Music is an ancient art that has soothed minds for centuries.

Music helps people regain inner peace and

is the voice that binds people together. It has been used to treat the sick since ancient times and
frequently is used to cure depression. Songs offer people solace in adversity and joy in prosperity. They
are sung on birthdays and even at the death of a loved one. Music is accepted as a universal means to
express one’s emotions. It was an essential component of ancient healing. A drum was beaten when
treatment was offered to a patient, and a successful recovery was announced with trumpets. 1 Great
philosophers have assigned important roles to music in the expression of their emotions and
teachings.2 Music was used to treat psychiatric illness in ancient Greek and Roman cultures. 3 More
recently, reports have indicated the usefulness of music therapy in managing psychiatric
disorders.4 Music has been used in psychosis and neurosis and now is being used in addressing organic
disorders such as dementia.5,6 There is a wealth of literature on music therapy in all fields, but sadly,
renowned psychiatry textbooks fail to mention music therapy as a treatment modality, and many
contain no information about it at all. The purpose of this article is to offer insight into the various types
of music therapy and review some of the literature on the use of music therapy in psychiatry.

Background Music Therapy

Background music therapy is a form of therapy in which music is heard for an average of 8 to 12 hours
per day as part of a hospital routine. It is transmitted via audiotapes and radio. The aim of this therapy is
to create a calm environment amid the chaos in the hospital. This plays a useful role in allaying anxiety
and relaxing patients in critical care.7

Contemplative Music

Contemplative music therapy helps patients appreciate the significance of music and art in general.
Before music is played for patients, they are given a biography of the composer and other details about
the music. This may be administered in a group setting or individually. This facilitates the uncovering of
morbid experiences, termed communicative music therapy, and causes emotional enlivenment, termed
reactive musical therapy. In contemplative therapy, both the music that soothes as well as the group
setting and the group therapy used bring out morbid experiences of the patients. This therapy also aims
to soothe agitation and alleviate sadness.8

Combined Music

In combined music therapy, music therapy is used in conjunction with other therapeutic procedures.
Unlike background music therapy, it calls for the patient to select musical compositions that enhance
therapeutic outcome and suit the patient. Sometimes in this form of music therapy, hypnosis is
conducted while the subject listens to the music. This music is often accompanied by suggestion under
hypnosis that improves the therapeutic outcome. In combined music therapy, the patient is asked to
select music he likes as it will soothe him better, and here music is used as an adjuvant to various other
therapies. The patient may or may not like the music chosen by the therapist and hence he is given the
choice so that therapy is adhered to. This form of music therapy has been used in combination with
cerebral electrosleep therapy and behavior therapy methods such as autogenic training. 9
Executive Music

Executive music therapy consists of individual or group singing and playing musical instruments. Patients
with long hospital stays are the best candidates for this form of therapy. It strengthens patients’ self-
confidence and their feelings of worth among others. Executive music therapy can be incorporated into
the occupational therapy routine.10

Executive Iatromusic

In executive iatromusic therapy, a musician performs in children’s psychiatric units. This form of therapy
frequently is used in managing emotionally disturbed, mentally retarded, and dyslexic children. 11-13

Creative Music

In creative music therapy, patients write songs, compose music, and play instruments as a form of
catharsis. Grief over a deceased loved one, oppression, and repressed feelings and fears often are well
expressed in music and song.14

The Use of Music Therapy in Psychiatric Disorders

Music therapy has been used effectively in both adults and children with psychiatric disorders. It has
been used to modify the behavior of children with autism and pervasive developmental disorders with
moderate success.15It has been used to reduce agitation in patients with dementia by soothing them and
eliminating the social isolation of these patients. 16,17 Music therapy has been used in patients with
Parkinson’s disease to improve motor skills and emotional problems. 18 There is ample evidence of the
usefulness of music therapy in alleviating grief and in combating bouts of depression. 19-21

Conclusions

Music no doubt plays a pivotal role in the lives of human beings. Incorporating music therapy into
regular therapy programs for psychiatric disorders can help speed recovery and also help make therapy
a more positive experience. Music therapy is a valuable but relatively unexplored asset in the field of
psychiatry and psychotherapy.
Art therapy, sometimes called expressive art or art psychology, encourages self-discovery and emotional
growth. It is a two-part process, involving both the creation of art and the discovery of its meaning.
Rooted in Sigmund Freud and Carl Jung's theories of the subconscious andunconscious, art therapy is
based on the premise that visual symbols and images are the most accessible and natural form of
communication to the human experience. Patients are encouraged to visualize, and then create, the
thoughts and emotions that they can't express verbally. The resulting artwork is then reviewed, and its
meaning interpreted by the patient. The analysis of the artwork typically enables a patient to gain some
level of insight into their feelings and allows them to work through these issues in a constructive
manner. Art therapy is typically practiced in conjunction with individual, group, or family
psychotherapy (or verbal therapy). While a therapist may provide critical guidance for these activities,
an important feature of effective talk therapy is that the patient/artist, not the therapist, direct the
interpretation of their artwork.

Some mental health professionals also view art therapy as an effective diagnostic tool for the
identification of specific types of mental illness or traumatic events. In the late 19th century, French
psychiatrists Ambrose Tardieu and Paul-Max Simon both published studies on the visual characteristics
of and symbolism in the artwork of the mentally ill. They found that there were recurring themes and
visual elements in the drawings of patients with specific types of mental illness. More recently,
psychiatric literature has explored common themes and symbols in the artwork of  sexual
abuse survivors and victims of trauma.

Applications

Art therapy can be a particularly useful treatment tool for children, who often have limited language and
communications skills. By drawing or visually expressing their feelings, even if they can't identify or label
the emotions, younger patients have a starting point from which to address these issues. Art therapy is
also valuable for adolescents and adults who are unable or unwilling to verbalize thoughts and feelings.

Beyond its use in mental health treatment, art therapy is also employed as an adjunct (or
complementary) therapy to traditional medicine for the treatment of biologically based diseases and
conditions. The correlation between mental health and physical health is well documented. Art therapy
has been used in the healing process to relieve stress and develop coping mechanisms, in an effort to
treat both the physical and mental needs of the patient.

Although art therapy has traditionally centered on visual mediums (paintings, sculptures, drawings, etc.),
some mental healthcare providers have broadened the definition to include music, film, dance, writing,
and other artistic genres.

Benefits

 Self-discovery. At its most successful, art therapy triggers an emotional catharsis (a sense of

relief and wellbeing through the recognition and acknowledgement of subconscious feelings).
  Personal fulfillment. The creation of a tangible reward can build confidence and nurture feelings
of self-worth. Personal fulfillment comes from both the creative and the analytical components
of the process.

 Empowerment. Art therapy can help individuals visually express emotions and fears that they
were never able to articulate through conventional means, and give them some sense of control
over these feelings.

 Relaxation and stress relief. Chronic stress can be harmful to both mind and body. It can weaken
and damage the immune system, cause insomnia and depression, and trigger a host of
circulatory problems (e.g., high blood pressure, atherosclerosis, and cardiac arrhythmia). When
used alone or in combination with other relaxation techniques such as guided imagery, art
therapy can be a potent stress reliever.

 Symptom relief and physical rehabilitation. Art therapy can also help individuals cope
with pain and promote physiological healing by identifying and working through anger and
resentment issues and other emotional stresses.

General effects of music therapy

Music has been used throughout human history to express and affect human emotion. The health
benefits of music to patients in Veterans Administration hospitals following World War II became
apparent, leading to its use as a complementary healing practice. Musicians were hired to work in
hospitals. Degrees in music therapy became available in the late 1940s, and in 1950, the first
professional association of music therapists was formed in the United States. The National Association of
Music Therapy merged with the American Association of Music Therapy in 1998 to become the
American Music Therapy Association.

Music can be beneficial for anyone. Although it can be used therapeutically for people who have
physical, emotional, social, or cognitive deficits, even those who are healthy can use music to relax,
reduce stress, improve mood, or to accompany exercise. There are no potentially harmful or toxic
effects. Music therapists help their patients achieve a number of goals through music, including
improvement of communication, academic strengths, attention span, and motor skills. They may also
assist with behavioral therapy and pain management.

Depending on the type and style of sound, music can either sharpen mental acuity or assist in
relaxation. Memory and learning can be enhanced, and this used with good results in children with
learning disabilities. This effect may also be partially due to increased concentration that many people
have while listening to music. Better productivity is another outcome of an improved ability to
concentrate. The term "Mozart effect" was coined after a study showed that college students performed
better on math problems when listening to classical music.

How music therapy is used

Music is used to form a relationship with the patient. The music therapist sets goals on an individual
basis, depending on the reasons for treatment, and selects specific activities and exercises to help the
patient progress. Objectives may include development of communication, cognitive, motor, emotional,
and social skills. Some of the techniques used to achieve this are singing, listening, instrumental music,
composition, creative movement, guided imagery, and other methods as appropriate. Other disciplines
may be integrated as well, such as dance, art, and psychology. Patients may develop musical abilities as
a result of therapy, but this is not a major concern. The primary aim is to improve the patient's ability to
function.

Learning to play an instrument is an excellent musical activity to develop motor skills in individuals with
developmental delays, brain injuries, or other motor impairment. It is also an exercise in impulse control
and group cooperation. Creative movement is another activity that can help to improve coordination, as
well as strength, balance, and gait. Improvisation facilitates the nonverbal expression of emotion. It
encourages socialization and communication about feelings as well. Singing develops articulation,
rhythm, and breath control. Remembering lyrics and melody is an exercise in sequencing for stroke
victims and others who may be intellectually impaired. Composition of words and music is one avenue
available to assist the patient in working through fears and negative feelings. Listening is an excellent
way to practice attending and remembering. It may also make the patient aware of memories and
emotions that need to be acknowledged and perhaps talked about. Singing and discussion is a similar
method, which is used with some patient populations to encourage dialogue. Guided Imagery and Music
(GIM) is a very popular technique developed by music therapist Helen Bonny. Listening to music is used
as a path to invoke emotions, pictures, and symbols from the patient. This is a bridge to the exploration
and expression of feelings.

Music therapy is particularly effective with children. The sensory stimulation and playful nature of music
can help to develop a child's ability to express emotion, communicate, and develop rhythmic movement.
There is also some evidence to show that speech and language skills can be improved through the
stimulation of both hemispheres of the brain. Just as with adults, appropriately selected music can
decrease stress, anxiety, and pain. Music therapy in a hospital environment with those who are sick,
preparing for surgery, or recovering postoperatively is appropriate and beneficial. Children can also
experience improved self-esteem through musical activities that allow them to succeed.

The geriatric population can be particularly prone to anxiety and depression, particularly in nursing
home residents. Chronic diseases causing pain are also not uncommon in this setting. Music is an
excellent outlet to provide enjoyment, relaxation, relief from pain, and an opportunity to socialize and
reminisce about music that has had special importance to the individual. It can have a striking effect on
patients with Alzheimer's disease, even sometimes allowing them to focus and become responsive for a
time. Music has also been observed to decrease the agitation that is so common with this disease. One
study shows that elderly people who play a musical instrument are more physically and emotionally fit
as they age than their nonmusical peers.

Music can be an effective tool for the mentally or emotionally ill. Autism is one disorder that has been
particularly researched. Music therapy has enabled some autistic children to relate to others and have
improved learning skills. Substance abuse, schizophrenia, paranoia, and disorders of personality,
anxiety, and affect are all conditions that may be benefited by music therapy. In these groups,
participation and social interaction are promoted through music. Reality orientation is improved.
Patients are helped to develop coping skills, reduce stress, and express their feelings.

Pain, anxiety, and depression are major concerns with patients who are terminally ill. Music can provide
some relief from pain, through release of endorphins and promotion of relaxation. It can also provide an
opportunity for the patient to reminisce and talk about the fears that are associated with death and
dying. Music may help regulate the rapid breathing of a patient who is anxious, and soothe the mind.
The Chalice of Repose project, headquartered at St. Patrick Hospital in Missoula, Montana, is one
organization that attends and nurtures dying patients through the use of music, in a practice they called
music-thanatology by developer Therese Schroeder-Sheker. Practitioners in this program work to relieve
suffering through music prescribed for the individual patient.