Support for a neurobiological view of trauma with implications for art therapy

https://doi.org/10.1016/j.aip.2008.12.005Get rights and content

Abstract

Three lines of research support the concept that trauma is primarily a nonverbal problem: (a) evolutionary survival responses; (b) brain imagery studies of human responses to trauma cues; and (c) the relation of alexithymia to posttraumatic dissociation. Based on these research findings the authors offer a neurobiological view of psychological trauma that points the way to use art therapy as a primary means of treating posttraumatic symptoms.

Section snippets

The hypothesized mechanisms of art therapy

According to Naumburg (1950), the healing mechanism of art therapy was that it offered “a specialized additional nonverbal technique for releasing, through symbolic imagery, the unconscious, repressed emotions” (p. vii). Building on the psychoanalytic theories of her day, Naumburg dealt with intrapsychic conflict, wish fulfillment, fears, and fantasy as expressed in art. Kramer (1971), whose work was informed by later developments in ego psychology, saw art therapy “primarily as a means of

Major guidelines for trauma therapy

The International Society for the Study of Traumatic Stress adopted guidelines for treatment (Foa, Keane, & Friedman, 2000) that emphasized evidence-based methods but included unproven treatments that have been used. Art therapy was described as a possibly helpful ancillary treatment. The established treatments are divided into two categories, those designed to improve coping and adjustment and those designed to process traumatic memories, the so-called “exposure” therapies. The former group

The Instinctual Trauma Response (ITR)

Our understanding of the role of evolutionary survival responses in trauma led to the concept of the “Instinctual Trauma Response” as a universal reaction to trauma in animals and humans (Gantt & Tinnin, 2007b). The human brain retains the neural networks for instinctual survival strategies acquired over evolutionary time from the oldest reptilian freeze to the most recent primate cognition (MacLean, 1990). First there was the freeze, then the mammalian flight/fight response, and finally, human

Neuroimaging findings

A review of the neurobiology of posttraumatic syndromes by Frewen and Lanius (2006) summarized evidence from functional neuroimaging studies that examined the nonverbal responses to script-driven imagery of PTSD subjects compared with controls. They reported observed differences involving the anterior cingulate cortex and several other areas of the brain (p. 114). They cited other studies that also showed that the anterior cingulate cortex is involved in verbal control of attention in terms of

Alexithymia

Alexithymia refers to difficulty identifying and labeling emotional states. It is measured by self-report questionnaires such as the Toronto Alexithymia Scale (Bagby, Parker, & Taylor, 1994). Frewen and Lanius (2006) report that their recent studies lead them to believe that deficits in conscious awareness of nonverbal bodily states are integral to the alexithymia construct. They found an association between increased activation of the posterior cingulate cortex during traumatic imagery and

A nonverbal model of trauma

In humans the pathological consequences that follow a traumatic experience are due to the involuntary instinctual survival reactions that interrupt verbal consciousness and dominate behavior and sensation during the time it takes to recover normal verbal thinking. While verbal consciousness is interrupted memory traces of the experience are without temporal narrative organization and may be stored in a nonverbal realm beyond the reach of verbal probes (Schore, 2002). When verbal dominance is

Art and trauma, past and present

Having described the present-day understanding of neurobiological mechanisms involved in trauma we now turn to the problems inherent in applying previous conceptions of art therapy to trauma work. We think there are three basic areas of difficulty: (a) continuing influence of the non-directive approach; (b) deferred trauma processing; and (c) undue emphasis on expressing emotion.

The non-directive approach that comes directly from psychoanalytic methods demands that the therapist encourage (in

Implications for art therapy

Since art therapy provides a means for communicating with the nonverbal mind (Tinnin, 1990a) and accessing traumatic memory, it is an ideal vehicle for helping a traumatized person accomplish the essential tasks necessary for recovery. But, what are these essential tasks and how are they accomplished through art? Can we devise protocols with interventions that are both necessary and sufficient without prolonging treatment unnecessarily? Above we made the case that trauma is a nonverbal problem;

Dealing with the loss of words

A person's inability to talk about a trauma and the attached feelings (alexithymia) or to construct a coherent narrative should not be considered an impediment to trauma processing or a cause for delay. Nor should it be considered defensive. Various writers (Malchiodi, 1990, Rubin, 2005, p. 118; Wilson, 2003, pp. 286–287) posit that one value of art therapy is to counter defenses. However, in light of the neurobiological findings summarized above we have to re-examine this concept. Art therapy

Problems with time and sequence

A fundamental problem for trauma survivors is the feeling that the trauma is happening now or will happen again; therefore, it makes sense that one should employ strategies to make the event truly “past history.” Dissociation at the time of the trauma has the net effect of stopping one's orderly and predictable sense of time (see van der Kolk, 1987, p. 7). Therefore, a crucial task is to organize the traumatic state memories into a narrative form that will be comprehensible and acceptable to

Future work

The task for art therapists who treat trauma is to devise additional targeted approaches. Such approaches could be based on two neurobiological processes: integration of the fragments of the traumatic experience into a coherent narrative to be avowed and owned by the verbal mind and an opportunity for reducing dissociation and alexithymia by externalizing dialogue between the verbal and nonverbal minds. In this way, the left-brain comes to accept a new partnership with the right. This

Conclusion

For those who suffer from PTSD it is not the release of emotion (abreaction) that is the mechanism of healing, nor is it the resolution of internal conflict. Ulman (1980) hypothesized about art therapy providing order through the meeting of the inner and outer worlds. We agree that it is the creation of order but, most likely, order of a different sort. Rather, it is restoring a sense of temporal order, promoting narrative closure, making traumatic events past tense, imbuing nonverbal material

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