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Psychology of Music
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DOI: 10.1177/0305735611430081
published online 8 February 2012Psychology of Music
Genevieve A. Dingle, Christopher Brander, Julie Ballantyne and Felicity A. Baker
disadvantaged adults
'To be heard': The social and mental health benefits of choir singing for
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DOI: 10.1177/0305735611430081
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‘To be heard’: The social and
mental health benefits of choir
singing for disadvantaged adults
Genevieve A. Dingle
School of Psychology, The University of Queensland, Australia
Christopher Brander
School of Psychology, The University of Queensland, Australia
Julie Ballantyne
School of Music, The University of Queensland, Australia
Felicity A. Baker
School of Music, The University of Queensland, Australia
Abstract
Compared with other members of the general population, adults living with a chronic mental
illness or disability tend to participate less frequently in occupational and social interactions. This
may exacerbate problems such as emotional flattening and social isolation. Supported activities
like choir singing present an opportunity for meaningful activity and social connectedness for these
individuals. The aim of this study was to explore the personal experiences of choir members (89% of
whom experienced chronic mental health problems, 28% physical disabilities and 11% intellectual
disability) in relation to their wellbeing using interpretative phenomenological analysis (IPA).
Semi-structured interviews were carried out with 21 members of the choir at three time points
in the choir’s inaugural year: at the inception of the choir, after six months, and after 12 months.
Three content themes emerged: (1) personal impact (positive emotions, emotional regulation,
spiritual experience, self-perception, finding a voice); (2) social impact (connectedness within the
choir, connection with audience, social functioning); and (3) functional outcomes (health benefits,
employment capacity, and routine). A fourth theme of time was also apparent in the data. Results of
this study were consistent with the social identity theory notion that forming a new and valued group
identity (as a choir member) was associated with emotional and health benefits for the participants.
Keywords
choir singing, disability, mental health, social inclusion, wellbeing
Corresponding author:
Dr Genevieve Dingle, School of Psychology, The University of Queensland, St Lucia, Queensland 4072, Australia.
[email: dingle@psy.uq.edu.au]
430081POM10.1177/0305735611430081Dingle et al.Psychology of Music
2012
Article
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2 Psychology of Music
Introduction
In the 2003 Australian census, 6.3% of people reported that they experienced a severe or
profound disability, and most of these were due to chronic mental illness or to intellectual/
developmental disabilities (Australian Bureau of Statistics, 2004). The term chronic mental
illness commonly refers to people who have schizophrenia, bipolar disorder, or major depres-
sive disorder, and is sometimes extended to people with post traumatic stress disorder, a
personality disorder, or anorexia nervosa (Woods, Willison, Kington, & Gavin, 2008). Mental
illness can have a negative effect on daily functioning as well as impairing or preventing
typical developmental milestones such as receiving tertiary education, participating in paid
employment, getting married, and raising children (Seltzer, Greenberg, Krauss, & Hong,
1997). People with serious mental illness are likely to have fewer social contacts and supports
and are likely to be receiving less income (SANE Australia, 2010; Shibusawa & Padgett,
2009). They are also at greater risk of homelessness, imprisonment, and social marginaliza-
tion (Boardman, 2006). Although medications have demonstrated efficacy in the treatment
of positive symptoms such as hallucinations and delusions, they are less successful at treating
negative symptoms such as emotional flattening, loss of motivation and social withdrawal
(Buchanan et al., 2010; Carpenter, 2005). Repeated psychiatric hospitalizations and coping
with symptoms such as paranoia, hallucinations, and depression can make it difficult for
people with mental illness to form intimate relationships or keep stable employment (SANE
Australia, 2010). For these reasons, and consistent with the ethos of deinstitutionalization,
there is a need for community-based strategies to assist individuals with chronic mental
health problems to achieve mental health and wellbeing while remaining out of hospital.
Supported activities (in which support workers from government or non-government chari-
table agencies assist the individual to attend and engage with an activity), such as choir
singing, present an opportunity for meaningful activity, social connectedness and quality of
life for these individuals.
Choir singing
Choir singing has demonstrated powerful effects on both professional and amateur singers, as
shown in reductions in the stress hormone cortisol during choir rehearsals (Beck, Cesario,
Yousefi, & Enamoto, 2000), increased oxytocin, improvements in immune system function-
ing, and self-rated improvements in mood and wellbeing (Clift et al., 2010; Grape, Sandgren,
Hansson, Ericson, & Theorell, 2003; Kreutz, Bongard, Rohrmann, Hodapp, & Grebe, 2004;
Valentine & Evans, 2001). A study of 84 members of a university college choir in England
identified six dimensions of benefits associated with singing: benefits for well being and relax-
ation, breathing and posture; social benefits; spiritual benefits; emotional benefits; and ben-
efits for heart and immune system (Clift & Hancox, 2001). Bailey and Davidson conducted a
series of studies exploring the effects of group singing among homeless and marginalized
people as well as among a group of middle-class people (Bailey & Davidson, 2002, 2003,
2005). The positive effects of group singing and performance in these samples were found on
four outcomes: clinical type benefits (energy, relaxation, singer’s high); group process (social
support, camaraderie, normalcy); choir/audience reciprocity (empowerment, contribution,
pride); and cognitive stimulation (concentration, ordered thought process). Australian
researchers (Grocke, Bloch, & Castle, 2009) investigated the effect of group music therapy
on quality of life and social anxiety among 17 people with chronic mental illness. Ten
one-hour weekly sessions were conducted with activities such as singing, song writing and
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Dingle et al. 3
improvisation and a recording session at the end. Although no significant changes were
found on psychiatric symptoms, the group music therapy resulted in significant improve-
ments on five items of a quality of life scale, including increased general quality of life, health,
and perceived support from friends.
Theorising how choir singing may relate to health outcomes
Beyond the health benefits of music and singing, choir singing is a regular group activity that
tends to draw members together as a single entity that must work together to produce a good
sound. Choir rehearsals provide the opportunity for members to form an additional social sup-
port group and an additional social identity. A whole body of social psychology research –
social identity theory – explains that it is not just group memberships that relate to positive
health, but when the members strongly identify with the group and when the groups provide
stability, meaning and purpose, groups can have a positive impact on a person’s mental health
(Tajfel & Turner, 1986). Conversely, when our social identity is threatened, whether by leaving
or changing groups, this can have a negative impact on our wellbeing. For instance, a change
in career can result in a loss of social connections and also a loss of a social identity. There is
growing evidence that being socially active and belonging to a number of different social
groups can help us cope with life changes and can be an important predictor of health
outcomes (Haslam, Jetten, Postmes, & Haslam, 2009).
A study by Iyer and colleagues (2009) with university students provides an example
where belonging to multiple social groups was related to increased resilience in students
transitioning to university. One hundred and four first-year university students were sur-
veyed in relation to their transition into university. Students who belonged to more groups
prior to attending university were better able to adjust to their new social identity of being a
university student and were found to have lower levels of depression (Iyer, Jetten, Tsivrikos,
Postmes, & Haslam, 2009).
Studies on stroke patients have illustrated the importance of group membership in pre-
dicting positive health outcomes. A study by Haslam and colleagues (Haslam et al., 2008)
surveyed 53 patients recovering from a stroke. The results indicated that there was a signifi-
cant correlation between life satisfaction and both the number of group memberships before
the stroke and the number of group memberships maintained after the stroke. In another
study of 655 stroke patients, it was found that patients who were socially isolated were more
than twice as likely to have another stroke within the next five years as people who had
meaningful social relationships (Boden-Albala, Litwak, Elkind, Rundek, & Sacco, 2005).
Being socially isolated was found to be an even greater risk factor than having coronary
heart disease or physical inactivity (Boden-Albala et al., 2005).
Bailis and colleagues (2008) investigated the effects of collective self-esteem on 144
community dwelling older adults. Collective self-esteem was a measure of how many social
groups the participants belonged to, how closely they identified with those groups and how
they thought those groups were perceived by others. Higher levels of collective self-esteem
were found to slow the rate of developing chronic illnesses and increase the rate of daily
physical activity (Bailis, Chipperfield, & Helgason, 2008). This research is particularly
relevant for disadvantaged people – many of whom live in social isolation. Participation in
a choir or other group activity can increase their level of social interaction and potentially
provide an additional social identity, which could have positive outcomes for their health
and well being.
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4 Psychology of Music
The Reclink Transformers choir
This study concerns the Transformers choir, which is organized and supported by the chari-
table agency Reclink (Dingle, Pennings, Brander, & Jetten, 2010). Reclink – which receives
funding from the Australian commonwealth government, local government and charitable
donations – is an inter-agency networking organization located in 17 networks across urban,
regional and remote Australia. Reclink co-ordinators liaise with local services (such as mental
health, disability, drug and alcohol, homeless, domestic violence, immigrant support services,
and so on) to provide disadvantaged adults a range of sporting and cultural activities with
varying levels of intensity and support. Some examples of Reclink activities include choirs,
artist collectives, tag football, bowling, and yoga. Individuals are referred to a Reclink activity
by their existing health worker or agency, and those that require support to attend and engage
with an activity can access this support either from their home agency or a Reclink support
worker. The Transformers choir is also supported by a number of volunteers who assist
members during rehearsals and provide catering for meals.
The current study
Supported recreational and cultural activities such as choirs deserve attention as they have
potential to improve the quality of life for people with chronic mental illness and disabilities.
The current study aimed to investigate the effects of participating in a supported choir for
people with mental illness and social disadvantage using qualitative analysis of interview
transcripts. A qualitative approach was chosen in part to capture the detailed and idiosyn-
cratic experiences that choir members described, and partly because many of the choir
members did not have the capacity to complete a set of questionnaires that would assess similar
concepts. The study used interpretive phenomenological analysis (IPA; Smith, 1996; Smith,
Flowers, & Larkin, 2009) in which semi-structured interviews allow for participants to
describe their experiences in a rich and personalized manner (the phenomenological aspect),
while the questions themselves cover topics of interest to the researchers (the interpretive
aspect) – in this case, mood, wellbeing, general health, social connectedness and social identity.
The IPA approach has been called the most psychological of the thematic analysis approaches,
with a particular focus on the cognitions and emotions of participants (Pistrang & Barker,
2010), which makes it a suitable approach for the current study.
Method
Participants. The first author was invited by the Reclink community development coordinator to
attend choir rehearsals from the first day and she briefly spoke to the choir about the study and
encouraged members to participate on several occasions. She then approached individual members
before rehearsals and during meal breaks to provide written information about the study and to
obtain signed consent from those willing to participate in the study. All procedures and materials
for this study were approved by the University of Queensland Behavioural and Social Sciences
Ethics Review Committee. During the year, membership of the choir fluctuated around 40 partici-
pants, with 21 members consenting to be interviewed for the study. This sample represented the
majority of members who joined at the start of the choir and who had the capacity to be interviewed
and/or to complete pencil-and-paper questionnaires. The first author spoke to the support workers
who accompanied choir members with intellectual disabilities and those who were able to be inter-
viewed were included; however, many of these individuals were not able to complete the
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Dingle et al. 5
questionnaires. It is therefore possible that the data presented in the study are biased towards the
higher intellectually functioning members of the choir.
Demographic information presented in Table 1 shows that 57% of the sample was female,
and ages ranged from 31 to 74 years with an average of 47 years (three participants did not
provide an age). The vast majority of choir members identified as Anglo Australian ethnicity
(90%), with one Greek Australian and one person of Anglo Indian ethnicity. Table 1 further
shows that most of the sample (89%) experienced chronic mental illness, and a smaller but still
sizeable percentage reported physical (28%) or intellectual (11%) disabilities. Sixty per cent
reported taking prescribed medication for a mental health problem. Only one participant
reported being in treatment for an alcohol problem; however, choir organizers were aware that
substance misuse was affecting the choir attendance of around 10% of members. Previous
musical experience varied widely among the participants, with half of the sample (54%) reporting
less than a year of musical involvement (singing or playing an instrument) over their lifetime,
while some participants reported over 10 years of musical involvement. The overall mean of
musical experience was 6.77 years (SD = 10.24).
Table 1. Details of the participants in the choir study (names have been changed)
Name Age Relationship Ethnicity Health status Financial support
Jillian 48 Single Anglo/Aust Mental illness Social security
Bob 43 Single Anglo/Aust Mental illness Social security
Louise 49 Engaged Anglo/Aust Mental illness & phys
disability
Social security
Tom 61 Engaged Anglo/Aust Mental illness Social security
Jack 54 Separated Anglo/Aust Mental illness Paid work & social
security
Joan 61 Single Anglo/Aust Mental illness & phys
disability
Social security
Paul 47 Single Anglo/Aust Mental illness Social security
Brooke 39 Single Anglo/Aust Mental illness Paid work & social
security
Amy 34 In a relationship Anglo/Aust Mental illness Health insurance
Pauline 39 In a relationship Anglo/Aust Mental illness Social security
Simon 52 Divorced Anglo/Aust Mental illness Social security
Fiona 37 Single Anglo/Aust Mental illness Paid work & social
security
Gary 51 Single Anglo/Aust Mental illness & phys
disability
Social security
Ernie — Single Anglo/Aust Physical & intellectual
disabilities
Other
Karen 39 Single Anglo/Aust Mental illness Social security
Robert — Single Greek Aust Intellectual disability Social security
Cassie — Single Anglo/Aust Mental illness &
physical disability
Social security
Tina 31 Single Anglo/Aust Mental illness Insurance
Alice 49 Separated Anglo/Aust Mental illness Social security
Rana 74 Divorced Anglo/Indian Mental illness Social security
Chris 44 Single Anglo/Aust Mental illness Paid work
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6 Psychology of Music
The choir
The participants chose the name ‘Transformers’ by popular vote. Rehearsals were held once a
week for 3.5 hours in a community hall, including morning tea and lunch breaks (nutritious
meals were provided by a group of volunteers). The choir director was experienced in directing
choirs for adults and young people, including individuals experiencing social disadvantage. She
selected the musical repertoire in consultation with the keyboard accompanist and other
musically-trained support workers, and included world music, ballads, and popular music.
Music was typically provided in the form of the lyrics to which choir members could add their
own notes; however, choir members who played musical instruments could request copies of
the sheet music for most songs. Most songs were sung in four-part harmony with the keyboard
accompaniment, although some songs were performed a capella (such as an African lullaby).
Choir members were also taught simple choreography to go with the songs, such as swaying,
steps, and clapping.
Interview procedure
Interviews were conducted one-on-one in a quiet place within or near the rehearsal hall by
either the first or the second authors at three points in time: at the inception of the choir, after
six months (which was after the choir’s first public performances), and after 12 months.
Interviews of around 20 minutes duration were conducted before or after rehearsals or during
the lunch break, as many of the participants relied on the charity’s minibus or public transport
to get home. The kinds of questions asked during the interviews are summarized in Table 2.
Of the 21 participants interviewed at the start of the year, 10 were interviewed at six months,
and six were interviewed at 12 months, making a total of 37 interview transcripts for analysis.
Of these 21 participants, six (29%) were interviewed at 12 months as mentioned, four had
dropped out of the choir, two were in hospital at 12 months, one was still in the choir but
declined to be interviewed, and the remaining seven were not present when the 12-month
interviews were being conducted (some away on holidays and others whose information is
unknown).
Interpretive phenomenological analysis
Semi-structured interview schedules (summarized in Table 2) were devised according to the
procedure described by Smith (Smith, 1996; Smith et al., 1999; Smith, Jarman, & Osborn,
2009). According to Smith and colleagues (Smith et al., 1999), this approach is phenomeno-
logical in that it aims to understand the ‘individuals’ personal perception or account of an
object or event as opposed to an attempt to produce an objective statement of the object or event
in itself’ (p. 218), and it is also interpretive because the researcher aims to ‘develop an under-
standing of participants’ experiences, with the themes that are identified considered to come
from your personal interaction with, and interpretation of, the interview data, regardless of the
particular strategy you choose to employ’ (p. 230). In this case, the first author, and later the
second author, joined the choir and attended rehearsals in order to build rapport and familiar-
ity with the choir members. The data obtained in interviews is therefore likely to reflect the
subjective experience of the choir members and the interviewers in interaction. Although the
interviewers clearly identified ourselves as ‘researchers’ independent from the agents running
the choir, the fact that we joined the choir could be seen as a positive endorsement which may
have influenced the participants to provide socially-desirable responses. We aimed to provide
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Dingle et al. 7
participants with the opportunity to speak freely about their experiences – both positive and
negative – by asking specific questions about positive and negative experiences and also more
generally in the process of recruitment and informed consent.
Responses were recorded and transcribed verbatim for the thematic analysis. Transcripts
were organized according to questions and time point, so the initial interviews came first, fol-
lowed by the six-month and then the 12-month interviews. Transcripts were read and reread
a number of times to gain a thorough understanding of the data. Transcripts were coded by
the all the authors independently, followed by a series of meetings to discuss and refine
dominant themes and subthemes (Smith, 1996). There was general agreement on the three
content themes arising from the data; however, there was some discrepancy among coders on
the detail of the subthemes. For example, one researcher perceived the subtheme of the choir
as an ‘outside activity’ that involved leaving the home as important, while other researchers
perceived this theme as part of the subtheme of ‘routine and structure’ under the major theme
of functional outcomes. The fourth theme of time was discussed several times, and later added
as a separate component in the thematic map to indicate how the various experiences described
by participants progressed over the three interviews from more personal impact of singing in
the choir, to the social impact of becoming closer to other choir members and performing for
the audiences around six months, and then to functional outcomes largely described at
12 months as participants reviewed their first year in the choir. The final themes are presented
in a thematic map (Figure 1).
Results
The three main content themes that emerged from the qualitative analysis were: (1) personal
impact; (2) social impact; and (3) functional outcomes. These are presented in the thematic
map (Figure 1). Subthemes related to each of these main themes are discussed with examples
Table 2. Summary of the types of interview questions asked at the three time points
Interview 1: Early experiences in the Transformers
What were your first impressions of the choir (both positive and negative)?
How does being in the choir influence your mood?
Are there any difficulties or down-sides of being a choir member?
Do you feel connected to the other choir members, like you belong and identify with this choir?
Interview 2: Six months, after the first public performances
Are there any differences between singing at rehearsals and singing in front of an audience (describe).
What does it mean to you to be a member of Transformers?
Have you noticed any (other) effects of being in the choir in terms of your mental or physical health and
wellbeing?
Are there any difficulties or down-sides of being a choir member?
Has your sense of connectedness with other choir members changed since you first joined Transform-
ers? (if yes, describe).
Interview 3: End of the first year of the Transformers
Looking back over the first year of the choir, what has been your favourite moment and why?
Comparing the year before the choir with the year you’ve been in the choir, what have been the benefits
for your mental health?
Have there been any changes in your work capacity since joining the choir?
Has the choir affected your personal relationships?
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8 Psychology of Music
in the following sections. Given that time played a role in the kinds of experiences described by
participants, we added another theme – (4) time – along the bottom of the thematic map,
indicating that experiences progressed from largely personal, to social, and then to functional
across the three time points. The time point is indicated next to each direct quote from a partici-
pant. In particular the main theme personal impact was derived heavily from early (time 1)
experience, the theme of social impact was largely informed by six-month and 12-month
experiences of giving concerts, connecting with the audience, and building more meaningful
relationships with other choir members; and the theme of functional outcomes was largely
informed by interview data gathered at 12 months (time 3).
Theme 1: Personal impact
Positive emotions. One of the most common descriptions of the experience of being in the choir was
the positive feelings and sense of wellbeing associated with singing. When asked about the feelings
experienced when singing during choir rehearsals, responses included:
It makes me feel very positive . . . makes me feel good for the whole day. (Jillian, time 1)
Energized. (Tom, Fiona, Gary, all time 1)
And when asked about how the choir influenced their mood, responses included:
Bob (time 1): Uplifted, positive influence on my mood. I get a feeling of accomplishment that I’ve done
another week in the choir.
Karen (time 1): Your endorphins are flying, your hands are buzzing. It’s a good thing for the body and
mind to do. If you are feeling down, I definitely feel better because the body switches on everywhere.
Personal impact Social impact
Functional
outcomes
Positive
emotions
Emotional
regulation
Spiritual impact
Negative
emotions/
experiences
Connectedness with
the audience
Self-perception/
accomplishment
Finding a
voice
Health Employment
capacity
Routine/ structure
Social
functioning
Connectedness with the
community
Connectedness
within the choir
Confidence Singing ability
Time: Time 1 (early days) Time 2 (6 months) Time 3 (12 months)
Figure 1. Thematic map derived from interviews with choir participants
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Dingle et al. 9
Emotional regulation. Many choir members reported that singing helped reduce stress and tension
and allowed for relaxation. Some examples include:
It’s like a release of anxiety and pressure. Generally I feel comfortable. Singing makes you feel relaxed.
(Bob, time 1)
I’m inclined to worry about things. The choir can help to break the cycle. (Paul, time 1)
Negative aspects. Of course, not all emotional experiences in the choir were positive. When asked
about negative aspects, nine choir members could not think of any negative. However, some mem-
bers reported negative aspects associated with the choir:
Tired, sore throat, anxious feeling that I can’t do as well as other people. Transport. It takes over an
hour to get here. I take a bus, city cat (ferry), then another bus. Also I get a sore throat. (Jack, time 1)
Very stressed. Very scared. Certain of singing wrong notes and at the wrong time. Agitated. Had to not
think about it – try not to think about it at all or it was too much. Too much adrenalin. (Tina, time 2 –
experience of the first performance)
Spiritual experience. Although there were no questions that asked about a spiritual experience, a
few choir members did report a spiritual impact from being in the choir:
It lets those emotions out – I believe it gives it to a higher power because I’m a Christian. (Brooke, time 1)
It means getting back through to the more spiritual side of myself, because of the safety in this group,
I’m starting to come out . . . I thought I’d have to stop the choir to stay stable but actually I need to stay
in the choir to stay stable in all the demands of the play. Spiritual unblocking . . . It means a great deal.
It’s healing my creative soul. It’s healing my spirit. It’s the most normal life I’ve lived in a long time.
(Karen, time 2)
Improved self perception. Being in the choir appeared to have a positive impact on the choir mem-
bers’ perception of themselves. An increase in confidence was commonly reported:
It gives me confidence and that I am capable and can do things when I try. I am not a failure . . . Yes, I’m
feeling quite chuffed with myself belonging to the Transformers and I’m becoming busy in my life like
I never used to be and people are noticing how I’m becoming a nicer person to know and how capable
I feel within me. (Jillian, time 2)
[Being in the choir] means a great deal. I feel honoured to be part of the choir and to have the oppor-
tunity. It’s a big part of my week. [It’s] helped with self-esteem and confidence. To be involved in a choir
like this is just what I needed . . . It’s given me what I needed to be on the road to recovery. It’s made me
stronger, more able to connect and try new things. It gives us something you can take out into the com-
munity in everyday life to meet other goals with more confidence. (Alice, time 2)
Improved singing ability. An increase in choir members’ perception of their singing ability was also
expressed:
It’s giving me confidence in the musical abilities, like singing in front of people like [the choir organizer]
today. I imagine that’s because of being involved in the choir . . . Because of being in the choir, I got the
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10 Psychology of Music
opportunity to be in [the recycled instrument making] group, the Reclaimers. That’s good as well. I’m
learning about how music is made and the rhythms and timing and things like that. (Jack, time 2)
When asked about intentions to stay in the choir and future goals in the choir, the most
common response was a desire to improve their singing ability:
Yeah, as long as it goes. Probably to sing better – to sing better than I am. (Louise, time 3)
Yes, most definitely. Yes to be able to sing. Lots of other stuff too. [Prompt: Anything else that springs
to mind?] Yes to develop rhythms, appreciation of rhythms. (Tom, time 3)
Finding a voice. Finding a voice was a subtheme that contributed to both the personal impact and
social impact of the choir. People experiencing chronic mental health problems and disabilities
often do not receive much attention by society but the choir was an opportunity to make themselves
heard. This was evident in members’ replies to the question about their favourite song in the choir
(see Appendix 1 for lyrics to the song ‘To Be Heard’ by Brian Procopis who works and sings with
the Transformers):
‘To Be Heard’ – I can identify with some people who have more abilities can put you in the background.
The song is about finding a voice and saying what you want so others can understand you. (Brooke,
time 1)
‘To Be Heard’ – it conjures up the whole box and dice of homelessness, mental health, addiction
problems. At times [people are] really marginalized. [This song] gives others some awareness and
insight into some people’s lives . . . bringing it into the mainstream society. (Simon, time 1)
Theme 2: Social impact
Connectedness within the choir. A sense of acceptance and belonging within the choir was one of the
most prevalent subthemes. For example, when asked, ‘Do you feel connected with other choir
members?’, all but two participants responded with a yes, while the other two gave a mixed
response. Identification as a member of the Transformers choir was probably reinforced by the
supply of a uniform for the concerts: a striking black t-shirt with an orange Transformers logo that
the choir members helped to design, black skirt or trousers and a black cap. Some examples of the
connectedness within the choir sub theme were:
Yes it’s a wonderful family. It’s my choir family . . . It means . . . um, a sense of belonging to an awesome
group of people. To be part of something that fulfills me, gives me happiness and self confidence and I
feel accepted as part of the group and I love choir. It’s the highlight of my week . . . People know my
name even without my name badge. We can talk more freely to each other and feel more comfortable
to be able to be ourselves to a point but with respect for others. We are all equals! (Jillian, time 1)
Yes, I realized when we went to the Town Hall [concert], looking around at others, that I was really
forming a peer group that I’m very comfortable with. (Karen, time 2)
Connection with local community. A number of participants reported that choir had helped them
reconnect with their local community. Some examples of the connection with the local community
subtheme include:
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Dingle et al. 11
Participating is a positive outlet in the community. I’ve been homeless and living rough for years. I’m
just getting back into life. [The choir] is completely different from AA [alcoholics anonymous] meetings
and (Salvation Army homeless men’s lodge) . . . definitely. It’s opening up . . . getting back into life,
extending my perimeter. It’s a social outlet. (Simon, time 1)
[Recalling the first performances – laughs] Yeah, the exhilaration of having been so well received by
the audience. I felt relieved and I felt like it didn’t matter sort of. We all did it together. (Paul, time 2)
Um . . . I think one of the initial things was to start me getting out again. I had dropped out of a lot of
things like jazz club. And it was the start of going out again. I’m now back at the jazz club and the Silver
club. I suffered from depression you see and I felt very alone. (Rana, time 3)
Connection with the audience. A sense of connection with the audience was another common theme.
When asked about their favourite moment in the choir so far, a large number of people responded
that is was during the performances and the warm reception from the audience:
I felt really, really good inside. A warm and fuzzy feeling. A major adrenaline rush. To me, it was a
99.9% success. (Jillian, time 2)
Um, the favourite one was the Christmas performance at Queen St Mall. A lot of people were stand-
ing around and listening. It was a good feeling. We did two sessions. A good feeling. It makes you feel
better – a good reaction from the audience. (Louise, time 3)
Improved social functioning. An increase in general social functioning was reported by a number of
participants. This was considered relevant to social impact but also functional outcomes. Increased
social interaction within the choir appeared to benefit members’ relationships outside of the choir
as well:
Yes, I don’t get as crabby as I used to . . . I’m more tolerant . . . I’m learning to be more at ease in myself
and not judgmental of others. To be more open to people in every walk of my life. All sorts of people
make the world go round and learning not to be so wrapped up in ‘me’. (Jillian, time 1)
People tell me my confidence has grown. Choir is the only activity I do so I guess that means I might be
less isolated than before. (Tina, time 2)
I definitely see a bigger sense of wellbeing [here and in the instrument making workshop]. Able to work
with men and women, safe and finding boundaries . . . it’s been difficult. The people running it are solid
in themselves and open in who they are. (Karen, time 2)
Theme 3: Functional outcomes
Functional outcomes refers to improvements in broader areas of functioning as a result of
being in the choir.
Health benefits. Positive health benefits were reported by a number of choir members:
Um, very good. I am about to come off the tablets I’m on now. I have no troubles at the moment. It gives
me a pick up on energy. A lot of benefits. (Louise, time 3)
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12 Psychology of Music
I have been dealt a lot of hard blows in the last year but having the choir and my husband come into
my life – I’ve done well. I’ve got my son back, I’ve got my sanity back, I’ve got my soul back. (Pauline,
time 3)
Improved work capacity. Another improvement in functioning that was reported was an increase in
employment opportunities. When asked about changes in work capacity, responses included:
Yes. My support worker thinks I’m more than capable of getting some part-time work. A few days a
week paid work. (Jillian, time 3)
Yes. I’m applying for a permanent part time job, which I wasn’t able to do before. (Pauline, time 3)
Routine and structure in daily life. Being in the choir also seemed to help choir members construct
routine and structure in their lives. Having a consistent activity to attend every week helped with
planning and was something to look forward to:
It’s a steadying influence. It’s helped me in making routines. (Jack, time 2)
Being a member is a hard word. Very hard. The Transformers is the only activity I do during the week
and the only place I’ve gone to mostly willingly for years. Sometimes it’s like the only positive in my
life. (Tina, time 2)
Overall, participants had very positive impressions of the choir. For instance, when asked ‘Do
you intend to stay in the Transformers?’, all but one respondent said ‘yes’, and the remaining
participant was unsure about his availability. When asked, ‘Is there anything else you would
like to add in relation to the choir experience?’, participants had this to say:
I do enjoy the kindness and the feeling of belonging to something . . . I’m 75 and I don’t feel like I’m
being judged for my age. (Rana, time 3)
No. It’s just been great. I thank them every time we rehearse. I felt like methadone was taking my life
away and now the choir has given me my life back as a clean person. (Karen, time 3)
Discussion
This longitudinal qualitative study was designed to investigate the experiences of disadvan-
taged adults during their first year of singing in a supported choir. The themes emerging from
the interviews indicated that there were three major benefits of choir singing for this group:
personal impact, social impact, and broader functional outcomes. The most prominent finding
in terms of personal impact was that choir singing made members feel good and also helped to
resolve negative emotional states and problems such as pain. These findings are consistent with
previous research on the emotional function of music (Hunter & Schellenberg, 2010), Clift and
Hancox’s (2001) emotional component and Bailey and Davidson’s (2005) therapeutic benefits
theme. One notable difference in the current thematic map is the distinction between feeling
good after singing (positive emotions) and the ability of singing to reduce stress (emotional
regulation). Other researchers (Laiho, 2004) acknowledge the multiple emotional functions of
music yet we feel it is useful for the model to separate these two functions. Also, previous models
have focussed only on the positive aspects of participating in a choir. An advantage of the
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Dingle et al. 13
current model is that it acknowledges that there are some negative emotional experiences of
joining a choir for some participants. For people with a chronic mental illness, there is perhaps
a greater chance of a choir being a stressful experience due to the demands of remembering
words, singing in tune, getting along with other choir members, getting oneself organized to
attend rehearsals and concerts in addition to managing one’s symptoms. Yet the findings of
this study suggest that, with an appropriate level of support, these individuals were able to
overcome challenges and enjoy singing and performing to an audience.
Research on music and emotions is a rapidly-growing field, as shown for example in the
recent publication of the 33-chapter Handbook of Music and Emotion (Juslin & Sloboda, 2010);
yet, little is known about how various mental disorders influence the way music is perceived
and responded to emotionally. There is some evidence that depression decreases the activation
of reward circuitry in the brain when listening to favourite music (Osuch et al., 2009).
Furthermore, adults with schizophrenia show deficits in the ability to perceive emotions in
others’ voices (Leitman et al., 2010). It is a notable finding of the current study that partici-
pants in the choir (the majority of whom experienced chronic mental health problems such as
depression and schizophrenia) were able to overcome the impact of their mental disorders and
experience a range of emotional responses while singing. Our results add support to those of
Grocke and colleagues (2009) and Ansdell and Meehan (2010) that were conducted with
similar samples of adults experiencing mental health problems.
The Spiritual subtheme matches with the spiritual component in Clift and Hancox’s (2001)
study of singing in a choir. The self-perception/accomplishment subtheme has some overlap
with the self actualization theme reported by Tarrant and colleagues in relation to adoles-
cents’ reasons for listening to music (Tarrant, North, & Hargreaves, 2000), and both the identity
and agency functions of Laiho’s (2004) model. An increase in confidence in particular stood
out in responses from participants in the current study. Finding a voice was a subtheme that
we thought had both personal and social impacts. The choir was seen as an opportunity for
disadvantaged people to be heard. This was similar to the safe environment to experience voice
and empowerment subthemes developed by Bailey and Davidson (2005) from their studies of
choirs for homeless men and women.
The social impact theme was also consistent with previous studies emphasizing social and
interpersonal benefits of choir singing (Bailey & Davidson, 2005; Clift & Hancox, 2001; Clift
et al., 2010). The current study extends on previous cross-sectional research as it shows the
longitudinal development of social connectedness over the 12-month period (the fourth theme
of time). A majority of choir members interviewed at 12 months reported that their social
contact with other choir members had extended beyond the choir rehearsals and included
phone calls, invitations to other social events, and offers of transport and other forms of social
support. Two members of the choir became engaged and another couple were married during
the year; there was a gradual increase in social demands as choir members were exposed first to
each other, then to audiences of supporters and finally to members of the general public (e.g.,
Christmas carols in the city mall). The theme of connection with the audience was also reported
as audience reciprocity in the study by Bailey and Davidson (2005). Adults with mental health
problems and/or disabilities often experience discrimination and social exclusion (SANE
Australia, 2010), so a positive response from the audience was reported to have an enormous
positive impact on the members’ mood and self-perception. An increase in social interaction
appears to have positive effects on relationships outside of the choir as well. It appears that the
regular experience of helpful accepting relationships within the choir provided confidence for
choir members to increase their social interactions outside of choir times. For people with
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14 Psychology of Music
chronic mental health problems and/or disabilities, this accumulation of positive social
experiences can be seen as an important step in the process of achieving broader outcomes
such as entering paid employment and maintaining stable housing, which rely on interper-
sonal skill and confidence.
The findings of this study build upon the existing research on health benefits of choirs by
adding a theoretical framework. For participants, joining the choir represented a new and
valued social (group) identity, and this was linked to increased social connectedness and
improved health. This phenomena is consistent with the social identity theory notion that
group membership and identity has important health benefits, and extends previous research
(Haslam et al., 2008, 2009; Iyer et al., 2009) showing the health benefits of social groups for
adults making the transition into university and adults recovering after a stroke to this sam-
ple of adults with chronic mental health and/or disabilities. Further research measuring
established social identity theory concepts in a mental health context is warranted to better
understand what it is about joining a new and meaningful group that is beneficial to partici-
pants’ mental health and wellbeing, and how this process works.
The results of this study also link to social capital theory more broadly – in particular the
notion that cultural capital shares many of the characteristics of economic capital (Bordieu,
1979/1984) in that cultural participation plays an important role in social relationships and
networks and, consequently, in collective wellbeing (Hyyppa, 2010). This link has been sup-
ported by cross-sectional empirical studies conducted in the United Kingdom (Windsor, 2005),
the United States (Wilkinson, Waters, Bygren, & Tarlov, 2007), and in South Korea (Kim & Kim,
2009), showing that participants with a higher level of cultural participation (e.g., going to art
galleries, music concerts, libraries, cinema, etc.) tended to have a higher subjective wellbeing.
An increase in employment capacity is a theme that has not been found in previous studies
and is a significant finding as little is known about the specific processes that are required to
help adults experiencing chronic mental health problems or disabilities to increase their
participation in employment. There could be a number of reasons for this finding. The social
interaction from the choir may have given the participants the social skills necessary for
employment. An increase in energy and health benefits, and also an increase in confidence
and self-esteem, could have improved employment prospects. Future research could explore
this promising finding further. The ability of the choir to provide routine and structure was
commonly reported by participants. Having an activity to look forward to each week appeared
to have a stabilizing effect on the choir members. For many who live in social isolation, this
was the only activity they did consistently each week.
The study was limited by the attrition of participants by the time 3 interviews, so that we can
only describe the year-long experience of a minority of choir members. We were unable to
interview participants who had left the choir or were unavailable at the time of the 12-month
interviews and this may have influenced the study findings. We are also unsure of the extent to
which the benefits described by these choir members were attributable to choir singing per se,
rather than participating in any other meaningful group activity in the community. The first
author and colleagues are currently conducting a larger study of socially-disadvantaged adults
participating in a range of sporting and cultural groups to investigate this question further.
Conclusion
The study extended on previous exploratory choir research with the longitudinal approach
across the year and the addition of a theoretical framework of social identity theory. This
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Dingle et al. 15
study demonstrates that, with appropriate support, adults experiencing chronic mental
health problems or disabilities are able to gain important social and health benefits from
choir singing.
Acknowledgements
We would like to thank the choir members, Ben Pennings and the Reclink staff in Brisbane, and the
wonderful support workers and volunteers for their support of this project.
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Biographies
Genevieve Dingle, PhD, is a Lecturer in Clinical Psychology at the University of Queensland.
Christopher Brander is a graduate of the Masters of Applied Psychology at the University of
Queensland and he now works as a counsellor.
Julie Ballantyne, PhD, is a Senior Lecturer in music education at the University of Queensland.
Felicity Baker, Associate Professor, is an Australian Research Council Future Fellow, and Head
of the Music Therapy Programme at the University of Queensland.
Appendix 1
‘To Be Heard’ (words and music by Brian Procopis)
Woh – oh oh woh – oh oh woh – oh oh woh
A time for talking for sayin’ it all
To feel the tears – let them fall
Let them fall
Chorus:
To be heard is a liberating thing
No matter where no matter who or whenever
When there’s something way down burning within
To be heard is a liberating thing
Lost inside the hurt and the sorrow
Wishing there was no tomorrow
No tomorrow
Chorus
Dreams in pieces thrown about
First a whisper then a shout
Then a shout!
Woh – oh oh woh – oh oh woh – oh oh woh
A time for movin’ through the pain (a time for movin’)
To find our voice – sing again
Sing again
Chorus
To be heard to be heard to be heard is a liberating feeling. To be heard.
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