I have an MA in English, so I’m used to having to defend the arts. People say that a degree in the arts won’t earn you money or success: Getting a Master’s in English is useless, because what career will it lead to outside of academia? I’ve been asked time and time again: “What good are the arts?” But culture – and art – are put on a pedestal at the same time as they're considered career garbage. Historically, it’s been thought that the arts connect us to what it means to be human and actually make us better people. It’s not surprising then, that arts-based therapies are part of the counseling field as a healing agent.
Expressive arts therapies have a long history in the United States, especially when you consider their connection to the humanities (loosely defined here as art/literature/the performing arts). Expressive arts therapies, which include art therapy, dance therapy, music therapy, bibliotherapy, and play therapy, are defined by their use of the arts in a counseling setting. Creating art is considered a source of healing that can connect a person to their emotions and inner self. Recent research on the brain has supported the assertion that arts-based therapies enable powerful changes in the brain to occur, often through the creation of art as a process vs. art as a product.
Art and science are often considered opposites, so it’s interesting that science is providing evidence for expressive arts therapies healing the mind. But I’m getting ahead of myself. A good starting point is defining what exactly the expressive arts are – and what is their history? Furthermore, how does the evidence pan out – in other words, how do these arts-based therapies create changes in the brain? Keep reading to find out.
Dance/movement therapy (DMT) emerged in the 1940s after founder Marian Chase noticed its benefit on students and later, on psychiatric patients. Dance therapy is defined as a combination of dance and therapy techniques; movement is the treatment of choice. The way that dance therapy works is through a mind-body connection. Dance therapy clients develop a mind-body connection by learning to identify their emotions, link them to specific regions of the body, and express them through movement. This expression can be a coping strategy that empowers people to reach their goals as they recognize that they can try something new and succeed (Anderson et al. 2014).
The way that dance therapy works in the brain is through stabilizing the sympathetic nervous system. The sympathetic nervous system controls the body’s ‘fight-flight-freeze-faint’ reaction after a threatening experience. This reaction is an evolutionary survival mechanism that is NOT well-adapted to modern life. 21st-century stressors are rarely life-threatening, leading the ‘fight-flight-freeze-faint’ reaction to misfire and cause stress and anxiety (Brach 2004). Dance therapy potentially stabilizes the sympathetic nervous system through increasing serotonin and decreasing dopamine. In one study, this led to a reduction in depressive symptoms and symptoms of psychosis while eliciting relaxation effects (Jeong et al. 2005). Another study also found that dance therapy has relaxing effects via alpha EEG activity. Alpha EEG activity increased in five psychotic patients after dance therapy, which is consistent with the bursts of alpha EEG activity that creative people experience when solving a problem (Margariti et al. 2012). This creative activity led patients to feel calmer and more centered.
The profession of music therapy began after WWI and WWII when musicians visited veteran’s hospitals to give concerts to veterans facing physical and emotional trauma. When patients improved, nurses and doctors began to request that musicians be hired in hospitals – and a curriculum was gradually developed for music therapists. Music therapy is defined as the use of musical interventions such as playing music, listening to music, singing, or moving to music; it is tailored to the individual needs of the client.
The way that music therapy works involves increased motivation and improved expressive range. Many clients with psychological disorders (e.g., depression) experience low motivation. This often prevents them from attending therapy and is a barrier to treatment. Improving expressive range, meanwhile, is important because affective flattening (lack of emotional expressiveness) is another common symptom of psychological disorders and a possible side effect of psychiatric medications. Gold et al. (2005) indicate that affective flattening can make it hard to feel and show emotion, to have relationships with others, and to feel interest or motivation.
Music therapy is associated with positive changes in the brain. Palaniappan et al. (2013) explain how music therapy increases neuroplasticity – or the ability of the brain to create new neural connections. Psychological disorders such as anxiety and depression can damage the brain in a type of “negative plasticity,” and increased plasticity can compensate for this. Music therapy has also been shown to create changes in the temporal regions of the brain that process sound by increasing alpha and theta frequencies (Fachner, Gold, & Erkkilä, 2012). This was found to decrease anxiety and depression symptoms for patients – hypothetically, because musical improvisation and reflection can actually reorganize neurons in the fronto-temporal brain.
Bibliotherapy was officially founded as a mental health treatment in 1941 in Dorland’s Illustrated Medical Dictionary. It is defined as an approach to therapy that uses literature – in the form of poetry, books, or nonfiction – to support mental health. Bibliotherapy creates changes in the mind through self-discovery, insight, and empathy. The therapist chooses a book/poem that the patient can relate to – with characters that they empathize with. As the client experiences the character’s emotions and experiences vicariously, they (ideally) gain insight into their own experiences. Through the character, the client can learn how to behave more adaptively in their own life.
The concept of Theory of Mind (ToM) explains how bibliotherapy can lead to increased empathy. ToM is the ability to understand the mental states – emotions, beliefs, intentions, etc. – of other people. Literature increases the ability of the brain to understand intentionality, which is part of ToM. Reading can increase our empathy through our ability to relate to the intentions (and the actions) of characters through ToM. Bibliotherapy also improves functioning in areas of the brain associated with memory, reasoning, and syntactic rules – which has implications for mental health. For example, Volpe et al. (2013) conducted a reading group of 41 patients with psychosis and found that self-care, social relationships, attention, memory, and mood improved!
Art therapy began in the middle of the 20th century and was highly influenced by Carl Jung and Sigmund Freud. Art therapy today still has its roots in psychoanalytic theory but has branched out to include influences from behaviorism, person-centered therapy, and cognitive therapy. It is defined as using the visual arts and the creative process to improve psychological health and motor functioning.
Art therapy is an emotional outlet that lets clients confront their problems by breaking through their defense mechanisms – leading to catharsis (releasing hidden/repressed emotions). Defense mechanisms are ways of coping that distance a person from perceived threats. Creating art is an emotional outlet that reduces inhibitions and weakens defense mechanisms, allowing clients to express negative feelings they might not otherwise be comfortable sharing. This is especially helpful for clients with trauma: researchers such as Lyshak-Stelzer, Singer, St. John, & Chemtob (2007) and Chapman et al. (2001) have seen greater decreases in PTSD symptoms after art therapy than other types of therapy.
Trauma is associated with neuroendocrine responses that decrease the prefrontal cortex’s ability to control the limbic system (the emotion center of the brain). The brain becomes unable to distinguish between threating and non-threatening stimuli. Art therapy allows the brain to integrate sensory-motor, visual, and verbal aspects of traumatic memories (Lusebrink & Hinz 2016). Through this integration, art therapy balances the neuroendocrine responses that drive symptoms of post-traumatic stress disorder.
Although play has been thought to have benefits since Ancient Greece, play therapy as a field came into being in the early- to mid-20th century with the work of psychodynamic theorists such as Anna Freud, Hermine Hug-Hellmuth, and Melanie Klein. Play therapy is also informed by the person-centered theories of Carl Rogers and Virginia Axline. Play therapy is defined as a type of therapy where a therapist uses play, toys, and games to help their client explore, express, and safely experience the difficulties they are working through. Using play, the therapist uncovers insights otherwise unable to be heard or recognized through typical conversation. The goal of play therapy is to help children behave more adaptively and learn new ways to work through problems.
The lower brain helps us process emotion, so if lower brain functions are overactivated through stress, higher brain functions like thinking are tougher. Play therapists can help recalibrate the brain with interventions that use different types of play. In the playroom, kids feel safe and in control – allowing the lower brain to become less activated. This lets higher functions such as thinking take control again, which leads to easier processing of stressful situations.
Play therapy can even change the way that the brain is structured, rewiring the child’s developing brain and promoting healing. When a child experiences trauma or pain, their body learns responses to trauma. If a different outcome occurs after a trauma response is reactivated, there is a ‘reconsolidation window’ of time where brain circuits are open to change. Through play, the play therapist helps the child change the way their brain processes previous trauma experiences in a safe, emotionally-regulating environment.
So, to get back to the question in my intro - what good ARE the arts? The evidence shows that expressive arts therapies create positive changes in the brain. What is common among expressive arts therapies is their holistic nature: these theories focus on unifying the whole person instead of treating a person as symptoms of a problem. Every genre of expressive arts therapy involves an aspect of self-revelation that helps people achieve their more. Research on expressive arts and the brain explains the "how" of expressive arts therapies, showing how science and art can and necessarily should be linked as two sides of the same coin.
Research on the brain is all fine and good, but I want to acknowledge the importance of experience over theory. I first wrote this paper for my Master’s degree and had never actually seen the expressive arts in practice. This is something I’ve had the chance to be a part of at Playmore and Prosper, and it’s inspiring to see the arts put towards the goal of healing and witness the changes that they can enact – even in myself as I make art for P&P’s social media!
Anderson et al. (2014). “Dance/Movement Therapy Impacts Mood States of Adolescents in a Psychiatric Hospital.”
Brach, H.S. (2004). “Freeze, Flight, Fight, Faint: Adaptationist Perspectives on the Acute Stress Response Spectrum.”
Chapman et al. (2001). “The Effectiveness of Art Therapy Interventions in Reducing Post-Traumatic Stress Disorder (PTSD) Symptoms in Pediatric Trauma Patients.”
Ecker, B., Ticic, R., & Hulley, L. (2012). “Unlocking the Emotional Brain: Eliminating Symptoms at Their Roots Using Memory Reconsolidation.”
Fachner, Jörg, Christian Gold, and Jaakko Erkkilä. "Music Therapy Modulates Fronto-Temporal Activity in Rest-EEG in Depressed Clients."
Gold et al. (2005). “Resource-oriented Music Therapy for Psychiatric Patients with Low Therapy Motivation: Protocol for a Randomised Controlled Trial.”
Hong, R. & Mason, M. (2016). Becoming a Neurobiologically-Informed Play Therapist (Norton Series on Interpersonal Neurobiology).
Jeong et al. (2005). “Dance Movement Therapy Improves Emotional Responses and Modulates Neurohormones in Adolescents with Mild Depression.”
Kestly, T. A. (2014). “The Interpersonal Neurobiology of Play: Brain-Building Interventions for Emotional Well-Being.”
Lusebrink & Hinz (2016). “The Expressive Therapies as a Framework in the Treatment of Trauma.”
Lyshak-Stelzer, F, Singer, P., St. John, P., and Chemtob, C. (2012). “Art Therapy for Adolescents with Posttraumatic Stress Disorder Symptoms: A Pilot Study.”
Palaniappan et al. (2013). “Neurophysiological and Behavioral Responses to Music Therapy in Vegetative and Minimally Conscious States.”
Volpe et al. (2013). “Reading Group Rehabilitation for Patients with Psychosis: A Randomized Controlled Study.”