So you want to use music? The ancient art of music as self-care has new awareness in our era of distress, depression, and anxiety, and research offers lots of encouragement to do so. Music Therapy, on the other hand, continues to make clinical strides and win acceptance by board-certified clinical governing organizations for the treatment of dementia, Alzheimer’s disease, and, most recently, autism spectrum disorder. Using music as self-care vs music therapy is a question many of us must answer well, especially as care partners.
Convergence of Music and Neuroscience
There is growing clinical and professional interest in the convergence of neuroscience and the application of music for clinical and/or therapeutic purposes by board-certified Music Therapists. Close alongside this collaborative effort, one finds psychologists and “music psychologists” using music to open new potentials for treatment. These developments, while they have their roots in 19th- and 20th-Century exploration and practice, are primarily 21st-Century fields of endeavor and, as a respected neuroscientist and musician Daniel Levitin has written, are still largely un-researched:
“There is a great need in the field [of neural correlates of musical behaviors] for research that involves (a) controlled experiments with random assignment, (b) well-matched stimuli and control conditions in order to uncover the mechanisms by which music works, (c) a better understanding of the neurochemical systems involved, and (d) the optimal role of the music therapist in such interventions.” (American Music Therapy Association Perspectives, Vol 31 (1), 2013)
On balance, I also want to quote Levitin’s more encouraging paragraph, which immediately precedes the cautionary concluding one in the same paper:
“The emerging picture is that music can play an important role in bolstering the physical and psychological health of already healthy individuals, and the in the treatment of patients across a wide range of presentations. The advantage of music-based treatments is that they are non-invasive, don’t have side effects, are cost-effective, and completely ‘natural.'” (op cit)
The over-arching point of Levitin’s paper is that, while we know a great deal more about the measurable effects of music on the brain, we know comparatively little about the vast body of what scientists call “anecdotal evidence” that has accumulated around the use of music for thousands of years. In my view, this results from our Western clinical proclivity to dissect “presentations” (aspects of how a client shows up for care) down to their component symptomology and then treat the symptoms rather than take a more holistic view of a “presentation” and actually treat that, similar to the way naturopathic physicians holistically seek to understand and treat patients.
In no way do I wish to negate the promise and profoundly amazing clinical research that has been done using music, especially with respect to its benefits in recovery from brain damage, including stroke, intervention with Parkinson’s and Alzheimer’s diseases, and management of autism spectrum disorder. Music Therapists have led the charge in these areas and are to be commended for doing so.
The point here comes in the form of a question: if we know comparatively little about the effects of music, do Music Therapists not have a clinical and professional obligation for continued rigor before offering music therapy as a credible “treatment?”
Music Therapy and Credible, Ethical Treatment
For example, imagine yourself with a profound “presentation” that impacts your daily life — it could be physical, mental, emotional, or some combination — and that no evidence-based music therapy intervention exists for your condition. Let us say that you have tried some drug therapies with moderate results and unwanted side effects. Let us also say that, based on 40 years of experience — pretty much the entire life span of the practice — a board-certified Music Therapist offers to treat you with nothing more than the credibility of their professional experience. You agree that there is a possibility of benefit to you resulting from the music therapy, but you observe that board-certified Music Therapists are not supposed to accept your case because of their commitment to “Evidence-Based Practice.” For this example, you feel that the offer of music therapy for your “presentation” is genuine and well-intentioned, so what do you choose? Hypothetically, do you accept the possibly experimental music therapy treatment? Keep in mind that you have no way of knowing which way the therapy will go: to your benefit, neutral, or to your detriment.
Having an experienced music therapist as a guide is a plus; knowing that the side effects of music are very few is a plus. (One unwanted and controllable side-effect of music is that decibel levels outside the comfortable range can damage your eardrums.) It’s great to know that music therapy and neuroscience are working hard to solve the mysteries of the brain, but not enough is known about this now to attempt a cogent diagnosis of your symptoms, so that’s a neutral factor in your decision to choose music therapy or music care. You could offer to become the subject of a study of how music changes you, if at all…but your goal is well-being, not becoming Exhibit A of a clinical paper. Even though you might be able to receive “treatment” at no cost if your insurance covers music therapy (it does in some cases) or agree to be the lab rat, you decide this is not in your best interest and contradicts the quality of life you want.
Professionally, your “presentation” is an outlier to the Music Therapist unless it fits into the existing, evidence-based clinical study and practice of music therapy. This is an issue of clinical and professional ethics: if there isn’t enough evidence to support taking you as a patient, the proper thing for a professional music therapist in your case would be a referral to some other clinician or therapist with more direct experience in whatever your “presentation” includes. There is certainly nothing wrong with giving you music therapy alongside whatever other clinical or therapeutic remedies are employed, and I’m a big proponent of doing so, but it is a good idea to stay within the bounds of professional integrity when it comes to primary treatment using evidence-based modalities.
But I’d like to suggest a third option.
A little-known pilot study of music as a self-guided intervention was completed by the United States Department of Veterans Affairs in September 2011. Over the course of six weeks of guitar lessons, Veterans with combat-related post-traumatic stress found a double-digit reduction in symptoms of depression and improved health-related quality of life. I’ll say that again…
Learning to play the guitar reduced symptoms of depression
and improved health-related quality of life.
Do you see the possibilities here? Your example “presentation” might respond to music that you can give yourself, whether that’s playing an instrument, singing, listening, or drumming…there is a wide-open potential for you to interact with music to your own benefit. You begin to consider this third option: music as self-care.
Music as Self-Care
You realize you listen to music throughout your day: you wake to music each morning, sometimes have it playing as you prepare for the day’s activities; you listen in the car and sometimes use your smartphone and earbuds at work between meetings. You’re always working out to music that powers you up, even with the “presentation” you’ve been fighting for months. Sometimes you sing along to the music; there’s a concert by a favorite performer coming up soon, and you’re looking forward to it. You’ve even tried apps like Pandora and Spotify and their mood-based playlists, and of course, you buy new music on iTunes or CDBaby whenever one of the emerging bands you like releases their latest CD or EP. Usually, you relax with something soothing in the evening or before bed. Surprising yourself, you start to examine the soundtrack in your life and begin to wonder what effect it might have on you…
Not surprising to think that there might be a correlation between your music and your “presentation.” There’s enough neuroscience to suggest it’s worth a look. You decide to vary just one song in your daily routine: the one that wakes you up. As much as you love waking up super-energized, you decide against all reason to wake up to something more subtle. You’ve done your research and made your choice of a new song, and what the heck? If this new tune doesn’t wake you up, there are plenty of others to choose from. You find, for example, a string quartet (?!) that looks intriguing (do Classical musicians really dress like that?!) and change your wake-up tune, and then you observe what happens. After a few days, you notice a change. You still wake up with energy, but you are less agitated. It takes a little longer to get out of bed because the music isn’t so energetic, but you set the alarm a little earlier to give you time to hear more of the music before actually leaving the bed. You’ve started to engage in the process of music as self-care.
Gradually, you begin to notice the effects of different types on you.
You’ve always known that workout music needs to pump you up — now you discover how there’s more to it than just a high number of powerful beats per minute. You learn how you can modulate your breath to the pulse of music, whatever speed that pulse may be. You begin to notice the paradox between music that feels one way and lyrics that feel the opposite. You begin to sense that there is a lot more going on than a plainly obvious and simple physical, emotional, or mental effect. You begin to engage with music in a different way. Even high-energy music has new meaning for you now that you are beginning to parse the polyrhythms and balance of each voice and instrument in the mix. You start to reverse-engineer what the producer had in mind in the various pop songs you love; begin to play around with equalization to hear interior sounds that aren’t obvious in the airplay mix. You decide to listen less to sampled music — most digitized music is compressed to make it more portable but winds up missing quite a bit of information that our brains “fill in” for us — and so you haul your CD (and/or LP!) collection out of storage to see if you can really hear everything in a given song. As your ears become accustomed to wanting more depth in the music, you start to change all your compression settings from “normal” to “high” or “studio quality,”…and you quickly run out of space on your mobile device… You come across the old flute you used to play in the high school marching band and try some tunes you still remember…
Are you getting the picture? I’m not suggesting that we all become audiophiles or start taking music lessons, but the small-and-growing stack of evidence for music as a “self-guided intervention” — what I call “music care” — supports the notion that you, with whatever your symptomology or “presentation,” might be able to give yourself a form of relief that simply isn’t available any other way.
The World Health Organization calls stress the “health epidemic of the 21st Century.” Debilitating stress, depression, and anxiety are a leading cause of “years lost to disability” worldwide — more so than even cancer or AIDS — and the pandemic hasn’t helped reduce our global “presentation” of these symptoms. The world needs better care for depression, stress, and anxiety. You deserve better care. If you had the opportunity to give yourself care — care that could be effective, is definitely safe and free of side effects, and that is available for free worldwide — why would you wait for a therapist?
It’s just a suggestion, but I believe that it’s time to get busy and listen with intent and expectation. What say you? You have options: using music for self-care vs music therapy, and both are powerful and effective ways towards wellness.
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