Affect Regulation and Treatment for Depression and Anxiety through Art: Theoretical Ground and Clinical Issues

Review Article

Ann Depress Anxiety. 2014;1(2): 1008.

Affect Regulation and Treatment for Depression and Anxiety through Art: Theoretical Ground and Clinical Issues

Nan Joshua Kin Man1,2 and Ho Rainbow Tin Hung1,2*

1Center on Behavioral Health, University of Hong Kong, Hong Kong

2Department of Social Work and Social Administration, University of Hong Kong, Hong Kong

*Corresponding author: Ho Rainbow Tin Hung, Center on Behavioral Health, Department of Social Work and Social Administration, University of Hong Kong, 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong

Received: August 13, 2014; Accepted: August 30, 2014; Published: September 01, 2014


Advances in neuroscience research have shown that depression and anxiety are closely related to affect regulation, the emotional processes that work within the brain system. This paper reviews two major areas of affect regulation. The first area accounts for the relationships between affect regulation and the functions of the left/right hemispheric brain, as well as the effect of these emotional processes on the autonomic nervous system. The interpersonalneurobiological basis of affect regulation is also elaborated. The discussion implies that depressed and anxious individuals with seriously disturbed emotional or cognitive processes could probably benefit from the enhancement of right hemispheric brain processes via nonverbal form of communication. With capabilities of strengthening emotional and nonverbal processes that occur in the right hemispheric brain, nonverbal forms of psychotherapy, including art therapy, could have benefits in the treatment of depression and anxiety.

On the theoretical basis of affect regulation, the second area of discussion focuses on how the assessment and healing functions of various art media adopted in art therapy treatment correlate with left/right hemispheric brain processes. The discussion sheds light on the therapeutic use of art media to allow individuals with mood problems to experience, express, and communicate emotions effectively via nonverbal forms of treatment. The mind-body approach and the various processes of art therapy treatment can attune psycho physiological processes and help to integrate brain processes holistically to improve affect regulation and enhance well-being.

Keywords: Affect regulation; Medical humanities; Emotional processes; Art therapy; Anxiety; Depression; Mirror neurons


MRI: Magnetic Resonance Imaging; ANS: Autonomic Nervous System; MNS: Mirror Neuron System


According to the World Health Organisation [1], depression is the most serious form of mental disorder in the world. It was ranked third among the 10 leading causes of disability in 2004 and is predicted to become the leading cause of disability in 2030, which will create an unprecedentedly serious economic and disability burden. Anxiety also is a serious health problem worldwide. In the United States alone, anxiety disorders affect 40 million adults in a given year, a figure that represents 18% of the over-18 population [2].

Mood problems, including depression and anxiety, are closely related to affect regulation, a term that refers to the emotional processes in the brain system. Affect deregulation causes series mood problems. For example, a state of hyper arousal might directly or indirectly lead to different forms of anxiety disorders, while a state of hypo arousal might lead to depression. Understanding how affect is regulated may significantly aid in elucidating the mechanisms of depression and anxiety in the human brain and, more importantly, indicate appropriate treatments and support for depression patients.

Individuals with serious mood problems typically find it difficult to express feelings and thoughts using verbal communication. Accordingly, it can be challenging for psychotherapists to effectively treat mood disorders, including depression or anxiety, using only verbal forms of therapy. Although cognitive approaches of disputing irrational thoughts have been documented in the literature in the last few decades, a growing body of literature documents the significance of nonverbal forms of psychotherapy for patients whose verbal communication is seriously blocked [3-6].

As one of the major nonverbal psychotherapeutic approaches, art therapy has received growing attention for its efficacy in treating depression and anxiety. It has been documented that art therapy could help to manage depression and improve functioning in various aspects of life among depressed patients [7], reduce the trauma symptoms of children experiencing post-truamtic stress disorder [8], enhance the emotional expression and psychological well-being of breast cancer patients with signs of depression, anxiety, and other forms of emotional problems [9], decrease depression and fatigue in cancer patients [10], treat depression in male and female inmates [11], and positively improve signs of depression in elderly people with dementia [12].

This paper is an attempt to understand depression and anxiety from the perspective of affect regulation. Recent advances in neuroscience have revealed new information on how affect functions in the human brain, and how the brain and the body are interrelated in their influences on illness and wellness. This knowledge has informed and improved the theoretical underpinnings and clinical techniques of art therapy for the benefit of depressed and anxious patients.

Fundamental Emotional Systems

Theories of emotion and basic emotional systems are varied. Ekman [13,14] suggests sadness, anger, disgust, fear, joy, and surprise as basic emotions. Frijda [15] proposes sorrow, desire, happiness, interest, surprise, and wonder, while Tomkins [16] lists distress, anger, interest, contempt, disgust, fear, joy, shame, and surprise. Parrott [17] classifies emotions into a tree structure in which primary emotions include sadness, love, joy, surprise, anger, and fear. Despite the differences in theories, two common basic emotions that theorists agree on are sadness and fear. Secondary or tertiary emotions based on sadness include distress, sorrow, depression, hopelessness, gloom, glumness, unhappiness, grief, misery, and melancholy.

Emotion is complicated, and is best explained as a dynamic process (or system) that involves the interplay of the nervous system, relationships, and mind. Some affective states or emotions, regarded as universal and basic expressions of internal states, are identifiable in cultures throughout the world. Each of the basic emotions reveals the way in which human beings create common pathways for neural firing. When these pathways are activated and linked together into a functional whole, they integrate as an emotional state of mind. Sadness and fear can be viewed as two of these states of mind [18].

In each of the integrated emotional states of mind, certain regions of the brain work together to link widely separated areas; for instance, the prefrontal cortex links information from the cortex to the sub cortical limbic, brainstem, and somatic regions [18]. Fundamental emotions are closely connected to a variety of bodily states and brain arousal systems (e.g. nor epinephrine and serotonin) that coherently generate actions and other secondary or tertiary feelings in response to the environment. However, when these emotions are deregulated, psycho physiological problems emerge [4]. Depression and anxiety are two conditions that can occur when emotion becomes deregulated.

Affect Regulation and Emotional Brain

Emotional process in left/right hemispheric brain

It is generally agreed that the left hemispheric brain is responsible in most people for processing verbal, conscious, linear and rational information. The left hemisphere is the region in which information is labeled, organized, categorized, and analyzed in logical ways [19,20]. The right hemisphere processes information that is nonverbal, unconscious, holistic, conceptual and emotional. It is also the region where information associated with spirituality is processed (Figure 1) [21,22].

Citation: Man NJK and Ho RTH. Affect Regulation and Treatment for Depression and Anxiety through Art: Theoretical Ground and Clinical Issues. Ann Depress Anxiety. 2014;1(2): 1008. ISSN:2381-8883