The Effectiveness of Guided Art Therapy on Mood in the Elderly

 

Niharika Burugapalli

Abstract:

Art therapy allows individuals to creatively explore emotions, positively impacts mental state and cognition, and increases resilience and self-esteem through its restorative properties. Many previously performed studies affirm the effectiveness of art therapy on a range of people from cancer patients to the elderly with varying levels of cognitive decline. The positive psychological benefits of art have been assessed with advanced technology that shows a correlation between changes in neurological activity and happiness and relaxation. Although most studies conducted had participants engage in freestyle drawing or painting, this study was done to examine the effectiveness of guided painting in a group setting. It was a prospective single-arm interventional study and was specifically targeted towards older individuals in various assisted living facilities to investigate whether a positive correlation exists between art and mood. Guided painting sessions were taught so that the painting would be broken down into a series of manageable steps without seeming overwhelming to the participants. The subjects were divided into four groups and evaluated, upon conclusion of the art session, using a survey to rate their mood on a scale of 1 to 5 before and after painting. Results showed that in 86.67% of the participants, painting enhanced their mood with fine (3) being the most common mood before and good (4) after painting. This enhancement of mood after painting may have been due to cathartic release, a distraction from ruminative thoughts, or heightened cognitive skills. 

 

Introduction:

Art therapy is thought to have restorative and adaptive purposes as it activates the creative and imaginative parts of the brain. It arose in the 20th century when conventional clinical methods were not adequately serving the needs of people diagnosed with mental and physical illnesses. Art therapy provides a platform for effective self-expression by stimulating subconscious emotions and memories. The visualization of these subconscious thoughts makes it easier to gradually put into words the problem that may not have been easily addressable before[1]. The mechanisms of change that can be obtained from art therapy consist of three tenets as proposed by King. First, the process of creating art along with the artwork are essential factors of treatment that help evoke verbal and non-verbal communication between the artist and the therapist. Secondly, creative and imaginative self-expression has the potential to heal and improve the quality of life. Lastly, the materials and methods employed provide a safe space for self-expression and help maintain emotional self-regulation.  To explore other methods in which you can get a guide for your life, consider reading this roundup review on juneauempire.com to learn how a psychic can offer guidance in our lives no matter our age.

Mobile Brain/ Body Imaging (MoBI) techniques such as electroencephalography (EEG), quantitative electroencephalography (qEEG), and functional near-infrared spectroscopy (fNIRS)  allow researchers to monitor neurological functions in the process of creating art. King found that EEG studies demonstrated that the process of creating art increased brain activity compared to rote sensorimotor tasks. A qEEG was utilized to detect discrepancies in brain activity patterns between artists and non-artists, showing a heightened presence of alpha brainwaves for both groups[1]. Alpha waves are present when experiencing a state of mindfulness or meditation, and have the ability to lessen depressive symptoms and foster creative thinking[3]. The qEGG demonstrates that art can activate areas of the brain associated with memory processing, meditative states, and spatiotemporal processing. Using the fNIRS, it was also evaluated that participants who were coloring, doodling, or free drawing activated a reward pathway in the brain[1]. These results indicate that even people lacking experience in the field of art have the ability to reap the benefits of painting, such as relaxation and positive emotional state, even if they are engaging in this creative activity for the first time. 

In light of these immense benefits that can be attained through art therapy, it is important to use this technique in populations that could be prone to depression or other mental and physical illnesses such as the elderly. The global elderly population has reached record numbers and is only going to continue to increase in the years to come, an estimated increase from 12% to 22% by 2050 according to the World Health Organization. Depressive symptoms affect 7% of the global elderly population and 35% of older adults living in nursing homes in the US, demonstrating how grave of an impact the health problems that older adults face can make on our society. Art therapy has been shown to alleviate symptoms of depression while being cost-effective compared to antidepressant drugs, which also produce undesirable side-effects. A systematic review of art therapy by Dunphy et al. with 17 studies, where depression was the main symptom, revealed that art interventions helped in five key ways: physical, cultural, emotional, interpersonal, and cognitive[4]. The physical attributes of art, such as making a certain brushstroke, induce relaxation, and release of stress. For the cultural aspect, art prompts creative expression and positive memories. Emotionally, art facilitates inner expression through visual communication and boosts self-esteem, leading to a more positive perspective of oneself. Interpersonal relationships are bolstered through group art sessions as they socialize and bond over sharing the experience of creating art. Lastly, painting strengthens cognitive abilities by eliciting positive memories and distracting from any negative thoughts[4]. 

Chronic illnesses such as cardiovascular disease are also correlated with psychosocial problems like depression and chronic stress[5].These side-effects can then contribute to worsening the primary disease. Thus, engaging in creative outlets like art can diminish stress and depression, thereby fostering a positive outcome for the illness. Art can also aid in dealing with intense emotions such as grief and provides cathartic release. For example in a study directed at women with cancer, it evoked self- confidence, and worth, and distracted them from being consumed by negative thoughts regarding their illness[6]. In another study performed at the Chelsea and Westminster Hospital, patients who participated in art interventions were more inclined to have better vital signs, decreased cortisol levels that are associated with stress, reduced medication to cause sleep, and overall improved clinical outcomes[5]. A study conducted on patients with dementia also resulted in clear, positive benefits including alertness, sociability, and engagement[7]. 

Mild cognitive impairment (MCI) is a phase in cognitive decline that can be reversed with proper intervention techniques like art. Participants with MCI engaged in a guided viewing and evaluation of art while also physically producing their own artwork. This study showed significant improvements in memory, sleep quality, and increased telomere length. Studies suggest that shorter telomeres are correlated with impaired cognitive performance. While the lengthening of telomeres reverses cellular inflammatory mechanisms that are associated with declining cognitive abilities[8]. Impaired cognition has even been identified as a predictor of early death and can affect people of various backgrounds[9]. It is important to find creative therapy options, such as art therapy, that enhance cognitive function, thereby decreasing the mortality rate and increasing the quality of life.

Given the evidence suggesting that art can enhance one’s psychological state, it was hypothesized that elderly residents living in nursing homes would experience a positive change in their mood upon completion of the guided painting session. If you\’d like to look around to see what nursing facilities are available then make sure to check the Chelsea Senior Living senior assisted living Bridgewater, NJ.

 

Materials and Methods:

This was a prospective single-arm study as the groups were all receiving the same method of intervention, and there was no group that was split up to not receive the treatment. The participants were members of three senior living communities in southeastern Connecticut, one of which was visited twice, but had a different group of people participating in the second session. Thus, there were four different subject groups designated A, B, C, and D. The demographics and conditions in these three communities were comparable. 

Guided painting classes were taught where the residents could follow along with the brush strokes made by the instructor. Each step of the painting was explained, a demonstration of how to mix a certain color was given, and finally, the placement of the color on the canvas was indicated. Adequate time was given for the majority of people to finish that particular stroke, during which time the residents could ask the instructor any questions, before advancing to the next section. The painting varied at each location, however, they each approximately had the same level of difficulty. They consisted of a more abstract sky that was open to interpretation and required the blending in of various colors, and a silhouette of trees or mountains was added in later. Subjects were given a canvas, an array of brushes, and acrylic paint in the three primary colors along with black and white. Depending on the number of people attending the art class and their cognitive abilities, the duration of the class would range between one to two and a half hours. 

 The participants would answer the anonymous survey in figure 1 to be evaluated on whether or not their mood was positively influenced by art.  

Figure 1: Survey used to evaluate the mood

In most studies regarding the subject of art therapy, the participant was not given directions on what to draw or paint and was supposed to create something of their own accord. However, this may sometimes be stressful for certain people who already question their artistic abilities, and it may even cause them to refuse painting and miss out on its invaluable benefits. This was the thought process of many people in the nursing homes we visited who was coaxed out of their room only after explaining that the seemingly complicated painting would be broken down into multiple manageable steps. Therefore we proposed a study where the participants had the option of following along to an instructor to create the final painting; however, they were free to stray from the directed colors or figures suggested if they wished to as depicted in figures 3 A-D. 

Mood in the two groups before and after was compared and statistical analysis between the two groups was confirmed using the Wilcoxon ranks test where a p-value less than 0.05 was deemed significant. 

Results:

 In 26/ 30 participants or (86.67% ) of the time, the process of painting enhanced the mood of the residents in each of the various nursing homes. The participants\’ mood stayed neutral (with a difference of 0) in four cases out of 30 (13.3%). The mood was not negatively affected by any of the 30 participants in this study.

Table 1: Quantitative summary of data collected from all nursing homes

Group	Subject	Before	After	Difference
A	1	3	5	2
	2	4	5	1
	3	2	4	2
	4	3	4	1
	5	3	5	2
B	6	2	3	1
	7	3	4	1
	8	1	4	3
	9	4	4	0
	10	3	4	1
	11	1	3	2
	12	3	4	1
	13	4	4	0
	14	3	4	1
C	15	3	4	1
	16	3	5	2
	17	2	5	3
	18	3	4	1
	19	2	3	1
	20	2	3	1
	21	3	5	2
D	22	3	4	1
	23	1	5	4
	24	5	5	0
	25	3	4	1
	26	1	3	2
	27	3	4	1
	28	4	4	0
	29	3	4	1
	30	3	4	1

The highest number of subjects (16) described their mood as fine (3) before the guided painting session. The highest number of subjects (17) described their mood as good (4) at the conclusion of the painting session. The mood after art was always greater than a 3, while the mood before art ranged between 1-5, illustrating that participants\’ mood post- art was fair or better as no one described their mood as very sad or unhappy after. The mode along with the median increased from 3 to 4.

Figure 2: Frequency distribution graph of mood changes

The Wilcoxon signed-ranks test was used to determine the statistical significance difference between the two groups. In order to be significant, the p-value needs to be less than 0.05 and in this study, the p-value was < .0001. 

Figures 3A, 3B, 3C, 3D depict the various landscapes the residents painted at each location. Although each person was given the same directions, they interpreted them differently and produced unique paintings.

Figure 3A: Paintings in progress of sunset reflected in water with group A

Figure 3B: Sunset at beach paintings with group B

Figure 3C: Winter trees at sunrise paintings with group C

Figure 3D: Paintings of a desert night with group D

Discussion:

The results of the study were consistent with the hypothesis that guided art therapy positively enhances mood in older individuals. The fact that different residents interpreted the same painting in a multitude of ways, as can be seen in figures 3A, 3B, 3C, and 3D, and produced paintings with subtle differences goes to show how art fosters self- expression and promotes the release of less conscious emotions. However, the act of painting may not have been the sole contributor to enhancing their moods as they may have been happier due to the fact that this activity allowed them to leave their rooms and engage with other residents. Sharing a common experience may have helped with socialization by providing a topic of discussion. Their mood may also have been positively influenced when they saw that a volunteer was choosing to spend time with them and talk and listen to them. Some factors that may have negatively affected this study was their understanding of the question because some residents interpreted the question as having to judge the quality of their work instead of the process of painting. To minimize this effect, the volunteer director would then help try to explain the true nature of the question until they had a better understanding. 

Although interpersonal benefits were not directly measured, the residents became more social throughout the activity as they shared the experience of painting. Although most residents expressed concern over their artistic abilities, in the beginning, they ended up admitting that they were surprised with the results and felt it less overwhelming when the painting was broken down into a series of manageable steps. Suggesting that this manner of actively painting each step with the residents helped calm their nerves about their artistic capabilities, allowing them to enjoy the process of painting instead of worrying about the end result. It may have been more daunting for them to stare at a blank canvas and be given no guidance or direction on what or how to paint. They may have also seemed happier to an extent because this activity could function as a coping mechanism. The involvement and mental capabilities necessary to produce a painting could prove an effective distraction. The physical part of the painting is often overlooked but it is very present. The effort coupled with the concentration it requires to paint an exact shape can also function as a shield that efficiently blocks ruminative thoughts. For some, holding a brush and painting was a real challenge that required 100% of their focus and energy. 

This form of guided art therapy may have been especially successful in nursing homes given that people there may be more prone to depression as they may feel abandoned or isolated from their families. Therefore art allowed them to have a creative outlet to channel their emotions and express their feelings instead of letting them get so bottled up that they may not be able to cope with the intense emotions that could result in the future. Art could have provided them with a variety of psychological benefits such as relaxation and heightened self-esteem, leaving them with a more positive view of themselves as they marveled at what they had created at this age. Perhaps this stress relief and calmer mental state were due to an increased generation of alpha waves in the brain. 

Many research papers explained that they held art therapy sessions every week for several months. If this study was expanded to be conducted for a longer period of time, the results might show a greater correlation not only between art and mood but art and cognitive or motor abilities as well. Performing a randomized controlled trial where one group receives guided art therapy and the other is visited by volunteers could also help eliminate some factors such as social interaction that may have influenced this study. 

Conclusion:

The study was conducted to observe the effectiveness of art therapy in a novel way as each painting was guided and explained in a series of manageable steps to relieve any stress associated with free drawing and foster more promising results. The results were consistent with the hypothesis as guided art therapy positively enhanced the mood of the elderly 86. 67% of the time. This may have been due to a variety of psychological benefits that art provides such as a calmer mental state, heightened self-esteem, a shield from ruminative thoughts, and cathartic release. Thus, art therapy is improving their quality of life. Nevertheless, the act of painting may not have been the sole contributor to mood enhancement as it could be attributed to the presence of a volunteer or the sociability of the activity. In the future, a randomized controlled trial could be performed with one group partaking in the guided painting session while another group is simply visited by a volunteer to eliminate factors that may have influenced the study. This study could be expanded to be conducted for an extended period of time to observe the correlation not only between art and mood, but also between art and cognitive or motor abilities.

Acknowledgments:

I express my sincere gratitude to Dr. Fred Oliver, my biology teacher at The Williams School, for always encouraging me to pursue research and patiently answering my questions. I am also very grateful for all the wonderful people in the various nursing homes who agreed to give their time and take painting lessons from me and the recreation directors for organizing the events. 

References:

1. King, Juliet L., and Girija Kaimal. \”Approaches to Research in Art Therapy Using Imaging Technologies.\” Frontiers in human neuroscience 13, 2019.
2. 2. King, J. L. Art therapy, trauma, and neuroscience: Theoretical and Practical Perspectives. New York, NY: Routledge, 2016.
3. 3.Bergland, Christopher. \”Alpha Brain Waves Boost Creativity and Reduce Depression.\” Psychology Today 17 (2015).
4. Dunphy, Kim et al. \”Creative arts interventions to address depression in older adults: a systematic review of outcomes, processes, and mechanisms.\” Frontiers in psychology 9, 2019).
5. Stuckey, Heather L., and Jeremy Nobel. \”The connection between art, healing, and public health: A review of current literature.\” American journal of public health 100, no. 2, 2010.
6. Staricoff, Rosalia Lelchuk. \”Arts in health: the value of evaluation.\” The journal of the Royal Society for the Promotion of Health 126, no. 3, 2006.
7. Regev, Dafna, and Liat Cohen-Yatziv. \”Effectiveness of Art Therapy With Adult Clients in 2018—What Progress Has Been Made?.\” Frontiers in psychology 9, 2018.
8. Mahendran, Rathi et al. \”Art therapy is associated with sustained improvement in cognitive function in the elderly with mild neurocognitive disorder: findings from a pilot randomized controlled trial for art therapy and music reminiscence activity versus usual care.\” Trials 19, no. 1, 2018.

9. Alders, Amanda, and Linda Levine-Madori. \”The effect of art therapy on cognitive performance of Hispanic/Latino older adults.\” Art Therapy 27, no. 3, 2010.

Biography:

Niha came up with this science project because she was volunteering in nursing homes and hospitals and saw the loneliness and lack of activity there. She wanted to do something to try to lift people’s spirits using two of her favorite things: science and art. Integrating both of these important aspects of her life she was able to test the role of art in elevating people’s mood. She hopes that the scientific data supporting art therapy will encourage more people to engage with it.