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, hospices, nursing homes, community centers, and sometimes even in the home.

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.

Benefits

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

Goals

Music is used to form a relationship between the therapist and 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 even greater benefits from music. Premature infants experience more rapid weight gain and an earlier discharge from the hospital than their peers who are not exposed to music. There is also anecdotal evidence of improved cognitive function in premature infants from listening to music.

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 more 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 psychiatric disorders

Music can be an effective tool for treating 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.

In the treatment of psychotic disorders, however, the benefits of music therapy appear to be limited. One study of patients diagnosed with schizophrenia or schizoaffective psychosis found that while music therapy improved the patients' social relationships, these benefits were relatively short-lived.

Music and hospice care

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 gynecologic procedures

Research has proven that women require less pharmaceutical pain relief during labor if they make use of music. Listening to music that is familiar and associated with positive imagery is the most helpful. During early labor, music 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-moving piece feeling like a natural accompaniment to the more difficult parts of labor. Instrumental music is often preferred.

The benefits of music therapy during childbirth have also been shown to apply to other surgical procedures. Women who have listened to music tapes during gynecologic surgery have more restful sleep following the procedure and less postoperative soreness.

Precautions

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

Research & general acceptance

There is little disagreement among physicians that music can be of some benefit for patients, although the extent of its effects on physical well-being is not as well acknowledged in the medical community. Acceptance of music therapy as an adjunctive treatment modality is increasing, however, due to the growing diversity of patient populations receiving music therapy. Research has shown that listening to music can decrease anxiety, pain, and recovery time. There are also good data for the specific subpopulations discussed. A therapist referral can be made through the AMTA.

Training & certification

Music therapists are themselves talented musicians; they also study the ways in which music can be applied to specific groups and circumstances. Coursework includes classes regarding music history and performance, behavioral science, and education. The American Music Therapy Association dictates what classes must be included in order for a music therapy program to be certified. There are approximately 70 colleges with approved curricula. A six-month internship follows the completion of the formal music therapy program, and the graduate is then able to take a national board exam to gain certification.

Resources

BOOKS

Campbell, Don. The Mozart Effect. Avon Books, 1997.

Cassileth, Barrie. The Alternative Medicine Handbook. W. W. Norton & Co., Inc., 1998.

Dillard, James, and Terra Ziporyn. Alternative Medicine for Dummies. IDG Books Worldwide, Inc., 1998.

Sears, William, and Martha Sears. The Birth Book. Little, Brown & Co., 1994.

Woodham, Anne, and David Peters. Encyclopedia of Healing Therapies. DK Publishing, Inc., 1997.

PERIODICALS

Good, M., J. C. Anderson, M. Stanton-Hicks, et al. "Relaxation and Music Reduce Pain After Gynecologic Surgery." Pain Management Nursing 3 (June 2002): 61-70.

Gregory, D. "Four Decades of Music Therapy Behavioral Research Designs: A Content Analysis of Journal of Music Therapy Articles." Journal of Music Therapy 39 (Spring 2002): 56-71.

Hayashi, N., Y. Tanabe, S. Nakagawa, et al. "Effects of Group Musical Therapy on Inpatients with Chronic Psychoses: A Controlled Study." Psychiatry and Clinical Neuroscience 56 (April 2002): 187-193.

Magee, W. L., and J. W. Davidson. "The Effect of Music Therapy on Mood States in Neurological Patients: A Pilot Study." Journal of Music Therapy 39 (Spring 2002): 20-29.

Robinson, A. "Music Therapy and the Effects on Laboring Women." Kentucky Nurse 50 (April-June 2002): 7.

Standley, J. M. "A Meta-Analysis of the Efficacy of Music Therapy for Premature Infants." Journal of Pediatric Nursing 17 (April 2002): 107-113.

ORGANIZATIONS

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

The 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/.

Judith Turner

Rebecca J. Frey, PhD

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

Music Therapy

Definition

Music therapy is the clinical use of music or music-making to assist the physical, spiritual, cognitive, or social needs of individual patients or groups. It can be used with people of all ages and in a wide variety of settings ranging from outpatient clinics and rehabilitation centers to schools, hospices, and prisons. In addition, music therapy can be used with healthy individuals for relaxation or stress reduction. The National Center for Complementary and Alternative Medicine (NCCAM) classifies music therapy as a form of energy therapy as well as a mind-body intervention.

Purpose

Music therapy has been shown to be an effective adjunctive form of treatment for the following conditions:

• Pain management and reduction. Music therapy is used in dentists' and pediatricians' offices to reduce the need for local anesthesia during uncomfortable outpatient procedures. It is also used for women in labor and cancer patients.
• Communicating strong feelings and/or improving communication skills. Because the ability to respond to music does not depend on verbal skills, level of education, or formal training in music, music can be used to help children with learning difficulties find a way to express themselves. It has also been used with rape survivors or others diagnosed with posttraumatic stress disorder to explore and release strong feelings associated with the traumatic experience.
• Improving physical coordination and range of motion. Music therapy is part of many rehabilitation programs for stroke patients, injured athletes, and patients who have had hip or knee surgery. In addition, music is used as background accompaniment in most forms of movement therapy.
• Relief of depression, fear, and anxiety. Music therapy can be used as part of the treatment of major depression and anxiety disorders. It has also been shown to benefit patients with schizophrenia.
• Sensory stimulation. Music therapy is used in nursing homes and hospices with patients who may have visual, memory, speech, or mobility impairments. Many patients with Alzheimer's can remember and respond to music from their youth when they can no longer speak or recognize caregivers.
• Healing of specific organs. Since the 1920s, some music therapists have practiced sound energy therapy, a treatment based on the notion that specific sound frequencies resonate with certain organs in the body to bring about healing.
• Spiritual nurture and growth. Chanting or singing is a part of many religious traditions, including Christianity, Hinduism, Tibetan Buddhism, Sikhism, and Native American religions.

Precautions

Music therapy should be done only by a certified music therapist.

Description

Music therapy has a long history. The Old Testament describes King Saul as finding relief from his mood disorder through listening to David's harp music. The Greek philosopher Plato (c. 400 b.c.) discussed the power of music to either encourage or weaken soldiers preparing for battle by the moods it conveyed. Medieval church musicians thought of the various modes of Gregorian chant as arousing or expressing such feelings as tearfulness, joy, seriousness, or warm devotion. Modern music therapy began shortly after World War II, when it was used to treat emotionally disturbed veterans. The first degree program in music therapy was started at Michigan State University in 1944.

Several theories have been advanced to explain the therapeutic effects of music:

• Music directly affects the autonomic nervous system, which controls such body functions as heart rate, breathing rate, digestion, and perspiration. Soft music with a slow tempo has been shown to lower blood pressure and slow heart rate.
• Music is thought to activate the right hemisphere of the brain and improve communication between the right and left hemispheres.
• Music may stimulate the release of endorphins, chemicals produced by the body that reduce sensitivity to pain and improve mood.
• Music may temporarily block the nerve endings in the spinal cord that transmit pain messages to the brain.

Music therapy is usually tailored to the needs and interests of an individual patient. Almost any style, period, or form of vocal or instrumental music can be used. The therapist may emphasize one or more of such aspects of music as tempo, pitch, rhythm, melody, or harmony. The American Music Therapy Association (AMTA) lists four basic methods of music therapy:

• Receptive. In this method, the patient listens or responds to live or recorded music. The receptive approach is the one most commonly used in pain management, stress reduction, and movement or dance therapy.
• Improvisation. The patient creates music spontaneously with voice or instruments. This method is used to stimulate creativity, release energy, or help the patient manage painful feelings. Drumming is a popular form of improvisation, particularly with younger patients.
• Recreative. The patient and therapist together sing or play previously composed music. This form of music therapy can also be used very effectively with groups.
• Composition. The patient is encouraged to write original songs or instrumental pieces. This approach is often used with children and adolescents to encourage a sense of competence and achievement as well as express feelings.

Preparation

A music therapist will usually meet with the patient and his or her treatment team to evaluate the patient's needs and plan the treatment before beginning therapy.

Complications

No complications from music therapy have been reported as of the early 2000s.

Results

Music therapy has been found to be an effective and low-cost treatment for acute or chronic pain, depression and other mood disorders, some types of learning difficulties, and social isolation. It has also been found to relieve stress and improve mood in hospital staff and other caregivers as well as patients.

Health care team roles

The increased willingness of HMOs as well as Medicare and Medicaid to pay for the cost of music therapy means that more and more health care teams will include music therapists. It is estimated that about 20 percent of music therapists receive third-party reimbursement for their services as of 2005.

Music therapists usually work together with a patient's treatment team, although some work for agencies that provide in-home care while others maintain private practices. To be certified as a music therapist, a candidate must complete a bachelor's or higher degree in music therapy from an approved college or university program as well as 1,200 hours in clinical training followed by a supervised internship. They must then pass a certification examination. Clinical training in music therapy includes instruction and practice in working as part of a medical, psychiatric, or special education treatment team.

NCCAM is conducting two clinical trials of music therapy as of 2005, for patients receiving chemotherapy for leukemia or non-Hodgkin's lymphoma, and for recipients of bone marrow transplants.

KEY TERMS

Adjunctive— Additional or helpful. Music therapy is an example of an adjunctive form of treatment.

Autonomic nervous system— The part of the human nervous system that controls such body functions as respiration, pulse rate, digestion, and others that are not under conscious control.

Endorphins— Chemicals produced by the pituitary gland and hypothalamus that function as natural painkillers. Music therapy is thought to stimulate the production of endorphins.

Improvisation— Making or creating music without previous preparation.

Sound energy therapy— A form of music therapy that holds that specific sound frequencies can resonate with certain body organs to promote healing.

Resources

BOOKS

Dossey, Larry, MD. Healing Beyond the Body: Medicine and the Infinite Reach of the Mind. Boston and London: Shambhala, 2001.

Pelletier, Kenneth, MD. The Best Alternative Medicine, Chapter 2, "Sound Mind, Sound Body: Music Therapy." New York: Simon & Schuster, 2002.

Woodham, Anne, and David Peters. Encyclopedia of Healing Therapies. New York: DK Publishing, Inc., 1997.

PERIODICALS

Burns, D. S., R. B. Sledge, L. A. Fuller, et al. "Cancer Patients' Interest and Preferences for Music Therapy." Journal of Music Therapy 42 (Fall 2005): 185-199.

DeLoach Walworth, D. "Procedural-Support Music Therapy in the Healthcare Setting: A Cost-Effectiveness Analysis." Journal of Pediatric Nursing 20 (August 2005): 276-284.

Gold, C., T. O. Heldal, T. Dahle, and T. Wigram. "Music Therapy for Schizophrenia or Schizophrenia-Like Illnesses." Cochrane Database of Systematic Reviews April 18, 2005: CD004025.

Good, M., G. C. Anderson, S. Ahn, et al. "Relaxation and Music Reduce Pain Following Intestinal Surgery." Research in Nursing and Health 28 (June 2005):240-251.

Hilliard, R. E. "Music Therapy in Hospice and Palliative Care: A Review of the Empirical Data." Evidence-Based Complementary and Alternative Medicine 2 (June 2005): 173-178.

Kemper, K. J., and S. C. Danhauer. "Music as Therapy." Southern Medical Journal 98 (March 2005): 282-288.

ORGANIZATIONS

American Music Therapy Association (AMTA). 8455 Colesville Road, Suite 1000, Silver Spring, MD 20910. (301) 589-3300. Fax: (301) 589-5175. 〈www.musictherapy.org〉.

National Center for Complementary and Alternative Medicine (NCCAM). P. O. Box 7923, Gaithersburg, MD 20898. (888) 644-6226. Fax: (866) 464-3616. 〈http://nccam.nih.gov〉.

World Federation of Music Therapy (WFMT). Office: Berklee College of Music, 1140 Boylston Street, Boston, MA 02215-3693. 〈http://www.musictherapyworld.de〉.

OTHER

Music Therapy Today. Official Journal of the World Federation of Music Therapy, available online at 〈http://www.musictherapyworld.de/index.html〉 as PDF files for download.

Music therapy

A technique of complementary medicine that uses music prescribed in a skilled manner by trained therapists.

General effects of music therapy

Music has been used throughout human history to express and affect human emotion . The health benefits of music to patients in Veterans Administration hospitals following World War II became apparent, leading to its use as a complementary healing practice. Musicians were hired to work in 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.

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.

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.

How music therapy is used

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.

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, pictures, and symbols from the patient. This is a bridge to the exploration and expression of feelings.

Music therapy is particularly effective with 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.

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.

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.

Pain, anxiety, and depression are major concerns with patients who are terminally ill. 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.

Judith Turner

Further Reading

Campbell, Don. The Mozart Effect Avon Books, 1997

Cassileth, Barrie. The Alternative Medicine Handbook W. W. Norton & Co., Inc., 1998

Woodham, Anne and David Peters. Encyclopedia of Healing Therapies DK Publishing, Inc., 1997

Further Information

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