Chapter Ten

Music and Health; Applications in Music Therapy

Music has been observed to have had a positive effect on health for many years(169), and recent studies show much evidence, and that we have seen confirms that music more frequently elicits positive emotions in us than negative ones(170), and also has many physiological and psychological implications for us, which we can use to our advantage.This leads us to the belief that music can be used for promoting health, and the very fact that we have these emotional, physical and aesthetic responses to music is the basis for the application of music therapy. The research which I discussed earlier of how our brains and bodies process music has brought us closer to an increased understanding of the benefits we can yield from music due to our evolutionary receptiveness to certain musical traits(171). Music can lead to improvements and be advantageous for stress, pain, physical and mental illness, child development, learning, speech disorders, and with patients with dementia or stroke. Evidence of connections between the mind and body has contributed to a strong basis for this understanding(172).

Music therapy is thereby an effective tool through which behaviour processes can be developed, and through clinical techniques an individual can gain and expand their capacity to communicate verbally and non- verbally and therefore have a greater connection and understanding of others, by music enhancing their capability to organise their emotional experiences(173). This is an important point, as the capacity of a person to be able to understand the emotional communications of others, identify their own internal emotional experiences and be able to in turn express this to others is one of the largest suggestive factors of healthy functioning and social integration(174). 

Additionally, there are elements aside from, but strongly involved with music- making which are also highly beneficial, such as the effects of interacting with a group, as music is rarely made alone, and also the therapeutic relationship between the music therapist and individual; the only therapeutic benefit is not solely from the music itself(175). 

All of this being established, how exactly does the use of music in health and music therapy draw upon musical, physiological and emotional understandings to bring about a beneficial result for an individual? What exactly is music therapy, and how effective is it?

Music therapy has been defined as a “clinical and evidence- based use of music interventions to accomplish individualised goals within a therapeutic relationship(176)”. Therefore, the therapist helps the client and promotes their health through the use of music and therapeutic relationships with the therapist and others, and this is the driving force for positive change(177). Emotions and memories are accessed, and behaviour and approaches to social behaviour are challenged to work towards achieving personal goals.

There are many different methods of delivering music therapy, and these can be both “active” and “receptive”, where the client is either included and part of the music- making, or they are receiving the music through listening. However, through either method, the processing of emotions and experiences is encouraged, and often a clinical aim. “Active” approaches to music therapy often include: improvising, performing, and composing. During improvisation, the client could make up the music vocally, with instruments or body parts, performing happens when a client learns music to recreate in the session, and composing takes place in the session to help the individual express themselves. Listening however takes place when either the client or therapist chooses music to listen to, which is in line with encouraging the therapeutic goals to be promoted(178). 

Although there are many associations which can be made between certain chords, musical structures or embellishments within music and our emotions, music cannot be applied in such a “pharmaceutical model(179)” way for everyone. This bestowing of power to musical features to bring about a desired response in a listener, is however not a formula which can be replicated for each individual. In focusing directly on a cause and effect and assuming it will occur without doubt every time, and regardless of context, is in itself reductionist and eludes addressing individual factors which could yield some command of the individuals’ response to the music therapist. "Musical selections that are relaxing and meditative to one client can be disruptive and annoying to another(180)". Only a broad and extensive understanding of the interconnected mechanisms and functions and environmental factors which are involved in eliciting emotion will allow music to be used to stimulate the required response, as this will be different for every person at different times. 

The importance for taking into account a person’s personal taste and liking for a particular style of music when considering effects on therapeutic levels has been demonstrated by Gerdner. She conducted a study considering elderly people with dementia, and the effects on peacefulness of listening to standard relaxation music, in comparison to music the person was known to prefer. Results here clearly showed that whilst both types of music showed effectiveness on reducing anxiety- driven behaviour and increasing relaxation, the music choices based on personal preference drew the most significant results(181).

Emotion seems to be involved in all music therapy, and is the core to effective practice(182). Just as people have emotions, music therapy always handles emotion in some way. 

Where emotion has been seen to play an integral part in music therapy, this can be shown in a study conducted by Bunt. They used an improvisational method with two groups of people, the first was a group of children who had trouble in expressing language, and the second a group of adults with difficulties with their mental health. Findings showed that for the children, who were given percussion instruments, they were so overjoyed and excited by playing the instruments that vocal sounds and gestures as methods of communication increased, and therefore these vocal expressions permitted the children to gain more self confidence in expression, and this confidence generalised to their experiences and communication outside of the therapy session, and their verbal communication grew. Similarly with the adult group, through communication by improvising, they were able to gain more self- awareness in relation to others, and relate to one another more efficiently which also extended to outside of the therapy session. This point echos back to Mill and Panksepp and Bernatzky and demonstrates how these theories work in practice, as as we have seen, having a sense of self- identity through emotional awareness increases our ability to connect with others(183). 

Childhood is an important time during our emotional and personal development, where many of our understandings and behaviours in how we interpret and respond to people and circumstances are formed, and many fundamental aspects of our personal identity are established. In studies in music therapy which consider children and which look to investigate emotional development during childhood, it is interesting to discover at what age and developmental stage our understanding of emotion and through this of ourselves and others is formed. Terwogt and Grinsven illustrated using classical music that young children under four years old are attuned to basic emotions, and can recognise these when listening to a piece(184). Children four years and above then become better able to also be expressive of these emotions(185). Development from four years allows children to become more able to discriminate between a larger diversity of more complex and mixed positive and negative emotions(186). 

How we learn to recognise emotions and to harness this internal environment to have appropriate, constructive and healthy responses and behaviours is important, as this has strong implications for us later in life when it comes to stress. Learning positive coping mechanisms in childhood is beneficial for us as we go through our lives, as we will have better learnt to manage stress, and reduce the impact this has on us mentally and physically. However, where stress does occur, studies have been conducted to show how music can reduce this, and how effective music therapy is. 

There have been many studies investigating the relationship between music and stress. Studies show cortisol levels are reduced after an individual feels, had an experience which placed them in a positive mood(187). Other research shows music is capable of being this positive experience which can be responsible for a reduction in cortisol and therefore stress levels prior, during, and post- operative procedures for patients(188). Interestingly, we see much evidence for fast tempo music increasing the heart rate and other arousal mechanisms within us physiologically, however, McCaffery found that both music of fast and slow tempos are similarly effective in reducing stress, however, the fast tempo music must be of a personal preference to the individual, which suggests the tempo isn’t the factor being adhered to in this instance, but other effects are taking place more strongly(190). 

Krout also finds this to be the case, and states that in a therapy setting, music of personal preference to an individual strongly positively influences stress reduction, and therefore it is very important to consider preference when working with an individual. Additionally, where someone feels they have autonomy over a given situation is also a strong reductor of stress(192). If an individual feels they have free choice over the music they can choose to listen to, cortisol levels are reduced, and they feel more at ease(193,194,195).

Following, when a person listens to music they choose and enjoy hearing, it has been found that levels of serotonin are increased, and activates the reward centres in our brain(196,197). Music with a calming effect activates our parasympathetic nervous system, which in turn decreases our heart rate, blood pressure, subsequently allowing vital organs to receive a better blood flow. Hanser 2010 studied the relationship between Coronary Heart Disease, blood pressure and music therapy, and found a positive relationship between music, and blood pressure, which positively impacted a reduction in heart disease(198). 

Finally, an important study which incorporates many of the points which have been discussed all throughout this discussion, is the application of music therapy administered in a clinical study by Hanser on depression. Depression, if left untreated can lead to chronic disability, affect social relationships and physical health, and many cognitive symptoms which impair functioning. The study aimed to observe if there was any significant link between a carefully designed model of music therapy provided over eight weeks, and any potential decrease in stress, anxiety, depression, and improvements in self esteem and mood(199). Thirty adults were divided into three groups, one who worked with a music therapist, one which was given instructions for strategies to carry out alone, and a control group. The strategies which were given to the individuals in both of the first two groups included: moving to music, facial massage with music, muscle relaxation alongside music, using music to encourage visual imagery, using music to envisage them problem solving, using music to promote energisation, and using music to stimulate sleep and relaxation, and using music to be creative. 

Self report tests were completed before, during and after the experiment, to observe the effects which the music therapy strategies had on the individual, and also the added element of the music therapist being present. Results showed that in comparison to the control group, both test groups had improved significantly on standardised tests for depression, anxiety, self esteem and mood, with the group which had regular weekly contact with a music therapist scoring the highest. Each individual person was reported to have individual responses to music, each strategy they utilised affected them in different ways, and strategies which were most beneficial to a person for example, for encouraging energisation or relaxation was continued to be developed and utilised by them after the study was completed. 

Studies such as this provide much evidence that the theories and mechanisms behind both music and psychological and physiological functions in us really do combine and offer us great benefit and add value to our life through changing our awareness of our emotions, our perception of the world, how we connect with ourselves and others, our memory, learning and self confidence. This is the meaning of music; through emotion there is greater happiness and connection.

169- Hanser, 2010

170- Juslin, Zentner, 2002

171- Thaut, 2005

172- Hanser, 2010

173- Thaut, 1984

174- Scherer, Ekman, 2014

175- Vink, 2001

176- American Music Therapy Association, 2007

177- Bruscia, 1998

178- Bruscia, 1998

179- Slobada, 2005

180- Guzzetta, 1991

181- Gerdner, 2000

182- Bruscia, 1987

183- Bunt, 2001

184- Terwogt, Grinsven, 1991

185- Field, Walden, 1982a

186- Manstead, 1993

187- Kemeny, Shestyuk, 2010

188- Koelsch, 2011

189- McCaffery, 1990

190- Allen, Blascovich, 1994

191- Krout, 2007

192- Brannon, Fiest 2007

193- Labbé, Schmidt, Babin, Pharr, 2007

194- Hanser, 2010

195- Khalfa, 2003

196- Evers, Suhr, 2000

197- Menon, Levitin, 2005

198- Hanser, 2010

199- Hanser, Thomson, 1994