What is the evidence base for sound therapy?
Does it work to heal and improve health and wellness?
This article addresses these issues and outlines a strategy to help make sound therapy treatments more effective.
The ‘conventional’ medical professional is characterised by a reliance on what is called ‘evidence-based medicine’. This term first appeared in print in 1892 though the movement took hold in the mid-20th century.
It is based on the belief that evidence-based medicine empowers doctors by providing them with the most reliable information, and therefore it benefits patients by increasing the likelihood that they will receive the most appropriate treatment.
The evidence is gathered by carrying out randomised controlled trials and publishing the results in respected peer-reviewed journals. There is now a growing consensus about what factors constitute a high-quality trial for drugs, devices and therapeutic techniques.
The key factors are:
- Having a large number of participants in the trial
- Assigning the participants randomly to test and control groups
- Using a placebo or sham – something that looks and feels the same as the item being tested, but is in fact inert e.g. if a drug being tested is blue with a red circle on it, then a ‘sugar pill’ also will be administered that will be the same size and shape, blue with a red circle.
- Double blinding – i.e. neither the participants nor the doctors / therapists know whether they are administering the real or placebo
- Standardising the treatment context and process to reduce the number of variables that could affect results
In recent years, it has been recognised that many trials that have been carried out do not match these standards and so are regarded as being of limited reliability and validity. In practice this means that different trials of the same drug, device or technique have produced different results. This has led to the realisation that it is perhaps unwise to rely too heavily on the results of any one trial.
Over the past 10 years or so there has been a movement towards systematic reviews and meta-analyses of multiple trials relating to the impacts on a particular health issue from a drug, devise or technique. In these reviews and analyses, trials that do not meet defined quality standards are excluded. As a result the findings of these studies are treated with the greatest of respect by the medical professional, and are generally used to guide treatment protocols by doctors / physicians.
In this approach, one of the main questions asked is: “Does this particular drug / device / technique have greater positive effects on the particular health issue than a placebo?”
This is done in an attempt to discount the power inherent in the belief in the minds of participants that if they take the drug / device / technique then they will get better – the so-called ‘placebo response’. In other words the main object of these systematic reviews and meta-analyses is to discover whether there is something of value over and above the placebo effect. If there is, then the drug / device / technique is regarded as being effective to a greater or lesser extent.
The movement for systematic reviews and meta-analyses has included assessments of some of the more prevalent complimentary and alterative medicines (CAMs), as well as conventional ones.
Acupuncture, homeopathy, chiropractic and herbal medicine are the most prevalent CAMs and they have been the most studied.
Please see below an example of a recently published meta-analysis on the effectiveness of acupuncture in treating chronic pain, published by the US National Centre for Complementary and Alternative Medicine (NCCAM), one of the 27 agencies of the US National Institutes for Health.
Acupuncture May Be Helpful for Chronic Pain: A Meta-Analysis
A recent NCCAM-funded study, employing individual patient data meta-analyses and published in the Archives of Internal Medicine, provides the most rigorous evidence to date that acupuncture may be helpful for chronic pain. In addition, results from the study provide robust evidence that the effects of acupuncture on pain are attributable to two components. The larger component includes factors such as the patient’s belief that treatment will be effective, as well as placebo and other context effects. A smaller acupuncture-specific component involves such issues as the locations of specific needling points or depth of needling.
Although millions of Americans use acupuncture each year, often for chronic pain, there has been considerable controversy surrounding its value as a therapy and whether it is anything more than an elaborate placebo. Research exploring a number of possible mechanisms for acupuncture’s pain-relieving effects is ongoing.
Researchers from the Acupuncture Trialists’ Collaboration, a group that was established to synthesize data from high-quality randomized trials on acupuncture for chronic pain, conducted an analysis of individual patient data from 29 high-quality randomized controlled trials, including a total of 17,922 people. These trials investigated the use of acupuncture for back and neck pain, osteoarthritis, shoulder pain, or chronic headache.
For all pain types studied, the researchers found modest but statistically significant differences between acupuncture versus simulated acupuncture approaches (i.e., specific effects), and larger differences between acupuncture versus a no-acupuncture controls (i.e., non-specific effects). (In traditional acupuncture, needles are inserted at specific points on the body. Simulated acupuncture includes a variety of approaches which mimic this procedure; some approaches do not pierce the skin or use specific points on the body.) The sizes of the effects were generally similar across all pain conditions studied.
The authors noted that these findings suggest that the total effects of acupuncture, as experienced by patients in clinical practice, are clinically relevant. They also noted that their study provides the most robust evidence to date that acupuncture is more than just placebo and a reasonable referral option for patients with chronic pain.
Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Archives of Internal Medicine. September 10, 2012; Epub ahead of print.
This meta-analysis essentially concluded that acupuncture is effective at treating neck, shoulder and back pain; osteoarthritis and chronic headaches. This is great news for acupuncturists as many previous studies had not demonstrated these positive results, and it means that the very best of modern scientific research has demonstrated the effectiveness for some health conditions of a medicine that has been practiced successfully for thousands of years in Asia.
WHAT HAS ALL THIS GOT TO DO WITH SOUND THERAPY?
Unfortunately, the funding has not yet been made available to test the effectiveness of sound therapy in this way, as it is currently regarded as a minor part of the CAM industry. Therefore we do not have the same level of evidence-base as acupuncture. However, we can point to the effectiveness of recorded sounds and music found in some systematic reviews and meta-analyses that have been published.
We can also refer to the theory of how sound therapy works from energetic, bio-chemical and physics perspectives and then allude to how this theory applies in a similar way to acupuncture as a vibrational medicine and also to recorded music therapy. We can then expect that future trials will also demonstrate the effectiveness of sound therapy. Until that happens, however, conventional medical professionals who are part of the evidenced-based medicine movement, are likely not to take sound therapy seriously as a valid health modality, and we have to live with that reality.
In the meantime, though, I think it is worthwhile taking a fresh look at the assumptions underlying evidenced-based medicine, as this might help to re-frame the position. The key issue concerns the placebo response itself.
THE PLACEBO RESPONSE
We’ve already identified that the symptoms of an illness or a disease can improve after a dummy drug or treatment protocol has been administered. This is the placebo response.
In fact, David Hamilton PhD, an ex-biochemical researcher in the pharmaceutical industry states in his book ‘It’s The Thought That Counts’ that the placebo response is effective in healing between 10% & 100% of health conditions.
There is an increasing body of research that suggests that the success of many currently accepted medical procedures is unrelated to the physical treatment itself. For example a meta-analysis of anti-depressant medication published in 1998 by Kirsch, I and Saperstein G titled: ‘Listening to Prozac but hearing placebo’ showed that the placebo response account for 75% of the success of the treatment. See “Magic in Practice” Garner Thompson and Khalid Khan p xxvi.
Indeed if you re-read the article on acupuncture above, you will notice that in the first paragraph it states:
“…results from the study provide robust evidence that the effects of acupuncture on pain are attributable to two components. The larger component includes factors such as the patient’s belief that treatment will be effective, as well as placebo and other context effects. (emphasis added) A smaller acupuncture-specific component involves such issues as the locations of specific needling points or depth of needling.”
So here again, we see that the largest component of the success of acupuncture is attributable to belief & the placebo.
In my opinion, something that is so effective should not be discounted, and we should look instead at how it works and what we can do, ethically, to maximise the potential of this healing force.
Having looked at the numerous research studies into this phenomenon, Thompson and Khan have identified 4 factors that are generally present in patients when the power of placebo is actively working:
- Desire – the patient wants their condition to change for the better
- Expectation – the patient has a positive outlook that their condition will change for the better
- Belief – the patient believes that by following the advice of their practitioner and the recommended treatment that their health condition will change for the better.
- Feeling – the patient has a positive feeling about their practitioner and the recommended treatment
From this we can see that it is vitally important for sound therapy practitioners to learn and apply basic coaching skills and techniques that will enable our clients to have that ‘feel-good factor’ about us and sound therapy; that will increase their desire for and expectation of getting better and, at the same time, enhance their belief in us and the effectiveness of sound therapy.
In my opinion, we need to pay apply two critical factors for this to succeed:
Strong ethics – it’s widely accepted that medical practitioners should act ethically, otherwise the profession gets corrupted. The industry is largely self-regulating usually via National Medicine Associations who punish gross transgressions of published Codes of Practice. For example, practitioners can get disqualified for acts of sexual abuse on their patients. This is enshrined in the legal system and malpractice of many forms is enforceable in the Courts.
One of the key arguments used against valuing the placebo response is that it is open to abuse by tricksters and fraudsters, who can make a lot of money from misleading the public by making untrue or over exaggerated claims to enhance the belief in the effectiveness of their products or treatment.
I believe that if we apply certain ethical standards to our behaviour and adhere to accepted Codes of Practice for CAM in general and sound therapy in particular, then we can and should work consciously to release the placebo response in our clients. In particular we should not mislead our clients and make untrue claims about sound therapy.
Strategy – we need to put in place a strategy for working effectively with the 4 key factors underlying the placebo response. We also need a plan that we can implement, based on the understanding that we can’t do everything at once. We can’t expect to do everything it takes to fully activate the placebo in just one session. We should plan to achieve that goal over 3 – 4 sessions.
In my opinion, if any client has not seen positive health outcomes of our treatment after 4 sessions, then it’s unlikely that they ever will, and we should face up to this honestly and stop working with them. I’m not suggesting that all their identified symptoms of illness or disease should be cured in that timeframe, but there should be at least some identifiable positive outcomes that they are satisfied with.
I suggest that sound therapists should work systematically with the coaching skills outlined in our courses to build up each of the 4 factors underlying the placebo response.
In practice this means:
In the first sound therapy session you need to focus on building the ‘feel-good’ factor in your clients. This is about establishing the basis for a high-quality relationship, characterised by warmth, empathy and rapport, in which we express loving-kindness towards our clients and they in turn feel a strong connection with us. In this first session, we should also lay solid foundations for our clients to believe in us and the effectiveness of sound therapy.
In the second session, you should focus on managing a process that builds their desire and expectation of positive change for the better. You should also agree an action plan for your clients to implement with clearly identified outcomes.
In the third session, you should focus on helping your clients to identify and overcome any limiting beliefs they might be holding about getting better. You should also monitor how well your client is doing in implementing their agreed action plan, and help them to break through resistances to change.
In the fourth session you should review their outcomes, celebrate any successes, honestly reflect on anything where there has been little or no positive change, and then decide whether to continue with the sound therapy process, and if so for how long, and on what basis.
This is a guide to how you can progress. It’s a bit linear and fixed, and in practice, you need to be flexible and be able to adjust to each client individually and go with the flow. Although, it’s likely to happen in a more organic process, it’s still useful to have some markers for a strategy and action plan covering 4 sessions, while also staying open to the possibility of instant healing!
We’ve devoted 3 Modules of our Level 2: Practitioner Diploma in Sound Therapy program, to covering the fundamentals of coaching. These are designed to help you implement this strategy and action plan.
For more details of the Level 2 course, please click the link below