A new dementia treatment with quieting focus, subtle sound vibration, and intentional shared silence: Introducing Resonant Silence Technique: Innovative Practice by Miriam I. Fein, BA, BSM (Bachelor of Sacred Music)

First Published July 28, 2018 in Dementia: the international journal of social research and practice

​Abstract
High levels of sensory stimuli in care facilities have been shown to negatively affect people with dementia. This article describes the development and application of Resonant Silence Technique which endeavors to create a calming and peaceful atmosphere through multiple periods of silence following sound. The use of a quieting environment, subtle sound, and intentional silence is reported to help people with dementia feel less anxious, more relaxed and cooperative, emotionally appreciative, empathetic, and to improve eye contact and communication. Other positive benefits include improvements in concentration. Suggestions are made for further work to measure the impact of this approach.

Introduction
Resonant Silence Technique (RST) is a new rehabilitative treatment approach for adults with dementia. RST creates what has been described as a calming and peaceful atmosphere through the synergy of certain aspects of sound and periods of silence that are observed after each of the sounds has been allowed to slowly and completely fade.

Silence has been found to be relaxing and therapeutic, restoring equilibrium and reducing brain wave frequency while lowering blood pressure, heart and respiratory rates (Bernardi, Porta, & Sleight, 2006; Kim, Lee, Kim, Whang, & Kang, 2013; Kim, Rhee, & Kang, 2014; Kriste et al., 2015; Siegel, 1999).

The two aspects of sound that RST primarily focuses on are vibrato and harmonics. “Vibrato is the pulsating, wavy variation in pitch that richens the tone of a singing voice, wind instrument or string instrument” (Gardner, 1990, p. 94), lulling and quieting the listener by entraining them to alpha and theta brain waves (Gardner, 1990).

Harmonics are used in RST for they decrease the activity of brainwaves (D’Angelo, 2005) and when ting-shas and singing bowls are played, they each produce sounds in the theta range, which is associated with profound levels of relaxation, internality (Gaynor, 1999) and a ‘deep quietness of body, emotions and mind’ (Schwartz, 1995, pp. 148–149).

During an RST therapeutic group session, the RST facilitator gently shares sounds from instruments carefully chosen for their easily discernible vibrato and harmonics. Then, after each of the sounds has been allowed to fade gradually and completely, a period of silence is shared.

The majority of the sounds that RST shares do not have a song-like structure. Single vocalized syllables, notes, and brief musical phrases are the predominant sounds in an RST therapeutic session. These kinds of sounds are shared so as not to stimulate the listener’s memory and cognition or connect with the cognitive centers of the brain. RST seeks, instead, to connect with the non-cognitive centers in the brain, centers that have not been damaged by dementia. During the silence following sound, in these healthy cranial areas, the brain can look in on itself, integrating what it is exposed to, repairing the damaged neural pathways that have been causing dysfunctional behavior and creating new neural circuitry that manifests in better health and improved function (Kim et al., 2014; Kriste et al., 2015; Siegel, 1999).

Developing RST
I have always been drawn to silence and quiet places like forests, fields, deserts, mountains, and silent meditation retreats for rest and renewal. Being a singer and wishing to combine singing and silence, I studied ancient Jewish chant, graduating as a Cantor from The Jewish Theological Seminary in 1979. As a Cantor, I shared music and quiet companionship with folks in hospitals, hospice, and skilled nursing facilities. This deeply fulfilling work led me to complete the Music for Healing and Transition Program (MHTP) in 2001 and become a Certified Music Practitioner (CMP) trained to play at the bedside in care facilities. In 2006, I attended an MHTP conference. After the opening presenter finished speaking, the room grew very quiet. When the quiet ended, I realized that I felt totally refreshed and clear. If a brief time of silence after sound could be so beneficial for me, perhaps intervals of silence following sound could also help the folks with dementia with whom I was currently working. From this beginning, I created Resonant Silence Technique.

Running an RST session
RST therapeutic group sessions are held in rooms in skilled nursing facilities that have been specially selected for their quietness; rooms that are distant from noisy areas (Dewing, 2009) and can be closed off from resident and nursing traffic.

Groups are usually limited to 5 to 15 participants so that individual attention can easily be given to each person. In addition to the RST facilitator, each session is attended by a staff member-caregiver who can provide behavioral and emotional support and direction in case the need arises.

During an RST session, the RST facilitator focuses on quieting her/his body and mind as he/she shares simple vocal tones, cedar, bamboo and silver transverse flutes, singing bowls, bowed psaltery, guitar, and Tibetan ting-shas (tuned, rounded, bell-like chimes). After each sound has been allowed to gradually and totally fade, a space of silence is observed.

The duration of the facilitated silent segments varies depending on how far the RST session has progressed. At the start of an RST group session, the silences are held from 5 to 10 seconds, and as the therapeutic process proceeds, the periods of silence are gradually increased to 15 to 30 seconds each.

A simple, gentle, well-known song may also be shared in the beginning of the session when the facilitator is informed that there are multiple cognitive levels among the individuals in his/her dementia group. Those identified as functioning on a higher cognitive level have been observed to sway and/or sing along with the song.

Those identified as lower cognitively functioning and who appear passive as the song is sung have been observed to participate more fully in the final phase of the RST therapeutic process after successive periods of silence following sound have been shared.

In this final, more interactive phase, well-known poetry is shared for 3 to 15 minutes. Participants have been seen to recite the words and move to their rhythms.

Findings
In an RST therapeutic group, participants have often been observed to begin the session, slumped in their seats with little or no facial expression or displaying, ‘flat affect’. As the RST session unfolds, participants are seen to raise their bodies to sit more fully upright, often smiling, and making eye contact. Then, as the RST session draws to a close, group members have been observed to speak about how amazed they are that silence can be so relaxing and that all their worries and stresses are gone. They speak as well of how wonderful, calming, soothing, peaceful, and therapeutic the RST experience has just been for them.

Group members have been seen to hold out their hands to be held, to share well wishes and totalk with other group members even inquiring about their well-being. Members of the group have, as well, been seen to wave and speak their goodbyes and appreciation for the preceding session.

When asked how her mind felt after an RST cycle of sound and silence, a participant said that her mind was blank. This participant’s comment provides evidence of the achievement of one of the underlying goals of RST which is the quieting and clearing the mind of perceived thoughts. With less perceived thought, stress and anxiety also appear to lessen.

Staff caregivers have also reported that the beneficial effects of the RST session carry over and appear to be sustainable. They have reported that after regular twice per week RST sessions during the first month of treatment and then once per week for the next two months, some very positive behavioral changes have been observed: a person who was only able to sit still for a few minutes before the RST sessions can now watch a movie for 1 hour; an individual who was largely uncooperative before RST, now works better with staff and can easily take direction; a person who had not spoken more than a few words for five years began to speak in whole sentences, confiding in caregivers; and an individual who was wheelchair-bound stood up from his wheelchair.

Discussion and next steps
Recent scientific research appears to provide a further explanation for the rehabilitative importance of silence. Kriste et al. (2015) has found that in silence, new neurons are generated in the hippocampus which is the brain region associated with the formation of memory and learning involving the senses (Kriste et al., 2015). While preliminary, these findings suggest that silence could be therapeutic for conditions like depression and Alzheimer’s which are associated with decreased rates of neuron regeneration in the hippocampus (Kriste et al., 2015).

Additional research is needed to evaluate the physiological changes that take place during the beneficial behavioral shifts observed within and following RST sessions. Measuring and tracking heart rate, galvanic skin response, blood pressure, respiratory frequency, brain wave production (EEG) etc. during and after RST sessions will produce the quantifiable data needed to bring RST more fully to the attention of the medical dementia treatment community. When this happens, individuals with dementia, autism, and other neurological and cognitive disorders can more widely benefit from the therapeutic synergy of subtle sound and intentional silence provided by RST.

Acknowledgements
My heartfelt thanks go to the following individuals who read the paper and offered their caring and insightful feedback. These individuals are Simme Bobrosky, Mitchell Albala, Teresa Chason, Erik Fromme, Steve Smith, Dave Willingham, Joan Cross, Shari Rosner, Eva Baharav, Joyce Prigot, Sheryl Akaka, Elkah Katz, Tricia Grantham, Sharon Begley, and Mike Thuot.

Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Through the Still Portal
Dementia Wellness Through Sound and Stillness

Miriam Iya Fein - Published in Senior Guidebook to Western Washington Winter 2007

Over the years, I have witnessed many miracles in my work as a therapeutic musician and sound healer. I do this work with Gero-Psychiatric and cancer patients, in major hospitals and skilled nursing facilities. I have repeatedly seen the resiliency of those with dementia, and their capacity for returning to fuller consciousness through sound and stillness.

I play a variety of instruments in my work: Native American Flute, Guitar, Bowed Psaltery, Tibetan Singing Bowls, tingshas (chimes) and tuning forks. I play them with the underlying goal of creating a field of peace that infuses and surrounds those I work with, helping them to enter into their own stillness. In this quiet, secure and loving space, those with dementia return.

Just recently, I worked with a group of ladies with early stage Alzheimer’s. All through the session one woman sat impassive, while others awakened to the sounds of the cedar flute, bowed psaltery and the gentle tones of the Tibetan tingsha. Toward the end of the session, I introduced the Tibetan singing bowl and asked if anyone would like to hold the bowl as I played. This particular woman, still sitting expressionless, nodded tentatively, “yes”. I placed the bowl in her hand and I began to play. Her frozen face softened as I played, and then broke into a great, glowing smile! From then on, she was present, vocal and fully engaged with the group. The quieting and loving sounds of the cedar flute and Tibetan tingsha opened her to receive the sound and stillness of the Tibetan bowl, that brought her home to herself.

The sound of the Tibetan singing bowl is a single, multifaceted, sound, much like a mantra in meditation. The sound leads us or awakens us to our own stillness, and in this stillness comes the flash of self-recognition. In the quiet we begin to hear ourselves, our inner voice speaking amid the din around us. We are then able to return to ourselves, either gradually or in an instant, as in our example.

People get separated from their consciousness for a variety of reasons. One cause seems to be over stimulus. The noted author and speaker, Wayne Muller, has suggested that this society is tuned to the speed of the mind, whereas previous generations were attuned to the tempo of the heart. We are wired into the sound of the machine - the hum of the refrigerator, lawn mower, lights and, of course, our automobiles. Just a hundred years ago, these sounds were not present. Life was quieter and we could more easily attune to the sound and stillness of nature, and her wondrous, soothing cadences. Life was simpler too, with less to propel our lives forward and fill our hearts and minds. Today we are literally assaulted by stimulus from TV, magazines, movies, computers and the pace that we maintain in our lives. This pace takes its toll on our bodies, minds and spirits. Based upon my experience, it is my belief that dementia is a survival mechanism that we humans are using to escape from the over stimulus that pervades our society, and the sped-up velocity of our lives. The more I do this work and see the effectiveness of stillness in helping others, the more I am convinced of this belief. Stillness is an antidote, as it were, to over stimulus. In the secure environment of stillness, fear is transcended, over-activity in mind and body ceases, and we relax into sweet recognition with a wink and a smile.

This wondrous potential to return exists within us all. Our precious souls with dementia can return with the quiet we provide, and come home, through the still portal.