© Circa 2001; "Stress in the Boardroom," doodlings by Cathy Malchiodi, PhD
Source: © Circa 2001; "Stress in the Boardroom," doodlings by Cathy Malchiodi, PhD

A recently published pilot study (Kaimal, Ray & Muniz, 2016) proposes that adults may experience a measurable reduction in their cortisol levels after a 45-minute art making session. Cortisol is often defined as a “stress hormone” that is correlated with levels of stress in the body and what is commonly known as the fight-or-flight response to threatening or dangerous events. The current study involved 39 adults, ages 18 to 59, who were asked to make art of any type using a choice of collage materials, modeling clay and/or felt marking pens. The participants’ saliva was tested before and after to evaluate cortisol levels and they were also asked to complete pre- and post-questionnaires to generate additional data on their experiences.

In brief, the study reports that nearly 75% of the participants had lower cortisol levels after art making than at the start of the session. For the remaining participants, cortisol levels remained about the same or were elevated. Prior experience did not seem to matter in the outcome—in other words, it may be possible to experience a reduction in stress despite any knowledge of art materials or processes. Future more comprehensive studies that include a control group (in this particular study, there was no control group) for comparison will likely help tease out additional data on these initially positive results.

This current pilot study and similar investigations of art-based protocols focus on the collection of what are called “biomarkers” or physiological measures of participants. About these measures and art therapy research, Warson and Lorance (2012) note: “The field of art therapy is rich with opportunities for research that can enhance and validate what is already common knowledge to most art therapists and their clients: that art is life enhancing. What is not know is that the act of making art can have a positive impact on physiology. This type of research involves the collection of ‘biomarkers’” (p. 363). In addition to cortisol, Warson and Lorance underscore the roles of the nervous, endocrine, and immune systems in stress and within their own research efforts on stress reduction and art activity. In brief, their pilot study examines the effects of coloring a mandala (circle) and working a maze puzzle (control group task) and measurements of cortisol, salivary alpha-amylase (SAM), IgA (immune response) and a standard anxiety inventory. Preliminary results support the idea that coloring the mandala design decreased SAM and increased immunity, and also that a variety of factors impact variations in cortisol levels.

If art therapy is indeed defined as a “relational” approach in which the helping professional plays an important role in facilitating change, then just what is the role of art therapy in stress reduction and changes in physiological measures of stress? One cortisol study does provide some emerging data on the impact of art therapy versus simply “art making” on stress reduction. Latvian researcher Dace Visnola and her colleagues (2010) investigated a specific art therapy protocol that examines not only cortisol levels, but also the perception of stress and reportable physical changes over time, demonstrating the complexities of stress reduction in clinical practice. The researchers devised art therapy sessions designed to reduce stress that included the role of the art therapist; they also employed specific interventions to facilitate change, self-concept, emotional expression and self-perception and thus sought to measure how stress levels are influenced by both art-based approaches and the therapeutic relationship (see References at the end of this article to access a PDF of their study).

While art therapists generally agree that the creative process of art making is life enhancing, the existing research efforts on art making and cortisol evoke a number of questions for this belief within the field. First, physiological measurements of stress include more than cortisol levels; also, while cortisol levels are fairly easy to obtain, it is not a “one sample only” procedure in order to demonstrate identifiable effects of any intervention. Secondly, art therapy is not just about “chilling out” (aka reducing stress or improving self-regulation) through art activity; that goal is achievable through many other avenues including activity therapy, recreation therapy, occupational therapy, rehabilitation, and even self-directed art making experiences. In contrast, art therapy as an approach challenges people to grow within their “windows of tolerance.” Art therapists, like most psychotherapists, offer what can often be modestly stressful experiences and strategic art-based approaches within the windows of individual tolerance; a little stress is often necessary for all of us in order to learn and achieve goals of behavioral change, emotional repair and resolution, personal and interpersonal growth, resilience and self-efficacy.

Finally, it is exciting to see the cumulative and emergent data that further the understanding of the impact of art making on stress. Perhaps the latest research in this area will inspire additional studies, identifying the distinct role of art making per se versus the practice of art therapy in facilitating health, including stress reduction and physiological measures of well-being. I believe that there are differences and that we can all look forward to deciphering what exactly those differences are in order to develop more effective art psychotherapeutic approaches in the future. 

Be well,

Cathy Malchiodi, PhD

© 2016 Cathy Malchiodi, PhD

References

Kaimal, G., Ray, K. & Muniz, J (2016) Reduction of cortisol levels and participants' responses following art making, Art Therapy, 33, 2, 74-80, DOI:10.1080/07421656.2016.1166832.

Visnola, D.,Sprudza, D., Baíe, M. A., & Piíe, A.  (2010). Effects of art therapy on stress and anxiety of employees. Proceedings of the Latvian Academy of Sciences, Section B, 64, No.1/2 (666/667), pp. 85–91, DOI: 10.2478/v10046-010-0020-y. Also found as a downloadable document at Research Gate: https://www.researchgate.net/publication/259980104_Effects_of_art_therapy_on_stress_and_anxiety_of_employees.

Warson, E. A., & Lorance, J. (2013). Physiological measures in evidence-based art therapy research. In C. Malchiodi (Ed.), Art Therapy and Health Care (pp. 363- 375). New York: Guilford Publications.

Download a sample chapter from Art Therapy and Health Care here, via Guilford Publications.

Visit the Trauma-Informed Practices and Expressive Arts Therapy Institute for more information about expressive arts therapy with children, adults and families and educational offerings on trauma-informed expressive arts therapy for mental healthprofessionals and students around the world.

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