Keyboard pedagogy and the future: lessons from human genome research: an interview with Barry B. Bittman, M.D. and Karl T. Bruhn.

A groundbreaking study published in the international research journal, Medical Science Monitor (February 2005), demonstrated for the first time that learning to play a keyboard instrument reversed multiple components of the human stress response on the genomic level. The study's principal investigator, Barry Bittman, M.D. of the Mind-Body Medical Center explained that these unique findings shed new light not only on the value of active music participation, but also extend our understanding of individualized human biological stress responses on an unprecedented level.

The following interview conducted by MTNA Executive Director Gary Ingle, presents a concise overview of the research in practical terms and highlights its importance for the future of keyboard pedagogy.

GI: Gentlemen I'd like to thank you for accepting our offer for this interview. I'm certain that the research we're about to discuss is extraordinarily important for our membership. Dr. Bittman, your inspirational keynote presented at our annual meeting continues to spark ongoing interest and excitement. I personally believe that all of our members need to become aware of your fascinating work. Could you begin by explaining your reasons for performing this study.

BB: Gary, allow me to begin by thanking you and your organization for this exceptional forum. It has been, and continues to be, an honor to present our work to MTNA. The impact your organization and its members have on the future of music education in our society cannot be underestimated. The underpinnings of this study clearly extend the lifetime work of Karl Bruhn, who is often referred to as the "Father of Music Making and Wellness." Karl's dedication and commitment to extending the joy of music making throughout the world inspired the performance of this and the other research studies we've conducted over the past seven years.

Our principal objective is to scientifically explore and demonstrate the inherent value and health benefits of active music participation. In addition, we strive to inspire people who are erroneously convinced they are not "musical" to discover the joy and health benefits of playing a musical instrument. We've set forth to steadily build a solid foundation of biological and psychosocial evidence that establishes recreational music making's value as a practical, affordable and sustainable strategy for preserving or reestablishing the gift of a healthy life.

GI: Karl, as a highly respected music products industry leader, you've committed a great deal of your life to extending the benefits of music making throughout the world. Your work with Dr. Bittman is clearly changing our overall perception of the value of learning to play a musical instrument. How did you get started?

KB: Gary, your question takes me way back to my childhood. My career began when my mother was told I had asthma. In those days we didn't have the kind of treatments that exist today. Our family doctor instead prescribed a move to a dryer climate and wind instrument lessons. I suppose that prescription changed my life. It's still working today.

Reflecting back over my early years as a musician, there's a part of me that always appreciated the value of playing a musical instrument. As a music products industry executive, not a day's passed without an inspirational story of how playing a musical instrument changed or saved a person's life.

In my retirement, it's been very clear to me that such an awareness must be extended to the many people who can potentially benefit from playing a musical instrument, especially in these challenging times. My work with Dr. Bittman is simply a way of giving back to society even a fraction of what I've received through music.

GI: Dr. Bittman, before we discuss your landmark study, could you provide a short overview of the research that led to this study?

BB: Essentially we began in the late 1990s with an exploration of the biological benefits of group drumming. That study, published in Alternative Therapies in Health and Medicine in 2000, as the first controlled scientific investigation to demonstrate a statistically significant boost of immune function attributable to playing a musical instrument. The activity of "natural killer" cells, specialized white blood cells that seek out and destroy cancer cells and virally infected cells, increased in our subjects who participated in what later become known as the Remo HealthRHYTHMS protocol.

Based upon our findings, we proceeded to explore the multidimensional benefits of recreational music making in a highly stressed long-term care workforce plagued by excessive turnover. Our study, published in Advances in Mind Body Medicine in 2003, demonstrated remarkable reductions of mood disturbances and employee burnout that persisted after completion of a six-week group-based program that incorporated hand drums and a Clavinova. A comprehensive independent review of our data performed by a leading healthcare economic consulting firm projected enhanced employee retention and remarkable cost savings attributable to the intervention. Actual savings exceeded these projections. Close to $500,000 was ultimately saved in a long-term care facility as a result of our intervention.

The following year we tested a similar protocol with first-year nursing students. Our findings, published in the International Journal of Nursing Education Scholarship in 2004, closely paralleled the prior study. The benefits to students who were beginning to experience considerable stress and burnout were substantial, and strongly supported by a financial analysis projecting considerable savings for nursing schools and hospitals.

Four months later, detailed findings from a comprehensive recreational music-making program for residents of two continuing-care retirement communities (Fredericka Manor in California and Wesbury United Methodist Retirement Community in Pennsylvania) were published in Provider. We collected and analyzed more than 22,000 individual measures documenting the multidimensional impact of active music participation across the aging spectrum. Our results justified the ongoing and widespread use of active music participation for older adults.

While our prior research revealed a host of clear-cut biological and psychosocial benefits associated with recreational music making, one question clearly remained to be answered. We wanted to know if learning to play a musical instrument could actually reverse the impact of stress on the biological level. Our latest study answers that question.

GI: Barry, that's a phenomenal amount of work in such a short period of time. And while I'd like you to tell us more about your research, perhaps Karl could begin by explaining the term, "recreational music making" before we get deeper into your findings.

KB: It's my pleasure. When we began these studies, it became apparent that a definition was needed to distinguish what we were doing from traditional music instruction. Basically there wasn't a term that separated our non-musical objectives from the performance and mastery goals people associate with the traditional process of learning to play a musical instrument.

It's interesting to note that the term, "recreational" comes from the Latin word, "recreatio" which means "restoration to health." Recreational music making, or RMM as we call it, encompasses enjoyable, accessible and fulfilling group music-based activities that unite people of all ages regardless of their challenges, backgrounds, ethnicity, ability or prior experience.

From exercise, nurturing, social support, bonding and spirituality, to intellectual stimulation, heightened understanding and enhanced capacity to cope with life's challenges, the benefits of recreational music making extend far beyond music. Recreational music making ultimately affords unparalleled creative expression that unites our bodies, minds and spirits.

GI: In essence, Karl, what you're describing is group-based. Your definition also seems to emphasize socialization. Can you explain this further and differentiate RMM from traditional music education?

KB: RMM is really about people interacting with each other in a meaningful way using music making as a tool for self-expression and community building. You may want to consider it group lessons with nonmusical objectives.

We don't begin with the basics of music education. Early on, participants don't know a quarter note from a half note. We start with the premise that each of us has the gift of music within us. As Dr. Bittman has commented many times, "we're hard-wired for music."

Our programs are led by dedicated caring facilitators whose primary responsibility is to guide a person from where they are to where they want to be. Students realize a great deal of success from the start. Many fall in love with music during the first session.

Our drop-out rate is remarkably low, and not surprisingly, a considerable number of students move on to traditional music lessons.

GI: The issue of dropouts is of great concern. Perhaps we can return to this later. Beginning where you left off Barry, can you tell us more about why you're interested in stress?

BB: Certainly. As medical scientists, one of our fundamental goals is disease prevention. Undoubtedly, numerous factors including genetic predisposition affect our health. Stress however is well-accepted as a key triggering factor for the development and progression of many serious life-threatening illnesses. Despite the fact that the inherited setup for a disease may exist within an individual, a rational strategy of exercise, nutrition and stress reduction may ultimately prevent or reduce the severity of an illness. While countless exercise and nutrition programs abound, few enjoyable effective stress-reduction strategies exist. We believe that RMM effectively can fill that gap.

To regress for a moment, perhaps I should begin by defining "stress." We all know how it feels, yet it's extraordinarily challenging to define. Let's consider "stress" in basic terms as anything that moves us out of our comfort zone. According to Hans Selye, often referred to as the "Father of Stress," we can extend the definition to "a nonspecific response by the body to any demand."

In biological terms, as humans, we are constantly experiencing a certain degree of stress. Yet at times, when the ongoing stresses and pressures of our daily lives become overwhelming, we have a tendency to become sick. A complex series of biological stress reactions can ultimately lead to disease. Our latest study explores stress from a unique perspective. We sought to determine whether or not learning to play a keyboard instrument could reverse the biological impact of stress induced in a controlled manner.

GI: Dr. Bittman, your explanation of stress and disease is intriguing. Is the association between stress and illness considered controversial in the medical field?

BB: Gary, the biological responses I'm describing fall into the realm of Psychoneuroimmunology (PNI), the medical discipline that studies the interactions of mind and body. PNI is well-established thousands of scientific papers have focused on intricate stress pathways and their relationship to disease. While there's much to be learned, a great deal of peer-reviewed scientific literature supports the complex relationship between stress and disease.

GI: What you're saying makes a great deal of sense. Yet, from a pedagogy perspective, I often wonder whether a certain amount of stress is good for our students. For some, maybe it generates that extra edge. Karl, what are your thoughts?

KB: I've often wondered about this as well. From my own observations, it seems that some people handle stress better than others. I also recognize the fact that many performers suffer from stress-related illnesses. It's hard to draw the line. No one would doubt that striving for perfection generates a lot of stress. What are your thoughts, Barry?

BB: I fully agree, Karl. Yet, I'm particularly concerned with the underlying biology that isn't readily apparent even in those who seemingly handle stress well. We erroneously tend to assume that disease begins suddenly with that abnormal electrocardiogram, CT scan or blood test. While a heart attack may present as a sudden event, the biological processes that lead to the damage do not develop overnight. Devastating life events have also been shown to predict disease development.

Ultimately it may be the way we handle external pressures that makes all the difference. Perhaps we take life too seriously.

GI: That's a valuable insight for all of us. The fact that stress takes its toll isn't surprising. Yet, how does one begin to test the impact of stress when each of us is so different?

BB: That's a fascinating question. You are correct--each of us experiences stress in different ways. Therefore from a research perspective we couldn't rely on a common baseline. We developed a two-phase protocol to level the playing field. In the first one-hour phase, we induced stress. In the second, we attempted to reverse its effects. We studied 32 subjects without prior music-making experience--4 groups of 8 subjects each.

During the initial phase, we asked subjects to assemble extremely frustrating jigsaw puzzles described by the manufacturer as "most difficult." We deliberately pressured our subjects to compete with each other. The one participant who put together the most pieces in an hour received a monetary reward. In phase two we divided the volunteers into three groups: ongoing puzzle assembly, rest and relaxation reading books and magazines, and a first group keyboard lesson.

Blood was sampled prior to the experiment and after each phase. Comparisons were carried out between the groups.

GI: What did you measure in the blood samples?

BB: We focused on stress-induced substances that have been documented to be associated with leading causes of death and disability such as cancer, heart disease, diabetes, chronic lung disease and inflammatory syndromes. Realizing typical detection challenges, we decided to take an extraordinary measure. We set forth to study the actual DNA switches that literally turn on or off the production of biological stress responses associated with these diseases.

It should be noted that this experiment was made possible through an unprecedented collaboration between Applied Biosystems, the world-renowned developer of the technology that first successfully deciphered the human genome in June 2000 and Yamaha Corporation of America.

GI: When I think of DNA, memories of spinning chains of molecules in biology class resurface. In simple terms, can you explain this further?

KB: Since Barry began this experiment, I've become increasingly interested in learning about DNA. From a layman's perspective, I envision the DNA code as a keyboard that stretches from New York to Los Angeles. When each note is played correctly, you have a wonderful symphony. When a note is played out of sequence or the keyboard is out of tune, the performance falls apart. Our health sort of works the same way.

BB: That's a wonderful example, Karl. Yet, perhaps a more detailed explanation is in order. Essentially, cells are the basic working units of every living system. All instructions needed to direct bodily functions are contained within our DNA, which exists in the form of a twisted ladder-like configuration with rungs that link base pairs.

DNA is found in the chromosomes that are located within the nucleus of each cell. The genome is our complete set of DNA and contains 3 billion chemical nucleotide bases and 20,000-25,000 functional genes.

Essentially, when we experience stress, our DNA immediately sets into motion a complex series of specific biological responses that literally create the substances that ultimately become our biology. By studying DNA, we are able to detect the initiation of biological changes before they actually occur. You might consider DNA as the command module for the entire body. Trip the master switch and a complex series of events eventually leads to the blast off of the space shuttle.

GI: The relationship between stress and disease is beginning to make sense. With this in mind, what did you discover?

BB: Surprisingly, when we initially examined the data from the stress-induction phase, we were extremely disappointed--there were no statistically significant findings. Despite a substantial investment of time and effort, we found ourselves literally at a standstill. After a great deal of frustration and a number of sleepless nights, I recalled Selye's definition at 2:00 one morning, and wondered whether or not we were on the verge of discovery. Could we be actually measuring biological diversity in action?

Early that morning, I woke up our statisticians in California and suggested that perhaps each person's DNA actually reflected one's unique response to the same stressor. After extensive analysis, that assumption proved correct. I coined the term, "individualized genomic stress-induction signatures," personalized DNA fingerprints that characterize each person's distinctive stress response.

KB: I clearly remember both Barry's initial frustration followed by his excitement. When he finally explained the discovery, I knew instinctively he was correct. It simply made sense. After all, how many times have you seen a husband and wife exposed to exactly the same stress such as the loss of a nest egg? One goes on to develop cancer while the other has a heart attack. Same stress, different response! We see it all the time. To prove it was no less than a breakthrough.

GI: A stress fingerprint, how interesting! Despite the complexity of what you're describing, this is becoming clearer. Each person's response is different. Yet how does that help us understand what actually happened when subjects played keyboard instruments?

BB: In view of these surprising findings, we wanted to know whether or not phase two strategies reversed the DNA switches that were turned on during the stress phase. That was the key question, pardon the pun.

In subjects who continued assembling puzzles during the second hour, no reversals were noted--the stress switches that had been turned on ... stayed on. In contrast, subjects who relaxed did far better. In that group, 6 of 45 stress-induced DNA switches actually reversed.

However, when we analyzed the keyboard group--19 of 45 genes reversed. For the first time in the history of science and music, we had successfully demonstrated that a first keyboard lesson for individuals who did not consider themselves musical reversed stress on the DNA level. Of substantial importance is the fact that the response in the keyboard group was more than three times greater than that of the relaxation group--19 versus 6 gene reversals. Playing a keyboard instrument was found to be far more effective at reducing the impact of stress than resting and reading newspapers or magazines.

GI: Barry, your comparison to the group that relaxed is extremely important. Yet, am I understanding you correctly? Are you saying that playing a keyboard instrument, even for the first time, turns off our stress response?

BB: We now have solid scientific evidence to support our contention that playing a keyboard instrument, in accordance with a specific protocol, substantially reverses the biological impact of stress. It should be noted that this is the first scientific experiment documenting induction and subsequent reversal of stress on the DNA level. Published in the esteemed international journal, Medical Science Monitor in February 2005, this peer-reviewed study has substantially increased our understanding of stress induction and its subsequent reversal accomplished by playing a keyboard instrument.

GI: Karl, these conclusions showcase the importance of our work on a new and exciting level. Can you place the importance of this into perspective for MTNA?

KB: Gary, this isn't news--it's history. The health benefits we've all experienced in our lives are now being supported by a solid foundation of medical research. Every piano teacher on the planet must become familiar with these findings. In an era where interest in playing musical instruments is waning, we now have exciting evidence that can positively impact the future of keyboard pedagogy. We share the opportunity and the challenge to extend the joy of playing a keyboard instrument to a vastly underserved market.

We should also take a closer look at the keyboard program used in the study. It's called the "Clavinova Connection" and it was developed by Barry, Craig Knudsen and myself for Yamaha. This group-based RMM program is intended for beginners, and uses electronic technology in the background to build success. There are basically 10 enjoyable steps that begin with a wellness exercise and progress through percussion, improvisation and a number of fun-filled group activities. Watching newcomers participate in the program is an eye-opening experience. The collective sense of immediate enjoyment is contagious.

GI: Karl, how do these findings directly impact MTNA's future?

KB: In a sense, the future has already happened. What we're doing now clearly impacts what will happen tomorrow. Too many people spend the bulk of their time trying to build a better yesterday. Every few hundred years a sharp transformation occurs. We cross a "divide." Within a few short decades, society rearranges itself--its worldview, its basic values, its social and political structure, its art and its key institutions.

The problem is recognizing the signs. People born after the transformation cannot even imagine the world in which their grandparents lived and into which their parents were born. Today's fundamental changes are actually only beginning and are just about to present their full impact.

It's a fact that only 7.6 percent of American adults over age 18 have actually touched a musical instrument in the last year in contrast to 76 percent who have participated in some sort of physical activity program. It also comes as no surprise that the majority of keyboard students drop out. This research, if applied properly by a group such as MTNA, can change the world.

GI: Barry, your findings and research insights are nothing short of fascinating. Looking back, how has your impression of music making changed over the years?

BB: Forty years ago I played classical piano in New York City concert halls. The stress I sensed as a teenager was immense to say the least. I didn't handle the pressure well, and subsequently stopped playing piano in my mid-teens.

Over the years, I gradually and reluctantly returned to the instrument associated with so much distress in my youth. I began playing the piano after frustrating days. Yet, I also experienced a prevailing sense of emptiness and failure as I could no longer play the way I did as a youth. Despite these feelings, I progressively discovered that I could effectively de-stress myself at the keyboard.

Unfortunately most people cannot enjoy the piano on that level. The prevailing belief is that it takes years of dedicated work to really enjoy the instrument. I personally find this extremely disappointing.

In order to remove that barrier, we developed the "Clavinova Connection" to enable people who were convinced they were not musical to discover the power of music as an extraordinary tool for creative personal expression. The "Clavinova Connection" empowers each person to immediately experience success. It's enormously rewarding to watch a person discover their musical spirit, and fall in love with music making in a way that certainly becomes instrumental to their health and well-being. Helping a person move beyond their perceived obstacles is an inspirational experience. From a physician's perspective, I consider the "Clavinova Connection" an antidote to stress!

GI: Karl, you've seen so much in your lifetime. You've been a part of so many advances in the music products industry, and your dedication on many levels has inspired all of us. Your wisdom is a guiding light. Recently, many of our teachers have contacted me to find out how they can get involved with this program. What would you suggest as a first step?

KB: First, I'm convinced there's a personal calling to this approach. It's a fact that most teachers love their work. Yet, it's also true that every student is not going to Carnegie Hall. Unfortunately, the vast majority of our students drop out. While multiple reasons exist beyond the scope of this discussion, it's time we took a closer look at the problem.

As Barry commented, many people envision years of study and practice to finally reach the point of enjoyment. Most give up along the way. The issue of dropouts cannot be ignored--it directly impacts the future of MTNA. Perhaps there is a better way. Why not empower our students to fall in love with music making first, and then decide whether or not they want to become serious students? The opportunity to touch so many lives is at stake. Both RMM and traditional music education can co-exist and strongly support each other.

GI: Karl, in the past you've successfully predicted the future of the music products industry. How do we, as MTNA members, begin to build upon your exciting vision?

KB: The first step is understanding the process. For those who wish to become facilitators, proper training is essential. Yamaha Corporation of America is now offering three-day intensive facilitation workshops.

Participants learn about the scientific aspects of RMM, become familiar with the research and experience the practical techniques that will help them effectively facilitate "Clavinova Connection" programs.

Emphasis is placed on creative personal expression and building a rewarding sense of success from the start. Facilitators experience first hand the key insights derived from the research we discussed that have great potential to impact lives. And as pedagogy evolves into facilitation, teachers discover new and meaningful ways to put back into their own lives what is missing.

GI: In summary, we now have credible proof of the value and benefits of playing a keyboard instrument. We've also gained new insights into RMM as an effective means to support underserved markets. Karl, you've also given us an exciting glimpse of the future. Barry, what are your next steps?

BB: Gary, I'd like to refer to the next few years as our evolutionary phase. We now have strong scientific evidence supporting what we've intuitively known all along ... playing a musical instrument is good for your health. While research will continue to expand our vistas, the next important step is to refine this approach through interdisciplinary input and ongoing experience.

MTNA is a vast valuable resource that can play an extraordinary role in the evolution of recreational music making. Your talented membership has extraordinary potential for building upon this foundation of research and extending the benefits of music making throughout society. I'm personally convinced that one day, a healthy lifestyle strategy will be defined in terms of exercise, nutrition and recreational music making. Playing a musical instrument will be considered instrumental to your health.

KB: I'd like to add that the MTNA membership is in a remarkable position to determine its destiny. The constructive application of these research findings is likely to generate the most significant advance in the history of playing the piano. There's never been a better opportunity to strengthen the foundations of keyboard pedagogy and boost public perception while improving quality of life for those we serve.

Gary Ingle is MTNA executive director. A former college professor, administrator and conductor, Ingle holds a D.M.A. degree from the Southern Baptist Theological Seminarjz He earned bachelor's and master's degrees in music at Samford University.

Barry Bittman, M.D., is a neurologist, author and international speaker. He is CEO and medical director of the Mind-Body Wellness Center and has pioneered a new paradigm for treating the "whole person."

Karl Bruhn has been active in the music industry, serving as senior vice president of marketing with Yamaha Corporation of America. Since retiring, he has served the music industry in many capacities and was a member of the MTNA FOUNDATION FUND Board of Trustees.