Brian Jantz marched down the hallway of the hospital with his guitar, accompanying a 4-year-old oncology patient with a maraca and a drum. He remembers they were singing their own creative version of "Itsy Bitsy Spider."
The girl had been anxious about an upcoming X-ray, he said, and resisted going to the procedure. Hospital staff paged Jantz to help. He kept the music going even on the elevator; the girl's parents, a nurse and a child-life specialist sang, too.
"I'm not completely sure that she realized when it was happening ... because before you knew it, we were back on the elevator, back in the room, and the music just continued straight through," Jantz said.
Jantz is one of two music therapists at Boston Children's Hospital, where the idea of using music to help patients as young as premature babies in the neonatal intensive care unit has taken off in the last decade. Jantz and his colleague have scheduled visits with patients in almost every unit but will come to a melodic rescue in urgent situations.
"We kind of joke around, 'It's like a music emergency,' but it really is," Jantz said. "It really can be like, 'This patient needs music therapy right now.' "
Music therapy formally began in the 20th century, after musicians went to play for World War I and World War II veterans at hospitals across the United States. Today, there are about 5,000 board-certified music therapists in the United States, according to the American Music Therapy Association. Over the last decade, the group's membership has expanded, particularly among students.
"We're not huge, but are slow growing -- but a mighty -- group," said Barbara Else, senior adviser for policy and research at the American Music Therapy Association.
Why it works
There is scientific research to back up the idea that music has healing properties. A 2013 analysis by Daniel Levitin, a prominent psychologist who studies the neuroscience of music at McGill University in Montreal, and his colleagues highlighted a variety of evidence: for instance, one study showed music's anti-anxiety properties, another found music was associated with higher levels of immunoglobin A, an antibody linked to immunity.
The brain's reward center responds to music -- a brain structure called the striatum releases the chemical dopamine, associated with pleasure. Food and sex also have this effect. The dopamine rush could even be comparable to methamphetamines, Robert Zatorre, professor of neurology and neurosurgery at Montreal Neurological Institute, told CNN last year.
Beyond that, music presents a nonthreatening tool for interventions that is already attractive to patients, Jantz said.
"On the surface it works because, in some way, everyone relates to music," Jantz said. "Music really is universal."
Music therapists often work nonverbally, which is why the method is particularly effective for individuals with verbal expression difficulties, such as children with autism, Else said. The profession helps people at every age, from babies to Alzheimer's patients.
For individuals with autism in particular, music therapy has shown to be a positive reinforcement of appropriate behaviors and a motivator to reduce negative ones, according to the American Music Therapy Association. Music can also help with the development of language skills, and the identification and expression of emotions, which are characteristic challenges in autism. Some children with autism have superb musical abilities, and music therapy can help them focus on their strengths.
Alzheimer's patients, who have memory and thinking impairment, may still recognize songs of their youth or respond emotionally to music. Music can also be used in elderly care settings to calm or stimulate residents.
Music as a tool
Singing with someone when you feel anxious, or expressing emotions through songwriting, are more than just casual activities in music therapy. Therapists always have specific goals in mind, such as helping patients overcome a fear.
One fundamental of music therapy is called the "Iso principle," the idea that the therapist takes cues from the client when choosing what music to play. This can inform the improvised music that therapists and clients play together. If the client feels hyped up, the therapist and client might play vigorous drum beats together, but if the goal is to relax, they might begin energetically and then tone down.
Therapists are conscious of rhythm, tempo, texture and melody of the music as clients express themselves. In a hospital setting such as Jantz's, such components of music can also distract a patient who is in pain.
In Else's private practice, she has been helping a college student with an anxiety disorder called agoraphobia; the young woman, who was homeschooled, has been fearful of leaving her house.
The student writes song lyrics when she meets with Else, and also learns guitar from the therapist in the process. By discussing the lyrics and other elements of the music that the student generates through improvisation, the client and therapist uncover clues about what is fueling the woman's anxieties.
"We are using music as a mechanism. One, for motivation, but also as a mechanism so she can express herself and we can figure out what are some of these things that are driving her fears," Else said. "We've made a lot of progress."
Having worked through her issues with music, the young woman became more open to going out in public, Else said. She accompanied Else to a rehearsal for an opera, and then to an actual opera performance.
She has now started junior college and is doing well, Else said. The young woman still sees Else for follow-up maintenance.
"Part of that therapeutic process working with her ... was building a high level of trust," Else said. "Developing trust with someone so she could understand that the world isn't quite so scary out there, to get to the root cause."