Art Therapy + CBT Treats Panic Disorder--Maybe
Does art plus cognitive behavioral therapy help us tame anxiety?
Posted August 31, 2014
Recently, the website Anxiety.org News announced that, “Art Help Treat Anxiety in Panic Disorder with Agoraphobia.” Because I am a strong believer in the self-regulating possibilities of art-based intervention, I am always excited to see a headline like this. It also makes good sense that pairing art therapy with a proven strategy for anxiety-related challenges like cognitive-behavioral therapy (CBT) (Malchiodi & Loth Rozum, 2012) could result in a form of effective treatment for panic disorder and generalized anxiety disorder.
Okay, before those of us who believe in the capacity of art therapy to support positive change get too excited, Anxiety.org News appears to have jumped the fence a bit in its bold headline. In brief, the article (Morris, 2014) cited refers to two case studies with participants including one who was diagnosed with panic disorder with agoraphobia (PAD) and the other with generalized anxiety disorder (GAD). A seven-session program (based on Marchand, 2007) was designed to include CBT principles such as psychoeducation, breathing training, cognitive restructuring, exposure and other accepted strategies. “Art-based therapy” was designed to complement these approaches and to address the participants’ symptoms. Using an A-B, single subject design, in the case of the participant with PAD, results indicated statistically significant reductions lower levels of panic frequency. In the case of the participant with GAD, the decrease in general anxiety was marginally significant.
So with a sample size so limited, why even discuss these findings? I believe this study is worthy of discussion for several reasons. First, one of art therapy’s strongest potentials is in the area of self-regulation and affect regulation. It is known from repeated studies involving stress reduction and repeated reports from participants in art therapy that there is a self-regulating impact achieved through specific art making experiences. Additionally, studies involving a combination of interventions such as mindfulness and art therapy (Monti et al, 2006) support the idea that combining art-based therapy with other approaches may be make a good thing more effective. For example, research on mindfulness-based art therapy underscores that it may reduce perceptions of fatigue and increase a sense of quality of life, two aspects relevant to an individual’s ability to self-regulate.
Perhaps these sample-limited research findings highlight two other important aspects. Art therapy research continues to be a challenge to the field, with limited participants and randomized clinical trials; fortunately, the author of this current study has published the procedures used in the course of treatment, thereby making this study replicable by other researchers. Finally, on a practitioner level, I was reminded that what often makes what can be a rather dry intervention like CBT more palatable is the value-added aspect of creative self-expression. Anecdotally, I can say that it is a lot easier to get the individuals I see in therapy to comply with their “CBT homework” if I infuse some relevant art making or visual journaling into the mix. In essence, art therapy not only helps people challenged by anxiety express their experiences, but it also supports the sensory-based understanding of how both the mind and body respond to stress. To quote Carl Jung (with my additions), “The hands (creative process of art making) will often solve the mystery that the intellect (cognition) has struggled with in vain.”
Make art and stay calm,
Cathy Malchiodi, PhD
© 2014 Cathy A. Malchiodi
Visit my website at www.cathymalchiodi.com.
For more information on Trauma-Informed Art Therapy and Trauma-Informed Expressive Arts Therapy, visit the Trauma-Informed Practices and Expressive Arts Therapy Institute at www.trauma-informedpractice.com.
Malchiodi, C. A., & Loth Rozum, A. (2012). Cognitive-behavioral and mind-body approaches. In C. Malchiodi (Ed.), Handbook of Art Therapy (pp. 89- 102). New York: Guilford Publications.
Marchand, A. et al. (2007). Effectiveness of a brief cognitive behavioral therapy for panic disorder with agoraphobia and impact of partner involvement. Behavioral and Cognitive Psychotherapy, 35 (5), 613-629.
Morris, F. (2014). Should art be integrated into cognitive behavioral therapy for anxiety disorders? The Arts in Psychotherapy, 41 (4), 343-352.
Monti, D. et al (2006). A randomized control trial of mindfulness-based art therapy program for women with cancer. Psycho-Oncology 15, 363–373.