Positive Health Online

The power of sound and music has been recognized since the earliest civilizations and incorporated in many aspects of cultural life, including religions, magic and healing.

A number of different sound therapies are now available, associated with claims that they can offer significant improvements for those with a range of physical, emotional and educational difficulties and/or promote general well-being and re-energise the mind-body system.

In recent years, there have been various initiatives to use both sound and music to help people with a wide range of difficulties. In some cases, sound therapy may be used to help with poor functioning attributable to physical, emotional, behavioural or learning difficulties.

In the medical world, sounds and music are increasingly used to reduce or eliminate pain during major surgery and dentistry and for the relief of pains in the joints. Music is also used to stimulate the overall mind-body system, for personal growth or perhaps to stimulate intellectual development and performance, in subjects like mathematics, or to improve behaviour and social interactions.

Sound Therapy or Music Therapy?

In this article, we are not concerned with the making of music for therapeutic purposes. We have therefore excluded voice work (singing, chanting, toning) and what is generally called 'music therapy', where people are encouraged to participate in the making of music to help with physical, emotional or behavioural difficulties. We are also excluding the use of music for relaxation and pain relief ('vibrational medicine', TENS, bio-acoustics, cymatics).

We have focused on approaches to 'sound therapy' that are designed specifically to correct distortions or imbalances in auditory processing. These may affect not just the hearing function but also the vestibular system, and thus many aspects of the mind-body system. Our initial interest was in helping children and adults with learning and sensory difficulties but some of the sound therapies are also powerful tools for helping with depression and re-energizing people after perhaps years of functioning below par. As a by-product, auditory change may be accompanied by other changes, linked to emotional and/or physical wellbeing. As Dr Bérard, creator of Auditory Integration Training (AIT), concluded, "everything happens as if human behaviour were largely conditioned by the manner in which one hears". He found so much evidence for this that he called his book Audition Égale Comportment (in American English: Hearing Equals Behavior).

Presenting Difficulties

Table 1 indicates the main difficulties for which each therapy is indicated but in Table 2 there is a more comprehensive list of the kinds of auditory processing difficulties and the presenting symptoms for which these therapies have been found useful. The range is wide and reflects the essential role of sound and hearing in our interactions with the world.

Assessment

In all our cases, assessment will follow a similar pattern: completion of a history questionnaire, detailed interview, standard tests (pure tone audiogram, laterality tests, selectivity tests), and exploration of options available. The most important assessment tool is the audiogram, which reveals whether the hearing profile and the associated behaviours are likely to be improved by sound therapy.

Clients may have previously had hearing tests in their quest to find reasons for their difficulties. In many cases the hearing threshold response departs considerably from the theoretical norm and they have been told that their hearing is 'within normal limits'. Generally this phrase indicates that, although there may be some hearing loss, the hearing threshold is above 25 or 30dBHL and there is not considered a need for a hearing aid or other medical intervention. This does not mean that auditory processing is unaffected, and it can be a false comfort to those seeking reasons for many educational, behavioural or emotional problems.

Sound therapists, however, are looking for specific aspects of the hearing profile: imbalance between left and right ears, extra acute hearing in one or both ears, poor hearing in one or both ears at specific frequencies, unusual peaks and troughs at certain frequencies and various other indicators apparent from the way they respond.

For instance, when the threshold is more sensitive than normal (hyperacute) it may have been discounted as a potential problem, yet this hyperacute response will often explain the covering of ears in noisy situations, difficulty in coping with loud domestic and street sounds, noisy environments such as classrooms or social gatherings (cocktail party deafness) and a reluctance to travel on the underground rail network. If such sound cannot be physically excluded then it may be 'tuned out'. Many with learning difficulties and autistic children without speech may have extra sensitive hearing in one or both ears, which causes them to filter out sounds to avoid discomfort or even pain.

There may have been ear infections that have affected the middle ear. The significance on the interpretation, processing or even the initial development of speech, of an auditory response with numerous variations in threshold, may also have been discounted, but experience shows that learning ability and emotional responses can be dramatically affected by the distortions generated within these 'normal limits'.

Which Sound Therapy?

Table 1 is a summary of the characteristics of five of the sound therapies offered in the UK. They come from different parts of the world and have been devised by professionals from various disciplines (doctors and ENT specialists, educationalists to physicists and sound engineers). The two clinic-based therapies have been developed by French ENT specialists: the first by Dr Alfred Tomatis, the second by Dr Guy Bérard who in fact consulted Dr Tomatis for his own tinnitus and encroaching deafness and then went on to develop his own protocols. The other three systems are home-based, using modified, pre-recorded audiotapes or CDs.

In all these sound therapies, the client is asked to listen through headphones to certain kinds of music or other sounds which are specially treated (modulated and/or filtered) to help correct the distortions in auditory processing which are affecting performance. It is essential that the recordings and playback equipment, including headphones, are of very good quality. In particular, the client needs to experience the high frequencies without distortion.

With both Bérard's AIT and the Tomatis Method the equipment used enables appropriate filtering to be introduced as well as modulating the music source, thus encouraging listening and attention to the whole frequency range, leading to a re-educated auditory system. With the Johansen system the tapes may be optionally customized.

Because the right ear provides the shortest route to the language centres in the left hemisphere, volume may be reduced in the left ear to encourage right ear dominance and thus improve speech perception and processing.

We generally favour AIT as, being a clinic-based approach, it is easier to customize, monitor and ensure that the correct protocols are being observed. We ask clients or parents to keep a daily diary of reactions, and by meeting twice daily it is easier to keep track of what is happening. Occasionally there may be temporary mood changes or increased tiredness. Children may have unexpected temper tantrums, generally short lived, but a sign that progress is being made. At such times, it is helpful to be at hand to reassure parents that all is well.

AIT is also more cost-effective for the client, being completed in just ten days. For clients who cannot easily get to the clinic for the ten days, because of distance or cost of travel/accommodation, then the home-based approach is a good alternative.

Although some of the home-based programmes are widely available, their use should still be carefully monitored by a professional sound therapist, since they are all potentially powerful interventions designed for therapeutic listening through headphones, and should not be considered as simply for casual relaxation and entertainment.

Outcomes: Universal Panacea or Mere Placebo?

Certainly sound therapies are not a universal panacea for all the conditions listed in Table 2 and specifically not recommended for schizophrenic individuals. However, if there are signs of auditory processing difficulties, we expect to find some improvements in the key areas causing concern; some may be immediate, within days; some may occur in the weeks or months following the intervention. Improvement depends upon the degree that the auditory system is contributory to the difficulty.

Many clients start to overcome learning and behavioural difficulties. The principal indications of improved auditory processing (including improved auditory discrimination and better phoneme segmentation skills) are not only better listening skills but also improved speaking, reading, spelling and memory skills. After being relieved of the frustration of not being able to process language satisfactorily, the behavioural and emotional problems start to disappear; e.g. the Attention Deficit Disorder (ADD) child discovers how to focus attention. For the non-verbal client with an autistic spectrum disorder, eye contact may improve or a gradual or even rapid speech development.

Those with depression change their outlook on life and feel more comfortable with their lives. The previously suicidal wonder what the problem was. The nightmare of tinnitus may in some cases reduce or even disappear. As mentioned above, some find as a by-product that the sound therapy has unexpectedly helped with other difficulties. With AIT we frequently note improvements in self-confidence, assertiveness, maturity and relationships with others. Improvements in sleeping and eating patterns are common. Clients have also reported positive effects in reducing or eliminating bulimia, anorexia, thyroid difficulties, psoriasis, eczema, asthma, horse allergies, addictions and obsessive-compulsive disorders.

Some commentators may wonder how much is attributable simply to spending time sitting quietly listening to music without distraction. Meditation, for example, with or without music, is reported to bring major physiological and emotional benefits. The objective test is whether the auditory profile has changed and whether associated improvements start occurring. It is our repeated experience that they do.

What's going on? It seems we don't know the answer to that yet. On AIT for instance, The Society of Auditory Integration Techniques (SAIT) has published a list of theories about why it is effective. They postulate changes in the middle ear, inner ear, and/or the brain, and include theories of conditioning, the effects on the vestibular system or biochemical changes.

What about independent research assessments rather than clinical reports? Unfortunately, like many areas in the complementary field, the few studies that have been done do not initially appear very encouraging for the outsider wondering whether this or that therapy will be helpful. One difficulty is the range of conditions for which these therapies are being used. Every client is different and has a different combination of experiences and presenting conditions. In severe cases, clients or parents may be desperate and have tried, or are trying, several other remedies at the same time, so it is difficult to disentangle what caused what benefit. It is difficult therefore to assemble an acceptably large test and control population with matching conditions. Another difficulty is that research tests are not necessarily carried out by fully trained practitioners and may not have followed the prescribed protocols or used the specified equipment. SAIT recently published an interesting commentary about a number of published research reports.

However, most practitioners keep their own records of case studies and are happy to put new clients in touch with clients with similar experiences. On this point, we suggest one of the most powerful recommendations for AIT is Dr Bérard's book, where he gives the results from clients coming to his own ENT practice. Of some 8,000 ENT clients, he identified 2,300 whom he felt would benefit from AIT. The outcomes are set out in Table 3.

Dr Bérard's figures speak for themselves. Our own practice, using AIT, has also produced many heart-warming stories to tell about the transformation in people's lives initiated by sound therapy. One depressed dyslexic child said after AIT, "I have been given a new life. I feel I have gone through a tunnel and come out happy and clever", and the parent of a young boy with autistic tendencies and minimal speech commented, "It's as if a light has been turned on in his soul."

Bibliography

About AIT
Bérard Guy. Hearing Equals Behavior. Keats Publishing. Connecticut. USA. ISBN 0-87983-600-8. 1993. French edition: Audition Égale Comportment. Maisonneuve. France. ISBN 2-7160-0097-2. 1982.

About AIT (case studies)
Stehli Annabel. The Sound of a Miracle. Keats Publishing. Connecticut. USA. ISBN 1-900238-0658. 1991.
Stehli Annabel. Dancing in the Rain. Keats Publishing. Connecticut. USA. ISBN 0-9644838-0-7. 1995.

About Tomatis Method
Tomatis Alfred. The Conscious Ear. Station Hill Press. New York. USA. ISBN 0-88268-108-7. 1991. translated from French L'Oreille et la Vie. 1977, 1990.
Tomatis Alfred. The Ear and Language. Moulin. Ontario. Canada. ISBN 0-9697079-8-3. 1996. French editions 1963, 1978, 1991.

About SAMONAS
Steinbach Ingo. SAMONAS Sound Therapy. The Way to Health Through Sound. Techau Verlag. Germany. ISBN 3-931050-48-3. 1997. German editions 1990, 1994, 1997.

About Johansen Sound Therapy
Johansen Kjeld. Numerous research papers. Baltic Dyslexia Research Laboratory Bornholm. Denmark.