What effect can music have on physical and · 6 J. Nattiez, Music and Discourse: Toward a Semiology...

What effect can music have on physical and psychological illness?

Nat Barrett

“Does Music Therapy Work?”

Thesis: There is increasing evidence that music therapy can have a dramatic positive impact on the treatment of and recovery from illness.

1) Introduction (1167 words) a) What is music therapy? b) The history of music therapy, incl. historical uses c) Music therapy as a practice today d) The Ethics of Music Therapy

2) A Theoretical Background (446 words) a) Why should we think it has any effect? b) Music and the Brain

3) A Case of Evidence (763 words) a) Problems with Methodology b) Brief Overview on Existing Evidence from Current Studies

4) Music Therapy - Studies (1679 words) a) Dementia b) Depression c) Heart disease

5) Conclusion (776 words) a) New frontiers of music therapy + re-statement of thesis

Does Music Therapy Work?

Introduction

What Is Music Therapy?

Music is defined as sound organised according to ‘pitch, harmony and timbre’. Over the 1

past few years, music has generated attention as a potential cure for illnesses relating to both the

function of organs and cells (the physical) and the function of the brain and its networks (the

psychological). Music therapy is a practice in which a patient listens to or plays music in order 2

to help alleviate the symptoms of illness. 3

Typically a music therapist will help the patient by providing social interaction and

encouraging the patient to engage with the music, through playing music or giving social cues. 4

Whilst some may criticise music therapy as being subjective and immeasurable , there is 5

increasing evidence that music therapy can have a dramatic positive impact on the treatment of

and recovery from illness, which this paper will explore in further detail.

A History of Music Therapy

Music has existed in some form since the Prehistoric times, and the first likely use of

music was a call used to communicate to other members of a family unit or group either for

entertainment, spiritual purposes (for example, rain dance chants) or for survival in hunting or

gathering situations. Notably, the role of the shaman or healer has been well documented and 6 7

can be considered analogous to the role of the music therapist today. A healer ‘heals’ a member

of the tribe, family or group like a music therapist ‘treats’ a patient. The first musical instrument

was probably a flute of some description, made out of bone - some of those found are dated at

C. Limb, Structural and Functional Neural Correlates of Music Perception, Wiley Interscience, 2006, 1

accessed 17th June 2016, p. 436.

E. Altenmüller and G. Schlaug, Apollo’s Gift: New Aspects of Neurologic Music Therapy, Progress in 2

Brain Research, 2015, accessed 17th June 2016, p. 1.

J. Warren, Personal Interview with Jason Warren 3

Ibid. 4

S. Rysewyk, A Criticism of Brain Music Therapy, Wittgenstein Light, 2008, accessed 27th June 2016. 5

J. Nattiez, Music and Discourse: Toward a Semiology of Music, Princeton University Press, 1990, 6


H. Hoppal, Music in Shamanic Healing, Macht Musik, accessed 28th June 2016, p. 141-147. 7

40,000 years old. Certain cultures and locations have closer ties to music as a historical 8

practice such as the Mayans of South America and the Indigenous peoples of North America. 9 10

It is difficult to ascertain exactly when music therapy began in Prehistoric times. This

depends on whether we consider singing to be a type of music. Singing is believed to predate the

development of language and there is ‘no culture that does not sing’ . Maternal singing (a 11 12

mother singing to her child) may reduce agitation in babies and the ‘universal’ language of 13

mothers, Motherese, has a ‘sing-song’ like quality with long and elongated sounds in order to be

soothing to the baby. Thus maternal singing to a child can be considered a type of primal and 14

universal music therapy. This idea is supported by a study of singers who sang in order to reduce

pain levels , although the sample size of the study is unknown and the effects were not large. 15

During the times of the Ancient Greeks, the priest used music to ‘restore the soul and

body’ and convey specific emotions. This purpose was also common in the cultures of China, 16

Egypt and India. Plato, an influential philosopher, wrote that ‘music is medicine to the soul’ . 17 18

During early Christian times, especially in Europe, the role of the priest with respect to music

was to give an uplifting spiritual experience in order to reduce pain. After the Renaissance, the 19

physician (no longer priest) used music in order to elicit psychological and emotional changes,

J. Wilford, Flutes Offer Clues to Stone-Age Music, The New York Times, accessed 28th June 2016. 8

D. Tedlock, Rabinal Achi: A Mayan Drama of War and Sacrifice, Oxford University Press, 2003, p. 2, p. 9

254.

C. Heth, Overview, The Garland Encyclopedia of World Music, p. 367-368. 10

J. Koopman, A Brief History of Singing and Unsung Songs, Lawrence University, 1999, accessed 28th 11

June 2016.

Ibid. 12

J. Warren, Personal Interview with Jason Warren. 13

Ibid. 14

D. Kenny and G. Faunce, The impact of group singing on mood, coping, and perceived pain in chronic 15

pain patients attending a multidisciplinary pain clinic, Journal of Music Therapy, 2004, abstract.

Dr D. Carroll, Historical Roots of Music Therapy: A Brief Overview, Revista do Núcleo de Estudos e 16

Pesquisas Interdisciplinares em Musicoterapia, 2011, accessed 28th June 2016, p. 173.

Ibid. 17

Ibid., p. 174. 18

Ibid., p. 175. 19

often associated with the nervous system. It is during the Romantic Era that music therapy as 20

our current model takes hold, with a physician-musician playing music to a ‘patient’. 21

Music Therapy as a Practice Today

Following the Industrial Revolution and urbanisation, mental hospitals became larger in

size and more common. After World War II there was increased interest in music’s therapeutic 22

potential in treating the trauma that veterans were confronted with following their service. 23

Music therapy societies and organisations were established in the 1950s to 1970s in order to

increase awareness about the field. Music therapy has since become a recognised part of 24

therapeutic practices around the world.

The Ethics of Music Therapy

Unlike a clinical psychologist who will need a doctoral degree to practice, a music

therapist needs only a Master’s in music or music therapy , which raises the issue of whether 25

music therapists are as qualified as a psychologist to provide therapeutic care to patients. Can

we compare the results of a psychological therapist and music therapist with regards to mental

illness, when standard psychology requires more intensive training? This is just one of the

ethical questions that music therapy poses.

Another question to keep in mind is whether it is economically sound to fund music

therapy, particularly in the context of larger health organisations and schemes like the National

Health Service (NHS) in the United Kingdom or Medicaid in the United States. In contrast to 26 27

Ibid, p. 175-176. 20

Ibid. 21

Ibid., p. 177. 22

Ibid. 23

History of the British Association for Music Therapy, BAMT, accessed 28th June 2016. 24

Music Therapist, National Careers Service, 2015, accessed 27th June 2016. 25

J. Garner and T. Christiansen, The Surveillance Gaze: A New Paradigm for Long-Term Care of Older 26

People in the UK National Health Service (NHS), Social Sciences in Health Care and Medicine, 2008, accessed 28th June 2016, p. 85.

America's Health Insurance Plans (HIAA), p. 232. 27

music therapy, which requires only a music therapist, music and a patient, drug trials are known

to cost large sums of money and take a great deal of time in order to organise legislation and 28

certify valid proof for a drug’s further clinical use . 29

In general, few papers will produce results that are unfavourable or neutral and may

exaggerate effects , particularly if the research is implicated in bias - for example, if there is 30 31

sponsorship from a tobacco company into the effects of smoking on the development of lung

cancer. Whilst bias and exaggeration is possible in music therapy trials (as with all research),

overall music therapy costs less than a drug trial - which often need millions of pounds in

support. In addition, drug trials are more likely to be implicated in pharmacological corruption , 32 33

with consequences for patients by virtue of skewing or altering results - as seen with the

understatement of the negative effects of Agent Orange, a carcinogenic (cancer-causing)

herbicide used in the Vietnam war, by Monsanto. 34

This issue is significant when we consider that homoeopathy - the use of herbal medicine

in disease treatment and prevention - is funded by the National Health Service, despite having

no or contradictory evidence with regards to beneficial effects. As the National Health Service 35

is funded by the taxpayer and owes a duty of care to all of its patients, should there not be more

funding for music therapy, when music therapy was shown to be as effective as medicine in the

treatment of cancer patients in a trial? This trial consisted of thirty adult cancer patients 36

G. Schott, et al. The Financing of Drug Trials by Pharmaceutical Companies and Its Consequences, 28

Deutsches Ärzteblatt International, 2010, accessed 17th June 2016, p. 1-2.

Ibid. 29

Ibid. 30

Ibid. 31

Ibid., p. 3. 32

Ibid, abstract. 33

P. Schuck, Agent Orange on Trial: Mass Toxic Disasters in the Courts, Harvard University Press, 1987, 34

p. 1-5.

C. Smallwood, The Role of Complementary and Alternative Medicine in the NHS, FreshMinds, 2006, 35


J. Bradt et al, The impact of music therapy versus music medicine on psychological outcomes and pain 36

in cancer patients: a mixed methods study, Support Care Cancer, 2015, accessed 28th June 2016, p. 1261.

participating in sessions with and without a music therapist, with pain measurements assessed

by numerical scale . Whilst this was a small study (though arguably not small compared to 37

those that have only ten participants for example) and numerical scaling can be subjective, this

evidence should make the National Health Service - and any other organisation which funds

‘alternative medicine’ - consider further funding for music therapy, which does not involve the

high costs of drug trials or potentially life-threatening side effects. 38

This does not mean that clinicians should cease to produce drugs or use them in studies

but that these large companies should consider using music therapy in addition to current

medicinal care, especially considering 77 percent of the patients in the aforementioned study

preferred the sessions with music therapy and this is important as the effect of a positive

psychological stimulus (similar to the placebo effect) on illness recovery is well-documented. 39

A Theoretical Background

Why Should We Think Music Therapy Would Have Any Effect?

Although music therapy has an extremely broad, universal and long history, that does

not imply that it is efficient in treating disease. Indeed, homoeopathic treatments have existed

for thousands of years and there is little to no clinical support or evidence for their use. 40

Therefore we must look at the relationship between music and the brain to understand how

exactly music therapy elicits a significant effect on the treatment of illness.

Music and The Brain

In discussing the brain we must first comprehend that the brain is a complex organ,

often described as a ‘paradox’ as we know little of its function, relative to other organs like the

Ibid. 37

G. Schott et al, The Financing of Drug Trials by Pharmaceutical Companies and Its Consequences, 38


D. Price et al, A Comprehensive Review of the Placebo Effect: Recent Advances and Current Thought, 39

Annual Review of Psychology, 2008, accessed 28th June 2016, abstract.

C. Smallwood, The Role of Complementary and Alternative Medicine in the NHS, FreshMinds, 2006, 40

accessed 28th June 2016, p. 11-12.

heart. This adds a layer of difficulty to the study of neurology and neurobiology as a whole, but 41

as the science advances so too will our knowledge . 42

Music perception - the ability to be aware of music through auditory stimuli - involves

not only physical features of the ear but also synaptic and neuronal pathways in the brain. In 43

this section, a background overview on music perception and the brain will be described.

The cochlea is a cavity in the inner ear containing the nerve impulse-producing organ of

Corti, where hearing begins. The vibrations produced by sound waves stimulate hairs which 44

make the cavity produce ‘afferent potentials’ or impulses which travel down the ‘cochlear nerve’

to the brainstem. These impulses travel down to the subcortical structures (structures below 45

the cortex) before arriving at the primary auditory cortex. 46

The primary auditory cortex then ‘relays’ these signals to other regions in the brain,

resulting in music perception. The exact structural representation of the auditory cortex still 47

needs further research, however, its activation is clinically significant in ‘cortical auditory

disorders’ (disorders involving malfunction of the auditory cortex). However, more recent 48

research needs to be conducted into the specific pathways involved in auditory processing.

Music activates the temporal lobe , which is particularly important considering the 49

function of the region; it is implicated in memory, language and knowledge about the world . 50

These are crucial to the basis of personality and identity, given that experience shapes almost

N. Kapur, The Paradoxical Brain, Cambridge University Press, 2011, p. 1.41

See “Conclusion” where this idea is explored further. 42

C. Limb, Structural and Functional Neural Correlates of Music Perception, Wiley Interscience, 2006, 43

accessed 17 June 2016, p. 437.

Ibid., p. 436. 44

Ibid.45

Ibid. 46

Ibid. 47

M. Mendez and G. Geehan, Cortical auditory disorders: clinical and psychoacoustic features, Journal 48

of Neurology Neurosurgery and Psychiatry, 1988, accessed 28th June 2016.

J. Warren, Personal Interview with Jason Warren49

Ibid. 50

everything we do. This is of course clinically significant, as restoring a sense of self can greatly

improve a patient’s quality of life. 51

The motor and sensory cortices are activated when someone plays a musical

instrument as well as the cerebellum and amygdala if the person is playing from memory. 52 53

This demonstrates that music activates a wide range of brain regions, which suggests that it is

more clinically significant than skeptics of the practice may believe. How exactly music alters

the brain and body in order to prevent and alleviate symptoms of dementia, depression and

heart disease will be explored later.

A Case of Evidence

Problems With Methodology

Unlike a drug trial, it is difficult - though not impossible - to create an absolute control

group (ie a group not receiving music) in music therapy trials. A control group is a group which

does not obtain the treatment, for example, a drug or treatment. This is to ascertain that the

independent variable (in this case, the treatment/drug) is producing an effect and not an

external factor. In music therapy, there is no equivalent to a placebo pill and thus without an

absolute control group , it is more difficult to conclude music’s efficiency in treating disease. 54

External factors can include age or lifestyle and social interaction with the music therapist or

other patients. Given that it is common scientific knowledge that a suitably comparable control 55

group is needed for an effective analysis of results, music therapy’s lack of absolute control

renders its results less reliable than a drug trial, for example. This lack of control makes

uncertain whether it is music eliciting a supposed therapeutic effect rather than merely the

H. Svansdottir and J. Snaedal, Music Therapy in Moderate and Severe Dementia of Alzheimer’s Type: 51

a Case–control Study, International Psychogeriatrics Association, 2006, accessed 17th June 2016, p. 2.

D. Levitin, This is Your Brain on Music, Atlantic Books, p. 270-271. 52

Ibid. 53




emotions produced by music listening or playing. A control that could be used would be a 56

similarly engaging activity such as reading , though few studies have used this as a control 57

group. This is particularly problematic in assessing music therapy’s effectiveness with regards to

dementia, where the perception of emotions is often altered . However, the presence of any 58

positive result in the field of music therapy should entice researchers into further investigation,

which would reduce this issue.

Many of the studies analysing music’s therapeutic potential are small in scale, with

groups of twenty or fewer individuals being assessed. Whilst there are exceptions , a small 59

number of patients also makes results less reliable , as with greater data collection standard 60

deviation is more accurate. The reliability of typically small-scale studies involving music

therapy and patients with neurological or neurodegenerative disease must be questioned, but

again any evidence in this area should be promising.

Another issue with music therapy is the Outside Effect problem. The study and

appreciation of music result in increased neuroplasticity. Neuroplasticity or ‘brain plasticity’ is 61

the ability of the brain to generate new neuronal cells in response to stimuli and is markedly

increased in children, particularly children with intense musical training. It is uncertain as to 62

whether the plasticity derived from music practice affects the patient’s real world experiences

outside of music therapy sessions and how long this effect lasts. The question of what external 63

effect music therapy produces is muddied by this difficulty in controlling for external factors, as

intensified by a lack of an absolute control group.

Ibid. 56

Ibid. 57

Ibid. 58

See a study using 76 schizophrenic patients: T. Wenzhong, et al., Rehabilitative Effect of Music 59

Therapy for Residual Schizophrenia: A One-month Randomised Controlled Trial in Shanghai, The British Journal of Psychiatry, 1994, accessed 17th June 2016.

J. Warren, Personal Interview with Jason Warren.60

Ibid. 61

A. Baird and S. Samson, Music and Dementia, Progress in Brain Research, 2015, accessed 17th June 62

2016, p. 225.


In music therapy studies, a double-blind trial is difficult to establish. A double-blind 64

trial ensures that none of the patients know whether they are receiving the treatment or a

placebo, as common in pre-clinical drug trials. Most patients are aware that they are listening to

or practising music for therapeutic purposes. At the minimum, all patients are aware of when

they are listening to music (the treatment) or silence. Given that patients are aware of whether

they are receiving the treatment or not, this introduces the possibility of bias, which reduces the

reliability of the clinical results obtained from music therapy. 65

However, music therapy offers its own advantages which are different to a drug trial. It

does not produce any side effects in patients , which may be harmful or even life-threatening in 66

a drug trial. The therapy can be considered largely benign. In addition, music therapy is more

cost effective than a drug trial; it does not need the high amounts of funding often associated

with the development of new drugs, which may be implicated in bias related to the support of

the pharmaceutical company, as discussed previously. 67

Music therapy is easy to put into practice: all that is needed is an instrument, including

the voice, and a trained therapist. This also reduces cost. Given that music therapy is shown to

have a marked positive effect, it should be explored in greater depth from a clinical perspective

with regards to treating patients . 68

Brief Overview on Existing Evidence from Current Studies

Through an analysis of various studies, discussions and issues related to music therapy,

the current science demonstrates that there is evidence which to show that music has a

significantly positive effect on certain illnesses, notably neurodegenerative conditions. Music

Ibid. 64

Ibid. 65



G. Schott, et al. The Financing of Drug Trials by Pharmaceutical Companies and Its Consequences, 67



can not only help to treat the autonomic nervous system effects of Crohn’s disease but also can 69

alleviate anxiety, stress and depression in dementia patients , reduce seizure frequency and 70

intensity in epileptic patients , help give patients with post-traumatic stress disorder and 71

addiction a sense of identity through community drumming and help autistic people to 72

communicate in healthy and fulfilling ways . 73

Music Therapy - An Analysis

Dementia

Dementia is a broad category of persistent disease which results in deficits in memory,

personality, emotional expression and reasoning. Dementia is a broad category of 74

neurodegenerative disease including Alzheimer’s disease and Creutzfeldt-Jakob Disease . 75

Alzheimer’s disease results from a buildup of beta-amyloid protein leading to nerve cell 76

damage. As an estimate, around 670 000 people in the United Kingdom have dementia. 77 78

R. Krabs et al, Autonomic Effects of Music in Health and Crohn's Disease: The Impact of Isochronicity, 69

Emotional Valence, and Tempo, Plos One, 2015, accessed 19th June 2016, p. 17.



M. Maguire, Music and Its Association With Epileptic Disorders, Progress in Brain Research, 2015, 71


M. Winkelman, Complementary Therapy for Addiction: “Drumming Out Drugs”, American Journal of 72

Public Health, 2003, accessed 19th June 2016, p. 1.

G. Geretsegger et al, Music therapy for People with Autism Spectrum Disorder (Review), The Cochrane 73

Collaboration, 2016, accessed 19th June 2016, p. 3.

Ibid. 74

Creutzfeldt–Jakob Disease (CJD): Classic, Centers for Disease Control and Prevention, 2008, 75

accessed 19th June 2016.

A. Khan, The Amyloid Hypothesis and Potential Treatments for Alzheimer's Disease, Quality Research 76

in Dementia, 2007, accessed 18th June 2016, p. 1.

D. Levitin, This Is Your Brain on Music, Dutton Penguin, 2006, p. 231.77

W. Lea, Dementia – a state of the nation report on dementia care and support in England, Gov.uk, 78

2013, p. 4.

A study of 48 dementia and Alzheimer’s disease patients found that singing 'improves

mood, behaviour and cognitive functioning' in people with dementia. This study’s reliability 79

was increased by the fact that it used a control activity of cooking and this is significant as on 80

the whole, not enough music therapy trials use a comparable control activity. In addition, each 81

intervention lasted for four weeks which, although not longitudinal, is a fair amount of time. 82

Whilst no cognitive effect resulted from the study , it improved the ‘wellbeing’ of dementia 83

patients and reduced ‘caregiver distress’. 84

Another similar study found that ‘musical intervention’, especially ‘active musical

intervention’ (for example playing an instrument), was beneficial in reducing stress in moderate

to severe dementia patients. Although this was a small sample size of 39 individuals , the 85 86

researchers used the widely recognised ‘Behavioral Pathology in Alzheimer's Disease (BEHAVE-

AD) Rating Scale’ and credit must be given as they assessed music therapy in patients with 87

severe forms of dementia, whereas most studies only examine mild dementia. 88

Researchers using a larger sample size of 89 elderly patients with early dementia found

that both listening to and singing music improved ‘mood’, sense of direction and memory. It 89

also resulted in smaller positive increases in ‘attention, executive function, and general


2016, p. 208.

P. Narme et al, Efficacy of musical interventions in dementia: Evidence from a randomized controlled 80

trial, Journal of Alzheimer’s Disease, 2014, accessed 29th June 2016, abstract.


P. Narme et al, Efficacy of musical interventions in dementia: Evidence from a randomized controlled 82

trial, Journal of Alzheimer’s Disease, 2014, accessed 29th June 2016, abstract.

Ibid. 83

Ibid. 84

Sakamoto et al, Comparing the effects of different individualized music interventions for elderly 85

individuals with severe dementia, International Psychogeriatrics, 2013, accessed 29th June 2016, abstract.

Ibid. 86

Ibid. 87

Ibid. 88

T. Sarkamo et al, Cognitive, Emotional, and Social Benefits of Regular Musical Activities in Early 89

Dementia: Randomized Controlled Study, The Gerontologist, 2014, accessed 29th June 2016, p. 1.

cognition.’ What also increased reliability in said study was that patients were assigned 90

randomly to the music therapy group to prevent bias and the researchers used a standard care 91

control . Therefore we can see that there is a fair amount of evidence to suggest music improves 92

the quality of life of dementia patients.

In a small-scale study of 38 patients with Alzheimer-type dementia, research showed

that there is a reduction in ‘depression and agitation’ in dementia patients both during and after

music therapy. This study, unfortunately, did not control for casual interaction with music in 93

the patients’ everyday lives, which may have altered results. However, the study included a 94

two-week baseline ‘no music’ period before the trial, demonstrated ‘rapid and sustained’ results

and lasted for a total of 12 weeks so results were statistically significant. 95

Although the aforementioned study of 48 patients showed no cognitive results in

dementia patients, two studies show the contrary. In the first study, cognitive assessment was

via the ‘Mini-Mental State Examination (MMSE)’ and language ability through the ‘Western

Aphasia Battery (WAB)’*. These increase the reliability of the results. The results from 20 96

participants show that music therapy ‘significantly improves’ performance in ‘speech content

and fluency’ , which is clinically important as this could ‘enhance communication’ between 97

caregivers and patients. However, the overall Aphasia Quotient (AQ, aphasia meaning ability 98

to speak) was not statistically significant , which means that further research should be done in 99

Ibid. 90

Ibid. 91

Ibid. 92

P. Janata, Effects of Widespread and Frequent Personalized Music Programming on Agitation and 93

Depression in Assisted Living Facility Residents With Alzheimer-Type Dementia, Music and Medicine, 2011, accessed 18th June 2016, p. 1.

Ibid. 94

Ibid. 95

M. Brotons and S. Koger, The Impact of Music Therapy on Language Functioning in Dementia, 96

American Music Therapy, 2000, accessed 29th June 2016, p. 5.

Ibid., p. 1. 97

Ibid. 98

Ibid. 99

this area. The second study showed that the language subscale of the Mini-Mental State

Examination (MMSE) improved ‘significantly’. 100

On the ‘Multidimensional Observation Scale For Elderly Subjects (MOSES)’, the

‘irritability’ scores ‘decreased significantly’. ‘Salivary chromogranin A (CgA) level’, an 101

endocrinological marker of stress, was ‘significantly decreased’ after music therapy. This 102

shows us that music therapy significantly affects the endocrine system and behaviour in positive

ways. Considering this study was very small in sample size (ten) and not recent (2004) , more 103

large-scale recent research needs to be conducted. However, we can see that music therapy can

appreciably improve dementia patients’ quality of life.

Depression

Depression is a mental illness characterised by a lack of serotonin resulting in a

persistent low mood, also affecting brain regions like the amygdala. In a small-scale study of 104

ten volunteers, researchers used ‘positron emission tomography’ (PET) scanning - a type of

brain scan using radioactive tracing - to examine blood flow to the brain (cerebral blood flow,

CBF). They showed that music activated both limbic and paralimbic systems, complex neural 105

networks associated with mood and instinct, including the amygdala. In another small-scale 106

study again using positron emission tomography scanning, scientists found that “chills”

resulting from music activated regions associated with positive emotions. Despite the fact that 107

M. Suzuki et al, Behavioral and endocrinological evaluation of music therapy for elderly patients with 100

dementia, Nursing & Health Sciences, 2004, p. 1.

Ibid. 101

Ibid. 102

Ibid. 103

S. Koelsch, Brain Correlates of Music-evoked Emotions, Macmillan Nature, 2014, accessed 18th June 104

2016, p. 3.

A. Blood et al, Emotional responses to pleasant and unpleasant music correlate with activity in 105

paralimbic brain regions, Nature Neuroscience, 1999, p. 1.

Ibid. 106

A. Blood and R. Zatorre, Intensely pleasurable responses to music correlate with activity in brain 107

regions implicated in reward and emotion, Montreal Neurological Institute, 2001, p. 1.

these are older small-scale studies, there is ‘significant’ potential for music to help with the

alleviation of symptoms of disorders of amygdala dysfunction such as depression. 108

From a more behavioural standpoint, a randomised control trial for the treatment of

depression through music therapy showed improvements in depression, anxiety and ‘general

functioning’ symptoms at a 3-month follow-up following prolonged music therapy. The 109

researchers found no statistical difference in the quality of life and alexithymia (inability to

describe own emotions) categories, contradictory to later research - this study is from 2011.

Also, the study was large with 79 patients , unlike the other small-scale studies. There was a 110

greater improvement of symptoms in patients participating in both music and standard therapy

than standard therapy alone , suggesting that a combination of music therapy and standard 111

care is most effective in treating depression.

As we have also seen previously, music therapy can not only help reduce levels of

depression in clinically depressed patients but also reduce these symptoms in patients with

dementia too. Similarly, a study of 15 stroke patients found that those who learned the piano 112

by responding to delayed music tones showed fewer depression symptoms than those who

learned without delay. This makes sense as the anticipation present in music is associated 113

with the activation of the amygdala and similar regions and this area has been well-

researched. 114

In addition, as depression is associated with low levels of the neurotransmitters

serotonin and dopamine , the relationship between music and these two chemicals is of clinical 115

Ibid., p. 6. 108

J. Erkkilä et al, Individual music therapy for depression: randomised controlled trial, The British Journal 109

of Psychiatry, 2011, accessed 30th June 2016, p. 1.

Ibid. 110

Ibid. 111

P. Janata, Effects of Widespread and Frequent Personalized Music Programming on Agitation and 112

Depression in Assisted Living Facility Residents With Alzheimer-Type Dementia, Music and Medicine, 2011, accessed 18th June 2016, p. 1.


Brain Research, 2015, p. 10.

Ibid., p. 5. 114

Ibid, p. 5-6. 115

interest. In a large-scale study, scientists found that levels of serotonin increased significantly

whilst healthy patients listened to ‘pleasant’ music. Assessing neurotransmission of serotonin 116

may be more useful when investigating depression as this is a more objective criteria than

emotional response scales. In an often-cited study, patients showed a dramatic increase in

dopamine levels both before and during music listening, with distinct forms of dopamine for

both criteria. Whilst the exact number of participants is not detailed, the methodology was 117

quite rigorous with controls and the use of positron emission tomography (PET) scanning , 118

increasing the reliability of the data.

Many older patients do not regard depression as seriously as younger patients which 119

has led to research into music therapy for treatment of depression in older adults. One

randomised-control study of 47 elderly people with controls found that there was ‘statistically

significant’ decreases in depression scores, blood pressure, heart rate and respiratory rate after

one month. Another randomised-control study of 50 older adults (26 control) showed a 120

‘significant reduction in depression levels’ over the course of music therapy. This 121

demonstrates that there is substantial evidence that music therapy can be beneficial in

improving the symptoms of depression in a wide variety of patients.

Heart Disease

Heart disorders are a broad category of illness featuring a malfunction of the heart. The

autonomic effects of music can help to decrease the variability of heart rate - useful when

S. Evers and B. Suhr, Changes of the neurotransmitter serotonin but not of hormones during short time 116

music perception, European Archives of Psychiatry and Clinical Neuroscience, accessed 30th June 2016, p. 1.

V. Salimpoor et al, Anatomically distinct dopamine release during anticipation and experience of peak 117

emotion to music, Nature Neuroscience, 2010, accessed 30th June 2016, abstract.

Ibid. 118

M. Chan et al, Effect of music on depression levels and physiological responses in community-119

based older adults, International Journal of Mental Health Nursing, 2009, accessed 30th June 2016, p. 1.

Ibid. 120

M. Chan et al, Effects of music on depression in older people: a randomised controlled trial, Journal of 121

Clinical Nursing, 2011, accessed 30th June 2016, p. 1.

treating conditions with irregular heart rate, called arrhythmia. In a large sample size group of 122

87 students preparing for a stressful event (a presentation) with and without music, the

‘significant’ increase in ‘heart rate, blood pressure, cortisol and salivary IgA’ associated with the

presentation was prevented by music. This was a study that went to great depths to ensure 123

certainty and reliability of data by using rigorous controls and in addition used very objective

assessment criteria. This has a therapeutic potential with regards to treating arrhythmia 124

associated with heart disease. In addition, given that ischemic heart disease is strongly linked to

high blood pressure levels (hypertension) , the blood pressure-reducing effects of music can 125

help prevent the development of heart disease.

In a study of 138 healthy patients and 19 with Crohn’s disease, heart rate variability (the

variation in time between heartbeats) decreased when listening to music, even if the music was

atonal or unpleasant. This study also used a control and measured objectively, although there 126

are not enough studies of this nature. This effect is clinically relevant when discussing the

variability in heart rate associated with poor breathing capacity due to heart disease. This also

shows that music’s effect is so potent that the likeability of the music does not matter in this

case, unlike more emotional responses like anxiety. 127

The reason for this is because music affects the autonomic nervous system (ANS), whose

malfunction is very linked to heart disorders, sudden death and heart failure. Unfortunately, 128

the literature on the relationship between music therapy and individuals with autonomic

nervous system dysfunction is limited. In a study of 16 singers with eight amateurs, researchers

found that although arousal increased more in the professional singers than amateurs, the latter

R. Krabs, Autonomic Effects of Music in Health and Crohn's Disease: The Impact of Isochronicity, 122


W. Knight and N. Rickard, Relaxing music prevents stress-induced increases in subjective anxiety, 123

systolic blood pressure and heart rate in healthy males and females, Journal of Music Therapy, 2001, accessed 30th June 2016, p. 1.

Ibid. 124

Risk factors: High Blood Pressure, British Heart Foundation, 2015, accessed 30th June 2016. 125






had greater positive autonomic nervous system effects from singing. Although this was a 129

small- scale study (with good controls and assessment), it does highlight how music therapy

could be clinically significant with regards to autonomic nervous system-related heart disease.

Another factor to consider is the relationship between anxiety and/or depression and

heart disorder. Given that patients with early-onset depression have a risk 1.5 to 2 times greater

than the average population for the development of heart disorder , music therapy’s ability to 130

alleviate depression symptoms can also be considered clinically significant with regards to heart

disease. This is consistent with scientific evidence as in a randomised-control trial of 40 patients

who underwent ‘open coronary artery bypass’ and/or ‘aortic valve replacement’ surgery, those

who listened to music during bed rest had an increase in levels of oxytocin release. However, 131

this study found no decrease in blood pressure or heart rate, although this is an older study with

the inclusion of subjective (as well as objective) assessment criteria. 132

Overall, there is strong clinical data to suggest that music therapy is beneficial in both

preventing and treating heart disease, particularly symptoms of high blood pressure, heart rate

variability, heart rate and increased hormonal markers of stress.

Conclusion

Our understanding of music therapy and its curative or preventative effect on illness

changes over time. Our current assessment is that music is a ‘powerful tool’ to engage and

induce changes in ‘multi-sensory and motor networks’, which link and strengthen regions of the

brain. This is notably true of music’s ability to alleviate emotional symptoms such as anxiety, 133

depression and agitation - although it is worth noting that many studies use subjective criteria

C. Grape et al, Does singing promote well-being?: An empirical study of professional and amateur 129

singers during a singing lesson, Integrative Physiological and Behavioural Science, 2003, accessed 30th June 2016, p. 1.

S. Koelsch and L. Jancke, Music and the Heart, European Heart Journal, 2015, p. 5. 130

U. Nillson, Soothing music can increase oxytocin levels during bed rest after open-heart surgery: a 131

randomised control trial, Journal of Clinical Nursing, 2009, p. 1.

Ibid. 132



when grading these responses rather than objective assessment. Fundamental to music 134

therapy is the desire to improve the quality of life of patients who have a neurodegenerative, 135

psychological or physical illness.

As our understanding of the role and function of brain regions increases, so does our

understanding of how music therapy can elicit changes in the brain. For instance, we know that

the frontal lobe and cerebellum are activated in response to musical practice , and it is these 136

regions that result in increased attention and motor-cognitive coordination , respectively. We 137

comprehend that thanks to musical practice, these particular regions (and many others) are

‘trained’ and synapses ‘strengthened’ , resulting in an improvement in cognitive skill following 138

a trial of listening to Mozart, for example. Our insight into the relationship between music, its

therapeutic effects and its neurological representation will only continue to grow with this

information.

Another interesting avenue is that of brain plasticity. With an increased interest in

preventing neurodegenerative disease and Alzheimer’s in the media due to an ageing

population , the topic is becoming more potent. Current research shows that musical training, 139

particularly musical training beginning at a young age, induces positive changes in brain

plasticity - this research has included many reputable and often longitudinal large-scale 140

studies to support this claim. This ‘brain plasticity’ important because ‘music-induced brain


2016, p. 221.





Ibid. 137

Ibid. 138

Ageing of the UK Population, Office for National Statistics, 2015, accessed 19th June 2016. 139



plasticity’ holds many ‘benefits’ in helping to restore or activate dysfunctional brain networks,

regulate hormone levels in the brain and allow for healthy ‘cognitive and emotional processes’ . 141

Whilst much attention is given to the increase in grey matter associated with musical

training , a recent medium-sized long-scale study showed us that white matter density also 142

increases with music practice along with an ‘enlargement’ of myelin-sheath cells, which give

insulation to allow for ‘rapid firing’ of electrical impulses, resulting in better and faster motor

control. This could make the difference between a patient with Parkinson’s who is unable to 143

hold even a spoon for example and having the autonomy to walk around the house, dramatically

improving quality of life.

Music has a ‘whole-brain effect’. Unlike languages, which are mostly localised to the 144

left-hemisphere, music activates both the right and the left hemisphere , which explains why 145

the corpus callosum in musicians is larger and more active than non-musicians (this research

has been heavily supported and cited). Given that neurodegenerative diseases such as 146

dementia, Alzheimer’s and Creutzfeldt-Jakob Disease - with the exception of stroke - affect 147

the whole brain, music may be more effective in preventing these diseases than language

training, for example. Music does not only alter the cortical level but also the subcortical level . 148

It does not only alter grey matter but white matter also . Music therapy induces activity level 149



C. Gaser and G. Schlaug, Brain Structures Differ between Musicians and Non-Musicians, The Journal 142

of Neuroscience, 2003, accessed 19th June 2016, p. 9240.




Ibid. 145



Creutzfeldt–Jakob Disease (CJD): Classic, Centers for Disease Control and Prevention, 2008, 147

accessed 19th June 2016.



Ibid. 149

changes in ‘almost all’ brain structures and modifies dopamine-pathway ‘circuitry’ and 150 151

these are reputable studies with objective assessment (brain scanning). We can see how music

elicits a number of changes in the brain which may, for example, be positive in the treatment

and prevention of dementia for instance.

Whilst there is a great deal of supportive data for the use of music therapy, there is still

more that can be done. More time could be spent on addressing the issues with music therapy

mentioned previously and finding solutions: by using a reading group as a control activity, by

controlling for external factors and by having a greater number of larger longitudinal studies. 152

Scientists can also use new imaging technology to trace the progress of dementia , with and 153

without music therapy, whilst considering ethical and economic dilemmas, if present.

Thesis

We have seen that music therapy has a broad and extensive history, that it is has a

dynamic relationship with the brain, offers unique advantages in comparison to a drug trial, has

a range of positive effects on numerous illnesses or disorders and diseases (both physical and

psychological) and we can also note that the science of music therapy continues to be explored

in new and exciting ways. Although there is always more research that can be done - as with any

area of science, this paper shows that there exists substantial evidence to support the use of

music therapy alongside standard care in the prevention and treatment of illness in order to

improve the lives of patients and caregivers worldwide.






P. Thompson et al, Tracking Alzheimer's Disease, Annals of the New York Academy of Sciences, 2013, 153

p. 1.

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