BILATERAL ART THERAPY FOR ADJUSTMENT

Bilateral Art Therapy for Adjustment to Chronic Stressors

Arielle R. Weil
Department of Counseling, Pennsylvania Western University
COUN 7560: Advanced Research in Art Therapy
Dr. Penny Orr
August 8, 2025

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Abstract
Exposure to chronic stressors has neurological and physiological impacts and can negatively
impact an individual’s physical, mental, and emotional wellness. When stressful experiences are
inadequately processed, one may remain in a state of heightened distress, making it difficult to
cope with and adapt to new stressors. One therapeutic tool that is effective in helping individuals
process experiences is bilateral stimulation (BLS), which involves activating both the left and
right hemispheres of the brain to increase interhemispheric communication and integration. Brain
functions are lateralized, meaning they reside mainly in one hemisphere or the other; BLS aids in
the holistic processing of experiences by accessing functions in both hemispheres at once.
Bilateral art therapy activates BLS by using both sides of the body in the creative process. A
heuristic inquiry was conducted to investigate the use of bilateral art therapy to facilitate
adjustment to chronic stressors. As was suggested in the existing literature, BLS facilitated
holistic processing of stressors by accessing cognitive content and emotional content, stored
primarily in the left hemisphere and right hemisphere of the brain, respectively. It also aided in
regulation while addressing stressors. The insights gained during the bilateral artmaking process
were solidified by writing them down with both hands following artmaking.
Keywords: art therapy, bilateral art therapy, bilateral stimulation, BLS, chronic stress,
adjustment

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Table of Contents
Section I: Introduction .................................................................................................................... 7
Problem to be Investigated ......................................................................................................... 8
Purpose Statement....................................................................................................................... 8
Justification ................................................................................................................................. 8
Research Question ...................................................................................................................... 9
Terms Related to the Study ......................................................................................................... 9
Affect ...................................................................................................................................... 9
Allostasis ................................................................................................................................. 9
Allostatic Balance ................................................................................................................. 10
Eye Movement Desensitization Reprocessing (EMDR)....................................................... 10
Global Processing ................................................................................................................. 10
Conclusion ................................................................................................................................ 10
Section II: Review of Literature ................................................................................................... 11
Neurobiology Framework ......................................................................................................... 11
Nervous System and Brain Structures .................................................................................. 11
Lateralization of Brain Function. ...................................................................................... 14
Neuroplasticity ...................................................................................................................... 15
Neurobiology of Bilateral Stimulation.................................................................................. 16
BLS and General Mental Health Treatment ............................................................................. 16
Eye Movement Desensitization and Reprocessing ............................................................... 17
Expressive Arts Therapies .................................................................................................... 17
Play Therapy ......................................................................................................................... 18

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Occupational Therapy ........................................................................................................... 18
Mirror Therapy.................................................................................................................. 18
Somatic Therapy ................................................................................................................... 19
Bilateral Walking .............................................................................................................. 19
Neurobiology in Art Therapy ................................................................................................... 19
Expressive Therapies Continuum ......................................................................................... 19
Bilateral Art Therapy ................................................................................................................ 20
Early Conceptualization ........................................................................................................ 20
Integration of Felt Experience and Cognitive Awareness .................................................... 21
Trauma .................................................................................................................................. 22
Parts of Self ........................................................................................................................... 23
Relational Attunement .......................................................................................................... 24
Physical and Emotional Wellness ......................................................................................... 24
Stressors and Adjustment.......................................................................................................... 25
Stress Response ..................................................................................................................... 25
Impact of Chronic Stress ....................................................................................................... 25
Adjustment Disorders ........................................................................................................... 26
Relationship Between Adjustment Disorders and PTSD...................................................... 26
Art Therapy for Stressors ...................................................................................................... 27
Bilateral Art Therapy for Chronic Stress .......................................................................... 27
Conclusion ................................................................................................................................ 28
Section III: Methodology .............................................................................................................. 30
Subject ...................................................................................................................................... 30

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Research Design and Procedures .............................................................................................. 30
Proposed Data Analysis ............................................................................................................ 31
Section IV: Results ....................................................................................................................... 32
Art Experiential 1 ..................................................................................................................... 32
Figure 1 ..................................................................................................................................... 32
Figure 2 ..................................................................................................................................... 34
Figure 3 ..................................................................................................................................... 35
Figure 4 ..................................................................................................................................... 36
Figure 5 ..................................................................................................................................... 37
Figure 6 ..................................................................................................................................... 39
Figure 7 ..................................................................................................................................... 40
Figure 8 ..................................................................................................................................... 41
Figure 9 ..................................................................................................................................... 43
Figure 10 ................................................................................................................................... 44
Section V: Discussion ................................................................................................................... 46
Summary of Research ............................................................................................................... 46
Analysis .................................................................................................................................... 46
Table 1 ...................................................................................................................................... 47
Table 2 ...................................................................................................................................... 47
Table 3 ...................................................................................................................................... 48
Table 4 ...................................................................................................................................... 49
Table 5 ...................................................................................................................................... 49
Discussion ................................................................................................................................. 51

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Limitations ................................................................................................................................ 52
Suggestions for Future Research .............................................................................................. 53
Conclusion .................................................................................................................................... 55

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Section I: Introduction
Exposure to chronic stressors has neurological and physiological impacts and can
negatively impact an individual’s physical, mental, and emotional wellness (Hass-Cohen & Carr,
2008). When stressful experiences are inadequately processed, one may remain in a state of
heightened distress, making it difficult to cope with and adapt to new stressors (Laliotis, 2020).
When an identifiable stressor leads to a disproportionate emotional and behavioral response and
causes functional impairment, the individual’s symptoms may meet the diagnostic criteria for an
adjustment disorder as set forth by the American Psychiatric Association (APA, 2022) in the
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5TR). If the stressor is chronic, the disorder may endure indefinitely (APA, 2022). Interventions
can be used to facilitate adaptive processing of experiences to mitigate the negative impacts of
chronic stress (Glinzak, 2016; Karagiorgakis & Palmer, 2024; Laliotis, 2020; Lee, 2013).
One therapeutic tool that is effective in helping individuals process stressful experiences
is bilateral stimulation (BLS; Shapiro, 2001; Solomon & Shapiro, 2008; Tripp, 2023). BLS
involves activating both the left and right hemispheres of the brain to increase interhemispheric
communication and integration. Brain functions are lateralized, meaning they reside mainly in
one hemisphere or the other; BLS aids in the holistic processing of experiences by accessing
functions in both hemispheres at once (Chara, 2023; Gazzaniga, 2005; Rogers, 2024). BLS is
used in many therapeutic modalities, including Eye Movement Desensitization and Reprocessing
(EMDR; Shapiro, 2001), expressive arts therapies, play therapy, occupational therapy, somatic
therapies, and art therapy.
Bilateral art therapy activates BLS by using both sides of the body in the creative process.
To this author's knowledge, no current bilateral art therapy protocols are specifically designed for

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chronic stress and adjustment disorders. However, several protocols support the integration of
emotional experience with cognitive understanding (Cartwright, 1999; McNamee, 2003, 2005,
2006), and others target trauma and processing relevant stressful experiences (Chapman et al.,
2001; Chapman, 2014; Elbrecht, 2018; McNamee, 2004; Talwar, 2007; Tripp, 2007, 2022).
Therefore, bilateral art therapy could be useful in fostering adaptive adjustment to experiences of
chronic stressors to mitigate negative symptoms that may rise to the level of an adjustment
disorder.
Problem to be Investigated
The experience of chronic stressors can negatively impact an individual’s sense of wellbeing, affect, emotional regulation, motivation, concentration, thought process, memory, sleep,
and appetite (Marroquín et al., 2017), and can compromise the immune system (Findlay, 2008;
Kiecolt-Glaser et al., 2002; Laliotis, 2020). While bilateral art therapy protocols exist for related
issues, there are none known to this author which addresses chronic stress directly despite this
being a shared and common part of the human experience. This heuristic study intends to explore
the use of bilateral art therapy for the treatment of chronic stress.
Purpose Statement
The purpose of this heuristic study is to gain insight into how bilateral art therapy can aid
in self-regulation, processing stressors, and improving overall wellbeing for an individual
experiencing chronic stress.
Justification
Although everybody experiences chronic stressors throughout their lives, bilateral art
therapy protocols to address this specifically are lacking. However, protocols to address trauma
are being developed and are increasing in popularity, particularly as neuroscience research

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increases the field’s understanding of the impact of these stressful experiences on individuals’
brains. I have used bilateral art in my own life for various purposes, finding that it allows for a
different type of thought, experience, and engagement in the artistic process. As I come to the
end of my master’s program in art therapy, I am encountering chronic stressors related to life
transitions, including graduating from university, leaving one career and beginning a new one,
buying a first home, and starting a family. While these transitions are positive, exciting steps in
life, they carry with them challenges and chronic stressors that cannot be avoided nor hastened.
Ultimately, these stressors are the growing pains that must be endured as we go through life
transitions.
Supported by peer-reviewed research, my personal case study will explore the use of
bilateral art therapy to foster adaptive adjustment to these chronic stressors to mitigate negative
symptoms and improve overall wellbeing. Through this process, I will gain insight to inform my
practice as an art therapist.
Research Question
How can bilateral art therapy be used to self-regulate, increase wellness, and process
chronic stressors resulting from significant life transitions?
Terms Related to the Study
Affect
Subjective experience of emotion.
Allostasis
Physiological processes that mitigate the effects of internal or environmental challenges
or stressors. Such bodily adjustments are essential for restoring and maintaining normal
functioning, stability, and viability within the organism (Hass-Cohen & Carr, 2008). “Allostasis

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results in adaptive, stress-reducing behaviors that can be repeated with minimal attention during
similar life contexts” (Kravits, 2008, p. 111).
Allostatic Balance
“A state or pattern of balance achieved through allostasis that is retained in memory. This
memory allows quicker generic responses in the future when similar homeostatic challenges or
stressors are encountered” (Hass-Cohen & Carr, 2008, p. 311).
Eye Movement Desensitization Reprocessing (EMDR)
EMDR is a psychotherapy treatment modality developed to decrease symptoms of posttraumatic stress disorder (Shapiro, 2001).
Global Processing
Engaging both hemispheres of the brain to process and integrate content.
Conclusion
Chronic stress can negatively impact one’s physical, mental, and emotional wellbeing.
During times of transition, these stressors are unavoidable and must be endured, which can
require that an individual remain in a state of elevated distress for long periods of time. Bilateral
art therapy could be a beneficial intervention to address chronic stressors, decrease negative
symptoms, and increase positive adjustment to life transitions. Through a heuristic self-study,
this research seeks to explore the use of bilateral art therapy to aid in self-regulation, processing
stressors, and improving overall wellbeing while experiencing chronic stressors.

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Section II: Review of Literature
The following section will use a neurobiological framework to understand lateralization
of brain function and the impact of BLS on functioning. Current uses of BLS in general mental
health treatment and art therapy will be discussed as improving interhemispheric communication,
accessing lateralized content, and facilitating holistic processing and integration of content and
experiences to improve functioning and alleviate negative symptoms. Stressors and adjustment
disorders will be reviewed with a focus on the impact of chronic stress, as well as art therapy
treatment to address stressors.
Neurobiology Framework
A neurobiological framework for mental health treatment uses brain-based understanding
to guide the development and implementation of interventions. Central to this framework is an
understanding of how brain structures, neural circuits, neurotransmitters, and neuroplasticity
influence mental health conditions as well as how these concepts can be used in mental health
treatment (Wojtalik et al., 2018).
Nervous System and Brain Structures
The nervous system is divided into two systems: the central nervous system (CNS) and
the peripheral nervous system (PNS). The CNS includes the brain, brainstem, and spinal cord,
and the PNS includes all other nerve cells in the body (Hass-Cohen, 2008). The CNS is
responsible for coordinating and directing all the body's biological activities; it receives and
processes sensory information, generates signals that control motor functions, and regulates
bodily processes (Hass-Cohen & Carr, 2008). The brain is responsible for executive functions
including thought, emotion, and memory. The brainstem controls involuntary functions including
breathing and heart rate. It connects the brain and spinal cord, which connects to the PNS (Hass-

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Cohen & Carr, 2008).
The PNS connects the CNS to the rest of the body and is responsible for sensory input,
motor control, and autonomic functions (Hass-Cohen, 2008). The PNS transmits sensory
information from the body's organs and peripheral structures to the CNS and carries motor
commands from the CNS to muscles and glands (Hass-Cohen, 2008). The PNS is divided into
three subsystems: the somatic nervous system, responsible for voluntary movements, the enteric
nervous system, responsible for digestion and gut functions, and the autonomic nervous system
(ANS), responsible for involuntary functions like digestion and heart rate. The ANS is divided
into the sympathetic nervous system, which is responsible for arousal of the fight-or-flight
response, and parasympathetic nervous system (PSNS), which works as an antagonist to the
sympathetic nervous system (Hass-Cohen, 2008). These two systems work in opposition to
regulate their functions. The vagus nerve, part of the PSNS, is the longest nerve in the body,
extending from the brainstem to the abdomen and connecting to many organs (Kravits, 2008). It
plays an important role in regulating numerous bodily functions.
The cerebral cortex, the brain's outermost layer, is responsible for higher-level cognitive
functions; it processes sensory information, controls voluntary motor functions, and mediates
complex cognitive processes such as language, memory, and decision-making (Hass-Cohen &
Carr, 2008). The network of neurons within the cerebral cortex facilitates perception, thought,
and conscious awareness, enabling humans to interact with and understand their environment.
The cerebral cortex is divided into four lobes—frontal, parietal, temporal, and occipital. The
frontal lobe, located at the front of the brain, is responsible for executive function, motor control,
and personality (Hass-Cohen & Carr, 2008). Within the frontal lobe, the prefrontal cortex is
responsible for executive functions, including abstract reasoning, planning, decision making, and

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working memory. The primary motor cortex is responsible for controlling voluntary movements,
and the premotor cortex serves to plan and sequence those movements. Broca's area, located in
the left frontal lobe, is responsible primarily for speech production (Hass-Cohen & Carr, 2008).
The parietal lobe, located behind the frontal lobe, is essential to sensory processing and
spatial awareness. The temporal lobe, located on the sides of the brain, is critical for auditory
processing, memory formation, and language comprehension. The left temporal lobe is important
in language processing and contains Wernicke’s area, which is responsible for language
comprehension (Hass-Cohen & Carr, 2008). The right temporal lobe primarily processes
nonverbal information, such as visual patterns, facial recognition, and musical melodies, and
contributes to spatial memory (Hass-Cohen & Carr, 2008). The occipital lobe, located at the back
of the brain, is responsible for visual processing (Hass-Cohen & Carr, 2008).
The corpus callosum serves as the primary communication pathway between the right
and left hemispheres (Hass-Cohen & Carr, 2008). It facilitates the transfer of sensory, motor, and
cognitive information, enabling interhemispheric integration and coordination. It allows for
unified perception, coordinated motor actions, and the sharing of cognitive processes across the
hemispheres (Hass-Cohen & Carr, 2008).
The limbic system is a network of central structures that play an important role in
emotion, memory, motivation, and survival responses (Hass-Cohen & Carr, 2008). It includes
the hippocampus, amygdala, hypothalamus, thalamus, and other components. The hippocampus
is vital for memory formation, the amygdala processes emotions, particularly fear and
aggression, and the hypothalamus regulates essential bodily functions like hunger, thirst, and
body temperature (Hass-Cohen & Carr, 2008). The thalamus transmits sensory and motor
information to the cerebral cortex and contributes to emotional processing and memory

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formation through connections with limbic system structures (Hass-Cohen & Carr, 2008).
An integral part of the limbic system is the cingulate cortex, which surrounds the corpus
callosum (Jumah & Dossani, 2022). It is divided into four regions: the anterior cingulate cortex
(ACC), the midcingulate cortex (MCC), and the posterior cingulate cortex (PCC), and the
retrosplenial cortex (RSC; Torta & Cauda, 2011). ACC is involved in monitoring conflict and
errors, selecting responses, and controlling attention (Torta & Cauda, 2011). The MCC is
involved in motor control and action-outcome learning (Rolls, 2019). The PCC is involved in
autobiographical memory and spatial navigation (Torta & Cauda, 2011). The RSP is involved in
visuospatial functions and memory (Torta & Cauda, 2011).
The insular cortex integrates sensory and emotional information, and contributes to
interoception, awareness of self and others, and the processing of extreme emotions (Hass-Cohen
& Carr, 2008). The cerebellum, located at the rear of the brain, is involved in motor
coordination, proprioception, timing of movements, procedural learning (Hass-Cohen & Carr,
2008), cognitive and emotional processing, social behaviors, and interoception (Ciapponi et al.,
2023).
Lateralization of Brain Function. The left and right hemispheres of the brain have
distinct ways of processing sensory input and controlling behavior (Rogers, 2024). This is known
as lateralization of brain function, and there is evidence that this improves cognitive capacity
(Rogers, 2024). The hemispheres are connected by the corpus callosum and are constantly
interacting and sharing resources (Gazzaniga, 2005). Split brain studies have shown that
“increasing the difficulty of a task in one hemisphere draws resources away from the other and
results in poorer performance by that other hemisphere” (Gazzaniga, 2005, p. 654). The
hemispheres’ functions are considered to be complementary rather than oppositional, increasing

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the efficiency of the brain’s resources (Chara, 2023).
Many brain functions are lateralized in humans, including language, music, visuospatial
processing, perceptual style, cognitive style, and feelings and emotions (Chara, 2023). The left
hemisphere is more specialized in language, speech, verbal memory, problem solving, and more
cognitive content, while the right hemisphere is more specialized in non-verbal information,
spatial awareness, spatial memory, pattern recognition, facial recognition, and more emotional
content (Chara, 2023; Ezzati et al., 2016; Gazzaniga, 2000; Rogers, 2024; Tripp, 2023). The
limbic system, involved in primary emotion, may also be more closely associated with the right
hemisphere (Schore, 1997). Additionally, sensory information and motor movements on each
side of the body are connected to the somatosensory and motor cortices in the opposite brain
hemisphere, known as contralateral somatosensory processing and contralateral control,
respectively (Sheposh, 2020). The movements and sensations on the left side of the body are
connected to the right hemisphere of the brain, and vice versa.
Neuroplasticity
Neuroplasticity is the brain’s ability to change and reorganize by forming new neural
connections and getting rid of unneeded connections (Sheposh, 2020). This process involves
functional and structural changes that occur in response to internal and external factors and
continues throughout a person’s lifespan (Puderbaugh & Emmady, 2023). Neuroplasticity allows
for adaptation to changes. The rewiring of neural networks can shift functioning in response to
injury (Sheposh, 2020). Considerable research efforts have sought to understand how
environmental changes can be used to guide the brain's neuroplasticity. Music therapy, exercise,
healthy diet, certain dietary supplements, decreasing stress, and avoiding sleep deprivation all
influence neuroplasticity positively (Puderbaugh & Emmady, 2023). While neuroplasticity can

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be adaptive, there is also maladaptive neuroplasticity, which occurs when the brain creates
connections that manifest as abnormal or negative symptoms (Puderbaugh & Emmady, 2023).
When an individual is stuck in negative patterns of thoughts, emotions, and behaviors, they may
be facilitating maladaptive neuroplastic changes. Therapeutic interventions can be helpful in
guiding positive neuroplastic changes and pruning neural connections associated with
maladaptive patterns (Puderbaugh & Emmady, 2023).
Neurobiology of Bilateral Stimulation
The corpus callosum connects the two hemispheres of the brain and is activated by using
bilateral stimulation (BLS). By engaging both hemispheres of the brain, BLS improves
interhemispheric communication and integration across the corpus callosum, leading to holistic
processing of experiences by accessing lateralized brain functions (Tripp, 2023). Through
contralateral somatosensory processing and contralateral control, sensory stimuli and movement
on each side of the body involves activation of the opposite hemisphere of the brain (Sheposh,
2020). BLS can be done through eye movements, body movements (e.g., walking or making art
with both hands), tactile stimulation (e.g., tapping or holding alternating vibrating touchpoints),
or auditory stimulation (Bay Area CBT Center, 2024). Evidence suggests that BLS increases
emotion regulation by decreasing activity in the amygdala, the brain structure responsible for
processing fear and aggression, and impacting the prefrontal cortex, which is involved in
emotion regulation and rational thought (Amano & Toichi, 2016). Due to neuroplasticity,
frequent use of BLS increases the connections in the corpus callosum and increases the ease with
which the brain engages both hemispheres in global processing.
BLS and General Mental Health Treatment
BLS is used intentionally in mental health treatment by incorporating bilateral stimuli

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such as eye movements, tactile stimuli, and auditory stimuli to engage both hemispheres of the
brain (Tripp, 2023). BLS is also intrinsic to treatment modalities that involve movement, sound,
and bimanual processes because engaging both sides of the body automatically stimulates both
hemispheres of the brain (Hovitz, 2024). BLS is used for a variety of purposes including trauma
treatment, improving cognition and mood, increasing emotion regulation, alleviating pain, and
improving mobility.
Eye Movement Desensitization and Reprocessing
Eye Movement Desensitization and Reprocessing (EMDR; Shapiro, 2001) is a
psychotherapy treatment modality developed to decrease symptoms of post-traumatic stress
disorder (PTSD). EMDR uses alternating bilateral stimuli to decrease feelings of anxiety and
stress while facilitating adaptive information processing to change the way traumatic memories
are stored in the brain. EMDR aids in global processing and integration by “stimulating the
brain’s intrinsic processing system, allowing information from other neural networks to link in”
(Solomon & Shapiro, 2008, p. 320).
Expressive Arts Therapies
Expressive arts therapies integrate music, visual arts, dance/movement, drama, literature,
and poetry with mental health counseling (Lesley University, n.d.). According to Cohen (2009),
“virtually every form of art provides optimal utilization of the benefits of synchronized
hemisphere involvement – optimally integrating left and right brain capacities” (p. 50). In music
therapy, BLS can be used to impact cognition and mood (Chaieb et al., 2015) and to aid in the
rehabilitation of movement disorders (Thaut & Abiru, 2010). BLS is inherent to
dance/movement therapy because using both sides of the body requires engaging both
hemispheres of the brain (Hovitz, 2024). Some movements inherently involve BLS, including

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crossing the midline of the body, alternating movements, and movements that incorporate both
sides of the body either symmetrically or asymmetrically (KET Education, n.d.).
Play Therapy
Play therapy is a therapeutic modality that is designed to facilitate emotional growth
through the language of play in which children naturally engage (Brems, 2024). Like other
movement-based approaches, play therapy inherently involves interhemispheric communication
due to the use of both sides of the body and movements that cross the midline. Play therapy can
also involve intentional BLS, such as using bilateral eye movements and tactile stimulation in
treating trauma (Beckley-Forest & Monaco, 2021; Potgieter, 2021).
Occupational Therapy
Occupational therapy is a therapeutic approach designed to increase patients’ ability to
engage in activities of daily living in order to foster independence and improve quality of life
(Harmon, 2024). BLS is used intrinsically when tasks focus on practical skills that involve
bilateral movements, such as cooking and hygiene tasks. BLS is used intentionally in
occupational therapy to promote bilateral coordination and bilateral integration, or the ability of
both brain hemispheres to function in a coordinated and efficient way (Beck, n.d.). Occupational
therapists use bilateral coordination activities that involve movement on both sides of the body to
foster the development of bilateral integration skills (Beck, n.d.).
Mirror Therapy. Mirror therapy is a technique used in occupational therapy to treat
phantom limb pain in amputees, as well as other conditions including strokes (Thieme et al.,
2018). The technique involves using a mirror to create the illusion that the affected limb is able
to move like the unaffected limb (Puderbaugh & Emmady, 2023). This technique directs
neuroplasticity in a way that improves functioning and sensory awareness and decreases pain by

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increasing neuronal “activation and functional connectivity in the frontoparietal network”
(Puderbaugh & Emmady, 2023).
Somatic Therapy
Somatic therapy is a body-centered therapeutic approach that focuses on the mind and
body in a holistic way (Psychology Today, n.d.). As a modality based in body movement and
sensation, somatic therapy uses BLS intrinsically. BLS is also used intentionally to support
trauma processing, emotional regulation, nervous system regulation, and body awareness (Levy,
2025).
Bilateral Walking. BLS is intrinsic to walking due to the alternating engagement of both
sides of the body and hemispheres of the brain. Bilateral walking is a technique used in somatic
therapy that involves walking during therapy to decrease psychological distress and promote
emotion regulation and a sense of calmness (Prince-Llewellyn & McCarthy, 2024). Evidence
suggests that habitual physical activity impacts the amygdala’s response in a way that decreases
anxiety (Chen et al., 2019).
Neurobiology in Art Therapy
Art therapy engages the entire brain, facilitating complex interactions between the
hemispheres through neural pathways (Lusebrink, 2004). The logical and verbal left hemisphere
interprets the creative expressions generated by the right hemisphere (Lusebrink, 2004).
Different art media and processes vary in their activation of brain regions as well as the emotions
and behaviors they elicit (Malik, 2022). This understanding can guide art therapists in their
selection of art materials and processes to address specific therapeutic goals.
Expressive Therapies Continuum
The Expressive Therapies Continuum (ETC), developed by Kagin and Lusebrink (1978),

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is a conceptual model that outlines how clients engage with various media to process information
and create images on three different levels made up of seven components: Kinesthetic/Sensory,
Perceptual/Affective, Cognitive/Symbolic, and Creative (Hinz, 2016). The ETC model proposes
that the properties of creative media activate different levels of cognitive and visual processing
(Malik, 2022). While art media and processes tend to elicit different responses, it is possible for
one medium or technique to access all levels of the ETC (Lusebrink, 2016). Bilateral art therapy
protocols use art materials and processes that elicit engagement with each of the levels of the
ETC as well as the Creative level, which bridges opposite components and balances external
focus and internal attunement (VanMeter & Hinz, 2023).
Bilateral Art Therapy
Bilateral art therapy involves using both sides of the body to make art. This stimulates
and activates both hemispheres of the brain to connect the cognitive parts, which are mainly in
the left hemisphere, with the emotional parts, which are mainly in the right hemisphere (Tripp,
2023). While functions are lateralized, both hemispheres contribute to the creative process.
Bilateral art therapy can facilitate integration of content from both brain hemispheres, increase
relaxation, improve mood, and focus attention (Chapman, 2014). Some examples include
bilateral drawing, scribbling, writing, painting, and art processes that intrinsically involve
bimanual techniques, such as needlework, origami, claywork, knitting, woodwork, and collage
(Scarce & Wilson, 2022). Following the early conceptualizations of bilateral drawing, bilateral
movement has been used in art therapy for a variety of purposes, including the integration of felt
experiences and cognitive awareness, trauma treatment, exploration of parts of self, relational
attunement, and physical and emotional wellness.
Early Conceptualization

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Florence Cane (1951) was one of the first art therapists to document the use of bilateral
movement in art therapy. The intention of Cane’s use of bilateral drawing was to subvert
conscious thought and access unconscious rhythms. She discussed using the nondominant hand
to subvert the conscious mind and used bilateral movement and drawing to “liberate expression”
(Cane, 1951, p. 45). Cane (1951) outlined exercises that involved bilateral alternating arm
movements followed by simultaneous movements, as well as exercises that incorporated whole
body bilateral movement, such as shifting weight from one leg to the other. She used bilateral
scribble drawings to help her students loosen up by increasing engagement and creativity.
Elinor Ulman used bilateral scribble drawing directives as part of her diagnostic tool the
Ulman Personality Assessment Procedure (UPAP; Ulman, 1975, as cited in Tripp, 2019). The
directives facilitated kinesthetic engagement, and in the projective task clients were asked to
identify and reinforce imagery within their scribbles. “This task is purposefully playful and
encourages innovation” while eliciting unconscious content (Tripp, 2019, p. 134). While the
UPAP is not currently used for diagnostic purposes, the projective scribble task is still used due
to its utility in increasing engagement and creativity. Modern art therapists have built and
expanded upon these early conceptualizations of bilateral art therapy for a variety of purposes.
Integration of Felt Experience and Cognitive Awareness
Cartwright (1999) developed a bilateral art protocol that incorporates mindfulness and
meditation practices with art therapy in order to facilitate integration of experiences and
memories from both hemispheres of the brain. McNamee (2003) developed a bilateral art therapy
protocol based on Cartwright’s (1999) protocol. McNamee (2003) incorporated a family systems
perspective and the process of scaling the strength of a cognition used in Shapiro’s (2001)
EMDR. McNamee’s protocol aims to integrate cognitive awareness and felt experiences and has

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been used to address polarized struggles, parts of self, identity and differentiation of self,
relational issues, trauma, and symptom of depression and anxiety (McNamee, 2003, 2005). The
goal is to use BLS to facilitate integration and balance by reducing negative thoughts and
increasing the strength of positive thoughts (McNamee, 2006).
McNamee’s (2005) protocol begins by identifying a focus for the intervention that
typically involves two conflicting beliefs or emotions. The client then assesses the strength of the
beliefs on a scale of 1-7, with 1 meaning it is totally untrue for the client and 7 meaning it is
entirely true for the client. The client then decides which hand “feels most connected to which of
the two conflicting elements of the experience” and which element “wants” to be drawn first
(McNamee, 2005, p. 548). The client focuses on the feelings of the element and draws based on
those feelings. The process is repeated with the other element using the other hand. After both
elements have been drawn, the client traces one element at a time by letting the opposite hand
rest on top of the drawing and then repeats this on the other side (McNamee, 2005). Next, both
hands together trace over both images in any order. The client then reassesses the strength of
each belief using the same scale as before.
Trauma
Chapman et al. (2001) and Chapman (2014) developed the Chapman Trauma Narrative
for use in pediatric trauma treatment. This protocol uses kinesthetic bilateral scribble drawing for
grounding and pairs it with a structured verbal interview. Similarly, McNamee (2004) uses an
annotated scribble drawing to access the right brain, which is later explored through verbal
discussion and narrative formation using the left brain. Kolodny uses bilateral activation with
trauma clients by having them draw alongside a disturbing image until the memory shifted and
new insights emerged (Tripp & Kolodny, 2013, 2014, as cited in Tripp, 2022).

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23

Talwar (2007) developed the art therapy trauma protocol (ATTP), drawing from
McNamee’s (2003) bilateral art and EMDR. In ATTP, the participant paints intuitively while
focusing on a traumatic memory, switching between hands, and walking back and forth from the
art piece hung on the wall to a table with containers of paint (Talwar, 2007). This process
involves BLS activated by switching hands to paint, by the creative process itself, and BLS
intrinsic to walking. Talwar (2007) reported ATTP to have “success in integrating the cognitive,
emotional and physiological levels of trauma” (p. 22).
Tripp (2007, 2022) developed an art therapy protocol based on EMDR that uses auditory
and tactile BLS while the client engages in artmaking. Tripp (2022) incorporated a focus on the
somatic experience by tracking sensations using a body scan and body-mapping component. The
goal is to follow bodily sensations and any related changes in awareness, emotion, or thought,
helping the brain form new pathways to reprocess the traumatic memory (Tripp, 2022).
Sensorimotor art therapist Cornelia Elbrecht (2018) developed a guided drawing
technique for treating trauma in which clients use both hands to express inner bodily sensations
through broad "drawn movements" (p. 4). Elbrecht suggests this kinesthetic process reveals
essential rhythms and repetitions, connecting with implicit memory rather than conscious past
narratives.
Parts of Self
In her Creative Journal approach, Capacchione (2001) uses both hands in drawing and
writing for personal growth. Capacchione (2001) uses left and right hand dialogues to aid in
exploration of internal parts of self, parts of the body, creativity, emotions, “inner wisdom” (p.
29), and to “access unresolved trauma in the right hemisphere (connected to the nondominant
hand) and cognitive resources in the left hemisphere (dominant hand)” (Warson & Warson,

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24

2023, p. 106). Tinnin and Gantt’s (2014) dual brain theory is based on the fact that the human
brain is two separate parts until the corpus callosum is fully formed at approximately 3 years old.
In their Intensive Trauma Therapy approach, Gantt and Tinnin (2009) use bilateral writing,
which involves switching between left and right hands and inviting internal parts to engage in a
written “external dialogue” (p. 152) that is similar to Capacchione’s (2001) dialogues. Each hand
activates the opposite hemisphere of the brain, resulting in written responses that are unique to
the hemisphere to which the writing hand is connected. Tinnin and Gantt (2014) believe the
verbal hemisphere comes to take ownership of the entire self, so the use of a written external
dialogue allows for the expression of the emotional self and other parts of self that are located in
the nondominant hemisphere.
Relational Attunement
McNamee and McWey (2004) use McNamee’s (2003) bilateral art therapy protocol with
clinical supervision dyads to foster communication, empathy, and new insights. Tripp and
Kolodny (2016, 2017, as cited in Tripp, 2023) developed mirrored bilateral scribbling, a method
where a client and therapist imitate each other's movements on a large sheet of paper between
them. This practice emphasizes attunement and mindful focus as they take turns guiding and
following.
Physical and Emotional Wellness
Elkins-Abuhoff and Gaydos (2022) use BLS through bimanual manipulation of clay in
art therapy with patients diagnosed with Parkinson’s disease. They have found it to be effective
in decreasing neurological and physical symptoms related to their disease, as well as increasing
overall neurological activity and “the ability to address the emotional stresses of living with the
disease” (Elkins-Abuhoff & Gaydos, 2022, p. 206). Warson and Warson (2023) used a case

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25

study to explore different types of bilateral movements in artmaking—simultaneous, continuous,
overlapping, and midline crossing—and their effect on emotional and physical regulation.
Warson and Warson (2023) emphasized the need for further research into the types of movement
involved in bilateral art making.
Stressors and Adjustment
Stress Response
The objective of the stress response is to mitigate the perceived threat so that the
individual can return to allostatic balance (Sapolsky, 1998, as cited in Kravits, 2008). The stress
response involves neurological and physiological arousal to ensure survival, which dissipates
once the threat subsides (Hass-Cohen & Carr, 2008). When an individual first encounters a
stressor, they experience high levels of distress (Kravits, 2008). Time, support, and experience
increase familiarity with the stressor and decrease subsequent distress. The process of allostasis
allows for the development of stress-reducing behaviors that can be efficiently repeated when
presented with similar situations in the future (Kravits, 2008). When the system is unable to
return to normal functioning and regain allostatic balance, the body bears the burden, and over
time it results in a condition of chronic stress (Hass-Cohen & Carr, 2008). Inadequate processing
of stressful experiences can lead to difficulty adapting to current stressors, diminished capacity to
cope, heightened distress, and a higher chance of maladaptive responses to future stressors
(Laliotis, 2020).
Impact of Chronic Stress
Experiences of chronic stress have neurological and physiological impacts. It directs
neurological functioning toward the limbic system as a survival response, and away from the
integrated processing of thoughts and feelings in the frontal lobes (Hass-Cohen & Carr, 2008).

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26

Stress raises cortisol levels, which can compromise the immune system, as can the negative
emotions related to chronic stress (Findlay, 2008). Stress may also cause wounds to heal more
slowly and increase the risk of infection (Kiecolt-Glaser et al., 2002). Persistent stressors can
negatively impact an individual’s sense of well-being, affect, emotional regulation, motivation,
concentration, thought process, memory, sleep, and appetite (Marroquín et al., 2017). Chronic
stress can also cause somatic issues including headache, muscle tension, stomachache, and
digestive issues, and can impact blood pressure and heart rate (Laliotis, 2020).
Adjustment Disorders
In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text
Revision (DSM-5-TR), the American Psychiatric Association (APA, 2022) classifies adjustment
disorders under the category of trauma- and stressor-related disorders. The disorders in this
category have variable presentations, ranging from anxiety- or fear-based symptoms to
symptoms of anhedonia, dysphoria, anger and aggression, or dissociation (APA, 2022).
Adjustment disorders are characterized by emotional and behavioral symptoms that develop as a
result of an identifiable stressor, and which cause impairment in functioning (APA 2022).
Symptoms may include depressed mood, anger, rumination, anxiety, and conduct disturbance
(APA, 2022). Stressors can be of any type and level of severity, must be identifiable, and can be
either single or multiple, acute or persistent (APA, 2022).
Relationship Between Adjustment Disorders and PTSD
Adjustment disorders and PTSD are two separate disorders under the category of traumaand stressor-related disorders in the DSM-5-TR (APA, 2022). There is overlap between the two
disorders in that they both develop in response to a significant stress-related experience and share
many of their symptoms (APA, 2022). However, people with PTSD report greater symptom

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27

severity and impairment than those with adjustment disorders (Kim & Park, 2025). Another
difference is the duration of symptoms, with symptoms of adjustment disorders lasting no more
than 6 months after the stressor has ended, while there is no upper limit for how long symptoms
of PTSD may endure (APA, 2022). There is also evidence to suggest overlap in the underlying
neurological mechanisms for the two disorders, with a higher degree of neurological disruption
in PTSD (Knaust et al., 2025).
Art Therapy for Stressors
Art therapy can be used to improve coping and reduce distress in the face of stressors,
both acute and chronic. Karagiorgakis and Palmer (2024) found that drawing can reduce anxiety
following the experience of an acute stressor. Lee (2013) studied adjustment in young
immigrants and found that the experience of creative flow in art therapy was critical to
participants’ ability to cope with daily struggles. Glinzak (2016) found that adults in cancer
treatment had an overall decrease in distress after engaging in art therapy, and that participants
perceived art therapy as calming, providing containment, and helpful in decreasing negative
symptoms. Futterman Collier et al. (2016) studied flow state and mood repair by using a textile
handcraft planning activity to induce flow state to repair mood through increased focus and
decreased rumination.
Bilateral Art Therapy for Chronic Stress. Currently, there are no bilateral art therapy
protocols known to this author that are specifically designed for the treatment of persistent
stressors. However, through their use of BLS, all bilateral art therapy protocols improve emotion
regulation and cognition and foster holistic processing of experiences (Amano & Toichi, 2016;
Tripp, 2023). Due to neuroplasticity, frequent use of bilateral art therapy can strengthen the
neural pathways involved in interhemispheric communication and improve functioning through

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28

increased global processing. Additionally, many protocols address the symptoms and associated
consequences of chronic stress. Protocols used for the integration of felt experience and
cognitive awareness may be used to shift functioning away from the limbic system back toward
the frontal lobes to reverse the impact of chronic stress. Those used to treat trauma may be
beneficial in treating chronic stressors due to the overlap in symptoms between PTSD and
adjustment disorders.
Conclusion
The experience of chronic stress can have widespread negative impacts on an individual’s
life, including their physical, mental, and emotional well-being. The first encounter with a
particular stressor causes an individual to experience a high level of distress to mitigate a threat
and regain allostatic balance. In cases in which stressful experiences are not processed
adequately, the individual will likely remain in a state of heightened distress and have difficulty
coping and adapting to new stressors. When the stressor is identifiable and results in a behavioral
and emotional response that is out of proportion and causes functional impairment, an individual
may meet the DSM-5-TR diagnostic criteria for an adjustment disorder. While the duration of
adjustment disorders is limited to 6 months for an acute stressor, the disorder can endure
indefinitely as long as the stressor persists, with the disorder only being limited to 6 months after
the stressor and its consequences have ended. In the presence of persistent stressors, and given
the negative impacts of chronic stress, it is important to facilitate the processing of experiences to
promote adaptive neuroplastic changes which help regain allostatic balance.
Art therapy has been shown to improve coping and reduce distress in populations
experiencing persistent stressors. Bilateral art therapy stimulates both sides of the brain to
improve interhemispheric communication and integration across the corpus callosum, which

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29

accesses lateralized brain functions, and leads to holistic processing of experiences. Repeated
experiences of bilateral art therapy facilitate adaptive neuroplastic changes to improve
functioning and alleviate negative symptoms. While there are currently no bilateral art therapy
protocols designed specifically for the treatment of adjustment disorders that are known to this
author, there are several that aid in the integration of felt experience with cognitive awareness,
and several more designed specifically to treat trauma. Adjustment disorders and PTSD share
overlapping stress-related symptoms and underlying neurological mechanisms. Given that
bilateral art therapy is used to treat trauma, integrate stressful experiences, and alleviate negative
symptoms, it may therefore be a useful approach to foster adaptive adjustment to chronic
stressors and mitigate negative symptoms that could develop into an adjustment disorder.

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30

Section III: Methodology
This section outlines the methodology for a heuristic research study into the use of
bilateral art therapy to facilitate adjustment to chronic stressors related to life transitions.
Subject
As in all heuristic studies, I, the researcher, was the subject of this research study. As an
emerging art therapist, my experiences in this study provided insights that will help me, my
clients, and other clinicians.
Research Design and Procedures
This study used a heuristic research design. The following procedure was used for
artmaking:
•

Write and identify target stressors at the top of a journal page.

•

Complete a pre-intervention scale check-in on a scale of 0 to 10 for symptoms of stress
and write the number down on the journal page, with 0 being no stress symptoms and 10
being extreme stress symptoms.

•

Using a larger artmaking surface, engage in bilateral artmaking while thinking about the
identified target stressor.
o

Initially, I used intuitive bilateral artmaking, and after seven sessions I began
using McNamee’s (2005) bilateral art protocol.

•

Upon gaining insight or reaching a conclusion, write it down on the journal page with
both hands to solidify and internalize it.

•

Complete a post-intervention scale check-in on a scale of 0 to 10 for symptoms of stress
and write the number down on the page, with 0 being no stress symptoms and 10 being
extreme stress symptoms.

BILATERAL ART THERAPY FOR ADJUSTMENT
Proposed Data Analysis
Descriptive statistics and qualitative analysis were used in this study.

31

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32

Section IV: Results
This section presents the 10 art experientials completed during the heuristic inquiry and
their corresponding journal entries. As outlined in the methodology section, I began by
identifying a stressor and scaling stress symptoms, then engaged in bilateral artmaking while
thinking about the identified stressor. I created art until I gained insight or reached a conclusion
and then wrote it down with both hands. I finished each session by scaling my stress symptoms
post-intervention.
Art Experiential 1
•

Date: 6/2/2025

•

Time at start: 15:12

•

Time at stop: 15:19

•

Time used to create: 7 minutes

•

Identified stressor: Pregnancy – changes to my mind and body

•

Scaling of symptoms (0-10) pre-intervention: 4

•

Insights or conclusions: I’m scared. I’m angry and frustrated, but underneath that I’m
really scared of how my mind and body are changing and I’m scared of being not in
control.

•

Scaling of symptoms (0-10) post-intervention: 4

•

Vertical or horizontal surface: vertical

•

Materials used: markers and water brushes

•

Bilateral art therapy protocol used: intuitive bilateral artmaking

•

Image of artwork: see Figure 1

Figure 1

BILATERAL ART THERAPY FOR ADJUSTMENT
Art Experiential 1

Art Experiential 2
•

Date: 6/3/2025

•

Time at start: 09:37

•

Time at stop: 09:42

•

Time used to create: 5 minutes

•

Identified stressor: Pregnancy - Fatigue and lack of motivation

•

Scaling of symptoms (0-10) pre-intervention: 7

•

Insights or conclusions: My body has different needs now and I need to work with it
rather than try to control and dominate it.

•

Scaling of symptoms (0-10) post-intervention: 6

•

Vertical or horizontal surface: horizontal

•

Materials used: Oil pastels

•

Bilateral art therapy protocol used: intuitive bilateral artmaking

•

Image of artwork: see Figure 2

33

BILATERAL ART THERAPY FOR ADJUSTMENT
Figure 2
Art Experiential 2

Art Experiential 3
•

Date: 6/4/2025

•

Time at start: 08:47

•

Time at stop: 08:51

•

Time used to create: 4 minutes

•

Identified stressor: Internship

•

Scaling of symptoms (0-10) pre-intervention: 7

•

Insights or conclusions: I need to have a schedule of more, shorter days

34

BILATERAL ART THERAPY FOR ADJUSTMENT
•

Scaling of symptoms (0-10) post-intervention: 6 - a bit less tired, more hope

•

Vertical or horizontal surface: horizontal

•

Materials used: Oil pastels

•

Bilateral art therapy protocol used: intuitive bilateral artmaking

•

Image of artwork: see Figure 3

Figure 3
Art Experiential 3

Art Experiential 4
•

Date: 6/9/2025

35

BILATERAL ART THERAPY FOR ADJUSTMENT

36

•

Time at start: 11:54

•

Time at stop: 12:01

•

Time used to create: 00:07

•

Identified stressor: Schoolwork

•

Scaling of symptoms (0-10) pre-intervention: 5

•

Insights or conclusions: I need to take advantage of the times I feel ok and use them to
get things done and set up plans.

•

Scaling of symptoms (0-10) post-intervention: 4 - more hope

•

Vertical or horizontal surface: vertical

•

Materials used: markers

•

Bilateral art therapy protocol used: intuitive bilateral artmaking

•

Image of artwork: see Figure 4

Figure 4
Art Experiential 4

BILATERAL ART THERAPY FOR ADJUSTMENT
Art Experiential 5
•

Date: 6/10/2025

•

Time at start: 16:48

•

Time at stop: 16:52

•

Time used to create: 4 minutes

•

Identified stressor: Pregnancy

•

Scaling of symptoms (0-10) pre-intervention: 4

•

Insights or conclusions: I feel scared and disconnected, but I will be loved, supported,
and connected at every step.

•

Scaling of symptoms (0-10) post-intervention: 3 - more connected

•

Vertical or horizontal surface: vertical

•

Materials used: oil pastels

•

Bilateral art therapy protocol used: intuitive bilateral artmaking

•

Image of artwork: see Figure 5

Figure 5
Art Experiential 5

37

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38

Art Experiential 6
•

Date: 6/15/2025

•

Time at start: 12:04

•

Time at stop: 12:10

•

Time used to create: 6 minutes

•

Identified stressor: Pregnancy – changes to my mind and body, fatigue, nausea, lack of
motivation

•

Scaling of symptoms (0-10) pre-intervention: 6

•

Insights or conclusions: There’s so much going on in my body and fighting it doesn’t
help.

•

Scaling of symptoms (0-10) post-intervention: 6

•

Vertical or horizontal surface: vertical

BILATERAL ART THERAPY FOR ADJUSTMENT
•

Materials used: oil pastels

•

Bilateral art therapy protocol used: intuitive bilateral artmaking

•

Image of artwork: see Figure 6

39

Figure 6
Art Experiential 6

Art Experiential 7
•

Date: 6/17/2025

•

Time at start: 12:31

•

Time at stop: 12:37

•

Time used to create: 6 minutes

•

Identified stressor: Pregnancy – future and being a parent

•

Scaling of symptoms (0-10) pre-intervention: 4

•

Insights or conclusions: I need all the natural processes that happen in pregnancy to help
me feel capable of being selflessly devoted to a baby.

BILATERAL ART THERAPY FOR ADJUSTMENT
•

Scaling of symptoms (0-10) post-intervention: 4

•

Vertical or horizontal surface: vertical

•

Materials used: oil pastels

•

Bilateral art therapy protocol used: intuitive bilateral artmaking

•

Image of artwork: see Figure 7

Figure 7
Art Experiential 7

Art Experiential 8
•

Date: 6/20/2025

•

Time at start: 15:49

•

Time at stop: 16:05

•

Time used to create: 6 minutes

40

BILATERAL ART THERAPY FOR ADJUSTMENT
•

41

Identified stressor: Pregnancy – “I am too self-centered to be a good mother” (pre: 6,
post: 3) vs. “I am attuned to others’ needs and can put a baby first and be a good mother”
(pre: 2, post: 3).

•

Scaling of symptoms (0-10) pre-intervention: 6

•

Insights or conclusions: I am still caring for my inner child and will shift focus to my
baby when she comes.

•

Scaling of symptoms (0-10) post-intervention: 3

•

Vertical or horizontal surface: horizontal

•

Materials used: hollow colored pencils

•

Bilateral art therapy protocol used: McNamee (2005)

•

Image of artwork: see Figure 8

Figure 8
Art Experiential 8

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42

Art Experiential 9
•

Date: 6/25/2025

•

Time at start: 14:18

•

Time at stop: 14:30

•

Time used to create: 12 minutes

•

Identified stressor: Pregnancy – “I cannot learn new things and grow” (pre:4, post: 3) vs.
“I can learn new things and grow” (pre:3, post:5)

•

Scaling of symptoms (0-10) pre-intervention: 4

BILATERAL ART THERAPY FOR ADJUSTMENT
•

43

Insights or conclusions: I am tired now and going through changes, and I will grow and
learn as I go.

•

Scaling of symptoms (0-10) post-intervention: 3

•

Vertical or horizontal surface: horizontal

•

Materials used: hollow colored pencils

•

Bilateral art therapy protocol used: McNamee (2005)

•

Image of artwork: see Figure 9

Figure 9
Art Experiential 9

BILATERAL ART THERAPY FOR ADJUSTMENT

44

Art Experiential 10
•

Date: 6/30/2025

•

Time at start 17:14

•

Time at stop: 17:25

•

Time used to create: 11 minutes

•

Identified stressor: Pregnancy – lack of energy and motivation
“I am unmotivated, tired, and unable to get going on my work (pre: 6, post 4)” vs. “I am
motivated, energized, and able to get going on my work” (pre: 2, post: 3)

•

Scaling of symptoms (0-10) pre-intervention: 5

•

Insights or conclusions: I need to create my own energy to get myself to feel motivated.

•

Scaling of symptoms (0-10) post-intervention: 3

•

Vertical or horizontal surface: horizontal

•

Materials used: hollow colored pencils

•

Bilateral art therapy protocol used: McNamee (2005)

•

Image of artwork: see Figure 10

Figure 10
Art Experiential 10

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45

Conclusion
The results of 10 bilateral art experientials used for chronic stress were presented, along
with the resulting art images. This data will be analyzed in the next section. Findings and
conclusions will be discussed and related to the existing literature.

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46

Section V: Discussion
In this section, the data from the 10 bilateral art experientials presented in the last section
will be analyzed. Findings and conclusions will be discussed and related to the existing literature.
The experience of using bilateral art for adjustment to chronic stressors will be discussed as well
as limitations and suggestions for future research.
Summary of Research
Bilateral art therapy was used in a heuristic inquiry to address symptoms related to
chronic stressors. Pre-intervention symptoms and post-intervention symptoms were assessed on a
scale of 0 – 10, with 0 being no stress symptoms and 10 being extreme stress symptoms. For the
first seven sessions, I used intuitive bilateral artmaking. For the final three sessions, I used
McNamee’s (2005) bilateral art protocol. I decided to make this change because three of the first
seven interventions had resulted in no change in the scores of my pre- and post-intervention
symptoms scaling. I chose McNamee’s (2005) protocol because it involves identifying a positive
belief that opposes an identified negative belief. It required that I shift toward positive thinking
and engage with a positive belief rather than only the stressor and the negative beliefs associated
with it.
Analysis
A comparison of pre-intervention symptoms and post-intervention symptoms can be seen
in Table 1. Of the 10 art-making sessions, the post-intervention symptoms score was lower than
the pre-intervention symptoms score in seven sessions, with scores changing by –1 in five
sessions, by –2 in one session, and –3 in one session (Table 2). The average change in score
across all 10 sessions was –1. In the first seven sessions, using intuitive bilateral artmaking, the
average change in score was –0.57, compared to –2 across the final three sessions in which I

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47

used McNamee’s (2005) bilateral art protocol. The average time used for artmaking across the
10 sessions was 6 minutes 48 seconds per session, with the shortest lasting 4 minutes, and the
longest lasting 12 minutes (Table 3). In the first seven sessions, using intuitive bilateral
artmaking, the average amount of time spent making art was 5 minutes 34 seconds. In the final
three sessions, using McNamee’s (2005) bilateral art protocol, the average amount of time used
for artmaking was 9 minutes 40 seconds.
In eight of the art-making sessions, the identified stressor was related to pregnancy. In
one session the identified stressor was internship and in one session the identified stressor was
schoolwork. In all sessions, an insight or conclusion related to the identified stressor emerged
during artmaking.
Table 1
Comparison of Pre- and Post-Intervention Stress Symptoms

Table 2
Change in Symptom Scaling Scores

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48

Table 3
Time Used for Artmaking

The data show that McNamee’s (2005) bilateral art therapy protocol involved more time
on average engaging in bilateral artmaking and yielded a greater decrease in stress symptoms
than did intuitive bilateral artmaking. In each of the three sessions in which McNamee’s (2005)
protocol was used, the strength of my negative belief decreased by an average of –2.67 points

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49

(Table 4), and the strength of my positive belief increased by an average of 1.33 points (Table 5).
I felt that this protocol required me to be more introspective because I needed to identify a
negative belief and its opposite and positive belief, and this process helped me to shift toward the
positive rather than try to alleviate the negative symptoms.
Table 4
Strength of Negative Beliefs in Sessions 8-10

Table 5
Strength of Positive Beliefs in Sessions 8-10

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50

I had thought this process would be helpful mainly for self-regulating in times of
heightened stress symptoms. While seven of the 10 sessions yielded a decrease in symptom
severity, three sessions saw no change in symptom severity. In all three of the sessions that did
not see a decrease in symptom severity, intuitive bilateral artmaking had been used. Although
bilateral artmaking was overall helpful in self-regulating in the face of stress symptoms, as the
literature suggested it would be, I felt that I benefitted more from having an insight or conclusion
emerge and writing it down.
During the process, it became clear that I needed to use a bilateral protocol that facilitated
a change in thinking that would foster a more positive and hopeful outlook. As discussed in the
review of literature, time, support, and experience increase familiarity with the stressor and
decrease subsequent distress. While I continued to address the same identified stressor in this
study, it began to feel like I was resigning myself to the current symptoms of the stressor rather
than instilling hope for a better future and confidence in my ability to adapt and change for the
better. In the literature review, the concept of neuroplasticity was discussed as having the

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51

potential to rewire neural networks. This process can be guided to facilitate positive, adaptive
shifts, but it can also cause maladaptive changes when an individual is stuck in negative patterns.
In my research, I chose to use McNamee’s (2005) bilateral art protocol because it involves
identifying positive directions rather than focusing solely on negative beliefs and symptoms.
Identifying and focusing on positive beliefs during each art-making session theoretically
strengthened these connections in the brain and facilitated positive neuroplastic changes that will
make positive thinking easier each time I face stressors.
By using McNamee’s (2005) protocol, I was able to integrate emotional and cognitive
content and strengthen positive, hopeful beliefs. As discussed in the literature review, chronic
stress can shift neurological functioning away from the integrated thoughts and feelings in the
frontal lobes and toward the limbic system as a survival response. By engaging in this process, I
theoretically began to strengthen the neural connections to the frontal lobes and increase the
likelihood of processing in this way in the future.
As mentioned in the literature review, Tinnen and Gantt (2014) believe that the verbal
hemisphere comes to take ownership of the entire self. Each art-making session involved an
insight emerging, and I wrote this down using both my left and right hands. As Tinnen and Gantt
(2014) suggested, I felt that integrating the resulting insight verbally on both sides of the body
served to unify the self across both hemispheres of the brain and help them to internalize the
same insight.
Discussion
This study demonstrated the use of bilateral art therapy to address chronic stressors. As
was suggested in the literature review, BLS facilitated holistic processing of stressors by
accessing cognitive content and emotional content, stored primarily in the left hemisphere and

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52

right hemisphere of the brain, respectively. It also aided in regulation while addressing stressors.
The insights gained during the bilateral artmaking process were solidified by writing them down
with both hands following artmaking, and I felt that I benefited greatly from these insights.
Ultimately, the process facilitated adjustment at least to specific aspects of a chronic stressor.
Two of the art experientials focused specifically on changes to my mind and body related to
pregnancy. Through this process, I have become less stressed about these changes, more
accepting of them, and began thinking more positively about them.
Limitations
This study was limited by being a self-study that only used one subject. I am very drawn
to bilateral processes already and have had a lot of practice doing bilateral art and working
bilaterally in other ways (i.e., writing with both hands). Bilateral art therapy may impact people
differently, and perhaps part of that is how much experience people have with working
bilaterally and how much they are naturally drawn to it. Because it was a self-study, I did not
have the experience of doing the interventions with another art therapist guiding me, as a client
would have, making the experience different from how it would be in the clinical setting.
The study only lasted for 1 month due to time constraints. Ideally, the study would have a
longer duration to address chronic stressors. Additionally, due to the space available, I was
limited in the materials I was able to use. Due to the limited duration and materials, I did not use
as many of the established bilateral art protocols as I would have liked to use.
The nature of my symptoms impacted the study as well. During the study I was under
less stress than I had been previously because I had a decreased workload for school. As the
number of co-occurring chronic stressors compound the overall experience of chronic stress, the
lessening of one chronic stressor decreased my overall level of stress to be addressed in the

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study. Additionally, I was impacted by symptoms of fatigue and nausea related to pregnancy, the
main chronic stressor that was addressed in the study. These symptoms made it difficult to
engage in bilateral artmaking as frequently as I would have liked to.
This study was limited by not having access to neuroimaging or biofeedback equipment,
or other laboratory testing. Although I could speculate as to the neurological processes that were
occurring based on the existing literature, I was unable to prove that these processes were
occurring. Additionally, the pre-intervention and post-intervention symptoms were assessed
using a simple scaling question. As with all pre- and post-intervention questionnaires, the way I
answered the question post-intervention was impacted by my knowledge of my pre-intervention
answer. A more scientific way of assessing stress would be to use biofeedback equipment or to
test cortisol levels.
Suggestions for Future Research
I would have liked the research process to last longer, perhaps for the entire duration of
the chronic stressor. I was only able to engage in research for 1 month and feel that I would have
seen better results and been able to identify aspects of other bilateral art therapy protocols to
incorporate into my process had the research lasted longer. Additionally, I would have liked to
use a larger space, messier materials, and a surface the size of a classroom chalkboard.
In the future, I would like to focus more on the process of finding meaning/insights and
combine that with a bilateral art protocol like McNamee’s (2005) that involves identifying a
positive belief. There are existing bilateral art therapy protocols developed to treat trauma that
could be explored for their use of narrative therapy and meaning making. I would be interested in
incorporating aspects of these into my research in the future.
The process and findings in this study could be used as a starting point for others

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interested in exploring bilateral art therapy for chronic stress. As this was a heuristic study, it was
subjective experience that drove the decisions I made while engaging in research, and this cannot
be generalized to fit others’ needs. However, the style of grounded research used in this study
could guide others to find bilateral art therapy practices that best suit their needs in adjusting to
chronic stressors.
There is a need to investigate the use of bilateral art therapy while performing
neurological imaging. While I could speculate as to the neurological processes occurring while I
was engaging in bilateral artmaking, these could not be proven. To understand the impact of
bilateral art therapy, it is necessary to have more concrete, scientific proof of the neurological
mechanisms at play.

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Conclusion
This project started with the intention of investigating the use of bilateral art therapy to
facilitate adjustment to chronic stressors. A heuristic inquiry was performed in which I engaged
in 10 artmaking sessions over the course of 1 month. In the first seven sessions I engaged in
intuitive bilateral artmaking. I found that my stress symptoms only decreased four out of seven
of these sessions, and that I was focusing too much on the negative beliefs and thoughts
associated with the identified stressor and lacking a positive direction. To address this, I used
McNamee’s (2005) bilateral art therapy protocol for the final three artmaking sessions. I saw a
much greater decrease in my stress symptoms as well as a decrease in the strength of my
negative beliefs and an increase in the strength of my positive beliefs. In the future, bilateral art
therapy should be studied using neuroimaging, biofeedback, and other laboratory equipment to
gain a greater understanding of the neurological and biological processes that occur when one
engages in bilateral artmaking.

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