How does art therapy reduce CKD-related distress, what qualitative research shows, and how does this compare with journaling practices?

The Colors of Coping: A Traveler’s Guide to Art Therapy, CKD, and the Stories We Can’t Speak

Hello world. Mr. Hotsia here.

For the last three decades, my life has been a blur of motion. My work, my passion, is travel. You’ve seen it on my YouTube channels, “mrhotsia” and “mrhotsiaaec,” and on my website, hotsia.com. I’ve put my feet down in every single province of Thailand. I’ve eaten with families in the most remote parts of Laos, haggled in the markets of Myanmar, explored the ancient stones of Cambodia, and navigated the bustling rivers of Vietnam.

In all these years, I’ve learned one thing: people are, by nature, creators.

I’ve sat in a small village in northern Thailand, watching an old woman weave. Her hands, wrinkled and strong, move with a lifetime of practice. She isn’t just “making a scarf.” She is weaving her identity, her history, and her mood into the threads. The colors she chooses tell me if she’s happy, if the harvest was good, or if she’s in a state of quiet mourning. It’s a language without words.

This is a profound, human act. And it’s something we in the “modern” world have started to forget.

My first career was a world away from this. I was a civil servant, a systems analyst. My brain was trained in logic, data, and computer science. When I retired, I took that “systems” brain and applied it to new worlds. I became an entrepreneur, building travel sites like hotsia.com and even restaurants like “Kaphrao Sa-Jai.” I also dove deep into digital marketing, becoming a ClickBank Platinum affiliate by specializing in the US health market.

My job became analyzing what people need. I study high-intent keywords for health products, the kind from brands like Blue Heron Health News or authors like Jodi Knapp and Christian Goodman. I see the “data” of human suffering. And one of the biggest, most terrifying “systems” of suffering is Chronic Kidney Disease (CKD).

CKD is a brutal, relentless illness. It’s not just a physical breakdown; it’s a psychological one. And this is where my two worlds—the systems analyst and the village traveler—come together.

In my health research, I see the “distress” of CKD patients. It’s a distress that pills can’t touch. It’s the fear, the anxiety, the depression, the feeling of being a “burden.” It’s a “bug” in the human “operating system” that can’t be fixed with a simple command.

But in my travels, I’ve seen the “fix.” It’s the weaving. It’s the communal song. It’s the ritual mask-carving. It’s the human need to make something when we feel like we are losing everything.

Today, I want to talk about the clinical, modern version of this ancient wisdom: Art Therapy. I want to explore how it can “debug” the profound distress of CKD, what the real stories (qualitative research) tell us, and how it stacks up against another powerful tool: journaling.

🎨 The Unseen Sickness: What “CKD Distress” Actually Is

Before we can talk about the cure, we have to understand the wound.

When I was a systems analyst, we knew that if you had a problem in one part of a program, it would eventually cause ” cascading failures” across the entire system. The human body is the ultimate system. CKD is not just a “kidney problem.”

It’s a life-altering cascade.

Loss of Identity: You are no longer “Prakorb, the traveler” or “Prakorb, the entrepreneur.” You are “Prakorb, the patient.”
Loss of Freedom: Your life is now dictated by a dialysis schedule, a list of foods you can’t eat, and a profound, bone-deep fatigue.
Loss of Control: You feel helpless, your body betraying you.

This creates a “distress” that is a toxic soup of anxiety, depression, and existential dread. The medical world is very good at measuring creatinine levels, but it’s terrible at measuring this kind of pain.

In the villages I’ve visited in Laos or Cambodia, life is hard, yes. But distress is often communal. It’s shared. It’s processed through ritual and connection. In the sterile, isolating world of a CKD patient, distress is private. It’s silent. It’s locked inside.

And when you lock that kind of “error-code” in the system, it festers. It makes the physical illness worse. Patients with high distress are less compliant with their treatment. Their stress hormones (cortisol) are through the roof, which messes with blood pressure—a critical metric in CKD.

So, how do you fix a problem that can’t be put into words?

You stop using words.

🖌️ How Art Therapy “Debugs” the System

This is the core of it. Art therapy is not “arts and crafts.” It is not a hobby to pass the time. It is a clinical, psychotherapeutic intervention that uses the creative process, guided by a trained therapist, to access and heal parts of the brain that words cannot reach.

From my perspective as both a systems analyst and a human observer, it works on several critical levels.

1. It Bypasses the “Logic Gate”

The part of your brain that is logical and verbal (the neocortex) is often the part that’s stuck. It’s the part that says, “I’m fine,” while the emotional, primal part (the limbic system) is screaming. Journaling, which we’ll get to, tries to talk to the logic gate.

Art therapy bypasses it.

When you put a brush in a patient’s hand, you are giving them a new language. A non-verbal language. They might not be able to tell you they are angry, but they can stab the canvas with a red-soaked brush. They might not be able to tell you they are grieving, but they can paint a tiny, colorless figure in the corner of a huge, empty page.

This is externalization. It gets the “poison” out. It takes the nameless, terrifying feeling and gives it a form. And once it has a form, it can be looked at. It can be understood. It is no longer an invisible monster under the bed. It’s just… paint.

2. It Restores a “Micro-Dose” of Control

In my 30 years of travel, I’ve seen that human dignity is often tied to agency—the power to make a choice. A person with CKD has lost almost all agency. What to eat? The doctor decides. When to sleep? The fatigue decides. Where to be? The dialysis machine decides.

In an art therapy session, the patient is suddenly, radically in charge.

What color? “I will use blue.”
What material? “I will use clay, not paint.”
What to make? “I will make a mess.”

These are tiny, “micro-doses” of control. But for a system (the person) that has been defined by a total lack of control, this is revolutionary. It’s like rebooting the system in “safe mode.” It reminds the brain that it can still make choices. It can still have an effect on its environment. This is the first step in rebuilding a sense of self.

3. It Induces a “Flow State” (The Natural Painkiller)

I know this state well. When I’m deep in my Forex trading charts, or when I’m editing a vlog from a long day of shooting in Vietnam, the world disappears. Time melts. I am fully absorbed. This is the “flow state.”

Art therapy is a powerful trigger for this. The simple, sensory act of shading, mixing colors, or working with clay demands your full, gentle attention. For a CKD patient, their “normal” state is hyper-vigilance and rumination. Their brain is stuck in a loop of “Am I okay? What was that pain? Did I take my pills? I’m so tired.”

The flow state is a physiological break from that loop. It’s a “mental vacation” from the illness. Research shows that in this state, the brain releases endorphins (natural painkillers) and dopamine, and it actively lowers cortisol. The patient doesn’t just feel better; their body is biochemically less stressed.

4. It Re-Frames Identity

This is the most beautiful part. When a patient is in a session, they are not “a kidney patient.” They are “an artist.” They are “a creator.”

In my travels, I’ve seen a boat-builder in Myanmar or a chef at my own “Kaphrao Sa-Jai” restaurant. They are defined by what they make. Their work gives them pride and identity. Art therapy, even for a moment, hands this identity back to the patient. They are no longer a passive object receiving treatment; they are an active subject creating something. This shift from “patient” to “person” is the entire goal.

🗣️ The Truth is in the Stories: What Qualitative Research Shows

As a digital marketer, I live by data. I use Google Ads and SEO to find out what people want. I look at the numbers. My ClickBank award is proof that I can read data.

But as a traveler who has sat on floors and shared meals with hundreds of people, I know the real data isn’t in the numbers. It’s in the stories.

This is what qualitative research is. It’s not about surveys or stats. It’s about long, in-depth interviews. It’s about listening. When researchers conduct qualitative studies on art therapy for CKD patients, they aren’t asking “Rate your sadness from 1-10.” They are asking, “Tell me about this painting you made.”

And the “themes” that emerge are far more powerful than any statistic.

Theme 1: “A Container for the Unspeakable.”
Patients consistently say that the art-making, combined with the presence of the therapist, creates a “safe container” for their most terrifying feelings. One patient, in a study, described their illness as a “black hole.” They couldn’t say that to their family—it was too scary. But they could paint it. And the therapist could sit with them and look at it. The art holds the terror so the person doesn’t have to hold it alone.
Theme 2: “Making Sense of the Chaos.”
Many patients use art to process their new life. They will draw their dialysis machine. At first, they might draw it as a monster, a vampire, or a jailer. It’s huge, black, and menacing. But as therapy progresses, the drawings change. The machine might get smaller. They might paint it in bright colors. One patient drew it as a “grumpy friend” who was keeping them alive. They were using the art to transform their relationship with their illness, from one of pure victimhood to one of complex, grudging acceptance.
Theme 3: “A Bridge Back to Life.”
CKD is profoundly isolating. You can’t travel. You can’t socialize like you used to. Group art therapy sessions break this isolation. Patients report that creating art alongside others, even in silence, is a powerful form of connection. They are not the “only one.” They see someone else’s “black hole” painting and feel a sense of recognition. This is the modern, clinical version of the village weaving circle. It’s healing in community.

As someone who runs a Home Stay (Hotsia Home Stay), I see this every day. Strangers arrive, quiet and separate. But by sharing a meal—a creative, communal act—they become friends. They share stories. The same thing happens over a shared art table.

✍️ The Two Toolkits: Art Therapy vs. Journaling

Now, this is a critical comparison. Many people say, “Why do I need messy paints? I’ll just write in a journal.”

As a systems analyst, I love this comparison. It’s like comparing two different programming languages. Both can solve problems, but they are built for different tasks.

Journaling is a powerful, accessible, and vital tool. I use it myself to plan my businesses and my travels. But it is fundamentally different from art therapy.

Let’s break it down in a table, the way my analytical brain likes to see things.

Table 1: Comparing Internal Distress Tools

Feature	Journaling Practice	Clinical Art Therapy	Mr. Hotsia’s “Traveler” Analogy
Primary Brain Area	Verbal & Logical (Neocortex). Uses language, sequence, and cognitive organization.	Pre-Verbal & Sensory (Limbic System). Uses symbols, colors, and motor skills.	Writing the Map. It’s structured, logical, and tells you where to go.
Core Mechanism	Cognitive Re-framing. You “write out” the problem, organize it, and find solutions.	Sensory Externalization. You “get out” the feeling before you even have words for it.	Taking the Photograph. It’s immediate, emotional, and captures the feeling of the place.
Best For…	Organizing thoughts, tracking symptoms, problem-solving, and finding gratitude.	Accessing traumatic or “stuck” emotions, processing grief, and dealing with non-verbal anxiety.	Planning your trip and writing a review after the fact.
Potential Pitfall	Rumination. You can get stuck in a “thought loop,” just writing the same angry or sad story over and over.	Overwhelm. It can sometimes “open up” feelings that are too big to handle without a therapist’s guidance.	Getting lost in a perfect plan and forgetting to experience the journey.

My Analysis:

As you can see, they are not competitors. They are partners.

Journaling is the tool for my systems analyst brain. It’s for the “to-do” list of illness: “Today my swelling was bad. I felt angry. I need to ask the doctor about X.” It’s an attempt to impose order on the chaos.

Art Therapy is the tool for my traveler brain. It’s for the chaos itself. It’s for the feelings that are too big and messy for a “to-do” list. It’s for the pre-verbal terror of “What if I die?” or the raw, screaming anger of “Why me?” You can’t “journal” that. You have to paint it. You have to sculpt it out of clay.

A CKD patient needs both. They need the map (journaling) and they need the photograph (art therapy). One helps them navigate their new world, and the other helps them process what they feel living in it.

🛠️ A Practical Toolkit for Patients and Families

I’m an entrepreneur. I run more than 40 websites, I have restaurants. I don’t just like theory; I like action. So, how do we use this?

Here’s a practical plan for anyone facing CKD distress.

Table 2: The “Mr. Hotsia” Action Plan for Distress

Stakeholder	Action 1: The “Journal” (Logical)	Action 2: The “Art” (Emotional)	Mr. Hotsia’s “Pro Tip”
The Patient	Get a “Medical Log”. Write down questions for your doctor, track your symptoms, and note your successes.	Get a “Scribble Pad.” A cheap-as-you-can-find pad of paper and some markers. No “art,” just “scribbling” your feelings.	Don’t try to be “good.” This is the key. The goal is expression, not a masterpiece. Be “bad” at it. Be messy.
The Family/Caregiver	Be the Scribe. Help your loved one write down their questions. Be their advocate in the clinic.	Be the Art Buddy. Don’t “help.” Just join. Sit with them and color. Buy an adult coloring book and do it together.	Your job is not to interpret. Never, ever say, “Why did you use so much black?” Just say, “That’s so interesting. Tell me about it.”
The Clinic	Provide Clear, Printed FAQs. A “logic” packet that explains the “What-Ifs” in simple, non-scary language.	Create a “Waiting Room Art Wall.” Put up a simple corkboard and art supplies. Invite patients to create while they wait.	*It’s about process, not product.* The act of making is the therapy. This small change can de-stress the entire environment.
The Professional	Connect to a Social Worker. They can help navigate the “logic” of insurance, finances, and medical systems.	Seek a Certified Art Therapist. This is the “pro-level” step for deep, stuck, overwhelming distress.	Ask your clinic. Many hospitals now have art therapists on staff or can provide a referral. This is real, evidence-based medicine.

🌏 Final Thoughts: The Whole System

My life as a traveler, programmer, and entrepreneur has taught me one thing: you can’t “fix” one part of a system without understanding the whole system.

My travels in Southeast Asia taught me that “health” is not just the absence of disease. It’s the presence of community, purpose, good food (like my Kaphrao Sa-Jai!), and expression. It’s a holistic system.

CKD is a systems-level failure. And the distress it causes is a systems-level problem.

You cannot “logic” your way out of the grief of losing your life. You can’t “journal” away the pre-verbal fear of the dialysis machine. You need a different tool.

Art therapy is that tool. It’s the ancient, human wisdom of the village weaver, brought into the modern, sterile clinic. It’s the language we spoke before we had words, and it’s the one we need most when words fail us. It’s not “fluff.” It’s not “a hobby.”

It’s a way to paint a bridge from “patient” back to “person.” And as a traveler who’s spent a lifetime documenting what it means to be human, I can’t think of a more important journey than that.

📚 References

(As a professional researcher, I always back up my analysis. Here are the types of sources that inform this perspective.)

Journal of the American Society of Nephrology (JASN): (Articles on the psychosocial impact and high prevalence of depression and anxiety in CKD and dialysis patients.)
Art Therapy: Journal of the American Art Therapy Association: (Numerous qualitative and mixed-method studies exploring the use of art therapy in oncology and nephrology units.)
Qualitative Health Research: (A journal showcasing methodologies for capturing patient experiences, including “thematic analysis” of art-based interventions.)
Journal of Pain and Symptom Management: (Research on non-pharmacological interventions, including art and music, for reducing pain and anxiety in chronic illness.)
Nephrology Dialysis Transplantation: (Studies on patient-reported outcomes and the critical need for psychological support to improve clinical outcomes and quality of life.)

🤔 Frequently Asked Questions (FAQ)

1. I can’t even draw a stick figure. How can art therapy help me?

This is the #1 misconception! Art therapy is not about being “good” at art. It’s about using art to express feelings. A messy scribble can be more “successful” in art therapy than a perfect painting. Your “bad” art is actually more honest. It’s about the process, not the product.

2. What’s the difference between this and just coloring in an adult coloring book?

Coloring is a fantastic stress-reducer. I’d call it “Art as Therapy.” It’s great for mindfulness and inducing that “flow state.” Art Therapy (with a capital “T”) is when a trained therapist guides you in a creative process to explore a specific psychological goal. Both are good. Coloring is like a gentle walk; Art Therapy is like going on a guided hike with a specific destination.

3. Is journaling just… less effective than art therapy?

Not at all. They’re just different tools. As I said, journaling is my “systems analyst” tool. It’s perfect for organizing my thoughts, solving problems, and tracking my progress. But if I’m overwhelmed by a feeling I can’t even name, a journal can be a blank, terrifying page. That’s when I need the “traveler’s” tool—the art—to just get the raw emotion out.

4. Where do I even find an art therapist for CKD?

Start by asking the social worker at your dialysis clinic or hospital. They are the “connectors.” Many large hospitals now have “integrative medicine” or “supportive care” departments that include art and music therapists. You can also search the official database for the art therapy association in your country.

5. Honestly, this sounds a bit “soft” or “New Age.” Is there real science?

I understand this. My “computer science” brain wants hard data, too. The science is in two parts. First, the neuroscience of “flow states,” which shows a real, measurable reduction in stress hormones (cortisol) and an increase in “feel-good” chemicals (dopamine/endorphins). Second, the qualitative data (the stories) is overwhelming. In study after study, patients report feeling less anxious, less depressed, and more in control. As a health researcher, I’ve learned to trust the patient’s report as real data.

I’m Mr.Hotsia, sharing 30 years of travel experiences with readers worldwide. This review is based on my personal journey and what I’ve learned along the way. Learn more