Showing posts with label Music. Show all posts
Showing posts with label Music. Show all posts

Friday, May 13, 2011

Music Therapy

I believe that many creative modalities can be usefully included in a therapeutic relationship.    There are times when spoken dialog can be more difficult, unwelcome, inhibited, or even frankly unhelpful.  Other types of activities can be part of a therapeutic milieu, and work on non-verbal forms of communication, as well as other forms of positive experience in the therapeutic frame.

The use of music in therapy is well-established.  Music therapy is a recognized profession, with a substantial academic literature behind it.  I believe that music is under-utilized in therapy generally,  perhaps considered outside the scope of experience or training of most therapists.  Even therapists with a background interest in music may not share this with patients, for a variety of reasons.  The predominantly oral tradition of psychotherapy can be so dominant sometimes as to view non-verbal activities as eccentricity.

Music -- listening, performing, learning, and coordinating -- can touch upon the following therapeutic themes:
1) emotional expression
2) performance anxiety / communicative inhibition
3) perfectionism
4) assumptions about capacity or incapacity to learn something new
5) focusing on an activity which is sufficiently engaging as to calm anxiety or agitation, or at least distract attention away from negative emotions or unwelcome thoughts
6) enjoyment
7) a sense of achievement
8) patterning the same learning schedule which leads to psychological change or skill acquisition of any sort -- some immediate progress in the moment--which needs to be enjoyable in itself-- but part of a process which can include thousands of hours of experience to grow substantially
9) a sense of trust and "harmony" with the therapist; possibility a modality which makes the therapeutic relationship stronger
10) on a sort of psychodynamic or developmental level, music could be understood as one of the individual's first experiences of emotional soothing (from the mother humming or singing to her infant), a modality which precedes verbal language.  There might be deprivations or problems associated with this dynamic for some individuals, which could become a therapeutic theme if music was part of the frame of activities and discussion.
11) music preferences and interests are, of course, an element of identity expression.  I believe that questions about music preference and experience are a useful part of a psychiatric history; often an understanding about this part of a person immediately deepens understanding, and offers a chance to connect in different ways, to build rapport and interested collaboration.  

Many types of music therapy involve having the patient improvise on a simple instrument, etc., or perhaps listen to music.  I think that doing cooperative musical exercises can be a valuable element, in which the therapist can act partly as collaborator or music teacher.  The technical skill level is not relevant, in my opinion, and in fact could be considered a type of neutral transferential theme to be worked with in the therapy.  Simply practicing a simple technical exercise on an instrument--even during a conversation--could be a tactic to help attain calm and relaxation, in the same way that many other physical skills can be relaxing (e.g. knitting, swimming, yoga). 

Here is a review of some of the research literature on music therapy:

http://www.ncbi.nlm.nih.gov/pubmed/19269725
2009 meta-analytic review showing music therapy robustly effective for a wide range of problems in severe mental illness, including overall function, well-being, and symptom control.  More sessions are more effective; 16-51 sessions associated with large effect sizes.


http://www.ncbi.nlm.nih.gov/pubmed/21474494
a 2011 article from the British Journal of  Psychiatry, showing robust effects of music therapy in the treatment of depression.  There was a "control group", but in this case the control group received "standard care" (medications + a few sessions of psychotherapy), while the active group received this same standard care plus up to 20 sessions of music therapy.  So, in my opinion, the study did not control for the effect of simply spending time with the patients for 20 extra sessions.  There should have been a control group which had 20 sessions of the same length of time as the music therapy group, but doing a "placebo" activity.  Nevertheless, this does show that, at the very least, doing music activities with patients during therapy sessions is a supportable practice.  


http://www.ncbi.nlm.nih.gov/pubmed/15846692
2005 Cochrane review showing that music therapy is an effective component of therapy for schizophrenia, leading to improved global state, as well as probable positive changes in various symptom clusters.  

http://www.ncbi.nlm.nih.gov/pubmed/18254052
2008 Cochrane review showing that music therapy may be effective in the treatment of depression.  4 of 5 studies showed greater improvements in depressive symptoms in the music therapy group compared to standard care.  

http://www.ncbi.nlm.nih.gov/pubmed/20614449
music therapy shown to be helpful to improve the rate of rehabilitation in brain injury or stroke

http://www.ncbi.nlm.nih.gov/pubmed/21292560
this is quite a cute study, showing that listening to Mozart's K.448 (sonata for 2 pianos) once nightly for 6 months leads to substantial reductions in seizures in children with refractory epilepsy.  It's a weak study, of course, since there is no control group. 

http://www.ncbi.nlm.nih.gov/pubmed/20129759
a similar study, but a bit stronger, since it shows that Mozart's K. 448 leads to an immediate change in EEG patterns, as long as the recording does not have prominent higher harmonics.  I've noticed this myself, that tones with very strong higher-order harmonics above the fundamental tone can prevent focus on music performance, particularly for those with very strong ear skills, or could even be strident and unpleasant.  Mozart himself was apparently very sensitive to this as a child.  This leads to another issue, about sound level:  the modern habit of listening to music at very high sound levels could sabotage not only one's hearing, but also the psychological benefits of the music. 


http://www.ncbi.nlm.nih.gov/pubmed/21290852
a discussion of the role of music in non-suicidal self-injury.

I think some music may itself be self-injurious, or at least a consistent cue associated with self-injury; but clearly there is therapeutic potential, for music to be helpful in affect regulation or as a healthy substitute behaviour instead of self-injuring.

I'm curious as to the manner in which musical lyrics or the emotional tone in music affects "self-talk" or inner emotional tone.  In a "Rogersian" sense, music with very depressive or hostile lyrical or tonal content may help a person to feel less alone--a type of empathic bond with the music--which may be therapeutic.  But I believe that such a bond is much more therapeutic if it leads to a sense of resolution of the underlying problems, or offers a consistent message of hope or joy despite whatever empathic connections are made with sadness, anger, emptiness, etc.  I think the greatest songs (present in all genres and eras) are those which suggest a resolution for problems of suffering or emotional pain, rather than simply evoking the negative emotion.

Wednesday, November 4, 2009

Rhythm Practice

There's a lot out there about various exercises or games you can do to keep your brain sharp.

I would like to compile a list of things for sharpening your mind that I think are interesting, which you can do at little or no financial cost.

I think that music practice can take many forms, many of which are not only intellectually stimulating, but also possibly quite meditative: a way to let go of worries or agitation.

Here are a few sites where you can do some rhythm practice (i.e. reading rhythms or imitating them). The difficulty is quite variable, from beginner to advanced:

http/www.emusictheory.com/practice/rhythmPerf.html
http://www.tedvieira.com/onlinelessons/sightreading101/values/reading.html
http://www.rhythmpatterns.com/

Wednesday, April 22, 2009

Studying & Practicing Techniques

The field of optimizing study or practice time is quite interesting. There are elements of wisdom from diverse points of view, such as from athletic trainers & coaches, elementary and high school teachers, musicians, and educational psychologists.

Here are a few ideas:

1) make a commitment to spend regular, frequent periods of time in study or practice

2) make your study or practice time interesting or fun

3) if your attention is failing, try to compete with yourself gently (e.g. put a mark on your page if you catch your attention wandering off); but also allow yourself brief breaks. In order to control this process (and to prevent your brief break from becoming a 6-hour break), you could use a timer. During breaks, you could rest quietly or go for a walk, perhaps reviewing in your mind some of what you have just learned. During periods of decreased attention, you may need to allow for more frequent breaks.

4) frequent review helps with memory consolidation. If you have just learned something, go back right away to remind yourself of it--maybe ask yourself, and answer to yourself, a few questions about it, rather than immediately plowing ahead with the next chapter.

5) Sleeping after learning improves consolidation of memory. Slow-wave sleep, which tends to occur in the first few hours after you fall asleep, is particularly important for memory consolidation. In one clever 2007 study published in the presitigious journal Science, subjects were exposed to an odor when learning a task. If they were exposed to that same odor during subsequent slow-wave sleep, their retention of the learning task was significantly improved. Here's the reference:
http://www.ncbi.nlm.nih.gov/pubmed/17347444
This suggests a simple aromatherapy technique to enhance your studying: infuse your study environment with a distinct, pleasant fragrance (for example, try an aromatherapy oil) -- then infuse your pillow with the same fragrance afterwards. During an exam or test, try infusing the same fragrance on your skin or clothes (just don't overdo it, or you might irritate the people writing their exams next to you!)

Furthermore, there is evidence that brief naps (60-90 minutes) in the middle of the day can help with memory consolidation, motor learning, and can also prevent the deterioration of mental and physical performance which tends to happen in a long day. Here is one reference about this:
http://www.ncbi.nlm.nih.gov/pubmed/12819785

6) choose a study or practice environment which is psychologically pleasing. This could include multi-sensory environmental manipulation, including access to healthy foods, smells, comfortable seating, quietness, soothing background noise, etc.

7) if part of the learning task requires repetition, make special effort to infuse the repetition with something imaginative.

8) if part of the practice is for exam preparation, etc. then you could try to mimic the exam environment repeatedly--e.g. by doing mock exams at the same time of day as the scheduled exam, or by doing these practices in the same physical location as the actual exam, if possible.

9) if the practice is for a performance, it can help to record yourself periodically; when you hear or look at your recording you may need to be critical but you should also consciously affirm the aspects of your performance that went well. Self-criticisms should never be in the form of a personal attack (e.g. "I'm stupid!") but should be gentle observations of areas to work on or change.

10) a tutor could be quite helpful, not merely to "teach you" but as a motivational figure to help you practice or study more efficiently or with greater enjoyment (along the lines of a personal trainer for fitness). A friend or study partner could have this type of role, provided the friend does not become a distraction from your work.

Tuesday, March 17, 2009

Drum Circles

Drum circles are groups where people gather to pound drums together: producing, hearing, and appreciating rhythms.

The perception of rhythm is one of the core elements of human experience.

Over hundreds of thousands of years of human evolution--even before the development of culture--the perception of rhythm must have been a very important part of daily life experience.

Here are some examples of rhythms that have been part of life experience for millions of years:

-The rhythmic pounding of ocean waves
-The beating of the heart (as perceived by feeling the pulses through touch, by feeling a throbbing, excited heart in the chest, or sometimes by hearing one's own or someone else's heartbeat)
-The rhythm of breathing (regular and soft in a calm state, rapid or erratic in anxious or excited states, irregular in various particular ways as a person is crying or sobbing; or when a person is dying, e.g. Cheyne Stokes respiration)
-The chirping of crickets or the croaking of frogs (these rhythms being affected by human proximity)
-The rhythm of work tasks (e.g. preparing some kind of meal or building some kind of structure would involve repetitively pounding, picking, or working with a material, and if this was a monotonous, laborious task, a rhythm would naturally form to help the person "get into it")
-The rhythm of human footsteps (steady and strong when feeling confident and certain, rapid or timid when frightened, stomping when angry)
-The rhythms of the human voice. Before the development of languages over 50 000 years ago, probably a great deal of communicative content between humans would have been based on "non-verbal" vocalizations, which would have emphasized tonal quality but also rhythm. Today vocal rhythms are most obviously part of the expressive content in poetry and song.
-Part of rhythm includes silence. It is the "empty space" between sounds. There was a lot more silence in pre-modern cultures.

Upon the development of human culture, starting perhaps 50 000 years ago, rhythms would have been generated spontaneously as a part of creative expression, as celebration, or as ritual.

In modern culture, perhaps a lot of the ancient, prehistoric aspects of rhythmic perception have been "drowned out". In urban environments, we have a lot of cacophonic, industrial sounds, or multiple sources of sounds all coming at us at the same time. There may not be very much silence at all. I suspect that this cacophony is a contributing factor to life stress, and one of the variables increasing the rate of mental illness (there are certainly many studies showing increased prevalence of various mental illnesses in urban environments). As a corollary, I believe that spending time developing one's musical and rhythmic experiences is beneficial to mental health.

As a therapeutic modality, drumming could help people in various ways:
1) as a form of meditative focus
2) it involves physical action: it is a form of exercise as well as a form of tactile stimulation
3) it helps to focus attention: it is a form of mental exercise, as well as a means to distract mental energy away from anxiety or other negative emotions
4) it can be an endless source of intellectual stimulation, with hearing or producing increasingly complex rhythms and cross-rhythms. This can evolve to become a source of esthetic enjoyment, also leading to appreciating rhythm in other aspects of life and music more richly.
5) it can be a social activity, in which other members of the group can be guides or teachers: in drum circles, individuals need not be skilled in drumming or in generating complex rhythms--exposure to the group permits a social learning experience
6) similarly, a drum circle could be a good setting to deal with performance anxiety or social anxiety, in the comfort of an encouraging and accepting group
7) it can simply be a healthy, enjoyable form of stress management
8) drum circles can be a means to build community: the experience combines elements having to do with conformity (maintaining the same rhythm together) and with individuality (each person may have a separate or special rhythmic role or task) -- both such elements are required to have healthy community life

In Vancouver, I know of one regular drum circle group, which has been open to anyone interested. The leader of this group, Lyle Povah, has done interesting work with drum circles as part of an inpatient eating disorders treatment program. Here's his website:
http://lylepovah.com/

There may be similar groups in other communities across the world, and I encourage people to research this, and to consider checking one out.

Friday, March 13, 2009

Doidge (Neuroplasticity) review - part 1 (Merzenich)

This post begins my review of Doidge's references from his book on neuroplasticity.

The first references I have looked through pertain to the work of Michael Merzenich. He has done very interesting research, dating back 4 decades, a lot of it having to do with studying the auditory cortex, and how it changes in response to stimulation of various sorts during different phases of development. Also he done major work researching and developing cochlear implants for treating hearing loss.

His 2006 article about using a "brain plasticity based training program" to improve memory in older adults (http://www.ncbi.nlm.nih.gov/pubmed/16888038) is interesting and encouraging, yet it warrants a close look at the actual results: the memory improvements from this technique were very modest (though significant), also the control groups were both quite passive (one group just looked at DVD videos, the other had no "intervention" at all). It would have been much more interesting to me to see an active control group in which the individuals would be doing simple memory exercises or other active intellectual stimulation for the same length of time. Because this type of active control was absent, the results may aggrandize the specific form of skill training described in the study; this skill training regimen is now being marketed, and money is surely disappearing from the pockets of many people, including many elderly people who may not have an abundant financial reserve. This makes me especially less enthusiastic about the results. I have no doubt that active mental exercise changes the brain through "plasticity" but I have to wonder if we have to sign up for the deal ("save 20% and get free ground shipping!") with this specific technique to achieve this. Perhaps signing up for a book club, memorizing poetry, and playing chess daily, would accomplish similar results. I would like to see what the evidence has to say about this. His website is interesting to look at, has a few mental exercises to check out, the style of which I think really is quite positive and imaginative. I will be curious to see if his approach--and variations of it-- could be specifically helpful in treating disorders such as autism. But I don't see good clinical data out there yet.

As an amateur musician, I have found that "ear training" is probably the most important, but often least taught or practiced, form of mental development for improving musicianship. Merzenich's exercises clearly focus on "ear training" as a significant component. Here's his website for you to check it out yourself: http://bfc.positscience.com/

Here's a link to a program you can acquire, designed for music students, which develops musical ear-training ability much more thoroughly, in my opinion (I recommend this to all musicians): http://www.earmaster.com/

Friday, February 13, 2009

Singing

There are a number of reasons why singing (out loud!) can be beneficial for mood:

1) the parts of the brain, as well as the facial and pharyngeal muscles, involved in singing, are similar to those most active in positive mood states. This may seem a trite or ridiculous association, but it is supported by evidence, namely that voluntary actions associated with happiness, even if unconsciously initiated, lead to more positive mood. Here's a link to the abstract of a classic, amusing, 1988 paper by Fritz Strack, published in The Journal of Personality and Social Psychology (another great journal that I recommend following), demonstrating that changing the position of facial muscles leads to a change in emotional response:
http://psycnet.apa.org/journals/psp/54/5/768/

2) singing is active, yet relaxing; potentially social, yet individual; creative, yet structured

3) Fellow singers--if singing is done in a group--are likely themselves to be emotionally positive and encouraging, leading to a positive social environment.

Here's a link to an abstract demonstrating that choir singing leads to improved mood and reduced stress hormone levels:
http://www.ncbi.nlm.nih.gov/pubmed/15669447

Of note, actively singing music -- not merely listening to music -- was required to produce a beneficial effect.

Monday, February 9, 2009

Noise Pollution

Peace and quiet are important for mental and physical health.

Here are a few links to references:

http://www.ncbi.nlm.nih.gov/pubmed/14757721

http://www.ncbi.nlm.nih.gov/pubmed/15936421
(A 2005 study published in Lancet which showed that noise causes increased irritability, and a negative impact on cognitive development in school-aged children)

On a related note, the use of music players such as iPods can cause permanent hearing loss, particularly if people have the volume turned up very high. People are more likely to use higher iPod volumes if the background noise level is also high. Here are some links to information and evidence:

http://www.hearinglossweb.com/Medical/Causes/nihl/mus/ipod/ipod.htm#fast

http://www.ncbi.nlm.nih.gov/pubmed/19124629

http://www.ncbi.nlm.nih.gov/pubmed/17430434

http://www.ncbi.nlm.nih.gov/pubmed/17711774

Also, the sound volume at a rock concert or a nightclub is sufficient to cause hearing damage, especially if this is an activity done regularly without hearing protection. I recommend using earplugs at rock concerts (yes, I'm serious!) Here is some evidence:

http://www.ncbi.nlm.nih.gov/pubmed/8499785

http://www.ncbi.nlm.nih.gov/pubmed/16825883


http://www.ncbi.nlm.nih.gov/pubmed/12176760

Friday, August 8, 2008

Music & Repetition

Life is full of repetition.

Life problems, including many of those associated with depression, involve a lot of repetition, and monotony.

Symptoms recur. Relationship problems recur. Problematic themes recur.

We often seek to end the repetition.

Sometimes it is necessary to end the repetitive cycles, if we can see them.

Other times, I think one can work with repetition in a similar way as occurs in music.

Music is repetitious. The rhythm or beat may be constant. Various accompaniments may be the same throughout. Themes within a piece of music may continuously recur. Without some degree of repetition, a musical piece would seem confusing or aimless. Changes, colourations, variations, and harmonies can transform monotonous repetition into a beautiful and dynamic composition. Repetition itself may not be the problem.

I encourage the idea of managing some recurrent life themes in a musical way --your repetitive theme could be part of a meaningful composition. Also, a musical approach may permit you to work through the old theme, say goodbye to it, and introduce something new.

Tuesday, July 29, 2008

Music

The intersection between music and emotion is complex.

Musical preferences or predilections are often very personal and individual, and are often coloured by a person's past history (e.g. some songs may be associated with positive or negative past life events). Of course, the musical styles that you grow up with often become those you permanently prefer.

I've noticed quite often that patients of mine who struggle with sadness or anger may choose music that has a sad or angry emotional tone. In these situations I worry sometimes about whether the music itself is "feeding" the negative emotion. An extreme example of this would be music in which the performer is screaming, often about how bad life is, where the listener--often using headphones that are socially isolative--is absorbed for hours every day.

But I think that music is an external experience that can touch us, or resonate with emotions. In this way a musical experience can help us feel less alone, more understood, more "in synchrony" with something outside of ourselves, even if the music is laden with the same kind of sadness that we may experience internally.

Therapeutically, I have to acknowledge the value and power of this kind of "synchrony". So I generally would never try to dissuade the fan of "screaming angry music" from continuing their choice of genre (besides, I would be just one more person unsuccessfully attempting such subjectively intrusive and unwelcome advice). Yet I encourage people to gently explore types of music outside of their familiar territory, and to search for music which goes further than emotional synchrony alone, but also soothes, calms, inspires, provides hope, gives energy, or gives a thrill of joy. Some of the great works of music can touch us in our sadness, and therefore "resonate", while also guiding us towards hope or even making us smile with delight.

Here are some specific examples (off the top of my head) which work for me (everyone will have different tastes, of course, but if you're looking for something different, give these a try) :

-anything by W.A. Mozart. the piano sonatas (exquisite, sweet); the piano concertos (poignant and sometimes sad but always ending with hope and joy -- and the tunes stay in your mind); the wind concertos (clarinet & oboe).

And very specifically a vocal piece by Mozart called "Exsultate, Jubilate"; the piece in its entirety is a distillation of the joy of life. The last item in this piece is the perfectly beautiful and energetic "Alleluia". In fact, I would go so far as to make this whole piece--including the composition itself as well as the performers and their backgrounds--a metaphor for joy in life: to have joy, one must work at it for years (as the performers have done). One must hear others and learn from others. One must pursue poignancy as well as virtuosity. One must have moments of tension and dissonance, but they must always be relieved imaginatively and beautifully. Some of the joyous moments may be brief, but they stay with us forever even after they are literally over. My favourite performer of this piece is now Carolyn Sampson. Kiri Te Kanawa was my previous favourite. I'd recommend listening to it on the best possible stereo system available to you.

Another specific selection is the Goldberg Variations by J.S. Bach as played by Glenn Gould (who made two recordings of this piece, in 1955 and in 1980 -- I'd recommend hearing them both, starting with the 1955 version; the final aria at the end of the 1980 version is like a sweetly beautiful farewell from one of the great musical geniuses of the century). Also there's a version by Murray Perahia which is extremely good too, in case you find Glenn Gould's playing too eccentric. This piece is another metaphor for life: it starts with something simple and beautiful; it moves through many variations with different degrees of motion, emotion, and energy, yet always with the same underlying grounding theme; then it ends beautifully and serenely, almost just as it began. Implying a cycle that continues yet changes, beginning and ending at peace, but with lots of work and tension and playfulness and growth in-between.

Other specific suggestions:
1) Chopin, Piano Concerto #1 in E minor, Opus 11. The second movement is an example of sublime beauty.
2) Beethoven: Violin Concerto. Beethoven had a difficult life as a result of his own inner emotional problems (lots of depression, irritability, anger, relationship disappointment) in conjunction with various external sorrows, especially the total loss of his hearing. His music is full of emotion and power; underneath the sorrow there is sweetly touching beauty and joy, and I think the violin concerto is one of my favourite examples. Anne-Sophie Mutter is a great performer of this piece.
3) Beethoven: slow movements from many of the piano sonatas, such as "Pathetique" and "Moonlight".

With all of these suggestions, I realize that for some people, they would just rather listen to something else (musical taste is such a personal thing). Also, when feeling very unwell in any way (emotionally or physically), sometimes even your favourite music can feel irritating or can make you feel worse (it may remind you, for example, of how much you could be enjoying it if you were feeling well; your lack of enjoyment when ill could then remind you again of your illness and make you feel worse).