Music therapy - an effective tool for treating depression

Transcription

1 Music therapy - an effective tool for treating depression IOANA CIOCA 1 ABSTRACT: The relationship between music and human body is very complex and incomplete elucidated. Music has a direct effect of relaxation, being considered a true eustress, but the strongest influence of music on body is exercised through the neuroendocrine system. The strong relationship between music and neuroendocrine system can be illustrated using the analysis of music effects on pain, anxiety, depression, stress and immune system. In case of psychiatric disorders, music therapy does not only match to a single diagnosis. Music therapy for patients with psychiatric disorders is guided rather on patient resources, powers and potential than on problems and conflicts. Music therapy can be used in a variety of ways to treat depression. It can reduce the quantity of drugs administered or can serve as a way to replace medication. Pain, loneliness, even anger - are all better managed when the right music is added to drug therapy and psychotherapy. Music therapy is an important part of a complete and effective treatment for emotional disorders such as depression, as long as it involves the identification and the seizure of emotions. Keywords: music therapy, depression, neuroendocrine system, subcortical limbic system, frontal brain areas, eustress, sanogenetic behavior. REZUMAT: Relaţia dintre muzica şi corpul uman este foarte complexă şi incomplet elucidată. Muzica are un efect direct de relaxare, fiind considerată un eustres adevărat, dar cea mai puternică influenţă a muzicii asupra organismului se exercită prin intermediul sistemului neuroendocrin. Relaţia puternică între muzică şi sistemul neuroendocrin poate fi ilustrată prin analiza efectelor muzicii asupra durerii, anxietăţii, depresiei, stress+ului şi sistemului imunitar. 1 Psychologist, Assistant Professor in Department of Medical Psychology and Psychosomatics of University of Medicine and Pharmacy "Carol Davila", Bucharest 1

2 În caz de tulburări psihice, terapia prin muzica nu se potriveşte doar la un singur diagnostic. Terapia prin muzică pentru pacienţii cu tulburări psihice se ghidează mai degrabă pe resursele pacientului, competenţele şi potenţiale sale decât pe probleme şi conflicte. Terapia prin muzică poate fi folosită într-o varietate de moduri de a trata depresia. Aceasta poate reduce cantitatea de medicamente administrate sau poate servi ca o modalitate de a înlocui medicamentele. Durere, singurătate, chiar şi furie - toate sunt gestionate mai bine atunci când muzica se adaugă la terapia medicamentoasă şi psihoterapie. Terapia prin muzică este o parte importantă a unui tratament complet şi eficient pentru tulburari emoţionale, cum ar fi depresia, atâta timp cât aceasta implică identificarea şi gestionarea emoţiilor. Cuvinte cheie: terapie prin muzică, depresie, sistem neuroendocrin, sistem limbic, arii cerebrale frontale, eustres, comportament sanogen. Introduction Music ability to "heal the soul" is a stuff of legend in every culture. Many people consider that music "raises the spirits" and modern researches tends to confirm the psychotherapeutic benefits of music. (Maratos et al., 2002) One of the particularities of music that can explain the great influence which she exerts on mind and body is that, while poetry and literature is based on reason to trigger an emotion, as long as they are mediated by words, music avoids this route and directly targets at the level of evoking emotions. So, music does not move to the rationality to express the essence, it travels directly to the emotional-affective level. And these emotions have a direct impact on human body through the neuroendocrine system. The relationship between music and human body is very complex and incomplete elucidated. Music exerts its influence on human body through many ways. Music has a direct effect of relaxation being considered a true eustress. But perhaps the strongest influence is exercised and at the same time, explained through neuroendocrine system activation. The physiological bases of music therapy and the relationship between music and brain complete the perspective of vast effects of music on body and mind. The strong relationship between music and neuroendocrine system can be illustrated using the analysis of music effects on pain, anxiety, depression, stress and immune system. 2

3 The literature describes particular effects of music on certain hormones and neuropeptides: cortisol, adrenocorticotropic hormone, growth hormone, adrenaline, noradrenaline, endorphins, dopamine, serotonin, melatonin, prolactin and cytokines. The researches have shown that music has a profound effect on body and mind (Scott, 2000). This is not a surprise, because the music affects body and mind through many ways. The following examples are some of the effects of music, which helps to explain the effectiveness of music therapy in depression: Brain waves: The researches have shown that music with a strong rhythm can stimulate brain waves to resonate synchronized with the rhythm, fast rhythms bringing greater concentration and a quick thinking, and slow rhythms promoting a calm state, meditative. Also, the researchers have found that changes in brain wave activity levels that music brings can help brain to "change gears" easier, as needed, which means that music can bring long term benefits to mood, even after you've stopped listening. Breathing and heart rate: with changes in brain waves, it also appears changes in other body functions. Those functions led by the autonomic nervous system, such as breathing and heart rate, can be influenced by changes that music brings. This could mean a slow breathing, slow heart rate and the activation of relaxing response. For this reason music and music therapy can reverse or prevent the damaging effects of chronic stress, promoting not only the sense of relaxation, but health. The mood: music can also be used to promote, trigger and maintain a positive mood, helping to prevent depression and anxiety. This can help prevent body's response to stress and can help to maintain a high level of creativity and optimism, bringing many other benefits. Other benefits: it has been discovered that music brings many other benefits on somatic and mental health, for example she lowers blood pressure (which can also decrease the risk of stroke and other further problems), increases immunity, helps to reduce muscle tension and more. With many benefits and deep physical effects, it is no surprise that many people see music as an important 3

4 tool in maintaining a healthy body, music listening becoming a real sanogenetic behavior. Music therapy in psychiatric disorders In case of psychiatric disorders, music therapy does not only match to a single diagnosis. Therapy content is, rather negotiated with the patient during therapy, taking into account the individual characteristics of each patient. But music therapy is extremely effective in all situations where patients - regardless of diagnosis - are not motivated for therapy. It has been suggested (Wampold et al., 2002) that factors unrelated to psychiatric diagnosis, such as therapeutic motivation must be taken into account in assessing psychotherapy, because it might not work if the patient is not enough motivated (Nickel et al., 2005; Schneider et al., 1999). In music therapy, using music itself can often be a motivating factor for patients (Rolvsjord, 2001). So, lack motivation for therapy of psychiatric patients may become reason for his direction to music therapy, because these factors can sometimes be more important than the primary diagnosis. The problem of lack motivation has been described for a variety of disorders such as schizophrenia (McEvoy et al., 1981), depression and bipolar disorder (Ghaemi et al., 1995), therefore music therapy is often recommended for these patients. Music therapy for patients with psychiatric disorders is guided rather on patient resources, powers and potential than on problems and conflicts. In music therapy, music may be seen as a central resource for patient, but an approach based on resources also provides emphasis on patient skills during conversations that take place in music therapy sessions. Music therapy purposes, based on resources for people with psychiatric disorders includes, among other things, increasing ability to feel and express emotions, building and maintaining relationships with others, but also development of interest and motivation. Music therapy purpose is to help people with psychiatric disorders to develop relationships and solve problems that could not solve using only words. 4

5 Music therapy in treating depression Depression is a common problem that affects millions of people around the world and she is characterized by a persistent low mood. The disorder is characterized by a marked decline in self-esteem and feelings of worthlessness and guilt. Symptoms include anhedonia, tiredness, trouble concentration, changes in appetite. Depression is a common disorder associated with low social functioning, significantly affecting life quality. It is proved that people with depression have less need for medication and psychotherapy is more successful, especially when music is added to standard treatment. Pain, loneliness, even anger - are all better managed when the right music is added to drug therapy and psychotherapy. Depression is therefore one of the most common reasons for using complementary alternative therapies. The reasons are complex and vary according to the group of patients. These may be represented by the absence of satisfaction on conventional treatments and / or the desire to avoid side effects of drugs. Side effects such as nausea, headache, diarrhea and anxiety are well known, and the patients are in search of additional alternative treatments, for this reason. Music therapy has the potential to serve as an adjuvant to medication. It can reduce the quantity of drugs administered or can serve as a way to replace medication. Music therapy can be used in a variety of ways to treat depression. The approaches can be active or receptive. The series of interventions includes image guidance through "prescribed" music to induce particular emotional conditions such as relaxation or motivational and volitional increasing. Receptive techniques involve the use of music for relaxation, guided reflection to change mood. The action mechanism assumed that therapy through receptive music is that different types of musical triggers directly induce physical and emotional changes. It was suggested that this form of music therapy can help to reduce stress, relieve pain and energize (Bruscia, 1991; Standley, 1991). Also in music therapy can take place reflective discussions around music chosen by the patient or the therapist or improvised by the two protagonists in the case of active music therapy. Active techniques can be used when the participants cannot effectively verbalize their 5

6 most complex feelings. In this case the therapist uses clinical techniques to connect with the patient in an improvised dialogue, which then act as a springboard for affective awareness and emotional catharsis. In active approaches the therapist uses clinical techniques to stimulate and guide the patient who can use his voice or any musical instrument. The action mechanism involved here is that the relationship between therapist and patient, created through musical improvisation, allows the patient to express and gain a perspective on relational or emotional problems through discussion in the "music" dialogue. (Nordolf et Robbins, 1977; Odell-Miller, 1995) Improvised music therapy is based on achieving a spontaneous and dynamic music, often in client-therapist dyads. The method uses the typical non-verbal language, as well as the verbal one and the subsequent analysis highlights in particular, their meaning and the process that uses emotions as an essential part of the therapeutic process. The analytical music therapy uses words and symbolic music improvisations as means of exploring the private life of the customer and facilitates growth in the psychological. The fact that music influences the emotions is a well known phenomena and modern neuroscience revealed the cortical areas involved in processes and emotional disorders. (Blood et Zanatorre, 2001) In particular, it is believed that subcortical limbic system and frontal areas of brain works inadequate in depression or even presents morphological changes or biochemical dysfunction. (Maletic et al., 2007) Here, the perception of music and the interaction of music therapy seem to be a powerful noninvasive tool in encouraging the cerebral and affective systems involved in depression. EEG studies have shown signs of depression in frontal alpha area. (Allen et Kline, 2004) Hypo left frontal area is a stable marker of vulnerability characteristics of depression or anxiety disorders (Coan et Allen, 2004) because depression is correlated with the hypoactivity of left hemisphere, this fact could be attenuated through music therapy, as some studies have shown (Jones et Field, 1999). Recent studies have found that positive affects are associated with greater left frontal activity recorded EEG, while the negative affects are associated with 6

7 greater right frontal EEG activity. More chronically depressed adults have the right frontal EEG activity predominantly. A study (Field et al., 1998) has investigated the effects of music on mood and the front straight on the EEG activity associated with chronic depression. The results showed significant changes in self-reported mood but registered lower cortisol levels and significant attenuation of right frontal activation during and after listening the music. It has been concluded that music had positive effects on physiological and biochemical indicators, even if self-reported disposal hasn t significantly changed. Various studies explore the effects of music therapy in depression. Some (ChenChen, 1992; Hanser et Thomson, 1994; Hendricks, 1999) have reported significant positive effects by reducing clinical symptoms of depression. Another (Zerhuser et al., 1995), in which music therapy was used as a control treatment, didn t show any effect. Another study (Maratos et al., 2008) compared music therapy with the standard one and suggested that music therapy has been accepted by people with depression and has been associated with improvements in mood. The researches showed that music therapy helps patients to improve their general symptoms, specific symptoms of depression and anxiety and their level of functioning. The report has confirmed the conclusion that music therapy is a treatment for depression with noticeable effects. In a study (Erkkila et al., 2008) was analyzed the effect of improvised music therapy on depression treatment. In particular the attention was given to agents mediators, such as musical expressions and interactions in meetings, but also the potential to explain the EEG recordings, which investigates emotions related to depressed individuals perception regarding music. The results reveal that music related to the emotional experience, measured by EEG, can be successfully used in the counseling of clients with depression. The basic principle of this intervention is to encourage and engage the patient in interaction with music. The starting point for improvisation can be both free and referential. The common experience is discussed and the therapeutic process is based on building mutual meanings of thoughts, images, emotional content and expressive qualities as they are reflected and 7

8 understood in psychodynamic context. The main objective is to achieve a dynamic music experience using verbal processing after listening. In a study (Tornek et al., 2003) were performed electroencephalograms (EEG) to 48 mothers internalized and withdrawn which presented depressive symptoms. These were evaluated after a music session of 20 minutes to determine if music would affect mood. The results indicated that the level of anxiety - anxiety inventory measured by State Anxiety Inventory (STAI) - has decreased, while levels of depression - mood profile measured with Profile of Mood States (POMS), has decreased significantly after music listening. To conclude, for those depressed patients who are not receiving treatment with verbal psychotherapy, music therapy, through her body language way to express different feelings and the opportunity to interact with that person, is a suitable offer. Music therapy is therefore an important part of a complete and effective treatment for emotional disorders such as depression, as long as it involves the identification and the seizure of emotions, either in receptive music therapy, or in its active form. Bibliography 1. Maratos AS, Gold C, Wang X, Crawford MJ. (2002) Music therapy for depression. Cochrane Database System 22; 2. Scott E. Music and Your Body: How Music Affects Us and Why Music Therapy Promotes Health How and Why Is Music A Good Tool For Health? Available online at www. about.com; 3. Wampold BE, Lichtenberg JW, Waehler CA (2002) Principles of empirically supported interventions in counseling psychology, Counseling Psychology., 30: ; 4. Nickel C, Tritt K, Kettler C, Lahmann C, Loew T, Rother W, Nickel M: (2005) Motivation for therapy and the results of inpatient treatment of patients with a generalized anxiety disorder: a prospective, Wien Klin Wochenschr., 117: ; 5. Schneider W, Klauer T, Janssen PL, Tetzlaff M. (1999) Influence of psychotherapy motivation on the course of psychotherapy, Nervenarzt, 70: ; 8

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