American Scientist

One-fourth of the global population is at risk of developing a mental health challenge in their lifetime, and one-fifth of children and adolescents could develop mental health problems, according to a 2014 World Health Organization report. Wars, adversity, discrimination, natural disasters, and illnesses such as COVID-19 further exacerbate these unmet needs for psychosocial support.

Oscar Wilde once said, “Man is least himself when he talks in his own person. Give him a mask, and he will tell you the truth.” Art provides a way to communicate experiences when individuals lack verbal skills or when words are insufficient. Humans evolved artistic expression as an imaginative tool for adapting to changing conditions and solving problems. Other scholars and I have asserted that art making is an integral part of human functioning, and that it helps humans survive. As an art therapist, I have spent decades trying to understand the role of art making as a therapeutic tool.

Professional art therapy began in the mid-20th century as a restorative practice that allowed people to express themselves in nonverbal ways, such as drawing and painting. Trauma affects the brain’s speech centers and can limit the effectiveness of traditional talk-based therapies. The impetus behind the creation of modern art therapy in the United States and Europe was to serve the needs of veterans from the two World Wars who were suffering from post-traumatic stress, and to address the development of children and adolescents with special needs.

Despite the prominent application of art therapy programs and the widespread belief that art supports mental health, many of the claims that art and art making can help people have remained anecdotal. My colleagues and I are among a growing group of art therapy researchers working to strengthen the scientific evidence that art can heal and to better understand how and why it does so.

Art as a Therapy Tool

Adults typically have complex, ambivalent feelings about art and art making; common responses range from dismissal and derision to awe and sometimes shame about their own lack of artistic skills. Young children, on the other hand, typically draw and sing and dance without worrying about their abilities. That freedom and joy is often lost as we grow and begin to self-consciously evaluate the quality of our art. Too often, we become viewers of others’ art rather than being active creators, and we lose the many benefits of creative self-expression. Art therapists guide people in connecting or reconnecting with the creative practices that support mental health, and that help people to grapple with life challenges and uncertainties. The United States has more than 6,000 credentialed art therapists, and the profession is growing in all parts of the world.

As a child, I used drawing and expressive writing to cope with boredom. (I was home sick a lot.) In India, I started a career as a textile designer, working in the vast and rich landscape of the artisanal traditions. But in the 1990s, as markets were disappearing, many artisans were despairing and committing suicide. I cherished working with them to adapt their exquisite craft to a modern market.

My interest in the connection between artistic practices and human well-being deepened, and I chose to pursue a master’s degree in art therapy and clinical work. As I worked with clients, I continued to wonder how humans can best work through traumatic experiences and grapple with adversity, and I eventually pursued my current work studying creative expression in a range of human populations.

Art therapy is founded on the assumption that everyone is creative and capable of self-expression. My job is to create a safe environment that allows clients to express themselves and communicate without worrying about whether they have great visual arts skills or whether their artwork is technically brilliant. Art therapy clinicians focus on the process of making rather than the artistic product, which allows our clients to gain insights about their situations and develop inner emotional resilience. Therapy sessions—in groups or with individuals—provide time for engaging all the senses and integrating these aesthetic experiences so that participants can reimagine and rework established neural pathways to establish new ways of seeing, thinking, and experiencing.

What is my superpower as an art therapist? I can change how you see yourself.

Art therapists can channel maladaptive or dangerous instincts into creative products that allow clients to communicate and work through difficult thoughts and complex emotions. I can guide a person toward taking risks in art making rather than engaging in risky behaviors in their outside life. These creative choices fulfill the brain’s desire for novelty without compromising personal safety. Rather than punch another human being, for instance, someone with aggressive tendencies could work with materials such as clay and wood that can absorb their energy and transform it into a creative product.

What is my superpower as an art therapist? I can change how you see yourself.

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In the early 2000s, when I worked as an art therapist with teens in an alternative high school in Pennsylvania, the students often created socially inappropriate objects, such as clay penises and drug paraphernalia, during their art therapy sessions. By acting out with their art, the teens could visually express their family challenges and the developmental issues that brought them to the alternative school setting. Communicating these kinds of issues safely and nonverbally with a responsive adult can help such students make adaptive choices as they move into adulthood.

As we started looking at the science behind art therapy, my colleagues and I studied the effects of art making alone versus with an art therapist, starting with research at Drexel University with a test group of healthy adults, including students, faculty, and staff. We found that individuals who worked with an art therapist had lower levels of the stress hormone cortisol in their saliva; they also reported improved mood and self-efficacy and lower perceived stress than those who made art alone. These gains appeared across a variety of media, including collage, colored pencils, markers, modeling clay, and even new media, such as virtual reality.

Art therapy can influence a range of human functioning, we find, including self-perception and interpersonal interactions. Even a 45-minute creative activity can change a person’s mental state. Among healthy adults, some solitary activities, such as coloring, can help reduce stress and negative feelings. Working with an art therapist does even more: It can significantly enhance positive mood and boost measures of well-being, such as self-confidence and self-perception of creative abilities.

Healing the Body and Mind

After our initial studies with healthy adults, we wanted to examine whether cancer patients and caregivers experiencing chronic stress would benefit from art therapy. In 2017, with funding from the National Endowment for the Arts’ Research Labs program, we set up an art therapy study within the radiation oncology unit at a large urban hospital. We offered 22 patients and 34 caregivers individual, 45-minute sessions of coloring or free art making with an art therapist. Meanwhile, we monitored the patients with several surveys of psychological functioning before and after the sessions. Afterward, participants reported feeling more positive, less stressed, less anxious, and more self-confident. Several patients described these sessions as one of the few moments of respite from their hectic treatment schedule, and they appreciated the time and space to reflect on their experiences.

We also surveyed the caregivers, who reported feeling less burnout. Many responded that the experience distracted them from their daily concerns and allowed them to focus elsewhere. In addition, the art therapy session was the first time that some participants had a chance to process the psychological and existential challenges of dealing with cancer. I watched people open up and begin conversations with strangers after a facilitated drawing activity, in ways they might not have if they were only talking alone. Almost all participants took their creations home, and many have told me that they have kept their artwork in their home or office. They often can’t believe that they made it.

Earlier this year, in the Journal of the American Medical Association, Maria Steenkamp of New York University Grossman School of Medicine and her colleagues reported that popular verbal psychotherapies, such as cognitive behavioral therapy and cognitive processing therapy, might not be adequate for military service members with post-traumatic stress disorder. For clients who struggle to understand and verbally share their psychosocial experiences, art therapy provides a nonverbal option. In a project to aid military service members, art therapists Melissa Walker at the Walter Reed National Military Medical Center, Jacqueline Jones, now at Eglin Air Force Base, and I have found that art making can help individuals who have experienced traumatic brain injury address their identity issues. (The project was supported by Creative Forces, a federally funded initiative of the National Endowment for the Arts, in partnership with the U.S. Departments of Defense and Veterans Affairs.) Service members’ experiences creating paintings, drawings, and sculptures allowed them to spend a long time working with their hands and to express and communicate thoughts and feelings that they had previously struggled to share.

In our studies, which combined quantitative and qualitative research methods, several hundred participants at Walter Reed and Fort Belvoir Community Hospital in Virginia reported that creative expression changed their perceptions of themselves, their relationships, and their life situations. A deep sense of grief and loss underlies trauma, and art therapy provides a metaphorical way to address the complex inner struggles of service members. Through art, they can slowly begin to communicate more openly about previously unsayable, shameful, or even taboo topics. They are better able to name their emotional experiences, and they use more words to express themselves.

Art therapy can also help service members to cope with the isolation and alienation that many feel after returning from a deployment, and to develop a sense of belonging and agency. In a retrospective study, we examined more than 400 pieces of visual artwork in the form of masks created by 370 service members between 2011 and 2015. These masks were created as part of an intensive military outpatient program at Walter Reed for service members who had a history of traumatic brain injury and other physical health conditions, and who had not responded to other treatments. We compared their artwork with clinical notes maintained by their therapists, looking for recurring themes and for links between image types and levels of post-traumatic stress, depression, and anxiety.

Service members who created fragmented imagery, we found, showed greater risk of mental health challenges, while those who created integrated images (depicting groups or cohesive visual metaphors) were more likely to show signs of improved psychological health. The correlation between the ability to express challenges visually and later well-being suggests that the act of naming and identifying ongoing challenges can help set the service member on a pathway to adaptive functioning.

Art Therapy in Virtual Reality

Today’s digital media technologies are expanding the options for art therapists to connect with clients, including the use of telehealth. Unlike traditional media, digital art media interfaces allow for a range of expression that includes sculpting and drawing in two and three dimensions. Participants can easily edit or change shapes and content, creating imagery that does not or cannot exist in real life. These technologies can present challenges because they only engage our visual and aural senses, and lack the tactile aspects of traditional art creation. But they provide a way of sustaining therapeutic connection by facilitating creative expression and communication through a digital interface, especially for clients who may be unwilling or unable to work with physical art materials.

To take the two-dimensional digital experience into three-dimensions and bring it closer to our lived experience of the world around us, my colleagues and I have been exploring the potential of virtual reality, both to expand our notions of what is possible and to encourage movement and immersion in digital artistic expression. In studies conducted in collaboration with Johns Hopkins University’s International Arts + Mind Lab and Drexel biomedical engineering professor Hasan Ayaz, we measured brain activity with functional near- infrared spectroscopy (fNIRS) in adults while they participated in virtual reality art therapy experiences. The data from brain scans and the participants’ self-reported responses indicate that novel media such as virtual reality can promote creative expression and physical activity, while also breaking down fears among many participants that they are not good at creating art. People don’t seem to associate the same stigmas and fears with creating in virtual reality as in traditional art media. This, in turn, helps participants engage in self-expression that they might not otherwise have had the confidence to explore.

Virtual reality provides an alternate universe where participants can move through objects, create structures that defy gravity, and step in and out of their creations. After creating in such a space, people often feel energized with a sense of creative possibility that they had not previously imagined. Though intangible, these digital experiences can help people appreciate the physical world in new ways, and technology such as 3D printing could soon help us make some digital creative experiences more tactile. As a result, virtual reality art therapy could be useful for patients with debilitating injuries and those who feel psychologically stuck in their life patterns.

Over the past half century, art therapy has expanded from a tool to address the unmet needs of individuals facing adversity and trauma to much wider use in hospitals, schools, and community organizations to promote health and well-being through artistic self-expression. In the future, the definition of therapy is poised to expand beyond talk therapy alone, and art therapy will be recognized as a cost-effective and sustainable psychosocial treatment option.

Telehealth will also help art therapists reach previously unreachable audiences in remote locations. As we connect with communities worldwide, where distinct traditional or indigenous practices remain intact, we will need to be mindful of and respect existing cultural practices. But we also hope to learn how traditional practices already integrate creativity to support mental health and well-being. Such insights could offer a deeper understanding about how art making can heal and lead to new tools to help others.