Saturday, April 29, 2017

The Neuroscience of Music Therapy



Recently, while re-posting Positive Difference Making Fundamentals - an Introduction to Music Therapy, I said that "If you were to be ensnared by me in conversation about all this brain and mental health stuff, there is almost nothing I enjoy more than talking about music and the brain". And it's true, I can get pretty animated and passionate about it (as a couple of young people who were thus ensnared by me not long ago found out).

As many of you know, the world of mental health struggles is both my outer world (what I study and work within) and my inner world (what I often suffer myself). It's a difficult field in many ways. Dealing with people's struggles and pain is what I do. It can, as you might imagine, get a person down. As some of you also know, I am also beginning to record and post talks on a Taming the Polar Bears YouTube channel and thus far I've talked more about the dark and difficult stuff. 

It can all become quite a weight to carry on top of the struggles in my personal life so I have to be very careful with my own mental states <understatement>. As you all know (or I hope you do), I rely mostly on the Positive Difference Making Fundamentals for working on and trying to maintain the best mental state balance I can. This is not a perfect process, I think you should know - I can falter like anybody else. It might be due to a sudden impact trigger or the accumulative effects of many things, large and small or both.

In any case, I realized this past week (after having a lot of fun talking to that young couple about music and the brain) that for me it's not enough to only practice the fundamentals like music therapy, I sometimes have to remind myself of all the fun brain stuff that got me jazzed about them in the first place. And it's not only about why I get jazzed about it, I have to remind myself how important these things are for you and your brain and mental health. I have to tell myself that I have to be much firmer about teaching these things and getting you to implement them. 

Most of you know (and for those who don't, you will know in time) that one of my other great passions about the study of brains is the concept of neuroplasticity. It is not only a great passion, it is the cornerstone for everything I believe about your ability to change and grow and learn and move forward from where you are now. Neuroplasticity and music are very closely related in the brain so it is important to touch on that here to form the basis for our understanding of what music therapy can do for you.

What I refer to as "positive change" neuroplasticity (there is a dark side to the brain's ability to adapt and change itself, we must bear in mind) needs a spark. It doesn't just happen out of the blue. It needs certain things to initiate the process. There are many ways we might think about this but for now let's think of it as part of the process of baking bread. For bread to become light and fluffy the way we like it - to expand, in other words - it needs yeast to start the process of rising. So to help get this process of positive neuroplasticity going, we need a "yeast" to begin this "leavening" of your brain and mind. 

Enter music. Music is the yeast that's going to get this magical process of neuroplasticity going. 


I'm going to talk in another post about why I believe in you so much (yes you. Not that other person you think I'm talking to, but you). I can - and will - wax on in shear rhapsody why I believe in you and your potential and believe you can get past where you are right now (wherever and however that might be) but I want to touch on that belief a bit here now. 

It's easy to talk about belief but for many it's woo-woo blowing rainbow unicorn farts up your butt stuff. As you all by now should know, that's not me. You don't need woo-woo "it's all going to be alright if you just believe" rainbow unicorn farts blown up your butt. It wasn't - and isn't - good enough for me and it's not good enough for you. My belief has to come from a very solid foundation of science and evidence. My job then - the job of this blog (and coming talks) - is to pass that along to you so your belief is built on solid foundations, not woo-woo unicorn farts that will shift or blow away with every passing breeze (not to mention storms!). No, no, no, we need something much more solid than that to weather all the crap we go through. 

Back in the post on an introduction to belief I talked about evidence based belief. This here is what I was talking about and why. When I say I believe in you, I can look into your brain and vividly imagine all the potential you may have there waiting to be discovered, unlocked and nurtured. Again, this is not woo-woo imagination, this is imagination based and fantastic amounts of knowledge on brains, how they work and their enormous potential power and capabilities. This, folks, is why I love studying neuroscience - to not only know about the potential that lies within you, but the very neuroanatomical basis for it all. 

So, my fine feathered mental health suffering friends, if your belief is not there yet, I'm going to ask you to put your trust in my belief in you - deal?

As regular readers and followers will know, my posts seldom take form without some kind of long Bradonian preamble so without any further ado, let's proceed. 


Music and the Brain

Before I start talking about this in more detail, here's where we brush up a bit on our basic brain anatomy  with this handy 'road map' of some of the brain regions related to music therapy that we'll look at and discuss here today. 

In the introductory post I mentioned that nothing stimulates more regions of the brain than music. This is especially true for playing music, of course, but it is also true when we are listening to music. This gives us a good idea of what I meant by that. 



Let's look at these in more detail to get a better understanding of each and their importance in a well designed music therapy program. 

Let's start with the obvious - the auditory cortex

Auditory issues will be a problem in many cases of depression and anxiety along with ageing. Due to various inner and external stressors, this area can become over sensitized and misfire leading to irritability with sounds around us (even ones that would not normally be irritating). New evidence is emerging that tinnitus that often accompanies cases of depression and anxiety (and indeed will become a significant contributing factor) may be due to - as those in the brain biz would say - maladaptive auditory cortex reorganization or "unfavourable plastic changes" (part of the "dark side" of neuroplasticity that I often refer to). Certain ageing related hearing loss may well be due to what's going on in the auditory cortex rather than the "signal gathering devices" (IE: your outer and inner ear). 

That aside, it is the auditory cortex and tracts that will analyze the more intricate components of music like tones, intervals, melodies, timbre and rhythm. 

These are aspects and factors we want to keep in mind when selecting music and musical sounds for a music therapy program. 

Next, let's look at the corpus callosum 

Our brains have two hemispheres (I talk about these in some detail in this post in my neuroscience blog). Over there I debunk the myth of "left brain" and "right brain" people and personality traits, nonetheless there is a great deal of quite distinct "division of labour" between the hemispheres. It is vital for balanced thinking and perspectives that these two regions work well together. I've spoken often of the main "trunk lines" of white matter (bundles of axons, AKA our connectome) and the corpus callosum is one of the key bundles as it is what connects the two hemispheres. Enormous amounts of "data traffic" must pass back and forth through it. 

It's not hard to imagine, then, that the right kind of stimulation for this all important axon bundle can be tremendously beneficial to overall brain function. 

Moving downwards and to the rear of our brain we will find the "little brain", the cerebellum 

This humble and rather ancient part of our brain "hardware" is of enormous interest to us here when it comes to music therapy. It is here that the great majority of planning and execution of movements takes place. How well this region functions and is connected to the rest of the brain is crucial to all our physical movements. We take these things for granted but it is finer motor skills that decline with age and eventually lead to falls and general "clumsiness". As we age, however, we tend to not only be less active, but our movements tend to become more routine putting less demand on this region to "stay sharp". One of the tenets of neuroplasticity is "use it or lose it", meaning that critical connections within the cerebellum plus networks connecting it to other regions of the brain such as the sensory and motor cortex

We will address the sensory and motor cortex here rather than separately as their activity is so closely connected to that of the cerebellum. Within these two regions are mini-regions that correspond to all parts of the skeletal-muscular parts of your body. It is these regions that when damaged by a stroke will result in paralysis. These areas too then are very important for body movement and tactile sensations related to parts of the body. 

The cerebellum and motor cortex must maintain vast connection networks for your body movements to work properly. But again, keeping in mind "use it or lose it", these will become less strongly connected if we do not regularly move our bodies in challenging ways (as opposed to simple routine walking, for example). We see this not only as we age but as I brought up in the lecture on depression, psychomotor retardation can occur along with vegetative states and fatigue (all related, I believe). These all impair a patient's physical ability to move and we will see a negative cycle of the less one can move the more impairment there will be. 

As music demonstrably stimulates all these regions and the connections between them, for this reason alone music therapy is an absolutely essential part of any treatment or recovery program for depression or any major psychiatric or mood disorder. 

But the importance and roles of the cerebellum doesn't end there. 

A good body of research over the past twenty-five years shows strong evidence that the cerebellum has significant connections to brain areas involved in higher cognitive functions, including the prefrontal cortex (see more below). The cerebellum appears to play important roles in both coordinating and helping motor cortex areas automate cognitive functions (thus making them more efficient and easier). 

These networks are crucial to stimulate as much as possible.  

Let's now leap forward (sort of literally) to the prefrontal cortex


The term most associated with the prefrontal cortex area is "executive function" which, briefly, relates to abilities to differentiate among conflicting thoughts (1), determine good and bad, better and best, same and different, future consequences of current activities, working toward a defined goal, prediction of outcomes, expectation based on actions, and social "control" (the ability to suppress urges that, if not suppressed, could lead to socially unacceptable outcomes).
What I found of great interest is that a good deal of study has indicated an integral link between a person's will to live and PFC activity, something that obviously is critically important in many cases of depression. It has also been strongly tied to planning complex cognitive behavioiur, personality expression and decision making. We can think of the general "job" of this region to be orchestration of thoughts and actions in accordance with internal goals. 

For a number of reasons, impairment of or difficulty in many of these functions will be associated with virtually all mood and psychiatric disorders. I need to get to this in more detail in another post but briefly activation of the PFC becomes reduced (though I do touch on this a bit in this post). And again, with the basic brain principle of "use it or lose it", the less stimulation there is of a region, the more it and brain wide network connections will atrophy or weaken. 

I think we can now see how crucial it is to positively stimulate this region and related networks as much as we can! 

Let's look at the hippocampus, amygdala and nucleus accumbens collectively. By now we are becoming more familiar with the former two in our looks at the limbic region of the brain in relation to stress and emotional responses. The hippocampus is greatly involved in encoding and retrieval of memories of experience (episodic memory) and the amygdala is central to how we experience and react to emotions, fears, dangers and threats. Both of these will be involved in depression, bipolar disorder and other psychiatric and mood disorders. 

The nucleus accumbens is a key "relay hub" in dopamine pathways related to reward and pleasure. It is located "upstream" from the Ventral Tegmental Area (where dopamine pathways originate). Activation here is critical for passing along dopamine signalling from the VTA to the pre-frontal cortex where it may be involved in a number of higher functions such as long term motivation and reward. 

The right kind of music therapy has positive affects on all these brain nodules and there is even some compelling evidence that listening to music can stimulate neurogenesis in the hippocampus, which is kind of the holy grail of neuroplasticity. 

Now, it's not only these specific regions that are activated and stimulated by music. 

Let's first look closer within them to get a better idea of what kind of neuroplasticity we're kicking into gear. 

Music and Neuroplasticity in the Brain - the Finer Details

Okay, now we have to think back on and recall some neuroscience 101 stuff. Here we have our neuron illustration from back then.



For many neurons, their jobs are to "encode stuff" - all the tiny fragments of details that make up all kinds of memory and higher cognitive functions. The "stuff" of these neurons isn't static - it changes according to input and even our very thoughts. Other specialized neurons are involved in perception and learning. These too are not static and respond to new experiences and learning. In neuroscience 101 I said that the activity in a single neuron has been compared to that of an entire city (I really must get to that in some detail some day - fascinating stuff, I can assure you!). 

When we "input" new information or "put in a call" for existing information, there will be furious amounts of activity within neurons relative to that task all in real time.

So just within individual neurons in many, many critical regions related to higher cognition, perception and memory they are stimulated in very important ways. This is just one aspect of the 'positive' neuroplasticity stimulated by music. 

Neurons will get excited as all hell with this activity and get all fired up to connect to other related neurons or even unrelated neurons that may "be interested" in this juicy new stuff (or even juicy old stuff! - neurons can be great gossips). Which takes us to the next step of all this neuroplasticity we're kicking into motion. 

As I've said numerous times in various posts, all that information and activity within individual neurons is "useless" if they cannot connect to and pass that information along to networks of other neurons to complete "big picture" processes of cognitive functions, memory formation and recall, etc. 

Along those lines, it's important to understand that a single neuron can play many roles in several different senses and cognitive, memory and perception functions. 

Let's look at the next illustration. This gives a rough idea of the "flow" of information through a network of neurons. 



Let's imagine that that single neuron on the left is the one from the above illustration and it's all full of fun and exciting stuff. We want that baby connected! 

The bursts of information flow along axons (the direction of the arrows) and are received by dendrites (the little spikes reaching out towards the axons). At the point they connect are the synapses that I've been writing about. Let's have another quick look. 




The connections between axons that are sending the information take place at dendrites and synapses. I don't want to get into the details of this again here today (I get into quite a bit of detail about these connections here  and there elsewhere) but briefly, the more dendrites and synapses the better. 

This is a very cool 3D animation. Now imagine this happening with millions and millions of neurons and hundreds of billions of synapses second by second all over the brain as its grooving to music! (this is actually slowed down for your viewing pleasure - that all happens much, much faster in real time and on a vastly greater scale)




The number and quality of these connections are an enormous part of neuroplasticity as well and this is precisely the kind a well designed music therapy program will stimulate. 

Now, I'm going to show you how important this is. 



These phases are considerably more complex than that and there's more to the time lines of them but this gives us a good general idea. As well, please ignore at the bottom where it says "conscious front portion of the brain" as that is quite misleading. What we want to pay attention to is that middle peak part. That's generally what we want - lots of dense connections (though not 100% necessarily - more in a moment). What I need you to really pay attention to is to the right. For most people that's what will happen. That's what cognitive and memory decline looks like. Note that there are still lots of neurons - they actually do pretty well with this whole aging thing - it's the connections that are lost. Lose connections, lose memories and cognitive functions. Not good, folks. 

That shows decline in older age but in many cases of depression, bipolar disorder, schizophrenia, mood disorders in general, both cognitive and memory function decline are often part of the long term symptoms. In mood and psychiatric disorders the reasons and causes of these are a bit more involved though also very similar. Either way, a good deal of what is happening is the lost connections illustrated at right.

But - but! - and I need you to really drill this into your head: it does not have to go that way. Repeat: does not have to go that way. 

One more time: it DOES NOT HAVE TO GO THAT WAY.

There are a number of reasons for the mass "pruning back" and loss of connections we see on the right but the greatest, most likely and most common reason is because one of the most fundamental principles to brain function - use it or lose it. And that on the right, folks, is what "lose it" looks like. 

When you read or hear of "grey matter" in the brain and the loss thereof, this is a great deal of what that means. The denser connections and the building of them is what is happening when we hear of "increasing" grey matter. 

Okay, so what then does "use it" look like? Simply put it means regular stimulation. So what does that look like? There again are a number of possibilities but the two best known for maintaining connections and growing new ones are learning and new experiences. 

So what then do learning and new experiences look like? 

Well, the possibilities there are sort of endless but of course today we are looking at the effects of music on the brain. 

Music in general will stimulate more areas of the brain and more connections within them than almost any other activity.

One way to understand why music stimulates the brain so much is to understand how complex sound waves are. 

According to Dr Jon Lieff in Searching for the Mind, even the Fourier transform equations used by Einstein to analyze light fall far short of being able explain the brain's ability to analyze sound waves. Each note is made up of extremely complex series of vibrations, IE; the harmonics or overtones (these entail involve enormously involved mathematical ratios). 

Yet the brain takes all this and sorts into all the notes and so on that you experience as the sound of music. 

And while everything involved in the brain is going to be tremendously stimulated by that alone, that's not quite enough - we need learning and new experience. 

And that, folks, is why I emphasized in the original piece introducing music therapy that it is very important as part of designing your program that you include not only as much new music as possible, but also completely new genres. 

And not only that but the complexity of the composition is important as well. To give an idea of that, let's look at that a bit. 




It's figuring all that out and storing it away that's going stimulate so many brain wide regions and networks. 

And it doesn't end there!

It's not just neurons and all those connections that are stimulated, it's that big beautiful "wiring harness" or connectome of ours that will also be greatly involved and stimulated. The connectome is all the "long distance" wiring that connects all these regions we've been looking at. 

Just check out this beautiful illustration! 



This too can experience loss with age and/or lack of good stimulation and key bundles of axons will be very actively stimulated as your brain roars around all over dancing to the beat of all kinds of music. 

And the benefits of music don't end there!

While all this stimulation of neurons and spurring connections and growth all over the brain is fantastic, there are actually several key areas we want to de-stimulate. We want those regions and networks to calm down and not be so connected to our overall brain activity that creates our conscious experiences. 

These will be areas in the amygdala and hippocampus associated with fearful memories, difficult emotions or emotional responses and so on plus their related places throughout the brain. The right kind of music can calm those down and reduce their activity and thus their roles in our behaviours, moods and reactions to outside and inner stimuli. 

As well, there are powerful areas in the brain involved in ruminative negative thinking (recall that we looked at these back in the post on Staying in the Now). This is where many people get trapped in depressive episodes and part of what's happening is the build up of too much activity and connectivity within these areas and long distance connections to other parts of the brain. This is the kind of "use it" we don't want! This is more what we want under the "lose it" end of neuroplasticity, IE; we want these areas deactivated and calmed down more and to not be so much a part of what is producing our thoughts, emotions and general conscious experience. 

And well designed music therapy program will help us there as well. When we feel ourselves slipping into those times of ruminating negative thoughts (and probably lots of negative self-appraisal and beating ourselves up thoughts and morose, pessimistic visions and ideas of ourselves and the future) if we instead switch to certain kinds of music, we can get our brains away from activating those areas and get stimulation and activation going in all the areas we looked at above, instead. In addition to de-stimulating those specific areas, we are also reducing the activity in the connectome that that "wires" those regions into our overall mental activities and states thus reducing their "hold" on us. It takes time, but gradually this will make a difference. 

A well designed music therapy program done in concert with (a little play on words there) some variation of my brain training exercises in which we're learning to focus on positive self-talk, problem solving and looking for the best outcomes possible will be very, very powerful in all kinds of positive neuroplasticity and thus building better mental states and long term functions. 

I think now we have a very strong understanding of why this Positive Difference Making Fundamental is so vital. As I said in the original post, when we are hammered by the fatigue and everything seems so impossible and exhausting to do, it can be really, really challenging to do any of the things we know are important for getting better. And it is prolonged stretches of this fatigue, mental fog and so on that will greatly contribute to the loss of connections we looked at above and thus create the symptoms of loss of cognitive and memory functioning. This is a huge reason why music therapy is so important to you - you absolutely must exercise your brain in some way to increase the chances of getting better and music can do that better than anything else you can do. 

What's most exciting about what music does for the brain and positive neuroplasticity, is that all this brain wide stimulation really helps "set the table" or "activates the yeast" for all kinds of other neuroplasticity for learning, creativity, better more positive imagination and so on (known as metaplasticity).

Phew, that's a lot! I know that's a great deal of information to take in but trust me, your brain is soaking it up. Just reading posts like this is positive stimulation!

I have in the works a blog post, video presentation and webinar where we'll look at how to design a music therapy program for you. Please be patient until then - we will get there!

Stay tuned and thanks for reading!


(1) When we are practicing mindfulness CBT this is one of the brain regions we're activating, "building up" and strengthening its connections to other parts of the brain.

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