The Embodied-Enactive-Interactive Brain: Bridging Neuroscience and Creative Arts Therapies

The Science of Tai Chi and Qigong as Whole Person Health- Part II: Evidence Gaps and Opportunities for Future Research and Implementation

Background: The emerging paradigm of whole person health shares many core principles with traditional complementary and integrative health frameworks, including Tai Chi and Qigong (TCQ). Methods: In the fall of 2023, the Harvard Medical School Osher Center for Integrative Health hosted the inaugural international conference on The Science of Tai Chi & Qigong for Whole Person Health: Advancing the Integration of Mind-Body Practices into Contemporary Healthcare at Harvard Medical School. A two-part white paper was written to summarize key conference topics, findings, and issues. Results and Discussion: Part II presented here summarizes evidence gaps and future research opportunities, including: understudied clinical conditions and populations, impact of long-term TCQ training, understanding the impact of specific TCQ styles, training regimens, dosage, and contextual effects; implementation, cost-effectiveness, and medical utilization research; individual data meta-analysis, and teaching competencies, credentialing, and licensure. Part I of this white paper discusses the rationale for the conference, synthesizes the state of evidence for TCQ as rehabilitative and preventive tools for a range of clinical conditions, and summarizes the translational research informing therapeutic mechanisms associated with TCQ training.

Neuroscience-based relational art therapy and deep brain reorienting in the treatment of dissociative identity disorder

Art therapy (AT) has been proposed as a treatment for post-traumatic conditions, potentially by providing somatic sensory input that can (i) enhance the client's sense of self and embodiment, (ii) modulate arousal, and (iii) aid in rethinking and reframing traumatic memories. However, evidence supporting AT as a treatment for dissociative disorders remains limited. The theoretical basis for the efficacy of AT is discussed in relation to findings regarding the traumatized person's brain and mindset, as well as its altered functional network connectivity. It is crucial to consider specific alterations in brain networks associated with trauma, particularly those occurring in the deep brain regions, which include the midbrain, the brainstem, and the cerebellum. The hypothesis suggests that early or severe trauma can impair the brain's higher regulatory functions, as explained by the cascade theory. This theory explains how diverse activation patterns within the midbrain's periaqueductal gray (PAG) of the midbrain influence the limbic system and cortices, thereby modulating states of being and behavior. Phase-specific, resource-oriented, and long-term therapy for complexly traumatized and dissociative individuals can benefit from novel insights from neuroimaging studies to inform and enhance therapeutic methods. This is illustrated in a clinical vignette with a client diagnosed with dissociative identity disorder (DID), where deep brain reorienting (DBR) was combined with relational AT. The AT component is hypothesized to have facilitated a sense of grounding in the present moment and enhanced the client's access to her neurophenomenological self. Moreover, changes may have occurred at implicit and non-verbal levels. DBR is believed to have helped the client remain present with her previously avoided and unbearable internal experience. To validate these assumptions, the second author conducted a semi-structured interview that focused on the client's experiences of being dissociative and in psychotherapy, including the effect of DBR when introduced after AT. The client's experiences were articulated through a thematic analysis of the interview, which yielded the following themes: Loneliness, getting help, and moving towards togetherness. Further research on and development of therapy methods that enhance the neuroplasticity necessary for highly dissociative clients to change and heal are highly recommended.

Art therapy's engagement of brain networks for enduring recovery from addiction

The field of addiction in its priority to save lives has emphasized harm reduction and medication therapies that have taken precedence over counseling and psychotherapy. The extensive mental health needs, traumatic histories and cognitive challenges of this population call for more availability of all treatments, but also in-depth treatment for the causes of the addiction. The prevalence of trauma is examined with regard to the challenge it presents in treatment for substance use disorder (SUD), and other comorbidities. Two case examples are offered that exemplify how art therapy expedites key information about underlying trauma. Art therapy is proposed as a treatment approach for SUD for its apparent activation of key neural networks that are also impacted by trauma, and its usefulness in engaging those who have cognitive challenges experientially. Quantitative research is cited that suggests art therapy's activation of the reward system, which may make art therapy useful in treating the stress and inhibition coefficients of addiction that map to neural networks of addiction. The need for additional empirical research is cited that may improve the efficiency and effectiveness of art therapy and mental health treatment.

Telehealth in arts therapies for neurodevelopmental and neurological disorders: a scoping review

Background

Arts therapies, encompassing art therapy, music therapy, drama therapy, and dance movement therapy with the broader practice of expressive arts therapies, have demonstrated positive outcomes in the treatment of neurodevelopmental and neurological disorders (NNDs). Integrating arts therapies into telehealth has become increasingly important to improve accessibility for people with mobility impairments or those living in remote areas. This study aims to map the existing body of literature to provide an in-depth overview of telehealth in arts therapies for individuals with NNDs.

Methodology

This scoping review followed the PRISMA guidelines. Six databases were systematically searched, with 2,888 articles screened for eligibility. Inclusion criteria focused on primary research peer-reviewed articles in English that addressed telehealth arts therapies for NNDs.

Results

Seventeen telehealth studies published between 2009 and March 2024 were included, with a notable increase in publications after 2020. The studies covered various neurodevelopmental disorders, including autism spectrum disorders, attention deficit hyperactivity disorder (ADHD), Rett syndrome, and neurological disorders such as stroke, epilepsy, cerebral palsy, central nervous system (CNS) tumors, dementia, Alzheimer's disease, Parkinson's disease, spinal cord injuries, and mild cognitive impairment. Music therapy was the most widely studied modality. Interventions ranged from therapeutic singing and songwriting to virtual reality experiences. Different platforms and specialized virtual environments were used alongside pre-recorded sessions. Positive benefits included psychological enrichment, social connectivity, cognitive improvements, and brain changes, although some studies reported mixed or no significant effects in certain areas.

Conclusion

Telehealth in arts therapies significantly benefits individuals with NNDs, improving accessibility and providing psychological, emotional, social, and cognitive benefits. The positive benefits observed highlight the potential of these interventions to improve overall well-being and daily functioning. Future research may focus on high-quality qualitative studies and neuroimaging assessments to further validate the impact of telehealth arts therapies.

Thematic and intertextual analysis from a feasibility study of the Bonny Method of Guided Imagery and Music with clients in eating disorder treatment

Introduction

Eating disorders (ED) are characterized by serious and persistent disturbances with eating, weightcontrol, and body image. Symptoms impact physical health, psychosocial functioning, and can be life-threatening. Individuals diagnosed with an ED experience numerous medical and psychiatric comorbidities due to issues caused by or underlying the ED. Therefore, it is vital to address the complex nature of an ED, as well as the comorbid and underlying issues. This necessitates a psychotherapeutic approach that can help to uncover, explore, and support working through unresolved emotions and experiences. Guided Imagery and Music (GIM) is an in-depth music psychotherapy approach utilizing therapist-programmed music to support the client in uncovering and examining underlying and unresolved issues. The literature surrounding the use of GIM with clients in ED treatment is anecdotal and comprised primarily of clinical case studies.

Method

This secondary analysis, based on a descriptive feasibility study that integrated GIM sessions into the client's regular ED treatment and examined 116 transcripts from a series of sessions of eight clients.

Results

Thematic analysis of the transcripts identified nine subthemes and three themes that emerged. These themes include emotional landscape (feeling stuck, acknowledging emotions, and working through unresolved emotions), relationships (self, others, and eating disorders), and transformation and growth (finding strength, change, and empowerment). A short series of GIM sessions helped ED clients identify and address issues underlying the ED and to gain or reclaim a sense of self that enabled them to make choices for their life that support their recovery and sense of empowerment. Intertextual analysis revealed imagery indicative of the Hero's Journey.

Discussion

Further, how engagement in this embodied aesthetic experience stimulates perceptual, cognitive, and affective brain functions which are key in fostering behavioural and psychological change is explicated as it relates to ED treatment and recovery.

How the arts heal: a review of the neural mechanisms behind the therapeutic effects of creative arts on mental and physical health

Background

The creative arts have long been known for their therapeutic potential. These modalities, which include dance, painting, and music, among others, appear to be effective in enhancing emotional expression and alleviating adverse physiological and psychological effects. Engagement in creative arts can be pursued as a personal hobby, in a classroom setting, or through a formal therapeutic intervention with a qualified therapist. Engagement can be active (i.e., creating) or passive (i.e., viewing, listening). Regardless of the modality and manner of engagement, the mechanisms explaining the therapeutic efficacy of creative arts remain poorly understood.

Objective

This study aims to systematically review research investigating the neurological mechanisms activated during active or passive engagement in creative arts, with a specific emphasis on the roles of the medial prefrontal cortex (mPFC) and the amygdala in emotional regulation (ER) and creative behaviors. The review seeks to provide preliminary evidence for the possible existence of common neural mechanisms underlying both phenomena, which could inform the development of targeted therapeutic interventions leveraging creative arts for ER.

Methods

A systematic review was conducted following the Cochrane Collaboration guideline and PRISMA standards to identify studies examining the neurological mechanisms underlying creative activities.

Results

A total of six out of 85 records meet the inclusion criteria, with all being basic research studies. Preliminary findings suggest that active and passive engagement with creative arts consistently activate neural circuits implicated in adaptive emotional regulation, including the mPFC and amygdala. These activations mirror the neural pathways engaged in effective ER strategies, suggesting the possible existence of shared mechanisms between creative expression and emotional processing.

Conclusion

The evidence underscores the potential of creative arts as a complementary therapeutic strategy alongside conventional care and other evidence-based mind-body modalities. By elucidating the shared neural mechanisms between creative arts engagement and ER, this review contributes to the theoretical and practical understanding of the role of creative arts in mental health. Future research is recommended to further explore these neural correlations and their implications for therapeutic practice.

Art therapy and neuroscience: evidence, limits, and myths

The evidence base for the effectiveness of art therapy continues to grow, even as a mechanistic understanding of how art therapy works remains limited. One promising avenue for increasing our understanding of how and why art therapy works is through the lens of neuroscience. A neuroscience-based approach to art therapy provides opportunities for improving understanding of the neural processes that underlie the complex interaction between perception, cognition, emotion and behavior that play out in the art therapy process. Understanding how therapeutic change occurs can result in improved treatment and better outcomes for clients. However, it can be tricky to connect art therapy and psychological theory directly to neural responses. The purposes of this perspective are to provide an overview of the current evidence and limits of neurobiological concepts of neuroplasticity, mirror systems, and interoception as applied to art therapy practice, and to provide updated information about outdated concepts that are still actively used in clinical practice. Critical analysis and understanding of the current scientific knowledge base can then be used to guide art therapy practice and support the development of hypothesis-based research to determine the primary mechanisms that drive the observed effects of art therapy interventions.

Meeting the multidimensional self: fostering selfhood at the interface of Creative Arts Therapies and neuroscience

Intriguing explorations at the intersection of the fields of neuroscience and psychology are driven by the quest to understand the neural underpinnings of "the self" and their psychotherapeutic implications. These translational efforts pertain to the unique Creative Arts Therapies (CATs) and the attributes and value of the self-related processes they offer. The self is considered as a multi-layered complex construct, comprising bodily and mental constituents, subjective-objective perspectives, spatial and temporal dimensions. Neuroscience research, mostly functional brain imaging, has proposed cogent models of the constitution, development and experience of the self, elucidating how the multiple dimensions of the self are supported by integrated hierarchical brain processes. The psychotherapeutic use of the art-forms, generating aesthetic experiences and creative processes, touch upon and connect the various layers of self-experience, nurturing the sense of self. The present conceptual analysis will describe and interweave the neural mechanisms and neural network configuration suggested to lie at the core of the ongoing self-experience, its deviations in psychopathology, and implications regarding the psychotherapeutic use of the arts. The well-established, parsimonious and neurobiologically plausible predictive processing account of brain-function will be discussed with regard to selfhood and consciousness. The epistemic affordance of the experiential CATs will further be portrayed, enabling and facilitating the creation of updated self-models of the body in the world. The neuropsychological impact of the relational therapeutic encounter will be delineated, acknowledging the intersubjective brain synchronization through communicative verbal and non-verbal means and aesthetic experiences. The recognition and assimilation of neuroscientific, phenomenological and clinical perspectives concerning the nested dimensionality of the self, ground the relational therapeutic process and the neuroplastic modulations that CATs have to offer on the premise of fostering, shaping and integrating selfhood.

Narrative simulation of social experiences in naturalistic context - A neurocinematic approach

Narratives may be regarded as simulations of everyday social situations. They are key to studying the human mind in socio-culturally determined contexts as they allow anchoring to the common ground of embodied and environmentally-engaged cognition. Here we review recent findings from naturalistic neuroscience on neural functions in conditions that mimic lifelike situations. We will focus particularly on neurocinematics, a research field that applies mediated narratives as stimuli for neuroimaging experiments. During the last two decades, this paradigm has contributed to an accumulation of insights about the neural underpinnings of behavior and sense-making in various narratively contextualized situations particularly pertaining to socio-emotional encounters. One of the key questions in neurocinematics is, how do intersubjectively synchronized brain activations relate to subjective experiences? Another question we address is how to bring natural contexts into experimental studies. Seeking to respond to both questions, we suggest neurocinematic studies to examine three manifestations of the same phenomenon side-by-side: subjective experiences of narrative situations, unfolding of narrative stimulus structure, and neural processes that co-constitute the experience. This approach facilitates identifying experientially meaningful activity patterns in the brain and points out what they may mean in relation to shared and communicable contents. Via rich-featured and temporally contextualized narrative stimuli, neurocinematics attempts to contribute to emerging holistic theories of neural dynamics and connectomics explaining typical and atypical interindividual variability.

Dance/movement therapy as a holistic approach to diminish health discrepancies and promote wellness for people with schizophrenia: a review of the literature

Individuals with a diagnosis of schizophrenia face a myriad of obstacles to wellness, beginning with diagnostic discrepancies including over- and misdiagnoses on the schizophrenia spectrum. People with schizophrenia experience profound amounts of stigmatization from the general population, their healthcare providers, and even themselves. Such stigmatization creates a barrier for wellness, poorer prognoses, and often limits adherence to physical and mental healthcare. Moreover, it can exacerbate the already stifling symptomatology of their diagnoses, including specific bodily-related symptomatology. Oftentimes, a diagnosis of schizophrenia disrupts one's relationship with their body including a diminished mind-body connection, decreased interoceptive awareness, and thus unsuccessful intra- and interpersonal relationships. Some recent research suggests the use of mind-body therapies, however, if these practices are internalizing, they may not be appropriate for people with schizophrenia experiencing more acute symptomatology excluding them from treatment. Dance/movement therapy (DMT) is an embodied psychotherapeutic treatment option that can support participants in improving mind-body connection, social relationships, and self-regulatory skill development. Research on DMT has shown promising results for people with schizophrenia, however such research is limited and would benefit from increased studies that particularly measure the effects of DMT on mind-body connection and increased interoception for people with schizophrenia. Moreover, integrative and collaborative treatment models that couple DMT and biofeedback may further our understanding of the physiological and neurological effects of DMT interventions for people with schizophrenia and beyond. This review will examine the recent literature on health inequities for people with schizophrenia, their specific body-based disruptions and needs, and DMT as a promising treatment model, particularly when coupled with biofeedback.

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.

Why art? The role of arts in arts and health

This article is an answer to a report called "What is the evidence on the role of the arts in improving health and well-being?" The authors conclude that the arts have an impact on mental and physical health. Yet, the question of the role of the arts remains unanswered. What is and what is not an art effect? Recently, embodied theory has inspired articles on the perception of art. These articles have not yet received attention in the field of Arts and Health. Scholars in psychosomatic medicine have argued for an approach based on recent work in enactive embodied theory to investigate the connection between the body and the mind. The present article examines how key concepts in this theory relate to art. This leads to a discussion of art in terms of empathy-the relation between the internal state of the artist and the internal state of the beholder. I exemplify with a conceptual framework of musical empathy. Implications for health are addressed.

Repeating patterns: Predictive processing suggests an aesthetic learning role of the basal ganglia in repetitive stereotyped behaviors

Recurrent, unvarying, and seemingly purposeless patterns of action and cognition are part of normal development, but also feature prominently in several neuropsychiatric conditions. Repetitive stereotyped behaviors (RSBs) can be viewed as exaggerated forms of learned habits and frequently correlate with alterations in motor, limbic, and associative basal ganglia circuits. However, it is still unclear how altered basal ganglia feedback signals actually relate to the phenomenological variability of RSBs. Why do behaviorally overlapping phenomena sometimes require different treatment approaches-for example, sensory shielding strategies versus exposure therapy for autism and obsessive-compulsive disorder, respectively? Certain clues may be found in recent models of basal ganglia function that extend well beyond action selection and motivational control, and have implications for sensorimotor integration, prediction, learning under uncertainty, as well as aesthetic learning. In this paper, we systematically compare three exemplary conditions with basal ganglia involvement, obsessive-compulsive disorder, Parkinson's disease, and autism spectrum conditions, to gain a new understanding of RSBs. We integrate clinical observations and neuroanatomical and neurophysiological alterations with accounts employing the predictive processing framework. Based on this review, we suggest that basal ganglia feedback plays a central role in preconditioning cortical networks to anticipate self-generated, movement-related perception. In this way, basal ganglia feedback appears ideally situated to adjust the salience of sensory signals through precision weighting of (external) new sensory information, relative to the precision of (internal) predictions based on prior generated models. Accordingly, behavioral policies may preferentially rely on new data versus existing knowledge, in a spectrum spanning between novelty and stability. RSBs may then represent compensatory or reactive responses, respectively, at the opposite ends of this spectrum. This view places an important role of aesthetic learning on basal ganglia feedback, may account for observed changes in creativity and aesthetic experience in basal ganglia disorders, is empirically testable, and may inform creative art therapies in conditions characterized by stereotyped behaviors.

Beauty and Uncertainty as Transformative Factors: A Free Energy Principle Account of Aesthetic Diagnosis and Intervention in Gestalt Psychotherapy

Drawing from field theory, Gestalt therapy conceives psychological suffering and psychotherapy as two intentional field phenomena, where unprocessed and chaotic experiences seek the opportunity to emerge and be assimilated through the contact between the patient and the therapist (i.e., the intentionality of contacting). This therapeutic approach is based on the therapist’s aesthetic experience of his/her embodied presence in the flow of the healing process because (1) the perception of beauty can provide the therapist with feedback on the assimilation of unprocessed experiences; (2) the therapist’s attentional focus on intrinsic aesthetic diagnostic criteria can facilitate the modification of rigid psychopathological fields by supporting the openness to novel experiences. The aim of the present manuscript is to review recent evidence from psychophysiology, neuroaesthetic research, and neurocomputational models of cognition, such as the free energy principle (FEP), which support the notion of the therapeutic potential of aesthetic sensibility in Gestalt psychotherapy. Drawing from neuroimaging data, psychophysiology and recent neurocognitive accounts of aesthetic perception, we propose a novel interpretation of the sense of beauty as a self-generated reward motivating us to assimilate an ever-greater spectrum of sensory and affective states in our predictive representation of ourselves and the world and supporting the intentionality of contact. Expecting beauty, in the psychotherapeutic encounter, can help therapists tolerate uncertainty avoiding impulsive behaviours and to stay tuned to the process of change.

Art Therapy Open Studio and Teen Identity Development: Helping Adolescents Recover from Mental Health Conditions

Adolescent identity development is driven to a significant degree by peer interaction. However, when mental health conditions (MHC) or other crises separate teens from their peers, their identity development can be slowed or arrested. We developed a unique open studio intervention (OS-ID) that could facilitate identity development in teens recovering from MHC, and incorporated this intervention into a therapeutic day school catering to our target population. We utilized qualitative case study research to explore these students' experiences. Over the 10-month period of our intervention, we saw positive changes in the participants' identity development. Key elements in OS-ID include the therapists' commitment to supported autonomy; the absence of participatory demands; the emphasis on creative process over product; the use of setting and materials to promote the healing process; the facilitators' and participants' witnessing the process; the privatization and protection of the participants' creations; and the ubiquitous presence of non-threatening significant others. This OS-ID modality could be an effective mechanism for assisting socially isolated teens to manage their social anxiety, develop their identity, and transition back into their peer environments.