Music therapy is a technique of complementary medicine that uses music prescribed in a skilled manner by trained therapists. Programs are designed to help patients overcome physical, emotional, intellectual, and social challenges. Applications range from improving the well being of geriatric patients in nursing homes to lowering the stress level and pain of women in labor. Music therapy is used in many settings, including schools, rehabilitation centers, hospitals, hospices, nursing homes, community centers, and sometimes even in the home.
Music has been used throughout human history to express and affect human emotion. In biblical accounts, King Saul was reportedly soothed by David's harp music, and the ancient Greeks expressed thoughts about music having healing effects as well. Many cultures are steeped in musical traditions. It can change mood, have stimulant or sedative effects, and alter physiologic processes such as heart rate and breathing. The apparent health benefits of music to patients in Veterans Administration hospitals following World War II lead to it being studied and formalized as a complementary healing practice. Musicians were hired to continue working in the hospitals. Degrees in music therapy became available in the late 1940s, and in 1950, the first professional association of music therapists was formed in the United States. The National Association of Music Therapy merged with the American Association of Music Therapy in 1998 to become the American Music Therapy Association.
Music can be beneficial for anyone. Although it can be used therapeutically for people who have physical, emotional, social, or cognitive deficits, even those who are healthy can use music to relax, reduce stress, improve mood, or to accompany exercise. There are no potentially harmful or toxic effects. Music therapists help their patients achieve a number of goals through music, including improvement of communication, academic strengths, attention span, and motor skills. They may also assist with behavioral therapy and pain management.
Brain function physically changes in response to music. The rhythm can guide the body into breathing in slower, deeper patterns that have a calming effect. Heart rate and blood pressure are also responsive to the types of music that are listened to. The speed of the heartbeat tends to speed or slow depending on the volume and speed of the auditory stimulus. Louder and faster noises tend to raise both heart rate and blood pressure; slower, softer, and more regular tones produce the opposite result. Music can also relieve muscle tension and improve motor skills. It is often used to help rebuild physical patterning skills in rehabilitation clinics. Levels of endorphins, natural pain relievers, are increased while listening to music, and levels of stress hormones are decreased. This latter effect may partially explain the ability of music to improve immune function. A 1993 study at Michigan State University showed that even 15 minutes of exposure to music could increase interleukin-1 levels, a consequence which also heightens immunity.
Depending on the type and style of sound, music can either sharpen mental acuity or assist in relaxation. Memory and learning can be enhanced, and this used with good results in children with learning disabilities. This effect may also be partially due to increased concentration that many people have while listening to music. Better productivity is another outcome of an improved ability to concentrate. The term "Mozart effect" was coined after a study showed that college students performed better on math problems when listening to classical music.
The ability of music to influence human emotion is well known, and is used extensively by moviemakers. A variety of musical moods may be used to create feelings of calmness, tension, excitement, or romance. Lullabies have long been popular for soothing babies to sleep. Music can also be used to express emotion nonverbally, which can be a very valuable therapeutic tool in some settings.
Music is used to form a relationship between the therapist and the patient. The music therapist sets goals on an individual basis, depending on the reasons for treatment, and selects specific activities and exercises to help the patient progress. Objectives may include development of communication, cognitive, motor, emotional, and social skills. Some of the techniques used to achieve this are singing, listening, instrumental music, composition, creative movement, guided imagery, and other methods as appropriate. Other disciplines may be integrated as well, such as dance, art, and psychology. Patients may develop musical abilities as a result of therapy, but this is not a major concern. The primary aim is to improve the patient's ability to function.
Learning to play an instrument is an excellent musical activity to develop motor skills in individuals with developmental delays, brain injuries, or other motor impairment. It is also an exercise in impulse control and group cooperation. Creative movement is another activity that can help to improve coordination, as well as strength, balance, and gait. Improvisation facilitates the nonverbal expression of emotion. It encourages socialization and communication about feelings as well. Singing develops articulation, rhythm, and breath control. Remembering lyrics and melody is an exercise in sequencing for stroke victims and others who may be intellectually impaired. Composition of words and music is one avenue available to assist the patient in working through fears and negative feelings. Listening is an excellent way to practice attending and remembering. It may also make the patient aware of memories and emotions that need to be acknowledged and perhaps talked about. Singing and discussion is a similar method, which is used with some patient populations to encourage dialogue. Guided Imagery and Music (GIM) is a very popular technique developed by music therapist Helen Bonny. Listening to music is used as a path to invoke emotions, picture, and symbols from the patient. This is a bridge to the exploration and expression of feelings.
Music and children
The sensory stimulation and playful nature of music can help to develop a child's ability to express emotion, communicate, and develop rhythmic movement. There is also some evidence to show that speech and language skills can be improved through the stimulation of both hemispheres of the brain. Just as with adults, appropriately selected music can decrease stress, anxiety, and pain. Music therapy in a hospital environment with those who are sick, preparing for surgery, or recovering postoperatively is appropriate and beneficial. Children can also experience improved self-esteem through musical activities that allow them to succeed.
Newborns may enjoy even greater benefits from music. Premature infants experience more rapid weight gain and an earlier discharge from the hospital than their peers who are not exposed to music. There is also anecdotal evidence of improved cognitive function in premature infants from listening to music.
Music and rehabilitation
Patients with brain damage from stroke, traumatic brain injury, or other neurologic conditions have been shown to exhibit significant improvement as a result of music therapy. This is theorized to be partially the result of entrainment, which is the synchronization of movement with the rhythm of the music. Consistent practice leads to gains in motor skill ability and efficiency. Cognitive processes and language skills often benefit from appropriate musical intervention.
Music and the elderly
The geriatric population can be particularly prone to anxiety and depression, particularly in nursing home residents. Chronic diseases causing pain are also not uncommon in this setting. Music is an excellent outlet to provide enjoyment, relaxation, relief from pain, and an opportunity to socialize and reminisce about music that has had special importance to the individual. It can have a striking effect on patients with Alzheimer's disease, even sometimes allowing them to focus and become more responsive for a time. Music has also been observed to decrease the agitation that is so common with this disease. One study shows that elderly people who play a musical instrument are more physically and emotionally fit as they age than their nonmusical peers are.
Music and psychiatric disorders
Music can be an effective tool for treating the mentally or emotionally ill. Autism is one disorder that has been particularly researched. Music therapy has enabled some autistic children to relate to others and have improved learning skills. Substance abuse, schizophrenia, paranoia, and disorders of personality, anxiety, and affect are all conditions that may be benefited by music therapy. In these groups, participation and social interaction are promoted through music. Reality orientation is improved. Patients are helped to develop coping skills, reduce stress, and express their feelings.
In the treatment of psychotic disorders, however, the benefits of music therapy appear to be limited. One study of patients diagnosed with schizophrenia or schizoaffective psychosis found that while music therapy improved the patients' social relationships, these benefits were relatively short-lived.
Music and hospice care
Pain, anxiety, and depression are major concerns with patients who are terminally ill, whether they are in hospice or not. Music can provide some relief from pain, through release of endorphins and promotion of relaxation. It can also provide an opportunity for the patient to reminisce and talk about the fears that are associated with death and dying. Music may help regulate the rapid breathing of a patient who is anxious, and soothe the mind. The Chalice of Repose project, headquartered at St. Patrick Hospital in Missoula, Montana, is one organization that attends and nurtures dying patients through the use of music, in a practice they called music-thanatology by developer Therese Schroeder-Sheker. Practitioners in this program work to relieve suffering through music prescribed for the individual patient.
Music and gynecologic procedures
Research has proven that women require less pharmaceutical pain relief during labor if they make use of music. Listening to music that is familiar and associated with positive imagery is the most helpful. During early labor, music will promote relaxation. Maternal movement is helpful to get the baby into a proper birthing position and dilate the cervix. Enjoying some "music to move by" can encourage the mother to stay active for as long as possible during labor. The rhythmic auditory stimulation may also prompt the body to release endorphins, which are a natural form of pain relief. Many women select different styles of music for each stage of labor, with a more intense, or faster-moving piece feeling like a natural accompaniment to the more difficult parts of labor. Instrumental music is often preferred.
The benefits of music therapy during childbirth have also been shown to apply to other surgical procedures. Women who have listened to music tapes during gynecologic surgery have more restful sleep following the procedure and less postoperative soreness.
Patients making use of music therapy should not discontinue medications or therapies prescribed by other health providers without prior consultation.
Research & general acceptance
There is little disagreement among physicians that music can be of some benefit for patients, although the extent of its effects on physical well-being is not as well acknowledged in the medical community. Acceptance of music therapy as an adjunctive treatment modality is increasing, however, due to the growing diversity of patient populations receiving music therapy. Research has shown that listening to music can decrease anxiety, pain, and recovery time. There are also good data for the specific subpopulations discussed. A therapist referral can be made through the AMTA.
Training & certification
Music therapists are themselves talented musicians; they also study the ways in which music can be applied to specific groups and circumstances. Coursework includes classes regarding music history and performance, behavioral science, and education. The American Music Therapy Association dictates what classes must be included in order for a music therapy program to be certified. There are approximately 70 colleges with approved curricula. A six-month internship follows the completion of the formal music therapy program, and the graduate is then able to take a national board exam to gain certification.
Campbell, Don. The Mozart Effect. Avon Books, 1997.
Cassileth, Barrie. The Alternative Medicine Handbook. W. W. Norton & Co., Inc., 1998.
Dillard, James, and Terra Ziporyn. Alternative Medicine for Dummies. IDG Books Worldwide, Inc., 1998.
Sears, William, and Martha Sears. The Birth Book. Little, Brown & Co., 1994.
Woodham, Anne, and David Peters. Encyclopedia of Healing Therapies. DK Publishing, Inc., 1997.
Good, M., J. C. Anderson, M. Stanton-Hicks, et al. "Relaxation and Music Reduce Pain After Gynecologic Surgery." Pain Management Nursing 3 (June 2002): 61-70.
Gregory, D. "Four Decades of Music Therapy Behavioral Research Designs: A Content Analysis of Journal of Music Therapy Articles." Journal of Music Therapy 39 (Spring 2002): 56-71.
Hayashi, N., Y. Tanabe, S. Nakagawa, et al. "Effects of Group Musical Therapy on Inpatients with Chronic Psychoses: A Controlled Study." Psychiatry and Clinical Neuroscience 56 (April 2002): 187-193.
Magee, W. L., and J. W. Davidson. "The Effect of Music Therapy on Mood States in Neurological Patients: A Pilot Study." Journal of Music Therapy 39 (Spring 2002): 20-29.
Robinson, A. "Music Therapy and the Effects on Laboring Women." Kentucky Nurse 50 (April-June 2002): 7.
Standley, J. M. "A Meta-Analysis of the Efficacy of Music Therapy for Premature Infants." Journal of Pediatric Nursing 17 (April 2002): 107-113.
American Music Therapy Association, Inc. 8455 Colesville Road, Suite 1000 Silver Spring, ML 20910. (301) 589-3300. http://www.musictherapy.org.
The Chalice of Repose Project at St. Patrick Hospital, 312 East Pine Street, Missoula, MT 59802. (406) 329-2810 Fax: (406)329-5614 http://www.saintpatrick.org/chalice/.
Copyright 2008 The Gale Group, Inc. All rights reserved.