Music Therapy: A Panacea for Eating Disorders Patients
With their keynote presentation at the 2020 iaedp Virtual Symposium, “The Brain Comes Alive with the Sound of Music: Innovative Treatments for Eating Disorders Clients through Music Therapy,” Drs. Ralph Carson and Annie H. Heiderscheit outlined the direct and powerful effects music and music therapy can have in treatment of patients with EDs.
The Healing Power of Music
Dr. Carson, Senior Clinical and Research Advisor at the Eating Recovery Center, and longtime iaedp Board member, told audience members that the use of music as healing therapy has a long history, going back at least to biblical times, when David played his harp for King Saul. During World War I and II, when professional entertainers and volunteers entertained wounded soldiers with music, nurses and clinicians noticed that hospitalized soldiers who had been exposed to music were able to leave the hospital more quickly.
Dr. Carson explained the neurologic framework and the power of sound and music in human therapy and in nature, where soothing sounds affect songbirds, and reduce the fight or flight instinct. He explained that music can reduce anxiety and build a therapeutic bond with clients. Listening to relaxing low-tempo sounds reduces blood pressure and produces oxytocin. Opposite to the effect of cortisol, oxytocin reduces anxiety.
Therapy with music—particularly low-tempo music—can help reduce anxiety in the clinical setting and helps build a therapeutic bond, so that clients become more engaged in therapy, he said. The effect of music on the heart can be seen in a series of studies by Dr. Carrol Mclaughlin and colleagues (Evidence based Complementary and Alternative Medicine. 2013; article 428731) that showed patients needed less anesthesia and had lower levels of atrial fibrillation, suggesting that oxytocin relaxed the heart.
Playing music at bedtime can be very helpful for slowing the heart rate, Dr. Carson said. Background music can enable clients to fall asleep more quickly and to sleep longer, facilitating healing and neurogeneration. The music that is most calming to people is music they associate with times when their life was good, and/or music was experienced as calming and soothing. The most effective approach integrates music into regular bedtime routines, he added. Classical music, in particular soothing melodies that progress from low to higher notes, is the best form for reducing anxiety, he said.
The therapeutic impact of movement to music involves a complex cortisol process that weds emotions and a reward system, Dr. Carson noted. The way we respond depends on the social context. When movement is synchronized to a steady beat, humans and songbirds automatically feel that beat. Not all humans can get into the beat, he added, but for those who do, musical synchronization has many benefits. Some of these include helping children with speech impairments; sychronization can also help boost the immune system.
Taking up a new musical instrument can be helpful for slowing aging and for preventing the onset of certain degenerative processes, Dr. Carson explained. For example, playing the drums stimulates alpha waves that help balance the brain and enable an individual to be more creative and to have a heightened sense of spirituality as well. Learning to play a musical instrument also has a direct and beneficial effect on the aging brain. In the brain, the hippocampus produces stem cells that migrate, and may slow cognitive decline (Transl Neurodegener. 2017; 6: 2; Geriatr Gerontol Int. 2014; 14:440).
Music and COVID-19
Dr. Carson told the audience that use of music might be very helpful as part of COVID-19 therapy. For example, inflammation is one of the most serious problems in COVID-19. Music reduces inflammation by keeping cortisol levels and the respiratory rate lower, improving breathing, and reducing pain-all goals in COVID-19 therapy.
Music and EDs
How does music come into play for treating people with eating disorders? Dr. Carson noted that music soothes emotional disorders, quells vomiting, and reduces pain and traumatic brain injury. Music reduces pain in conditions such as fibromyalgia, osteoarthritis, and in postoperative pain. Cognitive behavioral therapy and music therapy can help reduce cognitive distortions. As a result, patients have an increased ability to eat healthier meals, and can learn to self-limit. Other benefits are increased quality of life, improved social skills, and increased motivation to recover and to challenge self-defeating body disorders. Self-determination is also improved, according to Dr. Carson. Music can also become a helpful diversion during chemotherapy, he said. In heart disease it is soothing and relaxes the arteries; however, it does not necessarily reduce heart disease.
Singing is another beneficial part of music therapy. Singing reduces depression, improves camaraderie, as is seen with karaoke, and reduces blood pressure and heart rate.
Our thoughts can override the effort to relax, he said. If a patient has distracting thoughts, music can counteract this. By focusing on music, breathing or imagery, it is possible to pull the focus away from such distracting thoughts and allow the body to relax.
Finally, Dr. Carson, who is also an expert in exercise physiology, noted that music could be very helpful to athletes trying to get through a workout. By itself, working out decreases anxiety and enables the athlete to feel less pain as it releases endorphins. Music boosts physical endurance and is helpful for people in all activities (Int Rev Sport Exerc Psychol. 2012 Mar; 5: 44).
An NIH Award to Explore the Potential of Sound
Growing interest in the brain and the effects of music is reflected in a recent educational project. Dr. Carson noted that the National Institutes of Health awarded $20 million in 2019 (www.nih.gov/research-training/medical-research-initiatives/sound-health) to be used over the next 5 years to support the Sound Health Initiative, a program to explore the potential of music to treat a wide range of conditions resulting from neurological and other disorders. Sound Health Initiative research aims to advance the understanding of music’s mechanism of action in the brain and how this knowledge can be applied more broadly to treat symptoms of disorders such as Parkinson’s disease, stroke, and chronic pain. The research will also explore the effect of music on the developing brains of children.
The Body as a Symphony
Dr. Heiderscheit, Director of Music Therapy and Associate Professor of Music at Augsburg University, Minneapolis, MN, described how music is “a very holistic process connecting every part of our body.”
She told the virtual audience that the four main methods used in music therapy are: (1) receptive, listening to music; (2) recreational, playing music and singing a favorite song; (3) recreating, where music is created with science and (4) creating, improvising music in the moment.
The body is a symphony of rhythms, she said. During sleep, our normal heartbeat is 60 to 80 beats per minute, and during the deeper sleep cycle this falls to 40 to 60 beats. Breath is the life force, the essence of who are, she said. For example, during periods of anxiety our breath becomes shallow and rapid, and when we feel overwhelmed, moves into hyperventilation. The vagus nerve responds to the breath, sending a signal cueing the body that we are going into a fight or flight mode. Our breath is the barometer.
Music of 60 to 80 beats per minute is best for relaxation, she said. A patient should also choose music he or she likes. It is a challenge, as our thoughts can easily override the system.
Help During the Pandemic
Music has useful applications during the pandemic, she said. Music is a great tool for quieting the mind and relaxing the body. The listener can lean back in a chair, close his or her eyes, and listen to sounds of ocean waves or Native American flute music. With string instruments, the tension mimics the muscles: the higher the pitch, the lower the tone, and muscles mirror this. With sleep, a variety of types of music can produce delta rhythm, designed to help the client move into a very deep sleep cycle.
Dr. Heiderscheit also noted that songs can be helpful for many therapeutic needs. Does a song express unsaid thoughts or things a patient might want to hear? Dr. Heiderscheit said, “We might use a song to serve as a springboard for a therapeutic issue.” Songs can help clients express or disclose something when they cannot find the words. Songs enable us to explore and reflect upon our lives. A song can act as an autobiography, of different moments, experiences, and can be a bridge to help the client and therapist explore these experiences. She provided a good example with a song, “This Is Me,” from the Broadway musical The Greatest Showman. The story behind the musical about PT Barnum had to do with abuse. A client might bring in a song as a way to express or disclose something that is difficult or impossible to address directly with the group or therapist.
A song can also enable the client to hear and discover new self-understandings. Songs can connect with us and can change our affect; lifting our mood or shifting it down, she added. Mostly it is a way to explore relationships and to communicate energy and movement. As a demonstration, Dr. Heiderscheit invited audience members to notice what happens to the body when one is listening to a song like “YMCA.” The rhythm of the song gets the body moving, and is an activating agent, a motivation for movement and action. She also pointed to the many other benefits of singing, such as building lung capacity and a bringing a sense of empowerment. Singing may let us feel this sense of empowerment, using our own instrument, connection, and community. This is very applicable right now, in the era of COVID-19, she said.
One of the final pieces in music therapy is song writing. She gave an example where a group of her ED patients chose to transform a song from The Dixie Chicks (recently renamed The Chicks), “Goodbye Earl” that details an abusive relationship. This song, chosen by the group and rewritten, provided the group with a way to safely explore their feelings and experiences. Similar to an eating disorder, which is toxic and destructive, the group could explore the ugly feelings and experiences they had encountered and to find a place to put them. The song they produced and recorded led to an “artifact” that the group could retain. The song the women developed was titled, “Goodbye ED.”
Ralph Carson, LD, RD, PhD
Dr. Ralph Carson is a clinical nutritionist and exercise physiologist with nearly 40 years of experience in the treatment of addictions, obesity, and eating disorders. Prior to joining Eating Recovery Center, Dr. Carson was the Executive Director of FitRx in Brentwood, TN. He was also a clinical consultant to Pine Grove Behavioral Health & Addiction Treatment Center, Hattiesburg, MS. He has been a faculty member of the University of Alabama at Huntsville for over 20 years, is a nutritional advisor to numerous university athletic departments, including the University of Tennessee National Basketball Champion Lady Volunteers, and speaks regularly to professional and lay audiences alike. Dr. Carson is the author of Harnessing the Healing Power of Fruit and The Brain Fix: What’s the Matter with Your Gray Matter: Improve Your Memory, Moods, and Mind. Additionally, Dr. Carson is an active board member of the International Association of Eating Disorder Professionals (iaedp) and the Binge Eating Disorder Association (BEDA).
Annie Heiderscheit, PhD, MT-BC, LMFT
Dr. Heiderscheit has been a board-certified music therapist for 28 years. She is currently Director of Music Therapy and Associate Professor of Music at Augsburg University, Minneapolis, MN. She is a licensed marriage and family therapist, and has advanced training in music psychotherapy and the Bonny Method of Guided Imagery Music. She has worked with clients with eating disorders for 17 years, and has published numerous case studies and four books, including Creative Arts Therapies and Clients with Eating Disorders. She maintains a clinical practice at the University of Minnesota Children’s Hospital, as well as a music therapy private practice. Dr. Heiderscheidt consults and teaches within major healthcare organizations on the benefits of using music as an integrative modality in patient care. She is a fellow of the Association of Music and Imagery.