It's Time We Talk About Music Therapy


Photo credit: midiman / Foter / CC BY

Photo credit: midiman / Foter / CC BY

In addition to being a common form of self-medication for people, music is also used in a systematic way to support wellbeing, recovery and health. This practice is called music therapy.

People intuitively use music as medicine - to improve mood, process feelings, deepen concentration, and to support physical performance. Music has the potential to help people in a multitude of ways and this power rests on the deeply rooted connections that music has to several health-related mechanisms in human physiology. Research on these connections has shown that among other things, music can shape our emotions and connect to brain mechanisms related to movement. In addition to being a common form of self-medication for people, music is also used in a systematic way to support well-being, recovery and health. This practice is called music therapy. Research on music therapy and the mechanisms behind its effects show that it offers an effective way to complement traditional treatment of even severe conditions such as autism, Parkinson’s, stroke and depression. This post is a short review on the many ways in which music therapists help patients recover and manage symptoms of a wide variety of disorders.

Music therapy is an evidence-based, systematic practice that makes use of the different ways that music can support health, education, recovery and well-being (1.) It is practiced by licensed experts in clinical, correctional, educational and residential settings and is prescribed as treatment for patients who have already been diagnosed by a health professional. Common diagnoses for which music therapy is prescribed include developmental disorders such as autism, neurological disorders such as Alzheimer’s and Parkinson's, and psychiatric disorders such as depression, anxiety, and schizophrenia. Music therapy is also frequently used to help otherwise healthy populations reduce the perception of pain (2) and to alleviate stress associated with painful medical procedures (3.)

Another benefit to music therapy is that the music being made is responsive to the patient’s preferences and it can be modified depending on their reactions and progress toward treatment goals

Music therapy varies in content according to the individual needs of the patient, the context of treatment, and the specialization of the therapist. For example, music therapists who work in schools to assist with special education requirements may design songs that incorporate cognitive and behavioral goals such as learning numbers or waiting till prompted to pick up an object. Other specializations include techniques that assist in treatment and assessment of neurological conditions such as stroke and Parkinson's Disorder. A music therapist can incorporate information about someone’s abilities, their sensory profile (an assessment of sensitivity to different sensory stimuli) and their emotional, cultural or spiritual associations to music with any medical diagnosis they have been given to design a “music intervention” that will accelerate progress toward therapeutic or educational goals.

Patients in music therapy may actively participate in a music making experience by playing an instrument or singing, or be asked to listen to a piece of music while performing other tasks such as exercise or recalling memories. Music therapy can be conducted individually or in groups and is often combined with other treatment protocols such as cognitive behavioral therapy or physical therapy to improve treatment compliance or to provide different means to access treatment goals that may be shared by a team of medical or educational staff. Another benefit to music therapy is that the music being made is responsive to the patient's preferences and it can be modified depending on their reactions and progress toward treatment goals.

Could music-making and music listening as joint activities between the caregiver and the patient be used to improve functioning and well-being of both?

In part due to the small number of randomized controlled studies on the effectiveness of music therapy and lack of large-sample size studies, and in part due to the variety of forms it can take, systematic comparison of treatment results has proved tricky. Because treatments may vary according to the needs of the patient, it can be challenging to study which aspects of therapy help the patient, and what part music plays in the therapy’s effectiveness. Cochrane reviews (meta-analyses of randomized controlled studies used as decision-making tools by professionals in evidence-based medicine) of music therapy are available for only some of conditions in which it is successfully used as part of treatment. However, those studies have shown that it is effective, or at least feasible as treatment for relieving symptoms of conditions such as depression (4), autism (5), and schizophrenia (6). What are the specific effects that music therapy can have on depression and autism? Why would music therapy help in recovery or symptom management in these disorders?

In a somewhat recent randomized controlled study (7) on music therapy for depression, 79 patients were assigned either standard care or standard care plus active music therapy that included free musical improvisation and psychotherapeutic discussion techniques. The patients who received music therapy in addition to standard care showed greater decrease in anxiety and depression symptoms than those who received standard care alone. The patients in the music therapy group were also more motivated about treatment. It is possible that music, known to activate areas of the brain related to motivation and pleasure, could be more pleasurable to go through than standard care. Since psychotherapeutic discussions can deal with life situations that cause considerable anguish, music could be used to, in a sense, take the edge off the pain.

The patients who received music therapy in addition to standard care showed greater decrease in anxiety and depression symptoms than those who received standard care alone.

Studies on children with autism have found that musical play vs. non-musical play (8) and music therapy versus standard care (9) can increase nonverbal communication gestures such as eye contact and turn-taking. Similar effects of musical play on social cognition have been found also in preschool-aged children not diagnosed with autism spectrum disorders (10): In a study published in 2010, children who took part in a joint music-making play session were more likely to show voluntary helping behavior towards others and cooperate more than children who took part in a carefully matched play situation with no music. The authors speculate that increased pro-social behavior could be explained by a) joint music making inducing a positive mood, b) music making increasing mimicry and synchronization or c) music making creating joint intentionality, or shared goals, between the children.

Another area where music therapy shows great promise is in the treatment of the movement disorders related to Parkinson’s. Parkinson’s symptoms include slowness of movement, tremor, muscle rigidity, and instability of gait (11.) The symptoms stem from the fact that Parkinson’s causes degeneration of parts of the deep brain structures related to movement - the basal ganglia. As the perception of rhythm (in music, for example) activates motor structures such as the basal ganglia, it has been thought that the automatic activation of these areas during music listening could result in motor improvements in Parkinson's disease (12.)

...“listening” to music while walking improves walking pace and number of steps in Parkinson’s patients, but ... factors such as familiarity with the music used or the ‘grooviness’ of the music influence treatment outcomes

Already in 1996 a study (13) was published that showed that something called rhythmic auditory stimulation (RAS) does indeed improve the gait velocity, stride length, and number of steps of individuals with Parkinson’s. The RAS intervention entailed walking, stair stepping, and stop-and-go exercises to beat-enhanced music. Subsequent studies have shown that even mentally “listening” to music while walking improves walking pace and number of steps in Parkinson’s patients (14), but that individual factors such as familiarity (15) with the music used or the "grooviness" of the music influence treatment outcomes (16.)

As people never exist in isolation, so do different medical conditions touch not only patients but also family members and other caregivers. Could music-making and music listening as joint activities between the caregiver and the patient be used to improve functioning and well-being of both? A recent study (17) says yes. In the study caregivers (nurses and family members) of individuals with dementia were trained by music therapists to use music as part of their standard care activities. Altogether 89 patients were randomized into a singing group, a music listening group, and control group receiving standard care alone. After 9 months, individuals in the singing and music listening groups showed improved mood, orientation, memory and attention when compared to the individuals receiving only standard care. In addition to alleviation of dementia symptoms in patients, singing was found to enhance also caregiver well-being.

...just 1-2 hours of listening to music in addition to standard care improved cognitive and emotional recovery after a condition as severe as stroke.

Music therapists are a valuable asset in clinical contexts and it seems that caregivers can be trained to incorporate the beneficial health effects of music listening and music making into standard care. However, resources are typically very limited in healthcare and the availability of trained therapists is in reality sometimes very small. Could just having patients listen to music be enough? A paper (18) published in 2008 found that astonishingly, just 1-2 hours of listening to music in addition to standard care improved cognitive and emotional recovery after a condition as severe as stroke. In the study, 54 patients were randomly assigned to a music group, a language group, or a control group. The music group listened to self-selected music and the language group to audiobooks in addition to standard care. The control group only received standard care.

The study showed that the music listening group showed improved recovery in memory and attention and mood when compared to the audiobook and the control groups. The researchers speculate (19) that the effects on cognition and mood stemmed from modulation of the dopaminergic system of the brain, related to pleasure or reward system. This system is important for attention, memory, arousal as well as motivation, and activation of the system by music listening could therefore improve performance in tasks requiring these functions. In summary, it seems that music listening could in itself help recovery and management of symptoms in a number of clinical conditions. The effects of listening are most probably enhanced by the interaction between patients and caregivers, and accentuated when therapy includes music making.

Mounting evidence on the effectiveness of music therapy shows that the therapeutic effects are as diverse as the symptoms of the conditions that can be treated, and as multifaceted as the ways in which music influences brain function and physiology. In addition to active music therapy which often incorporates music-making, research is beginning to show that music listening can have clear effects on recovery and be used as part of treatment of many conditions and disorders. While music therapy is not a substitute for standard care, research shows that it can offer enjoyable, motivating, affordable, and non-stigmatizing ways to support recovery and improve well-being of patients as well as caregivers.

The Sync Project is currently focused on research and medical interventions involving recorded music. However, we recognize and greatly appreciate power of live music-making in clinical contexts and see that the platform may offer a way to investigate the physiological effects of not only music listening but also more active forms of music therapy in the future. The Sync Project platform could provide a way for researchers and therapists to assess the physiological effects of music interventions in ecologically valid settings, and from patient populations that are difficult to investigate in the lab.

Written by Ketki Karanam (Head of Science) and Alex deRaadt (Marketing intern at The Sync Project and music therapist in training at the Berklee College of Music)

References

1. Bruscia, K. E. (1998). Defining music therapy. Barcelona Publishers, 1998.

2. Tan X, Yowler CJ, Super DM, Fratianne RB. The efficacy of music therapy
protocols for decreasing pain, anxiety, and muscle tension levels during burn
dressing changes: a prospective randomized crossover trial. Journal of Burn Care Research 2010
Jul-Aug;31(4):590-7.

3. Hanser SB, Bauer-Wu S, Kubicek L, Healey M, Manola J, Hernandez M, Bunnell C. Effects of a music therapy intervention on quality of life and distress in women with metastatic breast cancer. Journal for the Society of Integrative Oncology. 2006;4(3) 116-124.

4. Maratos, A., Gold, C., Wang, X., & Crawford, M. (2008). Music therapy for depression. The Cochrane Library.

5. Gold, C., Wigram, T., & Elefant, C. (2006). Music therapy for autistic spectrum disorder. The Cochrane Library.

6. Gold, C., Heldal, T. O., Dahle, T., & Wigram, T. (2005). Music therapy for schizophrenia or schizophrenia‐like illnesses. The Cochrane Library.

7. Erkkilä, J., Punkanen, M., Fachner, J., Ala-Ruona, E., Pöntiö, I., Tervaniemi, M., ... & Gold, C. (2011). Individual music therapy for depression: randomised controlled trial. The British Journal of Psychiatry, 199(2), 132-139.

8. Kim, J., Wigram, T., & Gold, C. (2008). The effects of improvisational music therapy on joint attention behaviors in autistic children: a randomized controlled study. Journal of Autism and Developmental Disorders, 38(9), 1758-1766.

9. Gattino, G. S., Riesgo, R. D. S., Longo, D., Leite, J. C. L., & Faccini, L. S. (2011). Effects of relational music therapy on communication of children with autism: a randomized controlled study. Nordic Journal of Music Therapy, 20(2), 142-154.

10. Kirschner, S., & Tomasello, M. (2010). Joint music making promotes prosocial behavior in 4-year-old children. Evolution and Human Behavior, 31(5), 354-364.

11. Antony, P., Diederich, N. J., Krüger, R., & Balling, R. (2013). The hallmarks of Parkinson's disease. FEBS Journal, 280(23), 5981-5993.

12. Nombela, C., Hughes, L. E., Owen, A. M., & Grahn, J. A. (2013). Into the groove: can rhythm influence Parkinson's disease?. Neuroscience & Biobehavioral Reviews, 37(10), 2564-2570.

13. Thaut, M. H., McIntosh, G. C., Rice, R. R., Miller, R. A., Rathbun, J., & Brault, J. M. (1996). Rhythmic auditory stimulation in gait training for Parkinson's disease patients. Movement Disorders, 11(2), 193-200.

14. Satoh, M., & Kuzuhara, S. (2008). Training in mental singing while walking improves gait disturbance in Parkinson’s disease patients. European Neurology, 60(5), 237-243.

15. Leow, L. A., Rinchon, C., & Grahn, J. (2015). Familiarity with music increases walking speed in rhythmic auditory cuing. Annals of the New York Academy of Sciences, 1337(1), 53-61.

16. Leow, L.-A., Parrott, T., & Grahn, J. A. (2014). Individual Differences in Beat Perception Affect Gait Responses to Low- and High-Groove Music. Frontiers in Human Neuroscience, 8, 811.

17. 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.

18. 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.

19. Särkämö, T., & Soto, D. (2012). Music listening after stroke: beneficial effects and potential neural mechanisms. Annals of the New York Academy of Sciences, 1252(1), 266-281.