Lucy Bolger and Katrina Skewes McFerran (2024). Music Therapy and Anhedonia: A Case Study. The Arts in Psychotherapy, Online, August 8.
Anhedonia involves a reduced ability to experience pleasure and enjoyment in everyday activities and is a common symptom in many chronic and mental disorders. For the first author in this case study, it was about finding a way out of her own anhedonia, which had arisen as a result of pain following cancer treatment. Bolger, who is herself a music therapist, instinctively felt that music activities, listening, and dancing could be a way back. But the problem was finding the motivation to get started, which is typical for anyone suffering from this condition. With the support of her colleague and supervisor, Katrina McFerran, as a guide, they created a program that would prove to yield results.
A Feasible Program The program they designed was intended to be practically manageable while also providing a foundation for thorough and systematic reporting and evaluation. Bolger set aside five minutes each day over 45 days. McFerran followed up with her support, sending SMS messages to encourage her, they had conversations, and they were eventually able to analyze and interpret the data that had accumulated during the process. The article describes the procedures in detail, and the analysis shows how Lucy gradually experienced an increased ability to access pleasurable experiences. This involved both the ability to look forward to something, so-called "anticipatory pleasure," and to experience joy during the activity itself ("consummatory pleasure"). After the 45 days, Lucy’s symptoms of anhedonia disappeared.
The activities Lucy carried out ranged from listening to improvisation, singing, and dancing, with listening and dancing being the most common activities. Some of the activities were planned but not always followed through. Instead, Lucy followed her mood and impulses to choose an activity. This could depend on where she was, at home or at the office, whether she could use headphones, if there were others present in the room, etc.
A Private Relationship
An interesting reflection made by the authors concerns this private relationship with music. Often, in music therapy, the emphasis is on community and participation, and on activities that offer outward engagement. This listening or music-making presented here was perceived as a safe opportunity to engage freely in music-making.
Systematic Approach
The authors provide a very transparent account of the process and how they conducted the thematic analysis. They are also aware that, although the results were good, more research is needed to shed light on such processes. Not least because Lucy herself, as a music therapist, could mobilize all her musical and reflective resources in this process. At the same time, with the support of McFerran, who, in addition to being one of our leading music therapy researchers, also has extensive clinical experience and is certified in Guided Imagery and Music (GIM). But the authors are already planning a larger study on music and anhedonia, this time involving a larger group.
Why Music?
It is also interesting to understand why music activities can help open up greater zest for life. Bolger and McFerran point to several possibilities. Perhaps it is more effective to focus on positive symptoms rather than negative ones, as some anxiety disorder researchers suggest. In that case, one should practice giving oneself positive experiences, activities that reactivate such experiences. It may be that there are connections in the brain that link aesthetic experiences to pleasure-reward centers, as we know from research showing that music experiences follow the same reward pathways as food, opioids, or sexual experiences. Here, it is essential to think broadly and contextually and not fall into simplified mechanisms that turn music into a new drug within a medical model of thinking.
A New Self-Help Practice?
It is tempting to think that this research will eventually support procedures that can help people out of this condition, which can paralyze one’s ability to live fully. Specifically, music, which is often associated with pleasurable experiences and joy, could become the way out of a life without resonance, as Hartmut Rosa says. It could also be an ambition to develop a program that people can carry out on their own, perhaps with or without the support of a therapist. After all, we are familiar with the slogan “five fruits and vegetables a day.” What about five minutes of health-musicking every day?
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