music therapy

Music as medicine is ancient

King David played for King Saul to soothe him

Egypt legally ordained some songs
Pythagoras treated conditions with music
Xenocrates cured mania with melodious sounds

The Australian Music Therapy Association

Playing the didgeridoo is good medicine, singing can help asthmatic children and breathing

Receptive music therapy

patients listens to recorded/live music in order to achieve a desired outcome such as reduced anxiety, is most appropriate in circumstances where active music participation is not possible or desirable, as in palliative care

music listening is used to evoke a “dynamic unfold-ing of inner experiences” in the form of therapist- assisted mental imagery

This imagery, in turn, is used as a basis for therapeutic discussions and allows clients to confront and embrace their experiences and feelings

Active music therapy

involves creative participation in music making by patients, whether individually or in groups

Huberman Lab

• Listen to your favorite music for 10-60 minutes per day! Benefits: reduce resting heart rate, increase heart rate variability, activate features of the parasympathetic nervous system – sustained after you stop listening to music
• Ranking conditions of music best for learning and cognition: (1) silence; (2) faster instrumental music; (3) music with lyrics; (4) your favorite music – it’s a performance buster because there are too many dialogues in our head
• Nuance: music (even your favorite music) in the breaks between bouts of cognitive work can be a performance enhancer
• Listen to new music! It will enhance the brain’s neural circuitry and neuroplasticity for learning beyond music

Defining well being/How music contributes to well being

How we feel about the quality of our lives
Flourishing:
• Competence (music skills), Emotional stability, Engagement, Meaning (in life), Optimism, Positive emotion and relationships, Self-esteem, Vitality

Sound therapy (not music therapy!)

• Uses sound, music and specialist instruments played in therapeutic ways, combined with deep self-reflection techniques to improve health and wellbeing.
• Sound bath: sound baths use instruments like bowls to initiate "a deeply immersive, full-body listening experience.“

How does a sound bath work?

• trigger a phenomenon called “sound healing.” Sound healing has been a home remedy favored by many cultures for thousands of years.
• lying in a reclining position after taking part in yoga or meditation exercises, musical techniques will use one or several instruments to create soothing/overlapping vibrations.
• These vibrations ”theoretically” lead you deeper into a state of contemplation or relaxation, shutting off your body’s fight-or-flight reflex.

Goldsby et. Al. (2017)

• pre-meditation, following the sound meditation participants reported significantly less tension, anger, fatigue, and depressed mood
• participants who were previously naïve to this type of meditation experienced a significantly greater reduction in tension compared with participants experienced in this meditation
• Feeling of spiritual well-being significantly increased across all participants
• reducing feelings of tension, anxiety, and depression, and increasing spiritual well- being.
• decreasing tension in individuals who have not previously practiced this form of meditation.

Music therapy

the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.

Music medicine

a term used to describe when a medical practitioner uses music in the course of treating their patient.

Performing arts therapy

making music as therapy

Neurologic Music Therapy

brain areas involved in music are not exclusive to music, promotes meaningful interaction between networks.
music learning changes the brain, use of cortical plasticity, resulting in the creation of new neural pathways
explains how music therapy interventions “work.”

neurologic music therapy (NMT)

This scientific foundation has enabled the profession to shift from a social science model to a neuroscience model, resulting in a new approach to research and clinical practice

The Rational- Scientific Mediating Model (R- SMM)

investigators use basic research evidence to identify parallel brain processes between musical behaviors and nonmusical behaviors.

These processes establish a scientific foundation for subsequent applied research by clarifying how music therapy interventions work in terms of brain function.

helps music therapists select and provide the most effective and evidence-based interventions for their patients

Psychiatric: 3 types/levels

• Mental health = 14% of music therapy
1) Supportive music therapy
• main goals are to promote mood-lifting stimulation and healthy behaviors, require active involvement and
awareness of the here and now.
2) insight and process-oriented music therapy with re-educative goals
• re-educative goals, the client is now at a higher level of insight and is ready to reflect and process interpersonal relationships and emotions with a greater level of verbal participation, well oriented to reality, demonstrates appropriate interaction skills, and is ready to focus on conscious conflicts and associated unhealthy defense
mechanisms.
3) reconstructive, analytically, and catharsis-oriented music therapy.
• reconstructive, analytically, and catharsis-oriented music therapy, interventions are used to uncover and process subconscious conflicts resulting from past traumatic situations

It Should work for Mental Health Condition

• music’s unique ability to access affective/motivational systems in the brain.
• a theoretical paradigm of music therapy in psychiatry must integrate musical response models in music perception and music cognition with the understanding
of music’s influence on psychological and neurobiological nonmusical human behavior, and with concepts of behavioral learning and therapeutic change
• emotions are an essential part of cognitive processing, emotion is the main force for motivation, and motivation is an essential force that drives behavior and cognition
• Music’s ability to induce emotions should make it useful for emotion work

People report using it for Mental Health

• A number of studies have shown that many people use music for emotion regulation throughout their lives.
• goals of emotion self-regulation through music remain much the same from youth through old age.

These include:
• (1) to relax and revive oneself
• (2) maintain a positive mood
• (3) distract or divert attention from negative thoughts
• (4) provide a framework for the mental work involved in processing internal conflicts;
• (5) energize or ‘psych’ oneself up;
• (6) stir up and access a range of intense feelings
• (7) discharge anger or other negative emotions
• (8) provide solace when dealing with loss or loneliness

Research Support: Anxiety

• Research has confirmed that relaxing music can reduce subjective feelings of anxiety, corresponding reduction in the stress hormone cortisol, or a reduced increase in cortisol in response to stress
• Other researchers have failed to observe effects of music on cortisol even when participants report feeling less anxious.

Research Support: Depression

• Among people who have not been diagnosed with depression, music can alleviate negative mood states whether the music is experienced during physiotherapy, receptive music therapy, active music therapy, or while listening for pleasure (positive results)
• Limited evidence that music is an effective treatment for clinical depression, although it may help to ease the anxiety experienced by depressed individuals.
• music therapy to be accepted by people with depression and associated with improvements in mood, but this was based on only a few studies and they were not of high quality.

Research support: Serious Mental Illness

• music therapy added to standard care was superior, might also improve mental state and functioning if a sufficient number of music therapy sessions were provided
• research on dose–response relationships for people with serious mental disorders: effective treatment that helps people with psychotic and nonpsychotic severe mental disorders to improve global state, symptoms, and functioning, slight improvements with few therapy sessions— longer courses/more frequent sessions needed to achieve more substantial benefits
• children and adolescents with psychopathology: music therapy has a medium to large positive effect on clinically relevant outcomes that was statistically highly significant
• practice and outcomes with adult psychiatric inpatients with acute disorders: effective in addressing a range of symptoms, studies were limited by methodological shortcomings and small sample sizes.

Research Support: Schizophrenia

• meta-analysis of the influence of music on the symptoms of schizophrenia, found a significant effect size but with inconsistency in the results
• RCTs of group music therapy, in patients with schizophrenia had positive results

Emotional Regulation

• it can influence impulse control and self-regulation in young children and children with disabilities and assist with managing anger
• support the development of self-control and enable disaffected young people to express their emotions more effectively, drumming particularly effective in this respect.
• In vulnerable and older people musical activity can reduce depression, promote positive emotions, emotional regulation and provide spiritual experiences.
• supports the healing of children who have been traumatised through war, those forced to fight, serve as spies, soldier-wives or camp followers and who are now refugees. Using their own cultural music and creative compositions can help these young people to overcome fears and difficulties and promote healing.

Basic research findings on music therapy

• music during cesarean section, for pain, for mechanically ventilated patients, improving psychological and physical outcomes in cancer, preoperative anxiety, stress and anxiety reduction in coronary heart disease, and in end-of-life care.
• Meta-analyses on the effects of music/music therapy in general medical areas, during medical treatment of pediatric patients, and in the NICU
• All have indicated that music and music therapy can provide positive benefits for medical treatment

Cochrane reviews

• developed a brand as a prestigious, independent and unbiased medical research non-profit pursuing evidence-based choices involving healthy interventions of health professionals, patients, and policy makers.
• considered to be gold standard quality; clearly reported and methodologically better than systematic reviews (SRs) published elsewhere.
• Researchers conducting systematic reviews use explicit, systematic methods that are selected with a view aimed at minimizing bias, to produce more reliable findings to inform decision making.

Specific Medical problems

• Pain
• Stroke
• Parkinsons

Basic Ideas behind anxiolytic music

• Averse stimuli are less/no longer perceived and processed “under music.”
• subcortical centers of pain processing and emotional control are directly influenced
• descending pain-inhibiting structures of the central nervous system are activated
• subjective perception of ongoing, pain-accompanying vegetative activation can be changed through the parallel input of external musical stimuli. By listening to music a situation can be reconstrued as being less threatening and less stressful and painful
• cognitive and emotional factors can moderate the degree of pain experienced

musicogenic muscle detonization

Proprioception from skeletal muscles influences emotional state as well as pain perception, and vice versa

Koelsch et. al (2011)

• Effects of music on patients undergoing hip surgery
• Randomized placebo-controlled study
• Light anesthesia- instrumental music vs. ocean sounds
• 20% lower cortisol level in blood during surgery
• Consumed 15% less anesthesia during surgery
• Possible mechanisms:
• DA reward system activation
• downregulation of amygdala
• music as distraction

Pain Management Procedure

1 Attention is focused on the aesthetic stimuli
2 There is distraction from the pain sensation
3 Stress response is markedly decreased
4 Pain tolerance is increased on a subcortical and cortical level
5 Muscle tonus decreases
6 Motivation, compliance, and psychomotor performance are enhanced
7 Improved motor coordination in rehabilitation programs for low back pain

Research Findings: Pain Management

• chronic pain: receptive music therapy approaches were found to be effective
• effectiveness of music therapy for patients with muscle-related pain
• significant effects in the pre-post-comparison and the group comparison condition in a sample of chronic pain patients
• Children: the music therapy condition showed a significant placebo superiority with regard to relative reduction of headache frequency
• listening to music, especially preferred music, can increase tolerance to pain
• Meta-analysis support it, Large anecdotal evidence base, Lack large scale rcts
• Meta-analyses small to medium effects for kid, medium to large for adults
• reduces pain and opiate use but small effect

Overview: Music therapy for Stroke patients

• Music as a complex, temporally structured “sound language” arouses the human brain on sensory, motor, perceptive- cognitive, and emotional levels simultaneously and stimulates and integrates neuronal pathways in a music-specific way.
• Three domains of rehabilitation: Sensorimotor rehabilitation, Speech and language rehabilitation, Cognitive rehabilitation.

Receptive Music Research Finding: stroke study

• patients who had suffered a stroke randomly assigned to one of three groups: a music listening group, an audio-book listening group, or a control group (no additional treatment)
• All groups received standard stroke rehabilitation, patients with music and audio-book groups listened every day, while the control group received no listening material.
• Stroke patients who listened to music daily showed greater recovery in verbal memory and in focused attention, compared to audio books and control
• verbal memory improved 60% in music listeners and less than 30% for other groups
• Focused attention improved 17% in music listeners, no significant improvement in audio-book listeners and control
• follow-up: music group showed greater gray matter increase than other groups

Neurologic Music Therapy (NMT)

• The therapeutic application of music to cognitive, sensory, and motor dysfunctions due to neurologic disease of the human nervous system.
• Treatment techniques are based on the scientific knowledge of music perception and production and the effects of nonmusical brain and behavior functions.

Neurological Foundation of NMT

• Rhythmic Stimulation and Entrainment: profound effects as coordinative sensory input to entrain timing functions
• Patterned Information Processing: Timing is a key component in neural information processing in regard to perception and learning. Rhythm and synchronization are critical parameters in this processing
• Differential Neurological Processing: The neuroanatomy and neurophysiology of music processing show shared, parallel, and distinct neural processing systems for nonmusical functions
• Affective-Aesthetic Response (Arousal, Motivation, Emotion): Music communicates emotion and meaning through the perception of its intrinsic symbol structure of musical elements and emotional responses that have become connected to it through an associative learning process

NMT Research findings

• neurologic music therapy (NMT) technique of rhythmic auditory stimulation (RAS) may be beneficial for improving gait parameters in patients who had strokes. There were insufficient data to examine the effect of music therapy on other outcomes.
• consistent positive and significant results in music therapy methods in the rehabilitation of most gait parameters and for fine and gross motor functioning.
• One NMT method, RAS, is listed as one of 10 higher-level evidence-based motor therapies in a critical review of this area

Music therapy for Parkinson’s

• rhythm is the most crucial dimension for initiating movement (they often move too quickly or slowly)
• Dramatic results from Oliver Sacks “parkinsonism” patients
• Musical rhythm, by initiating a sequence of audible events, allows patients to time their movements without having to produce their own internally generated sequence plan.
• Playing music at a desired tempo allows patients to time their movements at this desired rate: rhythmic entrainment.
• RAS is an effective treatment for movement disorders associated with conditions
• benefits to motor function appear to depend on ongoing treatment.
• evidence is equivocal regarding the potential for music to change symptoms of neurodegenerative disease in the elderly.
• Most of the evidence is anecdotal, and many of the controlled studies have yielded inconclusive results

Music therapy with Parkinson’s cont.

• Thaut: showed music with a beat can help initiate and coordinate walking
• Rhythmic Auditory Stimulation (RAS): practice walking to music with steady beat; initially matched to patients gait and then gradually increased
• RAS vs. physical therapy; 2x advantage over PT on gait velocity and stride length, Study replicated in 2007