Palliative care I Dyspnea I Art therapy

Music therapy

Music therapy is used in the integrative therapy of (mostly chronic) dyspnea. The sounds, intervals and rhythms of music have a direct influence on breathing and can release accompanying anxiety and tension. Music directly touches the emotions, enabling the person to let go of emotional strain and breathe more easily. Often things that are not (yet) expressible in words can express themselves in the music and thus find relief. The musical statement of a composition or song can support the inner forces needed for coping with an illness and allow new perspectives to arise. Music therapy can have a positive effect on dyspnea through the accompanying moments of silence, as well (1, 2).

Already the process of sound formation is part of a social “breathing process” which involves the listening patient and the surrounding world. This is also true during the visit of a spouse or someone else close to the patient—hearing the music can help them “resonate” with the situation. Ideally, patients benefit from a calm, safe atmosphere and a feeling of connectedness.

Therapeutic approach

  • The therapist plays “breathing” melodies with figure-eight structures, as well as intervals of thirds and fifths—preferably on an alto lyre.
    This can relieve anxiety and shortness of breath. Changes in harmony help to support the patient’s breathing and the ability of the soul to vibrate. This also stimulates hearing and has a positive effect on physiological breathing. This happens most directly when singing, which captures the patient as a whole via his breathing.

Stabilizing elements are used for dyspnea with inner agitation, such as

  • compositions with clear structures and reference to the tonic note, as well as elements of repetition.
  • The tenor chrotta, a deep stringed instrument, has also proven valuable.
    Rhythmic bowing of its open strings stimulates structuring forces and imparts inner support. In dyspnea, the tense sensory organization is oriented towards the neurosensory system. Deep tones help reconnect the agitated soul with the body.

Dyspnea leads not only to inner agitation, but also to mental and muscular tension. In this situation the

  • lyre and the tenor chrotta have proven to be helpful.
    Both instruments convey protection and warmth. Among the metal instruments, copper or bronze gongs are suitable, best played from the surroundings, also in combination with singing. Sounds of a pentatonic-tuned kantele, played around the patient’s bed, also have a psychologically relaxing effect. Warmth can be stimulated from the outside.
  • e.g., via vibrations—a kantele played on the patient’s feet, or on their back by having them lie on a vibrating kantele couch.
    Breathing is a rhythmic process, with a ratio of about 1 to 2 between inhalation and exhalation (an octave in musical terms). The rhythm of breathing can be positively influenced by rhythmical sequences of intervals.
  • Playing a pentatonic-tuned drone lyre
    with flowing sounds and little melodies or improvised tone sequences has also been successful,
  • as well as playing drone lyres with other tunings.
    Passing a finger over the strings elicits a harmonious sound in a major or minor key. Major keys cause an “inner process of exhalation”, minor keys an “inner inhalation”, which goes along with increased body perception. In very weakened patients, the phase of active playing should be short. Listening into space creates a sense of vastness and liberation. When the therapist plays a lyre or kantele from the surroundings, the patient answers with her own instrument, such as a kantele, drone lyre or sansula.
  • Playing cymbals with a widening arm movement during the long ensuing reverberation
    widens and deepens the breath. The effect increases with the alternation of ascending and descending interval sequences and a short-long rhythm. Attention must be paid to pauses.
  • Singing is particularly helpful.
    Here there is a direct connection to the patient’s breathing processes, both on the psychological and the physiological level.
    When a patient feels carried by the stream of sounds, e.g., when they hear a familiar song, this awakens an impulse to sing along. Decisive is the perception of the sounds, which can support the patient’s weakened life forces (etheric organization). If it is possible to get the patient to experience the aftereffect as a space of silence, then the phases of sounding and fading away merge into a whole. The soul expands, finds inner peace, sometimes even joy.
  • Consonant singing with “M”
    brings the lips together and creates a rhythmically pulsating oscillation between binding and loosening. The formation of consonants stimulates form-giving processes—the flowing sound of the sung tone remains the supporting element.
  • Vowel singing directly reaches the level of soul.
    It has the effect of deepening the breathing. Often the easiest way to start is with the vowel “O”.
  • Sound sequences with a vibrating quality, e.g., with the sound “R”,
    can have an expectorant effect.