Art Therapy for PTSD: Healing Through Creative Expression

Introduction to PTSD and Art Therapy

Art has always played a major role in human life and development. Some of our knowledge of our earliest ancestors comes from the drawings and sculptures they left behind. Art is an essential part of what it means to be human, and can be utilized for a variety of purposes including communication, expression, and even therapy. Art therapy is known to have beneficial results for individuals suffering from a variety of cognitive disorders, including Post-Traumatic Stress Disorder (PTSD). PTSD is an anxiety disorder that plagues patients after one or more traumatic events, instilling painful memories that later manifest as a wide variety of behavioral and physical symptoms depending on the individual.

Young children exposed to trauma and war veterans who have witnessed the horrors of battle are particularly vulnerable to developing PTSD. Recent research has utilized art therapy as a methodology to help alleviate the stress associated with PTSD and remove some of the emotional pain experienced by sufferers through catharsis. Through the various assessment models available to art therapy practice, PTSD can be diagnosed and treated through non-verbal expression, which proves less complicated than traditional therapies that rely on interviews. Art therapy can prove successful in relieving the symptoms of PTSD, especially in those most vulnerable to its development.

One disorder in particular that has been known to benefit from art therapy for a wide variety of reasons is Post-Traumatic Stress Disorder (PTSD). This proves to be an anxiety disorder which occurs after the individual patient has had to deal with a traumatic event of some sort (Riley, 2004). As a traumatic experience unfolds, human nature responds with a primitive form of survival: fight or flight. When a person becomes overwhelmed in a traumatic experience, that individual's verbal consciousness fails, and the mind enters a nonverbal state. This creates a dangerous situation which can result in PTSD. The resulting stress can then manifest itself in a variety of ways and symptoms, which can affect the sufferer for short or long periods of time, depending on the nature of the trauma.

PTSD Symptoms, Types, and Vulnerable Populations

In many cases, individuals have higher risk factors for developing PTSD if they have previously been exposed to traumatic experiences, a difficult familial environment, alcohol or drug abuse, or a lack of social support during recovery from their traumatic experience (Riley, 2004). Most cases of PTSD involve symptoms that manifest across three different categories. The first deals with the individual re-living the traumatic experience through dreams, nightmares, waking flashbacks, heightened anxiety, and even hallucinations in the most extreme cases. These symptoms can create real disturbances in the otherwise normal life of an adult or child.

The second category is known as avoidance symptoms. These manifest as avoidance of strong emotional contact out of fear that anxieties will surface, avoiding people and locations that trigger reminders of the traumatic event, loss of memory, and an overall feeling of numbness and detachment from the external world (Riley, 2004). Through these symptoms, the patient becomes increasingly and intentionally cut off from the external world that initially fostered the trauma. The final category, most noticeable to outside observers, is known as arousal symptoms, which mainly involve changes in behavior and daily routines. These symptoms include insomnia, extreme anger and irritability, lack of concentration, and nervousness (Riley, 2004). Alongside the psychological ramifications of PTSD, some patients are also burdened with physical symptoms such as digestive problems, chest pain, headaches, and dizziness.

In many cases, symptoms differ from individual to individual based on the severity of the triggering event and how long those symptoms persist. Acute PTSD occurs directly after the event and lasts for a short duration, typically from one to three months, followed by relief for various reasons (Riley, 2004). Chronic symptoms last much longer—over three months after the occurrence of the traumatic event—while delayed-onset symptoms can appear months after the event. Children and veterans deal mainly with chronic and delayed-onset PTSD due to the extreme nature of their trauma and the complete helplessness they experienced during the event or events that caused it. This anxiety disorder has been plaguing people for generations and is said to have no absolute cure, only a variety of methods used to help individuals cope with the fears and anxieties created by traumatic experiences.

Particular demographics prove far more vulnerable to developing PTSD following physical and mental trauma. War veterans are especially susceptible, giving rise to colloquial terms such as "shell shock" or "battle fatigue" (Riley, 2004). Cases linked to war can be traced back almost as long as war has been examined as a factor in psychological health. More recently, the Vietnam War produced thousands of soldiers returning home with symptoms of PTSD, and many more turned to heavy drug use as a way to cope with the horrors of combat. Today, as conflicts in Iraq and Afghanistan have continued, more and more soldiers have returned home with stress related to PTSD. One 2004 study (Hoge et al.) conducted early in the war found an astonishing 12–20% of soldiers and Marines returning from Iraq to have symptoms of PTSD—a substantial proportion, particularly for individuals returning to a society that often expects its veterans to manage the psychological ramifications of modern warfare. Around 6–11% of soldiers returning from Afghanistan also exhibited signs of PTSD related to their combat experiences (Hoge et al., 2004). These veterans were dealing with the stress of witnessing death, killing in combat, and losing people close to them—experiences that can quickly give rise to the anxiety-driven disorder of PTSD.

Beyond war, typical experiences leading to PTSD include rape, assault, severe natural disasters, car accidents, and abuse (Riley, 2004). Children have a heightened vulnerability to PTSD in cases of physical or sexual abuse and other traumatic events that an adult mind might more readily process. Because children have very little control over their circumstances during trauma, many are prone to developing PTSD following particularly painful experiences. This is further complicated by their limited command of language, which can make traditional therapy difficult when exploring and relieving emotional stress. Thus, even with treatment, PTSD in many children can go unresolved based on a limited ability to explore trauma through traditional therapeutic practices that rely on language as a core component.

When stress occurs, most children are unprepared to deal with it properly and react severely, which only increases their vulnerability to developing PTSD (Perry, 1999). Children exhibit a wide variety of PTSD-related symptoms including impulsivity, distractibility, dysphoria, numbing, social avoidance, dissociation, insomnia, aggressive play that often re-enacts lived traumatic experiences, poor school performance, and delayed development (Perry, 1999). These unique symptoms make diagnosis and proper treatment difficult, especially as the diagnosis is left unchecked for years after the trauma. The true source of the problem remains buried deep within the child's mind and is masked by symptoms that can resemble other disorders such as Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD). Despite the increased risk and potential damage of PTSD in children, relatively little research has been conducted devoted strictly to managing PTSD in young children.

There are a variety of ways currently used to treat and diagnose PTSD, including art therapy. Typically, cognitive behavioral therapy is used to help PTSD patients manage their stress and anxieties in order to further distance themselves from the traumatic event (Riley, 2004). Unfortunately, many war veterans suffering from PTSD fail to seek proper treatment due to the negative stigma attached to mental health care, resulting in years of unaddressed psychological harm (Hoge et al., 2004). Yet, for those individuals who do seek treatment—whether dealing with PTSD from war or other traumatic events—a wide variety of options are available.

Art Therapy: History, Benefits, and Catharsis

Unfortunately, in today's world, many children are being exposed to traumatic events (Wethington et al., 2008). These events can lead to the development of PTSD symptoms that haunt individuals for an entire lifetime. Children need special attention when dealing with traumas they may not fully understand. Art therapy has been proven to benefit the increasing number of children dealing with PTSD and other trauma-related disorders that create fear and anxiety. One major benefit of art therapy is its informal nature of expression. Unlike language, which is governed by strict grammatical rules, artistic expression has the freedom to convey complexities that lie beyond words (Malchiodi, 2006). In children who do not yet have a full grasp of language, art therapy allows certain emotions to emerge that would otherwise be impossible to express: "Children do not have extensive vocabularies for describing their feelings and experiences, but they are generally comfortable with art as a natural way to communicate" (Malchiodi, 2006, p. 13). Art therapy thus provides a necessary alternative that allows children dealing with PTSD to cope with their stress and engage in treatment rather than simply discussing it. Art therapy has been proven to benefit many cases of children dealing with acute PTSD, yet more research is needed to fully explore its impact on children suffering from long-term chronic PTSD.

Despite a lack of research in some areas, art therapy has proved a popular alternative for a wide variety of mental and anxiety disorders. Throughout history, art has been harnessed by individuals to convey religious and emotional meaning, and generations have witnessed art serve as both a communicator and a source of personal relief. Since the 1930s, art therapy has been used in a variety of settings to help relieve mental stress. Many cases have seen art empower the artist in pure emotional expression: "Art therapy has grown from this concept that art images can help us to understand who we are, to express feelings and ideas that words cannot, and to enhance life through self-expression" (Malchiodi, 2006, p. 2). The art involved in such therapeutic methods is vast and incorporates a variety of media, including painting, drawing, sculpture, and other forms of artistic expression used within therapy models aimed at reducing stress and diagnosing depression and PTSD.

These visual therapeutic methods have been known to noticeably lift the moods of patients suffering from PTSD (National Standard, 2008). There is also physical evidence showing that serotonin levels increase during the creative process: "the actual process of art making can also alleviate emotional stress and anxiety by creating a physiological response of relaxation or by altering mood" (Malchiodi, 2006, p. 13). This elevation can help remove a patient from their anxious fears and worries, at least for a period of time while art is being created.

This form of therapy can be a significant release of negative and harmful emotions. Understood as catharsis within the context of psychology, art therapy can cleanse or purge negative emotions from an individual's mind through the medium of art: "Catharsis literally means cleansing or purging; in therapy it refers to the expression and discharge of strong emotions for relief. Making a drawing, painting, sculpture, or other art form can be cathartic in that it may provide relief from painful or troubling feelings" (Malchiodi, 2006, p. 13). Art therapy has proven very effective in cases where patients are otherwise unable to express emotions verbally: "art therapy enables the expression of inner thoughts or feelings when verbalization is difficult or not possible" (National Standard, 2008). It provides a release of emotional stress without the complications of elaborate verbal explanations and the anxieties that accompany them.

Art therapy empowers an otherwise powerless individual, allowing him or her to visually express what has haunted them, thus giving the patient a sense of self-control when such feelings were potentially lost due to PTSD. Like other cognitive-behavioral therapies, it can be adapted to suit a multitude of different environments (Wethington et al., 2008). Each individual patient can have art therapy activities tailored to his or her needs and the specific demands of their disorder. The creation process involved in art therapy also has a significant impact on the minds of those suffering from PTSD and other disorders, as "the creation of a tangible reward can build confidence and nurture feelings of self-worth. Personal fulfillment comes from both the creative and the analytical components of this process" (Krapp & Cengage, 2002). Art therapy has been used as a type of intervention in order to curb various disorders from doing more harm to the minds of both children and adults.

References

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Chapman, Linda M.; Morabito, Diane; Ladakakos, Chris; Schreier, Herbert; & Knudson, M. Margaret. (2001). The effectiveness of art therapy interventions in reducing post-traumatic stress disorder (PTSD) symptoms in pediatric patients. Art Therapy: Journal of the American Art Therapy Association, 18(2), 100–104.

Freeman, Chris. (2006). Psychological and drug therapies for post-traumatic stress disorder. Psychiatry, 5(7), 231–237.

Hoge, C. W.; Castro, C. A.; Messer, S. C.; McGurk, D.; Cotting, D. I.; & Koffman, R. L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351.

Krapp, Kristine & Cengage, Gale. (2002). Art therapy. Encyclopedia of Nursing & Allied Health.

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Perry, Bruce D. (1999). Stress, trauma, and post-traumatic stress disorders in children. Child Trauma Academy: Interdisciplinary Education Series, 2(5).

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Wallace, J.; Yorgin, P. D.; Carolan, R.; Moore, H.; Sanchez, J.; Belson, A.; Yorgin, L.; Major, C.; Granucci, L.; Alexander, S.; & Arrington, D. (2004). The use of art therapy to detect depression and post-traumatic stress disorder in pediatric and young adult renal transplant recipients. Pediatric Transplant, 8(1), 52–59.

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