Music therapy is a type of creative arts therapy originating in therapeutic practice since ancient times and research oriented treatments since the 1950’s. It has been used for healing in ancient cultures of greek, roman, egyptian societies, and great philosophers including Plato and Celsius. In treating archaic diseases and illnesses of the mind and spirit, it was even written of and promoted by robert burton in the 17’th century with his classic work, The Anatomy of Melancholy, in promoting music and dance as critical to treating mental illness of melancholia or what we now understand as depression. The 18’th century is where music therapy truly began its revival in the understanding of its effects on the nervous system.
The Brunonian system of medicine was introduced that argued the stimulation of nerves caused by music could directly improve an individual’s health and effects on the body. Yet, nothing compares to the surge of music therapy understanding as post World War One and Two in the treatment of soldiers returning from horrific trauma and PTSD on a new massive and global scale. It actually began in the UK where musicians would travel to hospitals to perform for soldiers suffering intense emotional and physical trauma. Now more than ever, as our technological advancements of our society are progressing at such a rapid rate, we are now able to scientifically, test, and observe the effects music has on the brain neurologically and in clinical treatment settings.
Music therapy itself is defined by the the certified board of music therapists as, “ The specialized use of music by a credentialed professional who develops individualized treatment and supportive interventions for people of all ages and ability levels to address their social, communication, emotional, physical, cognitive, sensory, and spiritual needs.” It has several far reaching clinical benefits, assisting clients in multiple domains including cognitive functioning, motor skills, emotional development, communication, sensory, social skills and overall quality of life. Delineations of specific music therapies can include multiple facets as well, from musical improvisation with multiple instruments, re-creation or composition of songs, and listening and discussion of music to achieve specific treatment goals.
Practices themselves can also include developmental work with children with special needs, trauma, PTSD (communication, motor skills, etc.) Music therapy is also used in some medical hospitals, cancer centers, schools, alcohol and drug recovery programs, psychiatric hospitals, and multiple correctional facilities. Physically, music therapy has been sound to improve heart rate, reduced anxiety, stimulation of the brain, and improve learning retention. There is also strong evidence of the biological and emotional responses to music neurologically, as listening to music activates brain structures involved in reward, pleasure, and emotional processing (e.g. insula, ventral medial prefrontal cortex, ventral striatum, amygdala, hippocampus;) ( Koelsch 2009).
Specifically in music therapies treatment of children with PTSD, from a plethora of psychological research music therapy has proved largely to be effective in treatment outcomes, especially in children who didn’t respond to other forms of therapy such as CBT.
Studies show around 15- 43% of girls and 14- 43 % of boys experience at least one trauma in their adolescent years. Of those children who experienced a trauma, 3- 15 % of girls and 1-6% of boys will develop PTSD. Also, rates of PTSD development differ for certain types of trauma survivors. PTSD itself is characterized by an inability to recover from a reaction of stress by one month following exposure to a traumatic event (American Psychiatric Association (APA), 2013). Some common symptoms of PTSD in both children and adults can include re-experiencing the event, intrusive memories of the event, prolonged emotional distress and physiological reactivity after exposure to trauma-related stimuli, avoidance of trauma-related thoughts and external reminders, negative alterations in mood and cognition APA, 2013.
Also symptoms such as anhedonia, constricted affect, social detachment, persistent negative trauma-related emotions and beliefs,alterations in arousal and reactivity such as hyperarousal, irritable and aggressive behavior, exaggerated startle response are also common in diagnosis APA, 2013. These individuals still experience residual posttraumatic stress symptoms that negatively impact their quality of life (Thomas et al., 2010) as well as increased risk for other mental health conditions such as depression and problematic substance use (Thomas et. al, 2010; Campbell et al., 2007).
Music therapy itself offers a widely accessible therapeutic option for children with PTSD. There is a large body of evidence that music therapy reduces stress and anxiety in clinical populations of children; Westrhenen & Fritz, 2014; Gold, Voracek, & Wigram, 2004; individuals with depression; Guétin, et al., 2009; Erkkila, et al., 2011; and even Alzheimer’s patients; Svansdottir & Snaedal, 2006). This research suggests it may have the potential to improve clinical outcomes and develop a strong sense of resilience in struggling individual. Music is evidenced to reduce emotional distress (Gross & Jazaieri 2014), foster social connectedness (Gregory, 1997), and improve overall wellbeing (Bonde & Wigram, 2002).
For children and adolescents who have experienced trauma, the resulting impact on the brain is connected with “difficulties in emotional regulation, behavior problems, poor concentration, and deficits in verbal memory” (Stien and Kendall 2004) One study found that children who listened to music while having an IV inserted into their arms showed significantly less distress and actually felt less pain than the children who did not listen to music while the IV was inserted.
Music therapy also has been implemented with many cognitive CBT therapy approaches, focuses using music as an aid in the processing of complex feelings and emotions. As in a case study of 8–11 year old children who had survived a tornado in the US, music was used to assist the children in expressing feelings and to help them make the transition back to school (Davis, 2010). The children created a musical composition based on their feelings about the tornado, which enabling them to acknowledge and process their very complex emotions in a new healthy and healing form. Similarly in another study that used music interventions with teenagers after the “Black Saturday” fires in Victoria, Australia in 2009.
The use of techniques such as improvisation, songwriting and the sharing and discussing of songs and the playing music with others who had been through very similar experiences and was very important in bonding, and healing outcomes, especially regaining personal confidence (McFerran and Teggelove 2011). In another study working with survivors of the September 11’th attacks in New York City, 33 music therapists provided over 7000 programs to children, adults and families. The programs were designed to reduce stress, improve coping, and process the trauma associated with the crisis by drawing on a range of techniques including musical improvisation, songwriting, singing, sharing stories, and relaxing with music (American Music Therapy Association,2011).
Even apart from the strict clinical setting evidence that music has been used as a healing agent, such as with survivors of the post-election violence in Kenya in 2007, It has shown to be tremendously effective. In the study, a community musician used music to recall and experience the trauma, incorporating humor into his work with survivors to help them deal with the distress associated with the initial violence as well as the resulting displacement (Akombo,2009).
Benefits of music therapy observed in studies such as the ones mentioned above, include improvements in mood, self expression, catharsis, facilitating grieving, relaxation, reflection, socialization, community building, stress reduction, and much more.
Considering the developmental stages in the effectiveness on children with PTSD, the research seems to suggest that between the sensorimotor, preoperational, concrete operational and formal operational period, music therapy can be effective in each stage. In the sensorimotor stage, birth to 24 months, it can help infants reduce their stress levels and self soothing behavior. At the preoperational, ages 2-7, an example study in 2001, found that an 8-week music therapy intervention in social skills development in moderately disabled children, resulted in an increment in terms of turn-taking, imitation, and vocalization.
This can include improvements in social skill learning, memory retention and speech development. By the concrete operational stage, ages 7-11, children are dealing with developing peer relations and handling change and transitions. In a case study of 8–11 year old children who had survived a tornado in the Southeastern, for example, music was used to assist the children in expressing feelings and to help them make the transition back to school (Davis, 2010).
Effects were quite positive, as they were able to use music as a coping mechanism, allowing them the opportunity to acknowledge and process their emotions in a therapeutic way. By the normal operational ages, or the teenage years of 12-18, music therapy can arguable be at its most effective, allowing music to become a refuge, improve coping, reduce the patients stress, and process the trauma or ptsd, by employing a wide range of musical therapy techniques. Including, musical improvisation, songwriting, singing, sharing stories, and relaxing, all with music.
Lastly, it is arguable that music therapy originated and remains the post effective in treating adults, specifically veterans returning from war who have experienced significant PTSD. because music elicits such a strong emotional response and is correlated with physiological functioning, we can measure that neurological response by the changes in the sympathetic (Iwanaga & Tsukamoto, 1997) and parasympathetic nervous systems (Krumhansl, 1997), and by changes in neural activity (Panksepp, 1997).
Multiple studies have also shown that music creates changes in the mesolimbic dopaminergic system, an area of the brain that mediates the experience of pleasure, reward, and arousal (Goldstein, 1980; Swanson, 1982; Wise, 2004). furthermore, fMRI neuroimaging studies have found that music increases the cerebral blood flow to areas of the brain associated with reward and reinforcement of pleasurable behaviors (e.g., nucleus accumbens and ventral tegmental area; Goldstein, 1980; Menon & Levitin, 2005; Swanson, 1982; Wise, 2004).
In victims of PTSD, music therapy is also helpful for patients experiencing anhedonia or muted emotional experiences, as it can access neural pathways to emotion previously down-regulated after the experience of the trauma (DeNora, 2002; Saarikallio & Erkkila, 2007). Music can also increase the release of endorphins to the brain, boosting positive feelings while reducing fear, self-awareness, and sadness, improving one’s overall emotional state (Chanda & Levitin, 2013; McNeil, 1995). The sense of community and group cohesion fostered in group music therapy can reduce feelings of isolation and estrangement (McNeil, 1995).
Indeed, while threat of social rejection has been shown to activate neural “alarms” (e.g. the amygdala), cues that indicate safety, group care, integration, and support activate areas of the brain affiliated with reward (e.g. ventromedial prefrontal cortex and posterior cingulate cortex) and increase the production of stress reducing hormones (e.g. oxytocin and endogenous opioids; Eisenberger & Cole, 2012). Studies have also shown that engagement with music is correlated with increased self-esteem and the reduction of feelings of worthlessness, particularly in younger populations (Haines, 1989).
Taking into account all the remarkable therapeutic aspects music therapy can have on an individual, there are some cultural differences than can either help or hinder the therapy process.