TWO The Neuroscience of Art Therapy and Trauma

Margaret Naumburg, the “mother” of art therapy, coined the term “art therapy” in the 1940s (Junge, 2010; Vick, 2003). For the first 50 years of art therapy’s existence as a profession, we knew that it worked but did not know why. Advances in neuroscience research over the past 20 years changed that. A surge in neuroscience research has helped to define what happens in the brain when a person is exposed to prolonged trauma and what happens in the brain during art making. These two paths of research provide strong evidence for understanding why and how art therapy works, which was missing in its early years. This chapter will summarize some of these important discoveries.

Trauma and the Brain

When people think about their traumas, increased activation of the right hemisphere, and deactivation of the left, demonstrates how they tend to relive the experience but cannot analyze it and have great difficulty verbalizing it (van der Kolk, 2002, 2015). Neuroimaging studies examine how traumatic memories are stored in the brain. In particular, traumatic memories appear to be stored in the right hemisphere, making verbal declarative memory of the trauma more difficult. Schiffer, Teicher, and Papanicolaou (1995) measured hemispheric activity in the brain in subjects with a history of trauma while they thought about a neutral, work-related memory and then an unpleasant early memory. The responses were compared with a control group with no known trauma, in which participants recalled a neutral work-related situation. The trauma group showed significant left-dominant activity during the neutral memory that shifted markedly to the right during the unpleasant memory. Further work by Schiffer (2000) suggested that the two hemispheres of the brain can have distinct personalities, memories, and perspectives. His review of split-brain studies and his own experiments with lateral visual stimulation in patients with trauma histories have indicated that the “immature side maintains a perspective very similar and consistent with that which a child in troubled circumstances might be expected to experience” (p. 98). Schiffer proposed that the traumatized child maintains those feelings and perspectives in one part of the brain while the other half matures.

Other studies have shown that exposure to violence or trauma alters the developing brain by altering neurodevelopmental processes. Rauch et al. (1996) used PET scans to study patients suffering from posttraumatic stress disorder (PTSD). When presented with vivid accounts of their traumatic experiences, these individuals showed autonomic arousal, with heighted activity in their right amygdala and associated areas of the temporal and frontal cortex as well as in the right visual cortex. At the same time, the area concerned with language in the left hemisphere was “turned off.” This suggests that the tendency of PTSD clients to reexperience emotions as physical states rather than as declarative verbal memories has a neurobiological explanation (Glaser, 2000; Rauch et al., 1996). These studies lay the groundwork for understanding why nonverbal, expressive therapies can be more effective than verbal therapies when working with severely maltreated children (Klorer, 2005, 2008).

The brain is comprised of three levels. The lowest portion of the brain, the brain stem, is the more primitive “survival” center, comparable to the reptilian brain, whose initial response to stress is to freeze (Gantt & Tinnin, 2007). The brain stem includes all of the more primitive, instinctual brain functions, including cardiopulmonary activities: breathing, sleeping, eating. The midbrain, consisting of the limbic system, is the emotional center of the brain and includes the amygdala, hippocampus, thalamus, hypothalamus, and anterior cingulate. The amygdala is the central alarm system, alerting the threatened individual to a fight-or-flight response. The highest portion of the brain, the cerebral cortex, is comprised of the right and left hemispheres and provides the ability to engage in higher cortical functions, perception, reasoning, executive functioning, and complex memory. The brain develops in a bottom-to-top fashion, beginning with a newborn functioning in the more primitive, survival mode of the lower brain. During the first 2 years of life, as the baby receives external stimulation, the basic circuits of a more complex brain are developed (Balbernie, 2001; De Bellis, 2001;

Schore, 2002). The higher cortical areas are not completely developed until late adolescence or early adulthood, around the mid-twenties.

The child’s brain develops in what Perry (2001) termed a “use-dependent fashion,” meaning that the more any neural system is activated, the more likely it is to become permanent. Holding and talking to a child are crucial components of normal cognitive and emotional development. During the first 3 years of life, forming an attachment with another is a crucial component of optimal brain development. Schore (2002) described the neurobiology of a secure attachment: Early in the relationship the primary caretaker comforts the distressed baby by holding and feeding. In order to form a complete and healthy attachment, the mother must be able to create psychobiological attunement with the infant, developing what Schore defined as “affect synchrony” (p. 13). When the infant cries, the mother creates attunement by holding and rocking so that the child becomes synchronized with the mother’s rhythm and calms down. This begins as an external regulator for the child, and neuropathways in the brain are stimulated each time this happens. With repetition, the neuropathways become permanent, and ultimately the child learns to self-regulate. When a maternal figure is not able to provide this comforting stimulation, the child suffers emotionally and physiologically. According to Schore, a lack of relational stimulation at a crucial age affects the development of the frontolimbic regions of the brain, especially the right cortical areas involved in affect-regulating functions. Evidence shows that early relational trauma is expressed in right hemispheric deficits in the processing of social-emotional cues (Schore, 2002). Therefore, the child operates at a much lower socio-emotional- developmental level than normal in terms of affect regulation and behavior management.

Multiple studies have shown that severe maltreatment and a lack of significant attachment figures in the crucial early years lead to adverse brain development. These include changes in the hippocampus and prefrontal cortex (Bremner, 2001), with up to 19% decreased hippocampal volume in women with abuse and PTSD histories (Bremner et al., 2003). Changes in hippocampal volume are associated with chronic, ongoing stressors that began with an acute trauma (Bremner, 2005). Brain imaging studies of Romanian orphans revealed “significantly decreased metabolism bilaterally in the orbital frontal gyrus, the infralimbic prefrontal cortex, the medial temporal structures (amygdala and head of hippocampus), the lateral temporal cortex, and the brain stem” (p. 1290), concluding that early deprivation may lead to dysfunction of brain systems mediating cognitive and behavioral deficits (Chugani, Behen, Muzik, Juhasz, Nagy, & Chugani, 2001). De Bellis

(2001; De Bellis et al., 1999) found smaller intracranial and cerebral volumes in severely maltreated children, with a negative correlation of intracranial volumes and abuse duration, suggesting that there is a cumulative effect of trauma on brain development. As Schore (2002) described, clearly an individual with a history of severe maltreatment reacts to stress with compromised coping. The amygdala, when alerting the individual to a need for action, directly projects to the brain stem startle center, the more primitive part of the brain that reacts in a fight, flight, or freeze response. The orbito- frontal and medial frontal areas of the brain, which would normally help an individual regulate emotions and rationally think through a proper reaction, are unavailable.

In recent years, the neuroscience paradigm has taken the stage for trauma treatment (Johnson, 2009). Johnson noted that there are problems with this paradigm, too, including oversimplification of lateralization of the brain studies, inconclusive evidence on the causal effects of decreased brain volumes, and a lack of understanding of how neurohormones regulate stress related to trauma. Johnson cautioned that PTSD symptoms reflect the experience of traumatization, but a causal relationship between damage to the brain and symptoms has not been proven.

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