How art therapy can be viewed as a mind/body practice providing a means of regulation via newly experienced cognitive and sensory processing aiding the chance for neural plasticity.
By Colleen Steiner Westling
Art Therapist, London Art Therapy Centre
“A human being functions as a whole organism, and at any given time, many brain processes and areas are active and involved. The interaction of 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, 1990)The quote above opens a window onto the functional workings for how, through art therapy, the brain and body communicate in relation to the processing of emotional experience. While art therapy has a long established history, this new chance for understanding its key neurological factors comes most recently due to the scientific advent of neuro-imaging tools such as fPET and fMRI scansPrior to introducing art therapy’s effect on the brain, I will first give a general overview for ways to consider a person from a neurological perspective including; how the body effects the brain in a ‘bottom-up’ way via afferent information and how the brain responds to sensory information from the body in ‘top-down’ efferent communicationThe brain and body communicate via the multiple branches of the nervous system. There are two kinds of cells in the nervous system: Neurons and Glial cells. Neurons receive information, integrate it, and pass it along acting as the communicators of the nervous system. Neurons communicate with other neurons and with cells in the sensory organs, muscles and glands. Glial cells support the neurons by providing structure, insulation, nourishment and waste removal. The structure of a neuron consists of a central cell body called a soma, containing a nucleus and mitochondria (as all cells in the body). The outer perimeter of a neuron branches out into fibres called dendrites. Dendrites further stretch out into axons that send and receive information from other neurons, muscle cells and gland cells. Bundles of axons from many neurons form into nerves. Nerve transmission occurs electrically with speed of transmission influenced by whether the nerve is myelinated not.
Myelin sheath is a fatty coating produced by glial cells, protecting the nerves and allowing nerve impulses fast movement down the axon. Myelin sheath damage can cause impairment in nerve transmission (as in MS). Neurotransmission occurs in the brain when a chemical neurotransmitter crosses from one neuron to another neighbouring one, crossing the space between neurons called a synapse. Neurotransmitters are chemicals released by axons via terminal buttons at their ends. Neurotransmitters produced by endocrine glands and are used by the endocrine system to transmit messages through fluid based systems in the body. The Central Nervous System consists of the brain and spinal cord. From there, many nerves of The Peripheral Nervous System branch off to extremities of the body, including the viscera and beyond. The peripheral nerves carry information (via neuron electrical signals) from sensory bodies back to the CNS for assessment and further direction, such as movement. The automatic processes of the body such as; circulation, respiration, digestion, etc. are the work of the The Autonomic Nervous System which consists of two branches; the Sympathetic Nervous System (excitatory) and the Parasympathetic Nervous System (calming). The Sympathetic Nervous System works to activate the body’s systems into an excitatory response by releasing the neurotransmitter norepinephrine which causes the heart to speed up. To counteract this sympathetic response and to avoid a system “burn out”, the Parasympathetic Nervous System acts slow things down. The main nerve of the Parasympathetic Nervous System, is the Vagus, thus named for its latin translation which is “to wander”. The 2 branches of the Vagus nerve, the 10th cranial nerve, travel continuously down the body, through the neck, thorax, lungs, abdomen, and through mid body providing parasympathetic inhibitory effects on blood pressure, respiratory rates and heart rate variability by releasing Gamma-Amino Butyric Acid (GABA) into the system.These two systems of the Autonomic Nervous System work together, in a complimentarily way, to maintain balance in the body (homeostasis).
The Somatosensory system is governed by sensory bodies that pick up stimulus and respond by feeding back information to the brain about the body’s external environment such as; touch (via contact with skin) and the position and movement of the body picked up through stimulation of muscles and joints. The sense of the brain knowing where the body is in space is called proprioception. The somatosensory systems also monitor processes such as body temperature, tactile stimuli and the environment, by providing information about the nature of the stimuli (painful, sticky, cold, hot etc). The Peripheral Nervous System is responsible for movement of the body and sensory feedback. In the brain, the processing of somatosensory information mainly occurs in the primary somatosensory area in the parietal lobe of the cerebral cortex.
How does the brain feel the world?
Signals from the sensory cells get processed through corresponding brain circuitry and can either consciously or unconsciously shape emotions, memories, mood and beliefs. Ultimately a sense of the world is created by the brain based on sensory experience. Often the senses are referred to as having 5 different types; sight, hearing, taste, smell and touch, however other senses such as proprioception, visceral sensations, body temperature and pain are also experienced. In the brain, the senses pass through a structure located at the top of the brain stem called the thalamus which acts as a relay station where signals are then furthered on to designated areas of the cortex for processing. For example, the visual cortex of the occipital lobe receives information for sight while the auditory cortex in the temporal lobe receives information about hearing. Interestingly, smell is a sense that does not take the time to be processed through the thalamus but goes directly to the phylogenically older olfactory bulb. For this reason, smell is one of the most intensely connected senses to memory and emotions.
At birth, the brain has activity in all the sensory processing structures however they continue to develop and mature throughout childhood and adolescence. As a way of describing how sensory information if prioritised in the human brain, neurosurgeon Wilder Penfield devised The Cortical Homunculus as a map of the somatosensory areas of the brain. The cortical homunculus shows how the brain relates to the body from the inside based on which parts of the cerebral cortex control specific voluntary body functions and feeling. Interestingly, the brain does not prioritise the arms and legs but rather the hands, the tongue, the genitals, and the facial features factor extremely important, providing great sensory information. As a result, these take up a lot of brain space. However, this mapping of the body in the brain is possible to change in response to injury (such as stroke) when sensory information may not be received due to damaged travel along different anatomical pathways. Further specified areas include; the sensory homunculus, cortical homunculus, and motor homunculus for different ways to understand the anatomical divisions of the primary motor cortex and the primary somatosensory cortex of the brain directly responsible for movement and senses and motor information of the body. Sense receptor neurons fire faster with increased intensity and occurrence. Neurons that fire together, wire together and with repeated sensory experience, deeper neural pathways become established. So while sensations may be fleeting, they may engage neural networks beyond the primary sensory cortices. Perception is the process by which the brain makes sense of sensory data, combining memory, emotions, and cognition into the experience. Perception involves “top-down” as well as “bottom-up” processing. Higher cortical areas not only respond to senses, but process the information by piecing together what is relevant toward meaning making. Specialised higher structures continue on further processing to form words to explain the sensation. Emotions coming from the Limbic
region, also amplify sensory processing.
How is the brain ordered for activity?
According to neuroscientist Paul D. MacLean’s Triune Brain Theory, the human brain can be viewed from an evolutionary perspective to consist of three hierarchical levels. With this theory, the first level is the Brain stem region, termed the Reptilian Brain as this survival response area is what humans share with reptiles. Next and central to the human brain is the Limbic area, or the Mammalian Brain, as it is often called due to some mammals sharing this regions emotional neural processing. Finally at the top and over the first two levels is the Neocortex, the Thinking Brain, which resembles the grey squiggly object often illustrated as “The Brain”. This evolutionary way of the referring to brain regions provides a generalised view for the processing of stimulus noting that the emotional limbic area is stuck in between
lower survival networks and higher, rational thought regions. A general overview for the structures of these levels and their functions include; The oldest and lowest region, the Hindbrain connects the upper areas of the brain to the spinal cord. It includes the Medulla which controls many autonomic functions such as heart rate, breathing and blood
pressure. Connecting to the Medulla is the Pons which helps coordinate movement for both sides of body, next is the Reticular Formation which is actually a network within the Medulla controlling functions like sleep and attention. The Brainstem consists of the midbrain area combined with structures of the Hindbrain; the Medulla and the Pons.
The midbrain, though the smallest region, acts as a relay station for auditory and visual information by controlling many important functions such as the visual and auditory systems as well as eye movement. Interestingly this is an area where a large number of dopamine-producing neurons are located. Dopamine is a neurotransmitter/neruomodulator of the CNS associated with feelings of pleasure and salience, and is essential for motor functions, motivation, learning and memory.
Degeneration of this area is associated with Parkinson’s disease.
The Limbic area is comprised of the Amygdala which is first in line to the emotions, the Hippocampus which is essential to the formation of new memories about past experiences, the Thalamus which takes in sensory info and relays it out to specific structures, the Hypothalamus which is a group of nuclei at the base of the brain near the pituitary gland. Due to its location the Hypothalamus connects to many brain regions and controls; hunger, thirst, emotions, body temperature, and circadian rhythms. The hypothalamus has a control over many body functions of the body via its control of the pituitary gland. The Pituitary Gland as part of the Endocrine system secretes chemicals (hormones) produced to transmit messages throughout fluid based systems in the body. The Basal Ganglia, as a group of nuclei, integrates with the Thalamus to aid in the control of movement. As a whole system, the entire Limbic brain is where emotions are “felt”.The Thalamus sits on top of the brainstem to processes and transmit sensory information on to the cerebral cortex. The Cerebral Cortex also sends information down to the thalamus, which then sends this information to other appropriate systems.
The Cerebellum lies at the lower back of the brain, top of the pons, behind the brain stem. This large structure is referred to as the “little brain” as takes up 10% of total brain size and contains 50% of neurons in entire brain. It receives information from the balance system via the inner ear, sensory nerves, and the auditory and visual systems. The Cerebellum coordinates motor movements, helps with posture, balance, and coordination of voluntary movements, allowing muscle groups in the body to act together for controlled, fluid movement. The cerebellum is also important in cognitive functions including language and basic aspects of memory and learning.
The higher regions of the brain, include the Neocortex as part of the Cerebral Cortex. Here areas are thicker in comparison to lower regions providing for higher functions such as sensory perception, generation of motor commands, spatial reasoning, conscious thought, and language. The neocortex has deep grooves (sulci) and wrinkles (gyri) which increase the area of the neocortex considerably. In humans it accounts for about 76% of the brain’s volume. The Neocortex is considered to be grey matter surrounding the deeper white matter of the Cerebrum.
The Cerebrum is the most highly developed part of the human brain responsible for; thinking, perceiving, producing and understanding language. Most information processing occurs in the Cerebral Cortex. The Cerebral Cortex is divided into 4 lobes that each have a specific function.
The Frontal lobe is associated with; reasoning, motor skills, higher level cognition, and expressive language. At the back of the frontal lobe, near the central sulcus, lies the motor cortex. This area of the brain receives information from various lobes of the brain and utilises this information to carry out body movements. Damage to the frontal lobe can lead to changes in sexual habits, socialisation, and attention as well as increased risk-taking.
The Parietal lobe at mid section is associated with; processing tactile sensory information such as pressure, touch, and pain. A portion of the brain known as the somatosensory cortex is located in this lobe and is essential to the processing of the body’s senses. Damage to the parietal lobe can result in problems with verbal memory, an impaired ability to control eye gaze and problems with language.
The Temporal lobe at the bottom section of brain associates with; the primary auditory cortex, which is important for interpreting sounds and the language we hear. The Hippocampus is located in the temporal lobe making this portion of the brain associated with the formation of memories. Damage to the temporal lobe can lead to problems with memory, speech perception, and language skills.
The Occipital lobe, located at back of the brain associated with; interpreting visual stimuli and information. The Primary Visual Cortex receives and interprets information from the retinas of the eyes, is located in the Occipital Lobe. Damage to this lobe can cause visual problems such as difficulty recognizing objects, an inability to identify colours, and trouble recognizing words.
Sitting over the top of the brain, the Cerebral Cortex is thin layer of tissue on the outer portion of the grey squiggly area of the cerebrum and also covers the Cerebellum. Its grey colour is due to its lacking the insulation that makes most other parts of the brain white. Left and right hemispheres of the brain also differ in functionality and processing with the left hemisphere associated with analytical and sequential processes. The right hemisphere is predominantly involved with creativity and imagination, feeling and visualisation. However more recent studies late have indicated this brain divide may be more myth that science. “What research has yet to refute is the fact that the brain is remarkably malleable, even into late adulthood. It has an amazing ability to reorganize itself by forming new connections between brain cells, allowing usto continually learn new things and modify our behavior. Let’s not underestimate our potential by allowing a simplistic myth to obscure the complexity of how our brains really work. the two hemispheres.” (A. Novotney)
The role of the amygdala in both attachment and the fear response? “Emotions involve patterns of autonomic activity and hormonal and cortical responses. The integration of these different inputs takes place in the amygdala. The connections of the amygdala to the neocortex are direct as well as indirect through the thalamus” (Fuster, 2003). The amygdalae are part of the oldest, survival region of the brain, yet close to limbic region structure of the hippocampus toward the front of the temporal lobe. The amygdala acts as the first order of feeling primary emotions in a person and also sensing them in other people. The amygdala reacts to information coming from down from higher regions in the form of thoughts but also registers changes in sensations coming up from the body (ie. thinking about past experiences or sensing things in the environment).
Amygdala function is essential to survival and is activated by sensory experience that drives us toward this end including; food, sex, rivalry, rescuing others, etc. It is due to its “guard dog” role that it is connected to many other structures of the brain. Facial recognition in other people is strongly associated higher areas of the cortex, but the amygdala is earlier in the complex process of distinguishing faces from other objects and identifies emotional expressions in others.
The Fear Response occurs when the amygdala is triggered (by a thought or sensation) to let the whole system know instantaneously it is under threat by first creating a rapid (startle) response alert the higher structure of the brain (to wake up!). Then depending on the health and robustness of the neurological condition as a whole, either one of two paths will be taken, a long route or a short route of response. The order by which the long route occurs is as follows; first sensory information taken in and is assessed in the “relay station” that is the thalamus which sends the message onto the appropriate sensory area of the brain (i.e., auditory cortex, visual cortex, etc) where the information is evaluated and given meaning (sounds like?, looks like?, etc). If this information is deemed threatening, the amygdala is further informed to take appropriate response
(emotional response). However the short route occurs when the sensory information goes directly to amygdala (without thalamus or cortex presorting) causing a much quicker alarm bells response (physical response with strong emotion attached).
How stress can lead to neurological overload leading to excessive cortisol in the body with ingrained catastrophic or negative thinking “rumination”.
Chronic stress and or overwhelming fear (trauma) can set off the fight or flight emergency response of brain/body organism as a whole. In this case, The HPA axis (hypothalamus-pituitaryadrenal)
are activated whereby the hypothalamus releases the hormone CRH (corticotrophin releasing hormone) which signals the pituitary gland to secrete ACTH (adrenocorticotrophic
hormone) which goes on to stimulate the adrenal cortex (part of the adrenal gland) to flood the body with the hormone cortisol (and other hormones), generating the “fight or flight” reaction. A prolonged or overloaded HPA axis activation could also tip over to a “freeze” response whereby the parasympathetic NS steps in to save the whole system by causing the dorsal vagal complex to shut down all sympathetic response causing the ‘mouse playing dead’ freeze response. The HPA axis phylogenetically goes back to our pre ancestral makeup and is a leftover response from when we needed quick reaction to an imminent threat like fighting an enemy or running away from a tiger
To counteract the stress response, the body works to keep the systems in balance (homeostasis) by reducing the amount of CRH released by the hypothalamus which in turn lowers the levels of ACTH and cortisol. Activation of the HPA axis often leaves a person exhausted yet with the potential of being stuck in an infinite loop of stress and emotional burnout leading to neurological imbalances and possible cortical structure damage. Studies have shown prolonged exposure to HPA activation can cause shrinkage of the hippocampus leading to memory problems along with reduced PFC activity dulling learning and thinking capacity. Studies have also shown excess cortisol in the body to be catabolic leading to break down of healthy cells, lessened immunity and increased inflammation. Imbalances of HPA axis have been linked to many possible factors from
genetics to developmental history, recent and past psychological stressors, nutritional health and environmental exposure to toxicity, as well as general physical heath and the ageing process.
How are memory and emotional states seen to be neurologically processed?
As we understand, emotions are often connected to memories. Memory involves formation and activation of many different areas of the brain “based on three hierarchical levels of perceptual knowledge based on sensory input stored in the posterior cortex. Most of the perceptual memory is implicit or non declarative” (Fuster, 2003). Generally speaking, Memory is often divided into three categories; Sensory memory, Short term memory and Long term memory. Sensory memories have been touched on earlier in the section on the homunculus where by sensory information taken in is stored for future reference (I don’t like the taste of_, I do like the look of _, etc). Short term memory is considered our “executive memory” where information is kept either for a short time or transferred over into Long-Term memory. Long-term memories are further categorised as; Explicit
(declarative, requires conscious thought), Implicit (rote memory, not requiring conscious thought) and Autobiographical (parts of life remembered most). A recent additional type of memory,
Morpheus memory, is thought to occur during sleep when the brain attempts to consolidate information taken in from recent experiences. “Executive memory takes place in the frontal cortex. The prefrontal cortex performs the integrative functions of working memory, attention, and inhibition. Motor memories of concrete and stereo typical sequences of actions are stored in the basal ganglia. Long term or declarative memories involve two brain areas; the right hippocampus and the right prefrontal cortex. The integration of sensory information and formation of declarative memories take place in the hippocampus, which is active in the formation of long term memories but does not store them.” (Lusenbrink, 2004)
How art therapy may help mitigate the stress of painful memories?
Due to the recent advances in neurological research, the field of art therapy is in a position to benefit. According to research “The basic level of interventions with art media is through sensory stimulation. Visual feature recognition and spatial placement are processed by the ventral and dorsal branches of the visual information processing system. Mood-state drawings echo the differences in the activation of different brain areas in emotional states. The cognitive and symbolic aspects of memories can be explored through the activation of their sensory components”. (Lusebrink, 1990, 1991).
In their report, Paint attachment and meaning making; Report on an art therapy relational neuroscience assessment protocol, N. Hass-Cohen and J. Clyde Findlay write “The Convergent interpersonal neuroscience of pain experiences. Processing pain involves three convergent experiences. The first is the sensory procession of pain, the second is emotional -cognitive bottom up processing of pain and the third is cognitive-affectve top-down modulation of pain. Sensory pain sensation are transmitted to the spinal cord dorsal horn and from there to the brain by afferent, ie., incoming nerves (Malzek & Wall, 2004).
Simply revisiting and talking about painful memories and feelings may not be helpful in mitigating their effect on one’s life. Verbally going over painful thoughts, known as rumination, can be experienced in the body as if it is happening again in real time. As pain is carried through the body via the spinal-thalamic route so pain is felt in the body but also in the mind. This occurs due to this information setting off the system of “feeling” the pain informed by limbic structures responsible for creating emotions and higher cortical structures informing that pain is part of the self identity making “bottom up processing of pain both emotional and cognitive”. (N. Hass-Cohen and J. Clyde Findlay).
As the amygdala is “associated with emotional experiences of pain, including fear and the stress response, attachment experiences have also been associated with the functions of these same structures” (Insel, 1997; Panksepp, 1998, 2005) This indicates that even the fear of pain has the possibility of creating the flight or fight response “enacting cardiovascular, respiratory, gastrointestinal , renal, and endocrine changes.” (N. Hass-Cohen and J. Clyde Findlay).
Both a fight and flight response would involve taking some action and so the neurological response excites the sympathetic nervous system to prepare the body for either. Interestingly however, the freeze response is associated with a greater amount of stress detected causing a tipping point whereby the parasympathetic nervous system takes over to create inaction in order to save the whole system. This is caused the activation of the “dorsal vagal complex, one of the four cranial nerves that originate in the brain stem activated by the parasympathetic nervous system” (Porges, 2001).
When thinking of an art therapy client’s history of emotional and/or physical pain and the potential for it triggering a fear/stress response, it may be useful to consider that “there could be apprehension as to whether the person can represent her story well enough in the art.” (N. Hass Cohen and J. Clyde Findlay). In contrast, Greenberg & Pascual Leone (2006) offer “experiencing positive emotions such as pleasurable art making, also lead to pain reduction as long as a minimal threshold of arousal is maintained during their processing”.
Additionally, it is considered that “creating emotion-centered images aims to promote brain activity in the limbic system and simultaneously engage the hippocampus, thus encouraging enhanced cognitive performance is concrete, can be evaluated, and clear goals can be established. Cognitive performance pre and post treatment can be measured, for instance. Art directives can be systematically oriented towards positive, emotion-centered image-making, and discussions can be focused on reminiscence. Art Therapy descriptions phrased around neuroscience themes may become more concrete, goal-oriented, and outcome-based.” (http://neuroarttherapy.blogspot.co.uk/)
When creating art pieces, the “mind-brain connection” may be activated. For some people, the materials and method they choose may cause the art making to become similar to meditation, aiding in relaxation and providing a sense of balance and stability. Others choose materials, colors, and processes that are stimulating and may help give them the passion they might not normally feel, passion that is necessary in combating sadness. http://neuroarttherapy.blogspot.co.uk/
In considering that “art therapy applications may utilize higher brain structures to inhibit and extinguish conditioned fear and anxiety responses created in lower brain regions” (Richard Carr), the grand potential for neural plasticity arises.
The Senses and Neuroplasticity
Until recently, it was believed that the human brain was “fixed” by adulthood. In other words, that its 100+ billion neural cells, could not generate new ones. Today however, neurogenesis has been scientifically proven to be possible with certain areas of the brain capable of generating fresh cells. Additionally, it has been shown that the brain has an ability to create new neural pathways, away from older established ones. The new studies, generated through brain scanning technology, have shown new neural cells are generated throughout life as well as new neural pathways. These changes however are not always quick or easy but occur over time through concerted focus on a defect area. “Sensory training makes a difference in more subtle ways . . . Visual skills can be similarly sharpened. A recent study suggested that artistic training doesn’t alter activity in the visual cortex itself, but refines the ability of higher brain areas to process this information.” (http://www.whatisneuroplasticity.com/)
As previously discussed, the brain’s sensory systems are wired from before birth, and they continually develop through interaction with the environment as a child grows and learns. The senses form necessary neural connections for survival. Interestingly, it has been shown that when certain senses are delayed, the corresponding neural structures and pathways also do not develop fully. However, if such senses are able to be newly experienced due to medical intervention (ie, choclear implant) the sense of hearing, neural pathway and neural structures involving processing hearing may be established later. Most impressive feat of sensory neuroplasticity is cross-modal compensation whereby the loss of one sense heightens another. A terrific example of this is accounted for in Sharon Begleys book, The Plastic Mind, where accounts of impairments of certain sensory systems allow their cortical structures to be used in the processing of other senses (ie, the auditory processing structures highjacked by the visual systems for more visual acuity in some people deaf from birth. Also, “reportedly, some blind individuals even learn to use “echolocation” to navigate their way around objects by listening to reflected sounds, using repurposed brain areas that ordinarily process sight.” (Carl Sherman)
In summary, but by no means conclusion, I would like to end this paper/presentation with some personal reflections. It is with great hope that this information, while truncated into words and time not copious enough to further expand explanation, has been encouraging and exciting. While not all arts therapists may feel cheerful about evidence based demands be them real or imagined, the new neuroscience coming forth can be used to show what benefit is possibly already happening in an art therapy intervention. There is so much to be curious about and so much evidence is open and available to drawn from. Not covered in this paper included; the therapists stance which is a significant part of a Metallisation based practice. Additionally, therapist voice tonality and attunement have been shown to effect the therapeutic relationship at a neurological level. Much is still to
be discovered and written about. I hope this short presentation on neuroscience and art therapy with inspire others to allow this information to be useful to them. After all, in any 1:1 therapeutic session, there are least 2 different sets of nervous system networks at play in the room, and I haven’t even mentioned the consideration of mirror neurons . . . . .
Please feel free to contact me with comments, questions for more research, or anything else to say about this presentation.