Times like these you need some “One Four Five”

A little known gem from the band Cat Empire is a song called One Four Five. It’s about someone visiting a doctor, complaining of aches and pains in body and soul, desperate about the pollution and stress of the modern world. With a grin, the doctor reaches into his bag, but “instead of an injection got a record with a tag” that says, “Listen to this daily with hip-shaking and such things.” Then he puts the record on, grabs a mike, and starts to sing … “you need some One Four Five.”

One Four Five is a simple reference to a common progression of chords, but, more deeply, it’s a call to celebrate the power of music. After taking the recommended dose the song’s narrator soon feels better in bone and spirit, as the doctor continues to extol the virtues of harmony: breeding positivity, and helping protect against insanity and insecurity. The lyrical musings seem whimsical, but they resonate through a small though growing evidence base, confirming our intuitive sense of the healing power of music.

Recent systematic reviews suggest that music therapy might offer benefits to people with many conditions, including autism disorders, depression, schizophrenia, acquired brain injury, and a range of cancers. For cancer, 30 trials involving almost 2000 patients were recently reviewed, covering music therapy interventions with trained practitioners as well as “music medicine”—which can involve simply listening to pre-recorded music.1 It found that both forms might have beneficial effects on anxiety, pain, mood, and quality of life, although most trials were at “high risk of bias,” so results need to be taken with caution.

One of the most comprehensive reviews of music therapy for those with severe mental illness has actually discovered a “dose-response” relation: the more sessions, the bigger the effect.2 Fifteen studies were reviewed, including prospective non-randomised studies, involving around 700 patients: two thirds had psychotic disorders, and a third non-psychotic, mainly depression. The sessions involved techniques including playing instruments, improvisation, singing and writing songs, and verbal reflection, happening from one to six times a week, from one to six months: two thirds in group settings, one third individually with therapist.

The meta-analysis found that music therapy, when added to standard care, brought “strong and significant effects” on general and negative symptoms, depression, anxiety, functioning, and musical engagement. The “dosage” was the best predictor of effects, with estimates that between 16 and 50 sessions might be needed to achieve a large impact. Notwithstanding potential limitations, including a lack of clarity about how randomisation had occurred in some studies, reviewers felt that the strong dose-response relation suggested true effects.

The lead reviewer was Christian Gold, from the Grieg Academy Music Therapy Research Centre in Bergen, Norway, also the author of several other systematic reviews in the field. “Music is known as the language of emotion and it’s a social process,” he told the BMJ. “So music therapy can be valuable for people who have difficulty receiving or expressing emotions, or building and sustaining relationships—and it can also help with motivation.” Stressing the value of scientific assessment, and randomised controlled trials, Gold is also interested in how best to evaluate complex interventions that can involve highly individualised therapy. Like other researchers he is exploring mixed methods, combining qualitative approaches with investigate processes and quantitative designs to assess outcomes. Like his clients, he says that music therapy offers him “meaning and pleasure.”

As to questions about broader benefits for all, Gold is sceptical about whether music has some inherent power in itself, arguing that the value depends very much on context. “It’s like a language, a medium that can be used.” In modern society, with media forms like radio being so ubiquitous, he says that “we’ve often unlearned how to actively use music.” Conversely, activities such as singing in community choirs or playing in bands may build what’s known as “social capital”—a sense of community, trust, and interconnectedness.

In a recent article about social capital, music therapist Simon Proctor shares a beautiful vignette of a therapy session with a man called John.3 For the first 15 minutes John is drumming with his head down, alone—with Simon feeling increasingly unsatisfied by the lack of contact between them. Sitting at the piano, trying many of his musical tricks, he finally pushes from regular 4/4 time to the 3/4 of a waltz, with which slowly John joins. “His head lifts and our eyes meet. A grin. There’s a sense of fun now.” The tempo increases, and the pair are now playing together as they accelerate to an ending, both now laughing. At the end of recounting the story, the therapist realises he hasn’t mentioned John’s diagnosis—underscoring the fact that the social experience of music happens independent of diagnostic labels. As the folk at Music in Hospitals have observed, musical interaction helps “bring the person out of the patient.”4

For Christian Gold, one of the most exciting lines of research is the exploration of how early parent-infant communication might have musical qualities, suggesting “music may be at the foundation of who we are as human beings and as social beings.” His comments are echoed in that Cat Empire song: as the young man feels better he asks where the three chords came from. “They’re written in your brain,” the doctor answers, as the song laughs towards its own ending: “Times like these you need some One Four Five.”