Creative Expression as Therapy for TBI: A case for art-based interventions

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.

Aaron* is a composite of clients I've worked with, and represents my observations of male clients, ranging in age from 35 - 65, over several years. There's lots of information missing. Firstly, TBI has never been a primary diagnosis of any client I've worked with, but all clients used for this composite reported experiencing multiple head traumas during their intake assessments. Second, all the clients presented with at least 3 co-occurring conditions, symptoms of which I have attempted to broadly suggest under 'significant barriers'.

Aaron participated in a Cognitive Behavioural Group Therapy programme designed to support individuals with mood and anxiety disorders. He faced significant barriers to participation: persistent tiredness, impaired concentration, emotion regulation difficulties, anger management, and working memory difficulties that left him frustrated during the sessions. However, something surprising (or perhaps not!) happened when he participated in creative expression activities. Aaron's posture visibly relaxed, and he stayed engaged and focused until he'd completed the activity. For the first time in weeks, he was able to articulate his emotions—this time directed through his artwork—without the visible distress and difficulties he was usually observed to experience when trying to express himself verbally.

My reading on the topic indicates Aaron’s experience reflects a key principle in therapeutic design for brain recovery: the power of nonverbal, process-focused activities.

Research and my observations suggest several reasons why creative expression might have been effective for Aaron:

Reduced Cognitive Load

Art-making taps into those areas of the brain associated with sensory processing and spatial awareness, rather than the prefrontal cortex, which governs higher-order thinking. For someone with TBI, this can be a relief. The act of drawing allowed Aaron to bypass the verbal and analytical processes that seemed so draining for him.

Emotional Safety

Talking about emotions, especially in the context of a group, can trigger anxiety or frustration for those with TBI. Art offers a less confrontational medium for expressing emotions. The focus on the drawing allowed Aaron to process and communicate his feelings indirectly, which helped him avoid becoming overwhelmed.

Improved Focus Through Structure

The structured task of creating something tangible (like a drawing) gave Aaron a clear focus, reducing the mental scatter that often accompanies working memory challenges. Instead of juggling abstract concepts, he was able to channel his attention into the present moment.

Engagement of the Reward System

Completing an art activity offers a sense of accomplishment, boosting mood. For Aaron, this might have contributed to his ability to reflect on his work and share his experience with less obvious distress.

Quiet!

The therapy space became very quiet during the art activities as the participants focussed on their individual tasks and I wonder if this sensory modulation removed excess stimuli and lowered stress, thereby supporting improved focus and attention.

Aaron’s story underscores the importance of tailoring therapy to the individual, particularly in cases of TBI where cognitive and emotional resilience are often stretched thin. While CBT remains a valuable framework, integrating creative therapies into group settings can offer a complementary pathway for healing—one that acknowledges the unique challenges of brain injury recovery.

These therapy observations raise more questions for me: how can we more effectively integrate creative modalities into traditional therapeutic frameworks for brain recovery? For those with TBI in Australia, is art therapy being under-utilised as a tool for emotional processing and focus training?

I’d love to explore this topic further if anyone has any ideas for a collaboration let me know ...

I'm also keen to hear your thoughts on Aaron's experience and my observations - I am in no way a TBI SME so if you are and I'm a little/a lot off let me know!

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
Subiaco | Mullaloo | Outdoors | Online
Evidence-based therapy for adults seeking clarity, resilience, and renewal