Shunda Wallace’s Book Review of Dr. Eric Miller’s Bio-Guided Music Therapy

Bio Guided Music Therapy Book Review by Shunda Wallace
First published in 2011 by Jessica Kingsley Publishers

Bio Guided Music Therapy composed by Dr. Eric B. Miller, presents a colorful and fascinating 256 long wealth of information with 13 chapters of rich insight. The contents of the book are preceded by a three page foreword written by Joseph P. Scartelli who emphasizes in great detail, the relevance of Miller’s work. Scartelli posit’s the importance of advancements that have occurred in technology which provides clients with the opportunity to learn while participating in the bio-guided music therapy process. Joseph P. Scartelli is the Dean of the College of Visual and Performing Arts, Professor of Music and Music Therapy at Radford University in Radford Virginia. Scartelli’s foreword is followed by a two page forward from C. Norman Shealy who asserts that deep relaxation is exceptionally useful in becoming and adjunct in conducting past life therapy in addition to psychotherapeutic approaches. C. Norman Shealy MD and PhD is President of Holos Institutes of Health and President Emeritus of Energy and Medicine at Holos University Graduate Seminary in Bolivar Missouri.

Dr. Miller provides a two page acknowledgement of key people who inspired him while writing the book followed by a two page overview of the book called “About This Book” and a four page introduction on the history of biofeedback and it’s relevance as a holistic non-drug intervention. The book is divided into four parts: Part I. Historical and Theoretical Background, Part II. Physiology Measures, Assessment and Digital Music Parameters, Part III. Practicing Bio-Guided Music Therapy and Part IV. A Glimpse of the Future

Part I. Historical and Theoretical Background that consists of 5 pages of personal experiences at the Juncture of Music and Physiology by David Darling who provides and anecdote of his experience playing Schubert’s unfinished Symphony and how becoming a professional musician has transformed his life. Jorg Fachner provides a two page journal of his experience as a music therapist at Witten/Herdecke University Clinic in Germany, followed by three additional pages called “feed back your sound” and vision with additional anecdotes on brain circus light show ideas and his love, passion and fascination with EEG biofeedback.
Chapter I
Part I of the book provides a well crafted Historical and Theoretical Background of Bio-Guided Music Therapy. Within the framework of this section are chapters one through five rich with historical components. The historical components in chapter one include technology beginning with early primitive DOS operating systems in the 1980’s that brought us to current day portable laptops which utilize real time data guiding, to provide a therapeutic outcome.

The theoretical components in chapter two discuss Shifting Healthcare Paradigms. In chapter two Miller masterfully ‘guides’ the reader into a cognitive paradigm shift from a “reductionistic biomechanical scientific program” back to the original “holistic approach” of providing health and wellness. Taking a page from the Eastern Meditational Practices, Bio-Guided Music Therapy empowers the client and readers to create his or her own shift in health consciousness by understanding the relationship between ecological and individual wholeness rather than relying exclusively on medicine and doctor’s as healing agents.

In chapter three The Process of Gaining Legitimacy, Miller methodically builds a solid figurative court case by persuading the reader on What Constitutes Legitimacy while demonstrating examples of literal court cases won by biofeedback professionals in the United States. Like an opening statement in a court proceeding, Miller asks relevant questions to build his case. Can A Non Accepted Profession Turn Into A Legitimate Treatment? How Is It That People Have A Change In Perspective? Why Are These Professions Only Partially Accepted by Mainstream Healthcare? These questions and many others are answered to legitimize the relevancy biofeedback in the US.

Miller goes on further to provide evidence of biofeedback professionals that have gone before administrative judges, state legislators and against insurance companies in court proceedings to win their cases. This book is a wonderful resource for music therapists and non music therapists that are uninformed to the various organizations instrumental in changing healthcare laws, policies and procedures throughout the United States. Some of those organizations include but not limited to The Health Care Financing Administration (HCFA), Technology Advisory Group (TAG), and The Agency For Healthcare Policy and Research (AHCPR).

In Chapter four A Case For Integrating Music Therapy, Miller utilizes the AMTA’s and Bruscia’s definition of Music Therapy to challenge the traditional music therapists perspective that tones cannot be produced by the body’s physiology. To further substantiate his claim that tones can, parallels are drawn between Bandura’s Social Learning Theory with Classical Conditioning, Western Balancing Systems (Homeostasis) with Chinese Yin and Yang balancing systems. Parallels are also drawn with the Input Output systems in the clinical capacity with Input/Output systems in biofeedback. Essentially proving that every approach utilized in the clinical capacity is also utilized in biofeedback.

Chapter five Developing the EEG-Guided Music Therapy for ADHD focus’ primarily on treating Attention Deficit Hyperactivity Disorder based on the principals of EEG-Guided Neurofeedback. This chapter is a little more technical for those readers unaware that EEG is short for Electroencephalogram, a measure utilized to record electrical brain activity. Emphasis in this chapter is placed primarily on developing a rationale for treating ADHD utilizing EEG Bio-Guided Music Therapy. Miller asserts that Sensorimotor Rhythm (SMR) a low beta rhythm is most effective when there is a combination of cognitive processing, mental tasking and reduced motor firing during training measures for clients with ADHD.

Miller references Thomas Armstrong’s proactive teaching perspective designed to challenge traditional educational approaches. Within this innovative perspective there are multiple intelligences of eight distinctive differentiated learning modes. These modes include linguistic, logical, spatial, bodily, musical, interpersonal, intrapersonal and naturalistic. Armstrong suggests that anyone is capable of learning to use this model. Miller also references Armstrong’s proposal of a holistic paradigm in teaching methods rather than the “biomedical model” that ADHD is best treated by traditional behavior modification methods along with medication.

Part II. Physiology Measures, Assessment and Digital Music Parameters
While reading this section of the book, I was pleasantly surprised to read Professor Karen Goodman’s comments on how she got involved with her colleague Dr. Miller. Professor Goodman mentioned how her interests in physiological monitoring of music therapy provided her and Dr. Miller the opportunity to cross paths. Subsequent to that, Professor Goodman suggested the formation of the Ott Center for Music and Health that David Ott fund benefactor’s were gracious enough to provide.
As a result of Professor Goodman’s suggestion, I and so many other music therapists will benefit from Dr. Miller’s great research work. After reading this book, I am more excited than ever at the prospect of working with Dr. Miller. I am really enjoying the book thus far and I am more than sure I will not be disappointed with the additional chapters.

Chapter six entitled Biofeedback Measures with Music provides a thorough education on measuring instruments that are utilized to measure specific physiological responses in the body. This is another chapter that is a bit technical for those readers and music therapists alike that are unfamiliar with the inner workings of measuring instruments utilized in biofeedback.

Some of the instruments include the electromyogram which measure muscle firing neurons, electrodermograph which measures skin resistance to an electrical current, electroencephalograph that measures electrical cortical potentials which provides an electrical output of the brain, the photoplethysmograph that measures the degree of red frequencies in blood volume pulse, in addition to the the non-invasive infrared temperature gun that displays a thermal reading of body temperature in the fingers and toes. These measuring procedures are utilized to inform the therapists and the client on how to treat general anxiety, stress, TMJ, lower back pain, hypertension, ADD, asthma, migraines, headaches, fibromyalgia, depression and many other ailments, illnesses and disorders.

Miller doesn’t stop there, in chapter five he goes on further to discuss the interplay between measuring devices and the digital musical parameters. Those parameters include digital interface, wave files, digital thresholds and audio feedback to name just a few.

Chapter seven is entitled Adding Physiological Measures to Music Therapy Assessment. Throughout this entire chapter, Miller provides the readers with a very thorough and concise education on assessment techniques. Early in the chapter the author provides a scripted demonstration on all of the key elements that unfolds during the assessment process. This is particularly relevant for the layperson that is unaware of all that an assessment entails and why assessment is important in music therapy. Additionally Miller provides assessment contributions from established and credible music therapists Nordoff and Robbins, Karen Goodman, Kenneth Bruscia, Tony Wigram and Brunk and Coleman.

The author addresses all of the various types of assessment techniques utilized by music therapists. Those assessment approaches include improvisational, psychoanalytic, educational and biomedical models. I was particularly impressed with the general music therapy assessment profile charts with measuring ratings on a scale of 1 to 5 since I am a music therapist in training. Miller makes mention in this chapter that music therapy assessment “still lags behind other professions in it’s development of cohesive assessment measures”. I agree wholeheartedly especially as it relates to Neuroimaging. I believe as does Miller, that this chapter on assessment is imperative because it holds therapists accountable while also providing justification of services.

Part III. Practicing Bio-Guided Music Therapy
Chapter Eight
I absolutely love chapter eight Role of the Music Therapist in Bio-Guided Music Therapy. While discussing the role of the therapist Miller provides quick reference charts of bio-guided approaches by music therapy intervention for just about every disorder. For example, toning and chanting is utilized for high stress, anxiety and high blood pressure and drumming for addictions, depression and fibromyalgia.
According to Miller the role of the therapist is very important for creating a physical and musical atmosphere of trust. The therapist is responsible for tasks that include creation of musical menu’s, developing musical design and maintaining the integrity of the musical environment.

Additionally, the therapist is also responsible for choice of instruments, keys, scales and note duration (for patches). Skills in improvisation are also essential to reflect the clients, feelings, behaviors and attitude. Midi banks are discussed in this chapter and can become a bit overwhelming technically speaking, for the reader that is not well versed in midi patches. All in all, this is one of my favorite chapters.

Chapter Nine Bio-Guided Music Therapy for Stress
Miller begins this chapter by providing statistical data of the Anxiety Disorder of America. According to the ADAA (2007) 40 million adults over the age of 18 years, are impacted annually by stress. Miller provides additional statistics by the AADA that are jaw dropping. In order to understand generalized anxiety disorder and stress, one must understand the brain structures that are related to anxiety. Subsequently, an overview is provided of the limbic system, which is also referred to by some as the fight-or-flight response system.

The clinician in bio-guided music therapy is a key component to monitoring stress indicators, heart rate variability and galvanic skin response. Taking into account the role of the clinician, Miller references Helen Bonny’s Guided Imagery in this chapter. Bio Guided Music Therapy for stress utilizes similarities to the guided imagery approach and subsidiary, Helen Bonny’s guided imagery. Instead of the therapist acting alone in guiding the client to the subconscious, the shift occurs by musical biofeedback acting as a co-therapist. Taking into account the process between the client, the clinician and the biofeedback monitor, Miller provides a six step process of monitoring and treating stress within a biofeedback session. Miller ends the chapter by discussing the different phases of guided imagery that include induction, stability, transition, transformation and return. I would be remissed if I did not mention the similarities in biofeedback modalities and Eastern meditational enhancement usages.

While chapter five delves into the developing of EEG-Guided Music Therapy for ADHD chapter ten Bio-Guided Music Therapy for ADHD goes into greater technical detail on the actual EEG feedback approach. I also found this chapter to be very technical while reading about quantitive EEG Brain Maps. I will be working with professor MIller next semester and I look forward to actually experiencing this chapter rather than trying to analyze it.

Chapter eleven Bio-Guided Music Therapy for Aging In the cognitive circle of life, a child’s brain is continually developing while the brain of the elderly is a deteriorating one. Research and the work that I do weekly in an adult psychiatric facility with dementia clients has shown the playing musical instruments decreases the likelihood of Alzheimer’s. Cerebral blood flow from brain activities has been known to decrease cognitive impairment increases. For optimal results, the brain does require adequate cerebral blood flow. The hemoencephalography does provide optimal results. In a study of 469 seniors over the age of 75 that read, dance regularly, play board games and musical instruments dementia showed a significant decrease. Studies looking to find musical memory as superior to verbal memory however were inconclusive. According to Miller, Theta and Gamma EEG bands in combination with magnetic resource imaging, are related to functional networks related to working memory. The hippocampus which is involved with long term spatial navigation, when decreased, blood volume is related to decreased cortical low Alpha power for clients that are mildly cognitive impaired within the Alzheimer’s disease population.

Chapter twelve A Multi-Modal Approach to Addictions Utilizing Music Therapy and Biodfeedback. Early in the chapter the author provides a definition of addiction that emphasizes terms “relapsing” and “drug seeking” key concerns with addition. Miller posits fundamental attribution error (the extent to which environmental factors exacerbate mental health) as a primary contributing factor to relapse and subsequent addiction. Additionally discussing biological and genetic factors that strengthen addiction. Stress according to Miller, is another primary indication that points to addiction. Clients with addictive personalities do particularly well with biofeedback because there is an addictive component to biofeedback that happens in learning, that can provide positive physiological responses to stress.

Chapter twelve is a lofty chapter that draws parallels between addictive personality traits with the Taoist Yin and Yang balancing system (or lack thereof of as it relates to addictive personality types). Numerous examples are provided on how to tweak balance for depression and codependency (both key components of addiction). Lastly, I was very impressed with the section on relapse triggers. Some of which include: loneliness, boredom, reactivation of denial and exhaustion just to name a few.

I found chapter thirteen Bio-Guided Music Therapy for Pain very useful since I am currently in physical therapy for chronic back pain. I can definitely attest to stress as a leading cause of pain in all areas of the body. Miller provides numerous modalities that assist with pain reduction. Primary modalities that may assist in pain reduction include electromyogram for upper and lower back pain, cramping and tension headaches. The photoplethysmograph is utilized for blood volume pulse or temperature feedback for vascular perfusion. Also electrodermal activity feedback for heart rate variability. In this chapter step-by-step instructions are provided on to conduct a bio-guided music therapy session for both lower back pain and headaches. Miller thoroughly addresses strategies to treat headaches and functional abdominal pain caused by stress with a very impressive biofeedback symptom rating chart on a scale of 1 to 5. Miller also provides a step-by-step guide on how to conduct a bio-guided music therapy session for children with functional abdominal pain using electrodermal activity and heart rate variability.

Part IV. A Glimpse of the Future
This section of the book provides personal experiences at the juncture of music and physiology by Shea O’Neil, David B. Yaden and Eric B. Miller himself. Shea O’Neil is a patient/client of Dr. Millers whose story I found to be quite extraordinary. Shea was gracious enough to share his story battling nocturnal primary generalized epilepsy. Shea began his journey with Dr. Miller when he experienced seizures at night while sleeping as a young boy. Shea began working with Dr. Miller while in the third grade and was able to successfully reduce his seizures for three years and now intermittently for the past seven years. With Biofeedback, Neurofeedback and Music Therapy combined, Shea has improved in his school work in addition to other areas in his life. Shea has stopped taking medication and is living proof that the holistic model that Bio Guided Music Therapy provides is astoundingly effective.

Dr. Miller doesn’t take all of the credit himself, he very graciously and humbly acknowledges the contributors to the book. Key contributors mentioned are Grammy Award winning cellist, David Darling, co-founder, with Bonnie Insull, of the nonprofit music improvisation organization, Music For People, Educationalist, Jorg Fachner who holds a PhD in medicine and has edited an international eJournal on music therapy and music studies with numerous publications and research interests.

Additional contributors include professor Karen Goodman, who has directed and taught in the music therapy program at Montclair State University for over 30 years. Professor Goodman is an accomplished music therapy author who continues to maintain a private practice, VJ Manzo, composer and guitarist who is currently pursuing and PhD from Temple University with a research emphasis in interactive composition and performance systems for music education, Dr. Miller’s son, Zak Miller who is currently a sophomore in high school that enjoys playing tennis and badminton, artist Victoria O’Neill who is a painter, illustrator, fiber and collage artists, Shea O’Neill a talented musician and artists whose inspiring story was mentioned in the book and lastly, David B. Yaden, a certified hypnotherapist with an education in psychology and Zen meditation. Additional key figures in the field of medicine and music therapy mentioned in the book are Helen Bonny, Oliver Sacks and Michael H. Thaut.

The author Eric B. Miller a pioneer in the areas of real time bio-guided music therapy, neurofeedback and biofeedback is definitely ahead of his time. While the book was written primarily for music therapists, hence the title “A Practitioner’s Guide” I do see the relevancy of this material to those individuals interested in a more natural holistic approach to treating anxiety, stress, illness and psychological disorders. I would definitely recommend this book, in fact I have already done so numerous times to anyone that will listen. I love Dr. Miller’s referencing of the similarities of Eastern Meditational and Spiritual practices natural approach with his model in Bio-Guided Music Therapy. I have been searching for the perfect therapy session that is antithetical to talk therapy but is run by a psychotherapist that is well versed in both Eastern Spiritual Practices and Psychology. The therapy session where the fields of the East and West are merged to provide a natural more holistic approach to treatment. Dr. Miller has done a wonderful job.

Eric B. Miller is a psychotherapist, certified biofeedback therapist and board-certified music therapist with experience in inpatient, outpatient corporate and educational settings. Dr. Miller instructs in the capacity of adjunct faculty and guest lectures at Immaculata University, Antioch University, Bryn Mawr College, Montclair State University and the Naropa Institute. Dr. Miller is a published author presenting internationally on neurofeedback, music and healing. Dr. Miller also has a donation based community biofeedback and neurofeedback clinic and has served as president of Expressive Therapy Concepts since 1993. Among Dr. Miller’s many accomplishments, he has also collaborated with Grammy Award winning cellist David Darling on his first instrumental CD Jazzgrass.

Ms. Wallace joined the faculty at Michigan State University as Guest Lecturer in 2004-2005 while being considered for the Doctorate of Musical Arts in Western Composition Program (later learning there was no Doctoral Program in Jazz Composition).  Ms. Wallace holds a Bachelors of Music in Music Management from William Paterson University a Masters Degree in Jazz Arranging and Orchestration from William Paterson University in addition to an Advanced Level Board Certification in Music Therapy from Montclair State University.