Annotated Bibliography

Topic Area: Physiology of Art in Healing

Title: Assessing Stress Reduction as a Function of Artistic Creation and Cognitive Focus

This is a short-term outcomes study on art therapy (defined here as “psychological therapy using art as a tool for facilitating therapeutic growth”) and its application to stress reduction. Participants in the study who used artistic media to focus on and express positive experiences were found to have lower heart rates and lower levels of anxiety after making artworks (measured by comparing heart rate and cognitive focus before and after the creation process). It was concluded that the art-making process was a form of catharsis and the experience of a “creative high” allowed for stress reduction.
This study is relevant because it demonstrates an instance where the process of art-creation has successfully enhanced stress reduction. The use of both physiological (heart rate) and psychological (State-Trait Anxiety Inventory) components in the study allows one to apply these methods to the biopsychosocial model of holistic care. Studies, such as this one, can be used to prove the importance of incorporating the arts into healthcare because it is an example of evidence-based medicine. Several patients who live in industrialized countries suffer from diseases, such as coronary artery disease, which are exacerbated by stress and would benefit highly from using art to reduce their stress levels.

Curl K. Assessing Stress Reduction as a Function of Artistic Creation and Cognitive Focus. Art Therapy: Journal of the American Art Therapy Association. 2008; [cited 2012 July 17]; 25(4):164-169. from:


Topic Area: Psychoneuroimmunology

Title: Psychoneuroimmunology and Psychosomatic Medicine: Back to the Future

The article is a meta-analysis of previous psychoneuroimmunology studies and looks ahead to the possible directions of further studies within this intriguing field. Previous studies are used to prove that negative emotions – stress, anxiety, depression etc – have a diminishing effect on immune-cell activity and therefore also on immune response. This leads to various physiological effects such as increased susceptibility to infectious diseases, slower wound healing. Medical students with greater social support had a better immune response to Hepatitis B vaccine and stressed medical students had a slower antibody response to Hepatitis B vaccination.

A solid link between the psyche and the immune system is established in this article. The uncovering of this intricate connection between ones behaviour and the workings of immune cells opens a gateway for the use of complementary management options in psychological conditions (which are also related to many other diseases). Although not specifically discussed in this article, Arts-in-Healthcare can be applied in this manner and in order for this to be effective more research on the physiology of art in healing needs to be undertaken.

Kiecolt-Glaser JK, McGuire L, Robles TF, Glaser R. Psychoneuroimmunology and Psychosomatic Medicine: Back to the Future. Psychosomatic Medicine. 2002 January-February; [cited 2012 July 17]; 64(1):15-2. Available from:


Topic Area: Psychoneuroimmunology

Title: Psychoneuroimmunology

This book chapter defines psychoneuroimmunology as an interdisciplinary field which investigates the bidirectional relationship between the mind, brain, immune system and health. This is examined to provide evidence for links between psychological processes, physiological mediators and disease progression (X-Y-Z model). It was found that HIV-positive individuals with high levels of depression, those with cynical views of their health and those who feared to disclose their sexual orientation had faster progression to HIV disease and died of AIDS sooner than their counterparts (who were also HIV positive); these patients were associated with high levels of cortisol and this hormone may be involved HIV-1 replication and prolong gene expression.

The book poses a question: If stressors, negative moods and negative self-image can antagonistically affect the immune system then can interventions that reduce these negative psychological conditions enhance the immune response? It briefly goes on to describe the effects of interventions such as relaxation exercises and hypnosis but does not explicitly explore the benefits of arts programmes in healthcare. Since there is such an evident relationship between the above-mentioned disciplines, one would expect the next step to be scientific investigation of art therapies because these are suspected and proven to be of health benefit, especially psychologically. Scientific evidence could open the eyes of the biomedical community to the relevance and efficacy of arts-in-healthcare and this could lead to more support (including funding) for such programmes.


Kemeny ME. Psychoneuroimmunology. In: Friedman HS, editor. The Oxford Handbook of Health Psychology. 1st ed. New York: Oxford University Press; 2011. p. 138-61. (Book)


Topic Area: Psychoneuroimmunology

Title: Emotional Style and Susceptibility to the Common Cold

This is a study to investigate the hypothesis that negative emotions lead to declined immune response and that positive emotions enhance immune response. A sample of people was separated into two groups according to either positive or negative emotional styles and all participants were inoculated with rhinovirus. The findings were that people with positive emotion styles were at less risk of developing disease, had a lower concentration of stress hormones, and had better health practices but also more self-reported symptoms than their counterparts (who had negative emotional styles). The hypothesis was therefore proven.

The study is relevant because it shows the importance of a positive outlook on life for better health. Having a positive outlook was shown to physically benefit the participants in this study. Art-creation is an enjoyable activity but also has many psychological benefits. If we as healthcare providers can change the perceptions that patients have about themselves and their illnesses by the incorporation of art into management programmes we will have healed them in a more meaningful and holistic way.

Cohen S, Doyle WJ, Turner RB, Alper CM, Skoner DP. Emotional Style and Susceptibility to the Common Cold. Psychosomatic Medicine. 2003 July-August; [cited 2012 July 17]; 65(4):652-7. Available from:


Topic Area: Physiology of Art in Healing

Title: Music as Therapy

Music has direct and indirect physiological effects on the autonomic nervous system. This article reviews studies which found that music with steady rhythms stabilised respiratory rate; students who listened to music while performing stressful tasks had lower salivary cortisol levels than their counterparts; premature infants who listened to classical music and lullabies had increased weight gain and suckling and decreased distress and oxygen desaturation; patients who listened to music while waiting for various surgeries (breast biopsy, prostate surgery etc.) were less anxious than their counterparts; long-term caregivers who participated in group music therapy experienced less burnout and had improved mood.

This article is relevant because it explains several physiological links between music and positive health outcomes which validates the use of music in health management. It is also cost effective and has few, if any, adverse effects when used correctly. The study also shows that a variety of people in the medical setting (staff, patients, families) can benefit from the use of music therapy. I believe that more extensive research and use of music in healthcare would create an environment that is more conducive to healing.

Kemper KJ, Danhauer SC. Music as Therapy. Southern Medical Journal. 2005 March; [cited 2012 July 17]; 98(3):282-8. Available from:


Topic Area: Placebo Effect

Title: The Placebo Response and the Power of Unconscious Healing

This book is a comprehensive study of the placebo effect and its role in healing. It covers the following topics: “the placebo response, the basis of the placebo response in sickness and healing, what we know about the placebo effect; who gets the placebo and how it acts; the evolution medicine of the placebo effect; the dilemma of the placebo as truth; the abnormal placebo responses and a deep discussion on the challenge of harnessing the placebo response in order to use it for healing and curing patients”. Various articles and books are referenced in this book.

The book presented a sound argument on the placebo effect with the line “Doctors cure; nature heals” (pg25) as it’s banner. Illustrating simply and effectively its topics, it related well to Arts in Healthcare as it cited the use of alternative medicines as a form of a placebo. The manner of argument was carefully and immaculately set out. It argued the release of dopamine (a neurotransmitter in the brain) in individuals during a placebo trial, which is the same neurotransmitter released when art is involved; playing music, painting, dancing etc. It aids in healing. It also pointed out various theories that supported the use of art as a form of healing. Information was clear, scientific, relevant and accessible.

Kraden, R. The Placebo Response and the Power of Unconscious Healing. Oxford university Press. New York: Routledge; 2008. pg 255-320. pg 222.


Topic Area: Placebo Effect and Art in Healthcare

Title: Mind, Body, and the Doctor 

This article takes a look at the relationship between a patient’s hopes and expectations and the outcome of his disease. It discusses the importance of the doctor-patient relationship, explains the term psychoneuroimmunology and provides insight on the placebo effect.

With the quote “He cures most successfully whom the people have more confidence in.” The article reveals the importance of a doctor-patient relationship in healing and curing. The article is relevant to Arts in Healthcare as it highlights the need for therapeutic interventions and an excellent doctor-patient relationship to jump-start the natural process of healing. Art has been shown in numerous resources to be a therapeutic intervention that may act as a placebo for patients and aid in healing the body by either removing the threat or strengthening the body’s own immune response; or other actions. “Their therapeutic procedures, whether they were inert or whether they were dangerous, were placebos, symbols by which their patients' faith and their own was sustained”. The article was clear and to the point, although there was some speculation and gaps in some information due to a lack of scholarly research to support the argument.

Nuland, S.B. Mind, Body and the Doctor. American Scholar; [serial online]. 2001. [cited 2012 July 18]; Vol. 70 Issue 3, p123, 4p Available from:


Topic: Placebo and Art therapy

Title: Transforming the placebo effect in art therapy.  

The article “Transforming the placebo effect in art therapy” deals with medical opinions on the placebo effect, the various models of the placebo mechanism and the patient’s response to placebos. It looks at comments and procedures of art therapy as a specific medical treatment and the possibility of replacing the placebo effect with art therapy. Through this article we also gain insight into the physiological aspect of the mimicry model; which looks at the mimicry nature of humans, from infancy to adulthood behaviours, trying to link it to the mechanisms of the placebo effect.

The relevance of this article comes in when Tinnin explains that art and its usage evokes the same response as the placebo effect. Thus art can be used as a means of not only treating but healing a patient, a principle espoused by the discipline of art therapy. Another interesting finding was that when patients engaged in art-making with the physician-a good patient-doctor relationship was established; an essential part of the placebo effect. Therefore art in and of itself can be used as a form of treating a patient who may not be responding to other forms of treatment or in conjunction with other forms of treatment. “My hypothesis, therefore, is that an art therapy approach that makes use of the image and preverbal mimicry in the principles of the placebo effect will have a probability for success in treating a specific condition...” 

Tinnin, Louis W. Transforming the Placebo Effect in Art Therapy. American Journal of Art Therapy[serial online]. Feb1994,[cited 2012 July18] Vol. 32 Issue 3, p75, 4p.


Topic: Pleasures of Music

Title: Pleasures of the Brain

Pleasure of the brain explores the brain and life aspects that stimulate it to conclude it is a pleasurable experience. It looks at various pleasures; searching topics such as hedonic Hotspots: Generating sensory pleasure in the brain and Neuroethology of pleasure, human pleasures; scientifically and experimentally exploring different kinds of pleasures such as art, music, food, smell, sex and so forth, the nature and function of pleasure and investigates the role of dopamine in pleasure, and finally Clinical Applications which deals around the subject of pain and how pain and pleasure link, the placebo of analgesia and deep brain stimulation and pleasure.

The field of Arts in Healthcare can use this book as it has some scientific evidence and research of pain and how it relates to patients health and well-being. The book investigates how pleasure generates placebo analgesia; using art or playing music can be a form of an analgesic as the pleasures of the music and art generate a healing act. As there is insufficient research done on the placebo and arts or using arts as a means of healing, there were some gaps in the knowledge of some topics. It, however, illustrated the relationship between dopamine, opiates, serotonin (neurotransmitters released which augment desire and elicits positive emotions) and music and this can be used in arts in healthcare to bring pain relief and aid in healing as it stimulates the natural pain-killing element of the body. It would aid Arts in Healthcare as it is the most scientific item I have found that can explain and foster a movement that can bridge the gap between arts and healthcare. The book also reveals the much-needed the physiological response of the brain to art. There was an uncertainty portrayed in using art as a placebo for healing as it was difficult to obtain scientific research.

Kringelbach L.M., Berridge K.C. Pleasures of the Brain .New York: Oxford University Press; 2010. p1-249.


Topic: The placebo as a healing effect

Title: Harnessing the Placebo effect

The article showcases the physiology of the placebo effect and how it can be used in treating ailments. It draws from previous studies and provides information on whether art and other alternative medicines are placebos that aid in healing.

The relevance of this article in Arts in Healthcare lies with Lim’s findings on the release of natural painkillers in the brain which are stimulated by the use of placebos such as arts, music and alternative medicines. These placebos would be excellent for relieving pain and regulating heart rate and breathing patterns. Dopamine, which has been shown to be released in creative arts, music etc, causes many effects that generate the sense of ‘well-being’ in a patient. It is also excellent in stimulating growth factors in wound-healing. The article was brief and to the point and debated the use of alternative medicine, such as art, in a clinical setting and treating of patients.

Lim J. Harnessing the Placebo effect. The Thai Message Blog [serial on the internet]. 2011 [cited 2012 July 19]; 10(4) Available from


Topic Area: Physiology, psychology, and psychoneuroimmunology.

Title: Dr. Deepak Chopra on Spontaneous Remission

Dr. Chopra relates spiritual experience with spontaneous remission and how the body has the ability to heal itself into spontaneous remission. He also mentions that the loss of fear of death, by getting in touch with your spirit or soul, and experiencing internal states of euphoria and extreme joy, is necessary to go into remission. Immunoimodulators, Dr. Chopra explains, synchronize in the brain when euphoria is found and thus boost the immune system and allow the body to heal itself. The experience of joy and euphoria brings about chemicals in the brain that enhance the effects of the immune system, resulting in a boost in the body’s natural defense mechanism. Dr. Chopra, overall, makes the connection with spiritual experiences and how enjoyment in life brings about healing and, in more modern terms, spontaneous remission.

Dr. Deepak Chopra’s video on spontaneous remission was beginning to touch, or even underline, the topic area of physiology. It relates to the immune system by mentioning immunoimodulators and how they become active in the body and work synergistically to promote self-healing; in more modern terms, allow the immune system to attack foreign cells, such as cancerous cells, and lead into spontaneous remission. In order to find a deeper understanding in this video there must be background knowledge of how the immune system works and which chemicals in the brain are to be considered immunoimodulators. Overall the video provides a spiritual insight and understanding that the body has the ability, or tools, to heal it’s self, and we can learn how to promote this self-healing.

LightbridgeMedia (2011) Healing Quest: Deepak Chopra on Spontaneous Remission. [video online] Available at: [Accessed: July 19, 2012].


Topic Area: Physiology, psychology, and psychoneuroimmunology.

Title: The Role of Auditory and Premotor Cortex in Sensorimotor Transformations

Using fMRI to identify brain activity, Joyce Chen found that the superior temporal gyrus, and ventral premotor and dorsal premotor cortex, all become active as it processes rhythms of varying complexity. These parts of the brain have to do with direct and indirect auditory-motor transformations, such as speech and motor skills, and engagement with action related sounds. Research has shown that when we listen to music and silently sing along the neurons that control the larynx, or the hands in the case of musicians, become active. Analysis of fMRIs were also correlated with findings of Isabelle Peretz and Luciano Fadiga, which showed that Broca’s region of the brain responds to both music and complex sentences, suggesting that music can also help with speech impairments in stroke and traumatic brain injury patients. It is also submitted that Broca’s region might function as a representation of “perpetual motor acts”, suggesting that one can retrain regions of the brain to function in place of lost or damaged regions.

Evidence found in the studies mentioned lead way to greater understanding of how the brain’s plasticity functions to plan and initiate motor skills for singing and dancing, which can eventually lead up to new ideas for therapeutic exercises involving music; this deals directly with Arts in Healthcare initiatives. Evidence is showing direct linkage between the motor regions of the brain and how music can produce activity in these regions that may have been damaged. Such evidence will lead to the development in therapeutic techniques and initiative for doctors and hospitals to use programs that involve music in their practice. In order for programs like Arts in Medicine to become part of a modern hospital routine scientific evidence like this must be present.

Chen, J. et al. (2009) Part 1: Rhythms in the Brain: Basic Science and Clinical PerspectivesThe Role of Auditory and Premotor Cortex in Sensorimotor Transformations. Annals of the New York Acadamy, 1169 p.15-34.


Topic Area: Physiology, psychology, and psychoneuroimmunology.

Title: Can Music Heal the Brain

This conference summarized the clinical literature that documents cases of aphasia patients who suffer from lesions in areas of the brain that play a major role in speech and motor functions and how they have the ability tosing fluently, even though they have completely lost the ability to speak. There are other studies that describe advanced senile patients who that are able to remember lyrics, even though they have completely forgotten their family members. It has been shown that learning and listening to music simultaneously activates sensory and motor systems in ways that facilitate plasticity, necessary to regain lost function and bring about new therapeutic strategies for neurodegeneration and brain damage. These proven effects of music on the brain has suggested that language might be supported by duplicate networks in the right hemisphere of the brain and relearn to use what is left in the damaged left hemisphere. Studies dealing with rhythmic stimulus are currently helping stroke and traumatic brain injury patients to relearn to walk, maneuver and speak again, by providing a more explicit timing cue.

This conference elaborated on multiple studies and findings that deal with the plasticity of the brain when listening to music, and how specific areas of the brain can be retrained to take over lost neurons from brain damage and stroke. Multiple studies have shown that music has the ability to activate sensory and motor areas, used during speech and motor reflexes, such as walking, hand coordination and dancing, even when neurons have been damaged or lost. Evidence like this gives music and art programs in healthcare reason to be present and useful in rehabilitation. It seems that the only way for art, music, and literature programs to be instilled into hospital settings, is to have viable findings such as this.

Schlaug, Gottfreid, Grahn, Jessica, Thaut, Michael. The Neurosciences and Music III: Disorders and Plasticity. ln: Kathleen McGowan. Can Music Heal the Brain. New York: The New York Academy of Sciences; 2012. p. 1-569.


Topic Area: Physiology, psychology, and psychoneuroimmunology.

Title: The Fine Art of Healing the Sick: Embracing the Benefits of Writing, Music, and Art

The press release encompassed the subject of art therapy programs practiced in hospitals in the U.S and of their effectiveness in the symptoms and attitudes of the patients. Medical music therapists use puppets and soothing instruments to calm young patients during testing, such as echocardiograms, resulting in a calm, non-squirming or wiggling patient. This is important for tests like these because they require much time and no physical movement from the patient. This article also spoke on a young patient, who suffers from severe asthma and chronic lung disease, and how she uses the Literature and Arts program at her hospital to improve her symptoms and well being. It was also mentioned that in 2004, a study showed that AIDS patients who completed writing exercises had higher levels of T cells, which play a large role in cellular immunity. Overall, literature, music, and arts programs in hospitals have shown to be beneficial in the symptoms and well being of patients.

The Fine Art of Healing the Sick directs attention to active work on art, music, and literature programs in hospitals and the progress it is making in physical symptoms and overall well being of patients. These are the results that arts in healthcare focuses on and strives to see. To read and hear of documented evidence of successful programs in rehabilitation is profound in the world of medicine and will make certain that programs involving the arts will continue. This evidence will also reach farther into the practice of nurses and doctors and change the relationship with patients in a more positive and healing.

Larson, Christine. (2006) The Fine Art of Healing the Sick: Embracing the Benefits of Writing, Music, and Art. U.S News and World Report. [Online Press Release], May 28, 2006.