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=Musical Treatment of Neurological Disorders= The use of music therapy (MT) in treating mental and neurological disorders is on the rise. MT has showed effectiveness in treating symptoms of many disorders, including schizophrenia, amnesia, dementia and Alzheimer’s, Parkinson’s disease, mood disorders such as depression, aphasia and similar speech disorders, and Tourette’s syndrome, among others.

While MT has been used for many years, up until the mid-1980s little empirical research had been done to support the efficacy of the treatment. Since then, more research has focused on determining both the effectiveness and the underlying physiological mechanisms leading to symptom improvement. For example, one meta-study covering 177 patients (over 9 studies) showed a significant effect on many negative symptoms of psychopathologies, particularly in developmental and behavioral disorders. MT was especially effective in improving focus and attention, and in decreasing negative symptoms like anxiety and isolation.

The following sections will discuss the uses and effectiveness of MT in the treatment of specific pathologies.

Schizophrenia
MT is used with schizophrenic patients to ameliorate many of the symptoms of the disorder. Individual studies of patients undergoing MT showed diminished negative symptoms -- such as flattened affect, speech issues, and anhedonia – and improved social symptoms, such as increased conversation ability, reduced social isolation, and increased interest in external events.

Meta-studies have confirmed many of these results, showing that MT in addition to standard care to be superior to standard care alone. Improvements were seen in negative symptoms, general mental state, depression, anxiety, and even cognitive functioning. These meta-studies have also shown, however, that these results can be inconsistent and depend heavily on both the quality and number of therapy sessions.

Alzheimer’s and Dementia
Alzheimer’s and dementia are two of the diseases most commonly treated with MT. Like many of the other disorders mentioned, some of the most common significant effects are seen in social behaviors, leading to improvements in interaction, conversation, and other such skills. A meta-study of over 330 subjects showed music therapy produces highly significant improvements to social behaviors, overt behaviors like wandering and restlessness, reductions in agitated behaviors, and improvements to cognitive defects, measured with reality orientation and face recognition tests. As with many studies of MT’s effectiveness, these positive effects on Alzheimer’s and dementia are not homogeneous among all studies. The effectiveness of the treatment seems to be strongly dependent on the patient, the quality and length of treatment, and other similar factors.

Another meta-study examined the proposed neurological mechanisms behind MT’s effects on these patients. Many authors suspected that music has a soothing effect on the patient by affecting how noise is perceived: music renders noise familiar, or buffers the patient from overwhelming or extraneous noise in their environment. Others suggest that music serves as a sort of mediator for social interactions, providing a vessel through which to interact with others without requiring much cognitive load.

Amnesia
Some symptoms of amnesia have been shown to be alleviated through various interactions with music, including playing and listening. One such case is that of Clive Wearing, whose severe retrograde and anterograde amnesia have been detailed in the documentaries Prisoner of Consciousness and The Man with the Seven Second Memory. Though unable to recall past memories or form new ones, Wearing is still able to play, conduct, and sing along with music learned prior to the onset of his amnesia, and even add improvisations and flourishes.

Wearing’s case reinforces the theory that episodic memory fundamentally differs from procedural or semantic memory. Sacks suggests that while Wearing is completely unable to recall events or episodes, musical performance (and the muscle memory involved) are a form of procedural memory that is not typically hindered in amnesia cases [Sacks]. Indeed, there is evidence that while episodic memory is reliant on the hippocampal formation, amnesiacs with damage to this area can show a loss of episodic memory accompanied by (partially) intact semantic memory.

Depression
Music therapy has been found to have numerous significant outcomes for patients with major depressive disorder. One study found that listening to soft, sedative music for only 30 minutes a day for two weeks led to significantly improved global depressive scores, and improved scores on individual depressive sub-scales. Like many of the other studies mentioned, the effects were seen to be cumulative over the time period studied – that is, longer treatment led to increased improvement [Hsu]. Another study showed that MDD patients were able to better express their emotional states while listening to sad music than while listening to no music or happy, angry, or scary music. The authors found that this therapy helped patients to overcome verbal barriers in expressing emotion, which can assist therapists in successfully guiding treatment.

Other studies have provided insight into the physiological interactions between MT and depression. Music has been showed to significantly decrease the levels of the stress hormone cortisol, leading to improved affect, mood, and cognitive functioning. A study also found that music led to a shift in frontal lobe activity (as measured by EEG) in depressed adolescents. Music was shown to shift activity from the right frontal lobe to the left, a phenomenon associated with positive affect and mood.

Aphasia
Melodic intonation therapy (MIT) is a commonly used method of treating aphasias, particularly those involving speech deficits (as opposed to reading or writing). MIT is a multi-stage treatment that involves committing words and speech rhythm to memory by incorporating them into song. The musical and rhythmic aspects are then separated from the speech and phased out, until the patient can speak normally. This method has slight variations between adult patients and child patients, but both follow the same basic structure.

While MIT is a commonly used therapy, research supporting its effectiveness is relatively lacking. Some recent research suggests that the therapy’s efficacy may stem more from the rhythmic components of the treatment rather than the melodic aspects.