The news that she had breast cancer did not faze May Wong Mei-lin. It was not until after the housewife had received her first dose of chemotherapy that reality hit home. Depressed by how sick the drugs made her feel, she found solace in malls. 'I shopped a lot to make myself feel good,' Wong, 58, recalls. Then she found the Hong Kong Breast Cancer Foundation (HKBCF). 'The nurse and psychologist there helped me understand that shopping was the wrong way to cope with my negative emotions.'
Encouraged by a fellow survivor, Wong found a more positive outlet for her feelings. She joined Melody-in-Mind, the foundation's choral group for breast cancer survivors, and attends the group's singing sessions every week. 'I enjoy being part of the group so much. We get together to sing, laugh and have lunch after class.'
In the past 50 years, music has become formalised as part of the healing process. Music therapy supplements the work of doctors, nurses and other allied health professionals in physical rehabilitation, improving mental well-being and providing an outlet to express feelings. Now an allied health profession, music therapy traces its history back to the two world wars, when groups of amateur and professional musicians gathered at veterans' hospitals to play to wounded soldiers.
Noticing the positive effects that music had on their patients, doctors and nurses began to ask for the musicians more regularly. But it was clear that the musicians needed training to be effective, so a college curriculum was born.
Music therapists see clients with a wide range of issues - from children with emotional problems and adults suffering from depression, to elderly stroke victims and those living with chronic diseases such as diabetes. They work in hospitals, community settings, correctional facilities, addiction rehabilitation centres, long-term care facilities and in private practice.
Although music therapists are in high demand, there are only a handful of them in Hong Kong. The Hong Kong Music Therapy Association (HKMTA) has a membership of only 15 professionals serving a highly stressed population of more than seven million.
The 2003/04 Population Health Survey found that 1.5 per cent of the population in Hong Kong aged 15 and above had been diagnosed with depression, 2 per cent had anxiety disorder and 1.4 per cent had attempted suicide in the previous 12 months. So music therapists have their work cut out for them.
'I can see the growth of demand for music therapy in Hong Kong, from children aged three years and above to patients in palliative care,' says Francesca Tam, a HKMTA-registered music therapist who works at Sheng Kung Hui Welfare Council - Providence Garden for Rehabilitation in Tuen Mun. She works with adults and elderly people with chronic mental health issues, as well as the intellectually disabled.
'The centre has a body-mind-spirit approach. Music therapists work hand in hand with social workers to enhance our clients' quality of life. It has positive effects on mood as well as other psycho-social aspects of living,' Tam says.
Music has tremendous positive effects. It affects brain activity. Stronger and faster beats stimulate brainwaves, resulting in heightened alertness and concentration. Slower tempos, on the other hand, promote a calm, meditative state. Rhythmic therapy also increases blood flow throughout the brain, improving cognitive functioning in the elderly.
Several studies have shown that cancer patients experience benefits such as improved blood pressure, heart rate and respiratory rate when they participate in music therapy. Most recently, a Cochrane systematic review, led by Joke Bradt of the department of creative art therapies at Drexel University in Philadelphia, showed that sessions with trained music therapists or listening to music can reduce anxiety in cancer patients, and may also have positive effects on mood, pain and quality of life.
In addition, music is a great stress reliever. It has been proven to lower amounts of the stress hormone, cortisol, and to increase endorphins, the body's natural 'feel-good' hormones. A 2009 study conducted by the University of Maryland Medical Centre found that Alzheimer's patients who received music therapy experienced lower levels of anxiety and depression. It also improved their sleep and mood, and reduced feelings of restlessness.
Music therapy can also be beneficial for stroke victims and other patients with neurological problems. Through a process called 'entrainment', muscle movements become synchronised with the rhythmic beat.
As the patients' movements become more regular and efficient, their motor skills also improve.
Music therapy was found to be effective in easing the pain and enhancing the comfort, relaxation, mood, confidence, resilience, life quality and well-being of patients with terminal illnesses, according to a study published in May in the journal Music and Medicine.
In the three-year study, led by the Concordia University department of creative art therapies, music therapy undergraduates and professional symphony orchestra musicians paired up and, supervised by an accredited music therapist, gave 371 palliative care patients between the ages of 18 and 101 years old a therapy session each of between 15 and 60 minutes.
Since client profiles and music tastes can vary widely, there is no one-size-fits-all approach to music therapy. Therapists consider a range of factors, including the client's age, health profile and specific needs.
There are four main types of intervention - performing including singing or playing instruments, composing, improvising and listening. A music therapy session may incorporate multiple interventions or a single in-depth one, depending on the therapeutic goal. Sessions may be one on one on in a group setting.
'What we do really depends on the needs of the client and the objective of the session. We could talk, draw, dance and play within the session, but music is the major medium and tool for assessment and intervention for clients,' says Tam.
Breast cancer survivor Pollina Ip Lai-chun, 36, became depressed after undergoing through chemotherapy. After joining Melody-in-Mind, she discovered that singing helped her express her emotions and elevate her mood. 'I feel that I've become more cheerful. It's nice being with my classmates. I can't wait for Mondays to come as that is when I meet my friends at Melody-in-Mind,' she says.
Although the Melody-in-Mind programme is not a music therapy group per se, it offers similar benefits. HKBCF adviser Dr Rhoda Yuen notes that most breast cancer survivors have a hard time accepting the physical changes that cancer has on their body. 'They may be oversensitive about how others see them. Meanwhile, they are anxious about worrying their family or being a burden on the ones they love.'
According to Yuen, the singing group helps survivors relax and relieve anxiety through sharing their experiences with others. It helps alleviate stress, which can affect hormone levels and immune systems especially in those with fragile health.
'Participating in social activities such as a singing group is a way to relax and distract oneself from anxiety and worries.
'Members feel good and carefree when they sing. There is no stress or comparison in the group,' Yuen says. The friendships formed through the group also give its members a strong sense of social support. 'Members have self-recognition of their identity as survivors and feel like they are building bonds with their peers.'
You can reap the benefits of music without going for music therapy. A study published this year in Nature Neuroscience showed that simply listening to one's favourite music causes the brain to release dopamine, a chemical that improves mood. Even just anticipating the sounds of music one likes will trigger this release.
Researchers at the Osaka University Graduate School of Medicine found that study participants who listened, sang and stretched to their choice of Japanese pop, classical, or jazz music for 60 minutes daily lowered their systolic blood pressure (the top number in the reading) by an average of six points after three months.
'Listening to music will enhance one's quality of life. It doesn't have to be part of a music therapy session,' Tam says.
- Percentage of Hong Kong population over 15 years old diagnosed with depression (2003/4 Population Health Survey)