Creative Expression as Therapy for TBI
December 18, 2024
When recovering from a traumatic brain injury (TBI) Cognitive Behavioural Therapy (CBT) is the mostly widely used intervention, but for some people, talk therapy can feel overwhelming, especially when cognitive fatigue, memory challenges, and emotional frustration are part of the picture. Could creative expression help?
To explore this I thought I'd share a case study.
This case study draws from a composite of male clients I’ve worked with over several years, ranging in age from 35 to 65. While none of these individuals had traumatic brain injury (TBI) as a primary diagnosis, each reported multiple head traumas during their intake assessments. All presented with at least three co-occurring conditions, which manifested as persistent tiredness, impaired concentration, emotional regulation difficulties, anger management issues, and working memory challenges. These combined barriers consistently affected their engagement in therapy.
Participants were enrolled in a Cognitive Behavioural Group Therapy (CBGT) program designed to support individuals experiencing mood and anxiety disorders. Despite the structure and intent of the program, many found it difficult to participate fully due to their cognitive and emotional challenges.
However, a noticeable shift occurred during creative expression activities. Participants’ postures would visibly relax, and they remained engaged and focused for extended periods something not typically observed during other group exercises. For some, it was the first time in weeks they were able to articulate complex emotions, doing so not verbally, but through artwork. These expressions were often accompanied by less distress and greater clarity than verbal attempts in previous sessions.
Why Did Creative Expression Work?
My clinical observations, supported by literature on therapeutic design for brain recovery, point to several key factors that may explain the effectiveness of these nonverbal, process-focused activities:
1. Reduced Cognitive Load
Art-making activates regions of the brain involved in sensory processing and spatial awareness, allowing participants to bypass the heavily taxed prefrontal cortex. For those managing cognitive fatigue, this shift offers a welcome reprieve. The act of creating becomes a low-barrier form of engagement that doesn't rely on verbal or analytical processing.
2. Emotional Safety
In group settings, verbal discussion of emotions can trigger anxiety or dysregulation. Creative expression offers a safer, less confrontational outlet. The focus on a task rather than direct emotional disclosure allows participants to process feelings in a more manageable way.
3. Improved Focus Through Structure
The clear, tangible nature of a creative task seemed to reduce the mental scatter associated with working memory difficulties. Participants could anchor their attention in the present, immersed in a task with a defined beginning and end.
4. Activation of the Reward System
Completing an artwork offered a sense of achievement. This emotional reward, however subtle, appeared to boost mood and supported the participants’ willingness to reflect and share without becoming overwhelmed.
5. A Calmer Environment
Sessions became noticeably quieter during art activities. This drop in ambient noise and stimuli may have further supported focus and reduced stress, acting as a form of informal sensory modulation.
These collective observations raise important considerations for the design of therapeutic interventions particularly for individuals with a history of head trauma. While CBT remains a powerful tool for cognitive and emotional work, the integration of creative modalities may provide a vital bridge for participants who struggle with traditional, language-based methods.
This experience leaves me asking:
How can we more effectively integrate creative practices into evidence-based therapy programs for cognitive and emotional recovery?
In the Australian context, is art therapy being under-utilised for individuals with TBI or similar profiles?
And what would it take to make such interventions a routine part of therapeutic care?
Some of my readings:
Berberian, M., Walker, M. S., & Kaimal, G. (2019). ‘Master My Demons’: art therapy montage paintings by active-duty military service members with traumatic brain injury and post-traumatic stress. Medical humanities, 45(4), 353-360.
Campbell, M., Decker, K. P., Kruk, K., & Deaver, S. P. (2016). Art therapy and cognitive processing therapy for combat-related PTSD: A randomized controlled trial. Art therapy, 33(4), 169-177.
Malhotra, B., Jones, L. C., Spooner, H., Levy, C., Kaimal, G., & Williamson, J. B. (2024). A conceptual framework for a neurophysiological basis of art therapy for PTSD. Frontiers in human neuroscience, 18, 1351757.
Walker, M. S., Stamper, A. M., Nathan, D. E., & Riedy, G. (2018). Art therapy and underlying fMRI brain patterns in military TBI: A case series. International Journal of Art Therapy, 23(4), 180-187.
Wolf, D. R., & Rattigan, M. D. (2024). Art therapy and brain injury: making the invisible visible. Frontiers in Psychology, 15, 1489813.
Michelle Saleeba Psychology
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