups or with individuals—provide time for engaging all the

senses and integrating these aesthetic experiences so that participants can

reimagine and rework established neural pathways to establish new ways of

seeing, thinking, and experiencing.

What is my superpower as an art therapist? I can change how you see

yourself.

Art therapists can channel maladaptive or dangerous instincts into creative

products that allow clients to communicate and work through difficult

thoughts and complex emotions. I can guide a person toward taking risks in

art making rather than engaging in risky behaviors in their outside life. These

creative choices fulfill the brain’s desire for novelty without compromising

personal safety. Rather than punch another human being, for instance,

https://www.americanscientist.org/print/4648 Page 5 of 15
How Art Can Heal 7/5/20, 3)31 PM

someone with aggressive tendencies could work with materials such as clay

and wood that can absorb their energy and transform it into a creative

product.

What is my superpower as an art therapist? I can change how

you see yourself.

Facebook
Twitter

In the early 2000s, when I worked as an art therapist with teens in an

alternative high school in Pennsylvania, the students often created socially

inappropriate objects, such as clay penises and drug paraphernalia, during

their art therapy sessions. By acting out with their art, the teens could

visually express their family challenges and the developmental issues that

brought them to the alternative school setting. Communicating these kinds

of issues safely and nonverbally with a responsive adult can help such

students make adaptive choices as they move into adulthood.

As we started looking at the science behind art therapy, my colleagues and I

studied the effects of art making alone versus with an art therapist, starting

with research at Drexel University with a test group of healthy adults,

including students, faculty, and staff. We found that individuals who worked

with an art therapist had lower levels of the stress hormone cortisol in their

https://www.americanscientist.org/print/4648 Page 6 of 15
How Art Can Heal 7/5/20, 3)31 PM

saliva; they also reported improved mood and self-efficacy and lower

perceived stress than those who made art alone. These gains appeared

across a variety of media, including collage, colored pencils, markers,

modeling clay, and even new media, such as virtual reality.

Art therapy can influence a range of human functioning, we find, including

self-perception and interpersonal interactions. Even a 45-minute creative

activity can change a person’s mental state. Among healthy adults, some

solitary activities, such as coloring, can help reduce stress and negative

feelings. Working with an art therapist does even more: It can significantly

enhance positive mood and boost measures of well-being, such as self-

confidence and self-perception of creative abilities.

Healing the Body and Mind

After our initial studies with healthy adults, we wanted to examine whether

cancer patients and caregivers experiencing chronic stress would benefit

from art therapy. In 2017, with funding from the National Endowment for the

Arts’ Research Labs program, we set up an art therapy study within the

radiation oncology unit at a large urban hospital. We offered 22 patients and

34 caregivers individual, 45-minute sessions of coloring or free art making

with an art therapist. Meanwhile, we monitored the patients with several

surveys of psychological functioning before and after the sessions.

https://www.americanscientist.org/print/4648 Page 7 of 15
How Art Can Heal 7/5/20, 3)31 PM

Afterward, participants reported feeling more positive, less stressed, less

anxious, and more self-confident. Several patients described these sessions

as one of the few moments of respite from their hectic treatment schedule,

and they appreciated the time and space to reflect on their experiences.

We also surveyed the caregivers, who reported feeling less burnout. Many

responded that the experience distracted them from their daily concerns

and allowed them to focus elsewhere. In addition, the art therapy session

was the first time that some participants had a chance to process the

psychological and existential challenges of dealing with cancer. I watched

people open up and begin conversations with strangers after a facilitated

drawing activity, in ways they might not have if they were only talking alone.

Almost all participants took their creations home, and many have told me

that they have kept their artwork in their home or office. They often can’t

believe that they made it.

https://www.americanscientist.org/print/4648 Page 8 of 15
How Art Can Heal 7/5/20, 3)31 PM

Trauma can affect the brain’s speech centers, making traditional talk therapies more difficult. Research conducted by the
author and her colleagues is showing how art therapy can help individuals connect, find ways to express themselves, and
heal. A service member created a mask (left) to represent two sides of himself. A cancer patient undergoing radiation
treatment used mixed media to show her tumor breaking up (right).
© 2020 BMJ Publishing Group Ltd. (left); © 2020 SAGE Publications (right)

Earlier this year, in the Journal of the American Medical Association, Maria

Steenkamp of New York University Grossman School of Medicine and her

colleagues reported that popular verbal psychotherapies, such as cognitive

behavioral therapy and cognitive processing therapy, might not be adequate

for military service members with post-traumatic stress disorder. For clients

who struggle to understand and verbally share their psychosocial

experiences, art therapy provides a nonverbal option. In a project to aid

military service members, art therapists Melissa Walker at the Walter Reed

National Military Medical Center, Jacqueline Jones, now at Eglin Air Force

https://www.americanscientist.org/print/4648 Page 9 of 15
How Art Can Heal 7/5/20, 3)31 PM

Base, and I have found that art making can help individuals who have

experienced traumatic brain injury address their identity issues. (The project

was supported by Creative Forces, a federally funded initiative of the

National Endowment for the Arts, in partnership with the U.S. Departments

of Defense and Veterans Affairs.) Service members’ experiences creating

paintings, drawings, and sculptures allowed them to spend a long time

working with their hands and to express and communicate thoughts and

feelings that they had previously struggled to share.

In our studies, which combined quantitative and qualitative research

methods, several hundred participants at Walter Reed and Fort Belvoir

Community Hospital in Virginia reported that creative expression changed

their perceptions of themselves, their relationships, and their life situations.

A deep sense of grief and loss underlies trauma, and art therapy provides a

metaphorical way to address the complex inner struggles of service

members. Through art, they can slowly begin to communicate more openly

about previously unsayable, shameful, or even taboo topics. They are better

able to name their emotional experiences, and they use more words to

express themselves.

https://www.americanscientist.org/print/4648 Page 10 of 15
How Art Can Heal 7/5/20, 3)31 PM

Art therapy can also help service members to cope with the isolation and

alienation that many feel after returning from a deployment, and to develop

a sense of belonging and agency. In a retrospective study, we examined

more than 400 pieces of visual artwork in the form of masks created by 370

service members between 2011 and 2015. These masks were created as part

of an intensive military outpatient program at Walter Reed for service

members who had a history of traumatic brain injury and other physical

health conditions, and who had not responded to other treatments. We

compared their artwork with clinical notes maintained by their therapists,

looking for recurring themes and for links between image types and levels of

post-traumatic stress, depression, and anxiety.

Service members who created fragmented imagery, we found, showed

greater risk of mental health challenges, while those who created integrated

images (depicting groups or cohesive visual metaphors) were more likely to

show signs of improved psychological health. The correlation between the

ability to express challenges visually and later well-being suggests that the

act of naming and identifying ongoing challenges can help set the service

member on a pathway to adaptive functioning.

Art Therapy in Virtual Reality

https://www.americanscientist.org/print/4648 Page 11 of 15
How Art Can Heal 7/5/20, 3)31 PM

Today’s digital media technologies are expanding the options for art

therapists to connect with clients, including the use of telehealth. Unlike

traditional media, digital art media interfaces allow for a range of expression

that includes sculpting and drawing in two and three dimensions.

Participants can easily edit or change shapes and content, creating imagery

that does not or cannot exist in real life. These technologies can present

challenges because they only engage our visual and aural senses, and lack

the tactile aspects of traditional art creation. But they provide a way of

sustaining therapeutic connection by facilitating creative expression and

communication through a digital interface, especially for clients who may be

unwilling or unable to work with physical art materials.

To take the two-dimensional digital experience into three-dimensions and

bring it closer to our lived experience of the world around us, my colleagues

and I have been exploring the potential of virtual reality, both to expand our

notions of what is possible and to encourage movement and immersion in

digital artistic expression. In studies conducted in collaboration with Johns

Hopkins University’s International Arts + Mind Lab and Drexel biomedical

engineering professor Hasan Ayaz, we measured brain activity with

functional near- infrared spectroscopy (fNIRS) in adults while they

participated in virtual reality art therapy experiences. The data from brain

https://www.americanscientist.org/print/4648 Page 12 of 15
How Art Can Heal 7/5/20, 3)31 PM

scans and the participants’ self-reported responses indicate that novel media

such as virtual reality can promote creative expression and physical activity,

while also breaking down fears among many participants that they are not

good at creating art. People don’t seem to associate the same stigmas and

fears with creating in virtual reality as in traditional art media. This, in turn,

helps participants engage in self-expression that they might not otherwise

have had the confidence to explore.

Virtual reality provides an alternate universe where participants can move

through objects, create structures that defy gravity, and step in and out of

their creations. After creating in such a space, people often feel energized

with a sense of creative possibility that they had not previously imagined.

Though intangible, these digital experiences can help people appreciate the

physical world in new ways, and technology such as 3D printing could soon

help us make some digital creative experiences more tactile. As a result,

virtual reality art therapy could be useful for patients with debilitating

injuries and those who feel psychologically stuck in their life patterns.

Over the past half century, art therapy has expanded from a tool to address

the unmet needs of individuals facing adversity and trauma to much wider

use in hospitals, schools, and community organizations to promote health

and well-being through artistic self-expression. In the future, the definition of

https://www.americanscientist.org/print/4648 Page 13 of 15
How Art Can Heal 7/5/20, 3)31 PM

therapy is poised to expand beyond talk therapy alone, and art therapy will

be recognized as a cost-effective and sustainable psychosocial treatment

option.

Telehealth will also help art therapists reach previously unreachable

audiences in remote locations. As we connect with communities worldwide,

where distinct traditional or indigenous practices remain intact, we will need

to be mindful of and respect existing cultural practices. But we also hope to

learn how traditional practices already integrate creativity to support mental

health and well-being. Such insights could offer a deeper understanding

about how art making can heal and lead to new tools to help others.

BIBLIOGRAPHY

Jones, J. P., M. S. Walker, J. M. Drass, and G. Kaimal. 2017. Art therapy

interventions for active duty military service members with post-traumatic
stress disorder and traumatic brain injury. The International Journal of Art
Therapy 23:70–85.

Kaimal, G., K. Ray, and J. M. Muniz. 2016. Reduction of cortisol levels and
participants’ responses following art making. Art Therapy: Journal of the
American Art Therapy Association 33:74–80.

Kaimal, G., et al. 2017. fNIRS assessment of reward perception based on visual
self- expression: Coloring, doodling, and free drawing. The Arts in
Psychotherapy 55:85–92.

Kaimal, G., M. S. Walker, J. Herres, L. M. French, and T. J. Degraba. 2018.

https://www.americanscientist.org/print/4648 Page 14 of 15
How Art Can Heal 7/5/20, 3)31 PM

Observational study of associations between visual imagery and measures of

depression, anxiety and stress among active duty military service members
with post-traumatic stress and traumatic brain injury. BMJ Open 8:e021448.

Kaimal, G. 2019. Adaptive response theory (ART): A clinical research

framework for art therapy. Art Therapy: Journal of the American Art Therapy
Association 36:215–219.

https://www.americanscientist.org/print/4648 Page 15 of 15

View publication stats