February 2021 • DALLAS MEDICAL JOURNAL 17
narrative of loss to gaining a new identity
as a creative person. Jones has used art
therapy both for mental and physical improvements,
such as with stroke patients
who are seeking to restore body movement
and small motor control.
At her Dallas Art Therapy offices, Andrea
Davis treats individuals of all ages and
strives to make art therapy accessible and
affordable. Her ability to work successfully
with children and teens has grown through
word of mouth, especially for clients and
their families who are grappling with
issues of gender identity and transformation.
In her group and individual sessions,
Davis also works with children and their
family’s post-adoption. Davis says that our
memories are made of images and that art
therapy, which is grounded in the creation
of visual imagery, is an especially effective
methodology for addressing trauma and
bypassing trauma response.
Pioneers in art therapy theorized its success
through various hypotheses, some of
which have presaged the findings of modern
science. Adrian Hill, a British artist,
coined the term “art therapy” in 1942. Suffering
from tuberculosis, he spent time
in a sanatorium, where he witnessed the
palliative effects of painting and drawing
on fellow patients who, for the most part,
did not consider themselves artists.
In the mid-1940s, as effective
treatments for tuberculosis were
discovered and implemented, sanatoriums
began to close, and art therapy migrated
into mental hospitals. Leading this work
was Edward Adamson, a colleague of Hills
who was also an artist. Adamson worked
at two long-stay asylums in Britain as
art director at a time when lobotomies
and primitive electric shock were still
administered. He believed that art
therapy’s healing powers were the result of
being able to express the true self freely
and without judgement. In fact, although
Adamson is considered the British “father
of art therapy,” he was a purist. Adamson
believed that psychologists should be
kept out of the studio and that if involved,
they would only meddle with the work, its
process and meaning, thereby negating its
value.
Contemporaneously, Edith Kramer laid
the groundwork for art therapy in the U.S.
Kramer promoted art as therapy rather
than as an adjunct to therapy. She believed
that the healing powers of art were
due to its ability to access the subconscious
and unlock meaning for the client.
The role of the art therapist, then, was
to act as a “third hand,” facilitating the
client’s vision but not intervening in it. A
highly influential educator as well as artist,
Kramer helped develop one of the country’s
earliest art therapy graduate degree
programs at New York University.
It is in the last decade that art therapy
has made its greatest strides. Much of
this growth is due to the invention and
application of new technologies as well
as to art therapists who have conducted
biology-based research, often with neuroscientists.
These empiric studies have elevated
the field of art therapy, validated its
effects, and pointed to new research areas
that will continue to improve practices.
Giriji Kaimal EdD, MA, is an oft-cited
researcher on the biology that underlies
art therapy. She is also the incoming chair
of the American Art Therapists Association,
an art therapist, and an assistant professor
in Drexel’s College of Nursing and
Health Professions.
In a study using fNIRS (functional
near-infrared spectroscopy), Kaimal and
colleagues tracked the reward pathways
that are activated when subjects draw or
doodle. They measured blood flow in the
brain of 50 volunteers when they were
at rest with eyes closed and when they
colored a mandala, doodled on a page
that already had a circle printed on it, or
engaged in drawing freely. Kaimal found
that all three drawing activities increased
blood flow to the medial prefrontal cortex,
an area of the brain that is responsible for
higher cognitive function such as decisionmaking
and problem solving but that also
influences emotional responses, with the
strong implication that making art can
regulate mood and evoke pleasure while
also exercising the brain.
Several of the recent studies in art
therapy have looked at its ability to lower
stress by measuring levels of cortisol, a
stress hormone that, while being useful
in protecting against a threat, can have
detrimental effects on brain function and
health when chronically elevated. One
quasi-experimental pilot study (Kaimal,
Ray, & Muniz, 2016) used this measure
on healthy individuals working with an art
therapist. They noted that cortisol levels
were lowered in 75% of the participants.
Participants were also surveyed about how
they experienced art therapy to establish
any correlations with lowered cortisol.
The two predominant experiential themes
tied to the lowered cortisol group were 1)
learning about self and 2) feeling satisfied
about their artwork after an initial struggle
with it. Researchers noted that cortisol levels
were lowered for most participants but
not all, indicating a need to further explore
stress reduction mechanisms.
Even the types of media that art
therapists use are being investigated.
Using an electrocardiogram to measure
HRV (heart rate variability) along with
self-reports, researchers (Haiblum-
Itskovitch, Czamanski-Cohen, & Galili,
2018) asked 50 subjects to use three
different art media: pencil, gouache (a
thicker version of watercolor), and oil
pastel, on the same type of paper to freely
express themselves. Their hypothesis
was that more fluid materials would lead
to a greater parasympathetic response,
a response that tamps down stress and
promoting relaxation, which would make
gouache the favored art material. The
conclusion was that pencil use did not
provide a positive response. Gouache and
oil pastel were similarly useful as tools in
the art therapist’s arsenal; researchers
noted some of the possible variables to
investigate in the future.
These and numerous other studies
are filling in the puzzle pieces of how art
therapy contributes to health by measuring
changes in client biology. In so doing, they
are informing the field with best practices
and leading to better recognition of art
therapy’s role in health and wellness.
It remains for health practitioners and
institutions to fully integrate the use of art
therapy.
One way for physicians to better understand
art therapy is to become acquainted
with it on a firsthand basis. Susan Anand,
MA, ATR-BC, ATCS, LPAT, LMFT, is on the
faculty in the Department of Psychiatry
at the University of Mississippi Medical
Center. There, she supervises psychiatry
residents in addition to teaching and
providing clinical therapy. All psychiatry
residents (and other medical students as
well) participate in Anand’s art therapy
program, often acting as co-leads. This
integrative approach has provided benefits
for individual students and furthered their
understanding of art therapy methods and
benefits.
While this article addresses art therapy
alone, it is important to recognize that it
belongs to the family of creative therapies,
which also includes dance/movement
therapy, drama therapy, music therapy, and
most recently, therapies using virtual reality.
These fields are continuing to grow and
evolve, providing health benefits that truly
are state of the art. DMJ
Pioneers in art therapy
theorized its success
through various
hypotheses, some of
which have presaged
the findings of modern
science.
Digital image courtesy of the Getty’s Open Content Program