Program: You've got the music in you

Sana Qadar: Matt McCrary is a man of many talents. He's a jazz drummer.

Matt McCrary: Yes, I essentially went to university to play music as my undergraduate degree.

Sana Qadar: He's a former exercise physiologist.

Matt McCrary: I have worked as a post-doc on exercise trials for cancer patients.

Sana Qadar: And now he's a music and health researcher. Combining all of those skillsets, he wanted to know how much of a quantifiable impact can music have on our physical or mental health.

Matt McCrary: We have just centuries really of stories about music improving people's health, so there is a lot of evidence out there. The evidence is not very quantitative, and that limits what we can do in terms of when we present music as a potential health intervention.

Sana Qadar: So, Matt set out to investigate, sifting through all of the data that has been collected across 26 studies over the past 15 years. And what he found was striking. There are caveats of course, but the research throws up all sorts of questions about how music could be applied in medicine.

Matt McCrary: We are kind of at the moment viewing music as exercise 50 years ago. So exercise 50 years ago was a recreational activity that people thought had some health benefits, it wasn't really integrated into the health system, there were no recommendations for physical activity. Now exercise is an integral part of public health programs. Optimistically I think that music could go in a similar direction.

Sana Qadar: You're listening to All in the Mind, I'm Sana Qadar. And music is central to the human experience; we celebrate with it, we commiserate through it, and some of our strongest memories are even tied to it.

Victoria Williamson: Just about every topic you could possibly be interested in within the human condition has a musical side to it.

Sana Qadar: So, on today's show, how music affects us from the womb through the rest of our lives, and what new research tells us about its measurable impact on our health.

We might intuitively know that music makes us feel good, but without quantitative evidence, we can't really say for sure. We also can't tell if it's better, worse or on par with other activities known to improve well-being, like exercise, for example. But before we go on, maybe we should quickly recap here the difference between qualitative and quantitative research. Here's Dr Matt McCrary again. He's now a lecturer and researcher at Hannover University of Music in Germany, as well as an adjunct lecturer at the Prince of Wales Clinical School at the University of New South Wales.

Matt McCrary: Yes, so quantitative is essentially dealing with numbers and scores, whereas qualitative is dealing with experiences. So we have a lot of evidence from experiences and stories that music can do wonderful things for people's health and people's lives, but in terms of quantifying that…so the health system very much runs on a quantitative basis, so you evaluate interventions or you evaluate treatments or medications based on quantitative data, so you can see that X medication gives you a 10% increase in your health versus this medication, which gives you a 5% increase in your health. So in terms of trying to move towards integrating music into the health system as a public health good and also as a clinical intervention, it's really important to be able to present these experiences in a quantitative way.

Sana Qadar: So for his systematic review and meta-analysis of the existing research, Dr Matt McCrary and his colleagues looked at clinical trials where music was used as an intervention to improve various aspects of health, and where a particular questionnaire was used to measure the impact that music had. More on why that's important in a moment but they found 26 studies conducted over the past 15 years that met this criteria. Together, these studies involved nearly 800 participants.

Matt McCrary: So people would listen to music or sing or play an instrument multiple times over a number of weeks, and you would evaluate health at the beginning and at the end of this 'treatment period'. Specifically what we were interested in in this study was a metric that's called health related quality-of-life, which essentially is a fancy way of just saying overall health and well-being. So there is a specific questionnaire that is used to evaluate health related quality-of-life, it's called the Short Form 36, it's essentially 36 questions which are related to mental health as well as physical health and functioning. And so the reason we were interested specifically in the SF 36 is that it's the most widely used questionnaire in the world to evaluate well-being. And so, again, going back to the quantitative point, we are able to quantitatively compare the effects of music with the impact of other established interventions.

Sana Qadar: Right, okay, so across the 26 studies you were looking at, what did you find were the results, what impact did music have on health?

Matt McCrary: Yes, we found that the impact of music on physical health related quality-of-life is not significant, so there's no real significant improvements in physical health related quality-of-life related to music, but we found quite striking improvements on average in mental health related quality-of-life that were above the threshold for what's called clinical significance, which means in a health context this is something that's worth looking at and worth potentially investing in. And then also the magnitude of these improvements in mental health related quality-of-life was on average about half of that associated with exercise interventions, and roughly equivalent to the improvements in mental health related quality-of-life that you see in studies of weight loss.

Sana Qadar: When you say half of physical movement, what you mean by that? So half the effect that physical activity would have on mental health is what music was having?

Matt McCrary: Yes, exactly, the improvement in the scores on this SF 36 was roughly half as big as what we see typically in an exercise intervention, so a similar set-up where you get some exercise for a period of time.

Sana Qadar: Wow. Were you surprised by the strength of these results?

Matt McCrary: Yes, absolutely. So I think one of the risks when you look at things such as music very quantitatively is that the impact is actually much smaller than you think it is, based on your own personal biases. And so yes, we were definitely pleasantly surprised to find that it's actually quite a robust effect that can be quantified using the same metrics that are already used to quantify a range of other health interventions.

Sana Qadar: Can you describe why music would have this kind of impact? Sure, we enjoy it, but why would it have such an impact on our mental health? What's going on in our brains and bodies when we listen to music?

Matt McCrary: Our best guess and our working hypothesis for why music would have these positive effects on mental health that we saw in this study is that music has a similar impact on what's known as the autonomic nervous system, which essentially regulates our stress responses, so music has a similar impact on this system as exercise. And so essentially what happens when you listen to music or when you play music, as well as when you exercise is that you have a spike in your sympathetic nervous system, which is your fight or flight response. And then after the music stops, your parasympathetic nervous system kicks in, which is your rest and digest response. So, essentially you have this spike of a stress response and then a relaxation response after the music stops. And so what this does is, at least in the case of exercise, and we see no reason that it would be different for music, essentially this trains your autonomic nervous system to be able to better respond to stress. It translates into your daily life as if you are in a stressful situation then you are better able to return to a place of relaxation and to your baseline physical and mental health state. And so we think that this similar response would be the foundational mechanism through which music has all of these positive impacts on our mental health.

Sana Qadar: And does this mean…kind of a facetious question, but if you are someone who hates exercise and you don't want to go running on a particular day but you want your mental health to stay good, should you just listen to music instead and get half the benefit you would have gotten from a run?

Matt McCrary: I think we're not at that point yet where we can say that confidently, but I think that's certainly one of the drivers behind this research is that if that's true we'd like to figure that out to give…statistically there is a large portion of the population that is not very interested in exercise, so yes, we'd love to have an alternative that even if it's half as good, we are still getting half the way there that we would be with exercise.

Sana Qadar: A couple of other things to mention about this study. It's not really clear if there's much of a difference between playing an instrument versus listening to music in terms of the boost to mental health that you could get. Also…

Matt McCrary: The effects that we are looking at in terms of health-related quality-of-life and the impact of music on your overall health and well-being are on average. And so one of the things that is a challenge with music at the moment is that the individual variability is very, very large. So, the average was about a three-point improvement or about a 5% to 10% improvement, but in any given individual in these studies, the improvement was sometimes nothing at all and sometimes very, very large. So sometimes 0%, and sometimes even as high as 20%.

So although the impact of music on average is quite significant and quite robust, on an individual level it's still very difficult to predict what listening to music or playing music is going to do for your health. There are a few reasons for that that we are looking into. Some of it is how music is prescribed in these studies. Essentially people will, say, listen to…people in these studies would prescribe listen to Mozart for 30 minutes a week for eight weeks, and if you don't like Mozart, we know that you don't get much of a physiologic response out of that, so you are less likely to respond. And so what are the things that we are also planning on looking at is the type of music that gives the biggest physiologic response out of the autonomic nervous system, and so we think that will have the biggest long-term impact on health and the most reliable long-term impact on health is just music that you like. So, music that you like the most and you react to the strongest, and so we think that that's going to be the most health promoting and potentially will address some of this wide variability that we are seeing at the moment.

Sana Qadar: I was going to ask whether we had any sense of what kind of music in terms of genre or instrument has the biggest effect but it sounds like we don't really know.

Matt McCrary: Yes, it seems like it's very individual. So, for some people classical music, Mozart, is great and gets a very big response, and so these autonomic nervous system responses are correlated to emotional responses. So for some people that's Mozart, for some people that's heavy metal, for some people that's rap. It really just depends on the individual.

Sana Qadar: Heavy metal, I can't imagine…I mean, sure, to each their own, that's interesting. Overall, given these results, despite limitations and the fact that you want to extend the research elsewhere, can you talk about how music could potentially be included in health policy and care down the track? Could we get to a point where we see music applied as a prescription in a clinical setting?

Matt McCrary: Yes, absolutely, and it's already happening on a small scale, particularly with respect to music therapy, which is essentially including music within a broader psychological therapy context. In terms of more broadly including music in the health system as well as potentially in public health recommendations, we are kind of at the moment viewing music as exercise 50 years ago. So, exercise 50 years ago was a recreational activity that people thought had some health benefits but there were no recommendations for physical activity 50 years ago, and now exercise is an integral part of public health programs as well as many rehabilitation programs. And so optimistically I think that music could go in a similar direction. So, we could have in the future recommendations similar to exercise; listen to music that you like the most for 150 minutes a week to do the best for your mental health, and then similarly for a range of conditions. We are already seeing great effects in the field of dementia specifically, what music can do to reduce anxiety and reduce agitation in patients with dementia as well as bring some memories back and restore some cognitive functioning. So I think in the future that's optimistically…if we continue to get results that are encouraging, like this study, I think that that's the direction that this is heading.

Sana Qadar: That's really fascinating, that's such an interesting way of putting it, you know, it's like exercise 50 years ago. And given that, is there some scepticism in the medical community about the real applicable value of music to mental health? Or is it just, you know, research is still being done and it has to catch up to where exercise is at?

Matt McCrary: I think both. There is scepticism in the community, which is for good reason. I mean, the way that the health system is set up is that you only want to invest in things that you really, really know that they work, and the burden of proof is very, very high for integrating things into the health system. So yes, the research is definitely not there yet, we have a lot of things to prove, particularly quantitatively I think is the big gap in the research in music, we have just centuries really of stories about music improving people's health, and how can we quantify that in a context using a lot of the same metrics that are used in the health system to quantify and establish this is what works and this is what doesn't work.

Sana Qadar: You're listening to All in the Mind, I'm Sana Qadar.

I want to shift topics slightly now and talk about how we experience music throughout our lifespans, starting with in utero. When I was pregnant with my son back in 2020 I used to hold my phone up to my belly and please the same Sufjan Stevens song for him each day. It was 'Mystery of Love' which, if you know it, might sound a bit weird because it's a song about a romance and a heartbreak, but if you ignore some of the lines it's a pretty gorgeous song in general, and so I used it to marvel at the mystery of parental love. I always wondered though, what was he actually hearing in there?

Victoria Williamson: So, our hearing is one of the first senses to develop in utero. It develops some time within the second trimester, so around 4 to 5 months into a pregnancy, and of course sound to start with is simply vibrations.

Sana Qadar: This is Dr Victoria Williamson, a music psychologist and author of the book You Are the Music: How Music Reveals What It Means to be Human.

Victoria Williamson: But rather than vibrations in the air, which is what our ears are picking up, a foetus is picking up the vibrations in water, so imagine how much you can hear when you are swimming underwater, that's as close as we can possibly imagine what sound is like for a foetus. So, through the mother's anatomy and the water that's inside, they're losing a lot of sound, in particular high frequencies. So there's the fine details of language and of any instrumental sound. What they are getting is the more muffled beats and the lower frequencies of any sounds in their environment.

But of course music, most music makes use of a wide frequency structure, so most musics will include bass and will include drumbeats and this kind of thing. And those are the sounds that are really easily transmittable within that fluid, and those sounds, because they are music constructions, have a regularity. And foetuses and their growing brains are designed to pick up on regularity, to find it interesting, to be drawn to understanding what it is about their environment because these are the clues they are going to need immediately on arrival, that's how the brain is designed to prepare itself as best it can. So whereas a child will come into the world with hardly any idea about the visual world and only very basic visual processing capability, they will already come into the world with not only a good idea about the regularity of a lot of musical structure, they can even have a memory of some of the regular structures they've heard in utero, if they have heard them enough.

Sana Qadar: One study that demonstrated this was published in 2011.

Victoria Williamson: This is Carolyn Granier-Deferre's study, and she was working with very, very simple sounds, you can think of it like scales, just melodies that went up or that went down, and these were played in the very last weeks between 35 and 37 weeks of gestation, and the tests were done at six weeks old, and these tests are done with very basic anatomy responses, so you're not looking for any kind of sophisticated musical response in a six-week-old, you're looking either at brain rhythms or heart rhythms or breathing rate typically.

And in this case they were looking at the heart rate, and when the babies were even asleep, they found that the heart rates stabilised and lowered when the babies were exposed to the same either ascending or descending melodies that they'd heard in utero. So that is a sign that the body was relaxing and you could make the connection between we are relaxed when we are in a familiar environment. So when the noise…when the sound was familiar, the baby relaxed as opposed to if it was a baby that had heard an ascending scale, they weren't relaxed by descending scale and vice versa. So you can make the association between the type of sound that they heard in utero and their later memory for it once they are born.

Sana Qadar: Let's fast-forward to late adolescence now and why music seems to have a particularly powerful grip on us as teenagers and young adults.

Victoria Williamson: The power of music in adolescence has a real physical key to it. There are two things going on really that can explain why the music that we take in during adolescence that we become involved with, that we listen to or that we produce ourselves or compose really has a strong impact on how we grow during that time period and how we reflect back throughout the rest of our lives.

The first is the basic psychological concept called the memory bumps, so later on in life studies have been done asking people about their memories from their life, and you get these reminiscence bumps, these little hills around particular periods of life where memories are both very dense and numerous. So because there are so many unique events around adolescence and that could be emancipation, it could be financial freedom, it could be changing schools, it could be falling in love, all of these things, because there's so many big psychological life events, we tend to form a lot of memories around that time, and there is such a strong and powerful link between memories and music, and that's a whole other story to do with brain chemistry and so on and so forth.

The other thing that's going on during that time period is a lot of hormones, and the emotional turmoil that goes on and the rewiring of the brain through the emotion centres at that point in our life means that we create a lot of strong associations with music through those pathways of the brain as well, and that involves something called the reward circuitry in the brain, which is largely hormonally driven, which is what creates stimuli within our life that we find rewarding and enjoyable, motivating and that we want to bring into our life again, and music finds its way into our life during the adolescent period by that mechanism as well.

Sana Qadar: And given how emotional music is, it's not surprising that we often use it to influence our mood, especially when we are young.

Victoria Williamson: That's very much the case. That's the sort of period of life where we learn to do that, as it were, and people think often it's a sort of simplistic 'you play music to make yourself feel better'…yes, we all do that. But we also play music to make ourselves feel worse, and adolescence is a period that people really start to do that. But there are theories about why we might do that, and in his book Sweet Anticipation David Huron talks about the power of music to induce an emotional catharsis. And if you can make yourself feel just a bit worse, you might have an emotional release, you might cry or scream, shout, whatever, in the privacy of your own room, and that catharsis actually releases neurotransmitters and hormones in the brain like prolactin, which offer a psychological comfort effect, a tangible one, a real physical one. So in that case, listening to the music is a safe place because there's nothing actually terrible going on, it is just music, but it's a safe way to induce that emotional catharsis that can lead to healing and a more positive state of mind.

Sana Qadar: So that explains the universal appeal of sad songs. Now, whether you consider yourself musically gifted or not, research suggests you may well be an expert in the music you know really well.

Victoria Williamson: Daniel Levitin's studies of music and memory were a breakthrough because they pointed out for the first time how really powerful our memory for the music that we know well can be. It was known for many years that there were some musicians that had something called absolute pitch, so they appear to have a perfect memory for musical sounds. You could hit a glass and they will say that's a C#. It was assumed that that was limited to that specific small population, but what Daniel Levitin did was demonstrate that the music we know well, really, really well, if we hear a tone, even half a tone out from its original recording, we know, we can spot it above the level of chance. So the more we hear music, the more likely it is we can actually create a pretty much perfect version in our long-term memory, so that there is this real power to our musical memory to create an image.

Sana Qadar: Then there's the Plink study which really illustrates this.

Victoria Williamson: Yes, so this is one of Carol Krumhansl's classic studies of musical memory. Carol is one of the founders of our discipline, she has produced hundreds of really fascinating papers, but Plink always sticks out in my mind from when I first saw it demonstrated because of the power it had on me. So, what Carol did in this study was to play people tiny, tiny snippets of music, we're talking 300, 400 milliseconds, so less than a second's worth of music, so you really only just get the smallest flavour of the instrumentation over less than a note probably. But from that, you know what it is.

Sana Qadar: Want to give it a try? Here are seven songs from the original test in Plink form. We'll give you the answers at the end of the episode, but here they are now, starting with number one [music snippet], number two [music snippet], number three [music snippet], number four [music snippet], number five [music snippet], number six [music snippet], and number seven [music snippet]. And just because we are feeling generous and this isn't a real test, we'll play them again. Some of them familiar? We are about to give away one of the answers actually. Here's Dr Victoria Williamson again:

Victoria Williamson: I remember the first one she played when she gave a talk was Britney Spears's 'Hit Me Baby One More Time', and just the quality of that first note as it came in, I was, oh yeah, I know what that is, and the rest of the track just unfolds then. And the power of this is that it allows you to test people's memory across decades and decades of music very, very quickly because you've only got to have a tiny stimuli, you don't have to have people listening to 20 seconds of each one. And from then she was able to mathematically calculate the likely depth of our musical memory, and by doing that she was able to estimate that the average music listener is likely to have thousands if not tens of thousands of songs hidden away within our musical long-term memories.

Sana Qadar: Britney Spears brings me back to Dr Matt McCrary who we heard from at the start of the show. Remember, his research was all about the measurable health benefits of music, especially when it comes to mental well-being. And since it's probably the case that you have to listen to music that you actually like in order to reap the full benefits, I asked him what he listens to to boost his mood and general well-being. His answer was unexpected.

Matt McCrary: What I listen to to improve my mood is very, very well-made pop music, I would say.

Sana Qadar: Like who?

Matt McCrary: We're getting deep into the weeds here, but yes, there's a lot of Swedish producers, particularly people like Max Martin who I think are very, very clever in the way that they produce pop music, which is both clever on a musical level but also is accessible to billions of people and makes me feel good, there is an inherent appeal to it.

Sana Qadar: If you are still wondering about the Britney connection here, Max Martin famously produced many of her biggest hits, including 'Hit Me Baby One More Time'

Matt McCrary: And so, yes, I admit that's what I've been into over the last few years, is just really, really cleverly made and well produced pop music.

Sana Qadar: So a bit of Britney Spears then?

Matt McCrary: Yes, I do like a good bit of Britney. I think the early NSYNC albums, especially No Strings Attached, are brilliantly produced and written. So yes, not probably what you would expect from someone who researches music for a living.

Sana Qadar: No, I love it, that's great. That automatically puts you in a good mood, that kind of music, so I can understand that.

Matt McCrary: Yes, that's always a risky question, because when I hang out with music academics they're just like, who is this guy, who have we let into our academic circles, this guy who listens to pop music? But I'm glad that…I thought radio was probably safe.

Sana Qadar: It's awesome, I'm a fan too, so it's great.

That's All in the Mind for this week. Thanks to Dr Matt McCrary from Hanover University of Music. We'll put a link to his study that was published this year in JAMA Network Open on our website. Thanks also to Dr Victoria Williamson, music psychologist and author of the book You Are the Music: How Music Reveals What It Means to be Human.

Okay, it's time to reveal the answers to the Plink test that we mentioned earlier. And song one you already know, it was 'Baby One More Time' by Britney Spears', song two was 'Respect' by Aretha Franklin, three was 'Every Breath You Take' by The Police, four was 'Imagine' by John Lennon, number five was Red Hot Chili Peppers 'Californication', number six was 'Hotel California' by The Eagles, and number seven was 'Smells Like Teen Spirit' by Nirvana. I got that one and the Britney Spears one, but the rest were a bit of a mystery for me. Hope you did better than I did.

All in the Mind's producer is James Bullen, sound engineer this week was Ann-Marie Debettencor. I'm Sana Qadar, thanks for listening, I'll catch you next time.