Music Therapy, Alzheimer's and Post-Traumatic Stress

Alicia Clair.  “Music Therapy, Alzheimer’s and Post-Traumatic Stress.” Music and the Brain. Library of Congress, February 15, 2011. Podcast.

http://www.loc.gov/podcasts/musicandthebrain/podcast_clair.html

In this podcast, Alicia Clair, Head of Music Education and Music Therapy at the University of Kansas, discusses with host Steven Mencher the use of music in treating patients suffering from various types of brain injury. Professor Clair focuses largely on patients suffering from Post-Traumatic Stress Disorder (PTSD), Alzheimer’s, and dementia.

Clair begins by describing how music therapy was given a “boost” of sorts in the 1940’s when veterans from WWII were returning, suffering from all manner of injuries. In her particular experience in Topeka, Kansas, there were soldiers who had shellshock, brain injury, and what we now would classify as PTSD.  In the hospital, there were band and orchestral instruments available, as well as several choirs, and both residents and patients took part in the musical activities available.

Clair then explains how music is able to assist in dampening the autonomic nervous system, which causes breathing and heart rate to slow, and generally allows for feelings of anxiety to be let go much easier. For those with brain injury where some facilities require remapping, such as certain motor functions, rhythm gives the therapy exercises more form and works as an excellent facilitator for getting those motor functions to connect again.

When asked what kind of music is preferred in therapeutic context, Clair’s answer is that it is a somewhat individualized process and the same music will not work for everyone. Associations with music that people may already have in their background might be disruptive, so a music therapist might compose something to use for a specific purpose, like something with a strong backbeat for rhythm/motor function work. She also notes that the most successful music tends to be music that patients associate with their young adult years – whether that is Western art music or rock and roll. When the host points out that this is rather contradictory, Clair explains that the process must be very tailored to the individual patient – while you may need to use the music of young adulthood to connect with one person, you might need to get away from it entirely with another.

Clair then goes on to discuss what she has observed in patients with Alzheimer’s. She admits that as of yet, there is no way to tell if it might be able to prolong some of the stages of Alzheimer’s, or keep it from progressing as fast. She talks about people as primarily social beings and our needs to interact with one another, and using music primarily as a way to engage those with people who are losing their ability to engage with others in the same way. She describes it as an issue of quality of life, especially in patients with dementia, when people lose contact with their loved ones and can feel cut off from either side of the situation.

Clair makes a very clear assertion that there are many ways to use music to engage, even if you’re not a music therapist or a musician, and encourages people to try; or, as she says, “Don’t not try!” When asked what steps someone might take in incorporating music into their care-giving, she emphasizes the ability of music, used appropriately, to help decrease stress reactions in many situations. She particularly notes its use in helping to ease “transition” situations, such as needing to ready a family member to go out.  By playing music the person has good associations with thirty minutes ahead of whenever the transition situation is coming, it can again help to dampen the autonomic nervous system and allow them to feel relaxed as they prepare to do what they need to do. In using the music and the slower time, Clair describes, we get away from giving off nonverbal cues that indicate our frustration at our loved one for not understanding or getting ready fast enough that cause them to feel anxiety and confusion. Using the music allows them enough time to process, start to move, get into things at a more relaxed pace.

Clair also mentions singing as a caregiver to be a particularly useful tool – she describes singing instructions to people and how she felt that made very special connections between caregiver and patient. She also notes that “not being able to sing” is not a valid excuse as we all can sing, and all care-givers should give it a try regardless of their own self-conscious feelings.

In the end, Clair makes herself clear in saying that although there may be situations in which consultation with a music therapist/professional might be advisable, music is an important part of everyone’s lives and it’s not enough to say that you aren’t a musician – “just try it.”

Reflections:

I had never really heard anything about treating those suffering from PTSD with music before, but now that I have heard it, it makes completely perfect sense. I thought having the orchestra/choir in the hospital was especially interesting, and I would imagine that even the act of having to commit to learning an instrument, let alone a part in an orchestra, would be a great source of stress relief for the soldiers. When I think of how much brain power I’ve used in trying to pick up new instruments, I could see how having something to focus on that doesn’t really allow you to think about anything else simultaneously would be of great help.

What I think I found most interesting was Clair’s assertion that you don’t need to be a music therapist to start using music as an aid in care-giving situations. I think coming from a very academic world where I have a tendency to lump people into their specialties a little too readily, I was ready for her to say that the use of music therapy should be left to music therapists, or at least requires extensive knowledge of music therapy practices and repertoire before it should ever be attempted. It was really refreshing to hear someone say that, yes, it’s okay if you’re not a musician or you “don’t have a good voice,” because you can still use this. I find this to be something very positive and affirming of the importance of music in all our lives, not just as musicians, but as people. Personally, this leads me to feel hopeful in these methods being more widely employed, if people are made to feel that they can participate regardless of their perceived musical skill level.