Research has shown that because the brain accesses similar states during both treatment
modalities, it is not mentally difficult for clients to combine them and receive the benefits of these two
methods at once (Smalley & Winston, 2010).
Smalley, S. L. & Winston, D. (2010). Fully present: The science, art, and practice of
mindfulness. United States of America: De Capo Press.

Neurological

In order to make sense of a traumatic responses, we look first at the central nervous system

(CNS), specifically the sympathetic system (SNS). When we experience a threat of any kind, the

initial sounding alarm is the amygdala, a part of the limbic system (Duros &Crowley, 2014).

Once this alarm is sounded the amygdala, the chain of reaction moves to the thalamus which acts

as a relay station for sensory information. The thalamus sends a wake-up call to the brain stem

which responds by telling the hypothalamic pituitary adrenal (HPA) axis to release

norepinephrine, a chemical that functions as a hormone and neurotransmitter, that stimulates the

brain. The hypothalamic pituitary adrenal (HPA) axis is responsible for communication between

hypothalamus and the pituitary and adrenal glands, controlling a good portion of the body’s

reactions to stress. The hypothalamus, which controls the endocrine system and our basic human

drives, signals to the pituitary gland to release adrenaline and cortisol, the stress hormones of the

body. Almost simultaneously, the brain stem, critical for creating fast, defensive responses, send

signals to all the major organs and muscle groups in the body, accelerating the heartbeat,

increasing blood flow, dilating the pupils and opening the bronchi in the lungs, preparing the

body for what we know as the fight or flight response. This initial chain of responses happens

within seconds. The brain is on high alert, and stress hormones are flowing through the veins
(Duros & Crowley 2014) The release of cortisol activates a feedback loop, causing a chain

reaction that continues to stimulate the amygdala until the perceived threat has passed. The

continued cortisol production suppresses the hippocampus, which slows down the digestive

system. At this point, the vagus nerve, an integral part of the automatic nervous system (ANS),

turns off, and in doing so, increases the emotional response (Duros & Crowley, 2014). The

prefrontal region, the “hippocampus and the corpus callosum are particularly vulnerable to

cortisol damage” (Follette et al., 201, p. 211). With the automatic nervous system (ANS)

deactivated, the rest of the digestive response, which controls the body’s ability to find

homeostasis after fight or flight, is unable to relax the muscles, slow the heart rate, or decrease

the stress hormones sitting in the body, allowing the cortisol response loop to continue activating

the sympathetic system SNS. Over time, this continued activation causes the amygdala to

become hypersensitive and activated more easily to external stimuli, which is why many trauma

survivors are in a constant state of arousal. The long-term dysregulation of norepinephrine and

cortisol in the system create a vulnerability within the body, specifically in the hippocampus and

the amygdala. The repeated stimulation of the sympathetic system SNS affect the amygdala,

which controls emotion, and the hippocampus, which controls memory formation. These

disturbances inhibit the amygdala, suppressing the individual’s fear and limiting their emotional

responsiveness, and decrease the hippocampus’ ability to form and store memory, causing the

events surrounding the trauma to remain in an activated, short-term state. This also impacts the

ability to create explicit memories, the more complex memory formation that involves verbal

recall, further preventing the memories from being properly integrated (Duros & Crowley,

2014). As the hippocampus becomes overworked, our memory of what actually happened in the

traumatic event becomes hazy and fragmented, and often exists without access to language,
preventing a survivor from being able to understand or verbalize their traumatic experience.

When an over-sensitized amygdala combines with an under-functioning hippocampus, perceived

threats find a place in implicit memory, which recalls memory unconsciously, making survivors

highly reactive to anything related to their experiences (Duros & Crowley, 2014). Considering

this entire process from the initial trigger, this explains that trauma survivors often find

themselves overwhelmed or shut down when the slightest external stimuli can ring a response

alarm. These overwhelmed and shut down reactions are sometimes referred to as ‘on’ and ‘off’

positions, as the inability to release traumatic stress causes a symptomatic response. When

someone is stuck in the ‘on’ position, they often report symptoms of anxiety and panic,

hypervigilance, anger and irritability, being on high alert, heightened emotionality “chaos and

rigidity” (Follette et al., 2018, p.212). Alternatively, when someone is stuck in the ‘off’ position,

they often present with a flat affect, appear lethargic, and disoriented and report constant fatigue

and dissociative symptoms (Duros & Crowley, 2014; Follette et al., 2018). This ‘off’ position is

more likely to occur if the threat doesn’t disappear, causing the shut down completely and enter a

state of no pain and limited awareness of their surroundings. This is an adaptive way for the body

to respond to inescapable trauma and represents itself physically by a person experiencing a

lowered heartrate, slowed, limited breathing, and a slowed metabolism. By understanding this

process, we are able to better comprehend how trauma sits in the brain and the body when

someone feels under constant threat.

The balance of survival of the human brain has involved to accommodate three core needs,

safety, satisfaction and connection. To accommodate these needs is that we have an old brain,

referred to as the, emotional brain, limbic system. The amygdala is situated in the limbic system

and is responsible for survival, as well for our emotional memory and reactions to things, like
fight or flight. It has five functions motivational drive, appraisal, generating affection,

differentiating different kinds of memory and attachment relationships. This part of the brain is

activated by neurochemical transmitters such as cortisol which is released by the autonomic

nervous system (ANS) and to ensure survival, it activates relevant body systems and shuts down

others to convert energy for the fight and flight response notifying the amygdala to flee or freeze

in the face of danger. The parasympathetic nervous system (PNS) reverses the process by

releasing neurotransmitters such as dopamine to restore homeostasis to regulate physiological

and psychological processes. (Jean, 2015; Follette et al., 2018). The new brain has evolved to

include the cortex region. The pre-frontal cortex is divided into two hemispheres, the left side is

responsible for executive functioning logical, reasoning, making sense of our environment. It is

responsible for higher levels of functioning. It is also associated with visual recognition,

retrieval of facts, speech and language functions, mathematical calculations and processing

music. The right brain is responsible for intuitive and special reasoning, spatial skills, visual and

auditory processing and artistic and creative ability. The linkage of differentiated parts of the

system, called integration enables the coordination and balance of the neural functions

distributed throughout the nervous system and body as a whole. (Follette et al., 2018).

Having an in-depth knowledge of how the brain responds and changes after a traumatic

experience provides health care professionals with the understanding of how to approach

treatment options. Understanding that the automatic nervous system (ANS) and parasympathetic

nervous system (PNS) provide answers for recovery. It brings us one step closer to better

integrating appropriate interventions for diminishing hyperarousal and post-traumatic stress with

clients. Since we already know how the sympathetic system SNS activates the fight or flight

response, we look to the other half of the ANS to relax and calm the system, the parasympathetic
nervous system PNS. If we compare the automatic nervous system ANS to a seesaw, we can

grasp how the system works; when the sympathetic system SNS is activated and our fight or

flight response is engaged, the parasympathetic nervous system PNS is deactivated, and then the

PNS is activated and our system prepares for rest and relaxation, the sympathetic system SNS is

deactivated. The systems work together to react appropriately to situations, but when the

sympathetic system SNS remains activated and engaged, the other side of the see-saw is unable

to participate in helping the body find homeostasis. It is with this information that trauma-

informed providers can focus on re-balancing the automatic nervous system ANS, countering the

overactive responses to bring the two hemispheres connected by neural integration through the

corpus callosum in order to send messages between the two hemispheres, for body awareness,

language function, modulation of mood and the regulation of emotions. Mindful art-based

therapy teaches people to coordinate their response to stress and directly affect restoration by

bringing people into the present to calm down hyperarousal states. It’s the balance between

thought and emotions that play a regulatory role in moderating things like fear, anxiety,

withdrawal or conflict through the mechanisms of appraisal, evaluation and regulation. This

happens when one’s thoughts can be reappraised by the prefrontal cortex, the left side of the

brain, logical, problem solving side and combine it with the right side of the brain, intuitive side

to generate physiological and psychological safety in which the body can repair, restore and

recover even if momentarily (Jean, 2015) therefore, the “brain-based healing cycle entails

seeking to know, tolerate, understand, and make positive use of pain and suffering which

depends on the prefrontal cortex” (Follette et al., 2018 p.194).

With the new knowledge about neurological change which was considered ridged before,

allows for the capacity for new neural pathways, connections to be formed to respond to
experiences, called neuroplasticity (Jean, 2015). Based on this notion, “neurons that fire

together, wire together” (Jean, 2015, p. 28). Mindful art therapy can help people come back to

baseline from a reactive to a nonreactive state when feeling triggered, by creating a “wise mind,

to help negotiate competing realities” (Jean, 2015, p. 28). Through the exploration of conscious

and nonconscious processes to structure emotional understanding, as the left-brain is functional,

analytical and limited to understanding and verbalizing, whereas right brain function is intuitive

and more directly linked to felt experience. Then talking about emotions can often become

hindered by defenses. The symbolic, metaphorical qualities of art expression of feelings and

mindfulness which engages in inner mental life through a range of neurological processes that

extend beyond ordinary reasoning can bring order to chaos. (Jean, 2015).

Art Therapy

While art has historically served as an aesthetic practice, it has evolved into a diverse range or

product of human activity that involves creative or imaginative talent and expressive of technical

proficiency, beauty and emotional power linked to personal growth, self-understanding and

empowerment. Art can hold and convey a wide range of meaning and emotion, often channeling

ideas and experiences without words or language. We acknowledge this evolution of the use of

art as a healing agent through the creation of the field of art therapy.

Art therapy has been expanded and adapted to treat a wide variety of needs, including that of

traumatized individuals. This has been achieved by providing a meeting ground of internal and
external experiences. Art therapy can create healthy way of coping with traumatic events or

stressors that are too difficult to face and properly integrate into one’s sense of self.

Art therapy offers an alternative approach to trauma treatment, providing interventions that can

be used in a wordless and nonverbal state.

The concentration on the inward journey during creativity, allows for the absorption and total

focus of the present moment. The use of the imagination, with all its possibilities and options

contends Allen (1995, 2005) is the pre-curser to making art, which in turn informs self-

knowledge and wellness. Art reaches into the deep psyche of the individual (Moore, 2001)

utilizing the means of symbolic communication and archetypal themes. (Malchiodi, 2013b;

Moore, 2011). The awakening of these archetypal images by the use

of art (McNiff, 1992) guides the externalized illustration of the intra-psychic process and

interactive patterns of the unconscious to become conscious (Allen, 2011; Malchiodi, 2012). By

using all of the senses, art can (Malchiodi, 2012) provide the opportunity for the innate

characteristic of the human being to become a tool for realizing purpose and meaning after a

traumatic event. Art and healing are closely aligned agree (Malchiodi, 2002),

as the act of creating images provides the opportunity for taking the journey inward and

expanding the paths of becoming whole (Allen, 2005, Malchiodi, 2002).

Healing through art and art making, concur Horovitz (2002), Malchiodi (2002 and

McNiff (2004), is one of the most ancient cultural practices in every region of the world.

More recently Ganin (1999) reports that neurology has discovered that art and healing

have similar brain wave patterns that associate mind-body changes with feeling and

meaning. Once these areas are awakened and merged, the medicine of art (McNiff,

2004) begins to flow inward allowing for true healing to transpire (McNiff, 2004) as
a wide range of emotions are recognized and expressed (Malchiodi, 2007).

When these emotional wounds that have been created by internal suffering and

turmoil find their release through the vehicle of art making (McNiff, 2004),

a restoration of emotional, physical and psychological is achieved (Malchiodi 2007). By

connecting treatment methods with a rounded neurological understanding of trauma, art

therapists are better able to bridge the gap linking expressive work with sensory-based

techniques that work to heal the body and mind, making possible treatment approaches more

practical and more tangible. In doing this the therapist can work within their window of tolerance

to improve functioning and increase their tolerance for emotions surrounding their experience.

More evidence of this is seen when traumatized clients improve attention, memory, integration,

and resilience through artistic healing practices.

Art therapy is the application of the visual arts and the creative process within a

therapeutic relationship, to support, maintain, and improve the psychosocial,

physical and cognitive health of individuals. It is based on current and emerging research that art

making is a health-enhancing practice that positively impacts the quality of life. Integrating art

therapy into trauma treatment helps the individual to better process their trauma experiences

through intentions that provide opportunities for the person to distance themselves from the

emotions surrounding the trauma itself and to instead attach meaning and documentation to

reduce the garmented nature of the memories surrounding trauma (Schouten et al., 2014).

Mindfulness
We have learnt through decades of research and numerous studies, that trauma cannot be

resolved from left-oriented interventions alone. Trauma sits in the body and therefore more

effective treatment approaches focus on calming the nervous system while utilizing talk therapy.
By examining the see-saw relationship between the left brain, sympathetic nervous system and

the right brain parasympathetic nervous system, mindfulness- therapy has a way of creating

trauma-oriented intervention that focus on rebalancing the system, by countering the overactive

reactions with meditative mindfulness and cognitive attentional method. The “meditative

practice involves contemplative practice through inner stillness to “gain insight into thoughts and

feelings that guide behavior” (Jean 1015, 24) and cognitive attentional methods borrow solely

from the active component of the mind to “skillfully turn people toward emotions in detached

ways that allows emotions to be there, without struggling or denying them” (Jean 1015, p.24).

(Rappaport 2014, P.24) and Debra Kalmanowitz use mindfulness as a means by which clients

can bear witness to themselves and their experiences by being open and aware. By understanding

the role that mindfulness plays in conjunction with empirically-based interventions, we are able

to build more concrete mind-body approaches that recognize fight or flight patterns and help

regulate emotions and responses to external stimuli. Finding balance in using both bottom-up

(body) and top-down processing (mind) (Malchiodi, 2020). This method of focusing on the

body-mind, achieves the diminishing of the autonomic nervous system in deactivating a

traumatic response to work with the limbic system and the brain stem to balance mood, increase

cognitive abilities and improve physiological regulation to decrease trauma-related symptoms

(Duros & Crowley, 2014). Mindfulness can alleviate some of the more physiological effects

that trauma can have on the body creating opportunity for individuals to appreciate their

experience with intentionality of being present in the mind and body while learning to “relate

differently to the way we see, perceive and respond in life” (Jean, 2015, p.23,24).

Trauma
There are at least two sources of distress associated with traumatic experience. The event itself,

objective pain and the emotional pain it produces, some of which may be lasting and intense and
the other is the suffering associated with attempts to avoid pain and the struggle to maintain

previous models of self in the face of intruding and unwanted reality (Follette, 2018). Trauma is

the experience of extreme stress-physically and psychological. – that overwhelms and

individual’s normal capacities to process and cope. The entire reality is confined to the sense of

the self in isolation, helplessness and fear. This profound state of disconnection is the core

characteristics of trauma (Follette, 2018; Malchiodi, 2020). Unprocessed pain keeps the

traumatized person’s system on permanent alert. In order to endure the reawakened pain, some

victims of trauma dissociate from their bodies, numbing their sensitivities as if they are

“disembodied and experiencing life from a great distance” (Follette, 2018, p. 32; Malchiodi,

2020). They are cut off from wholeness of being.

Trauma and the post-traumatic stress (PTSD) often follow a traumatic experience and can

manifest itself in may ways. The nature of trauma reactions resides in three main domains,

including emotional dysregulation, loss of self-integrity, and conflicts with the ability to relate to

and be intimate with others (Courtois & Ford, 2016). All three of these reactions can be seen in

PTSD, which exaggerates emotions like fear, anxiety, anger, shame and guilt (Fonzo, 2018).

PTSD is characterized by intrusive, thoughts, dissociations, dreams, often accompanied by a

complete loss of awareness to present surrounding (American Psychiatric Association, 2014).

This distress is intense and can be prolonged, often being triggered by external or internal stimuli

that resembles or symbolizes any aspect of the original trauma. The survivor will often

persistently avoid stimuli associated with the trauma including people, conversations, or

situations that arouse memories, thought, or emotions associated with the event (American

Psychiatric Association, 2014). PTSD manifests itself through negative affects and emotions

and reduces inherent positive emotions and affective states of happiness or love because the
neurocircuitry of reward and positive emotions are being numbed by implicit denial (Fonzo,

2018; Jean, 2015; Follette 2018) The trauma survivor separates their emotions from the

traumatized part of themselves, creating an interference between feelings and their experience

with more positive emotions. The area of the brain that is heavily impacted by fear and threat is

increasingly activated while the part of the brain that controls positive regard and reward are

being used for aversive, avoidant behavior. This is how emotional numbing is created and the

trauma survivor will feel symptoms of decreased levels of energy, pleasure and engagement.

Recovery is an individual experience and will look different for every client. However,

I am hoping to use mindful art therapy to focus on processing trauma by helping the client find

their window of tolerance, where a person is able to function most effectively. Mindful attention

can “harness the power of change in both brain structure and functioning” (Jean, 2015, p.27) by

controlling autonomic body function that goes into hypo or hyperarousal. Mindfulness provides

a place of noticing, which gives one the ability to turn away from anxiety or the drama of why

one feels the way they do, towards the felt sense which can be expressed in art through

acknowledging, accepting and allowing the feelings to be there. (Rappaport Then one can begin

to change one’s relationship to stress by how one chooses to respond by not identifying with the

trauma but shifting attention to what’s going on at present in the mind-body. (Jean,

2015;Rappaport. ). Mindful art therapy will help clients build the skills necessary for

increasing their window of tolerance, clients will be able to sit with their memories and

experiences in treatment without being traumatized and better able to build their capacity to

recover. My approach will lay the foundation for personal, environmental safety and

stabilization, using personal resources to build on the client’s existing strengths and resilience

(Courtois & Ford, 2016) by using positive psychology, which “espouses that neurological
integration is fundamental to coping and psychological functioning” (Jean, 2015, p. 28) by fusing

positive and negative neural sequences together, simultaneously reflecting and experiencing the

present moment. Through self-activated positive experience using imagination, one will develop

greater capacity to hold negative stress and positive feeling simultaneously without overreacting.

It does not deny that the negative feelings exist but rather to recruit a stronger more adaptive

neural repertoire to anchor to in times of stress. The next step will be to help the clients develop

an “adaptive response to stress rather than shutting down to it” (Jean, 2015, p. 29) by helping

clients learn to mediate unconscious ANS hyperarousal to focus on the emotion rather than the

trigger by developing “positive social engagement” (Jean, 2015, p. 29) to create a calming

response to cultivate rather than separate from the problem. This is facilitated through openness

embodied awareness through relational empathy, building trust, share experiences, validation,

understanding of the emotions, feeling heard, shared understanding, becoming self-

compassionate, seek satisfaction and receptive to the possibly of change. This often revolves

around a self-reflective process of the client’s experiences as they become the basis for

determining a more direct method working with their trauma.

Mindful Art Therapy

The capacity to appraise and reappraise negative emotions is significate and impacts one’s

responses and how one expresses themselves, as we “typically react in accordance with previous

neural conditioning” (Jean, 2015, 32). Through self-governance one learns to be present and

aware so that feelings have less power. Art is used as symbolic tools to hold and process

emotions paired with meditative mindfulness and cognitive mindfulness strategies to bring

about emotional regulation through collaboration. Meditative mindfulness involves

contemplative practice through the inner stillness, aids relaxation by cultivating awareness on the

content of mind in a detached, observing and non-judgmental way. Cognitive attentional

methods borrow solely from the active components of the mind. The client is taught to allow

thoughts and feelings to be there without judging or trying to change anything. “The client learns

to identify less with the story or what they do or don’t like about life, and learn instead to

reappraise negative experience within a context of what it means” (Jean, 2015, p35).

With the understanding about the brain’s reaction to trauma, we can use the combination of

art therapy and mindfulness to create a better foundation for resiliency, improve stress responses

and overall well-being. The brain has two branches of the vagus nerve, the dorsal vagal complex

(DVC) and the ventral vagal complex (VVC), calm the body in different ways, we can recognize

how to create interventions that allow traumatized clients to shift their defense response in a

restorative way (Rappaport 2014). The dorsal vagal complex regulates heartbeat, breathing, and

digestion, working to maintain internal composure. Through the stimulation of the Ventral Vagas

complex, the hypothalamic -pituitary adrenal axis releases oxytocin, allowing a person to feel

safety and bonded to those around them. When interventions like mindful art therapy support and

stimulate the dorsal vagal complex DCV and the ventral vagal complex VVC, the client is able

to form attachments, attunement, communication, and resiliency.

The interventions and exercises of reflective listening and breathing to be used as the opening

exercises throughout the study, to facilitate mental openness to help keep the mind present and

the body grounded and ultimately work to teach the client resilient by processing experience

through developing coping skills of reflecting on strengths, adaptive response to stress, positive

social engagement and appraise and reappraise negative emotions (Jean, 2015) by holding and

processing emotions through interpretation to change response and gain emotional regulation.
 With mindful art therapy, the client discovers that they have within themselves whatever is

needed to meet their life circumstances with increased equanimity.

Trauma-Informed Approaches
“Trauma-informed expressive art therapy emphasizes the centrality of the body as a source of

trauma through nonverbal, embodied communication” (Malchiodi, 2020, pg.202).

Trauma-informed care help people make the link from their past trauma and reframe their

reactions to present and behaviours as attempts to cope with what they have experienced.