Abstract
Art therapy is an effective method of treating behavioral and psychological issues in individuals with dementia and Alzheimer's disease, and has been tested amongst patients as early as the 1980s. Although similar benefits have been seen in populations of people who are not at risk for this disease, studies have shown art therapy to be effective at lowering levels of depression, improving social skills, supplementing verbal communication, enhancing quality of life, and maintaining fine motor skills in participants with dementia and Alzheimer's disease. Additionally, some research has suggested that art therapy may play a role in improving cognition, delaying neuronal decay, and inspiring autobiographical memories, though further research is needed to support these arguments. This chapter will dissect the many studies that suggest various cognitive and psychological benefits, analyze current interventions, examine art's role in a therapeutic setting, and advocate for future studies.
TopIntroduction
Art therapy is a term used to encapsulate the practice of utilizing artistic mediums as a form of treatment in a therapeutic setting. Clinicians certified by the state who have acquired their LCAT (Licensed Creative Arts Therapist) use structured approaches backed by the American Art Therapy Association (AATA) and the Art Therapy Credentials Board Inc. (ATCB) to create art in a clinical setting that engages “the mind, body, and spirit in ways that are distinct from verbal articulation alone” (AATA). The field continues to grow as studies examine the correlation between artistic creation and improved behaviors, providing an increasingly solid basis of research and data to support its effectiveness. The present chapter will focus on the applications and known benefits of art therapy on the symptoms of dementia and Alzheimer's disease, highlighting both neurological and psychological improvements the therapy promotes. Furthermore, the current treatments and early interventions used to combat symptoms of dementia and cognitive decay will be discussed and cross-referenced to analyze effectiveness in conjunction with art therapy and promote further research.
Art as Therapy
The term was first coined in 1942 by World War I artist Adrian Hill, who noted the benefits of creating art while convalescing during his hospitalization for tuberculosis. The practice began to spread in hospitals worldwide following the influential works and findings of Edward Adamson, Margaret Naumburg, and Edith Kramer, respectively. Art therapy has historically been used alongside medicinal and behavioral therapies to treat “development, medical, educational, social, or psychological impairment(s)” (ATCB) and was first used with dementia patients in the 1980s-1990s by practitioner Judith Wald. Wald noted that the artwork created by patients with dementia appeared broken and repetitious, featuring fragmented lines, confused perspectives, and a lack of detail (Wald, 1986, pp. 74-80). Over time, further studies confirmed effectiveness through signs of improved moods, enhanced memory, and decreased symptoms amongst dementia patients utilizing pencil drawing, collage making, and cutting shapes as a form of art therapy (Kahn-Denis, 1997, pp. 194-199). These breakthrough studies launched further research into the application of art therapy as a form of treatment and symptom relief for dementia and Alzheimer's disease throughout the 1990s and 2000s.
Within the past two decades, Art Therapy has become a staple of therapeutic communities worldwide, with at least thirty separate associations and organizations representing the practice across twenty-six countries, including South Africa, Hong Kong, Korea, Israel, The United States, Germany, France, Ireland, Canada, Brazil, and more. The use of the therapy alongside clinical treatments has also increased, gaining notability for use with pediatric (Aguilar, 2017; Clapp, Taylor, Folco, Mackinnon, 2018) and geriatric patients (Shore, 2013; Ciasca, Ferreira, Santana, Forlenza, Santos, Brum, Nunes, 2018). However, setbacks for the field are still present. Much of the public remains ill-informed on the legitimacy of the practice as a genuine form of psychotherapy rather than an exercise for stress relief. This misconception has been aided by the rapid growth of “fake” art therapists over the years who host workshops, sell products, and offer services with no legitimate certifications or “knowledge of both art and therapy (which) are necessary to the art therapist” (Rubin, 1982, pp. 57-58). Though it was Edith Kramer's belief that “all art is therapeutic in the broadest sense of the word” (Kramer, 2001, p. 17), the misrepresentation of the field as a commercial entity diminishes the value and effectiveness of the therapy and misses the “opportunity to offer accurate information and educate the public” (AATA). The continued presence of this issue emphasizes the critical distinction between art as therapy, or a cathartic method of stress relief, and art therapy as a form of psychotherapy, backed by studies collecting empirical data and research (Slayton, D’Archer, Kaplan, 2010). Furthermore, it highlights the continued importance of defining and specifying what art therapy is and is not. For the sake of the present chapter, all references to art therapy are intended to align with the definitions and standards set by professional and educational associations such as AATA and ATCB.
Key Terms in this Chapter
Vascular systems: Circulatory systems composed of vessels that carry blood and lymph fluid throughout the body.
Chronic inflammation: Long-term and long-lasting inflammation.
Action potentials: The sending of information down the axon to trigger an impulse.
Milieu: An individual’s social environment.
Cognitive Reserve: The capacity for retaining information and resisting damage to the brain.
Structural plasticity: The ability of neural networks to change through growth and reorganization as a result of learning.
Synapses: The gap between two neurons across which impulses are transmitted.
American Art Therapy Association (AATA): An organization dedicated to growing and developing the profession of art therapy.
Visual-spatial abilities: The ability to decipher where objects are in space.
Right cerebral hemisphere: The right half of the cerebellum which controls muscles on the left side of the body.
Empirical data/research: Data and research based on verifiable observation rather than theory.
Art Therapy Credentials Board Inc. (ATCB): An agency ensuring the ethical practice of art therapy through credentialing.
Convalescing: Recovering strength and health over the course of an illness.
Entorhinal cortex: A component of the hippocampal formation that acts as a gateway for incoming and outgoing information.
TAU: A protein involved in stabilizing the internal structure of neurons.
Ulman Personality Assessment Procedure (UPAP): A historical art therapy assessment based on experimental directives that consists of 4 drawings completed in one session.
Microglia: Immune cells in the central nervous system that combat brain infections and inflammation.
Apathy: The loss of interest or concern.
LCAT (Licensed Creative Arts Therapist): The license that creative art therapists pursue.
Efficacy: The ability to produce a desired outcome.
Neurodegenerative disorder: A type of disease in which immune cells in the central nervous system die or stop working.
Cholinesterase Inhibitors: Chemicals that decrease the breakdown of neurotransmitters.
Compensatory strategies: Techniques used to complete tasks in an alternative manner.
Neurogenesis: The growth of nervous tissue from neural stem cells in the adult brain.
Geriatric: Relating to the elderly, especially relevant in healthcare.
Neurons: A brain cell that transmits nerve impulses.
Center for Medicare & Medicaid Services (CMS): A division of the Department of Health and Human Services that oversees the medicare and medicaid services.
Cognition: The acquisition of knowledge and understanding through thought and experience.
Cerebral Cortex: The outermost layer of the brain responsible for higher level processing.
Beta-amyloids: A protein that is normally responsible for neuronal growth and repair, however when corrupted can lead to dementia.
Levick Emotional & Cognitive Art Therapy Evaluation & Assessment (LECATA): An assessment developed to evaluate the therapeutic needs of children on the spectrum.
Directives: A statement or command made by a therapist that specifies or suggests an action the client should perform.
Corporeal memory: The hypothesis that the body is capable of storing memories.
Prodromal: The period between the first appearance of symptoms and full development of a disease or illness.
Neuronal decay: The death of neurons.
Hippocampus: A highly plastic and malleable brain structure located in the temporal lobe responsible for learning and memory.
Interventions: An action intended to interfere with or alter the course of a pathological process.
Temporal Lobe: A pair of lobes located beneath the temples concerned with the understanding of speech.
Proteinopathies: The abnormal aggregation of proteins within neurons.
Astrocytes: A glial cell that regulates blood flow and transfers mitochondria to neurons.