Finding memories in music
Music therapist Professor Felicity Baker uses singing and songwriting to ease the distressing behavioural and emotional symptoms of dementia
CHRIS HATZIS
Eavesdrop on Experts, a podcast about stories of inspiration and insights. It’s where expert types obsess, confess and profess. I’m Chris Hatzis, let’s eavesdrop on experts changing the world - one lecture, one experiment, one interview at a time.
[Music]
CHRIS HATZIS
What you’re hearing is a song called “True Spirit” by New Dimensions, a carer songwriting project put together by the University of Melbourne, the Dandenong Ranges Music Council and with carers and members from Caladenia Dementia Care, Melbourne. It’s an excellent example of how music therapy can be used as a powerful tool to alleviate the distressing behavioural and emotional symptoms of dementia.
FELICITY BAKER
I’m Felicity Baker, Head of Music Therapy and Director of the International Research Partnerships for the Creative Arts and Music Therapy Research Unit.
CHRIS HATZIS
Professor Baker studies how music, especially singing and songwriting, can be used to treat people with a range of conditions – from young people with traumatic brain injuries to adults with substance abuse issues and especially, people with dementia. Felicity says music therapy can be a way for people living with dementia – and their carers – to deal with their psychosocial, emotional, cognitive and communication needs.
Dr Andi Horvath sat down with Felicity Baker to talk about her work, her involvement in various projects on neurorehabilitation and dementia, and music’s unique power to increase mood, provide mental stimulation and reduce behavioural disturbances when drugs fail to provide a cure.
ANDI HORVATH
Tell us about your research; you’re involved in a huge global study.
FELICITY BAKER
Yeah, I’ve got a few studies that are going on at the moment, but the latest one - which I find really exciting - is working with family carers of people living with dementia. We’re actually showing the family carers how to use music in really strategic ways to support the care of the person that they’re looking after. But we’re also interested in preserving the relationship between the carer and the person that they’re caring for, because one of the challenges for carers is that, when they’re caring for someone and that person starts to forget who they are and stops recognising them, the person with dementia doesn’t give anything back. So, using music in a way that helps to bring that person to the present.
ANDI HORVATH
So, how does music therapy work? What does it trigger in these people with dementia?
FELICITY BAKER
One of the beautiful things about music is that it triggers autobiographical recall; so, when we hear a song, it evokes memories of our past. For people living with dementia, who have difficulty remembering that they had a cup of tea five minutes ago, being able to recall pleasurable moments from their past that were triggered by music, helps to kind of keep them active, and to communicate with their loved ones, in a way that they couldn’t do otherwise.
ANDI HORVATH
Is there a period of time in our lives where music is particularly potent in our memory?
FELICITY BAKER
Yes, definitely. We refer to this as the reminiscence bump, and this is a period in our life, between 18 years of age and up to around 30 years of age, at a time when we are falling in love for the first time, and all these special memories, and also music is very important to young people, it’s part of how they develop their identity, and this music seems to be the music that is most potent for people living with dementia.
ANDI HORVATH
If we followed you or your staff around, how would we see music therapy being implemented?
FELICITY BAKER
For a music therapist to come in to a person’s home, what would happen is, the music therapist would demonstrate to the carer how to use music strategically. So, just to give you some examples, let’s just imagine that the person living with dementia is about to have a shower. They get undressed, it’s freezing cold Melbourne right now, and they’re sitting on a shower chair, waiting to be wheeled in, they don’t understand why they’re naked, and they’re sitting there waiting for the carer to wheel them in. They get confused, they get agitated, they’re at a risk of then falling out of the chair onto the floor, and it’s distressing for them. If it’s distressing for them, and their carer sees that they’re distressed, then they’re going to be distressed as well. The carer will then - we’ll show the carer how to use music in a way that calms that person, what kind of music they should select, and then to sing. We not only show them which song to sing, but also how to change the way they sing, to encourage that person with dementia to become calmer. So, they’re changing the way they sing, we call this process attunement. They attune, or they’ll tune in to the state of the person they’re caring for, and then get them to become more calm over time.
ANDI HORVATH
What are the outcomes of that particular type of therapy?
FELICITY BAKER
Well, what we want to see in the person living with dementia, is that they become more calm, and that they become less depressed and less anxious. We’re looking - we call these psychological and behavioural symptoms of dementia - we’re trying to look at a reduction in those symptoms. But we’re also wanting to look at the carer as well, this is important, that we’re looking at carer burden, carer stress, carers level of depression and quality of life. Because we know if we look after the carer, they’ll do a better job of looking after the person they’re caring for, and then there’s less chance that that person they’re caring for will need to go into residential care. So, the music is like a bridge between them; it’s a way that they can connect and experience some of the relationship that the person used to have with their carer, before the dementia took hold.
ANDI HORVATH
What have other researchers said that’s going on in the brain; what’s happening when we apply music that evokes emotions and mood?
FELICITY BAKER
Now, that’s a good question. So, music has this unique ability to connect with emotion, and with memory, so they’re very intricately linked. When you hear a piece of music and then the memories become evoked as a result of that, then the neural network is activated, and it also then leads to the activation of more positive moods. There’s this kind of - we call it the mesolimbic system, it’s the pleasure centre of the brain, music is able to activate that pathway.
ANDI HORVATH
Dementia is a degenerative disease, there’s no recovery; but we’re seeing some good results from your research. Tell us about that.
FELICITY BAKER
Yes, I was involved in doing a project about a year or two ago, with people living with dementia who were attending a day centre; so, they’re still living at home. One of the things we know about the symptoms of dementia, is they have difficulty with ongoing memory; so, they forget who you are five minutes after you introduce yourself - mind you I also forget peoples’ names [laughs], not very good at that. But they forget where they leave their keys and that becomes more and more common as the disease progresses. What we’ve found when we’ve been working with them, is of course, music accesses long term memory. We’ve been working with them creating songs, new songs, new material, new music. Week by week I come back, and they remember the lyrics of the songs that they have written; so, this is new learning. This is because we know that music has this ability to stimulate recall, and so, when we pair these new lyrics with music, then they learn it, then they’re more likely to recall it.
CHRIS HATZIS
OK. Now, let’s hear from some of the choristers and volunteers at the Musical Memories Choir from the Continuing Care Clinical Service Unit at the Austin Hospital in Melbourne. First up, Judy Kearney and her husband John…
[Music and singing]
JUDY KEARNEY
The absolutely lovely thing that we can do is sing and I’ve always loved it. That really gives me a lot of hope…
JOHN KEARNEY
Hmm…
JUDY KEARNEY
...for what I’ve got, the dementia… semantic dementia, which takes a lot of words and I’m in that stage and it’s really very… um, it makes you sad. But you can always go back to the...thing and have a good old sing-along and it’s good…
CHRIS HATZIS
This is Sue Mountain, daughter and carer of her mother Betty Hamilton.
SUE MOUNTAIN
It’s a really joyous and happy thing to do because music makes us feel really good. I’m sure my mum feels that way, too.
BETTY HAMILTON
It’s a natural thing to do.
SUE MOUNTAIN
And the other thing, too, is that I love to see my mum really enjoy herself, too. Also, I’m enjoying myself as well and I think that’s really good for both of us. And also the group. I would never have believed to come and do this that you would find other things that benefited you. I mean, the music is good, we love doing it, and that’s what you expect but then we’ve met so many lovely people. People that… the carers all understand how you feel and without saying a word they can be supportive.
BETTY HAMILTON
And we all belong.
[Music and singing, laughing, talking]
CHRIS HATZIS
Once again, Judy and John Kearney.
JUDY KEARNEY
Well, I know that I’m loved here, and…
JOHN KEARNEY
Hmm…
JUDY KEARNEY
... it doesn’t matter if I make a mistake, or people… I’ve got people like my own self here and I love to see how they are as well.
[Music and singing ends, clapping, talking]
ANDI HORVATH
How did your interest in music begin?
FELICITY BAKER
My interest in music goes back to when I was, I think, in prep or grade 1, and my parents thought that music would be good for me, because I was - let’s just say, probably, a little bit hyperactive [laughs]. Probably these days, they would label me as ADHD, or something like that, but I was just a very busy child, that’s what I was described as. So, my parents thought that playing music might be useful for me, in terms of settling me down, which it did. But somewhere along the way, I took a stronger interest in it, and by the time I was about 14 or 15 years of age, had started to get quite good at it. Then I started thinking, what might I do with my music. So, at that point, was when I was introduced to this concept of music therapy, and I’ve never looked back since then. That was - I think I had committed to it when I was about 15 or 16, and if I had my life over, I would choose it all again.
ANDI HORVATH
You’re involved in really large international projects. You must have ordinary project management skills, because you’ve got many countries involved. Give us a little insight into the big global studies you’re doing.
FELICITY BAKER
The study that’s involving carers of people living with dementia, is a global study, it involves research teams in the UK, in Norway, in Poland and in Germany. We are trying to recruit 500 dyads - so that’s a thousand participants, so 500 carers and 500 people living with dementia at home, with that carer. We are trying to look at how this music training program improves carer wellbeing, and it is really challenging to work on a global scale. We’ve got different rules, in terms of ethics, cross country, different ways of practicing music therapy that we have to take into account, even different levels of people living with dementia who are still at home. In some countries they tend to go into care a lot earlier than they do here in Australia, for example; so, the spectrum of people living at home is quite different across these different countries.
ANDI HORVATH
You’re also involved in neuro rehab; firstly, what is that?
FELICITY BAKER
Oh, neuro rehabilitation is a branch of medicine that involves working with people who have acquired brain injury, and we would be using different interventions to rehabilitate different areas of functioning. Physical functioning, communication, cognition and emotion, sometimes. In respect to the work I’ve been doing, for me it’s about developing music specific tasks and activities for these people to do, that helps them to recover lost skills. If I use - maybe I could tell you an example of somebody?
ANDI HORVATH
I’d love to hear it.
FELICITY BAKER
I worked with a lady who was from the Philippines, and she was here visiting her sister, because she was recuperating from the loss of her daughter who died from cancer, while she was in the Philippines. She came to Australia - to Melbourne, actually, for a bit of a break, really. Just on her way home from the airport, she was involved in a motor vehicle accident, and was in a coma for some months. Then when she came out of the coma, they round that she could not speak. She had a combination of Aphasia, which is a well-known impairment, in terms of language production. But she also had a motor disorder, called Dyspraxia, which is about coordinating the speech muscles - and other muscles - but the speech muscles to articulate speech. She was involved in speech therapy for some time, and didn’t seem to make any progress. Then one day, someone heard her singing along to a Beatles song, and off she came to me in music therapy, and I worked with her for a couple of weeks, just singing, just getting her used to using her voice again. Over time we developed a very music-based program, to teach her how to speak again. We would do things like, I would sing a phrase like, [sings] where are the toilets. We would sing that as a way of helping her develop functional speech.
ANDI HORVATH
That’s wonderful. Music seems to be so wired into our brain for memory, as well as emotion; it is a very powerful medicine.
FELICITY BAKER
It is.
ANDI HORVATH
What misconceptions do people have about music therapy, when they first encounter it?
FELICITY BAKER
Many people think, what is this? What is this music therapy; is it just playing music to people? Actually, it’s far from that. The other thing, the other misconception too, is that people think you have to be musical to get something from music therapy, but that’s also not the case. There’s not that many people in the world who don’t like music. I very rarely come across anyone who doesn’t like music of some shape and form. So, it’s not - music isn’t entertainment, it’s not just something that you put on and expect it to have a therapeutic effect. Music therapists think very carefully about what they do with people, and it’s very targeted, the way they use music and music activities to affect a change in either mood or behaviour or in speech - as I just mentioned in the case study.
ANDI HORVATH
There’s such a wide variety of music; tell me about peoples’ choices in music.
FELICITY BAKER
So, we all have a repertoire of music that we enjoy, and one of the fascinating things about music, if we want to use music in a very strategic way to make ourselves feel better, for example, getting in the car after work and you want to turn on some music, what you choose will often depend on what your mood is at that time. To use myself as an example, if I’ve had a pretty heavy day, and I’m feeling a bit exhausted, as opposed to stressed, just tired, I might choose a piece of music that will give me a lift. I Will Survive, is one of my songs, that I like to play.
ANDI HORVATH
The Gloria Gaynor version?
FELICITY BAKER
That’s the one. But, if I’m feeling stressed, as opposed to tired, I might choose something different that will calm me down and help me relax and unwind a bit. I guess the important thing about that is that the same piece of music can have a different effect on a different day, depending on what you’ve been doing that day, and how you’re feeling at that specific moment. So, when we’re working with people with dementia, this is a really important thing to teach our carers, that it’s not - just because you used a piece of music yesterday, doesn’t mean that that same piece of music is going to work today, because it’s so dependent on other things.
ANDI HORVATH
Felicity, next time we’re reaching for the music knob, deciding on what to think about, what would you like us to think about?
FELICITY BAKER
In terms of choosing your music, perhaps a little bit of reflection on your own mood or emotion at that particular moment; so, if you are feeling quite stressed, you might think, okay, what music will make me feel calm. Or if you feel low in mood, what music might lift me up. If you’re with other people, you might feel like playing music that connects you with other people. There are different things that you can think about when you’re reaching out for your selection.
ANDI HORVATH
Now, you’re launching an appeal.
FELICITY BAKER
I would like to see all carers of people living with dementia being able to access these strategies that help them to manage the person they’re caring for, but of course, there’s not enough music therapists compared to how many people are living with dementia in the world now, and is on the increase. So, I wanted to develop something that would enable us to scale it up, to make it more accessible and provide access for people. What we really want to do is translate this intervention, that is currently a face to face intervention with a music therapist training a carer, into other modes of delivery. We would like to develop a smart phone app, or a tablet app. We would also like to develop train the trainer model, so we could train, for example, a community worker in a rural and remote area where there is no music therapy, to then train carers. Even develop some massive online courses where people can enrol in a course and learn the strategies. The annual appeal is basically calling for people to donate to this program, so that we can develop these translated delivery modes.
ANDI HORVATH
Dementia is a huge problem in society. I’d think most people are touched by it in some way; they certainly will be touched by it, if they haven’t already. I wish you all the very best with this appeal, this is a very important project for the wellbeing of not just carers - and I know, I’ve been one - and of course, those who are suffering dementia. So, Professor Felicity Baker, thank you.
FELICITY BAKER
My pleasure. Thank you.
CHRIS HATZIS
Thank you to Professor Felicity Baker, Head of Music Therapy and Director of the International Research Partnerships for the Creative Arts and Music Therapy Research Unit, Faculty of Fine Arts and Music, University of Melbourne. And thanks to our reporter Dr Andi Horvath. For more information about the “Music Heals Hearts and Minds” appeal that Felicity mentioned, go to our show notes.
Eavesdrop on Experts - stories of inspiration and insights - was made possible by the University of Melbourne. This episode was recorded on August 29, 2019. You’ll find a full transcript on the Pursuit website. Audio engineering, by me, Chris Hatzis. Co-production - Silvi Vann-Wall and Dr Andi Horvath. Eavesdrop on Experts is licensed under Creative Commons, Copyright 2019, The University of Melbourne. If you enjoyed this episode, drop us a review on Apple Podcasts and check out the rest of the Eavesdrop episodes in our archive. I’m Chris Hatzis, producer and editor. Join us again next time for another Eavesdrop on Experts.
Music has this unique ability to connect with emotion, and with memory, so they’re very intricately linked, says Professor Felicity Baker, Head of Music Therapy and Director of the International Research Partnerships for the Creative Arts and Music Therapy Research Unit at the University of Melbourne.
“When you hear a piece of music and then the memories become evoked as a result of that, the neural network is activated, and it also then leads to the activation of more positive moods.”
Professor Baker studies how music, especially singing and songwriting, can be used to treat people with a range of conditions – from young people with traumatic brain injuries to adults with substance abuse issues and, especially, people with dementia.
“We’re actually showing the family carers how to use music in really strategic ways to support the care of the person that they’re looking after. But we’re also interested in preserving the relationship between the carer and the person that they’re caring for,” Professor Baker says.
“So, using music in a way that helps to bring that person to the present.”
Special thanks to the Dandenong Ranges Music Council, Caladenia Dementia Care, Melbourne, the Musical Memories Choir from the Continuing Care Clinical Service Unit, Austin Hospital, Melbourne, Judy and John Kearney, Sue Mountain and Betty Hamilton.
For more information about Felicity Baker’s work and the Music Heals Minds And Hearts appeal, click here or email annual-appeal@unimelb.edu.au.
Episode recorded: August 29, 2019.
Interviewer: Dr Andi Horvath.
Producer, editor and audio engineer: Chris Hatzis.
Co-production: Silvi Vann-Wall and Dr Andi Horvath.
Banner: Getty Images
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