OBSERVATIONS
REALITY CHECK Ray Moynihan
Times like these you need some “One Four Five”
We should celebrate the magic of song and music therapy’s power to heal
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.” 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, 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 benefits 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
BMJ | 31 MARCH 2012 | VOLUME 344
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 16 to 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. “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
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
bmj.com
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by Ray Moynihan are
available on bmj.com
used.” In modern society, with media
forms like radio being 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
independently 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 that “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 ending: “Times like
these you need some One Four Five.”
Ray Moynihan is an author, journalist, and
conjoint lecturer, University of Newcastle,
Australia [email protected]
Competing interests: RM plays music and sings
regularly in choirs.
References are in the version on bmj.com.
Cite this as: BMJ 2012;344:e2342
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