Updated: Aug 24
Selective mutism is a complex anxiety disorder characterised by a consistent failure to speak in specific social situations, despite the ability to speak in other settings. This subject is very close to my heart, as I find it deeply moving and the most rewarding when clients feel safe to communicate creatively. It's such an empowering process and one that I find client's and parent's feel so isolated and helpless with. My aim is that this post helps shine a light on a new perspective and gives hope in a topic that is so easily dismissed.
While traditional therapeutic approaches have shown some success, the integration of art psychotherapy offers a unique and promising avenue for individuals with selective mutism. This post explores the relationship between art psychotherapy and selective mutism. Highlighting the neuroscience behind its effectiveness and presenting quantitative data that support its therapeutic benefits.
Art psychotherapy is a therapeutic modality that utilizes various art forms, such as drawing, painting, and sculpture: to facilitate self-expression, emotional exploration, and personal growth. It provides a safe and non-verbal outlet for individuals to communicate their thoughts, feelings, and experiences. This is particularly helpful when verbal communication is challenging.
The Neuroscience of Selective Mutism
To comprehend the impact of art psychotherapy on selective mutism, it is essential to understand the neuroscience underlying this anxiety disorder. Research suggests that selective mutism is associated with an overactive amygdala, the brain's fear centre, and an underactive prefrontal cortex, responsible for emotional regulation and decision-making. This neurobiological imbalance often contributes to the difficulty individuals with selective mutism face, in speaking in certain social situations. From the perspective of the nervous system, it can be considered a hypo-aroused (dorsal vagal, parasympathetic response) or a ‘shutdown response’.
Art Psychotherapy and the Brain
Engaging in art-making activates various brain regions, including the prefrontal cortex, which plays a crucial role in emotional regulation and decision-making. Studies utilizing neuroimaging techniques, such as functional magnetic resonance imaging (fMRI), have demonstrated that art therapy can modulate brain activity. Showing to reduce amygdala hyperactivity and enhancing prefrontal cortex functioning. This is evidence that art psychotherapy helps restore the neurobiological balance disrupted in individuals with selective mutism.
Quantitative Data Supporting Art Psychotherapy
While research specifically focusing on art psychotherapy and selective mutism is limited, studies examining the efficacy of art therapy in treating anxiety disorders provide valuable insights. For instance, a meta-analysis conducted by Stuckey and Nobel (2010) reviewed 30 studies and found a significant decrease in anxiety levels among participants who engaged in art therapy interventions. This suggests that art psychotherapy may have similar benefits for individuals with selective mutism. Qualitative studies exploring the experiences of individuals with selective mutism who participated in art psychotherapy have reported positive outcomes. These include increased self-expression, improved emotional regulation, and enhanced social interactions.
The Therapeutic Mechanisms of Art Psychotherapy
Art psychotherapy offers several therapeutic mechanisms that contribute to its effectiveness in addressing selective mutism. Firstly, the non-verbal nature of art-making provides individuals with an alternative means of communication, bypassing the anxiety (and alarm system in the brain) associated with speaking. Secondly, art therapy allows for the externalization and exploration of complex emotions, facilitating emotional processing and self-awareness.
Nervous System Regulation and Selective Mutism
Research has found that the regulation of the nervous system is vital to reducing anxiety for clients with SM. Melfen found in their study
“The majority of cognitive–behavioural interventions for SM were designed based on anxiety treatment. Focusing only on the reduction of anxiety may not be sufficient to treat SM. Following our findings, an important focus of therapy should be to improve self-regulation to bring stable balance into the nervous system.”
By utilising a somatic therapy like Art Psychotherapy client’s will be able to regulate their nervous system through art making and create a neuroception of safety. This will turn off the alarm system in the brain “amagydala” and re-engage the pre-frontal cortex – the language part of the brain. This will bring the client out of their shutdown response and help them feel safe to access their ability to communicate gradually at a safe pace that feels right for them.
This process help individuals with selective mutism gain confidence and develop strategies to overcome their communication challenges, in a staged approach but also safely increasing their window of tolerance. The window of tolerance is a concept originally developed by Dr. Dan Siegel, MD to describe the optimal zone of “arousal” for a person to function in everyday life. When a person is operating within this zone or window, they can effectively manage and cope with their emotions. When they step out of their window into hypo-arousal/shutdown, (like clients with selective mutism) they are working from a part of their brain that is primal and unable to speak. It is important to remember this is not a concious process, but a safety mechanism wired into the brain that has become a little too protective.
Art psychotherapy holds promise as a therapeutic approach for individuals with selective mutism. By harnessing the power of creativity, this modality engages the brain's neural networks, promoting emotional regulation and reduces the anxiety symptoms associated with selective mutism. The neuroscience and existing research on art therapy for anxiety disorders provide a foundation for further exploration. Art making is very powerful tool at regulating the nervous system. If we approach selective mutism as a sensitive nervous system we can creatively empower clients to increase their window of tolerance and rewire their brain back to safety creatively. As we continue to uncover the potential of art psychotherapy, it offers hope and possibilities for individuals with selective mutism to find their voice, communicate at a pace that feels safe for them and thrive in social interactions.
· Information on the window of tolerance:
· Information on a nervous system approach to selective mutism:
Episode 31 “Lessons from the Playroom” Podcast: Selective Mutism in the Playroom with Lisa Dion, founder of Synergetic Play Therapy
Understanding Selective Mutism and Art Psychotherapy:
Dummit, E. S., Klein, R. G., Tancer, N. K., Asche, B., & Martin, J. (1996). Systematic assessment of 50 children with selective mutism. Journal of the American Academy of Child & Adolescent Psychiatry, 35(6), 653-660.
The Neuroscience of Selective Mutism:
Black, B., Uhde, T. W., & Tancer, N. K. (1992). A family study of selective mutism. Biological Psychiatry, 32(9), 961-966.
Art Psychotherapy and the Brain:
Kaimal, G., Ray, K., & Muniz, J. (2016). Reduction of cortisol levels and participants’ responses following art making. Art Therapy, 33(2), 74-80.
Quantitative Data Supporting Art Psychotherapy:
Stuckey, H. L., & Nobel, J. (2010). The connection between art, healing, and public health: A review of current literature. American Journal of Public Health, 100(2), 254-263.
The Therapeutic Mechanisms of Art Psychotherapy:
Malchiodi, C. A. (2005). Expressive therapies. Guilford Press.
Art Psychotherapy and Anxiety Disorders:
Silverman, M. J. (2016). Art Therapy for Children with Anxiety. In Handbook of Art Therapy (pp. 283-298). Routledge.
Betrayed by the nervous system: a comparison group study to investigate the 'unsafe world' model of selective mutism.
Melfsen S, Romanos M, Jans T, Walitza S. J Neural Transm (Vienna). 2021 Sep;128(9):1433-1443. doi: 10.1007/s00702-021-02404-1. Epub 2021 Aug 14. PMID: 34390394; PMCID: PMC8423629.