What is Music Therapy? CHRISTY

WHAT IS MUSIC THERAPY?

By Christy

The article in the 1789 Columbian Magazine titled, ‘Music Physically Considered’ is the earliest known reference to music therapy (American Music Therapy Association, 2021a). The definition of music therapy has changed over time.

From, “music therapy is the treatment of physical and mental ills by means of music” (Antrim, 1944), to the modern definition that it is a clinical and evidence-based intervention using music in a therapeutic setting, to achieve personal goals (American Music Therapy Association, 2021b). The defining factors of music therapy is alleviation, change, music, relationship and personal qualities (Bunt, 1988).

Music therapy can be used to help people with communication difficulties, ranging from children with Autism Spectrum Disorder to patients who suffered from brain injuries to elders with dementia (Cleveland Clinic, 2020) (University of Minnesota, 2016). Other applications of music therapy include lessening withdrawal symptoms for individuals with substance abuse disorders and aiding individuals with mental health disorders to understand their feelings (Cleveland Clinic, 2020).

There are numerous approaches for music therapy, for instance, the Nordoff-Robbins method, Cognitive Behavioural Music Therapy, Analytical Music Therapy, and Community Music Therapy (Wong and Gans, 2021). They are all categorised under 4 types of musical interventions (Parkinson, 2020). Firstly, receptive music therapy is when the patient listens to music, either a live performance or a recording, and responds. This approach is more passive, and it can help stimulate or relax the patients, depending on the music choice. Secondly, recreation music therapy is when the patient is encouraged to play or sing along to a precomposed song. This approach is more engaging, and it helps the patient to develop fine motor skills. Thirdly, improvisation music therapy is for spontaneous music making. This includes patients playing a rhythm on the drum or singing a melody, which helps patients build their relationship with the music therapist or other individuals, if practised in a group setting. Finally, composition music therapy is when the patient creates their own piece of music, or a song with lyrics, with the support of the music therapist. This approach allows patients to express their creativity and externalises their thoughts and emotions, so they can understand their feelings.

Each music therapy session is unique and tailored to the individual, and it can be in a group setting or just the patient and the therapist; it can use recorded music, or a live performance by the music therapist or even professional musicians; the session can use a combination of the different music therapy approaches, or it could use just one approach. Music therapists are trained to select the most beneficial approach and pieces to tailor to the patient’s therapeutic goals. Their main role is to build a relationship with the individual so they can achieve any physical, emotional, cognitive, or social goals through different musical activities. A music therapist can either be an experienced musician who is trained to be a therapist or a highly trained clinician who is trained in musician skills (Bunt, 1988). In order to be a music therapist in the UK, it is necessary to complete an approved Master’s degree in music therapy, and be registered with the HCPC1 (NHS, 2015; British Association for Music Therapy, 2021). Music therapists are a part of a multidisciplinary team alongside other healthcare professionals, including psychotherapist and physical therapists. They work with each other to provide the patient with holistic healthcare.

Music therapy is for everyone. Musical training in not required in order to engage in Music Therapy (British Association for Music Therapy, 2021). It is the music therapist’s role to discover and utilise each patient’s natural musicality to offer therapeutic musical interventions.

WHY DOES MUSIC THERAPY WORK?

Music has been playing a significant role throughout the evolution of humans. Many primitive tribes use music in their ceremonies and religious rituals (Nettl, 1956), which modern humans also use in the same way. Mothers have been singing lullabies to their babies since around 2000 BC, when the earliest lullaby was recorded (Perry, 2013).

Music can create a sense of social connectedness, for example when we sing our school song or the national anthem. Many researches have showed that music engages multiple areas of the brain, including the prefrontal cortex, corpus callosum, amygdala and the hippocampus (JB Music Therapy, 2021). Music slows cognitive decline, triggers the releases of neurochemicals and can help regulate emotions (Stanborough and Wilson, 2020). Music also brings physical benefits, for example, increasing metabolism (Antrim, 1944), altering breathing rate, therefore heart rate and blood pressure; and can enhance physical performance by helping one’s body exercise more efficiently and cutting down one’s awareness of exertion.

HOW IS MUSIC PERCEIVED?

Sounds are processed by our auditory system (Sahyouni, 2014; CrashCourse, 2015; Neuroscientifically Challenged, 2015; Oliver, 2018; McCollum and Resnick, 2019). The pinna catches the sound waves, which then enter auditory canal, and eventually hit the tympanic membrane (the ear drum). This causes the membrane to vibrate. The tympanic membrane is connected to the auditory ossicles – the malleus, the incus, and the stapes, which amplifies the vibration. The stapes is connected to the elliptical window, so when the tympanic membrane vibrates, the elliptical window also vibrates, moving the fluid, the endolymph, in the cochlea. The movement of the fluid causes certain sections of the basilar membranes to move. The basilar membrane is made up of at least 20,000 fibres, which are longer further down the membrane. The different length of the fibre causes them to resonate at different frequency. The longer fibres resonate with lower frequencies; and the shorter fibres resonate with higher frequencies. The organ of Corti translates this movement of fluid into electrical impulses, for the brain to process it. The organ of Corti has hair-like receptor cells, called stereocilia. When the movement of the endolymph causes the stereocilia to move, it opens the sodium gated channels, allowing sodium ions to enter the cell. This change in potential difference could lead to an action potential, and is sent to the vestibulocochlear nerve, which carries the information regarding the auditory stimulus to the brain to be analysed and perceived.

Figure 1. The anatomy of the ear (created on BioRender) Figure 2. The anatomy of the cochlea (created on BioRender)

However, music is much more complicated than sound. Music is often defined as, “the art of organising sound” (McLeish, 1993; Martin and Law, 2003; Hutchinson, 2018). Music is made up of many elements, to name a few – pitch, rhythm, pulse, timbre, texture, harmony, tempo, and dynamics. Music is split into these different elements, which will be processed in different parts of the brain. With the advance in technology, for example, functional magnetic resonance imaging (fMRI), functional near-infrared spectroscopy (fNIRS), electroencephalogram (EEG), and Network Science, scientists now have a better understanding on how each element of music is processed.

Figure 4. Some examples of area that is engaged when processing music (sagittal view of the brain) (created on BioRender) (Husain and Schott, 2016; Johannes Sobotta et al., 2018; Kirollos et al., 2019; Neuroscience for Musicians, 2021) Figure 3. Some examples of area that is engaged when processing music (lateral view of the brain) (created on BioRender) (Husain and Schott, 2016; Johannes Sobotta et al., 2018; Kirollos et al., 2019; Neuroscience for Musicians, 2021)

www.musictherapy.org/about/history/ www.musictherapy.org/about/musictherapy/ www.jstor.org/stable/739403 www.bamt.org/music-therapy/what-is-a-music-therapist Bunt, L. (1988) ‘Music Therapy: An Introduction’, Psychology of Music, 16(1), pp. 3–9. doi:10.1177/0305735688161001.

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