If You’re Sad and You Know it…

iWhat do you do when you feel down or upset? Do you ever turn to music? In that moment, did you ever stop to think about why you listen to music in that emotional state? Bruscia, (1991) and Standley, (1991) both suggested that music can reduce stress, sooth pain, and energize the body (Maratos, Gold, Wang, & Crawfield, 2008). In some who are clinically depressed music is often used as a form of therapy, in combination with medication, as a means of internal expression. Music therapy has become an addition to a course of treatment, or even a complete alternative to other forms of medicine. However, music therapy is not the societal cliché that only depicts the client violently banging on a keyboard yelling about why he/she is sad. (Or is it?) So what is music therapy? And what is the state of the brain during the treatment?

Music therapy is used for treatment in depression to bring repressed material and emotion from unconscious (repressed, psychic material) to conscious (rational thinking, skills, knowledge, techniques) processing. The music therapist uses a combined method of clinical free improvisations whilst talking. In order to conduct a randomised controlled trial (RCT), there was standardization in music therapy in which you would not go under or over in which how people were being treated. The therapists had to be standardized on what language they would use with the patient, the interaction levels with the psychiatrist, and the musicality levels of all the musicians (the music therapists). This standardisation is also very important when you are doing intervention research. The use of restricted instrumentation is necessary for both the music therapist and the patient during research for observational data. If during treatment the music therapist is using 2 xylophones (e.g. one for the music therapist and one for the patient), a music therapist can then say, “let’s play together how that act occurred, and then we can talk about it”. From there it is then important to watch and note how the patient is playing, to listen to what the patient is saying, or even to note the patients’ posture. This is a skill which can be harder on instruments that the therapist and patient are more intricately playing.

Jörg Fachner is a professor at Anglia Ruskin University, Cambridge in Music, Health and Medicine. He has looked at music therapy and fronto-temporal resting state changes in EEG scans to study the clinical effects of music therapy as a treatment in clinically depressed outpatient clients (with comorbid anxiety). Dr. Fachners’ motivation was to show that improvisational psychodynamic music therapy shifted frontal asymmetries, therefore lowering depression and anxiety within patients. Dr. Fachner discussed his research during his visit to Goldsmiths College on November 14th, 2013. These landmark studies were conducted in Finland where depression affects 5-6.5% of the population (Erkkilä, Punkanen, Fachner, Ala-Ruona, Pöntiö, Tervaniemi, & Vanhala, 2011). Although medication and psychotherapies are the recommended course of action for treating depression and are found to be effective, music therapy may be an alternative treatment for patients who have a hard time communicating verbally (Erkkilä et al., 2011).

Dr.Fachner presented research from two related studies. For both studies, the clinically depressed outpatients were randomly placed into either a standard care group, or a music therapy treatment group which also received standard care. The standard care group continued with their normal treatment methods: psychiatric counselling, short term psychotherapy (5-6 sessions), and treatment with a depression nurse. The music therapy group received individual music therapy sessions biweekly for about 3 months (18 sessions).

In the first study, Dr. Fachner measured depression and anxiety by means of psychiatric tests at the 3 and 6 month markers for both the standard care and the music therapy groups. The primary measurement test was the Montgomery–Asberg Depression Rating Scale (MADRS), in support with the Hospital Anxiety and Depression Scale (HADS–A), Global Assessment of Functioning (GAF), the health-related quality of life survey RAND–36, and the Toronto Alexithymia Scale (TAS–20). (Erkkilä et al., 2011). Dr. Fachner found that music therapy significantly reduced depression and anxiety symptoms based on survey feedback from his patients as compared to the standard care group.

Resting state EEG is baseline neuroimaging of the brain that is conducted during wakefulness in which the brain is in a high energy state with zero stimuli (Mantini, Perrucci, Gratta, Romani, Corbetta, 2007). These biomarkers are a biological mechanism we use to show how a treatment works and to predict response to a treatment. In Dr. Fachners’ second study he measured the resting state EEG recordings at baseline and after 3 months. An increase in frontal theta waves (working memory) was hypothesised for it has been shown that depressed individuals show a decreased left anterior cortical activity (Fachner et al., 2012). He used this to correlate the resting EEGs with the survey feedback results his patients gave about their depression and anxiety symptoms. Dr. Fachner also looked to see if music therapy had shifted the frontal alpha asymmetry, or difficulties expressing and recognizing emotion, and increased frontal midline theta waves for a lasting change.

Results between the two studies showed a significant dip in depression and anxiety with those that had received the music therapy treatment versus those who had just received the standard care. This was displayed by a correlation between more mid-frontal theta power and with low HADS-A score (Fachner et al, 2012). The EEG scans also showed an asymmetrical shift of processing to the right which indicates more emotional and speech processing than before the therapy began. This could indicate that the patients receiving music therapy were able to express their emotions and issues more easily because of the tools learned in music therapy.

Dr. Fachners’ research brought tremendous insight into the clinical field of music therapy. His presentation at Goldsmiths College covered the standardization of music therapy, psychiatric testing in those with comorbid anxiety and depressive disorder, as well as EEG scans and biomarkers pre and post music therapy sessions.

The next time you are feeling sad, will you pick up a piece of chocolate or your headphones?

More information about Dr. Fachner and his research can be found at: www.anglia.ac.uk/jorg_fachner

Written by: Sarah Khazzam


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