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Eating Disorders

Using Music in Eating Disorders Treatment

The neurobiological effects of music during eating disorders recovery.

Key points

  • Music therapy can improve emotion recognition, anxiety, self-identity formation, and social skills in people with eating disorders.
  • Despite the potential of music therapy for eating disorders treatment, it isn't widely used.
  • Explorations of music's neurobiological effects on eating disorder symptoms are needed to develop effective music therapies for them.

Eating disorders are notoriously challenging to treat. Nonetheless, music therapy has been demonstrated to alleviate some of the most common symptoms in eating disorders.1; 2; 3; 6

Exactly why music therapy benefits eating disorders recovery isn't quite clear. Nonetheless, neuroscience can provide some possible explanations.

What Is Music Therapy?

Music therapy is a clinically-based type of therapy guided by professionally trained therapists. The objective of music therapy is to use the multifaceted ways humans connect with music to guide them towards personal recovery goals.

There are two main ways people engage in music therapy: receptive (e.g., listening to music) or active (e.g., producing music).

George Milton/Pexels
Source: George Milton/Pexels

Music Therapy and Eating Disorders

Demonstrated benefits of using music therapy to treat eating disorders have been reduced anxiety,1 increased body acceptance,2 increased awareness of bodily experiences (e.g., emotions; hunger cues),3 and improved emotion verbalization.6

Improved Bodily Awareness

Charles Parker/Pexels
Source: Charles Parker/Pexels

People with eating disorders have low interoceptive awareness (i.e., difficulties recognizing and appropriately responding to bodily signals, such as emotions and feeding cues). They also typically have alexithymia, a condition that makes verbalizing emotions challenging. These difficulties with bodily awareness are likely due to brain alterations in regions involved in emotion and related cues.

One way music therapy might improve bodily awareness for people with eating disorders is by activating mirror neurons. Mirror neurons are special brain cells that allow us to feel the emotional experiences of others.4 How this works is, when we observe other people's sensory experiences, mirror neurons start "talking" about what we're seeing, which then allows us to experience something similar. These cells partially explain why we feel a connection with people after seeing them sing, dance, or play music.5 It also explains why seeing others cry makes us cry.

If the brain cells of people with eating disorders aren't used to "talking" about emotions, music therapy might be a way to reintroduce them to the conversation, while teaching them what certain bodily cues feel like and what they mean.

Improved Social Anxiety

In addition to poor emotion recognition, other common eating disorder symptoms that music therapy alleviates are social anxiety and negative self-comparisons. Targeting these symptoms is essential for effective therapy because they encourage self-isolation and, consequently, treatment avoidance.16

Free-Photos/Pixabay
Source: Free-Photos/Pixabay

One way music therapy might minimize social insecurities is by releasing oxytocin, the brain's "social bonding" chemical.10 By establishing both vicarious feelings of social inclusion, as well as active bonding experiences through music-making or community involvement (i.e., subcultures), music's influence on the neuroendocrine system could reduce social difficulties that are common in eating disorders.

Building Self-Identity and Self-Acceptance

Lack of self-identity, likely due to certain brain alterations, is another eating disorder symptom that music therapy might improve.15

A recent music therapy study with recovering anorexics found that the most common lyrical theme people with anorexia write about is self-identity struggles.7

StockSnap/Pixabay
Source: StockSnap/Pixabay

For people without eating disorders, strong self-identities are created through mental identity frameworks called self-schemas. These mental frameworks are made up of our personal views about the world and ourselves, and they're what we use for self-reference (e.g., I am an artist).

People with eating disorders, however, have fewer self-schemas to rely on than most people, and the ones they do have are largely negative (e.g., I am unattractive).8

To understand how music therapy might improve identity difficulties in eating disorders, we can look to dementia research. Studies with dementia patients have illustrated that listening to one’s favorite music can “reactivate” and rescue neural pathways involved in self-identity.9 It's possible that people with eating disorders can experience a similar neural “reawakening” of the self while listening to music that is meaningful to them.

Anxiety and Eating Disorders

It shouldn't be surprising that music can also reduce anxiety, which is another common symptom in eating disorders.14 Anxiety is an important symptom to treat in eating disorders because it can prolong illness by creating long-lasting brain changes that maintain the disorder, which interferes with full recovery.14

ClaudiaBarbosa/Pexels
Source: ClaudiaBarbosa/Pexels

Listening to music has been shown to reduce stress and improve cardiovascular health in humans, both of which are common consequences of eating disorders.12

Moreover, a recent rat study found that listening to music in adolescence for several hours a day increases brain-derived neurotrophic factor (BDNF), the brain’s learning/memory molecule. This might protect against learned negative fear associations (i.e., learning that food or body weight should be feared).11; 13

Conclusions

The intangible ways music communicates to us and the meaning it holds cannot be underestimated. While this power has yet to be formally utilized in eating disorder recovery, those with eating disorders are aware of its effectiveness in helping them recover. It's now up to clinicians and researchers to utilize it, as well.

References

1) Bibb, J., et al. (2019). Reducing anxiety through music therapy at an outpatient eating disorder recovery service. Journal of Creativity in Mental Health, 14, 306-314.

2) Testa, F., et al. (2020). A systematic review of scientific studies on the effects of music in people with or at risk for eating disorders. Psychiatria Danubina, 32, 334-345.

3) Gaete, M., et al. (2016). From body image to emotional bodily experience in eating disorders. Journal of Phenomenological Psychology, 47, 17-40.

4) Molnar-Szakacs, I., et al. (2006). Music and mirror neurons: From emotion to ‘e’ motion. Social Cognitive and Affective Neuroscience, 1, 235-241.

5) Overy, K., et al. (2009). Being together in time: Musical experience and the mirror neuron system. Music Perception, 26, 489-504.

6) Akbari, R., et al. (2020). The effectiveness of music therapy on reducing alexithymia symptoms and improvement of peer relationships. International Journal of Behavioral Sciences, 14, 178-184.

7) McFerran, K., et al. (2006). A retrospective lyrical analysis of songs written by adolescents with anorexia nervosa. European Eating Disorders Review, 14, 397-403.

8) McAdams, C., et al. (2012). Who am I? How do I look? Neural differences in self-identity in anorexia nervosa. Social Cognitive and Affective Neuroscience, 9, 12-21.

9) Baird, A., et al. (2017). The impact of music on the self in dementia. Journal of Alzheimer’s Disease, 61, 827-841.

10) Greenberg, D., et al. (2021). The social neuroscience of music: Understanding the social brain through human song. American Psychologist.

11) Chen, S., et al. (2019). Regular music exposure in juvenile rats facilitates conditioned fear extinction and reduces anxiety after foot shock in adulthood. Hindawi, 2019.

12) Cervellin, G., et al. (2011). From music-beat to heart-beat: A journey in the complex interactions between music, brain, and heart. European Journal of Internal Medicine, 22, 371-374.

13) Dincheva, I., et al. (2016). The role of BDNF in the development of fear learning. Depression and Anxiety, 33, 907-916.

14) Kinzig, K., et al. (2010). Adolescent activity-based anorexia increases anxiety-like behavior in adulthood. Physiology & Behavior, 101, 269-276.

15) Riva, G. (2014). Out of my real body: Cognitive Neuroscience meets eating disorders. Frontiers in Human Neuroscience.

16) Goodwin, R., et al. (2002). Social anxiety as a barrier to treatment for eating disorders. International Journal of Eating Disorders, 32, 103-106.

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