The Wonders of Group Singing – BSLM Social Prescribing SIG

Social prescribing offers unique opportunities to deliver personalised care by taking a holistic approach to an individual’s health and wellbeing. Patients are often referred to voluntary and community groups, facilitated by social prescribing link workers within primary care. An example of which includes singing groups and choirs. As a member of the BSLM Social Prescribing SIG, I chose to explore the wide-reaching health benefits of group singing and its expanding evidence base.

Everyone loves to sing, even if we cannot necessarily carry a tune. It’s free, easy to do and makes us feel good. It is no surprise that nearly two and a half million people in the UK belong to a choir¹. A decade ago, just the very mention of a choir would have brought hymns to mind but there has been a shift in attitudes towards joining a local choir. Every type of musical interest is catered for, and we are now seeing the increased visibility of choirs such as Popchoir and Rock Choir.

After seeing them perform at a local event, I joined Indie Choir Harrow for their weekly practice sessions. The choir have been running since 2017 and belt out tunes from the indie/alt rock and pop genre from the 70s, 80s, 90s and 00s. There was that initial apprehension on entering the room for my first session, but this soon passed after I had been introduced to some of the friendly choristers. After a short 10-minute vocal warm up exercise, we spent the remaining 90 minutes trying to perfect the songs carefully chosen by facilitator and founder, Brett, for the forthcoming performances which were taking place around the local community.

Like many social and community enterprises the accessibility of the choir makes it extremely successful. It is free and open to anyone regardless of age and vocal ability (which bode well for me!). Though most attendees attend regularly, which is a testament to the dedication of the facilitator, making an ongoing commitment to attend every week would be a deterrent. For this reason, every group is run as an open free session, and everyone is welcome to drop-in and out as suits them. Choosing repertoire with many potential layers is very helpful, so that each time a song is revisited there is the chance to teach the best-known parts to newcomers while offering new variations to those who have already sung the song many times.

In the West, making music has been perceived to be open to the talented few creating barriers for most to engage. However, very few people have no musical ability and the simple act of singing together confers real benefits for many people as discussed below. Being part of a cohesive group has been essential for survival throughout our evolutionary history. Group singing has been embraced throughout the ages amongst many cultures during important life events such as births and deaths as well as religious festivals. In view of increasing concern about social isolation and loneliness and its impact on health we need to be looking at ways in which we can get people connecting with one another. Singing together offers one such option and the growth of community choirs which are open and free to all demonstrates this. The evidence indicates that our singing ancestors might have held a key to better social well-being.

Singing has been shown to improve sense of happiness and wellbeing². Research has shown that people feel more positive after singing than they do passively listening to a piece of music or chatting about positive life events^{3 4}. It is thought that the neurochemicals dopamine, serotonin and beta-endorphin have a role to play in this effect. In addition, singing is thought to be beneficial for improving breathing, posture and muscle tension. Existing research within small-scale studies⁵ have illustrated low to moderate improvements in COPD with an increased FEV1/FVC ratio, FEV1 and FVC, suggesting community singing that includes attention to posture and breathing techniques can have an exercise training effect on the lung function of people with COPD. Singing could be considered a form of cardiovascular exercise and is worthy of the attention of those health professionals such as Respiratory Nurses and Pulmonary Rehabilitation teams working with this group of patients.

Further to this, group singing has shown to reduce stress levels. A 2017 study⁶ illustrated a statistically significant reduced cortisol level in saliva after choir singing (which was not seen in solo singing). There is also some evidence⁷ to suggest that group singing can play a role in sustaining a healthy immune system, by reducing the stress hormone cortisol and boosting the Immunoglobin A antibody. Additionally, there is partial support for singing effects on some pain outcomes^{8 9} with qualitative data suggesting group singing may be an effective and safe approach for reducing persistent pain and depression in people with long‐term health conditions.

Group singing may also have a beneficial role in controlling the emotional pain associated with bereavement. In a 2019 study¹⁰ conducted among people dealing with grief, depression symptoms did not get worse with time and the subjects’ sense of well-being remained stable. The choir singers felt a gradual improvement in their self-esteem during and after the 12-week study. Those who did not participate the singing intervention did not report this benefit. It is understandable that as far back as we can remember music has been used in different cultures throughout history in many funeral rituals.

Ageing brings with it changes to cognitive functioning as well as the physical and social environment of individuals. A cross sectional study¹¹ from 2021 illustrated group singing as providing a good opportunity to support psychological wellbeing and improve cognition of the elderly. The author (Pentikäinen, E) suggested the benefits occur as it requires flexible executive function and the regulation of attention.

“Choir singing is easy to do in practice, with little cost. It’s an activity that requires versatile information processing, as it combines the processing of diverse sensory stimuli, motor function related to voice production and control, linguistic output, learning and memorising melodies and lyrics, as well as emotions roused by the pieces sung.”
Regular choir members report that learning new songs is cognitively stimulating and helps their memory, and it has been shown that singing can help those suffering from dementia, too. The satisfaction of performing together, even without an audience, is likely to be associated with activation of the brain’s reward system, including the dopamine pathway, which keeps people coming back for more.

With an ever increasing need to support patients holistically with their health needs, group singing represents just one of the many tools of social prescribing that can offer a multitude of benefits to patient wellbeing.

About the Author

Dr Akshay Bhanshaly

Dr Akshay Bhanshaly is a GP based in North West London. He graduated from the Royal Free and University College School in 2005 before undertaking postgraduate training and qualifying as a GP in 2010 and completing the BSLM diploma in 2018. He runs a monthly Walk with a Doc group in the local community and is currently a member of the BSLM Social Prescribing Special Interest Group.

1. Voices Now Big Choral Census 2017
2. Group singing fosters mental health and wellbeing: findings from the East Kent “singing for health” network project – Clift, Morrison (2011)
3. Tuning in to others: Exploring relational and collective bonding in singing and non-singing groups over time – Pearce, Launay et all (2016)
4. Is Group Singing Special? Health, Well-Being and Social Bonds in Community-Based Adult Education Classes: Group singing, well-being and social bonds – Pearce, Launay et al (2016)
5. COPD – Singing for Better Breathing – Sidney de Haan Research Centre for Arts and Health (2019)
6. Choir versus Solo Singing: Effects on Mood, and Salivary Oxytocin and Cortisol Concentrations – Schladt TM, et al (2017)
7. Effects of choir singing or listening on secretory immunoglobulin A, cortisol, and emotional state – Kreutz G, Bongard S, Rohrmann S, Hodapp V, Grebe D (2004)
8. A systematic review on the effects of group singing on persistent pain in people with long‐term health conditions – J. Yoon Irons, et al. (2020)
9. Performance of Music Elevates Pain Threshold and Positive Affect: Implications for the Evolutionary Function of Music – Dunbar, Kaskatis et al (2011)
10. Group singing in bereavement: effects on mental health, self-efficacy, self-esteem and well-being – Fancourt, et al. (2019)
11. Beneficial effects of choir singing on cognition and well-being of older adults: Evidence from a cross-sectional study – Pentikäinen, E., et al. (2021)