The origins of Singing for Health

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Dr Stephen CliftProfessor Emeritus at Canterbury Christ Church University, Visiting Professor at York St John University and Professorial Fellow of the Royal Society for Public Health - looks back over 20 years of Singing for Health research.

The idea that group singing is good for wellbeing and health goes back to at least the late 16th century. The English composer William Byrd (Byrd, 1588) claimed, that singing is good for health, strengthens the muscles of the chest, improves breathing, and helps with voice problems including stammering.

However, it is only in the last 20 years that these insights have been subject to scientific scrutiny. In 2001, with my colleague Grenville Hancox (Clift & Hancox, 2001), I published findings from two simple surveys of members of a University Choral Society. This small study has been cited over 400 times in subsequent studies of singing and wellbeing, and the findings have stood the test of time. 

We identified over 30 distinct benefits described by singers, which defined six broad dimensions. The most substantial dimension related to feelings of well-being and relaxation, followed by benefits for breathing and posture, social benefits, spiritual benefits, emotional impacts, and a final dimension related to exercising the heart, increased oxygen and improved immune function. 

The most substantial dimension related to feelings of well-being and relaxation, followed by benefits for breathing and posture, social benefits, spiritual benefits, emotional impacts, and a final dimension related to exercising the heart, increased oxygen and improved immune function.

These findings showed that singers experienced different kinds of benefits from singing and experienced them to different degrees. The dimensions emerged because of variations in whether singers agreed, were unsure, or disagreed with the component items. For well-being and relaxation, breathing and posture and social benefits dimensions most singers ‘strongly agreed’ or ‘agreed’ about these benefits. For spiritual benefits, emotional impacts and heart and immune function, in contrast, more singers were ‘unsure’ or ‘disagreed’ about such benefits. 

Following the establishment of the De Haan Centre in 2005, we replicated the preliminary survey in a study of over 1,000 choral singers in 21 choirs in Australia, England, and Germany (Clift et al., 2009, 2010, 2012; Clift and Hancox, 2010; Livesey et al., 2012). We found that choir members who faced challenges to their mental health were more likely to strongly endorse the supportive value of singing. These included people who had:

  • Personal experience of mental health problems

  • Experience of mental health problems in their family

  • Physical health problems, or had

  • Lost partners or family members

Singers with physical health challenges (e.g. stroke, heart disease, lung disease) compared with people free from health problems, were also more definite in endorsing the therapeutic value of singing, (Clift et al., 2009).

It appeared, therefore, that participants with mental or physical health problems used choir membership and singing as a therapy or an aid to rehabilitation. 

This insight led to research projects on the value of singing for people with long-term health challenges. These included people with dementia (Bungay et al., 2010; Skingley and Bungay, 2010; Unadkat et al., 2017), enduring mental health problems (Clift et al., 2011, 2017), chronic obstructive pulmonary disease (Morrison et al., 2013; Skingley et al., 2014, 2018), and Parkinson’s (Irons, et al., 2020).  Most of the participants in these studies had no previous experience of singing in choirs. 

All of these studies revealed improvements in mental health and wellbeing, disease specific quality of life, and improved day to day self-management of chronic breathing difficulties.

Our most significant achievement was running the world’s first randomized controlled trial on community singing for older people (Coulton et al., 2015). This showed that weekly singing over three months significantly improved mental health related quality of life. These benefits were maintained for a further three months after the singing programme ended. 

 

Finally, the De Haan team has contributed to systematic reviews, and Cochrane reviews, on the effects of singing for older people and dementia (Clift, Gilbert and Vella-Burrows, 2017), respiratory illness (Lewis et al., 2016, MacNamara et al., 2017), mental health challenges (Williams et al, 2018), and Parkinson’s (Irons et al., 2019).  These reviews have critically evaluated all previous studies and of course, identified priorities for further research (see also Dingle et al., 2019).

I want to end with recent examples of research, which have explored ideas expressed in the 2001 paper, but not directly investigated by the De Haan Centre:

  • Daisy Fancourt (2016) has identified biochemical and immune function changes due to singing among people affected by cancer

  • June Boyce-Tillman (2020) has explored the sacred significance of music and singing

  • Bjorn Vickhoff et al. (2013) has shown that when a group sings in unison individual heart rhythms synchronise, and

  • Rosie Perkins (2020) has definitively identified the range of benefits from music participation and singing in a systematic review of all previous qualitative research

 

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