Last weekend, at the Group Sound & Movement Therapy Workshops, I shared with you a page of the literature from the below article on sound healing by Liz Cooper. This article allowed us to embrace the role of live instruments, visualisation, imagination, play as well as the importance of sharing our respective reflection in our group - all significant aspects which support our transformative journey. As promised, please find the full article below which depicts the research conducted by Liz Cooper on the relationship between Sound Healing and General Anxiety Disorder :
THERAPEUTIC SOUNDSCAPES - A MUSICAL HEALING MEDIUM By Liz Cooper
Introduction
The focus of this article is to explore music as a healing medium. I will discuss the use of music to improve health and wellbeing in a general sense. I will describe an approach which combines narrative therapy, group musical improvisation and reflective practice to create a therapeutic process I have called a ‘therapeutic soundscape’. I will suggest that this approach could be helpful with central nervous system (CNS) disorders such as General Anxiety Disorder (GAD). With the advancements in psycho-neuro-immunology I will also mention connections between long-term, chronic stress and other conditions, some of which are life-threatening.
This article is based on my observations of the benefit of this methodology supported by relevant literature.
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CNS disorders include anxiety, depression, Alzheimer’s and Parkinson’s disease. Although the latter conditions are long-term and degenerative, anxiety and depression, in many cases, can be overcome and are usually treated with different approaches including medication, Cognitive Behavioural Therapy (CBT), counselling (or other psycho-therapeutic approach) and general relaxation methods such as meditation. Generalised Anxiety Disorder (GAD) is different from the anxiety that many people experience, such as when one is about to take an exam, for example. Individuals diagnosed with GAD feel anxious most of the time, with the level of anxiety being disproportionate to the issue. For example, a journey to work may be highly stressful because they may anticipate all of the events that may happen before leaving the house – ‘will there be an accident?’, ‘will I be late?’, ‘what if the car breaks down on the way’, and so on. According to Anxiety UK, an online resource, ‘Generalised Anxiety Disorder (GAD) can be defined as a disorder in which the sufferer feels in a constant state of high anxiety and is often known as ‘chronic worrying’ or a ‘free floating’ anxiety condition.’ (www.anxietyuk.org.uk)
GAD can have a devastating effect on the quality of life. The impact on health can include symptoms such as insomnia, irritability and panic attacks. There can also be physical manifestations such as muscle tension, headaches, eczema, irritable bowel and heart disease. The body-mind link has been a subject of much research and debate and with advancements in psycho-neuro-immunology it is now accepted that our psychology affects our physiology and vice-versa. Pert (1997) states, ‘intelligence is located not only in the brain but in cells that are distributed throughout the body, and that the traditional separation of mental processes, including emotions, from the body is no longer valid. (Pert, 1997, p.187). More recently Pert stated ‘our work is demonstrating that all cells of the nervous system and endocrine system are functionally integrated with the cells of the immune system by networks of peptides’. (Pert & Ruff, 2008, p.108).
More recently Alzheimer’s, another CNS disorder, has been linked to long-term stress. In a longitudinal study spanning 35 years, Johanssen, et al., (2010) discovered ‘an association between psychological stress in middle-aged women and development of dementia, especially Alzheimer’s disease’. (Johanssen, et al., 2010, p.2217). Holmes (2012) states that ‘one factor increasingly implicated in the process (Alzheimer’s) is chronic stress’ (brackets mine). (www.alzheimers.org.uk). There are also links between stress and its debilitating effect on the immune system, which suggests that stress could be a contributing factor with regard to almost any disease.
Goleman (2004) states, ‘both anger and anxiety, when chronic, can make people more susceptible to a range of diseases...if chronic emotional distress in its many forms is toxic, the opposite range of emotion can be a tonic’ (Goleman, 2004, P.177). With this in mind, any pleasurable experience, such as community music making and improvisation, could be a ‘wholing’ medium. According to North & Hargraves (2008) ‘music can affect the autonomic nervous system and lower stress’. (North & Hargraves, 2008, p.308). If stress is lowered then there could be a positive impact on GAD. Clarke, et al., (2010) state that the ‘therapeutic uses of music, then, encompass any uses of music that meet the restorative needs of a person’. (Clarke, et al., 2010, p.115). As previously mentioned, in addition to the reduction in stress, an improvement in stress-related physical symptoms may also be achieved.
On this matter, North & Hargraves (2008) comment that if ‘lowered stress (or increased well-being) is associated with improved immune functioning, then music ought to relate to immune functioning’. (North & Hargraves, 2008, p.308). They go on to say, ‘there is a clear need for future research that determines the reliability of the effect of music on immunity whether it can be produced through group therapy or requires one-to-one administration.’ (North & Hargreaves, 2008, p.309).
Due to the pleasurable nature of group music making, it would be difficult to isolate and measure the effectiveness of music alone. This raises several questions; to what extent is the interaction of individuals who are not making music therapeutic? Would individuals enjoying a game of football achieve the same significant change in DHEA-Cortisol ratios? How much is influence is the music alone having on reducing stress? This would be an interesting area for future research.
‘Music, by its very nature, is essentially powerless to express anything at all, whether a feeling, an attitude of mind, a psychological mood, a phenomenon of nature, etc...Expression has never been an inherent property of music. That is by no means the purpose of its existence. If, as is nearly always the case, music appears to express something, this is only an illusion, and not a reality.’
Stravinsky (1935), (http://en.wikiquote.org/wiki/Igor_Stravinsky)
In contrast to the above quote by Stravinsky (1935), Ockelford (2009) states:
‘One factor is the very nature of the sounds that are used in most styles and genres: They have intrinsically musical characteristics that...have the capacity to induce consistent emotional responses, within and sometimes between cultures.’ (Ockelford. A, 2009, p.100).
These characteristics include register, dynamic level, key (major or minor) and tempo as well as the timbre and character of the instrument being played. It is generally considered that music played in a minor key is melancholic, whereas music played in a major key is considered to be more optimistic and uplifting. Music often has a story to tell, either through the lyrical content, or through the structure of the piece. An example of this would be ‘The Hebrides (Fingals Cave)’ by Felix Mendelssohn. This piece was inspired by a trip to the Hebrides in 1829. The rise and fall of the melody reflects the ebb and flow of the ocean on his way to the cave.
Music and our Life Stories
Our lives are a series of stories. Booker (2004) suggests that ‘much of our conversation is taken up with recounting the events of everyday life in the form of stories’ (Booker, 2004, p.52). Narrative is extremely important, whether one is telling a story of how they made their way through heavy traffic and rainstorms in order to make it to an important meeting on time, or recounting a childhood tragedy - humans define their experiences through story-telling. Narrative is an important communication technique, and, according to Schank & Abelson (1995), ‘at a cognitive level, narratives have been said to represent the default format for human thought’. (Schank & Abelson, 1995, in Dahlstrom & Ho, 2012, p.594).
Narratives are not always the truth, and in relation to individuals diagnosed with GAD, can become distorted and unhelpful, contributing to the high levels of anxiety already being experienced. Coombs & Friedman (2012) state that ‘the narrative metaphor alerts us to orient to these accounts as stories, rather than truths’. (Coombs & Friedman, 2012, p.1037). Dahlstrom & Ho (2012), state ‘The fact that narratives are able to construct reality....without argument makes it difficult to counter their claims’. (Dahlstrom & Ho, 2012, p.597). According to Cowley & Springen (1995) ‘Interpretation of one’s experience in the world serves as the essence of narrative approach to therapy’. (Cowley & Springen, 1995 in Etchinson & Kleist, 2000, p.61). O’Hanlon (1994) describes a narrative therapeutic approach as ‘a fundamentally new direction in the therapeutic world...the third wave’ (O’Hanlon, 1994, in Etchinson & Kleist 2000, p.61).
As previously explored, many pieces of music have a story to tell. Whether this is intended by the composer or interpreted by the listener there is communication and reflection taking place between them. One could argue that many talking therapies may be difficult for some individuals and could re-enforce unhelpful narratives. Rather than narrative therapy in the conventional sense, with narratives being recounted and examined verbally, in the musical sense the narrative forms a therapeutic soundscape which enables a participant to move from the perceived negative to a more positive outcome. Coombs & Freedman (2012) state ‘Once we identify an event that lies outside the problematic story line, we can ask questions that invite people to step into that event..., developing it into a memorable and vivid story’. This process can easily be achieved through the musical improvisation of the narrative soundscape. According to White & Epson (1990), ‘once a person sees a problem as separate from the person’s identity, the opportunity for change has been created’. (White & Epson, 1990, in Etchison & Kleist, 2000, p.61).
Clarke et al., (2010) draw comparisons between improvised speech that we use in everyday life in conversation and improvised music making stating ‘in many ways, musical improvisation shares a great deal with this kind of everyday linguistic experience’. (Clarke et al., 2010, p.52). If improvised speech and improvised music have a connection, then playing a narrative could serve to bypass the need to disclose anything verbally, and yet still enable engagement with and communication of the most traumatic events and deepest anxieties.
Play is an important part of the learning process and an area that has received much interest in recent years. Natural development occurs through play. Hannaford (2005) states, ‘when we truly play...emotions are allowed to surface in a safe way that insures us a richly motivated and passionate life’. (Hannaford, 2005, p.72-73). In addition to the therapeutic aspect of storytelling there is the pleasure of playing an instrument. Levitin (2008) states, ‘when I am playing an instrument I like...Dopamine, the neurotransmitter associated with emotional regulation, alertness and mood, is released’ (Levitin, 2008, p.198).
Another therapeutic benefit is the interaction and support of the group itself. According to Vosmer (2012), ‘The group receives, contains and transforms people’s contributions in a way which is integrating and healing through the ‘matrix’. (Vosmer 2012, p.508). Csikszentmihalyi’s ‘Flow Theory’ also helps reinforce the importance of the social aspect of group interaction by explaining the phenomenon that occurs when groups of individuals interact with each other. Individuals enter into a flow state when they are fully absorbed in an activity during which they lose their sense of time and have feelings of great satisfaction. Csikszentmihalyi (2000) describes flow as ‘Being completely involved in an activity for its own sake. The ego falls away. Time flies. Every action, movement, and thought follows inevitably from the previous one’. (Csikszentmihalyi, 2000, www.brainchannels.com). Flow theory highlights an important point with regard to individuals diagnosed with GAD as being engaged in a pleasurable group process such as a therapeutic soundscape may bring respite from anxious thoughts consistent with the condition.
The instruments used in therapeutic sound work fall mainly into two categories; tonal instruments and percussion. Himalayan singing bowls, gongs, crystal singing bowls, chimes, monochords and bells are the most popular of the tonal instruments used and shakers, rainsticks, ocean and frame drums are the most common percussion tools to use in a soundscape. There are many different reasons why these are used; sustained tones and rhythm can be very relaxing, the instruments blend well together, are very easy to play and require no prior musical knowledge or skill. As there is no melody involved in a classical sense, there is no need to follow a musical score or learn a tune and the sound is created without too much forethought. This could be considered to be a process very similar to speech. Clarke et al., (2010) state, ‘...spontaneous creation is a fiction: a free improviser always starts from some state of consciousness in which there is some residual influence of previous events, or starting point.’ (Clarke et al., 2010, p.49). The instrument becomes the method by which the story is told and therefore, in relation to the comment above by Clarke et al., (2010) the narrative or unhelpful belief is the influence or starting point.
Resonance with the narrative and the instrument is important within a therapeutic soundscape. The facilitator demonstrates each instrument and different playing techniques during which time group members are asked to reflect on their personal story, noticing where there is a relationship between the instrument and the narrative. The facilitator then invites group members to visualise who they would be without the unhelpful belief or narrative and what new story they would like to create going forward. This is an important process as the act of reflection and visualisation offers the potential to challenge and possibly change their paradigms. According to Issit (2003), reflection ‘when made a conscious process enables people to apply theory to, and derive it from experience, with the potential for transforming understanding’. (Issit, 2003, p.176).
Group members then choose an instrument or instruments that best reflect their ‘before and after’ narratives (and possibly the journey in-between) and between them, assisted by the facilitator, construct their soundscape including each person’s story within the piece. The soundscape starts with the unhelpful beliefs and then moves toward the new story. The process of ‘trying on’ a new narrative can be very transformative. After performing the soundscape, the group reflect on their individual experience of playing the unhelpful belief and the new narrative, as well as how it felt to play with the other group members. According to Combs & Freedman (2012) ’the sharing and circulation of different stories contributes to building different communities’. (Combs & Freedman, 2012, p.1034).
Case Study
I worked with a woman who was extremely anxious when speaking in public. As a result she had become withdrawn, depressed and regularly experienced panic attacks when faced with conversation. She was in her late 60’s and had amassed a vast amount of knowledge which she wanted to share. She had dreams of teaching adult education classes but felt that this was impossible for her. She was brought up in a very strict household where ‘children were seen and not heard’. The females in the family were considered as not having anything important to say and often retired following dinner, leaving father and two brothers to talk.
Her unhelpful belief was ‘no one listens to me or thinks that what I have to say is important’. She chose a tiny bell to represent her belief. When asked to reflect on where she would like to be she pointed to a large gong. Consequently, when constructing the soundscape with the group she started off tinkling the bell, which could hardly be heard among the other members of the group, moving to a low rumble on the gong which ended in a crescendo at the end of the soundscape. During the crescendo the other members of the group stopped playing their instruments and listened to the gong, which was not a planned part of the soundscape.
When invited to reflect on why this happened many members of the group felt that they wanted to stop and listen to what this group member had to stay. In that moment the unhelpful belief of ‘no one listens to me or thinks that what I have to say is important’, was found to be untrue. This process was extremely transformative for this person who had spent a large part of her life avoiding communication with others.
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Self-awareness allows people to develop a greater sense of self which many individuals find empowering. With regard to individuals with GAD this process may Interrupt the fight/flight cycle, allowing for a shift in psychology. Coombs & Freedman (2012) also make an important point, stating ‘there is power in deciding what stories are told and retold’. This is very important because the narrator is in control of their own therapeutic process.
Healing is defined by the Oxford Dictionary, an online resource, as ‘the process of making or becoming sound or healthy again’. (http://oxforddictionaries.com). With regard to some conditions, such as a broken leg, for example, this definition is appropriate - however in some cases, such as with terminal illness or a mental or physical condition that is long-term or degenerative; healing in the above sense may not actually be possible. It may helpful for individuals with potentially long-term conditions such as GAD to consider this intervention as a therapeutic process that enables an individual to manage their symptoms over time. Attaching to a ‘quick fix’ outcome may work against the therapeutic endeavour, with participants feeling that the intervention is working if they are not ‘cured’ in a few sessions.
It is also worth noting that GAD can be a life-threatening condition whereby individuals may be considered to be a danger to themselves or others. In this case caution needs to be taken and possibly advice from a medical professional, consultant or psychiatrist that is familiar with the medical condition and mental health of the individual obtained in advance of an intervention.
Summary and Conclusion
I have described the characteristics of General Anxiety Disorder (GAD) and the potential far-reaching impact on the health of those diagnosed with this condition. Due to the potential impact of long-term stress on health and well-being and the recent links with conditions such as Alzheimer’s, as well as other life limiting and life-threatening conditions, further research conducted with regard to sound and musical healing would be extremely beneficial - especially with regard to the improvement in immunity.
I have discussed the benefits of music as a healing medium and posited an intervention that, in my experience, has been beneficial in working with a wide range of different conditions. With this in mind I also feel that individuals diagnosed with GAD would also find this methodology beneficial. I have focussed on group music making, improvisation, reflection and narrative therapy. A potential challenge with regard to the validity of the research and robustness of the data with this intervention (or any other group therapeutic music making intervention) is that it is not possible to isolate the enjoyment of the individual from the music alone.
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