Music Therapy Awareness Month: Could Doctors Prescribe Music Like a Drug?

Carolyn Abraham | March 1st, 2022

From its ability to improve memory and mood to its effect on immune function, listening to music may serve a higher function than a simple pastime. Illustration: Holly Stapleton

Music has a proven power to help heal the mind, body and soul, but could doctors prescribe it like a drug to boost health and lifespan?

At 94, my father had a new woman in his life. She was a tiny thing and needed Wi-Fi to function, so my mother was okay with it. Since Alexa arrived the year before, my dad had developed a love-hate relationship with his virtual assistant. Her trademarked voice could drive him bonkers with pre-programmed reminders that tell him when it’s time to take his morning pills, his evening pills, his eye drops. Yet he was utterly smitten with the fact that when a song popped into his head, Alexa could conjure it out of the silence.

One minute he’s looking for something in his bureau, pulling out batteries and very old business cards, and he’ll say, “Alexa, play ‘Chattanooga Choo Choo.’” And just like that, Dad was snapping his fingers, bobbing his head and swaying all the way back to the 1940s, when he was a boy with his first radio, falling in love with big bands.

Hearing is the fastest of the human senses. Sound waves reach the brain 10 times quicker than the blink of an eye. Still, it never fails to amaze me how, in a beat, music can transform and transport us, mentally, spiritually, to another place and time. There’s no drug like it, certainly not for my father and, as stacks of research now show, its side-effects can be as wonderful as they are astonishing.

Music can help stroke victims regain their speech and steady the gait of someone with Parkinson’s. A little ABBA can entice the immobile not only to move but to dance. Studies find it can reduce seizures, lessen the need for painkillers and alleviate the symptoms of depression, anxiety and the fog of dementia, even in the late stages. When most signs of personhood have slipped away, a familiar song can suddenly bring them back, awakening, animating, putting a passionate verse of “I’ll be Home for Christmas” on the tip of a tongue.

Precisely how music heals in so many ways is still mysterious, but increasingly it’s the subject of serious science. The U.S. National Institutes of Health, for instance, has teamed up with the John F. Kennedy Center for the Performing Arts and earmarked $20 million for research to pinpoint music’s effects on brain circuitry, how it might be prescribed to treat neurological disorders and other ailments but also to improve the health of everyone.

After all, if music can help heal the sick, could it also keep us well?
Scientists have shown that in older musicians the investment in honing their craft pays big cognitive dividends later in life. But work underway also suggests it’s never too late to reap the benefits of music, which include improvements in mood, memory, relationships and hearing, even if – like my father – you’ve never had a formal lesson in your life.

“When you’re a kid, you don’t think about it. You sing at the top of your voice, you dance, you move,” says Chrissy Pearson, a certified music therapist with the Canadian Music Therapy Fund, a Toronto-based charity that supports music therapy services across the country. “Then as we get older … there’s the construct of what music should be, so we don’t do it. But you’re born with the ability to be rhythmic, to be melodic. We’re all musical.”

Hear, Hear

Pearson believes there’s no question that listening to music can directly benefit your well-being, but it depends on how you listen. To get the most from music’s therapeutic potential, people should engage in what she describes as “intentional listening.”

Back in the day, she says hand-selecting albums for a record player required a concerted effort. But with on-demand access to digital music, we consume it anywhere any time and rarely think of listening itself as its own leisure activity. “We’ll watch TV, read a book, do a crossword puzzle, but I would guess that very few people say, ‘I’m just going to sit and listen to music.’”

Yet when we do, imaging scans show that music can light up the brain like a pinball machine. Rhythm, melody and lyrics activate the auditory and motor systems, the reward circuits, memory centres and deep brain structures involved in emotion, mood and breathing. “It’s a full-brain workout,” Pearson says, one that can be even more beneficial if it gets you moving in some way or if you listen to a brand new piece of music. “But the extent of the impact depends on how intentionally you are listening.”

Pearson suggests choosing a favourite track, sitting back with eyes closed and focusing on the musical elements. “Notice how your body feels, notice what emotions come up … maybe you’re having memories of times you’ve heard that music and emotionally you are going to react. You may not be aware of what’s happening physiologically, but a lot is happening. Your blood pressure may lower or your serotonin levels may increase, for example.”
Studies show serotonin rises significantly in response to pleasing music, and it’s much more than the happy neurochemical that Prozac made famous. It’s a multitasker that’s also involved in learning, memory, sleeping, digestion, even bone health.

Music therapy — illustration: Holly Stapleton

Like food, sex and recreational drugs, music also primes the brain’s reward system to pump out dopamine, the so-called pleasure chemical crucial for cognitive function, working memory, movement and emotional well-being. In February 2019, scientists at McGill University reported that listening to music you love will make the brain release even more of it.

For the aging brain, music may offer a timely neurochemical cocktail: both dopamine and serotonin are known to decline as people get older, contributing to memory lapses, cognitive problems and depression.

Other research finds intentional listening may be a boon to the body as well as the brain. A small 2007 study from Hong Kong found older adults who listened to relaxing music for 25 minutes a day for four weeks lowered their blood pressure. A 2008 European study of 300 people who listened to upbeat dance music for 50 minutes showed an increase in the production of antibodies, suggesting a groovy tune might boost the immune system.

One Song Does Not Fit All

As with any pharmaceutical drug, the same music can trigger different reactions in different people. Pink Floyd, for instance, will never make my father sway.

Benjamin Zendel, an assistant professor at Memorial University in St. John’s, N.L., who holds the Canada Research Chair in Aging and Auditory Neuroscience, says fallout from the so-called “Mozart effect” proved this decisively.

In the 1990s, parents and politicians bought into research findings that listening to Mozart would boost IQs and make children smarter. But further study showed it wasn’t Mozart: it was simply music. “What was really happening was that when you listen to music you like, it increases your arousal levels, and being more aroused improves your performance on cognitive tests,” says Zendel.

“So if you play Mozart to people who like Mozart, it would have this [cognitive-boosting] effect, but kids listening to rock music did better than they did listening to Mozart.”

But whether it’s Bowie or Beethoven, any cognitive boost from listening to music will be short-term, Zendel stresses. Any long-term benefits are more indirect, motivating people to exercise or enhancing their mood.

“If you continually keep yourself in a better mood, that has long-term outcomes … if music listening can help with that, reduce feelings of stress or anxiety or feelings of sadness, over time you are going to see that has a benefit.”

But playing music is a different story – even for newbies who learn to play an instrument later in life. In a small study published last year, Zendel and his team taught piano for six months to 15 adults 65 and over who’d never played before and found the lessons improved the subjects’ hearing and neural processing when there was background noise. Further research, soon to be published, also shows the lessons slightly improved subjects’ IQ and working memory. “It doesn’t matter what age you pick up an instrument,” Zendel says. “By learning an instrument, the brain changes.”

In the Key of Life

Culture, age and experience all influence musical preferences, and technology gives today’s listeners the opportunity to “self-medicate” with personalized music like no generation before.

“We have these devices that allow us to organize and create playlists,” Pearson says. “Back in the day, it took a lot of effort to make a mixed CD, then once it was done, you couldn’t change it. But digital music has created a neat tool to help people listen to music intentionally.”

The first step, she suggests, is to make a list of all the music that’s important to you, perhaps grouping it by decade. Include songs you like, those that are somehow meaningful — “Maybe you danced to it at your wedding” – and note how each one makes you feel to create a “musical experience.”

Pearson concedes that it may sound daunting, “but realize it’s an ongoing process. You’re never going to think of all the songs you like in one afternoon … in some cases, you won’t remember to include that song by Roy Orbison until you hear it.”

A key principle of clinical music therapy is that a session should always start by matching music to mood – particularly if you’re blue – and then changing the music to gradually improve an emotional state. Pearson likens it to making a workout playlist. “You’re not going to start off with a really fast song when you haven’t warmed up.”

The process of creation itself could be therapeutic too, she says. “It should be fun.”

After I suggested my parents use Alexa to create a playlist, it became a game. The challenge was recalling the titles of the songs they enjoy. They hummed and sang a few random lyrics, pushing each other – and their virtual assistant – to name that tune. “Who was that Webber we liked?” my mother asked. “Andrew Lloyd Webber!” my father bellowed. And Alexa cued up The Phantom of the Opera.

Some therapy clients create playlists to accompany the physical stages of childbirth. In palliative care, patients create them to work through their fears around dying. And since they’re portable, Pearson suggests packing the Advil and a playlist if you’re heading to the hospital for, say, a hip replacement. “It would be great to plan music to help with your recovery,” she suggests. If that sounds far-fetched, many studies have found that pleasing music can be a significant painkiller after surgery, in the ICU and in burn units. It’s thought that music distracts from pain, reduces the perception of it but also boosts the ability to tolerate it with the neural release of opioids, the brain’s own morphine.

Sing, Sing, Sing

Frank Russo, a psychology professor at Toronto’s Ryerson University, has been studying what happens to healthy older adults who join a choir out of the blue. He first became interested in group singing as a potential way to combat the type of hearing loss that haunts people as they age: the ability to
perceive speech against a backdrop of noise.

“It’s not that they can’t hear what’s on TV or in a quiet conversation. It’s when they’re at a party or a family get-together, and they can no longer follow the streams of conversation.”

It’s the most common reason older adults see an audiologist, and its effects can compromise all sorts of other cognitive abilities, says Russo, who holds the Hear the World Research Chair in Music and Emotional Speech.

Struggling to “fill in the gaps of what they’re missing draws resources away from the prefrontal cortex that are otherwise used for focused attention and short-term memory.” The upshot is the recollection of what’s transpired “is not going to be as robust.”

Hearing aids don’t fully resolve the problem, and about 80 per cent of people who invest in them leave them in a drawer. But Russo found that group singing mitigates the impairment. “The short story is that 10 weeks of singing in a choir changes the brain and in ways we can measure. It changes the neural response to voice pitch, and we can measure that. It also improves our ability to perceive speech in noise.”

Russo and his team were equally struck by other benefits that group singing conferred: choir members were making friends and forming bonds. “It probably sounds ridiculously obvious,” he says, but it was an observation that prompted him to investigate the “bio-psycho-social” effects of singing in older adults, since “social isolation is a big predictor of cognitive decline.”

The ongoing study now involves a cross-country network of 15 choirs that include people with communication disorders and hearing loss, as well as healthy adults aged 60 and up, assessing quality of life and neurochemistry changes. A recent British study, for instance, has found group singing produces endocannabinoids in the brain like a runner’s high.

In Russo’s work, saliva tests of choir members taken before and after practices are showing the activity not only lowers levels of cortisol, the stress hormone, it increases oxytocin, known affectionately as “the love” or “bonding” hormone.

The higher oxytocin levels also appear to be boosting pain thresholds. Using a machine that applies pressure to a person’s fingertips, researchers measure how much discomfort a subject can withstand. “The pain threshold effects are just huge. It’s probably the biggest effect we’re looking at, consistently. When people sing, they can tolerate more pain after an hour and a half of singing,” says Russo.

“The way we’re interpreting this is that now you’re with your people, you’re kicking it and doing really well, you’re socially connected – you’re not alone in this cold world. This releases oxytocin, which allows us to feel bonded to others and makes us feel more powerful.”

That sense of power, he believes, accounts for the spike in pain tolerance.
Although Russo’s lab tests show cortisol levels dip when a subject sings alone, oxytocin does not rise. But he suspects simply imagining you are singing with others may also boost oxytocin. Other research suggests that whether it’s music, sports or even stroke rehabilitation, the effects of imagination on the brain can be a lot like reality.

Picture This

In our digital world, where a virtual assistant like Siri or Alexa can instantly channel a big band or a live set from a concert hall, imagination is often in full swing. On a recent afternoon, with my father in a mellow mood, he’s requesting a Hoagy Carmichael ballad.

Some people play air guitar. My dad tends toward orchestral manoeuvres. As he sings along to “Stardust,” his eyes are closed, and he’s conducting the string section that’s filling the room, his outstretched arms carving the air in waves and swoops.

As I watch him, I contemplate the soundtrack of my father’s life: the Glenn Miller tunes he sang when we were kids; the jazz he blasted Saturday mornings to wake the house; the kitchen serenades that still make my mother’s eyes roll. Last year, with 28-year-old titanium knees, he boogied to the last song at his granddaughter’s wedding.

I have to wonder if music has been more than a portal to memory lane for my dad. Maybe it has helped keep him well all these years. In the future, perhaps doctors will actually prescribe music as an intangible drug to boost mind, body and longevity. While science continues to investigate precisely how music impacts the brain, it’s already clear there’s no harm in adding new songs in the key of life.

A version of this article appeared in the March/April 2020 issue with the headline, “Good Vibrations,” p. 59.

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