A recent article entitled, " Art Therapy for Combat-Related PTSD: Recommendations for Research and Practice," make the heavily-referenced case that we shouldn't overlook art therapy's potential for treating PTSD in combat veterans -- particularly because of its nonverbal nature, and its ability to integrate and express experience trapped below the level of conscious thought. Typically, art therapy has been under-studied, or studied with victims of trauma who are children, not combat veterans -- but over time, those facts are changing. The article, linked here, and referenced in a previous blog post linked here, is well worth reading.
They introduce their argument by saying (citations are everywhere in the original article, I'm leaving them out of this summary) that PTSD is difficult to treat in part because no single treatment has emerged as the clear leader, with effectiveness across the board. Similarly, PTSD can be somewhat intractable to treat because any trauma severe enough to cause PTSD seems to affect the brain's underlying physiology. Pharmaceutical drugs and talk therapy, among other treatments, are commonly-used approaches for treating PTSD, but the attractiveness of art therapy as a treatment is expressly because of its non-verbal nature. It has the potential to allow combat veterans to process and integrate what has happened to them, without specifically requiring them to talk about it -- something many veterans are reluctant to do.
Some interesting points from the article:
PTSD is thought to be caused in part by the nature of traumatic memories, which are encoded in implicit as well as declarative memory systems and are likely to exist primarily as dissociated emotional, perceptual, or sensory fragments with no coherent verbal, symbolic, or temporal basis (O’Kearney & Perrott, 2006; Reisberg & Hertel, 2004).
Furthermore, implicit and declarative memories of an event can become disconnected due to trauma. These qualities of traumatic memory make it hard to describe traumatic experiences in words or to “integrate” them as part of one’s life story (Christianson, 1992; van der Kolk,Hostetler, Herron, & Fisler, 1994). The failure to process information symbolically (verbally or otherwise) after a trauma is thought to be a core element of PTSD (van der Kolk & Fisler, 1995). Indeed, brain imaging research has demonstrated hypoactivity in Broca’s area, which is involved in the motoric aspects of speech, and hyperactivity in the amygdala (fear, anger), hippocampus (memory), and occipital cortex (visual processing), among veterans with PTSD (Rauch & Shin, 1997).
By their nature, traumatic memories are difficult to express in words alone. Non-verbal expression, as is used in art therapy, can facilitate both the shift to declarative memory and the creation of a coherent narrative. The narrative can be pictorial rather than verbal. Indeed, visual imagery may be necessary for the symbolic processing involved in constructing a trauma narrative (van der Kolk & Fisler, 1995).
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Additionally,
Although art therapy has not been extensively researched, a number of small studies of art therapy for veterans with PTSD have yielded promising results. In a study designed to identify which components of a specialized inpatient PTSD program (SIPU) were most effective, Johnson and colleagues (1997) found that art therapy was the only component among 15 standard SIPU components, such as group therapy, drama therapy, community service, anger management, and journaling, that produced the greatest benefits for veterans with the most severe PTSD symptoms. (The other 14 components were most effective for those with the least severe symptoms.) They also found art therapy to be exceptional in that the veterans could tolerate war-zone content during art therapy and could not do so during other activities. The authors surmise that art therapy was more effective than other therapies because it provided pleasurable distraction in conjunction with exposure to difficult content and thus allowed traumatic material to be processed without the negative short-term side effects of verbal introspective interventions. Other studies also have found art therapy to be more effective than verbal therapy for veterans with PTSD. Morgan and Johnson (1995) assessed a drawing task for treating nightmares in combat-related PTSD and found that those who did the drawing task when they were awakened by nightmares had fewer and less intense nightmares than those who did a writing task.
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Editor's Note: To learn more about art therapy, or to find an art therapy practitioner who may have some experience with PTSD (and there could be very few who do), contact the American Art Therapy Association, Inc., 11160-C1 South Lakes Drive, Suite 813, Reston, VA 20191. Tel.: (888) 290-0878 or
(703) 212-2238. Their website is linked here.
