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Emotional expression and psychological symptoms: A comparison of writing and drawing
Abstract
The psychological effects of writing versus drawing about a stressful experience were compared. Participants were randomly assigned either into a control group (n = 34), a journaling group (n = 29), or a drawing group (n = 29). A measure of psychological symptoms was completed before and after two 15-min sessions. The results indicated that participants in the journaling group had a significantly greater decrease in their psychological symptoms than those in the drawing group or the control group. Journaling was also found to have a more positive effect for participants who initially had higher levels of psychological distress.
... More recently, researchers have been interested in studying the combined effects of writing plus other forms of non-verbal expressive methods, such as drawing and dancing (see Chan & Horneffer, 2006;Pizzaro, 2004;Pantchenko, Lawson & Joyce, 2003;Krantz & Pennebaker, 1995). While the benefits of written disclosure are now well documented, for some people, the use of words may be more of a hinder than a catalyst. ...
... Art making, for example, has been shown to improve and repair moods , generate discussion and sharing of past negative experiences (Yamaguchi, 1997), and reduce stress (Rubin, 1999). Overall, results of studies examining both verbal and non-verbal means of disclosure have indicated that a combined method, engaging both verbal and non-verbal means of disclosure, may be an effective intervention, allowing for more emotional expression, higher participant satisfaction and better memory retrieval than verbal disclosure alone (Chan & Horneffer, 2006;Pantchenko et al., 2003). ...
... This unintended side effect of writing therapy may, in the end, defeat the potential benefits of the treatment (Pizzaro, 2004). In addition, while journaling has the advantage of being a familiar and comfortable activity for many people, given the common use of writing in day-to-day life, for some people, the use of words may be a greater obstacle than catalyst for accessing feelings (Chan & Horneffer, 2006). This has been the case for people with deficits in emotional awareness and understanding (a condition termed alexithymia). ...
Abstract (1) Objectives This study aims to explore self-disclosure by the use of Pennebaker’s writing therapy plus a drawing task on a group of art students in Hong Kong. Pennebaker’s research has shown that writing about traumatic events reduces psychological symptoms,and have long-termhealth benefits. The first hypothesis of this study is whether a non-verbal art therapy in conjunction with a verbal writing therapy would be effective in reducing self-perceived stress and improving life satisfaction. The second hypothesis is that Hong Kong students are
... This negative mindset could potentially take precedence over the positive effects of art on stress and emotion (Halprin, 2003). Along these lines, creating art about stressors has been shown to be less beneficial than writing about them (Chan & Horneffer, 2006). Despite this criticism, most literature presents art as a way to decrease anxiety and depressive symptoms and to even increase the perceived quality of one's life. ...
... Another similar study, a short-term artistic intervention, concluded that positive art making leads to decreases in stress (Curl, 2008). In our art activity, individuals were not asked to draw about their stressors, which sometimes takes away from the therapeutic qualities of art (Andrus, 2019;Chan & Horneffer, 2006). The idea of neutral visuals with short-term art making may have been enough to reduce stress and elevate mood, in line with findings by Bell and Robbins (2007). ...
The objective of this study was to determine if either creative movement or art were effective in decreasing stress among college students and improving their mood. Sixty participants were randomly assigned to either a movement (n = 30) or an art (n = 30) intervention. Before the intervention, participants in both conditions wrote about a current stressor, rated their perceived intensity of the stressor, and completed a mood questionnaire (Positive and Negative Affect Schedule; Watson et al., 1988). Following the intervention participants again completed the mood questionnaire, wrote about a current stressor, and rated their perceived intensity of the stressor. Two-way ANOVAs (group x time) found significant reductions in stress (p < .001) and negative affect (p < .001), in addition to increases in positive affect (p = .007) for both groups from pre- to post-intervention. Our results suggest that briefly partaking in creative movement or art can psychologically help college students in the short-term.
... The use of group written song lyrics and song based interventions support the effectiveness of words and written expressions for dissociative clients. These word based interventions have been shown to have lasting effects for clients, as described by Chan and Horneffer (2006). The cognitive component of expressing thoughts and emotions in written dialogue has been hypothesised to create long lasting psychological benefits for clients (Chan & Horneffer, 2006). ...
... These word based interventions have been shown to have lasting effects for clients, as described by Chan and Horneffer (2006). The cognitive component of expressing thoughts and emotions in written dialogue has been hypothesised to create long lasting psychological benefits for clients (Chan & Horneffer, 2006). ...
Dissociative identity disorder (DID) is a debilitating disorder acquired due to severe ongoing neglect or abuse, characterised by the presence of two or more identities that frequently control the individual's behaviour (American Psychiatric Association [APA], 2000). Literature pertaining to the wider spectrum of trauma outlines the benefits of various therapeutic interventions, including music therapy. With limited research into the field of DID and music therapy, the current authors identified a need for a systematic approach to the treatment of clients in music therapy programs. Through the use of Lev-Weisel's (2008) suggested four therapeutic goals of treatment: symptom relief, de-stigmatisation, increase self-esteem, and prevention of future abuse; an accessible framework is provided for use with dissociative clients. With a session example of the use of song parody, a practical use of the four-goal framework is outlined. As there has been limited research in the field of DID and music therapy to date, along with the theoretical framework, the authors provide recommendations for future music therapy practice with DID clients.
... In addition to the scripted experimental self-disclosure research, other forms of self-disclosure have evolved. Reflective journaling, an act of written emotional expression, has become popular among writers and educators (Stone, 1998), and in various therapeutic milieus (Chan & Horneffer, 2006). Hubbs and Brand (2005) endorsed reflective journaling as the avenue to gather thoughts, feelings, and actions. ...
... Converse to the reports of this studies' null findings, positive outcomes involving journaling or written emotional expression have been reported in studies (Chan and Horneffer, 2006;Sloan, Marx, & Epstein, 2005). One future direction for researchers could be the exploration of a journaling section to accompany the symptom checklists. ...
... In related evidence, the effectiveness of venting negative experiences through drawing and writing is investigated in several empirical studies. Chan and Horneffer (2006) (n = 63) for example, found that in the short term, drawing mean- ingful negative experiences elicited stronger negative emo- tions and was less effective in decreasing social dysfunction than writing about them. Contrasting findings by Pizarro (2004) (n = 45), which show in the short-term writing about trauma leads to higher levels of negative affect than drawing, suggests research is inconclusive in this area. ...
This research explores the outcome of positive visual reframing (PVR), a single session intervention where drawn images of negative experiences and open memories were redrawn and visually reframed to form new positive narratives. The study hypothesised that PVR would lead to improvements to positive and negative affect, self-efficacy and the perceived intensity and perceived resolution of a selected negative experience. Healthy adults (n = 62) were randomly assigned to the PVR or control condition. For the experimental group, statistical significance was identified for positive affect and the perceived intensity and resolution of the negative experience immediately following the PVR activity. Self-efficacy was marginally significant. The findings highlight the potential of positive visual reframing to enhance emotional regulation when negative emotions are triggered. At two weeks‟ post-intervention, improvements were identified in both conditions. This suggests that over time, the visual and sensory exposure created by drawing a negative memory may also lead to positive gains. The study emphasises the potential of PVR to regulate emotions and defuse the intensity of negative or open memories by visually transforming a moment of peak perceptual intensity. Future studies exploring the effectiveness of positive visual reframing to shift negative emotions in clinical and non-clinical populations are recommended.
... Studies have shown that expressive techniques such as writing, music, and art making are creative interventions that can have lasting health effects on participants' mood and self-efficacy (Chan & Horneffer, 2006;Mercer, Warson, & Zhao, 2010;Pennebaker, 1997;Pizarro, 2004). A number of studies have shown that premade coloring pages or simple drawing tasks and other art-making activities have been effective in reducing anxiety (Carsley, Heath, & Fajnerova, 2015;Eaton & Tieber, 2017;Sandmire, Gorham, Rankin, & Grimm, 2012;van der Vennet & Serice, 2012), regulating mood (Babouchkina & Robbins, 2015;Collier & von Karolyi, 2014;Diliberto-Macaluso & Stubblefield, 2015;Laurer & van der Vennet, 2015), reducing stress (Abbot, Shanahan & Neufield, 2013;Curl, 2008;Huet, 2017), and increasing overall health and well-being (Greer, Fleuriet, & Cantu, 2012;Kim, 2013), which have led to claims about the efficacy of art therapy in general. ...
Background: Coloring books for adults have become a ubiquitous presence in retail outlets worldwide and in the visual cultural landscape. The goal of this study was to determine differences in outcomes between art therapist-facilitated open studio and individual coloring.
Methods: The study used a within-subjects experimental design. Healthy adult participants (aged 19–67 years) were invited to engage in one session each of individual coloring, and open studio facilitated by an art therapist. A total of 36 participants enrolled in the study; 29 completed pre- and post-surveys for both conditions. Outcomes measured included positive and negative affect, perceived stress, self-efficacy, and creative agency.
Results: The art therapist-facilitated open studio condition resulted in superior improvements in positive affect, creative agency, and self-efficacy compared to the coloring condition. Both conditions resulted in lowered stress and reduced negative affect.
Discussion and implications: The results indicated that coloring might have therapeutic benefits on distress; however, only the art therapist-facilitated open studio session showed significant improvements in self-efficacy, self-perceptions of creativity, and positive mood. Art therapists might consider using the phenomenon of coloring as a doorway to art therapy and more spontaneous creative and self-expression for transformative change. Future studies should seek to identify the unique mechanism of change through which art therapist-facilitated art making explains the shifts in positive affect, creative agency, and self-efficacy.
... 4) This limits generalisability of results and presents some ecological validity issues, like those present in related literature (e.g., Chan & Horneffer, 2006). It is recommended that creative persons outside university be evaluated and compared with this study, to see how accurate current findings are with a more pervasive sample. ...
Most creativity theorists consider artists as “agents of control”, capable of overcoming and controlling psychological distress. However, studies have yet to map the “healing” tendency for “everyday creative people” in detailing the process’ effects on perception and change. This study was aimed to examine this process via a phenomenological and Perceptual Control Theory perspective (PCT: see Powers, W. T. (1973). Behaviour: The control of perception. Chicago: Aldine). We recruited and interviewed eleven participants who had engaged in art-making and experienced recovery from psychological distress. Interpretative Phenomenological Analysis was used to identify themes between participant responses, generated from self-created semi-structured interview schedules following Smith and Osborn’s technique (IPA: see Smith, J. A., & Osborn, M. (2008). Interpretative phenomenological analysis. In J. A. Smith (Ed.), Qualitative psychology: A practical guide to research methods, 2nd edition, (53-80). London: Sage). Data analysis identified six superordinate themes: 1) “the process of creating as a goal-oriented focus”, 2) “internalising process and product”, 3) “awareness shift and self-focus”, 4) “emotion regulation”, 5) “goal change, bonding, and conflict resolution”, and 6) “feelings and perceptions within the art-making process”. Disconfirming Case Analysis and participant feedback also indicated a seventh theme: 7) “the ‘superficial’ creative process”. The results were interpreted to indicate that art-making involves the purposeful creation of perceptual experience to fulfil higher-order goals and values. The creative process is also a learning process which instigates and promotes positive affect, enhances skills, and facilitates change in higher-order goals. We consider these interpretations in the light of the components of PCT.
... Expressive activities such as drawing and writing are often seen as methods of communication that can externalize that which is not easily accessible, providing a point of contact for explicit intellectual analysis and construction/reconstruction of an individual's concepts of self and environment or their life narratives (Chan & Horneffer, 2006;Holmes et al., 2007;Muri, 2007;Pennebaker, 1997). These activities can generate spontaneous insights in the maker that are both intellectual and affective and that may be particularly valuable to those who have suffered traumatic events. ...
This study evaluated a creative workshop where college students (N = 300) devised self-expressive products to explore their inner and outer worlds. Participants devised products with drawing and writing components to examine their relationships with negative life events, self-concepts, and worldviews. Participants then evaluated the workshop. Artists and psychologists rated products for effort, creativity, and self-exploration. Participants evaluated the workshop as valuable (e.g., helped them feel mentally flexible, gave them freedom to express inner feelings). Past stressful life events correlated with positive evaluations of the workshop and self-exploration shown in products. Past visual art experience, personality (openness), and verbal ability predicted the creativity of products, whereas gender and life events interacted to predict self-exploration. A key finding of this study was that women who had experienced physical, sexual, or emotional abuse devised the most self-exploratory products and most strongly evaluated the activity as valuable.
... Although the research examining the effectiveness of group therapy in the meaning-making process of bereaved individuals is limited, coping-focused group therapy has been found to be effective in decreasing depression and grief (Smith, Tarakeshwar, Hansen, Kochman, & Sikkema, 2009). There is also evidence that therapeutic writing can foster personal growth following a difficult life experience (Ullrich & Lutgendorf, 2002); it has been found to be associated with a decrease in psychological symptoms compared to other forms of nonverbal emotional expression methods (i.e., drawing), especially when clients experience high levels of initial distress (Chan & Horneffer, 2006). ...
This study examined the mediating effect of reflection on the relationship between search for meaning, positive affect, negative affect, and positive meaning-finding among 380 bereaved individuals. Using structural equation modeling, reflection was found to mediate the relationship between search for meaning, affect (positive and negative), and positive meaning-finding. The hypothesized model accounted for 32% of the variance in reflection and 34% of the variance in positive meaning-finding. Implications of the findings, including strategies to increase reflection and positive affect following the loss of a loved one, are discussed.
... This study suggests that venting through visual art-making leads to greater short-term mood improvement than does venting through writing. Contradictory findings were reported by Chan and Horneffer (2006) who found that drawing about stressful experiences was less effective at reducing distress in the short-term than was writing about stressful experiences. ...
We examined two mechanisms by which creating visual art may serve as a form of short-term mood repair. After viewing a film
that induced a negatively valenced mood, participants were given a self-report affect grid that assessed mood valence and
arousal. Participants then engaged in one of three tasks: creating a drawing expressing their current mood (venting), creating
a drawing depicting something happy (positive emotion), or scanning a sheet for specific symbols (distraction control). Mood
valence and arousal were then reassessed. Arousal remained unchanged after the interventions in all conditions. Valence became
more positive in all three conditions, but the greatest improvement occurred after the positive emotion intervention. Valence
improved no more after venting than after the control task. Results show that in the short-term, attending to and venting
one’s negative feelings through art-making is a less effective means of improving mood than is turning away from a negative
mood to something more positive. These findings are consistent with research on the beneficial effects of positive emotions
and cast doubt on the often assumed view that artists improve their well being by expressing suffering.
... When writing has been compared to psychotherapy, writing about traumatic events was found to be as useful as therapy in promoting clients' positive emotions, cognitions, and behaviors (Donnelly & Murray, 1991). In addition, when compared to other creative forms of therapy, such as drawing, writing was found to encourage a greater decrease in psychological symptoms, especially for individuals who had higher baseline levels of psychological distress (Chan & Horneffer, 2006). The combination of these results seems to suggest that writing in general is beneficial to clients regardless of the theory behind its use. ...
Research on therapeutic writing indicates that it can offer a range of physical and psychological benefits. There is no consensus, however, concerning how writing achieves these benefits. To address this question, the authors propose a matrix framework with emotional-cognitive change processes (what can be activated) along its horizontal dimension and abstract-concrete structure (how the processes are activated) along its vertical dimension. On the horizontal dimension, writing can encourage clients who are distant from their emotional world to approach or to modulate emotional intensity, and to create meaning and coherence. Along the vertical dimension, these processes can be activated through tasks that vary in structure, including programmed writing, diaries, journaling, autobiography, storytelling, and poetry. Finally, the authors consider constraints on writing that apply to particular client groups. The matrix framework is meant to encourage clinicians to use therapeutic writing and to assist researchers in framing questions to advance our knowledge of writing as a therapeutic practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved).
Emerging adults face significant risk of experiencing mental health problems, especially since most lifetime mental problems have first onset by age 24. Despite the pervasiveness of these issues, emerging adults face barriers in receiving help including stigma surrounding help-seeking behavior and negative attitudes about perceived usefulness of therapy. Creative and expressive art therapies (CATs) can address these needs by providing potentially destigmatized, non-invasive approaches to mental health care. To examine how this population can benefit from CAT, we conducted a systematic review of the literature to understand the types of CAT interventions that have been empirically tested among emerging adults. From a total of 7,276 articles published between 1985 and 2020, we filtered down to 11 studies, both qualitative and quantitative, meeting our inclusion and exclusion criteria. Results showed art therapy and poetry therapy were the most frequently studied CATs for the emerging adult population; and art therapy studies comprised the largest proportion of studies reporting statistical significance on its efficacy among all CATs reviewed. We highlight the need for more studies using replicable, generalizable methods in evaluating CAT. We then discuss implications for counselors, practitioners, and clinician-researchers interested in using CAT to improve mental health care among emerging adults.
Narrative medicine (NM) sessions draw out the patient’s narrative of illness or injury and treatment in the context of the patient’s whole life story. The focus is to discover topics and areas in the patient’s narrative that the patient needs to explore. PNES may be understood in many cases as a communication disorder in which distress is expressed somatically in a pathological way instead of an adaptive and verbal manner. Patients with PNES are frequently misdiagnosed, and accurate diagnosis may be delayed for many years. PNES may cause severe disruption of the patient’s quality of life in terms of employment or schooling as well as relationships and activities of daily living. NM sessions encourage patients to communicate more effectively about their unspeakable distress and reclaim their lives from the communication disorder of PNES. Narrative writing exercises have also proven helpful for patients facing a variety of traumas and major stresses in situations similar to those faced by patients with PNES. This paper is a narrative review with an illustrative case report indicating NM applications to help a patient with PNES to communicate about a traumatic past that has been avoided and address psychogenic symptoms.
Background
We explore the applications of Narrative Medicine (NM) in the clinical care of brain cancer patients whose self-identity and quality of life are challenged by their disease and treatment. This paper considers how NM may help patients retain and rediscover self-identity during treatment.
Methods
We performed a retrospective review of NM sessions at our institution in 2016 with focus on life perspectives and priorities along with outlook or attitude and any changes in their symptoms and possible impact on their lives.
Results
The narratives shared by four brain cancer patients provided examples of loss of self-identity during illness and treatment, along with ways that NM sessions encouraged patient resilience and discovery of meaning.
Conclusions
NM sessions made visible contributions for the patients mentioned in these case studies. Understanding the patient’s story is critical for evaluating the significance of impairments due to brain cancer and treatment relative to the patient’s unique sense of self and quality of life. NM is at the nexus of clinical management and quality of life concerns for brain cancer patients. Insights from NM sessions may also help the treatment team as they assess patient needs, attitudes, and abilities.
With a record number of women reporting gambling addictions, and more and more gaming facilities being built throughout Canada, evidence-based treatment protocols need to be developed to best treat women who develop gambling addictions. This article focuses on the effectiveness of the journaling process—as a qualitative data collection approach and as a therapeutic technique—by exploring the opinions and perceptions of the women participating in a women-only problem-gambling counseling group. Results illustrate that the reflective and intellectual processes of journaling make it an effective counseling tool and research technique.
Educating secondary students with emotional and behavioral disorders (EBD) is often an overwhelming task that places high demands on teachers. Existing research on effective social-emotional/behavioral and academic interventions for students with EBD is limited but expanding. Unfortunately, school and life outcomes for these students are dismal compared to other students. Certainly, there is much to learn about achieving positive outcomes for students with EBD. This article examines the potential role that caring teacher—student relationships have in achieving better outcomes for students with EBD within their current educational contexts. A rationale for why developing caring teacher—student relationships is important to improved outcomes for students with EBD is presented based on the current literature on caring teacher—student relationships. Potential barriers are delineated, followed by a summary of practices that serve as starting points for developing caring relationships between teachers and students with EBD. Last, research implications are suggested.
The emotional benefits of pairing a brief relaxation with journaling about a stressful event were considered through an experimental design, with alexithymia included as a potential moderator. Participants (n=217) were randomly assigned to a full treatment group (n=54), relaxation-only group (n=57), journaling-only group (n=51), or control group (n=55). The results indicated an interaction, with high-alexithymic participants in the full treatment group reporting increased levels of emotional distress several days after writing. The hypothesis that preceding journaling with a relaxation would be beneficial for non-alexithymic participants was not supported. These findings contribute to the ongoing examination of how best to optimise the effectiveness of journaling. They also lend support to the importance of including alexithymia as a moderator variable in future journaling research.
A writing group can serve to reinforce literary and therapeutic goals. The model outlined here assumes a leader with literary and clinical training, including expertise in group dynamics. The group format is adapted to support exploration of the writer's main problem, the absence of the reader at the moment of writing. The group modifies the writer's "mythical" reader through member interactions with writer and writing. Giving and receiving feedback are central to the group process. The leader's dilemma in a bifocal form like this is to know when and how far to interpret group members' psychological issues. The best rule is to interpret "toward" the group (i.e., to bring up material that can be safely and readily processed there), but to be cautious about interpretation of patterns of early character formation.
A research synthesis was conducted to examine the relationship between a written emotional expression task and subsequent health. This writing task was found to lead to significantly improved health outcomes in healthy participants. Health was enhanced in 4 outcome types—reported physical health, psychological well-being, physiological functioning, and general functioning—but health behaviors were not influenced. Writing also increased immediate (pre- to postwriting) distress, which was unrelated to health outcomes. The relation between written emotional expression and health was moderated by a number of variables, including the use of college students as participants, gender, duration of the manipulation, publication status of the study, and specific writing content instructions.
The words people use in disclosing a trauma were hypothesized to predict improvements in mental and physical health in 2 studies. The first study reanalyzed data from 6 previous experiments in which language variables served as predictors of health. Results from 177 participants in previous writing studies showed that increased use of words associated with insightful and causal thinking was linked to improved physical but not mental health. Higher use of positive relative to negative emotion words was also associated with better health. An empirical measure that was derived from these data correlated with subsequent distress ratings. The second study tested these models on interview transcripts of 30 men who had lost their partners to AIDS. Cognitive change and empirical models predicted postbereavement distress at 1 year. Implications of using computer-based text analyses in the study of narratives are discussed.
Healthy Epstein-Barr virus (EBV) seropositive undergraduates (N = 57) completed a personality inventory, provided blood samples, and were randomly assigned to write or talk about stressful events, or to write about trivial events, during three weekly 20-min sessions, after which they provided a final blood sample. Individuals assigned to the verbal/stressful condition had significantly lower EBV antibody titers (suggesting better cellular immune control over the latent virus) after the intervention than those in the written/stressful group, who had significantly lower values than those in the written/trivial control group. Subjects assigned to the written/stressful condition expressed more negative emotional words than the verbal/stressful and control groups and more positive emotional words than the verbal/stressful group at each time point. The verbal/stressful group expressed more negative emotional words compared with the control group at baseline. Content analysis indicated that the verbal/stressful group achieved the greatest improvements in cognitive change, self-esteem, and adaptive coping strategies.
Can psychotherapy reduce the incidence of health problems? A general model of psychosomatics assumes that inhibiting or holding back one’s thoughts, feelings, and behaviors is associated with long-term stress and disease. Actively confronting upsetting experiences—through writing or talking—is hypothesized to reduce the negative effects of inhibition. Fifty healthy undergraduates were assigned to write about either traumatic experiences or superficial topics for 4 consecutive days. Two measures of cellular immune-system function and health center visits suggested that confronting traumatic experiences was physically beneficial. The implications for psychotherapy as a preventive treatment for health problems are discussed.
This paper is based on Pierre Janet's dissociation theory and his concept of the non-realization of a traumatic event. A model of treatment that integrates Janet's dissociation-integration theory with contemporary trauma-based models of therapy is delineated. The nature of traumatic memories is described, and a stage-oriented model for their treatment in patients with multiple personality disorder (MPD) is presented. Ideally a discrete phase in the overall treatment of MPD, this phase can itself be subdivided into the following stages: (1) preparation; (2) synthesis; and (3) realization/integration. Although a number of treatment recommendations are offered, the emphasis here is more on clarifying concepts than on the description of techniques. Multiple Personality Disorder (MPD) usually results from severe and repeated traumatization in childhood (Putnam, Guroff, Silberman, Barban, & Post, 1986; Ross, Norton, & Wozney, 1989; Schultz, Braun, & Kluft, 1989). The core pathogenic problem, i.e., the presence and disrupted impact of dissociated traumatic memories, is often independent of the form or complications of the MPD. Experienced therapists concur that this disorder cannot be completely resolved until these traumatic memories have been successfully processed. Modern clinicians working with MPD have developed effective treatment strategies to achieve this (e.g.. Fine, 1991; Putnam, 1989,1992; Ross, 1989; Steele & Colrain, 1990), but in our opinion the conceptual language in which these strategies are couched is inadequate. In two related papers, some of the authors drew attention to the uncritical use of the term "abreaction," and they argued in favor of the concept of dissociation over repression in describing and explaining the origins and maintenance of traumatic memories (Van der Hart, & Brown, 1992; Van der Hart, Steele, & Brown, manuscript in preparation). Recently,
This current review of the literature attempts to identify all published empirical evidence regarding art therapy effectiveness. The authors attempt to identify any outcome trends associated with study design (single group with no control group, controlled clinical trial, and randomized controlled clinical trial) and to review the overall literature base concerning art therapy effectiveness. The literature search identifies 17 published studies which met the authors' inclusion criteria. Results show that these three types of study designs produce very similar results regarding the positive effects of art therapy, but their conclusions may appear very different. The clarification of study design differences may lend some insight into the perceived effectiveness of art therapy.
Can psychotherapy reduce the incidence of health problems? A general model of psychosomatics assumes that inhibiting or holding back one's thoughts, feelings, and behaviors is associated with long-term stress and disease. Actively confronting upsetting experiences--through writing or talk- ing-is hypothesized to reduce the negative effects of inhibition. Fifty healthy undergraduates were assigned to write about either traumatic experiences or superficial topics for 4 consecutive days. Two measures of cellular immune-system function and health center visits suggested that confronting traumatic experiences was physically beneficial. The implications for psychotherapy as a preventive treatment for health problems are discussed. There is little doubt that psychotherapy reduces subjective distress and yields positive behavioral outcomes. In recent years, a small group of researchers has sought to learn whether psychotherapy can also reduce health problems. Two promising reviews have indicated that the use of mental health services is associated with fewer medical visits, fewer days of hospitaliza- tion, and lower overall medical costs. In a summary of 15 stud- ies published between 1965 and 1980, Mumford, Schlesinger, and Glass (1981) found that individuals who underwent psy- chotherapy evidenced a 13% decrease in medical utilization rel- ative to nonpsychotherapy control subjects. Similarly, in a re- view of 13 studies of mental health services that were intro- duced into organizations, Jones and Vischi (1980) found that psychotherapy was associated with a 20% drop in medical utili- zation.
Examined whether writing about traumatic events would influence long-term measures of health as well as short-term indicators of physiological arousal and reports of negative moods in 46 introductory psychology students. Also examined were aspects of writing about traumatic events (i.e., cognitive, affective, or both) that were most related to physiological and self-report variables. Ss wrote about either personally traumatic life events or trivial topics on 4 consecutive days. In addition to health center records, physiological measures and self-reported moods and physical symptoms were collected throughout the experiment. Findings indicate that, in general, writing about both the emotions and facts surrounding a traumatic event was associated with relatively higher blood pressure and negative moods following the essays, but fewer health center visits in the 6 mo following the experiment. It is concluded that, although findings should be considered preliminary, they bear directly on issues surrounding catharsis, self-disclosure, and a general theory of psychosomatics based on behavioral inhibition. (24 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Healthy Epstein-Barr virus (EBV) seropositive undergraduates (N = 57) completed a personality inventory, provided blood samples, and were randomly assigned to write or talk about stressful events, or to write about trivial events, during three weekly 20-min sessions, after which they provided a final blood sample. Individuals assigned to the verbal/stressful condition had significantly lower EBV antibody titers (suggesting better cellular immune control over the latent virus) after the intervention than those in the written/stressful group, who had significantly lower values than those in the written/trivial control group. Subjects assigned to the written/stressful condition expressed more negative emotional words than the verbal/stressful and control groups and more positive emotional words than the verbal/stressful group at each time point. The verbal/stressful group expressed more negative emotional words compared with the control group at baseline. Content analysis indicated that the verbal/stressful group achieved the greatest improvements in cognitive change, self-esteem, and adaptive coping strategies.
The words people use in disclosing a trauma were hypothesized to predict improvements in mental and physical health in 2 studies. The first study reanalyzed data from 6 previous experiments in which language variables served as predictors of health. Results from 177 participants in previous writing studies showed that increased use of words associated with insightful and causal thinking was linked to improved physical but not mental health. Higher use of positive relative to negative emotion words was also associated with better health. An empirical measure that was derived from these data correlated with subsequent distress ratings. The second study tested these models on interview transcripts of 30 men who had lost their partners to AIDS. Cognitive change and empirical models predicted postbereavement distress at 1 year. Implications of using computer-based text analyses in the study of narratives are discussed.
Nonpharmacological treatments with little patient cost or risk are useful supplements to pharmacotherapy in the treatment of patients with chronic illness. Research has demonstrated that writing about emotionally traumatic experiences has a surprisingly beneficial effect on symptom reports, well-being, and health care use in healthy individuals.
To determine if writing about stressful life experiences affects disease status in patients with asthma or rheumatoid arthritis using standardized quantitative outcome measures.
Randomized controlled trial conducted between October 1996 and December 1997.
Outpatient community residents drawn from private and institutional practice.
Volunteer sample of 112 patients with asthma (n = 61) or rheumatoid arthritis (n = 51) received the intervention; 107 completed the study, 58 in the asthma group and 49 in the rheumatoid arthritis group.
Patients were assigned to write either about the most stressful event of their lives (n = 71; 39 asthma, 32 rheumatoid arthritis) or about emotionally neutral topics (n = 41; 22 asthma, 19 rheumatoid arthritis) (the control intervention).
Asthma patients were evaluated with spirometry and rheumatoid arthritis patients were clinically examined by a rheumatologist. Assessments were conducted at baseline and at 2 weeks and 2 months and 4 months after writing and were done blind to experimental condition.
Of evaluable patients 4 months after treatment, asthma patients in the experimental group showed improvements in lung function (the mean percentage of predicted forced expiratory volume in 1 second [FEV1] improved from 63.9% at baseline to 76.3% at the 4-month follow-up; P<.001), whereas control group patients showed no change. Rheumatoid arthritis patients in the experimental group showed improvements in overall disease activity (a mean reduction in disease severity from 1.65 to 1.19 [28%] on a scale of 0 [asymptomatic] to 4 [very severe] at the 4-month follow-up; P=.001), whereas control group patients did not change. Combining all completing patients, 33 (47.1%) of 70 experimental patients had clinically relevant improvement, whereas 9 (24.3%) of 37 control patients had improvement (P=.001).
Patients with mild to moderately severe asthma or rheumatoid arthritis who wrote about stressful life experiences had clinically relevant changes in health status at 4 months compared with those in the control group. These gains were beyond those attributable to the standard medical care that all participants were receiving. It remains unknown whether these health improvements will persist beyond 4 months or whether this exercise will prove effective with other diseases.
Psychology students were randomly assigned to a condition in which they had to write for 20 min on 3 days or for 3 min on 1 day a factual description of disclosed traumas, undisclosed traumas, or recent social events. In the case of undisclosed traumatic events, intensive writing about these events showed a beneficial effect on affect and on the affective impact of remembering the event and appraisal. Participants who wrote briefly about an undisclosed traumatic event showed a more negative appraisal. Participants who wrote intensively about a traumatic event and had a dispositional deficit in self-disclosure, measured by a Toronto Alexithymia Scale subscale, showed a positive effect on self-reported measures of affect. Difficulty in describing feelings, an alexythimia dimension, correlated with psychological health problems, emotional inhibition, and a less introspective content of written essays about the emotional events.
The effects of two journaling interventions, one focusing on emotional expression and the other on both cognitive processing and emotional expression, were compared during 1 month of journaling about a stressful or traumatic event. One hundred twenty-two students were randomly assigned to one of three writing conditions: (a) focusing on emotions related to a trauma or stressor, (b) focusing on cognitions and emotions related to a trauma or stressor, or (c) writing factually about media events. Writers focusing on cognitions and emotions developed greater awareness of the positive benefits of the stressful event than the other two groups. This effect was apparently mediated by greater cognitive processing during writing. Writers focusing on emotions alone reported more severe illness symptoms during the study than those in other conditions. This effect appeared to be mediated by a greater focus on negative emotional expression during writing.
This study investigated the effect of alexithymia upon a person's art production. Subjects were 100 patients, 24 men and 76 women, hospitalized on an inpatient psychiatric unit. The Toronto Alexithymia Scale and 100-mm analog scales for depression and anxiety were administered. Each subject was asked to draw, then identify his/her illness. Verbatim associations were recorded. Artwork was rated as concrete, abstract, combination of the two, or symbolic. Number of colors used and presence or absence of body parts were noted. No significant correlations were found. All subjects, even those quantified as alexithymic, were able to graphically communicate their illness using these instructions. These results suggest the possibility for art therapy to contribute significantly to the multidisciplinary milieu.
Engaging people in treatment is a primary concern at a community outpatient day treatment program serving 280 adults with severe mental illness and chemical dependencies. Goals include stabilizing one's life in order to remain out of the hospital and gaining skills to live more independently. The immediate focus is directed towards monitored medications and attendance at the weekday program that provides breakfast, lunch, and a variety of educational and therapeutic groups and activities. The art therapy program consists of two weekly groups, a gallery for exhibiting client artwork, and a quarterly newsletter for sharing art and writing produced by the community. Art therapy has proven to be a strong link to treatment for many individualsand fosters stability that will pave the way to a greater sense of well-being and success in achieving greater independence. Case material from one consumer of this program is presented in the following discussion.
The emotional effects of writing about stressful experiences was studied using a quasi-experimental design in which ninety-one college students, who journaled for fifteen minutes on two occasions, were compared to 71 participants in a comparison group. Locus of control, extroversion, and previous experience with journaling were considered as moderating variables. The results indicated greater improvements in emotional health for the treatment group, with males benefiting to a greater degree than females. These findings suggest the short-term effectiveness of brief journaling interventions across the personality dimensions considered. The relevance of these findings for occupational therapists is considered.
Cancer patients who have completed medical treatment are often left with unresolved psychological issues. The need for a readjustment of self-identity is often emphasized as the core goal of therapy with this patient population. In this article, a model is presented for a 10-week group art therapy program that is currently offered to posttreatment cancer patients at Memorial Sloan-Kettering Cancer Center, New York. The general aim, the framework of the program, and the structure of each workshop are described. The response of the 70 patients who have participated in the program has been very positive. The analysis from the questionnaires completed by each patient at the end of the program indicates some key concepts have emerged.
Research has shown that traumatic stress has negative effects on overall health and well-being. Traumatic exposure has been linked to higher rates of psychological and physical health problems. Writing about trauma or stress has been shown to improve health and reduce stress, but can negatively affect mood. The purpose of this study was to examine whether art therapy is as effective as writing therapy in improving psychological and health outcomes. Participants in the writing condition, but not the art therapy condition, showed a decrease in social dysfunction. However, participants who completed artwork reported more enjoyment, were more likely to continue with the study, and were more likely to recommend the study to family and friends. Future research could combine writing and art therapy to determine whether a mixed design would both improve health and maximize participant retention.
Since the mid-1980s and throughout the 1990s a burgeoning population of adult female survivors of childhood sexual abuse has presented for treatment. This paper describes a time-limited, psychoeducational group in its 16th consecutive year of providing a safe, predictable, structured, and supportive milieu that breaks down isolation and mistrust while helping women understand the impact of abuse on their lives and empowering them to alter their victim identity. Within a 12-week format, cognitive, affective, and expressive arts approaches are used to address those aspects of current functioning most frequently impacted by abuse. This paper highlights the history, overall structure, focus for each session, and the role of art therapy in clarifying issues and mobilizing creative energies in service of personal growth.
Plant molds are common in the basaltic lavas of Hawaii. The number varies with lava structural type, being lower in distal-type aa than in pahoehoe or proximal-type aa. Plant molds prove to be very scarce on Oahu. Oahu was evidently a near-desert 3.9 to 1.8 m.y. ago when its Waianae and Koolau shield volcanoes were active. This conclusion is supported by the virtual absence of earthy soils among, and the negligible contemporaneous chemical weathering of, the shield-building flows. It is proposed that when it formed, Oahu stood 2000 m or more higher than today. It projected above the Trade Winds and hence was arid. -from Author
Although the power of writing has been widely recognized by such diverse individuals as health-care providers and poets, its use in group work has received scant attention. This article introduces interactive journal writing in which group members write not only for themselves or their leaders but also to communicate with other group members. This practice departs from the customary practice in which group members share their journals exclusively with the leader Several years of experience with this new format suggest that this adjunctive methodology complements the live group process, enhances a greater sense of community, and accelerates group cohesion. Advantages and disadvantages of interactive journaling are discussed.
This paper describes a method for using art therapy with adolescents in crisis. A model developed for the study defines four trauma stages and associated art therapy goals. They are Stage I, Impact—Creating Continuity; Stage II, Retreat—Building Therapeutic Alliance; Stage III, Acknowledgment—Overcoming Social Stigma and Isolation Through Mastery; and Stage IV, Reconstruction—Fostering Meaning. An example of the application of the paradigm is presented through a case study, including the art therapy approaches and method for assessing the artwork and art processes across the continuum of these stages. It is found that hope is experienced through art and generative processes. The author draws on research conducted on an intensive care burn unit to develop a new paradigm for understanding crisis and trauma through art therapy (Appleton, 1990).
The thesis of this paper is that principles of art and science can be successfully integrated to form a firmer and more socially responsible foundation for art therapy. Recent literature from a variety of research disciplines, the work of a number of art therapists, and the author's training in both art and science aid in developing this thesis. Preliminary guidelines for systematically incorporating a scientific perspective with art therapy are presented, and the important role research plays in constructing a combined knowledge base is emphasized. Finally, some implications for current art therapy practice are discussed, leading to fresh support for the art-as-therapy approach.
Obtained an indication of how a normal population that is going through a difficult change would draw a bridge going from one place to another. Ss were 150 normal adolescents aged 14–18. 12 variables found most helpful in the interpretation of the drawings are presented: directionality, placement of self in the picture, places drawn on either side of the bridge, solidarity of bridge attachments, emphasis by elaboration, bridge construction, type of bridge depicted, matter drawn under the bridge, vantage point of the viewer, axis of the paper, consistency of gestalt, and written associations to the drawing. Also discussed is how bridge drawing can be used to enhance communication and therapeutic change in the therapy session. (11 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The authors hypothesize that the success of verbal or written disclosure techniques hinge on the ability and willingness of people to access, express, process, and ultimately resolve negative emotional memories. Beneficial disclosure outcomes occur when people recognize and acknowledge personally stressful experiences, access and activate emotional memories of those experiences, identify and put into words their emotions, and eventually think differently about the experience. In this chapter, the authors examine whether the effects of disclosure depend on people's motivation and ability to engage in these steps. In particular, they examine theory and research on people with two types of limitations in emotional awareness and expression--people with repressive personalities and people with alexithymia (a deficit in emotional awareness and understanding). (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The present investigation was intended principally as a concurrent validation study for a new self-report symptom inventory: the SCL-90. A sample of 209 'symptomatic volunteers' served as subjects and were administered both the SCL-90 and the MMPI prior to participation in clinical therapeutic drug trials. The MMPI was scored for the Wiggins content scales and the Tryon cluster scales in addition to the standard clinical scales. Comparisons of the nine primary symptom dimensions of the SCL-90 with the set of MMPI scales reflected very high convergent validity for the SCL-90. Peak correlations were observed with like constructs on eight of the nine scales, with secondary patterns of correlations showing high interpretative consistency.
Health benefits derived from personal trauma disclosure are well established. This study examined whether disclosing emotions generated by imaginative immersion in a novel traumatic event would similarly enhance health and adjustment. College women, preselected for trauma presence, were randomly assigned to write about real traumas, imaginary traumas, or trivial events. Yoked real-trauma and imaginary-trauma participants wrote about real-trauma participants' experiences. Imaginary-trauma participants were significantly less depressed than real-trauma participants at immediate posttest, but they were similarly angry, fearful, and happy. Compared with control group participants, both trauma groups made significantly fewer illness visits at 1-month follow-up; however, real-trauma participants reported more fatigue and avoidance than did the other groups. Imaginary-trauma group effects could reflect catharsis, emotional regulation, or construction of resilient possible selves.
A research synthesis was conducted to examine the relationship between a written emotional expression task and subsequent health. This writing task was found to lead to significantly improved health outcomes in healthy participants. Health was enhanced in 4 outcome types--reported physical health, psychological well-being, physiological functioning, and general functioning--but health behaviors were not influenced. Writing also increased immediate (pre- to postwriting) distress, which was unrelated to health outcomes. The relation between written emotional expression and health was moderated by a number of variables, including the use of college students as participants, gender, duration of the manipulation, publication status of the study, and specific writing content instructions.
Inability to express emotions is common in patients with long-lasting somatic symptoms associated with incapacitation and impaired quality of life. One method for treating this inability is art psychotherapy. In this study the typical course in such treatments is described. Patients were followed longitudinally before therapy and every 4th to 6th month during the treatment.
Patients with long-lasting psychosomatic conditions resulting in partial or total loss of working capacity for at least 1 year have been treated in the programme. All of them had chronic pain. The majority of the patients that were referred to us were offered treatment. Three-fourths of those who started treatment stayed in treatment as long as the therapist considered it optimal. Twenty-four patients (22 women and 2 men) in the present study had their treatment started on average 2 years (range 13-42 months) before the end of the treatment period. In addition these 24 patients were contacted 6-48 months after the end of the therapy (average 23 months) and a short post-evaluation was made by telephone.
The first year of treatment was characterized by emotional turmoil paralleled by increased energy level reflected in temporary elevation of serum uric acid. Significant improvement was observed with regard to anxiety-depression after one year of treatment. A tendency towards decreased levels of psychosomatic symptoms in general was observed after two years of treatment. One-fourth of the 20 non-working or part-time working patients increased their working activity.
A slow partial recovery was observed. Art psychotherapy may have contributed to this.
The use of writing, alone or in conjunction with traditional psychotherapy, has increased substantially in recent years. The most widespread use of writing has been for single-shot ad hoc purposes or to log behavior. The purpose of this review is to summarize a decade of research demonstrating the efficacy of writing about past traumatic experiences on mental and physical health outcomes. It is widely acknowledged in our culture that putting upsetting experiences into words can be healthy. Research from several domains indicates that talking with friends, confiding to a therapist, praying, and even writing about one's thoughts and feelings can be physically and mentally beneficial. This review highlights advances in written disclosure that determine some therapeutic outcomes. In addition, we attempt to explore the mechanisms that predict improved psychological and physical health. Finally, limitations of previous studies are highlighted, and suggestions for future research and application are made.
Inhibiting or holding back one's thoughts, feelings, or behaviors is associated with long-term stress and disease. Actively confronting upsetting experiences can reduce the negative effects of inhibition. The present study describes a unique approach to aid individuals in dealing with psychological and emotional issues that they must often face.
Forty-one of the 81 university employees who were participating in a wellness program agreed to participate in the present study. Subjects were randomly assigned to write about either personal traumatic experiences (n = 23) or non-traumatic topics (n = 18) for 20 minutes once a week for four consecutive weeks.
Results indicate that individuals who wrote about upsetting personal experiences evidenced significant drops in selected blood measures compared to those who wrote about non-traumatic topics (e.g., for SGOT: 4.0% drop among traumatic topic group versus 13.1% increase among non-traumatic topic group, ANOVA p = .029; for SGPT: 24.5% drop versus 7.7% increase, p = .001). During the month of writing, traumatic topic group subjects evidenced a 28.6% reduction in absentee rates from work relative to the eight months before the experiment compared with a 48.5% increase in absentee rates among non-traumatic topic subjects (p = .04). Subjects low in emotional inhibition evidenced the greatest reductions in absentee rates following personal disclosure compared to those high in emotional inhibition (p = .011).
The proposed writing strategy offers a unique tool for health promotion practitioners.(ABSTRACT TRUNCATED AT 250 WORDS)
Directly and indirectly, sudden life transitions can profoundly influence people's social, family, physical, and psychological lives. One traditional goal within psychology has been to understand and develop ways by which to reduce the adverse impact of individual and collective traumas. Four major issues surrounding coping with emotional upheavals are discussed in the current paper. The first concerns the natural sequence of coping that occurs in most disasters. The second focuses on the advantages of talking about upsetting experiences and, conversely, the dangers of not talking about emotional upheavals. The third section, which has been central to our lab's approach, deals with evidence that writing about upsetting experiences is beneficial to health and well-being. The final part of the paper discusses these findings within the context of Critical Incident Stress Management (CISM) debriefing strategies.
Symptom Checklist-90-R: Administration, scoring, and procedures manual—Third Edi-tion. Minneapolis, MN: National Computer Services The SCL-90 and the MMPI: A step in validation of a new self-report scale
- L R Derogatis
- L R Derogatis
- K Rickels
- A Rock
Derogatis, L. R. (1994). Symptom Checklist-90-R: Administration, scoring, and procedures manual—Third Edi-tion. Minneapolis, MN: National Computer Services, Inc. Derogatis, L. R., Rickels, K., & Rock, A. (1976). The SCL-90 and the MMPI: A step in validation of a new self-report scale. British Journal of Psychiatry, 128, 280–289.