Neuroplasticity, Stress and the Creative Arts Therapies

The experiential work of art therapists is not new. Increasingly, neuroscientific research is providing evidence of its importance. This knowledge and its integration into practice and education can contribute to a better understanding and explanation of how the creative arts therapies work in a variety of situations. Including trauma and chronic or extreme stress. This allows the therapist to observe, formulate goals, and define interventions that best help the client improve health 1,2.

In this blog, we will explore the phenomenon of neuroplasticity, specifically in chronic stress and trauma, and what the creative arts therapies can do about it.

Neuroplasticity refers to the ability of the brain to (re)adapt its form and function in response to experiences in our internal and external environments 3, 4 . This is an adaptive phenomenon because it helps to anticipate, understand, and respond to various factors in the environment 5,6,7. For a long time, it was thought that the brain changed only during critical periods of development, and that the brain was more or less fixed after early childhood. However, research shows that the brain can continue to adapt throughout life, even into late adulthood. This contributes to adaptability and therefore to health. We often see this as a positive thing, for example when other parts of the brain take over certain functions after a brain injury. And while this is essentially a healthy phenomenon, it can also have a downside. For example, when certain neural networks are built or strengthened in response to chronic or extreme stress (trauma), which may be adaptive in the short term, but may lead to dysfunction in the long term.

And while neuroplasticity is a trending topic, it is not a simple phenomenon. In fact, there are a number of complex mechanisms involved. Stimulating neuroplasticity is also quite complicated. Nevertheless, knowledge of neuroplasticity can contribute to a better understanding of (dis)functioning and help to think about if, why and how the creative arts therapies can be used to promote adaptability in the client.

In this blog I will try to simplify neuroplasticity a bit and discuss the relationship between (mental) health and neuroplasticity, especially in the case of trauma and chronic stress. I will also share my thoughts on the relationship between neuroplasticity and the arts therapies. Spoiler alert: I conclude that stimulating neuroplasticity is not a goal in itself, but a phenomenon that helps explain the effect of the arts therapies in increasing adaptability.

Neuroplasticity

Everything you do activates your brain. Connections between different areas of the brain are made. We now know that certain functions, such as emotion, memory, and motor skills, are not the result of a single brain area, but rather of multiple brain areas working together to form neural networks. These networks can be compared to a road network.

Roads that are frequently used are easily accessible: they are paved or even asphalted and well lit. Other roads are less used or even abandoned: they are poorly lit or even overgrown.

Image 1: how brain circuits are similar to busy highways and overgrown paths

There are about 100 billion neurons in this network. That is an almost unimaginable number! If we zoom in on one of these neurons, a nerve cell (and you can skip this part if you already know this, but I'll link the mechanisms of neuroplasticity to it later 😉 ), we see that it consists of a cell body, dendrites, and an axon (see Figure 1).

Figure 1: Neuron Structure (Vecteezy)

The cell body contains the nucleus and cytoplasm. Dendrites branch out from the cell body and receive signals from the axons of other neurons. The point at which one neuron communicates with another is called a synapse. The communication takes the form of electrical impulses that are sent along the axon. This is called synaptic transmission. Neurotransmitters from the axon of one nerve cell are received at the synapse by receptors on the dendrites of another nerve cell.

Many axons are coated with a layer of myelin. The thicker this layer, the faster the signals are transmitted. Each neuron is connected to about ten thousand other neurons. There are billions of these synaptic connections, creating countless neural circuits. These circuits underlie movement, emotion, memory, basically everything you do. But how do these pathways form?

The Brain is a Work in Progress

You may have heard the quote from neuroscientist Donald. O. Hebb: "Cells that fire together wire together". This sounds logical, but recent research has shown that it is not entirely accurate.

Of course, every time you do, learn, or experience something, your brain is activated. More specifically, neurons are activated by synaptic transmission (see above). But the strengthening of these synaptic connections only occurs under the right conditions. Repetition and attention, for example, play an important role, but above all, experience. Not just any experiences, but meaningful experiences that surprise you, move you emotionally, are new, and most of all: have an impact on you 8,9. But why is this so?

We can look at it from a developmental perspective: the brain develops from the inside out and from the back to the front. First, the brain stem develops in the womb. When we are born, the limbic system is partially developed, but the neurons in the cortex (the outer layer of the brain) do not yet have many and strong connections. Neither to each other nor to the other (subcortical) parts of the brain, such as the limbic system and the brain stem. This makes it necessary for us to be open to experience in order to make new and stronger connections. The degree to which we are open to learning from new experiences depends in part on our temperament, which, by the way, is largely determined before we are born, based on genes and also just chance. Some people love to explore new situations; others are more reserved.

But regardless, our brains are formed in response to experiences in our environment. How exactly does that happen? How is it that experiences actually change the structure of your brain?

Mechanisms of neuroplasticity

We recognize three main mechanisms in neuroplasticity 9:

1) Synapse formation

2) Myelin production

3) Neurogenesis

Engaging in meaningful experiences activate neurons. When neurons are activated, genes in the nucleus (see Figure 1) produce certain proteins. These very proteins allow new synaptic connections to be formed or existing connections to be strengthened. This is called synapse formation resulting in enhanced synaptic transmission. Incidentally, this also means that neurons that are not activated (enough) no longer form connections and may die. This is called "pruning. The phrase "Use it or lose it" probably sounds familiar. This process maximizes the effectiveness of neural circuits to adapt to the (changing) environment, learn and remember.

In addition, gaining experiences stimulates the production of myelin, the fatty layer around axons (see Figure 1). The thicker this layer of myelin, the faster the conduction of signals.

Neurogenesis is the mechanism by which meaningful experiences stimulate stem neurons to differentiate into entirely new neurons, creating new neural networks.

In short, networks are created and strengthened on the basis of meaningful experiences. The older we get, the more our temperament and experiences intertwine, and the more neural patterns develop and define our personality. Roads that are often traveled in response to experiences in our environment wear out and become like highways. They are known and familiar, and so after a while we automatically take that route. Even if these roads do not always lead to the desired destination. For example, in response to trauma or chronic stress.

Trauma, Chronic Stress and Neuroplasticity

Meaningful experiences contribute to the creation and development of our neural networks. But even negative experiences can be meaningful. For example, experiences in response to trauma or chronic stress. How does that work?

Stress is a physiological, psychological, and behavioral response to stressors. It is an important process to reduce or avoid exposure to stress and to recover from it. Effective and healthy coping with stressful situations involves 1) a rapid response through activation of the sympathetic nervous system and the HPA axis that makes you ready to fight, flee or freeze and 2) a quick termination thereafter so that the body can recover.

This process of responding and recovering is also called "allostasis" 10. It is an adaptive response to disturbances of "homeostasis" with the goal of restoring it.

So stress is not necessarily unhealthy. In fact, having experiences that challenge you contribute to neuroplasticity and adaptability. Dealing with stressors that take you out of your comfort zone, but are still manageable, trains your adaptability, so to speak, making you more resilient in dealing with stressors. You could say that these challenging experiences train your carrying capacity, allowing you to carry a greater burden.

However, when the stress response is inadequate, excessive and the effort to restore homeostasis is too great, it can lead to a state called "allostatic overload"11. The body then no longer recovers adequately, the connection to the regulatory prefrontal areas diminishes, the sympathetic nervous system is constantly activated and your body remains in a constant state of readiness. This leads to disruptions in the hormonal and immune systems and thus increases the risk of a variety of physical and mental complaints 12.

Chronic stress or extreme stress (as in trauma), for example, can lead to the development of depression, anxiety and PTSD.

Structurally increased allostatic load reduces neuroplasticity 4. Chronic or extreme stress shows a negative effect on several brain areas, specifically the hippocampus, amygdala and prefrontal cortex. These are areas closely involved in memory and emotions. In the hippocampus, one of the most plastic areas in the brain, stress leads to reduced neurogenesis (fewer new neurons are produced) and reduced synapse formation (fewer branching). This affects memory (for survival, for example, events are blocked from your memory). Also in the prefrontal cortex, stress leads to reduced synaptic formation, which can cause executive functions such as attention and concentration to decrease. And in the amygdala, on the other hand, more synaptic formation takes place, which may be related to feelings of tension and anxiety.

The response to trauma is, to some extent, similar to a disrupted stress response. Prolonged exposure to unsafe situations, severe abuse or neglect, in which a person had no direction and which were unmanageable, affect brain development. Until later in life, a person anticipates the threatening situation, even when it is long gone. Even then, the body is in a continuous state of survival. The integration between different brain areas is disturbed, which can lead to problems in emotion regulation and reduced executive functions.

In addition, chronic or extreme stress contributes to the brain remaining less plastic. Namely, when we are stressed, we are more inclined to take the familiar route because there is less room mentally to explore new paths. Go figure: to survive, the key is to deal with the stressor as quickly as possible. Then you don't first calmly weigh all possible options to respond. The space to explore becomes smaller. This can greatly reduce adaptability, which can cause us to get stuck in rigid patterns of functioning, less open to seeing things from a different perspective, less curious about other possibilities and not having the space to have new experiences.

And this creates a vicious circle, because we already saw that the very act of having meaningful experiences is important for neuroplasticity. Failure to explore new paths ensures that existing paths continue to be preferred, even if they do not lead to the desired final destination. And then what?

Window of opportunity

The influence of experiences on our neural networks continue until late in life. And this is good news, because this makes change possible: old, deeply ingrained pathways in response to previous experiences can be dissolved once new more functional pathways are established.

To change, other neural networks must be activated. Some were constructed long ago but are little used and have become overgrown. Creating new pathways, or clearing overgrown ones, takes time and repetition. And that is quite a challenge, especially if you are experiencing physical or mental stress. So it's important to keep a hopeful, yet realistic perspective in mind for clients: change is possible, but it requires attention, repetition and therefore time.

Several factors contribute to neuroplasticity such as exercise, healthy diet, rest and sleep, positive social interactions, varied and challenging living environments, learning new things, repetition and attention. A range of possible forms of therapy is therefore available, ranging from physical therapy to psychopharmaceuticals. The therapeutic use of the arts can contribute to some of these factors. Compared to medications, for example, the arts therapies have no side effects, allowing it to be used in a preventive, low-threshold and cost-effective manner without risk.

Neuroplastic potential of the creative arts therapies

My doctoral research showed that the way in which a person creates visual art - the material interaction - becomes visible in the structure and variation of the art product and is significantly related to adaptability 20, 21.

Adaptability has much in common with resilience and psychological flexibility. It is about the range of abilities you have to respond to a variety of challenges, tasks, people and situations and that you can switch in them. It's about having an open attitude that makes you able and willing to take on different perspectives, being curious, daring to take risks, daring to experiment in new situations and not seeing mistakes as disastrous. It also has to do with self-management: being able to make considered choices and implement them by stepping back and paying attention to the situation at hand. And lastly, it has to do with creativity: being able to combine different possibilities and problem-solve.

We already saw that openness to having experiences is important for neuroplasticity. Not just any experiences, but experiences that matter, surprise you, impact you, demand your attention or take you out of your comfort zone. The arts can make an important contribution to this 8, 13-18. I will highlight some aspects here:

Challenge yourself

Engaging in new experiences, "forcing" your brain to not react on autopilot, contributes to change. It stimulates you to explore new avenues, see more possibilities, or look at things from a different perspective. An environment that stimulates, inspires and challenges you, but is still manageable, contributes to this. For many people, design in the arts is not something they are familiar with. At the same time, the professional guidance of a professional therapist provides a safe context in which new ways of responding can be tried and experienced.

The therapist knows the art form inside and out, so he or she can tailor the material, technique, and instruction to the individual client. The art form can then be used in a way that challenges but does not overwhelm the client. The therapist creates a context in which the client can explore and experience new ways of responding in a way that is manageable for the client. This increases the sense of agency. These positive experiences have a regulating and catalyzing effect: gaining positive experiences of success has a relaxing effect and gives confidence in one's own abilities, which - at the client's pace - creates space to expand one's repertoire in future situations. This allows the therapist to direct the treatment in a very focused and client-centered way.

The Artful Mind

Relaxation and rest contribute to recovery, an important part of allostasis. Just as you allow your body to rest after a physical workout, it is important that when you are "training" your adaptability, you feel challenged, you dare to go a little beyond your comfortzone, but also have space to recover. Rhythmic forms of work in the arts, for example, can contribute to this. They have a relaxing and regulating effect. Artistic expression activates different brain areas and networks that are not normally activated by language. In a safe context, you can become aware and conscious of sensory signals. This allows you to be more attentive in the here and now and to consider different perspectives and possibilities.

I like to move it , move it

Movement is an important factor that contributes to neuroplasticity. Movement creates the ability to have experiences. There are many reasons why the ability to move may be limited. Treatment may involve (re)training specific muscle groups to activate the affected brain regions. However, research shows that stimulating movement through the arts, such as dance and music, bypasses the brain areas (affected or not yet developed) and provides an alternative, unaffected way to still move. Repetition strengthens this pathway.

Conclusion

Neuroplasticity is not so much a goal as a mechanism that explains how action and experiential approach in the arts therapies stimulate adaptability and thus contribute to physical and mental health.

For now, I will leave it at that. I have relied as much as possible on existing research. This research is still in its infancy, but it is gaining momentum. Therefore, I will always incorporate new findings into future blogs or modify existing ones. Very plastic 😉!

Want to learn more about balance and adaptability as aspects of mental health and in relation to art therapy? https://www.routledge.com/Art-Therapy-Observation-and-Assessment-in-Clinical-Practice-The-ArTA-Method/Penzes/p/book/9781032549613

References

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2. King, J.L. (2016). Art Therapy: A brain-based profession. In D.E. Gussak & M.L. Rosal (Eds.). The Wiley handbook of art therapy (pp.77-89). Wiley-Blackwell

3. Kumar, J., Patel, T., Sugandh, F., Dev, J, Kumar, U., Adeeb, M., Kachadia, M.P., Puri, P, Prachi, F.N.U., Zaman, M.U., Kumar, S., Varrassi, G., & Syed, A.R.S. (2023). Innovative Approaches and Therapies to Enhance Neuroplasticity and Promote Recovery in Patients With Neurological Disorders: A Narrative Review. Cureus, 15(7). DOI 10.7759/cureus.41914

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5. Vaisvaser, S. (2021). The Embodied-Enactive-Interactive Brain: Bridging Neuroscience and Creative Arts Therapies. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.634079

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14. Loewy, J. & Jaschke, A.C. (2020). Mechanisms of Timing, Timbre, Repertoire, and Entrainment in Neuroplasticity: Mutual Interplay in Neonatal Development. Frontiers in Integrative Neuroscience. https://doi.org/10.3389/fnint.2020.00008

15. Stegemöller, E.L. (2014). Exploring a Neuroplasticity Model of Music Therapy. Journal of Music Therapy, 51(3), 211–227. doi:10.1093/jmt/thu023

16. Teixeira-Machado L, Arida RM, de Jesus MJ. (2019) Dance for neuroplasticity: a descriptive systematic review. Neurosci Biobehav Rev. 96, 232-240.

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18. Cox, L., & Youmans-Jones, J. (2023). Dance Is a Healing Art. Current Treatment Options in Allergy, 10, 184. https://rdcu.be/dm3n8

19. Lardone, A., Liparoti, M., Sorrentino, P., Rucco, R., Jacini, F., Polverino, A., Minino, R., Pesoli, M., Baselice, F., Sorriso, A., Ferraioli, G., Sorrentino, G., & Mandolesi, L. (2018). Mindfulness Meditation Is Related to Long-Lasting Changes in Hippocampal Functional Topology during Resting State: A Magnetoencephalography Study. Neural Plasticity, 5340717. https://doi.org/10.1155/2018/5340717

20. Pénzes, I. (2024). Art Therapy Observation and Assessment in Clinical Practice. The ArTA Method. Routledge/ Taylor Francis. https://www.routledge.com/Art-Therapy-Observation-and-Assessment-in-Clinical-Practice-The-ArTA-Method/Penzes/p/book/9781032549613

21.Pénzes, I. (2020). Art form and Mental health. Studies on art therapy observation and assessment in adult mental health. (PhD Dissertation). Behavioural Science Institute. 216188.pdf (ru.nl)

Images: Freepik