How can singing in music therapy influence social engagement for people with dementia?:Insights from the polyvagal theory

Suffering from dementia is synonymous with loss. Dementia is a neurodegenerative disease, and the clinical diagnosis refers to loss of neurons in the cortex due to a variety of factors. The loss of cognitive functioning causes further losses such as loss of employment and driver’s license, and when the disease progresses further, loss of memory and of the ability to speak, orientate, navigate, and take care of oneself usually occur. The cognitive losses in dementia frequently lead to aloneness and social isolation (Cheston and Bender 1999; Kitwood 1997) and this again leads to early institutionalization/hospitalization, prescription of antidepressive and antipsychotic medication, and increased mortality (Wright 1994). Panksepp indicates that the pain of social loss, whether this is the loss of a parent, a partner, or social status, “opens the gateway to depression” (2009, p.15), and many psychiatric syndromes are marked by a “chronic sense of aloneness” (2009, p.15) caused by loss of social bonds. In this chapter I focus on how to engage persons with dementia in social communication via the use of integrative therapeutic singing in music therapy. This approach is described elsewhere (Ridder 2003, 2005, 2007; Ridder, Wigram and Ottesen 2009) but in this chapter it is presented using the “polyvagal theory” perspective (Porges 2001). Steven Porges’ neuroaffective theory is relevant to music therapy as it gives an insight both into the various ways of interacting with the client in therapy and into the importance and influence of the human voice. Book review by Yasmine A. Iliya: Hanne Mette Ridder (Chapter 6) presents thepolyvagal theory in describing voicework to increase social interaction in people with dementia. Developed by Dr. Stephen Porges, the polyvagal theory refers to the role of the tenth cranial nerve, the vagus, in different mammalian stress responses.Ridder connects the vagus to breathing, vocalisation, and communication, and asserts the need for safety to decrease the stress response in people with dementia. Using the human voice in a therapeutic context can increase social interaction, especially by singing familiar, predictable songs. Ridder brings great sensitivity to her chapter, and provides excellent connections between the brain,the voice, and the need to ensure safety for the clients. As she states, “the therapist’s voice is an important instrument and is used to signal a stable ground, a clear structure, and a secure frame” (p. 137). (Approaches: Music Therapy & Special Music Education | 4 (2) 2012 | http://approaches.primarymusic.gr