Thursday, October 18, 2012

The Positive Effects of Music Therapy on Health

Podcast: "The Positive Effects of Music Therapy on Health"
Date: April 29, 2010
Hosted by: Steve Mencher from the Library of Congress
Guest: Concetta M. Tomaino, the executive Director for the Institute for Music and Neurologic Function and Senior Vice president for Music Therapy at Beth Abraham Family of Health Services

This podcast is from the Library of Congress Music and Brain series. Host Steve Mencher interviews Concetta Tomaino about music therapy and the positive effects it has on health. Tomaino begins by discussing how she discovered music therapy in the 1970s during her pre-med studies (she was double-majoring in music and biology), where she observed the powerful effects music had on her dementia and Alzheimer's patients. She mentioned that with the "right" songs, people with dementia who could not previously talk, came alive with memories and singing. Tomaino continues on to say that with the advent of technology in the last ten years, neuroscientists can now explain what she was observing at her clinic. She says that research now shows that music is processed through a complex system of neural networks - networks that "talk to each other" when processing music. She says that through sound, music therapists are able to reach fundamental areas of the brain through these complex neural networks.

The podcast continues with Mencher asking Tomaino if music therapy should be done with a therapist or if music can be prescribed like medicine. Tomaino responds that the best music therapy is accomplished through interactive musical therapy sessions. After seeing what activities cause a positive change in the patient, the therapist can then continue with that activity or prescribe practice tapes and recordings of a particular music that will enforce these positive changes. She says that through a combination of music and the constant repetition of a particular musical activity, the therapist can help the patient make permanent changes in his/her brain.

Mencher then asks Tomaino how music therapy could help his mother-in-law who has trouble with her gait. She explains that musical rhythm can drive the fundamental motor areas, the basal ganglia and the cerebellum, into action. Rhythm "turns" on these parts of the brain that are associated with movement and gives the patient something to synchronize his/her movement to. Tomaino says this is much easier and more natural than trying to think about how to walk.

Mencher continues on by asking about the importance of rhythm and melody in music therapy. First, Tomaino discusses that rhythm is fundamental mechanism in music and the human body. She talks about how from the time of birth, humans are wired to perceive rhythm. This is a basic mechanism that therapists can "tap" into in order to turn on neural networks. In regard to melody, Tomaino talks about its importance in discussions of music and emotion. It is in the melody of a song that is important to you, or the shape of a given melody where musical meaning is perceived and explained. She discusses how neuroscience has discovered that when people listen to music that is pleasureful and meaningful to them, certain parts of the brain turn off (the amygdala). This part of the brain that is responsible for fear is not needed during these pleasureful experiences; thus, we are able to more fully engage in and relax into the experience of listening to music. Tomaino discusses that the effect of melody, emotion and rhythm on the brain is key to music therapy.

Mencher asks a final question about how the field of music therapy has gained more attention through writers such as Oliver Sacks. He asks how Tomaino's work has been impacted by this attention. She answers that people have finally started to take the field more seriously, even scientists. She comments that only thirty-two years ago, scientists told her that music and the brain could not be studied scientifically; but now, everyone is interested in studying it, from cognitive scientists who want to understand the mechanisms with which we process music, to clinicians who want to know the neuroscience behind what they see on a daily basis, to the general public who want to know how it is that music can be so powerful. She says that with the expansion of literature from writers like Sacks, there has been a general growing inquisitiveness and more wide-spread use of music therapy.

Tomaino ends this podcast by saying "I feel reassured that the world has changed". Thirty-two years ago she knew that music had healing properties and observed this in her clinical work, but it is only now that science is reaffirming this power of music.

I thought that this podcast was an informative introduction to how music therapy works, as well as to how the field as developed in more recent years as a credible, scientifically-based form of therapy. I think it is absolutely amazing that music can help Alzheimer's patients come "alive", as Tomaino says. My grandmother had Alzheimer's, so I now have some more insight into the reasons why she was able to respond and remember songs I played for her, when she couldn't even remember who my grandfather was. I was also fascinated by Tomaino's discussion on rhythm and its ability to effect us at neurological level in the most primitive parts our brains (cerebellum and basal ganglia). It is interesting to know that rhythm is so engrained in us that it can be used to help people regain important motor functions.

Tomaino discusses how she has seen the healing power of music in her clinical work throughout the last thirty-two years, but that it has only been in the last ten years that her observations have been able to be explained by neuroscience. It's too bad that it has taken so long for this field to be recognized as legitimate among scientists and therapists. I do remember back to my impressions of the music therapy program at the school where I did my undergrad (about ten years ago). I knew very little about the program, but I do remember hearing daily group drumming and xylophone playing by students dressed like hippies. At the time I thought that music therapy couldn't possibly be a legitimate form of therapy, and that if anything, music therapy could only add enjoyment to a patient's life. This was my impression until I read Oliver Sacks' Musicophilia (which covered some of Tomaino's work). Now taking this course, I am even more interested in learning about music therapy. This podcast is a great introduction to the field of music therapy, a field that I hope will continue to grow and eventually become part of mainstream medicine.

Wednesday, October 17, 2012

Article:  Spahn, C., Echternach, M., Zander, M., Voltmer, E. & Richter, B.  Music Performance Anxiety in Opera Singers.  Logopedics Phoniatrics Vocology, December 2010, 35 (4): 175-182, UK.


A singer’s “business is emotion and sensitivity” (Janet Baker).  Singers have to create emotions in their audience, and also find “artificial” feelings related to their role, or the interpretation of their work.  On the other hand, a singer is full of his own personal emotions, and needs to deal with these while being on stage in a “role”.  The success of a singer’s career is highly dependent on how they deal with their own emotions.  Often feelings of insecurity are present in singers, since they are the only instrument that cannot hear themselves and are reliant on feedback from others.  
Musical performance for singers induces many feelings in them.  Often singers become “high” from their experience because of a release of the hormone beta-endorphin.  On the other hand, performance can lead to negative emotions, such as distress or anxiety.  This is called musical performance anxiety (MPA) and can occur on a scale from low to high.  Where it is high, it is pathological and needs to be treated.  One singer who suffered acutely from this was Enrico Caruso to such an extent that it “led everyone around him to despair”.  
Steptoe carried out a study of opera singers in five different environments- lesson, private practice, audition, dress rehearsal, performance.  In all five environments Steptoe monitored level of tension.  The best results of singing were in the environments where there was intermediate level of tension (performance) while the worst performances occurred in the environments with the greatest level of tension (dress rehearsal and audition).  Another study revealed a high state of anxiety for 18.8%   of a sample of singers, as compared to 15% in a sample of normal working adults.  
MPA functions at four different levels:
Affect:  Feelings of anxiety, tension, apprehension, dread, or panic.
Cognition:  Loss of concentration, heightened distractibility, memory failure, catastrophizing.
Behaviour:  tremour, difficulty in maintaining posture and moving naturally
Physiology:  Disturbances in breathing pattern, dry mouth, cardiovascular changes, gastrointestinal disturbances.
In terms of what happens in the brain, there are two pathways that occur.  
  1. Stimulus --> Thalamus --> Amygdala --> Hypothalamus or PAG.  From the Hypothalamus hormones are produced which then affect the sympathetic nervous system.
  2. Stimulus --> Thalamus.  From Thalamus --> a) Associative cortex --> Hippocampus or b) Sensory Cortex -->  Consciousness.  From the Hippocampus --> Amygdala and now follow path 1.

Essentially what is important is that one pathway is much longer and goes through parts  of the brain that the other does not.  It seems that the first pathways is associated with mere stage fright, which is low on the scale of MPA.  The second pathway is associated with high MPA.  


This study looked at anxiety levels versus heart rate and blood pressure.  The heart rate and blood pressure were measured with a Somnoscreen, while the anxiety was monitored by a questionnaire.  The sample was nine musicians, seven singers and two wind players.  None of them suffered from pathological MPA.  
The results of the study were that heart rates on average were highest during the performance, and before and after the performance differed in the participants.  For the blood pressure, most participants had a higher blood pressure before and during performance, as opposed to after.  From the questionnaire, all participants had a higher anxiety state before the performance than after.  The results showed no correlation between anxiety and blood pressure/heart rate.  A possible explanation is that physiological arousal is necessary for MPA, but the presence of physiological arousal does not guarantee MPA.  Perhaps, certain performers react to physiological arousal differently- one finding it energizing, the other finding it leads to anxiety.


This treatment is proposed from the Freiburg Institute for Musician Medicine.  It takes as its basis the cycle of MPA- perception --> thoughts and feelings -->  anxiety -->  somatic reactions -->  perception--> ...  It suggests ways of interfering with the cycle at each stage.  At the level of thoughts and feelings, it suggests positive imagination exercises as well as psychotherapy.  At the level of perception, it suggests watching successful performance videos of one’s own performance.  At the level of somatic reactions, relaxation techniques are suggested.  
They only recommend pharmaceutical therapy in a few situations, and even suggest that many of the drugs are bad for the voice.


Yet again this article for me emphasizes how little we know about the brain, and how complicated the brain is!  This always amazes me and it is exciting to see how much further we could go!  Why this thought comes to mind in relation to the article is because of the study carried out in the article.   In the experiment, the only way they were monitoring anxiety scores was through a survey.  It was interesting to see that they could get hard facts about the other variables in the experiment- blood pressure and heart rate but not for anxiety.  I am used to scientific experiments being backed up by hard scientific facts and not by the opinions of the participants.  It would be interesting to see how in a similar study in fifty years, anxiety would be monitored.

I agree with the authors that the study is rather inconclusive, as heart rate and blood pressure can be affected by many things besides levels of anxiety, for example movement.  In fact, what was very interesting for me, was the one subject who seemed to suffer from more serious MPA, had completely normal blood pressure throughout the experiment.  

Something else which would have been on my “wish list” regarding the article, would be a further elaboration of the two pathways that MPA takes in the brain.  I find it fascinating that there are two pathways- one pathway faster and less conscious, and the other one slower, more conscious, and going through a larger portion of the brain (the cortex).  It is suggested that the slower one leads to pathological MPA, the other to mere “stage fright”.  I would love a further explanation of why this happens.  I wonder what the significance is of the shorter pathway skipping the cortex.  

As for the treatment suggested, I was extremely impressed with its thoroughness and multidimensional character, and how positive it aimed to be.  I was also amazed at how much dedication, work and preparation is required to carry out the treatment.  Much more challenging than popping a pill!  I believe that with true dedication, the treatment suggested could really help a singer with MPA.

This is an area of study which I would love to further look into.  I find it fascinating, complex and rather relevant as a performer and as a future teacher.  I have seen MPA within myself and many colleagues and think that knowing how to deal with it is a great tool for every performer, as well as for every voice teacher.

Tuesday, October 16, 2012

Can Teens’ brains predict which songs will be popular?

Berns, G. and Moore, S. (2012). A neural predictor of cultural popularity. Journal of Consumer Psychology, 22 (1), pp.154-160.
The current approaches to predicting popularity rely on standard marketing strategies such as focus groups and questionnaires. The purpose of the paper was to test whether it is possible for functional magnetic resonance imaging (fMRI) to forecast the popularity of music (cultural popularity). Past research had suggested that “activity in reward-related regions of the brain, notably the orbitofrontal cortex and ventral striatum is predictive of future purchasing decisions of the individuals who are scanned.” However, it had not been clear whether this activity in the brain of individuals can correlate to purchasing decisions of a population.
Teenagers were first asked to rank 6 musical genres. The ranking of the genres showed that the participants had tastes similar to the national population. They listened to 20 songs from each of their top 3 genres. The songs were by unknown artists from What they heard was a 15-s clip including either the hook or chorus of the song. Each participant went through 60 trials, two-thirds of which included a display of popularity of the song among users. The brain scan was taken before the display of popularity. The total of sales of the songs within the three years following the scans were compared to the initial scans or brain responses.
Although the individuals’ personal opinions on the likability of the songs did not correlate with the number of units sold, their brain responses did.  The study found that the “final pathway linking the brain to album sales was mediated only thought the NACC. When these relationships were visualized, it became clear that “hit” songs did not result from a specific combination of NACC and OFC activity, but that “non-hits” were associated with a combination of both low OFC and low NACC activity.”
We should note that most of the songs that were heard did not go on to be ‘hits’, many genres were used and only 27 individuals were used, all teenagers who make up only 20% of music consumers.
OFC = Orbitofrontal cortex
NACC = ventral striatum/nucleus accumbens
This article left me wanting more, although the topic is very attention-grabbing, it lacked in depth explanations of the results from a neuroscience perspective. More background information was necessary regarding the functions of the orbitofrontal cortex, the ventral striatum and their connections. However, I understand that the paper’s aim was more to do with marketing than science.
The authors did address several reasons that may have caused the ratings not to go hand-in-hand with the brain scans but I still think that the brain’s ability to “know” which songs are “hits” regardless of the compatibility with likability is quite remarkable.

Dangerous Music

 Krash, J. and Middleton, N. (2009) Dangerous Music, Jessica Krash and Norman Middleton: Music and the Brain. [podcast] January 29, 2009.
Link: [Accessed: October 12, 2012].

Dangerous Music

This podcast is another from the Library of Congress’ Music and The Brain series. It is an interview with Jessica Krash, musician and composer who teaches at George Washington University, and Norman Middleton, concert producer at The Library of Congress. Krash teaches a course on “dangerous music” at GWU and this is the subject of the podcast.

They begin the interview by discussing the tritone, considered by many throughout history to be a “devilish” interval. Krash explains that this may be rooted in physics, for if you take a string tuned to C and another tuned to F# (a tritone), the ratio would be √2:1. Historically the √2 has been an uncomfortable number for mathematicians and physicists; it was even forbidden on various occasions. Interesting how the sound of that ratio is also uncomfortable for our ears! Middleton mentions that diminished chords are still frowned upon in gospel music, adding to the negative connotation of the tritone today.

Continuing on the topic of Diabolis Musica, the “devil in music,” Middleton touches on urban myths linked to evil within music, including musicians selling their souls to the devil for enhanced talent. They discuss myths surrounding the Italian baroque composer Tartini, Italian violinist Paganini, and American blues musician Robert Johnson. And finally, naturally, they talk about the devil in heavy metal music. Middleton notes that heavy metal musicians use the tritone heavily in composition on purpose because they know that the interval is considered evil.

The subject takes a political turn when Krash starts discussing Jewish music in Nazi Germany during WWII. She says that the Nazi party was able to latch onto the negative reception of modern dissonance in Jewish compositions to gain public support. Germans were already uncomfortable with this new, modern sound and it was used against musicians like Schoenberg during the war. The Nazis claimed that he was destroying the triad and ruining German music, when Schoenberg saw himself as a rescuer of it. An interesting side note - the Nazi’s tolerated the same kind of modernist dissonance from the Italians and from Stravinsky in Russia.

Middleton goes on to discuss a specific instance of suicide that was motivated by rock music where two young men in Las Vegas committed suicide after listening to “Beyond the Realms of Death” by Judas Priest. They discuss the prevalence of murder and/or suicides being attributed to an individual’s reaction to rock and roll or heavy metal music.

Finally they touch on the subject of “dangerous” dance. Krash examines Stravinsky’s “Rite of Spring” and the riots that occurred at the premiere of the work. She notes that the destruction of the traditional ballet hierarchy in the choreography represented a strong political statement; it was “provocative in it’s primitivism.” Middleton comments on the sensuality inherently associated with dance and notes the rules established within the three major religions - Christianity, Muslim, and Jewish – to include dance in their individual moral frameworks.


I have always been really interested in the social implications and culture of music. I love learning about specific instances throughout history when music was condemned and/or lauded and why that was. What I enjoyed most about this interview was not necessarily the information I learned, but the way in which I reacted critically to it. I found myself, for maybe the first time, unconsciously questioning what I was listening to and constantly asking “why”?

In keeping with our class subject I was really interested in the suicide-by-music story. Naturally, it brought to mind images of Charles Manson and I began humming The Beatles’ “Helter Skelter.” I wonder why some humans have a compulsion to act aggressively and sadistically when listening to specific genres of music. Does it happen with all types of music but we just don’t think about it the same because it doesn’t cause mayhem? Is it the music itself, or the associations one may have with music? We know music evokes an emotional response – is that all that it boils down to? What’s going on in the brain when someone is listening to satanic music? Are neurons firing in the same part of your brain that processes aggression? Morals? Is there a physiological area in the brain that is associated with “evil?”

If so, can we start looking at ways in which we can use music to combat aggression? Violence? Would it be the same way in which we lower stress and anxiety? Are these things all linked anyway?

Using music to reconstruct language


The first video is an interview with Dr. Barbara Reuer and Dr. Anirrudh Patel on a television show called Health Matters. The interview focused on the role music plays in brain development and how this information can be used to help people recover from certain conditions.

The second set of videos chronicle a public figure’s recovery from brain damage. Gabrielle Giffords, an American congresswoman was shot in the head and sustained damage to the left side of her brain. She made a remarkable recovery and was able to re-obtain much of her language skills through the use of music therapy.


The first video focused on music therapy from the practitioner’s point of view (Reuer) and the neurological point of view (Patel). In this interview, the topic of brain plasticity arose and I found myself to be highly intrigued. I conducted several searches for related resources which led me to videos about Gabrielle Giffords, a public figure who suffered damage to her left brain, consequently losing language function and full control of the right side of her body. She made remarkable progress in regaining her language skills through the use of rigorous music therapy. I found it worthwhile, therefore, to examine the connection between both videos.

The main theme in these videos is that music and language are neurologically related. Dr. Patel even stated that musically trained people are proven to be more efficient at mastering a second language. He claims that music that people like stimulates deep and ancient reward centers in the brain and he linked this to Dr. Reuer’s theories that music has healing powers. Reuer spoke of a specific example in music/language therapy where a song that people like is used and key words are left out, e.g.  ‘you are my __________’ (sunshine). Because music is involved, the brain takes a different route to access the word. Research exists supporting claims that music can help stroke patients recover speech and can also help Parkinson’s patients recover some motor function. Robert Jourdain claims that in aphasia, rote aspects of speech such as greetings or swearing may be preserved because these aspects are more ‘performed than spoken’.

These theories are difficult for the layman to believe. However, the specific anomic aphasia case and recovery of Gabrielle Giffords is considerable proof of the claims of Dr. Patel and Dr. Reuer. At one point, Giffords was having trouble saying the word ‘light’ and burst into tears. However, when the therapist started singing ‘this little light of mine’, Giffords sang along with almost all the words… inclusive of the word ‘light’! Her music therapist Meagan Marrow, says that pitch, melody and rhythm work from a different part of the brain to access language (as opposed to the areas that traditionally process language on the left side of the brain, such as the Broca’s Area). The same technique mentioned by Dr. Reuer was used on Gabrielle Giffords. The therapist sang ‘Now I’m free, free_________ ‘(fallin’). The videos showed a most dramatic improvement over a period of time with the help of music therapy. Possibly, also supporting these claims is the fact that every time the reader has encountered a missing word in this passage, they have perhaps filled in the blanks on pitch in their minds.

Monday, October 15, 2012

Between Music and Medicine - Robert Gupta

TED Talks: Robert Gupta - "Between Music and Medicine"


In this talk, Robert Gupta, violinist and member of the LA Philharmonic, discusses his personal experiences in deciding to turn to music after completing a pre-med undergraduate degree. Gupta has strong assertions about the important role music can play in the lives of the mentally ill, and how his personal experiences have Gupta exemplified this assertion.

Gupta begins by describing his response to a video of Gabrielle Gibbons, the US Congresswoman who was shot in Tuscon last November, as she struggles to regain her control of speech after damage to the left hemisphere.( The video is very emotionally charged, and Gibbons is seen crying in frustration while working with her therapist. Miraculously, moments later, she is able to sing "This Little Light of Mine" with the help of her therapist.

At the age of 17, Gupta decides to visit prominent neuroscientist Dr. Gottfried Schlaug, himself a former organist. He describes how Schlaug gives him an overview of some of the most exciting research being done surrounding music and the brain, including the ability of sufferers of an aphasic stroke being able to sing through the favourite songs, allowing the brain to create an almost new speech centre in the right hemisphere. Schlaug gives Gupta many examples of how music could be - and has been - used in helping patients with Alzheimer's and children with autism. Ultimately, Schlaug advises Gupta that while "medical school can wait, the violin will not[,]" and Gupta lands his first orchestral position with the LA Philharmonic.

A year later, Gupta comes across a man named Nathaniel Ayers - homeless and living on the street, but with a very unique story. Ayers entered Julliard in the 70's as a double-bass player, but when his schizophrenia and psychotic episodes began to take hold, he dropped out, and eventually wound up living on the streets of LA, still playing a violin. Nathaniel Ayers himself became very famous, especially after the release of the movie "The Soloist", which is based on his story. ( Gupta takes Ayers on as a student, stating "wherever he had his violin, and wherever I had mine, I would play a lesson with him."

Seeing Ayers on skid row, Gupta recounts his frustration at how many people there must be aside from Ayers living on the street because of mental illnesses but who were "never going to have a book or a movie made about them to [get] them off the streets[.]" Gupta takes this newly found outrage and pours it into his project, the Street Symphony, which was an organization beginning in Skid Row that brought classical music to the homeless and mentally ill in homes, hospitals and clinics. He recounts a woman approaching him after a concert, describing how she had never heard classical music before but that it sounded "like sunshine," and how no one ever came to visit the patients at the hospital. She suffered from a palsy, but during the concert her shaking stopped - the first time this had happened without medication in 6 years.

In the end, Gupta extols the virtues of bringing classical music to these audiences that might never have access to it in the way that we do, and how important a role musicians can play in the therapeutic delivery of our talents. He culminates this belief in this statement:

          humanity has not forgotten them. And the spark of that beauty, the spark of that humanity transforms


Although this was certainly not the most "technical" of lectures I've seen on the relationship between music and the brain, I found Gupta's words to ring extremely true in terms of our responsibility as musicians to more than just the concert hall audiences. It is such an unfortunate circumstance that so many mentally ill or otherwise disabled people that would benefit so greatly from exposure to music, let alone music therapy, are unable to because of social or financial boundaries. It would be wonderful to see more organizations like Street Symphony pop up for all the good that they do and for the sake of bringing musical beauty into the lives of those who may most need reminding of the beauty in life.

I actually found the small amount of footage from Youtube (linked above) about Gabrielle Gibbons and her recovery to be very moving. I can't even begin to grasp how frustrating that struggle with words must be, and it was overwhelming to hear her singing along with such determination. To me, the fact that such a thing is even possible hints at the potentially limitless applications of music therapy in guiding the recovery of so many different kinds of brain damage. If we can access words through singing but not through speaking, would a pianist suffering from fine motor damage still be able to navigate through a familiar piece of music if it had been learned to the point of "auto-pilot"? In any case, the really important message seems to be one of endless possibilities, and it's hard not to feel overwhelmingly optimistic.

Sunday, October 14, 2012

Reference: Podcast: Dangerous Music, Speakers: Jessica Krash (George Washington University) and Norman Middleton (Library of Congress Music Division), January 29, 2009.


The podcast "Dangerous Music" explored issues surrounding the "censorship of musical expression" on moral or political grounds. First Krash spoke of the tritone which has been deemed an "evil" sound for centuries. The ratio of the interval is the square root of two to one, and coincidentally is viewed also by mathematicians to be an uncomfortable number to deal with- thus underlying perhaps rules in physics unseen and unexplainable. Further discussion was of the avoidance of diminished chords which are comprised of these intervals of an augmented fourth, the "devil" in music. Middleton adds that there is a prevalence of this interval in heavy metal music and how it is used as a marketing ply to attract a certain audience. He discloses a story of two teenagers who committed suicide while listening to this type of music, the song was entitled "Beyond the Realms of Death." Middleton considers to what effect the nature of the music influenced their decision psychologically. The dialogue advanced to the topic of dance and how music can cause our bodies to move in very intimate ways. Religious views of dance was brought up and how for many, it is seen as impure, as a result the nature of the music is viewed inappropriate to the ears. Krash uses the example of Stravinsky's "Rite of Spring" to speak of how music and dance can create a social uprising. The riot post premiere of this ballet denoted that Stravinsky had intentionally used his work to make a statement against the Parisian upper class society. Krash explains how he succeeded in this through the elimination of debasing hierarchical dancing to the more primitive communal form. Another example of musical censorship that was touched upon was the reaction to Schoenberg's music in Nazi Germany. As Schoenberg was Jewish, the Germans displayed to society this new dissonant music, which "destroyed the triad", as a negative music, therefore benefiting their plot for all to despise Jews.


I found this podcast to be very interesting in its description of how certain music can compel us to think, feel and act certain ways. I wonder very much whether the exposure to certain "evil" sounding music can shape our brain in particular ways that promote negative thoughts. On the physics end of the discussion, I would like to look into the mathematical construction of certain intervals more. Perhaps these laws of physics underline the same reason for why certain keys such as D major are considered  very "happy" tonalities.