Katrina Skewes McFerran og Carol Barbara Lotter (2024). The Psychology of Music Listening for Health and Wellbeing Professionals. Palgrave Macmillan, 284 sider (e-book).
This is a book that truly brings listening to music into focus, particularly in the context of listening with the aim of enhancing well-being, health, and quality of life. Written by two experienced and prominent music therapy professors, the prolific Katrina McFerran from Melbourne, Australia, and Carol Lotter, who leads the music therapy program in Pretoria, South Africa, the book is an exceptionally good presentation of research combined with thoughtful reflections on practical application. In the following, I highlight some central themes from each chapter. It’s entirely possible to read individual chapters based on specific areas of interest. In the introduction to each chapter, the authors provide pointers to other chapters to indicate connections and overlaps.
Broad Audience
The book is aimed at all professional healthcare workers, as well as music therapists, and is written in simple language with numerous up-to-date sources from research literature. Through ten chapters, listening to music is presented under various life circumstances, institutional contexts, and different health challenges. A key objective for the authors is to help music therapists and others find personal music that can promote health and prevention.
Stress, Pain, Grief, and Social Isolation
The first chapter addresses autonomous or independent music listening, meaning the music that is listened to in everyday life, outside of a professional context. There is now a wealth of music psychology research showing how music listening can have health consequences for many. I recently read the Swedish music researcher Lars Lillestam’s book from 2020, Lyssna till musik. Upplevelser, mening, hälsa (Bo Ejeby Förlag), which presents a series of in-depth interviews demonstrating how, for many, popular music artists provide lyrics and music that are appropriated to care for one’s health and well-being. Lotter and McFerran's book provides further references to a range of research on how people use music in grief work, to counteract stress, relieve pain, provide hope, find coherence in life, use music as a social resource, or as support and self-care after natural disasters.
After COVID-19
We are now beginning to see the research results on the use of music during the COVID-19 pandemic. It appears that music and listening to music have meant a great deal to many during this challenging time. We are familiar with how music brought people together through balcony singing. We have also seen research where many followed live-streamed concerts online and had positive musical experiences that could also be shared with others. Now, we see that private listening has been a source of comfort and support for many who have felt socially isolated.
Music Listening as a Self-Help Strategy
A key purpose of the chapter is to help people create playlists to address challenges related to anxiety, stress, insomnia, or other life problems that require attention. In this first chapter, where autonomous listening is described, there are also reflections on how to talk with individuals and guide a process that leads to a greater awareness of music use in self-care. Practical instructions are provided on what to discuss to clarify individual musical tastes and experiences, with the goal of creating playlists with a specific focus, such as Music that Comforts, Songs of Hope, Good Memories, Relaxation Music, Music to Fall Asleep to, and Music that Gives Me Energy, among others.
I recently browsed Spotify and searched for 'Music therapy', and there are numerous pre-made playlists available. This might give individuals an idea of what kind of music they want, but I personally found much of it to be meaningless and impersonal. Lotter and McFerran also emphasize the importance of creating a personal playlist based on one’s own experiences and knowledge of how music affects oneself. In a process of ‘personal recovery’, one may need help becoming aware of this.
Listening to Music in Life’s Transition Phases
The next chapter is devoted to listening to music during different life circumstances, transitions between life stages, or more dramatic and involuntary relocations. It begins with a description of how music listening can support refugees forced to leave their home country. Music can help preserve cultural identity and roots, or aid in adapting to a new situation, whether in a refugee camp or a new country with a new school and new friends. Again, there are many references, and one of the book’s strengths is that it draws on research and experiences from various countries worldwide. Norwegian research is referenced, such as Kaja Enge's study on musical interactions between immigrant children and Norwegian schoolchildren in an article she co-wrote with Brynjulf Stige (Enge and Stige, 2020. Musical Pathways to the Peer Community: A Collective Case Study of Refugee Children’s Use of Music Therapy. Nordic Journal of Music Therapy, 31:1).
Adolescence is a time when interest in music is strong and intense. There is a great deal of music psychology research that is well addressed in the book, with many discussions around genre, music preferences, and the positive and negative uses of music. These are valuable considerations for anyone working with youth and looking to tap into the resource that is young people’s often strong relationship with music.
Pregnancy and Childbirth
We are also given an overview of research on how many women around the world use music during childbirth. Music listening can also provide support during pregnancy, helping one to adjust to changes in identity and roles. Several studies point to the positive effects of music listening. For example, it is recommended that pregnant women listen to music for half an hour daily to counteract anxiety and protect against postnatal depression, especially for women who already experience reduced well-being.
Healthier Aging
Many older adults find that opportunities for social activities related to music become more limited. Social isolation can be combated by creating spaces for music listening and sharing. Music experiences can evoke memories, and we know how autobiographical memories can create coherence and meaning in this stage of life. Life meaning, existential, and spiritual aspects can also be promoted during this phase of life, which is referred to as gerotranscendence.
Therapeutic Guidance
After each chapter, there are a few pages with practical guidance, advice, and tips on how to help anyone who wants to benefit from listening to music. Primarily, we see how a conversation can help people find their personal music. In the chapter on transformation, the role of the therapist or healthcare worker is to support people going through a transition in life. This involves helping people find songs that have previously provided a sense of strength and empowerment or assisting users in discovering what resources they possess in facing current challenges. Music can also be used to prepare for the future, and this can involve helping users establish good daily routines for music listening. We also know that daily music use can bridge the gap between everyday music use and the professional support offered by music therapists and others.
Stress
There is a great deal of documentation on how people use music in their everyday lives to relax and find calm. For many, this happens without the help of healthcare professionals or music therapists. Some need help getting started, finding music, and creating routines to regulate themselves and be more present in life. Listening to music can have direct implications for our neurophysiological system. Daniel Levitin, a neuroscientist, argues that music can improve our health by activating the neurochemical systems related to 1) reward, motivation, and pleasure, 2) stress and arousal, 3) immunity, and 4) social attachment.
However, it’s important to recognize that music doesn’t always promote sleep. Sometimes, music can trigger memories that provoke disturbing thoughts. In cases where music gets ‘stuck’ on repeat, known as ‘earworms’, it can make it difficult to fall asleep.
Which Music?
When it comes to the question of what type of music is best for promoting relaxation, opinions vary. Some point to what’s called Meditative Binaural Music (MBM), which creates a sense of a percussive beat in the music through small differences in sine waves. This, combined with a slow tempo and gradual changes—something common in all music suggested for relaxation—seems to be effective. MBM might be more suitable for younger people, as some research suggests, while classical music may be perceived as more relaxing for others. There is plenty of MBM available on YouTube, and it has also been somewhat commercialized. Since opinions vary and many forms of music work, there might also be a placebo effect in play. What seems to be effective is combining music listening with progressive muscle relaxation.
Mindfulness
Combinations of music listening and mindfulness techniques have also been tested. Mindfulness involves a state of awareness achieved through paying special attention to how one relates to the present moment with a non-judgmental attitude toward the experiences unfolding from moment to moment. However, this can be difficult to combine with music, as listening to music requires a type of focus that diverts attention from other stimuli, whether external or internal. Different combinations have been tried, for instance by reducing music to a faint background. What has been well-studied and supported by research is Guided Music and Imagery. Some have tried incorporating mindfulness techniques into the first induction phase of this musical journey. Regardless of the approach, it is important to be mindful of where to place the focus—on mindfulness or music listening, as McFerran and Lotter point out.
Sleep Problems
There is also much research and experience on using music to improve sleep. It’s suggested to identify one’s preferred music genre, create a playlist, and try listening to it before bedtime for several weeks. Such a "soothing" playlist should be personal and consist of slow music with a steady tempo, minimal rhythmic changes, a predictable melody, few leaps, and within a narrow range. It should have a clear tonal structure, a predictable chord progression, use string instruments and woodwinds instead of brass and percussion. There should be few dynamic changes, and those introduced should be gradual.
Emotion and Mood Regulation
The authors prefer to talk about "mood regulation" rather than "emotion regulation." Moods are more enduring states, and Suvi Saarikallio’s research identified seven strategies for mood regulation through music listening: entertainment, revival, strong emotions, distraction, release, mental work, and solace. McFerran and Lotter highlight research suggesting gender differences in how music is used to regulate moods and emotions. While the research points in various directions, considering gender alongside other factors that influence the regulation process is worth noting.
After this chapter, the authors make several reflections on how to help users select music for relaxation, mindfulness, sleep, and mood management.
Problematic Music Listening
The fourth chapter is dedicated to music listening that may be linked to increased rumination, depressive thoughts, aggressive behavior, prejudice, and destructive actions. This includes misogynistic music videos and lyrics, which call for a critical media approach. There is also music that fosters aggressive energy and affiliations with criminal groups or ideologically charged networks. Research also examines music that glorifies one's religion while belittling others' beliefs. Research in these areas exists, with some studies indicating that listening to so-called "problematic music," often heavy rock, is associated with undesirable behavior or negative moods. However, a clear distinction is not always made between causation and correlation. No direct causal link exists between a particular music genre and specific reactions. On the other hand, vulnerable individuals in difficult situations seem to be drawn to harder music genres, such as Depressive Suicidal Black Metal. Therefore, it’s not the music itself to blame, but rather how and in what context it is used by the listener.
Given conflicting research results, but knowing from practice that young people in at-risk situations need help managing their playlists and becoming aware of problematic listening habits, therapeutic conversations and counseling become crucial. A strength of this chapter is its nuanced discussion of international research contributions and the therapeutic insights provided. For those working with vulnerable youth, these guidelines on how to converse, ask questions, raise awareness, and offer advice are very helpful. This applies to prevention, early intervention, and treatment of people with problematic listening habits.
Listening as Mental Health Care
Interpreting this research is challenging due to the many conflicting findings. This research looks at listening in the treatment of people with serious depressive disorders, post-traumatic stress syndrome, women who have experienced sexual abuse, or in addiction recovery. On one hand, there is always a risk that music could lead to more rumination, depressive thoughts, trigger trauma, or increase cravings for substances. On the other hand, research across these fields, including meta-studies, shows positive effects from structured music listening. Studies come from various regions, not just the Western world. The material is presented pedagogically, with case studies illustrating dilemmas handled in practice.
In such situations, it’s crucial that music therapists work with clients to assess their music use, ask the right questions, raise awareness of the effects of music, and create a safe listening environment. Equally important is the user’s motivation and willingness to let the music help them. Once suitable music is found, the key lies in how much the user can receive and benefit from the emotions, bodily sensations, and reflections the music triggers.
Practical Advice
In this field, safety is paramount. Therapeutic sensitivity, creating safety, and building trust are key points. We must also remember that what one person finds safe and secure music may feel quite the opposite for others in a group, the authors stress. Music is a powerful medium that can evoke strong emotions and memories, especially for traumatized individuals.
Song analysis is a valuable tool but requires careful consideration of who should select the songs—the therapist or the client. Both options are discussed, and the challenges and opportunities with each are outlined. Music listening can evoke strong emotions, memories, associations, images, and bodily sensations. As we know from Guided Imagery in Music (GIM), these experiences can give access to more or less conscious processes or experiences we haven't always communicated well with ourselves. In psychodynamic traditions, the aim is to bring the unconscious to consciousness. For therapists with a humanistic-existential approach, music opens up transcendent experiences and existential dilemmas. Entering such processes requires further education and self-experience, something those pursuing GIM certification are familiar with. We also receive advice on music selection, which is usually made by the therapist in these cases. In terms of the listening process itself, we are reminded of considerations, as we are well-acquainted with through GIM training.
Listening in Medical Contexts
One chapter is also devoted to music listening in relation to various somatic conditions and procedures. This includes listening to music before surgery, for pain management (such as distraction), in neonatal units, and in sections about live music performances in hospital wards. The chapter refers to extensive literature. However, it’s not always easy to draw definitive conclusions, given the wide variety of medical conditions and the different ways interventions are described in medical contexts. Some researchers focus on increasing relaxation and calmness, while others emphasize reducing anxiety. Some studies describe a reduction in perceived pain, while others focus on self-mastery. This creates overlaps and the potential for confusion when interpreting the research.
Pain reduction is, of course, central, as we now know that pain is not an objective phenomenon but is influenced by subjective psychosocial factors. How music can reduce pain, often combined with relaxation techniques, is well-documented. However, it’s not always clear to what extent preference-based music should be recommended. This is because patients might choose music full of excitement and energy, which may not be beneficial for relaxation. On the other hand, preference-based music can evoke good memories and associations, providing effective distraction. Distraction draws attention away from the situation and doesn’t necessarily calm anxious people or relieve their pain and tension. I sense that music therapists may hold different opinions on whether to use distraction or invite patients into the procedure by supporting self-mastery of discomfort.
In the subsequent reflections in this chapter, the importance of mapping preferences and music interests is emphasized. It is crucial to understand the significance of music for the individual and to set clear goals for the interventions. Decisions must also be made about methods, such as whether to use live or recorded music, use headphones, have music as background or encourage focused listening, and use music before, during, or after a treatment. Evaluation becomes important in determining to what extent the listening helped achieve the set goals.
Listening in Neurological Disorders
This section primarily discusses four conditions under the umbrella of neurological injuries: traumatic brain injuries, Parkinson's disease, schizophrenia, and dementia. Since music therapy or listening does not necessarily lead to the repair of damage to the brain and nervous system, the goal of music listening in neurology is to enhance the quality of life, encompassing aspects such as vitality, relationships, belonging, and life purpose. Many of the videos circulating online are not necessarily representative of what is achievable, as they may feature individuals with specific brain injuries or a strong pre-existing connection to music.
That said, research shows that playing or singing for people, using live or recorded music, can reach individuals who have experienced traumatic brain injuries, for example, following accidents that have affected the head. However, there are several considerations to bear in mind, such as previous musical preferences, the complexity of the music, volume levels, noise control, and involving the family. Research shows that even patients in comas can be reached through music, resulting in favorable physiological reactions in the body, with a need for vigilance towards the smallest reactions during music listening.
Regarding individuals diagnosed with schizophrenia, music listening is also recommended, even in cases where the person experiences hallucinations, hears sounds, or voices. However, working with these cases requires special experience and competence. Music listening has proven to be helpful rather than harmful. Cochrane studies highlight the positive effects of music listening on negative symptoms, such as flat affect, emotional and social withdrawal. Once again, the choice of music is crucial, and a thoughtful approach is required.
In the case of Parkinson's disease, we know how music listening is used in the training of walking functions. Neurological music therapy has shown good results with rhythmic auditory stimulation (RAS). This method is somewhat different from what is described elsewhere in the book. RAS can involve the music therapist walking backward while playing preference-based songs on a guitar at a tempo suggested by a physiotherapist and adjusted according to needs. Numerous studies now point to the fact that playlists on smartphones can also help these patients feel more secure while walking, thereby enhancing the effect of training. For patients who experience "freezing" while walking, the music can help initiate movement. The impact of listening on quality of life and managing the psychological aspects of the disease has also been demonstrated.
The last condition addressed is dementia, where individuals with memory challenges benefit significantly from music listening. We now have substantial research supporting this, which is thoroughly referenced and discussed. Following the chapter, there are a few pages of reflections, this time focusing on how to carry out various procedures and tailor music listening for the different patient groups. There are useful tips for practitioners and method teachers.
Rehabilitation and Special Education
The eighth chapter is devoted to how music listening can be used to develop a wide range of physical, cognitive, and speech abilities within rehabilitation, early intervention, and special education. Examples are drawn from four areas: supporting language and communication, physical rehabilitation, special education classes, and for users of cochlear implants.
There is a substantial amount of research on how music listening can affect physical development, with studies on sports performance providing evidence. In terms of language rehabilitation, research is ongoing to determine if the perception of sounds and auditory processing, which occurs through music training, can support the ability to understand speech and language. Again, results vary, although regular music listening seems to have an effect.
For people with hearing impairments who use hearing aids or cochlear implants, research shows that a significant proportion of these individuals enjoy listening to music. This is despite difficulties they may face with musical details, melodies, and harmonies, especially if the orchestral sound is too dense. Even when the sound is perceived as distorted, out of tune, dissonant, or emotionless, a surprising number of hearing-impaired individuals still listen to music. There are also technological solutions that can separate voices and clarify the sound.
In the reflections following this chapter, the authors direct their advice towards physiotherapists, speech therapists, and special education teachers, offering helpful tips on how to facilitate listening and select music.
Performance-Enhancing Music
This chapter primarily addresses how music can improve well-being and performance in the workplace, learning environments, or elite sports. The chapter includes research on how different conditions, contexts, and types of music influence learning and performance, as well as the challenges faced when selecting music. Some prefer a particular type of music or sound environment while studying or learning, while others prefer silence. The research is extensive, and this chapter is also packed with references. There is excellent advice for study counselors, organizational psychologists, and coaching teams on how to approach the selection of music.
Group Music Listening
The final chapter highlights the value of group music listening. However, it also points out the challenges that can arise, such as differences in musical taste, emotional reactions that may occur, or how to deal with prejudices that emerge during a group process. Vignettes illustrate themes related to situations where youth groups listen together. There is an interesting explanation of how a common genre classification is often insufficient, with countless subgenres—such as numerous variants of electronic dance music—being tied to identity markers, which can easily cause friction when young people listen to each other's music.
The authors also emphasize music listening for purely aesthetic purposes, for joy and pleasure. Music listening is also an excellent starting point for support groups for caregivers or healthcare workers at risk of burnout. Relatives of patients with cancer or dementia have a need for support and time to process their situations. Listening groups with conversations provide great support for participants.
The final example is from listening groups with patients in mental health care. In addition to the aesthetic goals, the listening also has analytical objectives, led by therapists with special training to manage the processes that can arise. The reflections aim to help individuals appreciate different types of music, understand the emotions that emerge, and ultimately manage participants in the group who do not enjoy the music.
Translated from Norwegian by ChatGPT
Comments