Most of our clients have sensory processing issues, whether its hyper-sensitivity to sound or poor grading of movement (or a host of others). In this blog post, I share two great resources for understanding how REI can help with sensory processing.
1. Video. Here is a video on how we approach sensory processing using complex drumming
2. Article: A Look at Rhythmic Entrainment Intervention by Its Creator
Published in: Insights into Sensory Issues for Professionals: Answers to Sensory Challenges, edited by Kathleen Morris. MS CCC/SLP. 2010.
by Jeff Strong
Director, Strong Institute
Auditory rhythm has a long history of use for affecting neurological function, with the earliest uses being documented tens of thousands of years ago. These original techniques are some of the most pervasive therapeutic practices known to man, existing on every continent even among people who had no contact with one another (Harner, 1990). As an ethnomusicologist I was fascinated by the commonality in the techniques within such disparate cultures. I spent over a decade trying to understand how the same basic therapeutic approaches developed when so many other aspects of these societies were vastly different.
The answer, it appeared, was that the physiological mechanisms at work are so powerful that experimentation by each culture resulted in a common finding: You can affect consciousness, cognition, and behavior by employing only two specific rhythmic techniques. One consists of a repetitive pulse while the other employs complex rhythmic structures.
Discovering such commonality among traditional therapeutic rhythm practices prompted another, perhaps more important, question: Can these therapeutic effects sustain themselves outside of the cultural context in which they developed? I believed so, but many of my colleagues did not, believing instead that the rhythm was secondary to the rituals they were imbedded in (and is often attributed to the placebo effect). This led to an odyssey that began in 1992 and has continued to this day, culminating in the development of Rhythmic Entrainment Intervention™ (REI).
REI is unique in several ways. First, REI employs auditory rhythm to directly stimulate the listener’s brain. Other auditory programs use modulated frequency (Tomatis, 1992), binaural beats (Oster, 1973), or simply classical-based music (Rauscher, Shaw, and Key, 1993).
As I developed REI, my first step was to identify the core mechanisms of the traditional techniques. It turns out that these mechanisms are simple, powerful, and easily understood. First, human consciousness can be directly affected by an auditory stimulus. This is called “auditory driving” (Goldman, 1992). Auditory driving states that a listener’s brain wave activity will synchronize with the pulsation of an auditory rhythm (provided certain conditions are met).
Traditional practitioners would employ a four-beat-per-second rhythm, which would in turn facilitate a corresponding four-beat-per-second pulsation in the listener’s brain, resulting in bilateral neurological synchronization and a shift in consciousness to a theta state (this is a meditative state)(Maxfield, 1994). With REI we double the tempo to synchronize a listener’s brain into a relaxed neurological state called alpha. This is the state of consciousness where sensory processing is optimized.
The second core mechanism involved in traditional therapeutic rhythm techniques consists of using complex rhythms to activate the brain (Scartelli, 1987; Shatin, Koner, Douglas-Longmore, 1961; Parsons, 1996). Here complex auditory rhythms stimulate the Reticular Activating System (RAS), a part of the brain that controls sensory input (Scartelli, 1992). Applying rhythm – especially complex rhythm – to activate the brain is one level of the stimulation provided by REI. As we conducted research we discovered another dimension to the rhythms: One that appears to be more important than just complexity. It seems that each rhythm produces a different response.
Once the core mechanisms were discovered the next step was to determine the best way to deliver the correct stimulus to aid in the areas in which I was interested. Traditional practitioners performed the rhythms live for each person and adjusted their rhythms based upon the responses they saw in their patient.
Daily Listening for Long-Term Change
This is where I started — the first 1,000 people that REI was used for experienced this one-on-one, live stimulus. They also listened to a recording of one of their live sessions daily in their home. Daily listening was a departure from the traditions, but I felt that people needed the stimulation repeated consistently for a length of time in order for any long-term change to be expected.
One of the first children that I worked with in this manner was a seven-year-old girl on the autism spectrum. In this case, the girl, let’s call her Stephanie, was referred to me because of extreme anxiety. This anxiety impacted every aspect of her life: She wasn’t able to sleep in her own room and needed to be in constant contact with her mother; transitions and even minor changes in her environment were a point of crisis for her throughout the day.
She also had significant language and social delays. Her language consisted largely of repeating rote words and phrases. Although she had a large vocabulary, she was unable to communicate beyond her basic needs and desires. Socially, she lacked eye contact and wasn’t able to interact appropriately with her peers.
She calmed down within minutes during the first live session, and after the second session she remained calm and was able to sleep in her own room from that night on. Stephanie listened to a recording of her third live session everyday for eight weeks. At seven weeks she spontaneously described events in proper sequence for the first time. She was also developing social connections and had begun making friends.
She was mainstreamed at school (she was in a classroom with non-autistic children and had a one-on-one aide) and at 10 weeks the school psychologist evaluated Stephanie in her classroom and noted that she was “indistinguishable from the “normal” children in the class.” She continued listening to her recording for several more months and eventually no longer required her one-on-one aide.
Universal Calming Effects
This, and many other cases studies, led to a formal study conducted in a public school setting (Strong, 12). This study consisted of 16 children from age 6 to 12 who were on the autism spectrum. The results of this study showed almost universal calming effects (only one child was not calm most of the time, and this child ended up not being on the autism spectrum).
Long-term change was significant for anyone who heard the recording at least four times per week. This study caught the attention of several prominent autism professionals and led to a paper of this study being presented at several professional research conferences (including one organized by The Center for the Study of Autism led by Dr. Stephen Edelson, who went on to design all of our double-blind, placebo-controlled studies).
At this point my interest in exploring the therapeutic application of auditory rhythmic stimulation techniques deepened. I formed the REI Institute with Beth Kaplan with no intention of creating a “therapy” that would be available outside of a research environment. Our goal was simply to try to understand how auditory rhythmic could be used to enhance neurological function.
Over the next 10 years the REI Institute conducted numerous studies and presented dozens of scientific papers on what we were learning. Two of the key discoveries of this period were that synchronization was universal when certain techniques were applied and that each rhythm used elicited a definite, observable response over time.
Specific Rhythms’ Observable Effects
In other words, we found that we could introduce specific rhythms to have a pre-determined effect on each listener. To date, we have documented over 600 rhythms that seem to correspond to symptoms and combinations of symptoms. As a result we found it was critical to use just the right rhythms for each person in order to have the greatest positive benefits for that person.
During the 1990s, the REI Institute conducted a series of double-blind, placebo-controlled studies to try to understand the best approaches to take in balancing auditory stimulation and synchronization. What we learned in a nutshell was that the custom-made CDs are more effective than CDs created for a broad user base.
Custom-made, Revisable CDs
This leads to the second unique aspect of REI: The REI Custom Program™ is custom-created for each person based on his unique characteristics. By custom-making each CD we can ensure that the correct level of stimulation is used for that person. In the event that we aren’t seeing the results we’ve come to expect, we also revise the CDs until we see the results we are looking for. The practice of revising the custom-made CDs is the third unique aspect of REI.
Because the REI Custom Program™ is created for each person, we are able to focus the CDs on the three or four main issues someone faces. As a result, everyone responds differently to his CDs, but we see the most significant benefits in some general categories. These include anxiety, sleep, self-stimulatory behaviors, language skills, sensory sensitivities and defensiveness, socialization, attention and focus, and aggressive or oppositional behaviors.
Another example of the results with the REI Custom Program™ (and one most relevant to this article) can be seen with a 10-year-old boy with severe sensory issues. Gerald, as I’ll refer to him, saw significant improvement within just a few days. Before he began the REI Custom Program™ he refused to wear shoes or socks, covered his ears whenever music was played, couldn’t tolerate headphones, and socially isolated himself from others, often retreating to a dark, quiet room.
Within the first week of listening to his CDs, Gerald was more tolerant of everyday sounds. He also spontaneously joined his extended family outside and began interacting with them. By the second week he was interacting with his siblings and cousins much more frequently, and by week four, according to his REI Provider, “… He is wearing socks and tennis shoes every day. He now not only allows mom to listen to music in the car, he often goes to his room and ‘rocks out’ to his own pop music. He has been more interactive and engaged in activities as well as initiating appropriate play with other children.”(Strong, 1996) He was also able to tolerate headphones for the first time.
This leads to the fourth thing that distinguishes REI from other auditory programs: REI is designed to be used in an open-air environment. That is, we don’t use headphones for the implementation of the therapy. The CDs simply need to play quietly in the background once a day (with the exception of the third week where the CDs are used twice a day). Having the stimulus in the background while the rest of the sensory input of life goes on forces the brain’s RAS to work hard to decipher the pattern in the stimulus while also ensuring that the listener doesn’t become over-stimulated by the rhythms.
In 2004 we began offering REI Custom Program™ through trained providers -– we now have hundreds across the U.S. This represented a monumental shift after 22 years of research — research that simply started from my desire to understand why traditional therapeutic rhythm practices were so prevalent around the world.
In spite of our growth and the expansion of REI beyond just research, I am still personally involved in the creation of all the REI Custom Program™ CDs that leave our office and am still impassioned by learning more about how auditory rhythmic stimulation can impact individuals with neurological issues.
Goldman, J. (1992). Sonic entrainment. In R. Spintge & R. Droh (Eds.), MusicMedicine (pp. 194-208). St. Louis, MO: MMB Music, Inc.
Harner, M. (1990). The Way of the Shaman (3rd ed.). New York: Harper San Francisco.
Maxfield, M. (1994). The journey of the drum. ReVision, 16(2), 157-163.
Oster, G. (year, month). Auditory beats in the brain. Scientific American, 229, 94-102.
Parsons, L. M. (1996, October). What components of music enhance spatial abilities? Paper presented at the VI International MusicMedicine Symposium. San Antonio, TX.
Rauscher, Shaw, & Key (1993, October 14). Music and spatial task performance. Nature, volume, pages.
Scartelli, J. (1987, November). Subcortical mechanisms in rhythmic processing. Paper presented at the meeting of the National Association for Music Therapy. San Francisco, CA.
Scartelli, J. (1992). Music therapy and psychoneuroimmunology. In Spingte & Droh, (pp. 137-141).
Shatin, L., Kotter, W. L., & Douglas-Longmore, G. (September 1961). Music therapy for schizophrenics. Journal of Rehabilitation, 27, 30-31.
Spintge, R., & Droh, R. (1992). The International Society of Music in Medicine (ISMM) and the definition of MusicMedicine and music therapy. In Spintge & Droh, (pp. 3-5).
Strong, J. (1996, October). Rhythmic Entrainment Intervention (REI) as applied to childhood autism. Paper presented at the VI International MusicMedicine Symposium.
Tomatis, A. (1992). The conscious ear: My life of transformation through listening. Barrytown, NY: Station Hill Press.
Since our first clinical study in 1994, we have focused on how to reduce anxiety and induce calm. For ten years our research examined children and adults on the autism spectrum. This population proved to be an excellent anxiety-based arena for two reasons:
1. People with autism often have a lot of anxiety. And anxiety can rule much of their behavior. A child may tantrum when asked to enter a noisy, stimulating environment like a restaurant or shopping mall (or school lunchroom) or an adult may react aggressively when sharing mealtime with others.
Observing anxiety in people with autism is easy and noticing changes, however small, becomes simple. The cessation of crying in a tantruming child or halting of aggressive behavior in an over-stimulated adult is an obvious measure of a reduction in anxiety.
2. Because autism is characterized by an inability to socially engage in an appropriate manner or an inability to communicate wants or needs, many people with autism have little to no awareness that some music (or other intervention) is going to be calming. And if they have such awareness, many have no idea how to self-regulate to calm on command.
This effectively removes the placebo effect. And because we are not using self-observed changes in anxiety, but instead use behavioral measures, we further remove any effects of the participants’ expectation from the studies. Either a tantrum stopped or it didn’t.
Our First Study Showed Significant Anxiety Reduction
Our first study was conducted in a public school setting with children between 6 and 12 years old. In this study we tracked immediate anxiety reducing effects as well as long term changes in anxiety levels. In other words, we wanted to see if listening to REI Rhythms would reduce anxiety as it happened (ending a tantrum, for example) and whether any residual calming effect would result in changes of overall behavior.
Immediate calming effects were significant. Nearly all the participants were calmed most of the time. The average frequency of time calmed by the recordings was 86.4%.
As far as overall changes in anxiety levels, we also saw significant changes as an average based on the pre and post tests. In the pre-test, average anxiety was listed at 82 on a 100 point scale. Anxiety on average after the study was reduced to 38 on a 100 point scale. This represents a significant reduction in anxiety over this 8-week period when the REI Rhythms were played quietly in the background. (1)
Subsequent Studies Support These Results
Follow-up studies with autism as well as other conditions such as Anxiety Disorders, Attention Deificit Disorders, and Sleep Disorders, showed similar reductions in anxiety while listening to REI music.
For example, a study conducted in a residential facility for adults with severe autism showed significant changes in anxiety levels both facility-wide and in individual behavior.
One resident was extremely aggressive before the study began, often injuring other residents or the staff. Before the study, incidents were reported several times per week. Within two weeks of beginning using the REI recording, his agggressive outbursts virtually stopped. And they remained rare for the entire study period and extended follow-up of 6 months. (2)
In another recent study, children within a public school showed significant reduction in anxiety-based behaviors while listening to REI rhythms. This study followed 10 students and showed reductions in behaviors in the following areas:
• Emotional outbursts
• Generalized anxiety
• Self-stimulatory behaviors
• Aggressive behavior
• Sound sensitivity
As the study states: Anxiety reduction can take many forms, especially with the large variation of symptomatic behaviors and characteristics present in children on the autism spectrum. (3)
Rhythmic Entrainment Intervention (REI) Customizes Your Calm
Everyone’s stress and anxiety are different. Some people struggle with the stress of the day while others experience deep-seated anxiety. Because of this we offer several solutions for your calm needs. These include:
Calming Rhythms CD. This CD provides episodic calm. Just turn it on when you need calm; your brain will respond in a few minutes.
Brain Shift Radio. BSR is our personalized streaming music site. Here, you will find episodic relief for your anxiety. Plus, you can mix and match your music to play across the 7 categories of calm, focus, brain boost, uplift, energy, meditation, and sleep.
REI Custom Calm Program. This program is created just for you and will provide long-term improvement in your anxiety and anxiety-based behaviors. 6 custom-made REI tracks are delivered over 6 weeks; we will get to the root of your anxiety.
REI Custom Program. This is our premier, all-inclusive program for long-term improvement. We will make improvements in any combination of 10 symptoms areas you may struggle with, including anxiety. Over the course of 12 custom-created REI tracks, we can address anxiety, attention, cognition, impulsivity, mood, language and communication, social skills, sensory processing, sleep, and self-stimulatory behaviors.
Several years ago we created a Continuous Performance Test (CPT) to see if listening to complex drumming rhythms can improve focused attention.
We created this test to follow-up on two independent studies showing that REI drumming can increase focused attention. One study compared BSR music to the AD/HD stimulant medication, Ritalin, using a Continuous Performance Test (the T.O.V.A.) for an adult with Attention Deficit Disorder while the other study used a blinded placebo-controlled format for elementary-age children in a classroom setting.
Complex REI Drumming Beats Ritalin for Sustaining Attention in an Adult with ADD
This study (1) compared BSR’s music to two different doses of the ADD stimulant medication, Ritalin (10mg and 20mg). Using quantitative measures of scores from the Test of Variables of Attention (T.O.V.A.), four conditions were examined: Baseline (no meds or music), 10mg of Ritalin taken 90 minutes before the test, 20mg of Ritalin taken 90 minutes before the test, and while listening to REI music rhythms.
The subject’s baseline score was -12.74, putting him squarely in the AD/HD camp (anything below a score of 0.00 suggests attention problems).
His score with 10mg of Ritalin was a slightly improved -6.60 while his 20mg Ritalin score showed a significant improvement with a score of -3.47.
His score when listening to the REI focusing music, the same tracks you will find in the Focus category of Brain Shift Radio, were a near normal score of -1.87.
This improvement was nearly 50% greater than the better of the Ritalin scores.
These results suggest that REI offers a strong alternative to Ritalin (and other stimulant medications used for ADD).
The advantages of BSR music include an absence of side-effects, individual customization to achieve the optimal stimulation level for each person, and improved sustained attention.
REI Drumming Improves Concentration in Elementary School Children
This study (2) examined 100 elementary-aged children in a double-blind, placebo-controlled format. Students performed four separate CPTs (Continuous Performance Tests), consisting of two tests with no music and two tests with either a placebo music recording or REI music tracks. Children were randomly assigned to the placebo or REI test group.
The results showed a significant improvement in attention for those who listened to the REI recording over both the silence and placebo conditions. The silence group produced an average score of 23, the placebo group scored at 31, and the REI Rhythm group scored an average of 68.
These results have been encouraging enough that Brain Shift Radio has invested tremendous time and energy developing a next-level study to further explore the efficacy of REI rhythms and the delivery of BSR music.
BSR’s Attention Tests Move Music Research a Step Forward
With Brain Shift Radio’s Continuous Performance Test we are moving music research forward by conducting the largest study ever done on music for focusing.
Our attention tests were built using standardized, quantitative testing methods on an expanding platform which will allow us to collect and analyze limitless data with a goal of using this data to not only determine whether music can improve focused attention but also which techniques offer the most significant results for each population group.
Thousands of Tests = Some amazing results
Since we launched the BSR CPT initiative thousands of people have taken the test. The results we’ve seen are 3.6 times better than the most popular study on music for cognition (and the number of people who have taken our test is hundreds of times more than this study) (3).
As an overview, the average error-rate reduction was 36.73% with improvements falling fairly consistently across the three error types.
These are significant numbers and suggests that listening to Brain Shift Radio when you need to focus may help you sustain your attention.
We saw reductions in all three error rates – detection, commission and omission – with the BSR music (stimulated) condition compared to the silence (control) condition.
Detection errors (Detect): The silence (control) condition error rate was 12.42. The BSR music (stimulated) condition showed an error rate of 8.69. This is a 3.73 or 30.0% reduction of errors.
Commission errors (Comm): The silence (control) condition error rate was .73. The BSR music (stimulated) condition showed an error rate of .39. This is a .34 or 46.5% reduction of errors.
Omission errors: The silence (control) condition error rate was 11.58. The BSR music (stimulated) condition showed an error rate of 7.67. This is a 3.91 or 33.7% reduction of errors.
Fastest click: For the silence (control) condition the fastest click speed was 383 ms. The BSR music (stimulated) condition showed an average click speed of 355 ms (milliseconds). This is a 28 ms or 7.3% slower click-time.
Slowest click: For the silence (control) condition the slowest click speed was 968 ms. The BSR music (stimulated) condition showed an average click speed of 932 ms. This is a 36ms or 3.7% faster click-time.
Average click: Of the three click speeds the average offers us the best data. For the silence (control) condition the average click speed was 608 ms. The BSR music (stimulated) condition showed an average click speed of 579 ms. This is a 31 ms or 5.1% faster click-time.
Aside from the stress-reducing effects of drumming (and playing music in general), drumming activates the brain and can increase focused attention.
The following is an excerpt from my book, Different Drummer, which explores my inspiration for using fast, complex drumming to help with sustaining focused attention. I describe how I stumbled upon the core technique that would be the basis for the stimulation in all our programs and CDs.
I’m a drummer and a tapper. I drum on everything. All the time. It drives many people crazy. I always thought that my need to drum was just because of my obsession with music and rhythm; but as I was doing some research for an upcoming study on ADHD, I discovered that I’m not alone in my need to tap.
“Have you ever heard of ‘fidget-to-focus’?” David asked as we were talking about our study. David was a neuropsychologist. He worked at a progressive clinic in San Diego and he was also a drummer. Although ADHD wasn’t his specialty, he was excited about exploring whether my drumming can impact attention. We were planning a study using a Continuous Performance Test (CPT) to collect quantitative data.
“No, what is it?” I replied.
“It’s based on a study done years ago on coping strategies people with ADHD develop to help them focus. This study was exploring why it was believed that ADHD was considered a childhood disorder that people grow out of as they reach adulthood. It turns out that people don’t necessarily grow out of ADHD. Instead, many people develop strategies to help them function better. The ADHD is still there.”
“So what does fidgeting have to do with it?”
“Well, it seems that fidgeting is one of the most common strategies people with ADHD use to keep their attention. Most are simple things like rocking, shaking a leg, playing with a pen or pencil, anything that uses a motor movement to keep them engaged.”
“Perhaps. Do you suppose there is a higher prevalence of drummers with ADHD than other musicians?”
“I don’t know. That’s an interesting idea, though. Most of the drummers I know are kind of like me. In fact, I don’t know any drummers who are not at least a little distracted, impulsive or hyperactive.”
“That would be an interesting study to do someday. But for now, if we consider fidgeting to help with attention, musical or not, perhaps the rhythm impacts the brain in a positive way.”
“It seems like the case to me, but what does fidgeting mean for our study?”
“Probably nothing, but maybe we can use the concept of fidget-to-focus as a basis for our hypothesis. Didn’t you say that you started developing your therapy from your experiences playing the drums and feeling more focused?”
“Yes. I guess that would be like fidgeting-to-focus. Only I wasn’t doing it solely to help focus. The drumming exercises were homework. And I wasn’t just focusing better while I drummed, I felt more focused afterward. The residual focusing effect was the basis of exploring the drumming for focus. My goal was to see if listening to syncopated drumming rhythms provided the same focusing effect as playing my homework exercises.”
I described to David that one of my challenges while attending the Musician’s Institute was being able to keep up with the pace of my classes. The most difficult for me, and many percussionists, was music theory and composition. I spent a lot of time analyzing music, digging deep into the structures that were being used in rock and jazz music (to this day I can’t listen to the Beatles and enjoy their music for what it is. I always find myself remembering the many hours spent dissecting their songs). As someone with ADHD, focusing on the mundane analysis of music theory and composition was nearly impossible. Contrasted with this was my favorite class, sight-reading, where it was always interesting and, as a result, easy for me to focus on.
Because I wanted to avoid music theory and instead work on sight-reading, I decided that I would reward myself for my theory and composition work by doing my sight-reading exercises before going back to some of the mundane work I was assigned. As someone who was somewhat impulsive and hated delayed gratification, I quickly decided to reverse this plan. Instead of theory first, I would allow myself to spend a half hour or so doing my sight-reading exercises then dig into theory for 30 minutes, followed by another bit of sight-reading.
The reason I preferred sight-reading was that I was able to play continually unique patterns. One basic exercise consisted of reading rhythm patterns from a book on syncopation, calledProgressive Steps to Syncopation For the Modern Drummer, by Ted Reed. The patterns were random combinations of 8th and 16th notes written across the page, page after page throughout the book.
My assignment was always to choose a page and read it in varying ways. Left to right, top to bottom, bottom to top, right to left, diagonally, whatever. The goal was to always be reading one or two measures ahead of where I was playing. This got me accustomed to reading ahead, therefore when confronted with a new piece of music, I could read, comprehend, and interpret it right away and convincingly perform it the way the composer intended. I loved these exercises. They gave me a rush.
Imagine my surprise when I also discovered that these exercises made doing my theory and composition work easier. After 30 minutes of sight-reading, I’d switch to theory and, to my amazement, could focus. The analysis was easier and the musical structures started making sense. I could even begin to appreciate the simple predictability of the Beatles’ music (especially since I never really liked listening to it – still don’t).
And analyzing more complex music of some of the progressive jazz-fusion bands like the Mahavishnu Orchestra or Weather Report became rote. My grades for the semesters after discovering this sight-reading-then-theory pattern confirmed what I felt. I was focusing better and grasping complex concepts better.
In this video, I show you a traditional ceremonial drumming rhythm used to empower and support courageous action. I then play a meditation using this rhythm as a foundation, illustrating how I learned how to influence the brain and behavior by interacting with my listener.