The harrowing experience of recovering from an eating disorder (ED) involves deprogramming one’s own relationship with reality. Old routines are replaced, new habits are drilled, and self-image is deconstructed. Furthermore, patients are encouraged to articulate their experience in an unfamiliar environment. The individuals who experience the necessary and uncomfortable residential programs work 24 hours a day to put in the time to recover from their mental diseases, and they require consistent support from peers and mental health professionals. One resource that has been provided throughout the country in ED recovery programs is Music Therapy. In a group setting, music is an engaging, pleasurable, and cost-effective therapy that provides intrapersonal and interpersonal opportunities for participants. Clinical research has been conducted for several decades by music therapists to find the benefits of music therapy for patients with disorders such as Anorexia Nervosa and Bulimia Nervosa. Parente (1989) facilitated interpretive music therapy interventions to address self-degradation and fear of losing control of patients suffering from anorexia. In the same year, Nolan (1989) provided information about how musical improvisation can serve as a transitional object to interrupt the binge/purge cycle of bulimia. Since then, music therapy has served as a successful complementary therapy in ED treatment settings. Music pervades modern culture and is extremely accessible to the young adult population (ages 18-21), who also are most likely to suffer from an ED (Journal of the American Academy of Child and Adolescent Psychiatry, 2010). The opportunity of participating in a music therapy group is ongoing; from the initial discovery, through the process of recovery, and continuing after graduation from the program. Providing group music therapy in this rehabilitative setting encourages emotional expression, improves group camaraderie, and provides healthy coping skills long after the period of recovery.
A primary goal of music therapy in a mental health setting is to increase and improve emotional expression. The experience of an eating disorder can involve significant isolation and internalized feelings, and music encourages participants to let out their feelings in an artistic way. In spoken therapy, words are crucial to moving forward with treatment. In music, however, expression can occur without words. For example, a music therapist might facilitate an improvisation exercise where they maintain a steady beat on a drum while participants in a group play their own instruments. As a ‘flow’ is formed within the group, the music therapist verbalizes emotions one at a time for the participants to represent on their instrument. For “embarrassment”, instruments may be played more inhibited and quiet in comparison to “frustration”. The individuals in the group express their relationship to each emotion without the use of words, and occasionally might discover how they relate to that emotion in their lives. In therapy sessions, music creates an opportunity for participants to express their emotions and try new things in a supportive, judgment-free, non-threatening environment. These experiences also provide a safe way to gain frustration tolerance and are a safe container for trying new and uncomfortable things, or lead to a sense of success in their treatment progress.
Throughout the world, music brings people together. A sense of community is formed through cultural traditions such as Jug bands, Hoedowns, Native American Powwows, African drum circles, and Irish sea shanties. As community forms through group music therapy, the opportunity to bond and communicate with each other transfers to the world outside of treatment. By sharing their preferred music with one another, participants in a group music therapy session get to know one another beyond their EDs. In one particular drumming experience I facilitated with a group of participants who were feeling anxious after dinnertime, we each played our own 4-measure rhythm to be repeated by the rest of the group. While the idea of producing a rhythm with an unfamiliar instrument on the spot appeared daunting at first, by the end of the 10-minute exercise, the group was engulfed by laughter and eagerness to hear from the next person, and much of the anxiety they felt at the beginning of the exercise had dissolved. The group reflected on their participation throughout the exercise, commenting on one another’s playing as well as their own. One participant who was playing loudly observed the other participant who was more reserved in her rhythms, and extended support for her and her playing. When one participant revealed that in the beginning of the exercise it was challenging to create a unique rhythm, the others agreed, and we identified that as it translates to life, it is challenging at times to find your voice out in the world. They recognized a common struggle and stated why it is important to support one another regardless of what they have to offer. Enjoyable experiences in music therapy are shared between participants, producing a sense of camaraderie. This camaraderie translates into friendship, which may make the process of treatment less lonely. Also, the scientific implications of music and the brain can be applied to this particular setting. Music activates the reward pathway of the brain by influencing several processes such as dopamine release, reduction in cortisol levels, and an increase in estrogen and testosterone levels (Bhandarkar et al. 2024). The neurochemicals dopamine and serotonin are essential to survival, and music can be a conductor in naturally producing these chemicals long after being in a therapeutic setting.
In addition to providing a way for group members to connect, music therapy provides a variety of healthy coping skills for the individual suffering from ED symptoms. Mental health diseases are challenging to manage in any kind of environment - familiar or foreign - and music is more accessible than ever. Music streaming platforms like Spotify, Soundcloud and Youtube are widely used across the world, and nearly 40% of US households have at least one person involved in musical endeavors such as playing an instrument or singing in choir (source). In music therapy, neither experience nor profound preconceptions of music are necessary to participate in music therapy; just an open mind and dedication to healing will increase the meaningful exchange an individual has with a musical activity. Depending on the needs of the recipients, passive and active music experiences can be restorative during ED recovery. In an active songwriting experience, I started by playing a progression of chords on the guitar in the key of D major including an A minor chord. When asked to interpret the feeling of the chords, the participants reported feeling melancholy in the minor chord as it contrasts to the lighthearted quality of the rest of the progression. The feeling in response to Am might have been a similar sensation to traumatic memories or feelings of loneliness, hopelessness, or numbness. While the participants may not have known about the theory of major versus minor chords as it relates to feeling and physiological sensations, they actively listened and intuitively knew how the music impacted them. This experience encourages a great deal of being present with one’s emotions and when an individual applies this frame of mind to listening to music in their own time, they become aware of their feelings and embrace the music they naturally connect with. On the other, equally beneficial hand, by practicing musical skills like rhythm, melody and writing lyrics, the individuals who learn how to compose music can then access a skill of processing their emotions and experiences related to their ED in a healthy way. Practicing rhythm with an instrument is grounding and reduces anxiety, creating a melody with the voice increases mindful breathing and vocal awareness, and writing words about one’s experience dwindles the feelings that might accompany challenging tasks like eating a meal or looking in a mirror. Furthermore, the creativity accessed when writing a song contributes to a sense of accomplishment. An example of a more passive music therapy experience is music-guided relaxation. In one scenario, the music being played is a languid melody at around 50 BPM (beats per minute) and does not include lyrics. The music therapist plays this music on an amplified device while guiding the participants in a deep breathing exercise, “breathe in…inflating the lungs like a balloon…hold it at the top for 3 2 1…and exhale slowly, deflating, releasing as much air as you took in.” This produces an awareness of the body while increasing oxygen intake. Other directions may be “let the melody guide your breath” or “if you experience tension in the body, readjust your position in your chair… and find stillness once again.” Music-supported relaxation like this can be self-guided without the need for a music therapist. An example that provides an ongoing positive coping skill is creating a collaborative playlist of songs that represent one’s feelings toward their ED. One group created a playlist called “Break Up with Your ED”, with songs containing ideas about grief and loss, as well as freedom from a harmful relationship. As we curated the playlist to the participants’ experience of recovery, I reminded the participants that when they look back on the time of their recovery by listening to this playlist, they can show compassion towards their past and current selves and reflect on their progress since the creation of the playlist.
There is great value in discussing how music therapy can bring more awareness to how the music we listen to affects us mentally, emotionally, and physically. These implications have lasting effects post-treatment as the individual’s connection with music morphs into a healing relationship. There are many individuals who have encountered music therapy during their period of recovery from eating disorders as well as mood disorders and anxiety. With music in their toolbelt of coping skills, they have an outlet of expression and connecting with others.
Sources:
Music-Making in America: Recent Gallup Poll Contradicts Conventional Wisdom. Antique Sound Workshop, Ltd. https://aswltd.com/gallup.htm#:~:text=More%20than%20one%2Dhalf%20
Alice Ball Parente, Feeding the Hungry Soul: Music as a Therapeutic Modality in the Treatment of Anorexia Nervosa, Music Therapy Perspectives, Volume 6, Issue 1, 1989, Pages 44–48, https://doi.org/10.1093/mtp/6.1.44
Paul Nolan, Music as a Transitional Object in the Treatment of Bulimia, Music Therapy Perspectives, Volume 6, Issue 1, 1989, Pages 49–51, https://doi.org/10.1093/mtp/6.1.49
David S. Rosen, the Committee on Adolescence; Identification and Management of Eating Disorders in Children and Adolescents. Pediatrics December 2010; 126 (6): 1240–1253