Expressive Therapies Continuum Research Articles

The expressive therapies continuum and mentalization-based art therapy for individuals diagnosed with a cluster B/C personality disorder: A successful marriage!

The Expressive Therapies Continuum (ETC) is increasingly used in various art therapy practices, including Mentalization-Based Art Therapy. However, there is little empirical evidence about the mechanisms of change and therapeutic factors of the ETC. In this study, ten respondents were interviewed to explore whether patients with a cluster B or C personality disorder consider psychoeducation about the ETC beneficial to their mentalizing capacity. The Grounded Theory Approach was applied to collect and analyse data, main categories were formed from the data and merged into a theory. According to the respondents, knowledge about the structure offered by the ETC contributed to increasing insight, providing alternative options, improving emotion regulation and increasing autonomy. This study is an exploration of the mechanisms of change and therapeutic factors of the ETC used as psychoeducational theoretical framework. Given the size and the evidential value of this study, further research is recommended.

Brain activation in response to art-based tasks using diverse materials based on the Expressive Therapy Continuum (ETC)

This study investigated the relationship between art creation and brain function using functional near-infrared spectroscopy (fNIRS) via a portable NIRSIT device, focusing on the frontal lobe’s oxygen saturation changes during art activities. Authorized by the Institutional Review Board of Seoul Women’s University, the research involved 26 healthy participants aged 20 to 29, without prior mental, medical, or substance use issues. They engaged in four art tasks, separated by rest periods, to monitor pre- and post-task brain activity through fNIRS scans.The research unfolded in two phases: initially, it analyzed brain activity based on the Expressive Therapies Continuum (ETC) framework, comparing different art mediums; next, it then examined differences between drawing on paper and on a digital tablet.Findings indicated unique activation patterns in various brain regions—including the Ventrolateral Prefrontal Cortex (VLPFC), Orbitofrontal Cortex (OFC), Dorsolateral Prefrontal Cortexes (DLPFC), and the parietal cortex—highlighting a notable increase in the Left Frontopolar and Orbitofrontal Cortexes during paper drawing compared to tablet drawing. These results provide insights into how different art mediums influence neural activation, particularly showing enhanced activity in regions linked to empathy and feedback in paper-based tasks. It clearly suggests that different art materials significantly influence varying brain region activation, highlighting the importance of art medium and art-making in art therapy in enhancing cognitive and emotional functions.By examining changes in frontal lobe oxygen saturation via diverse art activities grounded in the ETC framework, this study contributes to understanding art therapy’s neurological impact on cognitive and emotional functions. It offers evidence-based guidance for art therapists on selecting materials that meet therapeutic objectives. The study’s limitations include a small sample size that may affect the generalizability of the findings and the exclusive use of NIRSIT focusing on the frontal cortex, potentially neglecting the involvement of other brain regions like the temporal and parietal cortexes in art activities. Future research should therefore consider expanding the sample size and employing comprehensive neuroimaging techniques.

The Role of the Expressive Therapies Continuum in Human Creativity in the Age of AI

Art generated by artificial intelligence (AI) programs resembling human creative outputs profoundly challenges cultural, social, and psychological conceptions of creativity and its value. Defining creativity within the psychological literature amid the rise of AI poses limitations and highlights the significance of the Expressive Therapies Continuum (ETC). The ETC theory provides a model for understanding the unique nature of human creativity because it includes bodily based, emotional, and cognitive influences on creativity alongside social, cultural, and relational experiences. Understanding the limitations, risks, and benefits of AI applications can help art therapists explore this new medium in ethical and therapeutic ways. Therefore, an opportunity emerges for art therapy to incorporate both AI and the ETC to produce effective and creative interventions.

IMPROVING COGNITIVE DECLINE FOR PERSONS LIVING WITH DEMENTIA: A RCT ART THERAPY BASED ON THE ETC FRAMEWORK

Abstract Abstract This randomized controlled trial explored the impact of Expressive Therapies Continuum (ETC)-based art therapy interventions for older adults with dementia living in a complex care home. The trial examined the efficacy of 10 art therapy intervention sessions over 4 months, comparing results with an active control group that participated in 10 art sessions. Pre- and post-assessments, including the Mini-Mental State Examination (MMSE), Clock Drawing Test (CDT), and the Older People’s Quality of Life (OPQOL-Brief) questionnaires, were conducted. Results demonstrated that participants displayed similar visual expression elements, shared preferences for specific media types, and equivalent ETC-based intervention entry levels. In addition, participants in the experimental group showed significant increases in OPQOL-Brief scores. Finally, MMSE-Language scores demonstrated statistically significant increases in the experimental group and a decrease in the control group. The current study aligns with previous research demonstrating that art therapy can improve cognitive functioning and enhance the quality of life in older adults living with dementia. It expands on previous research by providing new insights into expressive and stylistic elements, ETC entry-level, and media preferences for engaging in artmaking. Keywords: Art therapy, dementia, older adults, Expressive Therapies Continuum, cognitive functioning, quality of life

Strong Mind, Strong Body: The Promise of Mind-Body Interventions to Address Growing Mental Health Needs Among Youth.

As the prevalence of childhood and adolescent anxiety, depression, and other mental health concerns continues to rise, there has been an unprecedented increase in support of mind-body practices like yoga, dance, meditation, mindfulness, aerobic exercise, and more-in part driven by the mental health burden imposed by the COVID-19 pandemic. While a growing body of evidence supports the safety and effectiveness of mind-body approaches, gaps in funding for and empirical research on mechanistic underpinnings, methodology development to assess multi-component therapeutic practices, dissemination and implementation, and diversity in researchers, practitioners, and recipients remain. As a consequence, the neurobiological impacts of mind-body techniques are not well understood nor broadly accepted as standard forms of care by clinicians and insurers-often being considered as 'alternative' rather than 'complementary' or 'integrative'. In this commentary, we summarize work from our labs and others highlighting the promise of mind-body approaches for improving mental health in youth, in line with the National Institute of Mental Health's strategic plan to address health disparities. We offer a potential framework for implementation and research-the Expressive Therapies Continuum. We also propose solutions to key research and policy gaps, that by could have positive public health impacts for those who are struggling and to prevent emergence of psychiatric illness, especially in developing youth.

Stepping Into the Circle: Inviting Spirit Through Medicine Wheel Teachings in the Expressive Therapies Continuum (Entrer dans le cercle : invitation de l’esprit à travers les enseignements de la roue médicinale dans le Continuum des Thérapies Expressives)

This article explores the intersections between colonial trauma and Indigenous identity as a centralizing factor of Indigenous wellness. Focusing on the Expressive Therapies Continuum theory, this author continues her research on using culturally significant materials and material interaction as a way to honor Indigenous knowledge. Taking a Two-Eyed Seeing approach, this author proposes changing the shape of the continuum from hierarchal to cyclical in order to invite clinicians to reflect on the role of Spirit and cultural identity as important elements when considering wholistic health. Using the teachings of the Medicine Wheel, the body, heart, mind, and Spirit are connected with the somatic/kinesthetic, perceptual/affective, cognitive/symbolic, and creative levels of the continuum.

Understanding the value of art prompts in an online narrative medicine workshop: an exploratory-descriptive focus group study

Narrative medicine is an interdisciplinary field that complements and expands on conventional healthcare training by supporting narrative competence skills and creativity derived from the arts and humanities domains to address...

Development of the Expressive Therapies Continuum: The Lifework of Vija B. Lusebrink, PhD, ATR-BC, HLM

This Viewpoint essay serves three purposes: (1) revealing the life experiences of Vija Lusebrink that shaped what would become the pantheoretical art therapy assessment and treatment model known as the Expressive Therapies Continuum; (2) clarifying the broad and deep scope of this model; and (3) encouraging the art therapy audience to recognize this model as a complex marriage of information processing and agents of change. The Expressive Therapies Continuum (ETC) lends itself to outcome-informed treatment in art therapy as a systems-oriented means of gauging client responses to multidimensional interventive inputs and modifying the therapist’s approach accordingly. It is important for art therapists to share a unified understanding of the ETC that is consistent with the ideas of its co-creators.

The Effect of Medium and Instruction While Creating Mandalas

This randomized controlled study examined the effects of creating open circle mandalas with divergent instruction type (distraction and reflection) and medium type (resistive and fluid) on state anxiety, mood, and mindfulness. The design followed a 2 (instruction type) × 2 (medium type) × 3 (time) mixed experimental design. Reflective writing tasks were analyzed for linguistic expression. Results indicated anxiety reduction and improved mood across all conditions as evidenced by explicit assessment. Implicit assessments determined enhanced mindfulness for reflection instruction type and fluid medium type. Practical connections to the Expressive Therapies Continuum (Lusebrink, 1990) and Media Dimensions Variable (Kagin & Lusebrink, 1978) frameworks are discussed.

Clarifying the Creative level of the Expressive Therapies Continuum: A different dimension

The Expressive Therapies Continuum (ETC) originally incorporated creativity as the Creative “level.” This denotation as a separate level is a misnomer because creativity can be present at any ETC level. Also, innate distinctive characteristics of the creative process differ from those of the other three levels. The objectives of this article are to help delineate the features of the Creative “level” within the ETC, designate its name as a Creative “dimension” to avoid confusion, and to provide case illustrations to help clarify these concepts. Creative functioning within the ETC model has been described as the integrative and self-actualizing forces within the individual occurring during expressive activities. Creative functioning has been described as comprising moments of self-realization and unique self-expression associated with well-being. These moments share similarities with the concepts of Flow, everyday creativity, small-c creativity, and mini-c creativity; concepts that can further describe creative activity in art therapy.

Using neuroscience to explore creative media in art therapy: a systematic narrative review

ABSTRACT Background Few studies have investigated brain responses to different art media. Investigations into brain processes during art making have highlighted important structures. Neuroimaging tools have been used to investigate activation of brain areas whilst artmaking, but not in a therapeutic setting. This review highlights recent advancements in this area and encourages researchers to be the first to apply this in the UK. Aim To understand how the principles of neuroscience are currently informing the literature to explain the effects of art media in art therapy practice. Methods Review of published peer-reviewed research between years 2000 and 2020 on neuroscience and art therapy. Results Findings were summarised into categories discussing psychological/neurobiological issues, art media, neuroimaging technology, and models posited. Forty-six studies were found; majority discussed the structure and function of the brain to explain art therapy processes. The Expressive Therapies Continuum (ETC) model theorised that media properties stimulate different levels of visual and cognitive processing. The novel Mobile Brain/Body Imaging (MoBI) neuroimaging technology may be used as a means of quantifying data. Conclusion Significant progress has been made in attempting to explain brain responses during the art therapy process. However empirical data is needed to prove theoretical models. The use of neuroimaging has started this process to lead research into evidence-based practice. Implications for practice/further research Evidencing the ground-breaking ETC model, using neuroimaging and MoBI technology is needed through close collaboration between transdisciplinary departments. Art therapists should be encouraged to use the ETC to inform art therapy assessment, planning and treatment. Plain-language summary Neuroscience is the study of the brain and its processes, and recently technology has been available to researchers to examine brain processes in detail. This systematic narrative review explores recent literature that uses the principles of neuroscience to investigate the effects of art therapy, with a specific interest in art media. A systematic narrative review is when the findings of the study rely on the use of words to summarise the data. Art media is an important part of art therapy, as it is through artistic expressions that the client communicates their inner troubles. Different art media has been shown to elicit different feelings and behavioural responses in clients. However, research showing brain responses to different art media is limited. This study highlights ways in which further research in this field can take place. Results show that significant advancements have already been made that identify important structures and functions of the brain accessed during art therapy. Important models which incorporate neuroscience principles and theorise the art therapy process are highlighted. A significant model is the Expressive Therapies Continuum. This model explains how the brain processes information when different art media is used. However empirical data is needed to substantiate the theory behind this model. The use of neuroimaging technology is one way to achieve this. Therefore, this paper encourages transdisciplinary research to further investigate the effects different art media has on the brain during the art therapy process.

Expressive Arts Therapy with Chinese Calligraphy Elements as a Working Approach

Creative Arts Educ Ther (2020) 6(2):179–186 DOI: 10.15212/CAET/2020/6/2 Expressive Arts Therapy with Chinese Calligraphy Elements as a Working Approach 中國書法元素融入表達藝術治療作實踐模式 Abstract The properties of Chinese calligraphy and its beauty have captured the imagination and expression of artists throughout the Eastern history. Although some in the Chinese world still practice Chinese calligraphy as an art today, many first encounter it as part of the literacy education in primary school curriculum. Repetitive mimicking is often emphasized in the process without much creative element. As a Chinese calligrapher who aspires to reflect on the creative aspect of the art form, this author chose to integrate elements of Chinese calligraphy with other art modalities in work with teenagers in school setting. This article will look at applying Chinese calligraphy elements to a framework called the expressive therapies continuumin group therapy setting. Keywords: Chinese calligraphy, Expressive therapies continuum, Expressive arts therapy 摘要 中國書法的特性及其美麗捕捉了整個東方歷史藝術家的想像力和表達。在華人社會中有不少人仍將中國書法視作為藝術來實踐，但許多初次接觸中國書法卻是小學課程中練字課程內。在教學過程中通常會強調重複模仿，而沒有太多創意元素。作為一位反思藝術形式創造性方面的中國書法愛好者，作家選擇將中國書法的元素與其他藝術形式相結合，並與學校中的青少年一起實踐。本文將探討如何將中國書法元素應用於團體治療中，並探討在表達性治療連續系統框架下的應用。 關鍵詞：中國書法，表達性治療連續系統，表達藝術治療

Ink for Mettā

Creative Arts Educ Ther (2020) 6(2):187–199 DOI: 10.15212/CAET/2020/6/5 Ink for Mettā 墨‧映 Abstract “Ink for Mettā” is the integration of Chinese calligraphy and mettā meditation in the practice of expressive arts therapy. Chinese calligraphy is a traditional form of writing with aesthetic appreciation value, and it is one of the Buddhist meditative practices for enhancing self-awareness. Mettā meditation is a Buddhist tradition of fostering loving kindness with an altruistic view from self toward others. Instead of tackling any emotions or thoughts arising during both practices, we should acknowledge them and return to the present moment of practice. The practices leave room for expressive arts therapy to explore the unattended emotions and thoughts for furthering well-being. The integrative use of Chinese calligraphy and mettā meditation is structured basing on a framework for using art in therapy, expressive therapies continuum. The concepts and applications of “ink for mettā” will be discussed, and the potential for further incorporation of dance and movement therapy will be explored. Keywords: ink, Chinese calligraphy, mettā meditation, expressive arts therapy, Buddhist practice 摘要 《墨‧映》是中國書法和慈心觀在表達藝術治療實踐的結合。中國書法是一種具有美學欣賞價值的傳統書寫藝術，抄寫經文更是佛教修煉自心覺性的練習。慈心觀是一種佛教傳統修持，提倡自利利他的精神，培養慈愛 。修持旨在提升專注力和覺察，當情緒和念頭生起，毋須對抗，只要覺察，並回到當下的修習。表達藝術治療正與這種修習相應，在活動的過程中，讓潛藏的情緒被探視，以至逐漸得到紓解，促進心靈健康。中國書法和慈心觀在表達藝術治療的實踐，建基於運用藝術於治療中的「表達性治療連續系統」理論架構。本文將分享《墨‧映》的概念和應用，並進一步探討加入舞蹈治療元素的可能性。 關鍵詞：墨, 中國書法, 慈心觀, 表達藝術治療, 佛教修持

Effects of Creative Expressive Arts-based Storytelling (CrEAS) programme on older adults with mild cognitive impairment: protocol for a randomised, controlled three-arm trial

IntroductionEarly non-pharmacological interventions can prevent cognitive decline in older adults with mild cognitive impairment (MCI). Creative expression (CrExp) can potentially mitigate cognitive decline and enhance the physical and mental health...

The first 15 min in art therapy: Painting a picture from the past

Many affective experiences and learning processes including attachment patterns from early developmental phases manifest during psychotherapy. The first 15 min in art therapy can potentially reveal clients’ preferred ways of processing information or Expressive Therapies Continuum components, attachment patterns in the material handling process, and emotion regulation strategies during art making. This article discusses how, through clients’ choice of materials and manner of interaction with those materials, information about attachment patterns and preferred emotion regulation is available in art therapy. Paying close attention to the first image and material interaction provides crucial information that will guide the goals and course of art therapy. Two case vignettes demonstrate that within the first 15 min of art therapy information is readily gathered about attachment styles, Expressive Therapies Continuum components, emotion regulation, and the course of art therapy.

Drawing on the brain: An ALE meta-analysis of functional brain activation during drawing

Art therapy researchers and practitioners are increasingly interested in the brain mechanisms underlying art therapy, an investigation area associated with almost no neuroimaging research. Lusebrink (2010) hypothesized that expression at different levels of the Expressive Therapies Continuum (ETC) would be supported by different patterns of functional brain activation. In the current study, we tested Lusebrink’s (2010) hypotheses through an activation likelihood estimation (ALE) meta-analysis of past neuroimaging research as participants engaged in different drawing tasks. Results supported our predictions that cognitive drawing, operationalized by internally-cued drawing stimuli or objective drawing content, would be associated with activation of the prefrontal and cingulate cortices. However, results failed to support our predictions that perceptual drawing, operationalized by externally-cued drawing stimuli and nonobjective drawing content, would be associated with activation of the ventral visual pathway in the temporal lobe. Perceptual drawing was associated with cerebellum, frontal, and parietal lobe activation (including the motor and somatosensory cortices). The dorsal visual pathway, largely in the parietal lobe, was engaged during cognitive and perceptual drawing. Our findings on patterns of brain activation can inform broader neuroscientific conceptualizations of the ETC framework and future directions for art therapy research and practice.

EXPRESSIVE THERAPIES CONTINUUM-INFORMED EVALUATION OF THREE RESOURCE-ORIENTED RECEPTIVE AND ACTIVE MUSIC THERAPY TECHNIQUES IN CANCER PATIENTS IN PSYCHOSOCIAL REHABILITATION PROGRAMME

Expressive Therapies Continuum (ETC), a model posed by Lusebrink and widely used in arts therapies, stipulates that human being is perceiving the world and processing the information in three modes – motion (kinesthetic-sensory perception), emotion (perceptual-emotional perception) and thought (cognitive-symbolic perception), and that optimally functioning person can freely function in all the modes, can slide between the poles of each of the mode and can integrate the elements from various modes and poles. And vice versa - difficulty or inability to function or being stuck in certain modes, can indicate to malfunction and even psychopathology. If that is the case - purposeful integration of various functions by offering expressive activity promoting utilisation of various functions of the ETC, can promote the optimal functioning. In order to find out the capacity of the three resource-based music therapy activities – 1) receptive music therapy activity, 2) semi-structured musical improvisation, 3) song-writing activity - to stimulate the utilisation of specific levels and polarities of the ETC, participants (n=24 cancer patients participating in the psychosocial rehabilitation programme) were asked to assess the elements of the ETC they applied while executing each of the activities. Results of the study show that during the receptive music therapy activity participants mostly used the affective, symbolic and sensory function, during the song-writing activity the mostly used all ETC functions except for sensory, but musical improvisation provoked application of all the ETC functions, and therefore turned out as ultimate activity, capable of integrating all the modes of perception and information processing.

Art Therapy and the Malnourished Brain: The Development of the Nourishment Framework

Art therapy can be particularly successful in addressing the specific needs of individuals struggling with anorexia nervosa (AN) through the use of the creative process. This article provides an understanding of the effect of malnourishment on the brain for individuals with AN and discusses how their unique needs can be met through the application of the Nourishment Framework. The Nourishment Framework is a structured treatment approach that utilizes the individual components of the Expressive Therapies Continuum (ETC) to address specific clinical needs for those struggling with AN. A case study documents the application of the Nourishment Framework while highlighting the directives and materials used to meet client goals.

Walking on Two-Row: Reconciling First Nations Identity and Colonial Trauma Through Material Interaction, Acculturation, and Art Therapy (Marcher sur deux voies : réconcilier l’identité des Premières Nations et le traumatisme colonial par l’interaction matérielle, l’acculturation et l’art-thérapie)

As a Kanien'kehá:ka First Nations art therapist and researcher, the author explores how accessibility to First Nations and Western art materials could impact the experience of acculturation and identity formation. The research was conducted for a Concordia University graduate study in Montreal using multiple methodologies: Moustakas' six-step heuristic inquiry, Hervey's arts-based research design and Wilson's concept of land as measurement. This arts-based heuristic inquiry engaged an Indigenous paradigm that documented Western and Kanien'kehá:ka First Nations material interaction over a 28-moon lunar cycle while noting systemic changes in functioning and identity reflection during the process. The data was examined using the Expressive Therapies Continuum Use and Therapist Self-Rating Scale and witness writings. The findings indicated that access to both Western and Kanien'kehá:ka materials could foster a bicultural identity, cultural restoration and shame resilience for a Kanien'kehá:ka population.

Music therapy for emotion regulation skills and better psychological well-being for cancer patients: Making of a therapeutic programme

Objective of this research is to explore the subjective experience and perceived benefits of 60 cancer patients participating in the music therapy based and Expressive Therapies Continuum and Dialectical Behaviour Therapy informed psychosocial support programme. The data was obtained by means of questionnaire and focus group discussions. All participants (n = 60) performed written evaluation of the programme: a) of their overall experience, b) its specific benefits for addressing pain, anxiety as well as social support, emotion regulation and overall quality of life issues, c) its most/least enjoyable/helpful elements. Participants (n = 20) of the four focus group discussions, on their turn, explored the specific elements (contents, organisation, instructions, timetable) of the programme to provide the grounds for future amendments. Results reveal that 70% of participants rated their overall experience as “very valuable” or “valuable”, 24% indicated as “neutral”, whereas 6% admitted that their participation has not led to “substantial gains”. The top five benefits included: improved mood, reduced stress, received support, improved communication, coping with negative emotions linked with disease or treatment. Among the most enjoyable and helpful elements, participants emphasized the ones that were linked with the acquired ability to face and survive difficult emotions (n = 43), discovering inner strength (n = 58), gaining more confidence by acquiring new skills or experience (n = 29), gaining connectedness with group and music (n = 32), musically beautiful moments and transcendence (n = 58) as well as normalization of their experience (n = 50). Focus group discussion provided with valuable recommendations regarding the inclusion of psycho-education elements, size of the group, format of task instructions, pace of the work and necessity for balance between the safety and novelty. It can be concluded that participation in the programme positively affected psychological and social well-being of the cancer patients. Results of this research provide valuable input for the further development of the programme – both organisation and content-wise.