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A recent study authored by researchers from the Department of Anesthesia and Intensive Care, Maulana Azad Medical College and Lok Nayak Hospital in New Delhi demonstrated that targeted music therapy significantly reduced the requirement of propofol, a common anaesthetic, during gallbladder removal surgery, and led to better overall outcomes for the patient. The study provides critical insight into the efficacy of using music as a powerful non-pharmacological tool in medicine.
Music therapy is an established health profession in many parts of the world, where the therapist uses music and all of its facets — pitch, timbre, melody, harmony, tune, lyrics, etc. — to help patients improve, restore or maintain health.
Techniques employed may be active, that is, participatory, or receptive, which involves listening. These can help achieve non-musical goals such as pain management, anxiety reduction, stress management, addressing sleep problems, improving speech and communication in specially-abled children, and improving the quality of life in palliative care and dementia patients, among other things.
The therapeutic value of music has long been recognised. For instance, Vedic texts dating to c. 4th century BCE refer to ‘Raga Chikitsa’, that is, the use of certain melodic frameworks for healing. King Shahaji, who ruled Thanjavur from 1684 to 1712, helped preserve this ancient Indian system of music therapy in his Saraswathi Mahal Library.
One of the earliest Western references to music therapy can be found in the article ‘Music Physically Considered’, published in 1789 in the Philadelphia-based Columbian Magazine. Penned by an unknown author, probably a medical student, the article referenced the works of Dr William Cullen and Dr Herman Boerhaave, two of Europe’s leading physicians at that time.
In the 1800s, two medical dissertations were published by Edwin Atlee (1804) and Samuel Mathews (1806) under Dr B Rush, that spoke of the therapeutic value of music. The asylum at the Blackwell’s Island (now Roosevelt Island) in New York was the first institution to record a music therapy intervention, while the first systematic experiment in music therapy was conducted by neurologist Dr J Leonard Corning who used music to alter dream states during psychotherapy.
Development of music therapy picked up in the aftermath of the two World Wars when musicians would frequent veterans’ hospitals. The patients’ physical and emotional responses to music eventually led to hospitals hiring them full time. Soon, it was evident that hospital musicians needed particular training, leading to demand for structured curricula. The first academic program on music therapy was started in 1944 in Michigan State University.
Three innovators from the 1930s-40s are credited for helping grow music therapy as an organised clinical profession: psychiatrist Ira Altshuler from Michigan, Willem Van de Wall who wrote the first “how to” text on music therapy in institutional settings (Music in Institutions, 1936), and the “father of music therapy” E Thayer Gaston who moved the profession forward from an organisational and educational standpoint.
Research conducted over the years by institutions such as Harvard University have revealed that listening to and engaging in music works on all areas of the brain.
Listening to music is like a full brain work-out: it engages multiple areas of the brain simultaneously, including the auditory and motor cortex, and the limbic system which regulates emotions and processes memories. It also facilitates the release of the reward hormone dopamine, and alters the mood by affecting the neurotransmitter serotonin.
Music therapy promotes a parasympathetic drive by activating the nervous system’s “rest and digest” response, which leads to physiological relaxation. This is achieved through listening to calming music, which can reduce stress hormones, slow heart rate and breathing, and increase heart rate variability, particularly in areas of high frequency. The vagus nerve, a key component of the parasympathetic system, can be stimulated by sounds and vibrations from music, further enhancing relaxation.
Calming music can also lower the activity of the sympathetic nervous system, and the so-called “fight or flight” response. Music that evokes relaxation has been shown to decrease heart rate and both systolic and diastolic blood pressure.
Beyond listening, song writing, group singing, improvisation, etc. can help improve mental and emotional wellbeing, and can also help in building much-needed life skills such as solving problems, coping with stress and emotions, and becoming creative and critical thinkers.
Our study, published the journal Music and Medicine, integrated patient-selected music with general anaesthesia to see for the effects of music on the unconscious brain, as well as its impact on vital parameters like heart rate and blood pressure, the consumption of the anaesthetic to maintain a constant depth of anaesthesia, and overall surgery-related stress.
After an ethical clearance, 56 patients were enrolled in the study and were provided noise-cancelling headphones to listen to their pre-selected musical piece (flute or piano) while general anaesthesia was given for gallbladder removal operation. The patients were randomly divided into two groups: while under general anaesthesia using propofol infusion, one group was given music therapy while the other slept in silence with noise cancelling headphones.
The data showed that the group which received music therapy needed 15% less propofol to stay under, did not need any additional doses of painkillers like fentanyl, had more stable blood pressure levels, and significantly lower levels of the stress hormone cortisol. This means that even though a person under the effect of general anaesthesia does not appreciate or remember the music, the auditory pathway remains intact, with music acting on the subconscious to improve operation outcomes.
Music therapy is a non-pharmacological technique. This means that there are no side effects, but at the same time, there is also potential for ineffectiveness. Music therapy can thus never be used to replace any form of medical or psychological treatment, but rather should be used as a complementary tool for additional therapeutic benefits.
Moreover, in some patients, certain songs may trigger emotionally unpleasant memories; it is therefore preferred to use non-lyrical, instrumental musical pieces to prevent any such distractions while doing personalised sessions.
In order to make music therapy an established health profession in India, the National Medical Commission needs to recognise it as an allied health professional degree.
There are already a number of institutes offering PG diploma and certificate programs in music therapy: these include the likes of Chennai School of Music Therapy; Mahatma Gandhi Kashi Vidyapeeth, Varanasi; Yenepoya Medical College, Mangalore; and Nada Centre for Music Therapy, Chennai.
Music therapists can then be hired by hospitals and medical colleges, to provide integrated services within hospital premises. This may become a form of integrative medicine which is a patient-centred approach to healthcare combining conventional medicine with complementary therapies that have been proven to be safe and effective. It treats the whole person — mind, body, and spirit — by considering physical, emotional, social, spiritual, and environmental factors to achieve optimal health and healing.
Lastly, adding music therapy services to any hospital, palliative care set ups, and special needs schools will not only enhance wellbeing of patients but may also be utilised by the staff.
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Dr. Tanvi Goel, Senior Resident at Department of Anesthesia and Intensive care, Lok Nayak Hospital and Maulana Azad Medical College, New Delhi
Dr Farah Husain, Senior Specialist and Certified Music Therapist, Dept of Anesthesia and Intensive care, Lok Nayak Hospital and MAMC, New Delhi
Dr Sonia Wadhawan, Director Professor, Dept of Anesthesia and Intensive Care, MAMC, New Delhi
They corresponded with Arjun Sengupta
