Music Therapy and PTSD in War Veterans

According to the U.S. Department of Veteran Affairs, an agency that specializes in providing benefits and health care to military veterans, approximately “5 out of every 100 adults (5%) in the U.S. are diagnosed with post-traumatic stress disorder (PTSD) in any given year”. John Elfein, Statistas research expert for topics concerning medical professionals worldwide, finds that in 2022, about 76 percent of U.S. veteran and active service survey respondents stated they experienced (PTSD) as a result of their military service after 9/11. These numbers create growing concerns because the majority of these patients diagnosed with PTSD will often perceive typical talking therapies as distressing and intrusive; however, the newly emerging implementation of music therapy has shown to have the potential to be a beneficial intervention for PTSD as music engages individuals in a perceived safe and enjoyable environment that is universal to all languages. Similarly to the trauma that war veterans were exposed to, the 2010 Haiti earthquake was unexpected and triggered the expression of terror and helplessness in response to inescapable forces that were beyond the ability of its victims to manage or resist . As stated in the article title In Their Own Words, “Trauma may cause adverse physiological changes such as the release of stress hormones that can actually weaken health and resilience.” By increasing resiliency levels, music therapy offers a path for traumatized individuals to relate to their healthy identity and encourage individuals to seek treatment more often. Such evaluation raises the question: To what extent can music therapy be effective in treating PTSD in war veterans? Overall, an analysis of the chemical impacts on the brain shows that music therapy is proven to be effective on patients diagnosed with post-traumatic stress disorder. This is due to the fact that music therapy increases resilience levels, produces regulatory chemicals in the brain, as well as regulates emotions. 

Combat Induced PTSD

Combat-Induced PTSD is a mental health condition that develops in individuals who have experienced traumatic events during combat or deployment. Symptoms include avoidance, hyperarousal, flashbacks, nightmares, and negative changes in cognition, which can significantly impact an individual's daily routine. Because the majority of these patients diagnosed with PTSD will often perceive typical talking therapies as distressing and intrusive;  Without treatment, the psychological symptoms of PTSD are likely to worsen over time. Along with severe depression and anxiety, other serious outcomes may include heart issues and increased risks of suicidal thought.

Music Therapy and Combat Induced PTSD

According to Moshe Bensimon, a music therapist who specializes in the field of victimology, “Combat stress reaction (CSR) is a condition in which soldiers are unable to perform their duty because of extreme situational psychological disturbance”(224).CSR is extremely common among soldiers and can quickly develop into post-traumatic stress disorder. Between 27% and 29% of WWII veterans and 5.27 percent of Vietnam veterans suffered from PTSD as a result of trauma exposure during the war. Beck proves music therapy’s effectiveness by describing how in 31 newly arrived refugees, music therapy had contributed to a decrease in hyperactivity, aggressive behavior, depression, anxiety, and somatization. Music therapy helped refugees with PTSD regulate emotions, decrease arousal, express repressed emotions, and connect better with others. Hyperarousal includes sleeplessness, irritability, aggression, poor concentration, and a general mistrust of others, often caused by hypervigilance and exaggerated startle responses. However, hyperarousal may be regulated through encouraging the tolerance of silence and sounds in music.

Clare Macfarlane, who holds a bachelors degree in social work, describes the SMAART( Short Term Music Therapy Attention and Arousal Regulation Treatment) method, which is a protocoled intervention focusing on the first steps of trauma treatment(decreasing hyperarousal, and improving selective attention skills. This intervention is primarily geared toward the application of musical assignments to calm the brain's stress response and cue attention. Macfarlane directly addresses prisoner’s need for improvement of their ability to focus, sustain attention, and increase mastery over their arousal symptoms(339). The SMART method has been proven to show an increase in the engagement of PTSD treatment and it is applicable in a complex clinical setting with a mixed treatment resistant population.

Music Therapy and Brain Chemistry

Music has the ability to stimulate the amygdala, the hippocampus, and the reward pathway, which releases dopamine. It can cause a stop in the cortisol-stress cycle as brain imaging techniques have proved that music can stimulate neuroplasticity, which is the ability of the nervous system to change its activity in response to a stimulus by reorganizing its structure, after traumatic brain injuries. In individuals diagnosed with post traumatic stress disorder, the presence of cortisol indicates stress and causes the dendrites in the hippocampus and prefrontal cortex to retract. The prefrontal cortex is responsible for controlling complex functions that include emotional regulation, planning for the future, decision-making, integrating information, and reflecting. Furthermore, the hippocampus is associated and involved with learning and memory. If both the prefrontal cortex and hippocampus are not functioning correctly, individuals may experience symptoms that include decreased social communication and awareness. If the functioning of the hippocampus and prefrontal cortex deteriorate , the hippocampus and prefrontal cortex have a difficult time determining if the stimulus is dangerous or not. In an effort to survive, the amygdala then assumes that the stimulus is dangerous, and responds by activating the HPA axis. Over time, this stimulates the production of a greater amount of cortisol and the cycle repeats.

Music Therapy has the ability to stimulate communication regions of the brain that include the amygdala, prefrontal cortex, and hippocampus which are all necessary when an individual is exposed to a stress stimulus. According to Usha Pant, who is part of the Edmonton Clinical Health Academy (ECHA),  various studies have used different experimental approaches, that include investigating music therapy cases where music triggered the remembrance of experiences with pleasure, sadness or fear in response to dissonant music, happy or sad music, or fear-evoking music. To build on this idea, Pant elaborates on how actively listening to or playing music can also stimulate neurogenesis and neuroplasticity in the brain allowing it to heal, which is relevant for individuals with PTSD who experience neuronal loss and impaired neurogenesis in parts of the limbic system. For instance, instrumental music without lyrics, such as Chinese and Western music can evoke changes in emotion and stimulate the brain structures involved with motivation, and emotion.

Bolette Daniel Becks, Department of Communication and Psychology professor further elaborates on music therapy and brain chemistry with his findings that music contributed to the production of peptides such as oxycontin, vasopressin and dopamine. These chemical aids in those diagnosed with PTSD by adding to the creation of social bonding, and endogenous opioids that contribute to the maintenance of steady social relationships. Music has the ability to stimulate the amygdala, the hippocampus, and the reward pathway, which releases dopamine. It can cause a stop in the cortisol-stress cycle as brain imaging techniques have proved that music can stimulate neuroplasticity and neurogenesis.

Music Therapy and The Stimulation of Memories

Because the hippocampus has the ability to play a role and memory, and the reprocessing of memories are used to heal PTSD, music therapy has the potential to stimulate negative memories that may end up worsening PTSD symptoms of war veterans over time. For instance, a music therapist may unintentionally play a song that triggers a memory that the client does not want to remember, and it may put them in a state of distress or further anxiousness. It's important for clients of music therapy to be given time to know what their treatment will involve and the effects of it in order to be able to regulate their emotions outside of session before considering participating in music therapy. 

Music Therapy and Recognition

“Emotion regulation is an internal process through which a person is able to maintain a comfortable state of arousal by modulating one or more aspects of emotion,”(Moore 199). Usually an individual with difficulty regulating emotions reacts to cues that they would not normally respond to.The individual may not be able to figure out the cause of their emotional distress but people with PTSD vary in the intensities of reactions to the potential presence of threat and can develop a pattern in their reactions..In cases where traumatic memories and feelings had been repressed for days, music therapy had proven to enable clients to express and release their traumatic emotional burden, thus recognizing its existence and their own sense of being. For instance, the process of improvisation has enabled clients to recognize their subjective presence in the world and create ‘something out of nothing’ in the ‘here and now’. While traumatic experiences threaten to eliminate individuals from the world, the rhythm of music provides clients of music therapy with a physical feedback of existence.

Conclusion

Music therapy has proved to be a useful addition to traditional treatment as it has shown a decrease in typical symptoms associated with PTSD. It allows clients to be able to express themselves non-verbally as many with post traumatic stress disorder have a difficult time  talking openly about their traumatic experiences. Music gives clients something to focus on in the present, and reminds them that they are in a safe and healing environment. Using music as a way to talk about and name emotions can additionally be used as a tool for self disclosure.  Furthermore, group music therapy has the potential to reduce isolation as well as feelings of detachment, and increase pleasurable emotions.  In addition, variability in music therapy program structure allows for the flexibility for clinicians and facilities to adapt and customize their methods of treatment, in an effort to achieve the maximum effectiveness. 

Works Cited

Aurelius Antoninus, Marcus. "Book IV." The Meditations of the Emperor. George W. Chrystal, Trans. AP Seminar Performance Task 2: Individual Research-Based Essay andPresentation, College Board, 2023, pp. 43-48. Public Domain, 1902.

Beck, B.D., Lund, S.T., Søgaard, U. et al. "Music Therapy Versus Treatment as Usual for Refugees Diagnosed with Posttraumatic Stress Disorder (PTSD): Study Protocol for a Randomized Controlled Trial." BioMed Central, vol. 19, no. 301, 30 May 2018, https://doi.org/10.1186/s13063-018-2662-z. Accessed 13 Mar. 2023.

Bensimon, M., Amir, D., & Wolf, Y. A pendulum between trauma and life: Group music therapy with post-traumatized soldiers. The Arts in Psychotherapy, vol.39 no.4, pp.223–233, 2012, https://doi.org/10.1016/j.aip.2012.03.005. Accessed Mar 14. 2023

Bensimon, Moshe. "Relational Needs in Music Therapy with Trauma Victims: The Perspective of Music Therapists." Nordic Journal of Music Therapy, vol. 29, no. 3, 2020, pp. 240–54, https://doi.org/10.1080/08098131.2019.1703209. Accessed 14 Mar. 2023.

Blake, Roberta L., and Susan R. Bishop. "The Bonny Method of Guided Imagery and Music (GIM) in the Treatment of Post-Traumatic Stress Disorder (PTSD) with Adults in the Psychiatric Setting." Music Therapy Perspectives, vol. 12, no. 2, pp. 125-29. LIU, https://doi.org/10.1093/mtp/12.2.125. Accessed 14 Mar. 2023.

Bronson, Hannah, et al. "Music Therapy Treatment of Active Duty Military: An Overview of Intensive Outpatient and Longitudinal Care Programs." Music Therapy Perspectives, vol. 36, no. 2, 2018, pp. 195-206. LIU, https://doi.org/10.1093/mtp/miy006. Accessed 14 Mar. 2023.

Carr, Catherine, et al. "Group Music Therapy for Patients with Persistent Post-Traumatic Stress Disorder - an Exploratory Randomized Controlled Trial with Mixed Methods Evaluation: Group Music Therapy for Post-Traumatic Stress Disorder." Psychology and Psychotherapy, vol. 85, no. 2, 2012, pp. 179–202, https://doi.org/10.1111/j.2044-8341.2011.02026.x. Accessed 14 Mar. 2023.

Hakvoort, Laurien, et al. "Music Therapy to Regulate Arousal and Attention in Patients With Substance Use Disorder and Posttraumatic Stress Disorder: A Feasibility Study." Journal of Music Therapy, vol. 57, no. 3, Fall 2020, pp. 353–78. EBSCOhost, https://doi.org/10.1093/jmt/thaa007. Accessed 14 Mar. 2023.

Jespersen, Kira V., and Peter Vuust. "The Effect of Relaxation Music Listening on Sleep Quality in Traumatized Refugees: A Pilot Study." Journal of Music Therapy, vol. 49, no. 2, 2012, pp. 205-229. ProQuest, http://0-search.proquest.com.liucat.lib.liu.edu/scholarly-journals/effect-relaxation-music-listening-on-sleep/docview/1033201183/se-2. Accessed Mar 14. 2023.

Landis-Shack, Nora et al. "Music Therapy for Posttraumatic Stress in Adults: A Theoretical Review." Psychomusicology vol. 27, no. 4, 2017, pp. 334-342. https://doi:10.1037/pmu0000192. Accessed 13 Mar. 2023.

Macfarlane, Clare, et al. "Short-Term Music Therapy Attention and Arousal Regulation Treatment (SMAART) for Prisoners with Posttraumatic Stress Disorder: A Feasibility Study." Journal of Forensic Psychology Research and Practice, vol. 19, no. 5, 2019, pp. 376–92, https://doi.org/10.1080/24732850.2019.1670023. Accessed 14 Mar. 2023.

Moore, Kimberly S. "A Systematic Review on the Neural Effects of Music on Emotion Regulation: Implications for Music Therapy Practice." Journal of Music Therapy, vol. 50, no. 3, 2013, pp. 198-242. ProQuest, http://0-search.proquest.com.liucat.lib.liu.edu/scholarly-journals/systematic-review-on-neural-effects-music-emotion/docview/1441290143/se-2. Accessed Mar 14 2023.

Ophir, Iftach, and Rebecca Jacoby. "'Sparks That Became a Little Light over Time': A Qualitative Investigation of Musicking as a Means of Coping in Adults with PTSD." PloS One, vol. 15, no. 1, 2020, pp. e0228050–e0228050, https://doi.org/10.1371/journal.pone.0228050. Accessed 14 Mar. 2023.

Pant, Usha, et al. "A Neurobiological Framework for the Therapeutic Potential of Music and Sound Interventions for Post-Traumatic Stress Symptoms in Critical Illness Survivors." International Journal of Environmental Research and Public Health, vol. 19, no. 5, Mar. 2022, p. 3113. Crossref, https://doi.org/10.3390/ijerph19053113. Accessed 13 Mar. 2023.

Rahill, Guitele J., N. Emel Ganapati, Manisha Joshi, Brittany Bristol, Amanda Molé, Arielle Jean-Pierre, Ariele Dionne, and Michele Benavides. "In their Own Words: Resilience among Haitian Survivors of the 2010 Earthquake." AP Seminar Performance Task 2:Individual Research-Based Essay and Presentation, College Board, 2023, pp. 17-40. Originally published in Journal of Health Care for the Poor and Underserved 27:2, 2016.