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In the complex and often challenging journey of dementia care, music therapy emerges not just as a treatment but as a transformative force that brings joy, connection, and a sense of calm to those affected. This month, we had the privilege of sitting down with Kristen Stewart, experienced music therapist and Assistant Director of The Louis Armstrong Department of Music Therapy at the Icahn School of Medicine at Mount Sinai. With a rich background in medical, educational, and residential treatment contexts, Kristen brings a wealth of knowledge and passion to her practice, particularly in the realms of trauma and neurologic music therapy.
Kristen shares how personalized music interventions can significantly enhance the quality of life for individuals living with dementia. From her hands-on experiences to her academic research, Kristen provides an enlightening perspective on how integrating music into care routines can not only soothe and stimulate cognitive functions but also foster meaningful connections between people with dementia, families, and caregivers.
1. Can you explain the principles behind music therapy and how it benefits those living with dementia?
For me, music therapy is a systematic and reflexive clinical process wherein a credentialed therapist helps a servicee to promote health and meet individualized goals, including physical and emotional integration, and using music experiences and the relationships that develop through them as dynamic forces of change (AMTA, 2020; Bruscia, 1998).
While it may seem magical how deeply and universally music may support health and happiness throughout the human lifespan, there is a strong and ever-growing body of research evidence that also points to music’s capacity to reach us uniquely and individually in profound ways.
As humans are innately complex beings and one’s relationship to music is likely equally complex, the way a music therapist might use music and the therapeutic relationship to promote health and help to preserve healthy engagement with life, including factors that matter most to an aging individual with dementia, is equally broad. While it may seem magical how deeply and universally music may support health and happiness throughout the human lifespan, there is a strong and ever-growing body of research evidence that also points to music’s capacity to reach us uniquely and individually in profound ways. For example, we now know that engagement with music activates every area of the brain that has currently been mapped (Levitin, 2013; Särkämö et al., 2013). Data gleaned from burgeoning developments in neuroscience and the mechanisms of music that drive change also continue to expand our clinical and experiential knowledge base and affirm how engagement in music may provide broad health benefits.
Additionally, issues common for people coping with dementia are impacted by a complex set of individual protective factors and factors that place an individual at greater risk. These factors need to be considered when setting supportive goals for care. According to Dr. Oliver Sacks, well-known neurologist whose work was featured in the movie “Awakenings” and who is the author of Musicophilia, “It (music engagement) aims to enrich existence, to give freedom, stability, organization, and focus. …address(ing) the emotions, cognitive powers, thoughts and memories, (and) the surviving ‘self’ of the patient, to stimulate these and bring them to the fore” (Sacks, 2012, p. 336). Other noted benefits include improving caregiver relationships and easing caregiver burden (Gotell, Brown, and Ekman 2000), improving symptoms of depression, anxiety and agitation while promoting emotional well-being and quality of life (Van der Steen et al., 2018), and delaying and decelerating neurodegeneration (Matziorinis & Koelsc, 2022).
Music therapy aims to enrich existence, to give freedom, stability, organization, and focus. …it addresses the emotions, cognitive powers, thoughts and memories, the surviving ‘self’ of the patient, to stimulate these and bring them to the fore.
Here at the Louis Armstrong Center for Music and Medicine, we take an integrative and holistic approach that allows us to use music and all its facets to offer enrichment as well as address needs across multidimensional domains of experience, including, though not limited to, physical, behavioral, psychological, environmental, cultural, educational and spiritual aspects of self. Through tailored music interventions that illuminate and deepen meaningful connections, such as playing, singing and improvising with favorite music that marks significant life events, we help to illustrate and embody anew meaningful moments of one’s life story, re-ignite feelings of agency and capacity, foster self-expression, bear witness to and offer space for honoring and expressing surfaced feelings, and validate life legacy using identified and celebrated moments and personal resources to impact here-and-now experience. Doing this at the same time, entraining with someone builds a felt sense of connection that is unique and unlike other experiences (Loewy, 2024). Music naturally evokes associations and imagery that provides a gateway to the psyche and soma (Rossetti, 2024, personal communication). Additionally, as music engagement dynamically activates the brain, it reaches long-term memory, sense-memory and motor-memory, and can by-pass impaired areas to stimulate healthy parts of the brain (Jacobson et al., 2015; Zihl & Reppermund, 2023).
Doing this at the same time, entraining with someone builds a felt sense of connection that is unique and unlike other experiences (Loewy, 2024). Music naturally evokes associations and imagery that provides a gateway to the psyche and soma (Rossetti, 2024, personal communication). Additionally, as music engagement dynamically activates the brain, it reaches long-term memory, sense-memory and motor-memory, and can by-pass impaired areas to stimulate healthy parts of the brain (Jacobson et al., 2015; Zihl & Reppermund, 2023).
Some other well-noted areas of impact in applications of music to promote healthy aging from a neurocognitive perspective also include promoting spontaneity and fluidity, sensory integration, perception, emotional resilience and regulation, memory recall, and meaningful social engagement.
We take an integrative and holistic approach that allows us to use music and all its facets to offer enrichment as well as address needs across multidimensional domains of experience
2. Could you share a memorable moment from your practice where music therapy had a profound impact on someone with dementia?
Certainly. There are many!
I often view moments sharing music experiences in treatment as a priming of the brain that allows ever-deepening and broadening connections and associations. I use this description psycho-educatively, to invite a normalizing view of reported experiences of when the brain may “mis-fired” and “stall-out.” This relatable and simple analogy seems to empower and evoke curiosity, which also promotes self-awareness, energizes cognitive focus, and stimulates collaborative exploration.
I used this approach recently when a client shared a similar recognition and building frustration in response to feeling a block that was impeding fluid thought-processing and was straining her relationship with her son. To explore this concept experientially, I invited the client, let’s call her Mary, to tap a steady drum beat that was further cued by my matching guitar strum as we played an identified Song-of-Kin (Loewy, 2015). Song-of-Kin (SOK) is a culturally-based, client-selected piece of music that is personally significant and highly familiar, which is then proofed for its efficacy through music therapy assessment.
This engagement appeared to animate Mary as she smiled, tapped, and intermittently sang along. As this music was being played live, there was a live interaction between Mary and I as we mutually responded to each other musically and inter-personally, as well as both responded to the musical structure I was offering. This spontaneity and here-and-now inter-play is a core reason for using live music in music therapy and is designed to magnify attunement and help entrain states of experience in the moment.
Mary’s excitement was evident as her smile brightened, she sat up straighter in her seat, and she exclaimed, “I’m doing it! No problem!” This experience of successful experiential fluidity was then parlay-ed, if you will, to expand feelings of agency as we moved through two incrementally more complex iterations of this experience by adjusting the rhythmic pattern. This accumulated priming while observing, witnessing, and reflecting success validates effort exerted and can fuel motivation, which can then be applied to each next experience. In Mary’s case, this led to incorporation and adaptation of the above patterned music experience into an intervention focusing on expressive language fluidity and spontaneity, a personal goal for Mary. Using the same identified SOK and returning the rhythmic pattern to a simple steady beat, we repeated this experience, now using the song lyrics as the adapted musical element. The steady beat served as the “primed” underlying organization to this process as the most familiar lyrical phrase (usually the chorus of a song) was shared as written, then incrementally modified by omitting the last word of each line in the chorus, and finally omitting two- and three-word combinations between returning to the chorus as written.
During this subsequent music experience, Mary remained highly engaged and demonstrated focus through her consistent eye-contact and contemplative affect, appearing to indicate an increased demand of her focus in this more complex task. Whenever gaps of response were observed, simplification of the music was provided until smooth lyric expression and steady beat were restored. At the close of the music, Mary clapped her hands, beaming as she sat with apparent pride.
In the next session, Mary arrived singing the SOK we’d used, again beaming as she noted, “I’ve been singing all week!” Modifications of this intervention were used often in Mary’s treatment going forward, layering potential benefits through emphasis on repeated, cumulative experience. Additional iterations expanded to exploration of rhythmic and lyric improvisation to invite increased creativity and spontaneity, and led to songwriting experiences with her preferred and familiar selected song, using tools such as lyric fill-in and free-associative singing.
3. You’ve worked in diverse settings, from medical to residential treatment centers. How does the setting influence the approach to music therapy?
The environment of care can be highly influential for a variety of reasons, such as the intensity and frequency of ambient sound and other sources of stimulation. One example referring to sound stimuli in a care environment, and which is under the purview of music therapy influence and consideration, is when this acoustic environmental stimulation is noxious, which is an unfortunately common issue in managed care settings and can include things as innocent as staff’s preferred music played loudly from a work station or music broadcast through the environment that is not considerate of individual preferences and sensitivities. Music therapy professionals bring awareness to this impact and work with care teams to inform and guide valuable changes to better recognize and regulate environmental sound stimuli. Developing an Environmental Music Therapy (EMT) program also provides a valuable service to help modify care environments by directly integrating environmental sounds into a live musical container and harmonizing these inputs to temper impact and create dynamic experiences of release, comfort and support (Rossetti, 2020; Stewart & Scheider, 2000). Of course, toxic acoustic environmental stimuli is only one factor of a care environment. Important considerations that optimize health and well-being in a treatment environment is a huge topic and I encourage additional investigation into associated research on this.
Engagement with music activates every area of the brain that has currently been mapped, enhancing our clinical and experiential knowledge base and affirming how engagement in music may provide broad health benefits.”
4. What advice would you give to families who are just starting to use music therapy with their loved ones who have dementia? Are there any music therapy activities that caregivers can incorporate into their daily routines?
There is much information available through public access sites regarding the use of music to promote healthy aging. Music-based experiences that promote interaction and provide positive engagement are highly valued as functional status wanes and can increase strain on loving relationships. Common recommendations include sharing favorite music from significant times in life to invite reminiscence, using familiar music to activate and organize movement, and engaging in community music opportunities as a social prescription. However, it is important to differentiate this type of therapeutic use of music from music therapy, which is a professional treatment requiring application by a certified professional trained in this area of specialization, as defined above.
Common recommendations include sharing favorite music from significant times in life to invite reminiscence, using familiar music to activate and organize movement, and engaging in community music opportunities as a social prescription.
5. Music can be powerful in evoking memories and emotions. Have you seen any surprising reactions from people with dementia during therapy sessions that you didn’t expect?
No. Though there is a dynamic of freshness and aliveness to any clinical moment, I have no pre-conceived expectations for how any moment in music therapy may evolve. Conducting a thorough clinical music therapy assessment is designed to help gather insight into needs, strengths, resources and characteristics of personality. Also, my training and history of clinical experience are important resources that inform my understanding and expectations in the work and guide me to view each individual from a deep understanding of the complex, multi-dimensional, and contextual fabric that contributes human experience and relationship.
6. Looking ahead, what developments or innovations in music therapy are you most excited about that could further enhance care for people living with dementia?
New research on music and the brain is constantly emerging and adding insight. Thankfully, the use of music to support the needs and desires of those with dementia is receiving high attention and driving the speed of new knowledge acquisition in this area. This is truly an exciting time of innovation and I am particularly inspired by the new research outcomes on music mechanisms that promote change and growth. These are elevating our understanding of our human potential and validating the intuitions and experience-based knowledge we’ve accumulated and been witnessing for years.
Thank you for these insights into music therapy! We hope the information and experiences Kristen shared will help you understand how to incorporate music therapy into care for your loved one with dementia.
Kristen Stewart is Assistant Director at the The Louis Armstrong Department of Music Therapy, Mount Sinai Beth Israel. To learn more you can call 212-420-2704 or email: info@musicandmedicine.org.
Lizzy Care is reimagining dementia care for your whole family. We provide personal care for people living with dementia and a vast array of support for families who want to make sure their loved one is getting the best care possible. Our best-in-class app helps doctors, caregivers, and families easily stay in contact to make sure the care plan is on track and communicate important information. Please reach out if you need help caring for someone in your life who is living with dementia. Get in touch or call us at 234-567-9449.
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