Music Therapy Today, Vol. 7, No. 4 by World Federation of Music Therapy

Music Therapy Today a quarterly journal of studies in music and music therapy from the Chair of Qualitative Research in Medicine

Volume VII, Issue 4 (December 2006)

David Aldridge & Jรถrg Fachner (eds.) Chair of Qualitative Research in Medicine Published by MusicTherapyWorld.net UniversityWitten/Herdecke Witten, Germany ISSN 1610-191X

Editor in Chief/Publisher Prof. Dr. phil. David Aldridge Managing Editor Dr. Jörg Fachner, joergf@uni-wh.de Translation and editorial assistance Christina Wagner, cwagner@uni-wh.de Book review editor and dissertations archive Annemiek Vink, a.c.vink@capitolonline.nl “Odds and Ends, Themes and Trends” Tom Doch, t.doch@t-online.de International contacts Dr. Petra Kern, PETRAKERN@prodigy.net Scientific Advisory Board Prof. Dr. Jaakko Erkkilä, University of Jyväskylä, Finland Dr. Hanne Mette Ridder, University of Aalborg, Denmark Dr. Gudrun Aldridge, University Witten/Herdecke, Germany Marcos Vidret, University of Buenos Aires, Argentinia Dr. Cochavit Elefant, Bar-Ilan University, Israel Prof. Dr. Cheryl Dileo. Temple University in Philadelphia, USA Prof. Dr. Marlene Dobkin de Rios, University of California, Irvine, USA Dr. Alenka Barber-Kersovan University of Hamburg, Germany Prof. Dr. Tia DeNora, University of Exeter, UK Dr. Patricia L. Sabbatella, University of Cadiz, Spain

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Table of contents Music Therapy Today i a quarterly journal of studies in music and music therapy from the Chair of Qualitative Research in Medicine i Volume VII, Issue 4 (December 2006) i Table of contents vii Editorial Music Therapy Today Vol. VII, Issue 4 (Online December 22, 2006) 775 Fachner, Jörg 775 Research in practice 781 Smeijsters, Henk 781 Beyond Body, Beyond Words: Cognitive analytic music therapy in forensic psychiatry - New approaches in the treatment of Personality Disordered Offenders 839 Compton Dickinson, Stella 839 Melody and Rhythm – ‘Indianness’ in Indian music and music therapy 876 Sairam, T.V. 876 If you can’t beat them, join them! Long-term music therapy with an “autistic savant” man 892 Graham, Janet 892 Just sing… 913 Boymanns, Britta 913 vii

„Painting is good for your soul!“ 932 Merz, Regine 932 Report on a research meeting 2006 in Berlin: “Music Therapy as Applied in Neurology” 939 Pfeffer, Karolin 939 “My Top Ten” 944 Aldridge, David 944 Odds and ends - themes and trends 947 Tom Doch 947

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Music Therapy Today Vol. VII (4) (December)

Editorial Music Therapy Today Vol. VII, Issue 4 (Online December 22, 2006) Fachner, Jörg

Welcome to the new issue of „Music Therapy Today“! In our last issue for 2006 we present articles on the debate about music therapy and evidence-based research, Indian music therapy, a case study with an autistic person, about group singing in a psychiatric day clinic and a developing study on HIV and art therapy.

PDF SITE INDEX

Since January 2005, we have numbered pages consecutively in Music Therapy Today. The intention was to offer an opportunity to cite articles or quotes from “Music Therapy Today” by page numbers. Now we have managed to build a PDF Site Index of Music Therapy Today. All past issues (eBooks as PDF) and articles (single PDFs) from 2005 and 2006 are available as references for download from this page. This page will be updated after release of a new issue. Be aware that some PDF-Files, like conference proceedings, will be large and may take time to down-

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Welcome to the new issue of „Music Therapy Today“!

load according to your Internet connection and the limits set by your Internet provider.

THE ISSUE

Our first article comes from Henk Smeijsters on “Research in practice”. This article continues a series of articles discussing the pros and cons of integrating evidence-based ideas into the practice of researching and doing music therapy. “This article illustrates, that, with respect to research, there are many ways to reach evidence, and also, that there are different sorts of evidence.” As David Aldridge has pointed out in several other publications since the late 1980’ that music therapy needs its own research methodology, Smeijsters also stresses the need for reflective practitioners to develop - as their own peers - suitable approaches to research. For the original idea see Aldridge (1996; 2004). “The professional himself does the road to science of the profession. The investment in professionals’ research in practice is the motor of knowledge-productivity that bridges the theory-practice gap.” This article is based on a chapter of a forthcoming book by Henk Smeijsters on research into art therapies. Stella Compton Dickinson leads us into her work in Rompton Hospital in the UK. Those who ever had the chance to visit or work in a high-security hospital in forensic psychiatry know how hard it is to get permission to publish in-depth work done with a client. Her article “Beyond Body, Beyond Words: Cognitive analytic music therapy in forensic psychiatry New approaches in the treatment of Personality Disordered Offenders” presents a case study of a man with psychopathic and borderline personality disorders. “The aim was to provide a twenty-four-week time-limited

Editorial Music Therapy Today Vol. VII, Issue 4 (Online December 22, 2006)

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psychotherapy intervention that included attuned musical improvisation as a central component. The treatment has been developed with personality-disordered patients who have offended and who are in high-secure hospital treatment. The author considers the phenomena of dissociation in relation to the aetiology of self-states (Ryle and Kerr 2002) and with reference to the creative arts. Within the therapeutic context she considers the potential of music as a mediating tool for emotional regulation in the transition between self-states.” The article “Melody and Rhythm – ‘Indianness’ in Indian music and music therapy” by T.V. Sairam continues another series of articles published in “Music Therapy Today” by scholars from India and their reflection on the richness of Indian music used in a therapeutic context. “The 3000-odd year old Indian genre of music is basically melodic, is based on the principle of resonance, sruti and rhythms, laya, regarded as ‘mother’ and ‘father’ respectively. The Indian system of music is an individualistic, subjective, and spiritual art, aiming not at symphonic elaborations but at personal harmony with one’s own being. Sruti, the very backbone of the Indian music, plays a vital role in rendering a specific identity and individuality to a raga that distinguishes it from an ocean of ragas.” T.V. Sairam who works at the Nada centre for music therapy in Chennai is an expert on Indian music and here he shares his long experience and knowledge. The paper “If you can’t beat them, join them! Long-term music therapy with an “autistic savant” man by Janet Graham is based closely on a presentation given at the 3rd International Symposium of Nordoff - Robbins Music Therapy, which was held in Germany in June 2006. It focuses on stages in the music therapy process with a middle-aged autistic man with

Editorial Music Therapy Today Vol. VII, Issue 4 (Online December 22, 2006)

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moderate learning disability and savant calendrical skills. He had become very ritualistic and inflexible over the years and this impinged not only on his own social life, but also on that of the sister with whom he lived. Reference is made to parallels between his progress in music therapy and changes in his social skills as perceived by his sister, friends and day centre staff. Another article based on a presentation at the 3rd Nordoff/Robbins Music Therapy Symposium comes from Britta Boymanns. The article “Just sing…” will give a view into seven years of music therapy at the Day Clinic for psychiatry and psychotherapy in Witten. Her experiences from the past seven years of practical work have shown that singing simple songs and canons can have a deep therapeutic effect at various levels of human existence, and encourage social growth in the community. To do this, it needs an exact choice of songs and preparation of the material, a free but friendly inviting approach towards individuals, exact and targeted musical-artistic work on the songs spiced with much humour and joy – and an openness towards all dimensions of humans and music. Just sing… Regine Merz, a certified art therapist and leading researcher in this study report “Painting is good for your soul!”, intends to provide HIV and AIDS patients as well as breast cancer patients with art therapy. In her current doctoral studies at the University Witten/Herdecke she addresses the question whether HIV-specific parameters are visible in patients’ paintings, and how these may be interpreted. On 19 November 2006, the IMB, International Music Therapy Institute Berlin, arranged a research meeting on the subject “Music Therapy as

Editorial Music Therapy Today Vol. VII, Issue 4 (Online December 22, 2006)

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References

Applied in Neurology”. Karolin Pfeffer reports on presentations by Mechthild Jahn-Langenberg, Hans Ulrich Schmidt Jane Edwards, Wolfgang Schmid, Kathrin Mertel, Anna Hinkelmann, Stefan Mainka, and Annkathrin Pöpel. David Aldridge and Lutz Neugebauer have initiated a new research project called “My Top Ten”. “My Top Ten” is an international research project that will gather qualitative information about what music people aged 60 years and over remember and how that is associated with events in their lives. Reminiscence is seen as an important factor in various therapeutic interventions and this project will concentrate on musical reminiscences. Similarly, giving voice to the elderly is seen as an important factor in establishing the worth of the elderly in modern western industrialised societies. And finally, Odds and ends presented by Tom Doch.

Merry Christmas and a happy new year

Jörg Fachner

References Aldridge, D. (1996). Music therapy and research in medicine - from out of the silence. London: Jessica Kingsley Publishers. Editorial Music Therapy Today Vol. VII, Issue 4 (Online December 22, 2006)

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References

Aldridge, D. (2004). The reflective practitioner in a community of enquiry: case study designs. Journal of Holistic Healthcare 1(2), 19-23.

Editorial Music Therapy Today Vol. VII, Issue 4 (Online December 22, 2006)

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Music Therapy Today Vol. VII (4) (December)

Research in practice Smeijsters, Henk Smeijsters, H. (2006) Research in practice. Music Therapy Today (Online 22nd December) Vol.VII (4) 781-838.

‘The novel The curious incident of the dog on the Night-Time tells a lot more on Asperger’s syndrome than the case descriptions in the medical textbook DSM-IV.’ Douwe Draaisma (2004)

Abstract This article1 illustrates, that, with respect to research, there are many ways to reach evidence, and also, that there are different sorts of evidence. The road to science for the Arts Therapies requires research on the full breadths of the spectrum, from systematic case studies to RCTs. It is important that Arts Therapists and Arts Therapeutic researchers reflect on the typical characteristics of each research paradigm, research type and research method and select what is appropriate with regard to the particular research question. Questions rather differ. Finding out whether a certain intervention has a particular effect with a large group of clients differs from wanting to know which change occurs at which moment by which interventions in the treatment of this individual client. 1. This article is based on a chapter in the forthcoming book ‘Research in the arts therapies’, a translation of ‘Praktijkonderzoek in vaktherapie’ (2005a), with chapters on research in drama therapy, music therapy, art therapy and dance/movement therapy.

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Research in practice remains close to questions encountered by Arts Therapists in their daily practice. It concerns questions Arts Therapists have about their lived experience of acting due to the complexity and variability of practice. By carrying out research in practice that links up with those questions, evidence evolves; evidence that enables the professional to proceed and that makes explicit what often remains implicit and unsaid. What is explicit can be communicated, can be criticised and tested. The professional himself does the road to science of the profession. The investment in professionals’ research in practice is the motor of knowledge-productivity that bridges the theory-practice gap. Research in the Arts Therapies should lead to ‘knowledge’ in which neither the ‘art’, nor the ‘subject’ of therapist and client have been lost.

Introduction Douwe Draaisma’s quote illustrates that a narrative description of a phenomenon can tell a lot more than scientific analysis. Theoretical knowledge does not always lead to understanding and removes professionals from the ‘lived experience’. This originates mainly in the fact that theoretical knowledge is of generalising nature and abstracts experiences. The experience from which the particular knowledge is deduced, however, is concrete, variable, rich in nuances, knows width and depths. A novel does not explain such an experience by the means of general regularities, but describes the phenomenon in a way that the reader becomes immersed in the experience. However, the question whether abstract knowledge is worth more than concrete knowledge is an absurd question. Both forms of knowledge help us to understand reality. Social science, as it has developed from traditional physical scientific thinking, enables us to describe phenomena systematically and objectively, to standardise, classify and generalise. The DSM-IV serves as a collection of items that tells us what a depression is. A questionnaire used to measure depression helps us to grasp this phenomenon. However, sometimes it is only then that we understand, if we enter into the role of

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the client, even more, if we have experienced something similar and enter the role of the client based on empathic counter transference. Objectively, we know things, and subjectively we comprehend and feel what it is about. In research on therapy, this difference in approach is expressed in different research paradigms that are at times specified as ‘quantitative’ and ‘qualitative’, at times as ‘positivistic’ and ‘constructivistic’. A quantitative researcher searches for general regularities that are generally valid. A qualitative researcher seeks to describe the complexity, the subtle differences, width and depth of a concrete experience. A quantitative researcher unravels, the qualitative researcher tells a story. In addition, those approaches are expressed in different opinions on evidence: on the one hand the Evidence Based Medicine (EBM), which puts the emphasis on controlled experimental research. On the other hand the Evidence Based Mental Health (EBMH), with a strong emphasis on systematised experience knowledge. This article pursues the question how practice-relevant knowledge can evolve through research. Practice relevant knowledge is knowledge that improves, renews and develops professional competences of acting. Or, in the terminology of Wierdsma & Swieringa (2002), that leads to ‘single loop, double loop and triple loop learning’. It is knowledge that by excellence is suited for the research domain of research centres established at universities where mental health professionals are trained1. This article tries to describe different paradigms, research types and research meth-

1. In the Dutch system there are two types of universities: the scientific universities in which fundamental and applied research is done and the universities of professional education (hogescholen) in which professionals are trained and research is used in practice .

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ods. It is meant to work out typical characteristics of

different

approaches in order to clarify which approach leads to which kind of outcomes. It is not about demonstrating that one paradigm is better than the other, it is about demonstrating that they are different, that they ask different questions, deliver different outcomes and score differently with regard to focussing theory or practice. However, practical relevance acts as criterion and it is investigated critically which form of research is more or less appropriate to improve, renew and develop practice-relevant knowledge. Research results are not applied in practice automatically, this is meant by the term theory-practice gap. On the one hand, this originates in professionals’ lack of competence in the evaluation and application of research results. On the other hand research results often are far from practice. Preventing this to happen by choosing a practice-relevant problem and research method is the red line of this article.

The university of professional education as a “gate of knowledge” Franssen (2004), Chair of the Dutch Foundation for Knowledge Development at Universities of Professional Education (SKO), sees universities of professional education changing from ‘education factories’ into institutions of expertise, regarded by the outside world as a centre for renewal with regard to contents and professional aspects. According to Franssen, pure educational transfer belongs to the past. The university of professional education needs to take into account the curiosity of students and train students to become professionals equipped optimally for developing their professionalism continuously. Franssen points out that this has to happen on a larger scale than before. Universities of professional education need to contribute to the development of the profession by carThe university of professional education as a “gate of knowledge”

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rying out research in practice. According to Franssen, it is difficult to think of an educational institution that does not perform research. In order to realise this, universities of professional education need to transform into institutions in which professional development, research in practice, concepts like ‘learning organisation’ and ‘gate of knowledge’ are subsequent aspects. In today’s professional practice, it is more than ever desired to improve, innovate and develop standards1 and services and to validate professional acting. In this respect, criteria like transparency, efficiency and efficacy are valid within the Health Services. Research in practice is the tool par excellence for making the professional performance of Arts Therapists transparent, efficient and effective. This requires that the current reflective practitioner grows into a scientific practitioner, who does not merely reflect upon his own actions but has the ability to improve, innovate and develop his performance based upon research (if possible carried out by himself). In a parallel process, the purely (re)producing organisation will evolve into a learning organisation. A learning organisation is characterised by the fact that it improves its standards and services, innovates and develops in a continuous dialogue with its external environment and anticipates developments in the external environment. A learning organisation aims to engage internally and externally in variable expertise-intensive coalitions in order to mobilise its creative and problem-solving potentials.

1. In the Dutch system a standard (product) is a description of goals, interventions, outcomes and rationale used with a particular health problem that is part of a disturbance or handicap. The treatment by means of the standard is limited in time and part of a total treatment program.

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The university acts as ‘gate of knowledge’ if it turns into a learning organisation that enters into dialogue with practice, among others through performing research in practice. University and health organisations together develop the profession and the training programmes by the means of research in practice and influence each other, based upon their own expertise, over and over again. Together, they sustain intensive traffic through the ‘gate of knowledge’. At universities of professional education students should gain competences in carrying out research in practice. The university of the future is a dynamic institution in which research in practice and the development of competences go hand in hand. The university of professional education offers students the opportunity to acquire the most up-to-date professional competence based upon the results of research in practice. In addition, this designated university enables students to gain competences regarding research so that they can contribute to the development of the profession after their training. At the university of professional education, educational processes and the development of the profession are integrated. By the means of the educational model called ‘reflection on learning’ the student learns how he can direct his learning processes in such a way that he can develop and test his own professional performance. Universities of professional education create changing internal and external co-operations in order to develop student’s competences. Students develop their competences, their profession in dialogue with the professional field.

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Research in practice in universities of professional education Research in practice is connected with concepts that describe the university as a ‘gate of knowledge’ and a ‘learning organisation’. The research is preferably research in the service of the community of practice (Wenger & Snyder 2000). In those forms of co-operation, people who are confronted with the same problems work together in order to exchange, intensify and develop their knowledge by the means of interaction. Communities of practice are focused on creating and sustaining the body of knowledge with the help of participants holding expertise, interest and commitment. In so-called ‘ateliers of innovation’, different parties meet in order to work on complex and creative solutions (Krogh, Ichijo & Nonaka 2000). The cooperation between university and practice institution can be regarded as a community of practice where professors, students and professionals from the area of work develop the profession together. By means of a systematic dialogue, they may analyse problems, consider strategies of solution and develop standards. If this happens by using research techniques, we could talk about a research based community of practice. Central to the interaction between professor, students and professionals is the cycle of learning: analysing a problem, designing a solution, applying a solution and evaluating the solution. What is developed in the research community becomes applied in practice and included in training. This two-direction traffic between practice and training illustrates the operation of a ‘gate of knowledge’. A question that has been discussed during the past years was whether there is a particular research methodology for universities of professional education. Through the discussions that have been conducted on this topic, I came to the conclusion that an exclusive research methodology Research in practice in universities of professional education

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for universities of professional education does not exist, but that in these universities certain research methods are used more often, because these methods are closely linked to the lived experience in practice. In other words: scientific universities carry out research in practice as well, and scientific and professional researchers use the same research methods (qualitative and / or quantitative). However, to a high degree, in universities of professional education a practice-focused and practice-relevant research methodology is used. The acknowledgment of its practical applicability in the field of work and the way of co-constructing results together with the field of work are the most important features.

The Arts Therapies as a learning profession Corresponding to the idea of a ‘learning organisation’ I see a ‘learning profession’ in front of me in which experiential knowledge (implicit knowledge) is made explicit, is analysed, combined, improved and developed and optimises practical acting by the means of education and training. It is about defining the client’s problems, the appropriate aims, specifically arts therapeutic interventions and expected results based upon practice (see Hutschemaekers 2003a). By monitoring process and results, knowledge about delivery and results develops. Figure 1 on page 789 demonstrates how the cycle of externalising and internalising leads to theoretical and practical innovation. Research in practice is, as we will see later, the motor that keeps the cycle going.

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FIGURE 1. The Arts Therapies as a learning profession: making explicit and internalising

Paradigms Within the thinking on the topic of research, it is currently differentiated between so-called paradigms, that is essentially different opinions on how research is to be done. Especially the difference between quantitative and qualitative paradigm can be found back in a lot of research projects and manuals on research. Those paradigms are based upon philosophical conceptions of reality: the way knowledge can be gathered and how reality needs to be studied, respectively ontology, epistemology and methodology. The following description is based on Lincoln & Guba’s publication (2000) as starting point. First publications, among others Lincoln and Guba (1985), was talked about naturalistic inquiry. Naturalistic inquiry, with its emphasis on non-manipulative, open, context-specific, holistic, ‘subjective’ characteristics of research, formed the counterpart to (post-)positivism. Later, the term naturalistic was replaced by the term

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constructivistic in order to demonstrate that it is a matter of constructing knowledge in dialogue with respondents. ONTOLOGY

Ontology is defined as ‘theory of reality’. It answers questions with regard to what we comprehend as reality. Positivism is often referred to as ‘naïve realism’. Positivists are strongly influenced by traditional nature scientific thinking before quantum physics. They assume that an independent reality outside human beings exists that can be depicted by research. Post-positivists slightly abate this point of view and suggest that the depiction cannot be perfect, but certainly plausible. In the latter we recognise the origin of statistics that calculate probabilities (think of the statistic test that calculates whether a hypothesis is true or not). Constructivists, on the other hand reject the assumption that reality can be depicted objectively. They join in with philosophic currents like for instance phenomenology and hermeneutics which assume that meaning is not located outside the human being but is given by the human being, therefore it is definitely ‘subjective’. Constructivists, however, go a step further than phenomenologists and hermeneutici. Whereas phenomenologists assume that they can get through to the essence of a phenomenon, to the core of the subject, constructivists, strongly influenced by post-modernistic thinking, advocate the idea of relativism. By that, they emphasize that there is nothing like a general meaning, but that meaning always depends on a specific context that determines what meaning people ascribe. Think of a therapist saying that results of experimental research are nice and pleasant but not applicable for individual clients. In addition, Lincoln and Guba (2000) differentiate between constructivistic and participant research within the constructivistic paradigm.

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Participant research consists of different forms, among them action research, which aims at an improvement of the practical action by means of research in practice (Kemmis & McTaggart 2000). An example from Arts Therapies is a practice researcher who is in constant dialogue with the Arts Therapist during the treatment of the client, aiming to optimise the treatment of the client by means of a dialogue on an equal level from different perspectives. Research at universities of professional education, aimed at the improvement of practical acting, innovation and development, benefits from a research methodology in which researcher and professional learn from each other, in which intervention and research, practice and theory fructify each other critically. Research in practice carried out at universities of professional education can by excellence meet the characteristics that Kemmis and McTaggart mention for participant research:

•

a social process in which respondents with their knowledge participate on an equal level focussed on the joined development of practical acting by means of a (self)critical and dialectic dialogue that runs in a cycle of doing, evaluating, thinking, planning, doing, etc.

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in which both practice and theory transform.

• • • •

This form of research goes further than learning from practice or learning in practice as it is about research that aims at innovating theory and practice in a continuous circle. EPISTEMOLOGY

Epistemology is the ‘theory of knowing’ and tries to answer the question how we can get to know reality. Positivists handle a dualistic/objectivistic approach, based on the assumption that the researcher is able to state objective truths regarding the reality around him. The researcher posi-

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tions himself independently and is no more than an observer of the - in his eyes - objective reality. He is positioned opposite to the reality that he researches (dualistic). Post-positivists share this opinion, but dilute it by assuming that as independent researchers, they will not find absolute but plausible truths. Constructivists, on the other hand, propagate that it is only possible to acquire knowledge by entering into a transaction with the environment, which in this case are respondents, and creating knowledge together with them. Therefore, it is not about a dualism between researcher and research. METHODOLOGY

Methodology is defined as â&#x20AC;&#x2DC;theory of methodsâ&#x20AC;&#x2122; and describes how we approach the acquisition of knowledge. Positivists use a theory from which they deduce a hypothetic causal connection which they try to verify by the means of an experimental design. The experiment is designed artificially in order to be able to research exactly the influence of the independent variable. It is aimed to control all other variables by eliminating them or measuring them so as to be able to state the effect of the independent variable. Dependent variables, that are expected to be influenced by the independent variable, are measured by the means of standardised and objectified measuring instruments to which the researcher applies statistic procedures. Since Karl Popperâ&#x20AC;&#x2122;s example of the impossibility to prove definitely that all swans are white, the verification principle, implying the search for evidence to prove the hypothesis that all swans are white, has come under pressure. Popper introduced the falsification principle, suggesting that one needs to try to refute the hypothesis (thus search for a black swan). If one does not find a black swan, the hypothesis suggesting that all swans are white, is probably true. In inductive statistics, probability procedures are developed in order to determine, Paradigms

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based on a sample, whether a hypothesis is true (this can be seen in the p-value of statistic tests). Therefore, by means of an experimental design based on a sample, post-positivists are able to determine the probability whether the results found in the sample are valid for the population. Thus, post-positivistic research methodology unfolds reality in standardised variables. They enable different situations to be studied with the same instruments. Many clients, therapists and treatments are observed in the same way. The advantage: in the end, it becomes possible to say something in general about a large quantity. In order to make this possible, phenomena are simplified and expressed in figures so that they are statistically comparable. Averages, standard deviations, t-tests, analysis of variance, factor analysis, regression analysis etc. are operations that combine a great quantity of simplified phenomena. This form of research is merely possible if phenomena are simplified. (Post)positivistic research methodology works with comparable facts occurring a lot as particular phenomena have been reduced to comparable variables. Exactly because data are comparable, a great quantity of the same data arises.This makes statistical processing possible. In other words: reduction and standardisation are conditions for statistical analysis. If this does not happen, it is about unique phenomena that cannot be analysed statistically. Therapists working with individual clients often oppose themselves suspiciously to the results of quantitative research. However, this form of research is very useful in the medical world and for therapies that are more standardised and therefore measurable in this way. A problem arises if this way of researching is declared as the one and only true and other forms of therapy that, on the contrary, draw their strength from less standardisation, are left aside. As clients differ and problems are com-

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plex, treatments often are different. Therapists do not work with abstract regularities, but with a complicated interaction process full of nuances and levels (Buchholz, 1999). The individual, subjective experience of pain, angst or grief withdraws from quantification (Aldridge 2004b). A political-social problem that arises from standardised forms of research possessing the highest status is, that therapies for which standardisation is possible, are considered for funding, both with regard to treatment and research. By this, a reduced picture of effective therapies develops. Aldridge (2004c) criticises the fact that a technocratic elite with a deficit in practical experience set themselves up as inquisitor, judging that merely one form of research leads to evidence. He claims that inexperienced researchers think that they can set up guidelines based upon reductionistic research outcomes, prescribing experienced professionals how they could act in a better way. Positivistic research however, is not able to resolve the quandary of action that arises for the professional in an un-standardised context. Constructivistic researchers do not think in terms of samples and statistic probabilities. For them, the specific context is the starting point, which they describe in full breadth. Whether or not outcomes are usable in another context, this is something that people from another context can find out for themselves based upon a comparison. Striking in constructivistic methodology is the equivalence of researcher and respondent. The researcher is not the one who, based on theories, formulated questions and research tools, considers himself able to discover truths on his own. He enters in an equal dialogue with respondents. In this way, a learning process develops which involves three criteria: the researcher learns from the respondent, the respondent learns from the researcher and together they create new practice-focussed knowledge. Equivalence, by the way,

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does not mean equality, as researcher and respondent enter the dialogue based upon their peculiar competence. This implies dialectics: questioning each other critically from different backgrounds. There is no theory set up in advance, there are no measuring instruments. Research techniques merely serve as support in co-creating subjective knowledge concerning the practice situation as it occurs under normal circumstances. Experimental manipulations are not applied. One research methodology is not better than the other. It is essential for the researcher to choose a method that fits to his question. Aldridge (2004c) pledges for methodological pluralism: one story can be told in different ways. Manipulations, standardisations and measuring variables deliver other knowledge than the description of natural situations. Certainly in the Arts Therapies, the medium1 tells its own story, too. Science and profession are two different, but equivalent sources of knowledge (Buchholz, 1999), and within science, different research methods produce different, equivalent sorts of knowledge.

Quantitative and qualitative The above paragraph demonstrates that quantitative and qualitative paradigms are narrowly connected with views on ontology, epistemology and methodology. Terms like qualitative and quantitative are currently mainly used in the service of methodology, but we realise that quantification mainly belongs to positivism and post-positivism, whereas qualitative research belongs to constructivism. Qualitative research and constructivism however are not identical. As mentioned before, traditional research methods (think of phenomenology, hermeneutics and grounded theory) 1. In the Dutch arts therapies the concept â&#x20AC;&#x2DC;mediumâ&#x20AC;&#x2122; refers to drama, music, art, dance and movement.

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assume that it is possible to describe the essence of a phenomenon. Constructivism, on the other hand, assumes that there is no general truth, and ‘truth’ is relative, depending on the human beings who construct (their) truth together. Within the qualitative paradigm, which is therefore wider than constructivism, a lot of methods are known and used frequently by Arts Therapists, e.g. phenomenology, grounded theory, hermeneutics, morphology (see among others Kenny 1989, 1996, 1998; Wheeler 1995/ 2005; Langenberg, Aigen & Frommer 1996; Tüpker 1996a; Smeijsters 1997b; McNiff 1998; Grainger 1999; Kaplan 2000; Petersen 2002; Aldridge 2004a). Discussing them here in detail leads us too far away from the subject. Therefore I merely refer to relevant literature. The quantitative versus qualitative research debate is carried out in the Arts Therapies internationally, as well. All positions can be recognised: researchers who swear by quantitative methodology, those who swear by qualitative methodology, those who aim to bridge the gap between both paradigms by connecting them or disapprove speaking of ‘paradigms’. As mentioned before: problems arise if it is forgotten that quantitative and qualitative researcher have a different view on reality, that they ask different questions, use other methods and therefore find other answers. Condemning each other as heretic does not make sense if one person wishes to examine apples and the other one looks at pears. Ignoring the fundamental differences in perspectives and acting as if it is merely about different methods and techniques that fulfil the same quality criteria does not make much sense either. Perspectives differ so much, that it is very much about different quality criteria. This implies that, regardless which form of research is chosen, each research methodology has to fulfil the quality criteria valid for it. Who carries out experimental research needs to meet the quality criteria valid for this kind of research and someone

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who does hermeneutic research needs to stick to criteria valid for hermeneutic research. As it is a matter of different approaches, there are different sorts of evidence as well. As a result of the propositions above, neither qualitative nor quantitative researchers can claim ‘truth’ and ‘certainty’. Knowledge that is gained through experimental research by the means of standardised measuring instruments is no closer to ‘the truth’ than knowledge gathered by the means of in-depths-interviews in the natural context (Kemmis&McTaggard 2000).

Sorts of evidence In this paragraph, I will examine the ‘sorts of evidence’ possible. It is a very recent perspective in which a lot of the matters discussed before, will be raised again. We will see that EBM is of a (post)positivistic-quantitative nature. EBMH is of a constructivistic-qualitative one. In addition, we will find that a third form of evidence, CBM, is possible, a form that is naturalistic (without being a matter of constructivism) and can exist in a qualitative or quantitative design. With the call for evidence currently being so strong, this paragraph corresponds to the question that confronts Arts Therapists in practice: ‘Does it really work?’ Ansdell, Pavlicevic&Proctor (2004) describe six forms of evidence that can be developed by professionals in practice: •

An expert’s opinion: let your work be validated by a practitioner from another profession (e.g. a psychiatrist) who is able to evaluate your work from a close distance. Such an expert’s opinion influences policymakers.

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A review of your treatment: make a review of the dossiers of your clients, describing the target group (age, diagnosis, etc.), how clients have been referred and how assessments have taken place, how many clients you treated individually and in groups, how you evaluated your work and results of your evaluation (intervision, supervision, other professional’s and client’s feedback etc.). Evaluation studies: apply a number of methods (‘triangulate’) that demonstrate that in practice, there is a relationship between aims and results (e.g. questionnaires filled in by clients and staff, participant observation). Using assessments: in this case, an Arts Therapeutic assessment model accompanies all stages of treatment (e.g. an assessment at the beginning is related to the problem and the expected results; an assessment at the end is compared to an assessment carried out at the beginning and to expectations). Qualitative effect study: make an extensive description of practice, among others from the client’s perspective (e.g. using client interviews). Systematic case study: a Case Control Study in which the client is matched with a control client, the Case History (the most common case study) and Case Series (several Case Histories). By using the same format (problem – intervention – process) it becomes possible to compare cases to each other and to reveal patterns. Experimental research: research by the means of an experimental and a control group; randomisation.

By this, they demonstrate that each professional can gather evidence in practice – apart from experimental research. This is important with regard to legitimating indications in practice: it is not about results of experimental research. It is about the credibility the Arts Therapies possess in the eyes of care managers, members of the multidisciplinary team, clients and people from the clients’ environment. I will not discuss all variants proposed by Ansdell et al. I restrict myself to the sorts of evidence I encountered in the course of years and that get a lot of attention in literature.

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EVIDENCE BASED MEDICINE (EBM)

EBM is mainly applied in medical science. From there, it gradually swept through to psychotherapy as well. It is applied frequently within Cognitive Therapy and Behavioural Therapy, hardly in psychoanalysis. This already tells us something about those therapist’s view on reality. The golden standard of EMB is the Randomised Controlled Trial (RCT). In medical research, EMB is regarded as the very best way to investigate the effectiveness of a certain treatment. The approach is ‘objectivistic’ and ‘experimental’, which means that the researcher is an outsider who designs an experiment in which he can observe what happens without interpretation. There is a control group that does not receive treatment and an experimental group that does. Members are placed in groups at random in order to guarantee that groups are comparable at the start. The experimental group receives a certain medication, the control group receives a placebo. Participants of each group do not know who receives the proper medication and who does not. Even doctors do not know which one is the genuine and the simulated medicament. This is called ‘double-blind’-research. It is meant to prevent doctors and patients – if they could identify the genuine medicament - from suggestive thinking that it helps. The effect is recorded by means of a measuring instrument. The measuring instrument neither leaves space for interpretation nor suggestions. The treatment (the medication) is exactly prescribed (standardised). The client’s problems are recorded precisely. In that way, it becomes possible to draw conclusions that the particular medicament in a certain dose and administered for a certain time (the independent variable) for this symptom (the dependent variable) has this kind of effect. This is a very strong research design from the point of view of post-positivistic methodology. It’s strength is, that to a certain extent of statistical probability, it is possible to state whether one treatment I (intervention), compared to another intervention C (comparison, co-intervention) leads

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to an effect O (outcome) for a large groups of patients presenting the problem P. This ‘PICO’ line of reasoning can be found in Cochrane Reviews and evidence based guidelines. It enables you to find out whether a standardised treatment leads to a standardised effect for a standardised group of patients. Therefore, this design is regarded as ‘golden standard’. Wesseley (2001: 49), a supporter of this design, declares: “If we hadn’t carried out clinical experiments, we still would give insulin to schizophrenic patients”. A convincing argument from medical books is that RCTs detect differences between medicament and placebo and whether treatments have positive or negative effects. Try to imagine that this is what you need to manage in psychotherapy or the Arts Therapies. You need to form two groups, both of them including clients with exactly the same problem and the same level of departure; without co-morbidity, because otherwise you won’t be able to find out exactly how therapy works for a specific problem. You need to divide them into a treatment group and a control group at random. Subsequently, you need to apply the same treatment to every client (same interventions, same intensity, same duration), because only then will you be able to state whether treatment I leads to effect O for client P. The client must not know whether he receives treatment or placebo; nor may the therapist know whether he carries out treatment or placebo. Afterwards, all clients are measured by the means of the same instrument. From this, we can deduce that this research design involves a variety of problems. Do you get clients whose presenting problems are clear, specific and equal? Is it possible in an institution to take clients out of their community and divide them at random in an experimental and a control group? Is it possible to provide the same treatment for every client? Is it therapeutically justifiable for the client not to know what kind of treatment he receives? How do you manage for the therapist not to know whether he actually

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treats? This raises questions. By the way, this does not mean that it is not possible to answer some of those questions. It usually leads to some kind of deviation from the original design. However, as a result of the questions raised just before, carrying out this form of research encounters many critics within psychotherapy. In the previous text, Buchholz (1999) has already been quoted. He clarifies that experimental research provides a simple psychology that cannot replace the complex psychology needed by the professional. In the same way, Seligman (1995) and Rustin (2001) conclude that RCTs cannot demonstrate the effects of psychotherapy as many crucial factors are left out of consideration. In reality, clients are complex; there are no two clients alike; there are no two treatments that can be alike and therefore, there can’t be two effects that are the same. Every experimental group forms a selected, specific ‘non-random’ group; its results cannot be generalised (Aldridge 2004b). The most important criticism of RCT is therefore that it is not representative and possesses little external validity (Slade en Priebe 2002). According to Seligman, the strong internal validity of RCT (randomisation, protocol-led treatment, delimited time and standardised effect measures) does not provide insight on the way how the process between therapist and client develops and what actually happens. ‘Internal validity’ means that you can state whether the effect is caused by the treatment. RCT is a technical-formalistic way of recording the effect of a treatment. It seems unimportant to know how the treatment took place; every researcher can do the methodological work without having a look at the process of treatment. In reality, insight on why something changes however merely develops by investigating the process, by paying attention to

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little changes and by recording what is influenced by what. RCT provides laws for big numbers, but no insight in where and why something changes. In addition, the RCT shows afterwards whether there is a statistical effect on an average score for a standardised treatment. We then know that on average, something influences something, but we do not know when, how and why the individual client changes. Thus, RCT does not tell us how a treatment works, for whom it works and for whom it does not work (Marshall 2002, Aldridge 2004b). That is why this kind of research is interesting for care managers and care insurances, as they can deduce from results where to spend their money - but less interesting for therapists who want to know how they need to act when confronted with the complexity of the individual client. Arts Therapies is not the performance of standardised interventions. Every therapeutic relationship is different and it is a matter of working focussed on the presenting problem (the treatment package approach, Edwards 2002). The quantitative single case design was developed in order to meet the individual process; it is flexible, focussed on practice and ethically justified (see e.g. Aldridge 1993, 2004b; Smeijsters 2005b). COGNITION BASED MEDICINE (CBM)

The criticism of RCT originates from the medical perspective. Clinical physicians and specialists wonder whether they are merely allowed to treat after a RCT has taken place. This approach condemns physicians to the computer where they can search for what is or is not investigated. I think, in this context a distinction needs to be made between the prescription of pills and other medical actions. The first one, I consider as a matter for RCTs. This is different for the other medical actions. What is practice like? A doctor possesses the competence to formulate individual diagnoses that meet the individual set of problems of the patient. Based on that, he assesses what he needs to do. Naturally, he will Sorts of evidence

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prefer prescribing medicaments that are tested extensively, but what to do if the decisive answers of the RCTs is unsatisfactory? The physician nevertheless needs to act, even more, he needs to invent a combination of remedies and measures that are appropriate for the individual client; no single RCT is able to provide an answer for this. The doctor is supported by two things: his insight in the way the human body works and his experience. In order to obtain these insights, he does not necessarily require research with an experimental and a control group. The physician gains insight by thoroughly mapping and following a large number of phenomena and combinations of measures in the case of the individual client. He is able to reliably state for an individual client whether the treatment leads to the desired effect. This may happen qualitatively or quantitatively (see Smeijsters, 2005b). To a certain degree, the individual doctor ‘experiments’ with the individual client, whereas in RCT, this is done with groups. This is even more observable in the case of a surgeon who acts based upon his competence and not based upon RCTs. Imagine a surgeon only then to be permitted to carry out an operation after an experimental group has been subjected to the same operation and a control group has not. Firstly, not a single fracture of patients from the experimental group is the same; the surgeon needs to adjust his work and needs to figure out per client how he needs to do it. Secondly, you can’t let clients from the control group wander about with broken bones. This may be a ridiculous example, but it demonstrates clearly that the surgeon needs to act; he does it by using his experience and competence adjusted to the situation and by developing it on the spot. This, by the way, characterises a true professional: he is able to act in diverging situations instead of merely being able to carry out standard procedures. Here, we can recognise a discrepancy between EBM and thinking on professionalism.

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Through the treatment of individual patients, the physician gathers a treasure of experiential knowledge that enables him to formulate diagnoses and to develop an appropriate treatment for the following patient more quickly. In RCT, the doctor is somebody who interprets and applies standardised knowledge; in CBM the doctor is a practice researcher who tries out things in a variable practice. Kiene (2001), Kienle e.a. (2003) and Petersen (2003) emphasise that EBM underestimates the person of the therapist as a trustworthy research instrument. The key question in effect research is about whether an effect actually occurs and whether one is able to state with certainty that the effect is a consequence of treatment and not one of other factors (e.g. the weather, the physicianâ&#x20AC;&#x2122;s personality, another treatment etc.). It is, as we have seen previously, the question regarding internal validity. This is solved in EMB by means of an experimental design. Experimental group and control group are alike. Imagine the treatment being successful for the experimental group but not for the control group. Do you then know with certainty, that this effect is a consequence of the treatment? Yes, according to the reasoning: if anything else had been involved, it would have occurred in the control group, as well and would have caused an effect there, too. The difference of effects between experimental and control group is merely regarded a consequence of a difference in treatment. Ergo: the treatment has caused the effect. CBM follows another line of reasoning in order to state causality. It is an individual and experimental model and based on recording similarities (morphologic and analogous). Adapted to the Arts Therapies, it means that changes visible in therapy, both in and outside the medium, corre-

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spond to changes outside therapy in a way that makes it very likely that they are caused by the therapeutic process. Take the example of a client who takes more initiative during an Arts Therapeutic session and does the same in his community during the following week, whereas before this was not at all the case before; in addition this phenomenon was only visible in other therapies after it had been observed in the Arts Therapies for the first time. Or, let’s turn back to the surgeon, if bones grow together, this is caused by the surgeon who set them well. There is no need for an RCT in order to state this. The causal relationship between the surgeon’s therapeutic action and the growing together of bones is evident. The same can be said for processes happening inside and outside the Arts Therapies. If a client, who was withdrawn before gradually takes more initiative in Music Therapeutic improvisation, there is a direct relationship to his behaviour in a discussion group if he takes initiative in this group too. EVIDENCE BASED MENTAL HEALTH (EBMH)

One way to cluster professional knowledge was shaped by what is called Evidence Based Mental Health (EBMH ) (Hutschemaekers 2003a/b). The word already demonstrates that a distinction is made between ‘medicine’ and ‘mental health’. This results from the fact that, in mental health, the psyche of the client is the centre of attention; this implies that it is impossible to merely carry out standardised treatments that are the same for everybody. In EBMH, therapists’ and clients’ knowledge from experience is made explicit, it is analysed and integrated to best practices. This concerns all parts of the therapeutic process as observation and diagnosis, aims, interventions, results and rationales. EBMH is interactive and searches together with experts (from experience) for the collective sense of the profession. EMBH owns to a smaller or greater extent characteristics of the qualitative paradigm (Lincoln & Guba 1985; Reason & Rowan 1991; Denzin & Lincoln 2000).

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The research method is frequently ‘open’, theories set up in advance move to the background during the research, there is attention for the totality of occurrences; in addition a construction of intrasubject and intersubject experiences takes place. Within EBMH, all sorts of specific qualitative research methods are applied, including phenomenology (Giorgi 1985), hermeneutic (Gadamer 1975), grounded theory (Glaser & Strauss 1967; Strauss & Corbin 1998; Charmaz 2000), constructivism (Gergen 1985, 1994; Denzin 1997) and morphology (Salber 1965). Instead of the criteria customary within the quantitative paradigm (as internal validity, external validity, reliability and objectivity), criteria of relevance within the qualitative paradigm are: • • • • •

Credibility (results need to be credible for respondents) Dependability (results need to be as complete as possible) Confirmability (an outsider needs to be able to comprehend how results came about) Transferability (results are processed in a way that facilitates assessment regarding to what is different or similar in a new context) Authenticity (respondents have had a fair chance to contribute their point of view)

In order to fulfil those criteria, a qualitative researcher has a large amount of research techniques at his disposal; among those are best known: thick description, memo’s, iterative analysis, member checking, peer debriefing, auditing and triangulation. A detailed discussion of these methods and techniques would lead too far from the subject. A short description is included in the tables (see page 812) at the end of this article. In this article, I would like to deal with Miller and Crabtrees’ notions (2000) on clinical research at more length. Just like other researchers, they criticise the biomedical paradigm and the RCTs deduced from it; according to both authors, the consequence is that the complexity of suffering becomes suppressed and the treatment of suffering is given shape Sorts of evidence

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in standardised procedures. What is interesting in Miller and Crabtrees’ notion is that they pledge for a research method in which storytelling, associations and metaphors take up a central role. If we follow this line, the notion links up to voices within the Art Therapies, pointing out that it is possible to describe the therapeutic process by taking the medium process as a measure of outcome. What happens during therapy after all is visible and audible ‘in’ the medium. Therefore, there is no need to ‘translate’ the medium into another language. As it frequently is difficult for outsiders to ‘read’ the medium, work needs to be shifted aiming at an ‘intermediary language’ that does justice to both medium and psyche (Smeijsters 2005c). Miller and Crabtree mention three criteria for a qualitative clinical story: Methodologically convincing as the ‘story teller’ gives an account to the reader of how he gathered and processed his material. • Rhetorically convincing as the reader, based upon personal experiences, becomes convinced that the story is credible. • Clinically convincing as therapists get convinced that the story is clinically credible. •

By this, Miller and Crabtree in a certain sense re-establish the position of the case study, which takes up a very humble rank in EBM. But they add something as well: the author needs to use a research method and accounts for the method. Case studies, as we know them, often do not fulfil the criteria valid for research. However, they may be rhetorically and clinically convincing. Their value would increase if authors of case studies made use of research techniques.

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Scientific practitioner and reflective client In Hutschemaekers’ opinion (2003a/b) the original principles of EBM stressed the collective sense of the profession, building also upon the implicit knowledge of reflective practitioners when setting up guidelines. Aldridge (2004b) emphasises that it is important to listen to the experience of both therapists and clients. FROM ‘REFLECTIVE’ TO ‘SCIENTIFIC’ PRACTITIONER

It is important that the reflective practitioner can develop himself to scientific practitioner. Entering into a critical dialogue with colleagues and practice researchers facilitates this. With that, among others, it is important to connect theory with a small letter t (work models from practice) with the theory with a capital letter T (scientific evidence). This will be worked out further in chapter 3 of my forthcoming book.

THE ‘REFLECTIVE CLIENT’

Within psychotherapy, research methods have been developed in which the client’s experience gets a lot of attention (Elliott, Slatick & Urman 2001). In a Change Interview, the therapist/researcher asks whether the client realised changes, what may have caused those changes, which factors facilitated or hindered the therapeutic process and what had been missed. The Helpful Aspects of Therapy Form (HAT) is comparable to that, but is held at the end of a session. The therapist asks which event has helped most during the session, how strong this help had been, when it happened and for how long it lasted. In a Brief Structured Recall (BSR), tapes of the session are looked at or listened to; the therapist helps the client to describe specific events. The client localises the event, describes what helped most during the event, and how the event passed off, explores possible relationships to other situations from every-day reality, describes what was experienced during Scientific practitioner and reflective client

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the event, the most important parts of the event and the effect of the event.

Characteristics of qualitative research in practice in EBMH This paragraph accentuates and specifies the preceding with respect to qualitative research in practice in EBMH. CYCLE OF PRACTICE AND CYCLE OF RESEARCH IN EBMH

Within EBMH, there is no big difference between the reflective practitioner who discovers gradually what the problem is, who develops work methods and tests every moment what is appropriate and what is not, and the qualitative practice researcher who by means of qualitative research methods supports and analyses the individual process of the reflective practitioner and integrates it with other reflective practitioner’s implicit knowledge as well as findings from theory and research. Qualitative research in practice is focused on the action process as it unfolds in practice. This form of research shows, with regard to the process, similarities with the action process in practice. Practice and research both focus on what the problem is and what needs to be investigated. The research methods are not neatly put together in advance, but get shaped gradually based upon feedback from the practical context. Qualitative research in practice often is as flexible and varied as practice itself.

EBMH INFORMED QUALITATIVE RESEARCH IN PRACTICE IN THE ARTS THERAPIES

In qualitative research in practice in the Arts Therapies, the following questions are central: How is the client’s set of problems expressed in the medium? • What sort of diagnostic model do arts therapists use with regard to a certain set of problems? • For which sub-problems, related to the client’s set of problems, do arts therapists consider their medium indicated? •

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• • • •

• •

Which goals are chosen by arts therapists, in the light of the problems they want to focus on? Which work modalities, methods, activities and techniques are used by arts therapists to achieve those goals? How do they phase their therapy? Which effects are perceived by the arts therapists as a consequence of the application of the chosen work modalities, methods, activities and techniques? Is there a clear relationship between the client’s set of problems, the goals, work modalities, methods, activities, techniques and results? How do arts therapists explain the effects occurring? On which theoretical current do they base themselves?

The quality criteria for qualitative research in practice are related to the question whether the facts reflect practice adequately; whether they are understandable, usable, acceptable etc. (see the preceding paragraph as well as Verhoef et al 2004 and Proot et al 2004).

Competences of a practice researcher in the Arts Therapies A practice researcher is someone who is able to pursue a dialogue in which he enters into discussions with respondents, listens well, follows their traces of thinking and clarifies. The researcher creates an atmosphere that enables questioning each other constructively and critically as well as bringing up assumptions for discussion. The discussion enables respondents to develop from reflective to scientific practitioners who integrate theory and practice, who make implicit knowledge explicit, and bring it up for discussion based upon extern sources (theory, research, other experts). A safe atmosphere facilitates letting go of potential conceptions that don’t provide psychological, therapeutic or mediumfocussed trustworthiness.

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Considering the fact that both respondent and researcher use the clinical process of reasoning in which observation, aims, indication, method, effect and rational are related to each other, this form of research in practice requires the researcher to know about the subject he talks about and therefore to have an understanding of the arts therapies. He needs to have at his disposal a wide knowledge concerning the arts therapies he wishes to investigate, so that he is able to drop one-dimensional theoretical and ideological assumptions. Based upon insight, the researcher needs to be able to (re)construct experiential knowledge and to create action knowledge together with the arts therapists; in this, it needs to become clear what can be generalized and what cannot. Then a content-directed, many-sided dialogue between professional and researcher develops. FIGURE 2. Dialogue between researchers and professionals

At the end of this article, I provide a systematic overview of types, methods and techniques of research. The overview in the next paragraph is not complete, however it gives an impression of the options among which researchers can choose.

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Tables - Types, methods and techniques of research TYPES OF RESEARCH

•

Inventory research: in an inventory research, an inventory is made of how often a phenomenon occurs, which phenomena occur; e.g. which target groups and methods arts therapists work with. Need research: A need research assesses people’s needs. This may include needs for education, facilities and, with regard to clients, needs for treatment (the client’s ‘question for assistance’). Development research: A development research project focuses on the development and improvement of (one’s own or somebody else) professional action by the means of research. The outcome can be assessment tools, a formulation of indications, a description of goals, treatment methods, standards, interventions, rationales etc. A development research goes further than an inventory research as it brings about new knowledge through analysis and integration. Process evaluation: A process evaluation aims at investigating how therapy actually takes place. In other words: does actually happen what is put down on paper? For this purpose, it is necessary to describe and analyse the actual acting, with regard to what was supposed to happen, as well as to compare it to the starting point. A process evaluation is both related to the quality concerns (‘Do we really do what we say we do?’) and effect evaluation. As, after all, a treatment turns out not to be effective, it is important to know whether it has been carried out the way it was meant to. Effect evaluation: Effect evaluation aims at evaluating the output of activities.

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TABLE 1. Research designs: Survey: by the means of a closed questionnaire, structured in advance, information in figures is collected from a big number of respondents. For instance, respondents record whether something does or does not exist and to which degree. This research is of an inventory-making character. • Correlational: a research aimed at investigating the correlation between variables; it is observed whether one variable scores high or low, in the same direction or the opposite one, or on the contrary, independently if another variable scores high or low. Experimental Randomized Controlled Trial (RCT): effect research in with groups which randomised groups are compared to each other; the experimental group receives treatment whereas the control group does not get treatment or receives a placebo. •

Quantitativ e:

Outcomes research Experimental single-case design

Non-experimental single case design

Controlled Clinical Trial (CCT), cohort studies: effect research in which non-randomised groups are compared to each other. Effect research by the means of a pretest-posttest measurement of the treatment group; without control group. Case Control Study: a client is matched with a control client or with himself: • Randomised single-case design: treatment and placebo are applied at random to an individual client. • Reversal design: according to a plan set up in advance, (e.g. ABABA) treatment and placebo alternate in the treatment of an individual client. • Multiple baseline design: a research in which the effect of the treatment is measured in several individual clients. Treatments and measurements proceed parallel to each other, but start and end at different points in time. Quantitative single-case study: here, by the means of assessments during all stages of treatment, data in figures are gathered for one client. The research can be describing or evaluating in nature (e.g. an assessment at the beginning is related to the set of problems and the expected outcomes; an assessment at the end is compared to the assessmentfrom the beginning and the expectations).

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TABLE 1. Research designs: •

•

• •

Qualitative:

Qualitative effect study: by the means of several methods (e.g. observation, client interview), effects of the treatment in practice for comparable client groups are described; it is demonstrated that there is a relationship between aims and results. Multiple qualitative case study (Case series): a combination of several qualitative case studies. The term multiple case study in the narrow sense of the word is used if results from the original case studies remain visible. In a consensus-based multiple case study, data of separate case studies finally become integrated. A treatment review: a review of the dossiers of treated clients in which the client group is described (age, diagnosis, etc.), how clients had been referred how assessments have taken place, how many clients had been treated individually, how many in groups, how the work has been evaluated and the results of this evaluation. Qualitative case study (case study, Case History): a systematic description of a client’s therapeutic process. An experts opinion: a validation of the work by a practitioner from another professional group (e.g. a psychiatrist) who is able to judge the effectiveness of the treatment from a close distance.

TABLE 2. Techniques for data collection Literature study • Questionnaire • Interview, among others: Change interview Helpful aspects of therapy form Brief structured recall •

Observation • Participant observation • Group technique •

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TABLE 3. Techniques in which data collection and data-analysis go hand in hand •

• • •

Naturalistic constructivis tic inquiry • • •

Grounded Theory

• • • • • • • • •

Delphimethod QUANTITATIVE METHODS FOR DATA ANALYSIS

•

Member checking: this technique involves that data collection and data analysis take place in close cooperation with the people from the context to which both data collection and data analysis refer (client and therapist) Peer debriefing: method of data collection, data analysis and first results are presented to independent experts during the research process. Repeated analysis: based upon newly collected data, the proceeding analysis is regularly compared to the original data and former analyses. Triangulation means that different sources are used for data collection (e.g. arts therapists, psychologists, managers), that different types of data collection are applied (e.g. interview, participant observation, questionnaire) and that several theoretical perspectives are given a chance in dataanalysis (e.g. creative-process theory, analogous-process model, analytically-orientated arts therapies etc.) In the occurrences you describe, look for concepts that give you something to hold on to and describe those concepts. Present concepts and original data to independent reviewers. Look for new material, using the already developed keywords as sensitising concepts. Carry out interviews in order to complete the concepts. Selecting experts, stake holders, clients (diversity of expertise). Exploring the theme by the means of literature study and interviews. Developing topics for the purpose of interviews and questionnaire. Holding interviews and filling in questionnaires (individually and anonymously). Content analysis of responses. Feedback to respondents: asking respondents to comment earlier answers. Several rounds in which respondents are confronted with their own answers and those of others. Indirect communication (via researcher). Similarity to naturalistic/ constructivistic inquiry: application of member checking, peer debriefing and triangulation. Meta-analysis of research results • Data-analysis: TABLE 4. Table of frequencies, diagram Mean, modus, median, variance, standard deviation •

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Cross table, correlation coefficient, linear regression, Parametric and non-parametric tests Logistic regression Analysis of variance Factor analysis and cluster analysis. TABLE 5. Qualitative methods for data analysis • • •

Content analysis

• •

• • •

•

Grounded theory • • •

Phenomenolo gy

•

Select: scrap unimportant passages. Paraphrase: drop superfluous words in important passages. Synthesize: integrate passages belonging to each other on a higher level of abstraction. Analyse: determine relations between kinds of phenomena (e.g. cause – effect, stipulations, conditions, stages etc.) Coding: divide the text into paragraphs dealing with one subject, mark similar paragraphs with the same colour or term (e.g. paragraphs on the diagnosis, the therapeutic relationship, the client’s reaction, etc.) Categorizing: put all corresponding passages into the same category and give a name to this category (e.g. the category ‘diagnosis’). Conceptualising: within the categories, develop concepts referring to important topics (e.g. ‘depressed mood’, ‘relational problem’). Axial coding: determine main- and subcategories (e.g. for the main category ‘work modality’ the subcategories ‘general work modality’ and ‘art therapeutic work modality’; for the main category ‘treatment’ the subcategories ‘cognitive therapy’ and ‘drama therapy’; within the subcategory ‘drama therapy’ the sub-subcategory ‘role method’). Selective coding: look for relations of topics within and between categories (e.g. within the category ‘treatment’ the phasing; between categories: the relation between problem, aims, treatment, effect and rationale). Departs from phenomena as they are experienced by people and the meaning that is given to them. Existing theories are bracketed. By adding or deleting characteristics, the researcher determines what belongs to the essence of a phenomenon. This happens by the means of rational reflection, intuition or imagination whether or not in dialogue with others or through document study.

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TABLE 5. Qualitative methods for data analysis Scrutinizing a phenomenon by the means of a strong form of engagement. • Projecting characteristics onto a phenomenon based upon counter-transference; that way, the phenomenon becomes better comprehensible. • Searching for the latent, deeper (unconscious) causes and meaning of a phenomenon. • Matching the meaning of one part with the entity (hermeneutic circle). Data-analysis methods suitable for Change Interview, Helpful Aspects of Therapy Form (HAT) and Brief Structured Recall (BSR): •

Hermeneutics

Grounded Theory analysis of Change Interview and HAT. • Task analysis of texts concerning significant events. • Discourse analysis. • Conversation analysis. • Comprehensive process analysis. Auditing: presenting the data-analysis to independent experts who control the chain-of-evidence and who determine whether the research methodology is appropriate and results and conclusions can be deduced from the data. •

Qualitative change process research Naturalistic constructivisti c inquiry

For the purpose of this table, the following sources were used: Ansdell, Pavlicevic & Proctor (2004), Baarda & De Goede (2001), Baarda, De Goede & Theunissen (2000), Berger, Imbos & Janssen (2001), Denzin & Lincoln (2000), Frommer & Rennie (2001), Giorgi (1985), Hutjes & Van Buuren (1992), Imbos, Janssen & Berger (2001), Lincoln & Guba (1985, 2000), Mayring (1990), Migchelbrink (2001), Smeijsters (1997b), Smeijsters (2005a/b), Smeijsters & Aasgaard (2005), Stake (1995), Swanborn (1994), Wester (1995), Wheeler (1995/2005), Yin (2003). These tables are meant to provide an overview that facilitates a first choice, suitable for the presented problem and the formulated question of inquiry. After this choice being made, the researcher needs to work out the research design according to the criteria valid for it with the help of specific manuals. Tables - Types, methods and techniques of research

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The research projects carried out by KenVaK1 concern several of those research types. For instance, it is a question of an inventory research if an inventory is made of how the set of problems are expressed in the medium. If, based upon those facts, an observation scale is developed by the researcher, it is a matter of development research. Research projects concerning the inventory of competences, e.g. how art therapists have been trained and what kind of methods and target groups they work with, belong to the type of inventory research. A need research has been carried out by KenVaK, preparing the master programme ‘Arts Therapies’. Managers and arts therapists were asked for which themes they consider themselves most in need for in a Master training programme. KenVaK-researchers frequently use development research. They mainly invent observation instruments and treatment standards. Effect evaluation is a matter of two sorts: it is either about asking arts therapists which effects they perceive or about carrying out experimental research, whilst measuring effects.

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1. KenVaK (Kenniskring Kennisontwikkeling Vaktherapieën) is the research centre for arts therapies at Zuyd University, the University of Professional Education Utrecht, and the ArtEZ Conservatory Enschede.

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Aigen, K. (1995). Principles of qualitative research. In B. Wheeler (ed.). Music therapy research - Quantitative and qualitative Perspectives. Phoenixville: Barcelona Publishers. Alderman, N. (2002). Individual case studies. In: S. Priebe & M. Slade (eds.). Evidence in mental health care. New York: Brunner Routledge. Argyris, C. & Schรถn, D. (1974). Theory in practice: Increasing professional effectiveness. San Francisco: Jossey-Bass Bie, D. de (red.)(2003). Morgen doen we het beter. Handboek voor de competente

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Stafleu van Loghum. Bie, D. de & Gerritse, J.J. (1999). Onderwijs als opdracht. Overwegingen en praktische suggesties voor een ontschoolsing van het hoger onderwijs. Houten/Diegem: Bohn Stafleu Van Loghum. Bie, D. de & Kleijn, J. de (2001). Wat gaan we doen ? Het construeren en beoordelen van opdrachten. Praktijkboek bij Onderwijs als Opdracht. Houten/Diegem: Bohn Stafleu Van Loghum. Blumer, H. (1969). Symbolic interactionism: Perspective and method. Englewood Cliffs: Prentice-Hall. Bogdan, R.C. & Biklen, S.K. (1982). Qualitative research for education: An introduction to theory and methods. Boston: Allyn & Bacon.

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Bromley, D.B. (1986). The case-study method in psychology and related disciplines. Chichester: John Wiley & Sons. Bruscia, K. (ed.) (1991). Case studies in music therapy. Phoenixville: Barcelona Publishers. Bruscia, K. (1995). The boundaries of music therapy research. In: B. Wheeler (ed.). Music therapy research - Quantitative and qualitative Perspectives. Phoenixville: Barcelona Publishers. Campbell, D.T. (1979). Degrees of freedom and the case study. In: T.D. Cook & C.S. Reichardt (eds.). Qualitative and quantitative methods in evaluative research. Beverly Hills: Sage. Cleven, G. (2001a). Met schrijven zichtbaar in beeld. Over het belang van het ontwikkelen en schrijven van modulen en producten. Tijdschrift voor Creatieve Therapie, 20 (4), 29-31. Cleven, G. (2001b). Van kunst naar kunde. Op weg naar een module schrijven. Tijdschrift voor Creatieve Therapie, (20 (2), 9-11. Cleven, G. (2002). De routeplanner voor producten en modulen. Tijdschrift voor Creatieve Therapie, 21 (3), 16-18. Creswell, J. W. (1998). Qualitative inquiry and research design. Choosing among five traditions. Thousand Oaks: Sage Publications Cronbach, L.J. (1975). Beyond the two disciplines of scientific psychology. American Psychologist, 30, 116-127. Drieschner, K. (2002). Het ontwikkelen van creatief therapeutische producten. Tijdschrift voor Creatieve Therapie, 21 (1), 12-15.

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Drieschner, K. & Pioch, A. (2000). Muziektherapie op maat. Methodische keuzes van ervaren muziektherapeuten. Tijdschrift voor Creatieve Therapie, 19 (3), 9-17. Duncker, K. (1963). Zur Psychologie des produktiven Denkens. Berlin: Springer. Ely, M., Anzul, M., Friedman, T., Garner, D. & McCormack Steinmetz, A. (1995). Doing qualitative research: Circles within circles. London: The Falmer Press. Emst, A. van (1998). Professionale cultuur in onderwijsorganisaties. Utrecht: APS/Edukern. Everdingen, J.J.E. van, Burgers, J.S., Assendelft, W.J.J., Swinkels, J.A., Barneveld, T.A. van & Klundert, J.L.M. van de (2004). Evidencebased richtlijnontwikkeling. Een leidraad voor de praktijk. Houten: Bohn Stafleu Van Loghum. Faller, H. & Frommer, J. (Hrsg.)(1994). Qualitative Psychotherapieforschung. Grundlagen und Methoden. Heidelberg: Asanger. Flick, U. (2002). An introduction to qualitative research. London: Sage Publications. Franklin, R.D., Allison, D.B. & Gorman, B.S. (1996). Design and analysis of single-case research. Hillsdale: Lawrence Erlbaum. Glaser, B.G. (1992). Basics of grounded theory analysis: Emergency versus forcing. Mill Valley: Sociology Press.

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Gomm, R., Hammersley, M. & Foster, P. (eds.) (2000). Case study method. London: Sage Publications. Guba, E.G. & Lincoln, Y.S. (1989). Fourth generation evaluation. London: Sage Publications. Guba, E. G. & Lincoln, Y. S. (1994). Competing paradigms in qualitative research. In: N. Denzin & Y. S. Lincoln (eds.). Handbook of qualitative research. Thousand Oaks: Sage Publications. Handwijzer voor het schrijven van zorgprogramma's, www.ggznederland.nl/zorg. Hattum, M. van & Hutschemaekers, G. (2000). Vakwerk. Producttyperingen van vaktherapeuten voor het programma stemmingsstoornissen. Utrecht: Trimbos-instituut. Higgins, R. (1993). Approaches to case-study. A handbook of those entering the therapeutic field. London: Jessica Kingsley Publishers. Hilliard, R.B. (1993). Single-case methodology in psychotherapy and outcome research. Journal of Consulting and Clinical Psychology, Vol. 61 (3), 373-380. Jacobson, N.S. (1988). Defining clinical significant change: an introduction. Behavioral Assessment, 10, 131-132. Kazdin, A.E. (1980). Research design in clinical psychology. New York: Harper & Row. Kleijnen, J. (2004). Onderzoekstypen in het HBO. Heerlen: Hogeschool Zuyd.

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Author information Prof.dr. Henk Smeijsters Prof.dr. Henk Smeijsters is head of research of KenVaK, an advanced research centre for the arts therapies (drama therapy, psychodrama, music therapy, art therapy and dance-movement therapy). KenVaK is a joint venture of Zuyd University, the University of Professional Education Utrecht, the ArtEZ Conservatory Enschede, and the partners Oostvaardersclinic (forensic clinic), the School for Psychodrama and the Papageno Foundation (music therapy for autism). MAILING ADDRESS:

Zuyd University, KenVaK, P.O. Box 550, 6400 AN Heerlen, The Netherlands Phone: 0031-45-4006483 Fax: 0031-45-4006069

Author information

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E-mail: h.smeijsters(at)hszuyd.nl Homepage: www.smeijsters.nl and http://kenvak.hszud.nl

This article can be cited as: Smeijsters, H. (2006) Research in practice. Music Therapy Today (Online 22nd December) Vol.VII (4) 781-838. available at http://musictherapyworld.net

This article can be cited as:

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Music Therapy Today Vol. VII (4) (December)

Beyond Body, Beyond Words: Cognitive analytic music therapy in forensic psychiatry - New approaches in the treatment of Personality Disordered Offenders Compton Dickinson, Stella

Compton Dickinson, S. (2006) Beyond Body, Beyond Words: Cognitive analytic music therapy in forensic psychiatry - New approaches in the treatment of Personality DisorderedOffenders. Music Therapy Today (Online 22nd December) Vol.VII (4) 839-875.

Is it not plain that breath conveys even the words that go out from our lips to the ears of the hearer? The voice is breath. The word is breath. Without breath speech cannot be produced.â&#x20AC;? Hazrat Inayat Khan. The music of life. 1988 Omega Press

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Abstract In this paper the author presents a case study of a man with psychopathic and borderline personality disorders. She demonstrates the application of dynamic music therapy skills and training integrated with those of cognitive analytic psychotherapy (CAT). The aim was to provide a twenty four week time limited psychotherapy intervention that included attuned musical improvisation as a central component. The treatment has been developed with personality disordered patients who have offended and who are in high secure hospital treatment. The author considers the phenomena of dissociation in relation to the etiology of self states (Ryle and Kerr 2002) and with reference to the creative arts. Within the therapeutic context she considers the potential of music as a mediating tool for emotional regulation in the transition between self states. The paper demonstrates some of the therapeutic functions of music in feeling, thinking, acting and behaving and in accessing unspeakable areas of emotion. It explains the interaction between the cognitive analytic tools and concepts and dynamic music therapy.

Background Over the last five years I have considered whether or not it may be possible to develop an integrated approach in which the skills of a qualified music therapist may be combined with those of a cognitive analytic therapist. The organizational and treatment demands of high secure hospital treatment require robust and acceptable forms of arts therapy. Multi disciplinary treatment requires a Patient to undertake specific offence related group or individual psychology sessions. The Patient may also be referred to music or art therapy to promote emotional relatedness through which offence related issues might also be addressed. Individual therapists and psychologists therefore have to work cohesively within the overall treatment programme. The twenty four week time limited model is not expected to achieve the depth of long term ongoing therapy, but rather to be delivered at an optimum time in the treatment pathway.

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Compton Dickinson, S. (2006) Beyond Body, Beyond Words: Cognitive analytic music therapy in forensic psychiatry - New approaches in the treatment of Personality Disordered Offenders. Music Therapy Today (Online 22nd December) Vol.VII (4) 839-875. available at http://musictherapyworld.net

PART 1 Introduction. I describe the model that I continue to develop as follows: Cognitive analytic music psychotherapy is an integrated approach developed towards helping Patients with severe and dangerous personality disorders to access, recognize and work with difficult to access feelings. It incorporates the skills of dynamic music therapy which includes jointly created musical improvisation with the structures and training of cognitive analytic therapy. The latter involves collaborative work between Patient and Therapist in which symbolic 'tools' are created. These take the form of a reformulation letter which identifies the target problem of the therapy and a sequential diagrammatic reformulation (SDR) which helps the Patient to recognize and understand his particular 'reciprocal roles' (Ryle and Kerr 2002). The aim of this diagrammatic work is to develop the patients ability for scaffolded learning.(Vygotsky 1978) Through this process he learns non didactically from the more experienced other. i.e. the therapist. Together the therapist and patient work diagrammatically to map out and recognize where the patient is in relation to his responses to others, his thoughts, feelings and behaviors, and how he arrives and moves from one state of being to another. (See Figure 1 on page 866) Reformulation in CAT is developed usually over the first eight sessions of therapy. It is a skill that is learnt throughout training and within weekly group supervision. The aim is two fold: The therapist focuses his thoughts on how the patient's problems developed and where the roots of these began in childhood in reference to object relations attachment theories. He then reframes these cognitively by identifying and clarifying the relating procedures of patient. A written explanation in the form of a let-

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Compton Dickinson, S. (2006) Beyond Body, Beyond Words: Cognitive analytic music therapy in forensic psychiatry - New approaches in the treatment of Personality Disordered Offenders. Music Therapy Today (Online 22nd December) Vol.VII (4) 839-875. available at http://musictherapyworld.net

ter is produced and read in the session . Within the reformulation letter an achievable target problem is identified which will be addressed in the pre agreed time limited model. The reformulation is further illuminated through collaborative diagramatic work in which therapist and patient work collaboratively to build up the SDR. This diagram should also aid the process of recognition within the patient, hence promoting self reflection, self awareness and insight. This provides an aide memoire for the patient to work with between sessions and after therapy in order to help him to think about where he is within his relating procedures. These reformulation tools should identify the reciprocal roles that operate within the patient : internally (self to self) as well as interpersonally (self to others)and others to self For example: perceived rejecting behaviors from another may elicit feelings of rejection in the patient and subsequently lead to self isolating behaviors indicative of being rejected. This may be followed by an acting out of being rejecting as a retaliation. Hence the reciprocal role of rejecting to rejected is learnt initially from others but both polarities can operational internally. Through the therapy process the patient may recognize the roots of his relating procedures as learnt in childhood . The reformulation should then help him to consider and revise learnt procedures that are no longer effective in the current situation which is generally hold very different circumstance to childhood. In this way the patient may revise his relating procedures hence finding new and effective exits to difficult interactions and situations. At the end of the twenty four week treatment the Patient and Therapist create and swap 'ending letters' to summarize and promote resolved closure to the agreed episode of treatment. The overall process involves facilitated self-reflection on significant past events in a supportive therapeutic environment. The development of healthy therapeutic

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attachment and separation is central to the process by which mitigation of damaging past experiences can occur.

Prequel This paper considers the application of cognitive analytic music therapy to Patients diagnosed in the International classification of diseases (ICD10) within the F60 descriptions of personality disorder, therefore primarily cluster A diagnoses according to the diagnostic and statistical manual (DSM1V) My thinking as a C.A.T Therapist is strongly underpinned by my philosophy, and training as a registered music therapist. This integrated approach uses CAT tools and techniques and the concept of collaborative music making through which the music becomes an artifact that represents the culture of the sessions. The collaborative relationship involves explanation of some processes thereby translating them into cognitive terms and aiming to provide less of a gulf of knowledge between what the analyst holds and what the patient does. One of the aims of jointly created improvisation within this model is to ensure that the reciprocal roles of overwhelming and superior to overwhelmed and inferior are not re enacted within the therapeutic relationship. This may occur if the patient's perception of the music therapist is that he/she holds a superior power demonstrated through the use of perceived 'clever' musical skills. For the forensic patients that there is commonly a risk of feeling humiliated due to past abuses experienced in childhood. Should this inadvertently occur, the risk of violent acting out is increased. The therapist therefore requires comprehensive subtle music therapy skills to ensure that aroused states can be musically contained, affect

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Compton Dickinson, S. (2006) Beyond Body, Beyond Words: Cognitive analytic music therapy in forensic psychiatry - New approaches in the treatment of Personality Disordered Offenders. Music Therapy Today (Online 22nd December) Vol.VII (4) 839-875. available at http://musictherapyworld.net

regulation maintained and that manipulation does not occur. Through an agreed collaborative process of creative self expression and cognitive understanding the Therapist and Patient can work together towards the patient's zone of proximal development (ZPD) (Vygotsky1978).This concept refers to the potential for development of inner growth by employing the structures of scaffolded learning i.e. the CAT Tools. The ideal is to discover how to use the skills and techniques learnt in therapy when alone. In this pre agreed time limited intervention the formulation or realistic goals is central along with acceptance of the patient's inner potential and rate of change. The pace may be intensified in a time limited therapy but the objective is to achieve a realistic and sustainable outcome that is not forgotten after closure. The development of an integrated model has involved the support of the organization in providing two forms of supervision: 1. Music therapy supervision: To consider the therapeutic relationship and how it is expressed within jointly created musical improvisation. This is objectively explored in relation to the patient's projections the transference and counter transference and within the overall psychotherapeutic process. 2. Cognitive analytic supervision: With a view to developing an integrated model of the two therapies. To include a detailed reformulation and other 'outside of session' written work. Supervision also considers from the CAT perspective the manifest procedures and behaviors as well as the feelings expressed in music, words and actions .These are mapped onto a Sequential Diagrammatic Reformulation. This supervision has intensified the focus of the ongoing nature of psychodynamic music therapy in which themes may emerge towards a time-limited structure which expects a commitment of jointly created work from the patient with the therapist. One of the challenges in treating the forensic client group is how to provide a Multi disciplinary treatment model that is compatible with concur-

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rent treatments and cost effective. I suggest that in music therapy emotional abreaction is central to the process of internal change: the patient remembers or enters a state of reverie and may experience the associated feelings to a past event. Clinical experience to date suggests that this can be incorporated into a robust cognitive analytic treatment model which recognizes but does not encourage regression. Freud and Breuer (1991) in the case of Anna O discovered that abreaction occurred when powerful emotions relating to a remembered event were expressed with feeling. The significant point being that feeling the emotion internally was considered necessary for the symptoms to disappear. Macdiarmid (1996) enlarges on this case pointing out that the symptoms started when Anna O had a powerful emotion that she couldn't express, thereby suggesting an internal resistance to the feeling which creative expression could possibly access. This difficulty in expression is I suggest particularly central in treating, redeeming and incorporating dissociative states in personality disordered patients because those feelings have frequently been unconsciously cast out as unbearable. As a result these patients are frequently highly articulate but their words may not hold any underlying feeling or meaning. It is well documented and commonly experienced that music can be the catalyst for feelings (Sloboda 1985). There are however inherent risks with pre-recorded music, because difficult or unmanageable feelings associated to powerful memories may be accessed. By developing improvised music, the music therapist can facilitate an accurate encapsulation of the Patient's here and now affect and through this promote the ability to self reflect on the emotional qualities of the music by listening to what has been created and recorded.

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Bliss's approach (1980) to the treatment of multiple personality disorder (MPD) was to explain to the Patient, (perhaps not dissimilarly as in a CAT therapy), that as an adult, he can 'flush out, remember and defeat unwanted personalities.' In the case of MPD the Patient may be unaware of his other personalities; who's function may be to say what the person can't say, or feel what the person finds unbearable to feel. Not dissimilarly, patients with borderline and psychopathic personality disorders may be unaware of their state shifts (Ryle and Kerr 2002). Sudden and unpredictable mood changes are symptomatic of state shifts and there may be no recognition or awareness of this process. This occurs when the feelings associated with the experience become intolerable and the unconscious defense mechanism of dissociation comes into operation. This constitutes a risk factor through resulting behaviors which have to be considered for the delivery of safe treatment. Whilst Bliss worked with hypnosis, I suggest that his explanation has some relevance in the development of music psychotherapy because music used in certain ways can create quasi hypnotic states and altered states of consciousness which could be either helpful or abusive if misused. Bliss also states that tactics that reduce emotional intensity can be helpful in reducing anxiety and panic. This supports the use both of the C.A.T cognitive tools and the central facilitative properties of the role of affect attunement (Stern 1987) to mediate emotional relatedness. In music therapy affect attunement occurs in the process of using the creative medium for empathic emotional recognition through mirroring and containment in spontaneously created musical improvisation. In my earlier paper (Compton Dickinson 2001) in which I compare and contrast dynamic psychotherapy with CAT, I explain in greater depth the link between affect attunement and sign mediation (Ryle and Kerr 2002). To

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summarise: musically expressed affect attunement is effected through working with elicited counter transference, i.e. the therapist chooses whether to identify with or reciprocate to the musically expressed reciprocal role of the Patient: hence tuning into the non verbal reciprocal roles that are perceived, seen and heard through musical and physical actions, gestures and behaviors. The therapist aims to meet, match, mirror and make recognizable the unrecognized mood or need of the patient as expressed or enacted through their reciprocal roles or self states. The Cognitive Analytic Therapy (C.A.T) split egg diagram (Ryle and Kerr 2002) see appendix, is a visual aid to understanding the psychic split that can occur between good and bad part states of varied individualized descriptions. It is a useful tool in CAT by which orientation to the real world is supported, hence promoting recognition of potentially escapist elements. This diagrammatic work may take place at any time during a session; for example prior to improvisation to help locate what state a patient is in at that time; alternatively to aid recognition when a Patient has used music defensively to avoid a difficult feeling through musical flight into an idealized state. This case study aims to demonstrate appropriate use of therapeutic musical interaction in improvisation to facilitate the reclamation of dissociated states.

PART 2 Musical developments towards treating personality disordered Patients In reformulation issue 21 Steve Potter asks â&#x20AC;&#x2DC;Where do states come from? And where are they when they are gone? He continues: â&#x20AC;&#x153;States can mediate our experience and come and go like headaches. They can be fleetingly or chronically endured. States once PART 2 Musical developments towards treating personality disordered Patients

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fleetingly embraced are subsequently fragile when achieved or pined for helplessly. States can saturate, or haunt, or empower our sense of self and other. They can be dreadfully avoided as can the people, or persons, or memories of place and time that are associated with them, We can get stuck in them; be triggered by events into or out of them. We can set our freedom of will and consciousness’ against them and ride over them. We can lose ourselves in them” (Potter2004) This description triggered a considerable journey of exploration in which I reflected on Potter’s observations and the potential for links to non verbal creative expression. THE ROLE OF JOINTLY CREATED MUSICAL IMPROVISATION IN THE RECOGNITION OF SELF STATES AND AS A MEDIATING TOOL FOR THE TRANSITION BETWEEN SELF STATES.

I suggest that the Patient must also accept the recognized feeling, rather than simply acknowledge it. The music may otherwise become dissociated, outside of himself or attributed to the therapist alone. When a jointly created artifact in the form of a musical improvisation is produced, it may be felt as part of the Patient’s own self-expression. It can be experienced as part of him. According to Vygotsky’s (1978) activity theory, the artifact is created with the help of the more experienced other i.e. the therapist. In the musically therapeutic context as the work proceeds the therapist may gradually offer less musical structure i.e. scaffolding. This would occur in response to the Patient’s developing abilities to explore, express himself and relate reciprocally in dialogue. Within this process, I suggest that the nature and qualitative effect of the vibrations absorbed into the body through the specific sounds produced are crucial towards the development or otherwise of the sense of therapeutic connection. It is in this way that recognition of the affective qualities of the music may occur. The sensitivity of the therapist’s musical skills should ensure that the Patient feels empowered rather than inferior or without any skill so that he can take ownership of his music. Subtle musical techniques support PART 2 Musical developments towards treating personality disordered Patients

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the creation of jointly created music so that the Patient can recognize his own musical self expression as well as build up his relating abilities through recognition and value of the support provided by the therapist. When self-states have been identified diagrammatically, the Patient can be musically and therapeutically supported to feel these through the musical interaction. The therapist may carefully initiate the associated quality of feeling whilst maintaining containment. The patient is in a safe relating situation that has the potential to challenge his old fears and bring forth the need to invest trust. In the primary abusive situation he may have been alone and terrified, in the therapeutic situation he may instead gradually tolerate and internalize the feelings rather than acting them out. There are situations where I suggest the music therapist can validate starting the musical interaction or even playing alone, rather than waiting. The use of the observing eye, (as if outside oneself looking at oneself,) informs this process. This enables decisions to be made about how to respond to what is perceived. Particularly with regards assessing whether the patientâ&#x20AC;&#x2122;s anxiety levels are bearable or unbearable, therapeutically containable and useful or otherwise contraindicated in the global sense. To ascertain and express what is felt implicitly from the patient rather than what is explicitly said is useful because the personality disordered patientâ&#x20AC;&#x2122;s words may not be felt sincerely as such they may not be congruent to the therapists counter transferential experience of the patient. It is in this way that the therapeutic process is informed. I suggest this technique can be helpful in gently shifting the focus of the therapy. For example where the sense of being stuck may have been thor-

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oughly felt by therapist and patient but has become counter productive: The counter transference may inform the therapist of a blank sense of emptiness, as if the Patient is struggling to identify any feeling at all. Initiating the music can sometimes create greater intensity than simply going with what the Patient presents. I have considered that a purely psychodynamic approach in some circumstances leaves the therapist open to manipulation from personality disordered Patients. Without appropriate structures in place the therapist requires is vulnerable to becoming an object through which a patient could sadistically re- enact abuse. Musical improvisation instead be incorporated into the containing and facilitative structures of cognitive analytic psychotherapy. A psychoanalytic approach in music therapy with offenders is demonstrated by Glyn (2003). He explains how a Patient’s choice to play certain songs and the meaning of their words, through accurate analytical interpretation promoted insight into the offence. The patient shifted from denial to being able to see what he had done to his victim. I understood Glyn’s description as ‘two people dynamically engaged but with the capacity to view what they are doing as if from a third external position’ as not unlike the CAT concept of the observing eye. There are many different therapeutic means to an end and this example is highly relevant to the development of victim empathy. Glyn strengthens the argument for music psychotherapy with this client group as opposed to a softer form of music therapy in which transference and counter transference are not primary tools. Without recognition and understanding of these processes the meaning of psychotic and erotic transferences may be missed, thereby loosing sight of the symbolic nature of the therapeutic relationship. The complexities and difficulties of addressing the index offence that brought the patient into treatment through the criminal justice system can be accessed through creative use PART 2 Musical developments towards treating personality disordered Patients

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of metaphor and non verbal expression. Recognition and understanding of deeper meanings may then follow. I suggest that psychotic defenses can be mitigated through further development of collaborative and cognitive music therapy processes that do not include psychoanalytic interpretation in the CAT time limited model. The patient may discover an acceptable musical medium through which he can find his own musical voice. In this way he may portray repressed or suppressed feelings relating to his offence. The musical interaction may also reveal aspects of how he related to significant others. The improvisation can then be objectively analyzed at deeper levels in supervision. In the following session the Patient and Therapist can reflect collaboratively on its meaning, hence promoting greater recognition and self awareness through self reflection rather than interpretation. The patient can feel directly and equally involved, empowered and can take ownership of his feeling. In this way analytic levels may be recognized but mindfulness of the closer nature of a collaborative therapeutic relationship has to be addressed.

PART 3 Case Study: Beyond Body, Beyond Words HISTORY

Colin is a British citizen in his forties, born of immigrant parents.. He is diagnosed with psychopathic and borderline personality disorders. He was a victim of childhood sexual abuse at the age of eight years old. During early childhood his grandparents brought him up because his mother ‘abandoned’ the family ‘to live with another man’. At age seventeen years Colin found his mother and threatened to kill her. Colin has been detained in prison and then high secure hospital for over 18 years in all. He has undertaken comprehensive psychology treatments including advanced dialectical behavioral therapy and anger management. He has

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had some musical education but no formal musical training. His index offence is assault and wounding with intent. He has also been convicted of indecent assault and burglary. He has attempted to poison a woman and has a history of violence towards women. DESCRIPTION

Colin is slightly built but can be large in presence. He is physically very fit but has several physical ailments that cause him a lot of bodily pain. He has a bright and amenable nature and a good sense of humour. He presents as articulate and intelligent. He is meticulous about his appearance, cleanliness and routine. He has a broad smile and natural bright eye contact. He is creative in song writing, drawing and painting.

REASON FOR REFERRAL

Colin was referred to music therapy to promote his engagement with feelings through music and to relate to a female therapist. I understood that the Team considered that he could talk convincingly but his words were not sufficiently related to his feelings.

THE PSYCHOTHERAPY FILE

This is a standard CAT Tool in the form of a questionnaire that identifies different problematic ways of relating in the forms traps, snags and dilemmas. Colin felt unable to complete this early in the therapy. We therefore worked on it gradually in the sessions. Colin did not identify with the traps, snags and dilemmas but the page of different self states provided rich material: I have written Colin’s comments in italics. He identified the Zombie state, Feeling bad but soldiering on, Rage:‘ Definitely! but not out of control’ In control of self, cheated by life and others. Untrusting, Fearing abandonment (If asked when a child, Yes,) I noted that this could not be acknowledged in present relationships. PART 3 Case Study: Beyond Body, Beyond Words

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Confused, misunderstood, rejected and abandoned. Contemptuously dismissive of myself-he described this ‘as the worst place’ this reminded him of his nightmares in which he was unable to scream. Needy’: to get out of here!’ Hurt by others. Secure in myself and able to be close to others. I was not convinced about his ability to get close to others, particularly as it opposed his final comment: Frightened of others ‘how long have you got? Aren’t most people?’ This last comment was particularly significant to the frightening to frightened reciprocal role and how C subsequently created distance between us. BEGINNING THERAPY

Colin firstly played The Tam Tam. This is a very large Chinese gong. He responded ”It feels like something is going to happen”. Having used a soft mallet to produce the sound, I showed him how to put his hand close to the gong by which he could physically feel the resonance of the resulting sound vibration without actually touching the gong. In this way Colin made a link between listening and feeling. I suggest that this sense of feeling without being touched was significant for Colin to create safe distance and yet still communicate and develop trust. Colin initially described ‘deep’ and ‘bright’ tones but nothing between the two polarities. Through some simple diagrammatic work with the split egg design, we linked these contrasting qualities of sound to Colin’s ‘demon’ and ‘normal’ states. These two states were all he could recognise about himself. With some surprise he said: “there’s nothing in the middle! Its blank.... Blankety blank!

There was limited emotional

expression and my counter transference was of shocked emptiness.

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At the end of this session he asked if he could bring his own guitar. The following week I was introduced to ‘Bessie’ the bass guitar. I perceived Colin’s sense of attachment to Bessie as similar to that of a transitional object and we noted that her voice was low and muted in quality, rather like his own voice. He said ‘she does what I want…at least... most of the time”. The latter seemed to have a hesitant quality. I wondered if this remark and his apparent need to be in control also reflected how he felt about the therapeutic relationship. I considered that his final remark may really be expressing his doubts about whether I would do what he wanted. Even if Colin could not yet articulate this to me directly, it became clear that the development of trust would take time. I had explained the structure and time limit of the therapy but I had insufficient material for a reformulation letter by session four. The first few sessions had been less directive than a purely verbal CAT therapy. This was my first application of CAT with the high secure hospital client group so I was cautious to consider the differences from community patients as well as the index offence. In supervision we reflected that an optimum point for the reformulation letter would probably evolve. This occurred after a significant improvisation in session thirteen. I will now describe how the therapy led up to this point. SESSION 7

Colin announced ruefully that he couldn’t bring Bessie because she was ‘poorly’. As the session progressed Colin described how he himself felt poorly and that he was ‘hurting’ both physically and mentally. He was having recurrent bad dreams. He shared that in the dreams he was the victim of the crime that he had in real life perpetrated. In supervision we recognised that he may have left Bessie behind as indeed he was also in the habit of leaving his dissociated feelings behind, but he had brought these back into the room via Bessie in order to look at the hurt parts of PART 3 Case Study: Beyond Body, Beyond Words

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himself. Colin seemed to be able to talk about his own body by projecting his feelings into his guitar. By telling me his nightmares I was holding and containing these feelings and so he was trusting me. We were connecting as two human beings as well as non verbally in musical interaction. Colin left session seven saying that he had come to the session ‘feeling little’. At the end he drew himself up to his full height and said, with what I experienced as a slightly puzzled and surprised sense of satisfaction, that he felt bigger than when he had arrived. Consistent orientation to the present reassured Colin that he would not be treated as a child even when we were exploring childhood issues and he presented as somewhat regressed. This may have given him permission to explore his own inner child within the therapeutic relationship without feeling ‘silly’ and to go back to the ward able to cope with the custodial environment . I discovered that I could work constructively with potentially regressed aspects of Cs personality. Various different ‘boy’ states surfaced, these were recognised and then contained within the maternal transference. In this way a dialogue began both from myself to each ‘boy’ state and then within Colin to that part of himself: quiet boy, sad boy, bully boy, happy boy etc. he then conveyed this connection to me. Trying to locate all of these states onto a cohesive diagram became a challenge as they were initially so compartmentalised that no links could be found in how he shifted between them. I view this as the key problem in personality disorder and dissociation. When Colin next brought Bessie to the session he too was feeling better. He related to the notion that his voice had been heard through the bass guitar and that ‘Bessie’ had helped him to talk about himself. In the next

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session he chose to play the six string electric guitar. He did so very quietly in an introverted and isolated manner. I perceived a distant quality. I responded that this sounded like quite a different voice that I hadn’t heard before. I described it to him as tiny and rather weak, continuing that I experienced this small voice as like a little flower struggling to grow. Colin engaged with this idea of a vulnerable flower and a little voice that needed to be nourished in order to survive. The following week he arrived highly motivated and with a clear plan. He had brought another of his own guitars. He said he had tuned it especially for the session. THE HEART OF THE THERAPY: SESSIONS 1114

I will describe the two significant Improvisations that occurred and led to the reformulation letter. Improvisation 1 retrospectively named by C as ‘Energy Child” Duration 6 minutes. (Session 13). I chose to play the Piano as I thought it would be less threatening for Colin than if I were to play the oboe on which I am a skilled player. I initiated a simple, modal melody. Colin played his Electro Acoustic Guitar. This was not in tune with the piano, yet he was very definite that he had tuned it as he wished it to be. I had chosen the piano to create harmony but I subsequently felt that I had been cleverly controlled as I could not provide harmony because of the fixed pitch of the piano. I could not adjust its tuning to that of the Guitar in the way that I would have done if I had chosen to play the oboe. Hence harmony in relating also became difficult because of the distance created. It was only after the therapy finished that Colin explained that he had tuned the guitar in this way on purpose to keep me at a safe distance. There was an abrasive edge to the music which was an agonising experience, yet also deeply moving and connected because he had allowed me PART 3 Case Study: Beyond Body, Beyond Words

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to enter his world. The out of tune aspect added to the emotional content. I reflected that there was a powerful parallel in how Colin succeeded in making me feel something of the agony, frustration, trappedness and unreality of the childhood situation that he subsequently described in the imagery of this piece of music: “Energy Child”Description . 1st section I play introductory notes on the piano to set the scene, aiming for a spacious open and non descript feel which was based on the counter transference experience. Thereby inviting Colin to initiate his theme. 2nd section I initiate a 6/8 dotted rhythm at the Piano. Colin listens then engages with chords, the piano melody is added, each time returning to the same home note. Colin accompanies this and it becomes a genuine dialogue. I then play as if treading water whilst Colin decides what to do next. I use a questioning motif leading to a moment’s silence then: 3rd section is initiated by Colin. This is clearly connected playing. I add to and support Colin’s theme and this is harmonious, together and accepted by Colin. Finally he becomes more adventurous harmonically. Silence follows then Colin adds his own resolved ending. At the end Colin said as if to himself ‘speak to me, speak to me!’ Colin listened to the recording and said it reminded him of when he was a child of eight years old. He began to describe his place of refuge where he would run away and hide after suffering childhood sexual abuse. The imagery was so vivid that I asked him if he would like to draw this place. (See Figure 2 on page 867). I only had a piece of A4 paper and a biro. Colin drew a straight river across the page and described how ‘boy’ would sit on a fallen tree trunk and cast out part of himself into the river’ like a boy mermaid’ to swim about freely. I noted that ‘boy’ was a word

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and did not have a body and that mermaids are female. Retrospectively recalling that in myth a mermaid cannot survive away from water and nor could Colin’s innocent state survive it had been taken from him. In his disclosures Colin explained that as a child he had been confused about his gender. In this scene we together recognised that he had cast out the shamed part of himself and all the intolerable feelings that it held. In his desire to be cleansed by the water of the river he had lost this voice because that part of him was no longer in his body. He had released this unacceptable, vulnerable, abused boy state and set him free into the river. Colin then realised how his ‘bully boy’ state has been able to take over and rule supreme within him, unchallenged and able to survive the hardships of youth with a tough protective mask. I have considered that this collaborative musical interaction took us to the place where Colin’s dissociation began as a coping mechanism and as a result of the unbearable feelings initiated through the traumas of childhood sexual abuse. Unlike his real mother, I had been there for him. He had developed trust sufficient to take me to his secret place. If he had allowed us to be in tune I believe we would have been too close which may have led him to feel a negative loss of control through the reciprocal role of powerful, frightening, dangerous parent to vulnerable, frightened weak child where the degradation had originally occurred. Instead he took control but in a dialogue of equals because it was more the real him to be out of tune. He was assertive in making his dissonant voice heard and therefore he gained recognition on his own terms. Colin brought a pastel drawing to the next session; it was of a flower with four petals. He asked me to tell him what was wrong with it. I said that I could see that one petal was paler than all the others. He was pleased with this response and explained that this represented his sad, silenced boy state and that he had surrounded it with prickles to keep people away. Of PART 3 Case Study: Beyond Body, Beyond Words

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course on a deeply unconscious level prickles also draw blood and cause pain. The quality of the interaction was not hostile. I considered after the ending of treatment that it was too intolerable for Colin to own his hostility towards me and the world. The next improvisation was called ‘happy boy’ in which on listening to the recording he recognized that his playing of the bass xylophone sounded ‘like a frightened rabbit beating its feet as a warning.’ I had responded on the descant recorder which gave the piece a childlike quality. However, the piece seemed to grow up and developed from these tentative, frightened childlike interactions into a rhythmically consistent and energetic reciprocal dialogue with sections that developed into a melody with four equal sections. Colin listened to the recording and reflected ‘ we are back in the flower’ with its four petals. I responded that this time, the four part music had individual petals that were equal in quality. At the time there was a sense of healing and integration. In retrospect I look at the flower (see Figure 3 on page 868) which has been perceived by some to resemble female genitalia and as I think of how the strength of his music developed I wonder whether Colin was in fact attacking me. It is indeed difficult to keep in mind both the cruelty and the helplessness of these patients. I probably preserved the split at the time because in parallel process to Colin’s experience, the holding of the domineering and threatening aspects can be almost intolerable for the therapist. The reformulation letter crystallised in words what had happened in the musical interaction. Colin had reclaimed some parts of his life story and personality. It also brought recognition of Colin’s need to be rescued, just as he used to be ‘rescued’ from his place of refuge by ‘a nice policeman who carried me home’. But in reality there was no real rescue because the policeman took him back to the home where the abuse continued to occur. PART 3 Case Study: Beyond Body, Beyond Words

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Self states and their Reciprocal Roles. Colin was able to recognise and locate his reciprocal roles and gradually to work with target problem procedures to link his self states. This began with diagrammatic work in which each ’boy’ state had a separate and unconnected box of its own. As the links were made collaboratively, Colin discovered through the guitar the different voices that linked to his different states. He developed the ability by the end of therapy to be able to sustain ‘play’. Like a child there was fun and laughter between us. He also realised that healthy musical interaction between a male and a female was acceptable and at times joyful. These experiences were recognised as ‘normal’ rather than his childhood experience of ‘being shaken like a doll’ by his mother. He exclaimed this discovery as coming “ after thirty one years of neglect ...by Mum”. I considered that this increased the pressure to effect a resolved ending, so that Colin could be normally sad without feeling abandoned. The Ending. Colin did not engage consciously with anger or fear about ending. I had been idealised as another person who had rescued him, having helped him to retrieve quiet, sad, abused boy from the river. Colin had drawn a representation of himself as a damaged flower with prickles to defend the damaged part. I had been expected like a good mother, to understand what the picture meant without his prior explanation. Colin had also spoken very explicitly about the sexual abuse from his father, but he has never told his mother, and she still does not know. Colin stated in his ending letter that bully boy demon state can’t rule him any more because abused boy with all his qualities has been recognised, seen, heard and can hold his own’. Abused boy can ‘forgive but not forget.’ Exits: Session 22

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Ongoing diagrammatic work led to a major revelation when Colin discovered that feelings lie centrally in the body. He had not realised that feelings were different to thoughts and that they could be felt safely within his body. In this way he discovered that feelings reside in the heart and not in the head. The heart could be conveniently located on the SDR between the two halves of the split narcissistic egg so that he could locate his feelings on his map and work out how to access them. This was helpful in mitigating his ability just to ‘talk the talk’. Final session Colin chose to play the electric Guitar, the music was reminiscent of ‘Energy child’ except this time I vocalised without words. There was a lamenting quality but with acceptance and the reciprocal role of controlling to controlled was not present. Bessie the Bass Guitar was reflected on as an object: The low voice of a man, the body shape of a woman. I consider that Bessie represented potentially dissociated aspects of Colin’s relating to himself and to others. Colin brought a second flower picture (see Figure 4 on page 869). He presented this to me as representing his healed self. He was clearly pleased with his creation which is dynamic and virile, strong and masculine in quality but it left me ill at ease. It was only later that I could acknowledge the barbed anger and potential power to harm that it might represent. Perhaps this was an unspoken, unconscious gesture of anger that we were finishing our weekly contact. I had been the woman who had witnessed his place of abuse and now I may be perceived to be abandoning him after he had opened himself up. Colin’s ending letter said that he can be soft, gentle boy because angry boy is at peace. He indicated some acceptance and reconciliation that I

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consider may have occurred because he abreacted aspects of the trauma in his relationships both to his mother and father. Colin discovered that he had the ability to invest trust enough to show me ‘the real me. He had gained some acceptance and the ability to love his own inner child rather than to hate himself and others. SEQUEL

Colin achieved his aim and moved on from Rampton Hospital. However a year further on this proved unsatisfactory and he returned. Colin had denied that the abuse ever took place. This had lead to mistrust in his team. I reflected on this in supervision. Perhaps Colin could not hold the therapy experiences within him just as he had no control over the appalling bodily experiences resulting from the physical pain and damage of childhood sexual abuse. Nothing could stay inside any more then than now. His containment as an adult had been provided by high walls and outer security. It was behind those high walls that Colin discovered some inner security and good enough symbolic parenting figures through the attentive care of his named nurse, his psychologist and his music psychotherapist. Perhaps it was too much that through the development of trust in the therapies that Colin exposed his inner self, thereby risking vulnerability. However all that he was unable to control as a child, all that made him vulnerable and degraded could be given temporary respite through identification with the aggressor and the re enactment of this abuse in the violent penetration of his offence. Perhaps when Colin was unable to employ the techniques learnt in his therapy in his new ‘home’ he felt intolerably abandoned by us all. He turned the tables on us by indicating through his dissociation from the childhood abuse that whilst we thought we knew him, we didn’t really. This may be viewed as tantalizingly provocative as if we see him but do not reach him. His isolation and terror would therefore be perpetuated. When ‘home’ alone without either internal or external controls he sought unconsciously perhaps to penetrate and

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return to the confinement of high security. The powerful rescue fantasy that began with the policeman by the river took him back in his mind so that he may have hoped for rescue from his named nurse and myself. But this may also be viewed as yet more of the same: whilst dissociated and unconscious there are both sadistic and masochistic elements in both his past experience and his response to recent perceived abandonment. The bully boy had reinvented himself because he discovered that there was no safe home. The ongoing work would be about true integration over the longer term, the split between the two boy states is still too useful to relinquish and twenty four sessions of therapy is a drop in the ocean in terms of time in comparison to Colinâ&#x20AC;&#x2122;s compounded problems over many years.

Conclusions The therapy was evaluated with the PROQ2 Person relating to others questionnaire (Birtchnell J. Institute of Psychiatry). At closure and follow up this scored sufficiently low to indicate that there was no evidence of active psychopathology. I suggest that this indicated a dynamic process of change that occurred during the therapy. However this and the sequel to treatment indicate that in personality disordered patients who are not receiving anti psychotic medication, their relating may be influenced by environmental factors and the responses of others. As such the patientâ&#x20AC;&#x2122;s ability to relate to others may fluctuate and is not necessarily sustainable on a balanced equilibrium. An internalised ability to recognise the state that he is in at any given time, the ability to continue to use the therapy tools to that end after treatment has finished, and a range of useful procedures of self management are all required towards sustaining inner growth and positive change.

Conclusions

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Jointly created musical improvisations when recorded can become an artefact which represents the meaning and nature of the therapeutic relationship. The music has a â&#x20AC;&#x2DC;bodyâ&#x20AC;&#x2122; in which the individual, with help from the more experienced other can find lost parts of himself. Bessie the Guitar was recognised as being like a transitional object, representing a part of Colin from which he could both dissociate and connect. The musically created component can take the personality disordered patient beyond words or to where words have not yet been possible. Colin discovered that all his states resided in his one body. Mildly regressive aspects were present, this could have lead to vulnerability if not carefully contained. Without ongoing support and containment the intense recall of some experiences facilitated through musical interaction could have led to overwhelming emotional pain and therefore further dissociation which would have been counter productive. The aim was to reintegrate split off aspects of Personality. Music making helped to create the links between these self states. Hence this model was manageable and has a place in the context of high secure hospital multi disciplinary treatment. The ending of time limited therapy in the high secure environment requires careful management particularly because the therapist may be seen in passing after treatment has finished. I have discovered that this can be usefully addressed in a shorter piece of follow up work by gradually increasing the time between planned sessions to fortnightly then monthly then three monthly sessions. Within the Multi Disciplinary Context, attendance at ward rounds can mitigate aspects of abandonment and aid healthy separation after ending. A creative world of symbolism can sometimes be difficult for patients who think in quite a concrete way. However, the symbolic use of music

Conclusions

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created a bridge across the split between Colin’s demon and normal states. This enabled him to struggle with and relate to his demon bully boy state and his lost innocent boy state. More work is required for Colin to accept both his polarised states as inseparable but manageable parts of the real him. Through inner and outer dialogue with another person rather than alone, the whole of his being may be understood further, forgiven and reintegrated.

Acknowledgements • • • • • • • • •

To the Patient in thinking about and giving consent. To the Responsible Medical Officers for their support and consent. To the Named Nurse for his support to the Patient and this project . Michael Knight, Helen Odell-Miller, Averill Williams and Anna Motz. To Nottinghamshire Healthcare NHS Trust and Rampton High Secure Hospital Therapies and Education department, Rampton Hospital for supporting the development of Arts Psychotherapies. Jaadu and Dorabella. * Dr B Brend Mrs N and Professor John Bessant.

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Appendices FIGURE 1. Sequential diagrammatic reformulation

Appendices

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FIGURE 2. First Drawing of the River and â&#x20AC;&#x2DC;Boyâ&#x20AC;&#x2122;

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FIGURE 3. Energy Child Flower

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FIGURE 4. Flower child flower.

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AN EXPLORATION OF SOME LINKS BETWEEN THE CREATIVELY DRIVEN THERAPEUTIC PROCESS AND SOME CULTURAL EXPRESSIONS OF DEMONS.

What happened to the Demon state? Colin expressed that by reclaiming and integrating his abused, silenced state and finding his voice that he could now manage his demon bully boy state. I was interested to explore some cultural examples of how our demons are represented as part of ourselves. Demons, angels, dragons, mermaids, the phoenix and the unicorn all have in common some human and some other world quality; whether divine or monstrous. This is also the case, past and present in how ‘mad’ bad and dangerous people are portrayed in popular culture and the tabloid press. This is witnessed when patients are sent to a locked hospital to be treated in an environment where the public cannot easily access or see them. They may then become portrayed as monsters. Yet in a clinical setting, they are real people with real problems who look like any ‘normal’ person. Whilst writing this paper it seemed to be synchronistic rather than coincidental that I had the opportunity to see at the Royal National Theatre in London “His Dark Materials”: the dramatisation of Philip Pullman’s book ‘Northern Lights”. Also, that I was accompanied by an expert on Persian culture and art to ‘The Turks’ exhibition at the Royal Academy of Art. I will describe the influence of these two events. Both feature different concepts of ‘demons’ which led me to question how the arts therapies might embrace these notions and promote a wider acceptance and integration of the term ‘demon state’ that in not uncommon in the forensic setting

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In the play ‘His dark materials’ each character has a ‘familiar’ which refers to the ‘daemon’ in Pullman’s writing. This represents a different but inseparable part of that individual’s personality in the form of their ‘Daemon’. The demons were represented in the play as different animals in the form of discreetly operated marionettes. These were manipulated by a puppeteer who was clothed to look like a shadow, thereby enhancing the effect. Within the mythology of the story the demon does not ‘settle’ in its form until the child has reached adolescence. This reminded me of the diagnostic criteria for the onset of personality disorder. ICD 10 F60 diagnostic guideline (d): “ the above manifestations always appear in childhood or adolescence and continue into adulthood” The link that I drew was that of personality development, the influence of life experiences during formative years, and how habits may become compounded and ingrained in adult personality. Pullman’s story states that each individual must remain connected to his daemon. If the connection is severed when under threat then the individual himself is also under threat. This is seen to be the case if we consider that under extreme threat the most profound defence mechanism is dissociation in which the individual does indeed become disconnected. My understanding was that the demon has to be worked with and listened to in much the same way as in therapy. This in CAT would be described as a self to self dialogue. The demon represents the shadow state as an integral part of the self. In the Turks exhibition there are several images of demons with humans, and demons fighting each other. Notable were those of the fourteenth and fifteenth century that were dark in colour and masculine in form. They had teeth, horns, tails and skirts. It is thought that these images may relate

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to central Asian ideas of shamanism: people who were believed to be half animal in form and who danced into a trance thereby entering another world. Perhaps these entities initiated fear in so called â&#x20AC;&#x2DC;normalâ&#x20AC;&#x2122; people. However, these pictures acknowledge and even celebrate the presence of the demon state. They may acknowledge internal conflict rather than invoking a fear of the darkly unknown, half human half animal aspects of human personality. In the later fourteenth to fifteenth century images, these human like demons are depicted as literally harnessed, industriously pulling the carriage of the newly married king Sulayman and his Queen across the sky. The demons carry his treasures whilst being shackled together, so they cannot run away. They generate energy and they are under the control of the benignly portrayed King. The Islamic view being that he can speak to and control demons and is frequently portrayed presiding over angels, animals and demons.* The demons are enslaved in chains and subservient. I conclude that this may be viewed as an effective and strong relationship for an individual who hopes to be master over his own inner demons and thereby gain untold riches. It may not be coincidental that within Turkish society, boys were taken to court as slaves, and could rise to the status of being a king. The metaphor and symbolism that this suggests is that through suffering and hard work in that society there was the hope of improvement and freedom. Cultural sources of creative work such as the examples above demonstrate subjective feeling and thought absorbed through vision and culture and through the movement and integration of people. Many of the images in this exhibition are drawn as taking place along the journey of the silk Appendices

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route. The inner conflict is depicted with demons and externalised in art. My perception was that the difficult and bad parts of human existence could be interpreted morally through the epic stories that these manuscripts describe. A parallel may be drawn to the inner journey of self discovery which can be equally rich. The art and drama that I have referred to provided inspiration through which I have considered that the hope is that different and opposing parts of the personality may develop and gradually be integrated. This is a gradual process that occurs through the challenges faced and the individualâ&#x20AC;&#x2122;s responses that provide the meaning of lifeâ&#x20AC;&#x2122;s journey. Copyright Stella Compton Dickinson 25.11.06

References: Birtchnell, J. (1999) Relating in Psychotherapy. The Application of a New Theory. Ed. Crown S and Lee A. Westport: Praeger. Birtchnell J.1; Shine J.2 (2000) British Journal of Medical Psychology 73 (4), 433-448. Bliss, E. (1980) Multiple Personalities A report of 14 cases with implications for schizophrenia and hysteria Arch Gen Psychiatry 37, 1388. Compton Dickinson (2001) Compare and Contrast the practice of C.A.T with dynamic psychotherapy. Ch.1 An overview past and Present. Ch. 4 The musical application of C.A.T principles in attachment and development Kings College Library: Academic Psychiatry, Guys Campus and Institute Of Psychiatry (IOP) References:

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Compton Dickinson, S J (2003) Community, Culture and Conflict: The role of creativity British Society of music Therapy. Conference Proceedings 2003 Compton Dickinson (2004) "Changes" - Community, Culture and Conflict: The role of Creativity. Music Therapy Today (online) Vol. V, Issue 5, available at http://musictherapyworld.net Freud, S. (1991) Case history Fräulein Anna O. Penguin Books Glyn, John (2003) New York Mining Disaster. British Journal of Music Therapy 17(2) 97. ICD-1O (1992) International Classification of mental and behavioral disorders. Geneva: World Health Organization. Macdiarmid, D. (1996) KCL M.Sc. Mental Heath studies. Dynamic psychotherapy Lecture Notes 6 Guys Hospital London: Dept of Academic Psychiatry. Potter, S. (2004) Untying the knots: relational states of mind in cognitive analytic therapy

A.C.A.T journal: Reformulation (issue 21) London:

Dept of academic psychiatry. St Thomas’ Hospital. Pullman, P. 1995 His dark materials “Northern Lights”. London: Scholastic Point. Ryle, Anthony and Kerr, Ian (2002) Introducing cognitive analytic therapy. Chichester: John Wiley and Sons. Sloboda, J. (1985) The Musical mind. The cognitive psychology of music. Oxford: Clarendon Press.

References:

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Stern, D. (1987) The interpersonal world of the infant. New York: Basic Books Vygotsky, L.S.(1978) Mind in Society, The development of higher psychological processes. Cambridge: Harvard University Press

This article can be cited as: Compton Dickinson, S. (2006) Beyond Body, Beyond Words: Cognitive analytic music therapy in forensic psychiatry - New approaches in the treatment of Personality Disordered Offenders. Music Therapy Today (Online 22nd December) Vol.VII (4) 839-875. available at http://musictherapyworld.net

This article can be cited as:

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MELODY AND RHYTHM – ‘Indianness’ in Indian music and music therapy Sairam, T.V. Sairam, T.V. (2006) Melody and rhythm – ‘Indianness’ in Indian music and music therapy. Music Therapy Today (Online 22nd December) Vol.VII (4) 876-891.

Indian Systems of Music The 3000-odd year old Indian genre of music is basically melodic, is based on the principle of resonance, sruti and rhythms, laya, regarded as ‘mother’ and ‘father’ respectively. It is impossible to perceive any musical piece without their intermingling. Sruti, the very backbone of the Indian music plays a vital role in rendering a specific identity and individuality to a raga that distinguishes it from an ocean of ragas. Indian system of music is an individualistic, subjective, and spiritual art, aiming not at symphonic elaborations but at personal harmony with one’s own being. MUSIC OF THE VEDAS

Indian music reflects the delightful blend of the exploring intelligence of the Vedic Aryans, with the imploring emotions, prevailing in the sub-continent’s music for millennia before their arrival.

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Indian System: The ‘Improvisation’ Music (Manodharma Sangita). Spontaneous and intuitive improvisations in melody as well as rhythm constitute the sublime underpinning of the Indianness characteristic in Indian music. While unfolding a highly moody raga with full freedom so as to scale the highs and lows of emotion, the artist is never expected to deviate from the full rigour of the rhythm. The entire exercise -which involves a ceaseless and continuous compromise between the freely meandering melodies (ragas) and the beats (talas) that bridle them, immensely contributes, in real life situations, towards developing an attitude of acceptance of contrasts, contradictions or dissent. It also imparts confidence in coping with such situations till they are resolved as pleasantly as in a musical piece. Swara: The Indian Note. While the western classical system insists on a machine-like precision in determining frequencies for its notes, its Indian counterpart, on the other hand, shows a liberal and human approach while dealing with the rendering of swaras in raga elaboration. In the south Indian Carnatic system of music, for example, the selected Swaras undergo oscillations with a view to heighten the emotions (Bhava). Raga is determined not by a sonic meter but by the human experience. According to a definition of raga by Matanga (the 7th century author whose work briahaddesi described raga in its technical sense for the first time), what is pleasant alone can be a raga. Raga, referred to as the ‘miracle of microtones’ is built by a choice of a minimum of five and maximum of seven swaras, all of which cover 22 srutis in an octave. The selected ones show a sustained quality of a definite single frequency or a combination of related frequencies, aesthetically suitable to the human voice range, ears

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and hearts. It is this human quality in indian music which promises a direct impact on the listeners in therapeutic settings. It is the usage of quarter tones that play up the Indianness in Indian music. Unlike the western note, Indian Swara is known for its flexibility. Its frequencies can even reach the territories of its neighbouring Swaras, thus intensifying the emotional content (Bhava) of the raga. The therapeutic role of the raga appears to lie in its oscillating Swaras. The listener’s attitude too could, over a time become less rigid and more flexible in synchronization with the raga system. Like a treadmill for trimming the body, the raga system can trim and shape a person’s mind and his behaviour pattern. The quarter tones celebrated in Indian music is not quite unknown to the western school. Piano made with 24 keys used in a whole opera employing quarter tones in Germany is a significant example. The European composers Ivan Vïshnegradsky (1893-1979) and Alois Hába found a firm Grotrian-Steinweg in Berlin and prepared to work on the development of a quarter-tone piano for their quarter tone compositions. Some experts in acoustics are of the view that a well-trained ear becomes capable of perceiving 50 notes in an octave!1 Various pitch patterns are believed to help us in shattering rigid energy patterns that limit our growth, Chakras awareness and health. For ages, there has been a belief that specific pitches affect specific Chakras in the body and that it is the pitch that has potency to bring back the Chakras back to their normal vibration pattern as and when disease occurs in the body. It is the under-activity or over-activity of the Chakras that is believed to cause disease or discomfort in the body.

1. According to a yogi whom I met sometime back such an experience is possible by coordinating one’s sense of hearing with his ‘inner’ (anahata) hearing capabilities.

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From time immemorial, in India, there has been a tendency to associate the seven notes (Swaras) to seven Chakras identified in the human body. Thus, the musical scale (c,d,e,f,g,a,b) is often associated to the seven chakras (c being associated to the 1st and b to the 7th). Singing the scale (or do, re, mi etc.) everyday is said to be beneficial to maintain the balance and harmony in the body. Listening to a piece of music that is written in the key associated to be unbalanced using harmonica in the key of c for root chakra, and using a chromatic pitch instrument (which can be bought in a music store and are very inexpensive) for all pitches. Learning to sing or tone pitches is said to be a traditional method to restore energies to their natural level. EVOLUTION OF SEVEN SWARAS

The primitive musical structure consisted in using a single tone, repeatedly causing veritable monotony! This practice was also common in the Vedic days and it was referred to as eka swari gayana, ‘singing with the help of one note’. Most of the sacred hymns were chanted in this fashion. Endless repetition of the tone could exercise the mind to get into the ‘track’ and remain focused on the object of meditation. From here, dilution started and a system of two notes called gatha gayana came into vogue, which consisted of two notes, one higher than the other. Gathas, or anecdotes containing poetically described stories from the lives of the Bodhisatva monks were sung with two notes. Use of three notes came to stay with saamagaayana chants. They were distinguished and named as udatta or raised (equivalent to N-G), anudatta or lowered (equivalent to R-D) and swarita or level (equivalent to S-M-P). It is these three swaras that form an important base for the evolution of seven swara system. The arrangement of these three basic tones formed the structure called graamas and with this, the solfa syllables in Indian music (S,R,G,M,P,D,N) came into existence. The Sanskrit dictionary has coined a word swaraghat, to represent these three essential notes. A liberal- rather than

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literal – translation of this term would read somewhat like this: ‘three positions of graded effective potency of sound’!

Laya: The Indian interpretation of a rhythm It is interesting to note the affinity that exists between the musical and life patterns and rhythms. In an unconscious and in an unintended manner, the creators of music present their art akin to life processes and patterns. In a workshop conducted at Delhi a few years back, an enlightened audience, comprising of diplomats, civil servants, yoga teachers and music lovers could appreciate the magic of rhythms that emanate from the Tabla and a manjira as one felt descending to alpha levels of `relaxation’, `happiness’ and `peace of mind’ (as remarked by the audience) by sheer concentration on them! The ancient Sanskrit works indicate a classification system for rhythms, which distinguishes 120 types of talas (beats) distinct from each other. Sage Bharata is said to have isolated 32 varieties of Tala from the song of a lark. The term laya has multiple meanings: musical time, fusion, melting, dissonance, exclusive concentration on one object, repose, unison, universal dissolution, the Supreme Being – just to mention a few. The beauty about Laya is that it exists in between one’s experience of sound and that of silence. Time is always present whether there is a sound or not. In fact, when the sound is not there, time still lingers on in the centre-stage. When a singer holds a note for a long time (karvai) it may give an illusion as if time had ceased altogether! Laya at this point depicts qualities of vishranti the quiet bliss.

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The ancient Greeks too had made subtle distinction between ‘rhythmos’ (rhythm) and arithmos (calculated Time), which is akin to the relationship which exists between Laya (rhythm) and Tala (calculated Time). Laya Prajna is the perception of Laya, the ability to perceive the most minute divisions of time, the aesthetics of tempo and spacing of notes in any pattern. Here mathematics has turned into an art indeed! IMPACT OF LAYA ON RAGA EMOTION

Different rhythm and tempo, (e.g., Vilambit (slow), Madhyam (medium) or Dhrut (fast) may influence variously the effect of raga on moods and emotions. While the slow-paced rhythms and tempo slow down the mental pace, leading towards calmness, they are also found to be capable of diverting the thought processes in mind, thus enhancing relaxation. Fastpaced tempos and rhythms, (especially as we come across in African Drums) on the other hand, preferably in combination with high frequency notes (as may be found in shrieks and catcalls of the tribal participants) are noted for their influence in stimulating and rejuvenating the mind and body. In his research work with severe cases of mentally retarded children of Visakhapatnam this author has noticed that it is such rhythms and metallic noises in music which enable them to shake off their passivity more easily than the regulated compositions in Gitam or Varnam.

Evolution of raga system The sheer lack of chronology or historic sense with regard to the rich system of music itself represents `Indianness’! One has to, therefore `guesstimate’ that the Vedic age in India is somewhere pegged between 2000 and 1000 B.C.E. Evolution of raga in that period is yet another area for guess-work. Vedas mirror meaning with sound vibrations and fine-tune the brain to establish harmony and peace. Ek Swari Gaayana or archika which means singing with the help of one note, as was done with regard Evolution of raga system

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to chanting of several sacred hymns, could be closer to the primitive style that could have existed in the sub-continent from the time immemorial. Then there was the Gatha Gaayana Gathika system of singing with two notes, one high and one low. Gathas, or anecdotes containing poetically described stories from the lives of the Bodhisatvamonks, were sung in these two notes. The swara-structures here being incomplete to be called as a raga has been termed proto-raga by Sairam (2005a+b +c) in his works. From here, there is a gradual progress. Saamagaayana chants were sung in three notes: Udatta (raised) (equivalent to Ni-Ga), Anudatta (lowered) (equivalent to Ri-Dha), and Swarita (level) (equivalent to Sa-Ma-Pa) positions, which according to Mandukay Shiksha, a music treatise of that period, evolved into seven notes. The Sanskrit dictionary interprets these three sound positions in a word called Swaraghat, arrangement of these basic tones formed the nucleus of scales called Graamas, and with that, the Sargam syllables or note names – S, R, G, M, P, D, and N – came into existence (there are comparable to the Western sofa syllables _ Do, Re, Mi, Fa, So, La Ti). Other authorities like Panini (520-460 B.C.), a Sanskrit grammarian1 who gave a comprehensive and scientific theory of phonetics and phonology and Naarada2, a legendary personage and celes-

1. About Panini: A treatise called Astadhyayi (or Astaka) is Panini's major work. It consists of eight chapters, each subdivided into quarter chapters. In this work Panini distinguishes between the language of sacred texts and the usual language of communication. Panini gives formal production rules and definitions to describe Sanskrit grammar. Starting with about 1700 basic elements like nouns, verbs, vowels, consonants he put them into classes. The construction of sentences, compound nouns etc. is explained as ordered rules operating on underlying structures in a manner similar to modern theory. In many ways Panini's constructions are similar to the way that a mathematical function is defined today. 2. About Naarada: A legendary figure, he is said to be the author of Naaradasmriti, Naarada Shiksha (on the principles of grammar and phonetics), Naarada Bhakti Sutra (aphorisms on the concept of Bhakti or devotion and Naaradiya Dharma Shastra (a work on law and morality)

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tial musician in the Hindu mythology both accepted the principles under which the seven notes were positioned around the three notes of the Vedic period, which are the graded sound positions noted above. Study of the Vedic culture reveals the pre-eminence and high esteem enjoyed by music in every family. Hardly any item of religious activity would be conducted without music Songs, dances and playing on instruments were all done in strict rhythms. The infinite variety of gods and goddesses representing various forms of the forces of nature were also linked to certain melodies depicting their powers and forces. Their worships were also associated with appropriate musical instruments that impart such effects. Between thundering tones of masculine drums, Damarus and Mridangams and gently flowing feminine strings and Veenas, a wide variety of instruments existed in the sub-continent, which helped in ‘balancing the mind’ and lending harmony between the individual and his society.

Raga Chikitsa: The Indian Music Therapy Long before acoustics came to be understood in Europe as a subject of study, the ancient Arab, Greek and Indian civilizations were already familiar with the therapeutic role of sounds and vibrations and the later day concepts pertaining to them. While music as a whole is well recognized for its entertainment value, the Indian civilization had gone a step forward to attribute the curative aspect to music (Sairam 2003). The ancient system of Nada Yoga, which dates back to the time of Tantras, has fully acknowledged the impact of music on body and mind and put into practice the vibrations emanating from sounds to uplift one’s level of consciousness. It is the Indian genius that recognized that ragas are not just mere commodities of entertainment but the vibrations in their Raga Chikitsa: The Indian Music Therapy

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resonance could synchronize with one’s moods and health. By stimulating the moods and controlling the brain wave patterns, ragas could work as a complementary medicine (Sairam, 2004 a, b, c). WHAT IS A RAGA?

Raga, we all know is the sequence of selected notes (swaras) that lend appropriate ‘mood’ or emotion in a selective combination. Depending on their nature, a raga could induce or intensify joy or sorrow, violence or peace and it is this quality which forms the basis for musical application. Thus, a whole range of emotions and their nuances could be captured and communicated within certain rhythms and melodies. Playing, performing and even listening to appropriate ragas can work as a medicine (Bagchi, 2003). Various ragas have since been recognized to have definite impact on certain ailments (Sairam, 2004b).

HISTORIC REFERENCES ON RAGA CHIKITSA.

The ancient Hindus had relied on music for its curative role: the chanting and toning involved in Veda mantras in praise of God have been used from time immemorial as a cure for several disharmonies in the individual as well as his environment. Several sects of ‘bhakti’ such as Chaitanya sampradaya, Vallabha sampradaya have all accorded priority to music. Historical records, too, indicate that one Haridas Swami who was the guru of the famous sixteenth-century musician Tan Sen1 in Emperor Akbar’s (1542-1605 AD) time, is credited with the recovery of illness of one of the queens of the Emperor with a selected raga. The great composers of classical music in India called the ‘Musical Trinity’, - who were curiously the contemporaries of the ‘Trinity of Western Classical Music, Bach, Beethoven and Mozart– were quite sensitive to the acoustical energies. Legend has it that Saint Thyagaraja brought a dead person back to life with his Bilahari composition Naa Jiva Dhaara. 1. Some people call Tan Sen an “Hindustani Monteverdi”)

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Muthuswamy Dikshitar’s Navagriha Kriti is believed to cure stomach ache. Shyama Sastry’s composition Duru Sugu uses music to pray for good health. Raga chikitsa was an ancient manuscript, which dealt with the therapeutic effects of raga. The library at Thanjavur is reported to contain such a treasure on ragas, that spells out the application and use of various ragas in fighting common ailments.

Raga Chikitsa: Raga Therapy in India Living systems show sensitivity to specific radiant energies – be it acoustical, magnetic or electro-magnetic. As the impact of music could be easily gauged on emotions and thereby on mind, it can be used as a tool believed to control the physiological, psychological and even social activities of the patients Indian classical music can be classified into two forms: kalpita sangita or composition, which is previously conceived, memorized, practised and rendered and manodharma sangita or the music extemporised and performed. The latter can be equated to the honey-mooner’s first night as it conceives both spontaneity and improvisation. It is fresh and natural as it is created almost on the spot and rendered instantly on the spur of the moment. According to an ancient Indian text, Swara Sastra1, the seventy-two melakarta ragas (parent ragas) control the 72,000 important nadis or nerves in the body, which are believed to transmit life energy into every cell of the body. It is believed that if one sings with due devotion, adher-

1. for more information see online resources in the reference section

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ing to the raga lakshana (norms) and sruti shuddhi, (pitch purity) the raga could affect the particular nerve in the body in a favourable manner. While the descending notes in a raga (avarohana) do create inward-oriented feelings, the ascending notes (arohana) represent an upward mobility. Thus music played for the soldiers or for the dancers has to be more lively and uplifting with frequent use of arohana content. In the same way, melancholic songs should go for ‘depressing’ avarohanas. Although it is not a rule, most of the Western tunes based on major keys play joyful notes, while those composed in minor keys tend to be melancholic or serious. Certain ragas do have a tendency to move the listeners, both emotionally as well as physically. An involuntary nod of the head, limbs or body could synchronize with lifting tunes when played. SOME THERAPEUTIC RAGAS

Some ragas like Darbari Kanhada, Kamaj and Pooriya are said to help in defusing mental tension, particularly in the case of hysterics. For those who suffer from hypertension, ragas such as Ahirbhairav, Pooriya and Todi are prescribed. To control anger and bring down the violence within, Carnatic ragas like Punnagavarali, Sahana etc. do come handy. It is generally believed in music circles, though scientific endorsement doesn’t appear to be forthcoming.) Sairam (2005c) experimenting on the impact of raga on mentallyretarded (MR) children has noticed that it is the right combination of rhythms and tempo, which also affect the quality of a raga. Not only psychological impact, but also somatic or physiological impact of ragas has come to light in some recent works. (Sairam, 2004b). For instance, digestion is reported to be activated with Hindustani ragas such as Deepak which is believed to cure acidity. For constipation, the musical Raga Chikitsa: Raga Therapy in India

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folk remedy is Gunkali or Jaunpuri. Malkauns or Hindolam are said to control fevers. Fevers like malaria are also said to be controlled by the ragas like Marva. For headaches, relaxing with the ragas like Durbari Kanada, Jayjaywanti and Sohni is said to be beneficial. The Chennaibased tiny Nada Centre for Music Therapy has quite recently embarked on raga therapy research to re-discover the therapeutic ragas by trial and error methods and some modest progress is already visible giving green signals. For want of logistics, the project is shelved down and we are hopeful it will be revived seen with the support we get from music-lovers and medical professionals all over India.

Conclusion There is a growing awareness that ragas could be a safe alternative for many medical interventions. Simple iterative musical rhythms with low pitched swaras, as in bhajans and kirtans are the time-tested sedatives, which can even substitute the synthetic analgesics, which show many a side-effect (see Nickel et al. 2003; Bernatzky et al. 2005). They are capable of leading to relaxation, as observed with the alpha-levels of the brain waves. They may also lead to favourable hormonal changes in the system (Crandall, 1986). It is therefore felt that there is an urgent need for further detailed enquiry to be based on scientific parameters, which will go a long way in unearthing the goldmine on which the Indian musical system is resting now. For this purpose, it is necessary that a group of exponents in Indian ragas join experts in medicine to help evolving a scientific system of raga therapy for the most common illness of the modern times: stress and stressrelated disorders. Our leaders, professionals and managers all suffer from

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stress, thanks to the ever-increasing man-machine interface, resulting in the machine making the man to behave!

BIBLIOGRAPHY Bagchi, Kalyan. (Ed) (2003) Music, Mind and Mental Health. New Delhi. Bernatzky, G., et al. (2005, March 27). Report on Research Series and Clinical Studies on the Psycho-Physiological Effect of Music on Patients with Musculoskeletal System Pain 2002 to 2005. Salzburg: Landeskliniken Salzburg, Mozarteum. (Retreived 1st of June 2005 from

http://www.mensch-und-musik.at/InfoIntern/

SchmerzStudie_05_gb.pdf) Crandall, J. (1986) Self-transformation through Music. New Delhi: New Age Nickel, A. et al. (2003) Music therapy in the treatment of children with migraine. Music Therapy Today (online) Vol IV, Issue 4, retrieved from

http://www.musictherapyworld.de/modules/mmmagazine/

index_dynamisch.php?issue=32&article=65 Sairam T V (2003) ‘From Nada Yoga to Neuro-musicology’. Indian Customs and Excise. New Delhi, 2nd Issue: 16-17. Sairam, T. V. (2004a) Medicinal Music. Chennai: Nada Centre for Music Therapy (http://www.nada.in/) Sairam T. V. (2004b) Raga Therapy. Chennai: Nada Centre for Music Therapy. (http://www.nada.in/)

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Sairam, T.V. (2006) Melody and rhythm – ‘Indianness’ in Indian music and music therapy. Music Therapy Today (Online 22nd December) Vol.VII (4) 876-891. available at http://musictherapyworld.net

Sairam, T. V. (2004c) What is Music? Chennai: Nada Centre for Music Therapy. (http://www.nada.in/) Sairam, T.V. (2005a) Proto-Ragas and Pseudo-Ragas: The Precursors to Ragas. Sadguru’s Blessings. (May) p.37-38 .Sairam, T.V. (2005b) Proto-Ragas: A Boon for the Mentally-challenged People. Ayurveda and All. (August) p. 35-36. Sairam, T.V. (2005c) Raga Therapy: A New Horizon in the treatment of the Mentally Challenged ‘ In: My Doctor. (June) p. 31-34 ONLINE RESOURCES

Sanskrit Dictionary (http://webapps.uni-koeln.de/tamil/) Website with some details on Swara Shastra: http://www.members.optusnet.com.au/skinbags/id50.htm )

SUGGESTED READINGS

Bagchee, Sandeep. (1998) Nad: Understanding Raga Music. Mumbai: Eeshwar. Bhagyalakshmi, S. (2000) 'Concept of sruti and its application in ragas', Shanmukha, Apr. 29-32. Govindarajan, Alamelu A miscellany in Indian Music. Madras. Menon, Raghava R. (1995). The Penguin Dictionary of Indian Classical Music.

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Sairam, T.V. (2006) Melody and rhythm – ‘Indianness’ in Indian music and music therapy. Music Therapy Today (Online 22nd December) Vol.VII (4) 876-891. available at http://musictherapyworld.net

Author details

T. V. Sairam, a senior member of the civil services in India, holds a doctorate in alternative medicine. He has several publications (10 books and 400 published articles) to his credit on an assortment of subjects, which include alternative medicine, herbal remedies and music. He has undertaken a pioneering research in Nada Yoga and Raga Therapy during his spare hours and has presented several lecture-demonstrations in national and international conferences. He currently guides a team of volunteers drawn from musicians, social scientists, medical professionals, musicologists, and psychologists, which is concerned with a scientific evaluation of Indian Ragas for their therapeutic role in mentallyretarded children. (The author can be contacted at tvsairam@gmail.com) Welcome to the author’s website: www.drsairam.com Author details

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Sairam, T.V. (2006) Melody and rhythm – ‘Indianness’ in Indian music and music therapy. Music Therapy Today (Online 22nd December) Vol.VII (4) 876-891. available at http://musictherapyworld.net

THIS ARTICLE CAN BE CITED AS:

Sairam, T.V. (2006) Melody and rhythm – ‘Indianness’ in Indian music and music therapy. Music Therapy Today (Online 22nd December) Vol.VII (4) 876-891. available at http://musictherapyworld.net

Author details

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Music Therapy Today Vol. VII (4) (December)

If you can’t beat them, join them! Long-term music therapy with an “autistic savant” man Graham, Janet

Graham, J. (2006) If you can’t beat them, join them! Long-term music therapy with an “autistic savant” man. Music Therapy Today (Online 22nd December) Vol.VII (4) 892-912.

ABSTRACT This paper is based closely on a presentation given at the 3rd International Symposium of Nordoff - Robbins Music Therapy, which was held in Germany in June 2006. It focusses on stages in the music therapy process with a middle-aged autistic man with moderate learning disability and savant calendrical skills. He had become very ritualistic and inflexible 892

Graham, J. (2006) If you can’t beat them, join them! Long-term music therapy with an “autistic savant” man. Music Therapy Today (Online 22nd December) Vol.VII (4) 892-912. available at http://musictherapyworld.net

over the years and this impinged not only on his own social life, but also on that of the sister with whom he lived. In sessions his playing was loud, fast and perseverative and, in order to bring about any change or growth of flexibility in his musical responses, it was necessary to try to get inside his routine-driven ways of doing things and find new ways of working. Audio examples from the sessions are given, including some demonstrating musical strategies which were developed from the client’s autistic routines and rituals. Reference is made to parallels between his progress in music therapy and changes in his social skills as perceived by his sister, friends and day centre staff.

1. INTRODUCTION: WHAT’S NEW? When we were invited to submit proposals for the Nordoff-Robbins Symposium in Nordhelle in 2006, it was suggested that we should focus on new directions our work has taken since training, for instance on broader connections with the clients’ community. Having chosen to present a case study of a single client I started to ask myself how, if at all, my therapeutic approach had changed or developed since 1990 when I trained at the London Centre. What, if anything, was new about this presentation? Firstly, words and phrases I remember most clearly from my training in 1989-90, and which are still central to the Nordoff-Robbins approach today, include “working through the music” and “growth of flexibility”. I have since come to believe that the music sometimes needs a degree of help in order to bring about the flexibility, and it certainly did in this case. Another factor is that the work covers approximately five and a half years of one-to-one sessions at the London Centre. Such long-term work needs justification and would not normally be possible in public-funded set-

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tings such as the National Health Service. In fact it is very unusual at the London Centre, but it did seem necessary for this client. The client, Johnnie, is an adult. In 1989-90, unlike today’s students, we were trained exclusively with children who had learning disabilities, multiple physical disabilities or communication problems. Any work with adults on which we embarked after training was largely learnt “on the job”. Johnnie has a mild learning disability and is “autistic savant”. Some people with autism have special abilities, for instance a photographic memory which enables them to draw buildings and scenes they have seen only briefly with accuracy to detail, or to count cards like Rain Man in the film of that title. (Baron-Cohen & Bolton 1993; Schopler & Mesibov 1992; Williams 2003; Grandin & Johnson 2005). Some clients show unusual musical abilities: I have worked with several children and adults who seemed to have some sort of skill connected with memory, including a kind of perfect pitch where they always sang at the same pitches and ignored or protested at any attempts on my part to shift them. Johnnie’s savant skills were not of this type, though musical memory was important to him in ways which will be described later. Johnnie’s savant skills and the rituals which went with them impacted on his everyday life, and this made it important for me to maintain contact with a wider network of people involved in his life. Throughout the therapy I kept contact with Johnnie’s day centre, as well as talking every week to his sister and occasionally to some of their friends too.

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2. THE CLIENT FIGURE 1.

Johnnie was 52 when I first met him. He had been referred to the Centre by his sister, Maggie, because he had always responded to music and had enjoyed taking part in a music class for people with learning difficulties. He was undiagnosed when young and it was Maggie who found out that he is “autistic savant” with calendrical calculation skills. This means that, if you tell him the date, he can tell you the day of the week on which you were born in what seems like a fraction of a second. He will remember your birthday every year, too, and will draw you a card with your age written in large numbers all over it! He can also remember what he was doing on any day in the past. For instance, the first time I met him, having told me I was born on a Friday, he said he had been horse-riding on my birthday in 1996 (i.e. 4 years earlier). Johnnie also has a moderate learning disability. Johnnie shares a small flat with Maggie and attends several group activities in a day centre. He has a number of rituals and patterns of behaviour 2. THE CLIENT

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which impinge on his, and Maggie’s, everyday life. For instance, he feels compelled to allow his face cloth to drip 40 times, however long it takes, before he will get out of the bath. He is very rigid in his routine; for example, if the minibus driver brings him back from the day centre the “wrong way”, he will have to walk the “right way” to compensate for it. He has a fascination for doors and hinges and has sometimes been mistaken for a surveyor. Maggie recollects that, as a child, he played with doors instead of toys. The residential hospital in which Johnnie lived as a child left him with emotional scars. When he went home at weekends he used to spread 28 sheets of newspaper on a window sill and bang it with a rolling pin, saying that it was Mr. L.’s ledge. (All Johnnie’s acquaintances have specific doors or ledges allotted to them by Johnnie). Over the whole five and a half years of his therapy, all that Johnnie would say to me about Mr. L. is that he was “very nasty”. It appeared to me that Johnnie had dealt with the problem in his own way and, unless he chose to talk about it, it did not seem appropriate to probe. I hoped, however, as would any selfrespecting Nordoff-Robbins-trained therapist, that any unresolved negative feelings which might emerge could be addressed within our interactive musical improvisations.

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FIGURE 2.

2. THE CLIENT

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This is one of my birthday cards from Johnnie. Notice the precise wording. “Music therapy side room door Janet Graham door on northbound side next to eastbound side and ground floor at Kentish Town and Gospel Oak Ward”. Johnnie’s birthday cards always have a drawing of the recipient’s own special door on the front. Recently he started giving us tunnels in the London Underground system and bus routes, too. In the middle of this card is a birthday greeting, including my age, and a reference to “my bus” the Number 84, which goes from North London to St. Albans, where I live.

3. OUR EARLY SESSIONS 3.1. DISCOVERING THE PROBLEMS

Making any headway was very difficult, especially with Johnnie’s playing. He used 2 beaters simultaneously, regardless of the instrument he was playing, and always played in the same way: very fast and very loudly. He did not respond to endings and would carry on playing after I had stopped. He tended to sit in a hunched position, elbows on knees, and not looking at me. He seemed to enjoy coming, however. I tried various strategies intended to increase his awareness and flexibility, e.g. introducing musical changes and surprises, or working side by side, or opposite him, using similar instruments. Whatever I tried, however, he just kept playing in his usual way. The main aims which emerged in Johnnie’s assessment were: 1. Encouraging more flexibility in his playing, which was perseverative, extremely loud and at a fast tempo; 2. Encouraging him to use his voice more expressively and communicatively. His speech had little inflection of tone or pitch, and was often

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difficult to understand. He sometimes hummed as he played, but did not like the idea of singing. 3.2. EXTRACT 1

FIGURE 3.

The first extract is about 9 months into Johnnie’s therapy. He is playing a drum with 2 beaters, while I play the piano. He is sitting in a hunched position, with his elbows on his knees, not looking at me. A major area of loss which Johnnie had to contend with was the death of his parents, especially that of his father, who died when Johnnie was a boy. In this extract, he is celebrating his father’s birthday, even though he has been dead for many years. By now Johnnie is confident in the therapy room, and this is how he likes to play. I try various musical strategies to encourage more awareness and flexibility, but he seems oblivious.

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Download AUDIO EXTRACT 1. (MP3 1.8 MB) After that session, Johnnie asked me if I had a rolling pin. He was remembering Mr. L. 3.3. SEARCHING FOR A SOLUTION

Musically, Johnnie was very stuck, in spite of all my inter-musical efforts to get him out of his perseverative playing. I decided that the only way I was going to get any sort of flexibility into his playing was to change the instruments. (I had already banned cymbals and metal wind-chimes because I was afraid he might damage his hearing). I asked myself if Johnnie really needed to become more unstuck? Why, if at all, did he need to change? He appeared to enjoy the sessions very much: perhaps he just needed the experience of playing music with another person. I thought about his inflexibility in his everyday life, and came to the conclusion that his obsessions and rituals were severely restricting his capacity for interacting with others, and that he (and Maggie) might enjoy life more if he were less isolated. If he could become more accepting of me and my musical structures, he might in time be more trusting with others, and this would in turn lead to more opportunities for joining in various activities in the community. I tried various strategies, both musical and verbal, with limited success. His preference was to sit to play an instrument while I played the piano. He was reluctant to share instruments, though he agreed to stand up to play some of them and I noticed some bigger and more purposeful arm movements. If offered a verbal prompt he would play more quietly, but soon reverted to his usual way of playing. It seemed impossible to bring about any significant change or development solely through musical means, and I realised that I would have to try to get inside Johnnie’s autistic ways of doing things. Maggie gave me 3. OUR EARLY SESSIONS

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the clue I needed by telling me that he likes orders for things, e.g. he has an order for what he has for breakfast on different days of the week, and he wears 4 pairs of shoes in strict rotation. 4 and 8 are his “special” numbers. I did not know this when I devised a 4-week order with 8 instruments for each week. Johnnie accepted this very well, and the new combinations and restrictions of instruments offered possibilities for quieter dynamics.

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4. FINDING A WAY FORWARD 4.1. THE ORDER FOR JOHNNIE’S SESSIONS

FIGURE 4.

When I gave Johnnie a copy of the order, he immediately said that it would be Drum Week on my birthday in two years’ time. I did not take too much notice of this, because there would be holidays and sessions missed for various other reasons, and I was not sure that he would still be

4. FINDING A WAY FORWARD

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coming for sessions by then, anyway. Looking back through my notes, though, I found that he was right. Johnnie always insisted on playing every instrument in the room, one at a time. Even if I arranged percussion instruments in groups, he would play each of them individually, so that we always needed eight improvisations in a session. The order worked well, however, and over the months I added new instruments and variations such as softer beaters. This made it possible for Johnnie to participate in quieter musical experiences and, even if he played at his fast tempo, I could make the music slower by taking his beats as half or quarter beats. He also began using his voice more strongly and spontaneously, although he still did not like singing songs (apart from “Happy Birthday”). 4.2. EXTRACT 2

FIGURE 5.

4. FINDING A WAY FORWARD

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This extract comes from about three and a half years into therapy. Johnnie is playing a set of small tubular bells which I have placed on top of the grand piano. He notices when I start singing “Here we are in the music room”, and he smiles and vocalises. This turns into a playful duet. Download AUDIO EXTRACT 2. (MP3 1.9 MB) 4.3. EXTRACT 3

FIGURE 6.

4. FINDING A WAY FORWARD

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The next extract is from later in the same session as the last. Johnnie particularly liked playing a long rain stick similar to the one third from the right of this picture. He played it with a very slow side-to-side movement, waiting until every single stone had got to the bottom before he would invert it. Here, I improvise slow and rather romantic, expressive music on the piano. It is in E-flat Major and in three-four time, which might be a challenge for someone who likes multiples of four. With some flexibility on my part, I can fit two bars into each side-ways movement of the rain-stick. Download AUDIO EXTRACT 3. (MP3 1.9 MB)

5. THE LATER SESSIONS: NEW STRATEGIES 5.1. EXTRACT 4

FIGURE 7.

My next extract is from just over a year later than the last, almost five years into therapy. It was “No pianos” week. Here, Johnnie is playing a

5. THE LATER SESSIONS: NEW STRATEGIES

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conga, with two beaters, and I am playing the metallophone. He notices when I start singing. Download AUDIO EXTRACT 4. (MP3; 2,5 MB) Previously, Johnnie had picked up phrase lengths if I had counted beats, e.g. 123 4--, but now he was able to pick up rhythms and endings just from my playing. 5.2. THE LISTENING SLOT

I continued trying new ways of encouraging flexibility: for instance, I introduced a listening slot in each session. We listened together to a few minutes of recorded music, and talked about it afterwards. Johnnie recognised pieces he had heard before: one day, after we had listened to “Summer” from Vivaldi’s “Four Seasons”, he told me he had heard it on Friday, April the 5th, 1991, in the Waffle House in Norwich (i.e. 13 years previously). Afterwards, Maggie confirmed that this was likely to be true, as they had lived in Norwich at that time and the Waffle House had certainly played classical background music including Vivaldi. He listened attentively and enthusiastically to a range of music from Haydn to Stravinsky and Takemitsu. He was particularly enthusiastic about Takemitsu’s “Rain Spell” and “Rain Coming”, and Maggie told me that “Rain Man” is one of his favourite films. Maggie tried to encourage Johnnie to include a wider range of music in his listening at home, to offer more opportunity for emotional support, and Johnnie’s day centre took note of this, too. Johnnie was very good at pop music quizzes, because he could remember the songs and their dates. He liked classical music, especially as his father had owned a large collection of classical records, but would listen only to Radio 1 (a pop music station) at home because that was what he had always listened to and he was unable to change. If Maggie was playing classical music in the next

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room, however, he would listen from the doorway. She started encouraging him to listen to classical music at specific times of the week, as part of his order at home. 5.3. COUNTING BELLS, TAKING TURNS

Other strategies I tried included numbering the tubular bells from 0 to 11, and asking Johnnie to play the notes of various people’s birthdays within the structure of the improvised music. Obviously this made him slow down, as well as giving rise to some unusual rhythmic and melodic ideas. I also introduced more turn-taking, for instance sharing an instrument with him. He found it difficult, but would keep it up for a while with support and encouragement.

5.4. EXTRACT 5

FIGURE 8.

The final 2 extracts are from Johnnie’s last few sessions. In Extract 5 he is playing a large ocean drum. When playing this instrument previously, he would simply swish it quickly from side to side, but here he controls it and produces a more continuous sound. The music is whole-tone / atonal and also sometimes arhythmic. He no longer needs his driven, fast and inflexible pulse. Download AUDIO EXTRACT 5. (MP3; 1,5 MB)

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After he had played the ocean drum, if I asked Johnnie whether the music had reminded him of anything, he would say the seaside, and going to Brighton with his father. 5.5. EXTRACT 6

FIGURE 9.

Johnnie’s playing still tended to be fast, but he was now often able to play quietly and to pick up rhythms from me. This extract is from his penulti-

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mate session, 2 months later than the last extract. He is playing the conga with 2 beaters. Again, the music is in a slow triple time. Download AUDIO EXTRACT 6. (MP3; 2,8 MB)

6. IN CONCLUSION 6.1. LOSS AND ADULTS WITH LEARNING DISABILITIES

As you have heard, it took a long time before I noticed any shifts in Johnnie’s playing, and over the five and a half years I worked with him I considered ending his therapy several times. Always, though, there would be a change of events in Johnnie’s life which indicated to me that he needed to carry on. For instance, friends moved away, and one of them died. The minibus service which took him to his Monday club was stopped, so he could not get there so often. At these times I felt he needed the continued support of his music therapy, not even more loss. Loss seems ever-present in the lives of so many adults with learning disabilities (Sinason 1992; Blackman 2003). Sometimes these events were reflected in our music, even though Johnnie did not talk about them much. When his favourite day centre worker went on maternity leave, we acknowledged his apparent sadness about this in our improvisations. Maggie later said she thought this had helped him and that he was accepting the changes of staff more positively and cheerfully.

6.2. CHANGE AND DEVELOPMENT IN EVERYDAY LIFE

Maggie noticed developments in Johnnie’s confidence and social skills since he had begun sessions. He appeared more at ease with people, and they noticed that his speech seemed clearer and easier to understand. His day centre workers said he was interacting much better, and felt that music therapy was helping. He still found it difficult to empathise, for

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instance he still laughed if he heard a baby crying, but he started showing more interest in people’s feelings in the soap operas he liked watching on television. He was sometimes able to tolerate breaks in his routine, such as going somewhere with Maggie by train and coming back by bus. He had previously insisted upon making the round trip by the same means of transport. FIGURE 10.

In her book “Exposure Anxiety – the Invisible Cage”, Donna Williams, herself autistic with savant abilities, considers the creative arts therapies effective for helping people with autism to connect with their emotions through connecting with others in a safe space. She says:

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Music, art and dance/movement therapy build a safe space, a meeting place, somewhere to feel equal,… (Williams 2003, p. 308) My therapeutic aims, as with any other client, depended on the development of a trusting interactive musical relationship. In Johnnie’s case, however, this needed more extra-musical help than usual, and I do not think it could have happened without trying to get inside his ritualistic ways of doing things and using them as a basis for our improvised music.

REFERENCES Baron-Cohen, S. & Bolton, P. (1993). Autism: the facts. Oxford, New York & Tokyo: Oxford University Press. Blackman, N. (2003). Loss and learning disability. London: Worth Publishing. Grandin, T. & Johnson, C. (2005). Animals in translation. London: Bloomsbury Publishing. Schopler, E. & Mesibov, G.B. (1992). High-functioning individuals with autism. New York & London: Free Association Books. Sinason, V. (1992). Mental handicap and the human condition. London: Free Association Books. Williams, D. (2003). Exposure anxiety – The invisible cage. London & Philadelphia: Jessica Kingsley Publishers.

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Notes on the Author Janet Graham studied Composition and Piano at the Royal Academy of Music, after which she worked as a composer and piano teacher for many years before training at the Nordoff-Robbins Music Therapy Centre in London. Since then she has worked in London and Hertfordshire with a wide range of client groups, most notably adults with autism and older people with dementia. She is a senior therapist at the London Centre and a tutor on the training course. THIS ARTICLE CAN BE CITED AS:

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Music Therapy Today Vol. VII (4) (December)

Just sing… Boymanns, Britta Boymanns, B. (2006) Just sing…Music Therapy Today (Online 22nd December) Vol.VII (4) 913-931.

Abstract The article will give a view into seven years of music therapy at the Day Clinic for psychiatry and psychotherapy in Witten. In the first section, I will describe the setting and in the second section I will present the major aspects of my work. My experiences from the past seven years of practical work have shown that singing simple songs and canons can have a deep therapeutic effect at various levels of human existence, and encourage social growth in the community. To do this, it needs an exact choice of songs and preparation of the material, a free but friendly inviting approach towards individuals, exact and targeted musical – artistic work on the songs spiced with much humor and joy – and an openness towards all dimensions of humans and music. I can only recommend music therapists to discover and continually develop this and put the therapeutic dimensions and qualities of group singing to good use for those who are ill.

The Day Clinic The Day Clinic in Witten exists since December 1998. It is a department of the Gemeinschaftskrankenhaus, the Community Hospital in Herdecke and follows a holistic concept based on anthroposophy. The team at the 913

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Day Clinic consists of 2 medical doctors, a psychologist, three nurses, four art therapists, one social worker and a secretary. With the exception of the doctors and nurses all colleagues have part-time positions of between twenty and fifty percent. At the Clinic, patients over 18 years of age and with a diverse range of psychological illnesses are treated: • • • • • •

psychosis neurosis all forms of depression personality disorders psychological crisis psychosomatic illnesses

Excluded from treatment at the Day Clinic are: acute suicidal individuals • people with primary addictive disorders • people with severe organic brain illnesses or severe mental disorders •

as the Clinic’s concept does not provide for such cases, nor is the required personnel available. The medical and psychotherapeutic treatment is in the form of group and individual therapy and the medication therapy covers anthroposophic medication and psychopharmaceuticals. These are complemented by physical treatment in the form of massage and balneotherapy. Alongside the medical treatment, art therapies are provided in the form of drawing, modeling and work therapy, healing eurythmia and music therapy. In addition, the nursing staff offers further groups including storytelling, role playing, sports, Tai Chi, relaxation group, gardening and cooking group.

The Day Clinic

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The daily structure is shown in the therapy plan. In the morning: arrival and communal start in the ”Morgenkreis” or morning circle. After this, the two basis groups begin, where patients together with one of the nursing staff recall events of the previous day or the weekend. On Wednesdays there is a group meeting for the patients where they are on their own to exchange thoughts and ideas and to organize minor duties. There are therapy appointments before and after lunch until the joint end of the day. And last not least: teatime at the end of the week on Friday afternoons. Based on interaction with patients, the therapists develop individual therapy programs. In the various team meetings there is intensive exchange to make sure that the therapy aims, which are often formulated by patients themselves, are pursued. The official understanding of the concept in the Center is as follows, I quote, ”Support the patients or persons in need of help to recognize their possibilities, and in the interaction with their bodies, their fate and their environment to achieve new possibilities of realization”. MUSIC THERAPY AS PART OF THE GENERAL CONCEPT

Nordoff-Robbins Music Therapy has been practiced in the Gemeinschaftskrankenhaus (GKH) since 1978, initially in the context of the twoyears mentor course which then grew to be the university-based training course at the University of Witten/Herdecke. Even after the University moved from GKH to new locations, GKH was and is the site for practice, training and research. So in the conception of the Day Clinic, it was not the question of whether music therapy would be included, but how. Out of the work on the concept, four forms of music therapy emerged, alongside the known individual and group therapy, the new forms ”Morgenkreis”, which translates directly as ”morning circle”, and ”Offenes Singen” which means ”open singing”. These developed as a response to the question about possibilities of musical activities with groups of The Day Clinic

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twenty to thirty participants and also reflects the ”tradition” of morning and evening groups as a concrete element in the daily structure in anthroposophic institutions.

The ”Morgenkreis” With the ”Morgenkreis” the communal day begins. Everyone who is at the Clinic at this time takes part: patients, employees, students, guests and so on. Participation in the Morgenkreis is obligatory as it is part of all prescribed therapies. The Morgenkreis has practical functions: to greet all who are in the clinic, particularly new patients • to greet and introduce new students and guests • to share general information of interest for everyone. •

The Morgenkreis also offers an opportunity to assess the state and condition of patients, answers the question whether everyone is present and provides a communal start to the day. In addition, all birthdays are celebrated in the large group with a birthday song, which is for some an unusual and special event. I lead the Morgenkreis on Mondays, Wednesdays and Fridays. On the other days and in the afternoons, other colleagues lead these ten minutes with a short dance, a communicative ball or word game, or the phrasing of a motto or slogan and so on. THE ”OPEN SINGING”

Open singing takes place once a week on Wednesdays from 09.00 to 09.45. In the largest room of the Clinic the tables are put aside and the chairs are formed in a half-circle, each with a songbook. Then the piano is rolled in. As an invitation, I begin to play the first song and improvise until all patients have arrived and get ready to sing with me. The ”Morgenkreis”

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THE OPEN SINGING IS ”OPEN” IN SEVERAL RESPECTS:

1. It is not obligatory, that means all participants are here as volunteers. Most come initially out of curiosity. Furthermore, it is easier to overcome inhibitions for this type of activity than in other settings, as all patients know me and my activities from the Morgenkreis. 2. The room in which it takes place is open – architecturally open to the staircase and entrance area. This means that patients can listen without being noticed, and that visitors, waiting to go to the secretaries office stand and listen to what is going on. In this way, there is an optimal mixture of secure space and openness that allows the possibility of a public appearance within a protected setting. 3. In addition, the open singing is a welcome opportunity for ex-patients who enjoy coming to the clinic for singing. On average, five to seven ex-patients with good voices and good spirit join in and support the rest of the group. The singing is also open for all colleagues who may come in for a favorite song or even manage to find time to take part in the whole session. Guests and short-term students can experience a part of my work without creating any difficulties for our patients.

CONCEPT OF THE MORGENKREIS AND OPEN SINGING

Selection of songs. The songs are selected very carefully. As time has passed, various selection criteria have developed: 1. Well known songs: Mein kleiner grüner Kaktus 2. Seasonal songs: songs of May or summer 3. Swinging songs: Dubidu 4. Fun songs: Wüstenkanon 5. Gospel and other spiritual songs: We shall overcome 6. Day Clinic Hits: Zwei kleine Wölfe 7. International songs: Shalom chaverim 8. Patient requests: Heute hier, morgen dort 9. Canons: Come follow me 10.Miscellaneous: The songs must be appropriate and understandable for patients both in theme and content. They often have a direct reference to life, such as birthday songs, morning songs (”Morning has broken”) or recreate a lost link such as seasonal songs or prayer songs. Oftentimes spontaneous comments are made about a song and lead to short general discussions in which the patients’ themes and issues become clearer and generate matters for further thought. The ”Morgenkreis”

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The songs should not be too long, as, for example the 15 verses of ”Geh’ aus mein Herz”. The text and structure should be clearly presented and well organized, hand-written notes are often problematic. A negative example is the following two-part notation of ”Nun will der Lenz uns grüßen”, which leads to confusion every time it is used. The songs should be musically interesting. This means that they express particular qualities such as ”Maienwind am Abend sacht”, a short but musically clear and well-structured song. Then one usually comes quickly into a musical experience. The selection of songs is unique, demands careful preparation and makes it impossible to purchase a songbook for each participant. That is why I have created folders in various colours: green– spring yellow – summer red – autumn light blue – winter dark blue – Christmas purple – Collection 1 pink – Collection 2 The copies are ordered numerically. Over the years, a song collection has grown that is based closely on practical use.

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How do I introduce a song? Normally I play a new song on the piano or sometimes sing straight away. Then I try to find out how many can sing spontaneously. Finally, I leave the piano and work on the song, part for part, through singing and repeating. During this I do not only practice the right notes, but begin directly with the musical expression. The practicing takes place in the form of exact song presentation with the instruction to carefully observe particular aspects, such as the lightness of the ”Fliederblütentöne” or the portato of ”Apfelblütentöne” in the song ”Maienwind am Abend”. The experience of different tempi, dynamics or other elements is simply a good training, but also provides different experiences and trains the perception of coherence: How fast do I have to sing ”Fliederblüten”, how does a portato feel? We complete the work with a song when the feeling ”that worked well”, or ” that was lovely” or ”ahh, managed it!” arrived. CANONS

I work with canons often and with pleasure. They are mostly well structured (”Come follow me”). Most are relatively easy to learn. It becomes exciting when the parts begin. There is an immediate social connection. The canon only functions when we all manage to hold a pulse. Often I use the resonance of the wooden floor and stomp not too gently but distinctly on the floor. Sometimes wild arm waving is enough and quite often one feels like an animal trainer in the circus ring. These drastic measures are mostly received with humor and the result can be enjoyed without the loud stomping on the floor. The number of parts is built slowly. Normally only two parts begin, the third group listens and then we swap. Through the combination of singing and listening, the patients get quite confident in the parts and enjoy the feeling ”I can” in an immediate way. ”I can sing”.

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It is not unusual that someone has never, or only a very long time ago, sung a multi-part song in a choir. This usually leads to spontaneous joy and a reduction in inhibitions towards music, music therapy and the music therapist. For the three Morgenkreis sessions I prefer canons so that I can work on three different aspects of the song, for example: Monday: Start practicing the canon, first attempt at two-part • Wednesday: Practice the canon again, through listening move from two-parts to three-parts • Friday: After a short single-part repeats, go directly into three-part singing, changing tempo and dynamics, often shifting the pitch a bit higher, at the close to sing a little softer in order to hear the other parts better. For me, the ”target is reached” when it sounds good, and when after starting the canon I join one of the groups and sing along. •

OTHER POSSIBILITIES

Solo – Tutti. Some songs – for example gospels, are well suited for solotutti versions, such as ”Swing low, sweet chariot”. After we have practiced the complete song, I sing the solo part and practice the correct tutti entrance. For some this is difficult enough. Then comes the exciting question: who is brave enough? In a small group of 4-5 singers we find success. For the very adventurous they can try out a ”real” solo. Everyone of us who has had to sing alone knows what that feels like… Get into the ”swing”. Some jazzy swinging songs are very popular (”Zwei kleine Wölfe”). Through clapping or light movements the singers feel carried along by the music, start to move and become more free in their soul. Steps into life. One aim at the Day Clinic work is the individual reintegration into the ”normal” everyday life, after long-term illness in many cases. Here are two examples: How do I introduce a song?

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Mr. M. came in the first year of the Day Clinic with a diagnosis of depression and a severe problem of self-esteem to individual therapy. He had no particular musical experience and no access to using his voice. We discovered quickly however that he had a wonderful tenor voice and he was interested to try it out. He made good progress, and he felt safe and enjoyed his singing. He used the open singing to try himself out as a soloist. With a great deal of excitement he sang the verses of ”Swing low”. The impressed applause of his fellow patients left him with large smiles and he obviously grew internally. A short time later there was a celebration of the Day Clinic’s first birthday. Many ex-patients came and the situation was public. We sang together, and with much excitement, but in a beautiful voice he mastered his song. A wonderful achievement! Second example: On the fifth birthday of the day clinic in December (we like to party!) there was a public celebration. Alongside the usual honored individuals from politics and society, all ex-patients were invited to take part. At the end in the early evening, we sang Christmas songs together. Without any differences, the current and ex-patients stood equal with the guests and therapists, and about eighty people enjoyed the full sound of emotional Christmas carols, the experience of communal singing and the festive mood of the coming Christmas celebrations. Many patients discover a sense of deep joy and healing happiness through communal singing. After the end of their time at the clinic I try to help them to find a suitable choir. Mr. H., who comes almost every Wednesday to sing, is, after much hesitation and a lot of persuasion, active in the local Witten Bach choir.

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Mrs. M. from Dortmund found a gospel choir in which she is getting to enjoy community with others. Mrs. S., who is chronically ill, sings in a choir once a week. After which she says she has at least two symptom-free days. I suggested she sings more often! Further aspects that lead to success It is necessary to continually search for suitable new songs, so that one does not fall into a pattern of routine, and also to find songs suitable for the new and ever changing group of patients. This means, one can hardly walk past a single new song book… • One’s own routine and security is helpful and relaxing, as is the exact preparation of the songs. Based on this, one is confident during the sessions and can react in a flexible manner to the current situation and mood of the patients. • It is extraordinarily helpful to have my team who have been musically trained over the past seven years. The team supports my work unequivocally and with much fun. As we sang as a group at a colleague’s wedding, someone asked if they could hire us for the next party… •

Therapeutic dimensions and aspects of singing in the day clinic In our society, singing is ”out”. Most people only use the radio, the CD player and the television. In most families only ”Silent night” is sung on 24th December. On most birthdays you hear only ”Happy birthday” in 15 different parts, mixed with the sound of champagne glasses after the first repeat. In football stadiums there is regular singing, sorry ”grunting”. In kindergarten and primary schools some effort is made but mostly without much competence or success. Later at school ”learning” is more important than ”doing”. Continuous critical remarks on one’s singing and comments like ”leave your mouth closed while we are singing” make many people silent for the rest of their lives. In Witten for example, there is no Therapeutic dimensions and aspects of singing in the day clinic

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secondary school with its own school choir, with the exception of the Steiner School. Am I right or exaggerating? I hope that some protest is stirring. Over the past two or three years there is a contrary movement – through projects like, ”rhythm is it” – a large music and dance program in inner city crisis areas in Berlin, a growing awareness of the significance of music for people and particularly in the development of children. Music schools have begun to cooperate with schools and offer not only instrumental courses but also children’s choirs. But these projects have not yet any significant effect – it is no exaggeration to say that over 60% of our patients have not sung a song for decades. Certainly 90% of the patients have no experience with a choir, no shared experiences in singing. This is obvious in those patients who arrive in the Morgenkreis on their first day in the Day clinic. Anxious, often with negative experiences and a lot of worry about what is about to happen, they see the music therapist who comes along with her colorful folders and after a friendly hello starts to sing an often unknown song. They see the doctors and secretaries in the circle also searching for the right note and the beat. The commonly strong reactions range between embarrassment, wonder, defense, inquisitiveness, and also indignation and fear. Mostly the feelings are overridden by inquisitiveness. Nobody attracts notice who tries tentatively to join in singing. The social need to belong commonly leads the patients to join in. Concentration on the musical work often helps them to forget everything else and to overcome the surprise or embarrassment of one’s own voice easily. The ”success” after 10 minutes leads mostly to a feeling of sponta-

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neous joy or at least comfort and relaxation: ”I have presented myself and have belonged”. After one song, one is no longer a stranger, contact is easier and a good start has been made. This makes contact with nurses and therapists easier, too. It is easier to talk about one’s problems after singing a canon with someone. Much has been published about therapeutic work with the voice. In the following section I will focus on those issues that I believe are most significant for my work with these patients. I will complement these issues with fitting citations. 1. SINGING DEVELOPS PERCEPTION

Some songs are simple, others unusual, for example very old melodies from the Middle Ages (e.g. ”Maienzeit bannet Leid”). I sing the unusual songs in short sections first, until all have entered this musical world. Exact intonation and phrasing or rhythmical accentuation exercise the perception of people with disturbed perception or with increased introspection. Hereby, this ”exercising” is without orders and actually is fun. ”Perhaps no other activity (such as singing) is so healing… The all inclusive discipline of rhythm and pitch develops the feeling for coherence and solidarity” Menuhin

2. SINGING INCREASES SOCIAL PERCEPTION

After we have practiced a song or canon and gone into the two and threepart I demand that the patients do not hold their ears closed, a favored practice from school, but to keep their ears open, to listen to the other voices, the resulting intervals and the resulting chords and to enjoy it, even though it may seem difficult at first. When a three-part canon is first practiced in changing two-part groups and one group has the opportunity to listen, the perception is also trained, listening is practiced. Slow tempos are good to practice listening, as are small intervals and chord exercises, or to sing for someone first. The ”a-ha” experience when it works and sounds good is always a big one. This trains intra- and interpersonal

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perception. Success is apparent when everyone can listen to each other, be involved with the other, but hold their own part. ” Singing develops as it unfolds from listening with attention. In singing we refine our ability to really listen to people and to the world surrounding us.” Menuhin 3. SINGING DEVELOPS COMMUNITY

Depending on the quality of the song, various social reactions can be observed. An emotional song leads to a warm, loving atmosphere that often leads to pleasant contacts and talks between the patients. A stronger song brings the group into movement. After we once had finished a song with gusto, the whole group came over to me, as if planned, and lay their songbooks in my arms with eye contact full of smiles. I was surprised by so much direct contact, normally they just leave the song books on a chair. The patients experience a direct pull in social interaction, they develop basic social competencies which may have been lost through illness. At the same time they experience togetherness in action instead of hierarchy. Communal singing and breathing creates an internal sense of connectedness. After singing there is much more contact and conversations. ”When one person sings out of his soul, He will heal his inner world. When all sing out their souls And are one with the music, They will as well heal the outer world.”

4. SINGING AFFECTS THE BODY

Menuhin

Breath is not only the basis of singing but also the basis of emotional life. A disturbed breath for whatever reason disturbs emotional experience. Singing is a deep body process, and the body is my instrument. Singing fills every thread of my body. And through this, the required breath links my body with the world.

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My bodily condition is reflected in my voice, everyone knows this. I often explain to the patients that a major part of singing, like sport, can be trained. Many, in particularly the younger patients have experienced sport and easily understand and accept this comparison. People with emotional illness are always not fully incarnated – or connected with their body. When the body is in balance, the soul is also in balance and vice versa. All body therapies are therefore helpful for emotional disorders. Singing works both physically and emotionally, and through this we come closer to the term ”holistic” in therapy. ”Perhaps, no other activity is as healing as singing is, because it requires our whole movement apparatus – breath and blood circulation, lungs and heart.” Menuhin 5. SINGING LEADS INTO THE WORLDS OF SOUL

In former times, there were no important events in the life of a person that were not accompanied by music and song. Songs, particularly traditional songs were sung often. All emotions of life were included, joy at a wedding, sadness at a burial, a lullaby at night, love songs and so on. In this way, all emotions of human life rang out in song, the variety of the internal world of emotions became expressed. I begin Open Singing with one or two well-known songs to invite, warmup and arrive. Then I ask if anyone has a favorite song. The various patients’ wishes comprise a wide range of songs, from their own emotional world. The range of emotions is, in turn, a possibility to recognize one’s own emotional world. The facets of emotional experience are similar to taking a walk through the most diverse and deep human emotional states and touch each individual person with their own themes and problems. Through the experiences and forms, blockages and hardness are touched, feelings are re-discovered and the emotional flexibility of the soul and the heart is expanded. Sometimes patients are overwhelmed by feelings suppressed and dried-up for a long time, may cry a little or go

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outside, smoke a cigarette or look for a conversation. The next time, they may be a step further, and may sing along for a song, or at least manage to cope with the situation. In this manner, everyone experiences during their stay, not only the diversity of other emotional worlds, but the various emotional worlds in themselves. This leads to more self-knowledge and more social tolerance. ”Teach your soul to sing. Each state has its songs. May singing be with you in all you do Love this singing and watch over it.” 6. SINGING MAKES IT POSSIBLE TO EXPERIENCE LIVING STRUCTURES

Arvo Pärt

Many of the patients come with ego structure disorders, commonly beginning in their childhood. Daily structure, day and night rhythm, and body rhythms are often disturbed, they are not able to form their everyday life. A given song offers a structure in the form of support and orientation. It is not a fixed unchanging structure, but a living one. The melody is given, but we can sing it as a two-part or canon. We change pitch, tempo or dynamics. Some verses have a different text structure or the accompaniment changes. One can hold on without being fixed, it is possible to stay in movement. “The Rhythm of music, proportions and movement in all other arts grant stability, a sense of purpose and consistency in our daily life. Without these guarantees, life would be chaos; it would seem senseless and with no reason to the individuum, confused by noise and chaos.” Menuhin

7. SINGING MAKES THE JOY OF LIFE ACCESSIBLE

Everyone who has been on a psychiatric ward knows the paralyzing, mostly somber, joyless atmosphere that commonly characterizes these wards. Singing, regardless how quiet and unimpressive it may be, changes this atmosphere. The patients experience, while singing, that even though there is much internal joylessness and heaviness, there is a Therapeutic dimensions and aspects of singing in the day clinic

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spark of the joy of life. They can feel this once again and gather hope that this joy can and is allowed to grow. I use every chance that a song or situation offers to say something humorous. And in fact, fun songs are repeatedly chosen. I often tend towards comic effects, by emphasizing some expressions, or make jokes at my own cost, for example in the desert canon "Sum gali gali" I am very intense with the portrayal of the camelâ&#x20AC;Ś This is when the last start to laugh or at least begin to grin. Through the concentration on the music, we repeatedly experience life energy, and the joy of life. "I praise music, As it frees people from the heaviness of things and connects the individual within the community" St.. Augustine 8. SINGING ENCOURAGES PERSONALITY INTEGRATION

Through singing, patients come in direct contact with themselves, with their "Self" or ego personality. Many are ashamed, and don't want to hear their voices, are shocked by their own voice and hide themselves in the sound of the choir. Through the shared musical work they manage to overcome this. They feel themselves grow within the community and grow in their ability and possibilities. Suddenly the difficult passage is managed, or one manages to stay in a shared rhythm. Through singing, patients come into contact with aspects of their personality, in their own form of reacting within the world. Those habits and behavior patterns that have developed in their biographical experience are reflected in their singing and in contact with the therapist. Sometimes, I sing the melodies a little differently than they are transcribed. If I do not mention this at the outset there is often loud protest. "You are doing

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something wrong there!" I take it with humor and cite the "artistic freedom" or we try various possibilities so that we can decide upon a final version together. “In those who do not love, music banishes all hatred. To the restless one it gives peace, And the crying will be consoled. Those who don´t know how to proceed Will find a new path, And for those who reject everything A new certainty and hope will grow.” Pablo Casals 9. SINGING TO STRENGTHEN THE ”SELF”

Singing touches the "Self" of a person, understood as his or her most internal being, which lives, forms and also suffers; this Self that stands as a unique individual in front of me, this individual that must accept that it is ill, and does not manage its life; this deepest core of the person expresses itself through singing. “Singing is a direct expression of the self, that lives at the same time in its emotional and mental aspects as well as in its physical and vocal organism. Singing is one of our most integrated activities, at the same time a most revealing and expressive act.” Paul Nordoff This Self that initially says, I cannot sing, and such a difficult song too, this Self begins gently to move and express. It experiences in singing a "I can", "I can sing, I can create form, I can change something, move something, I can sing together with others. I can even stand up and raise my voice before others, I can!"

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Mrs. M. discovered singing for herself. It was her element. She used every chance to work and try out solo parts. In individual therapy she had the wish to sing "O happy day". It was her song. She bonded so strongly with the song that she found her own individual expression. In open singing she presented her song and the group sung the repeating chorus. Through this she attained a range of freedom in musical expression with an almost stage-ready performance. Everyone was delighted. Often the patients are surprised about their inner growth through contact with music, with the experience of the "you" and the community. 10. SINGING INCREASES WILLPOWER

According to the strength and security of a group, the tasks increase in difficulty. We even managed an eight-part canon once! A second voice is initially sung by three or four stronger voices. Then all the other voices have to concentrate on the first part. For some, this is a challenging task. Things that don’t function are practiced again, no one is evaluated as right or wrong, behaviour and person are not, as often experienced, unfortunately linked to each other. In contrast, an unconditional "yes" to a person with their errors is experienced. Errors are allowed, I make errors too – and often more audible ones! Errors are not negatively judged, but are accepted as part of practice better and repeatedly take us closer to the musical expression. It is a healing atmosphere, when errors are accepted; the inner tension of avoiding mistakes can be released. Through this, I can be free to become involved with something and to focus my willpower on one aim. My inner strength does not get lost in the group, but is important for the success of the songs.

11. THE INNER SOURCE

The surprise and joy, when after repeated hard work, a canon unexpectedly comes together and also even sounds good, is often large. Through experiencing a musical figure or form we experience "beauty", wholeness, and maybe a feeling of being healed. I experience musical-artistic

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activity as a dimension of human existence, which extends over daily life and opens artistic and spiritual experiences in life. These experiences can reactivate inner resources that have been buried and unused, and also address and answer the question of sense, particularly with psychiatric patients. The state of being touched or moved through beauty in music, the experience of music as art can be a direct experience of music as a path, a bridge into the spiritual world. “God honors me, When I work, But loves me, When I sing.” Tagore

Summary Singing has many aspects and has been widely discussed and researched in terms of its effects on people and on a community. Singing has found various forms in therapeutic work. To discuss both would have been outside the scope of this presentation. ….just sing!

This article can be cited as: Boymanns, B. (2006) Just sing…Music Therapy Today (Online 22nd December) Vol.VII (4) 913-931. available at http://musictherapyworld.net

Summary

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„Painting is good for your soul!“ Merz, Regine Merz, R. (2006) “Painting is good for your soul!” Music Therapy Today (Online 22nd December) Vol.VII (4) 932-938.

Regine Merz, certified art therapist and leading researcher in this study, intends to provide HIV and AIDS patients as well as breast cancer patients with art therapy. Creative art therapies, specifically for HIV and AIDS patients, should be covered by health insurance. „Painting is good for your soul, stimulates the senses and has a steadying effect on emotions“, confirms Isabella. She attends the therapeutic painting group HIV-ART established by Regine Merz in the Ruhr area several years ago. For the art therapist, the positive response of participants and also of visitors to the exhibitions organized by HIV-ART are a confirmation that art therapies are a highly meaningful complementary intervention, specifically for HIV and AIDS patients, and therefore should be covered by health insurance. Regine Merz has started her doctoral studies on art therapies and AIDS in order to provide a solid academic basis in support of this demand.

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FIGURE 1.

When Isabelle appeared at the art therapy sessions she was rather quiet and absorbed in her painting. Her first water colours show much insecurity in brushwork. Frequently she asked the art therapist for advice and

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support when she had practical problems putting her ideas on paper. Water colours cannot be painted over. This increased her insecurity, and she changed over to more expressive acrylic paints. This also changed her artistic expression; now she was able to change and paint over what she wanted to cover. FIGURE 2.

She needed less and less help. She kept to her favourite colours, warm earthen shades. Gradually, still lives emerged on her canvas. Her comments on her first paintings were: „I don’t know what I am painting.“ Today her themes are clearly recognizable. Also she was less reticent to

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get involved with the others in the group. She was all in favour of meeting not every third, but every second week. Her paintings document her artistic as well as personal development, where the HIV infection does not seem to be in the foreground. FIGURE 3.

For other participants the disease and the exclusion experienced as a consequence are the core theme of their artistic endeavours. The title of the very expressive painting by Volker is „The better human being“ and refers to the yellow figure on the left. This work is an expression of his relationship and solidarity with the excluded person, as yellow was his favourite colour. He extended his commitment to solidarity with HIV patients and their families beyond the art therapy sessions. As his disease progressed his artistic abilities faded with his degenerating immune system. The final point is visible in his last painting shortly before he died, as a red burning sun in the sky above a village. Volker’s paintings, like

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those by Isabelle, reveal the relation between the works of art and the artist in his entirety, with all his individual traits and his outlook. Volker’s paintings reflect his physical condition and the way he copes with the disease in a very immediate manner. FIGURE 4.

In art therapy sessions, emotions and moods are taken down on paper more or less consciously; the person who paints envisages himself and is enabled to reflect his personal situation, using the canvas as a projection. The patient is no longer the passive person who just endures what others do to him – a role he associates with loss of control. The physical activity

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of painting ideally stimulates active ways of coping with the disease and the new situation in life. In 2006, more than 20 years after the first cases of AIDS occurred in Germany, HIV infection remains a medical problem and a highly complex phenomenon. Antiretroviral drugs were developed over the past ten years and improved medical treatment considerably. AIDS today does not necessarily mean a degenerative process, but a return to a normal daily life has become a possibility under new and better conditions. AIDS has become a chronic disease with individual forms of progress. This change may also be seen from the patients’ artistic expressions. Death and grief are no longer the most distinct subjects. Today we find landscapes, still lives and abstract compositions in such paintings. These works of art are as individual as their creators and their situations in life. Looking closely at the cycles of paintings by Volker and Isabelle and the contrary development of these cycles, we must wonder whether the paintings created in art therapy document, in addition to personal development, also changes in the pathological progress. Are HIV-specific parameters visible in patients’ paintings, and how may they be interpreted? This is the research question for this study. One day per week, people with an interest in art therapies may attend art therapy sessions for one hour. Dates are by appointment either in the morning or afternoon. After an introduction to techniques of acrylic painting, participants receive continued professional support in realizing the tasks set to them. A total of four different subjects have to be illustrated, and this requires four appointments of one hour respectively. Clients are supposed to produce one picture per art therapy session. Art therapy sessions are group sessions with a maximum of four participants and take place at the lecture centre of the St. Josef Hospital in Bochum. The study is a combined 937

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project monitored by the HIV/AIDS competence network and conforms to the pertinent data protection regulations. Attendance does not require previous training or artistic skills.

Author details FIGURE 5. Regine Merz

Regine Merz is a certified art therapist. In 1999 she founded the art therapy group HIV-ART. As a member of AIDS-Hilfe NRW she coordinates meetings of HIV positive patients in NRW. In her current doctoral studies at the University Witten/Herdecke (supervised by Prof. Dr. David Aldridge, Chair of Qualitative Research in Medicine) she addresses the question whether HIV specific parameters are visible in patients’ paintings, and how these may be interpreted. CONTACT DETAILS

Individuals with an interest in the above-mentioned study may contact Regine Merz at: (phone) 0174-56 14 897 or e-mail: merz(at)hiv-art.de

THIS ARTICLE CAN BE CITED AS:

Merz, R. (2006) “Painting is good for your soul!” Music Therapy Today (Online 22nd December) Vol.VII (4) 932-938. available at http://musictherapyworld.net Author details

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Music Therapy Today Vol. VII (4) (December)

Report on a research meeting 2006 in Berlin: “Music Therapy as Applied in Neurology” Pfeffer, Karolin

Pfeffer, K. (2006) Report on a research meeting 2006 in Berlin: “Music Therapy as Applied in Neurology”. Music Therapy Today (Online 22nd December) Vol.VII (4) 939-943.

On 19 November 2006, the IMB, International Music Therapy Institute Berlin, in close cooperation with the DGMT, arranged a research meeting dealing with the subject “Music Therapy as Applied in Neurology”. The IMB is an Institute of the University of the Arts, Berlin. It supports music therapy in practice, research and training and contributes to the public health care on a non-profit basis. Apart from the organisation and realisation of international symposia, it cooperates with institutions of psychosocial care to build up outpatient treatment possibilities. The next symposium will take place as a conference from 3.-7. September 2007 at the meeting point of the UdK in Sauen / Brandenburg (www.udk-berlin.de/musiktherapie/IMB). 939

Pfeffer, K. (2006) Report on a research meeting 2006 in Berlin: “Music Therapy as Applied in Neurology”. Music Therapy Today (Online 22nd December) Vol.VII (4) 939-943. available at http://musictherapyworld.net

On this Sunday, about 50 participants gathered in the UdK at Mierendorffplatz for lectures and discussions on the subject of music therapy as applied in neurology. Spirits were high while final preparatory works were accomplished. To start with, Prof. Dr. phil. Jahn-Langenberg gave a comprehensive survey over the course of the meeting, introduced the speakers and accentuated the importance of the interplay between research and practical operation. She pointed out that present health politics seem to ask for developing, examining and advancing both present and new fields of practice. Furthermore, new aspects of the concept of psychotherapy should be redefined. According to Prof. Jahn-Langenberg, there seems to be a need for a comparing examination of practices as applied in Germany and USA. Also, this day’s meeting was to treat the subject of polarity between humane arts and natural science in lectures held by Prof. Dr. Jane Edwards, guest professor of the institute, and Kathrin Mertel, Dipl.Mthp. (FH), MM Master of Music. At the outset, Prof. Dr. med. Hans Ulrich Schmidt discussed the subject of music therapy as applied in neurology. To an increasing extent, music therapy develops into an interesting interdisciplinary medical treatment. Improvements in the complex data capture in cerebral research permitted, within the past 5 years, the development of neurological music therapy as a methodically systemized as well as scientifically established therapeutic method. In using music therapy within the scope of neurology, psychotherapeutic settings are often modified. What is more, to some extent, treatment methods are applied that cannot really be defined as psychotherapeutic, but rather reach into the domain of functional music. (See M. Thaut, www.colostate.edu/dept/cbrm/publications.htm). He lectured on a “soft movement away from a therapeutic relationship” and suggested focusing on the impact of the object – of music and its 940

components, rather than on a therapeutic relationship. After all, as he puts it, one is finally always confronted with the question: What makes music therapy work? The following lecture was contributed by Prof. Dr. Jane Edwards on the subject of “Research in Context – a Response to the Evidence Based Medicine (EBM)”. She gave a survey over the EBM framework, which one might describe as a series of levels of evidence. (See MU 25,3 (2004), p. 221-232). EBM was thoroughly discussed and defined as a complex topic in music therapy serving as an element of objectification. As it is quite useful in maintaining or even creating posts, music therapy should get more deeply involved in EBM concerns. Furthermore, Jane Edwards pleads for openness towards the multitude of “Levels of Evidence” and for better appreciation. The point is to identify the wide range of research work being accomplished, and to find out which method might be the most efficient in pursuing which target of research. Her suggestion was not to consider EBM as a restriction to music therapy, but rather recognize the opportunity to build up a clearer position in international comparison and within medical contexts. Dr. rer. medic. Wolfgang Schmid presented „Functionality and Aesthetic – a Pilot Study of Music Therapy in the Treatment of People with Multiple Sclerosis”, this illness being the most widespread and incurable inflammatory disease of the central nervous system in young adults within the western industrialized countries. Since it includes stigmatization and heavy primary and secondary diseases (reactive depression, continually varying self-perception), a comprehensive treatment should not proceed from functional considerations. A full range of therapeutic methods should be offered, including the enhancement of the patient’s creative abilities. Those concerned desire improved psycho-social care and increasingly express an interest in alternative and complementary thera941

pies in addition to medical treatment. (See: Neurologie & Rehabilitation 2005; 11(3): 131-138); Music Therapy Today, Vol V (5) Nov 2003). Kathrin Mertel presented the connection between scientific evidence and music therapeutic training as for example the American master studies offered by the Colorado State University. Here, neurological music therapy (NMT) stands for music therapy as an application of music to treat cognitive, sensory and motor dysfunction brought about by neurological disease of the central nervous system. It is based on the neuro-scientific model of perception and production of music. Clinical studies in context with quality assurance deal with the question whether music is capable of influencing behaviour beyond musical comportment, and why music therapy is employed in neurology. Studies include music, therapy and research. Studies focus on empirical research in music and medicine. After 2 full-time semesters, the study ends with a Master of Music (MM) degree – with focus on neurologic music therapy. Costs amount to approx. 7,000.00 USD per semestre (http://www.colostat.edu/Depts/ cbrm). At this meeting, the catalogue of indications for music therapy in neurological rehabilitation published in May 2005 was presented for the first time by Anna Hinkelmann, Dipl.-Mthp. (FH) and Stefan Mainka, Dipl.Mthp. (FH). After approximately 2 years’ work, she presented the results of the study group consisting of 6 persons. The project was supported by the DGMT and accompanied by Dr. med. Hans Ulrich Schmid. The catalogue is a contribution to scientific discussion and teaching. It is designed to serve as a professional account to externals, as information to physicians and sponsors, also to facilitate communication with the interdisciplinary team. (To be ordered: www.musiktherapie.de, Webshop/Beiträge/ Nr. 455).

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Dr. Annkathrin Pöpel, who works as a doctor, music therapist and neurologist, moderated the meeting. See her Study “Evaluation of music therapy in Germany neurorehabilitation – starting point for European comparability” (http://musictherapyworld.net). The final discussion was mainly focussed on the significance of therapeutic relationship, ways to deal with EBM and its influence on music therapy as well as on the essential exchange between functional therapy and psychotherapy. Thus, at the end, all subjects and lectures of the research meeting were summed up in conclusion. The participants separated with a sense of having experienced an interesting and successful day.

Author information Karolin Pfeffer Dipl.-Mthp. (UdK) Kopenhagener Str. 13 10437 Berlin 030-48494926 THIS ARTICLE CAN BE CITED AS:

Author information

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Music Therapy Today Vol. VII (4) (December)

“My Top Ten” Aldridge, David Aldridge, D. (2006) “My Top Ten”. Music Therapy Today (Online 22nd December) Vol.VII (4) 944-946.

David Aldridge and Lutz Neugebauer have initiated a new research project called “My Top Ten”. For German readers they can see the first responses on the website http:// www.mytopten.de and also read details of their new CD collection “Meine Musik”, a set of four CDs designed specifically for relatives and carers of the elderly. The four CDs cover four differing musical styles and are original recordings, an important feature of reminiscence work. For general readers there is more to read on the Nordoff Robbins Centre website at http://www.nordoff-robbins.org “My Top Ten” is an international research project that will gather qualitative information about what music people aged 60 years and over remember and how that is associated with events in their lives. Reminiscence is seen as an important factor in various therapeutic interventions and this project will concentrate on musical reminiscences. Similarly, giving

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This article can be cited as: Aldridge, D. (2006) “My Top Ten”. Music Therapy Today (Online 22nd December ) Vol.VII (4) 944-946. avialable at http://MusicTherapyWorld.net

voice to the elderly is seen as an important factor in establishing the worth of the elderly in modern western industrialised societies. The educational intent is inter-generational in that the project will encourage younger people in schools, colleges and graduate courses to gather the project data, with appropriate supervision, by partnering a younger person with an older person. In addition, this project will provide information infrastructures for netbased international research cooperation, musical resources for practitioners, patients and carers, and an e–learning resource. The educational aspect has two parts. One, for the further education of practitioners and carers involved in working with the elderly as an e – learning resource. Two, an intergenerational aspect linking younger people with the elderly. This may be at senior school or at college level and could be incorporated in training schemes as a specific module of working with the elderly in health care, occupational therapy or nursing studies; as a music ethnology module; or as a qualitative research module. At school level, this would be suitable for scholars needing a community contact, with an interest in the healing and caring professions, as a local history project or a music project.

Author Information Professor David Aldridge has the Chair of Qualitative Research in Medicine at the University Witten Herdecke in Germany and is also Visiting Professor for the Creative Arts Therapies, Bradford Dementia Group at the University of Bradford, UK. Together with Prof. Lutz Neugebauer, he is Director of Nordoff-Robbins Zentrum, Witten, Ruhrstrasse 70, 58452 Witten in Germany, which is a centre specifically for research and practice into the arts in the community.

Author Information

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This article can be cited as: Aldridge, D. (2006) “My Top Ten”. Music Therapy Today (Online 22nd December ) Vol.VII (4) 944-946. avialable at http://MusicTherapyWorld.net

THIS ARTICLE CAN BE CITED AS:

Aldridge, D. (2006) “My Top Ten”. Music Therapy Today (Online 22nd December) Vol.VII (4) 944-946. available at http://musictherapyworld.net

Author Information

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Music Therapy Today Vol. VII (4) (December)

Odds and ends - themes and trends Tom Doch Anything under odds and ends, themes and trends is linking to existing work on the net – we cannot claim responsibility for the content of other websites (it may become outdated quickly).

Sense of Humor and Aurvival among a County of Cohort of Patients with End-Stage Renal Failure A Two-Year Study By SVEN SVEBAK, BJØRN KRISTOFFERSEN AND KNUT AASARØD Source: baywood.metapress.com/Volume 36, Number 3 / 2006 http://baywood.metapress.com/(dm1gyz2ku4t0yr45fxtr3q45)/app/home/ contribution.asp?referrer=parent&backto=issue,2,10;journal,1,139;linkingpublic ationresults,1:300314,1 The International Journal of Psychiatry in Medicine

Abstract: Objective: To explore the significance of sense of humor for survival in a county cohort of patients diagnosed with end-stage renal failure. This diagnosis is a life-threatening condition that calls upon coping skills and regular dialysis. Method: All patients receiving dialysis in the county of Sør-Trøndelag during February of one year (N = 52) were invited. Forty-one completed the survey and had complete data (78.9%). 947

The discordant eardrum

Predictors were related to survival status two years later. Three blocks of predictors were tested: 1) age, gender and education; 2) duration of disease, number of dialyses per week, and co-morbidity; and 3) quality of life and sense of humor. Confounding effects of variables in blocks one and two were controlled for using Cox survival analysis. Results: Nineteen patients (46.3 %) died over the 2-year observation period. Survival decreased with higher age at time of survey (p < .044), but was not significantly predicted by variables in block two. A highly significant increase in survival was due to the psychological variables of block three (p < .001) essentially accounted for by sense of humor (p < .005). Those who scored above the median in sense of humor increased their odds for survival by on average 31%. Conclusions: Sense of humor appeared to mediate better coping and, therefore, protected against detrimental effects of disease-related stressors upon survival. OutDoorLinks: Sven Svebak http://www.hint.no/Adresseboka/adresse/vc/index.php?uid=svs&vis=S

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The discordant eardrum By Jonathan P. Fay, Sunil Puria and Charles R. Steele Source: www.pnas.org/ December 14, 2006 http://www.pnas.org/cgi/content/abstract/0603898104v1?etoc Published online before print December 14, 2006 Proc. Natl. Acad. Sci. USA, 10.1073/pnas.0603898104

At frequencies above 3 kHz, the tympanic membrane vibrates chaotically. By having many resonances, the eardrum can transmit the broadest possible bandwidth of sound with optimal sensitivity. In essence, the eardrum works best through discord.

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The discordant eardrum

The eardrum's success as an instrument of hearing can be directly explained through a combination of its shape, angular placement, and composition. The eardrum has a conical asymmetrical shape, lies at a steep angle with respect to the ear canal, and has organized radial and circumferential collagen fiber layers that provide the scaffolding. Understanding the role of each feature in hearing transduction will help direct future surgical reconstructions, lead to improved microphone and loudspeaker designs, and provide a basis for understanding the different tympanic membrane structures across species. To analyze the significance of each anatomical feature, a computer simulation of the ear canal, eardrum, and ossicles was developed. It is shown that a cone-shaped eardrum can transfer more force to the ossicles than a flat eardrum, especially at high frequencies. The tilted eardrum within the ear canal allows it to have a larger area for the same canal size, which increases sound transmission to the cochlea. The asymmetric eardrum with collagen fibers achieves optimal transmission at high frequencies by creating a multitude of deliberately mistuned resonances. The resonances are summed at the malleus attachment to produce a smooth transfer of pressure across all frequencies. In each case, the peculiar properties of the eardrum are directly responsible for the optimal sensitivity of this discordant drum. To read fulltext go to attached PDF To whom correspondence should be addressed. Sunil Puria, E-mail: puria(at)stanford.edu

OutDoorLinks: Charles R. Steele http://me.stanford.edu/faculty/facultydir/steele.html

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Mozart's entire musical works now free on Net

Mozart's entire musical works now free on Net Site hosting complete oeuvre of the classical composer, backed by Packard Humanities Institute, is being flooded with traffic. By Reuters Source: http://news.com.com/Mozarts+entire+musical+score+now+free+on+Net/ 2100-1027_3-6142845.html?tag=html.alert

Wolfgang Amadeus Mozart's year-long 250th birthday party is ending on a high note with the musical scores of his complete works available from Monday for the first time free on the Internet. The International Mozart Foundation in Salzburg, Austria, has put a scholarly edition of the bound volumes of Mozart's more than 600 works on a Web site. The site allows visitors to find specific symphonies, arias or even single lines of text from some 24,000 pages of music. "We had 45,000 hits in the first two hours...we would not have expected that," program director Ulrich Leisinger told Reuters in a telephone interview. CNET News.com was not able to reach the site Tuesday morning, perhaps due to a traffic overload. A user who types in "Pamina" from Mozart's opera "The Magic Flute" will see the music for all five arias she sings, as well as critical texts discussing those passages. The version appearing on the Internet is a digitized copy of the "New Mozart Edition" published by Barenreiter, of Kassel, Germany. It is considered the "gold standard" of Mozart editions, and Leisinger said Barenreiter was paid $400,000 for the digital-publication rights. The financial backing came from the Packard Humanities Institute of Los Altos, Calif. "We hope we will be able to convince other people besides us to present their original materials online as well," Leisinger said. Story Copyright ÂŠ 2006 Reuters Limited. All rights reserved.

OutDoorLinks: Neue Mozart-Ausgabe/New Mozart Edition Digitalisierte Version / Digitized Version http://nma.redhost24-001.com/mambo/index.php

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It's the thought that counts

It's the thought that counts Belief in placebos can release natural painkillers in patients By Dennis O'Brien Source: www.baltimoresun.com/ December 8, 2006 http://www.baltimoresun.com/news/health/balhs.placebo08dec08,0,3278030.story?coll=bal-health-headlines

Using brain scans, acupuncture and the nasty stuff that puts the sting in pepper spray, researchers are learning how placebos play out in our brains. These innocuous medications - long used as decoys in clinical drug trials - aren't supposed to have real chemical effect on the body. But experience over the years has taught doctors that some patients who take placebos experience real relief. Now brain scans show that when test subjects think a placebo is a real medication or treatment, the expectation of relief can release natural painkillers. That, in turn, can ease the discomfort of ailments from overworked muscles to a stinging hand. "I think what we've shown is that the effects of placebo are real. It's not false pain relief at all. The body is releasing a chemical that induces pain relief," said Dr. James N. Campbell, professor of neurosurgery and director of the Blaustein Pain Treatment Center at Johns Hopkins Hospital. Campbell's tools are positron emission tomography (PET) scans and capsaicin - the compound that makes hot peppers hot and puts the sting in pepper spray. His tests show that when someone gets a placebo, a specific region of the brain responds by activating neurotransmitters thought to release morphine-like painkillers. "The question we asked was, 'Is there a release of morphine that corresponds to this placebo effect?' The remarkable finding was that there is," Campbell said. In initial tests, researchers applied capsaicin to the left hands of 30 volunteers. They also got injections that doctors described as a soothing medication. The injections were, in fact, a harmless inactive saline solution, but a thermal device connected to the volunteers' hands reduced skin temperature to about 80 degrees Fahrenheit. That eased the effects of the capsaicin so that volunteers came to associate the injections with reduced pain.

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It's the thought that counts

In follow-up tests, volunteers again got capsaicin treatments. Some also got placebo "painkiller" injections, while others got no injections at all. Meanwhile, researchers ran PET scans on subjects while they were given the injections. PET scans use positron emission tomography to trace the path of a mildly radioactive substance through the body. It's typically used to identify tumors or spot areas of brain function. The tests showed that when given the placebo injections, volunteers reported less pain from the capsaicin - even though the pepper treatments were the same. More importantly, the scans showed they actually had different reactions in the mid-brain area known as the periaque- ductal gray (PAG). The PAG released a class of painkillers known as endogenous opioids. Scientists couldn't tell exactly which opioids were released - brain scanning isn't that precise - but Campbell believes they were endorphins, which reduce the sensation of pain. Campbell reported his results last month at the annual conference of the Society for Neuroscience in Atlanta. He said his goal is maximizing the placebo effect by harnessing the body's ability to reduce pain naturally. 'Cognitive strategies' That could happen through cognitive therapy, self-hypnosis or focusing on the kind of distraction from pain experienced by someone watching a gripping movie. "You can't go around all the time in a state of self-hypnosis, but there could be some kind of cognitive strategies developed to control pain," Campbell said. Skeptics say the benefits attributed to placebos might stem from our ability to heal without treatment or medication. Researchers at the University of Copenhagen in Denmark concluded in 2001 that the benefits attributed to placebos were largely the result of diseases running their course. Believers in placebos acknowledge that benefits are often hard to nail down - if relief or healing occurs, it's hard to determine how much of it was from the placebo and how much was part of the natural healing process. But scientists such as Campbell argue that brain scans don't lie - they show that something physical is actually happening in our heads.

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It's the thought that counts

They note that placebos in controlled experiments produce the desired effects about 30 percent of the time, and in clinical trials of drugs before they're approved for market, placebos will sometimes be as effective as the tested medication. "Placebos are an inherent part of manipulation whenever a clinician gives a medication. They work very well at blocking pain. That's why a doctor will always talk up the effects of a medication - it increases the likelihood it will help," said Allan Basbaum, a neuroscientist at the University of California, San Francisco. Expectation a key Some experts say placebos are proof of the power of positive thinking. "A patient who has pain - if you give them a medication and tell them it will reduce the pain, that has a positive effect on the outcome," said Dr. Jon-Kar Zubieta, a psychiatrist who studies the effects of placebos on the brain at the University of Michigan. Part of Zubieta's research is aimed at figuring out why some people are more susceptible to the placebo effect than others. "There could be a genetic component, but nothing is certain," he said. Zubieta reported last year in the journal Neuroscience that giving placebos to volunteers who thought they were getting painkillers released natural compounds in several areas of the brain, including the prefrontal cortex and the anterior cingulate. Those areas are believed to control our expectations and how we regulate emotions. Unfortunately for researchers, the brain has no single pain control center, so pinpointing areas where placebos curb pain is a challenge. "There's an entire system of circuits that become activated, at just the expectation of pain relief," Zubieta said. Researchers have been studying placebo effects for years. But many placebo studies don't compare the outcomes from a placebo with those of accepted drugs, said Ted Kaptchuk, an assistant professor of medicine at the Harvard Medical School. Comparisons "One problem is there's been no controls in a lot of cases," Kaptchuk said. "If I give 100 people with colds a sugar pill and two weeks later the cold symptoms disappear, was that the placebo? A lot of what you see are those kind of reports."

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It's the thought that counts

This year, Kaptchuk turned to acupuncture to try to determine whether some placebos are more effective than others. He divided 270 patients, all with chronic arm pain from repetitive stress syndrome, into two groups. He gave one group either a dose of a pain medication in pill form, or a placebo pill. Members of the other group got either acupuncture or a sham acupuncture treatment involving needlelike sticks that didn't penetrate deeply enough to hit the right pressure points. Those given sham acupuncture reported a more significant decrease in pain - about 10 percent - than those given a placebo pill, Kaptchuk said. He reported the results Feb. 1 in the British Medical Journal. One unexpected result: The placebo effect also boosted the volunteers' chances of experiencing adverse reactions when they were warned in advance that unpleasant side effects might occur. In fact, some 30 percent of the patients who got acupuncture - but were told they might experience more pain afterward - actually reported experiencing more pain as a result, Kaptchuk said. The same percentage of placebo pill takers reported getting drowsy and experiencing dry mouths after they were warned about those side effects, he said. Kaptchuk is planning future research into the magnitude of placebo effects on patients with a number of conditions, including irritable bowel syndrome, asthma and chronic pain. "I think there's an intrinsic scientific value in understanding how the body reacts to what's going on in the mind," he said.

OutDoorLinks: James Campbell http://www.neuro.jhmi.edu/profiles/campbell.html Jon-Kar Zubieta http://www.umich.edu/~neurosci/faculty/zubieta.htm

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Laugh and the whole world laughs with you: why the brain just can't help itself

Laugh and the whole world laughs with you: why the brain just can't help itself Source: www.alphagalileo.org/08 December 2006 http://www.alphagalileo.org/index.cfm?fuseaction=readrelease&releaseid=517119

Cricket commentator Jonathan Agnew's description of Ian Botham's freak dismissal, falling over his own stumps – "He couldn't quite get his leg over" – was all it took to send himself and the late Brian Johnston into paroxysms of laughter. Laughter is truly contagious, and now, scientists studying how our brain responds to emotive sounds believe they understand why. Researchers at UCL (University College London) and Imperial College London have shown that positive sounds such as laughter or a triumphant "woo hoo!" trigger a response in the listener's brain. This response occurs in the area of the brain that is activated when we smile, as though preparing our facial muscles to laugh. The research, funded by the Wellcome Trust, Action Medical Research and the Barnwood House Trust, is published today in the Journal of Neuroscience. "It seems that it’s absolutely true that 'laugh and the whole world laughs with you'," says Dr Sophie Scott, a Wellcome Trust Senior Research Fellow at the Institute of Cognitive Neuroscience, UCL. "We've known for some time now that when we are talking to someone, we often mirror their behaviour, copying the words they use and mimicking their gestures. Now we've shown that the same appears to apply to laughter, too – at least at the level of the brain." The research team played a series sounds to volunteers whilst measuring their brain's response using an fMRI scanner. Some of the sounds were positive, such as laughter or triumph, whilst others were unpleasant, such as screaming or retching. All of the sounds triggered a response in the volunteer's brain in the premotor cortical region, which prepares the muscles in the face to respond accordingly, though the response was greater for positive sounds, suggesting that these were more contagious than negative sounds. The researchers believe this explains why we respond to laughter or cheering with an involuntary smile.

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Brain functional near infrared spectroscopy in human infants: cerebral cortical

"We usually encounter positive emotions, such as laughter or cheering, in group situations, whether watching a comedy programme with family or a football game with friends," says Dr Scott. "This response in the brain, automatically priming us to smile or laugh, provides a way of mirroring the behaviour of others, something which helps us interact socially. It could play an important role in building strong bonds between individuals in a group."

OutDoorLinks: Dr Sophie Scott http://www.icn.ucl.ac.uk/Staff-Lists/ MemberDetails.php?Title=Dr&FirstName=Sophie&LastName=Scott

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Brain functional near infrared spectroscopy in human infants: cerebral cortical haemodynamics coupled to neuronal activation in response to sensory stimulation By Marco Bartocci Source: diss.kib.ki.se/8 december 2006 http://diss.kib.ki.se/2006/91-7357-034-6/

Abstract: The assessment of cortical activation in the neonatal brain is crucial in the study of brain development, as it provides precious information for how the newborn infant processes external or internal stimuli. Thus far functional studies of neonates aimed to assess cortical responses to certain external stimuli are very few, due to the lack of suitable techniques to monitor brain activity of the newborn. Near Infrared Spectroscopy (NIRS) has been found to be suitable for functional studies of the infant brain. By this method haemodynamic changes coupled to cortical activity can be monitored.

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Brain functional near infrared spectroscopy in human infants: cerebral cortical

The overall aim of the research is to assess how the brain is processing sensory stimuli (pleasant and unpleasant) in infants using a non-invasive technique such as NIRS. Studies of smell perception (studies 1 & 2) Olfaction was mainly used as the paradigm in these studies. Smelling is essential for neonatal behavioural adaptation in many mammals, including humans. Methods Study 1 Twenty-three healthy, full-term newborn infants were included in the study at a postnatal age between 6 hours and 192 hours. As odorant sources we used (i) the own mother's colostrum; (ii) vanilla essence; (iii) distilled water as a negative control. The i NIRS optodes were placed over left orbito-frontal gyrus of the frontal lobe. Study 2 Twenty preterm newborn infants in stable condition at testing were studied. As odorant sources a disinfectant solution containing benzalconio chlorate (0.25%), ethylic alcohol (66.29%), excipients such as lemon oil, acetone, iso-propilic alcohol, camphor and a detergent containing dipropylene glycol methyl ether, water and mineral essences were used. The NIRS optodes were placed bilaterally over left orbitofrontal gyrus of the frontal lobe. Main findings and conclusion Study 1 The main finding of this study was that the NIRS technique can be used in the neonatal period to record activity in the orbito-frontal cortex - as mirrored by changes in blood circulation during exposure to biologically meaningful as well as artificial odors, colostrum and vanilla, respectively. The magnitude of the response in the illuminated region during colostrum exposure was inversely related to postnatal age. Study 2 This study demonstrated that the odors of solutions commonly used in NICUs might elicit a decrease in blood oxygenation in an area likely to include the orbito-frontal olfactory area.

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Brain functional near infrared spectroscopy in human infants: cerebral cortical

These haemodynamic changes are likely to be the result of a dynamic, physiological regulation of regional CBF based upon the olfactory- and trigeminus-related areas of the brain. Study of pain perception (study 3) Supraspinal pain processing of pain in neonates and preemies is still poorly understood. Methods Forty preterm neonates at 28-36 weeks of gestation and mean postnatal age of 30.7 h were studied following standardized tactile (skin disinfection) and painful (venipuncture) stimuli. Changes in regional cerebral haemodynamics were monitored by near infrared spectroscopy (NIRS) over both somatosensory cortices in 29 newborns, and over the contralateral somatosensory and occipital areas in 11 newborns. Main findings and conclusion Painful and tactile stimuli elicit specific haemodynamic responses in the somatosensory cortex, implying conscious sensory perception in preterm neonates. Somatosensory cortical activation occurs bilaterally following unilateral stimulation and these changes are more pronounced in male neonates and preterm neonates at lower gestational ages. Study of auditory perception (study 4) The aim of the study was to assess differences in activation pattern in response to auditory stimuli before and after the induction of anaesthesia with sevoflurane. Methods The 'Water music", by Handel, was presented to 7 infants aged between 18 and 22 months. NIRS was recorded in different conditions: baseline with no music when the child was asleep, during the music with the child sleeping before anaesthesia, and during the music when the child was in deep anaesthesia. Main Endings and conclusion We observed pronounced bilateral [HbO2] increase during sleeping, similar to that previously reported in waken subjects and suggesting that the infant perceives the auditory stimulus and likely processes it. When the infant is anaesthetised and many neuronal circuits are not functioning, the auditory stimulus can still be perceived as suggested by the increase of Hb02 in one hemisphere, but processing might be altered.

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New mechanism for smelling?

Overall conclusion These studies and other studies that have been carried out in parallel by other groups demonstrate that NIRS is a suitable technique to assess cortical activation in response to varying forms of sensory stimulation in human infants. The technique is likely to play an important role in providing new insights into the ontogeny of cortical function, as well as possibly providing a sensitive means for the early detection of perinatal cortical impairment.

OutDoorLinks: Marco Bartocci http://web.tiscali.it/marcobartocci/noflash.htm

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New mechanism for smelling? By Zeeya Merali Sorce: www.alphagalileo.org/06 December 2006 http://www.alphagalileo.org/index.cfm?fuseaction=readrelease&releaseid=517071

It kicked up a stink among sensory scientists when it was proposed a decade ago. Now a controversial theory that smell receptors in the nose respond to the vibration of molecules, rather than their size and shape, has been revitalised. The theory, first proposed in the mid-1990s by Luca Turin, then of University college London (UcL), was based on the observation that some molecules with almost identical shapes can smell wildly different, while others with the same vibrational frequency, but different shapes, can smell similar. Turin proposed that the nose may work like a particular type of spectroscope that identifies molecules on the basis of the frequency at which their atoms vibrate in response to an electron stream (New Scientist, 18 November, p 74).

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New mechanism for smelling?

It wasn’t clear that this would work in the nose, however, allowing critics to dismiss it as unfeasible. “It was a pretty sketchy idea,” Turin admits. Now Andrew Horsfield at UcL and his colleagues have entered the fray by modelling how a nasal spectroscope might work. The nose is thought to contain a wide variety of receptors, each of which responds to a particular type of molecule, and it is the activation of different patterns of these receptors that the brain recognises as different smells. In Horsfield’s model, smell receptors in the nose contain pockets. When a smelly molecule, for example ammonia, docks into a pocket it stimulates an electron on one side of the pocket to hop across the ammonia molecule to the other side. As it does so, it sets atoms in the molecule vibrating. “You can imagine the electron pinging the molecule like a violin string as it hops over,” Horsfield says. In the model, the electron only hops when certain molecules, which vibrate at specific frequencies, dock in the receptor. A signal is sent to the brain when the electron reaches the other side of the pocket. One persuasive feature of Horsfield’s model is how well it reproduces the speed of smell responses in the real world. The group’s calculations show that such a signal would be sent within a millisecond of an ammonia molecule entering the nose – on a par with observations of how quickly the brain actually reacts to scents. “It seems to be quite a complicated mechanism,” says John Mitchell, a chemist at the University of Cambridge who has studied odours and still prefers the established shape theory. “But sometimes biology requires complicated mechanisms.” Mitchell believes the next step is to test the mechanism experimentally. “It would be great to conduct a huge trial that tests both rival theories’ ability to predict odours against each other,” he says. Turin, who now works for fragrance company Flexitral in chantilly, Virginia, is currently examining the new mechanism to help improve his smell prediction methods.

OutDoorLinks: Luca Turin's Theory of the Sense of Smell http://www.applet-magic.com/turin.htm Andrew Horsfield Odds and ends - themes and trends

960

Cities Change the Songs of Birds

http://www.cmmp.ucl.ac.uk/~aph/ John Mitchell http://www-mitchell.ch.cam.ac.uk/

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Cities Change the Songs of Birds By Hans Slabbekoorn and Ardie den Boer-Visser Source: www.current-biology.com/5 December 2006 http://www.current-biology.com/content/article/abstract?uid=PIIS0960982206023086 Copyright ÂŠ 2006 Cell Press. All rights reserved. Current Biology, Vol 16, 2326-2331, 05 December 2006

Summary Worldwide urbanization and the ongoing rise of urban noise levels form a major threat to living conditions in and around cities. Urban environments typically homogenize animal communities, and this results, for example, in the same few bird species' being found everywhere. Insight into the behavioral strategies of the urban survivors may explain the sensitivity of other species to urban selection pressures. Here, we show that songs that are important to mate attraction and territory defense have significantly diverged in great tits (Parus major), a very successful urban species. Urban songs were shorter and sung faster than songs in forests, and often concerned atypical song types. Furthermore, we found consistently higher minimum frequencies in ten out of ten city-forest comparisons from London to Prague and from Amsterdam to Paris. Anthropogenic noise is most likely a dominant factor driving these dramatic changes. These data provide the most consistent evidence supporting the acousticadaptation hypothesis since it was postulated in the early seventies. At the same time, they reveal a behavioral plasticity that may be key to urban success and the lack of which may explain detrimental effects on bird communities that live in noisy urbanized areas or along highways. Corresponding author Hans Slabbekoorn h.w.slabbekoorn(at)biology.leidenuniv.nl

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961

What you speak may affect what you hear

OutDoorLinks: Hans Slabbekoorn http://biology.leidenuniv.nl/ibl/S8/index_files/Page444.html

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What you speak may affect what you hear By Roxanne Khamsi Source: www.newscientist.com/01 December 2006 http://www.newscientist.com/article/dn10689-what-you-speak-may-affect-what-youhear.html

What you speak may influence what you hear, a new study shows. People perceive different patterns in the same sound sequences depending on their native tongue, researchers have found. The short, first note of “Greensleeves” may sound naturally elegant to those who sing the tune. But this type of “pick-up note”, as it is known to musicians, sounds awkward to the ear of a native Japanese speaker, according to researchers. And they can explain why: people's preference for longer or shorter notes at the beginning of a musical phrase apparently depends on their native tongue. Scientists already know that human hearing naturally group sounds together. A listener might, for example, hear identical clicks from a watch as “ticktock; tick-tock” and so on, hearing an emphasis on the first click – even though all the clicks are identical. Another may hear “tock-tick, tock-tick” with the emphasis on the second click rather than the first. Aniruddh Patel of the Neurosciences Institute in San Diego, California, US, and colleagues wanted to know how people from different cultures group non-identical sounds. They recruited a group of 100 volunteers, half of whom were American and the other half Japanese.

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962

What you speak may affect what you hear

The volunteers listened to sequences of alternating long and short or loud and soft tones (audio clips in wav format). Preposition impact Conventional musical principles predict that people perceive louder sounds to mark the beginning of a group, and longer sounds to mark the end of a group. Nearly all of the American participants perceived exactly this. However, when Japanese participants heard the tones, many of them grouped them in reverse order, with the shorter tones at the end of each sound pairing. The researchers say this difference might result from the fact that, in Japanese, shorter words – such as articles and prepositions – tend to come at the end of a phrase. In English, these short words tend to come at the beginning. Previous studies by Patel have suggested that a composer’s native language can influence how they write music (see Music: The international language?). He says that while the previous study focused on music production, the new findings about how Americans and Japanese group sounds give insight in to musical perception. Patel presented the new findings at a joint meeting of the Acoustical Society of America and the Acoustical Society of Japan in Honolulu, Hawaii.

OutDoorLinks: Aniruddh D. Patel http://vesicle.nsi.edu/users/patel/ Music: The international language? http://www.newscientist.com/article.ns?id=mg18725071.200

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Odds and ends - themes and trends

963

Brand Perception—Evaluation of Cortical Activation Using fMRI

Brand Perception—Evaluation of Cortical Activation Using fMRI Source: http://rsna2006.rsna.org/rsna2006/v2006/conference/ event_display.cfm?id=66601&em_id=4429416

PURPOSE The aim of the study was to evaluate the neural correlates of brand perception with a special regard to the brand strength. METHOD AND MATERIALS 20 HS (10 m / 10 f, mean age 27 y) were examined using a 3.0T scanner. Prior to, during and at the end of the examination, subject’s perception of the two different brands was tested by a questionnaire. fMRI was block-designed with 2 active blocks consisting of 8 stimuli each (pictures of a subjective strong and a subjective weak car brand combined with the logo, presentation time 3.0 sec/stimulus). Each picture was underlined of a short question to evaluate the perception of the brand using a four-point scale ranging from “disagree” to “agree strongly”. As control condition, an abstract colored image was displayed. For anatomical reference 3D-T1w images were obtained. Statistical analysis was carried out using BrainVoyager QX™. Neuropsychological data were analyzed by SPSS 13.0. RESULTS Significant increase of activation was found bilaterally in the inferior frontal gyrus, anterior insula and the anterior cingulated while presenting the strong brand. A smaller cluster was detected predominantly left-hemispheric in the precuneus. In contrast presentation of the weaker brand showed activations in the precuneus bilaterally. In general the clusters of activations were larger by presenting the weak brand. No significant increase if SI was found using the contrast strong>weak. But we detected decrease of SI in parts of the inferior frontal gyrus and of the anterior cingulated bilaterally as well as occipital.

Odds and ends - themes and trends

964

Whale brains are part human

The opposite contrast (weak>strong) on the other hand showed significant activations bilateral in the frontal gyrus and in parts of the anterior cingulate as well as in the occipital lobe bilaterally. CONCLUSION The results may support the hypothesis that the perception of different brand-strengths follows an all-or-non-effect with reduced activations in areas of working memory and increased activation involved in processing of emotions and self-identifying by presenting strong brands. CLINICAL RELEVANCE/APPLICATION The key idea of this approach is to employ recent neuroscientific methods in order to analyze economically relevant brain processes.

QUESTIONS EMAIL: christine.born(at)med.uni-munchen.de

OutDoorLinks: Christine Born http://www.radiologie-lmu.de/mitarbeiter/mitarbeiter_frames.php?id=3&lang=de Annual Meeting of the Radiological Society of North America http://rsna2006.rsna.org/rsna2006/v2006/conference/track.cvn

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Whale brains are part human Source: Reuters/www.abc.net.au/28 November 2006 http://www.abc.net.au/science/news/stories/2006/1798885.htm

Humpback whales have surprisingly complex brains, which raises questions about how these cetaceans evolved (Image: NOAA) Humpback whales have a type of brain cell seen only in humans, the great apes, and other cetaceans such as dolphins, US researchers report. This might mean such whales are more intelligent than they have been given credit for, the scientists say. Odds and ends - themes and trends

965

Whale brains are part human

And it suggests the basis for complex brains either evolved more than once, or has gone unused by most animal species. The finding may help explain some whale behaviours, such as intricate communication skills, the formation of alliances, cooperation, cultural transmission and the use of tools, the researchers report in journal The Anatomical Record. Professor Patrick Hof and colleagues from the Mount Sinai School of Medicine in New York discovered a type of cell called a spindle neurone in the cortex of the whale brains. They found the cells in areas comparable to where they are seen in humans and great apes. Although the function of spindle neurones is not well understood, they may be involved in cognition - learning, remembering and recognising the world. Spindle cells may be affected by Alzheimer's disease and other debilitating brain disorders such as autism and schizophrenia. Complex social patterns The researches found spindle neurones in the same location in toothed whales with the largest brains, which the researchers say suggests the cells may be related to brain size. Toothed whales such as orcas are generally considered more intelligent than baleen whales such as humpbacks and blue whales, which filter water for their food. The humpbacks also have structures that resemble 'islands' in the cerebral cortex, also seen in some other mammals. These islands may have evolved to promote fast and efficient communication between neurones, the researchers say. Spindle neurones probably first appeared in the common ancestor of hominids, humans and great apes about 15 million years ago, the researchers say. They are not seen in lesser apes or monkeys. In cetaceans they would have evolved earlier, possibly as early as 30 million years ago, the researchers say. How did these cells evolve? Either the spindle neurones were only kept in the animals with the largest brains or they evolved several times independently, the researchers say. "In spite of the relative scarcity of information on many cetacean species, it is important to note in this context that sperm whales, killer whales, and certainly humpback whales, exhibit complex social patterns that

Odds and ends - themes and trends

966

Words come easier after a singalong

included intricate communication skills, coalition-formation, cooperation, cultural transmission and tool usage," the researchers write. "It is thus likely that some of these abilities are related to comparable histological complexity in brain organisation in cetaceans and in hominids."

OutDoorLinks: Patrick R. Hof http://directory.mssm.edu/faculty/facultyInfo.php?id=21205&deptid=93

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Words come easier after a singalong Source: www.newscientist.com/26 November 2006 http://www.newscientist.com/article/dn10657-words-come-easier-after-asingalong.html

If you have trouble finding the right words, maybe it's time to join a choir. Singing in a group seems to help people with aphasia to speak again. Neurologists have long known that people suffering from aphasia, in which brain damage disrupts the ability to produce and comprehend language, can sing words that they cannot produce otherwise. No one is certain why this is, but researchers had suspected it could be because singing slows the rate of speech and makes word retrieval simpler by limiting the number of syllables pronounced per beat. Therapists have tried different methods of getting patients to "reawaken" their powers of speech through singing, but these have met with only modest success. Isabelle Peretz and colleagues at the University of Montreal in Canada gave people with aphasia familiar and unfamiliar songs to sing on their own and with others. Singing alone did not improve speech, but singing in a choir dramatically improved their ability to recall and pronounce words, regardless of the song (Brain, vol 129, p 2571).

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967

Words come easier after a singalong

It is not the singing itself that helps language memory, but the sharing of mood and experience between singers, Peretz says. She believes that choral singing could be a potent method of speech therapy.

OutDoorLinks: Isabelle Peretz http://www.brams.umontreal.ca/plab/people/peretz_i

--Tales of the unexpected: how the brain detects novelty Source: www.alphagalileo.org/23 November 2006 http://www.alphagalileo.org/index.cfm?fuseaction=readrelease&releaseid=516815

When you sit down to watch a DVD of your favourite film, the chances are that you are able to predict the exact sequence of events that is about to unfold. Without our memories we would not only be unable to remember our past but perhaps more importantly predict the future. Dr Dharshan Kumaran and Dr Eleanor Maguire at the Wellcome Trust Centre for Neuroimaging at University College London have shown that the hippocampus, the area of the brain believed to play a crucial role in learning and memory, makes predictions of what will happen next by automatically recalling an entire sequence of events in response to a single cue. Scientists believe they may have identified how the brain allows us to anticipate future events and detect when things do not turn out as expected. The research is published today in the journal Public Library of Science Biology. Using an fMRI scanner, which uses changes in blood flow within the brain to provide measurements of brain activity, Dr Kumaran and Dr Maguire were able to show how the brain reacts to unexpected changes in a sequence of images. A subject is shown a series of four images which are then repeated in a different order. By changing the order of only the final two images, the researchers found that the hippocampus appeared to be predicting which image would come next and reacting when an unexpected image appeared.

Odds and ends - themes and trends

968

Dyslexia and the failure to form a perceptual anchor

"These experiments indicate that the hippocampus acts as a sort of comparison device, matching up past and present experienceâ&#x20AC;? says Dr Kumaran. "It does not appear to be reacting to novelty as such, but rather to discrepancies between what it expects to see and what it actually sees." The results imply that when the hippocampus is prompted by a cue, it recalls a sequence of associated memories, a process that may explain how seeing a particular person's face or listening to a piece of music can trigger the recollection of an entire past experience. Furthermore, the hippocampus would appear to perform a critical comparison between our past and present experiences alerting us to unexpected occurrences in our environment, such as changed layout. "Patients with damaged hippocampi, such as those with Alzheimer's Disease, often have trouble remembering sequences of events or finding their way around" explains Dr Kumaran. "This would seem to be because the damaged hippocampus is unable to rapidly bind together the many different components of our experiences into a coherent whole.â&#x20AC;?

OutDoorLinks: Dharshan Kumaran http://www.fil.ion.ucl.ac.uk/Staff/ Eleanor Maguire http://www.fil.ion.ucl.ac.uk/Maguire/

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Dyslexia and the failure to form a perceptual anchor By Merav Ahissar, Yedida Lubin, Hanna Putter-Katz & Karen Banai Source: www.nature.com/19 November 2006 http://www.nature.com/neuro/journal/vaop/ncurrent/abs/nn1800.html doi:10.1038/nn1800

In a large subgroup of dyslexic individuals (D-LDs), reading difficulties are part of a broader learning and language disability.

Odds and ends - themes and trends

969

The Biochemical and Neuroendocrine Bases of the Hyperalgesic Nocebo Effect

Recent studies indicate that D-LDs perform poorly in many psychoacoustic tasks compared with individuals with normal reading ability. We found that D-LDs perform as well as normal readers in speech perception in noise and in a difficult tone comparison task. However, their performance did not improve when these same tasks were performed with a smaller stimulus set. In contrast to normal readers, they did not benefit from stimulus-specific repetitions, suggesting that they have difficulties forming perceptual anchors. These findings are inconsistent with previously suggested static models of dyslexia. Instead, we propose that D-LDs' core deficit is a general difficulty in dynamically constructing stimulus-specific predictions, deriving from deficient stimulus-specific adaptation mechanisms. This hypothesis provides a direct link between D-LDs' high-level difficulties and mechanisms at the level of specific neuronal circuits. Correspondence should be addressed to Merav Ahissar, Email: msmerava(at)mscc.huji.ac.il OutDoorLinks: Merav Ahissar http://micro5.mscc.huji.ac.il/~ahissar/merav_page.html

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The Biochemical and Neuroendocrine Bases of the Hyperalgesic Nocebo Effect By Fabrizio Benedetti, Martina Amanzio, Sergio Vighetti and Giovanni Asteggiano Source: www.jneurosci.org/November 15, 2006 http://www.jneurosci.org/cgi/content/abstract/26/46/ 12014?lookupType=volpage&vol=26&fp=12014&view=short

Odds and ends - themes and trends

970

The Biochemical and Neuroendocrine Bases of the Hyperalgesic Nocebo Effect

The Journal of Neuroscience, November 15, 2006, 26(46):12014-12022; doi:10.1523/ JNEUROSCI.2947-06.2006

Despite the increasing research on placebos in recent times, little is known about the nocebo effect, a phenomenon that is opposite to the placebo effect and whereby expectations of symptom worsening play a crucial role. By studying experimental ischemic arm pain in healthy volunteers and by using a neuropharmacological approach, we found that verbally induced nocebo hyperalgesia was associated to hyperactivity of the hypothalamicâ&#x20AC;&#x201C;pituitaryâ&#x20AC;&#x201C;adrenal (HPA) axis, as assessed by means of adrenocorticotropic hormone and cortisol plasma concentrations. Both nocebo hyperalgesia and HPA hyperactivity were antagonized by the benzodiazepine diazepam, suggesting that anxiety played a major role in these effects. The administration of the mixed cholecystokinin (CCK) type-A/B receptor antagonist proglumide blocked nocebo hyperalgesia completely but had no effect on HPA hyperactivity, which suggests a specific involvement of CCK in the hyperalgesic but not in the anxiety component of the nocebo effect. Importantly, both diazepam and proglumide did not show analgesic properties on basal pain, because they acted only on the nocebo-induced pain increase. These data indicate a close relationship between anxiety and nocebo hyperalgesia, in which the CCKergic systems play a key role in anxietyinduced hyperalgesia. These results, together with previous findings showing that placebo analgesia is mediated by endogenous opioids, suggest that the analgesic placebo/hyperalgesic nocebo phenomenon may involve the opposite activation of endogenous opioidergic and CCKergic systems. Correspondence should be addressed to Fabrizio Benedetti, Email: fabrizio.benedetti(at)unito.it OutDoorLinks: Fabrizio Benedetti http://www.personalweb.unito.it/fabrizio.benedetti/

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971

Think of a concept, taste it on your tongue

Think of a concept, taste it on your tongue Source: www.newscientist.com/22 November 2006 http://www.newscientist.com/article/dn10644-think-of-a-concept-taste-it-on-yourtongue.html

New insight into one of the most intriguing word-associated conditions may have been found, with the discovery that, for one type of synaesthesia at least, the meaning of a word is key to the sensation experienced. For some people, the mere mention of a word can bring a very specific taste to the tongue. "Mountain" might elicit cold bacon, for instance, while "Michelle" might conjure egg whites. People who experience this have a rare condition known as lexicalgustatory synaesthesia, and for many of them every word comes with an appended taste. For some, even when the exact word cannot be recalled, the taste of the word is there. Synaesthetes tend to experience the same taste for words with similar sounds. In one subject, for instance, not only does the word "mince" call up a mince flavour, but "prince" and "cinema" do too. This suggests that the taste is somehow tied to the sound or the spelling of the word. Tip of the tongue Julia Simner at the University of Edinburgh and her colleague, Jamie Ward, at University College London, both in the UK, showed 96 pictures of obscure items such as a gazebo, a geisha or a metronome to six subjects with lexical-gustatory synaesthesia. In all but one subject they managed to induce a "tip of the tongue" condition, where the person recognised the object but could not remember what it was called, what letter its name started with or how many syllables the elusive word had. The researchers found that these individuals could still identify what taste the item elicited. One woman, for instance, unable to come up with the word "gramophone", reported tasting Dutch chocolate, precisely the flavour that the word is associated with for her. This shows that it is the meaning of the word â&#x20AC;&#x201C; not the sound or spelling â&#x20AC;&#x201C; that elicits the taste sensation in these people, Simner says. She suspects the associations begin in childhood.

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972

Singing whales make small talk too

Phil Merikle, at the University of Waterloo in Ontario, Canada, has carried out research with synaesthetes that experience numbers as colours. He found that those doing simple arithmetic can compute faster when they see the colour they associate with the correct answer. "It's the concept that elicits the synaesthetic experience," he agrees. OutDoorLinks: Julia Simner http://www.psy.ed.ac.uk/people/jsimner/index_html Jamie Ward http://www.icn.ucl.ac.uk/Staff-Lists/ MemberDetails.php?Title=Dr&FirstName=Jamie&LastName=Ward Jamie Ward http://watarts.uwaterloo.ca/~pmerikle/

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Singing whales make small talk too By Jennifer Viegas Source: www.abc.net.au/20 November 2006 http://www.abc.net.au/science/news/stories/2006/1792754.htm

Whales have such a broad vocal repertoire that they can call to their young, woo potential mates and even express emotions, according to researchers who have identified 622 social sounds in humpback whales. Their work will be presented at the upcoming joint meetings of the Acoustical Society of America and the Acoustical Society of Japan in Hawaii. Social sounds are brief, unpatterned noises that are distinct from lengthier, complex whale songs. The new research adds to a growing body of evidence that whales convey more meaning through vocalisations than previously thought. "I wouldn't say (whales possess) language, as that's a human term," says Dr Rebecca Dunlop, a researcher in the School of Veterinary Sciences at the University of Queensland, who worked on the study. "Whales don't string these sounds together like words and form sentences. It's more like a simple vocabulary," she says. Odds and ends - themes and trends

973

Singing whales make small talk too

The scientists visually tracked 60 pods of whales migrating along the east coast of Australia. The researchers used a static hydrophone array, sensitive equipment that detects sound waves, linking the whale sounds to various activities and contexts. Wops, thwops and yaps They identified 622 distinct sounds, which fell into 35 basic types. These include "wops" made by females, "thwops" made by males, "yaps" made when pods split, and high pitched cries that appeared to express anger. In addition to vocalisations, the researchers found that whales send messages through body language, by breaching the surface, slapping water with their tails and blowing underwater bubbles. Famous for their long, complex songs, whales also sometimes "speak" short song units individually instead of singing them. Males especially seem to do this when trying to woo a female. "Song is a loud broadcast signal and two singers singing at the same time is bound to be confusing to the receiver," Dunlop says. "If he's trying to attract a female, but doesn't want his signal confused with another singer in the area, then using song units in this case might be the way forward." She thinks one reason whales are so vocal is because sound travels better in water than light, and so sight is less useful to whales than hearing. Human interference Dr Christopher Clark, director of the Bioacoustics Research Program at Cornell University, conducted a similar study on right whales. He says that just as researchers are gaining a better understanding of whale vocalisations, humans are creating so much ocean noise, through shipping, oil and gas exploration, recreational traffic and more, that we often prevent whales from communicating. "Many whales have very traditional feeding grounds and their migratory routes occur along shallow coastlines, which are now some of the noisiest, most heavily impacted habitats," he says. "The ocean area over which a whale can communicate and listen today has shriveled down to a small fraction of what it was less than a century ago."

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974

AHA: The Heart Failure Waltz Leads to Improved Function

OutDoorLinks: Rebecca Dunlop http://www.uq.edu.au/vetschool/index.html?page=52357&pid=0

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AHA: The Heart Failure Waltz Leads to Improved Function By Peggy Peck Source: www.medpagetoday.com/ November 12, 2006 http://www.medpagetoday.com/Cardiology/CHF/tb/4488

Heart failure patients can waltz their way to improved function, and dancing made them much happier than cardiac rehabilitation that relied on treadmills and exercise bikes. Patients randomized to waltz classes significantly improved functional measures (P<0.001) compared with controls in traditional exercise training, Romualdo Belardinelli, M.D., of Lancisi Heart Institute in Ancona, Italy, reported today at the American Heart Association meeting here. What's more, the dancing patients posted significantly better quality-of life scores than the traditional exercise group (P<0.05), Dr. Belardinelli said. Nieca Goldberg, M.D., chief of women's cardiac care at Lenox Hill Hospital in New York, said the results are important because it is difficult to get patients to complete cardiac rehabilitation faithfully, so a program that patients consider "fun and enjoyable is likely to make rehabilitation more palatable." Dr. Belardinelli said he and his colleagues "chose waltz because it is a universal dance, which means that the findings can be generalized to other countries." He said, however, that other slow dances might be just as effective.

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975

AHA: The Heart Failure Waltz Leads to Improved Function

He and his colleagues studied 110 patients with stable congestive heart failure and a left ejection fraction of less than 40%. Eighty-nine of the patients were men and the mean age was 59 ± 11 years. Forty-four patients were randomized to supervised exercise training on cycles and treadmills at 70% of peak oxygen consumption (VO2) three times a week for eight weeks and 44 to a dance protocol of alternate slow-five minutes -- and fast-21 minutes -- waltz three times a week for eight weeks. Twenty-two patients served as a control group. Both exercise training and dance classes were conducted at the hospital and heart rate was monitored during the sessions. At baseline and at eight weeks all patients underwent cardiopulmonary exercise testing until volitional fatigue as well as two-dimensional echocardiography with Doppler, and endothelium-dependent dilation of the brachial artery. Quality of life was assessed by the Minnesota Heart Failure Living Questionnaire. Among the findings: Heart rate during exercise training was 110± 15 beats/min and during dancing it was 113±19 beats/min (NS) Peak VO2, anaerobic threshold, minute ventilation (VE)CO2 production /(VCO2) and VO2/Workload (W) slope were all similarly improved in both the dance and exercise arms (NS, P<0.001 versus controls). Ejection fraction was not significant changed by either exercise or dancing, but E-wave to A-wave ratio was decreased in both the exercise and dance groups compared with controls (P<0.05). "As might be expected, the real difference between the two groups was in quality-of- life scores," he said. Noting that a higher score indicated a worse quality of life, he said the patients randomized to the dance class improved scores from an average of 56±18 years at baseline to 41±16 after completing the study versus 58±20 to 48±21 in the exercise group (P<0.05), he said. Dr. Belardinelli concluded, "Dancing should be considered an alternative to traditional cardiac rehabilitation for patients with heart failure."

OutDoorLinks:

Odds and ends - themes and trends

976

Positive Emotional Style Predicts Resistance to Illness After Experimental

Nieca Goldberg http://www.bigspeak.com/nieca-goldberg.html

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Positive Emotional Style Predicts Resistance to Illness After Experimental Exposure to Rhinovirus or Influenza A Virus By Sheldon Cohen, PhD, Cuneyt M. Alper, MD, William J. Doyle, PhD, John J. Treanor, MD, Ronald B. Turner, MD Source: www.psychosomaticmedicine.org/ November 13, 2006 http://www.psychosomaticmedicine.org/cgi/content/abstract/ 01.psy.0000245867.92364.3cv1 Psychosom Med 2006, doi:10.1097/01.psy.0000245867.92364.3c ÂŠ 2006 by American Psychosomatic Society

Abstract Objective: In an earlier study, positive emotional style (PES) was associated with resistance to the common cold and a bias to underreport (relative to objective disease markers) symptom severity. This work did not control for social and cognitive factors closely associated with PES. We replicate the original study using a different virus and controls for these alternative explanations. Methods: One hundred ninety-three healthy volunteers ages 21 to 55 years were assessed for a PES characterized by being happy, lively, and calm; a negative emotional style (NES) characterized by being anxious, hostile, and depressed; other cognitive and social dispositions; and self-reported health. Subsequently, they were exposed by nasal drops to a rhinovirus or influenza virus and monitored in quarantine for objective signs of illness and self-reported symptoms. Results: Odds and ends - themes and trends

977

Net Music Makers.com Announces Launch Date for Revolutionary Music Website

For both viruses, increased PES was associated with lower risk of developing an upper respiratory illness as defined by objective criteria (adjusted odds ratio comparing lowest with highest tertile = 2.9) and with reporting fewer symptoms than expected from concurrent objective markers of illness. These associations were independent of prechallenge virus-specific antibody, virus type, age, sex, education, race, body mass, season, and NES. They were also independent of optimism, extraversion, mastery, selfesteem, purpose, and self-reported health. Conclusions: We replicated the prospective association of PES and colds and PES and biased symptom reporting, extended those results to infection with an influenza virus, and "ruled out" alternative hypotheses. These results indicate that PES may play a more important role in health than previously thought. Address correspondence and reprint requests to: Sheldon Cohen, PhD, E-mail: scohen(at)cmu.edu.

OutDoorLinks: Sheldon Cohen http://www.psy.cmu.edu/~scohen/

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Net Music Makers.com Announces Launch Date for Revolutionary Music Website Groundbreaking Online Music Collaboration Website Set for March 2007 Launch Source: http://www.netmusicmakers.com/bob/?p=news&news_id=6

Net Music Makers.com (â&#x20AC;&#x153;NMMâ&#x20AC;?) today announced plans to launch its online collaborative website in March 2007. In preparation for its launch, NMM will make its site available in January to allow bands to create a personal website and access a virtual studio

Odds and ends - themes and trends

978

Net Music Makers.com Announces Launch Date for Revolutionary Music Website

that allows public and private collaboration to create new music available for international podcast and internet radio broadcast. The new site will represent a groundbreaking social networking venue for musicians to create, collaborate, and broadcast their music. A key feature of the new site will be the availability of downloadable lick tracks provided by legendary artists and studio musicians, on a royalty free basis. “After six months in stealth mode, we are putting the finishing touches on our new services that will change the music world,” stated Jeff Tamelier, President of NMM. “In the next few weeks, look for us to announce some legendary musicians that have been in the studio creating a comprehensive library of music licks and grooves. Our users will be able to ‘Frankenstein’ these into their original tunes.” About Net Music Makers.com“We’re totally stoked about making NMM the next generation in music making,” commented Zaq Whitnack, NMM Creative Director. “Whether you’re an established band that wants to find your audience or looking to round out your tune with an international music community, NMM will be your one-stop shop. Our Battle of the Bands contest, currently posted on our site, is getting phenomenal response, with nearly 20,000 songs, covering 120 different genres, uploaded in our first sixty days.” Net Music Makers.com (“NMM”) is an online collaborative music website, in the process of rolling out innovative musician services that will revolutionize music-making. The new site provides a 360-degree music making experience, including a 24x7 virtual studio connected to a multi-channel fan-driven internet radio service. NMM is an interactive media property of House of Hansen Productions, LLC, a privately held company founded in April 2006 with headquarters in Sacramento, California. OutDoorLinks: Net Music Makers (NMM) http://www.netmusicmakers.com Jeff Tamelier http://www.jtfunkguitar.com/ Radiosender FM4 http://fm4.orf.at

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979

Human Opiorphin, a natural antinociceptive modulator of opioid-dependent

Human Opiorphin, a natural antinociceptive modulator of opioid-dependent pathways By Anne Wisner, Evelyne Dufour, MichaĂŤl Messaoudi, Amine Nejdi, Audrey Marcel, Marie-Noelle Ungeheuer and Catherine Rougeot Source: http://www.pnas.org/ November 13, 2006 http://www.pnas.org/cgi/content/abstract/ 0605865103v1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Opi orphin+&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT Proc. Natl. Acad. Sci. USA, 10.1073/pnas.0605865103

Mammalian zinc ectopeptidases play important roles in turning off neural and hormonal peptide signals at the cell surface, notably those processing sensory information. We report here the discovery of a previously uncharacterized physiological inhibitor of enkephalin-inactivating zinc ectopeptidases in humans, which we have named Opiorphin. It is a QRFSR peptide that inhibits two enkephalin-catabolizing ectoenzymes, human neutral ecto-endopeptidase, hNEP (EC 3.4.24.11), and human ecto-aminopeptidase, hAP-N (EC 3.4.11.2). Opiorphin displays potent analgesic activity in chemical and mechanical pain models by activating endogenous opioid-dependent transmission. Its function is closely related to the rat sialorphin peptide, which is an inhibitor of pain perception and acts by potentiating endogenous Âľ- and opioid receptor-dependent enkephalinergic pathways. Here we demonstrate the functional specificity in vivo of human Opiorphin. The pain-suppressive potency of Opiorphin is as effective as morphine in the behavioral rat model of acute mechanical pain, the pinpain test. Thus, our discovery of Opiorphin is extremely exciting from a physiological point of view in the context of endogenous opioidergic pathways, notably in modulating mood-related states and pain sensation. Furthermore, because of its in vivo properties, Opiorphin may have therapeutic implications. To whom correspondence should be addressed. Catherine Rougeot, E-mail: crougeot(at)pasteur.fr Odds and ends - themes and trends

980

Picture this: The Music Therapist

OutDoorLinks: Institut Pasteur http://www.pasteur.fr Proceedings of the National Academy of Sciences http://www.pnas.org Rougeot Catherine http://www.pasteur.fr/recherche/RAR/RAR2003/Prn.html

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Picture this: The Music Therapist By THOMAS E. FRANKLIN Homepage: www.tomdoch.de <http://www.tomdoch.de/> Source: www.northjersey.com/ November 13, 2006 http://www.northjersey.com/ page.php?qstr=eXJpcnk3ZjcxN2Y3dnFlZUVFeXk5JmZnYmVsN2Y3dnFlZUVFeXk3 MDE4Nzk0

Josephine Tomea, 87, lies in her nursing home bed in an advanced state of dementia. Under hospice care and ready to die, Tomea has been ravaged by a stroke, Alzheimer's disease, arthritis and diabetes. Her body remains constricted, her hands clenched tightly close to her body. She's unable to eat, talk or walk; she lives a life of non-verbal social isolation. But every week or so, Jennifer Knittel, a certified musical therapist, shows up with her Washburn guitar and a voice so sweet, and suddenly there is a flicker of life in Tomea. An eye opens. Her head lifts. Her breathing becomes louder and more pronounced. In her own limited way, Tomea is dancing, floating across the ballroom floor, swaying to Knittel's dreamy lullabies. "Danny Boy" and "When Irish Eyes are Smiling" were her favorites, says her daughter, Eleanor Maurer. Knittel plays them to perfection. "My mother always loved music," Maurer says. Music therapy is a combination of music, social work, psychology, counseling and anatomy. "The music is able to bridge a gap," explains Knittel, who is from Warren County. "The music tends to break down those barriers, barriers where they can't speak with you anymore, but there is something about the music that can connect you. You just have a sense of the person you are

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981

Picture this: The Music Therapist

visiting. She'll open her eye and look over at me. Whereas other staff might say she's unresponsive, there's definitely a response I see out of her. It benefits her family, too, knowing someone extra is here." Hospices provide physical and mental comfort to patients diagnosed with terminal conditions, and to their family and friends. They give palliative care, providing comfort, not a cure. Music therapy is just a part of hospice care. "She's an angel," says Ron Owens, the volunteer coordinator for Hospice of New Jersey, who supervises Knittel and other music therapists. "She's a miracle worker. She can reach patients that others can't. She can relate music like no other. It's remarkable. We don't know why it is, we only know that it is." Sometimes, physical contact is equally important, says Knittel. "I like to place my hand under hers. Touch the head, touch and hum, and come back to the guitar," says Knittel, brushing Tomea's cheek with the back of her hand. "A lot of times, actually most of the time, it's not as much just about the music, it's about the relationship you build with the person." Maurer says her mother was loving, a person who "cared about others more than herself." Tomea, a mother of three, lost her husband, Ted, in 1999. She called him Ace. "[But now] I don't feel like she has any quality of life," Maurer says. "She can't enjoy food. No way to communicate, sometimes she'll blink. I hope she has good dreams." Knittel says it's a way of making a friendship. "I've had people who were close to dying or on the very night that they died, look up and tell me thank you. I don't remember your name, but I know you've been very nice to me. It's nice knowing that you've given extra quality and meaning in their life. It's a great gift. For both of us."

OutDoorLinks: Hospice of New Jersey http://www.americanhospice.com/hospicenj/

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982

Episodic Encoding Is More than the Sum of Its Parts: An fMRI Investigation of

Episodic Encoding Is More than the Sum of Its Parts: An fMRI Investigation of Multifeatural Contextual Encoding By Melina R. Uncapher, Leun J. Otten and Michael D. Rugg Source: http://www.neuron.org/content/article/ abstract?uid=PIIS0896627306006337 Copyright ÂŠ 2006 Cell Press. All rights reserved. Neuron, Vol 52, 547-556, 09 November 2006

Summary Episodic memories are characterized by their contextual richness, yet little is known about how the various features comprising an episode are brought together in memory. Here we employed fMRI and a multidimensional source memory procedure to investigate processes supporting the mnemonic binding of item and contextual information. Volunteers were scanned while encoding items for which the contextual features (color and location) varied independently, allowing activity elicited at the time of study to be segregated according to whether both, one, or neither feature was successfully retrieved on a later memory test. Activity uniquely associated with successful encoding of both features was identified in the intra-parietal sulcus, a region strongly implicated in the support of attentionally mediated perceptual binding. The findings suggest that the encoding of disparate features of an episode into a common memory representation requires that the features be conjoined in a common perceptual representation when the episode is initially experienced. â&#x2C6;&#x2014;Corresponding author Melina R. Uncapher Email: melina.u(at)uci.edu OutDoorLinks: Melina R. Uncapher http://fnim.bio.uci.edu/Melina's_page.html

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983

Music therapy may help schizophrenia

Music therapy may help schizophrenia Source: www.irishhealth.com/01/11/2006 http://www.irishhealth.com/?level=4&id=10489

Music therapy may improve some of the symptoms of schizophrenia, new research indicates. The preliminary research marks the first time that this type of therapy has been evaluated in relation to people with acute schizophrenia. Schizophrenia is a serious mental illness characterised by disturbances in a person's thoughts, perceptions, emotions and behaviour. Symptoms can include delusions and hallucinations. The condition affects around one in every 100 people - an estimated 41,000 people in Ireland are currently affected. Researchers at Imperial College London, along with therapists at the Central and North West London Mental Health Trust, followed the progress of 81 inpatients at four hospitals in London. The participants were randomly divided in two, with one group receiving music therapy and the other group receiving standard care alone. Those receiving music therapy had between eight and 12 sessions, once a week, for up to 45 minutes at a time. During these sessions, they were given access to a wide range of musical instruments and encouraged to use them to express themselves. Initially the therapist listened carefully to the patient's music and accompanied them closely, seeking to follow their emotional state in musical terms. The therapist then offered opportunities to extend or vary the nature of the musical interaction. During this time, the researchers measured the patients' symptoms. They found that improvements were greater among those who received music therapy, compared to those who received standard care alone. In fact, music therapy was associated with a reduction in general symptoms, such as depression and anxiety and the negative symptoms of schizophrenia, such as emotional withdrawal. The researchers however warned that the study was small, therefore it is possible that other factors, such as the severity of the illness, may have influenced the findings. "We have known for some time that psychological treatments can help people with schizophrenia, but these have only been used when people are fairly stable. This study shows that music therapy provides a way of

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984

Evidence for large long-term memory capacities in baboons and pigeons and its

working with people when they are acutely unwell", said Dr Mike Crawford of Imperial College London. He explained that at certain times, patients may find it difficult to express themselves using words, 'but through the skill of the therapist, it may be possible to help people interact through music in a way that is constructive, creative and enjoyable'. The researchers believe that the findings so far provide sufficient evidence to justify a further trial of music therapy for people with schizophrenia. This, they said, should be designed to explore the effects and cost effectiveness of this kind of therapy. "Inpatient treatment is the form of care that people with schizophrenia are least satisfied with. Music therapy may provide a means of enhancing the effectiveness of inpatient treatment by reducing some of the symptoms of schizophrenia that respond least well to drug treatment", Dr Crawford added. Details of this study are published in the British Journal of Psychiatry.

OutDoorLinks: Mike Crawford http://www1.imperial.ac.uk/medicine/people/m.crawford/

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Evidence for large long-term memory capacities in baboons and pigeons and its implications for learning and the evolution of cognition By JoĂŤl Fagot and Robert G. Cook Source: www.pnas.org/cgi/content/ November 6, 2006 http://www.pnas.org/cgi/content/abstract/ 0605184103v1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Fag ot&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT Published online before print November 6, 2006 Proc. Natl. Acad. Sci. USA, 10.1073/pnas.0605184103

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985

Evidence for large long-term memory capacities in baboons and pigeons and its

Previous research has shown that birds and primates have a rich repertoire of behavioral and cognitive skills, but the mechanisms underlying these abilities are not well understood. A common hypothesis is that these adaptations are mediated by an efficient long-term memory, allowing animals to remember specific external events and associate appropriate behaviors to these events. Because earlier studies have not sufficiently challenged memory capacity in animals, our comparative research examined with equivalent procedures the size and mechanisms of long-term memory in baboons and pigeons. Findings revealed very large, but different, capacities in both species to learn and remember picture-response associations. Pigeons could maximally memorize between 800 and 1,200 pictureresponse associations before reaching the limit of their performance. In contrast, baboons minimally memorized 3,500-5,000 items and had not reached their limit after more than 3 years of testing. No differences were detected in how these associations were retained or otherwise processed by these species. These results demonstrate that pigeons and monkeys have sufficient memory resources to develop memory-based exemplar or feature learning strategies in many test situations. They further suggest that the evolution of cognition and behavior importantly may have involved the gradual enlargement of the long-term memory capacities of the brain. To whom correspondence should be addressed. JoĂŤl Fagot, E-mail: fagot(at)incm.cnrs-mrs.fr OutDoorLinks: JoĂŤl Fagot http://www.incm.cnrs-mrs.fr/equipedephy.php Robert G. Cook http://pigeon.psy.tufts.edu/index.php?content=materials&cat=Research

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986

Computer with Brain Connections Changing Quality of Life of Paralyzed

Computer with Brain Connections Changing Quality of Life of Paralyzed Source: www.blackwellpublishing.com/02 November 2006 http://www.blackwellpublishing.com/press/pressitem.asp?ref=957

Fundamental theories regarding consciousness, emotion and quality of life in sufferers of paralysis from Amyotrophic Lateral Sclerosis (ALS, also known as 'Lou Gerhig's disease') are being challenged based on new research on brain-computer interaction. ALS is a progressive disease that destroys neurons affecting movement. The study appears in the latest issue of Psychophysiology. The article reviews the usefulness of currently available brain-computer –interfaces (BCI), which use brain activity to communicate through external devices, such as computers. The research focuses on a condition called the completely locked-in state (CLIS, a total lack of muscle control). In a CLIS situation, intentional thoughts and imagery can rarely be acted upon physically and, therefore, are rarely followed by a stimulus. The research suggests that as the disease progresses and the probability for an external event to function as a link between response and consequence becomes progressively smaller, it may eventually vanish altogether. Researchers have found that by implementing a BCI before the CLIS state occurs, a patient can be taught to communicate through an electronic device with great regularity. The continued interaction between thought, response and consequence is believed to slow the destruction of the nervous system. The findings are also raising a number of new questions about the quality of life amongst paralysis sufferers. Patients surveyed were found to be much healthier mentally than psychiatrically depressed patients without any life-threatening bodily disease. Only 9% of ALS patients showed long episodes of depression and most were during the period following diagnosis and a period of weeks after tracheotomy. “Most instruments measuring depression and quality of life are invalid for paralyzed people living in protected environments because most of the questions do not apply to the life of a paralyzed person. Special instruments had to be developed,” says Niels Birbaumer, Ph.D., author of the study. Odds and ends - themes and trends

987

Neural Correlates of Self-distraction from Anxiety and a Process Model of

This contrasts previously accepted notions as many doctors believe that the quality of life in total paralysis is extremely low and continuation of life is a burden for the patient. The study challenges the myth of helplessness, depression and poor quality of life in paralyzed persons that lead to hastened decisions on euthanasia.

OutDoorLinks: Niels Birbaumer http://www.mp.uni-tuebingen.de/mp/index.php?id=62

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Neural Correlates of Self-distraction from Anxiety and a Process Model of Cognitive Emotion Regulation By Raffael Kalisch, Katja Wiech, Katrin Herrmann and Raymond J. Dolan Source: http://jocn.mitpress.org/cgi/content/abstract/18/8/1266 (Journal of Cognitive Neuroscience. 2006;18:1266-1276.) ÂŠ 2006 The MIT Press

Cognitive strategies used in volitional emotion regulation include selfdistraction and reappraisal (reinterpretation). There is debate as to what the psychological and neurobiological mechanisms underlying these strategies are. For example, it is unclear whether self-distraction and reappraisal, although distinct at a phenomenological level, are also mediated by distinct neural processes. This is partly because imaging studies on reappraisal and self-distraction have been performed in different emotional contexts and are difficult to compare. We have therefore investigated the neural correlates of self-distraction, as indexed by a thought suppression task, in an anticipatory anxiety paradigm previously employed by us to study reappraisal. Brain activity was measured by functional magnetic resonance imaging. We show that self-distraction recruits the left lateral prefrontal cortex.

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988

Self-recognition in an Asian elephant

Based on a review of the existing data, we develop a process model of cognitive emotion regulation. The model posits that both self-distraction and reappraisal attenuate emotional reactions through replacement of emotional by neutral mental contents but achieve replacement in different ways. This is associated with a dependence of self-distraction on a left prefrontal production function, whereas reappraisal depends on a right prefrontal higher order monitoring process. OutDoorLinks: Katja Wiech http://www.fmrib.ox.ac.uk/pain/people.html

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Self-recognition in an Asian elephant By Joshua M. Plotnik, Frans B. M. de Waal and Diana Reiss Source: www.pnas.org/ October 30, 2006 http://www.pnas.org/cgi/ search?fulltext=Plotnik+&submit.x=0&submit.y=0&submit=GO www.pnas.org/cgi/doi/10.1073/pnas.0608062103 Proc. Natl. Acad. Sci. USA, 10.1073/pnas.0608062103

Considered an indicator of self-awareness, mirror self-recognition (MSR) has long seemed limited to humans and apes. In both phylogeny and human ontogeny, MSR is thought to correlate with higher forms of empathy and altruistic behavior. Apart from humans and apes, dolphins and elephants are also known for such capacities. Animals that possess MSR typically progress through four stages of behavior when facing a mirror: After the recent discovery of MSR in dolphins (Tursiops truncatus), elephants thus were the next logical candidate species. We exposed three Asian elephants (Elephas maximus) to a large mirror to investigate their responses. (i) social responses, (ii) physical inspection (e.g., looking behind the mirror), (iii) repetitive mirror-testing behavior, and

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989

Anomalous Transparency of Water-Air Interface for Low-Frequency Sound

(iv) realization of seeing themselves. Visible marks and invisible sham-marks were applied to the elephants' heads to test whether they would pass the litmus "mark test" for MSR in which an individual spontaneously uses a mirror to touch an otherwise imperceptible mark on its own body. Here, we report a successful MSR elephant study and report striking parallels in the progression of responses to mirrors among apes, dolphins, and elephants. These parallels suggest convergent cognitive evolution most likely related to complex sociality and cooperation. To whom correspondence may be addressed at: Joshua M. Plotnik, E-mail: jplotni(at)emory.edu Frans B. M. de Waal, E-mail: dewaal(at) emory.edu Diana Reiss, E-mail: dlr28(at) columbia.edu OutDoorLinks: Joshua M. Plotnik http://www.emory.edu/LIVING_LINKS/Plotnik.html Frans B. M. de Waal http://www.emory.edu/LIVING_LINKS/de_Waal.html Diana Reiss http://maxweber.hunter.cuny.edu/psych/faculty/labs/reiss.htm

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Anomalous Transparency of Water-Air Interface for Low-Frequency Sound By Oleg A. Godin Source: http://scitation.aip.org/getabs/servlet/ GetabsServlet?prog=normal&id=PRLTAO000097000016164301000001&idtype=c vips&gifs=yes Phys. Rev. Lett. 97, 164301 (2006) ÂŠ2006 The American Physical Society

Sound transmission through a water-air interface is normally weak because of a strong mass density contrast.

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990

Tame your brain to keep your cool

We show that the transparency of the interface increases dramatically at low frequencies. Almost all acoustic energy emitted by a sufficiently shallow monopole source under water is predicted to be radiated into air. Increased transparency at lower frequencies is due to the increasing role of inhomogeneous waves. For sources symmetric with respect to a horizontal plane, transparency is further increased by a destructive interference of direct and surfacereflected waves under water. The phenomenon of anomalous transparency has significant geophysical and biological implications. OutDoorLinks: CIRES in Boulder http://cires.colorado.edu/

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Tame your brain to keep your cool Source: www.newscientist.com/28 October 2006 http://www.newscientist.com/channel/being-human/mg19225755.000tame-your-brain-to-keep-your-cool.html IT SEEMS that emotional self-control really does come from within. Previous studies have shown that people can learn to control the activity levels of specific brain regions to alter, for example, pain levels, when shown real-time "neurofeedback" from fMRI brain images. Now a similar approach may help psychopathic criminals increase their emotional fluency. Niels Birbaumer and Ranganatha Sitaram from the University of T端bingen in Germany found that by showing healthy volunteers the activity levels of the insula, a brain region important in emotional processing, represented in real time as a thermometer bar on a screen, the volunteers could control their emotional responses. After four training sessions they had learned to raise and lower their insula activity levels, in turn changing how they rated the emotional quality of disturbing or neutral images.

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991

Nonlinear auditory mechanism enhances female sounds for male mosquitoes

Three psychopathic prison inmates who lacked a normal insula response trained the same way. After four days, one appeared to have learned to raise his insula activity towards more normal levels. It opens a potential avenue for treating emotional disorders such as psychopathy or social phobia, the team told a meeting of the Society for Neuroscience in Atlanta, Georgia, last week. OutDoorLinks: 36th Annual Meeting of the Society for Neuroscience http://apu.sfn.org/am2006/ Niels Birbaumer http://www.neuroscience-tuebingen.de/research-groups/ display.php?type=Department&id=37&search=dep_list Ranganatha Sitaram http://www.mp.uni-tuebingen.de/mp/index.php?id=160

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Nonlinear auditory mechanism enhances female sounds for male mosquitoes By Joseph C. Jackson and Daniel Robert Source: www.pnas.org/ October 26, 2006 http://www.pnas.org/cgi/content/abstract/0606319103v1?etoc Published online before print October 26, 2006/Proc. Natl. Acad. Sci. USA, 10.1073/ pnas.0606319103

Sound plays an important role in the life history of mosquitoes. Male mosquitoes detect females by the sound generated by their wingbeat. Because female wings are weak acoustic radiators, males have been driven by sexual selection to evolve sensitive acoustic sensors. Mosquito antennae are very sensitive acoustic receivers, featuring up to 16,000 sensory cells, a number comparable with that contained in the human cochlea. The antennal sound receiver exhibits frequency selectivity, input amplification, and self-generated oscillations, features that parallel the functional sophistication of the cochlear amplifier.

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992

Photoacoustic detection of metastatic melanoma cells in the human circulatory

Although arguably the male antenna is well suited to receiving weak female sounds, the role of active mechanisms in mosquito hearing is far from understood. Previous mechanical studies on mosquito hearing largely focused on the steady-state antennal response to harmonic sounds, mostly evaluating the data through conventional Fourier transforms. Here, we report on the time-resolved mechanical behavior of the male antenna in response to female sounds. Crucially, stimuli were designed to reflect the temporal acoustic profile of a female flying by. With these stimuli, several previously unreported nonlinear features were unveiled, involving amplification, compression, and hysteresis. The time-resolved analysis reveals that, through the active participation of the sensory neurons, the antenna mechanically responds to enlarge its own range of detection. This behavior augments the capacity of the antennal receiver to detect female sounds, enhancing the male's chance to successfully pursue a passing female. To whom correspondence should be addressed. Joseph C. Jackson, E-mail: j.c.jackson(at)bris.ac.uk

OutDoorLinks: Joseph C. Jackson http://www.bio.bris.ac.uk/people/staff.cfm?key=930 Daniel Robert http://www.bio.bris.ac.uk/people/staff.cfm?key=726

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Photoacoustic detection of metastatic melanoma cells in the human circulatory system By Ryan M. Weight, John A. Viator, Paul S. Dale, Charles W. Caldwell, and Allison E. Lisle Source: http://ol.osa.org/abstract.cfm?id=111347

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993

Photoacoustic detection of metastatic melanoma cells in the human circulatory

Optics Letters, Vol. 31, Issue 20, pp. 2998-3000 ÂŠ 2006 Optical Society of America

Abstract Detection of disseminating tumor cells among patients suffering from various types and stages of cancer can function as an early warning system, alerting the physician of the metastatic spread or recurrence of the disease. Early detection of such cells can result in preventative treatment of the disease, while late stage detection can serve as an indicator of the effectiveness of chemotherapeutics. The prognostic value of exposing disseminating tumor cells poses an urgent need for an efficient, accurate screening method for metastatic cells. We propose a system for the detection of metastatic circulating tumor cells based on the thermoelastic properties of melanoma. The method employs photoacoustic excitation coupled with a detection system capable of determining the presence of disseminating cells within the circulatory system in vitro. Detection trials consisting of tissue phantoms and a human melanoma cell line resulted in a detection threshold of the order of ten individual cells, thus validating the effectiveness of the proposed mechanism. Results imply the potential to assay simple blood draws, from healthy and metastatic patients, for the presence of cancerous melanoma providing an unprecedented method for routine cancer screening.

OutDoorLinks: John A. Viator https://fsb.missouri.edu/BE/viator.htm

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994

Early verbal abuse may reduce language ability

Early verbal abuse may reduce language ability Children who are verbally abused may suffer lasting negative effects in their brainâ&#x20AC;&#x2122;s ability to process language, researchers report Source: www.newscientist.com/19 October 2006 http://www.newscientist.com/article/dn10332-early-verbal-abuse-may-reducelanguage-ability.html

They say the new findings illustrate the seriousness of this type of abuse and should encourage greater action to combat it. Brain scans of people who were verbally abused as children showed that they have 10% less grey matter in the part of their brains involved in language, compared with non-abused adults. Martin Teicher at Harvard Medical School in Boston, Massachusetts, US, and colleagues used an exhaustive questionnaire to select 17 people who had suffered severe verbal abuse in childhood but not other forms of abuse. Experts define verbal abuse as frequent disparaging or critical comments that are intended to demean and diminish the victimâ&#x20AC;&#x2122;s self-esteem, he explains. The team recruited 17 additional participants for the trial, matched for age and socioeconomic status, who had suffered no such abuse. Tone of voice Brain scans revealed that those who had experienced verbal abuse had a 10% reduction in the size of a brain region known as the right superior temporal gyrus, compared with those who had not been abused. This part of the brain contains a section responsible for auditory processing and is believed to help the brain understand the tone of speech. The scans also showed a significant reduction in a small part of the left superior temporal gyrus, which is thought to be involved in understanding the syntax of speech. Teicher speculates that verbal abuse might inhibit development in the superior temporal gyrus, perhaps by triggering a pathway that stops growth hormones from reaching it. Causal link?

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995

Early verbal abuse may reduce language ability

The new experiment does not necessarily establish a causal link: the abnormalities could be a genetically inherited trait. But Teicher suspects the relationship is causal. For example, previous research has shown that victims of sexual abuse by non-relatives have decreased development in the visual processing parts of the brain, compared with people who have not suffered such abuse. The brain abnormalities seen in the verbal abuse victims appear to be related to reduced language skills, Teicher adds. The subjects in the study who had experienced verbal abuse scored about 112 on a test of verbal IQ, on average, while their control counterparts had a score of about 124. “I think they didn’t reach their full potential,” he says of the students who suffered verbal abuse and scored lower on the test. Incredible anger The results are important because they contribute to a growing body of evidence that the stress caused by early abuse – including neglect – can disrupt the normal development of brain "circuits", says Barbara Rawn of Prevent Child Abuse America, in Chicago, Illinois, US. Teicher believes that parents have begun to grasp the negative effects of physically reprimanding their children, but he fears that parents may feel that no harm is done by frequently reprimanding their children with disparaging comments. “Verbal abuse really has a long-term effect on a child,” says Rawn. “There’s a lot of incredible anger that shows up in kids that have been told they are worth nothing.” She adds that some children who have been verbally abused sometimes develop behavioural traits such as extreme aggression, or instead become overly compliant. Teicher presented the new findings this week at the annual Society for Neuroscience meeting in Atlanta, Georgia, US.

OutDoorLinks: Martin Teicher http://www.mclean.harvard.edu/about/bios/detail.php?username=mteicher Barbara Rawn Prevent Child Abuse America, in Chicago, Illinois, US.

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996

More than 90 mins plugged-in music harmful

http://www.preventchildabuse.org/events/conference/downloads/ PCAAmerica_Staff.pdf

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More than 90 mins plugged-in music harmful Source: news.yahoo.com/18.10.2006 http://news.yahoo.com/s/nm/20061018/hl_nm/ hearing_music_dc;_ylt=AsJpaQf4Z3Ey_hr8QDDm7c0Q.3QA;_ylu=X3oDMTA5aHJv MDdwBHNlYwN5bmNhdA--

Listening to loud music with earphones on a digital music player for more than 90 minutes a day can damage your hearing, according to a new U.S. study. The study of 100 doctoral students concluded that people who listened to music at 80 percent of volume capacity, at which point the sound is considered loud, should stick to under 90 minutes a day. "If a person exceeds that on one particular day and happens not to use their headphones for the rest of the week, they're at no higher risk," study author Brian Fligor told Reuters. "I'm talking about someone who's exceeding 80 percent for 90 minutes day after day, month after month, for years." The study also found no problems for people who listened to music at 10 percent to 50 percent of maximum volume for extended periods. It found, however, that anyone who listened at 100 percent for more than five minutes faced the risk of hearing loss. The findings of the study, co-authored by doctoral candidate Cory Portunff, applies to children and adults. The researchers do not know if children are more susceptible than adults. The scientists found no differences in sound levels between brands of digital music players or between the genres of music tested which ranged from rock, R&B, country, to dance. Fligor, an audiologist at the Children's Hospital of Boston and faculty of Harvard Medical School, said people who consistently listen to high levels of volume don't realize that hearing loss can take up to 10 years to show up.

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997

When listening to music, your brain is “moving” even if you are not

"I worry about the teen-ager who's going to be 23, 24, 25 years old and has a measurable noise-induced hearing loss and now has another 60something years to live with his hearing which is only going to get worse," said Fligor, who will present his study on Thursday to a conference in Cincinnati. Fligor will also present the findings of another study, co-authored by Terri Ives of Pennsylvania's College of Optometry's School of Audiology, that found in-ear earphones, which broadcast sound directly into the ears, are no more dangerous than headphones that are placed over the ears. Both studies are being delivered to a "Noise-Induced Hearing Loss in Children in Work and Play" meeting.

OutDoorLinks: Brian Fligor http://www.asha.org/pressevent/experts.htm

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When listening to music, your brain is “moving” even if you are not Source: web.sfn.org/10/15/2006 http://web.sfn.org/index.cfm?pagename=news_101506d

Recent findings have uncovered that when listening to a rythmic sound, the motor region of our brain is active even if our body isn't. Research also shows, for the first time, activation of another area of our brain, the visual center, when temporarily blinded individuals recognize an object by touch. Other new reports include an understanding of how neurons are arranged in the visual cortex, how evolution gave human vision an advantage by being sensitive to three primary colors instead of just two, and a new understanding of synesthesia, a rare condition of crossed senses, such as tasting sounds. While you listen to music, the areas of your brain that enable your body to move are active, even if you are not. Recent research shows that you

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When listening to music, your brain is â&#x20AC;&#x153;movingâ&#x20AC;? even if you are not

don't have to think about the music's rhythm or tap your feet to the beat to engage your brain's motor control areas. "This finding goes against the traditional view that the brain's motor regions are involved only in executing body movement," says Robert Zatorre, PhD, of McGill University in Montreal. Does this research help explain the irresistible urge to dance, or at the least, to tap your fingers, when music is played? "Research carried out in our laboratory and in others have already shown that both auditory and motor regions of our brain become engaged when we listen to a musical rhythm and concurrently tap our fingers with it," says Joyce Chen, who collaborated with Zatorre. "More interestingly, we also know that when we listen to a musical rhythm and just think about, or imagine ourselves, tapping along with it, motor regions of our brain are also engaged," she adds. Using functional magnetic resonance imaging (fMRI), Zatorre and Chen pinpointed the brain areas in which neurons became active when the human volunteers listened to music. The fMRI measures the changes in blood flow that occur when neurons are active. The researchers used fMRI to monitor the volunteers' brains during three conditions. In the first, they asked the volunteers just to listen to the music. Next, the volunteers were instructed to anticipate, as they listened to the music, that they they would tap their fingers to the beat of the music. In the third condition, they actually tapped their fingers while listening to the music. "The results revealed that the brain's motor regions were involved in all three conditions, surprisingly, even when the volunteers were listening to a sequence of sounds that had no explicit association to movement," Chen says. "The sounds we used sounded like a wood block, that is, they had no pitch, so there was no melody per se. So we really think it's the complex time patterns involved in rhythm that engage the motor system." Hearing is only one of the senses with previously unknown links in the functional architecture of the brain. Tactile inputs, associated with the sense of touch, exist in the visual brain areas of people who can see, says Amir Amedi, PhD of Harvard Medical School.

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When listening to music, your brain is â&#x20AC;&#x153;movingâ&#x20AC;? even if you are not

"Our findings are important because they reveal that even in people with normal vision, there must be non-visual inputs into the primary visual cortex of their brain, and these inputs can undergo rapid, dynamic changes in strength if a person's sight is lost," said Amedi. Such research may help identify the brain mechanisms that can allow blind people to become extraordinarily adept in one or more of the other senses. Using fMRI and transcranial magnetic stimulation in his research, Amedi discovered that the sense of touch encroached into the brain's visual centers in volunteers whose vision is normal but who were blindfolded for five days to simulate sudden, total blindness. "Because humans rely heavily on visual information to understand the world, large portions of our brain appear specialized to process vision," Amedi says. "Therefore, it is not surprising that the brain of a blind person undergoes changes in order to adapt to the sensory loss by processing tactile, auditory or other sensory information from other senses." However, Amedi's study showed for the first time that robust and significant activation occurs in the brain visual centers when temporarily blinded individuals recognize an object by touch. "The extremely rapid time-course of the brain's recruitment of the visual cortex for tactile processing suggests that the visual cortex of sighted people have tactile inputs that can be rapidly unmasked by sudden and complete visual loss," he added.The activation of the brain's primary visual cortex, which was absent during the baseline fMRIs, declined dramatically soon after the volunteers removed their blindfolds. Two days later, it was negligible. New research results show for the first time that pinwheel centers are the convergence site for the orientation domains in the visual cortex, and that that these singular points in the cortical map exist at the finest possible scale: individual cells. This finding suggests that cortical circuits can be built with tremendous precision. Even when we are viewing a very simple scene -- for example, a paper clip on a piece of white paper -- the visual signals from our retina must be processed by roughly 30 visual areas, or zones, of the brain. Each area is responsible for interpreting certain defining attributes such as contours of specific orientations. In the visual cortex, neurons that

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When listening to music, your brain is â&#x20AC;&#x153;movingâ&#x20AC;? even if you are not

respond to contours of specific orientations are arranged in wellorganized orientation maps. One of the best-studied features in orientation maps is known as a pinwheel, a small region in which all orientations are represented in segments that appear to come to a point. "A long-standing question is, 'How are neurons arranged in the pinwheel centers?'" says R.C. Reid, PhD, of Harvard Medical School. Reid provided the answer by using two-photon calcium imaging, which determines the physiological response of hundreds of cells simultaneously as well as their precise location in the cortical circuit. "By recording from hundreds to thousands of neurons at each pinwheel center, we demonstrated that pinwheel centers are remarkably well organized," he says. "Neurons selective to different orientations are arranged in an orderly manner even in the very center," he adds. "There was virtually no mixing of cells with different orientation preferences even at the center. Thus, pinwheel centers truly represent singularities in the cortical map." This finding is suggesting extraordinary precision in the development of cortical circuits. Over evolutionary time, color perception has given humans an advantage. "It is known that color facilitates object perception and improves memory of these objects," says Hans-Peter Frey, PhD, of the University of Osnabrueck in Germany. Many humans and some non-human primates are trichromatic because their eyes contain three types of cones that are sensitive to red, green, and blue. These three cone types work together to convey information about all visible colors. Some humans and most primate species are dichromatic -- with cone types sensitive to only two of the three colors. Although our visual system allows us to see colors, our ability to perceive movement, depth, perspective, the relative size of objects, shading, and gradations in texture all depend primarily on contrasts in light intensity rather than in color. Supporting this concept, Frey describes an "ongoing controversy" in color perception: Did trichromacy evolve to enable humans and some non-human primate species to detect ripe fruit embedded in foliage? To answer this question, he determined whether trichromatic human volunteers took advantage of their ability to discriminate red and green colors. He recorded eye movements of human subjects while they were looking at images of the Kibale rainforest in Uganda. The images showed Odds and ends - themes and trends

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When listening to music, your brain is â&#x20AC;&#x153;movingâ&#x20AC;? even if you are not

foliage with embedded fruits. Previously, researchers observed nonhuman primates in the Kibale rainforest for several months and recorded the color of their food with a spectrometer, Frey explains. They found that ripe fruits could be discriminated from unripe fruits using the blueyellow color channel, or the red-green color channel. "This result suggests that there is no advantage of being trichromatic," he says. In his studies of human volunteers, he did not evaluate the opponent color channels themselves, but instead the color contrast in these channels. He determined that the color contrast of the red-green visual inputs enables trichromatic individuals to detect fruit among foliage, because this color contrast is especially high in parts of the visual scene that contain fruit. "Thus, dichromatic non-human primates should be less efficient in finding fruit by visual inspection," he points out. " This prediction could also apply to some of the dichromatic humans." Imagine that when you think of Wednesday, you experience the color magenta. Or when you hear the name Susan, you taste cinnamon in your mouth. Or when you hear a Beethoven symphony, you smell gardenias. "You may be one in a hundred otherwise normal people who experience the world this way," says David Eagleman, PhD, of the University of Texas, Houston Medical School, referring to the neurological condition called synesthesia. "In synesthesia, stimulation of one sense triggers an experience in a different sense," says Eagleman. "For example, a voice or piece of music are not only heard but also seen, tasted, or felt as a touch. Synesthesia is a fusion of different sensory perceptions, and most synesthetes are unaware their experiences are in any way unusual." Synesthetic perceptions are involuntary, automatic, and generally consistent over time. Eagleman will describe a new, large scale genetic study -- called a family linkage analysis -- to map the gene or genes that correlate for color synesthesias. "Understanding the genetic basis of synesthesia yields insight into the way normal brains are wired," he explains. "And it demonstrates that more than one kind of brain, and one kind of mind, is possible."

OutDoorLinks:

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5th AMRC Susan Porter Symposium: Music and Health in America American

Robert J. Zatorre Montreal http://www.psych.mcgill.ca/faculty/zatorre.html Amir Amedi http://tmslab.org/faculty/?id=15 R.C. Reid http://neuro.med.harvard.edu/site/faculty/reid.html Hans-Peter Frey http://www.home.uni-osnabrueck.de/hfrey/ David Eagleman, PhD http://www.uth.tmc.edu/nba/resources/faculty/members/eagleman.htm

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5th AMRC Susan Porter Symposium: Music and Health in America American Music Research Center presents 5th AMRC Susan Porter Symposium Music and Health in America June 28-30, 2007Boulder, Colorado Source: http://ucblibraries.colorado.edu/amrc/musichealth2007/index.htm

A Rich Multi-disciplinary Symposium: Exploring the historical, medical, therapeutic and spiritual ways that music affects healthy individuals and societies. Featuring nationally recognized speakers and performers from both music and health disciplines. With keynote talks, panel discussions, concerts, experiential workshops and post-symposium intensives. Who Will Attend: music therapists, ethnomusicologists, medical and healthcare professionals, composers, musicians, spiritual healers, historians and the general public.

To read more go to <http://ucblibraries.colorado.edu/amrc/musichealth2007/index.htm> To read the schedule go to

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5th AMRC Susan Porter Symposium: Music and Health in America American

<http://ucblibraries.colorado.edu/amrc/musichealth2007/schedule.htm> --New Book: Music Therapy Methods in Neurorehabilitation A Clinician's Manual Felicity Baker and Jeanette Tamplin Foreword by Barbara Wheeler www.tomdoch.de +49 (0) 221-58 91 95 33

With a contribution from Jeanette Kennelly Quelle: http://www.jkp.com/catalogue/book.php/isbn/9781843104124

The value of music therapy in neurological rehabilitation is increasingly recognised and this practical manual provides comprehensive guidance for clinicians on the application of music therapy methods in neurorehabilitation. Felicity Baker and Jeanette Tamplin combine research findings with their own clinical experience and present step-by-step instructions and guidelines on how to implement music therapy techniques for a range of therapeutic needs. Photographs clearly illustrate interventions for physical rehabilitation, for example through the use of musical instruments to encourage targeted movement. The chapter on cognitive rehabilitation includes resources and lists suitable songs for use in immediate memory or abstract thinking tasks, among others. In her chapter on paediatric patients, Jeanette Kennelly demonstrates how procedures can be adapted for working clinically with children. A comprehensive list of terminology commonly used in neurological rehabilitation is also included. Music Therapy Methods in Neurorehabilitation will prove an invaluable reference book for music therapy clinicians and students. It is also suitable for work with other populations, in particular for work in special education. Music Therapy Methods in Neurorehabilitation A Clinician's Manual

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Friends for Life: An Emerging Biology of Emotional Healing

Paperback, ISBN-10: 1-84310-412-1 ISBN-13: 9781843104124, 256pp, 2006, £29.99, $55.00 OutDoorLinks: Felicity Baker http://www.uq.edu.au/music/index.html?page=27266 Jeanette Tamplin http://www.austin.org.au/Content.aspx?topicID=303 Barbara Wheeler http://www.louisville.edu/music/bios/b_wheeler.html

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Friends for Life: An Emerging Biology of Emotional Healing By DANIEL GOLEMAN Source: DANIEL GOLEMAN/www.nytimes.com/ October 10, 2006 http://www.nytimes.com/2006/10/10/health/psychology/ 10essa.html?_r=2&oref=slogin&ref=health&pagewanted=print&oref=slogin

A dear friend has been battling cancer for a decade or more. Through a grinding mix of chemotherapy, radiation and all the other necessary indignities of oncology, he has lived on, despite dire prognoses to the contrary. My friend was the sort of college professor students remember fondly: not just inspiring in class but taking a genuine interest in them — in their studies, their progress through life, their fears and hopes. A wide circle of former students count themselves among his lifelong friends; he and his wife have always welcomed a steady stream of visitors to their home. Though no one could ever prove it, I suspect that one of many ingredients in his longevity has been this flow of people who love him. Research on the link between relationships and physical health has established that people with rich personal networks — who are married, have close family and friends, are active in social and religious groups — Odds and ends - themes and trends

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Friends for Life: An Emerging Biology of Emotional Healing

recover more quickly from disease and live longer. But now the emerging field of social neuroscience, the study of how people’s brains entrain as they interact, adds a missing piece to that data. The most significant finding was the discovery of “mirror neurons,” a widely dispersed class of brain cells that operate like neural WiFi. Mirror neurons track the emotional flow, movement and even intentions of the person we are with, and replicate this sensed state in our own brain by stirring in our brain the same areas active in the other person. Mirror neurons offer a neural mechanism that explains emotional contagion, the tendency of one person to catch the feelings of another, particularly if strongly expressed. This brain-to-brain link may also account for feelings of rapport, which research finds depend in part on extremely rapid synchronization of people’s posture, vocal pacing and movements as they interact. In short, these brain cells seem to allow the interpersonal orchestration of shifts in physiology. Such coordination of emotions, cardiovascular reactions or brain states between two people has been studied in mothers with their infants, marital partners arguing and even among people in meetings. Reviewing decades of such data, Lisa M. Diamond and Lisa G. Aspinwall, psychologists at the University of Utah, offer the infelicitous term “a mutually regulating psychobiological unit” to describe the merging of two discrete physiologies into a connected circuit. To the degree that this occurs, Dr. Diamond and Dr. Aspinwall argue, emotional closeness allows the biology of one person to influence that of the other. John T. Cacioppo, director of the Center for Cognitive and Social Neuroscience at the University of Chicago, makes a parallel proposal: the emotional status of our main relationships has a significant impact on our overall pattern of cardiovascular and neuroendocrine activity. This radically expands the scope of biology and neuroscience from focusing on a single body or brain to looking at the interplay between two at a time. In short, my hostility bumps up your blood pressure, your nurturing love lowers mine. Potentially, we are each other’s biological enemies or allies. Even remotely suggesting health benefits from these interconnections will, no doubt, raise hackles in medical circles. No one can claim solid data showing a medically significant effect from the intermingling of physiologies.

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Friends for Life: An Emerging Biology of Emotional Healing

At the same time, there is now no doubt that this same connectivity can offer a biologically grounded emotional solace. Physical suffering aside, a healing presence can relieve emotional suffering. A case in point is a functional magnetic resonance imaging study of women awaiting an electric shock. When the women endured their apprehension alone, activity in neural regions that incite stress hormones and anxiety was heightened. As James A. Coan reported last year in an article in Psychophysiology, when a stranger held the subject’s hand as she waited, she found little relief. When her husband held her hand, she not only felt calm, but her brain circuitry quieted, revealing the biology of emotional rescue. But as all too many people with severe chronic diseases know, loved ones can disappear, leaving them to bear their difficulties in lonely isolation. Social rejection activates the very zones of the brain that generate, among other things, the sting of physical pain. Matthew D. Lieberman and Naomi Eisenberg of U.C.L.A. (writing in a chapter in “Social Neuroscience: People Thinking About People,” M.I.T. Press, 2005) have proposed that the brain’s pain centers may have taken on a hypersensitivity to social banishment because exclusion was a death sentence in human prehistory. They note that in many languages the words that describe a “broken heart” from rejection borrow the lexicon of physical hurt. So when the people who care about a patient fail to show up, it may be a double blow: the pain of rejection and the deprivation of the benefits of loving contact. Sheldon Cohen, a psychologist at Carnegie-Mellon University who studies the effects of personal connections on health, emphasizes that a hospital patient’s family and friends help just by visiting, whether or not they quite know what to say. My friend has reached that point where doctors see nothing else to try. On my last visit, he and his wife told me that he was starting hospice care. One challenge, he told me, will be channeling the river of people who want to visit into the narrow range of hours in a week when he still has the energy to engage them. As he said this, I felt myself tearing up, and responded: “You know, at least it’s better to have this problem. So many people go through this all alone.” He was silent for a moment, thoughtful. Then he answered softly, “You’re right.” Odds and ends - themes and trends

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Programming social, cognitive, and neuroendocrine development by early

Daniel Goleman is the author of â&#x20AC;&#x153;Social Intelligence: The New Science of Human Relationships.â&#x20AC;? OutDoorLinks: Daniel Goleman http://www.danielgoleman.info/ Lisa M. Diamond http://www.psych.utah.edu/people/faculty/diamond/ Lisa G. Aspinwall http://www.psych.utah.edu/people/faculty/aspinwall/ John T. Cacioppo http://psychology.uchicago.edu/people/faculty/cacioppo/index.shtml James A. Coan http://www.people.virginia.edu/%7Ejac3zt/people.html Matthew D. Lieberman http://www.scn.ucla.edu/people_liebermanm.html

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Programming social, cognitive, and neuroendocrine development by early exposure to novelty By Akaysha C. Tang, Katherine G. Akers, Bethany C. Reeb, Russell D. Romeo and Bruce S. McEwen Source: www.pnas.org/ October 9, 2006 http://www.pnas.org/cgi/content/abstract/0607374103v1?etoc Proc. Natl. Acad. Sci. USA, 10.1073/pnas.0607374103

Mildly stressful early life experiences can potentially impact a broad range of social, cognitive, and physiological functions in humans, nonhuman primates, and rodents. Recent rodent studies favor a maternal-mediation hypothesis that considers maternal-care differences induced by neonatal stimulation as the cause of individual differences in offspring development. Using neonatal novelty exposure, a neonatal stimulation paradigm that dissociates maternal individual differences from a direct stimulation effect on the offspring, we investigated the effect of early exposures to

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Task-modulated "what" and "where" pathways in human auditory cortex

novelty on a diverse range of psychological functions using several assessment paradigms. Pups that received brief neonatal novelty exposures away from the home environment showed enhancement in spatial working memory, social competition, and corticosterone response to surprise during adulthood compared with their home-staying siblings. These functional enhancements in novelty-exposed rats occurred despite evidence that maternal care was directed preferentially toward homestaying instead of novelty-exposed pups, indicating that greater maternal care is neither necessary nor sufficient for these early stimulationinduced functional enhancements. We suggest a unifying maternal-modulation hypothesis, which distinguishes itself from the maternal-mediation hypothesis in that (i) neonatal stimulation can have direct effects on pups, cumulatively leading to long-term improvement in adult offspring; and (ii) maternal behavior can attenuate or potentiate these effects, thereby decreasing or increasing this long-term functional improvement. To whom correspondence may be addressed at: Akaysha C. Tang, E-mail: akaysha(at)unm.edu Bruce S. McEwen, E-mail: mcewen(at)rockefeller.edu OutDoorLinks: Akaysha C. Tang http://www.unm.edu/~atlab/ Bruce S. McEwen http://www.rockefeller.edu/research/abstract.php?id=109

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Task-modulated "what" and "where" pathways in human auditory cortex By Jyrki Ahveninen, Iiro P. Jääskeläinen, Tommi Raij, Giorgio Bonmassar, Sasha Devore, Matti Hämäläinen, Sari Levänen, FaHsuan Lin, Mikko Sams, Barbara G. Shinn-Cunningham, Thomas Witzel and John W. Belliveau Source: www.pnas.org/September 26, 2006

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Task-modulated "what" and "where" pathways in human auditory cortex

http://www.pnas.org/cgi/content/abstract/103/39/14608?etoc Published online before print September 18, 2006, 10.1073/pnas.0510480103 PNAS | September 26, 2006 | vol. 103 | no. 39 | 14608-14613 © 2006 by The National Academy of Sciences of the USA

Human neuroimaging studies suggest that localization and identification of relevant auditory objects are accomplished via parallel parietal-tolateral-prefrontal "where" and anterior-temporal-to-inferior-frontal "what" pathways, respectively. We found a double dissociation in response adaptation to sound pairs with phonetic vs. spatial sound changes, demonstrating that the human nonprimary auditory cortex indeed processes speech-sound identity and location in parallel anterior "what" (in anterolateral Heschl’s gyrus, anterior superior temporal gyrus, and posterior planum polare) and posterior "where" (in planum temporale and posterior superior temporal gyrus) pathways as early as {approx}70–150 ms from stimulus onset. Using combined hemodynamic (functional MRI) and electromagnetic (magnetoencephalography) measurements, we investigated whether such dual pathways exist already in the human nonprimary auditory cortex, as suggested by animal models, and whether selective attention facilitates sound localization and identification by modulating these pathways in a feature-specific fashion. Our data further show that the "where" pathway is activated {approx}30 ms earlier than the "what" pathway, possibly enabling the brain to use top-down spatial information in auditory object perception. Notably, selectively attending to phonetic content modulated response adaptation in the "what" pathway, whereas attending to sound location produced analogous effects in the "where" pathway. This finding suggests that selective-attention effects are feature-specific in the human nonprimary auditory cortex and that they arise from enhanced tuning of receptive fields of task-relevant neuronal populations. To whom correspondence should be addressed at: Jyrki Ahveninen, E-mail: jyrki(at)nmr.mgh.harvard.edu

OutDoorLinks: Jyrki Ahveninen http://www.nmr.mgh.harvard.edu/martinos/people/showPerson.php?people_id=205

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Forget 'emoticons' â&#x20AC;&#x201C; use your own smiley face

John W. Belliveau http://www.nmr.mgh.harvard.edu/martinos/people/showPerson.php?people_id=8

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Forget 'emoticons' â&#x20AC;&#x201C; use your own smiley face By Tom Simonite Source: www.newscientisttech.com/29 September 2006 http://www.newscientisttech.com/article/dn10190-forget-emoticons--use-your-ownsmiley-face.html

Software that contorts an image of a person's face to express different emotions could enrich text-based internet chat. The researchers behind the system say it can quickly transform a user's face to convey any of six emotions, ranging from anger to happiness. A user first uploads a picture of their face with a "neutral" expression. Then they use their mouse to mark the ends of their eyebrows, the corners of their mouth and the edges of their eyes and lips. The software uses these points to morph the face to express different emotions: happiness, sadness, fear, anger, surprise, and disgust. A user can select an emotion and one of three intensity levels when using the system. "We think it could be an improvement on the crude emoticons [ :-) ] instant messaging programmes use now," says Anthony Boucouvalas who created the system with colleagues at Bournemouth University in the UK. "It isn't perfect but it gets the message across and is very convenient." Reduce misunderstandings The software uses a facial image database to determine the correct spatial relationship between different facial features for different emotions. It distorts the points and areas marked by the user to shift them for a desired emotion. In tests, a group of 35 volunteers were able to correctly recognise morphed emotions 60% of the time. Boucouvalas believes this is high enough to be used with internet chat, where the text could help reduce misunderstandings.

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Talent vs. Practice

In future, the researchers may integrate the face morphing software with a program that uses a dictionary of 18,000 words and basic grammatical phrases to identify the emotional content of a message. This could help internet chat rooms function more like group conversation in real life, says Boucouvalas. "If I enter an online environment I've got no idea what kind of mood you are in," he says. "This tool could give me an idea based on what you have been saying before I arrived."

OutDoorLinks: Anthony Boucouvalas http://dec.bournemouth.ac.uk/staff/tboucouvalas/tony1.htm

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Talent vs. Practice by Joyce Gramza and Victor Limjoco Source: www.sciencentral.com/3. Oktober 2006 http://www.sciencentral.com/articles/view.php3?article_id=218392857

Is talent something you're born with or can practice really make you perfect? Experts on expertise -- who've studied the minds of experts in fields from sports to medicine -- have the answer. As this ScienCentral News video explains, they're applying it to life or death situations. Thinking Like an Expert In the Human Performance Laboratory at Florida State University's Center for Expert Performance Research, a nursing student is told to care for a simulated patient admitted for chest pain. The dummy patient's vital signs, as well as his voice, are controlled by a nursing professor behind a two-way mirror. When the "patient" suddenly can't breathe, the student gets to experience a novice nurse's nightmare -- a life-or-death situation with no one to take over and rescue the patient, or coach her what to do. Putting both experts and novices through critical scenarios like this, cognitive psychology researchers K. Anders Ericsson and Paul Ward don't just observe the differences in subjects' performance. They also use

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Talent vs. Practice

interviewing techniques they've developed to understand the differences in their minds. "We’re looking at how people think and how that thinking affects how they perform," says Ward. Ericsson Ward Researchers Before a novice or expert participates in the simulation, Ward prepares them for how they will be debriefed afterward. He teaches them how to give a "think-aloud" report of their performance, in which they simply recount what they were thinking throughout the scenario without trying to evaluate or explain it. "That’s when we uncover the expert superiority: their ability to perceive more information, and also, after the fact, remember more of the thought processes than the novices," says Ericsson. "Some key differences would be the way in which they pick up information from the environment," Ward says, "and the way in which they comprehend that information such that they could then use it to good effect." In fact, even in sports, where we tend to think that successful athletes have not only natural abilities, but also superior physical skills, Ward's research on top soccer players has shown that mental processes are a much better predictor of performance than physical attributes. Elite players not only make better decisions than less-skilled players, they do it by more accurately perceiving and analyzing cues around them and anticipating consequences of their actions. "These are skills that are intangible," says Ward, "because you can’t touch or feel them but they result in a difference in your performance." Ericsson and Ward have used techniques like this to compare thousands of experts with novices in fields from music, sports, medicine and law enforcement. They've found no evidence that experts are born with any more natural "talent" than other people. "We have yet to find any compelling evidence that any talent matters," says Ericsson. Instead, the key to dramatic improvement in any field is -- that's right -practice. But, it has to be what Ericsson calls "deliberate practice." "A lot of people like to do things that they’re already good at, but what deliberate practice says is you need to find those things that you are weak at and that there’s room for improvement and that’s the activity you should focus on," Ericsson says. Nurse

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Talent vs. Practice

"The interesting finding is that experts in any domain seem to share very, very similar attributes," he says, "and they are acquired through extended practices, not just mere experience. They actually are doing a lot of thinking work that would allow them now to acquire the skills that are necessary for superior performance." Ericsson and Ward say their findings suggest that any novice can become an expert with enough of the right kind of training. "It suggests that anyone with the right kind of practice will be able to dramatically improve their performance and it looks like they would be able to become experts with sufficient practice," Ericsson says. They suspect that what many people think of as "talent" may just be the motivation and commitment to continually challenge yourself. Future research is focusing on healthy people who fail to reach expert levels, exploring the idea of individual limits. They're looking at individuals who prematurely stopped practicing and don't know how far they would've reached at a particular skill. "We are actively searching for people who can help us find those kinds of individual limits that would not allow somebody to become proficient in a language or proficient in some profession," Ericsson says. "If we could understand that, it would allow us to help a lot of individuals hopefully reach much higher levels of performance." Their research was funded by the Office of Naval Research and featured in Scientific American, August 2006. Ericsson and others edited The Cambridge Handbook of Expertise and Expert Performance in 2006. OutDoorLinks: Human Performance Laboratory at Florida State University's Center for Expert Performance Research http://www.lsi.fsu.edu/cepr/ K. Anders Ericsson http://www.psy.fsu.edu/faculty/ericsson.dp.html Paul Ward http://www.lsi.fsu.edu/cepr/people7.html

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Train your brain to hear your friends at a party

Train your brain to hear your friends at a party Source: www.alphagalileo.org/05 October 2006 http://www.alphagalileo.org/index.cfm?fuseaction=readrelease&releaseid=515750

A major science prize was today awarded to a researcher who is looking for the region of the brain that helps us to hear someone in a noisy place, such as a party or bar, and is responsible for “training” the brain to hear better in these situations. Not being able to hear a person’s voice in a noisy room and follow conversations is one of the most common problems for Britain’s nine million people with a hearing impairment. Deafness Research UK, the leading medical charity, has awarded the 2007 Pauline Ashley Prize to Sam Irving, a young researcher at the MRC Institute for Hearing Research in Nottingham. The Pauline Ashley Prize, established in memory of the charity’s founder, Lady Ashley of Stoke, is awarded annually to a talented young scientist near the beginning of their career and undertaking research into deafness, or a related condition such as tinnitus. Most people with a hearing impairment have trouble picking out what someone is saying when they’re in a noisy room. Parties or bars are some of the worst places because the level of background noise is high, and so scientists call this the “cocktail party effect”. To see what this was like, Irving wore an earplug in one ear for a week which gave him a one-sided hearing loss. He said: “It was hell - especially when I was in the pub with friends. The background hubbub of the bar seemed to be the same level as the people I was talking to so I could barely hear what they were saying and it took a huge effort of concentration to follow any conversation. During the week, I gave up and spent a lot of time at home on my own because it was so distressing and tiring to be with lots of people or in a noisy place.” Our ability to detect a particular sound in the middle of lots of noise relies on the fact that we have two ears, and each detects an individual sound at a slightly different time (a sound coming from the left will reach the left ear slightly faster than it reaches the right ear). This is known as binaural or “spatial” hearing because it helps us identify where a sound is coming from and to concentrate or focus our hearing on that particular sound. But, if you have some form of hearing problem in at least one ear, this ability is disrupted and the brain struggles to tell one sound from another. Odds and ends - themes and trends

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Train your brain to hear your friends at a party

The key to understanding this ability lies in the brain. Scientists are currently trying to work out exactly what part of the brain is responsible and how it allows us to distinguish one sound from lots of noise. Early research has had some remarkable results. Most mammals also have this ability and in 2006, scientists working in the Oxford Auditory Neuroscience Group found that spatial hearing in ferrets has the ability to bounce-back or adapt to a hearing loss over time. Their brains are being “trained” to cope with the hearing loss and distinguish sounds much better. The Oxford study placed healthy ferrets in a “ring of sound” where a sound is played from one of 12 speakers placed in a circle around the ferret and their response is monitored to see if they can detect which speaker the sound is coming from. Ferrets with normal hearing are very good at this and have excellent spatial hearing. The team then fitted each of the ferrets with a small earplug in one ear which blocks some of the sound and so mimics a hearing loss. They then got the ferrets to perform the same task twice a day for two weeks and made a startling discovery. At first, the ferrets’ ability to identify where the sound was coming from was dramatically reduced (because their spatial hearing had been disrupted by the earplug) but after two weeks they regained their ability and by the end of the period were as good at detecting the location of the sounds as they were before being fitted with an earplug. Something in their brain was changing or adapting to the new situation and they were learning to compensate for the hearing loss. Irving said: “When we switch on a bright light our eyes detect the increase in light levels and the brain sends a message to the eye to tell it to contract the pupil and let in less light. This is a feedback system where the brain is getting information from the eye about its surroundings, processing that information, and sending messages back to the eye to help it cope with different situations. We think something very similar is happening with the ear in spatial hearing.” “The brain is constantly monitoring the sounds around us and so knows what normal sound levels it would expect. When we introduce an earplug, it can detect the reduction in sound being received and we think it is actively sending messages back to the ear telling it how to cope with the new hearing loss, perhaps by stimulating or increasing the signal

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Train your brain to hear your friends at a party

which is being blocked. It’s compensating for the problem in a really clever way.” Irving is trying to locate the place in the brain which is channeling these feedback messages back to the ear. “We already have a likely candidate called the OCB, the Olivocochlear Bundle, which is a part of the brain that we know is a centre of feedback information being transmitted from the brain back to the ear. We’re now trying to work out if the OCB is responsible for spatial hearing in ferrets.” The Pauline Ashley Prize will allow Irving to work with a team led by Professor Charles Liberman at the Eaton Peabody Lab at MIT/ Harvard, leading experts on the OCB system. His study will compare the performance of ferrets which have had their OCB removed with normal ferrets in the “ring of sound”. At the same time, Irving is conducting a study with human subjects who have volunteered to wear an earplug for five days. These subjects will be tested in a similar ring of sound and their performance measured over time. Early results show that humans also have the same ability to train their brain to cope with the hearing loss and become better at the task the longer they’re wearing the earplug. Irving said: “Understanding how this system works is fairly basic science, but will be vital in the future for engineering new ways of helping people with hearing impairment cope with difficult situations. They could be helped by computer generated training programs which run like regular computer games, but can target weaknesses in listening skills. By incorporating training exercises much like those performed by the ferrets, they can lead to auditory learning and an improved ability to listen.”

OutDoorLinks: Deafness Research UK http://www.deafnessresearch.org.uk/ Sam Irving http://www.ihr.mrc.ac.uk/staff/ Charles Liberman http://hst.mit.edu/servlet/ ControllerServlet?handler=PeopleHandler&action=viewOne&id=HST000678

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When Just One Sense Is Available, Multisensory Experience Fills in the Blanks

When Just One Sense Is Available, Multisensory Experience Fills in the Blanks By Liza Gross Source: http://biology.plosjournals.org/perlserv/?request=getdocument&doi=10.1371%2Fjournal.pbio.0040361 Published: September 26, 2006 DOI: 10.1371/journal.pbio.0040361 Copyright: © 2006 Public Library of Science. Citation: Gross L (2006) When Just One Sense Is Available, Multisensory Experience Fills in the Blanks. PLoS Biol 4(10): e361

Our brains are wired in such a way that we can recognize a friend or loved one almost as easily whether we hear their voice or see their face. Specialized areas of the brain — in this case, the visual and auditory networks — are specially tuned to different properties of physical objects. These properties can be represented by multiple sensory modalities, so that a voice conveys nearly as much information about a person’s identity as a face. This redundancy allows rapid, automatic recognition of multimodal stimuli. It may also underlie “unimodal” perception — hearing a voice on the phone, for example — by automatically reproducing cues that are usually provided by other senses. In this view, as you listen to the caller’s voice, you imagine their face to try to identify the speaker. In a new study, Katharina von Kriegstein and Anne-Lise Giraud used functional magnetic resonance imaging (fMRI) to explore this possibility and understand how multimodal features like voices and faces are integrated in the human brain. Studies using fMRI have established that when someone hears a familiar person’s voice, an area of the temporal lobe called the fusiform face area (FFA) is activated through temporal voice areas (TVAs), suggesting early interactions between these cortical sensory areas. von Kriegstein and Giraud wondered whether these cortical ensembles might lay the foundation for general “multisensory representation” templates that enhance unimodal voice recognition.

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When Just One Sense Is Available, Multisensory Experience Fills in the Blanks

To explore this question, the researchers analyzed changes in brain activity and behavior after people learned to associate voices with an unfamiliar speaker. One group of participants learned to associate voices with faces and a second group learned to associate voices with names. Though both types of learning involve multimodal associations, voices and faces provide redundant information about a person’s identity (such as gender and age), while voices and names provide arbitrary relationships (since any name could be associated with any voice). To further explore the contribution of redundant stimuli from the same source, the researchers added an additional set of conditions in which participants associated cellular phones with either ringtones or brand names. In this case, both cell phone and brand name were arbitrarily associated with a ringtone. In the first phase of the fMRI experiment, participants listened to and identified either voices or ringtones. In the second phase, one group of participants learned to associate the voices and ringtones with faces and cell phones, while another group learned voice–name and ringtone–brand name associations. In the third phase, participants again heard only the auditory signals and identified either voices or ringtones as in phase one. The brain scans showed that learning multisensory associations enhanced those brain regions involved in subsequent unimodal processing for both voice–face and voice–name association. Recognizing people on the phone: Does knowing the face help? But at the behavioral level, participants could recognize voices that they had paired with faces much more easily than they could recognize voices they had linked to names. Participants who had learned to associate voices with faces were the only ones to show increased FFA activation during unimodal voice recognition. The fMRI results show that even a brief association between voices and faces is enough to enhance functional connectivity between the TVA and FFA, which interact when a person recognizes a familiar voice. In contrast, voice–name association did not increase interactions between voice and written name sensory regions. Similarly, people did not recognize ringtones any better whether they had learned to associate them with cell phones or brand names.

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1019

Morphometry of the amusic brain: a two-site study

Nor did their brain scans reveal any interactions between auditory and visual areas during ringtone recognition. Altogether, these results show that learning voice–face associations generates a multimodal sensory representation that involves increased functional connectivity between auditory (TVA) and visual (FFA) regions in the brain and improves unimodal voice recognition performance. When only one sensory modality of a stimulus is available, the researchers conclude, one can optimally identify a natural object by automatically tapping into multisensory representations in the brain — cross-modal ensembles that are normally coactivated — as long as the stimulus provides redundant information about the object. Given that faces and voices are the major means of social communication for nonhuman primates as well as for humans, the reliance of multiple, redundant sensory modalities likely has deep roots in our evolutionary history.

OutDoorLinks: Katharina von Kriegstein http://www.science.mcmaster.ca/~IMRF/2005/viewabstract.php?id=117 Anne-Lise Giraud http://www.cogmaster.net/cogmaster_files/identiteCP.html

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Morphometry of the amusic brain: a two-site study Krista L. Hyde, Robert J. Zatorre, Timothy D. Griffiths, Jason P. Lerch and Isabelle Peretz Source: brain.oxfordjournals.org/August 24, 2006 http://brain.oxfordjournals.org/cgi/content/abstract/awl204v1

Abstract

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Morphometry of the amusic brain: a two-site study

Congenital amusia (or tone deafness) is a lifelong disability that prevents otherwise normal-functioning individuals from developing basic musical skills. Behavioural evidence indicates that congenital amusia is due to a severe deficit in pitch processing, but very little is known about the neural correlates of this condition. The objective of the present study was to investigate the structural neural correlates of congenital amusia. To this aim, voxel-based morphometry was used to detect brain anatomical differences in amusic individuals relative to musically intact controls, by analysing T1-weighted magnetic resonance images from two independent samples of subjects. The results were consistent across samples in highlighting a reduction in white matter concentration in the right inferior frontal gyrus of amusic individuals. This anatomical anomaly was correlated with performance on pitchbased musical tasks. The results are consistent with neuroimaging findings implicating right inferior frontal regions in musical pitch encoding and melodic pitch memory. We conceive the present results as a consequence of an impoverished communication in a right-hemisphere-based network involving the inferior frontal cortex and the right auditory cortex. Moreover, the data point to the integrity of white matter tracts in right frontal brain areas as being key in acquiring normal musical competence. To whom correspondence should be addressed. Krista L. Hyde, E-mail: krista.hyde(at)mcgill.ca

OutDoorLinks: Isabelle Peretz http://www.brams.umontreal.ca/plab/ Montreal Neurological Institute der McGill Universit채t http://www.mni.mcgill.ca Universit채t Newcastle http://www.ncl.ac.uk

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Silent night: adaptive disappearance of a sexual signal in a parasitized

Fachzeitschrift Brain http://brain.oxfordjournals.org

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Silent night: adaptive disappearance of a sexual signal in a parasitized population of field crickets By Marlene Zuk, John T. Rotenberry and Robin M. Tinghitella Source: Biology Letters/DOI: 10.1098/rsbl.2006.0539 http://www.journals.royalsoc.ac.uk/(nhnfjunzn33vrjjyjoeq02e5)/app/home/ contribution.asp?referrer=parent&backto=issue,3,37;journal,1,8;linkingpublicationresu lts,1:110824,1 ISSN: 1744-9561 (Paper) 1744-957X (Online)

Abstract: Sexual signals are often critical for mate attraction and reproduction, although their conspicuousness exposes them to parasites and predators. We document the near-disappearance of song, the sexual signal of crickets, and its replacement with a novel silent morph, in a population subject to strong natural selection by a deadly acoustically orienting parasitoid fly. On the Hawaiian Island of Kauai, more than 90% of male field crickets (Teleogryllus oceanicus) shifted in less than 20 generations from a normal-wing morphology to a mutated wing that renders males unable to call (flatwing). Flatwing morphology protects male crickets from the parasitoid, which uses song to find hosts, but poses obstacles for mate attraction, since females also use the males' song to locate mates. Field experiments support the hypothesis that flatwings overcome the difficulty of attracting females without song by acting as â&#x20AC;&#x2DC;satellitesâ&#x20AC;&#x2122; to the few remaining callers, showing enhanced phonotaxis to the calling song that increases female encounter rate. Thus, variation in behaviour facilitated establishment of an otherwise maladaptive morphological mutation.

OutDoorLinks:

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U.S. study finds fear on-off switch in brain

Marlene Zuk http://www.biology.ucr.edu/people/faculty/Zuk.html John T. Rotenberry http://www.facultydirectory.ucr.edu/cgi-bin/pub/public_individual.pl?faculty=849

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U.S. study finds fear on-off switch in brain Quelle: news.yahoo.com/20.9.2006 http://news.yahoo.com/s/nm/20060920/hl_nm/ science_fear_dc&printer=1;_ylt=Ary9ldcDhJBLBtckLA7a0ZAR.3QA;_ylu=X3oDMT A3MXN1bHE0BHNlYwN0bWE-

U.S. researchers said on Wednesday they had identified an "on-off" switch in the brain that controls the emotional response to fear, and said it might some day be manipulated to help patients with anxiety disorders. The team at Columbia University Medical Center used a simple attention test and a type of real-time brain scan called functional magnetic resonance imaging, which can catch the brain in action. It showed an area in the rostral cingulate or rACC region of the brain was involved in turning on or off the fear response in the amygdala -- the almond-shaped brain center where emotional responses to fear are processed. "People are exposed to an ever-increasing amount of stimuli in our everyday lives, and so we realized that the brain must employ a processing mechanism to prioritize and refine responses -- we don't run away from every loud sound or unexpected sight," said Dr. Joy Hirsch, who led the study, published in the journal Neuron. They used a test called the Stroop test to try to activate whatever region must be involved. The Stroop test measures mental flexibility by forcing people to choose between a word's meaning and its color. For instance, someone may be asked to read a list of words such as "red," "yellow," or "green" in which the word "red" might be written in blue ink, "yellow" in pink ink and so on. People usually respond more quickly if the color and word match.

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U.S. study finds fear on-off switch in brain

Hirsch's team adapted this test, using photographs of fearful and happy faces, with "FEAR" or "HAPPY" written across the images. They gave the test to 19 healthy volunteers and ran the brain scan at the same time. The rostral cingulate seemed to light up just before the amygdala was activated, they reported. For instance, the amygdala activated at first if FEAR was written across a happy face, and then the rostral cingulate would activate, apparently as the image of the smiling face registered, after which the amygdala would calm down, they said. But the amygdala stayed activated for longer, and the rostral cingulate stayed unlit longer, if a fearful face also carried the "FEAR" label. Hirsch said it is important to have a circuit to control the fear response. Some patients with anxiety disorders and depression may eventually be helped by the findings, said Dr. Eric Kandel, a Howard Hughes Medical Institute senior investigator and professor in brain sciences who worked on the paper. "For example, if someone with anxiety has a disturbed functioning of part of the amygdala or a disturbed functioning of rostral cingulate control mechanism, and treatment could be based on the individual's specific problem," Kandel said.

OutDoorLinks: Columbia University Medical Center http://www.cumc.columbia.edu/ Dr. Joy Hirsch http://cumc.columbia.edu/dept/radiology/fmri.html Dr. Eric Kandel http://www.columbia.edu/cu/biology/faculty-data/eric-kandel/faculty.html

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The effect of anticipation and the specificity of sex differences for amygdala

The effect of anticipation and the specificity of sex differences for amygdala and hippocampus function in emotional memory By Kristen L. Mackiewicz, Issidoros Sarinopoulos, Krystal L. Cleven and Jack B. Nitschke Source: www.pnas.org/September 19, 2006 http://www.pnas.org/cgi/content/abstract/103/38/14200?etoc ÂŠ 2006 by The National Academy of Sciences of the USA

Prior research has shown memory is enhanced for emotional events. Key brain areas involved in emotional memory are the amygdala and hippocampus, which are also recruited during aversion and its anticipation. This study investigated whether anticipatory processes signaling an upcoming aversive event contribute to emotional memory. In an event-related functional MRI paradigm, 40 healthy participants viewed aversive and neutral pictures preceded by predictive warning cues. Participants completed a surprise recognition task directly after functional MRI scanning or 2 weeks later. In anticipation of aversive pictures, bilateral dorsal amygdala and anterior hippocampus activations were associated with better immediate recognition memory. Similar associations with memory were observed for activation of those areas in response to aversive pictures. Anticipatory activation predicted immediate memory over and above these associations for picture viewing. Bilateral ventral amygdala activations in response to aversive pictures predicted delayed memory only. We found that previously reported sex differences of memory associations with left amygdala for women and with right amygdala for men were confined to the ventral amygdala during picture viewing and delayed memory. Results support an established animal model elucidating the functional neuroanatomy of the amygdala and hippocampus in emotional memory, highlight the importance of anticipatory processes in such memory for aversive events, and extend neuroanatomical evidence of sex differences for emotional memory.

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INTERNATIONAL CONGRESS OF MUSIC & CONTEMPORARY TECHNOLOGIES

To whom correspondence should be addressed. E-mail: jnitschke(at)wisc.edu OutDoorLinks: Jack B. Nitschke http://psych.wisc.edu/Nitschke/

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INTERNATIONAL CONGRESS OF MUSIC & CONTEMPORARY TECHNOLOGIES Seville, 12 to 16 December 2006 Source: http://www.congreso-musica.org

Presence and implication in current society State of the question * The preservation and restoration of the heritage * Pedagogy and analysis * Available technologies * Interpretation and perception * Sociology and aesthetics Music technology experienced one of its most notable changes in the 20th century: from the era of mechanics and sound production through the human body it evolved, firstly, towards electronic sound production and later, towards digital technology. The first stage consisted of the invention of musical instruments using the possibilities of electricity and electronics (Theremin, Ondes Martenot, etc.) and later the use of recording and reproduction methods for manipulating sound and organising it in music that at first dispensed with the instrumental presence. From this came the different currents that marked musical thought as from the late 1940s: Concrete Music, Electronic Music, Tape Music, Electro-acoustic music, Live-Electronics, Acousmatic Music, Digital Music â&#x20AC;Ś The second stage began with the possibility of producing digital sound, a process that began in the late 1950s. This stage made what had previously been a laborious task of controlling the performance of frequently unstable machines that much easier, resulting in a more

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INTERNATIONAL CONGRESS OF MUSIC & CONTEMPORARY TECHNOLOGIES

precise control of the parameters that make up the sound and the possibility of repeating the actions. We had to wait for the technology to develop so as to be able to work on the sound in all its complexity before digital technology would replace its predecessor, analogue technology: in the early years we had to wait several days to obtain the sound, but gradually we went from Recorded time (as it was called) to Real time, in which the composerâ&#x20AC;&#x2122;s aims were immediately audible. In the long journey from the early sounds until today, the computer has gone from being a tool difficult to control and confined to high technology centres to being an everyday, accessible tool, adapted to all spheres of human activity and easy to use. This evolution, however, brought significant and in some cases irreversible changes in the way we think and work in our society: pedagogy, the role of music in science, music in practice, composition and aesthetic concepts have all experienced changes and developments that enable us to identify a clear turning point. Perhaps the most significant fact is that, for the people who want to, it has never been easier to be able to invent, create and compose music, or simply have fun with sound. This first congress provides us with not only a general introduction to the technological problems in the musical field, but also the analysis and understanding of the impact that technology has had and is having on music today in all spheres of musical activity. It will also give us the chance to get a glimpse of future perspectives and of the possible challenges and needs that we will have to face. The preservation and restoration of the heritage Music is a richness that is valued with time, so it is therefore necessary to preserve it, study it and restore it. Digital technologies have simplified and aided in the preservation, cataloguing and restoration of this accumulated richness. However, we run the great risk of losing the greater part of this rich heritage that took shape as from the 1940s. What are these risks? The selfsame fragility of the means by which the information is preserved, the unstable technologies, the lack of preservation centres and the difficulty in defining what should be preserved. Which should be preserved: the recorded concert or the computer program that enabled the final result to be obtained?

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INTERNATIONAL CONGRESS OF MUSIC & CONTEMPORARY TECHNOLOGIES

Music forms a unique patrimonial, cultural and educational asset: we need to ensure that it becomes part of the process of the development of society. There are initiatives, foreshadowing of centres and above all musicological questioning, about which it is necessary to both preserve and define the essential setting so that a modern piece of work, created with innovative technology, can be preserved and restored in the future. Herein lie two problems: how to ensure the long-term preservation of almost 30,000 works composed since the 1940s and how, within the framework of constantly evolving technology, to integrate the problem of preservation of the works as a full part of its production process. The ideal situation would be for the piece of work, on being created, to produce its own memory, preserve the traces of its evolution, enabling at the same time the preservation of the development of the composerâ&#x20AC;&#x2122;s ideas. What is at stake today is our memory, our comprehension of the past to be able to project ourselves into the future, as well as the possibility of being able to interpret and rediscover essential works for understanding our current musical world. Alongside effective actions to ensure what already exists is saved, it is necessary to undertake actions that enable preservation to be something simple that does not interfere with the creative process but which ensures perpetuity. Pedagogy and analysis Analysing and transmitting is the key to understanding and the development of pleasure in music. Analysis enables the study of the ideas and structures of music; pedagogy is the essential element for sharing and developing auditory skills and the discovery of new musical worlds. Both aspects are traditionally structured around the representative element of the music, the score. Musical practice, within the school setting, is mainly instrumental and directed at developing the relationship between writing and playing. The use of new technologies in music has had two major consequences: the growing separation between the music that is heard and the music that is studied, as well as the fact that musical practice using digital technology has spread greatly among young people, something that, given that practice is rudimentarily linked to creation, requires training related to their concerns. This has resulted in a big question: how can we analyse and teach when the score disappears or when it is replaced by other means of Odds and ends - themes and trends

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INTERNATIONAL CONGRESS OF MUSIC & CONTEMPORARY TECHNOLOGIES

representation? The roots of musicological analysis are eroded, given that the parameters of the object to be analysed are not the same and the existing terminology and concepts cannot be easily applied. Inversely, the object of teaching is much wider and teachers need new educational concepts and analytical tools. Music teaching becomes more interesting for educationalists and students when technology is integrated into it. The contemporariness of the object studied renews the position of music teaching, which has to seek out complex compromises between music teaching of the past and the modernity of musical practice. A similar situation arises in the field of musical analysis, in which the study of contemporary works and tendencies enables a greater understanding of the musical phenomenon and greater integration into musical practice. Available technologies Technology is the central axis of the massive evolution of music over the last sixty years. Technology in itself does not cause evolution, but rather musicians include it in their work and propose new uses and functions. In many cases, during the first decades, it was the musicians who proposed new technological developments and it was they themselves who produced them (synthesizers, computer programs, dedicated processors). Technological innovation took place in the 1980s, when digital technology began to be within everyoneâ&#x20AC;&#x2122;s reach, in the centre of thought and communication of musical creation, so much so that often the technological device was better presented and described than the actual piece of music. Nevertheless, the fact that there is an extremely diversified technology and that its use is relatively simple and within the reach of all has resulted in evolution in the aesthetic field and in the richness of the work produced; the technology is no longer more an element for judging the work but rather an essential element in its existence.Today the situation has changed dramatically: the technology is increasingly more complex and its development increasingly in the hands of specialised companies, with large technical set-ups and with commercial ends in sight. It is in this context that the evolution of technology must be critically thought about. There are very few centres specialising in contemporary music today that are capable of conceiving, developing and above all commercialising specific products in the long term.

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INTERNATIONAL CONGRESS OF MUSIC & CONTEMPORARY TECHNOLOGIES

This results in a growing separation between those that develop (big companies) and those that use (composers and players). What are the expectations of the creators in the technological setting? Do they agree with the current situation regarding technologies or are they looking for new tools? If this is the case, how can the conception of new systems be brought closer to the innovative ambitions of the creators? Interpretation and perception The phenomenon of playing music is historically based on the fact that on the one hand there is the creator and on the other, the listener, or the audience. This relationship has changed between them over the last decades: the emergence of music created with new technology caused a situation whereby the composer directed the work straight at the listener, without intermediaries, in “acousmatic” concerts at which the listener attended a show for the hearing. In more recent cases, it is the listener, often called the “user”, who will play a decision-making role in the way in which a musical phenomenon passes. This is what is known as interactivity. In other words, the method and the scope with which a user relates to a computer system. However, this did not mean that the player disappeared: on the contrary, new forms of playing were developed as traditional writing became more complex, as a result of the integration of technological devices by the players themselves, and due to the appearance of players of machines, devices, computers and decks, in which the player function is doubled up with that of the creator. Alongside the evolution in the ways that the creator transmits to the listener and the evolution in the concept of the concert, changes are taking place in the way we perceptively face the musical phenomenon. The universe of possible sounds for music has continually expanded to the point where any sound is potentially useable in music. Our way of listening and playing sound phenomena has changed dramatically: by listening to music, our mind is open to all kinds of situations, sound or visual, in which there are no distinctions between musical sounds and noises, but acceptance, rejection, attraction or repulsion. Philosophy has taken part in this situation: starting from the first ideas regarding phenomenology, many thinkers, musicians and philosophers have become interested in the problem of what we hear, how we hear and how the brain goes from perception to sense, particularly in situations of Odds and ends - themes and trends

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INTERNATIONAL CONGRESS OF MUSIC & CONTEMPORARY TECHNOLOGIES

expansion and enrichment of possibilities in sound. Despite this, hearing continues to be a mystery, particularly in matters relating to the creation of the sense and the generation of pleasure. Sociology and aesthetics Technology, and the changes that have been introduced through it in music production and transmission, has influenced the behaviour of listeners and particularly the role of music in society. Music is not only omnipresent, but it is consumed in any situation and circumstance and, above all, consumed at all times. Sound reproduction systems surround us in all the situations of daily life: to this is added the immediate legal or illegal access to any type of music, which poses the question about a change in the function of music and in its role in the development of society. Access to music is made through players and recordings: attendance at concerts, although still important, is very small compared to the circulation of recorded music. Perhaps this evolution can be interpreted, the beginning of which would be situated with the appearance of music created with recorders, as a development towards the listenerâ&#x20AC;&#x2122;s autonomy and their capacity to create the world of sound they yearn and dream for. Nevertheless, while autonomy is developing, the need for and presence of referents, myths, trends and other forms of identification and differentiation are becoming increasingly more significant. The listener often knows the technology required and is capable of controlling it, but needs more the figure that goes beyond the technology, that which expresses desires, longings and hopes. As well as looking into the phenomena of popular music, we will be discussing a multitude of musical theories, aesthetic currents and attitudes towards sound and music. Despite the massive fragmentation of musical currents, are there common denominators, identifiable tendencies, currents of philosophical thought or aesthetic communities? The answers will be contradictory, will depend on the cultural context, the social context or simply the understanding that the listener has of Music as an infinite universe. OutDoorLinks: Congress Website http://www.congreso-musica.org

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Empathy and the Somatotopic Auditory Mirror System in Humans

Empathy and the Somatotopic Auditory Mirror System in Humans By Valeria Gazzola, Lisa Aziz-Zadeh and Christian Keysers Source: www.current-biology.com/19 September 2006 http://www.current-biology.com/content/article/abstract?uid=PIIS0960982206021178 Copyright ÂŠ 2006 Cell Press. All rights reserved. Current Biology, Vol 16, 1824-1829, 19 September 2006

Summary How do we understand the actions of other individuals if we can only hear them? Auditory mirror neurons respond both while monkeys perform hand or mouth actions and while they listen to sounds of similar actions. This system might be critical for auditory action understanding and language evolution. Preliminary evidence suggests that a similar system may exist in humans. Using fMRI, we searched for brain areas that respond both during motor execution and when individuals listened to the sound of an action made by the same effector. We show that a left hemispheric temporo-parieto-premotor circuit is activated in both cases, providing evidence for a human auditory mirror system. In the left premotor cortex, a somatotopic pattern of activation was also observed: A dorsal cluster was more involved during listening and execution of hand actions, and a ventral cluster was more involved during listening and execution of mouth actions. Most of this system appears to be multimodal because it also responds to the sight of similar actions. Finally, individuals who scored higher on an empathy scale activated this system more strongly, adding evidence for a possible link between the motor mirror system and empathy. Corresponding author Christian Keysers, Email: c.keysers(at)med.umcg.nl

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Researchers find first evidence that musical training affects brain development

OutDoorLinks: Christian Keysers http://www.rug.nl/bcn/education/researchMaster/teachers/trackN/keysers Valeria Gazzola http://www.rug.nl/bcn/research/phdProjects/gToL/valeria-gazzola Fachzeitschrift Current Biology http://www.current-biology.com

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Researchers find first evidence that musical training affects brain development in young children over the course of a year under embargo Source: www.alphagalileo.org/19 Sep 2006 http://www.alphagalileo.org/index.cfm?fuseaction=readrelease&releaseid=515364

Researchers have found the first evidence that young children who take music lessons show different brain development and improved memory over the course of a year compared to children who do not receive musical training. The findings, published today (20 September 2006) in the online edition of the journal Brain (to get more, please read the attached PDF), show that not only do the brains of musically-trained children respond to music in a different way to those of the untrained children, but also that the training improves their memory as well. After one year the musically trained children performed better in a memory test that is correlated with general intelligence skills such as literacy, verbal memory, visiospatial processing, mathematics and IQ. The Canadian-based researchers reached these conclusions after measuring changes in brain responses to sounds in children aged between four and six.

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Researchers find first evidence that musical training affects brain development

Over the period of a year they took four measurements in two groups of children – those taking Suzuki music lessons and those taking no musical training outside school – and found developmental changes over periods as short as four months. While previous studies have shown that older children given music lessons had greater improvements in IQ scores than children given drama lessons, this is the first study to identify these effects in brain-based measurements in young children. Dr Laurel Trainor, Professor of Psychology, Neuroscience and Behaviour at McMaster University and Director of the McMaster Institute for Music and the Mind, said: “This is the first study to show that brain responses in young, musically trained and untrained children change differently over the course of a year. These changes are likely to be related to the cognitive benefit that is seen with musical training.” Prof Trainor led the study with Dr Takako Fujioka, a scientist at Baycrest’s Rotman Research Institute. The research team designed their study to investigate how auditory responses in children matured over the period of a year, whether responses to meaningful sounds, such as musical tones, matured differently than responses to noises, and how musical training affected normal brain development in young children. At the beginning of the study, six of the children (five boys, one girl) had just started to attend a Suzuki music school; the other six children (four boys, two girls) had no music lessons outside school. The researchers chose children being trained by the Suzuki method for several reasons: it ensured the children were all trained in the same way, were not selected for training according to their initial musical talent and had similar support from their families. In addition, because there was no early training in reading music, the Suzuki method provided the researchers with a good model of how training in auditory, sensory and motor activities induces changes in the cortex of the brain. Brain activity was measured by magnetoencephalography (MEG) while the children listened to two types of sounds: a violin tone and a white noise burst. MEG is a non-invasive brain scanning technology that measures the magnetic fields outside the head that are associated with the electrical fields generated when groups of neurons (nerve cells) fire in synchrony. Odds and ends - themes and trends

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Researchers find first evidence that musical training affects brain development

When a sound is heard, the brain processes the information from the ears in a series of stages. MEG provides millisecond-by-millisecond information that tracks these stages of processing; the stages show up as positive or negative deflections (or peaks), called components, in the MEG waveform. Earlier peaks tend to reflect sensory processing and later peaks, perceptual or cognitive processing. The researchers recorded the measurements four times during the year, and during the first and fourth session the children also completed a music test (in which they were asked to discriminate between same and different harmonies, rhythms and melodies) and a digit span memory test (in which they had to listen to a series of numbers, remember them and repeat them back to the experimenter). Analysis of the MEG responses showed that across all children, larger responses were seen to the violin tones than to the white noise, indicating that more cortical resources were put to processing meaningful sounds. In addition, the time that it took for the brain to respond to the sounds (the latency of certain MEG components) decreased over the year. This means that as children matured, the electrical conduction between neurons in their brains worked faster. Of most interest, the Suzuki children showed a greater change over the year in response to violin tones in an MEG component (N250m) related to attention and sound discrimination than did the children not taking music lessons. Analysis of the music tasks showed greater improvement over the year in melody, harmony and rhythm processing in the children studying music compared to those not studying music. General memory capacity also improved more in the children studying music than in those not studying music. Prof Trainor said: â&#x20AC;&#x153;That the children studying music for a year improved in musical listening skills more than children not studying music is perhaps not very surprising. On the other hand, it is very interesting that the children taking music lessons improved more over the year on general memory skills that are correlated with non-musical abilities such as literacy, verbal memory, visiospatial processing, mathematics and IQ than did the children not taking lessons. The finding of very rapid maturation of the N250m component to violin sounds in children taking music lessons fits with their large improvement on the memory test. Odds and ends - themes and trends

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Researchers find first evidence that musical training affects brain development

It suggests that musical training is having an effect on how the brain gets wired for general cognitive functioning related to memory and attention.” Dr Fujioka added: “Previous work has shown assignment to musical training is associated with improvements in IQ in school-aged children. Our work explores how musical training affects the way in which the brain develops. It is clear that music is good for children’s cognitive development and that music should be part of the pre-school and primary school curriculum.” The next phase of the study will look at the benefits of musical training in older adults. OutDoorLinks: The Study: One year of musical training affects development of auditory cortical-evoked fields in young children Read Attached PDF Laurel Trainor http://www.psychology.mcmaster.ca/ljt/ Takako Fujioka http://www.zoominfo.com/search/PersonDetail.aspx?PersonID=1061574593 Suzuki method http://www.suzuki-music.com/

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