Musicothérapie dans l'unité des grands prématurés © Pascal Deloche/Godong/Corbis
Musicothérapie dans l'unité des grands prématurés © Pascal Deloche/Godong/Corbis

Music therapy: do we really understand it?

Does music really heal us and how? Is there certain music that has more beneficial effects on certain pathologies than others? For the World Music Therapy Day, the neuropsychologist Hervé Platel provides answers to some of these questions.

We hastily associate hypnosis, with sophrology, or even just relaxation. But do we even know what music therapy is exactly, how it is practiced and it is used for? For example, the simple act of listening to headphones on a crowded subway on your way home, is this considered to be music therapy?

Hervé Platel, professor of neuropsychology at the University of Caen is one of the first to have identified brain networks involved in the perception and memorization of music, and especially on patients affected by Alzheimer's disease. Regarding the definition of music therapy, he is categorical:

"The mere exposure of a subject to listening music is not music therapy. We talk about music therapy when it comes to the applying care in a therapeutic context, with the intervention of a qualified person - a music therapist. Three factors are important: the patient’s history and the specificities of his pathology, the characteristics of the chosen music and the relationship with the therapist."

Originally used to soothe mental suffering, music therapy was primarily a means for relaxation or building self-esteem. With the evolution of this discipline, its field of application has been expanded: today it is widely used to stimulate intellectual or cognitive functions.

"Today there are two main applications: an active application, when the speaker works with group or individual subjects around instrumental practice, and a receptive application, which is based on relaxation through music with meditation from the therapist. The first technique promotes self-expression, facilitates communication or can help in the resocialization of certain subjects. The receptive technique is mainly used in for pain treatment, anxiety and depression through relaxation and easing and for diverting attention. In accordance with the therapist, music can also be used as a trigger for verbal exchange on the emotions it provokes, it is used to analyse and understand the developed pathologies in a psychoanalytic approach."

An example of a music session composed according to music therapy criteria ( Source : Music Care )

Does music really heal? 

For a long time, the beneficial effects on a very vast field of pathologies have been demonstrated empirically. But over the last twenty years, the evolution of neuroimaging techniques has made it possible to precisely identify the effects and modifications that music can cause in our brain:

"Music easily captures our attention: as soon as there is music in the environment, the brain very naturally synchronizes. The pathways to music in the brain are much more complex than those for speech, for example, and when involving different brain regions: music stimulates, relaxes, calms pain, _butcan also increase brain plasticity and cause changes in synaptic connections_. Among people with autism, who are hypersensitive to music, in addition to being a medium of communication, it has a considerable impact on attention and concentration abilities and therefore reduces behavioural problems. In the case of neuro-rehabilitation patients following head trauma or stroke, music can accelerate the recovery of certain damaged intellectual functions: regular listening to music increases attentional abilities and improves faulty memory functions."

A miracle method? Hervé Platel restrains his words:

"In the context of neurodegenerative diseases - Alzheimer type - music therapy will indeed delay the effects of the disease, but it has no impact on healing itself, the disease’s progression is inevitable. On the other hand, only music therapy succeeds in activating * the residual memory capacities: although one has the impression of having patients with no more memory, they still manage to retain new melodies and can reproduce them, whereas they cannot memorize the words."

Le schéma de l'impact de la musique sur le cerveau
Le schéma de l'impact de la musique sur le cerveau

Which music for which treatment? 

Even if each clinical context is different, the protocol applied by music therapists is very precise as for the implemented musical choices:

"Nothing is left to chance. The patient can choose the style of music he prefers, and then expose him to a carefully crafted matrix: a sequence of unfamiliar music, in a logic named ‘U’: _stimulating-relaxing -stimulating_. We start with a tempo close to the rhythm of the heart and with rich harmonies, to continue by slowing down the rhythm and simplifying the musical fabric, and in the last sequence we return to a more sustained rhythm by complexifying the harmonies once again."

Aside the importance of the chosen music used in the therapeutic setting, the relationship with the therapist is essential: what is the ideal music therapist profile, must he be a musician?

"It is important that the intervening individual is trained in specific techniques according to the treated pathology, to be able to adapt the therapeutic objectives to the patient needs.   Before being a musician, the music therapist must know treatment or therapeutic re-education techniques of the pathology in question: the approach will not be the same in the case of Alzheimer's disease, autism or caring for premature babies, all this depending on the patient’s history."

A therapeutic practice still not recognized 

Although the applications of music therapy are very widespread in hospitals or health centres, the recognition of music therapy is slow. The heterogeneity of practices and approaches further complicates objective assessments of the effects music therapy may have on health. "There is no institutional framework that defines the status of music therapists today. Most of the interventions are done by volunteers, because there is no specific funding for this discipline. We always refer to an intervention as a cultural order or an animation. If an institution wishes to hire a music therapist, it will hire a health care assistant or a nurse trained in music therapy. The main reason is that the clinical effects of music therapy still lack scientific evidence, physiological evidence of the impact of music on health. But validating studies are increasing, and the contribution from neuroscience will be decisive in the coming years." 

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