Music therapy

DEFINITION: The clinical and evidence-based use of music, including playing instruments and singing, in therapeutic practice.

PRINCIPAL PROPOSED USES: Aggressive behavior in children, autism, dementia, frontal lobe syndromes, language disabilities, movement disorders, stress, Tourette’s syndrome

OTHER PROPOSED USES: Depression following brain surgery, post-traumatic stress disorder, stroke

Overview

The usefulness of music in medical settings has been recognized for more than two hundred years. It was initially used to distract patients from the monotony of a hospital stay, but the medical utility of music therapy is now being investigated as knowledge of the human brain increases. The American Music Therapy Association oversees professionals in the field of music therapy. In the United States, music-therapy education programs include multiple areas of study, clinical internships, and a national board certification examination.

Music therapy is frequently used in the treatment of persons with language deficits and in those persons recovering from strokes or traumatic brain injuries. Studies of healthy volunteers have identified the area of the brain that responds to and processes music; it is located within the right hemisphere. Other structures involved in experiencing music include the frontal lobe, limbic system, and imagery-related cortical regions of the temporal, parietal, and occipital lobes. The frontal lobe and the limbic system are also important structures in the formation of emotions, so the use of music may help persons with neurological conditions express themselves through means other than language.

As is well known, the left hemisphere of the brain controls language functions. Experts believe that melodic intonation therapy (MIT), which combines music with singing, may help children with autism develop language skills. (Many children with autism spectrum disorders have musical ability, so association of music with language may assist in the advancement of their language skills.) In the practice of MIT, the music component is removed after speech begins or improves; it is hoped that the child continues to develop. It is difficult, however, to determine if the development of language skills comes from music therapy or from the maturation of the child. Using the same MIT techniques, persons recovering from strokes or traumatic brain injuries who have suffered left-hemisphere damage may relearn speech using the right hemisphere of the brain. Although MIT was developed in 1973, the empirical evidence for using MIT for aphasia and apraxia of speech remains limited, as the studies conducted reported positive outcomes but suffered design flaws. At the same time, some studies aimed to determine whether modified forms of MIT, which could include additional techniques such as phonetic placement and tapping, could prove beneficial, particularly in use for aphasia.

Music therapy is also used with physical rehabilitation therapy and to alleviate symptoms similar to those of Parkinson’s disease. During physical therapy, the rhythm of the music helps the person anticipate his or her next movement and move in a more smooth and natural manner. Persons with neurologic disorders suffering from shaking or spasms may be able to regain some control over their movements, using rhythm to help them focus on regulating their movements.

Music therapy is often used as a pain management tool and in complex medical procedures in which the person must remain conscious. Music may alleviate mild to moderate pain through distraction, but it has not been effective for more painful procedures. It is unclear what, if any, effect music has on pain-detecting mechanisms in the brain. Alternative theories suggest that music therapy simply provides a distraction for a person with painful physical symptoms.

In 2014, a documentary titled Alive Inside premiered at the Sundance Film Festival, earning the event's Audience Award. The film highlights the increased interest in music therapy as a treatment tool for a wide range of physical and psychological issues, as it presents various cases in which individuals have benefited from the experience of listening to music. In addition to these cases, the documentary also includes interviews from experts such as neurologist Oliver Sacks, who dedicated part of his career to studying the effects of music on the brain. The American Music Therapy Association (AMTA) notes, however, that the music listening program featured in the documentary fails to meet criteria for clinical intervention.

Mechanism of Action

Although the exact mechanism of action of music therapy on the brain has yet to be elucidated, it is believed to affect areas of the brain controlling the autonomous nervous system. Music may help regulate the endocrine system and the autonomic nervous system. There is evidence that music affects areas of the temporal lobe of the brain associated with seizures because persons with epilepsy have occasionally had seizures induced by music or have had audio hallucinations preceding a seizure.

Uses and Applications

In active music therapy, the therapist and patient participate in playing music, such as using instruments or singing. In passive music therapy, music is played while the patient is in a relaxed state. There are five types of music therapy that may be used alone or in combination: receptive (listening to music to draw out an emotional response); compositional (the patient writes an original musical composition); improvisational (the music therapist and the patient spontaneously create music); re-creative (the patient learns to play an instrument); and activity (the patient and the therapist play musical games).

According to the AMTA, music therapy has been used to treat developmental disabilities, autism spectrum disorders, stroke, dementia and age-related conditions, psychiatric problems such as depression, substance abuse disorders, neurologic problems, and pain. It is also employed in neonatal intensive care, rehabilitation, and hospice.

The psychological benefits of music were particularly discussed and highlighted during the outbreak of a novel coronavirus causing the disease COVID-19 that began in late 2019 and was declared a worldwide pandemic by March 2020. Though people in communities throughout the world suffered effects of depression and anxiety as they were compelled to isolate themselves in an effort to slow the spread of the disease, many reported that engaging with music helped to lift their spirits. While some were able to take part in virtual music therapy sessions offered through platforms such as Instagram and Zoom, others were able to listen to or take part in musical performances conducted on balconies. Often touted during the crisis as a potential coping tool, music was seen not only as a means of emotional release but also as a way for people to remain connected during a difficult time. Music therapy continued to be employed at increased levels in the years following the pandemic, as rates of depression and anxiety remained high. Additionally, some therapists found success using music to help children in homeless shelters—the numbers of which also increased during and after the pandemic. For instance, the Brooklyn Conservatory of Music's music therapy program helps thousands of homeless youth in New York City heal from trauma and mental illness each year.

Scientific Evidence

The benefits of music therapy are difficult to quantify because each patient’s treatment is customized based on the type and severity of disability or injury. No studies have compared the results of music therapy with other types of therapy, but there is a growing body of evidence in the form of controlled clinical studies seeming to support the effectiveness of music therapy.

In a study of forty-eight children with violent or aggressive behavior, twenty-four participated in a music intervention program and twenty-four did not take part in any therapy. The music intervention therapy comprised two music classes each week for fifteen weeks and was conducted by a certified music therapist in a group setting. At the end of the study, children who participated in the music therapy sessions demonstrated statistically significant improvements in aggressive behavior and self-esteem, as measured by questionnaires completed by parents and teachers.

Another study evaluated eighty-seven elderly, institutionalized persons with cerebrovascular disease; fifty-five persons received music therapy for forty-five minutes each week for a minimum of ten weeks, and twenty-two persons received no therapy. At the conclusion of the study, persons in the music-therapy group demonstrated statistically significant decreases in acute chronic heart failure and in plasma levels of cytokines, adrenaline, and noradrenaline. These results suggest that music therapy may be a useful tool in preventing heart failure in persons with cerebrovascular disease.

Several studies have investigated music therapy's effects in cancer treatment, with mixed results. A study of patients in hospice care suggested that pain control, the ability to relax, and overall comfort increased in those receiving music therapy compared to those that did not, although no increase in survival rate was identified. Clinical trials have also found music can reduce factors such as depression, high blood pressure, insomnia, and heart rate associated with cancer. However, a 2013 survey of previous investigations of music's impact on cancer patients' levels of anxiety found that music therapy had no definite benefit.

Researchers have attempted to better understand music therapy's psychological as well as physiological effects. A study published in the journal Music Therapy Perspectives in 2014 examined the efficacy of group-based music therapy on men's psychological wellbeing. Using a system of outcome rating scales (ORS), the study found that such interventions were significantly effective at increasing wellbeing even among those who did not have a prior interest or ability in music.

A 2020 meta-analysis study showed that music therapy was associated with a reduction in depressive symptoms. Specifically, the study revealed that guided imagery and music and recreative music therapy proved the most effective in reducing depressive symptoms.

Choosing a Practitioner

Music therapists usually practice in conjunction with a medical or rehabilitation team. Music therapists in private practice receive clients through recommendations from either medical doctors or psychologists/psychiatrists. In the United States, the Certification Board for Music Therapists provides national examinations to certify music therapists; choosing a certified practitioner ensures that they have met educational and training standards and can be expected to provide better therapy.

Safety Issues

No adverse events have been reported in cases using music therapy. However, attempting therapy without training or incorrectly may prove ineffective, and could potentially even increase a patient's stress level or emotional discomfort. Additionally, if a patient with a serious medical condition attempts to rely on music therapy alone, they risk complicating or worsening their condition through lack of proper treatment.

Bibliography

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