How Art Stimulates the Brain

How Art Stimulates the Brain 1

Running head: HOW ART STIMULATES THE BRAIN

How Art Stimulates the Brain

Kimberly Harper

Texas Tech University Health Sciences Center

School of Nursing

N5372 Fine Arts in Healthcare

Lynda Billings, M.F.A., PhD

April 13, 2011


Review of Arts in Healthcare

Throughout recorded history, we have seen evidence that pictures, stories, dances, music,

and drama have been central to healing rituals. Today there is a renewed focus on humanistic

care that is leading the resurgence in the knowledge and practice of incorporating the arts into

healthcare services (Rollins, Sonke, Cohen, Boles & Li, 2009). In fact, there is an increasing

numbers of clinicians and other professionals from the medical community that are working side

by side with the arts professionals in both healthcare and community settings, and around the

world the arts are emerging as an important and integral component of healthcare and the healing

process. According to several recent surveys, nearly fifty percent of the healthcare institutions in

the United States reported having arts in healthcare programming (Rollins, Cohen, Boles & Li,

2009). The research demonstrates the benefits of the arts in healthcare in hospitals, as well as

nursing homes, senior centers, hospices, and several other locations within the community. Arts

in healthcare programs and creative art therapies have been successfully utilized in many

different healthcare situations, such as; depression, Alzheimer’s, dementia, neurological

disorders and brain injuries. These art therapies focus on improving the patients’ overall health

outcomes, their treatment compliance, and their quality of life. There is also a rich and growing

body of research connecting arts in the healthcare programs to improved quality of care for

patients, their families, and even medical staff (Rollins, Cohen, Boles & Li, 2009). The

incorporation of the arts into the healthcare setting has proven to be beneficial to the patients by

aiding in their physical, mental, and emotional recovery, including relieving anxiety and

alleviating pain. In a hospital, patients, visitors and staff are often under constant pressure and in

a state of stress and anxiety. The arts can serve as a therapeutic and healing tool, reducing stress

and loneliness and providing opportunities for self expression in an atmosphere where the patient

often feels out of control (Nanda, 2011).


A large amount of the research literature on the benefits of the arts in healthcare with

patients concerns music, visual arts, dance, literature, creative writing, and storytelling (Rollins,

Cohen, Boles & Li, 2009). For example, music has been found effective in increasing comfort

level, decreasing anxiety, improving depression and coping with stress. Several studies have

dealt with the use of music for coping with stress. Ryan-Wenger and Walsh (1994) reported that

school-aged children with heart disease have identified listening to music as one of the four most

effective and frequently used strategies for coping with their disease. Music therapy has offered

healing to patients of all types, such as, patients with Alzheimer’s who often respond to music

when they respond to nothing else; lowering the heart rates, respiratory rates and myocardial

oxygen demand for patients recovering from myocardial infarction; and even for reducing stress

among visitors in hospital surgery or intensive care unit waiting rooms (Rollins, Cohen, Boles &

Li, 2009).

The visual arts have also been found to be an essential component to the process of healing.

Some of the documented benefits of participating in visual arts or art activities include,

decreasing symptoms of distress and anxiety, improving depression, and strengthening positive

feelings for patients after having a stroke. As with all of the arts, engaging in the visual arts

provide opportunities for individuals to make choices and to be in control at a time when many

things in their lives are beyond their control, an important factor in reducing stress (Rollins,

2007). It has been recognized that drawing abilities and stereovision, imagery, and thinking

three-dimensionally are of great importance in neurosurgery, and in the surgical profession

generally (Madden, Mowry, Gao, Cullen & Foreman, 2010). This is especially important for

patients with brain injuries related to trauma, stroke, and cancer.

Dance therapy has shown improvement in variables related to psychosocial functioning,

self-image, and quality of life. For older adults with neurological disorders such as Alzheimer’s,


and dementia, the participation in dance therapy resulted in stronger patient satisfaction and

improvement in social interaction parameters as well as, psychomotor functioning (Rollins,

Cohen, Boles & Li, 2009). In an older study by Westbrook & McKibben (1989), which used a

crossover design to compare dance therapy with exercise for Parkinson’s patients, it was found

that only dance therapy improved psychosocial functioning. More recently, the findings

regarding the benefits of dance included that dance therapy was the number one leisure activity

that most contributed to the delay in onset of Alzheimer’s disease for those at risk of the disorder

(Verghese, Lipton, Katz, Hall, Derby & Kolinsky, 2003).

Literature, creative writing, and storytelling have similar benefits to music, visual arts and

dance. In a recent study, the quality of life for cancer patients improved after a single 20-minute

writing session while waiting for their clinic appointment and there was a decrease in physician

visits along with fewer symptom complaints (Rollins, Cohen, Boles & Li, 2009). In addition, the

levels of depression in individuals who were guided to read selected fiction, poetry, or literature

were reduced in comparison to individual who did not participate in the guided reading. Finally,

storytelling resulted in a greater level of relative well-being for individuals with mild to moderate

dementia.

Art and the Brain in the Learning Process

The utilization of the arts in healthcare is a diverse, multidisciplinary field that is dedicated

to transforming the healthcare experience by connecting people with the power of the arts at key

moments in their lives. For example, at infancy a child has all the synapses needed to speak any

language, to learn and appreciate music and movement, and to create visual art; but these

synapses must be used in order to be developed (Church, 2008). Participating in art, music,

movement and storytelling activities not only develop language, mathematics, science, and social

skills, but these activities also strengthen the synapses between the brain cells. Research shows


that these synapses grow stronger through active participation in the arts (Church, 2008). The

arts stimulate brain growth but they also stimulate healing. Through neurobiology, we can see

how the brain is affected by trauma and how the arts can actually help the brain development of

patients who are exposed to traumatic experiences at an early age. In fact, research has shown

that specific parts of the brain are stimulated by specific artistic enrichment modalities (Church,

2008). For instance, the base or brain stem responds to touch; the midbrain to music-making and

movement; the limbic region to dance, art, play therapy, and nature discovery; and the cortical

region to art, storytelling, drama, and writing (Church, 2008).

According to the National Institute of Neurological Disorders & Stroke (NINDS),

The brain is the most complex part of the human body. The three-pound organ is

the seat of intelligence, interpreter of the senses, initiator of body movement, and

controller of behavior. Lying in its bony shell and washed by protective fluid, the

brain is the source of all the qualities that define our humanity. The brain is the

crown jewel of the human body (2011).

When the brain is healthy it functions quickly and automatically, but when problems occur the

results can be devastating. Some 50 million people in this country suffer from damage to the

nervous system. Some of the major disorders include; cerebrovascular diseases such as stroke

and vascular dementia; degenerative diseases of adult life such as Parkinson’s disease and

Alzheimer’s disease; and trauma such as spinal cord and head injury (NINDS, 2011). Suffering

from a brain injury can be an incredibly traumatic and worrying experience. However; the arts

emphasize the complexity of human experience and the needs of sick people over and above any

type of surgery or treatment. “The arts help remind medicine of its humanistic origins in healing


as it seeks to provide the most up-to-date scientific care for its patients” (Rollins, Cohen, Boles

& Li, 2009, p. 24).

Art Therapy and the Brain

The application of new techniques in brain imaging has expanded the understanding of the

different functions and structures of the brain involved in information processing (Lusebrink,

2004). For example, visual feature recognition and spatial placement are processed by the

ventral and dorsal branches of the visual information processing system (Lusebrink, 2004).

During art therapy, mood-state drawings echo the difference in the activation of different brain

areas in emotional states. Also, the cognitive and symbolic aspects of memories can be explored

through the activation of their sensory components. The process of expression through art media

and the products created in an art therapy session engage and are perceived predominantly

through the tactile-haptic and visual sensory and perception channels, and than are processed for

their affect, associations, and meaning through cognitive and verbal channels (Lusebrink, 2004).

Hence, the basic level of interventions with art media is through sensory stimulation. Therefore,

artists are in some sense neurologists, studying the brain with techniques that are unique to them,

but studying unknowingly the brain and its organization.

The process of art expression is considered an important part of art therapy and art therapy

research. Several art therapists have pointed out the need for art therapists to become more

familiar with the basic brain structures and functions that support art therapy expressions and

interventions. According to Kapitan (2010), art therapy is a mind-body interaction. A human

being functions as a whole organism, and at any given time, many of the brain processes and

areas are active and involved. For example, the interaction with art media in art therapy can

proceed from the peripheral stimulation of the different sensory modalities or from spontaneous


expression of emotions, or both. An expression through art media can also originate from

complex cognitive activity involving decisions and internal imagery, thus activating the sensory

channels and motor activity (Lusebrink, 2004). We are starting to appreciate the fact that all

mental processes involved in art therapy derive from brain activity.

According to Perry (2008), art therapy is good for the brain because it involves the following

key aspects; art therapy provides experiences that are relevant and appropriately matched to

developmental needs; art is pleasurable for most people and therefore rewarding; and

experiences that provide positive rewards attract and increase healthy brain activity. In addition,

art therapy elicits cultural expression that is respectful toward people, their families, and cultures.

Most of all, the brain responds to art therapy because it is rational. Kapitan (2010), points out

that because we are psychosocial beings who are hardwired for relational learning, the

interpersonal environment of art therapy creates a foundation of security that is necessary for

brain development. As we learn more about the biological and neurological levels of disease, we

must not focus on the disease so much as too forget the suffering person before us who seeks our

imaginative and empathetic response.

Art Therapy and Trauma to the Brain

Arizona congresswoman Gabrielle Giffords was shot in the head at close range January 8,

2011 while hosting a public event outside a Tucson supermarket (Moisse, 2011). The shooting

became the lead story throughout the United States. The shooting rampage claimed six lives,

including a 9-year-old child and U.S. District Judge John Roll. Thirteen more were wounded at

the scene, including Giffords. Five were listed in critical condition and five were in serious

condition. In terms of the location of Giffords’ injury, the surgical team tells Moisse (2011) that

the bullet entered the left hemisphere of the brain, exiting through the front left front part of the


brain and miraculously spared any major blood vessels. Although the right and the left

hemispheres seem to be mirror images of each other, they are different. For instance, the ability

to form words seems to lie primarily in the left hemisphere and music generally in the right

hemisphere (NINDS, 2011). The main functions of the left and right hemispheres are commonly

known by art therapists. In fact, protocols like music stimulation and melodic intonation therapy

can help patients with damage to the brain’s communication center, like Giffords, learn to speak

again. Maegan Morrow, Giffords’ music therapist and a certified brain injury specialist stated,

the brain can heal itself if you do the right protocol. Patients can be essentially

mute, unable to utter a single word but put on the Beatles’ “All You Need is

Love” and suddenly patients can sing. If you substitute some the words the patient

is now speaking again. Music is powerful (Moisse, 2011).

Evidence supporting a healing role for music in the recovery from brain injury is mounting, but

many people are still skeptical, and few insurers will cover it. Maybe Giffords’ progress will

change this skepticism. Her recovery has been astounding; she began singing “Happy Birthday”

within the first two weeks of her recovery and she was chanting prayers with her rabbi a short

time after. Music is an important and extremely useful tool in the way we learn and to deny its

power is a waste of a truly wonderful resource.

Art Therapy for Patients with Alzheimer’s or Dementia

Caregivers have observed for decades that Alzheimer’s patients can still remember and

sing songs long after they have stopped recognizing names and faces. Many hospitals and

nursing homes use music as recreation, since it brings patients pleasure. But beyond the

entertainment value, there is growing evidence that listening to music can also help stimulate


seemingly lost memories and even help restore some cognitive function in Alzheimer’s and

dementia patient (Beck, 2009). By engaging very basic mechanisms of emotions and listening,

music is stimulating dormant areas of the brain that haven’t been accessible due to degenerative

disease such as Alzheimer’s and dementia (Beck, 2009). Dr. Tomaino, who has studied the

therapeutic effects of music for more than 30 years, spearheaded a new program to provide iPods

loaded with customized playlists to help spread the benefits of music therapy to Alzheimer’s

patients even at home (Beck, 2009). In addition, she frequently sees dementia patients make

gains in cognitive function after music therapy. Another music therapist and psychologist, David

Ramsey, held twice weekly music small sessions with Alzheimer’s patients (Beck, 2009). He

sometimes would stop singing and let the patients fill in the blanks on their own. When they fill

in the blanks they are exercising their cognitive brain function just like they exercise their bodies

in physical therapy; the music stimulated the brain (Beck, 2009).

In addition to benefiting Alzheimer’s patients, decades of studies have demonstrated that

music can help autistic children communicate and stroke patients regain their speech and

mobility (Beck, 2009). Today, neuroscientists are starting to identify the underlying brain

mechanisms that explain how music connects with the mind and body, and they are starting to

work hand in hand with music therapists to develop new therapeutic programs for people with

neurological disorders such as Alzheimer’s disease.

Art Therapy & Stroke Rehabilitation

To experience the trauma of stroke is to experience a sudden change in one’s physical and

psychological being that is not anticipated and over which a person has no influence. Many

stroke survivors return to health, however, a considerable number remain moderately or severely

disabled for the rest of their lives (Michaels, 2011). The art therapies in neuro-rehabilitation are


well established here in the United States. Michaels (2011) suggests that the flexibility and

complexity of art-making, together with its ability to connect physical and psychological

resources, make it well suited to address the wide range of deficits that are associated with brain

injury and stroke. For example, as mentioned earlier, some of the documented benefits of

participating in visual arts or other art activities include; decreasing symptoms of distress and

anxiety, improving depression, and strengthening positive feelings for patients after having a

stroke (Michaels, 2011). The symbolic nature of art and its capacity to hold and express the

unspeakable, as well as to offer opportunities for reflection, and to facilitate choice and control in

the face of loss and powerlessness are strong reasons to use art in rehabilitation of a stroke

patient.

Summary

With the advent of new imaging techniques, we know that the brain is a dynamic, ever-

changing system of interconnecting neurons that work it concert to produce our complex,

dynamic responses to the world around us. The discovery that new networks and connections

may be formed in the brain every time we learn a new skill has implications not only for early

childhood development, but also for potential recovery of function after brain injury (Tomaino,

2009). Evaluations, observation and research findings demonstrate that there are both

instrumental and intrinsic benefits to art therapy. Art therapy can be a powerful thing, and when

we understand its significance, it can bring dramatic and positive changes to the well-being of a

patient with an injury to their brain. Evidence-based practice has also shown that literature,

creative writing, storytelling, music, visual arts and dance have significant healing benefits for

the patients suffering from brain trauma, stroke, Alzheimer’s and dementia.


The ability of an art therapist to creatively imagine into another’s state of being is at the

heart of art therapy and the most effective and humane environments where healing takes place

(Kapitan, 2010). We are human because of our brain, our hand, and our heart. “Only the human

being can express inspiration and emotion by combining all three and thus produce the

expression of the human condition in writing, poetry, music, dance, visual art and design; all a

creative expression of heart and soul” (Rollins, Cohen, Boles & Li, 2009, p. 16). Whitman &

Rose (2003) also referred to art as a medium for forming or reforming the human soul, the life

spirit. They believe that art captures, expresses, and recreates humanity and life. Today’s

healthcare providers will someday become the recipient of the care as a patient and thus should

always be treating the patient as they wish themselves to be treated; as a human-being with a

mind as well as a heart.


References

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Alzheimer’s patients. The Wall Street Journal: Health Journal, November 16, 2009.

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24, 2011 from CINAHL Plus with Full Text Database.

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