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Key points
- Music therapy works with the rhythms of the body to help reduce anxiety and pain.
- Music therapists can achieve a relaxation response.
- It's achieved by matching the music's tempo to the patient's heart rate and gradually slowing it down.
“Rhythm is sound in motion. It is related to the pulse, the heartbeat, the way we breathe. It rises and falls. It takes us into ourselves; it takes us out of ourselves.” —Edward Hirsh
Rhythm. It is the most important element in music. It is the foundation of all music and is essential for creating structure and movement. Rhythm is the magic that holds the music together, the heartbeat that keeps the body of a song alive. And, even though it pains me to say it (being a guitarist), the drummer is the most important part of the band. Why? The drummer keeps the rhythm. When the rhythm is off, well, there is no way to recover.
Music and rhythm are rooted in every known culture. What parent does not use rhythmic rocking to soothe a crying baby? The repetitive sounds and silences that comprise rhythmic patterns make dancing possible, aid in memory, and facilitate group singing, playing, or drumming.
Rhythm has been used for millennia to tie societal members together. The chants of a religious order or the cadence calls of military ranks are just two examples. And there’s poetry and verse, the rhythm of language, circadian rhythms in sleep, and the rhythmic changes of the seasons.
Music Therapy Works in a Hospital Setting
Our bodies work "in rhythm." We walk in rhythm, we breathe in rhythm, and our heart beats in rhythm. And just like in music, if the rhythm is off, everything is off. One of the main reasons music therapy helps patients in a hospital setting is rhythm.
Then there’s "entrainment." Entrainment occurs when body rhythms synchronize with the music to produce a desired response. It’s like walking through Target, and Stayin’ Alive is playing overhead. Without realizing it, you soon walk in sync with the rhythm. (You may even feel a little like Tony Manero walking through Manhattan on a Saturday night.)
A music therapist may use entrainment and rhythm to work on gait issues with a Parkinson’s patient. After assessing and finding the right tempo and song, the patient may soon walk more steadily with the music, entraining to the rhythm. (And, perhaps, also feeling a little like Tony Manero.)
I do a lot of work in critical care in the hospitals where I work as a music therapist. And I work with patients on mechanical ventilation, using music to help reduce their anxiety and pain. Since the patient on the vent cannot speak (because of the breathing tube inserted in their windpipe.), how can we tell if they are anxious? We can look at the rhythms of the body.
One indication may be their heart rate. If their heart rate is high, something over 100 bpm, that may be an indication of anxiety or pain. (There are also scales and tools that critical care nurses use to assess pain and anxiety in vented patients.) One way to help reduce their anxiety and pain is to give them more medications.
But they are usually already quite medicated, with strong sedating drugs. And we know that the more drugs are given, the longer it could take to get them off the vent, which can then lead to more long-term issues.
Fortunately, medical teams are now looking at more non-pharmacological means to help their patients, such as music therapy. How can music therapy help? Again, it uses the inherent elements in music to work with the body: rhythm and entrainment.
When working in this forum, the patient’s heart rate monitor becomes like a metronome (a tool that produces a rhythmic, steady beat.). So, when I initiate a music experience to help reduce anxiety, their heart rate is my starting tempo. I match the music’s tempo to their heart rate (and, in other cases, to their respiratory rate).
Once the music and their heart rate are in sync or entrained, I will gradually start decreasing the tempo of the music. Often, the heart rate will follow. Over 30 minutes, give or take, we can often reduce a heart rate from somewhere over 100 bpm down into the 80s—entrainment.
The Music
Sometimes, I improvise and create in the moment on the guitar. I may even include some light, purposeful tension to start. As the tempo decreases, the tension gradually moves to more soothing and harmonic themes to help prompt a relaxation response. I may also incorporate structured songs if I can find out from family members what the patients’ music preferences are.
I’ve used Elvis, Frank Sinatra, and Green Day (adding humming or singing), all working with entrainment, rhythm, and heart rate. (Although I never assume music preferences. If I don’t know, I will stay with improvisation.)
Entrainment and Breathing
We can do the same with breathing. If someone is having breathing issues, they are often anxious, and when we are anxious, we tend to tighten up, and our breathing becomes shallower. So rhythm. Entrainment. Here’s a story of an older female patient I recently worked with.
She was having trouble breathing and trying to find the right position in her hospital bed. She couldn’t speak more than a few words without losing her breath. She was very anxious. In our initial conversation, when I asked her about music in her life, she told me that she used to sing in the church choir,
'It’s been a long time.' She loved the old hymns.
'Well then,' I said, 'we should sing.' She looked at me with apprehension, 'But I can’t breathe.' I asked her,
'What is your favorite hymn?'
'In The Garden.'
'OK, just follow me, nice and easy.'
I kept the rhythm solid and steady but with an easy feel, and the tempo just a bit slower than her shallow breathing rhythms. And we sang. Her breathing started to follow the song's phrasing naturally—the rhythm—and gradually became slower and deeper.
(When you sing, you naturally breathe within the rhythm of the music, drawing in breath fully for the next phrase, which opens up your airways. (Yes, singing is great for breath maintenance.) Our breathing ‘entrains’ to the rhythm of the song. And yes, I purposefully slowed the tempo as we went along. Her breathing rhythm followed.)
After the song, she recalled an Easter concert she sang in when she was younger. Then, I asked, “How’s your breathing now?”
“Oh, I wasn’t even thinking about it.”
We walk in rhythm, breathe in rhythm, and beat our hearts in rhythm. And if the rhythm is off, everything is off. Fortunately, we have music (and rhythm and entrainment).
“The art of healing, the art of ecstasy, the art of God-consciousness has millions of names in mystic terms. It has to do with rhythm and reality. When the body is in rhythm, there is ease. When the body, or any part of the body, goes out of rhythm, there is dis-ease.” –Harbhajan Singh Yogi
The healing power of music and rhythm.
