Can Music be Medicine?

20 April 2019
Presented by Katie Haylor.

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This month, Naked Neuroscience is putting music therapy under the microscope. We’re tuning into the therapeutic properties of tunes, asking  - what actually is music therapy? What health conditions can music therapy treat? And what’s it actually doing to the brain? Plus, we’ll be picking apart some of the latest neuroscience research, with the help of our local experts.

In this episode

Brain schematic

01:13 - Building a brain

We pick apart some of the latest neuroscience news...

Building a brain
with Helen Keyes, Anglia Ruskin University; Duncan Astle, Cambridge University

Can we build a brain? What does musical training do to your brain? We pick apart some of the latest neuroscience news with Duncan Astle from Cambridge University and Helen Keyes from Anglia Ruskin University. First up, Helen looked at a paper about whether musical training can improve your ability to filter out irrelevant information, and focus on the task at hand...

Helen - Well we know quite a lot about how music shapes the brain but we don't know anything yet about how music affects your attention. So we know that music can actually change your brain structure in ways that have to do with music. So they can change the auditory cortex if you're musically trained, it can make changes in your brain that lead to you being better at recognizing melody and tempo changes, things that you might expect. And slightly more interesting is that those skills can transfer into other auditory and skill improvements such as being able to recognize speech in a jumbled noisy environment. So there is a slight transfer already known and from these skills but this paper was being a bit more ambitious, looking at whether musical training can transfer to other cognitive skills and lead to improvements in your attentional skills.

Katie -  how did they go about trying to do that?

Helen - Well they looked at 18 professionally trained musicians who were pianists and compared them to 18 non musicians and these samples were matched for age and gender.They asked the participants to carry out an attentional network test to measure their executive control function. So in this test your job would be to say whether a centrally presented arrow was pointing to the left or right. A very easy task but that arrow would be surrounded by other arrows. Sometimes it'd be pointing in the same direction as the central arrow so to be congruent, and sometimes it'd be pointing in the opposite direction to the central arrow so incongruent.

Now this task is very easy if all the arrows are pointing the same way, but if the central arrow is pointing in a different way from the distractor and flanking arrows, it can take you a little bit longer to focus your control on the central arrow and put the irrelevant distracting information out of your mind. So that's what this test was measuring and they found that musicians were more efficient at ignoring the distractor arrows and focusing on the task at hand and getting the answer right more quickly, the direction that the central arrow was pointing.

Katie - So if being a musician is good for our ability to attend to things, does that mean we should all be teaching our kids to play the piano?

Helen - It depends on your perspective. So I would say yes! Teach for success. This is a great idea. The tiger parents are correct. The idea that if you teach your child or train your child to be and have a sustained attention on a musical task, this might transfer over to other cognitive skills and their ability to focus their attention better. However I'm sure other psychological colleagues would point out that this can also have negative impacts of putting too much pressure on your children. But from a purely and cognitive point of view yes this is a very good idea.

Duncan - I always think with these sorts of natural experiments, the chicken and the egg problem, as in how do we know for sure that it's the musical training that is causing these cognitive changes over time and not that these cognitive differences are there anyway, and they emerge at different points and in different ways across the lifespan and that's why they seem to co-occur with the musical playing.

Helen - I mean this is an excellent question and it's addressed by the paper in two ways. So firstly they ran additional analyses to show that the number of years of musical training that you have is strongly correlated with this improved cognitive function. So that suggests that it might be the training that's driving the effect, but I think you're right it's very difficult to say, you know, especially with classically trained musicians whether it's you know an educational effect or something else happening here to drive this.

The only study that I can think of that would support the idea that it's the training driving the improvement is a study that looked at 70 children who were between the ages of 5 and 7 and some of these children showed an interest in taking up musical training and some of them didn't. And at that particular stage, no differences, no cognitive differences or musical differences even were observed in that group at that stage. So it's not fantastically concrete evidence but it is suggesting that you can take people with the same baseline and musical training can perhaps have this positive effect.

Duncan Astle looked at a paper which built an artificial brain in order to better understand how the human brain works...

Duncan - A brain cell in this pretend brain is - imagine it just like a circle on a piece of paper. We could draw it out. But at a computational level it's just a simple equation. And usually it's a learning equation. So it takes information in and it adjusts itself depending upon what it's just received and then it sends on a message or an answer to the equation onto the next neuron and so on, and so we can then imagine that we have a whole sheet of those neurons, a whole sheet of those circles each with an equation. Then of course we can layer the sheets up to create multiple different layers of our pretend neural network and that in essence is how the simulation works.

Katie - You've got this pretend brain, this highly complex system. What did they do with it?

Duncan - Well they trained this pretend system to perform multiple different cognitive tasks by giving the brain input and then checking its output. And gradually over many thousands of iterations they managed to train it to perform 20 different tasks - memory tasks, some inhibition tasks, attention tasks, some target detection tasks. And when they had trained it to perform these different tasks they could then explore "what has this neural network learnt and how is it able to do this?". And they found some really important things so the first amazing thing is that it can do it. It can be so flexible that it can perform these 20 different tasks really well. That is a first and that's surprising.

The second thing they learnt is that naturally emerges different types of neurons or different types of brain cells within the network that offered different functions. So for instance some of them seem to be really important for the inhibition tasks. Others seem to be really important for the memory tasks, just like you might expect to find in the real brain.

The third thing they found is that some of the tasks will share neurons so there seems to be some general purpose neurons. We know that's true in the real brain.

Also the fourth thing they learnt was that the system learned to combine different clusters of networks to perform really complex tasks. So we learned that you can perform really complex tasks by combining much simpler tasks. Again that's something that the real brain does too. And finally they were able to show that you can damage this simulated brain in different ways and the patterns of impairment to performance that will produce are really similar to the pattern that you get when real people experience brain damage. So there was some really key surprising and kind of quite groundbreaking findings from that analysis.

Katie - First of all that's amazing. We've got a pretend brain going on in a computer. Looking ahead what kinds of applications could this be used for? Could you get to the stage where if it's good enough you can test out treatments on a pretend brain before testing on a real brain?

Duncan - I think artificial intelligence often gets a really bad rap. It's going to steal your credit card details and steal your job and so on. But actually it's an amazingly powerful tool that we can use to all sorts of brilliant ends. So from a scientific perspective it gives us a great way of exploring how the brain might work and provides us with a way of interrogating that system in a way that you can't do with a real human being. So for instance in our lab when we're designing new tasks or new experiments we not only run them with human beings, we also run them using these kinds of simulations so that we can compare and contrast how the two systems are doing it.

So that means that we make a lot more progress in our understanding of what's really going on under the bonnet. And you can start to simulate things, so for example maybe we could simulate different kinds of environments that children might grow up in by simulating the way in which we train the network. And that's the kind of thing that we would never be able to do as an experiment ourselves but because we can simulate a brain and we can experiment with it in all sorts of incredible ways to reveal new insights about how the brain works, how it develops, how it recovers from damage and potentially in theory what kinds of interventions might be beneficial to create a more robust or more resilient system in the future.

Katie - Is it fair to say that even though this pretend brain is incredibly sophisticated, there's always going to be room for a bit of human error, because I guess there's always going to be a coder behind the the equations that I've gone into in the first place.

Duncan - In essence even as complex and sophisticated as this particular simulation is, it's still not a patch on the real thing. So the human brain is the most complex computational piece of equipment known in the universe. And so simulating it in this simple way is really useful from a scientific perspective but it would always be a bit of a simplification relative to the real thing. That doesn't mean it's not useful, it still is massively useful but it's never going to be, you know, 20 different tasks. You and I can perform a lot more than 20 different tasks and I think we'll always struggle to produce a full simulation, but this could still be really useful.

this is a cartoon of a human brain, made from musical notation

What is music therapy?
with Jorg Fachner, Anglia Ruskin University

Whether it’s Basement Jaxx or Beethoven, Jazz or punk rock, everyday billions of us enjoy listening to and playing music. But can this ancient artform be used therapeutically, to benefit our health? This month, Naked Neuroscience is putting music therapy under the microscope. To find out what actually goes on in a music therapy session, Katie Haylor spoke with Jorg Fachner from the Cambridge Insitute of Music Therapy Research, at Anglia Ruskin University...

Jorg - Music therapy has different approaches. So let's say the music therapy which is based on making music together and then discussing about music or not discussing on what you have done. So let's say when you just make music together you are in a non-verbal space interacting with the other one. You may think "well I'm not able to play that" but rhythm is kind of something that everybody can use, a rhythmic activity. So we are basing a lot on the rhythmic activity when we're playing music together and it does not mean that you need to be sophisticated on the instrument. You can just hack on a piano.

Then of course the therapist would just join in and try to get the pace off your [tap tap] or whatever you do on the piano, you know. When you start playing single notes, the therapist gets in place or just gives you a certain range of harmony and you can add melodies onto it. So these are things that we are doing when we do music together.

We just may sing songs together which are of importance for that person because we know that this is now that therapist when he has spoken with that person before that this song is of value for him or for her. So this actually it is quite interactively situated so you can adapt completely to the other one in that situation with the music you can play music that will cheer the person up, or you can calm somebody down that is agitated in a way, so you can use the properties of music in an interactive context to bring somebody to a goal that you want to set or that the other one wants to achieve.

Katie - There are various different types of therapy, talking therapy for instance or maybe medication. Why you use music to tackle a problem rather than other techniques?

Jorg - Music is the language of the emotions, so the way that you can say something in the music is different to using words. So I'm trying to say something now which makes sense, but if you have a very complex thing sometimes you can say it much better - like an emotion that you can't express - but if you can play it very strongly on a drum or you play it very gently which is like a symbol of touching, you can express much more sensitive with your senses what is inside which is unspeakable which you can bring out and that is something that makes music incredible as a tool to express yourself.

So that's the emotion and then attention on what you're listening to and then joining in with others, you know, you don't need to speak. People who don't have the social techniques, talking properly, expressing you know what they want to say properly they may be able just to express themselves much better in the music. So music for them is a proxy or can be a proxy to express things.

Katie - I know you're particularly interested in neurodegenerative diseases like dementia for instance.

Jorg - When dementia kicks in, then the brain degenerates and of course with that then we have mental health problems coming in so you can't express what you want to say, you may not remember properly what you once knew, you may not be able to do things that you were able to do and that of course is causing distress and you're emotionally disturbed, you feel something's not working so my body is not doing what I am used to, and you can become very depressed. You will be isolated in a way, not functioning in the society as you were and you know exactly every hour every minute that this is the case now.

And so when we use the music we can offer a space in which all the, let's say, social techniques, conventions of everyday life, is not really needed but you are together with somebody and you can do things together and you can still be a human being. So music therapy allows you to be human even when you have lost a lot of capabilities.

woman being reflective

17:58 - Music therapy for mental health

How can music therapy be used to help in psychological illness?

Music therapy for mental health
with Catherine Carr, Queen Mary University of London; Jorg Fachner, Anglia Ruskin University

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.

Cartoon representation of the brain and upper body

26:19 - Can music help stroke recovery?

Music therapy is used in neuro-rehabilitation...

Can music help stroke recovery?
with Alex Street, Anglia Ruskin University

Can music therapy help to aid recovery from physical illness? Katie Haylor spoke with Alex Street, music therapist and researcher at the Cambridge Institute of Music Therapy Research at Anglia Ruskin University, who also works on the stroke ward at Addenbrooke's Hospital in Cambridge...

Alex - Let's say it's affected their left side, left side of their brain where the parts for speech are mainly represented. And so they can't speak anymore. But because of singing being something that is using both halves of the brain and more of the whole brain, sometimes somebody who can't speak can actually sing instead. If it's quite a mild stroke, those language areas aren't completely destroyed, it can be as simple as saying "sing what you want to say and beat your left hand to regulate your speech rate". I've encountered this sometimes where I can say "well if you could have anything to do eat now, what would you eat?". And I've assessed that they can understand language but they just can't speak. And they'll be able to tap and say "a cheese sandwich". And so then they can use that as a strategy to help them to communicate and sometimes then there's some spontaneous recovery and sometimes they need to do more of those kinds of exercises so that those parts of the brain actually become repaired or they use other pathways, other connections in the brain that then become more strongly connected with the speech areas.

Katie - It sounds like it's almost this kind of innate mechanism that we've got. I don't know if that's accurate. It feels like it should be.

Alex - Yes. Well we we can all perceive rhythm. We can tell when there's a regular beat, depending on how damaged certain areas are, we can tell when there's a change in rhythm. It's the structure of music and the way that the brain is activated by music. So music is processed globally by the whole brain. And that also means - and this has been found in various research - that we can draw out certain elements of music and use them to support rehabilitation. So for example walking is the most rhythmic movement that we do. If you have had a stroke and you can't walk very well, if you set a metronome or a very simple piece of music to the existing speed of walking, then you set the metronome or the music to that tempo, then as soon as they start walking to it their balance improves and the angles at which their legs are moving also have been found to improve. They can entrain to that beat or that music set to that tempo, and it can gradually be increased towards a normal walking pace.

Katie - So that's rhythm. What about melody though? Can melody be used to help people recover from physical damage?

Alex - Yeah. There's an intervention called the melodic intonation therapy and that's for people who have aphasia. And so again that's where the left side, where language is predominantly connected, and it affects word finding so that people might be speaking jargon and they might not know that, they might even not be able to monitor that they're doing that. It's not certain yet whether it's the melody or rhythm that supports speech recovery. But certainly for some people singing what they want to say they can do or you can sing a song to them that will be very overlearnt. So you mentioned something about music being an innate part of us. Well actually we do grow up and we're exposed to rhythm you know because that's the way our bodies work. We have pulse, we have breathing rate, heartbeat and also nursery rhymes and songs are a common parlence across cultures and it's often accompanied by rhythm, that rhythmic rocking. So sometimes you'll be singing to the infant and rocking them on your lap as well. You can use those songs with people who've had a stroke. Sometimes it might be something like row your boat or twinkle twinkle little star or something like that. And it's because it's so overlearnt that they might be able to sing "star" at the end of the line or they might be able to come in somewhere else.

And so that's the beginning of them starting to use to access language again. And so you'll do lots of those singing exercises and you can use the structure of music and the structure of song to help them start re-learning and the key to neuro rehabilitation is repetition. It's mass practice of the right thing. Any musician will know that they've achieved those skills in moving their fingers and whatever skills are needed to play the instrument that they're playing, through hours and hours and hours of practice.

Katie - As someone who learnt the cello for a number of years I can completely relate to that! A lot of practice!

Alex - Anybody who's working in neuro-rehabilitation is trying to do the same with that patient. They're trying to give them the government recommendation, 45 minutes a day, five days a week, for as long as improvement can be observed or measured. I worked with somebody who now is who's doing very well and had very little movement in the left arm. We ran a group every week that was co-facilitated by physiotherapy assistants. It's been running for over a year now. I saw him individually sometimes mainly in the group, and his range of movement, do how far he could reach, how he could grasp, the whole movement has increased dramatically and he didn't really have any other rehabilitation while he was there.

It's really devastating for people when they when they have something like a stroke you know - it's not from an accident or something, it just just happens you know so it's particularly cruel event really to experience.

Katie - If we talk about the theoretical person who's had a stroke. I'm guessing they're on all sorts of other interventions, physiotherapy, maybe they're on medication. Where does music therapy fit in?

Alex - Let's say somebody can't move their arm very well, so often with stroke one half of the body will be affected. So being asked to repeat the same arm movement again and again and again in physio and they do use other things like sports equipment and things like that. If they're doing it to a beat it actually becomes much easier because it's a temporal framework. They know when they've got to move their arm, when it's going to hit the target or the object that they could going to try and grasp and pick up and then when it returns back again.

So that's one thing. The other thing is that you can then do that as an interaction. So I might be playing something with a very strong pulse while they're performing that arm movement, and the arm movement results in them playing an instrument so they reach out and they hit a drum and I'm playing a chord sequence or something on the guitar while they're doing that. And so then they're not actually as conscious of how much they're repeating that movement, because they're playing music with me by performing that movement.

If you're playing a piece of music at 60 beats per minute and the person is hitting a drum on every beat in four four time and you do that for three minutes that's a hundred and eighty times that they've hit that drum. If they can move that quickly that point, often you have to do it on every first beat in that sort of tempo setting. So if you then do that for another 10 minutes, they're getting more of that massed practice that is going to change the parts of the brain that need to be changed. So they're recruiting new cells where the damaged cells were.

Katie - How widespread is music therapy in this clinical hospital setting?

Alex - Well not very much. And there are several reasons for that. So the predominant teaching of music therapy in the UK and Europe uses a model of music improvisation. It's more centred on the relationship with the music therapist rather than what needs changing in the brain. That is gradually changing, so there's this growing body of neuroscientific evidence that shows using brain imaging and EEG, how the brain responds to rhythm, melody, harmony, whole pieces of music.

It would be brilliant if at acute stage, every patient has an iPad next to their bed. It has the music based exercises, the neuropsych, the O.T., the speech therapy exercises, everything they need when they're discharged. All of that is transferred onto a tablet they have at home. The data is still collected so we know that they're doing the exercises and that they're responding to them. That's my dream project and that's what I'm working on with the other team at Addenbrooke's as well. There are some really good companies that we're partnering with in Cambridge that have secure data collection and data transfer systems set up.

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