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Autism, Music, and the Therapeutic Potential of Music in Alexithymia

01 Apr 2010-Music Perception (University of California Press)-Vol. 27, Iss: 4, pp 251-261
TL;DR: This article explored possible mechanisms for musical mood induction in listeners, hypothesizing that the simulation theory of empathy may illuminate current controversies over the nature of emotion in music, and put forward suggestions for using a simple associative learning process between musically induced emotions and their cognitive correlates for the clinical treatment of alexithymia, a disorder that is common in autism and characterized by an absence of cognitive insight into one's emotions.
Abstract: It has been argued, in view of the social evolutionary origins of music and the social deficits found in autism, that individuals with autism will be emotionally unresponsive to music. However, a recent study of high-functioning adults with autism has shown that they appear to have a range of responses to music similar to typically developing people, including the deliberate use of music for mood management. In examining why these responses appear unaffected in autism, we explore possible mechanisms for musical mood induction in listeners, hypothesizing that the simulation theory of empathy may illuminate current controversies over the nature of emotion in music. Drawing on these ideas, we put forward suggestions for using a simple associative learning process between musically induced emotions and their cognitive correlates for the clinical treatment of alexithymia, a disorder that is common in autism and characterized by an absence of cognitive insight into one’s emotions.

Summary (3 min read)

Heterogeneity in Autism

  • D ESPITE SIX DECADES OF RESEARCH, CONSENSUS on the developmental and neurological basis of autism has not been reached.
  • This heterogeneity is manifested in great variability in the extent and severity of core diagnostic features as well as in intellectual and language impairments.
  • Such heterogeneity limits the extent to which unitary treatment approaches can be adopted by educators and therapists.
  • One possible contributing factor to this variability has been suggested by findings from a recent large-scale twin study (Happé, Ronald, & Plomin, 2006).
  • Indeed, many of the deficits assumed to characterize autism vary in severity within the disorder and are also observed in other, apparently unrelated genetic or neurodevelopmental disorders.

Musical Cognition in Autism

  • A number of authors (Huron, 2001; Levitin, 2006; Peretz, 2001) have speculated that individuals with autism are likely to be emotionally unresponsive to music; at most, they may respond to the structural complexity of music.
  • Authors sympathetic to the value of music therapy have reviewed the evidence for its effectiveness.
  • A question that must be addressed when considering the efficacy of music therapy in autism relates to the locus of effects.
  • The pervasive nature of the neurological effects of autism means that the presence of compulsive behaviors could well reflect a compromised reward system in some individuals.

The Role of Music in the Lives of High-Functioning Adults with ASD

  • In recent years there have been a number of studies that have focused on the complexities of how normal populations of children or adults engage with music in their everyday lives (e.g., Batt-Rawden & DeNora, 2005, DeNora, 2002, Lamont, 2008).
  • Notable among the responses were those of individuals who acknowledged their social deficits, craved social contact, and used music to meet unfulfilled social and emotional needs, among them a sense of belonging to a wider music-loving community, or simply that of being one of a large number of people buying a particular hit record.
  • There was, however, one striking difference between the responses of the autistic adults who participated in their study (Allen et al., 2009) and those of the typically developing individuals reported in the literature.
  • Items from their study that corresponded to Thayer’s vigour/tiredness axis included statements about the use of music to induce states of excitement or exhilaration.
  • There is clear evidence that on the autism spectrum are sensitive to music’s emotional and social dimensions.

Self-Report Data on Emotions Induced by Music

  • Returning to published experimental work on the nature of musical emotions, Zentner, Grandjean, and Scherer (2008) analyzed self-report data and observed first order factors identifiable with the emotions of joy, wonder, transcendence, nostalgia, tension, and sadness, among others.
  • It seems to be generally agreed that anger, surprise, and disgust are difficult emotions to evoke musically, as well as being emotions that people seldom seek to experience via their planned listening experiences.
  • It may be that the typical listener’s tendency to further subdivide Zentner’s three second-order factors into specific musical emotions reflects confabulation, as outlined in the cognitive labelling theory of emotion (see e.g., Schachter & Singer, 1962).
  • People with autism are unlikely to engage in such confabulation.
  • On the basis of this finding the authors conjectured that the fundamental emotions experienced by their autism group might also be similar to those induced in the wider population, and that group differences in the use of musical descriptors might reflect the presence of alexithymia in the autism group.

Application to Clinical Interventions in Alexithymia: Developmental Origins

  • On the principle that if one wishes to treat a condition one needs to understand its aetiology, their first step was to formulate a hypothesis about the developmental trajectory of alexithymia in autism.
  • These are no longer purely internal and private (its own feeling) but are also external and public (a facial expression and a set of verbal labels).
  • ‘Mr. Grumpy’ shows a range of typically churlish behaviors, whereas ‘Mr. Happy’ smiles a lot and is pleasant to other people.
  • If the infant seldom orients to its mother’s face, and does not observe her mimicry of its expressions, links between its own internal emotional states and her facial expressions will not be formed.
  • The authors suggest that the autistic infant’s inability to benefit from such early bootstrapping experiences may, at least in part, account for the phenomenon of alexithymia in autism.

Application to Clinical Interventions in Alexithymia: Systematic Induction of Emotion by Music

  • The authors conjectured above that the fundamental music emotions that their autism group experienced might be similar to those experienced by typical listeners, and that group differences found in experimental results reflect alexithymia in their autism group.
  • This would help participants to learn to distinguish their particular varieties of negative and positive emotions, by associating them with passages of music, so that when they experienced a feeling they could give it a music-related label.
  • In developing a treatment for alexithymia in adulthood, one is faced with the problem of finding a substitute for the developmental process that, in typically developing individuals, enables them to associate internal feeling states with external signs.
  • A system along these lines is already being developed by Professor Rosalind Picard in the MIT Media Lab, and is being tested on college-aged ASD students with promising results (Picard, in press).

Author Note

  • This work was supported in part by Goldsmiths, University of London.
  • How alexithymia mediates ability to describe the emotional impact of music in autism.
  • Diagnostic and statistical manual of mental disorders (4th ed., text revision).
  • Music and informal learning in everyday life.

BORMANN-KISCHKEL, C., VILSMEIER, M., & BAUDE, B.

  • The development of emotional concepts in autism.
  • The case for the likely value of a music-based treatment for alexithymia in autism must consider the objection that the approach may be perceived as a form of Journal of Child Psychology and Psychiatry and Allied Disciplines, 36, 1243-1259.
  • Understanding of simple and complex emotions in nonretarded-children with autism.
  • Journal of Child Psychology and Psychiatry and Allied Disciplines, 33, 1169-1182.

DAWSON, G., CARVER, L., MELTZOFF, A. N., PANAGIOTIDES,

  • Neural correlates of face and object recognition in young children with autism spectrum disorder, developmental delay, and typical development.
  • Time to give up on a single explanation for autism.

MARCELLI, D., TOURRETTE, C., KASOLTER-PERE, M. A., &

  • A study of the search for behavioral signs which differen- tiate between depressed mothers and a control group of mothers in the neonatal period.
  • The rewards of music listening: Response and physiological connectivity of the mesolimbic system.
  • Intellectual impairment and exceptional skill, also known as The savant syndrome.

NORTH, A. C., HARGREAVES, D. J., & HARGREAVES, J. J.

  • Oxford University Press. PICARD, R. W. (in press), also known as Oxford.
  • Future affective technology for autism and emotion communication.
  • A neurological theory of aesthetic experience, also known as The science of art.

SAKURAI, T., RAMOZ, N., REICHERT, J. G., CORWIN, T. E.,

  • Association analysis of the NrCAM gene in autism and in subsets of families with severe obsessive-compulsive or self-stimulatory behaviors.
  • Cognitive, social, and physiological determinants of emotional state.
  • Music therapy in the assessment and treatment of autistic spectrum disorder: Clinical application and research evidence.

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Music Perception VOLUME 27, ISSUE 4, PP. 251–261, ISSN 0730-7829, ELECTRONIC ISSN 1533-8312 © 2010 BY THE REGENTS OF THE UNIVERSITY OF CALIFORNIA. ALL
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Therapeutic Potential of Music in Alexithymia 251
R
ORY ALLEN AND PAMELA HEATON
University of London, London, United Kingdom
IT HAS BEEN ARGUED, IN VIEW OF THE SOCIAL
evolutionary origins of music and the social deficits
found in autism, that individuals with autism will be
emotionally unresponsive to music. However, a recent
study of high-functioning adults with autism has shown
that they appear to have a range of responses to music
similar to typically developing people, including the
deliberate use of music for mood management. In
examining why these responses appear unaffected in
autism, we explore possible mechanisms for musical
mood induction in listeners, hypothesizing that the
simulation theory of empathy may illuminate current
controversies over the nature of emotion in music.
Drawing on these ideas, we put forward suggestions for
using a simple associative learning process between
musically induced emotions and their cognitive corre-
lates for the clinical treatment of alexithymia, a disorder
that is common in autism and characterized by an
absence of cognitive insight into one’s emotions.
Received October 6, 2009, accepted December 14, 2009.
Key words: autism, music, alexithymia, emotion,
treatment
Heterogeneity in Autism
D
ESPITE SIX DECADES OF RESEARCH, CONSENSUS
on the developmental and neurological basis of
autism has not been reached. It is, however, widely
acknowledged that autism and autism spectrum disorders
are extremely heterogeneous. This heterogeneity is mani-
fested in great variability in the extent and severity of core
diagnostic features as well as in intellectual and language
impairments. Such heterogeneity limits the extent to
which unitary treatment approaches can be adopted by
educators and therapists. However, for verbal, intellectu-
ally able individuals with this disorder, the extent to
which they are able to achieve their educational and
professional goals may depend upon the development
of appropriate therapies and educational approaches.
One possible contributing factor to this variability
has been suggested by findings from a recent large-scale
twin study (Happé, Ronald, & Plomin, 2006). These
results show that the triad of impairments that form
current diagnostic criteria for autism in DSM-IV-TR
(American Psychological Association, 2000) may be
under the control of independent genetic factors, thus
allowing for an even greater degree of heterogeneity than
if there were a single, unitary mechanism underlying all
three elements of the triad. Given these findings, and the
intrinsic difficulties inherent in attempts to establish
genotype/phenotype links for human behaviors, uncer-
tainty about the causal mechanisms of autism is unsur-
prising. However, fundamental questions about the
nature and the range of variability in the emotional and
cognitive characteristics of autism have, too, still to be
fully addressed. Among these challenges are those of iso-
lating behavioral features that are truly unique to the
condition. For example, while difficulties in understand-
ing emotional cues in faces and voices in autism are well
documented, similar difficulties have been observed in
children and adults with Williams syndrome and Down
syndrome. Indeed, many of the deficits assumed to char-
acterize autism vary in severity within the disorder and
are also observed in other, apparently unrelated genetic
or neurodevelopmental disorders.
Musical Cognition in Autism
A number of authors (Huron, 2001; Levitin, 2006;
Peretz, 2001) have speculated that individuals with
autism are likely to be emotionally unresponsive to
music; at most, they may respond to the structural
complexity of music. They base this hypothesis on the
proposal (see for example, Huron, 2001) that music
evolved primarily for its value in promoting social
bonding in early human society. Given that autism by
definition involves deficits in social functioning, they
conclude that individuals with this disorder will be
deficient also in the appreciation of music.
In examining empirical data on autistic populations,
it is necessary to bear in mind one important proviso
AUTISM,MUSIC, AND THE THERAPEUTIC POTENTIAL
OF MUSIC IN ALEXITHYMIA
Music2704_02 3/25/10 9:38 AM Page 251

regarding the speculation cited above. While a number
of music perception and cognition in autism studies
have been carried out, these have often been with sam-
ples drawn from particular sub-populations, which can-
not therefore be truly representative of the wider
group. For example, studies testing musical savants have
described remarkable musical skills (Hermelin, O’Connor,
& Lee, 1987; Miller, 1999; Nettelbeck & Young, 1996;
Sloboda, Hermelin, & O’Connor, 1985; Treffert, 1988;
Young & Nettlebeck, 1995). The diagnostic status of
many musial savants is, however, very uncertain. While
the population may include intellectually unimpaired
individuals with a firm diagnosis of autism (Nettlebeck
& Young, 1996), many musical savants are visually
impaired and intellectually handicapped (Miller, 1999),
and unsuited to testing with standardized diagnostic
instruments. Other studies investigating the existence
of enhanced pitch processing in autism and its links
with savant skills (e.g., Bonnel et al., 2003; Heaton, 2003;
Heaton, Hermelin, & Pring, 1998; Heaton, Pring, &
Hermelin, 1999; Mottron, Peretz, Belleville, & Rouleau,
1999) have mostly been carried out with intellectually
able individuals, and the extent to which these findings
can be generalized to the wider population is unclear.
Those experimental studies that have directly tested
appreciation of higher-order aspects of music in wider
autism populations have focused on musical emotions.
In the first of these studies, Heaton, Hermelin, and
Pring (1999) showed that children with autism under-
stood the affective connotations of musical mode suffi-
ciently well to be able to pair schematic representations
of happy and sad faces with excerpts of music in major
and minor keys. In a more recent study (Heaton, Allen,
Williams, Cummins, & Happé, 2008), typically devel-
oping children, and children with Down syndrome and
ASD matched musical excerpts with pictures denoting
a range of affective and non-affective scenarios.
Interestingly, the findings from the latter study showed
that this ability was mediated by verbal mental age
rather than diagnosis. However, a limitation of both of
these studies is that they specifically tested the ability to
make conventional musical associations, and as such,
provided few insights into the nature of the partici-
pants’ personal musical experiences.
Other, non-experimental investigations into the
broader impact of music in autistic populations have
explored the value of music in a therapeutic context.
Authors sympathetic to the value of music therapy have
reviewed the evidence for its effectiveness. Based on a
meta-analysis of nine quantitative studies, Whipple
(2004) suggested that music therapy achieves positive
effects in children and adolescents with autism.
Another review by Wigram and Gold (2006) stated that
there was evidence that music had notable effects in
promoting interpersonal communication and relation-
ship-building skills in children with ASD.
A question that must be addressed when considering
the efficacy of music therapy in autism relates to the
locus of effects. Are positive outcomes an indirect con-
sequence of group participation or positive interactions
with therapists? It has been suggested that individuals
with autism are insensitive to the emotional aspects of
music (Levitin, 2006), and evidence from music ther-
apy does not in itself refute such a claim. One line of
evidence that has relevance to the subject of musical
responsiveness in atypical populations comes from
neuroimaging work reported by Menon and Levitin
(2005). This suggests that the three interconnected
structures in the brain (the nucleus accumbens, ventral
tegmental area, and hypothalamus) involved in the
dopaminergic reward system play an important role
in regulating emotional responses to music. Menon
and Levitin proposed that music could therefore be
used as a probe to test for anhedonia, the loss of pleas-
ure in daily activities, in patients suffering from clini-
cal conditions such as depression and schizophrenia.
Responses to music—as an index of the integrity of
the reward system—could be correlated against the
severity of clinical symptoms. Given that anhedonia is
not an invariable characteristic of autism, there is no
reason to suppose that responsiveness to music is
likely to be comprehensively damaged at this funda-
mental level in all individuals with this disorder. (The
most recent and powerful study into neuroimaging
work on reward circuit activation in music that con-
firms and extends the conclusions reported above, was
reported by Salimpoor, Benovoy, Longo, Cooperstock,
& Zatorre, 2009).
One theory put forward to explain addictive, impul-
sive, or compulsive behavior, including that sometimes
observed in autism, is that it results from a reduction in
the number of dopamine D-2 receptors in the brains
reward circuit, which leads to dysfunctional behavioral
compensation (Blum et al., 2000). The pervasive nature
of the neurological effects of autism means that the
presence of compulsive behaviors could well reflect a
compromised reward system in some individuals.
However, recent attempts to detect a genetic link
between autism and defects in the reward circuit by
examining the NrCAM gene failed to show any clear
association (Sakurai et al., 2006). These data further
increase the likelihood that a relatively unimpaired
capacity to appreciate music will be characteristic of
individuals with autism.
252
Rory Allen & Pamela Heaton
Music2704_02 3/25/10 9:38 AM Page 252

The Role of Music in the Lives of High-Functioning
Adults with ASD
In recent years there have been a number of studies that
have focused on the complexities of how normal popu-
lations of children or adults engage with music in their
everyday lives (e.g., Batt-Rawden & DeNora, 2005,
DeNora, 2002, Lamont, 2008). Some writers have sug-
gested that the pace of technical change in the delivery
of music means that it is now a resource rather than a
commodity, and can be used in different situations for
a variety of purposes including mood management
(North, Hargreaves, & O’Neill, 2000). These new
approaches to studying the psychology of music offer a
potentially fruitful way of looking at how autistic peo-
ple use music in their everyday lives.
In the first study adopting this exploratory approach,
Allen, Hill, and Heaton (2009) used a semi-structured
questionnaire to obtain information about the musical
experiences of high-functioning adults on the autism
spectrum. The transcribed interviews were analyzed
using NVivo7 (QSR International, 2006), a computer-
ized aid to qualitative data analysis, employing an
approach based on Grounded Theory (Glaser &
Strauss, 1967). While many high-functioning adults
with ASD obtain good scores on standardized tests of
language, semantic and pragmatic difficulties are nev-
ertheless widespread in this group (e.g., Jolliffe &
Baron-Cohen, 1999). This means that direct question-
ing may not always be the most effective way of elicit-
ing information. However, in some instances this
approach can effectively be used with adults with high-
functioning autism or Asperger syndrome (Hill, Sally,
& Frith, 2004). While we acknowledged that conclu-
sions drawn from such a sample may not generalize to
the whole ASD population, we predicted that direct
questioning could at least provide insights into the
experiences of the individuals who were able to take
part in our study. In fact, our participants readily
responded to our questions and we learned that their
uses of music were remarkably similar to those
reported in the literature on typical adults and adoles-
cents (e.g., North, Hargreaves, & Hargreaves, 2004;
North et al., 2000). These uses included self-manage-
ment for depression, mood change, and social affiliation.
Notable among the responses were those of individuals
who acknowledged their social deficits, craved social
contact, and used music to meet unfulfilled social and
emotional needs, among them a sense of belonging to a
wider music-loving community, or simply that of being
one of a large number of people buying a particular
hit record.
There was, however, one striking difference between
the responses of the autistic adults who participated in
our study (Allen et al., 2009) and those of the typi-
cally developing individuals reported in the literature.
Those without autism describe their mood changes in
response to music as lying along two axes, the first of
which is ‘valence, i.e., happy/sad, and the second of
which is ‘arousal’ (Bigand, Vieillard, Madurell,
Marozeau, & Dacquet, 2005). In contrast, the partici-
pants in our autism sample showed almost no use of
valence terms, and instead used descriptors of states
lying along two dimensions of arousal, with
calmness/tension as opposite poles of one axis, and
excitement or exhilaration as the desired state on the
other axis. While they reacted to the aesthetic qualities
of music, they tended to describe these as properties of
the music, rather than in terms of the emotional reac-
tions that they evoked.
This suggests similarities with a model described by
Thayer (1978), which expands the traditional concept
of arousal from one to two dimensions. Thayer’s model
can equally well be interpreted as a mood state rather
than an arousal model, and we chose to look at it that
way. Thayer identified dimensions of vigour/tiredness,
and of tension/placidity. The latter clearly maps onto a
tension/calmness dimension that emerged in the analy-
sis of the data from the high-functioning autistic indi-
viduals who participated in our qualitative music study.
Some of them described how they used music specifi-
cally to ease anxieties and reduce stress. Items from our
study that corresponded to Thayer’s vigour/tiredness
axis included statements about the use of music to
induce states of excitement or exhilaration.
The findings of Allen et al. (2009) that their ASD
group described their responses to music in terms of
internal arousal states rather than valence terms, is
consistent with work by Capps, Yirmiya, and Sigman
(1992) and Bormann-Kischkel, Vilsmeier, and Baude
(1995). In these studies, autistic participants showed
specific recognition impairments in response to facial
emotions (e.g., embarrassment or surprise) that had
an external locus of control, thereby requiring knowl-
edge about social scripts. The findings are understand-
able in the light of Bowler’s suggestions (2007) that
“individuals with ASD seem to engage in less top-
down processing when making perceptual judgements,
that is to say, their reactions to the world are based on
information that is closer to the properties of the
incoming stimulus (p. 246). Attributing emotional
characteristics to music would seem to involve more
top-down processing than describing changes in inter-
nal arousal.
Therapeutic Potential of Music in Alexithymia 253
Music2704_02 3/25/10 9:38 AM Page 253

To summarize, the first scientifically rigorous studies
specifically designed to investigate musical appreciation
in high-functioning individuals on the autism spec-
trum have revealed a well developed ability to react
with pleasure and appreciation to music. There is clear
evidence that on the autism spectrum are sensitive to
music’s emotional and social dimensions. However,
they do appear to experience some limitations in ver-
bally describing their emotional experiences, and this
appears to be associated with their more generalized
communication difficulties.
Autism and Alexithymia
The unusual way in which high-functioning adults with
autism described their affective reactions to music (Allen
et al., 2009) indicates the presence of the phenomenon of
alexithymia. Alexithymia, or being “without words for
emotions, implicates a cluster of cognitive and affective
components in a specific type of emotional dysregula-
tion. Central to alexithymia are difficulties in identifying
and describing feelings and difficulties in distinguishing
feelings from the bodily sensations of emotional arousal
(Hill, Berthoz, & Frith, 2004).
Alexithymia is a common condition in ASD, possibly
affecting as many as 85% of individuals (Hill, Berthoz,
& Frith, 2004). It should be noted however that alex-
ithymia is common in a range of other disorders,
including post-traumatic stress disorder (PTSD),
anorexia, bulimia, major depressive disorder, and panic
disorder, as well as among substance abusers. Two vari-
ants of alexithymia have been described with admirable
parsimony as types I and II (Bailey & Henry, 2007).
Individuals with type I fail to experience or describe
emotions, whereas those with type II show a normal or
high degree of conscious awareness of emotions but a
reduced capacity to cognitively appraise them. In other
words, the person with type II alexithymia may experi-
ence a relatively normal range of emotions, but will
have a deficit in the ability to label or identify them or
discriminate between their own internal emotional
states. This latter type of alexithymia is the one most
commonly observed in ASD (Berthoz & Hill, 2005).
Research comparing ASD and typical participants
has shown that higher levels of alexithymia are associ-
ated with higher levels of depression in ASD. It is
known that depression and alexithymia are correlated
in the general population, though to date, group sizes
have been too small to show such an effect within an
ASD sample (Berthoz & Hill, 2005). However, it is
plausible to suggest that there may be a causal link
from alexithymia to depression and anxiety, given that
sufferers are confused by the nature of their negative
internal feelings, and are therefore unable to identify their
causes. A second related characteristic of alexithymia is
that sufferers are unable to regulate their emotions. The
philosopher Spinoza believed that an emotion which is
a passion ceases to be a passion as soon as we form a
clear and distinct idea of it” (as cited in Russell, 1961,
p. 557). The processes of naming emotions enables the
individual to attribute a cause to the feelings he or she
is experiencing. For Spinoza, unlabelled passions are
both negative and destructive, and this labelling process
diminishes the power of our passions to do us harm.
To the extent that a persons internal emotional state
influences their behavior in social situations, alex-
ithymia also can contribute to the core deficits in social
functioning that are characteristic of ASD. This is
because an inability to identify one’s own mood state
means that one cannot make allowances for the effect
of this internal state on one’s behavior towards others.
Moreover, even if in some cases people with autism
retain some sensitivity to social situations and can
respond to them with appropriate changes of mood
(e.g., with anger in response to frustration or belittle-
ment), an inability to cognitively label these mood
changes may further increase levels of arousal, resulting
in inappropriate responses or damaging overreactions.
One high-functioning individual recently reported to
us that when under stress she often felt as though the
lights were going out inside me but had no way of
identifying or understanding the negative emotions
that were causing this feeling.
A recent quantitative study (Allen & Hill, 2010) fur-
ther investigated differences between autistic and typical
adults in their use of language to describe their emo-
tional reactions to music. All participants were screened
for alexithymia using the self-report measures TAS-20
(Bagby, Parker, & Taylor, 1994) and BVAQ (Vorst &
Bermond, 2001). Scores on these measures were signifi-
cantly higher for the ASD group than for the control
group. The musical stimuli used in the experiment were
previously piloted on a control group and expressed
happiness, sadness and fear. A list of the 14 most com-
mon musical descriptor items (drawn from a pilot study
with typical controls) were combined with an equal
number of the words that had been used by the high-
functioning autistic adults in the qualitative study
(Allen et al., 2009) to describe their typical reactions to
music. Participants were asked to tick any of the 28
words that described their emotional responses to the
musical passages they heard. It was emphasized that the
emotion(s) checked must be one(s) evoked in them,
rather than being simple descriptions of the music.
254
Rory Allen & Pamela Heaton
Music2704_02 3/25/10 9:38 AM Page 254

Two findings emerged from this study. First, consis-
tent with a predicted effect resulting from alexithymia,
the autism group used significantly fewer words over-
all to describe their feelings in response to the music
than the control group. However, the second result
contradicted our expectations. There was no clear ten-
dency for the autism group to prefer words describing
internal arousal states to more externally focused
words such as hopeful,“wistful, and “sad. One inter-
pretation of this finding is that people with autism are
able to understand and use a wider range of emotion
words when they are specifically cued.
The Induction of Emotion by Music (1):
Levinsons (2006) “Persona” Theory
and Theories of Empathy
Before considering interventions aimed at remediating
alexithymia using music, it is necessary to briefly exam-
ine the extensive literature (see e.g., Juslin & Sloboda,
2001) involving the debate between psychologists, musi-
cologists, and philosophers of music as to how, and even
whether, music can induce genuine emotions. Despite
numerous studies claiming to demonstrate that music
induces changes in affective states, heated exchanges
over the issue of whether or not these changes can legit-
imately be classified as emotions” continue to rage.
Philosophers of music tend to emphasize the reality of
the aesthetic as opposed to the emotional impact of
music. Without becoming too deeply involved in this
discussion, it has occurred to us that linking the issue to
an active research area in another discipline—whose
connection with it appears to have been overlooked—
may serve to reconcile these polarized positions and
increase our understanding of the problem.
A distinguished philosopher of music, Jerrold
Levinson, has suggested (Levinson, 2006) that we per-
ceive emotions in music by imagining the existence of
a musical “persona through which these emotions are
expressed. Taking these ideas as our present basis for
theorizing about music, it is plausible to suggest that
we perceive emotion in this “persona in the same way
that we perceive emotions in people; in other words,
using empathy. The simulation theory of empathy, as
persuasively outlined by Goldman and Sripada (2005),
proposes that we perceive the emotion in a persons
face (to take only the visual modality) by simulating
(and generating) the same emotion in ourselves at a
subconscious level, a process likely involving the mir-
ror neuron system. If we can generalize this theory to
music, the distinction between emotions perceived in
music and emotions evoked in the listener by music
may be more apparent than real. If the simulation the-
ory of empathy is correct, both interpretations may be
true. We perceive the emotions in the musical persona
and experience the emotions as part of the very process
of perception. While there is as yet little firm evidence
in favor of this idea, it is a fruitful area for further
investigation.
The Induction of Emotion by Music (2):
“Supernormal Stimuli” and
“Superexpressive Voices”
Of relevance also to the debate on emotion and music is
the work of Ramachandran and Hirstein (1999) on the
neuroscience of art. While a number of professional
sociologists and philosophers of aesthetics were hostile
to what they perceived as the “reductionist” tone of the
essay, the ideas outlined in the paper are entirely consis-
tent with views outlined by Aldous Huxley in his book
“Heaven and Hell” (2004), in which Huxley reflects
on his experiences of taking the hallucinogenic drug
mescaline. We particularly note similarities between
Ramachandran and Hirsteins (1999) theory of the use
of supernormal stimuli” for artistic effect, and Huxley’s
description of an interior world of extreme sensations in
the “mental antipodes” describing “praeternatural light,
praeternatural intensity of coloring and praeternatural
significance” (pp. 61-88). Huxley believed he had gained
direct access to this internal world through the use of
mescaline, but considered that artists through the ages
had aimed at stimulating the same brain areas visually,
by a process of abstraction and exaggeration.
The consistency between Huxley’s (2004) ideas and the
theory elaborated, in scientific detail, by Ramachandran
and Hirstein (1999), are an encouraging sign that the
current polarization between those who write about sci-
ence and art is not inevitable. Importantly, such ideas
may enable us to develop new ways of thinking about
music. Taking for example the idea that musical instru-
ments represent emotionally expressive sounds of human
or animal origin (“superexpressive voices”; Juslin, 2001),
we can draw parallels with visual art, in which certain
characteristics of light, color, and form are exaggerated.
In both music and visual art emotions may exemplify or
represent simplified, exaggerated, and indeed purified
versions of the emotions evoked in real life. Of course,
everyday emotions are rarely if ever simple. In the same
way that the colors of objects are always a mixture of
spectral components of different wavelengths, emotions
are grounded in the complexity of real life situations and
comprise many different cognitive and physiological ele-
ments. By contrast, techniques of composition may allow
Therapeutic Potential of Music in Alexithymia 255
Music2704_02 3/25/10 9:38 AM Page 255

Citations
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Journal ArticleDOI
TL;DR: The problem of which cues, internal or external, permit a person to label and identify his own emotional state has been with us since the days that James first tendered his doctrine that "the bodily changes follow directly the perception of the exciting fact".
Abstract: The problem of which cues, internal or external, permit a person to label and identify his own emotional state has been with us since the days that James (1890) first tendered his doctrine that \"the bodily changes follow directly the perception of the exciting fact, and that our feeling of the same changes as they occur is the emotion\" (p. 449). Since we are aware of a variety of feeling and emotion states, it should follow from James' proposition that the various emotions will be accompanied by a variety of differentiable bodily states. Following James' pronouncement, a formidable number of studies were undertaken in search of the physiological differentiators of the emotions. The results, in these early days, were almost uniformly negative. All of the emotional states experi-

1,828 citations

Journal ArticleDOI
TL;DR: Functional neuroimaging studies on music and emotion show that music can modulate activity in brain structures that are known to be crucially involved in emotion, such as the amygdala, nucleus accumbens, hypothalamus, hippocampus, insula, cingulate cortex and orbitofrontal cortex.
Abstract: Music is a universal feature of human societies, partly owing to its power to evoke strong emotions and influence moods. During the past decade, the investigation of the neural correlates of music-evoked emotions has been invaluable for the understanding of human emotion. Functional neuroimaging studies on music and emotion show that music can modulate activity in brain structures that are known to be crucially involved in emotion, such as the amygdala, nucleus accumbens, hypothalamus, hippocampus, insula, cingulate cortex and orbitofrontal cortex. The potential of music to modulate activity in these structures has important implications for the use of music in the treatment of psychiatric and neurological disorders.

752 citations

Journal ArticleDOI
TL;DR: It is argued that, where observed, emotional impairments are due to alexithymia—a condition that frequently co-occurs with autism—rather than a feature of autism per se, and has wide-reaching implications for the study of autism.
Abstract: It is widely accepted that autism is associated with disordered emotion processing and, in particular, with deficits of emotional reciprocity such as impaired emotion recognition and reduced empathy. However, a close examination of the literature reveals wide heterogeneity within the autistic population with respect to emotional competence. Here we argue that, where observed, emotional impairments are due to alexithymia-a condition that frequently co-occurs with autism-rather than a feature of autism per se. Alexithymia is a condition characterized by a reduced ability to identify and describe one's own emotion, but which results in reduced empathy and an impaired ability to recognize the emotions of others. We briefly review studies of emotion processing in alexithymia, and in autism, before describing a recent series of studies directly testing this 'alexithymia hypothesis'. If found to be correct, the alexithymia hypothesis has wide-reaching implications for the study of autism, and how we might best support subgroups of autistic individuals with, and without, accompanying alexithymia. Finally, we note the presence of elevated rates of alexithymia, and inconsistent reports of emotional impairments, in eating disorders, schizophrenia, substance abuse, Parkinson's Disease, multiple sclerosis and anxiety disorders. We speculate that examining the contribution of alexithymia to the emotional symptoms of these disorders may bear fruit in the same way that it is starting to do in autism.

429 citations

Journal ArticleDOI
TL;DR: A mechanistic cognitive model of empathy is delineated to provide a framework within which neuroimaging work on empathy can be located, and which may be used in order to understand various disorders characterised by atypical levels of empathy.

334 citations


Cites background from "Autism, Music, and the Therapeutic ..."

  • ...It is possible that forming these low-level associations may therefore be a useful therapeutic approach for those with Type 2 alexithymia (Allen & Heaton, 2010), but would be unavailable for those with Type 1 alexithymia....

    [...]

  • ...The sources of learning by which such links may be formed have been delineated elsewhere (e.g. Heyes, 2001; Allen & Heaton, 2010; Heyes, 2010) and include: direct self-observation (the infant feels happy and laughs, enabling the affective state of being happy to be associated with the sound of a…...

    [...]

Journal ArticleDOI
20 Oct 2014-PLOS ONE
TL;DR: This is the first comprehensive survey of music-evoked sadness, revealing that listening to sad music can lead to beneficial emotional effects such as regulation of negative emotion and mood as well as consolation.
Abstract: This study explores listeners' experience of music-evoked sadness. Sadness is typically assumed to be undesirable and is therefore usually avoided in everyday life. Yet the question remains: Why do people seek and appreciate sadness in music? We present findings from an online survey with both Western and Eastern participants (N = 772). The survey investigates the rewarding aspects of music-evoked sadness, as well as the relative contribution of listener characteristics and situational factors to the appreciation of sad music. The survey also examines the different principles through which sadness is evoked by music, and their interaction with personality traits. Results show 4 different rewards of music-evoked sadness: reward of imagination, emotion regulation, empathy, and no "real-life" implications. Moreover, appreciation of sad music follows a mood-congruent fashion and is greater among individuals with high empathy and low emotional stability. Surprisingly, nostalgia rather than sadness is the most frequent emotion evoked by sad music. Correspondingly, memory was rated as the most important principle through which sadness is evoked. Finally, the trait empathy contributes to the evocation of sadness via contagion, appraisal, and by engaging social functions. The present findings indicate that emotional responses to sad music are multifaceted, are modulated by empathy, and are linked with a multidimensional experience of pleasure. These results were corroborated by a follow-up survey on happy music, which indicated differences between the emotional experiences resulting from listening to sad versus happy music. This is the first comprehensive survey of music-evoked sadness, revealing that listening to sad music can lead to beneficial emotional effects such as regulation of negative emotion and mood as well as consolation. Such beneficial emotional effects constitute the prime motivations for engaging with sad music in everyday life.

154 citations


Cites background from "Autism, Music, and the Therapeutic ..."

  • ...of empathy), even in the absence of a specific emotional vocabulary [89]....

    [...]

References
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11 Jun 2013

113,134 citations

Journal ArticleDOI
TL;DR: An issue concerning the criteria for tic disorders is highlighted, and how this might affect classification of dyskinesias in psychotic spectrum disorders.
Abstract: Given the recent attention to movement abnormalities in psychosis spectrum disorders (e.g., prodromal/high-risk syndromes, schizophrenia) (Mittal et al., 2008; Pappa and Dazzan, 2009), and an ongoing discussion pertaining to revisions of the Diagnostic and Statistical Manuel of Mental Disorders (DSM) for the upcoming 5th edition, we would like to take this opportunity to highlight an issue concerning the criteria for tic disorders, and how this might affect classification of dyskinesias in psychotic spectrum disorders. Rapid, non-rhythmic, abnormal movements can appear in psychosis spectrum disorders, as well as in a host of commonly co-occurring conditions, including Tourette’s Syndrome and Transient Tic Disorder (Kerbeshian et al., 2009). Confusion can arise when it becomes necessary to determine whether an observed movement (e.g., a sudden head jerk) represents a spontaneous dyskinesia (i.e., spontaneous transient chorea, athetosis, dystonia, ballismus involving muscle groups of the arms, legs, trunk, face, and/or neck) or a tic (i.e., stereotypic or patterned movements defined by the relationship to voluntary movement, acute and chronic time course, and sensory urges). Indeed, dyskinetic movements such as dystonia (i.e., sustained muscle contractions, usually producing twisting and repetitive movements or abnormal postures or positions) closely resemble tics in a patterned appearance, and may only be visually discernable by attending to timing differences (Gilbert, 2006). When turning to the current DSM-IV TR for clarification, the description reads: “Tic Disorders must be distinguished from other types of abnormal movements that may accompany general medical conditions (e.g., Huntington’s disease, stroke, Lesch-Nyhan syndrome, Wilson’s disease, Sydenham’s chorea, multiple sclerosis, postviral encephalitis, head injury) and from abnormal movements that are due to the direct effects of a substance (e.g., a neuroleptic medication)”. However, as it is written, it is unclear if psychosis falls under one such exclusionary medical disorder. The “direct effects of a substance” criteria, referencing neuroleptic medications, further contributes to the uncertainty around this issue. As a result, ruling-out or differentiating tics in psychosis spectrum disorders is at best, a murky endeavor. Historically, the advent of antipsychotic medication in the 1950s has contributed to the confusion about movement signs in psychiatric populations. Because neuroleptic medications produce characteristic movement disorder in some patients (i.e. extrapyramidal side effects), drug-induced movement disturbances have been the focus of research attention in psychotic disorders. However, accumulating data have documented that spontaneous dyskinesias, including choreoathetodic movements, can occur in medication naive adults with schizophrenia spectrum disorders (Pappa and Dazzan, 2009), as well as healthy first-degree relatives of chronically ill schizophrenia patients (McCreadie et al., 2003). Taken together, this suggests that movement abnormalities may reflect pathogenic processes underlying some psychotic disorders (Mittal et al., 2008; Pappa and Dazzan, 2009). More specifically, because spontaneous hyperkinetic movements are believed to reflect abnormal striatal dopamine activity (DeLong and Wichmann, 2007), and dysfunction in this same circuit is also proposed to contribute to psychosis, it is possible that spontaneous dyskinesias serve as an outward manifestation of circuit dysfunction underlying some schizophrenia-spectrum symptoms (Walker, 1994). Further, because these movements precede the clinical onset of psychotic symptoms, sometimes occurring in early childhood (Walker, 1994), and may steadily increase during adolescence among populations at high-risk for schizophrenia (Mittal et al., 2008), observable dyskinesias could reflect a susceptibility that later interacts with environmental and neurodevelopmental factors, in the genesis of psychosis. In adolescents who meet criteria for a prodromal syndrome (i.e., the period preceding formal onset of psychotic disorders characterized by subtle attenuated positive symptoms coupled with a decline in functioning), there is sometimes a history of childhood conditions which are also characterized by suppressible tics or tic like movements (Niendam et al., 2009). On the other hand, differentiating between tics and dyskinesias has also complicated research on childhood disorders such as Tourette syndrome (Kompoliti and Goetz, 1998; Gilbert, 2006). We propose consideration of more explicit and operationalized criteria for differentiating tics and dyskinesias, based on empirically derived understanding of neural mechanisms. Further, revisions of the DSM should allow for the possibility that movement abnormalities might reflect neuropathologic processes underlying the etiology of psychosis for a subgroup of patients. Psychotic disorders might also be included among the medical disorders that are considered a rule-out for tics. Related to this, the reliability of movement assessment needs to be improved, and this may require more training for mental health professionals in movement symptoms. Although standardized assessment of movement and neurological abnormalities is common in research settings, it has been proposed that an examination of neuromotor signs should figure in the assessment of any patient, and be as much a part of the patient assessment as the mental state examination (Picchioni and Dazzan, 2009). To this end it is important for researchers and clinicians to be aware of differentiating characteristics for these two classes of abnormal movement. For example, tics tend to be more complex than myoclonic twitches, and less flowing than choreoathetodic movements (Kompoliti and Goetz, 1998). Patients with tics often describe a sensory premonition or urge to perform a tic, and the ability to postpone tics at the cost of rising inner tension (Gilbert, 2006). For example, one study showed that patients with tic disorders could accurately distinguish tics from other movement abnormalities based on the subjective experience of some voluntary control of tics (Lang, 1991). Another differentiating factor derives from the relationship of the movement in question to other voluntary movements. Tics in one body area rarely occur during purposeful and voluntary movements in that same body area whereas dyskinesia are often exacerbated by voluntary movement (Gilbert, 2006). Finally, it is noteworthy that tics wax and wane in frequency and intensity and migrate in location over time, often becoming more complex and peaking between the ages of 9 and 14 years (Gilbert, 2006). In the case of dyskinesias among youth at-risk for psychosis, there is evidence that the movements tend to increase in severity and frequency as the individual approaches the mean age of conversion to schizophrenia spectrum disorders (Mittal et al., 2008). As revisions to the DSM are currently underway in preparation for the new edition (DSM V), we encourage greater attention to the important, though often subtle, distinctions among subtypes of movement abnormalities and their association with psychiatric syndromes.

67,017 citations


"Autism, Music, and the Therapeutic ..." refers background in this paper

  • ...These results show that the triad of impairments that form current diagnostic criteria for autism in DSM-IV-TR (American Psychological Association, 2000) may be under the control of independent genetic factors, thus allowing for an even greater degree of heterogeneity than if there were a single,…...

    [...]

Book
12 Oct 2017
TL;DR: The Discovery of Grounded Theory as mentioned in this paper is a book about the discovery of grounded theories from data, both substantive and formal, which is a major task confronting sociologists and is understandable to both experts and laymen.
Abstract: Most writing on sociological method has been concerned with how accurate facts can be obtained and how theory can thereby be more rigorously tested. In The Discovery of Grounded Theory, Barney Glaser and Anselm Strauss address the equally Important enterprise of how the discovery of theory from data--systematically obtained and analyzed in social research--can be furthered. The discovery of theory from data--grounded theory--is a major task confronting sociology, for such a theory fits empirical situations, and is understandable to sociologists and laymen alike. Most important, it provides relevant predictions, explanations, interpretations, and applications. In Part I of the book, "Generation Theory by Comparative Analysis," the authors present a strategy whereby sociologists can facilitate the discovery of grounded theory, both substantive and formal. This strategy involves the systematic choice and study of several comparison groups. In Part II, The Flexible Use of Data," the generation of theory from qualitative, especially documentary, and quantitative data Is considered. In Part III, "Implications of Grounded Theory," Glaser and Strauss examine the credibility of grounded theory. The Discovery of Grounded Theory is directed toward improving social scientists' capacity for generating theory that will be relevant to their research. While aimed primarily at sociologists, it will be useful to anyone Interested In studying social phenomena--political, educational, economic, industrial-- especially If their studies are based on qualitative data.

53,267 citations

Frequently Asked Questions (7)
Q1. What are the contributions mentioned in the paper "Music2704_02" ?

However, a recent study of high-functioning adults with autism has shown that they appear to have a range of responses to music similar to typically developing people, including the deliberate use of music for mood management. Drawing on these ideas, the authors put forward suggestions for using a simple associative learning process between musically induced emotions and their cognitive correlates for the clinical treatment of alexithymia, a disorder that is common in autism and characterized by an absence of cognitive insight into one ’ s emotions. 

If the infant seldom orients to its mother’s face, and does not observe her mimicry of its expressions, links between its own internal emotional states and her facial expressions will not be formed. 

This would help participants to learn to distinguish their particular varieties of negative and positive emotions, by associating them with passages of music, so that when they experienced a feeling they could give it a music-related label. 

Research shows that social communicative cues are less salient for infants who are subsequently diagnosed with autism; for them familiar faces, in particular those of their mothers, are not salient (Dawson et al., 2002). 

They base this hypothesis on the proposal (see for example, Huron, 2001) that music evolved primarily for its value in promoting social bonding in early human society. 

In contrast, the participants in their autism sample showed almost no use of valence terms, and instead used descriptors of states lying along two dimensions of arousal, with calmness/tension as opposite poles of one axis, and excitement or exhilaration as the desired state on the other axis. 

All participants were screened for alexithymia using the self-report measures TAS-20 (Bagby, Parker, & Taylor, 1994) and BVAQ (Vorst & Bermond, 2001).