Music Therapy and Mental Health: PTSD Edition
For individuals diagnosed with Posttraumatic Stress Disorder, every day may consist of fear, uneasiness, flashbacks, difficulty completing day to day activities, or even emotional numbness. Along with most mental illnesses, there are no cures for PTSD. There are many different treatment options to provide coping skills for those with PTSD — one of those options is Music Therapy. There are therapeutic settings and interventions that are designed to help those with PTSD better adjust to difficult aspects of their everyday lives. By setting goals to decrease a negative behavior or increase a positive with Music Therapy, living with PTSD can become more bearable.
The American Psychiatric Association (2019) defines Posttraumatic Stress Disorder as a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault. This type of trauma creates dissonance. Dissonance is created between the magnitude of the threat and the individual’s resources for coping with the rest (Felsenstein, 2013, p. 1). Symptoms of PTSD can be mental, physical, and emotional. Some symptoms of PTSD can include re-experiencing the event, intrusive memories of the event, prolonged emotional distress and psychological reactivity after exposure to trauma-related stimuli, avoidance of trauma-related thoughts and external reminders, negative alterations in mood and cognition, and alterations in arousal and reactivity (Landis-Shack, Heinz, & Bonn-Miller, 2017, p. 2)
(Oglethorpe Inc., 2020)
There is a three-stage therapeutic process to help those experiencing PTSD stop using unhealthy coping behaviors: sense of safety, building a narrative, and engaging with the community (Story & Beck, 2017, p. 94). Treatment of PTSD can be difficult because it surfaces itself differently in everyone because everyone is different, and everyone experiences different trauma. Many different forms of treatment are being researched and will continue to be researched.
As Ahonen says, “music touches our emotions and triggers our memories on the deepest level. There is something in music that is transformative, making a difference in people’s lives” (2018, p. 26). Music Therapy has many benefits for individuals with PTSD. One benefit of Music Therapy is that music engages people in a universal environment that feels safe and more enjoyable than other verbal processing therapies (Carr, d’Ardenne, Priebe, Scott, & Wang, 2011, p. 180). Music Therapy interventions are used to help a person distinguish the present moment from past traumatic events, an important part of re-experiencing the trauma and staying grounded. Music can elicit traumatic associations, which can be both positive and negative for the individual, and it is important for the individual to understand that they are in a safe space so they can gain that first step of needing a sense of safety (Carr et al., 2011, p. 196).
One population where PTSD is common is military personnel. Over 15% of people in the military are women and they are the fastest growing demographic among veterans (Story & Beck, 2017, p. 1). Soldiers returning from deployments or active duty status have to readjust to civilian life, which can be very stressful due to what they experienced overseas. Common posttraumatic symptoms that females most commonly identify with in the military stem from combat, sexual trauma or harassment within the military, and family and support separation (Story & Beck, 2017, p. 1).
When it comes to Music Therapy techniques, guided imagery is commonly used with people in the military or veterans. The images used are supposed to be expressions of the inner world of the client (Story & Beck, 2017, p. 3). These images are called resource images and can help the individual face their conflict. Music is the basis of the guided imagery process to help clients deepen their relationship with the music so they are able to connect music to their positive inner resources (Story & Beck, 2017, p. 3). The goals most commonly worked on using guided imagery are resource mobilization, narrative reconstruction, and coping skills. Hyperarousal is also a focus when looking into physical, cognitive, and emotional domains. One example of a goal dealing with hyperarousal is “Poor concentration is addressed through requiring patients to attend to their own sounds and those made by others” (Carr, et al. 2011, p. 181). This will help the group or individual concentrate on the present stimuli instead of the past. An example of an emotional domain would be emotional expression mirrored by instruments. Improvisation is a Music Therapy technique that includes all three domains because it enables arousal regulation by promoting relaxation (Carr, et al. 2011, p. 181).
There are many other Music Therapy techniques that benefit those who have PTSD. One Music Therapy technique is relaxation music listening. Relaxation music listening can be music listening alone, or music listening along with imagery or muscle relaxation (Jespersen & Vuust, 2012, p. 208). Another important difference in techniques is individual versus group work. Individual work with children is most prominent when it comes to Music Therapy and PTSD. On the other hand, most adults work in a group setting. Group Music Therapy is often focused on social aspects and addressing the avoidant behavior of those with PTSD (Carr, et al. 2011, p.189). It is not always easy in the beginning to be social with new peers after traumatic events, but it gets easier over time as engagement increases.
Another technique using guided imagery and music is called the Bonny Method. The Bonny Method typically consists of individualized 90-120 minute Music Therapy sessions where the therapist picks classical music, specifically western art music, to evoke sensory and emotional responses in the listener (Story & Beck, 2017, p. 94). A controlled environment study conducted in 2017 focused on planning effective interventions for women in the military who have experienced sexual trauma (Story & Beck, 2017, p. 96). Overall, the Bonny Method helped the individuals in the study be able to confront the past. One individual said, “it’s just putting it in a positive way, and this has helped associate music with positivity” (Story & Beck, 2017, p. 98).
In conclusion, there are many different Music Therapy interventions that are beneficial to people who have gone through trauma or have been diagnosed with PTSD. Every day is different for individuals who have PTSD. One day could be easy and the next day could consist of fear and then numbness. Although there is no cure for PTSD, different treatments and techniques are available. Music Therapy has such a wide variety of approaches to assist individuals with adjusting to everyday life and increasing positive behaviors or decreasing negative ones.
-Amanda Brennen, Music Therapy Intern
References
Ahonen, H. (2018). Music medicine’s influence on music psychotherapy practice with traumatized individuals. Music & Medicine, 10(1), 26-38.
Beck, B., Messel, C., Meyer, S., Cordtz, T., Sogaard, U., Simonsen, E., & Moe, T. (2018). Feasibility of trauma-focused guided imagery and music with adult refugees diagnosed with PTSD: A pilot study. Nordic Journal of Music Therapy, 27(1), 67-86. doi: http://dx.doi.org/10.1080/08098131.2017.1286368
Carr, C., d’Ardenne, P., Priebe, S., Scott, C., Sloboda, A., & Wang, D. (2011). Group music therapy for patients with persistent post-traumatic stress disorder-An exploratory randomized controlled trial with mixed methods evaluation. Psychology and Psychotherapy, 85(2), 179-202. doi: 10.1111/j.2044-8341.2011.02026.x
Felsenstein, R. (2013). From uprooting to replanting: on post-trauma group music therapy for pre-school children. Nordic Journal of Music Therapy, 22(1), 69-85. doi: 10.1080/08098131.2012.667824
Jespersen, K., & Vuust, P. (2012). The effect of relaxation music listening on sleep quality in traumatized refugees: A pilot study. Journal of Music Therapy, 49, 205-229. doi: 10.1093/jmt/49.2.205
Landis-Shack, N., Heinz, A., & Bonn-Miller, M. (2017). Music therapy for posttraumatic stress in adults: A theoretical review. Psychomusicology, 27(4), 335-342. doi: 10.1037/pmu0000192
Story, K., & Beck, B. (2017). Guided imagery and music with female military veterans: An intervention development study. The Arts in Psychotherapy, 55, 93-102. doi: 10.1016/j.aip.2017.05.003