Music has been used to address the impact of trauma for millennia. In this blog post I will introduce the work of music therapy in trauma contexts. First I will introduce the topic of trauma and the characteristics of diagnostics such as PTSD. Then I will report on some of the literature related to music therapy and trauma.
I will also introduce clinical diagnoses that can emerge from traumatic events and about trauma and children.
What is trauma?
According to the American Psychological Association, trauma is “an emotional response to a terrible event such as an accident, rape, or natural disaster.” A discussion about trauma goes far beyond this definition, but it is important to note that trauma is not the event itself but the emotional response to the event.
The word “trauma” comes from Greek and it means “wound.” It was found in a vase from the 2nd century B.C. Indeed, trauma has accompanied mankind since times immemorial. It is a perpetual health problem that medicine has faced since before becoming a science.
Extraordinary threat events profoundly affect those who encounter them. Yet the mental and physical stress affects each individual differently.
Trauma to disorder
The development of a psycho-reactive disorder in the face of trauma is a classical example of a multifactorial ethio-pathogenesis. The individual process is determined by three elements:
- the extent and interaction of traumatic stress (trauma factors),
- the individual resources (protective factors),
- and the individual stressors independent of trauma (risk factors).
The trauma factors have to do with the length of the traumatic event and its intensity. It also makes a difference if it’s a single event or happening multiple times over a period of time. The individual resources, or protective factors, include items such as the previous history of the individual, his or her support network, personality, and other factors.
Lastly, the risk factors independent of trauma have to do with previous Adverse Childhood Experiences (ACEs) or events in the history of the individual, personality, previous illnesses, lack of support network, etc.
The protective and risk factors interact within the individual through an internal stress processing that can lead to psychological stability or a psycho-reactive disorder.
PTSD and ASD
For most people, the most acute symptoms occur during the 48 hours after the traumatic event. After 2 days the effects usually will diminish (Sutton, 2002). Others will have PTSD-like symptoms that last from two days to four weeks. They will not develop PTSD, but may be diagnosed with acute stress disorder (ASD). Acute stress disorder distinguishes the overwhelming impact of trauma from the chronic condition of PTSD (Sutton, 2002).
It is also possible for some to develop late-onset PTSD months or years after the event. “The aftermath of a traumatic event may be seen as echoing long into the future, an echo that may begin to be heard after rescue services have left the scene of the disaster” (Sutton, 2002, p. 23).
A traumatic event can make people vulnerable to serious and prolonged illness.
Trauma goes so far beyond the ordinary that it overwhelms the individual’s defenses, leaving him or her unable to function normally. People often feel a sense of disbelief and numbness and lose confidence that what was once felt to be safe is no longer safe. Perception of the world changes.
Trauma is not only about the external circumstances, but also about the person’s internal attempt to assimilate and make sense of the event and how it has irrevocably changed the person.
Now I would like to talk about those who do develop Post Traumatic Stress Disorder. In these cases there are symptoms that have been present for more than a month and have a major dysfunctional effect on several areas of the individual’s life.
There are three major areas of symptoms in PTSD:
- Reliving the trauma, here there are repeated episodes of re-experiencing the trauma in the form of flashbacks or dreams.
- A feeling of “numbness” and emotional dullness, detachment from others, lack of responsiveness to the environment, anhedonia, and avoidance of activities and situations evocative of the trauma.
- There is also a state of vegetative hyperactivity with hypervigilance, increased startle response, and insomnia.
- Finally, the symptoms are accompanied by anxiety and depression and suicidal ideation is not uncommon.
Trauma can have an effect on sleep, resulting in disturbances that can include trouble sleeping and recurrent nightmares. Sandahl et al. (2017) reported the results for a clinical sample of 752 refugees fulfilling criteria for PTSD based on the Harvard Trauma Questionnaire (HTQ) and according to their results, 99.1% of them reported trouble sleeping and 98.7% reported recurrent nightmares. They concluded that sleep disturbances are a prominent part of PTSD in refugees but that research in this area is limited. The effects of trauma can result on insomnia, parasomnia, and other sleep disturbances.
Bessel van der Kolk
Bessel van der Kolk (1994; 2015) has explored trauma and its effects on the body. Van der Kolk has written at length in his book The Body Keeps the Score about the effects of trauma on people’s well-being.
These effects are not only cognitive and emotional, but also physical. This is particularly relevant to music therapy work as music can be a point of access to deal with the somatic effects of trauma, particularly for refugees. Van der Kolk (1994) pointed out that trauma is stored in somatic memory and expressed in a biological stress response.
This can be seen in observable phenomena such as tremor at rest, masklike faces, cogwheel rigidity, gastric distress, urinary incontinence, mutism, and a violent startle reflex. Additionally, individuals who suffer from trauma sequels go immediately from stimulus to response without psychologically assessing the meaning of an event.
This could be seen in intense but neutral stimuli, such as the loud banging of a drum in a music therapy group. Such intense stimuli could lead to autonomic responses such as increased heart rate, skin conductance, and blood pressure.
Van der Kolk (1994) further summarized his findings, saying that “chronic exposure to stress affects both acute and chronic adaptation: it permanently alters how an organism deals with its environment on a day-to-day basis and interferes with how it copes with subsequent acute stress” (p. 256).
Addressing trauma according to Bessel van Der Kolk
Van der Kolk (1994) further pointed out the danger of leaving non-clinical responses to trauma unaddressed. In a nutshell, physiological arousal in general can trigger trauma-related memories. Trauma-related memories in turn precipitate generalized physiological arousal. This creates a positive feedback loop that can cause subclinical responses to trauma to become clinical PTSD.
It is important to take van der Kolk’s (1994) suggestions in treating responses to trauma, which include helping people live in the present and locating traumatic experiences in time and place to differentiate them from current reality.
He also pointed that communal rhythms and theater can help open up the imagination, something he considers necessary in treating trauma (van der Kolk, 2015). In fact, he has expressed that “the capacity of art, music, and dance to circumvent the speechlessness that comes with terror may be one reason they are used as trauma treatments in cultures around the world” (van der Kolk, 2015, p. 242).
Music therapy and trauma
Music therapists have worked in contexts of trauma treatment with various populations in the past. These populations have included military populations (Bradt, Biondo, & Vaudreuil, 2019; Gooding & Langston, 2019), survivors of abuse and developmental trauma (Coulter, 2000; Curtis, 2013), patients with persistent post-traumatic stress disorder (Carr et al., 2011), refugees and asylum seekers (Alanne, 2010; Beck et al., 2018; Jin, 2016; Orth, 2005; Quinlan et al., 2016), and others.
Even considering this literature, there is no clear methodological framework in treating traumatized refugees in a clinical setting while paying attention to cultural and social considerations.
Music therapy interventions and trauma
Music therapists reported using interventions to treat emotional disturbances, processing of the trauma, encouraging relaxation, aiding sleep, and many other goals (Dixon, 2002; Lang & McInerney, 2002; Pavlicevic, 2002; Smyth, 2002; Stewart & Stewart, 2002; Sutton, 2002).
Music therapy can:
- help clients regain a sense of control of their lives,
- explore emotions,
- reduce the emotional stress and anxiety levels,
- develop relaxation,
- stimulate an increased awareness of self,
- and validate one’s feelings (Orth, 2005).
To accomplish these goals, music therapists have reported to use:
- vocal holding techniques (Austin, 2002),
- sleep inducing tapes,
- relaxation through music,
- improvisation with room for associations (Orth, 2005),
- use of folk songs known by the clients (Zharinova- Sanderson, 2004),
- and more.
Music, music therapy, and trauma – Book
Sutton (2002) has argued that there is a strong case for the application of music therapy with traumatized children, which “impinges upon states of feeling at a pre-conscious level” (p. 34). She further clarified that
“perhaps the presymbolic – some would say pre-conscious – level at which we experience music in the body as emotion has a special role in working with those traumatized. Feeling grounded in one’s own body while processing and assimilating the emotional impact of traumatic experience is accessible when one is musically engaged with the therapist” (p. 35).
Furthermore, Pavlicevic has explored the idea of the “dynamic form,” an idea that resonates in music therapy as those vulnerable to the effects of trauma respond to music because of the qualities of musical embodiment (Sutton, 2002).
Music therapy can offer a way to begin to adjust to extreme experiences, for in the pre-symbolic form of music, there is an opportunity to express fragmentation and chaos. This expression can allow the traumatic experience to ‘come into form.’
With this expression also comes a sense of loss and mourning, a sense of mourning the person the client was before the trauma to make space for their new reality (Sutton, 2002).
Pavlicevic (2002) has introduced a vignette from her experiences working with South African children. She initially referred to a boy named ‘Adam. Pavlicevic illustrated her work with Adam as something rather uneventful.
She used the word ‘numbing’ to characterize it, as she explained how Adam seemed to not engage in playfulness but rather seemed distracted and unengaged.
Pavlicevic then clarified how upon a second viewing of a video of her work with Adam she realized a glimpse of playfulness and connection, something that could have led to more engagement in music therapy. Referring back to Bessel van der Kolk, it is relevant to note here the importance of always being present in therapy and being aware as a therapist to the child’s responses and all their nuances.
Music and Medicine Journal – Special Edition on Music, Music Therapy, and Trauma
This special edition from the Music and Medicine Journal was edited by Stephen Porges PhD, author of the Polyvagal Theory and Andrew Rossetti, MMT, LCAT, MT-BC, music therapist at the Louis Armstrong Center for Music and Medicine. The articles in this edition focused on different populations and approaches.
The articles included:
Listening to Music Improves Language Skills in Children Prenatally Exposed to Cocaine (Stephen W. Porges et al.)
This study compared two interventions that used music. The first group listened to vocal music filtered to emphasize frequencies within the bandwidth of human speech. The second group listened to the same vocal music in its original unaltered form. The control group received the standard early intervention services provided by the preschool.
All Roads Lead To Where I Stand: A Veteran Case Review (Kristen Steward)
This study approached many theoretical constructs related to trauma while focusing on a case review to illustrate the role of music therapy as part of the treatment process for veterans with PTSD.
Trauma Informed Care in the NICU: Implications for Parents and Staff (Mary Coughlin McNeil)
This article introduces a trauma-informed care paradigm for neonatal intensive care to mitigate and minimize many post NICU infant morbidities.
Moral Injury and Music Therapy: Music as a Vehicle for Access (Torrey Gimpel)
This article introduces the concept of moral injury and its differences to PTSD, as well as how music therapy can be support in cases where moral injury is present.
Trauma, Disability and the ‘Wounded Healer’ (David L. Abbott)
This is a medical memoir addressing the author’s history of trauma, limb loss, use of music as a resource, and how these experiences shaped his pursuit of education and career in music therapy. It also introduces Jung’s “wounded healer” concept.
Weaving Words and Music: Healing from Trauma for People with Serious Mental Illness (Gillian Stephens Langdon, Faye Margolis, Kristina Muenzenmaier)
This article presents the development of music-verbal therapy trauma groups for people with serious mental illness. The work grew out the collaboration of an interdisciplinary trauma committee in an urban mental health center.
Music Related Sensibilities in Trauma Treatment: An interview with Janina Fisher (Andrew Rosetti, Janina Fisher, Marija Pranjic)
This interview with Janina Fisher expanded upon the growth and ‘interdisciplinarization’ of the evolving field of trauma.
I Am Still Alive (Amy Clements-Cortés)
Music, Rhythm and Trauma: A Critical Interpretive Synthesis of Research Literature
More recently, Katrina McFerran and her team did a critical interpretive synthesis of research literature on the past 10 years to cross-examine the ways that music and trauma have been connected.
“Having systematically disentangled the various dimensions, we then constructed a spectrum of approaches that offers a logical categorization of four different ways of using music with people who have had adverse life experiences. These included using music for stabilizing, entrainment, expressive and performative purposes. Specific music-based methods were proposed for those associated with brain-based rationales, and more responsive, multi-method approaches were congruent with recovery and social change models.”
Humans have used music for millennia in contexts of trauma. Music therapy also has a long history in trauma treatment and recovery in working with various populations. This article served as an introduction into the topic of music, music therapy, and trauma. Yet, there is so much more learn and discover. We encourage you to check out the resources we mentioned in this article! Thank you for reading!
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