Without a Song or Dance, What are We?

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The medical world is slowly discovering the power of music as an intervention for people affected by Alzheimer’s.

My grandmother was 85 when she began to forget. She couldn’t remember my name, never knew where she was, and barely recognised her own husband even when he sat right in front of her. But when we were at the piano, and I played Somewhere Over the Rainbow, she knew all the words.

Our healthcare systems imagine human beings to be incredibly complex machines with medicines to adjust the dials. We have pills to regulate blood pressure, blood sugar, even anxiety. We haven’t done anything to touch the heart of the patient. That’s where music comes in.

What is music therapy?

Music plays an important role in shaping our identity. Music connects people to who they are, who they have been. Music has the power to alter our mood; it can evoke joy, sorrow, despair, hope and love. Music can stir memories and powerfully resonate with our feelings. It allows us to connect with ourselves and with others. It is because of this connection between our minds and music, that music therapy is increasingly being used as a method of intervention for several mental health conditions.

Music therapy is the clinical and evidence-based use of music interventions to address physical, emotional, cognitive, and social needs of individuals. Music therapy also provides avenues for communication that can be helpful to those who find it difficult to express themselves in words. Usually, a trained therapist builds a therapeutic relationship with a patient or client, just the way people approach conventional therapists and psychiatrists to talk about a mental health issue.

There are four major interventions involved with music therapy:

1. Lyric analysis — While talk therapy allows a person to speak about issues that may be difficult to discuss, analysing lyrics is a less intimidating approach to unearthing thoughts and emotions. Analysing the words of a song allows an individual to identify songs which correlate to their own experiences.

2. Playing an instrument — Learning and playing music encourages emotional expression, socialisation and exploration of therapeutic themes (i.e. conflict, communication, grief, etc.). Improvisation in music is a way of expressing an emotion without talking about it.

3. Active music listening — Music can be utilized to regulate mood. Because of its rhythmic and repetitive aspects, music engages the neocortex of our brain, which calms us and reduces impulsivity. We often utilize music to match or alter our mood. While there are benefits to matching music to our mood, it can potentially keep us stuck in a depressive, angry or anxious state. To alter mood states, a music therapist can play music to match the current mood of the person and then slowly shift to a more positive or calm state.

4. Songwriting — Songwriting provides opportunities for expression in a positive and rewarding way. Anyone can create lyrics that reflect their own thoughts and experiences, and select instruments and sounds that best reflect the emotion behind the lyrics. This process can be very validating, and can aid in building self-worth. This intervention can also instil a sense of pride (as someone listens to their own creation).

Music and memory

Dementia is a general term for loss of memory and other mental abilities severe enough to interfere with daily life. It is caused by physical changes in the brain. Symptoms of dementia include the inability to remember recent events and names, disorientation, difficulty in speaking, and poor judgement. A natural effect of dementia should have been that such a person would not be able to recognise or remember music either. However, recent scientific studies with respect to music and dementia show different results.

Research shows that the seat of long-term musical memory is preserved, even when other areas of the brain degenerate due to diseases such as Alzheimer’s. The results of the study indicate that long-term musical memory is better preserved in Alzheimer patients than short-term memory, autobiographical long-term memory and speech. It can, therefore, remain largely intact even in advanced stages of the disease. In other words, the part of the brain which processes music remains unaffected in degenerative diseases such as dementia. This explains why, like in my grandmother’s case, people can remember the tune or the words to a song even if they have forgotten how to communicate effectively.

Music and depression

Our first experiences of relating (with our primary caregiver) are fundamentally musical. Developmental psychologists use musical vocabulary to describe the finely attuned interplay of gesture and sound between a parent and the newborn baby. It is in this pre-verbal interaction that we first learn who we are, how to think and to take pleasure in the possibilities that the world around us has to offer.

A music therapist is similar in that she nurtures a person in her quest for meaning and pleasure, through the portal of music. Music, with all of its riffs and chords and progressions, allows us to engage with the world in a way that makes us feel like we are part of something meaningful. While depression feeds on withdrawal and inactivity, music can engage a person, draw out their emotions while they participate. This is the power of music.

The action of playing an instrument involves movement. It enables people to think of themselves as physical beings. Music allows us to participate with others. This mirrors the experiences of musicians when playing in groups as can be seen in the coordinated movements of the players in a string quartet. Our participation, in turn, enables us to hear (and feel) ourselves in the context of the aesthetic experiences outlined earlier, and this lends a potent sense of being part of something meaningful in the here-and-now.

This is another potential benefit of music therapy. Often, mental illnesses cloud our ability to be truly present because we are stuck in the past. Music therapy allows us to communicate without words, in a way that talking cannot. Music therapy builds a system through which we engage through sound, relate to others and communicate our emotions in a very different way.

… music heard so deeply

That it is not heard at all, but you are the music

While the music lasts. (The Dry Salvages by T. S. Eliot)

Music and nature

The Chinese have been using music therapy for over 2,300 years. Music therapy is an aspect of the Five-Element theory, in which five musical notes correspond to the elements of earth, water, fire, metal and wood. The Chinese use the relationships between internal organs and five-element correspondences, such as musical notes, to achieve different healing purposes. For example, the “Zhi” note (corresponding to G) belongs to the fire element and is the sound of summer. It aids blood flow and nourishes the heart.

We hear music in nature, all the time. The reason why we feel calmer, more at peace with ourselves when we hear the rhythmic rolling of the waves, the myriad morning calls of the birds, the silence of towering mountains is the same — these are sounds of music which help us to listen inward. They are sounds that bring us closer to ourselves, and demand that we listen to ourselves.

Music therapy is an alternative that alleviates depression and anxiety and could potentially reduce dementia. It could also help with a host of other physical and mental illnesses because it goes beyond pill popping. Sound has the power to alter our state of being. It has the power to remind us of our happiest moments and draw us out into social engagement.

The exploration of music therapy as an alternative intervention while beneficial to medical science, reminds us of the incredible power of music to make us feel alive, inside.

 

Feature Image Credit: Providence Doucet on Unsplash

 

Sanaya Patel is the Assistant Editor and Research Associate (Legal Reform) at One Future Collective.

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AI and the Future of Psychotherapy

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What do we have in store for us?

Can a Chatbot or Freud app fully replace a therapist? As of today, No. It seems plausible that the future of psychotherapy involves significant advancements in AI which will have a profound influence on psychological practice with systems that will administer evidence-based and very effective treatments to clients. Although the application of AI technologies in the mental health care field is filled with the potential to increase access to care innovatively, it comes with its own risks and drawbacks.

AI Therapy Systems:

There already have been major breakthroughs which indicate an interesting future in therapy. Beginning with ELIZA in the 1960s, a simple computer program that mimicked non directive social interactions and received a shocking number of personal responses by its administrative staff, to the currently popular Woebot, a chatbot by Facebook which responds to maladaptive thought patterns by using the principles of cognitive behavioral therapy (CBT) and engages in more than 2 million conversations a week.

Paro, a harp seal stuffed robot was created for the elderly and those in homes or those who cannot responsibly take care of a pet. Although non-living, Paro can provide similar comfort as provided by a pet by responding to touch and voice and activating the parasympathetic nervous system, thereby reducing stress.

Ellie, created by USC researchers, helps people with depression and veterans suffering from PTSD using a webcam and microphone which enables her to analyse emotional cues and provide feedback and also by processing the rarest of speech which helps her record pauses. Similarly, Karim, a psychotherapy bot aids workers and refugee communities in the Middle East.

Therapeutic video games and mobile applications are on the rise with increased benefits such as improving self-confidence (eg. Mindbloom), adherence to treatment, reducing stigma surrounding mental health and also enhancing social skills, eg. Second Life, an online virtual game for children with autism or Sosh, a mobile app for individuals with Asperger’s Syndrome.

A bright future?

AI therapy can, in fact, prove to be extremely favourable.

Many times patients lack the motivation to follow up with their therapists or stick to plans and techniques advised for their betterment. Currently, a certain technology is being worked upon which provides tailored mental health treatment that helps clients to stay committed to therapy.

AI therapy can also spot suicidal patterns and thoughts which humans may potentially miss by analysing them and examining curated databases of clinical knowledge. This is a huge plus as it helps to prevent self-harm and will reduce the number of deaths caused by suicide.

The future also takes a look at having potential implanted AI technologies which may repair general cognitive abilities or restore function to areas of the brain that have been damaged by strokes or brain injuries.

A self-help paradigm that can be personalised according to an individual’s needs and can also experience important emotions needed during counselling like empathy or respond and recognise emotions of the patient while taking in cultural differences into consideration does indeed sound all too good. However, it can have threatening downsides.

Risk factors:

Chatbots and AI therapy systems aren’t protected by medical data privacy and security law. The early ELIZA program was shut down immediately when its creator perceived it as a threat after its outraged users found out that all their conversations were recorded and accessible. Similarly, although Facebook’s Woebot keeps identities anonymous, Facebook still owns logs of all conversations which Woebot has with its users. Confidentiality and privacy become blurred with the use of autonomous AI systems.

At the same time, certain AI therapy systems can be very expensive. For eg., Paro costs almost $7,000. This defeats the purpose of AI therapy aiming at increasing accessibility to mental health care. Although doubtful, AI therapy can also have other economic implications to the field of psychology leading to job losses in a knowledge-based profession if systems are developed to a point where they can provide a full range of mental health services.

Therapists frequently encounter ethical dilemmas. To tackle these, AI systems will be expected to make value judgements which involve complex reasoning and technology at the end of the day which is always vulnerable to errors. An extreme advancement in AI that enables systems to develop their own values and beliefs is possible but risky as it may conflict with those of its own creator. Weizenbaum, the creator of ELIZA, said, “Computers should not be allowed to make important decisions because computers lack the human qualities of compassion and wisdom”.

An important aspect of therapy is the “human element” which develops the therapeutic bond between the client and therapist — something that futurists believe AI systems will lack. Along with such genuine connections, a consequential change in a patient’s life as a result of therapy comes with the fallibility and tension involved in the process. There is a good chance that AI systems will exceed these sensory capabilities of humans.

And lastly, unlikely but possible, a positive transference toward an AI system would be problematic and baffling to resolve, as depicted in the movie Her.

In any case, therapy may radically change. It is safe to anticipate that face-to-face counselling may not be practised everywhere at all times due to more convenient therapy systems supplanting them. There may be a rise of “surrogate counsellors” with protocol packaged treatments for common mental disorders (eg. depression, anxiety) that can be accessed by clients. Practice settings are bound to change and payment transactions may also be mostly electronic.

Advanced AI technology is already found in almost all sectors today including mental health care. AI and the future of psychotherapy seem to be ideal in many ways, opening doors to incredible possibilities which were not at all imagined in the past. Technological singularity is near and it is definitely something to be thrilled about but it also shoots a series of new professional, legal and ethical complications. Considering how technology dependent we are becoming each day, it is easy to assume that the above mentioned paradigms will become a reality. However, it is difficult to predict whether they will eventually and inevitably affect us favourably or not and it is imperative to build a unique framework which only aims at improving healthcare and lifestyle.

 

Feature Image Credit: Riccardo Annandale on Unsplash

 

Shruti Venkatesh is a Research Associate (Mental Health) at One Future Collective.

 

References:

Cottone, R. R. (2015, March 27). The end of counselling as we know it. Counseling Today.

Molteni, M. (2017, July 6). The Chatbot Therapist Will See You Now. Wired.

Goldstein, E. (2008, September 3). Are artificial intelligence and robots the future of mental healthMHMR Services for the Concho Valley.

Tieu, A. (2015, August 13). We Now Have an AI Therapist, and She’s Doing Her Job Better than Humans Can. Futurism.

Solon, O. (2016, March 22). Karim the AI delivers psychological support to Syrian refugees. The Guardian.

Celco, M. (n.d.). The Freud Apps: AI, Virtual Life Coaching, and the Future of Psychotherapy. Big Think.

Matthews, K. (2017, June 8). Will robots replace therapists? The Week.

Luxton, D. D. (2013, November 11). Artificial Intelligence in Psychological Practice: Current and Future Applications and Implications. Professional Psychology: Research and Practice. Advance online publication. doi: 10.1037/a0034559

 

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