Ada, Michigan, United States
|The Lute Player. Caravaggio. 1596. Wildenstein Collection. Via Wikimedia.|
Imagine a musical style that is emotionally evocative yet highly organized, thereby conferring structure to emotion; that gives artistic expression of the fusion of emotion and reason; that mimics biology at cellular through ecological levels through its organized complexity; that brings unity from the diversity of multiple simultaneous melodic lines; that integrates its moving pieces into a whole that is greater than the sum of its parts.
Baroque music was written circa 1600 to 1750, yet its appeal is timeless; it transcends historical and cultural contexts. Baroque compositions are performed frequently today in a diversity of arrangements that vary from original period to modern acoustic and electronic instruments, and sound as fresh as they did 300 years ago.
Baroque music is an art of contrasts. Compositions juxtapose scintillatingly exuberant fast movements with slow movements of profound introspective depth. For all its structure, baroque composition drives innovation. Composers expected soloists to improvise variations on opening themes. Motifs are repeated between solo instruments and orchestra with variations of contrasting timbre, pitch, dynamics, and rhythms, building what could be described as a relationship, a conversation, or a dance engaging solo and orchestral voices. On that note, an exploration of the biological origins and medical utility of baroque and other musical genres may be invigorating.
Are we hard-wired to enjoy repetitive musical phrases?
A model of prebiotic evolution proposes that because of the limited availability of nucleic acid templates, the first coding sequences were repeats of a limited number of base oligomers arranged in varying periodicities. As evolution progressed, repetitious elements became less prominent and more diverse. In what may be considered a recapitulation of evolution, baroque compositions feature motifs that are repeated with variations. As music changed from baroque to classical and romantic styles, repetitive elements became more varied and less obvious. The repetitive motifs of baroque composition may be analogous to codons in genetic sequences, suggesting that their appeal is rooted in our biological and even prebiotic origins.1
The origins of melody may be related to sounds generated by insects and vertebrates to communicate during mate selection, the care of offspring, and coalition signaling; while meter, rhythm, tempo, and melodic intervals may have been shaped by heartbeat, breathing cycles, and bipedal locomotion.2 Savage et al proposed that enhanced social bonding was the overarching adaptive function of music that encompassed the aforementioned roles, and that musicality enabled social bonding more effectively than grooming and other primordial behaviors.3 Alternatively, Perlovsky et al proposed that the biological fitness of music was linked to cognition; musicality enhances the tolerance of cognitive dissonance during learning and problem-solving, and thereby facilitates the accumulation of knowledge and the development of culture.4
Tonal music is characterized by a continuous flow of tension and resolution, a pattern that is the key mediator of music-evoked emotions.5,6 Artistically-expressed patterns of tension and resolution that address uncertainty in the context of predictability recapitulate processes that are essential to survival5 and that fulfill hopeful expectation, such as quenching thirst, satiating hunger, hunting and gathering, escaping predators, searching for companionship, and developing relationships. Consequently, it may come as no surprise that functional magnetic resonance imaging studies demonstrate that tonal music activates circuits that link the phylogenetically ancient limbic reward pathway to recently evolved frontotemporal and prefrontal cortices.5-7 In contrast, dissonant music activates limbic and cortical structures associated with negative emotions and defensive behaviors.7
In addition to its effect on the reward system, music modulates the autonomic nervous system, the neuroendocrine axis, the neuroimmune network, and neural networks for social affiliation, raising the prospect of music therapy as an adjunctive intervention in multiple clinical disciplines.
Clinical trials studying the effects of musical neurostimulation on cognition and clinical outcomes have yielded mixed results and may be confounded by multiple variables that include the cognitive domain being studied, the temporal relation between music and task, and listener-dependent variables such as age, gender, and musical preference.8 Levels of evidence may be limited by the use of subjective outcomes and the impossibility of double-blinding in most music medicine study designs.9 Nonetheless, a growing body of literature supports the use of music therapy as an adjunctive treatment in the full range of clinical settings, from outpatient clinics to intensive care units.
In a recapitulation of music’s prehistoric and current role in child-rearing, music therapy has been applied in neonatal intensive care units. Neuroimaging studies found that brain structural maturity was reduced in preterm infants compared to full-term newborns, whereas preterm infants exposed to music therapy had significantly improved maturation in auditory, cognitive, and socio-emotional processing pathways than preterm infants receiving standard-of-care, suggesting a maturational effect during a crucial phase of brain development.10,11 Music therapy also decreased pain perception and heartrate and improved oxygen saturation in neonates undergoing procedures.12 In addition, music therapy involving parents can reinforce family-centered care and promote parent-infant bonding.13
Baroque music improved cognitive performance in healthy subjects,14 older adults,15, 16 and Alzheimer’s disease patients16 listening to Vivaldi. Enhanced cognition has also been associated with the post-baroque classical style, notably with the music of Mozart and particularly his Sonata for Two Pianos in D Major, K 448; giving rise to the term “Mozart effect.” EEG recordings disclosed increased alpha band and median frequency index of background alpha rhythm activity (associated with memory, cognition, and open-minded problem solving) after listening to Mozart’s K 448, but no changes after listening to Beethoven’s piano sonata Für Elise.17 Of special note are multiple studies demonstrating the efficacy of Mozart’s K 448 in reducing interictal electrical discharges and the frequency of epileptic seizures.18
Music therapy has been shown to significantly reduce anxiety during dental surgery;19 pain, anxiety, and analgesic requirement in Cesarian section patients;20 anxiety, pulse, respiratory rates, and blood pressure in patients undergoing hemodialysis 21 and outpatient therapy of head and neck cancers;22 pain, anxiety, systolic blood pressure, respiratory rate, analgesic requirements, and sedative intake in intensive care unit patients;23, 24 to increase levels of consciousness in patients recovering from head trauma;25 and to reduce stress and emotional exhaustion in surgical operating room staff.26
Genres encompassing baroque,14-16, 23, 24 classical,12, 26, 29 romantic,12, 26 soft rock,21, 26 Turkish,19, 20 Tunisian,26 oriental,26 new age,12 and specially composed11 music have given positive results. Studies that compare the efficacy of different genres have shown mixed results, although baroque, classical, and romantic compositions usually yield better results than rock, heavy metal, or techno styles, which may exert neutral or negative effects.19, 24, 27, 28 Efficacy may be related to frequencies of approximately sixty to seventy beats per minute, simple and direct rhythms using six cycles per minute, periodicity and repetitions, repetitive frequency changes, and harmonic spectrum;21, 22, 24, 29 and may vary according to clinical indications.24 For example, low amplitude, slow tempo, long legato phrases, and unchanging dynamics are beneficial for modulating cardiovascular autonomic tone,24 while a comparative study of compositions by Mozart and Haydn suggested that the anticonvulsant activity of Mozart’s K 448 may be related to its high-frequency segments set in a gradually decreasing tempo.29
Musical neurostimulation presents a fertile domain for future research and clinical applications. Going beyond medical utility, the most important aspect of music may be not where it came from (its evolutionary and neural origins) but where it may take us in its portrayal of the fulfillment of hopeful expectation, in its expression of the entire spectrum of emotion, in its declaration of order in the universe, in its ability to evoke a sense of wonder at its beauty, to strengthen bonds of love among listeners, and to focus our thoughts on purpose, direction, and meaning, as expressed by J.S. Bach, for the honor of God and the refreshment of souls.
- Ohno S. Repetition as the essence of life on this earth: music and genes. Haematol Blood Transfus. 1987;31:511-518.
- Nikolsky A. The pastoral origin of semiotically functional tonal organization of music. Front Psychol. 2020 Jul 23;11:1358.
- Savage PE, Loui P, Tarr B, Schachner A, Glowacki L, Mithen S, Fitch WT. Music as a coevolved system for social bonding. Behav Brain Sci. 2020 Aug 20:1-42.
- Perlovsky L, Cabanac A, Bonniot-Cabanac MC, Cabanac M. Mozart effect, cognitive dissonance, and the pleasure of music. Behav Brain Res. 2013 May 1;244:9-14.
- Rodriguez Zivic PH, Shifres F, Cecchi GA. Perceptual basis of evolving Western musical styles. Proc Natl Acad Sci U S A. 2013;110:10034-10038.
- Lehne M, Rohrmeier M, Koelsch S. Tension-related activity in the orbitofrontal cortex and amygdala: An fMRI study with music. Soc Cognit affective Neurosci. 2013;9:1515–1523.
- Koelsch S, Fritz T, V Cramon DY, Müller K, Friederici AD. Investigating emotion with music: an fMRI study. Hum Brain Mapp. 2006;27:239-250.
- Silva S, Belim F, Castro SL. The Mozart effect on the episodic memory of healthy adults Is null, but low-functioning older adults may be an exception. Front Psychol. 2020 Nov 3;11:538194.
- Bradt J, Dileo C. Music interventions for mechanically ventilated patients. Cochrane Database Syst Rev. 2014;2014(12):CD006902.
- Haslbeck FB, Jakab A, Held U, Bassler D, Bucher HU, Hagmann C. Creative music therapy to promote brain function and brain structure in preterm infants: A randomized controlled pilot study. Neuroimage Clin. 2020;25:102171.
- Sa de Almeida J, Lordier L, Zollinger B, et al. Music enhances structural maturation of emotional processing neural pathways in very preterm infants. Neuroimage. 2020;207:116391.
- Rossi A, Molinaro A, Savi E, et al. Music reduces pain perception in healthy newborns: A comparison between different music tracks and recorded heartbeat. Early Hum Dev. 2018;124:7-10.
- Janner C, Gaden TS, Nakstad B, Solevåg AL. Implementing music therapy in a Norwegian neonatal intensive care unit. Nurs Child Young People. 2021 Feb 15. doi: 10.7748/ncyp.2021.e1331.
- Ribey LM. The joys of spring. Comparative Study Exp Psychol. 2013;60(2):71-79.
- Mammarella N, Fairfield B, Cornoldi C. Does music enhance cognitive performance in healthy older adults? The Vivaldi effect. Aging Clin Exp Res. 2007 Oct;19(5):394-399.
- Thompson RG, Moulin CJ, Hayre S, Jones RW. Music enhances category fluency in healthy older adults and Alzheimer’s disease patients. Exp Aging Res. 2005;31:91-99.
- Verrusio W, Ettorre E, Vicenzini E, Vanacore N, Cacciafesta M, Mecarelli O. The Mozart Effect: A quantitative EEG study. Conscious Cogn. 2015;35:150-155.
- Sesso G, Sicca F. Safe and sound: Meta-analyzing the Mozart effect on epilepsy. Clin Neurophysiol. 2020 Jul;131(7):1610-1620.
- Gulnahar Y, Kupeli I. Effect of different kinds of music on anxiety during implant surgery in Turkey: Randomized controlled study. Int J Oral Maxillofac Implants. 2020;35:762-766.
- Toker E, Demirel G, Doganer A, Karakucuk S. Effects of Turkish classical music on postpartum pain and anxiety in cesarean deliveries: A randomized controlled trial. Altern Ther Health Med. 2020 Nov 27:AT6516.
- Melo GAA, Rodrigues AB, Firmeza MA, Grangeiro ASM, Oliveira PP, Caetano JÁ. Musical intervention on anxiety and vital parameters of chronic renal patients: a randomized clinical trial. Rev Lat Am Enfermagem. 2018 Mar 8;26:e2978.
- Firmeza MA, Rodrigues AB, Melo GA, et al.. Control of anxiety through music in a head and neck outpatient clinic: a randomized clinical trial. Rev Esc Enferm USP. 2017;51:e03201.
- Froutan R, Eghbali M, Hoseini SH, Mazloom SR, Yekaninejad MS, Boostani R. The effect of music therapy on physiological parameters of patients with traumatic brain injury: A triple-blind randomized controlled clinical trial. Complement Ther Clin Pract. 2020 Aug;40:101216.
- Trappe HJ. Role of music in intensive care medicine. Int J Crit Illn Inj Sci. 2012:27-31.
- Yekefallah L, Namdar P, Azimian J, Dost Mohammadi S, Mafi M. The effects of musical stimulation on the level of consciousness among patients with head trauma hospitalized in intensive care units: A randomized control trial. Complement Ther Clin Pract. 2021 Feb;42:101258.
- Kacem I, Kahloul M, El Arem S, et al.. Effects of music therapy on occupational stress and burn-out risk of operating room staff. Libyan J Med. 2020 Dec;15(1):1768024.
- Gruhlke LC, Patrício MC, Moreira DM. Mozart, but not the Beatles, reduces systolic blood pressure in patients with myocardial infarction. Acta Cardiol. 2015;70:703-706.
- Trappe HJ, Voit G. The cardiovascular effect of musical genres. Dtsch Arztebl Int. 2016;113(20):347-352.
- Štillová K, Kiska T, Koriťáková E, Strýček O, Mekyska J, Chrastina J, Rektor I. Mozart effect in epilepsy: Why is Mozart better than Haydn? Acoustic qualities-based analysis of stereoelectroencephalography. Eur J Neurol. 2021 Feb 1. doi: 10.1111/ene.14758.
GEORGE W. CHRISTOPHER, MD, is a retired physician who enjoys listening to baroque music.