1 ‘What is the effect of musical consonance, specifically the perfect fifth musical interval, on emotional, psychological and neurophysical health?’ A systematic review with case studies. DISSERTATION JOANNA FRANCES SHAIRP MSC MENTAL HEALTH: PSYCHOLOGICAL THERAPIES CENTRE FOR PSYCHIATRY BARTS AND THE LONDON SCHOOL OF MEDICINE AND DENTISTRY WOLFSON INSTITUTE OF PREVENTATIVE MEDICINE 2 Part time MSc in Mental Health: Psychological Therapies 2013-2015 Queen Mary College, University of London Student: Joanna Frances SHAIRP 130149893 Supervisor: Mark Freestone Date of Submission: 10 August 2015 Word Count: 16, 469 words The word count excludes: Title, Personal details, Contents page, Appendices and Reference List. 3 TABLE OF CONTENTS Tables of contents 3-5 Abstract 6-7 Glossary 8-9 Quotation 10 Introduction 11-17 Aims and Objectives 17 Methods 18-31 Systematic Review Methods 18-25 Prisma Flow Diagram 24 Case Study Methods 25-31 Results 31-69 Systematic review Results 31-44 Data Extraction Form 33-36 Case Study Results 44-64 Case Study Quantitative Results 44-51 Case Study Qualitative Results 51-61 Artistic Representations 61-63 Narrative Synthesis of Results 64-68 Discussion 68-77 Limitations 78-82 Conclusion 82-85 Appendices Appendix 1 : Ethical Approval 86-87 Certificate Appendix 2 : Information Form and 88-90 Consent Form Appendix 3 : Research 91-93 Questionnaire Appendix 4 : Diary Sheet 94 4 Appendix 5 : Comparison 95 Questionnaire Appendix 6 : Articles included in 96 Systematic Review Appendix 7 : Papers thrown out 97-103 with reasons Appendix 8 : Quality Assessment 104-108 Table Appendix 9 : Case Study 109-112 Quantitative results Appendix 10 : Case Study 113-118 Qualitative results: Stage 1 Waves and Water Appendix 11 : Case Study 119-125 Qualitative results: Stage 1 Perfect Fifth Appendix 12 : Stage 2 Waves and 126-131 Water Appendix 13 : Stage 2 Perfect Fifth 132-138 Appendix 14 : Waves and Water 139 Initial Thematic Map Appendix 15 : Waves and Water 140 Developed Thematic Map Appendix 16 : Perfect Fifth Initial 141 Thematic Map Appendix 17 : Perfect Fifth 142 Developed Thematic Map References 143-167 5 TABLES Table 1 PICOS Inclusion and 21-23 Exclusion criteria Table 2 Stages of Thematic 30 Analysis Table 3 Final result of 31 electronic search Table 4 Final results from 32 other sources Table 5 Data Extraction Table 33-36 Table 6 Quality scores from 39-40 STROBE Table 7 Assessment of 41-42 Credibility of Measures Table 8 Assessment of 42-43 Credibility of Interventions 6 ABSTRACT Background Alternative therapies play an increasingly important role in mental health care. This paper investigates the psychological and neural responses to the perfect fifth musical interval, identifying outcome correlations with an altered state of consciousness and the default mode network. Methods Firstly, a systematic review was undertaken searching electronic databases Pub Med, Web of Science, Psych INFO, Cochrane, Embase, Scopus, between January 1980 and June 2015. Secondly, 4 mixed method case studies were carried out on healthy volunteers between November 2014 and March 2015. Case studies compared the perfect fifth musical interval to sounds of waves and water. Results Nine observational studies were eligible. The perfect fifth musical interval elicits robust neural responses and beneficial psychological responses. Case study results support the systematic review outcomes with all participants preferring the perfect fifth experience. T test results were favourable. Thematic mapping identified three major themes for the perfect fifth experience; (1) ‘psychological responses’, (2) ‘physical responses’ and (3) ‘spiritual and transpersonal’. 7 Conclusions Case study results complement systematic review findings adding further understanding and detail. Results suggest robust neural and cognitive responses and beneficial psychological effects. Responses may be comparable to those observed during a resting state, when the default mode network is activated. 8 GLOSSARY Music Therapy Client’s subjective experience and interaction with music. Sound Therapy The impact of sound vibrations on the body or energy system. Consonance Pleasantness to the ear Dissonance Unpleasantness to the ear Musical Intervals A combination of two simultaneously sounded notes. The octave The most consonant musical interval with a 2:1 ratio. The perfect fifth musical interval The second most consonant musical interval with a 3:2 ratio. Tuning forks Basic musical tools. The aluminium C 256 Hz, G 348 Hz, high C 4096 Hz, C 4225 Hz and C 4160 Hz, aluminium 136.1 Hz and set of steel octave forks are used. The Biofield Bio electromagnetic energy field hypothesised as surrounding all living things (Hammerschlag & Jain, 2012). 9 Altered State A highly focused state which diffuses external thoughts (Oakley & Halligan, 2013) Default Mode Network Area of brain activated during resting state. Construal Theory Study of cognition which compares abstract v concrete mind-sets and their effect on attitude judgements, choices and human behaviour (Gilead et al, 2014). 10 ‘I am convinced of the truth of Pythagoras’ saying that Nature is sure to act consistently….I conclude that the same numbers by means of which the agreement of sounds affect our ears with delight, are the very same which please our eyes and our minds.’ Leone Battista Alberti (1404-1472). 11 INTRODUCTION At a time of increasing need for mental health treatments (Collins et al, 2011), there is heightened demand for clinically relevant research into alternative therapies (Sarris et al, 2013). Music and sound has been used through the centuries to influence well-being (Nilsson, 2008), and there are increasing numbers of studies investigating their potential therapeutic effects on psychological health, (Philip, 1994), including their effects on stress, anxiety, depression and self-esteem, (Campbell, 1995; Dileo & Brandt, 2007; Hays et al, 2002, Knight & Rickard, 2001). When two different musical notes are played simultaneously they create a musical interval. The word ‘consonance’ describes combinations of notes which are perceived as pleasant (Di Stefano and Bertolaso, 2014), and ‘dissonance’ describes combinations which are perceived as unpleasant or ‘rough’ (Woods, 1976). The difference between the two notes of a musical interval is known as the interval size. It is usually expressed in semitones, or more precisely as a frequency ratio. The perfect fifth musical interval, with a 3:2 frequency ratio, separated by 7 semitones (Zenter & Kagan, 1998), is considered the second most consonant musical interval after the octave (Schellenberg & Trehub, 1994). The perfect fifth is produced by combining a lower note with a note which is seven keys higher on a piano (Bones et al, 2014). A common combination for the perfect fifth is a C and a G. MUSICAL CONSONANCE There are different explanations as to why some pairs of notes sound more pleasing than others. 2500 years ago Pythagoras investigated a mathematical approach and concluded that intervals with simple frequency ratios, are the most pleasing to the ear (Kung et al, 2014). Leading on from this, Helmholtz’s (1954) critical band theory proposes this is due to the level of compatibility between the two notes as they pass through the critical 12 bands which behave like auditory sieves (Schellenberg & Trehub, 1994). Intervals with complicated frequency ratios, tend to have two tones which are incompatible in the inner ear cochlear basilar membrane. The sound is perceived as beating or dissonance. Consonance occurs with simple frequency ratios, where the two notes are compatible. Simple frequency ratios occur all around us in nature. Doolittle et al (2014), find that the North African Songbird uses pitches which have simple frequency ratios, and predict that future research will reveal that more species have a preference for simple consonant ratios. Trainor (1997) refers to the exceptional status of simple frequency ratios, and after researching infant reactions to musical intervals, Trainor & Heinmiller (1998) conclude that simple frequency ratios are much easier to process than complex ratios. Furthermore, when adults are asked to rate musical intervals in order of agreeableness, very consistent results are achieved across studies (Zentner & Kagan, 1998). Simple consonant musical intervals are consistently ranked ‘beautiful’ and ‘harmonious’, whilst dissonant intervals are consistently ranked ‘unpleasant’ (Levelt et al, 1966). This reliability of meaning has been investigated by different theorists (Cooke, 1959; Meyer, 1973; Sethares, 1993) and suggests a profound dimension is present in the unique psychoacoustic properties of musical intervals. SOUND THERAPY Sound therapy has been described as a direct result of acoustical vibrations on body and brain functions (Crowe & Scovel, 1996). It is an unconscious phenomenon. The existing literature (Goldman, 1992; Gerber, 1988; McClellan, 1991) emphasises that what is important in sound therapy, is not the pleasure gained from the sound, rather it is the way in which the properties of the sound interact unconsciously with the patient, without any mindful cognitive involvement (Crowe & Scrovel, 1996). Music therapy is 13 different. It is traditionally understood to be how the individual enjoys and experiences the sounds of music, which relates to the person’s existing mood, memories, social and cultural situation (Crowe & Scrovel, 1996). This paper focuses on sound therapy and the therapeutic effects of the second most consonant musical