Music Therapy: even though patient Garrett Lambert is in an isolation room at Memorial Sloan Kettering Cancer Center in New York City, meaning visitors must don masks and gowns to enter, music therapist Holly Mentzer’s harp makes the enclosed room feel like a serene, welcoming space as she and Lambert harmonize.
Lambert says “Don’t Let Us Get Sick,” written
by Warren Zevon, is one of his favorite melodies to sing and strum in
“Don’t let us get sick. / Don’t let us get old. / Don’t let us get stupid, all right? / Just make us be brave. / And make us play nice. / Let us be together tonight.”
For almost 25 years, Lambert has been a part of the New York City Gay Men’s Chorus (NYCGMC) — about 260 singers of various ages, backgrounds and experiences who perform widely and “champion love, equality and acceptance,” according to its website. Recently, members of the group raised their voices in honor of the victims of the tragic shooting at a gay nightclub in Orlando.
Ever since Lambert became hospitalized, he has continued to rely deeply on music for strength and support. The music therapists with MSK’s integrative medicine service offer individualized and group sessions — as well as art and movement therapy — which aim to ease pain, nourish social connections and bring peace and familiarity to patients in the hospital.
“There have been times when Holly knocks on the door and asks if I’m up for a session and I sort of feel like I’m not, like I don’t feel well,” Lambert said. “But I usually say yes, and I’m always glad I did in the end, because I’m definitely lifted up by it. I’m taken to another place.”
Music and Medicine
MSK is not the only hospital offering music therapy. Music has been used therapeutically with special needs children since the 1940s in the U.S., but in recent years it has "expanded to treat the medically ill, including neonatal care, hospitalized children and adults and palliative care and hospice," according to Barbara Hesser, the director of the music therapy program at New York University.
The field is not necessarily captured by a single description or intervention, but music therapists rely on “clinical and evidence-based use of music interventions” to accomplish “individualized goals within a therapeutic relationship,” according to the American Music Therapy Association’s (AMTA) website. These therapists must be accredited in through programs that include 1,200 hours of clinical training.
Sometimes, music therapy involves playing a song at a rhythm that matches the human heartbeat to help lull a patient to sleep or help regulate breathing to reduce pain.
“There’s a notion in music called entrainment,” said MSK’s lead music therapist, Karen Popkin. “When we offer a regular pattern, we are able to kind of establish a river of sound or a gentle babbling brook, something that the listener can travel with.”
Memorial Sloan Kettering Cancer Center's Lead Music Therapist Karen Popkin lays out some of the instruments she uses with her patients.
Sometimes it’s about improving someone’s mood or distracting them from the daily realities of being ill.
Todd O’Connor, the senior creative arts therapy supervisor at the Kravis Children’s Hospital at Mount Sinai Hospital in New York City, said music therapy is about “being able to take something familiar like a piece of music and adapt it in the moment to what the conditions of the patient are in terms of their mood, their pain level, their need for sleep.”
“It’s about how we tailor the music to hold the environment and support the patient in that moment,” he said.
Communication and Collaboration
For other patients, the goal is to encourage communication or collaboration — like encouraging children being treated for psychiatric disorders to play music together and express themselves through song.
A 2014 Cochrane Review analysis concluded that music therapy was effective at improving social interaction, as well as nonverbal and verbal communication skills, for children with autism spectrum disorder compared to standard treatment and placebos.
Jonathan Weiss, a creative arts therapist at Mount Sinai St. Luke’s, works primarily with child adolescent psychiatric inpatients. Collaborative group music sessions are a major part of his therapeutic approach for children with many different diagnoses, he said.
“I try to provide an environment that almost necessitates collaboration,” Weiss said. “If they all are so into the musical creation, that is a kind of microcosm of a world for them where they are achieving success and working together.”
He noted that many of these children are grappling with traumatic pasts and that music can help patients process and communicate about trauma in a way that is nonthreatening.
“The musical environment — even if the topic verbally is sad or depressing — when we put it into the song form, it’s kind of a celebration of who we are in this moment and what we’re a product of and moving past our pasts, in a sense,” he said.
Popkin has seen music facilitate communication for adults in more subtle but equally powerful ways. She recalled one hospital-bound patient who engaged in a musical improvisation exercise with her husband. The patient later shared that the improvisation had allowed her to rediscover an “intimacy” with her husband that had been missing.
“She felt that this kind of communication was allowing them to really feel more like a couple,” said Popkin, who says she could sense the connection.
Memorial Sloan Kettering's Lead Music Therapist Karen Popkin shows ABC News contributor Dr. Alok Patel how she uses musical instruments to bring joy and relief to patients.
Rerouting the Brain
O’Connor said he loves that music therapy balances “psychotherapeutic and psychodynamic knowledge,” but noted that the neuroscience component has been “reaching a forte” in recent years, he said.
Dr. Gottfried Schlaug runs a lab at Harvard Medical School that examines the connection between music and the brain. He investigates everything from the neuroscience underlying tone deafness to brain lesions that cause verbal deficiencies.
He mentioned that music therapy can be used to improve function in patients that have lesions resulting from stroke or other disorders. Music therapy famously helped former Arizona Rep. Gabrielle Giffords regain communication abilities after she was shot in the head in an assassination attempt in Arizona.
Because verbal and music centers are in different parts of the brain, singing can help patients “bypass damaged regions of the brain, help them vocalize and help them express their desires and needs,” Schlaug said.
Even for less severe cases, Popkin and Mentzer have found that music making has tangible physiological impacts. Music that facilitates regular breathing can enhance blood oxygenation and raise energy levels, while working with others to produce music can release endorphins that improve mood.
The science supports this notion that music can lift your mood. Another Cochrane Review analysis from 2008 concluded that music therapy is associated with improvements in mood for patients with depression, though further studies are needed to make the findings more robust.
Enjoying music can also reduce stress, which can even boost immune function.
“I haven’t met anyone who says they didn’t feel better after singing,” Mentzer said. “It lifts your spirit.”
Music is strongly linked to memory. Joanne Loewy, the director of the Louis Armstrong Center for Music and Medicine and an associate professor at the Icahn School of Medicine at Mount Sinai, has been researching what she calls “songs of kin” — music with particular meaning to a patient or family, often across generations.
This music can “spark a memory” or bring back feelings of familiarity and warmth, according to O’Connor.
“Familiarity counts for a lot in the hospital,” he said.
‘I Have Music’
In a recent NYCGMC show, which they call the “No Talent Show,” Lambert submitted a recording of his and Mentzer’s rendition of “Don’t Let Us Get Sick.” The moving performance garnered a standing ovation from the chorus. Before and throughout his illness, Lambert said he has thought of the chorus as a “brotherhood.”
He recalled when the NYCGMC started more than 35 years ago, it was “a very big deal that men were standing up and saying, ‘I’m gay, and I’m singing,’” he said. He described the impact of the HIV/AIDS epidemic on members of the chorus in its earlier years and how the group would sing the song “Love Lives On” each time a member passed away.
“That just brings us even more together,” he said.
No matter where or how it enters one's life, Popkin said she feels strongly that music has a way of touching people in ways they never anticipated.
“Music itself is multimodal,” she said. “We experience it in so many different ways. It has ways to get to the parts of us that need it the most.”
She hopes to see an expansion of the prevalence and availability of music therapy resources. Mentzer said that the music therapy program at MSK is well supported but that the field needs more advocacy in some regions where it’s not available as an option for patients.
Since 1994, music therapy has been identified as a reimbursable service for Medicare patients, according to the AMTA website. Music therapy is covered by Medicaid in a few states, but not most. The AMTA has been working increase coverage by private insurers as well.
O’Connor agreed that more patients should be offered music therapy, noting that for people who are “severely compromised in terms of their health,” engaging in a musicmaking process can allow them to “experience themselves as a healthy individual.”
Lambert said he has to remind himself to keep coming back to it, even when he is tired and feeling weak — because music always gives him strength.
“There are days when I forget about the music,” he said. But then he remembers “I have music — that’s what I can do right now.”
TOKYO — Kyoko Wada discovered music therapy while undergoing treatment for osteoarthritis, and decided to make it her life’s work. She now helps people young and old find joy and improve their behaviour through the power of music.
“Let’s play together!” Wada, 37, gives her directions with a smile, and participants start singing while playing various percussion instruments, such as drums and wind chimes. The song is “Hamabe no Uta,” a song associated with summer.
Wada’s job is to calm elderly people, physically disabled people or children who have development disorders, and bring out their hidden talents. More than 100 kinds of musical instruments are used in her therapy, including drums and bells. She selects instruments based on participants’ ages, symptoms and how many members there are in a session.
If people sing songs that bring back memories, their brains are stimulated. If they perform as part of an ensemble, their social nature will be nurtured. Therapists need a wide knowledge across fields such as psychology, medicine and social welfare when selecting songs and planning methods for playing.
Wada has been especially fond of music since she was a child. After graduating from the literature department of a private university in Tokyo, she was active as a singer-songwriter. However, due to osteoarthritis of the hips suffered since her school days, she became disabled in both of her legs in her 20s.
While struggling with it for about five years, and having five operations, she heard about music therapy. Wada had long felt music has the power to change people’s minds and behaviour, and decided music therapy is what she wanted to do.
At the age of 31, she entered the Toho College of Music. After four years there, she obtained certification as a music therapist from the Japanese Music Therapy Association and started work as a music therapist at a nursing home and several other places.
She rejoices not only when people suffering from dementia express themselves, saying things like, “I want to play drums,” but also when paralyzed elderly people with few words strive to play a musical instrument.
“I’m encouraged by their satisfied expressions when they finish their performances,” Wada said.
Mixing poetry and music is the new strategy adopted by 22-year-old Malagasy singer Caylah who uses this music genre as therapy.
She targets single mothers or women who have been abused during this life in one way or the other.
Once a week she meets an association of young mothers to encourage them to remain confident despite the criticisms they receive from the public.
“I create jokes on prostitution for instance by saying, there is no bad job. I am a prostitute and I accept it. We feel the joy of living or the strength to say despite what happened to me, I remain a strong woman,” Caylah said.
As a committed artist Caylah does not beat about the bush. In her lyrics she tackles issues linked to politics, the adverse effects of globalisation as well as violence at home.
“I have a text which talks about a woman who is beaten at home. The message I want to pass across is that it is not because I am a woman considered in Malagasy as “fanaka malemy” or soft object that you should trample on me or beat me,” she added.
Caylah got interested in slam at the age of 16. Her style is highly respected in Madagascar.
She created an internet buzz few months ago after posting a song titled “Madagascar” highly critical of the government.
Henry has been a nursing home resident for about ten years. He isn’t able to say his daughter’s name when she asks him who she is. His caregiver explains that Henry tends to sit around with his head down, not talking. Then, as she hands Henry an iPod with his favorite music and puts headphones on him, there’s a transformation. His face lights up, his eyes open wide, he moves his arms and sings along. Afterward, he is able to answer questions and share memories about his youth.
The documentary Alive Inside features Henry’s story and shines a light on the work of Dan Cohen, founder of the nonprofit organization Music & Memory. “Dan Cohen founded the field,” said Tobias Overath of Duke’s Department of Psychology and Neuroscience and the Duke Institute for Brain Sciences. “People with Alzheimer’s who can’t communicate can awaken through music that’s personally meaningful.”
At Duke, School of Medicine students Kelly Ryan Murphy and Daniel Goltz initiated a quality improvement project at the Eno Pointe Assisted Living Center, “Connecting Residents with Dementia to their Autobiographic Soundtrack with Personalized Music,” mentored by Duke geriatrician Heidi White from the Department of Medicine. Their program received a 2016 AMDA Foundation Quality Improvement and Health Outcomes Award.
Faculty and Undergraduates Team Up for a Bass Connections Project
White, Overath and Cassandra M. Germain of the School of Medicine’s Department of Psychiatry and Behavioral Sciences led a related Bass Connections project, Music and Memory in the Aging Brain, with undergraduates Cole Jenson ’18, Amanda Lee ’17 and Megan Snyder ’17.
The study’s objectives were to examine the effectiveness of daily music listening on the behavioral symptoms of patients with dementia, and to examine perceptions of caregiver burden before and after the personalized music intervention.
The team worked with five pairs of patients and caregivers who live together at home in Durham: four couples and one parent-child pair.
Snyder explained the team’s process: “We go out and meet with them and do some baseline measurements, and assess their cognition and their neuropsychiatric behaviors associated with dementia. We also talk with their caregivers. Then we ask them what kind of music they like, and we come back with their favorite music personalized on an iPod. We ask them to listen to their personalized music every day, and we see if there were any changes with their neuropsychiatric symptoms—and also with the caregiver burden associated with caring for someone with dementia.”
The pre- and post-measures included the Caregiver Burden Inventory (CBI) and the Neuropsychiatric Inventory (NPI) to assess participant behavioral symptoms.
Snyder and Lee shared findings at the Society for Post-acute and Long-term Care Medicine conference in March 2016. The team found a reduction in CBI scores in three out of five caregivers. Some caregivers reported that their loved ones were less agitated immediately after listening to the music, and some said they found the music intervention enriching and that it improved quality of life by helping to increase interaction with their loved one.
Mentoring a New Generation
“One of the benefits for School of Medicine faculty is that the program provides a chance for faculty to mentor another generation of students, and also a means of collecting pilot data in an area of interest,” said Germain. “Our students have had a variety of opportunities to be exposed to the science side of medicine and the clinical side, which they wouldn’t have without this project.” White agreed: “It is reassuring to see college students who embrace the needs of the coming decades for our older adult population.”
Germain added that the undergraduates played a key role in shaping the
project. “One of the outcomes we were aiming for was a clinical
reduction of neuropsychiatric symptoms,” she said. “Based on student
interest, we added language and caregiver outcomes to the project.
Amanda became very interested in language production and quality; her
anthropology background influenced that. Cole had a background in the
arts, and his contribution helped to shape the music playlists and
provide technical support. Megan did a lot on the caregiver burden
For Jenson, this experience sparked an interest in further inquiry. “I want to do more research on stuff like why music makes people happy,” he said.
Duke’s involvement in this area of research continues with a summer extension that enrolled three more participant-caregiver pairs and involved one additional undergraduate, Morgan Ferrans, in the study. With direction from White, medical students Vinay Choksi and Kyle Freischlag identified geriatrician Katja Elbert-Avila as a mentor and are bringing personalized music therapy to patients in the long-term care facility at the Durham VA.
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