The Routledge Companion to Interdisciplinary Studies in Singing, Volume III: Wellbeing

Rachel Heydon, Daisy Fancourt, Annabel J. Cohen

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781351668521
• Edition: 1
• Topic: Media & Performing Arts
• Subtopic: Music

The Routledge Companion to Interdisciplinary Studies in Singing, Volume III: Wellbeing explores the connections between singing and health, promoting the power of singing—in public policy and in practice—in confronting health challenges across the lifespan. These chapters shape an interdisciplinary research agenda that advances singing's theoretical, empirical, and applied contributions, providing methodologies that reflect individual and cultural diversities. Contributors assess the current state of knowledge and present opportunities for discovery in three parts:

• Singing and Health
• Singing and Cultural Understanding
• Singing and Intergenerational Understanding

In 2009, the Social Sciences and Humanities Research Council of Canada funded a seven-year major collaborative research initiative known as Advancing Interdisciplinary Research in Singing (AIRS). Together, global researchers from a broad range of disciplines addressed three challenging questions: How does singing develop in every human being? How should singing be taught and used to teach? How does singing impact wellbeing? Across three volumes, The Routledge Companion to Interdisciplinary Studies in Singing consolidates the findings of each of these three questions, defining the current state of theory and research in the field. Volume III: Wellbeing focuses on this third question and the health benefits of singing, singing praises for its effects on wellbeing.

PART I

Singing and Health

1

A Logic Model For The Effects Of Singing On Health

Introduction to Part I

Daisy Fancourt

Department of Behavioural Science and Health, University College London

Katey Warran

School of Social and Political Science, University of Edinburgh

Singing is thought to be one of the earliest forms of human music and has been discussed across history in relation to our health and wellbeing (Fancourt, 2017; Mithen, 2005). However, over the last few decades, there have been major advances in our scientific understanding of the effects of singing on a range of different health conditions. As this first part of the volume will discuss, studies have found effects of singing on psychological, physiological, social, and behavioral responses, relating to outcomes from depression, dementia, lung disease, cancer, and Parkinson’s disease and in settings including hospitals, schools, communities, prisons, and hospices. Not only is singing thought to have tangible effects on specific health conditions, but specific health conditions also help to inform our understanding of singing. Take, for example, the popular book Musicophilia by Oliver Sacks (2011), which describes how case studies of people who have suffered brain lesions have been used to develop our understanding of how music affects the brain. This intrinsic, arguably inseparable, connection between health and music (and singing in particular) can make the process of identifying how and why singing affects our health challenging. Singing elicits immediate psychological, physiological, and biological responses in individuals but can also have cumulative and long-lasting effects on entire communities. Further, ‘singing’ is a highly complex social activity involving dynamic relationships with our environment and those around us. Singing involves not only the in-the-moment activity but also reminiscent and prospective thought processes. So, is it even possible to tease apart these different components, responses, and outcomes?

The chapters that follow will explore all of these issues in detail, each relating to a different aspect of our mental, physical, and social health. But in order to provide a context for these discussions, this chapter will develop a logic model that can act as a framework in which to situate our understanding of how singing affects our health.

Building a Logic Model for Singing and Health

Logic models are graphical depictions of a program’s ‘theory of change’: the relationship between interventions, components, responses, and outcomes (Frechtling, 2015). They are particularly useful for identifying causal relationships within complex systems and have enjoyed growing popularity within evaluations of both health interventions and arts programs. However, logic models are only partial representations of a complex system: not reality itself. As such, they cannot include every possible element involved in the system. Further, they offer no guarantee that by following the ‘ingredients’ presented, the responses and outcomes depicted will be achieved. What they do offer, though, is an initial depiction and matrix of relationships and a springboard for deeper discussions. Thus, for the purposes of Part I, logic models provide a helpful starting point.

Outcomes

In building logic models, it might be tempting to start ‘at the beginning’ with an activity. But in fact starting ‘at the end’ with a problem that needs to be solved can provide greater focus and clarity. How to support ‘good health’ is a major global challenge. Over the last century, the major health problems facing developed countries have focused increasingly on mental health and non-communicable diseases (NCDs) such as cancers, dementias, and respiratory diseases (Beaglehole et al., 2011). These health conditions are all bi-directionally inter-related, with mental illness known to increase the risk of NCDs (both through underlying biological mechanisms and through increasing health-impairing behaviors) and NCDs known to predict poor mental health (Whiteford et al., 2013). Traditionally, much of the focus has been on the treatment for people with these health conditions or the broader care that can be offered to them. But, over the last few decades, there has also been increasing emphasis on prevention of illness through reducing core physical risk factors (physical inactivity, alcohol, tobacco use, sodium intake, high blood pressure, obesity, and diabetes), reducing inequalities, and promoting good health and wellbeing (Pryor, Silva, & Melchior, 2017). The improved prevention of these conditions, their enhanced treatment, and the provision of more supportive care for people affected provide the ‘outcomes’ in our logic model (see Figure 1.1).

Figure 1.1 A logic model for singing and health: interventions, components, responses and outcomes.

NCDs and mental illnesses are complex health conditions, involving a range of different psychological, physiological, social, and behavioral components: No one type of intervention in itself can provide a complete solution. Consequently, research into prevention, treatment, and care involves focusing on multiple components through many parallel interventions. This provides an opportunity for singing interventions as they can provide support alongside other traditional medical interventions and other complementary interventions. As a result, research into singing and health tends to focus on the specific psychological, physiological, social, and behavioral processes that are known to affect the onset and progression of mental and physical health conditions. Some of these target processes (hereafter referred to as ‘responses’) are outlined below.

Responses

Linking Psychological Responses to Health Outcomes

There are a range of psychological responses that are linked with mental and physical illness. For example, stress is a well-known risk factor for the onset and progression of a range of health conditions, including cardiovascular disease (Steptoe & Kivimäki, 2012) and cancers (Chida, Hamer, Wardle, & Steptoe, 2008). Additionally, activities that are cognitively stimulating are known to be associated not only with a lower risk of developing dementias but also bi-directionally with mental health conditions such as depression (Kaser, Zaman, & Sahakian, 2017). There is also a wealth of research linking wellbeing and life satisfaction with mental and physical health, including lower risk of premature mortality (Martín-María et al., 2017).

Linking Physiological Responses to Health Outcomes

Physiological responses are also linked in with mental and physical health, often providing critical links between psychological or social responses and health. For example, crucial to the link between stress and disease are both stress hormones and inflammation, which can provide biological pathways connecting stress and health (Steptoe, Hamer, & Chida, 2007). Both can have suppressive effects on the immune system (Segerstrom & Miller, 2004), and are also associated with depression (Dowlati et al., 2010), which in turn is associated with other mental and physical health conditions. Cardiovascular factors such as heart rate and blood pressure are linked with a range of NCDs, in particular stroke, heart disease, and dementia (Lewington, Clarke, Qizilbash, Peto, & Collins, 2002). And lung function along with other biological markers including inflammation and body mass index are key responses related to physical health conditions such as lung disease (Cazzola et al., 2008).

Linking Social Responses to Health Outcomes

There has been increasing recognition over the last few decades of how social responses are linked in with mental and physical health. Loneliness and low social support are linked with adverse physiological responses, cognitive decline, functional and motor decline, mental illness, and premature mortality (Boss, Kang, & Branson, 2015; Steptoe, Shankar, Demakakos, & Wardle, 2013). Discrimination and minority group status are also linked with mental illness and a range of other health conditions including cardiovascular disease, respiratory conditions, and indicators of illness such as pain and headaches (Pascoe & Richman, 2009). These effects are partly due to the impact that discrimination and minority status have on health behaviors, other social responses, and psychophysiological responses such as stress (Pascoe & Richman, 2009).

Linking Behavioral Responses to Health Outcomes

Finally, a range of behavioral responses are linked with mental and physical health. Sedentary behaviors are associated with a range of conditions including chronic pain, depression, and dementia (Hamer & Stamatakis, 2014), while health-promoting behaviors such as a healthy diet and not smoking or drinking too much alcohol are linked with lower risk of mortality from cardiovascular disease and cancer (Wang et al., 2014). Similarly, health-focused behaviors such as taking medication and visiting the doctor for check-ups or screening are associated with a lower risk of mortality and better control of pre-existing health conditions (Simpson et al., 2006). More broadly, being of higher economic status and living in an area with low levels of poverty and crime are also linked in with improved mental and physical health (Marmot, 2005).

Consequently, a range of psychological, physiological, social, and behavioral responses are linked with prevention, treatment, and care for physical and mental health conditions. But how can singing affect these responses? Over the past few decades, research on singing has explored the far-reaching effects of singing on different components of our health. While a comprehensive list is beyond the scope of this chapter, a number of the key responses that have been shown to play key roles in mental and physical health and have been researched in relation to singing are shown in Figure 1.1 and discussed below. These constitute the ‘responses’ section of our logic model.

Psychological Responses to Singing

Singing is an effective way of regulating emotions (Dingle, Williams, Jetten, & Welch, 2017). It has been found to reduce psychological stress and anxiety including in professional and amateur singers, and among those with and without health conditions, over individual sessions and longitudinally (Coulton, Clift, Skingley, & Rodriguez, 2015; Fancourt et al., 2015; Fancourt et al., 2016). It has also been found to reduce symptoms of depression in different populations (Coulton et al., 2015; Fancourt & Perkins, 2018a). In relation to positive psychological measures, singing has also been found to increase quality of life and both hedonic wellbeing (relating to subjective experiences of happiness and life satisfaction) and eudemonic wellbeing (relating to self-realization and purpose) (Daykin et al., 2018). Singing additionally increases self-esteem, self-efficacy, and sense of agency among participants (Warran, Fancourt, & Wiseman, 2019; Williams, Dingle, & Clift, 2018). It also helps individuals develop resilience and coping skills (Gale, Enright, Reagon, Lewis, & van Deursen, 2012; Warran, Fancourt, & Wiseman, 2019), and provides a form of cognitive stimulation (Peretz, Gagnon, Hébert, & Macoir, 2004).

Physiological Responses to Singing

Singing has been found to lower stress hormones such as cortisol (Fancourt, Aufegger, & Williamon, 2015; Fancourt et al., 2016; Fancourt & Perkins, 2018b). It has also been found to increase levels of chemical proteins in the immune system and been linked with lowered levels of inflammation (Fancourt et al., 2016). Singing has been found to affect other physiological measures too, such as reducing blood pressure and affecting heart rate (Müller, Delius, & Lindenberger, 2018; Vickhoff et al., 2013). It has further been found to affect perception of pain and active coping with pain (Kenny & Faunce, 2004).

Social Responses to Singing

Singing has been found to lead to enhanced social bonding among mothers and babies, and children and adults (Fancourt & Perkins, 2018b; Pearce, Launay, & Dunbar, 2015). Singing has also been found to enhance social support and help to reduce loneliness (Dingle, Brander, Ballantyne, & Baker, 2013; Fancourt et al., 2016; Perkins, Yorke, & Fancourt, 2018). Relatedly, singing can enhance social capital (the tangible elements of our communities), supporting social cohesion both in the community and in specific settings such as prisons (Jeannotte, 2003; Silber, 2005). Singing provides people with a sense of social purpose (Livesey, Morrison, Clift, & Camic, 2012). It also gives a voice to minority groups and can help to reduce discrimination (Bailey & Davidson, 2001).

Behavioral Responses to Singing

In relation to behavioral research, less has been explored as to the effects of singing. Nevertheless, studies have suggested that singi...

Table of contents

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of Illustrations
• Notes on Contributors
• Foreword
• Preface: Singing – The Challenge of Interdisciplinarity
• Note about Ancillary Website
• Acknowledgments
• List of Abbreviations
• Introduction Singing and Wellbeing – Harnessing the Power of Singing
• PART I: Singing and Health
• PART II: Singing and Cultural Understanding
• PART III: Singing and Intergenerational Understanding
• Conclusion: Singing and Wellbeing – From Research to Advocacy
• Index