Book Review: Music Psychotherapy and Anxiety: Social, Community, and Clinical Contexts

书评：音乐心理治疗与焦虑：社会、社区和临床情境

Annie Heiderscheit

Augsburg University, USA

Music Psychotherapy and Anxiety: Social, Community, and Clinical Contexts is a comprehensive text providing a holistic exploration of anxiety, the sociocultural factors impacting it, and how music and music therapy can be instrumental in addressing and transforming its debilitating effects. The text is divided into four sections, and it provides the reader with a detailed overview of theoretical dimensions, physiological dimensions, clinical-cultural dimensions, and applied dimensions. The format of the text provides guideposts for the reader as they strive to develop a fuller and deeper understanding of the impact and nuanced aspects of living with and experiencing anxiety.

Part I includes the theoretical dimensions that more broadly examines the global impact of mental health issues and anxiety, revealing that anxiety is the most common mental health disorder. The global data provides a context to understand the collective nature of anxiety and to further compare and contrast the incidence of anxiety in countries around the world. The awareness and understanding of the collective impact of anxiety has fostered initiatives by global health organizations to raise public awareness and prevention of mental health issues. The initiatives explored in the text detail a strategy to reduce the disease burden by acknowledging that good mental health is vital to sustainability. It also recognizes that mental health issues vary in the range of severity, that mental health is impacted by one’s social and environmental contexts, and that mental health is a basic human right. Supporting these tenets requires a plan to provide greater access and availability to services, address barriers to services, combat stigma and discrimination associated with mental illness, decrease disparities in access to services, and ensure policies are updated to support these efforts. These actions serve as the foundation of a focused strategy to address the treatment gap and consider how music therapy can help to meet this urgent need. This section of the text also provides a more nuanced understanding of anxiety by examining the social roots of anxiety as a relational, multisensory, and embodied experience on an individual as well as the parallel nature of music therapy as a relational, multisensory, and embodied experience and how the process of active music engagement can be a valuable approach to addressing anxiety.

Part II focuses on the psychological dimensions and begins by defining anxiety and recognizing that it comprises cognitive, behavioral, and physiological responses. This leads the reader to explore the intersubjective and interpersonal experience of anxiety and approaches to assessing and treating anxiety. This section provides an in-depth examination of attachment and key characteristics of the various attachment styles across the lifespan. The impact of attachment and its relationship with anxiety are further explored through the neurobiology of attachment and in discussing the role of the vagus nerve and Porges’ polyvagal theory. In this section of the text, the author provides a broader view of collective anxiety as a cultural complex. This includes defining collective anxiety to understanding cultural expressions of anxiety and the integration of the cultural complex. The considerations of the collective and cultural nature of anxiety are examined as well as how they integrate the inner and outer experiences of clients and constitute the whole of the individual. Understanding anxiety in this holistic way creates space for a person’s unique experiences as well as those that are collective in nature such as trauma, systemic oppression, racism, etc. This then leads to a chapter on how the mind and body experience and express anxiety and guides the reader through a review of the stress response and Selye’s general adaptation response (GAD) and further highlights the affective, behavioral, and physiological response to stress and anxiety.

Part III, which is the largest section of the book, with nine dedicated chapters, addresses the clinical-cultural dimensions of music, music therapy, and anxiety. This section begins with a focus on exploring the role and meaning of music in our lives and the relationship among music, the brain, and anxiety. This examines how healthy uses of music are non-toxic and the wide array of music interventions that can help address the myriad of symptoms associated with anxiety. The author also highlights the growing interest across disciplines regarding the use of music to foster health and well-being. This includes considerations for the use of music beyond the psychosocial and sociopolitical contexts and exploring the ecological contexts and examining the intersections between musical cultures and our environment. This encourages the reader to ponder the use of music as means to foster public and organizational health.

This section also provides a thorough review of the music therapy research and practice related to anxiety. This review of the literature highlights the growing interest regarding the effect of music therapy on anxiety over the past several years as well as gaps in the current body of literature. This leads to a focus on clinical improvisation and how the creative expression inherent in the improvisation experience helps build therapeutic relationships, foster connection, help clients practice flexibility, and generate inspiration. Various models are presented and explored to more fully examine this music-centered approach and help the reader understand clinical-cultural listening in the clinical improvisation process. The next chapter provides a comprehensive review of psychodynamic assessment and evaluation of anxiety. This includes cultural, creative, and critical considerations for de-stigmatizing one’s actions in the assessment process, informal and formal assessment tools, and a rationale for ongoing assessment as well as the use of clinical improvisation as a means of assessment. Several resources and tools are provided in this section, which include considerations for designing treatment, general guidelines for working with anxiety in music therapy, examples of check-ins for affect regulation, self-report worksheets appropriate for use with children and adolescents and another for use with adults.

Next, the focus transitions to ways to evaluate and understand what is occurring in the clinical improvisation experience and approaches to clinical listening. Zarate lays out stages that move from analyzing the physical territory, to what is happening in the music and musical interactions, to deeper levels of the process that examine transferences, counter-transferences, boundaries, attachment, and the client’s level of conscious awareness. Several diagrams and tables are included to illustrate the process and help the reader understand the material within the clinical context. This leads to a chapter that explores the musical expressions and representations of anxiety in the clinical improvisation process. This includes considering the two domains of treating anxious sounds in improvisation: expressive and soothing/calming domains. Within each domain, symptoms, techniques, and a rationale for the technique are identified. Clinical illustrations are provided to contextualize the application of the concepts and methods. The latter two chapters in this section focus on the methods and ways of working with children, adolescents, and adults. Each chapter examines considerations based on developmental stages, examples of methods and interventions, and examples of individual and group methods from assessment through every stage of the treatment process.

The last section, part IV, explores the applied dimensions and details various settings and contexts of applying the information presented throughout the text. The first chapter in this section includes a community case study with a Women’s Rights Chorus. The case study focuses on a workshop that utilized clinical improvisation, voice and narrative song, and art materials to focus on girls’ rights education. The author provides detailed information and personal insights from her experiences co-facilitating this workshop. Each method utilized is described, and the co-facilitators’ clinical decision-making around the selection is also explicated for the reader. The nuances of group dynamics, musical countertransference, and ways of structuring the experience to amplify the musical experience are described. Pre-workshop questions are included as well as highlights and themes from post-workshop evaluations. These questions and comments give the reader a deeper understanding and insight into participants’ experiences in the workshop.

The last two chapters of the text focus on arts-based research inquiry into anxiety and teaching clinical improvisation for treating anxiety. The author provides the reader with an understanding and rationale regarding the value of arts-based research by examining the impact of the experience of self. Although this body of literature is small, a greater examination of one’s interaction and art as representation is needed and still necessitates a grounded and systematic process to ensure fidelity of the study design. Clear procedures are outlined in the chapter regarding how the data from arts-based research studies should be collected as well as how to analyze the data and approach performing or disseminating the findings. Finally, the text concludes with examples of how to approach teaching these concepts and imparting these concepts to students. The information includes how an educator moves from conceptualizing the overarching framework of the curriculum to designing the course syllabusand methods of teaching each subject area. The author provides snapshots of how this is conducted within classes and provides reflections from educators’ experiences of critical arts-based co-teaching as well as reflections from students.

Overall, Music Psychotherapy and Anxiety: Social, Community, and Clinical Contexts is the most comprehensive text to date that examines the impact of anxiety and the role that clinical improvisation plays in addressing this global health issue. The author draws up her extensive clinical and research experience to fully examine the multitude of dimensions and complexities integral to understanding and treating anxiety. This in-depth examination ensures that the reader gains a comprehensive understanding of anxiety by exploring how it is perceived and experienced by the mind and body and all the factors that impact one’s unique experience of anxiety. The book provides a micro view of anxiety by examining the nuanced aspects of this complex phenomenon and takes the reader through the research literature to develop a macro or larger view of the collective experience of anxiety. This provides a compelling argument for clinicians to be informed and prepared to address the diverse needs of clients diagnosed with anxiety. Further, the author encourages and implores the reader to consider how music and music therapy can effectively address anxiety globally and within organizational and community-based settings. The visioning laid out in the text leans into the growing interest from various organizations and disciplines to explore the use of music as a means to foster and promote health and well-being. The author encourages creative arts clinicians to recognize the potential of music and music therapy to address complex health issues and the precipice of awareness about music’s potential. The text cites examples from the current market that illustrate out-of-the-box thinking regarding the use of music and creative arts to foster health and well-being. These examples serve as a springboard to help shift clinicians and researchers generate plans of action.

Music Psychotherapy and Anxiety: Social, Community, and Clinical Contexts is well-designed text for experienced clinicians or students within a graduate music therapy or creative arts therapies degree program. The material in the text is well-suited for a music psychotherapy course as well as a methods-based course on clinical improvisation. This book should be a must-read for any music therapist or creative arts therapist in clinical practice with clients with anxiety or individuals conducting music therapy research with clients with anxiety. Whether practice or research is focused on the use of clinical improvisation or not, the text contains a plethora of information to educate the reader and considerations applicable and relevant to other music therapy methods.

The abundance of information included in the text would also allow it to serve as a valuable resource for a professional journal/book club to collectively read and discuss. Reading and exploring the material within a group context would allow clinicians and researchers to discuss these concepts as they related to their clinical setting and the complex profiles of the clients in their practice and to generate opportunities for treatment and research. Professionals trained in other disciplines (neuroscientists, psychiatrists, psychologists, psychiatric nurses, music psychologists, etc.) who are interested in expanding their knowledge and understanding of how music can help manage and treat anxiety would also benefit from this text.

About the Author

Annie Heiderscheit, PhD, MT-BC, LMFT, is the director of Music Therapy at Augsburg University and an associate professor. She has 32 years of clinical experience, working with clients in mental health, addictions, and eating disorder treatment. She has authored and coauthored three books related to music therapy practice and education and published nearly 30 book chapters and 75 peer-reviewed journal articles. She actively conducts research related to music therapy education and training and clinical practice and continues to practice as a music psychotherapist.