Musical Psychotherapy: History, Effects, and Applications

Musical Psychotherapy: History, Effects, and Applications Samah El Saadi Abstract We all enjoy music as a form of art but we rarely take into consideration the effect of the music that we listen to. Music therapy is using music in a therapeutic manner in order to recover or stabilize a mental, physical or psychological state. This review will introduce music therapy and trace its origins back in history, and then it will give an insight on music related neurosciences explaining what parts of the brain and neurotransmitters are involved. Music can affect us on many different levels; however, this review will focus on the ability of music to aid in psychotherapy. It is important to highlight that the potential power within music can be either constructive or destructive depending on the choice of music. Musical Psychotherapy What is music therapy and what are the origins? Everyone sees music as a form of art that they enjoy playing or dancing on its rhythms as they tend to develop a preference to certain type of rhythms. However, seldom do people think of the impact of music on their health although through their experiences with music they would know that their favorite type of music can make them feel relaxed, happy or even anxious. But have you ever considered music as a form of therapy? Research showed that music does have an effect on our health and it can be either positive or negative depending on the music, yet these effects are mediated through psychology and neurosciences (News in Health [NIH], 2010). Music therapy is applying music as a tool in order to improve, stabilize or restore an emotional, mental, or physical health. It is conducted by accredited music therapists who are able to skillfully use music and music elements in assessing patients, developing treatment plans, evaluating progresses and contribute in research (Music Therapy Association [MTAO], 2010). Music therapists plan music sessions for individuals or groups and may use active or passive approaches in the therapy depending on the patients’ need. The therapy may include listening to music, making music, talking about the lyrics or even writing songs, but definitely it is not restricted to people with musical abilities. Since music is accessible everywhere, music therapy is not limited to a place and sessions can be arranged at homes, hospitals, hospices, care centers or any calm place people may prefer (American Cancer Society [ACS], 2008). The nonverbal emotional entity of music makes it a universal langu age that can ease the self-expression, personal development and social interactions which would aid in psychotherapy. Music can always have a positive impact on people whether they are ill, disabled or perfectly healthy (MTAO, 2010). The principle of therapeutic use of music is not new, ancient cultures were aware of music power which for some was part of their traditional healing practices such as the case of Native Americans (ACS, 2008). The musical power of healing was marked in different ethnic ancient inscriptions like that of Rome, India, China and Egypt (Music as Medicine, 2014), as it was mentioned in the writings of Greek philosophers such as Aristotle, Pythagoras and Plato (ACS, 2008). However the modern music therapy dates back to World War II when music was used to help in the treatment of soldiers who were suffering from shell shock, and it was in 1944 when Michigan State University initiated the first degree program in music therapy (ACS, 2008). Music related neurosciences For many years research was ongoing to understand the means of action of music and why it does have this strong impact on our lives. Since the impact is mediated neurologically, scientists intensively investigated the brain regions and with the help of the emerging imaging techniques such as functional magnetic resonance imaging (fMRI) they noticed that it activates unexpected regions involved in emotions and memory, in addition to the brain’s motor regions that are responsible for coordinating physical movements. The neuroscientist Dr. Petr Janata in his recent studies proved that the area of the brain serving as a central hub between music, emotions and memories is the medial prefrontal cortex. In an attempt to understand the medial prefrontal cortex activity, young adults were subjected to extracts of childhood songs while being monitored with fMRI and it was noticed that the activity was optimal when they heard a familiar song that call to mind an emotion or memory (NIH, 2 010). Dr. Janata stated that in Alzheimer patients the medial prefrontal cortex is one of the last brain regions to deteriorate, hence this explains why patients with Alzheimer may recall childhood tunes whereas other memories are lost. In further investigation on the medial prefrontal cortex activity, Dr. Allen Braun and Dr. Charles Limb monitored via magnetic resonance imaging (MRI) scanner the medial prefrontal cortex in a jazz musician as he played his music. The doctors noticed that the region was not active when the musician played a memorized tune; however, it became active when the musician was improvising concluding that the medial prefrontal cortex also has a role in the creative expression of music (NIH, 2010). Going deeper into the music impact on the neurological level, an experiment was done to check the neurotransmitters involved and the time of their release. Via the ligand-based positron emission tomography (PET) scientists discovered that music triggers dopamine release in both the dorsal and ventral striatum. Nevertheless, this discovery was not surprising since dopamine is known to be responsible for the pleasure sensation whether due to sex, drugs or just music. But the more interesting discovery was the monitoring of the increase in dopaminergic voxels in the right nucleus accumbens (NAcc) preceding a favorite part and peaking when the favorite part was reached. The phase of increased dopaminergic voxels prior to the favorite part was termed Anticipatory phase, as depicted in the figure 1, and it prepares us for the subsequent musical part that we love and will cause the dopamine peek giving us the pleasure sensation (Salimpoor et al, 2011). To have a better understanding, scientists took a closer look on the music itself. Early theories about music argued that we get affected by music through the connotative meanings and mental images that it reflects; however, according to the musicologist Leonard Meyer it is the ambiguity and not knowing what the next note will be is what keeps us waiting in excitement. Repetitive expected patterns in music is boring and can be annoying like an alarm clock, hence it is the unpredictable patterns that give us the chills. Meyer stated that the uncertainty is what triggers the release of dopamine as we try to figure out what the next note is. We may be able to predict some of the notes but not all of them and that is what cause our brains to plead for those notes that will unleash the uncertainty and completes the pattern, yet these notes are usually spared till the end to keep us listening (WIRED, 2011). Music therapy in clinical trials Now that we had an insight on the neuroscience that relies behind the effects of music, we should note that music has effects on both physical level and psychological level. Some of the physical effects are enhancing immunity, decreasing anxiety, and altering the blood pressure and heart rate (NIH, 2010), whereas at the psychological level music has the power to alter our mood and aid in psychotherapy. In this review we will be focusing on the psychological effects and its role in psychotherapy. Several clinical trials have been conducted in order to ensure the effectiveness of music therapy. In a clinical trial 46 patients diagnosed with depression were randomly separated into two groups. Group 1 was subjected to the standard care that includes antidepressant medication, psychotherapy and psychiatric counseling, whereas group 2 underwent 60 min music therapy sessions in addition to the standard care. The patients were assessed after 3 months and results showed that people who received music-therapy had less depressive symptoms from those who didn’t. Professor Christian Gold, one of the two study leaders, said: Music therapy has specific qualities that allow people to express themselves and interact in a non-verbal way even in situations when they cannot find the words to describe their inner experiences.† (Erkkilà ¤ et al, 2011). Another similar clinical trial that was done on 79 patients with low- and medium-grade depression revealed results that reinforces the ones that were retrieved by the first clinical trial mentioned here (Castillo-Perez et al, 2010). In a clinical trial on 80 schizophrenic patients, 42 patient where assigned to do music therapy for 60 minutes twice a week while 38 other patients were assigned to undergo standard care. After 3-month follow-up the results indicated improvement in the depression status and psychiatric symptoms of the patients (Lu et al, 2013). It is important to note that there is dose-effect relationship in music therapy by which more recurrent sessions would result in more considerable improvements (Gold et al, 2009). Can music be destructive? The power of music is just like any other power that can be either constructive or destructive depending on the usage. Nice music can lift you up and motivate you, but on the contrary sad or violent music can be destructive. In a study published in 2003 by the American Psychological Association (APA), researchers from Iowa State University examined the effect of violent lyrics by which they made students listen to seven violent songs and 8 nonviolent songs being sung by the same artist and using the same musical style in order to control the other factors, and then they were assessed for their aggressive thoughts and feelings through psychological tasks. The results showed an increase in the aggressive interpretations where Dr. Anderson, a lead researcher, stated that violent and aggressive music makes people biased toward aggressive interpretations, and this form of interpretations will eventually manifest in aggressive verbal and physical expressions and antisocialism (APA, 2003). What complicate things more is the fact that classification of music as beneficial or destructive can be subjective. In an investigative study 80 people were played the same songs but prior that some of them were told that the music is suicide-inducing and others were told the music is life-affirming. The study shows that depending on the prior labeling of the music the same songs were perceived by listeners as either suicide-inducing or life-affirming, thus it is the censorship and prior labeling that might give songs their harmful effects on listeners (North Hargreaves, 2005). As some people argued by saying that negative music gives them sensation of relief due to knowing that someone else felt in a particular way but was able to recover and be creative enough to express their emotions in such a way, hence for them it is perceived as a form of hope if they were in a similar situation (Baker Brown, 2014). Music therapy today and its other potential powers Nowadays degrees in music therapy are becoming more available worldwide as people are becoming more aware of the therapeutic role of music whether it is physical, mental or psychological. There are a lot more potential powers in music yet to be discovered such as its role when played in businesses and retails stores and how it can affect the customers’ behavior (Yalch, 1993), its effect on fetuses by which some claim that the choice of music of the pregnant women will affect their children later on (Kisilevsky et al, 2004), and how effectively does music help hospitalized patients in recoveries and in lessening their pain (ACS, 2008). Music is an entertaining form of art that is easily accessible to everyone and flexible enough to satisfy different tastes; these characteristics makes music a potential power that if people knew how to utilize it correctly, they would be seeking a better state of a harmonic life. 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