How Art Stimulates the Brain

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

How Art Stimulates the Brain 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, Alzheimers, 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).

How Art Stimulates the Brain 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 Alzheimers 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 Alzheimers,

How Art Stimulates the Brain 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 Parkinsons 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 Alzheimers 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

How Art Stimulates the Brain 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 Parkinsons disease and Alzheimers 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

How Art Stimulates the Brain 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

How Art Stimulates the Brain 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

How Art Stimulates the Brain 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 brains 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 Alzheimers or Dementia Caregivers have observed for decades that Alzheimers 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

How Art Stimulates the Brain seemingly lost memories and even help restore some cognitive function in Alzheimers and dementia patient (Beck, 2009). By engaging very basic mechanisms of emotions and listening, music is stimulating dormant areas of the brain that havent been accessible due to degenerative disease such as Alzheimers 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 Alzheimers 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 Alzheimers 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 Alzheimers 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 Alzheimers disease. Art Therapy & Stroke Rehabilitation To experience the trauma of stroke is to experience a sudden change in ones 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

How Art Stimulates the Brain 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

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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, everchanging 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, Alzheimers and dementia.

How Art Stimulates the Brain The ability of an art therapist to creatively imagine into anothers state of being is at the

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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. Todays 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.

How Art Stimulates the Brain References Beck, M. (2009). A key for unlocking memories: Music therapy opens a path to the past for Alzheimers patients. The Wall Street Journal: Health Journal, November 16, 2009.

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Church, E. B. (2008). Learning through the arts. Early Childhood Today. Retrieved online March 24, 2011 from CINAHL Plus with Full Text Database. Kapitan, L. (2010). The empathetic imagination of art therapy: Good for the brain? Journal of the American Art Therapy Association, 27(4): 158-159. Lusebrink, V. (2004). Art therapy and the brain: An attempt to understand the underlying processes of art expression in therapy. Journal of the American Art Therapy Association,21(3): 125-135. Madden, J., Mowry, P., Cullen, P., & Foreman, N. (2010). Creative arts therapy improves quality of life for pediatric brain tumor patients receiving outpatient chemotherapy. Journal of Pediatric Oncology Nursing, 27(3): 133-145. Michaels, D. (2011). A space for linking: Art therapy and stroke rehabilitation. International Journal of Art Therapy, 15(2): 65-74. Retrieved online March 30, 2011 from http://dx.doi.org/10.1080. Moisse, K. (2011). Music therapy helps Gabrielle Giffords find her voice after Tucson shooting: Melody, rhythm can rewire a damaged brain. ABC News, March 8, 2011. Nanda, U. (2011). Art for healths sake: An evidence-based approach. Asian Hospital & Healthcare Management, 6(2): 1-19. Retrieved online March 24, 2011 from http://www.asianhhm.com/facilities.

How Art Stimulates the Brain National Institute of Neurological Disorders and Stroke (2011). Reducing the burden of neurological disease. National Institutes of Health. Retrieved March 25, 2011 online from http://www.ninds.nih.gov/disorders/disorder_index.htm. Perry, B. (2008). The healing arts: The neuro-developmental impact of art therapies. Paper presented at the 39th Annual Conference of the American Art Therapy Association, Cleveland, OH. Rollins, J. (2007). Arts for the Aging Appreciative Inquiry session report. Washington, DC: Rollins & Associates. Rollins, J., Sonke, J., Cohen, R., Boles, A. & Li, J. (2009). State of the field report: Arts in healthcare. Society for the Arts in Healthcare. Retrieved online March 24, 2011 from http://www.thesah.org/ . Ryan-Wenger, N., & Walsh, M. (1994). Childrens perspectives on coping with asthma. Pediatric Nursing, 20(3), 224228. Retrieved online March 24, 2011 from CINAHL Plus with Full Text Database. Tomaino, C. (2009). Cognition: How music can reach the silenced brain. Retrieved March 27, 2011 online at http://www.pbs.org. Verghese, J., Lipton, R., Katz, M., Hall, C., Derby, C., & Kuslansky, G. (2003). Leisure activities and the risk of dementia in the elderly. New England Journal of Medicine, 348: 2508-2516.

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How Art Stimulates the Brain Westbrook, B., & McKibben, H. (1989). Dance/movement therapy with groups of outpatient with Parkinsons disease. American Journal of Dance Therapy, 11(1): 27-38. Whitman, B. & Rose, W. (2004). Using art to express a personal philosophy of nursing. Nurse Educator, 28(4): 166-169.

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