The Effect Of Music Therapy On Mood And Anxiety–depression: An Observational Study In Institutionalised Patients With Traumatic Brain Injury

Summary:

This article written by Guétin et. al., is a continuation of a previous study conducted in 2003-2004, where thirty-four patients with traumatic brain injury were examined in order to study the feasibility and usefulness of music therapy. The researchers begins the article by stating that traumatic brain injury is characterized by cognitive and behavioural disorders. And although neuropsychological and behavioural disorders affect two thirds of patients with traumatic brain injury, lack of knowledge of these conditions may affect the rehabilitation and social/professional reintegration of these individuals negatively. 

Previous clinical studies have demonstrated the positive impact of music therapy on the rehabilitation of patients with traumatic brain injury. The 2003-2004 study conducted sessions based on playing instruments (active therapy) that were able to stimulate both cognitive functions and psychomotor functions. That research also concluded that receptive therapy (based on listening to music) enabled an improvement in anxiety and/or depression and encouraged the verbal expression of the patients’ suffering. 

For this observational study, the researcher’s objective is to evaluate the effects of music therapy on mood, anxiety and depression in thirteen patients with traumatic brain injury. These patients at “Les-Fontaines-d’O” rehabilitation centre (Adages) in Montpellier, France, from September 2005 to June 2006, took part in individual, weekly, 1-hour music therapy sessions over a period of 20 weeks. Each session was divided into two 30-minute periods – one devoted to listening to music (receptive music therapy, playing music of the patient’s musical taste) and the other to playing an instrument (active music therapy). The assessment criteria (measured at weeks 1, 5, 10, 15 and 20) were mood (on the face scale) and anxiety–depression (on the Hospital Anxiety and Depression (HAD) Scale). Mood was assessed immediately before and after the first music therapy session and every fifth session.

This music therapy research displays a significant improvement in mood after the first session. It also leads to a significant reduction in anxiety–depression from week 10 onwards and up until the end of the study. It is useful in the treatment of anxiety–depression and mood in patients with traumatic brain injury. According to the study, music can modify the course of disorders through its sensory, cognitive, affective and behavioural effects. 

The study discusses on how the effects of receptive music therapy are related to the fact that individualized musical listening markedly relieves painful experiences. The effects of music therapy are based on the impact of music on different components in the painful experience and changes in the perception of pathological disorders.

Ultimately, the goal after this study is to add a new “therapeutic weapon” (p. 35) -- devoid of side effects) -- to the resources available for rehabilitating patients with traumatic brain injury.  Music therapy will then, enable a comparison with other similar therapeutic interventions, such as speaking or singing.

Reflection:

Research on the effects of music therapy is comforting for me, to know that continuous scientific and theoretical research is made to record and publish the results of improvements through music therapy. These findings are a tangible way to recognize the importance and use for music therapy. It makes me wonder all the more, when research in music therapy began, and if significant findings were established before music therapy was officially used in medical centres. It also encourages me to continuously recognize that much more research on the brain with the use of music therapy is needed. 

What I find interesting is the fact that certain aspects of this paper that isn’t very specific. Some descriptions are quite confusing. For example, the paper explains the 2003-2004 study (of what was researched and its results), but does not state who researched it. A number of their references were published by 2005, making it all the more, challenging to determine which journal article they are referring to. The assumption is then, a possible study that the team conducted. Also, the researchers states “new, validated, “U-based” music therapy technique.” (p. 32) What is this “U-based” music therapy technique? How is it validated? What makes it new? The researchers has the assumption that the reader understands what a “U-based” music therapy technique is. Also, I am quite confused by the fact that “music (chosen according to the patient's personal taste) was played into headphones” (p. 32) was mentioned. Firstly, why did the researchers decide to have the patients choose music according to the patient’s taste”? And given that there’s great amounts of research on how styles of music affects people’s mood, heart rate, and emotions; won’t that alter the study? Secondly, the research then mentions the variants of taking select instrumentalists out of the orchestra in the music. Does that mean all the music actually have an orchestra playing in it? In that case, the patient’s personal taste in choice of music is then, limited in style? The study near the end, does state that the music is chosen by patient's personal taste and listening needs. They talked to the patients following a session, giving an opportunity for some of them to free themselves of their problems and encourage a supportive, listening relationship.

Regardless of the confusion in certain aspects of this paper, the research is focusing mainly on mood, and the study found results in positive mood changes (even if temporary). This research is made out of good intention, to prove the positive results music therapy has on patients with traumatic brain injury. I appreciate the fact that solid, scientific findings are continuously proven of the use of music therapy, and that as an observational study, relationships between the medical professional and subjects are being made. A trust factor is developed between the patient and the therapist. 

Source:

Guétin, S., B. Soua, G. Voiriot, M.-C. Picot, and C. Hérisson. "The Effect Of Music Therapy On Mood And Anxiety–depression: An Observational Study In Institutionalised Patients With Traumatic Brain Injury." Annals of Physical and Rehabilitation Medicine 52.1 (2009): 30-40. 

Heavy Metal Music and the Brain

Reference

Metal Evolution. “Pre Metal”. Dunn, S. and McFadyen, S. (Directors). (2011). [Video/DVD] Banger Films, Inc.

https://www.youtube.com/watch?v=_xXtVX56rz0 (brain scan at 5:20)

Summary

          In this episode of Metal Evolution, anthropologist and filmmaker Sam Dunn visits the McMaster University Department of Psychology, Neuroscience & Behaviour in Hamilton, Canada.  This series is about the evolution of heavy metal music throughout its 40-year history, and Dunn is trying to figure out metal listeners’ attraction to this music.  It is already known that heavy metal music greatly affects listeners on a social level; community and feelings of togetherness are salient in metal scenes across the world.  This is partly due to learned cognitive responses, but another part of it is the emotions of aggression and feelings of power that arise from listening.  Dunn is interested in “what actually happens to our brains” when we listen to heavy metal.

          To a neuroscientist, this seemingly broad question can have a variety of answers.  Dunn meets with Laurel Trainor, the director of the Music and Mind Lab at McMaster, and poses these questions.  Trainor is interested in the auditory system and how it develops, how music affects the brain, and how people hear, interpret, and react to music.  She proceeds to perform an EEG scan (Electroencephalography) on Dunn by putting the sensor net on his head, and as he listens to different pieces of music, his brain responses are measured.  Dunn is shown—with his long hair and Enslaved t-shirt—first listening to a piece of classical music (Mozart’s Piano Concerto No.21 in C major), then to a piece of heavy metal (Slayer’s “Raining Blood”).  As cliché as this musical comparison is, the difference in brain activity between classical and metal music is not actually explained.  Perhaps, because there is none that can be identified on an EEG scan?

          Trainor goes on to point out that heavy metal is often (hastily and perhaps wrongfully) associated with violence.  But in truth, metal’s sonic qualities—loudness, speed, distortions—tends to “turn off conscious thought”, consequently turning off inhibition.  Finally, an insightful point is made that the potential for violence and aggression is in all of us, and that it feels good to sometimes let go of control, but only can it be a positive and therapeutic practice if it is done in a safe environment where one feels comfortable.  For me, this brings up ideas of vicarious emotions and a sense of catharsis.  Music’s encoded meanings (learned through listening and forming cognitive associations throughout the span of one’s life) can act as a sort of emotional prophylactic.  Prominent metal musicians tend to agree:

“There’s something in metal music that speaks to the reptilian brain*; it doesn’t speak to the intellect, it doesn’t speak to a thought process that’s on the surface.  There’s something that connects very viscerally with heavy metal music, that it just feels awesome.”

Tom Morello, Guitarist of alternative metal band Rage Against the Machine

*Yes, the term “reptilian brain” is outdated, and his comment regarding music “speaking” to it is uninformed…but he’s a musician and not a neuroscientist, so we’ll forgive him.

“[Heavy metal] is certainly an outlet that you couldn’t get anywhere else.  You come to the show and lose your f*cking mind, and get in the pit and go crazy and stage dive and have fun.  It’s not about violence, it’s about fun.  You might be bruised and really tired the next day, but you know what, it’s like a great massage, you’re gonna feel really good afterwards.”

Scott Ian, Guitarist of thrash metal band Anthrax

          The segment concludes by Trainor explaining that listening to metal merely exercises the part of you that is aggressive or combative, but without any external physical stimuli or danger.  Dunn finishes by suggesting that this craving for affect is a possible reason why people are so drawn to heavy metal music.

Reflection

          On a cognitive level, listening to “angry”- or “violent”-sounding heavy metal music is akin to something ethnomusicologist call sonic tourism.  But instead of listening to music that reminds us of romanticized exotic places, we are attracted to the possible affect (as in the affect, cognition, conation model) that music might bring us.  We can experience music we understand to be sorrowful, distressing, forceful, or aggressive, all in the comfort of our own home without feeling a shred of any real threat or danger.  As if looking at paintings at a museum, we can perceive music and its encoded emotions without really feeling them ourselves.  Alternatively, music perceived as cheerful or joyful can elicit similar effects.

          One fear, of course, is that in the same way that listening to “happy” music can lift one’s spirits, listening to “angry” music can in turn make the listener angry.  Paradoxically, people often tailor music to their current mood, rather than use music to try and change their mood (DeNora 2011).  But the reverse is also true.  North and Hargreaves (2012) go as far as to say that listening to music expressing negative emotion (like certain rock and rap) promotes violent behaviour, suicidal tendencies, depression, and sexual promiscuity.  However, while there is an undoubted correlation between self-identified “angry” people and the “angry” music they listen to, the causality of this relationship is not so simple; those who already have violent or aggressive tendencies will be more likely to listen to music that promotes those tendencies (Shafron & Karno 2013).

          Unfortunately, Dunn’s question of “what actually happens to our brains” when listening to heavy metal music is never answered in the segment.  The opposing sounds of Mozart and Slayer are presented but their difference not explained.  One possibility is that at the sensory-cellular level there is no difference.  And it is at higher cognitive levels of processing that music encoded with various emotions elicits corresponding responses.  The feelings and emotions perceived in music are made audible to us due to our own enculturation, not because there is a notable difference in how the inner ear and auditory cortex experience and process it.  And due to individual tastes and preferences, certain people would already be drawn to heavy metal music for its perceived sonic qualities—meaning this music isn’t making anyone more violent or aggressive than they already are (Istók et al. 2013).

References

DeNora, T. (2011). Health and music in everyday life – a theory of practice. Music-in-action: Selected essays in sonic ecology (pp. 271-285). Burlington, VT: Ashgate.

Istók, E., Brattico, E., Jacobsen, T., Ritter, A., & Tervaniemi, M. (2013). ‘I love rock ‘n’ Roll’—Music genre preference modulates brain responses to music. Biological Psychology, 92(2), 142-151.

North, A. C., & Hargreaves, D. J. (2012). Pop music subcultures and wellbeing. In R. MacDonald, G. Kreutz & L. Mitchell (Eds.), Music, health and wellbeing (pp. 1-19). Oxford: Oxford University Press.

Shafron, G., & Karno, M. (2013). Heavy metal music and emotional dysphoria among listeners. Psychology of Popular Media Culture, 2(2), 74-85.

Musical Training affecting Cortical Thickness Development

Summary

In this paper, Dr. James J. Hudziak et al assessed the extent to which playing a musical instrument is associated with cortical thickness development among healthy youths.
The paper argues that all children possess symptoms of inattention, aggression, anxiety and sadness, and emotional dysregulation, and that these symptoms are influenced by genes and environments which are both negative and positive. With this being said, they published numerous behavioural genetic articles demonstrating that children with attention- deficit/hyperactivity disorder (ADHD) are not categorically different from children who do not meet criteria for ADHD; rather, they are quantitatively more severe in that they possess more symptoms than children who do not meet ADHD criteria. These reports say that subclinical anxious/depressed symptoms in healthy youths are related to cortical thickness maturation within aspects of the medial prefrontal network (a network implicated in the mediation of clinically significant mood and anxiety symptomatology). Many years ago, Dr. Hudziak aimed to determine how health-promoting activities might be associated with better outcomes in children and reported on the behavioural genetic architecture of the health benefits of exercise, music, and reading. Taking the approach to structural neuroimaging, he aimed to look at a wellness activity reported by others to be health promoting and having an effect on brain structure and function, and to study that activity in the same dataset on which he successfully published the behavioural findings. He focused on the wellness activity of playing a musical instrument.

In musical training, Dr. Hudziak discusses how structural MRI studies display strong evidence for an environmental training effect rather than a genetic predisposition. One of his studies outlined in this paper showed increased aptitude after 15 months of training for the experimental group versus the control group on finger motor tasks and melody/rhythmic tasks, but not on nonmusical tasks. He explains how brain deformation changes were observed in motor areas, the corpus callosum, and the right primary auditory region, all areas important for music performance and auditory processing. In addition, his results showed that unexpected areas increased in volume compared to those of the controls: various frontal areas, the left posterior pericingulate, and the left middle occipital region. He says there is evidence that musicians have brain architecture that is altered based on amount of practice and age at which music lessons are initiated.

Participants were part of the National Institutes of Health MRI Study of Normal Brain Development. This study followed a longitudinal design such that participants underwent MRI scanning and behavioural testing on up to 3 separate visits, happening at 2-year intervals. MRI, IQ, and music training data were available for 232 youths, ranging from 6 to 18 years of age. Cortical thickness was regressed against the number of years that each youth had played a musical instrument. Thickness was then regressed against an “Age Years of Playing” interaction term. Age, gender, total brain volume, and scanner were controlled for in analyses. The aim was to determine whether music training had specific effects on cortical organization in this sample and, if so, whether these brain regions correlate with any of the prior findings that we reported on structural correlates of behaviour such as aggression, inattention, anxiety, sadness, or dysregulation. The hope for the study was to provide strategies for using health-promoting activities in the prevention or treatment of common quantitative behavioural problems.

The results showed that males and females did not differ with regard to years playing a musical instrument. The analysis revealed that music training was associated with an increased rate of age-related thinning. Dr. Hudziak states that the same pattern was observed in other cortical regions associated with the “Age Years Playing” interaction term.
In his follow-up analyses, he investigated the relationship between years of playing a musical instrument and cortical surface area, as well as the degree to which surface area development was moderated by years of playing a musical instrument. In both analyses, he concludes that music training is associated with cortical thickness development but not cortical surface area development.

Reflection

When I first read this paper, I did not know what the value was to "cortical thickness". In our Music and Brain class, we have discussed how the cerebral cortex has been called the highest achievement of biological evolution and the neural substrate of human mental abilities. Could music training really affect cortical thickness? As Dr. Hudziak says, measuring cortical thickness is an important task for both normal and abnormal neuroanatomy. The cortical mantle varies in thickness depending on the region of the cortex, with considerable variation between individual brains as well as between hemispheres of the same brain. I have always believed that when children begin playing a musical instrument early at age, they develop certain memory and high attention span aspects faster. As Dr. Hudziak tries to explain, this affects the brain's cortical thickness.

Studies like this prove that free music programs need to stay within the public/private school systems. As I discussed, the cerebral cortex serves as an important matter within the brain and its thickness can contribute to better mental health. Children need to continue learning music in order to help brain development, such as the cerebral cortex.


To further benefit the research, I think Dr. Hudziak should follow through by examining the extent to which music training affects cortical development among youths with clinically significant attention problems because his study showed that participants with quantitatively higher scores on attention problems exhibit delayed cortical thickness maturation in portions of cortical regions. This might show that music training’s influence on cortical maturation, particularly in prefrontal regions, may serve to mitigate aspects of ADHD symptomatology.

Source: Hudziak, James. "Cortical Thickness Maturation and Duration of Music Training: Health-Promoting Activities Shape Brain Development." JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT PSYCHIATRY 53.11 (2014): 1153-161. Print.