The healing canvas

[Guest guest]

The healing canvas

Art can soothe the mind and body, therapists say. Now science backs

them up.

http://www.latimes.com/features/health/la-he-

art20mar20,1,5728142.story

By Hontz, Special to The Times

March 20, 2006

Six women sat at a table covered with colored pencils and pastels,

each of them focused on drawing a house with rooms representing their

emotions and desires.

St. Jon, 63, made an abstract sketch of an African jungle home,

with a circle of blank space in the center of the page. It reminded

her of a vacation house in which she'd watched wild animals creep

dangerously close. The white space, she surmised, was a window onto

her uncertain future. " Wherever it's going to take you, it's going to

take you, " she said, " regardless of what you do. "

The assignment was part of an art therapy support group at UCLA's Ted

Mann Family Resource Center. On this, St. Jon's third bout with

cancer — the disease has spread from her breast to her brain and

lungs — she's struggling to decide whether to pursue chemotherapy or

give up the battle. " I've already come to terms with death, " she

said. " I won't panic, and I won't be pushed. "

Art therapy harnesses the creative process to explore such difficult

issues. It's been used to treat mental and physical health problems

for more than 50 years and is offered in schools, hospitals, prisons,

hurricane shelters and private practice. But only now are scientific

studies beginning to show its effectiveness.

In art therapy, patients express their feelings not just through

discussion, but through drawing, painting and sculpting. That's why

this type of therapy is thought to be especially helpful for people

who have difficulty articulating feelings — including children and

those suffering from Alzheimer's disease, strokes and post-traumatic

stress disorder. However, much of the research has centered on cancer

patients. In a pilot study funded by the National Institutes of

Health, cancer patients who received eight weeks of group treatment

sessions of mindfulness-based art therapy (a combination of

meditation and art therapy) reported a significant decrease in

distress, anxiety and depression. They also reported significantly

improved quality of life and vitality.

The study of 111 women, published last fall in the Journal of Psycho-

Oncology, did not determine whether the art therapy or meditation

component was most beneficial, but " one informs the other, " said

study author Monti, director of the Center of Integrative

Medicine at Jefferson University in Philadelphia. " The two

sort of work together. "

A Northwestern Memorial Hospital study of 50 men and women published

in January in the Journal of Pain and Symptom Management found that

an hour of art therapy significantly reduced a broad spectrum of

cancer-related symptoms such as pain, anxiety, exhaustion,

depression, loss of appetite and shortness of breath. Patients rated

symptom severity on a scale of 0 to 10 before and after treatment;

only nausea was unaffected.

" A lot of people look at art therapy with suspicion. Is it just a

diversion, doodling or baby-sitting? " said American Art Therapy Assn.

director Malchiodi. " With research, doctors are seeing how much

progress patients are making, and they realize it's not just

entertainment. "

That's not to say that art therapy is for everyone. Although

therapists emphasize that patients don't need any artistic talent to

reap benefits, some people feel uncomfortable expressing themselves

through art. In the Northwestern study, 63 patients who were

approached declined to participate. Some were too sick, but at least

one person had tried art therapy before and simply didn't like it.

Others prefer tackling problems on an intellectual level, sometimes

finding the emotions stirred up by art therapy difficult to tolerate.

" It's not really my cup of tea, " said UCLA cancer support group

member Caren Desacoff, 54, whose drawing of a house triggered

memories of her unhappy childhood. She left the group early after

starting to have a seizure. " I shouldn't have been there. I really

did feel kind of overwhelmed. I was going into a really dark place. "

Most members of the UCLA group, however, described art therapy as

relaxing, energizing and cathartic. " It was the most important

nonmedical thing I did, " said breast cancer survivor Kerry Smallwood,

49, who attended for more than a year. " It was very powerful how the

artwork accessed deeper emotions, things that were unconscious,

things that you didn't necessarily think to talk about. "

Monti, who conducted the NIH-funded study, is currently overseeing

another five-year study comparing mindfulness-based art therapy with

talk-based support groups for 339 breast cancer patients. It is the

largest comprehensive study on art therapy to date. Already, pilot

data suggests that the art therapy is more effective in reducing

stress and depression.

The reason, Monti posits, is that meditation and art making, when

combined with discussions about the meaning of the art and the

feelings evoked, engages more of the brain than merely talking. " It

provides a means of conceptualizing and expressing the illness

experience and ways to cope, " he said.

Monti also plans to perform brain imaging research on a subgroup of

cancer patients in the study to determine precisely how art therapy

might affect the circuitry of the brain.

Brain matters

Psychiatrists already have strong theories about how art therapy

works, especially as it relates to trauma treatment. Allan Schore,

associate clinical professor of psychiatry and biobehavioral sciences

at UCLA's School of Medicine, says that traumatic and stressful

memories are stored in the right hemisphere of the brain, which

processes emotions, visual and nonconscious information.

The left brain controls logical thinking and verbal skills. But for

therapy to be effective, " it has to get into the right brain, " Schore

said. Creating art is a fast way to access the right brain and the

emotions stored there.

" Saying I'm scared and angry is one thing. Taking a crayon and

scribbling on a piece of paper is a visceral way of not just saying

it, but experiencing it, " said Jan Oxenberg, a TV writer who tried

art therapy after she was involved in a shooting during a civilian

ride-along with the LAPD.

While making art activates the right brain, talking about it and

constructing a coherent story about the traumatic experience

activates the left hemisphere as well. Integrating the two leads to

healing. " What is expanded is the interconnectivity of the brain, "

Schore said.

Interest in art therapy for trauma has skyrocketed in recent years

because of world events such as the Sept. 11 attacks, the Asian

tsunami, Hurricane Katrina and the Iraq war. According to Malchiodi

at the American Art Therapy Assn., membership has grown from 4,000 to

4,500 since Sept. 11, and many art therapy programs are having to

turn away applicants.

San Francisco art therapist Chapman, creator of a model for

treating pediatric trauma patients, conducted a 2001 UC San Francisco

study of 85 hospitalized children and adolescents suffering from

trauma after violence, abuse, accidents and chronic illnesses.

Results were published in the Journal of the American Art Therapy

Assn.

Chapman found that art therapy significantly reduced some of the

acute symptoms of post-traumatic stress disorder one week and one

month after discharge from the hospital.

However, it did not reduce the symptoms of PTSD compared with control

groups at a six-month follow-up. Chapman said it was impossible to

control whether participants had suffered additional traumatic

experiences and that more research is needed.

In fact, a large study of art therapy for veterans with PTSD is in

the planning stages. Stanford art therapy researcher Kate Collie and

a committee of the American Art Therapy Assn. are designing the

study, which may include recent Iraq War veterans, one of eight of

whom exhibit signs of PTSD, according to an Army survey. The long-

term goal is a clinical trial.

A small 1997 study of in-patient Vietnam veterans with PTSD published

in the Journal of Traumatic Stress compared the effectiveness of a

single session of 15 different treatment methods administered to 25

veterans over 16 weeks. Art therapy was the only treatment method

that reduced PTSD symptoms in the most severe patients. Researchers

theorized that it not only provided a distraction, but it helped vets

deal with traumatic memories at their own pace.

Pacing is also crucial for young trauma victims, who can get

overwhelmed recounting frightening experiences. By choosing specific

art materials, therapists can help children experience their emotions

in small, manageable doses. Chapman often starts with No. 2 pencils

and tiny pieces of paper. The familiar tools and their manageable

size give kids a sense of mastery and control — over the art and over

their feelings, she said.

In fact, when young trauma victims are given a choice of No. 2

pencils, colored pencils and markers, they often pick plain pencils.

That's because color evokes emotion, Chapman said.

Used correctly, however, color can be a powerful tool. When Chapman

worked with kids in pain, she would ask them to paint the color of

pain onto a drawing of the part of the body that hurt. Most kids

would choose red or black. Next she would have them pick a color to

take away their pain, usually blue or white. Chapman found the simple

act of painting over the problem area would soothe them.

Revelations and renewal

Art therapy can be an especially useful diagnostic tool with kids and

others who have a hard time talking about feelings.

Art therapist Esther Dreifuss-Kattan, who leads the art therapy group

at UCLA's Ted Mann center, also works with the university's Pediatric

Pain Program. She recalls one teenager whose drug addiction was

revealed in a single session.

Although he said he " had pain all over, " doctors could find no cause.

But then he created a collage of a monkey with a skeleton on its lap.

He told Dreifuss-Kattan, " When you take drugs you feel like a

skeleton. "

" Millions of things come up with one picture that would take three

months when you just talk, " she said. " You go to a level of depth so

fast. "

Art therapist Delaine Due, who works in a youth correctional facility

in Oregon, has found that combining art therapy with journaling helps

inmates reveal incidents and feelings they might normally find too

uncomfortable to share with others.

One boy in her group recently created a drawing with the

word " Failure " in red on a black piece of paper. In his journal, he

wrote about falling short of his mother's expectations. " If you just

ask questions, you would not get that type of information, " she

said. " But with 15 minutes to sit with it and get the whole brain and

body involved, it's a better intervention. "

Involvement of the body is a main difference between art and

traditional psychotherapy. Physical activity — particularly the act

of creation — can combat depression, said Noah Hass-Cohen, director

of Graduate Institute, one of two art therapy schools in the

Los Angeles area. " When we're depressed, we tend to be able to do

less, " she said. Making art is a safe way for people to jump-start

their brains and bodies after a period of lethargy and inaction.

Toni Morley and Angel Duncan, codirectors of the Memories in the

Making Program at the Alzheimer's Assn. of Northern California and

Northern Nevada, have documented positive effects of fine arts on men

and women with dementia.

Patients had a limited ability to verbalize their feelings, so

observers recorded signs of emotion and compared the effect of

attending two separate activity groups. Those in a watercolor

painting group displayed more positive emotions and little sadness,

anger and agitation compared with a group that discussed current

events.

One African American man from Louisiana, who was depressed when he

joined the art group, painted his childhood farm home entirely in

black. Within a month, he was painting in color and saying how much

he looked forward to it.

The art also helped some patients recall long-forgotten memories. One

generally nonverbal woman with Alzheimer's painted a pale pink

flower. When Morley asked if she'd seen the flower before, she put

her hands on her hips and said, " Well, my dear, for my 30th

anniversary, I booked a trip to the Hawaiian Islands. The flower

grows everywhere on the Hawaiian Islands. "

If not for the painting, such memories probably " would not have come

back, " Morley said.

A growing support group

The benefits of making art extend to people who aren't suffering from

emotional or physical problems, and a therapist is not necessarily

required either. Older adults, for example, have been shown to

improve their general health, mental health and social functioning

through community-based art programs.

In a 2001 study of 300 people ages 65 and older, Gene Cohen, director

of the Center on Aging, Health and Humanities at Washington

University in Washington, D.C., found that art gave study

participants a sense of accomplishment, boosted the immune system and

decreased loneliness.

Those who participated in art groups also had fewer doctor visits and

used less medication than those in control groups.

" Art is like chocolate to the brain, " Cohen said. " It taps into both

sides. It has benefited the soul of the species since the time of

cavemen or before. "

Of course, that raises a fundamental question about art therapy: How

much of the benefit derives from the art and how much from therapy?

" There's always a dynamic tension between the two, " said a Howie,

president of the American Art Therapy Assn. Some programs emphasize

one more than the other, and no one knows for certain which methods

work best.

At UCLA's art therapy cancer support group, the time is split evenly

between making art and discussing emotional issues. After St. Jon

disclosed that she might not seek treatment, art therapist Dreifuss-

Kattan urged her to reconsider.

She also offered a less fatalistic interpretation of the tunnel-like

center of her sketch. " For me, the space here gives an opening, a

possibility for a way through the jungle, " she said. " It's a

protected, quiet, contained area, but not enough to stay here because

the lion might creep up. "

Group member Desacoff chimed in to add support. " I see a bridge, " she

said. " I see hope. I think there's brightness in your future. "

Creative therapy resources

• For more information about art therapy, contact the American Art

Therapy Assn. at (888) 290-0878 or http://www.arttherapy.org .

• To find a licensed art therapist near you, go to

http://www.arttherapistlocator.org .