Music therapy : why it’s not in every hospital, but could be soon

Music therapy has been around for a while; it had its unofficial beginnings with Pythagoras, who proscribed music treatments for mental disorders⁶ and took root in the United States around 1950, with the return of World War II veterans in need of rehabilitation². Still, for many, “music therapy” might evoke nothing more than psychiatry sessions with occasional bouts of soothing Mozart sonata, and we have yet to see music therapists become an integral and habitual part of the healthcare system. The relative obscurity of music therapy flies in the face of its rather staggering breadth of applications, as well as some stunning success stories (for example, speech and gait recovery in Parkinson’s patients). Why this gap?

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Another hindrance to the widespread acknowledgement of music therapy’s utility is the difficulty of generalizing the successes obtained. Due to the wide variety of applications and often personal nature of the connection between a music therapist and their client, documentation of music therapy’s successes have historically tended to take the form of case studies rather than full-fledged clinical trials. Different subcategories of the therapy are more or less conducive to research quantification methods. To counter this lack of generalizable data, there is a modern push in the field to quantify and experimentally test music therapy outcomes using a model called the Rational-Scientific Mediating Model (R-SMM), which can help quantify music therapy’s efficacy for insurance and medical communities. Such activity could transform the reception of music therapy, making it a more integral part of patient care.

Tourette’s syndrome
The therapeutic aspects of music are hardly more visible than in the case of Tourette’s. One compelling case of this is Mat Giordano, who discovered at a young age that drumming controlled his involuntary movements and violent fits, allowing him a respite from them for a brief period after each drum session⁷. (See Matt in action on YouTube.)

Motivation 
Familiar music is a pleasant and motivating stimulus for humans as early as infancy. Premature infants often struggle with breathing and sucking motions crucial to their survival: a pacifier-activated lullaby system invented by a professor at Florida State University uses familiar music (that the child was exposed to in vitro) as a reinforcement to motivate breathe-suck-swallow behavior, improving infants’ reflexes and allowing them to leave the hospital much more quickly¹³. (For more information, visit : http://www.research.fsu.edu/pal/gallery.html)

Depression
Stress-reduction music listening has been found to effectively reduce symptoms of depression, distress, and anxiety, with results lasting beyond a 9 month follow up period⁵. This method was effective even when participants were left to self-administer the program with only weekly phone calls from a therapist, making this method a highly cost-effective one for reaching home-bound elderly populations struggling with mental illness. Similarly, a study of 24 depressed substance abusing adults and adolescents in Venezuela revealed that those treated with 3 months of group improvisation therapy had significantly lower depression ratings (according to the Hamilton Rating Scale for Depression) than before treatment¹.

Pain Perception
Similarly, music has been proven to be “anxioalgolytic”: that is, it can reduce pain intensity levels and opioid requirements, although the magnitude of this reduction is subject to debate¹⁰. Anxioalgolytic music causes negative stimuli to no longer be perceived, activates pain-inhibiting structures in the central nervous system, and reprograms dorsal root nerve cells. This effect can help improve the lives of those in acute or chronic pain.

Schizophrenia
Music therapy is typically used in schizophrenia cases where the patient is not responding to medication, or used in conjunction with medication treatment³. A month of either active or passive music therapy yields statistically significant reduction of schizophrenia’s symptoms, in particular improving negative symptoms such as anhedonia and asociality¹¹ as well as anergia, activation and depression³. These results have held true across cultures and different cultural musics. Overall, passive music therapy proved to be more effective than active.

Anxiety
Music relaxation programs help increase frustration tolerance and focus, and provide a diversion from a state of psychological or physical tension⁸. Research reveals that situation-dependent anxiety can be mitigated by even a single music therapy session¹⁵. In a similar vein, passive music listening has been linked to faster sleep onset and less night-time awakenings for those suffering from sleep disorders⁹.

Memory
Music also holds special currency in the domain of memory. Reminiscence therapy is used to help PTSD victims -for whom intrusive traumatic memories are a recurrent threat- reframe the act of remembering in a positive way. It is also used to trigger reminiscence with geriatric populations for whom memories can help affirm a positive sense of self. Music therapy is used internationally to enhance the care of elderly dementia patients. A meta-analysis of music therapy dementia cases revealed that the therapy’s primary effects on dementia are to reduce aggressive behavior, agitation, and anxiety, and to increase positive mood and sociability¹⁴. In addition, musical sensory orientation training, using live or recorded music, can stimulate arousal and the recovery of wake states in coma patients⁸. It can further maintain meaningful responsiveness, as well as orientation to time, place, and person.

Communication
Music therapy can be integrated with speech-language therapy services for children with communication difficulties. Music is conducive to greater amounts of repetition than normal speech, allowing practice of challenging speech elements. It also enhances communication because it can be practiced together with others, creating the potential for both learning through mimicking others and social validation¹². Music therapy can also be a communicative bridge for individuals with autism, such as Derek Paravicini, who is a blind, autistic musical savant, or Rex Clack, who learned to walk and eat without assistance thanks to musical rhythms⁸. Music therapy has been experimentally proven to improve auditory discrimination, information retention, attention, auditory processing, and affective perception in autistic children⁸.

References

(1) Albornoz, Yadira. “The Effects Of Group Improvisational Music Therapy On Depression In Adolescents And Adults With Substance Abuse: A Randomized Controlled Trial.” Nordic Journal Of Music Therapy 20.3 (2011): 208-224. Academic Search Premier. Web. 21 Apr. 2013.

(2) De L’Etoile, Shannon. “Processes of Music Therapy : Clinical and Scientific Rationales and Models.” The Oxford Handbook of Music Psychology. By Susan Hallam. Oxford [u.a.: Oxford Univ., 2012. 493-99.

(3) De Sousa, Avinash, and Jaya De Sousa. “Music Therapy in Chronic Schizophrenia.” Journal of Pakistan Psychiatric Society 7.1 (2010): 13-17.

(4) Grocke, Denise (2003) Thoughts on the Global Community of Music Therapy. Voices: A World Forum for Music Therapy. Retrieved April 16, 2013.

(5) Hanser, Suzanne B., and Larry W. Thompson. “Effects of a Music Therapy Strategy on Depressed Older Adults.” The Journal of Gerontology 49.6 (1994): 265-369. Oxford Journals. Oxford University Press, 2013. Web. 19 Apr. 2013.

(6) “History of Music Therapy.” American Music Therapy Association. American Music Therapy Association, 2013. Web. 23 Apr. 2013.

(7) Howland, Kathleen and Cariani, Peter. “Music Therapy.” Mind, Brain, Behavior 91z: Music, Mind, Brain. William James Hall, Cambridge. 1 Apr. 2013. Lecture.

(8) Hurt-Thaut, Corene. “Clinical Practice in Music Therapy.” The Oxford Handbook of Music Psychology. Oxford [u.a.: Oxford Univ., 2012. 503.

(9) Johnson, Julie E. “The Use of Music to Promote Sleep in Older Women.” Journal of Community Health Nursing 20.1 (2003): 27-35. Print.

(10) Leins, Spintge, et al. “Music Therapy in Medical and Neurological Rehabilitation Settings.” The Oxford Handbook of Music Psychology. Oxford u.a.: Oxford Univ., 2012. 503.

(11) Mohammadi, Ali Z., Lakwinder S. Minhas, Mahmood Haidari, and Ereshteh M. Panah. “A Study of the Effects of Music Therapy on Negative and Positive Symptoms in Schizophrenic Patients.” The University of Göttingen. German Journal of Psychiatry, n.d. Web. 19 Apr. 2013.

(12) Porter, Jessica et al. “Integrating Music Therapy Services And Speech-Language Therapy Services For Children With Severe Communication Impairments: A Co-Treatment Model.” Journal Of Instructional Psychology 35.4 (2008): 311-316. Academic Search Premier. Web. 19 Apr. 2013.

(13) Standley, J.M. (2000). “The effect of contingent music to increase non-nutritive sucking of premature infants.” Pediatric Nursing, 26(5), 493-495, 498-499.

(14) Wall, Michelle, and Anita Duffy. “The Effects Of Music Therapy For Older People With Dementia.” British Journal Of Nursing 19.2 (2010): 108-113. Academic Search Premier. Web. 19 Apr. 2013.

(15) Chlan, L. “Effectiveness of a Music Therapy Intervention on Relaxation and Anxiety for Patients Receiving Ventilatory Assistance1.” Heart & Lung: The Journal of Acute and Critical Care 27.3 (1998): 169-76. Print.

Images for depression, pain perception, schizophrenia, anxiety, memory and communication are from Wikimedia Commons.