with Norman Swan
Summary: This is a report from the VIIth International Music Medicine Symposium held recently at the Faculty of Music at Melbourne University.
Norman Swan: Hello. Today's Health Report is about the healing and biological powers of music. At first it sounds just like another alternative idea, but the reality is that music therapy is gaining increasing credibility, which is why film maker and producer Aviva Ziegler attended a recent international conference on the field, a meeting which attracted the world's leading experts, took place in Melbourne.
Aviva Ziegler: I had always thought of music as an art form, and I must admit that I'd never thought about it in the realm of science. Since the time of the Ancient Greeks, music has been recognised as a catalyst for changing mood and behaviour. There's hardly a culture that hasn't used it in its own particular way. But the modern idea of music as therapy, a form of treatment, only began at the end of World War II. Music was so successful in relieving the boredom of hospitalised troops, it opened up a whole new field.
Dr Rosalie Rebollo-Pratt is Vice President of the International Society for Music in Medicine, and Professor of Music at Brigham Young University in the United States. She runs one of the many music therapy programs at universities around the world.
Rosalie Rebollo-Pratt: What we do is look at these specific effects of music on behaviour. Such as the effects of music on premature infants; physiological parameters; chronic fatigue syndrome in women; anxiety in the dental patient; women in childbirth. Not just any music, we're looking at specific kinds and characteristics of music. Such as the amount of repetition, the amount of melody, tonic chords, things that the ear hears and wants to hear again.
Aviva Ziegler: Why and how the music actually helps is something you'll hear a little later. Let's look more at what it does.
Dr Jane Standley is Professor of Music Therapy at Florida State University in the United States. She's been researching the effect of music on premature babies with feeding difficulties.
Jane Standley: Music seems to be very effective for the babies, particularly those who are in a very stressful environment. If you can imagine a new-born baby who's going to spend the first two or three months of its life 24-hours a day in an environment with lights and lots of noise and alarm systems and equipment noises from ventilators, and the machines that are keeping the babies alive, you can imagine why the music might be very soothing in that environment.
MUSIC - lullaby
For this study, we used commercially recorded lullabies with female vocalists. New born babies probably prefer the female voice because they've heard the mother's voice for the last trimester in the womb, and we particularly selected lullabies that had accompaniments that were not very changeable. By that I mean a steady piano accompaniment, or a steady guitar accompaniment, as opposed to an orchestra where instruments are coming in, or ceasing to sound. Because each of those factors is an alerting response for the infants, and the infants that are as premature as the ones in the study are easily overwhelmed.
So I created a pacifier with an air pressure transducer that converted air pressure change to an electrical energy tape recorder. I have two switches available; one lets me program the amount of time that the baby receives music, and we usually give about 10-seconds, so if the baby sucks within the 10-seconds, the music will just continue, it will not cut off. If the baby fails to suck after 10-seconds, the music cuts off and the baby has to reactivate the music with an additional suck. And the other switch allows me to set the amount of pressure the baby has to use. So as the baby learns to do this, increasing the pressure that's required increases the baby's endurance. They have to suck a bit harder to keep the music on.
It ran for several months, and the results were that all of the babies discriminated when the music was on and off, and increased their sucking rates about 2-and-a-half times in order to receive the music reinforcement, and that they very quickly learned the discrimination; that only took about 2-and-a-half-minutes on the average for the babies to learn the skill.
Aviva Ziegler: In an earlier study, using music and massage with agitated premature babies, Dr Standley found that baby boys left hospital one-and-a-half days sooner than those not receiving music. But the females, in typical form, did even better: they left hospital 11 days sooner.
It's findings like those which have reinforced Dr Fred Schwartz's faith in the value of music for babies. Dr Schwartz is an anaesthetist in the neo-natal ward at Piedmont Hospital, in Atlanta, Georgia.
Fred Schwartz: What we're doing with music is using music to cause a stress reduction for the babies, and this has been replicated in a number of studies, that music can change the behavioural state of an agitated premature baby that perhaps is thrashing the arms, and consuming precious oxygen and calories. So these babies are often blue, when you play music, they stop thrashing, they go into a restful awake or asleep state, and their oxygen saturation actually goes up right before your eyes. The cost of intensive care for our premature babies in the United States is about $3-1/2-billion per year. If we can incorporate music into our neo-natal intensive care units, we can perhaps save 10%, 15% of the total expenditure.
Aviva Ziegler: The cost-saving potential of music therapy certainly impressed the board at Piedmont Hospital where Dr Schwartz works. Since the beginning of 1998, every premature baby now receives music as therapy as a matter of course.
Fred Schwartz: We have a system where we have a CD player for every baby. The CD player is mounted on the wall and then the output of that goes into a little computer speaker. The total cost of our music system for every baby is between $400 and $500 US, and this is a fairly automatic system where all the nurse needs to do is just press the button, No.1 CD; No.2 CD.
We like to start out with something rather simple, perhaps similar to what the babies have been hearing in the womb, so for most premature babies in our intensive care unit, we use womb sound, and female vocal sound music, perhaps for the 20 week to 29 gestational week premature babies.
Then they start being able to respond to a little bit more complex music, not over-orchestrated but a lovely lullaby is what these babies respond to very well. And perhaps a classical arrangement that is arranged very, very simply, so that the baby is not overloaded with their senses.
Fred Schwartz: You can watch the monitors, and within one minute you can see the heart rate going down, the oxygen saturation going up and often a behavioural change fairly immediately. Levels of oxygen in the blood go up and they stay up, and this has long-term consequences as far as helping that baby grow faster.
Aviva Ziegler: Dr Fred Schwartz from Piedmont Hospital in Atlanta, Georgia.
What is it about the music and the lullabies in particular, that might help babies to thrive? Dr Tony Wigram, of the University of Aalborg in Denmark, is President of the World Federation of Music Therapy. He offered me his theory:
Tony Wigram: Lullabies frequently are sung in a soft, gentle voice with gentle timbres. Whoever heard of a lullaby being played on an oboe, because it's got a more precise and hard timbre. And the music, the melody of a lullaby is quite often a series of short repetitive phrases. So the repetition of the melody and the way the melody may go up a little bit, but then go down, is very significant in its effect.
Tony Wigram: There's been some good research on those sorts of parameters. For example, by an English psychologist called John Sloboda who wrote a very interesting book, and has written many articles on the emotional effects and the language of music. Looking at the musical components that could cause people to have certain reactions like changes in their mood, or feelings of going to sleep, or feelings of sadness. And analysing those parameters and working out why does a piece like the Albinoni Adagio for Organ and Strings always make people feel a little melancholy, mournful, or remind people of situations where they feel sad?
Tony Wigram: There are actually clear parameters in the music, in the falling phrases and the way the melody is structured, and the repetitive minor rhythm of the harmony that you can identify that this music is going to cause that effect because of those parameters. And that's why the study of music and the skill of being able to use music is essentially music therapy. Music therapists need to be skilled musicians, because they need to know that in order to use those parameters in their interactions with clients.
Aviva Ziegler: Dr Tony Wigram.
There is some evidence suggesting that in the baroque era, some compositions were actually written to match the human heartbeat in the belief that music has healing properties to which the body is able to respond. But how the music really does affect the brain was the research interest of Professor Dale Taylor, Director of Music Therapy Studies at the University of Wisconson-Eau Claire in the United States.
Dale Taylor: People would ask me as a professional music therapist, 'How does music do these things?' and I really couldn't tell them, and that always bothered me. And so what I've done is to create what I call a biomedical theory of music therapy, and that biomedical theory basically says that music affects human behaviour by affecting the brain. And by knowing what those effects are, then the musical effects become predictable and they're reliable, they can be replicated. My work shows how music therapy helps decrease stress, lower anxiety and to improve those areas that are damaged when anxiety and stress are at high levels, such as the immune system for example.
The first real attempt that I made at explaining music therapy in terms of brain functioning was to come up with a neurological model for treating aphasia, and when those parts of the brain that are damaged are language parts of the brain, then that's called aphasia. And so what I've done is to propose a system for using music to help healthy parts of the brain take over the functions of the language functions of the damaged language centres which in 97% of the population are in the left hemisphere. So what I've done is to use the music functions of the right hemisphere to help regain those functions that were lost through damage to the language centres in the left hemisphere.
Actually we're using music to do that now. The neurological basis of that recovery process is based on findings showing that when a person talks, the most active parts of the brain are the language centres in the left hemisphere, but when a person is involved in music, the scans of the brain show (and they basically measure oxygen consumption in different parts of the brain) that much more of the brain, particularly the right hemisphere, is activated. And so there are billions more neurones brought to bear on the task. Using music, we can get the brain to start doing some things that it cannot do when there's no music, simply because it's much more of the brain working on it. The brain then will shift that task from the damaged area in the left hemisphere, perhaps over to the right hemisphere in a corresponding area. And because the brain has been shown through lots and lots of research to have that ability to shift functions from one part to another, I call that functional plasticity. And so we're using music to activate the functional plasticity of the human brain.
Aviva Ziegler: Dr Dale Taylor.
It was only Day 2 of the Symposium, and I was already reeling from immersion in a whole new world. Trying to take in papers with titles like 'The Anxioloytic Effects of Music in Perioperative Analgesia' and 'Changes in Quantitative Electro Encephalographic Parameters Occuring when Musicians undertake a Melodic Task' were enough to set my heart pounding. But I was beginning to understand that with the right piece of music, calm could be found.
Aviva Ziegler: Dr Tony Wigram explained how the music might affect my pounding heart.
Tony Wigram: The effect on heart rate and blood pressure and other physical parameters has evoked a lot of research, not just from music therapists but music psychologists. And it's a lot to do with arousal levels and with the elements in the music. What's really important when making this type of research is to define and describe the musical parameters in the music that you're using. So for example, to say somebody's heart rate reduces over a period of 30 minutes when they listen to Mozart, may indicate to the general population that if they go out and get a piece of Mozart and listen to it for 30 minutes that their heart rate will go down. But of course that can't be true. We have to know which piece of Mozart, and what were the musical parameters in that piece that may have caused heart rate to reduce.
One of my research areas has been the physiological effects of sound on the body, in particular, low frequency sounds. In some research I did, I found that arousal levels did reduce over time if you used pulse low frequency sinusoidal vibration together with sedative or relaxing music.
Sedative music is going to be music that's very predictable, because if you have music which has got a lot of surprises in it, where you don't expect sudden crescendos, sudden accents, changes in tempi, then you're always being surprised and your heart rate will fluctuate accordingly. If it suddenly goes very loud or very soft. So if we define the parameters of predictable music as being very stable, very equal level of intensity and without sudden changes in tempo, then I found that over time, heart rates reduce significantly with this type of music. And that can be very useful for somebody who has anxiety or stress related disorders, who needs to find a way of slowing themselves down and calming down.
Aviva Ziegler: Dr Tony Wigram.
Dr Rosalie Rebollo-Pratt took pity on me and others at the Symposium who weren't quite up to scratch on the science.
Rosalie Rebollo-Pratt: We were talking about pain. It sounds very complicated and rather daunting when you first hear all this Latin terminology as we did this morning. But if you think of it this way: if you stuck a pin in a muscle, say on your hand surface, that sensation goes up a certain pathway something like an autobahn or a freeway, and it goes up what we call the spinal theramic tract, everything goes up that tract, that's our main artery, up to the brain. Well, if you find some way of making a detour, distracting the signal, the brain doesn't perceive it as pain. Music can do this. Because of its patterning, it lures the brain away, it interrupts the signal and so you can be distracted from the pain, you can either not recognise it or be temporarily put off by it.
Aviva Ziegler: Dr Rosalie Rebollo-Pratt.
MUSIC - Song
Aviva Ziegler: The use of songs and songwriting is part of a pragmatic approach to music therapy prevalent in Australia. Emma O'Brien is the music therapist in oncology and palliative care at the Royal Melbourne Hospital. That song was written by one of her cancer patients.
Emma O'Brien: We use music therapy methods to help treat the symptoms for chemotherapy, for bone marrow transplants, to help them cope with their treatment and long periods of hospitalisation, so they can be alleviating sensory deprivation, feelings of loneliness, emotional stresses and also physical stresses that they may experience as part of the experience of being in hospital and having the diagnosis of cancer.
Aviva Ziegler: That song, written by another of Emma O'Brien's patients, appears on a CD called 'Life Sounding the Soul.'
Emma O'Brien: We had a male who had leukaemia but was unable to have a bone marrow transplant because there wasn't a donor available to match. And he then eventually became palliative, and I worked extensively with him and his wife. And he then wrote a song called 'How I Keep Going' which is on the CD, and it was about how he got up every morning to face the fact that he was living with dying, and the people in his life that were significant, and he dedicated the song to his wife. He used music therapy as an adjunct to his treatment in for instance, platelet transfusion when you have leukaemia, the platelet count, and platelets are the components that help clot the blood, can drop to drastically low levels, and so they have to undergo transfusions. This can be quite stressful because a sort of a result of the transfusion, they can have a terrible shaking fit that goes right through the body. So he used to get me to play pre-platelet transfusion, during it, and afterwards, and even the nurses would comment on how relaxed and happy he seemed, how quickly the platelets which were going through, a physiological response of relaxation is that your veins will dilate, and he found it much less stressful and didn't have any shaking fits.
Aviva Ziegler: Emma O'Brien.
As well as teaching at the University of Aalborg in Denmark, Tony Wigram practices music therapy in Britain. There he works with children with communication and developmental disorders like autism and similar conditions.
Tony Wigram: I think the most important area that music therapists are evaluating quite often with children with these particular problems, is their social interaction, their imagination and their creativity. And because of this, you're enabling them, you're empowering them to communicate in a non-verbal way, because most of the conventional ways of communicating for these particular children, are quite inhibited, delayed, or disordered. So we're trying to create a potential for them to communicate. But that means that you do need to analyse the musical material: the way they play a drum, the way they bang it, or the instruments they choose to use, and you need to understand by the analysis, what is the meaning of what they're saying. Are they telling you that they're feeling angry, or they're frustrated, or are they telling you that they're happy and they want to communicate with you.
We saw a little boy who was five years old, and he was referred to us because people thought he was autistic. He consistently talked about the toilet; he mentioned the word 'toilet' about 20, 25 times in the first three minutes of our meeting him. In fact he was very interested in the toilet because he wanted to watch the water go down, not because he wanted to use the toilet. In the music therapy session I didn't use verbal language with him at all. I gave him some drums to play and he stood with the drum either side, and he banged the sticks up and down. I mean his playing was very skilful; very quickly he showed me that he had great rhythmic capacity.
He could hear the rhythms I was playing and reproduce them. And then, what I think was most significant, was he was able to quickly anticipate and understand turn-taking. He played a few notes then stopped, and waited for me. And I played back to him. And we built up a process that was added to by the musical dynamic.
He became louder, he became softer, he got faster and slower. Everything was reciprocal and that's quite untypical in children with autism. This little boy showed a great capacity for creative improvisation at the same time in this dialogue as respecting and listening to what I was doing. So it was some very good evidence that this child had much more potential perhaps, at a non-verbal level, for communicating than had previously been estimated because of his rather repetitive and echolalic speech patterns.
Aviva Ziegler: Dr Tony Wigram.
These Tibetan bowls were demonstrated by Alan Lem, a music therapist and PhD student at the University of Western Sydney.
Alan Lem: The Tibetan bowls are probably the most fascinating sound-producing tools for the purpose of music therapy, because of the multi frequency characteristics. A common experience amongst my clients is that the person feels an immediate sensation of warmth and a certain feeling of being centred. People achieve very quickly a state of relaxation when I use the bowls, and also people go very quickly into an altered state of consciousness as we've witnessed today during this workshop.
Aviva Ziegler: The bowls might not be everyone's idea of relaxing sounds, but Alan Lem's workshops were mobbed by conference delegates curious about something new.
Alan Lim: In Australia, people tend to use conventional music more often than just sound. But I think the scope and potential for the use of bowls is tremendous, because we're dealing with sound more than just music. It means that the client can very often relate quicker, because there are no boundaries, there are no rights and wrongs, as to whether we play right note or wrong note.
If a sound like this, which is a dissonating sound, is immediately followed by a warm tone, like this for example, from a psychological point of view, what we're dealing with here is tension release. Tension and relaxation. So a person by listening to these sounds or playing them, can identify themselves immediately with the two states, and much quicker than they would be without these sounds to enter into a state of relaxation for example.
Aviva Ziegler: Alan Lem.
Whatever you might think of the music, a huge effort is being put into finding a rationale for its use as therapy. Tony Wigram explains.
Tony Wigram: The analysis and the scientific evaluation of the effect of music as therapy, is developing, and with the increasing demand that you find in health systems for evidence-based practice, we could say from my perhaps anecdotal or vague look at the field, that there's proportionately a lot more research going on in music therapy than there is in other professions, perhaps because people do perceive as maybe on first glance as new-agey. We have been provoked to try and provide more scientific evidence of the effectiveness of our therapy so that it will be used regularly.
Aviva Ziegler: Tony Wigram.
Taking in all the scientific data and new ideas had my head reeling again as I left the conference, and I certainly wasn't receptive to the thumping pop music which assaulted me as I entered a taxi to the airport. But my Indian taxi driver kindly changed it for some traditional Indian music, and I immediately fell asleep.
When I woke, after what felt like only minutes, the 40-minute trip was over, but the difference was that I now knew that it was the gentle, repetitive tone of the female voice which had sent me into another state of consciousness.
Norman Swan: And we'll leave Aviva snoozing at Tullamarine. Aviva Ziegler, who usually makes films, made that Health Report feature which was produced by Brigitte Seega and engineered by Janita Palmer.
I'm Norman Swan and here's some more from Ali Akbar Khan and Asha Bhosle.