Singing, wellbeing and health

Singing, Wellbeing and Health

Stephen Clift, Professor Emeritus, Canterbury Christ Church University

(This is the speech of Dr. Clift on IACAET Global webinar: The Intersection between the Arts in Education, Health, Community and Therapy in International contexts: Tradition, Innovation and Breakthroughs. This talk is based on: Clift, S. (2020) Choirs and singing.  In Crawford, P., Brown, B. and Charise, A. (Eds.) The Routledge Companion to Health Humanities. London: Routledge.  See also videos produced by the De Haan Centre to illustrate its work)

The idea that group singing is good for wellbeing and health goes back to at least the late 16th century. The English composer William Byrd (Byrd, 1588) claimed, that singing is good for health, strengthens the muscles of the chest, improves breathing, and helps with voice problems including stammering.

However, it is only in the last 20 years that these insights have been subject to scientific scrutiny. In 2001, with my colleague Grenville Hancox (Clift & Hancox, 2001), I published findings from two simple surveys of members of a University Choral Society. This small study has been cited over 400 times in subsequent studies of singing and wellbeing, and the findings have stood the test of time. 

We identified over 30 distinct benefits described by singers, which defined six broad dimensions. The most substantial dimension related to feelings of well-being and relaxation, followed by benefits for breathing and posture, social benefits, spiritual benefits, emotional impacts, and a final dimension related to exercising the heart, increased oxygen and improved immune function. 

These findings showed that singers experienced different kinds of benefits from singing and experienced them to different degrees. The dimensions emerged because of variations in whether singers agreed, were unsure, or disagreed with the component items. For well-being and relaxation, breathing and posture and social benefits dimensions most singers ‘strongly agreed’ or ‘agreed’ about these benefits.  For spiritual benefits, emotional impacts and heart and immune function, in contrast, more singers were ‘unsure’ or ‘disagreed’ about such benefits. 

Following the establishment of the De Haan Centre in 2005, we replicated the preliminary survey in a study of over 1,000 choral singers in 21 choirs in Australia, England, and Germany (Clift et al., 2009, 2010, 2012; Clift and Hancox, 2010; Livesey et al., 2012).  We found that choir members who faced challenges to their mental health were more likely to strongly endorse the supportive value of singing.  These included people who had:

  • Personal experience of mental health problems
  • Experience of mental health problems in their family
  • Physical health problems, or had
  • Lost partners or family members

Singers with physical health challenges (e.g. stroke, heart disease, lung disease) compared with people free from health problems, were also more definite in endorsing the therapeutic value of singing, (Clift et al., 2009).

It appeared, therefore, that participants with mental or physical health problems used choir membership and singing as a therapy or an aid to rehabilitation. 

This insight led to research projects on the value of singing for people with long-term health challenges. These included people with dementia (Bungay et al., 2010; Skingley and Bungay, 2010; Unadkat et al., 2017), enduring mental health problems (Clift et al., 2011, 2017), chronic obstructive pulmonary disease (Morrison et al., 2013; Skingley et al., 2014, 2018), and Parkinson’s (Irons, et al., 2020).  Most of the participants in these studies had no previous experience of singing in choirs. 

All of these studies revealed improvements in mental health and wellbeing, disease specific quality of life, and improved day to day self-management of chronic breathing difficulties.

Our most significant achievement was running the world’s first randomized controlled trial on community singing for older people (Coulton et al., 2015).  This showed that weekly singing over three months significantly improved mental health related quality of life. These benefits were maintained for a further three months after the singing programme ended. 

Finally, the De Haan team has contributed to systematic reviews, and Cochrane reviews, on the effects of singing for older people and dementia (Clift, Gilbert and Vella-Burrows, 2017), respiratory illness (Lewis et al., 2016, MacNamara et al., 2017), mental health challenges (Williams et al, 2018), and Parkinson’s (Irons et al., 2019).  These reviews have critically evaluated all previous studies and of course, identified priorities for further research (see also Dingle et al., 2019).

I want to end with recent examples of research, which have explored ideas expressed in the 2001 paper, but not directly investigated by the De Haan Centre.

  • Daisy Fancourt (2016) has identified biochemical and immune function changes due to singing among people affected by cancer
  • June Boyce-Tillman (2020) has explored the sacred significance of music and singing
  • Bjorn Vickhoff et al. (2013) has shown that when a group sings in unison individual heart rhythms synchronise, and
  • Rosie Perkins (2020) has definitively identified the range of benefits from music participation and singing in a systematic review of all previous qualitative research

References

Boyce-Tillman, J. (2020) Re-enchanting the world: Music and spirituality, Journal for the Study of Spirituality, 10, 1, 29-41.

Bungay, H., Clift, S. and Skingley, A. (2010) The Silver Song Club Project: A sense of wellbeing through participatory singing, Journal of Applied Arts and Health, 1, 2, 165-178.

Byrd, W. (1588) Psalms, Sonnetts and Songs. Reprint. London: Stainer and Bell, 1965.

Clift, S., Gilbert, R. and Vella-Burrows, T. (2017) Health and well-being benefits of singing for older people.  In Sutherland, N., et al. (eds.) Music, Health and Wellbeing: Exploring music for health equity and social justice.  London: Palgrave Macmillan.

Clift, S. and Hancox, G. (2001) The perceived benefits of singing: Findings from preliminary surveys with a university college choral societyJournal of the Royal Society for the Promotion of Health, 121, 4, 248-256.

Clift, S. and Hancox, G. (2010) The significance of choral singing for sustaining psychological wellbeing: Findings from a survey of choristers in England, Australia and Germany, Music Performance Research, 3, 1, 79-96.

Clift, S., Hancox, G., Morrison, I.,Hess, B., et al. (2009) What do singers say about the effects of choral singing on physical health? Findings from a survey of choristers in Australia, England and Germany. In J. Louhivuoiri, Eerole, T., Saarikallio, S., Himberg, T. and Eerola, P-S. (Eds.) Proceedings of the 7th Triennial Conference of European Society for the Cognitive Sciences of Music (ESCOM 2009), Jyvaskkyla, Finland.

Clift, S., Hancox, G., Morrison, I.,Hess, B., et al. (2010) Choral singing and psychological wellbeing: Quantitative and qualitative findings from English choirs in a cross-national survey, Journal of Applied Arts and Health, 1, 1, 19-34.

Clift, S., Manship, S. and Stephens, L. (2017) Further evidence that singing fosters mental health and wellbeing: Findings from the West Kent and Medway project, Mental Health and Social Inclusion, 21, 1, 53-62.

Clift, S. and Morrison, I. (2011) Group singing fosters mental health and wellbeing: Findings from the East Kent ‘Singing for Health’ Network Project, Mental Health and Social Inclusion, 15, 2, 88-97.

Clift, S., Morrison, I. and Hancox, G. (2012) Singing, wellbeing and gender: Findings from a survey of choristers in Australia, England and Germany, In Harrison, S. and  Welch, G. (Eds.) Perspectives on Males and Singing, Dordretch: Springer.

Coulton, S., Clift, S., Skingley, A. and Rodriguez, J. (2015) Effectiveness and cost-effectiveness of community singing on mental health-related quality of life of older people: randomised controlled trial, British Journal of Psychiatry, 211, 6,1–6.

Dingle, G., Finn, S., Clift, S., Gilbert, R. et al. (2019) An agenda for best practice research on group singing, health, and well-being, Music & Science, 2, 1-5.

Fancourt, D., Williamon, A., Carvalho, L.A., Steptoe, A. et al. (2016) Singing modulates mood, stress, cortisol, cytokine and neuropeptide activity in cancer patients and carers, eCancer Medical Science, 10, 631.

Irons, J.Y., Coren, E., Young, M.K., Stewart, D.E., et al.  (2019) Singing for people with Parkinson’s Disease (Protocol), Cochrane Database of Systematic Reviews 2019, Issue 2. Art. No.: CD013279. DOI: 10.1002/14651858.CD013279.

Irons, Y., Hancox, G., Stewart, D., Vella-Burrows, T., et al. (2020) Group singing improves quality of life for people with Parkinson’s: An international study, Ageing and Mental Health, Published online 5 February.

Lewis, A., Cave, P., Stern, M., Welch, L., et al. (2016) Singing for Lung Health—a systematic review of the literature and consensus statement. npj Primary Care Respiratory Medicine, 26, 16080; published online 1 December 2016.

Livesey, L., Morrison, I., Clift, S. and Camic, P. (2012) Benefits of choral singing for social and mental wellbeing: Qualitative findings from a cross-national survey of choir members, Journal of Public Mental Health, 11, 1, 10-27.

McNamara, R.J., Epsley, C., Coren, E., McKeough. Z.J. (2017) Singing for adults withobstructive pulmonary disease (COPD). Cochrane Database of Systematic Reviews,                Issue 12. Art. No.: CD012296.

Morrison, I., Clift, S., Page, S., Salisbury, I., et al. (2013) A UK feasibility study on the value of singing for people with chronic obstructive pulmonary disease (COPD), UNESCO journal, 3, 3.

Perkins, R., Mason-Bertrand, A., Fancourt, D., Baxter, L., et al. (2020) How participatory music engagement supports mental well-being: A meta-ethnography, Qualitative Health Research, 1-17.

Skingley, A. and Bungay, H. (2010) The Silver Song Club Project: singing to promote the health of older people, British Journal of Community Nursing, 15, 3, 135-140.

Skingley, A., Clift, S., Hurley, S., Price, S., et al. (2018) Community singing groups for people with chronic obstructive pulmonary disease: Participant perspectivesPerspectives in Public Health, 138, 1: 66-75.

Skingley, A., Page, S., Clift, S., Morrison, I., et al. (2014) ‘Singing for breathing’ groups for people with COPD: participants’ experiences, Arts and Health: an international journal for research, policy and practice, 6, 2, 59-74.

Unadkat, S., Camic, P.M. and Vella-Burrows, T. (2017) Understanding the experience of group singing for couples where one partner has a diagnosis of dementia. The Gerontologist, 57, 3, 69-478.

Vickhoff, B., Malmgren, H., Åström, R., Nyberg, G., et al. (2013) Music structure determines heart rate variability of singers, Frontiers in Psychology, 9 July.

Williams, E., Dingle, G. and Clift, S. (2018) A systematic review of mental health and wellbeing outcomes of group singing for adults with a mental health condition, European Journal of Public Health. 28, 6, 1035-1048.