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Creativity and improvisation as therapeutic tools within music

Article  in  Annals of the New York Academy of Sciences · August 2013

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Concetta M Tomaino
Institute for Music and Neurologic Function
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A N N A L S O F T H E N E W Y O R K A C A D E M Y O F SC I E N C E S
Issue: The Emerging Science of Consciousness: Mind, Brain, and the Human Experience

Creativity and improvisation as therapeutic tools within

Address for correspondence: Concetta M. Tomaino, D.A., MT-BC, LCAT, Institute for Music and Neurologic Function,
612 Allerton Ave., Bronx, New York 10467. ctomaino@bethabe.org

The neuroscience of creativity and music improvisation is a fascinating topic and one with strong implications
for clinical music therapy. Music therapists are trained to use musical improvisation as a means to bring their
clients into deeper therapeutic relationship as well as free up any inhibitions or limitations that may block re-
covery. Could recent fMRI studies of jazz musicians showing areas of brain activation during music improvi-
sation provide a new framework to understand underlying mechanisms at work with neurologically impaired
individuals?

Keywords: music; improvisation; music therapy; music and brain; neurological function

The neuroscience of creativity and music impro- the impact of music therapy on various conditions
visation is a fascinating topic and one with strong is that there are limited interventions that can be
implications for clinical music therapy. The Ameri- done in a controlled double-blind study. The type of
can Music Therapy Association defines music ther- dynamic, interactive, personalized engagement that
apy as “the clinical and evidence-based use of mu- is a fundamental part of music therapy requires a
sic interventions to accomplish individualized goals different research paradigm and integration of neu-
within a therapeutic relationship by a credentialed roscience findings to truly understand how and why
professional who has completed an approved mu- music therapy is effective in these cases. Looking at
sic therapy program.” The important phrase here is the neuroscience of music improvisation may pro-
“within a therapeutic relationship,” a relationship vide some insight. In his text Improvisational Models
often formed through improvised musical interac- of Music Therapy, Kenneth Bruscia explains,
tion between the client and music therapist in real
In a music therapy context, improvising . . . is
time. The field of music therapy has been an es-
inventive, spontaneous, extemporaneous, re-
tablished profession in the United States since the
sourceful, and it involves creating and playing
1950s. Since then music therapists have researched
simultaneously. It is not always an “art” how-
and shown the efficacy of the clinical applications
ever, and it does not always result in “music”
of music and the components of music, for ex-
per se. Sometimes it is a “process” which results
ample, rhythm, vibration, melody, harmony, and
in very simple “sound forms.” Music therapists
song to affect cognitive, physical, and psychosocial
strive to improvise music of the highest artistic
function in all ages and across all need areas, in-
quality and beauty, however, they always ac-
cluding medicine, early child development, neuro-
cept the client’s improvising at whatever level
rehabilitation, and psychotherapy.1 It is only in the
it is offered, whether consisting of musical or
past 15 years or so that neuroscience has been able to
sound forms, and regardless of its artistic or
help answer some questions about how music is pro-
aesthetic merit.2
cessed in the brain and possibly shed some light on
how and why music perception influences various Music therapists often refer to “ability in the
brain networks. One of the challenges in researching moment”—when the patient who is engaged in an

doi: 10.1111/nyas.12224
84 Ann. N.Y. Acad. Sci. 1303 (2013) 84–86 
C 2013 New York Academy of Sciences.
Tomaino Creativity and improvisation as therapeutic tools

improvization is able to do something that was not It is interesting that the medial prefrontal cortex
possible outside of the musical interaction, such as has been identified by Limb as an area involved in
moving a weak arm or speaking a word that could autobiographical narrative, as this area has also been
not be previously recalled. Music therapists may call indicated in research on music and memory.4
this a moment of “release” or “flow” or “connec- A leading researcher in this area is Petr Janata of
tion.” But is the active engagement in music mak- U.C. Davis, whose functional magnetic resonance
ing contributing to the release of something that imaging (fMRI) studies on music and memory show
was inhibited outside of the music? I think a lot of an area of convergence in the medial prefrontal cor-
this has to do with the arousal of subcortical ar- tex when people listen to music that has connections
eas and neural networks that stimulate action and to self, important others, and important times and
inhibit self-monitoring. People who have suffered places.5 Janata’s research has implications for under-
a brain injury or neurologic disease often have to standing why people with dementia have the abil-
think hard about how to move a paretic arm or leg; ity to recognize a personally significant song even
similarly a person who has suffered a stroke may when other areas of recognition have been dam-
have trouble with word retrieval but may find the aged. Could this be because several processes con-
word easier to retrieve after singing a song. Those verge in the medial prefrontal cortex and/or other
with some type of brain injury, whether by trauma, active monitoring processes are inhibited to allow
disease, or stroke, often have trouble with multi- for the processing of this sensory input? Determin-
step planning, attention, and mental flexibility— ing which areas of the brain are engaged and disen-
all part of executive function. Understanding what gaged during creative music making may shed some
the improvising brain looks like can offer some in- light on why function becomes enabled under these
sights as to why a patient with impaired executive circumstances.
function shows the ability when engaged in sponta- Our skills, musical and non-musical, are devel-
neous activity. Can this be related to inhibition in oped over time and our brains learn to apply our
the prefrontal cortex? In her article, “Inner Spark: repertoire in an infinite array of possible outcomes.
Using Music to Study Creativity” (Scientific Amer- Basic motor skills can be applied to everyday tasks
ican, May 20113 ), Alicia Anstead highlights some like walking and dressing but can also be used for
of the findings in the neuroscience of creativity more advanced skills like playing the violin or com-
and quotes Charles Limb on his research on music peting in gymnastics. The more advanced our skills
improvisation. the more enriched the number of networks and
brain areas that are used to produce the given out-
Limb says his studies have revealed that “cre- come. Mental processes like fear and uncertainty in-
ativity is a whole-brain activity. When you’re hibit the freedom with which we apply these skills.
doing something that’s creative, you’re engag- Similarly, head trauma and disease can interfere with
ing all aspects of your brain. During impro- ability as well. So it is no wonder that an activ-
visation, the prefrontal cortex of the brain un- ity that allows for disinhibition of self-monitoring
dergoes an interesting shift in activity, in which produces increased ability in those with neurologic
a broad area called the lateral prefrontal region deficits.
shuts down, essentially so you have a signifi- I am reminded of a woman in her early twenties
cant inhibition of your prefrontal cortex . . . . who had been admitted with a left-arm paralysis
These areas are involved in conscious self- and possible diagnosis of multiple sclerosis. She had
monitoring, self-inhibition, and evaluation of been admitted to long-term care after undergoing
the rightness and wrongness of actions you’re procedures to unlock her contracted knee joints.
about to implement . . . . In the meantime, She had good range of motion in her right arm and
we saw another area of the prefrontal cortex— hand. She was emotionally withdrawn and not able
the medial prefrontal cortex—turn on. This is to benefit fully from traditional physical rehabili-
the focal area of the brain that’s involved in self- tation. She was referred to music therapy because
expression and autobiographical narrative. It’s she had an interest in music. (Patients do not need
part of what is known as a default network. It to have an interest in music to benefit from mu-
has to do with sense of self. sic therapy—but physicians often see the interest in

Ann. N.Y. Acad. Sci. 1303 (2013) 84–86 

music as a means to get a marginal patient involved time. Could this disinhibition be similar to the lack
in therapy.) Though she was reluctant at first she of self-monitoring exhibited in the jazz musicians?
started to attend because I mentioned that I had an Understanding the mechanisms by which this re-
instrument she could play with only her right hand. lease is made possible would provide additional sup-
As the sessions progressed, I observed that her left port of the efficacy of music therapy in trauma cases
arm would move while she was fully engaged in as well as for those with neurological impairments
playing/improvising along with me. I shared this from disease, stroke, and head injury. What Charles
observation with her and she denied that the arm Limb and others are finding in their studies is very
could move. I engaged her in longer musical interac- important because it may bring new understand-
tions, and tilted the instrument so if she moved her ing of why our patients with brain injury do better
left hand it would touch the instrument and pro- during musical improvisation.
duce a sound. This would be proof that she could
move her arm. This did happen, and when she heard Conflicts of interest
herself make the sound she stopped playing, looked The author declares no conflicts of interest.
are her limp left arm and then slowly started to
move it. This was a turning point in her therapy. References
Up until then she had shared minimal information 1. Tomaino, C.M. 1993. “Music and the limbic system.” In Cur-
about herself. Moving her left arm, she told me of rent Research in Arts Medicine. F.J. Bejjani, Ed.: Illinois: A
Cappella Books.
how her mother would hit her. I relayed this to her
2. Bruscia, K.E. 1987. Improvisational Models of Music Therapy.
social worker and medical team as it seemed that pp. 5–6. Springfield, IL: Charles C. Thomas.
what was thought to have been multiple sclerosis 3. Anstead, A. 2011. Using music to study creativity. Sci. Am.,
may have been a hysterical paralysis. We were able May 2011.
to get her the psychological help she needed and 4. Barrett, F.S., K.J. Grimm, R.W. Robins, et al. 2010. Music-
evoked nostalgia: affect, memory, and personality. Emotion
soon she recovered full use of her left side. It was in 10: 390–403.
the context of being fully engaged in music making 5. Janata, P. 2009. The neural architecture of music-evoked au-
that she was able to move her left side for the first tobiographical memories. Cereb. Cortex 19: 2579–2594.

86 Ann. N.Y. Acad. Sci. 1303 (2013) 84–86 

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