music therapy

Music Therapy 

Definition

Music therapy is a technique of complementary medicine that uses music prescribed in a skilled manner by trained therapists. Programs are designed to help patients overcome physical, emotional, intellectual, and social challenges. Applications range from improving the well being of geriatric patients in nursing homes to lowering the stress level and pain of women in labor. Music therapy is used in many settings, including schools, rehabilitation centers, hospitals, hospice, nursing homes, community centers, and sometimes even in the home.

Purpose

Music can be beneficial for anyone. Although it can be used therapeutically for people who have physical, emotional, social, or cognitive deficits, even those who are healthy can use music to relax, reduce stress, improve mood, or to accompany exercise. There are no potentially harmful or toxic effects. Music therapists help their patients achieve a number of goals through music, including improvement of communication, academic strengths, attention span, and motor skills. They may also assist with behavioral therapy and pain management.

Physical effects

Brain function physically changes in response to music. The rhythm can guide the body into breathing in slower, deeper patterns that have a calming effect. Heart rate and blood pressure are also responsive to the types of music that are listened to. The speed of the heartbeat tends to speed or slow depending on the volume and speed of the auditory stimulus. Louder and faster noises tend to raise both heart rate and blood pressure; slower, softer, and more regular tones produce the opposite result. Music can also relieve muscle tension and improve motor skills. It is often used to help rebuild physical patterning skills in rehabilitation clinics. Levels of endorphins, natural pain relievers, are increased while listening to music, and levels of stress hormones are decreased. This latter effect may partially explain the ability of music to improve immune function. A 1993 study at Michigan State University showed that even 15 minutes of exposure to music could increase interleukin-1 levels, a consequence which also heightens immunity.

Mental effects

Depending on the type and style of sound, music can either sharpen mental acuity or assist in relaxation. Memory and learning can be enhanced, and this used with good results in children with learning disabilities. This effect may also be partially due to increased concentration that many people have while listening to music. Better productivity is another outcome of an improved ability to concentrate. The term "Mozart effect" was coined after a study showed that college students performed better on math problems when listening to classical music.

Emotional effects

The ability of music to influence human emotion is well known, and is used extensively by moviemakers. A variety of musical moods may be used to create feelings of calmness, tension, excitement, or romance. Lullabies have long been popular for soothing babies to sleep. Music can also be used to express emotion nonverbally, which can be a very valuable therapeutic tool in some settings.

Description

Origins

Music has been used throughout human history to express and affect human emotion. In biblical accounts, King Saul was reportedly soothed by David's harp music, and the ancient Greeks expressed thoughts about music having healing effects as well. Many cultures are steeped in musical traditions. It can change mood, have stimulant or sedative effects, and alter physiologic processes such as heart rate and breathing. The apparent health benefits of music to patients in Veterans Administration hospitals following World War II lead to it being studied and formalized as a complementary healing practice. Musicians were hired to continue working in the hospitals. Degrees in music therapy became available in the late 1940s, and in 1950, the first professional association of music therapists was formed in the United States. The National Association of Music Therapy merged with the American Association of Music Therapy in 1998 to become the American Music Therapy Association.

Goals

Music is used to form a relationship with the patient. The music therapist sets goals on an individual basis, depending on the reasons for treatment, and selects specific activities and exercises to help the patient progress. Objectives may include development of communication, cognitive, motor, emotional, and social skills. Some of the techniques used to achieve this are singing, listening, instrumental music, composition, creative movement, guided imagery, and other methods as appropriate. Other disciplines may be integrated as well, such as dance, art, and psychology. Patients may develop musical abilities as a result of therapy, but this is not a major concern. The primary aim is to improve the patient's ability to function.

Techniques

Learning to play an instrument is an excellent musical activity to develop motor skills in individuals with developmental delays, brain injuries, or other motor impairment. It is also an exercise in impulse control and group cooperation. Creative movement is another activity that can help to improve coordination, as well as strength, balance, and gait. Improvisation facilitates the nonverbal expression of emotion. It encourages socialization and communication about feelings as well. Singing develops articulation, rhythm, and breath control. Remembering lyrics and melody is an exercise in sequencing for stroke victims and others who may be intellectually impaired. Composition of words and music is one avenue available to assist the patient in working through fears and negative feelings. Listening is an excellent way to practice attending and remembering. It may also make the patient aware of memories and emotions that need to be acknowledged and perhaps talked about. Singing and discussion is a similar method, which is used with some patient populations to encourage dialogue. Guided Imagery and Music (GIM) is a very popular technique developed by music therapist Helen Bonny. Listening to music is used as a path to invoke emotions, picture, and symbols from the patient. This is a bridge to the exploration and expression of feelings.

Music and children

The sensory stimulation and playful nature of music can help to develop a child's ability to express emotion, communicate, and develop rhythmic movement. There is also some evidence to show that speech and language skills can be improved through the stimulation of both hemispheres of the brain. Just as with adults, appropriately selected music can decrease stress, anxiety, and pain. Music therapy in a hospital environment with those who are sick, preparing for surgery, or recovering postoperatively is appropriate and beneficial. Children can also experience improved self-esteem through musical activities that allow them to succeed.

Newborns may enjoy an even greater benefit of music. Those who are premature experience more rapid weight gain and hospital discharge than their peers who are not exposed to music. There is also anecdotal evidence of improved cognitive function.

Music and rehabilitation

Patients with brain damage from stroke, traumatic brain injury, or other neurologic conditions have been shown to exhibit significant improvement as a result of music therapy. This is theorized to be partially the result of entrainment, which is the synchronization of movement with the rhythm of the music. Consistent practice leads to gains in motor skill ability and efficiency. Cognitive processes and language skills often benefit from appropriate musical intervention.

Music and the elderly

The geriatric population can be particularly prone to anxiety and depression, particularly in nursing home residents. Chronic diseases causing pain are also not uncommon in this setting. Music is an excellent outlet to provide enjoyment, relaxation, relief from pain, and an opportunity to socialize and reminisce about music that has had special importance to the individual. It can have a striking effect on patients with Alzheimer's disease, even sometimes allowing them to focus and become responsive for a time. Music has also been observed to decrease the agitation that is so common with this disease. One study shows that elderly people who play a musical instrument are more physically and emotionally fit as they age than their nonmusical peers are.

Music and the mentally ill

Music can be an effective tool for the mentally or emotionally ill. Autism is one disorder that has been particularly researched. Music therapy has enabled some autistic children to relate to others and have improved learning skills. Substance abuse, schizophrenia, paranoia, and disorders of personality, anxiety, and affect are all conditions that may be benefited by music therapy. In these groups, participation and social interaction are promoted through music. Reality orientation is improved. Patients are helped to develop coping skills, reduce stress, and express their feelings.

Music and hospice

Pain, anxiety, and depression are major concerns with patients who are terminally ill, whether they are in hospice or not. Music can provide some relief from pain, through release of endorphins and promotion of relaxation. It can also provide an opportunity for the patient to reminisce and talk about the fears that are associated with death and dying. Music may help regulate the rapid breathing of a patient who is anxious, and soothe the mind. The Chalice of Repose project, headquartered at St. Patrick Hospital in Missoula, Montana, is one organization that attends and nurtures dying patients through the use of music, in a practice they called music-thanatology by developer Therese Schroeder-Sheker. Practitioners in this program work to relieve suffering through music prescribed for the individual patient.

Music and labor

Research has proven that mothers require less pharmaceutical pain relief during labor if they make use of music. Using music that is familiar and associated with positive imagery is the most helpful. During early labor, this will promote relaxation. Maternal movement is helpful to get the baby into a proper birthing position and dilate the cervix. Enjoying some "music to move by" can encourage the mother to stay active for as long as possible during labor. The rhythmic auditory stimulation may also prompt the body to release endorphins, which are a natural form of pain relief. Many women select different styles of music for each stage of labor, with a more intense, or faster piece feeling like a natural accompaniment to the more difficult parts of labor. Instrumental music is often preferred.

Precautions

Patients making use of music therapy should not discontinue medications or therapies prescribed by other health providers without prior consultation.

Research and general acceptance

There is little disagreement among physicians that music can be of some benefit for patients, although the extent to which it can have physical effects is not as well acknowledged in the medical community. Research has shown that listening to music can decrease anxiety, pain, and recovery time. There is also good data for the specific subpopulations discussed. A therapist referral can be made through the AMTA.

Resources

Organizations

American Music Therapy Association, Inc. 8455 Colesville Road, Suite 1000 Silver Spring, ML 20910. (301) 589-3300. http://www.musictherapy.org.

Chalice of Repose Project at St. Patrick Hospital. 312 East Pine Street, Missoula, MT 59802. (406) 329-2810. Fax: (406) 329-5614. 〈http://www.saintpatrick.org/chalice/〉.

Key terms

Entrainment — The patterning of body processes and movements to the rhythm of music

Physiologic — Characteristic of normal, healthy functioning

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therapy /ther·a·py/ (-pe) the treatment of disease; see also treatment.

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ablation therapy  the destruction of small areas of myocardial tissue, usually by application of electrical or chemical energy, in the treatment of some tachyarrhythmias.

adjuvant therapy  the use of chemotherapy or radiotherapy in addition to surgical resection in the treatment of cancer.

antiplatelet therapy  the use of platelet-modifying agents to inhibit platelet adhesion or aggregation and so prevent thrombosis, alter the course of atherosclerosis, or prolong vascular graft patency.

art therapy  the use of art, the creative process, and patient response to the products created for the treatment of psychiatric and psychologic conditions and for rehabilitation.

aversion therapy , aversive therapy that using aversive conditioning to reduce or eliminate undesirable behavior or symptoms; sometimes used synonymously with aversive conditioning.

behavior therapy  a therapeutic approach that focuses on modifying the patient's observable behavior, rather than on the conflicts and unconscious processes presumed to underlie the behavior.

biological therapy  treatment of disease by injection of substances that produce a biological reaction in the organism.

chelation therapy  the use of a chelating agent to remove toxic metals from the body, used in the treatment of heavy metal poisoning. In complementary medicine, also used for the treatment of atherosclerosis and other disorders.

cognitive therapy , cognitive-behavioral therapy that based on the theory that emotional problems result from distorted attitudes and ways of thinking that can be corrected, the therapist guiding the patient to do so.

convulsive therapy  treatment of mental disorders, primarily depression, by induction of convulsions; now it is virtually always by electric shock (electroconvulsive t.) .

couples therapy  marital t.

dance therapy  the therapeutic use of movement to further the emotional, social, cognitive, and physical integration of the individual in the treatment of a variety of social, emotional, cognitive, and physical disorders.

electroconvulsive therapy  (ECT) a treatment for mental disorders, primarily depression, in which convulsions and loss of consciousness are induced by application of brief pulses of low-voltage alternating current to the brain via scalp electrodes.

electroshock therapy  (EST) electroconvulsive t.

endocrine therapy  treatment of disease by the use of hormones.

estrogen replacement therapy  administration of an estrogen to treat estrogen deficiency, as that following menopause; in women with a uterus, a progestational agent is usually included to prevent endometrial hyperplasia.

enzyme therapy  in complementary medicine, the oral administration of proteolytic enzymes to improve immune system function; used for a wide variety of disorders and as adjunctive therapy in cancer treatment.

family therapy  group therapy of the members of a family, exploring and improving family relationships and processes and thus the mental health of the collective unit and of individual members.

fibrinolytic therapy  the use of fibrinolytic agents (e.g., prourokinase) to lyse thrombi in patients with acute peripheral arterial occlusion, deep venous thrombosis, pulmonary embolism, or acute myocardial infarction.

gene therapy  manipulation of the genome of an individual to prevent, mask, or lessen the effects of a genetic disorder.

group therapy  psychotherapy carried out regularly with a group of patients under the guidance of a group leader, usually a therapist.

highly active antiretroviral therapy  (HAART) the aggressive use of extremely potent antiretroviral agents in the treatment of human immunodeficiency virus infection.

hormonal therapy , hormone therapy endocrine t.

hormone replacement therapy  the administration of hormones to correct a deficiency, such as postmenopausal estrogen replacement ttherapy.

immunosuppressive therapy  treatment with agents, such as x-rays, corticosteroids, or cytotoxic chemicals, that suppress the immune response to antigen(s); used in conditions such as organ transplantation, autoimmune disease, allergy, multiple myeloma, and chronic nephritis.

inhalation therapy  former name for respiratory care (2).

light therapy 

1. phototherapy (def. 1).

2. photodynamic t.

marital therapy  a type of family therapy aimed at understanding and treating one or both members of a couple in the context of a distressed relationship, but not necessarily addressing the discordant relationship itself; sometimes used more restrictively as a synonym of marriage therapy .

marriage therapy  a subset of marital therapy (q.v.) that focuses specifically on the bond of marriage between two people, enhancing and preserving it.

massage therapy  the manipulation of the soft tissues of the body for the purpose of normalizing them, thereby enhancing health and healing.

milieu therapy  treatment, usually in a psychiatric hospital, that emphasizes the provision of an environment and activities appropriate to the patient's emotional and interpersonal needs.

music therapy  the use of music to effect positive changes in the psychological, physical, cognitive, or social functioning of individuals with health or educational problems.

occupational therapy  the therapeutic use of self-care, work, and play activities to increase function, enhance development, and prevent disabilities.

oral rehydration therapy  (ORT) oral administration of a solution of electrolytes and carbohydrates in the treatment of dehydration.

orthomolecular therapy  treatment of disease based on the theory that restoration of optimal concentrations of substances normally present in the body, such as vitamins, trace elements, and amino acids, will effect a cure.

photodynamic therapy  intravenous administration of hematoporphyrin derivative, which concentrates selectively in metabolically active tumor tissue, followed by exposure of the tumor tissue to red laser light to produce cytotoxic free radicals that destroy hematoporphyrin-containing tissue.

physical therapy 

1. treatment by physical means.

2. the health profession concerned with the promotion of health, the prevention of disability, and the evaluation and rehabilitation of patients disabled by pain, disease, or injury, and with treatment by physical therapeutic measures as opposed to medical, surgical, or radiologic measures.

poetry therapy  a form of bibliotherapy in which a selected poem, which may be created by the patient, is used to evoke feelings and responses for discussion in a therapeutic setting.

PUVA therapy  a form of photochemotherapy for skin disorders such as psoriasis and vitiligo; oral psoralen administration is followed two hours later by exposure to ultraviolet light.

radiation therapy  radiotherapy.

relaxation therapy  any of a number of techniques for inducing the relaxation response, used for the reduction of stress; useful in the management of a wide variety of chronic illnesses caused or exacerbated by stress.

replacement therapy 

1. treatment to replace deficiencies in body products by administration of natural or synthetic substitutes.

2. treatment that replaces or compensates for a nonfunctioning organ, e.g., hemodialysis.

respiratory therapy  see under care.

substitution therapy  the administration of a hormone to compensate for glandular deficiency.

thrombolytic therapy  fibrinolytic t.

thyroid replacement therapy  treatment with a preparation of a thyroid hormone.

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music therapy

Music-facilitated psychoeducational strategy Psychology The use of music as an interventional modality. See Guided Imagery and Music, New Age music, Noxious music, Sedative music, Sensory therapy, Stimulative music. Cf Art therapy, Color therapy, Dance therapy, Play therapy, Recreational therapy.