Cognitive Benefits of Art Therapy
for Individuals Who Have
Sustained Traumatic Brain Injuries:
A Resource Guide
Laura A Cope

Introduction
+ The purpose of this presentation is to share an art therapy-based resource guide
aimed to treat individuals who have sustained traumatic brain injuries.

+ We will cover the following:
+ The purpose of this resource guide
+ What is TBI?
+ Why Art Therapy?
+ Who this resource guide benefits
+ How to use it
+ Special Considerations when using this guide

+ Nine Interventions for individuals whoa have sustained TBI

Purpose
Develop a resource guide for Masters level art therapists to utilize when
working with clients that have sustained traumatic brain injuries. The
interventions in this guide are geared to help in gaining or regaining various
cognitive skills.

Brain injuries can occur in anyone, but the
highest prevalence of TBI occurs in children
14 years and younger and on the other end
of the spectrum, 65 years and older
(Roebuck-Spencer & Cernich, 2014).

Justification

The effects of traumatic brain injury can
include massive disruptions to the
individuals’ life-course, family, relationships,
income, earning potential and costly
expenses throughout their lifetimes.
Art therapy can be used in many of the
settings that treat TBI to help promote selfesteem, improve mental health,
socialization, and stimulate different brain
functions in a non-verbal way.

Terms
+ Traumatic brain injury

+ Traumatic brain injury (TBI) is the term used to describe an injury to the
brain acquired from an external force which results in some form of
cognitive and/or behavioral alterations (Roebuck-Spencer & Cernich,
2014).
+ Cognitive Rehabilitation
+ Cognitive rehabilitation refers to a set of interventions used to help an
individual regain previously learned skills or develop compensatory
strategies to manage newly acquired cognitive deficits. Goals of
neurorehabilitation include increasing cognitive ability, increasing
independence and reintegration with the community.
+ Cognitive Skills

+ Executive functioning deficits are common in TBI. Executive functioning
skills include a range of high order cognitive abilities that are mainly
associated with the prefrontal cortex. These abilities include planning,
judgement, memory acquisition and retrieval, attention and decision
making. Executive functions also include emotional aspects of decision
making, impulse control and motivation to initiate and execute tasks
(Rabinowitz & Levin, 2014).

Terms (cont.)
+ Art Therapy
+ Art therapy is a modality of therapy in which art making plays a central role
in nonverbal self-expression.
+ Expressive Therapies Continuum
+ The Expressive Therapies Continuum is a theoretical model which guides the
development of art-based assessments and art-based therapeutic interventions. The model
can help assess the artist’s creative level based on media choice, interactions with the
media, the imagery created and why they chose to create the imagery

Brain
Activity and
Art Making

+ Lusebrink (1990) described images as a bridge between
mind and body or “between the conscious levels of
information processing and the physiological changes in the
body” (p.218). As we increase our understanding of the
hemispheres of the brain, we begin to understand what
mental functions are involved in art making.

+ Research has also found connections between simple line
drawings and language functions in the brain through
positron emission tomography (PET) scans (Frith & Law,
1995).
+ In a study conducted by Walker, et al. (2018), 10 service
member participants who had been diagnosed with chronic
TBI received fMRI scans halfway through a four-week
intensive outpatient program which included art therapy
interventions.

How to use this resource guide
+ This guide is intended for Master's level art therapists to use for those who
have sustained traumatic brain injuries. The goal of these interventions is to gain or
regain cognitive skills that have been impacted by TBI. The art therapist using this
guide should also seek further training in TBI, neuroscience and cognitive therapy in
order to best understand the unique needs of their client. This is not a step by step
curriculum, but a collection of resources that can be implemented as needed.
+ Clients should be assessed prior to implementing any of the interventions to ensure
that the directive is appropriate for the individual. Consider any adaptations or
modifications that can be used to help the directive be as successful as possible.

Art therapy can serve as a non verbal method of
communication. Many who have TBI may also
suffer with aphasia , among other speech
deficits. While each intervention includes
discussion prompts, they may not be
appropriate for each individual.

Special
Considerations

Physical deficits may also impact a client's
ability to carry out some art making functions.
Art therapists should use discretion in identifying
when it is appropriate to adapt an intervention or
act as a hand to the individual.
A thorough assessment process should be
conducted before choosing directives for the
client.

Intervention One: Still Life Drawing
+Materials:
+ Paper, Drawing materials,
Objects/Landscapes that will act as the
subject

Intervention One: Still Life Drawing
Cognitive Benefits

Considerations and Adaptations

+Memory acquisition,
increased attention, develops
encoding strategies

+If drawing detailed objects is too
complex or the client's attention
deficits are more severe, have
the client draw three simple
shapes at a time. You can also
show them the shapes, have the
study the shapes, then take
them away. Have them draw
what they remember.

Intervention Two: Creating a Memory
Box
+Materials:

+Container/Shoe Box,
Personal Photos/Copies of
photos, Personal items,
Preferred materials to
decorate the box

Intervention Two: Creating a Memory
Box
+Cognitive Benefits

+Considerations and Adaptations

+Memory acquisition, Long term
memory, Sequencing, Emotional
regulation

+This directive may be conducted in
two sessions due to cognitive and
physical limitations.. Having the
clients discuss the items or photos
in the box may be an emotional
experience. Many living with TBI
grieve their lives before their injury.
Ensure this directive is conducted
in a safe space for the individual.

Intervention Three: Collaging my Life
+Materials:
+Paper, Scissors/adaptive scissors,
Glue/glue sticks, Personal photos,
Magazine/newspaper clippings

Intervention Three: Collaging my Life
+Cognitive Benefits

+Considerations and Adaptations

+Memory acquisition, Long term
memory, Sequencing, Emotional
regulation

+It may be beneficial for this
directive to be facilitated in a family
session with the individual. This is
especially true if the client decides
to create a timeline of events.
Family can assist in ordering
events in chronological order. This
activity can also facilitate
reminiscing which aids in LTM
retention.

Intervention Four: Mindful Clay
+Materials:

+Air dry clay, Clay tools, clay
knives if appropriate,
sponges, needle tools, rolling
pins, etc.

Intervention Four: Mindful Clay
+Cognitive Benefits

+Motor skill development,
Sensory memory, Build self
efficacy

+Considerations and
Adaptations
+It may be beneficial for this
directive to be facilitated with
an art therapist and
occupational therapist present
due to possible assistance
needed when clients are
manipulating the clay.

Intervention Five: Origami
+Materials:

+paper squares, step by step instructions
(optional)

Intervention Five: Origami
+Cognitive Benefits

+Motor skill development,
following directions, cognitive
flexibility

+Considerations and
Adaptations
+It may be beneficial for this
directive to be facilitated with
an art therapist and
occupational therapist present
due to possible assistance
needed with fine motor skills.

Intervention Six: Paint by Numbers
+Materials:

+paints (acrylic or tempera may be best),
paint brushes, Canvas/Acrylic Paper with
an unfinished images which the client will
fill with paint colors.

Intervention Six: Paint by Numbers
+Cognitive Benefits

+Considerations and Adaptations

+Improves attention, following
directions, sequencing, promotes
mindfullness

+This directive may not be
appropriate for clients who have
vision impairments due to their
brain injuries. Some client's who
suffer with aphasia may have
difficulty identifying numbers and
words. This could be a beneficial
intervention to work on those skills,
but may require one on one
assistance.

Intervention Seven: Jewelry Making
+Materials:

+Beads of various shapes and colors,
String to hold the beads together,
(optional) clasps or other jewelry findings.

Intervention Seven: Jewelry Making
+Cognitive Benefits

+Sequencing, Pattern making,
Improves attention, Promotes
Self efficacy

+Considerations and
Adaptations
+Clients that struggle with
shakiness or other motor
functioning impairments may
benefit from occupational
therapy support or the art
therapist acting as a hand to
the individual.

Intervention Eight: Scribble Drawing
+Materials:

+-Resistive mark making tools
(pens, markers, colored
pencils, crayons, etc.), Paint
(optional), Paper

Intervention Eight: Scribble Drawing
+Cognitive Benefits

+Cognitive flexibility, remote
memory, visual memory

+Considerations and
Adaptations
+As with most of these
directives, consider any
potential physical limitations
including poor motor skill
function or vision
impairments.

Intervention Nine: Print Making
+Materials:

+Styrofoam (plates, trays, etc. as long as
you have a flat surface) I used foam pads
in my example, pens, Printing ink
(speedball is affordable) or ink pads,
(optional) printing brayer (looks like a
roller), Paper

Intervention Nine: Print Making
+Cognitive Benefits

+Considerations and Adaptations

+Cognitive flexibility, Executing
multistep tasks, Skill building

+This project required many higher
executive functioning skills and
could be frustrating for some
clients who struggle with initiating
multi step tasks. If a client would
benefit from this task, but requires
additional assistance, it may be
best to use this intervention in an
individual setting rather than a
group session.

Limitations of Research
+ Has not been formally evaluated for effectiveness in improving cognitive abilities.
+ Interventions may require adaptations to meet the unique needs of each
individual.
+ While each directive includes a list of processing questions, some individuals may
live with speech impairments that affect their ability to verbally communicate.
+ Building rapport and assessing clients on cognitive functioning will help the
interventions be more successful.
+ These interventions are meant to be utilized by master's level art therapists who
have also acquired additional training in cognitive therapy and in traumatic brain
injuries.

Discussion

Conclusion
+There is a significant lack of research on the benefits of art therapy with
the TBI population.
+This curriculum serves as a flexible guide of directives that can be utilized
individually or in group settings.
+The target population would be individuals who have sustained traumatic
brain injuries and are in treatment to gain or regain certain cognitive
functions.
+These directives should be carried out by licensed art therapists who have
also had extensive training in the TBI population.

+These directives can be used in residential, hospital, or outpatient settings.

Q&A

References:
+Frith, C., & Law, J. (1995). Cognitive and physiological
processes underlying drawing skills.Leonardo, 28(3), 203–205.

+Roebuck-Spencer, T., & Cernich, A. (2014). Epidemiology and
societal impact of traumatic brain injury. Handbook on the neuropsychology of
traumatic brain injury, 3-23.c

+Walker, M. S., Stamper, A. M., Nathan, D. E., & Riedy, G.
(2018). Art therapy and underlying fMRI brain patterns in military TBI: A case
series. International Journal of Art Therapy, 23(4), 180-187.