Category Archives: medicine

How to practice effectively [video]

This is a short video from TED Talk on how to practice more effectively. It includes some useful tips & really interesting information based on what we know about the brain & how we learn tasks.

This ties-in with my previous blogs on rehearsal & my own (admittedly rather limited) research on music and the human brain [see previous posts]. Let me know what you think!

If the above video doesn’t work, here’s a link so you can access the short TED Talk video on YouTube.

Enjoy! xx

Music & Wellbeing (Part 5): Music & Pain Relief

Music & pain relief

So far, we have examined the positive effects of music on our wellbeing, both physically and mentally. However, if music can indeed make us ‘feel better’, is there any scope for its application towards pain relief? As well as being beneficial, can music be medicinal? There is historical evidence of music playing a role in treating disorders as early as ancient Egyptian times, circa 4,000 B.C. (Thompson, 2015). An additional benefit to the use of music is its lack of invasiveness, compared to other forms of treatment:

Music is perhaps unrivalled by any other form of human expression in the range of its defining characteristics, from its melody and rhythm to its emotional and social nature. The treatments that take advantage of these attributes are rewarding, motivating, accessible and inexpensive, and basically free of side effects, too. The attractive quality of music also encourages patients to continue therapy over many weeks and months, improving the chance of lasting gains (Thompson, 2015)

Rather than being a physical experience alone, pain is a ‘biopsychosocial experience’ (Gregory, 2014, p. 27) which exists in the mind as much as the body: ‘It is affected by psychological and social factors, such as the site and nature of the injury, personality, age, gender, anxiety, understanding and cultural factors’ (Godfrey, 2005, quoted in Gregory, 2014, p. 24).  In previous studies on chronic pain, it has been noted that patients who concentrated on other tasks or activities experienced less pain (Löfgren & Norrbrink, 2012, p. 2146). Since many sections of the brain are activated when listening to music (Levitin, 2006, pp. 270-271), it stands to reason that the use of music could be highly effective as a distraction from pain, reducing or cancelling-out pain signals.

A clinical study by Mitchell et al (2007) supported the idea of music as a means of distraction from chronic pain, if not a complete remedy to pain altogether:

Music listening, and in particular listening to our own preferred music, may provide an emotionally engaging distraction capable of reducing both the sensation of pain itself and the accompanying negative affective experience (Mitchell et al, 2007, p. 37)

Mitchell et al’s (2007) study paints a highly optimistic picture for the application of music as an effective means of distraction. In particular, they noted that the patients in their study who place a higher value on music, and listen to it more frequently, responded that they were ‘enjoying life more, having more energy and ability to perform activities, and feeling depressed and in need of medical treatment less often’ (Mitchell et al, 2007, p. 37).

Another study by Silvestrini et al (2011) produced similarly interesting findings:

The present study was designed to test the pain-reducing effects of pleasant music compared to silence, unpleasant music, and to an auditory attention task. Results partially confirmed our hypotheses. Compared to the silence and the unpleasant music, pleasant music had a significant effect on the pain ratings and pain tolerance to the cold pressor test but not on the NFR. This finding suggests that the auditory stimuli used in this study, and more particularly pleasant music, did not produce any central descendent analgesic effect on spinal nociception, which would have resulted in lower NFR. In contrast, music had a significant effect on the NRS, the sensory and the affective thresholds, and on the pain tolerance to the cold pressor test compared to silence and to the unpleasant musical stimulations, and these results are consistent with previous studies showing pain-reducing effect of music on reported pain experience (Silvestrini et al, 2011, p. 268)

Silvestrini et al’s (2011) report suggests that the areas of the brain responsible for processing pain signals are the same as the areas for analysing music we hear. This is mainly because our brains utilize several different areas and functions when listening to music. These include the areas which process movement: the Cerebellum; a combination of Cortexes (Prefrontal, Motor, Sensory, Auditory and Visual); and the areas which process emotions: the Amygdala and Nucleus Accumbens. (Levitin, 2006, pp. 270-271).

Does this mean music is a distraction? Pain acts as a signal in the brain, alerting the conscious mind of something which may be an ‘issue’ or problem. This is a survival-trait ingrained in us through our evolution. Like music, ‘the areas of the brain involved in pain experience and behaviour are very extensive’ (Melzack, 1996, p.134). However, some studies, such as those by Fabbro & Crescentini (2014), indicate that once we are aware of these ‘issues’ with the body, manifested as pain we experience in the affected area, it is possible to cancel out the signal. We can, in effect, ‘switch off’ pain, depending on the individuals attitudes to pain.

This might go some way to explain the variance in results found by Silvestrini et al (2011) and Mitchell et al (2007). Both seemed to find generally positive results when studying the effect of listening to music in relation to experience of pain. However, both reports clearly show mixed results amongst their test groups. Other research, while demonstrating an overall positive effect of music in medicinal use (Hargreaves & North, 2008, p. 301), met with similarly varied outcomes depending on the subject’s gender and age:

With regard to sex, music was less effective for males than it was for females. With regard to age, children responded more positively to music than did adults and infants (Standley, 1995, quoted in Hargreaves & North, 2008, p. 302)

This runs in accordance with the findings of Fabbro & Crescentini (2014), which stated that different people apply varying levels of importance and focus to the pain they experience. What one individual might experience as mild pain, another could feel something altogether more debilitating; the change in pain experience is determined mainly by the “expectations” of the patient’ (Fabbro & Crescentini, 2014, p. 545). Gregory (2014) agrees with this view. As we have already seen, pain is ‘an individual experience and the effectiveness of interventions can vary between individuals’ (Gregory, 2014, p. 24). Therefore, their ability to focus on music instead of the brain’s pain signals will be compromised. Giving focus to anything our minds have deemed important for our attention means the brain is devoting less processing energy to listening to the music. This renders as null the positive effect music can have on our experience of pain, because ‘even if you’re only paying attention to one other factor, our capacity to focus on the music may have already been cut in half’. (Green, 1986, p. 68)

It is especially interesting that both studies yielded more positive results when the participants were listening not only to pleasant music, but to music they preferred (Mitchell et al, 2007, p.37). Levitin (2006, pp. 231) states that we often make our preferred musical choices during our early teenage years, and we attach a level of emotional importance to this music. Therefore, music’s ability to have a reductive effect on pain must be, in part, the mental act of processing these positive emotional feelings when listening to music we enjoy.

 

REFERENCES

Fabbro, F., & Crescentini, C. (2014) ‘Review: Facing the experience of pain: A neuropsychological perspective’, Physics of Life Reviews, Vol. 11, pp. 540-552. Available from: 10.1016/j.plrev.2013.12.010.

Green, B. (1986) The inner game of music. United States: Pan Books.

Gregory, J. (2014) ‘Dealing with acute and chronic pain: part two – management’, Journal of Community Nursing, Vol. 28, No. 5, pp. 24-29.

Levitin, D. (2006). This is your brain on music: understanding a human obsession. Great Britain: Atlantic Books.

Löfgren, M., & Norrbrink, C. (2012) ”But I know what works’ – patients’ experience of spinal cord injury neuropathic pain management’, Disability & Rehabilitation, Vol. 34, No. 25, pp. 2139-2147.

Melzack, R. (1996) ‘Gate control theory: on the evolution of pain concepts’, Pain Forum, Vol. 5, No. 2, pp. 128-138.

Mitchell, L., MacDonald, R., Knussen, C. & Serpell, M. (2007) ‘A survey investigation of the effects of music listening on chronic pain’, Psychology of Music. Vol. 35 (1), pp. 37-57.

North, A. & Hargreaves, D. (2008) The social and applied psychology of music. United States: Oxford University Press.

Silvestrini, N., Piguet, V., Cedraschi, C. & Zentner, M. (2011) ‘Music and auditory distraction reduce pain: emotional or attentional effects?’ Music and Medicine. Vol 3 (4), pp. 264-270.

Thompson, W. (2015) ‘The Healine [sic] Power of Music’, Scientific American Mind, vol. 26, no. 2, pp. 32-41.

Music & Wellbeing (Part 4): Music & Movement

This blog is a continuation of my mini-series examining the value of music on our overall wellbeing. The next two instalments will look at the physical benefits of music as a means of healing and rehabilitation.

As always, if you have any comments, suggestions or would like any further information regarding any of the research provided below, please do not hesitate to drop me a line! Music therapy is still a relatively new field (especially when looking at the wider sphere of medicine), and a lot of this might be new information to some. However, there exists a huge array of prior research and reading material on the subject. If reading these articles has sparked an interest in learning more about music therapy, but unsure about the best place to start, I would be more than happy to point you in the right direction!

I got rhythm: Music & Movement

Levitin (2006, p. 174) states that the cerebellum, as one of the earliest parts of our brain to evolve, is responsible for motor functions, including timing:

The Cerebellum is the part of the brain that is involved closely with timing and with coordinating movements of the body…From phylogenetic studies – studies of brains of different animals up and down the genetic ladder – we’ve learned that the cerebellum is one of the oldest parts of the brain, evolutionarily speaking. In popular language, it is sometimes referred to as the reptilian brain. Although it weighs only 10 per cent as much as the rest of the brain, it contains 50 to 80 per cent of the total number of neurons. The function of this oldest part of the brain is something that is crucial to music: timing (Levitin, 2006, p. 174)

As one of our oldest brain functions, our propensity for rhythm is therefore hardwired into us. Combine these automatic functions with the reward-centre activation we experience when listening to music (Salimpoor et al, 2015), and it goes quite some way to explaining our natural need to set things in order; an ‘unconscious propensity to impose a rhythm even when one hears a series of identical sounds at constant intervals’ (Sacks, 2008, p. 264).

Sacks (2008) discusses studies which demonstrated that the motor cortex and subcortical motor systems were activated when listening to music, or even merely imagining it. He argued that keeping time, in both a mental sense and as a physical act, depends ‘on interactions between the auditory and the dorsal premotor cortex’ (Sacks, 2008, p. 262). The human mind is unique in its ‘functional connection between these two motor activations’ (Sacks, 2008, p. 262) which are so intricately integrated with each other. Further to this, when listening to music is coupled with a physical activity, such as finger-tapping or any other movement in the body, several more areas of the brain are utilised. These include the cerebellum and the areas of the frontal lobes commonly associated with ‘higher perceptual and cognitive control’ (Thaut, 2005, p. 179).

According to Thompson (2015), utilizing music’s effects on the brain has yielded a positive response in stroke patients with impaired motor skills:

Patients who engaged in this intervention, called music-supported training, showed greater improvement in the timing, precision and smoothness of fine motor skills than did patients who relied on conventional therapy. The researchers postulated that the gains resulted from an increase in connections between neurons of the sensorimotor and auditory regions…the hope now is that active music making-singing, moving and synchronizing to a beat-might help restore additional skills, including speech and motor functions in stroke patients (Thompson, 2015)

Thaut (2005) has also recorded positive results when using ‘rhythmic auditory stimulation to facilitate walking’ in patients who have been partially paralysed following a stroke (Sacks, 2008, p. 276). Again, we see rhythm at play here to increasingly useful effect. Similar research carried out by Jun, Roh, & Kim (2013) investigated the benefits of music therapy in rehabilitating stroke patients. They discovered that better results, and improved mood, were increased by providing music-based movement treatments on a more regular basis (Jun, Roh, & Kim, 2013, P. 29).

Parkinson’s Disease is another condition in which music has been proven to help in alleviating symptoms. Parkinson’s Disease is a progressive neurological condition (www.parkinsons.org) caused by the ‘degeneration of cells in the midbrain that feed dopamine to the basal ganglia, an area involved in the initation [sic] and smoothness of movements’ (Thompson, 2015). These symptoms worsen as the disease progresses (Ross & Singer, 2014). In later stages of the disease, it is not only movement which is slowed down, but also the ‘flow of perception, thought, and feeling’ (Sacks, 2008, p. 274). This highlights the roots of the disease in the brain rather than in other parts of the body, much in the same way that the body can be affected after a stroke. Most studies conclude that music supplants a rhythm where the patient’s brain has stopped carrying out movement functions automatically (Jun, Roh, & Kim, 2013; Sacks, 2008; Thaut, 2005; Thompson, 2015).

As we saw when looking at musical interventions on stroke patients, one of the key factors to the success of music therapy in patients with Parkinson’s Disease is down to timing. In regard to Parkinson’s Disease, there are particular observations to be made about the patient’s own perception of timing:

‘An observer may note how slowed a parkinsonian’s movements are, but the patient will say, “My own movements seem normal to me unless I see how long they take by looking at a clock. The clock on the wall of the ward seems to be going exceptionally fast.”’ (Gooddy, 1988, quoted in Sacks, 2008, p. 276)

Regarding this example of relative time, using music has a positive effect because it ‘imposes its own tempo’, effectively overriding the impulses to speed up or slow down that Parkinsonion patients experience (Sacks, 2008, p. 276). Sacks (2008) continued that for as long as the music lasts, the patients’ rhythms returned to pre-illness speeds of movement. In other cases, where one side of the body is operating at a different speed to the other, getting the patient to play on an organ brought his limbs back into synchronicity again (Sacks, 2008, p. 277).

In many of the case studies provided by Sacks (2008), he mentions that the patients ‘come alive’ and in some examples shake off all visible signs of Parkinson’s Disease; walking more fluidly; singing; and even dancing energetically. In one case, an especially motionless patient is seated at the piano and not only frees up in her movement, but plays beautifully from memory; the act of imagining the music has the same effect as physically hearing it (Sacks, 2008, p. 278).

The phrase ‘come alive’, to me, suggests a happier state of mind when music is present in these patients. This is similar to the stroke patients in Jun, Roh, & Kim’s (2013) study that experienced an ‘improved mood’. While music is being applied here seeking physical improvements, it is simultaneously improving the patient’s mental wellbeing. Therefore, music can be seen to have an overall positive effect on the patients’ combined wellbeing. I agree with the research in these chapters, and believe that further implementation of music-based interventions within the National Health Service will show quicker recovery times in patients. This, in turn, should lead to a greater overall mental wellbeing in the patients as their health improves. As for the National Health Service, they are optimistic about the positive use of music as a means for treating stroke and Parkinson’s patients. However, they wish to see larger studies with more varied groups of patients. (National Health Service, 2008).

REFERENCES

Jun, E., Roh, Y., & Kim, M. (2013) ‘The effect of music-movement therapy on physical and psychological states of stroke patients’, Journal of Clinical Nursing, Vol. 22, No. 1/2, pp. 22-31. Available from: 10.1111/j.1365-2702.2012.04243.x.

Levitin, D. (2006). This is your brain on music: understanding a human obsession. Great Britain: Atlantic Books.

National Health Service (2008) Music aids stroke recovery. Available at: http://www.nhs.uk/news/2007/January08/Pages/Musicaidsstrokerecovery.aspx (Last accessed: 07/05/2012).

Parkinson’s Society (2015). Available at: www.parkinsons.org

Sacks, O. (2008). Musicophilia: tales of music and the brain. 2nd Edition. United Kingdom: Vintage Books.

Salimpoor, V., Zald, D., Zatorre, R., Dagher, A., & McIntosh, A. (2015) ‘Review: Predictions and the brain: how musical sounds become rewarding’, Trends in Cognitive Sciences, vol. 19, pp. 86-91. Available from: 10.1016/j.tics.2014.12.001.

Thaut, M. (2005) ‘Rhythm, human temporality, and brain function’, in Miell, D., MacDonald, R. & Hargreaves, D. (Eds.) Musical communication. United States: Oxford University Press, pp. 171-191.

Thompson, W. (2015) ‘The Healine [sic] Power of Music’, Scientific American Mind, vol. 26, no. 2, pp. 32-41.

Music & Wellbeing (Part 3): Music Therapy

Music Therapy

As a practice, music therapy sits somewhere between art, therapy, healthcare, and psychoanalysis; it ‘invites the art, science and craft of music and healing’ (Pavlicevic, 1999, p. 141). Its practice has been proven as having a ‘huge impact on confidence, and therefore improved wellbeing’ (Therapy Today, 2011, p. 5). Besides more common associations with mental health and children with special needs (SEN), music therapy has also proved to be of benefit on a much wider scale, including, amongst other areas, ‘physical impairments, people with hearing and visual problems, the institutionalised elderly, and people in the criminal justice system’ (North & Hargreaves, 2008, p. 298-299).

Within the field of music therapy, there is a history of deploying music to ‘alleviate chronic psychological disorders and problems associated with long-term physical impairment’ (North & Hargreaves, 2008, p. 298). There is evidence of music-based practices dating back prior to the beginning of recorded history. Being centred on music makes it one of the most accessible forms of treatment in terms of engagement:

Everyone has the ability to respond to music, and music therapy uses this connection to facilitate positive changes in emotional wellbeing and communication through the engagement in live musical interaction between client and therapist (British Association for Music Therapy)

The idea of creating music ‘out of thin air’ might seem like an alien concept to some. However, the process of music therapy sessions is to create something out of the patient’s feelings, situation and environment, with the assistance of the therapist (Williams, 2014). In the context of a music therapy session, there are ‘no ‘right’ and ‘wrong’ notes: all are part of possibility.’ (Pavlicevic, 1999, p. 143) Improvisation between therapist and client is key to allowing the client to experience music as a positive means of therapy:

Music therapy allows people to discover for themselves what is going on underneath, as well as allowing them to express repressed emotions or memories. If verbal communication has shut down, as with autism or stroke, it has a huge impact on a person’s confidence, which in turn affects every aspect of their life (Angela Harrison, quoted in Therapy Today, 2011, p. 5)

Just as the act of talking, or indeed writing, about one’s personal experiences can be seen as therapeutic and empowering (Newham, 1999, p. 32), so too can singing about it (Stige et al, 2010; Harrison, 2006). Due to the connections music makes with the brain and emotions, singing as a means of therapy can be seen to be even more cathartic:

To fill our memories with emotion requires us to use the full range of our voice to express the full range of feelings. And nowhere do we witness such a use of the voice more intensely than in the art of singing (Newham, 1999, p. 59)

Community Music Therapy

Such feelings of catharsis and empowerment which music therapy can provide are also useful in the context of a community. One’s place in their community has an effect on their overall wellbeing (Venkatapuram, 2013). According to Feld (1994, p. 77), ‘music has a fundamentally social life. It is made to be engaged – practically and intellectually and communally’. I agree that the main purpose of music is as a shared form of communication, much as it has been considered a language throughout history (Thaut, 2005, p. 171). This language reaches us at a level of understanding deeper than verbal communication (Harrison, 2006).

According to the National Health Service (2006) there are five evidence-based steps we can take to improve mental wellbeing:

  • Get active
  • Connect with others
  • Keep learning
  • Be aware of yourself and the world
  • Give to others

(National Health Service, 2006)

I believe that the practice of community music therapy covers all five of these points, through a variety of styles. Modes of practice, including music workshops, which act to ‘foster active and collaborative music making’ are therefore an excellent way of fostering better community wellbeing (Higgins, 2012, p. 144). Harrison (2006) believed the power of singing lay in its power to move other human beings; its ‘transformative qualities’; the way it can allow others unable to sing to feel cathartic benefits through empathic listening (2006, p. 24). I am inclined to agree with this view. I believe this element of music therapy has in fact the most potential to affect overall wellbeing, through its inherently inclusive and group-based nature. Participants, in making music with others, can experience ‘one of life’s greatest pleasures’ (Green, 1986, p. 69).

Further examples highlight to me that community music therapy might be better thought of in more broad terms, such as ‘care’ and ‘service’ (Stige & Aarø, 2012, p. 14) Like Stige & Aarø (2012), I believe it represents a group musical ‘service’ which takes place outside of the private, confidential, one-on-one setting of the traditional music therapy session. It is a means of bringing the community, and neighbouring communities, together through local music-based activities, the kind of which I have witnessed throughout my life in one form or another, without ever having identified them as ‘therapy’. These activities can take place in ‘arts centers [sic], schools, prisons, health settings, places of worship, festivals, on the streets, and in a wide range of community contexts’ (Higgins, 2012, p. 174). They can be said to be having a beneficial effect on the wellbeing of the community, and therefore the individuals within those community groups (Choi, Lee & Lim, 2008).

Music Therapy & Dementia

The term dementia, generally associated with old age or degenerative neurological diseases, is displayed as memory loss and difficulties with thinking, problem-solving or language, the most common form of which is Alzheimer’s Disease (Alzheimer’s Society). Alzheimer’s is characterised by changes in nerve cells and neurotransmitter levels, as well as destruction of synapses (Levitin, 2006, p. 231). In many cases, short term memory is largely absent, creating frustration among patients (Pavlicevic, 1999, p. 130). However, music therapy has proven to be of enormous positive effect in improving the wellbeing of Alzheimer’s patients (Lee & Thyer, 2013; Stige et al, 2010). Levitin goes on to report an interesting observation in the musical memory of Alzheimer’s patients:

As the disease progresses, memory loss becomes more profound. Yet many of these old-timers can still remember how to sing the songs they heard when they were fourteen. Why fourteen? Part of the reason we remember songs from our teenage years is because those years were times of self-discovery, and as a consequence, they were emotionally charged; in general, we tend to remember things that have an emotional component because our amygdala and neurotransmitters act in concert to ‘tag’ the memories as something important (Levitin, D. 2006, pp. 231-232)

Music’s innate ability to hone in on these ‘tags’ seems to almost reverse the symptoms of dementia for a brief time; play or sing a song from their past and they are once again ‘present’ (Sacks, 2008, p. 377). The practise of community music therapy has also been seen to have a positive effect in regards to Alzheimer’s patients, due to the added social factor involved (Stige et al, 2010, p. 266).

Music as alleviation to anxiety and depression

The frustration experienced by many people with dementia can often lead to frustration and agitation (Clare, 2004). While research on the subject is limited, music therapy has been proven as a noticeably effective, low-cost, non-pharmacological intervention (Blackburn & Bradshaw, 2014). Music-based interventions have yielded positive results in easing depression among adults without dementia (Chan et al, 2012). Occasionally studies note reduced anxiety as a by-product of alleviating another condition (Hargreaves & North, 2008).

There has been found to allow improvements to self-esteem and reduced depression in children and adolescents with behavioural and emotional problems, which were sustained over a prolonged period (Therapy Today, 2014, p. 6). One particular advantage of music therapy over talking therapies is that younger people seem more open to participation:

The most popular activity was song-writing or writing their own lyrics to music, which seemed to benefit their ability to communicate their feelings more generally, she said. Nearly all — 97 per cent — chose to write autobiographically about how they were feeling, where they were at. This age group tend to find talking therapies slightly more challenging but our psychology colleagues tell us that, as a result of the music therapy, these children are more open to engaging with them in their sessions and more able to express how they were feeling. (Therapy Today, 2014, p. 6)

The level of effectiveness music has in relieving stress varies ‘according to age, the type of stress in question, the means by which the music was used, the listener’s musical preference, and their prior level of music experience’ (Hargreaves & North, 2008, p. 307). This brief overview highlights to me that music therapy is of intrinsic value to our wellbeing. As well as the areas mentioned above, music therapy has seen measurable success relieving anxiety in a variety of settings (Hargreaves & North, 2008). It is also useful in treatment as therapy for drug and solvent abuse (Oklan & Henderson, 2014; Silverman, 2009).

REFERENCES

Alzheimer’s Society (2015) What is Alzheimer’s disease? Available at: http://www.alzheimers.org.uk/site/scripts/documents_info.php?categoryID=200171&documentID=100&gclid=CI_j59OHv8UCFYgIwwodCqUAPA (Last accessed: 06/05/2015).

Blackburn, R., & Bradshaw, T. (2014) ‘Music therapy for service users with dementia: a critical review of the literature’, Journal of Psychiatric & Mental Health Nursing, Vol. 21, No. 10, pp. 879-888. Available from: 10.1111/jpm.12165.

British Association for Music Therapy (2012) What is music therapy? Available at: http://www.bamt.org/music-therapy/what-is-music-therapy.html (Last accessed: 12/05/2012).

Chan, M., Wong, Z., Onishi, H., & Thayala, N. (2012) ‘Effects of music on depression in older people: a randomised controlled trial’, Journal of Clinical Nursing, Vol. 21, No. 5/6, pp. 776-783. Available from: 10.1111/j.1365-2702.2011.03954.x.

Choi, A., Lee, M., & Lim, H. (2008) ‘Effects of group music intervention on depression, anxiety, and relationships in psychiatric patients: a pilot study’, Journal of Alternative & Complementary Medicine, Vol. 14, No. 5, pp. 567-570. Available from: 10.1089/acm.2008.0006.

Clare, M. (2014) ‘Soothing sounds: reducing agitation with music therapy’, Nursing & Residential Care, Vol. 16, No. 4, pp. 217-221.

Feld, S. (1994) ‘Communication, music, and speech about music’, in Keil, C. & Feld, S. (eds.) Music grooves: essays and dialogues. United States of America: The University of Chicago Press, pp. 77-95.

Green, B. (1986) The inner game of music. United States: Pan Books.

Harrison, P. (2006) The human nature of the singing voice: exploring a h basis for sound teaching and learning. Great Britain: Dunedin Academic Press.

Higgins, L. (2012) Community music: in theory and in practice. United States: Oxford University Press.

Lee, J., & Thyer, B. (2013) ‘Does Music Therapy Improve Mental Health in Adults? A Review’, Journal of Human Behavior in the Social Environment, Vol. 23, No. 5, pp. 591-603. Available from: 10.1080/10911359.2013.766147.

Levitin, D. (2006). This is your brain on music: understanding a human obsession. Great Britain: Atlantic Books.

National Health Service (2006) Wellbeing self-assessment. Available at: http://www.nhs.uk/Tools/Pages/Wellbeing-self-assessment.aspx (Last accessed: 11/05/2015).

Newham, P. (1999) Using voice and song in therapy: the practical application of voice movement therapy. United Kingdom: Jessica Kingsley Publishers.

North, A. & Hargreaves, D. (2008) The social and applied psychology of music. United States: Oxford University Press.

Oklan, A., & Henderson, S. (2014) ‘Treating inhalant abuse in adolescence: A recorded music expressive arts intervention’, Psychomusicology: Music, Mind, and Brain, Vol. 24, No. 3, pp. 231-237. Available from: 10.1037/pmu0000058.

Pavlicevic, M. (1999) Music therapy: intimate notes. United Kingdom: Jessica Kingsley Publishers.

Sacks, O. (2008). Musicophilia: tales of music and the brain. 2nd Edition. United Kingdom: Vintage Books.

Silverman, M. (2009) ‘A descriptive analysis of music therapists working with consumers in substance abuse rehabilitation: Current clinical practice to guide future research’, The Arts in Psychotherapy, Vol. 36, pp. 123-130. Available from: 10.1016/j.aip.2008.10.005.

Stige, B., Ansdell, G., Elefant, C. & Pavlicevic, M. (2010) Where music helps: community music therapy in action and reflection. Great Britain: Ashgate.

Stige, B. & Aarø, L. (2012) Invitation to community music therapy. United Kingdom: Routledge.

Thaut, M. (2005) ‘Rhythm, human temporality, and brain function’, in Miell, D., MacDonald, R. & Hargreaves, D. (Eds.) Musical communication. United States: Oxford University Press, pp. 171-191.

Therapy Today (2011) ‘NHS urged to pay for music therapy to cure depression’, 2011, Therapy Today, Vol. 22 (No. 7), p.5.

Therapy Today (2014) ‘Music therapy helps beat depression’, (2014) Therapy Today, Vol. 25, No. 9, p. 6.

Venkatapuram, S. (2013) ‘Subjective wellbeing: a primer for poverty analysts’, Journal of Poverty & Social Justice, Vol. 21, No. 1, pp. 5-17. Available from: 10.1332/175982713X664029.

Williams, T. (2014) ‘A journey to music therapy’, Exceptional Parent, Vol. 44, No. 4, pp. 30-32.