By Daniel Thomas, Managing Director & Neurologic Music Therapist, Chroma
Suffering a traumatic or acquired brain injury can have devastating physical, mental and emotional impacts upon the individual. Physical rehabilitation through physiotherapy, speech and language, occupational therapy and neurologic music therapy can all help improve quality of life by improving functional skills and abilities (to the extent for that individual) but, the case remains for improving their mental and emotional function.
Acceptance of their post-injury situation and medical condition is difficult, so it is here that arts therapies interventions can play a huge part in rehabilitation following a brain injury.
Investigating the effects of art therapy in rebuilding self-identity following a Traumatic Brain Injury (TBI), Di Vita, 2020, observed ‘an increased ability to adapt to the experiences of life as well as a higher level of awareness, social functioning and emotional autoregulation…patients exhibited a reduction in depressive symptoms and in the perception of physical problems.’1
Di Vita surmised that results highlighted the importance of treatments focusing on the patients’ emotional needs, in addition to the classic rehabilitation (i.e. physiotherapy, cognitive therapy).
In terms of rebuilding self-identity, the process of mask making can provide an effective medium in helping patients express their emotions regarding their condition, how they now see themselves and how they feel the world now sees them. This process provides a voice for the patient, allowing them to express their thoughts without saying a word. Art therapy helps to unlock emotions and to begin rebuilding self-identity.
Studies have found the arts therapies to be effective in helping TBI patients with emotional expression, socialisation, emotional adaptation to mental and physical disabilities, and communication in a creative and non-threatening way.2
In effect, arts therapies enables the individual to externalise their inner thoughts and feelings, as a result of a process which externalises what is happening internally for the individual.
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Chroma is the UK’s leading national provider of arts therapies services for neurorehabilitation clients and settings. We provide neurologic music therapy, dramatherapy and art psychotherapy and are commissioned by many of the leading case management and medico-legal organisations, via single case instruction.
We help people of all ages and at all stages of neurological rehabilitation as a result of an ABI/TBI, stroke, dementia including the emotional and social problems associated with a brain injury.
Mask making as an art therapy intervention has proved an effective medium for cases such as these (rebuilding self-identity) as it represents the face. The face is the one part of the body where one can choose to hide or show feelings. Emotional masking exists and can have detrimental effects upon emotional wellbeing if not addressed.
More girls than boys use emotional masking according to Davis (1995)3 and Garside and Kllimes-Dougan (2002)4, which may demonstrate the decisions children often make to fit it with peers, and the possible emotional strain this has upon them.
Based on such findings, it’s clear how society sees us is fundamental from an early age, so is no wonder significant physical changes caused by a brain injury would require addressing and a process of adaptation begun.
Mask making allows participants to reveal thoughts and feelings about themselves which they may find hard to express, or may not have even been aware of, and which may be being expressed through more difficult behaviours. They also create an opportunity for greater communication, allowing therapists to gain a deeper understanding of the client’s thoughts, anxieties and feelings.
Mask making can take on many forms. For children who have anxiety issues, superheroes tend to be the creative pathway of choice as it allows the child to feel powerful in a powerless situation. The powers they choose to depict also offer a great way of communicating deeper thoughts and feelings.
Communication through the arts therapies can help strengthen personal bonds. This is an essential aspect of rehabilitation for those living with a brain injury as its effects can change a person’s personality which can cause breakdowns within family/friends relationships.5,6 Helping the individual understand their own thoughts and feelings can help them open up to loved ones, which can help promote feelings of closeness once again.
Mask making as an intervention is effective is helping adjust a patient’s outlook towards their condition. The result can be to create a more accepting perspective on the reality of their condition, which then may become more bearable, somewhat freeing them from negative thoughts surrounding their injury. Being able to express themselves creatively helps the individual reveal their true feelings which in itself can be cathartic – a relief to release their emotions, in a personal, safe space.
Mask making essentially helps the patient externalise and explore their emotions in a fun, safe and creative way. Art as therapy provides a non-verbal creative outlet to freely express emotions. In fact, art can be the voice they truly need and one which therapists can use to try and help them process their emotions and ultimately feel confident to communicate (as much as their injury will allow) with family and friends.
Studies show art therapy has a positive impact upon chronic stroke survivors’ mental wellbeing, psychosocial outcomes, cognitive function as well as improving their quality of life (QOL).7,8,9
Sun-Hyun Kim 2011 noted ‘10 weeks of art therapy conducted twice a week, resulting in improvements in the patient’s emotions and cognition. The patient’s artwork provides an especially valuable opportunity for tracking improvements in cognition not easily detected in standard rehabilitation therapy’.7
Following a brain injury such as a Stroke, art therapy is a particularly useful tool in enabling the survivor to express themselves whilst providing the therapist with a basis of which to start helping them address their emotions. The emotional impact of living with a brain injury, affects not only that individual, but family and friends too. Creating art has a somewhat cathartic effect that can help the victim open up and let loved ones in.
In terms of PTSD and TBI in the military, Jones 2018 concluded ‘The art therapy journey serves as an agent of change, during which service members establish a new sense of self as creator rather than destroyer, as productive and efficacious instead of broken, as connected to others as opposed to isolated, and in control of their future, not controlled by their past.’ 10
This offers a clear depiction of how art therapy can in fact help transform one’s own self-perception and change a negative mind set to that of a positive resulting in enhanced mental wellbeing with improvements in personal relationships. This positive outlook will serve to enhance their QOL and mental wellbeing.
References
1 Journal of Health Psychology. Psychotherapy and Art Therapy: A pilot study of group treatment for patients with traumatic brain injury. Antonella Di Vita, Mario Augusto Procacci, Martina Bellagamba, Maria Jacomini, Roberta Massicci, Maria Paola Ciurli. First Published November 2, 2020 https://doi.org/10.1177/1359105320967099
2 Barker & Brunk, 1991; Dodd, 1975; Lazarus-Leff, 1998). Kline (2016)
3 Davis, T. L. (1995). Gender differences in masking negative emotions: Ability or motivation? Developmental Psychology, 31(4), 660–667
4 Garside, R. B., & Klimes-Dougan, B. (2002). Socialization of discrete negative emotions: Gender differences and links with psychological distress. Sex Roles: A Journal of Research, 47(3-4), 115–128
5 The Journal of Neuropsychiatry and Clinical Neurosciences. The Phenomenology of Personality Change Due to Traumatic Brain Injury in Children and Adolescents. Jeffrey Edwin Max, M.B.B.Ch., Brigitte Anna Marie Robertson, M.D., and Amy E. Lansing, Ph.D. 2001
6 Personality and Behavior Changes Subsequent to Traumatic Brain Injury: A Review of the Literature. Sarah McKay. April 2015. International Journal of Emergency Mental Health 17(2):469-474. DOI: 10.4172/1522-4821.1000196
7 Journal of the American Art Therapy Association, Volume 25, 2008 – Issue 3: Special Issue on Art Therapy in Palliative Care. Art Therapy Outcomes in the Rehabilitation Treatment of a Stroke Patient: A Case Report. Sun-Hyun Kim , Min-Young Kim , Jae-Hyuk Lee & Sae-il Chun. Pages 129-133 | Published online: 22 Apr 2011
8 Disability and Rehabilitation Volume 33, 2011 – Issue 22-23. Art after stroke: the qualitative experience of community dwelling stroke survivors in a group art programme. Kerry Beesley, Jennifer Helen White, Megan K. Alston, Anne L. Sweetapple & Michael Pollack. Pages 2346-2355 | Accepted 01 Mar 2011, Published online: 18 Apr 2011
9 Disability and Rehabilitation Volume 38, 2016 – Issue 7. Social context, art making processes and creative output: a qualitative study exploring how psychosocial benefits of art participation during stroke rehabilitation occur. Jacqui Morris, Madalina Toma, Chris Kelly, Sara Joice, Thilo Kroll, Gillian Mead & Brian Williams. Pages 661-672 | Received 12 Dec 2014, Accepted 22 May 2015, Published online: 18 Jun 2015
10 Jacqueline P. Jones, Melissa S. Walker, Jessica Masino Drass & Girija Kaimal(2018) Art therapy interventions for active duty military service members with post-traumatic stress disorder and traumatic brain injury, International Journal of Art Therapy, 23:2, 70-85, DOI:10.1080/17454832.2017.1388263
11 Journal of Health Psychology. Psychotherapy and Art Therapy: A pilot study of group treatment for patients with traumatic brain injury. Antonella Di Vita, Mario Augusto Procacci, Martina Bellagamba, Maria Jacomini, Roberta Massicci, Maria Paola Ciurli. First Published November 2, 2020 https://doi.org/10.1177/1359105320967099
