Groundbreaking Research Links Music Making with Stress Reduction at the DNA Level

While it's common knowledge that playing a musical instrument is a worthwhile endeavor, relatively little is known about its potential health benefits especially for individuals who do not consider themselves musical. Music Trades (August Issue) is pleased to announce a remarkable scientific breakthrough that will forever impact our global understanding and appreciation of music-making and health.

During the following interview, Terry Lewis, Senior Vice-President, Yamaha Corporation of America and Karl T. Bruhn, "father of the music-making and wellness movement" discuss what may be considered the most important scientific discovery linking music-making, stress-reduction and the human genome with Barry Bittman, MD, the study's principal investigator.

TL: Barry, when we originally discussed the basis for this project a few years ago, you emphasized the importance of investigating stress on a biological level. Before we get into the results of your study, could you share your rationale?

BB: Allow me to begin by stating that according to an article that appeared in the September 27^th 2004 issue of Newsweek, "experts claim that 60-90 percent of doctor visits involve stress-related complaints." On September 5^th 2004, The New York Times reported that, "workplace stress costs the nation more than $300 billion each year."

From a medical perspective, this isn't surprising. Just consider the world we live in – terrorism, the war in Iraq, the recent tsunami, road rage, stress on the job, two-earner families, the growing number of uninsured in a strained healthcare system, unemployment and financial pressures. The true extent of the list is clearly beyond the scope of this discussion.

Bottom line – stress for most people in our society is a 24/7 reality. It's also associated with some of the most challenging, costly and devastating healthcare issues we face.

Yet while most people understand and sense stress on a personal level, scientists continue to debate its precise definition. From a biological perspective, the most practical way of conceptualizing stress is to consider health as a complex orchestration of thousands of bodily functions that maintain a delicate internal balance. A stressor is considered anything that disrupts this balance. The resultant process of biological disruption is called the stress response, and the end result can lead to illness.

Hans Selye, the acknowledged "father of stress," was one of the first physicians in the early 20^th century to recognize the impact of stress on our health. For the purpose of understanding this study, we refer to his definition of stress as "a non-specific response of the body to any demand."

KB: Barry, looking at it another way, aren't we also talking about feelings of anxiety or tension that often become overwhelming? In fact, aren't a lot of people stressed out and unaware of it?

BB: Karl, you are correct. Some stressors are obvious while others are not. While feelings of tension and anxiety are often present, it's important to recognize that people are sometimes unaware of the stressors that affect them, or how they respond in our high-pressured fast-paced society. With the exception of exposure to universal stressors such as a burning building, human stress responses to common stressors are typically unique. No two people respond in the same way. For some, working under a deadline may be perceived as stressful, while for others it is not. Essentially, the way in which one perceives "the demand" ultimately influences their stress response.

TL: Barry, there isn't a day that goes by without some new warning about the ill effects of stress. Before we proceed, can you further explain the link between stress and disease?

BB: While the link is straightforward, understanding the intricacies of how it works is challenging at best. In the human body, primitive systems responding to external stressors protect us under certain circumstances. When a person smells smoke inside a burning building, a series of bodily reactions instantly prepares us to flee and thus save our lives. However, with exposure to ongoing stressors, that same protective response triggers a destructive biological cascade that can ultimately be devastating. Multiple health challenges such as heart disease, cancer, infections, inflammatory processes, diabetes and autoimmune disorders have been scientifically associated with stress responses.

KB: Each of us knows a number of people who are constantly living under high levels of stress. For some, giving a speech is extremely frightening, while others look forward to being in front of a crowd. When it comes to stress, some people seem to handle it better than others. How do you explain this?

BB: Undoubtedly, no two people respond in precisely the same manner. In fact, you've touched upon one of the most important findings of our study. Suppose for a moment that a married couple suddenly learns that their retirement savings have been embezzled by a former employer, and as a result, they find themselves destitute. Over the course of ensuing weeks, the husband experiences multiple bouts of chest pain, and the wife develops episodes of abdominal pain and vomiting.

TL: Barry, essentially you're saying that the stress response is highly individualized. Doesn't this provide an incredible obstacle to measuring the impact of music-making on stress?

BB: Terry, without doubt, your recognition of the challenge is correct. The question itself beckons an explanation of our methods. Perhaps we should begin with the human genome, and why we focused our efforts on analyzing stress on that level.

As you know, cells are the basic working units of every living system. All instructions needed to direct their activities are contained within the chemical, DNA, which is found within the nucleus of each cell. The genome is our complete set of DNA which essentially serves as a personal blueprint – an instruction book for the human body. It contains an estimated 20,000-25,000 functional genes.

Placing this into perspective, visualize a page filled with a continuous sequence of letters. It doesn't take a stretch of the imagination to realize that the 3 billion base pairs of the entire human genome would require a stack of paper over 300 feet tall!

From a functional vantage point, when we respond to any demand, DNA rises to the occasion. More precisely, this complex molecule unfolds along a specific region that serves as a template for the most intricate manufacturing assembly line that exists. Through a series of complex processes that are beyond the scope of this discussion, all biologically active substances within our bodies are produced through this process. Our research team studied a number of the key genomic switches that literally turn on what ultimately becomes the human stress response. It should be emphasized that our measurements were made precisely at the source.

KB: Terry, I think it's important for members of our industry to realize that leading scientists throughout the world refer to the importance of the human genome project as "bigger than splitting the atom." Nobel laureate Walter Gilbert of Harvard said, "the human genome is the holy grail of biology… it changes everything."

Barry, I wouldn't be alone in saying this study sounds like science fiction. It's really difficult to imagine how this works especially when we're talking about molecules. Through my reading, I found a reference to the human genome that does make a great deal of sense to me. It's described as a continuous piano keyboard spanning from New York to Los Angeles. A note out of tune, or a sticking key can spoil the most beautiful piece of music.

Yet what you're describing seems so much more complicated. If I understand you correctly, you are talking about an ongoing process that operates continuously every second throughout our lives. The ability to study DNA this way has to be one of the greatest scientific achievements of all time.

BB: Karl, you are correct. From a scientific perspective, genomic technology is nothing short of fascinating. It's important to note that two related factors enabled us to perform this study. The first is based on the fact that the full human genome was sequenced only a short time ago on June 26, 2000. The second factor relates to Applied Biosystems, the company responsible for inventing the technology that made it possible. I'm honored to state that Applied Biosystems partnered with us for this investigation. In fact, this is the first research study to use one of their latest sampling technologies to precisely detect genomic markers.

TL: Realizing the complex nature of this project, for all practical purposes could you explain the importance of your strategy in comparison to other methods for evaluating stress?

BB: The impact of stress can certainly be measured in different ways. Common methods include tracking subject outcomes over time, using self-reported psychological surveys, recording heart rate, blood pressure and skin resistance, or even detecting chemicals such as stress hormones from blood samples. Each has substantial drawbacks that considerably limit our understanding of the process. Ultimately these approaches focus exclusively on what we often refer to as downstream or end effects.

Analyzing the human genome enables us to precisely detect the biological switches that literally turn on the entire cascade leading to all other effects. It's really about getting close to the source of the biological response, and tracking the overall process on the molecular level.

Consider the following example: while identifying a plane crash can be accomplished by sifting through the rubble, further investigation is needed to determine its cause. Remember, the crash is just an endpoint – so is a heart attack!

KB: I'm impressed with the fact that in addition to using this incredible technology, you also performed a rather interesting experiment. Barry could you briefly take us though the design of your study?

BB: Our 2-phase protocol was basically designed to first induce stress, and then reverse it. During the first hour, each of 32 adult volunteers competed for a monetary prize by attempting to assemble a rather challenging and frustrating jigsaw puzzle. During the second hour subjects were randomly separated into 3 groups which were engaged in the following activities: ongoing puzzle assembly, relaxation reading newspapers and magazines, and participating in the Clavinova Connection. Blood was sampled at the onset, after phase I and after phase II. A total of 45 stress-related genomic markers were analyzed.

TL: Given the wide-ranging variations in stress responses that we've already discussed, how did the subjects compare?

BB: Frankly they didn't. Each subject manifested a rather unique response to the stress-inducing puzzle assembly competition. Comparing blood samples among volunteers, some genomic markers went up while others went down or didn't change at all. Subject to subject variations were substantial.

At first our scientific team was surprised and somewhat perplexed. While we anticipated some individual differences, such wide-ranging variations among subjects were not anticipated. Subsequent analysis of the group data led to no meaningful conclusions.

After a number of sleepless nights, I began to envision each subject's stress response as a personalized profile – a distinctive fingerprint comprising 45 genomic markers unique to each person. From a conceptual standpoint I veered away from the group analysis approach, and wondered if it was possible to use each individualized profile as a baseline for comparison with phase II stress-reduction activities. Two extraordinarily competent statisticians worked independently and relentlessly to test that possibility from a number of mathematical perspectives. Using different strategies they simultaneously arrived at the same conclusions. Their comprehensive analysis ultimately enabled us to coin the term, individualized genomic stress induction signatures.

KB: Barry, could you further explain how you used these signatures?

BB: Karl, we compared the genomic changes that occurred in phase II with each subject's stress signature, and discovered that 6 of 45 genomic markers reversed for the relaxation group reading newspapers and magazines, in contrast to 19 of 45 markers in the Clavinova Connection group. As you may have guessed, no significant reversals occurred in the group that continued assembling puzzles during the second hour of the study.

TL: If I'm correct, the Clavinova Connection group was made up of individuals without prior music-making experience or people who did not consider themselves "musical." Why do you think the people participating in their first music lesson did better than the group that was allowed to relax?

BB: In the context of traditional musical instruction, our results may seem surprising as most adults would anticipate varying degree of stress associated with learning to play a musical instrument. Yet from a Recreational Music Making (RMM) perspective, I'm certainly not surprised that more than three times as many genomic markers reversed in the Clavinova Connection group compared with the subjects who simply relaxed and read magazines and newspapers. RMM's underlying philosophy fosters a nurturing, supportive and expressive approach with an emphasis on building bridges of communication in sharp contrast to mastery and performance goals that typify traditional musical instruction. Both have their respective purposes. While traditional musical instruction might eventually lead to Carnegie Hall, I now consider RMM an antidote to stress!

KB: Barry, in the development of the Clavinova Connection, I remember you emphasizing the word, "conditioning" as a key element in the program. Why is that important here?

BB: Karl, each segment of the Clavinova Connection was designed to progressively condition a sense of success from the start. In the preliminary developmental stages we discussed the need for inspiring far more than just creative non-verbal expression and communication. We wanted each participant to feel good about themselves, and feel supported within the group.

Our team deliberately deemphasized technique yet focused on the use of technology in the background as an enabler of creativity. Thanks to Craig Knudsen who ran with that charge, Clavinova technology was ramped up to a point where it seemed to suddenly disappear. Even for the technophobes, the underlying technology was literally rendered invisible and non-threatening. As a result, we succeeded at conditioning a sense of positive anticipation for immediate success rather than failure.

KB: While the science is difficult to grasp, it's extraordinarily important to recognize that this is an unparalleled FIRST for the music products industry, and undoubtedly the most exciting boost for advancing the RMM movement worldwide.

TL: Karl, I agree. The science of genomics is as intriguing as this discovery. Yet delving deeper into the subject of creativity and technology, can you further explain how this combination led to stress reduction?

BB: Allow me to begin by stating that comments about the "how" in any research investigation are always presumptive. Yet with a certain degree of latitude, I tend to believe our strategy worked in part due to the stress-reduction expressive elements built directly into the Clavinova Connection. The recognition of an adult's potential frustration associated with learning to play a musical instrument guided the program's development. We remained keenly aware of two important factors: mistakes and quality.

In our competitive society, we tend to be judged against each other. During the early process of assimilating any new skill, often a focus on correcting mistakes takes precedence to acknowledging accomplishment. Fear of fumbling or making errors can be debilitating, while anxiety centered around appearing inadequate often serves as a roadblock to ongoing personal development. Not surprisingly, stress takes its toll, and people tend to give up. For the adult, this sense of failing early on is remarkably limiting, and can result in the failure to pursue what could progressively evolve into an extraordinary means of ongoing personal fulfillment.

To complicate matters further, we recognized that while the majority of people in our society do not consider themselves "musical," they do however recognize quality music. Expecting an adult to remain interested, gratified and personally committed to learning to play a musical instrument requires far more than an elementary repertoire that could appear condescending.

The Clavinova Connection simultaneously addresses both obstacles. It literally takes the fear of mistakes out of the equation. Without the challenge of a sharp learning curve, this innovative approach enables people to actively enjoy the music they've always dreamed of playing. I personally believe that as a result, one's immediate perception or anticipation of success could serve as a powerful stress reducer.

KB: Over the years I've observed many people whose lives have been positively affected by playing a musical instrument. Personally, I began my musical career with a prescription from our family doctor who told my mother that in order to treat my asthma, we would have to move to a more favorable climate, and that I needed to take up a wind instrument. Looking back, I realize that I may be the only person who is in this industry as a direct result of a doctor's prescription.

Since we now have medication that helps children with asthma, has the importance of playing a musical instrument changed?

BB: In fact, it has. The RMM movement is gaining sustainable momentum. Despite a vast array of medicines at our disposal, the incidence of many stress-related diseases has risen considerably. Medical scientists are now embracing the use of effective enjoyable stress-reduction strategies that have an integral role in the prevention and/or treatment of a number of serious disorders ranging from heart disease to cancer.

The underlying problem however is growing. We live in an era that's both fast-paced and pressured from many perspectives. As a society, we recognize the benefits of healthy nutrition, exercise and stress-reduction. While there's no shortage of diet plans or exercise opportunities, stress-reduction as a healthy lifestyle initiative simply doesn't appear on the radar screen for most people.

I personally believe that relaxation activities such as simply lying on the couch watching television, or drinking a cup of coffee while reading the world news are not the answer. Our study showed that active engagement in the Clavinova Connection was far more effective in reversing stress on the genomic level than relaxing and reading newspapers and magazines.

TL: From an industry perspective, your message is clear. We can for the first time state that playing a musical instrument is an important stress-reduction strategy. This is perhaps the most important strategic breakthrough in our understanding of the health benefits of music-making. The real challenges however are informing our industry and changing public perception. Barry, it's well known throughout the music products industry that a substantial number of doctors play or have played a musical instrument. Would you venture to comment about the medical community's perception of playing a musical instrument as a beneficial stress-reduction strategy?

BB: Terry, I'm firmly convinced the medical community already supports this notion. Frankly it doesn't take a lot of convincing. To date, our research has been successfully peer-reviewed and well-received.

The heart of the challenge, however, extends beyond perception. Let's assume for a moment that a physician recognizes the value of music-making as an effective stress-reduction strategy. His next patient is a highly-stressed corporate executive who recently suffered a heart attack. He's on a low fat medically-supervised diet, and is attending a cardiac rehab exercise program. However the need to become actively engaged in an effective stress-reduction activity has not been met. How does the doctor get his patient involved in RMM?

KB: Barry, perhaps you've touched upon two of our most important challenges we face as an industry – getting the word out and access. The RMM movement is just beginning to take off. I'm convinced it takes an industry-wide effort to kick this into gear. The bottom line is obvious – we need more research, programs and access.

Industry trade organizations and publications are in the best position to do just that. As an industry we need to get the word out to our global members. We also need to encourage RMM program development, testing and research. The public has to become aware of the life-changing benefits associated with playing a musical instrument. Finally local music merchants must offer RMM programs in their communities. They must take a grass roots approach to making these programs available to medical and wellness communities as well as the public at large. Fortunately the industry's firm commitment to support and expand the RMM movement is already being demonstrated on a number of levels.

TL: Karl, I agree with you, and personally believe we're on the right track. For Yamaha, this groundbreaking research inspires all of us to more fully realize the importance and potential impact of our work on an unprecedented level. Barry, as a global company, we welcome the challenge of expanding RMM, and we embrace the opportunity to support your research. The prospect of improving quality of life is something we all consider worthwhile. I personally view this extraordinary breakthrough as a key opening a door to a new and exciting era of synergy between the fields of music and medicine.

Yet I do have one more question. What are your next steps?

BB: From a research standpoint, this study represents only the beginning. Through subsequent investigations we intend to further refine and extend our approach.

Actually, the next important step has already been taken. When the scientific team at Applied Biosystems reviewed our findings, they offered us the opportunity to study the entire human genome on a select number of subjects in the Clavinova Connection group. This complex analysis requiring enormous computing power is presently being reviewed, and is already revealing new discoveries concerning RMM and its potential to reverse the impact of the human biological stress response.

I'd like to personally take this opportunity to extend my appreciation to you, Terry, for helping make this research possible. A few years ago when Karl and I stepped into your office to propose this research collaboration with Applied Biosystems, we anticipated a certain degree of healthy skepticism. We didn't expect the word, genomics to be in your corporate vocabulary. To my surprise, such was not the case. Your interest, enthusiasm and support made all the difference.

And Karl, your unrelenting dedication to extending the benefits of music-making throughout the world energizes all of us. Thank you for your tireless work and inspiration.

TL: Thank you, Barry. And Karl, any last thoughts?

KB: Both you and Barry recall that during the Fifth Global Economic Summit of the Music Products Industry held this past August in Carlsbad, attendees recommended that the music products industry should actively endorse RMM as a market-building and expansion strategy. They issued a challenge to suppliers to create products supported by protocols and programs developed in collaboration with medical and educational communities.

This genome research study is a stunning accomplishment – a shining reflection on our industry that is certain to inspire a renewed focus on the lifestyle benefits of playing a musical instrument. It is my hope that other manufacturers join in and propel this movement forward by supporting and encouraging this type of research that can help to expand the number of music-makers worldwide.

From a personal perspective, this is an astonishing moment in history. In an exciting era when we can get on the internet and practically download the genomic instruction book for the human body, music-making stands at the forefront of cutting edge science.

I'm 75 years old and we're beginning to see what I've dreamt of for years. Music-making and wellness is finally being reported as history – rather than news!

For additional information please contact: doctorb@mind-body.org

Recreational Music-Making Modulates the Human Stress Response: a preliminary individualized gene expression strategy has been published in the February 2005 issue of the international research journal, Medical Science Monitor (medscimonit.com).

Click here to download this article as it appeared in the August 2005 issue of Music Trades magazine.

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