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For The Love of Singing
Using Music in Therapy
April 18, 2013
Bruce Edwards, Speech-Language Pathologist
Christine Hein, Occupational Therapist
Janet Vogt, Analyst (Research)
Overview• Therapeutic Benefits of Singing• Music and The Brain • Singing and Speech • Music and The Body • Singing and Sensation • Benefits of Group Therapy • Choir Group – Rationale• Symphonic Passion Chorus• Outcomes Research: What We Learned
Therapeutic Benefits of Group Singing• Attention• Memory• Vocabulary• Social interaction• Self-esteem and self-confidence• Stress management• Mood
Music and the Brain• Perception and response to music• No single music centre in the brain• Involves nearly every region of the brain • Many levels of neural networks are activated• Rhythm, pitch, melody and emotional nuances deeply engrained• Musical memory lasts longer than episodic memories
Perception of Music• Feature extraction - musical feature detectors in the brain
– Pitch, Dynamics – primary auditory cortex
– Rhythm, tempo, beat - cerebellum
• Feature integration – putting it all together– Melody, harmony – prefrontal cortex, frontal lobe, hippocampus and
amygdala
– Timbre, Instrumentation– temporal lobe, hippocampus
• Listening to lyrics – language centres → temporal, frontal lobes
Performing Music• Planning – Frontal lobe• Muscle coordination – Motor cortex• Self-monitoring - Sensory cortex• Reading music and lyrics – visual cortex, occipital lobe• Recalling melody – hippocampus• Remembering lyrics – language centres → temporal, frontal lobes
Singing and Speech• Breath awareness and breath control• Articulation• Loudness• Vocal quality• Prosody
– Rhythm, stress and intonation of speech
– Syllable length, loudness and pitch in singing
Music and the Body Listening to Music can….
•Cause an increase in ‘immune boosting’ hormone secretion•Decrease cortisol levels (stress hormone) when listening and singing•Increase mood and decrease depression•Increasing productivity and energy•Release endorphins•Change your heart rate
Music and the Body
• Induces a calm alert state
(best for learning readiness).
• Improve motor planning ability (fine and gross).
• Creates an oxytocin release as you sing in a group.
• Creates pleasurable associations in the brain that can generalize to all of clients daily environments.
Singing and Sensation
• The activity of singing impacts the entire sensory system.
Calming effect – low frequency sounds and slower tempo, deep breathing
Alerting effect - High frequency sounds, fast tempo, shallow shorter
breaths
Singing and Sensation• Changing speech patterns
(increasing fluidity and pace to more intelligible).• Singing can changing the stress response in the body to open
awareness, ready to learn.• Grounds person in being present ‘in the now’ ‘DOING rather than
thinking.• Music is connected to memory and life experience. Feelings of
pleasure associated with life memories and experience.• Can generalize response to other environments impacting
QUALITY OF LIFEhttp://www.youtube.com/watch?v=5FWn4JB2YLU
Group Therapy - Singing
Psychosocial enhancement by:•Reduces anxiety, social emotional and enhances cognition and physical engagement.
Creates opportunity to create social bonds with others.
(Oxytocin is released when singing in groups)
Gives each individual a sense of belonging to something outside self, bigger than self.
Group Therapy - Singing
• Working on a unified goal (i.e. Performing in a concert).
• Opportunity to learn and grow from others (observation and participation).
• Used in many Clinical Setting because it is so effective (i.e. Attachment in newborns, Aphasia, Parkinson's, Neurological retraining, Dementia).
Abeles, H. F., & Chung, J. W. (1996)
Rationale for Creating the Choir Group• Group Therapy needs to be:
– Engaging
– Fun
– Social
– Non-threatening
– Motivating
• But at the same time it needs to be:– Structured
– Predictable
– Repetitious
– Goal focused
Symphonic Passion Chorus• Formed in 2005 • Co-facilitated – S-LP, OT• Adults with developmental disabilities (18+)
– Mild to moderate range DD
– No significant behavioural issues
– Many have little to no literacy skills
• Group size – grown from 14 to 30 clients, from 2 to 8 volunteers• Performed to audiences ranging from 40 to over 40,000
Choir Group Format• Weekly 2-hour rehearsals• September to December • 90 minutes singing, 30 minutes pizza dinner• Each rehearsal consists of:
– Welcome and announcements
– Reviewing group rules
– Relaxation exercise
– Warm-up
– Song review and singing
– Pizza dinner and socializing
• Members encouraged to listen to recordings at home during week
Choir Songbooks
Therapeutic Goals• Learning what new words mean in new songs (Vocabulary)• Remembering the words and music to songs (Memory)• Learning how to say different words (Articulation)• Having enough air in the lungs to sing (Breath Awareness/Control)• Singing loudly and softly (Loudness Control)• Singing high notes and low notes (Pitch Control)• Knowing you are able to learn new songs (Self-Confidence)• Feeling good about yourself (Self-Esteem)• Making friends in the group (Developing Social Relationships)• Working Together as a Group (Cooperation)
Research Context: Determinants of Community Health
• Student volunteers from the ‘Determinants of Community Health’ course were available to help
• Focus on ‘Social Support Networks’ as a key determinant
• Social support networks are positively associated with health status and quality of life (QOL) and are essential to the health of people with developmental disabilities (DD).
• Organized physical activity programs promote social inclusion and contribute to QOL in this population, but research on the impact of arts-based programs is limited.
Participants:17 choir members (8 ♂; 9 ♀; average age 41 years) 10 caregivers (5 parents; 2 siblings; 3 support workers)
Interviews:•20 open-ended questions•20 minutes in duration•face-to-face for choir members; phone for caregivers•recorded, transcribed, coded using a grounded theory approach
Research ethics approval from SPC and the University of Toronto.Informed consent obtained from all participants.
Methods
Reminder of the Benefits of Music in Therapy
• Improvements in:– Attention– Memory– Vocabulary
• Opportunities for social interaction
• Increased self-esteem and self-confidence
• Improved stress management
• Improved mood
“Well the thing I like being in a group with so many people is communicating with other people, like…learning with my communication skills.”
“Happy to know new songs; helps me to read.”
“Well it makes me feel good because I learn…and I also get to meet friends and get to get away from my mom for a change. That’s why I like coming to choir.”
Learning
“Being part of the group is a learning experience too…So, you know, in our mind there’s lots of other learning going
on besides music.”
Learning
“Um it makes it easier to stay…with my…disability people…I’ll stay for my rest of my life…”
“Happy, belong to them, very happy.”
“I like… hanging around with disability people[s] instead of hanging with the regular class. Regular class is too difficult for me to follow. Yes I feel comfortable…”
Social Interaction: Sense of Belonging
“Yeah it was better for me to meet friends; I’m not lonely…I have a lot of friends who care.”
“Yes I’ve made actually a bunch of new friends as well.”
“Ah I like these people. All the new people are getting to know me now.”
“See these friends of mine, I like these friends.”
Social Interaction: Friendships
“She enjoys being part of the group and doing things together, and it makes her feel special.”
“I would say that the social interaction part is vital...”
“... it's the combination of the communal musical aspect, and the social interaction, and the physical engagement of singing; those three aspects together provide a really powerful punch.”
Opportunities for Social Interaction
“I think it made my life better…Um I find myself not putting myself down as I used to…”
“Oh I feel better, confident as well.”
“Well I feel proud of myself because ever since I heard the choir sing I’ve always wanted to be part of it and now I am. That’s why I feel proud about it.”
“For his self-confidence, it’s done wonders.”
Increased Self-Esteem and Self-Confidence
“Travelling on her own, with the TTC, she really only took it seriously and got interested after she saw members of the choir going by themselves.”
“…learning to transition into the adult world.”
Increased Self-Esteem and Self-Confidence
“And then you go right into choir it’s like if you had a stressful day or whatever you can just forget about it and focus on singing and you feel good about yourself.”
“I dunno just something about singing, like even though I might be stressed out at work and then I go to choir I feel like it calms me down and gives me the confidence. It says hey you can calm down you don’t have to be so frustrated.”
Improved Stress Management
“And I find that when I sing I feel good. I feel sad sometimes, and when I’m feeling sad and down singing really helps me. I don’t know just something about singing that really helps me to get over…how I’m feeling. So that’s why I joined the choir.”
“My…choir makes my life happy …I love it.”
Improved Mood
“When she gets home from choir, she's like, on cloud nine. …she’s glowing. And she does everything she can not to miss a choir night.”
“It keeps him in a positive frame of mind.”
“And when he's happy to go, he's so motivated every
week.”
Improved Mood
Do you think choir makes your life better or worse?
All 17 choir members said choir makes their life better:
• because of how it makes them feel
• because of the opportunities for social interaction
• because of their passion for music and performing
Conclusion
• The Symphonic Passion Chorus group at Surrey Place Centre is having a positive effect on the quality of life of choir members.
Video of Symphonic Passion Chorus
