Monti also plans to perform brain imaging research on a subgroup of cancer patients in the study to determine precisely how art therapy might affect the circuitry of the brain.
Psychiatrists already have strong theories about how art therapy works, especially as it relates to trauma treatment. Allan Schore, associate clinical professor of psychiatry and biobehavioral sciences at UCLA's School of Medicine, says that traumatic and stressful memories are stored in the right hemisphere of the brain, which processes emotions, visual and nonconscious information.
The left brain controls logical thinking and verbal skills. But for therapy to be effective, "it has to get into the right brain," Schore said. Creating art is a fast way to access the right brain and the emotions stored there.
"Saying I'm scared and angry is one thing. Taking a crayon and scribbling on a piece of paper is a visceral way of not just saying it, but experiencing it," said Jan Oxenberg, a TV writer who tried art therapy after she was involved in a shooting during a civilian ride-along with the LAPD.
While making art activates the right brain, talking about it and constructing a coherent story about the traumatic experience activates the left hemisphere as well. Integrating the two leads to healing. "What is expanded is the interconnectivity of the brain," Schore said.
Interest in art therapy for trauma has skyrocketed in recent years because of world events such as the Sept. 11 attacks, the Asian tsunami, Hurricane Katrina and the Iraq war. According to Malchiodi at the American Art Therapy Assn., membership has grown from 4,000 to 4,500 since Sept. 11, and many art therapy programs are having to turn away applicants.
San Francisco art therapist Linda Chapman, creator of a model for treating pediatric trauma patients, conducted a 2001 UC San Francisco study of 85 hospitalized children and adolescents suffering from trauma after violence, abuse, accidents and chronic illnesses. Results were published in the Journal of the American Art Therapy Assn.
Chapman found that art therapy significantly reduced some of the acute symptoms of post-traumatic stress disorder one week and one month after discharge from the hospital.
However, it did not reduce the symptoms of PTSD compared with control groups at a six-month follow-up. Chapman said it was impossible to control whether participants had suffered additional traumatic experiences and that more research is needed.
In fact, a large study of art therapy for veterans with PTSD is in the planning stages. Stanford art therapy researcher Kate Collie and a committee of the American Art Therapy Assn. are designing the study, which may include recent Iraq War veterans, one of eight of whom exhibit signs of PTSD, according to an Army survey. The long-term goal is a clinical trial.
A small 1997 study of in-patient Vietnam veterans with PTSD published in the Journal of Traumatic Stress compared the effectiveness of a single session of 15 different treatment methods administered to 25 veterans over 16 weeks. Art therapy was the only treatment method that reduced PTSD symptoms in the most severe patients. Researchers theorized that it not only provided a distraction, but it helped vets deal with traumatic memories at their own pace.
Pacing is also crucial for young trauma victims, who can get overwhelmed recounting frightening experiences. By choosing specific art materials, therapists can help children experience their emotions in small, manageable doses. Chapman often starts with No. 2 pencils and tiny pieces of paper. The familiar tools and their manageable size give kids a sense of mastery and control -- over the art and over their feelings, she said.
In fact, when young trauma victims are given a choice of No. 2 pencils, colored pencils and markers, they often pick plain pencils. That's because color evokes emotion, Chapman said.
Used correctly, however, color can be a powerful tool. When Chapman worked with kids in pain, she would ask them to paint the color of pain onto a drawing of the part of the body that hurt. Most kids would choose red or black. Next she would have them pick a color to take away their pain, usually blue or white. Chapman found the simple act of painting over the problem area would soothe them.
Revelations and renewal
Art therapy can be an especially useful diagnostic tool with kids and others who have a hard time talking about feelings.
Art therapist Esther Dreifuss-Kattan, who leads the art therapy group at UCLA's Ted Mann center, also works with the university's Pediatric Pain Program. She recalls one teenager whose drug addiction was revealed in a single session.
Although he said he "had pain all over," doctors could find no cause. But then he created a collage of a monkey with a skeleton on its lap. He told Dreifuss-Kattan, "When you take drugs you feel like a skeleton."