What we talk about when we talk about music as medicine


Music as Medicine syncproject.co

The Sync Project’s mission is to develop music as medicine. We are building a data platform that maps music characteristics to real time, objective measurements of physiology from a rapidly growing variety of sensors and devices. The platform will enable discovery and validation of music signatures that are effective for health.  In this post co-founders Marko Ahtisaari and Ketki Karanam survey some of the recent research on music and health that lead us to start the Sync Project.

 

A rugged graffiti under a small bridge in Helsinki proposes a surprisingly powerful question: “What if you woke up tomorrow and all music was gone?”

 

Music is such an integral part of our lives that it is difficult to imagine a world without it. Music seems to be one of the defining features of our species. It dates back to the very origins of the human race and has endured all the subsequent changes in culture and cognition. Throughout history, music has served a multitude of purposes in human culture, all of which stem from music’s unique power in influencing our mental and physiological states and social interactions. With the advent of modern science, we are finally able to take a peek at the mechanisms behind what makes music so important and so powerful in regulating our emotions, and shaping our thoughts and interactions. Through this understanding we can start using music in an informed and targeted way, in support of overall wellbeing and health.

It is intriguing that music - abstract but organized sound without immediately obvious semantic meaning - can be of such profound importance to people. In addition to the deep enjoyment experienced from music listening, people actively use music as a tool: to alter and reflect on their mood and feelings, support concentration, and physical or cognitive performance, manage stress or to increase a sense of togetherness and social belonging. 

Where does the science stand on this matter? What do we know about the effects of music on the brain? How well-supported and generalizable are the claims that music could be used to augment physiology, mental states and ultimately support health?

The neuroscience of music encompasses a multitude of perspectives. It aims to explore the many ways in which music making and music listening manifest on the level of brain physiology, how it can be augmented and how these effects could be used in music-based interventions.

...music listening can exert its neuroplastic effects before birth....infants can form a memory trace of a song they hear in the womb during the last trimester

Not surprisingly, musicians have fascinated scientists in the field for a long time. It was suspected that individuals who spend some time, every day, practicing from a very young age might have different brains. In short, neuroimaging studies have found it to indeed be so. When comparing the brains of musicians and non-musicians, several differences in brain structure and function have been found (for a review, see 1). Longitudinal studies tracking the brain development of children who took music lessons has corroborated that music training (not pre-existing differences) is the source of the differences observed between musicians and laypeople (2,3,4.) 

The changes in musicians’ brains are typically seen in the structure of areas related to hearing and movement or as enhanced processing of sound features like pitch, timbre and rhythm. However, plastic changes appear to extend also to brain mechanisms important for higher-order cognitive functions such as attention as well as linguistic skills (5.) Musicians typically enjoy hearing about results like these and jokingly interpret them to indicate superior cognitive skills. But even though music making might not really make one supersmart, these results have in turn led to the intriguing new field study of whether music making could be applied in the rehabilitation of cognitive difficulties. 

Another field of interest is music how music listening influences us. Musicianship seems to be reserved for the few, and even non-professional music making is something that not everyone can do. On the contrary, music listening is very common. Even without consciously choosing to listen, people are exposed to music several times a day. Neuroimaging studies have shown that even though music starts as mere oscillation of the membrane of the eardrum, it is processed in the entire brain. Music listening causes widespread activation, including areas important for movement, emotions, memory, hearing, pleasure, reward and motivation (6,7.) This might explain why music listening is such a powerful experience. Music evokes emotions, memories, it makes us move, it causes us pleasure on a level comparable to that triggered by good food, sex and other intense sources of delight in life. This has led people to ponder whether in addition to enjoyment, music listening could be harnessed to create interventions and treatment for different kinds of disorders.

Music has been utilized in interventions related to pain, stroke, anxiety, Parkinson’s, dementia, and depression, to mention a few.

Indeed, it is possible that the greatest positive effects of music on health will be most prominent for those with the most to gain. Music has been utilized in interventions related to pain, stroke, anxiety, Parkinson’s, dementia, and depression, to mention a few. Although the use of music listening as part of treatment in severe conditions may at first sound a little far-fetched, research on its positive effects is an expanding field. There is evidence that music listening can support, for instance, management of pain (8), decrease anxiety during painful medical procedures, aid in recovery from stroke (9), decrease anxiety (10), improve mood, orientation, memory and general cognition in dementia patients (11) and decrease symptoms of depression (12). While the mechanisms underlying these effects are still not fully understood and require further research, they may be based on how music listening influences systems related to attention, stress, arousal, emotions, as well as motivation and pleasure (13). For instance, pain relief by music listening may be caused by the fact that music draws attention away from the experience of pain (13.) Another mechanism that may explain why music listening may help pain management and even decrease the amount of pain medication needed (8) is the aforementioned fact that music listening activates areas related to the experience of pleasure. Music listening as an intervention shows promising indications of wide-ranging effects in clinical populations. Providing access to music in the recovery environment would be an easy and inexpensive way to recruit the health-related mechanisms into the recovery process. 

However, the health effects of music are certainly not only limited to individuals with medical conditions. For instance, many people report that music is an effective way to control stress and to relax. But where does the research stand? There is some support. In healthy individuals, listening to relaxing music (soft tones, slow tempo) has been found to decrease the experience of stress (14). This effect may stem from the connection of music listening to the hormonal system that regulates stress. Several studies report lowered levels of cortisol (the stress hormone) after music listening (reviewed in 13). As prolonged high cortisol levels and accompanying chronic stress are connected, for example, to high blood pressure and heart disease, music listening could be an effortless and enjoyable way to maintain health.

And even if your blood pressure has already soared, don’t worry, it seems music listening can still help: it has been reported to lower blood pressure and heart rate (14,15.) Researchers speculate that particularly relaxing, slow-tempo music might be able to decrease heart rate and lower blood pressure because rhythm processing begins in the brainstem, which also modulates these cardiovascular functions (13.) It is a beautiful thought, that our bodies could at such a basic level sync to music.

...the most convincing evidence of music listening supporting cognitive performance comes from research conducted in settings where subjects listen to music before performing a task.

But what about if there’s no particular problem or ailment? It is also typical for people to look for ways to enhance performance in various domains; run the extra mile, study a while longer. For example, many report gaining extra energy from music while training in sports or being able to attain a good rhythm while running by listening to music. There is some research to support these experiences. For instance, according to two studies (16,17) synchronizing movements to the beat of music during training leads to longer time-to-exhaustion, better mood, lower perceived exertion, blood lactate concentrations as well as oxygen consumption. 

Many people also use music to enhance cognition, typically in the form of background music. This idea of using music is about creating optimal settings for concentration, creative thinking and learning. It is slightly disheartening that this perhaps most common use of music listening as enhancement has proved to be the most difficult to scientifically investigate. In their review of the literature on music listening and cognitive performance, Schellenberg and Weiss (18) describe the findings on the effects of background music on cognition as partly inconclusive and contradictory. According to the authors, the most convincing evidence of music listening supporting cognitive performance comes from research conducted in settings where subjects listen to music before performing a task. In these kinds of settings, music listening before a task has indeed been shown to support performance in a variety of tasks (reviewed in 18). The key is that the music that subjects listen to is subjectively enjoyable, which then results in a better mood, which supports cognitive function. Consequently, similar effects can also be gained from non-musical stimuli, like listening to a recording of a story that they feel is pleasurable before a cognitive task (19.) 

People already self medicate with music...the quest to satisfy curiosity, understand the mechanisms behind observed events and to answer the question why something works as it does [drives the scientific study of music and the brain].

However, most people who aim to support their thought process through music use music during their activities. Sadly, there are few reliable findings on how background music influences cognition (18, 20.) Background music may support cognitive functioning through reducing stress, or by increasing arousal. It may also hinder it through placing a load on same cognitive resources as the one being used in the task. The effects will therefore depend on several things: the type of music, the type of task, other background noise, and individual factors like personality. The reason behind and mechanisms that explain why people experience cognitive differences while exposed to background music remain to be comprehensively explored. 

When summing up the advances in the field of neuroscience of music, it seems that a lot of the experiences people have from music listening have a basis that can be scientifically investigated and possibly harnessed for health-related interventions. More studies are however needed to create reliable information about the possibilities to support health and recovery through music listening. Future research with randomized controlled trials, supplementing subjective ratings with physiological measures in evaluating treatment outcomes, and taking individual differences into consideration in treatment planning will provide understanding of the reliability of music interventions, as well as more insight into the mechanisms behind the salutary effects. 

Future studies, incorporating large-scale data collection of physiological and behavioral markers of performance in real-life situations and environments alongside lab investigations will also be able to shed light on why music might help and even provide physical and cognitive enhancement in different situations. The platform that the Sync Project is developing is aimed at supporting large-scale data collection on the physiological effects of music listening in real-life situations. Data on physiological effects of music listening might help us understand the mechanisms behind the daily self-medication that people do and also enhance its effects.  It might also provide valuable information in tracking the effects of music interventions in a multitude of clinical settings. 

Enjoying music is one of the fundamental aspects of being human. It does not require special training, as most people are equipped with the mechanisms needed to perceive music already at birth. (Actually, here’s a fun fact: music listening can exert its neuroplastic effects already before birth. According to a study (21) published in 2013, infants can form a memory trace of a song they hear in the womb during the last trimester). Researchers in the field of cognitive neuroscience of music are sometimes confronted with the question of why the health effects of music should be scientifically investigated when people already experience a wide variety of benefits from music listening and intuitively use it as medicine based on their own subjective experience. In other words, people already self medicate with music. Perhaps the answer relates to a human phenomenon as age-old and common to all people as music itself: the quest to satisfy curiosity, understand the mechanisms behind observed events and to answer the question why something works as it does. 

Ultimately the aim of scientific discovery is to create better, more reliable information about how the world works and what the human experience at its best could be. Research on the health effects of music listening will provide novel insights and understanding of why music works as it does, what it can and cannot do and how to make the most of this wonderful and central aspect of human existence.

 

By Marko Ahtisaari and Ketki Karanam

References

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  2. Hyde, K. L., Lerch, J., Norton, A., Forgeard, M., Winner, E., Evans, A. C., & Schlaug, G. (2009). Musical training shapes structural brain development. The Journal of Neuroscience, 29(10), 3019-3025. http://dx.doi:10.1523/jneurosci.5118-08.2009

  3. Kraus, N., Slater, J., Thompson, E. C., Hornickel, J., Strait, D. L., Nicol, T., & White-Schwoch, T. (2014). Music enrichment programs improve the neural encoding of speech in at-risk children. The Journal of Neuroscience, 34(36), 11913-11918. http://dx.doi.org/10.1523/jneurosci.1881-14.2014

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  5. Kraus, N., & Chandrasekaran, B. (2010). Music training for the development of auditory skills. Nature Reviews Neuroscience, 11(8), 599-605. http://dx.doi.org/10.1038/nrn2882

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  8. Hole, J., Hirsch, M., Ball, E., & Meads, C. (n.d.). Music as an aid for postoperative recovery in adults: a systematic review and meta-analysis. The Lancet, 386(10004), 1659–1671. http://dx.doi.org/10.1016/S0140-6736(15)60169-6

  9. Särkämö, T., Tervaniemi, M., Laitinen, S., Forsblom, A., Soinila, S., Mikkonen, M., ... & Hietanen, M. (2008). Music listening enhances cognitive recovery and mood after middle cerebral artery stroke. Brain, 131(3), 866-876. http://dx.doi.org/10.1093/brain/awn013

  10. Sung, H. C., Chang, A. M., & Lee, W. L. (2010). A preferred music listening intervention to reduce anxiety in older adults with dementia in nursing homes. Journal of clinical nursing, 19(7‐8), 1056-1064. http://dx.doi.org/10.1111/j.1365-2702.2009.03016.x

  11. Särkämö, T., Tervaniemi, M., Laitinen, S., Numminen, A., Kurki, M., Johnson, J. K., & Rantanen, P. (2014). Cognitive, emotional, and social benefits of regular musical activities in early dementia: Randomized controlled study. The Gerontologist, 54(4), 634-650. http://dx.doi.org/10.1093/geront/gnt100

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  13. Chanda, M. L., & Levitin, D. J. (2013). The neurochemistry of music. Trends in cognitive sciences, 17(4), 179-193. http://dx.doi.org/10.1016/j.tics.2013.02.007

  14. Knight, W. E., & Rickard, N. S. (2001). Relaxing music prevents stress-induced increases in subjective anxiety, systolic blood pressure, and heart rate in healthy males and females. Journal of music therapy, 38(4), 254-272. http://dx.doi.org/10.1093/jmt/38.4.254

  15. Triller, N., Eržen, D., Duh, Š., Petrinec Primožič, M., & Košnik, M. (2006). Music during bronchoscopic examination: the physiological effects. Respiration, 73(1), 95-99. http://dx.doi.org/10.1159/000089818

  16. Terry, P. C., Karageorghis, C. I., Saha, A. M., & D’Auria, S. (2012). Effects of synchronous music on treadmill running among elite triathletes. Journal of Science and Medicine in Sport, 15(1), 52-57. http://dx.doi.org/10.1016/j.jsams.2011.06.003

  17. Bacon, C. J., Myers, T. R., & Karageorghis, C. I. (2012). Effect of music-movement synchrony on exercise oxygen consumption. The Journal of sports medicine and physical fitness, 52(4), 359-365. http://www.ncbi.nlm.nih.gov/pubmed/22828457

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  19. Nantais, K. M., & Schellenberg, E. G. (1999). The Mozart effect: An artifact of preference. Psychological Science, 10(4), 370-373. http://dx.doi.org/10.1111/1467-9280.00170

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  21. Partanen, E., Kujala, T., Tervaniemi, M., & Huotilainen, M. (2013). Prenatal music exposure induces long-term neural effects. http://dx.doi.org/10.1371/journal.pone.0078946