Music Therapy: A Medical Application of Music
Listening to music has become an integral part in society. Whether someone is walking along the street, driving around, or even sitting in a room, chances are that they are listening to music. Music has inexplicable capabilities. It is a gateway, having the ability to transport the listener to different worlds. It has the ability to make a room full of exhausted wedding goers get up and dance. It has the ability to make someone smile on a mundane car ride home from a horrible day at work. It has the ability to make someone’s body tingle after listening to an awe-inspiring symphony. It even has the ability to make someone’s face whither in disgust if the dissonance is just right.
Music makes someone feel these emotions due to the chemicals the brain releases when we listen to it. It releases dopamine, which is the ‘feel good’ chemical. Dopamine increases pleasure receptors, and it is triggered as a reward for meeting a desire of our body. It can be triggered by activities such as sleeping or eating. The brain also releases endorphins. This gives a person a sense of euphoria through a happy state of mind. Endorphins are also a natural pain reliever, which can show that listening to music has physical ‘feel-good’ capabilities. Immunoglobulin A is released when listening to music. This antibiotic cell searches for and attacks viruses and other threatening agents in the body. An increased number of antibodies strengthens the immune system. Cortisol, a stress hormone, is also drastically lowered in presence while listening to relaxing music. The absence of a high amount of cortisol helps ease anxiety and stress. Music can also change the physical response of the body, relaxing muscles and lowering blood pressure and heart rate when listening to relaxing rhythms, and increasing heart rate when listening to music with a faster tempo.
Music therapists work to manipulate these attributes in order to heal a person who is struggling emotionally, mentally, psychologically, or even physically. Music therapy is the use of music to achieve non-musical goals. They work with all domains of human functioning: cognitive, communication, psychosocial, musical, physical, emotional, spiritual, and many more. They work in all settings from NICU (newborn intensive care unit) to hospice, including schools, hospitals, psychiatric facilities, substance use and abuse facilities, and physical rehabilitation centers by using various aspects of music to elicit change. This form of therapy has been around for a while, with the earliest application being associated with early Native Americans where they used music to communicate with their gods and nature as well as a healing tool and a form of socialization within their community. It was fairly common for a community to come together in order to chant, dance, and pray for ill members of the community. The concept of music therapy itself has been around since the writing of Aristotle and Plato.
Music therapy has been on the rise in popularity, and has been since the treatment was recognized as an accredited form of treatment after World War II. When nurses and doctors at the time saw how patients responded to music as a method to cope with physical and emotional trauma caused from their time serving the country, people were able to witness the power of music as a healing tool. At this time, there was a push to establish an educational program for people to professionally practice music in a medical setting, thus birthing music therapy in the West.
Music therapy plays a role in helping patients recover after suffering from traumatic brain injuries. Traumatic brain injuries are seen as a silent epidemic, forcing the person who is suffering from the injury into a coma. Comatose clients can be classified in eight different levels, according to the Rancho Los Amigos scale of cognitive functioning levels. At level II, the patient reacts inconsistently and non-purposefully to stimuli in a nonorganized manner. Responses to these stimuli may be as subtle as an eye twitch, slight head movement, or internal muscle movements. Responses are limited, but they are often the same. When a rhythmic phrase or tone is played for a level II patient, these responses may be recorded to ensure that the patient is still alive and aware of the outside world. At levels III-VI, the patient is still responsive and movement is increased. They usually display confused behavior and are often unable to make coherent conclusions about their memory or their environment. Music therapy can augment the patient’s awareness about their environment.
The music therapist may play and sing songs for the patient in order to help them gain a better understanding of their surroundings. These songs are often improvised, as they are simple vocalizations about everyday objects and various other topics an aware person may see as common sense. Patients who fall in this range may also benefit from group music therapy sessions from a group of close friends and family. For example, when live music is played for a patient and the support group, clients count or sing along and often match the energy emitted by the group. Range of motion is often dramatically increased as well since the patient is moving their body in rhythm to the music. Cognitive and speech production efforts are largely improved when paired with tonal and rhythmic stimuli, as seen in speech therapy. Speech therapy in conjunction with music therapy often yields better results since the patient is singing along with lyrics and provides some rhythmic foundation. As a result, music therapy patients who fall in this range demonstrate improved language reception since they are using and stimulating their left hemisphere more effectively than if they were simply trying to talk and construct a sentence.
Let’s apply this concept to someone who has received a traumatic brain injury and seen a significant recovery through music therapy. In early 2011, Arizona Congresswoman Gabby Giffords was shot in the head, with the bullet passing directly through her brain. 6 Her injury made her suffer from aphasia, the inability to speak due to damage to language pathways in the brain’s left hemisphere. Professionals had to work to restore her speech by essentially helping the brain pave new pathways around damaged areas to get to its destination. Language is held largely in the left side of the brain, while music activates visual, motor, and coordination areas on both sides of the brain as well as regions farther into the brain involved with memory and emotion. By having music therapist Meaghan Morrow sing little ditties like “Happy Birthday” and Giffords’ favorite song “Brown Eyed Girl”, she was able to slowly pave the road back to language. Her brain was able to use existing neural pathways to work around the damaged area in order to overcome the language barrier. 3 This is similar to how a person age 50 or 60 would learn how to play the piano. It’s much easier to do so at a younger age, since the neural connections have yet to be established. At an older age, the brain must retrain itself to perform tasks and engrave it in muscle memory. Thanks to music therapy, Giffords was able to relearn how to talk.
Music therapy also plays a role towards the end of a person’s life while they’re in hospice care. Music therapy sessions can help a person maintain a relatively high amount of energy and can help them reflect and reminisce upon their life through music, thus facilitating pain control and bringing closure to their soul. Music therapy within hospices can vary in form. In one case study, two patients had weekly music therapy sessions where they partook in guided imagery with music. The process of guided imagery with music involves relaxation exercises, verbal suggestion of scenes or settings, and imaginative thought as music is being played in the background. Structured musical procedures such as this involve active listening, concentration, and relaxation exercises that can be helpful to hospice patients. For those who have lost a lot of their physical abilities, guided imagery allows the patient to gain a sense of control in their life, allowing the patient to explore and be creative with their thoughts, images, and feelings.
One patient in this case study suffered from bladder cancer with a significant amount of pain in her right leg. She was depressed, resided in a nursing home where she was alone a large portion of the time, and she had no immediate family to take care of her. In a majority of her music therapy sessions, she was asked to imagine her favorite place. She often described her home and went into detail about how wonderful the room furnishings are, elaborating about how she would change the space to make it more beautiful. She would then be haunted by an image of her cancer. She would describe it as a large, red, twisted, ball-shaped mass. However, as the weekly sessions went on, she later imagined Pac-Man™ attacking her cancer, resulting in the image of her cancer to be a small, golfball sized blue, red, and yellow ball. Once she would imagine this, her pain was reduced, but only immediately after the session. As the weeks went on, she had increased pain and discomfort in her leg. In one session, she was asked to describe what was wrong with her leg, explaining that she imagined a blocked vein. She was then instructed to imagine the vein being cleansed, and her leg felt more comfortable afterward as well as the subsequent weeks. In these sessions, she would often reminisce in various events, something as simple as a picnic or a trip to a restaurant with one of her beloved friends.
Another patient described in the case study suffered from a metastasized back and neck as well as shooting pain in those areas. He resided in his house, and was often surrounded by his family. He described his favorite place to be outdoor places near water, or simply outdoor places in general. Many of the places he imagined were very similar recreations of places he had visited throughout his life. Each place involved warmth from the sun, the smell of the fresh outdoors, and vivid colors from flowers. He often fell asleep during his sessions since he was so relaxed, despite having difficulty sleeping at night and napping during the day.
By looking at patterns and similarities between these two patients, it was observed that relaxing helped ease their physical pain and discomfort. Guided imagery gave them the opportunity to explore their environment, be creative, control aspects of their life where they are no longer in control, reminisce, and feel safe and loved. These were things that they could not accomplish prior to partaking in these music therapy sessions. It provided them an outlet to where they can regain control of their life and feel happier about the life they lived even as their terminal illnesses eat away at their being.
Another technique used in hospice care settings is called music therapy entrainment, and it is used for pain management. Music therapists do this by assessing and treating a client’s perception of pain. Music therapy entrainment is founded on three principles: the ISO-Principle, the Concept of Resonance Vibration, and the Entrainment Principle. The ISO-principle states that a client’s mood can be altered by progressively changing the music. If a client is experiencing some sort of pain, the music therapist can then provide music that matches the client’s pain. The concept of resonance vibration can be described as a sympathetic vibration, which encompasses an idea that two objects can cause vibration in each other. The entrainment principle is a ‘pull’ exerting from one vibrating object to another vibrating object. In the environment of a music therapy session, the therapist can pull the client into another experience, away from the pain.
Music therapy entrainment has five stages: assessment, goal formation, creating auditory images, externalizing of pain and therapeutic resonance, and ISO-continued application and evaluation. When undergoing music therapy entrainment, the therapist establishes a connection with the client, getting a sense of their background, chronic illness, and their pain levels. They then discuss goals for pain management, what they want out of the therapy sessions, and expectations. The client is then asked to create auditory representations of their pain in order to give the therapist an accurate rating about the patient’s pain, and they continue to discuss healing methods. Going into the externalization of pain and therapeutic resonance, the therapist has the client listen to transitions between pain music and healing music. Pain music is characterized by loud and chaotic music, where the rhythms are fast and the tempo is frantic. When it transitions to healing music (the client indicates when they want the transition to happen, and the therapist adjusts to them), rhythms are slowed and the overall tone of the music becomes more relaxing. The effectiveness of this relates to the ISO-principle. The music being played can directly affect the mood of the person who is listening to it. The last stage of music therapy entrainment is simply a reflection regarding the efficacy of the treatment.
To put this idea into practice, a patient named Patricia was assessed and underwent music therapy entrainment. She was a 93-year-old woman suffering from debility and dementia. She would often have dull and sharp pains in her shoulders and head, rating the pain as an eight on a scale of one to ten. When asked to describe the pain she was feeling on a drum, she played quarter notes at 77 bpm. When her therapist would start playing the pain music, Patricia signaled for a transition approximately 30 seconds into the session. Once the therapist played the healing music, Patricia was noticeably more relaxed, and was reported to have fallen asleep while listening to the music. She was then asked to report the level of her pain, and she stated it was at a four out of ten, essentially cutting the amount of pain she had in half. Her pain rating during all the subsequent sessions would start out at a five or six, and would go down to a four towards the end of the session. Listening to the healing music made Patricia more relaxed and less anxious.
Through this form of music therapy, therapists and clients build a stronger connection through empathy and trust. A lot of the time, music therapy helps with the patient coping with their dying process and accepting an inevitable death. The transition between pain music and healing music is associated with life and death, where the transition between the two is the period of stillness and peace as the soul transcends out of the body. This way, patients come to accept their fate.
Overall, music therapy is a very powerful tool that can help recovery and rehabilitation processes as well as pain and death coping mechanisms alike. Music therapy is not simply a guy sitting in a room playing short tunes for a room full of elderly people. Music therapy is not a piano player fiddling with a piano in the lobby of a hospital. Music therapy is much more than that. It is establishing a connection based on musical interventions in order to accomplish physical, emotional, cognitive, and social needs of an individual. 1 Music therapy uses an incredibly strong and inexplicable phenomenon help people achieve the impossible.