Art therapy has proven benefits for a range of chronic conditions and mood disorders. It can be a powerful piece of your care plan if you have a diagnosis of multiple sclerosis (MS).

François Béthoux, MD, the Director of Rehabilitation Services at the Cleveland Clinic Mellen Center, spoke by phone to explain how picking up a paintbrush or marker and working through an activity with a trained therapist can benefit people with MS.

There are multiple modalities that fall under the umbrella of art therapy, including music therapy, and what we call the “therapeutic cues of the visual arts” — the display of art on the walls of a hospital — that can influence a person’s mood.

What people most often think of as art therapy is a situation where board certified therapists provide a creative activity — painting, sculpture, or something craft-based — for patients, and there is interaction with a therapist who has counseling credentials.

There’s not a lot of evidence on the effect of art therapy specifically on MS. However, I co-authored a review of studies that found an expected effect from art modalities on emotional issues and on self-confidence from feeling empowered in doing something through your body.

For many people with MS, perception of the body changes. They may have sensory issues, pain, and difficulty moving. Through the arts, we can engage people with positive emotions by allowing them to do more than they thought they could do, but also enjoying the immediate gratification of creating something.

In a creative mode, often we say people go into a “flow,” where they are captivated by what they are doing. Being very focused, they hopefully forget a lot of their stressors, and by the end, they have results — the artwork.

The piece can be shared with others, generate a discussion, and maybe allow them to unleash some emotions, which is where a trained counselor comes in.

The activity involves many areas. It’s sensory, because there is a tactile activity involved, and it’s also cognitive.

It’s increasingly understood that MS affects cognitive performance. Even healthcare professionals may not recognize this in people with MS, because by our standards, their attention, memory, and cognitive skills are fairly well preserved.

Yet, they manage cognitive issues on a daily basis despite fatigue, depression, and other factors that impact functional performance. A creative activity involves cognition in addition to an emotional component. There is this empowerment again to create something that is your own.

MS alters a person’s life in so many ways. I often comment that many of our patients have to stop working due to disability, though often their disability is not due to a single issue, but rather small or moderate effects that can alter a person’s ability to function.

What I like with art therapy is that you can touch on so many of these components. So many patients say that they forget about their pain while they’re painting. In the past, we were told people with MS don’t have MS-associated pain, and now we understand that they do, and often it is chronic pain.

Art therapy is a very accessible, low-cost intervention. It’s something that could have profound outcomes when other healthcare resources are limited.

Once someone has been introduced to this by a therapist, they can continue it at home or by distance. Online sessions can also help with the limitations that someone with MS has in getting places.

In MS, we classify treatments as either disease-modifying therapies — those which stop the immune system from attacking the brain and the spinal cord — or those that try to restore the nerves and the synapses, known as symptomatic or rehabilitative therapies. These involve adaptation to limitations or trying to limit the consequences of the damage to the nervous system. I would place art therapy in the latter category.

In art therapy with those with MS, we should never forget we’re working with an individual with a history and personality. People react differently to changes in neurological function and changes in how their body functions.

The literature about art therapy’s impact on self-esteem and empowerment, and how it can impact quality of life, would lead me to believe that we could initiate positive feedback loops. Anecdotally, in interacting with patients, that is a given.

I’m a rehabilitative specialist. We have to be aware of the person and of what MS is and what MS causes so we can be aware of people’s limitations, and be able to adapt on the fly.

We should be mindful of the mix of physical and cognitive consequences that require more time. We can also adjust the goal so at the end the person is not frustrated that they haven’t gotten their desired outcome or feeling like they can’t do it.

This requires a lot from the therapist during the session to adapt their approach to the consequences of MS, and to recognize people can get quickly tired in their brain and in their body.

People with MS can feel exhaustion from trying to concentrate, and their muscles may also tire. This requires the therapist to pick up on the signals and respond with something like, “I noticed your arm is getting tired, why don’t we stop or work on something else.”

It’s not so much that the activity itself should be standardized, but more about adjusting the activity in the moment to address limitations.

We have interventions that tend to be either short-term or episodic. We can’t generally give access to an art therapist every week, so the hope is that it will inspire the person to continue the activity at home and touch base with a therapist on an intermittent basis. The ongoing activity is also driven by the person’s interest.

We did some research on a “tasting menu” of different activities for people with different conditions, including MS. One of these activities was art therapy. We had positive feedback from people, such as, “I was doing art on my own and you gave me a new incentive to resume,” or, “I never thought of doing it and now I do it on a regular basis.”

As MS is a condition that tends to be progressive, a long-term plan can be worked out with a person’s consent and engagement.

Professional organizations can help you find a provider in your area. It’s also good to check with hospital systems. Healthcare organizations also often partner up with community centers.

François Béthoux, MD, serves as the Director of Rehabilitation Services at the Cleveland Clinic Mellen Center for MS, and as the Medical Director of the Cleveland Clinic Arts and Medicine program. He was born in Paris, France. He completed his medical studies and residency in physical medicine and rehabilitation in Lyon, France. After moving to the United States to complete a neuroimmunology fellowship at the Mellen Center for Multiple Sclerosis Treatment and Research, and today is the chairman of the Department of Physical Medicine and Rehabilitation.

Dr. Béthoux’s research interests include outcomes measurements in both general and multiple sclerosis-specific neurorehabilitation, gait analysis, and evaluation of symptomatic therapies and rehabilitative interventions for spasticity in MS and other disorders of the central nervous system.