Cognitive-Behavioral Art Therapy and Trauma

In Sexual Assault Awareness on January 12, 2012 at 5:00 am

Sexually abused children and adults often exhibit a variety of symptoms, many of which could be included in the diagnosis of PTSD (Pifalo, 2007). Posttraumatic Stress Disorder (PTSD) is characterized by six factors, (1) the person has been exposed to a traumatic event, (2) the trauma is re-experienced in at least one way, (3) persistent avoidance of stimuli associated with trauma, (4) persistent symptoms of increased arousal, (5) duration of more then one month, and (6) the disturbances cause significant distress. PTSD is categorized into acute and chronic subsets and can included a delayed onset. If symptoms appear within one month after trauma it is called Acute Stress Disorder (ASD) (American Psychiatric Association [DSM-IV-TR], 2000). A large number of people with PTSD are survivors of sexual violence.
Both cognitive behavioral therapy and art therapy can alter maladaptive and traumatic sensory processing and effect intrusive thoughts. Characteristics common to both therapies utilize sensory triggers as an exposure intervention; CBT utilizes imaginal exposure while art therapy traditionally uses sensory experiences. Even though both disciplines use similar interventions and goals the interventions come from different sources, one being cognitive and one being physical.  CBT and art therapy both modulate and challenge intrusive and traumatic thoughts and flashbacks. CBT intervenes by reframing the memories within the imagination. Art therapy produces an images, verbalizes the image, and altering the product. Although both approaches have different theories they both create connections between the physical, emotional, and cognitive aspects of traumatic experiences. Connecting these aspects of trauma reduce stress level and unify fragmented thoughts and memories relating to trauma (Sarid & Huss, 2010).
Cognitive-behavioral art therapy reduces negative symptoms and increases positive outcomes for victims of sexual violence. The combination of cognitive behavioral therapy and art therapy allows for communication on multiple levels providing for a powerful and effect therapeutic intervention for those in trauma focused therapy (Pifalo, 2007). Expressive arts and play therapist can offer children a means of processing emotional context of traumatic experience that they may not be consciously aware of. According to a study by Terry Pifalo, children who participated in an eight-week cycle of trauma-focused cognitive-behavioral art therapy showed a large reduction of symptoms in the PTSD, Dissociation-Overt, and Sexual Concerns subsets of the “Trauma Symptom Checklist for Children” (2006). By using expressive arts children can access traumatic experiences while also processing the impact the event has on the victim.
Survivors experience a variety of disordered though processes and maladaptive behaviors. Behaviors and reactions of survivors of sexual violence include negative self-talk, denial, emotional numbness, withdrawal, feelings of being contaminated or a lack of self-worth. Art therapy offers exploration of these intrusive thoughts while cognitive-behavioral therapy modifies thoughts and behaviors. Both art therapy and cognitive behavioral therapy are effective means of therapy for people who have experience sexual violence and are dealing with intense symptoms. Together, cognitive-behavioral art therapy offers clients the ability to experience the emotional impact of the trauma while simultaneously challenging the thoughts and actions that result from the emotional charge.


American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: Author.

Hansen, S. & Saxe, G. (2009). Trauma systems therapy: a replication of the model, integrating cognitive behavioral play therapy into child and family threatment. In A. Drewes (Ed.), Blending Play Therapy with Cognitive Behavioral Therapy (pp. 139-164). Hoboken, NJ: John Wiley & Sons.

Hill, C. (2004). Helping skills. (2 ed., pp. 32-33). Washington, DC: American Psychological Association.

Pifalo, T. (2006). Art therapy with sexually abused children and adolescents: extended research study. Art Therapy: Journal of the American Art Therapy​Association,23(4), 181-195.

Pifalo, T. (2007). Jogging the cogs: Trauma-focused art therapy and cognitive behavioral therapy with sexually abused children. Art Therapy: Journal of the American Art​Therapy Association, 24(4), 170-175.

Rosal, M. (2001). Cognitive-behavioral art therapy. In J. Rubin (Ed.), Approaches to Art Therapy (pp. 210-225). New York, NY: Tayor & Francis Group


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