How music can reduce distress

A new study has demonstrated for the first time how and why music can reduce distress and agitation for people with advanced dementia.

Studies have shown that over half the people diagnosed with dementia have an advanced form of the disease which can require specialist care and is often accompanied by behavior such as agitation, aggression, wandering, and resistance to care.

Published in the journal Nature Mental Health, the research reveals the different benefits of music therapy, identifies mechanisms to explain why music can have these effects, and provides a blueprint for implementing effective music therapy for people with advanced dementia.

Music therapy, delivered by trained therapists, can include singing, playing or listening to music. The therapist can also identify specific ways that music can be used by families and carers in an individual’s daily care routine.

The research shows that if music therapy is designed to individual needs, it can deliver an immediate, short-term reduction in agitation and anxiety for individuals with advanced dementia, and improvements in attention, engagement, alertness and mood. Musical interactions can help people feel safer and more orientated in their surroundings, which can lower levels of distress and improve wellbeing.

This effect happens because music, whether playing, singing or listening, delivers cognitive and sensory stimulation, activates networks across both sides of the brain enabling access to the person’s remaining abilities and memories, and helps people manage their emotions and remain calm. Music can also be tailored to reduce physiological stress, specifically in the autonomic nervous system.

Music-evoked memories, especially those triggered by familiar music, are recalled more quickly and are more positive and specific than memories recalled without music, and often relate to earlier in the person’s life. Songs from when the individual was aged between 10–30 years old are found to be the most effective.

As a form of nonverbal communication, music is accessible regardless of cognitive impairment or musical ability, and provides opportunities for social interaction with staff, carers and fellow patients or care home residents.

The study recommends that music therapists train other professionals, ensuring all staff involved in the care of people with advanced dementia can use music, regardless of their experience. Resources, including musical instruments and information about how to produce personalized playlists, should be available, and families should be encouraged to use music to support their relatives.

Engaging in music may also benefit care staff and family members by reducing their levels of stress and improving their wellbeing. It can deliver meaningful moments that may be different to the carers’ usual interactions, it can foster empathy, and help staff better engage with the person with dementia, especially during times of increased distress.

The study involved interviews with staff and music therapists on inpatient mental health dementia wards, a systematic review of published research, and a national survey of healthcare professionals.

What the researchers say: “With an aging population and increasing numbers of people diagnosed with dementia, music is a relatively straightforward and cost-effective way of improving the quality of life of those affected,” the lead author told us. “Our study not only shows why music therapy is successful – including meeting the person’s need for stimulation, supporting familiarity through memories, encouraging relationship and emotional expression, and crucially helping with the reduction of distress and anxiety – it also paves the way for its wider use in dementia care.

“Music, in particular recorded music, is an accessible way for staff and families to help manage distress, and music therapists can advise on tailoring music for individuals,” the researchers explained. “Just as a doctor prescribes medications with a specific dose and frequency, a music therapist can outline an individualized program, setting out how music should be used throughout someone’s day to reduce distress and improve their wellbeing.”

My take: Music has a profound effect on mental health generally, though it is only recently that we have come to an understanding of the biological underpinning of this connection.

We know that early man and our Neanderthal cousins made and used musical instruments -particularly flutes made from Mammoth tusks - so fairly obviously musicality, the genetically constrained and reliably developing set of neural capacities on which music production and perception rests (as opposed to specific music which is cultural), has a long history and must therefore be important in the development of our species.

Generally, we know that music is important in mood regulation, it can also help release pent up emotions and provides social connection.

All of these involve different areas of the brain and other aspects of our biology (gut regulation for example through stress reduction and influence on the autonomic nervous system).

In other words, we have an ingrained need for music (and, to a limited extent, in a number of other mammals and perhaps birds). Without it our mental and physical health deteriorates. It is, as recent research has shown, an “epistemic necessity” for mental and physical health.

It is hardly surprising, therefore, that music has a beneficial effect on dementia.