Tune Up Your Brain

For centuries, music and medicine have been closely connected across time and space.

Apollo, the Ancient Greek God recognized for both his ability for music and healing, and his son Asclepius (the god of medicine), were said to be able to cure the mind through song and melody. On the other side of the hemisphere, classical Chinese music was composed of five sounds that each corresponded to an element of nature — which in turn correlated to the health of certain internal organs.

Even now, there’s no denying the physical impact a catchy melody can have on the human brain. As music travels from its source through your ear and to your brain, it activates a visual rainbow of brain regions that reach even beyond the auditory cortex. From areas like the limbic system (1), controlling emotions, to the activation of the motor cortex (2), music is not only involved in activating nearly all of your brain, but synchronizing it as well. But what does this mean for music in healthcare? And how does a tune like Queen’s “We Will Rock You” become one of the top five songs to use in music therapy?

MUSIC THERAPY

While the term “music therapy” was first recorded in the Columbian Magazine by an unknown author, nowadays it commonly describes the evidence-based use of musical interventions to accomplish an individual goal (whether it be psychological or physical). These interventions are broadly categorized into two groups: receptive music therapy and active music therapy.

Receptive Music Therapy

Receptive music therapy (RMT) is the more common musical intervention, and the form of therapy that most people tend to think of first. In this format, subjects are allowed to simply relax and listen to music (regardless of whether it is live or recorded), without any further instructions. While this makes RMT the easiest form to self-administer to patients as it does not necessarily require outside assistance through a clinical specialist or music therapist, its effectiveness can vary greatly from person to person.

Most RMT studies focus on creating specific playlists to help subjects throughout the treatment process, narrowing genres down to playlists that favor relaxation and reduce stress (breathing), playlists that recover energy and encourage concentration (energy), and playlists that release tension in the mind (serenity) (3). “Breathing” playlists focus on including songs with steady and predictable melodies that could be familiar to listeners, with a balanced volume and simple structure. And while these playlists could very well be made up of songs by notable classical Western composers, modern songs could still apply as long as they followed the “steady and relaxing” structure required.

Take for example: Chopin’s Nocturne Op.9 №2, compared to a more modern song like Japanese Breakfast’s Road Head. Though decades apart in creation, they both have slow, repetitive rhythms that continue for the duration of the sounds. Any instruments or vocals present have a delayed attack time that gradually inches into the melody, building and meshing over time.

This general irrelevance of music age and (sometimes) genre is applicable to the rest of the playlists as well. As both “energy” and “serenity” playlists require more stimulation and an unpredictable melody or harmony, songs included could come from a multitude of selections ranging from modern pop music, to rock music, to jazz music. After all, both Beethoven’s Symphony №9 (Ode to Joy) and Queen’s 1979 hit single Don’t Stop Me Now are great songs to get your blood pumping for a hardcore workout.

With this in mind, it’s easy enough to make such “relaxation” and “energetic” playlists on your own, catered to your personal tastes to help calm you down after a stressful day, or maybe get you excited enough to stay awake and party. RMT itself focuses on the expression of emotions and self-awareness — and by listening to relaxing music that is selected by the self, typical physiological markers of stress (heart rate, blood pressure, serum cortisol) can be significantly buffered as opposed to songs that have been chosen by an outside examiner (4).

Active Music Therapy

Compared to its counterpart, active music therapy (AMT) is much more engaging. AMT commonly works in conjunction with Cognitive Behavioral Therapy (CBT) largely due to the importance of engagement and rhythmic movement required for AMT, meaning that a trained health professional of some form may need to be present for the therapy to be successful.

By itself, CBT is a psychological treatment approach based on the premise that cognitive processes and thought patterns that cause negative actions can be restructured to form more positive behaviors (5). The treatment model is largely focused on engagement between the patient and others (including the therapist) to build a relationship of empathy and empiricism, using in-session interventions combined with assignments and feedback to slowly conceptualize and reframe the patient’s belief system. This method, effective in both one-on-one sessions as well as group therapy, has proven itself to be successful especially when treating patients with depression, anxiety, and/or PTSD (6).

Creating this steady rapport is one of the largest obstacles in the CBT process, especially when working with more anxious subjects, as getting them to open up and discuss their thoughts can be a difficult task. But music is a universal language — and by forming a relationship between participants by first discussion different music tastes and preferred genres, AMT can have a wholly beneficial effect on treatment following typical CBT guidelines (7).

In a 2021 study on Korean adolescents, CBT-based AMT was used to measure changes in State Anxiety (reactions in an adverse situation) and Trait Anxiety (tendency to present general anxiety) in children when combined with typical CBT methods. And while the group that underwent CBT alone had significant decreases in State Anxiety, subjects who underwent CBT-based AMT had a significant decrease in both State Anxiety and Trait Anxiety, as well as a larger decrease compared to the CBT control group (7).

While not all forms of AMT follow the same structure, most (if not all) follow the core belief of directly engaging with music in order to encourage the exploration of emotions and personal histories. Group sessions are often facilitated by a CBT-certified therapist, or a certified music therapist to facilitate participants throughout the process. These therapists work to encourage participants to write their own lyrics, as well as analyze pre-existing songs — many are given instruments to play by themselves, and invited to improvise a rhythm regardless of if they had prior experience with the instrument or not.

This is where music preference knowledge becomes a vital part for AMT, unlike how it was more derivative for RMT. While RMT is determined by set music structure and familiarity, AMT can use specific songs and genres that a subject enjoys to analyze the associative emotion that comes with the music. Perhaps the lyrics contain themes that are meaningful to the subject, or serve as an outlet for their frustrations. Even further, using preferred music genres is most important when encouraging participation for CBT, and aiding future discussions — after all, who doesn’t want to talk about their favorite song?

USE IN SUBSTANCE ABUSE TREATMENT

Music therapy has a multitude of different uses in practice. Patients have not only reported lower anxiety and a sense of calmness, but also a new mechanism for removing the craving for substances. It is crucial to make the distinction that music therapy itself isn’t the sole solution for substance abuse, but is meant to be used as a coping mechanism and as a gateway to other substance abuse recovery exercises.

Substance Abuse Music Therapy (SAMT) is not widely used yet, with only ~15% of music therapy sessions relating to substance abuse treatment. Because of the small population that participates in this form of treatment, the preparation process remains universal for all. Prior to beginning a session patients must complete multiple prerequisite tests and surveys for a psychologist to analyze. Further, patients are required to speak to a psychologist to analyze their needs and strengths. During these sessions, the psychologist will analyze a wide range of topics from patient emotional well-being to their history with instruments. These assessments, alongside the patient’s background, will help process the goals of the therapy and how to proceed. Moreover, this step identifies the final goal for the patient. These goals might include quitting substances such as drugs, alcohol, or nicotine, or to help reduce anxiety. The best way for SAMT to work is by using popular songs. Chroma, an art therapy provider based in the UK, found that the most effective song for music therapy was Will We Rock You by Queen followed by Three Little Birds by Bob Marley. The question that followed was if there was an underlying genre more effective in music therapy. The common answer seemed to be that softer, calmer beats and songs should be the primary music given to patients.

Surprisingly, the Chroma study also indicated that most sessions involve music that is high energy, while lacking a strong beat. This is because most of these songs are very socially popular and are often connected to a theme song of a famous show or something that is chanted at sports games. The popularity and the connection to a “happy setting,” made patients feel more “uplifted, united, and orientated.” Another hypothesis for why popular songs are effective is that positive memories are associated with that song. For example, when hearing a throwback song patients might reflect on a nostalgic feeling of joy. These reflective feelings whether it be nostalgia, joy, or something else all have helped this type of therapy become very successful.

The use of SAMT is growing, which has led to great progress in raising awareness for the treatment. In fact, the American Addiction Center identifies music therapy as a form of intervention with patients that suffer from substance abuse disorders. This distinction is crucial for the rise of music therapy because it identifies this form of therapy as an intervention and not a sole solution. This gives music therapy a foundation in order to conduct more research and in the future possibly set it as more than just an intervention.

References:

1. Sachs, M. E., Habibi, A., Damasio, A., & Kaplan, J. T. (2020). Dynamic intersubject neural synchronization reflects affective responses to sad music. NeuroImage, 218, 116512. https://doi.org/10.1016/j.neuroimage.2019.116512
2. Gordon, C. L., Cobb, P. R., & Balasubramaniam, R. (2018). Recruitment of the motor system during music listening: An ale meta-analysis of fMRI Data. PLOS ONE, 13(11). https://doi.org/10.1371/journal.pone.0207213
3. Giordano, F., Scarlata, E., Baroni, M., Gentile, E., Puntillo, F., Brienza, N., & Gesualdo, L. (2020). Receptive music therapy to reduce stress and improve wellbeing in Italian clinical staff involved in covid-19 pandemic: A preliminary study. The Arts in Psychotherapy, 70, 101688. https://doi.org/10.1016/j.aip.2020.101688
4. Chanda, Mona Lisa; Levitin, Daniel J. (2013). The neurochemistry of music. Trends in Cognitive Sciences, 17(4), 179–193. doi:10.1016/j.tics.2013.02.007
5. Kazantzis, N., Luong, H. K., Usatoff, A. S., Impala, T., Yew, R. Y., & Hofmann, S. G. (2018). The processes of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 42(4), 349–357. https://doi.org/10.1007/s10608-018-9920-y
6. Diehle, J., Schmitt, K., Daams, J. G., Boer, F., & Lindauer, R. J. (2014). Effects of psychotherapy on trauma-related cognitions in posttraumatic stress disorder: A meta-analysis. Journal of Traumatic Stress, 27(3), 257–264. https://doi.org/10.1002/jts.21924
7. Bong, S. H., Won, G. H., & Choi, T. Y. (2021). Effects of cognitive-behavioral therapy based music therapy in Korean adolescents with smartphone and internet addiction. Psychiatry Investigation, 18(2), 110–117. https://doi.org/10.30773/pi.2020.0155

This article was written by Iris Lu, who is a junior undergraduate student at UC Berkeley studying Integrative Biology, and Rylen Patel, who is a freshman undergraduate pre-medical student at UC Berkeley studying Molecular and Cell Biology and Business.

This article was edited by Annabel Davis, a senior undergraduate student at UC Berkeley studying Cognitive Science, and Jacob Marks, a junior undergraduate pre-medical student at UC Berkeley studying Cognitive Science.