The covid 19 pandemic has impacted us all and for those experiencing existing mental health challenges, it presented a situation for those challenges to become exacerbated (Friedman, 2013; Rajkumar, 2020). The impact of the pandemic and the enforced isolation saw increases in stress, depression, irritability, insomnia, fear, confusion, frustration, anger and boredom (Brooks et al, 2020). Loneliness during the pandemic is a risk factor for anxiety and depression (Avidor et al, 2020).
As part of our Singing Clinic programme, we ran an online Singing and Mindfulness group during lock down for patients referred from St Austell Healthcare identifying as experiencing anxiety and/or depression. This was delivered as part of the Social Prescribing initiative.
One participant reported:
I’ve “been feeling anxious every morning this week. Glad to have this session to look forward to” … I have “no foundation anymore” and “long days of solitude…(which) has highlighted the fact that I do not have a support network of friends to meet up with.”
It is becoming well documented that singing can promote well-being and positive mental health (Clift et al, 2018). Benefits have been identified as personal, social and functional (Baker et al, 2012). Participants in research have reported benefits such as improved quality of life, ability to cope and self-awareness (Daykin et al, 2018) and it is understood that Singing can support and promote all aspects of well-being (Fancourt et al, 2020).
Mindfulness too has a growing body of evidence to suggest its effectiveness in promoting positive mental health (Ortiz & Sibinga, 2017) and was documented as a recommended activity during lock down (Chee et al, 2020).
The online Mindfulness and Singing programme took place over 9 weeks, led by a Singing for Health specialist and a Sound Therapist/Accompanist. Both practitioners are Certified Trauma and Mental Health Informed practitioners. 7 participants took part and all reported that the programme had contributed to their well-being, during what was a challenging time. We took measures with the Hospital Anxiety and Depression Scale and found that both anxiety and depression scores were reduced after the programme. The Warwick Edinburgh Scale also presented data to confirm that well-being levels had improved.
There was an enormous sense of support and social connection between group members, which was strongly observed in the sessions and in participant journals.
“At this particular time (Covid19) any social interaction was welcome, however in these sessions it was helpful to realise that there are others experiencing similar or worse afflictions. Nobody is judgmental, everyone listened patiently. In my view community singing is a great human cement.”
3 of the 7 participants claimed that if the provision had been face to face, it was very unlikely that they would have taken part. There was a consensus that being online helped to make the activity more accessible and feel manageable.
“Being able to sing on mute gave me confidence to sing a bit louder than I probably would of in a room of strangers.”
It was encouraging to see that over the course of the programme, participants were starting to build confidence, self-efficacy and were overcoming barriers.
One participant has had ongoing significant health issues. Before session one, this individual reported “my anxiety levels are quite high and I have had to psych myself up to log on.” The notes following session one are simply, ‘good fun, nice people, very friendly.” This participant was admitted to hospital during the course of the project and missed a couple of sessions. Despite having a low mood and no “mental energy to motivate myself, or the energy to cheer myself up”, this participant managed to click on the zoom link, overcome barriers, and join the session stating that “I knew seeing you guys would really help.” (Field notes). This is the same participant who cautiously used a virtual background found on zoom for the first session, then on the second session said “I’m going to let you in” by taking away the virtual background.
Another participant demonstrated significant overcoming of barriers in joining the group. At the beginning she reported feeling ‘’quite nervous about the session. I was worried and had anxiety about my tremors and how bad they would be and if the other people would notice.” This participant told us that if it had been a face-to-face group, she would not have attended. She went on to find great benefit from the sessions and even stated that she felt confident enough to join a choir. Other studies tell us that taking part in music sessions can promote self-development, including the building of agency and self-confidence (Fancourt et al, 2020). It was therefore encouraging to read a journal entry that reported; “I feel I am quite good at the voice exercises we do during the session which is nice because I’ve always been made to believe that I am no good.”
Sessions were a carefully planned combination of both relaxing and uplifting activities, mindfully and responsively working to ensure that participants left feeling positive.
“Afterwards felt better and our last song together stayed in my head for a couple of days. I found myself singing aloud when out with Reg (dog).”
The rippling effects meant that participants reported improvements in their general well-being and ability to function and carry out every day tasks.
“Overall I have found that I am in a better place mentally than when I started the course. I also have some new tools for Mindfulness and breathing to help me cope better with my issues (improved self-awareness). Physically my breathing is easier and I can do more things for longer as I am more conscious about my breathing technique, so I can cook myself a meal with less pain.”
We will be running more Singing for Health programmes in our Singing Clinic, funded by the Lottery and in partnership with St Austell Healthcare. There will be a blended model utilising the positive aspects of both online and face to face provision. This research was carried out with ethics board clearance from the University of Wales, Trinity St Davids for an MA in Professional Practice, Voice Pedagogy with Voice Workshop Ltd.
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