Music therapy for mental health

20 April 2019

Interview with 

Catherine Carr, Queen Mary University of London; Jorg Fachner, Anglia Ruskin University

REFLECTION

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Some music therapy occurs in community settings, but some goes on in hospitals where patients can be acutely psychologically unwell. Catherine Carr is a music therapist who supports patients in hospital, and she’s also a NIHR clinical trials fellow at Queen Mary University of London. Adam Murphy caught up with Catherine to find out how she uses music to help people in mental health difficulty...

Catherine - Quite often we use active music making. So we have a range of musical instruments and what we do is we work on a premise that there is no right or wrong way of playing. So people don't need to have any musical skill. And what we will do is we'll get used to playing the instruments together, explore them a bit, and then improvise together. So we make music up. And it's the role of the therapist to support the person in how they found the instrument. Afterwards we reflect perhaps about how it felt to play, what perhaps memories or issues that brought up, and we relate that back to what's going on for them right now with their mental health.

Duncan - In terms of mental health, what kind of conditions is this good for treating at the moment?

Catherine - In terms of evidence, there's very good evidence for music therapy helping schizophrenia and depression, but we work with a wide range of conditions, from eating disorders, anxiety and my own work is across different diagnoses within hospital care.

Adam - What does this actually do for them? How does it help them?

Catherine - I'd say there's probably three main ways it can be helpful. The first is just helping people to feel safe. So I think a lot of people know about the capacity of music to help to relax or to calm, and so quite often it's working with very strong emotions, whether it's anxiety or anger and helping find a way of expressing and regulating that. The second is that it's motivating, so it's a really good way of starting to relate to another person or people if you're in a group. And the third way is it's also enjoyable. A lot of people have lifelong love of music and it can be a really useful way of reconnecting back to that in day to day life.

Adam - And is this something that helps make long term changes or is it a short term management of mental illnesses?

Catherine - In terms of research evidence, we only really have evidence for up to about a year afterwards and that's quite often due to how the studies have been designed. So we do know that it can have an impact certainly within the year after having had music therapy. I think anecdotally you talk to people and the changes that are experienced can be perhaps broader than what you would measure in a study. So people can talk about how it's changed an aspect of their lives or improved their quality of life and some of those can be very longstanding.

Adam - Do we know much about what's actually going on in the brain? What evidence is there for what music therapy physically does?

Catherine - What's tricky with the evidence around the brain is that quite often these are sort of very controlled studies. We do know that specific types of music have different impacts on the brain. We know that when we listen to or partake in music, this works with the reward and motivation centers in the brain. So we know that it's something that is intrinsically rewarding for people.

We also know that when we make music as musicians, that we're using lots of different parts of the brain which go beyond those that we use in language. So certainly for things like brain injury there are ways that music can actually bypass damaged areas of the brain. And while that might not sound so relevant to mental health care, certainly if you're working with things like dementia, you can see it very visibly in how people remember songs or how people reconnect old memories through hearing music, that they've perhaps known in the past.

Adam - What kind of things, what what do you see?

Catherine - For example working on wards, people can be very disorientated in dementia and particularly because they're outside of their home context. So a song that they perhaps know or remember can mean that they go from being very withdrawn, very low, to starting to communicate with other people. They'll certainly remember all the words to the songs and so you can have these very lovely shared experiences with people on the wards and quite often that leads to talking about aspects of their lives that are important, that you wouldn't get in conversation without having had that musical interaction.

To delve deeper into the neuroscientific evidence behind music therapy, Katie Haylor spoke to Jorg Facher from the Cambridge Institute of Music Therapy Research at Anglia Ruskin University...

Jorg - Well the brain research into music therapy is starting, we do more and more. There's a lot of research investigating particular scenarios and then see how that is, you know, changing the brain. But what we've seen for instance in a depression study that was done in Finland, when you look at symmetries of the brain for instance, that the group that received music therapy in the resting state recording - so the one which is not related to any activity just when you sit and have your eyes closed, and that is showing how your brain is wired at the moment - was different after music therapy for 20 times two times one hour per week. So it had an influence on the brain processing per se, and that is something that is quite important and we have more and more studies that show that music first of all does change the brain. We know that the training changes the brain but then that the doing music is making a difference, even with short dosages to brain activity and that is that is very promising and that's why we're doing the research into that. And that's why we for instance also look in how it is when we interact in music.

Katie - Now just across the room, you have some EEG traces, I think, on a screen. Are you doing some research right now?

Jorg - Exactly. My colleague Dr Maidhof is currently investigating an improvisation that a dementia patient has done. And we had two EEG caps - one on the heads of the therapist and one on the patient. And then they were playing music together, drumming and then we recorded the electro-encephalogram of the brain activity. So what we are looking at is now how when we are playing music together and we join in. Let's say the patient plays duk and then the therapist also plays duk. And then the therapist goes on and then maybe the patient tries to join in and then the therapist adapts to the way of the playing of the patient.

And then at some point where you are in a synchronized. And when you experience that you can do that. You know well, you're still a human being, you're still in touch with others in the way you use music in the playing. And there's moments in the music therapy where there's a bit more for dense encounter. So that the person has insight and we know from psychotherapy research that when people change and they find out about themselves in the therapy, that there are certain moments which have a bit of a different quality. And we are very much interested how that quality looks like in the brain and what it is that makes it happen, because we are convinced - and not only us it is what therapists do - that there are parts in the therapy which are more important, which have more meaning and which are core to the change that music therapy does. And with the EEG which is giving us an ongoing signal of the brain's activity, we can trace that and can show and can identify that and that's what we have there on the screen.

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