Music therapy

Music therapy
Power of Music by Louis Gallait. A brother and sister resting before an old tomb. The brother is attempting to comfort his sibling by playing the violin, and she has fallen into a deep sleep, "oblivious of all grief, mental and physical".
ICD-9-CM	93.84
MeSH	D009147

Music therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program. Music therapy is one of the expressive therapies, consisting of a process in which a music therapist uses music and all of its facets—physical, emotional, mental, social, aesthetic, and spiritual—to help clients improve their physical and mental health. Music therapists primarily help clients improve their health in several domains, such as cognitive functioning, motor skills, emotional development, social skills, and quality of life by using both active and passive music experiences such as free improvisation, song, dance, listening, and discussion of music to achieve treatment goals. There is a wide qualitative and quantitative research literature base which incorporates clinical therapy, psychotherapy, biomusicology, musical acoustics, music theory, psychoacoustics, embodied music cognition, aesthetics of music, sensory integration, and comparative musicology.

Some commonly found practices include developmental work (communication, motor skills, etc.) with individuals with special needs, songwriting and listening in reminiscence/orientation work with the elderly, processing and relaxation work, and rhythmic entrainment for physical rehabilitation in stroke victims. Music therapy is also used in some medical hospitals, cancer centers, schools, alcohol and drug recovery programs, psychiatric hospitals, and correctional facilities [1]"About Music Therapy & AMTA". American Music Therapy Association, 2011. November 9, 2011.</ref>

Music therapy comes in two different forms: active and receptive. In active therapy, the therapist and patient actively participate in creating music with instruments, their voice, or other objects. This allows for the patient to be creative and expressive through the art of music. Receptive therapy takes place in a more relaxed setting where the therapist plays or makes music to the patient who is free to draw, listen or meditate. Usually the therapist determines the method unless specifically requested by the patient.

Music has been found to be an effective tool for music therapists through extensive research. It is beneficial for any individual, both physically and mentally, through improved heart rate, reduced anxiety, stimulation of the brain, and improved learning. Music therapists use their techniques to help their patients in many areas, ranging from stress relief before and after surgeries, to neuropathologies such as Alzheimer's disease. One study found that children who listened to music while having an IV inserted into their arms showed less distress and felt less pain than the children who did not listen to music while having an IV inserted. Studies have been carried out on patients diagnosed different mental disorders such as anxiety, depression and schizophrenia and there has been a visible improvement in their mental health after the therapy.

A music therapist from a "Blues in the Schools" program plays harmonica with a US Navy sailor at a Naval Therapy Center.

Approaches used in music therapy that have emerged from the field of music education include Orff-Schulwerk (Orff), Dalcroze Eurhythmics,and Kodály Method. Models that developed directly out of music therapy are neurologic music therapy (NMT), Nordoff-Robbins music therapy and the Bonny method of guided imagery and music.

Music therapists may work with individuals who have behavioral-emotional disorders.[2] To meet the needs of this population, music therapists have taken current psychological theories and used them as a basis for different types of music therapy. Different models include behavioral therapy, cognitive behavioral therapy, and psychodynamic therapy.

One therapy model based on neuroscience, called "neurological music therapy" (NMT), is "based on a neuroscience model of music perception and production, and the influence of music on functional changes in non-musical brain and behavior functions". In other words, NMT studies how the brain is without music, how the brain is with music, measures the differences, and uses these differences to cause changes in the brain through music that will eventually affect the client non-musically. As Michael Thaut put it: "The brain that engages in music is changed by engaging in music." NMT trains motor responses (i.e. tapping foot or fingers, head movement, etc.) to better help clients develop motor skills that help "entrain the timing of muscle activation patterns".

Children

Approaches used with children

Nordoff-Robbins

Further information: Nordoff-Robbins music therapy

Paul Nordoff, a Juilliard School graduate and Professor of Music, was a pianist and composer who, upon seeing disabled children respond so positively to music, gave up his academic career to further investigate the possibility of music as a means for therapy. Clive Robbins, a special educator, partnered with Nordoff for over 17 years in the exploration and research of music’s effects on disabled children—first in the United Kingdom, and then in the USA in the 1950s and 60s. Their pilot projects included placements at care units for autistic children and child psychiatry departments, where they put programs in place for children with mental disorders, emotional disturbances, developmental delays, and other handicaps. Their success at establishing a means of communication and relationship with autistic children at the University of Pennsylvania gave rise to the National Institutes of Health's first grant given of this nature, and the 5-year study "Music therapy project for psychotic children under seven at the day care unit" involved research, publication, training and treatment. Several publications, including Therapy in Music for Handicapped Children, Creative Music Therapy, Music Therapy in Special Education, as well as instrumental and song books for children, were released during this time. Nordoff and Robbins's success became known globally in the mental health community, and they were invited to share their findings and offer training on an international tour that lasted several years. Funds were granted to support the founding of the Nordoff Robbins Music Therapy Centre in Great Britain in 1974, where a one-year graduate program for students was implemented. In the early eighties, a center was opened in Australia, and various programs and institutes for music therapy were founded in Germany and other countries. In the United States, the Nordoff-Robbins Center for Music Therapy was established at New York University in 1989.

The Nordoff-Robbins approach, based on the belief that everyone is capable of finding meaning in and benefitting from musical experience, is now practiced by hundreds of therapists internationally. It focuses on treatment through the creation of music by both therapist and client together. Various techniques are used to accommodate all capabilities so that even the most low functioning individuals are able to participate actively.

Orff Music Therapy

Further information: Orff Schulwerk

Developed by Gertrude Orff at the Kindezentrum München, is another approach known as Orff Music Therapy. Both the clinical setting of social pediatrics as well as the Orff Schulwerk (schoolwork) approach in music education (developed by German composer Carl Orff) influence this method, which is used with children with developmental problems, delays and disabilities. The area of social pediatrics was developed after the Second World War in Germany by Theodor Hellbrügge, who understood that medicine alone could not meet the complex needs of developmentally disabled children. He consulted psychologists, occupational therapists and other mental healthcare professionals whose knowledge and skills could aid in the diagnostics and treatment of children. Gertrude Orff was asked to develop a form of therapy based on the Orff Schulwerk approach to support the emotional development of patients. Elements found in both the music therapy and education approaches include the understanding of holistic music presentation as involving word, sound and movement; the use of both music and play improvisation as providing a creative stimulus for the child to investigate and explore; Orff instrumentation, including keyboard instruments and percussion instruments as a means of participation and interaction in a therapeutic setting; and lastly, the multisensory aspects of music used by the therapist to meet the particular needs of the child, such as both feeling and hearing sound.

Corresponding with the attitudes of humanistic psychology, the developmental potential of the child- as in the acknowledgement of their strengths as well as their handicaps, and the importance of the therapist- child relationship are central factors in Orff music therapy. Theoretical foundations are also influenced by the strong emphasis on social integration and the involvement of parents in the therapeutic process found in social paediatrics. Knowledge of developmental psychology puts into perspective how developmental disabilities influence the child, as do their social and familial environments. The basis for interaction in this method is known as responsive interaction, in which the therapist meets the child at their level and responds according to their initiatives, combining both humanistic and developmental psychology philosophies. Involving the parents in this type of interaction, by having them participate directly or observe the therapist's techniques, equips the parents with ideas of how to interact appropriately with their child, thus fostering a positive parent-child relationship.

Bonny method of guided imagery in music

Further information: Guided imagery

Music educator and therapist Helen Lindquist Bonny (1921 – May 25, 2010) developed an approach influenced by humanistic and transpersonal psychological views, known as the Bonny method of guided imagery in music (GIM). Guided imagery refers to a technique used in natural and alternative medicine that involves using mental imagery to help with the physiological and psychological ailments of patients. The practitioner often suggests a relaxing and focusing image and through the use of imagination and discussion, aims to find constructive solutions to manage their problems. Bonny applied this psychotherapeutic method to the field of music therapy by using music as the means of guiding the patient to a higher state of consciousness where healing and constructive self- awareness can take place. Music is considered a "co-therapist" because of its importance. GIM with children can be used in one-on-one or group settings, and involves relaxation techniques, identification and sharing of personal feeling states, and improvisation to discover the self, and foster growth. The choice of music is carefully selected for the client based on their musical preferences and the goals of the session. Usually a classical piece, it must reflect the age and attentional abilities of the child in length and genre, and a full explanation of the exercises must be offered at their level of understanding.

The use of guided imagery with autistic children has been found to decrease stereotypical behaviours and hyperactivity, increase attention and the ability to follow instructions, as well as increase self-initiated communication, both verbal and non-verbal.

Assessment

Assessment includes obtaining a full medical history, musical (ability to duplicate a melody or identify changes in rhythm, etc.) and nonmusical functioning (social, physical/motor, emotional, etc.).

Premature infants

Premature infants are those born at 37 weeks or less gestational stage. They are subject to numerous health risks, such as abnormal breathing patterns, decreased body fat and muscle tissue, as well as feeding issues. The coordination for sucking and breathing is often not fully developed, making feeding a challenge. The improved developmental activity and behavioural status of premature infants when they are discharged from the NICU, is directly related to the stimulation programs and interventions they benefited from during hospitalization, such as music therapy.

Music is typically conducted by a musical therapist in the neonatal intensive care unit (NICU), with five main techniques designed to benefit premature infants:

1. Live or recorded music: Live or recorded music has been effective in promoting respiratory regularity and oxygen saturation levels, as well as decreasing signs of neonatal distress. Since premature infants have sensitive and immature sensory modalities, music is often performed in a gentle and controlled environment, either in the form of audio recordings or live vocalization, although live singing has been shown to have a greater effect. Live music also reduces the physiological responses in parents. Studies have shown that by combining live music, such as harp music, with the Kangaroo Care, maternal anxiety is reduced. This allows for parents, especially mothers, to spend important time bonding with their premature infants. Female singing voices are also more effective at soothing premature infants. Despite being born premature, infants show a preference for the sound of a female singing voice, making it more beneficial than instrumental music.
2. Promotion of healthy sucking reflex: By using a pacifier-activated lullaby device, music therapists can help promote stronger sucking reflexes, while also reducing pain perception for the infant. The Gato Box is a small rectangular instrument that stimulates a prenatal heartbeat sound in a soft and rhythmic manner that has also been effective in aiding sucking behaviours. The music therapist uses their fingers to tap on the drum, rather than using a mallet. The rhythm supports movement when feeding and promotes healthy sucking patterns. By improving sucking patterns, babies are able to coordinate the important dual mechanisms of breathing, sucking and swallowing needed to feed, thus promoting growth and weight gain. When this treatment proves effective, infants are able to leave the hospital earlier.
3. Multimodal stimulation and music: By combining music, such as lullabies, and multimodal stimulation, premature infants were discharged from the NICU sooner, than those infants who did not receive therapy. Multimodal stimulation (MMS) includes the applications of auditory, tactile, vestibular, and visual stimulation that helps aid in premature infant development. The combination of music and MMS helps premature infants sleep and conserve vital energy required to gain weight more rapidly. Studies have shown that girls respond more positively than boys during multimodal stimulation. While the voice is a popular choice for parents looking to bond with their premature infants, other effective instruments include the Remo Ocean Disk and the Gato Box. Both are used to stimulate the sounds of the womb. The Remo Ocean Disk, a round musical instrument that mimics the fluid sounds of the womb, has been shown to benefit decreased heart rate after therapeutic uses, as well as promoting healthy sleep patterns, lower respiratory rates and improve sucking behavior.
4. Infant stimulation: This type of intervention uses musical stimulation to compensate for the lack of normal environmental sensory stimulation found in the NICU. The sound environment the NICU provides can be disruptive; however, music therapy can mask unwanted auditory stimuli and promote a calm environment that reduces the complications for high-risk or failure-to-thrive infants. Parent-infant bonding can also be affected by the noise of the NICU, which in turn can delay the interactions between parents and their premature infants. But music therapy creates a relaxed and peaceful environment for parents to speak and spend time with their babies while incubated.
5. Parent-infant bonding: Therapists work with parents so they may perform infant-directed singing techniques, as well as home care. Singing lullabies therapeutically can promote relaxation and decrease heart rate in premature infants. By calming premature babies, it allows for them to preserve their energy, which creates a stable environment for growth. Lullabies, such as "Twinkle Twinkle Little Star" or other culturally relevant lullabies, have been shown to greatly soothe babies. These techniques can also improve overall sleep quality, caloric intake and feeding behaviours, which aid in development of the baby while they are still in the NICU. Singing has also shown greater results in improving oxygen saturation levels for infants while incubated than has mothers' speech alone. This technique promoted high levels of oxygen for longer periods of time.

In children

Music therapy has multiple benefits which contribute to the maintenance of health and the drive toward rehabilitation for children. Advanced technology that can monitor cortical activity offers a look at how music engages and produces changes in the brain during the perception and production of musical stimuli. Music therapy, when used with other rehabilitation methods, has increased the success rate of sensorimotor, cognitive, and communicative rehabilitation. Music therapy intervention programs can include an average of 18 sessions of treatment. The achievement of a physical rehabilitation goal relies on the child's existing motivation and feelings towards music and their commitment to engage in meaningful, rewarding efforts. Regaining full functioning also confides in the prognosis of recovery, the condition of the client, and the environmental resources available. Both techniques use systematic processes where the therapists assist the client by using musical experiences and connections that collaborate as a dynamic force of change toward rehabilitation.

Music has many calming and soothing properties that can be used as a sedative in rehabilitation. For example, a patient with chronic pain may decrease the physiological result of stress and draw attention away from the pain by focusing on music.

Music therapy used in child rehabilitation has had a substantial emphasis on sensorimotor development including; balance and position, locomotion, agility, mobility, range of motion, strength, laterality and directionality. Music motivate and can be an element of distraction. Rhythmic stimuli has been found to help balance training for those with a brain injury.

Singing is a form of rehabilitation for neurological impairments. Neurological impairments following a brain injury can be in the form of apraxia – loss to perform purposeful movements, dysarthria, muscle control disturbances (due to damage of the central nervous system), aphasia (defect in expression causing distorted speech), or language comprehension. Singing training has been found to improve lung, speech clarity, and coordination of speech muscles, thus, accelerating rehabilitation of such neurological impairments. For example, melodic intonation therapy is the practice of communicating with others by singing to enhance speech or increase speech production by promoting socialization, and emotional expression.

Music therapy is thought to be helpful with children with autism spectrum by providing repetitive stimuli which aim to "teach" the brain other possible ways to respond that might be more useful as they grow older.

Adolescents

Treatment techniques

There are many different music therapy techniques used with adolescents. The music therapy model is based on various theoretical backgrounds such as psychodynamic, behavioral, and humanistic approaches. Techniques can be classified as active vs. receptive and improvisational vs. structured. The most common techniques in use with adolescents are musical improvisation, the use of precomposed songs or music, receptive listening to music, verbal discussion about the music, and incorporating creative media outlets into the therapy. Research also showed that improvisation and the use of other media were the two techniques most often used by the music therapists. The overall research showed that adolescents in music therapy "change more when discipline-specific music therapy techniques, such as improvisation and verbal reflection of the music, are used". The results of this study showed that music therapists should put careful thought into their choice of technique with each individual client. In the end, those choices can affect the outcome of the treatment.

To those unfamiliar with music therapy the idea may seem a little strange, but music therapy has been found to be as effective as traditional forms of therapy. In a meta-analysis of the effects of music therapy for children and adolescents with psychopathology, Gold, Voracek, and Wigram (2004) looked at ten studies conducted between 1970 and 1998 to examine the overall efficacy of music therapy on children and adolescents with behavioral, emotional, and developmental disorders. The results of the meta-analysis found that "music therapy with these clients has a highly significant, medium to large effect on clinically relevant outcomes." More specifically, music therapy was most effective on subjects with mixed diagnoses. Another important result was that "the effects of music therapy are more enduring when more sessions are provided."

One example of clinical work is that done by music therapists who work with adolescents to increase their emotional and cognitive stability, identify factors contributing to distress and initiate changes to alleviate that distress. Music therapy may also focus on improving quality of life and building self-esteem, a sense of self-worth, and confidence. Improvements in these areas can be measured by a number of tests, including qualitative questionnaires like Beck's Depression Inventory, State and Trait Anxiety Inventory, and Relationship Change Scale. Effects of music therapy can also be observed in the patient's demeanor, body language, and changes in awareness of mood.

Two main methods for music therapy are group meetings and one-one sessions. Group music therapy can include group discussions concerning moods and emotions in or toward music, songwriting, and musical improvisation. Groups emphasizing mood recognition and awareness, group cohesion, and improvement in self-esteem can be effective in working with adolescents. Group therapy, however, is not always the best choice for the client. Ongoing one-on-one music therapy has also been shown to be effective. One-on-one music therapy provides a non-invasive, non-judgmental environment, encouraging clients to show capacities that may be hidden in group situations.

Music therapy in which clients play musical instruments directly shows very promising results. Specifically, playing wind instruments strengthens oral and respiratory muscles, sound vocalization, articulation, and improves breath support. Symbolic Communication Training Through Music is also an important technique in playing instruments in music therapy, because this makes communication (verbally and non verbally) improved in social situations. Most importantly, is that music provides a time cue for the body to remain regulated. Making music is also important for people of all ages because it causes motivation, increases "psychomotor" activity, causes an individual to identify with a group (in group music), regulates breathing, improves organizational skills, and increases coordination.

Though more research needs to be done to ascertain the effect of music therapy on adolescents with mood disorders, most research has shown positive effects.

Medical disorders

Heart disease

According to a 2013 Cochrane review, listening to music may improve heart rate, respiratory rate, and blood pressure in those with coronary heart disease (CHD). More research is required to determine the role of a trained music therapist for people with CHD. Music does not appear to have much effect on psychological distress. "The quality of the evidence is not strong and the clinical significance unclear." Research indicates that listening to music, whether a Mozart concerto or a song from the popular music charts, has been found to lower blood pressure, improve heart rate variability and can help to de-stress.

Neurological disorders

While music therapy has been used for many years, up until the mid-1980s little empirical research had been done to support the efficacy of the treatment. Since then, more research has focused on determining both the effectiveness and the underlying physiological mechanisms leading to symptom improvement. For example, one meta-study covering 177 patients (over 9 studies) showed a significant effect on many negative symptoms of psychopathologies, particularly in developmental and behavioral disorders. Music therapy was especially effective in improving focus and attention, and in decreasing negative symptoms like anxiety and isolation.

Stroke

Music has been shown to affect portions of the brain. One reason for the effectiveness of music therapy for stroke victims is the capacity of music to affect emotions and social interactions. Research by Nayak et al. showed that music therapy is associated with a decrease in depression, improved mood, and a reduction in state anxiety. Both descriptive and experimental studies have documented effects of music on quality of life, involvement with the environment, expression of feelings, awareness and responsiveness, positive associations, and socialization. Additionally, Nayak et al. found that music therapy had a positive effect on social and behavioral outcomes and showed some encouraging trends with respect to mood.

Music therapy can be used to improve function in patients that have lesions resulting from stroke or other disorders. More recent research suggests that music can increase a patient's motivation and positive emotions. Current research also suggests that when music therapy is used in conjunction with traditional therapy it improves success rates significantly. Therefore, it is hypothesized that music therapy helps a victim of stroke recover faster and with more success by increasing the patient's positive emotions and motivation, allowing him or her to be more successful and feel more driven to participate in traditional therapies.

Recent studies have examined the effect of music therapy on stroke patients when combined with traditional therapy. One study found the incorporation of music with therapeutic upper extremity exercises gave patients more positive emotional effects than exercise alone. In another study, Nayak et al. found that rehabilitation staff rated participants in the music therapy group more actively involved and cooperative in therapy than those in the control group. Their findings gave preliminary support to the efficacy of music therapy as a complementary therapy for social functioning and participation in rehabilitation with a trend toward improvement in mood during acute rehabilitation.

Current research shows that when music therapy is used in conjunction with traditional therapy, it improves rates of recovery and emotional and social deficits resulting from stroke. A study by Jeong & Kim examined the impact of music therapy when combined with traditional stroke therapy in a community-based rehabilitation program. Thirty-three stroke survivors were randomized into one of two groups: the experimental group, which combined rhythmic music and specialized rehabilitation movement for eight weeks; and a control group that sought and received traditional therapy. The results of this study showed that participants in the experimental group gained not only more flexibility and wider range of motion, but an increased frequency and quality of social interactions and positive mood.

Music has proven useful in the recovery of motor skills. Rhythmical auditory stimulation in a musical context in combination with traditional gait therapy improved the ability of stroke patients to walk. The study consisted of two treatment conditions, one which received traditional gait therapy and another which received the gait therapy in combination with the rhythmical auditory stimulation. During the rhythmical auditory stimulation, stimulation was played back measure by measure, and was initiated by the patient's heel-strikes. Each condition received fifteen sessions of therapy. The results revealed that the rhythmical auditory stimulation group showed more improvement in stride length, symmetry deviation, walking speed and rollover path length (all indicators for improved walking gait) than the group that received traditional therapy alone.

Schneider et al. also studied the effects of combining music therapy with standard motor rehabilitation methods. In this experiment, researchers recruited stroke patients without prior musical experience and trained half of them in an intensive step by step training program that occurred fifteen times over three weeks, in addition to traditional treatment. These participants were trained to use both fine and gross motor movements by learning how to use the piano and drums. The other half of the patients received only traditional treatment over the course of the three weeks. Three-dimensional movement analysis and clinical motor tests showed participants who received the additional music therapy had significantly better speed, precision, and smoothness of movement as compared to the control subjects. Participants who received music therapy also showed a significant improvement in every-day motor activities as compared to the control group. Wilson, Parsons, & Reutens looked at the effect of melodic intonation therapy (MIT) on speech production in a male singer with severe Broca's aphasia. In this study, thirty novel phrases were taught in three conditions: unrehearsed, rehearsed verbal production (repetition), or rehearsed verbal production with melody (MIT). Results showed that phrases taught in the MIT condition had superior production, and that compared to rehearsal, effects of MIT lasted longer.

Another study examined the incorporation of music with therapeutic upper extremity exercises on pain perception in stroke victims. Over the course of eight weeks, stroke victims participated in upper extremity exercises (of the hand, wrist, and shoulder joints) in conjunction with one of the three conditions: song, karaoke accompaniment, and no music. Patients participated in each condition once, according to a randomized order, and rated their perceived pain immediately after the session. Results showed that although there was no significant difference in pain rating across the conditions, video observations revealed more positive affect and verbal responses while performing upper extremity exercises with both music and karaoke accompaniment. Nayak et al. examined the combination of music therapy with traditional stroke rehabilitation and also found that the addition of music therapy improved mood and social interaction. Participants who had suffered traumatic brain injury or stroke were placed in one of two conditions: standard rehabilitation or standard rehabilitation along with music therapy. Participants received three treatments per week for up to ten treatments. Therapists found that participants who received music therapy in conjunction with traditional methods had improved social interaction and mood.

Dementia

Alzheimer's disease and other types of dementia are among the disorders most commonly treated with music therapy. Like many of the other disorders mentioned, some of the most common significant effects are seen in social behaviors, leading to improvements in interaction, conversation, and other such skills. A meta-study of over 330 subjects showed music therapy produces highly significant improvements to social behaviors, overt behaviors like wandering and restlessness, reductions in agitated behaviors, and improvements to cognitive defects, measured with reality orientation and face recognition tests. As with many studies of MT's effectiveness, these positive effects on Alzheimer's and other dementias are not homogeneous among all studies. The effectiveness of the treatment seems to be strongly dependent on the patient, the quality and length of treatment, and other similar factors.

Another meta-study examined the proposed neurological mechanisms behind music therapy's effects on these patients. Many authors suspect that music has a soothing effect on the patient by affecting how noise is perceived: music renders noise familiar, or buffers the patient from overwhelming or extraneous noise in their environment. Others suggest that music serves as a sort of mediator for social interactions, providing a vessel through which to interact with others without requiring much cognitive load. Because Music has the ability to access multiple parts of the brain, music therapy is highly effective in providing therapeutic support for individuals with all types of dementia. Research indicates that the sections of the brain weakened by dementia can be supported and in some cases strengthened by other areas of the brain through musical activities. Musical ability and awareness is also one of the last functions to be compromised in an individual with dementia, which makes it an especially effective intervention, even in people with very late stage forms of the disease. Music therapy is more than simply listening to or playing music. Through the use of evidence based interventions and clinical assessments, a music therapist works to improve the lives and abilities of individuals. These interventions can decrease anxiety, improve speech and self- expression, and a decrease in negative behaviors and isolation which are commonly found in individuals with dementia. Common negative behaviors that correspond with dementia are depression and agitation. According to Mary S. Mittelman, the director of psychosocial research at Langone Medical Center, music therapy helped to decrease both of these negative substantially. The reason for this is because in the brain, the parts corresponding to music are preserved even through the effects of dementia. Due to these being preserved, residents who live their lives in a blur find some clarity and familiarity through music, creating lower levels of stress and agitation.

Music & memory program

A music & memory program was developed by Dan Cohen, the executive director for a non-profit organization. The program began after Cohen spent time at a nursing home in New York City, where he provided the residents with iPods and playlists. The program was so successful that the Shelley & Donald Rubin Foundation funded the program in 2008 resulting in that Cohen could test his method on a wider scale. In 2010, the program became an official non-profit organization, which then led to a documentary two years later based on the program called Alive Inside: A Story of Music and Memory, which gave the program more attention. Mainly because a clip from the documentary showed a patient awakening from Alzheimer's disease by listening to songs from his era such as Cab Calloway. Once the documentary was previewed, Alive Inside gained at least 11 millions views, which gave awareness to the program and treatments.

In 2013, Wisconsin's Department of Health Science have been noticing the effects the Music & Memory Program has on the patients, and so the department commenced the Wisconsin Music & Memory Initiative, which allowed 100 nursing homes within Wisconsin to be Music & Memory Certified Care Facilities. A year later, an additional 150 facilities gained certification training. Within time, other states took part in broadening the program and opened more services to the Music & Memory Program such as adult day care, assisted living, hospital, home health care, and serving individuals in hospice care.

The Music & Memory Program was not just known in the United States, but other countries such as Canada and Europe were intrigued by the idea of music bringing patients back to themselves mentally. In January 2014, the documentary, Alive Inside had won the Audience Award for U.S. Documentaries, which was screened at the Sundance Film Festival. Alive Inside continues to gain more recognition that it has been released across the United States and continues to gain more awards.

Amnesia

Some symptoms of amnesia have been shown to be alleviated through various interactions with music, including playing and listening. One such case is that of Clive Wearing, whose severe retrograde and anterograde amnesia have been detailed in the documentaries Prisoner of Consciousness and The Man with the 7 Second Memory. Though unable to recall past memories or form new ones, Wearing is still able to play, conduct, and sing along with music learned prior to the onset of his amnesia, and even add improvisations and flourishes.

Wearing's case reinforces the theory that episodic memory fundamentally differs from procedural or semantic memory. Sacks suggests that while Wearing is completely unable to recall events or episodes, musical performance (and the muscle memory involved) are a form of procedural memory that is not typically hindered in amnesia cases [Sacks]. Indeed, there is evidence that while episodic memory is reliant on the hippocampal formation, amnesiacs with damage to this area can show a loss of episodic memory accompanied by (partially) intact semantic memory.

Aphasia

Melodic intonation therapy (MIT) is method used by music therapists and speech-language pathologists to help people with communication disorders caused by damage to the left hemisphere of the brain by engaging the singing abilities and possibly engaging language-capable regions in the undamaged right hemisphere. In MIT common words and phrases are turned into melodic phrases, generally starting with two step sing-song patterns and eventually emulating typical speech intonation and rhythmic patterns.

Neurological researchers Sparks, Helm, and Albert developed MIT in 1973.

Psychiatric disorders

A 2017 Cochrane review found that individual studies of music therapy for people with schizophrenia have been of moderate to low quality, have had inconsistent results, and depend heavily on both the quality and number of therapy sessions.

A 2017 review of studies of music therapy for children and adolescents with major depressive or anxiety disorders found that research was of poor quality and could not be generalized. A 2008 Cochrane review looking at the use of music therapy for all depressed people found similar results.

Music therapy is used to try to help people with post-traumatic stress disorder; as of 2010 there was no good evidence that it helped.

Usage by region

Africa

In 1999, the first program for music therapy in Africa opened in Pretoria, South Africa. Research has shown that in Tanzania patients can receive palliative care for life-threatening illnesses directly after the diagnosis of these illnesses. This is different from many Western countries, because they reserve palliative care for patients who have an incurable illness. Music is also viewed differently between Africa and Western countries. In Western countries and a majority of other countries throughout the world, music is traditionally seen as entertainment whereas in many African cultures, music is used in recounting stories, celebrating life events, or sending messages.

Australia

One of the first groups known to heal with sound were the aboriginal people of Australia. The modern name of their healing tool is the didgeridoo, but it was originally called the yidaki. The yidaki produced sounds that are similar to the sound healing techniques used in modern day. For at least 40,000 years, the healing tool was believed to assist in healing "broken bones, muscle tears and illnesses of every kind". However, here are no reliable sources stating the didgeridoo's exact age. Archaeological studies of rock art in Northern Australia suggest that the people of the Kakadu region of the Northern Territory have been using the didgeridoo for less than 1,000 years, based on the dating of paintings on cave walls and shelters from this period. A clear rock painting in Ginga Wardelirrhmeng, on the northern edge of the Arnhem Land plateau, from the freshwater period (that had begun 1500 years ago) shows a didgeridoo player and two songmen participating in an Ubarr Ceremony. Australia in 1949, music therapy (not clinical music therapy as understood today) was started through concerts organized by the Australian Red Cross along with a Red Cross Music Therapy Committee. The key Australian body, the Australian Music Therapy Association (AMTA), was founded in 1975.

Canada

In 1956, Fran Herman, one of Canada's music therapy pioneers, began a 'remedial music' program at the Home For Incurable Children, now known as the Holland Bloorview Kids Rehabilitation Hospital, in Toronto. Her group 'The Wheelchair Players' continued until 1964, and is considered to be the first music therapy group project in Canada. Its production "The Emperor's Nightingale" was the subject of a documentary film.

Composer/pianist Alfred Rosé, a professor at the University of Western Ontario, also pioneered the use of music therapy in London, Ontario at Westminster Hospital in 1952 and at the London Psychiatric Hospital in 1956.

Two other music therapy programs were initiated during the 1950s; one by Norma Sharpe at St. Thomas Psychiatric Hospital in St. Thomas, Ontario, and the other by Thérèse Pageau at the Hôpital St-Jean-de-Dieu (now Hôpital Louis-Hippolyte Lafontaine) in Montreal.

A conference in August 1974, organized by Norma Sharpe and six other music therapists, led to the founding of the Canadian Music Therapy Association, which was later renamed the Canadian Association for Music Therapy (CAMT). As of 2009, the organization had over 500 members.

Canada's first music therapy training program was founded in 1976, at Capilano College (now Capilano University) in North Vancouver, by Nancy McMaster and Carolyn Kenny.

Norway

Norway is widely recognised as an important country for music therapy research. Its two major research centres are the Center for Music and Health with the Norwegian Academy of Music in Oslo, and the Grieg Academy Centre for Music Therapy (GAMUT), at University of Bergen. The former was mostly developed by professor Even Ruud, while professor Brynjulf Stige is largely responsible for cultivating the latter. The centre in Bergen has 18 staff, including 2 professors and 4 associate professors, as well as lecturers and PhD students. Two of the field's major international research journals are based in Bergen: Nordic Journal for Music Therapy and Voices: A World Forum for Music Therapy. Norway's main contribution to the field is mostly in the area of "community music therapy", which tends to be as much oriented toward social work as individual psychotherapy, and music therapy research from this country uses a wide variety of methods to examine diverse methods across an array of social contexts, including community centres, medical clinics, retirement homes, and prisons.

United States

Music therapy has existed in its current form in the United States since 1944 when the first undergraduate degree program in the world was begun at Michigan State University and the first graduate degree program was established at the University of Kansas. The American Music Therapy Association (AMTA) was founded in 1998 as a merger between the National Association for Music Therapy (NAMT, founded in 1950) and the American Association for Music Therapy (AAMT, founded in 1971). Numerous other national organizations exist, such as the Institute for Music and Neurologic Function, Nordoff-Robbins Center For Music Therapy, and the Association for Music and Imagery. Music therapists use ideas from different disciplines such as speech and language, physical therapy, medicine, nursing, and education.

A music therapy degree candidate can earn an undergraduate, master's or doctoral degree in music therapy. Many AMTA approved programs offer equivalency and certificate degrees in music therapy for students that have completed a degree in a related field. Some practicing music therapists have held PhDs in fields other than, but usually related to, music therapy. Recently, Temple University established a PhD program in music therapy. A music therapist typically incorporates music therapy techniques with broader clinical practices such as psychotherapy, rehabilitation, and other practices depending on client needs. Music therapy services rendered within the context of a social service, educational, or health care agency are often reimbursable by insurance and sources of funding for individuals with certain needs. Music therapy services have been identified as reimbursable under Medicaid, Medicare, private insurance plans and federal and state government programs.

A degree in music therapy requires proficiency in guitar, piano, voice, music theory, music history, reading music, improvisation, as well as varying levels of skill in assessment, documentation, and other counseling and health care skills depending on the focus of the particular university's program. A music therapist may hold the designations CMT (Certified Music Therapist), ACMT (Advanced Certified Music Therapist), or RMT (Registered Music Therapist) – credentials previously conferred by the former national organizations AAMT and NAMT ; these credentials remain in force through 2020 and have not been available since 1998. The current credential available is MT-BC. To become board certified, a music therapist must complete a music therapy degree from an accredited AMTA program at a college or university, successfully complete a music therapy internship, and pass the Board Certification Examination in Music Therapy, administered through The Certification Board for Music Therapists. To maintain the credential, either 100 units of continuing education must be completed every five years, or the board exam must be retaken near the end of the five-year cycle. The units claimed for credit fall under the purview of the Certification Board for Music Therapists. North Dakota, Nevada and Georgia have established licenses for music therapists. In the State of New York, the License for Creative Arts Therapies (LCAT) incorporates the music therapy credentials within their licensure.

Lebanon

In 2006, Hamda Farhat introduced music therapy to Lebanon, developing and inventing therapeutic methods such as the triple method to treat hyperactivity, depression, anxiety, addiction, and post traumatic stress disorder. She has met with great success in working with many international organizations, and in the training of therapists, educators, and doctors.

United Kingdom

Live music was used in hospitals after both World Wars as part of the treatment program for recovering soldiers. Clinical music therapy in Britain as it is understood today was pioneered in the 1960s and 1970s by French cellist Juliette Alvin whose influence on the current generation of British music therapy lecturers remains strong. Mary Priestley, one of Juliette Alvin's students, created "analytical music therapy". The Nordoff-Robbins approach to music therapy developed from the work of Paul Nordoff and Clive Robbins in the 1950/60s.

Practitioners are registered with the Health Professions Council and, starting from 2007, new registrants must normally hold a master's degree in music therapy. There are master's level programs in music therapy in Manchester, Bristol, Cambridge, South Wales, Edinburgh and London, and there are therapists throughout the UK. The professional body in the UK is the British Association for Music Therapy In 2002, the World Congress of Music Therapy, coordinated and promoted by the World Federation of Music Therapy, was held in Oxford on the theme of Dialogue and Debate. In November 2006, Dr. Michael J. Crawford and his colleagues again found that music therapy helped the outcomes of schizophrenic patients.

India

The roots of musical therapy in India, can be traced back to ancient Hindu mythology, Vedic texts, and local folk traditions. It is very possible that music therapy has been used for hundreds of years in the Indian culture.

Suvarna Nalapat has studied music therapy in the Indian context. Her books Nadalayasindhu-Ragachikilsamrutam (2008), Music Therapy in Management Education and Administration (2008) and Ragachikitsa (2008) are accepted textbooks on music therapy and Indian arts.

The "Music Therapy Trust of India" is yet another venture in the country. It was started by Margaret Lobo She is the founder and director of the Otakar Kraus Music Trust and her work began in 2004. 7

History

Music has been used as a healing implement for centuries. Apollo is the ancient Greek god of music and of medicine. Aesculapius was said to cure diseases of the mind by using song and music, and music therapy was used in Egyptian temples. Plato said that music affected the emotions and could influence the character of an individual. Aristotle taught that music affects the soul and described music as a force that purified the emotions. Aulus Cornelius Celsus advocated the sound of cymbals and running water for the treatment of mental disorders. Music therapy was practiced in the Bible when David played the harp to rid King Saul of a bad spirit (1 Sam 16:23). As early as 400 B.C., Hippocrates played music for mental patients. In the thirteenth century, Arab hospitals contained music-rooms for the benefit of the patients. In the United States, Native American medicine men often employed chants and dances as a method of healing patients. The Turco-Persian psychologist and music theorist al-Farabi (872–950), known as Alpharabius in Europe, dealt with music therapy in his treatise Meanings of the Intellect, in which he discussed the therapeutic effects of music on the soul. In his De vita libri tres published in 1489, Platonist Marsilio Ficino gives a lengthy account of how music and songs can be used to draw celestial benefits for staying healthy. Robert Burton wrote in the 17th century in his classic work, The Anatomy of Melancholy, that music and dance were critical in treating mental illness, especially melancholia.

The rise of an understanding of the body and mind in terms of the nervous system led to the emergence of a new wave of music therapy in the eighteenth century. Earlier works on the subject, such as Athanasius Kircher's Musurgia universalis of 1650 and even early eighteenth-century books such as Michael Ernst Ettmüller's 1714 Disputatio effectus musicae in hominem (Disputation on the Effect of Music on Man) or Friedrich Erhardt Niedten's 1717 Veritophili, still tended to discuss the medical effects of music in terms of bringing the soul and body into harmony. But from the mid-eighteenth century works on the subject such as Richard Brocklesby's 1749 Reflections of Antient and Modern Musick, the 1737 Memoires of the French Academy of Sciences, or Ernst Anton Nicolai's 1745 Die Verbindung der Musik mit der Arzneygelahrheit (The Connection of Music to Medicine), stressed the power of music over the nerves.

After 1800 books on music therapy often drew on the Brunonian system of medicine, arguing that the stimulation of the nerves caused by music could directly improve health. For example, Peter Lichtenthal's influential 1807 book Der musikalische Arzt (The Musical Doctor) was also explicitly Brunonian in its treatment of the effects of music on the body. Lichtenthal, a musician, composer and physician with links to the Mozart family, was mostly positive about music, talking of 'doses of music', which should be determined by someone who knows the "Brunonian scale".

Music therapy as we know it began in the aftermath of World Wars I and II, when, particularly in the United Kingdom, musicians would travel to hospitals and play music for soldiers suffering from war-related emotional and physical trauma.

Even as recent as 2017, music therapy has shown the ability to provide emotional relief to the members of our society. With Logic's "1-800-273-8255", suicide prevention calls experienced a 33% growth in relation to their number of calls received in the previous year.

Military

History

Music therapy finds its roots in the military. The United States Department of War issued Technical Bulletin 187 in 1945, which described the use of music in the recuperation of military service members in Army hospitals. The use of music therapy in military settings started to flourish and develop following World War II and research and endorsements from both the United States Army and the Surgeon General of the United States. Although these endorsements helped music therapy develop, there was still a recognized need to assess the true viability and value of music as a medically-based therapy. Walter Reed Army Medical Center and the Office of the Surgeon General worked together to lead one of the earliest assessments of a music therapy program. The goal of the study was to understand whether “music presented according to a specific plan” influenced recovery among service members with mental and emotional disorders. Eventually, case reports in reference to this study relayed not only the importance but also the impact of music therapy services in the recovery of military service personnel.

The first university sponsored music therapy course was taught by Margaret Anderton in 1919 at Columbia University. Anderton's clinical specialty was working with wounded Canadian soldiers during World War II, using music-based services to aid in their recovery process.

Today, Operation Enduring Freedom and Operation Iraqi Freedom have both presented an array of injuries; however, the two signature injuries are Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI). These two signature injuries are increasingly common among millennial military service members and in music therapy programs.

Methods

Music therapists work with active duty military personnel, veterans, service members in transition, and their families. Music therapists strive to engage clients in music experiences that foster trust and complete participation over the course of their treatment process. Music therapists use an array of music-centered tools, techniques, and activities when working with military-associated clients, many of which are similar to the techniques used in other music therapy settings. These methods include, but are not limited to: group drumming, listening, singing, and songwriting. Songwriting is a particularly effective tool with military veterans struggling with PTSD and TBI as it creates a safe space to, "... work through traumatic experiences, and transform traumatic memories into healthier associations".

Programs

Music therapy in the military is seen in programs on military bases, VA healthcare facilities, military treatment facilities, and military communities. Music therapy programs have a large outreach because they exist for all phases of military life: pre-mobilization, deployment, post-deployment, recovery (in the case of injury), and among families of fallen military service personnel.

Resounding Joy, Inc., a San Diego, California-based music therapy program, is a pioneer for the use of music therapy in the military. Its Semper Sound program specializes in providing music therapy services to active duty military service members and veterans diagnosed with PTSD, TBI, substance abuse, and other trauma-related diagnoses. It features different programs such as The Semper Sound Band, based in San Diego, California, and the GI Jams Band, based in Chelsea, Massachusetts.

Walter Reed Army Medical Center located in Bethesda, Maryland, is another pioneer for the use of music therapy in the military. All patients at the medical center are eligible to receive music therapy services; therefore, the range of clients is wide: TBI, stroke, psychological diagnoses (anxiety, depression, PTSD), autism spectrum disorder, and more.

The Exceptional Family Member Program (EFMP) also exists to provide music therapy services to active duty military families who have a family member with a developmental, physical, emotional, or intellectual disorder. Currently, programs at the Davis-Monthan Air Force Base, Resounding Joy, Inc., and the Music Institute of Chicago partner with EFMP services to provide music therapy services to eligible military family members.

See also

• Affective neuroscience
• Biomusicology
• Chronobiology
• Eloise (psychiatric hospital)
• Embodied music cognition
• Harmony
• Melodic intonation therapy
• Music as a coping strategy
• Musical analysis
• Music cognition
• Music theory
• Music therapy in Canada
• Music psychology
• Psychoacoustics
• Psychoanalysis and music
• Psychoneuroimmunology

Further reading

• Aldridge, David, Music Therapy in Dementia Care, London: Jessica Kingsley Publishers, November 2000. ISBN 1-85302-776-6
• Boso M, Politi P, Barale F, Enzo E (2006). "Neurophysiology and neurobiology of the musical experience". Functional Neurology. 21 (4): 187–91. PMID 17367577. 
• Boynton, Dori, compiler (1991). Lady Boynton's "New Age" Dossiers: a Serendipitous Digest of News and Articles on Trends in Modern Day Mysticism and Decadence. New Port Richey, Flor.: Lady D. Boynton. 2 vol. N.B.: Anthology of reprinted articles, pamphlets, etc. on New Age aspects of speculation in psychology, philosophy, music (especially music therapy), religion, sexuality, etc. (Without ISBN.)
• Bruscia, Kenneth E. "Frequently Asked Questions About Music Therapy". Boyer College of Music and Dance, Music Therapy Program, Temple University, 1993. July 6, 2009.
• Bunt, Leslie – Stige, Brynjulf: Music Therapy: An Art Beyond Words. (Second edition.) London: Routledge, 2014. ISBN 978-0-415-45068-3.
• Davis, William B., Kate E. Gfeller, and Michael H. Thaut. An Introduction to Music Therapy: Theory and Practice. Third ed. Silver Spring: American Music Therapy Association, 2008. ISBN 978-1-884914-20-1
• Erlmann, Veit (ed.) Hearing Cultures. Essays on Sound, Listening, and Modernity, New York: Berg Publishers, 2004. Cf. especially Chapter 5, "Raising Spirits and Restoring Souls".
• Gold, C., Heldal, T.O., Dahle, T., Wigram, T. (2006) "Music therapy for schizophrenia or schizophrenia-like illnesses", Cochrane Database of Systematic Reviews, Issue 4.
• Goodman, K.D. (2011). Music Therapy Education and Training: From Theory to Practice. Springfield, Illinois: Charles C. Thomas. ISBN 0-398-08609-5. 
• Hart, Hugh. (March 23, 2008) The New York Times "A Season of Song, Dance and Autism". Section: AR; page 20.
• La Musicothérapie: thémathèque. Montréal, Bibliothèque du personnel, Hôpital Rivière-des-Prairies, 1978.
• Levinge, Alison: The Music of Being: Music Therapy, Winnicott and the School of Object Relations. London: Jessica Kingsley Publishers, 2015. ISBN 978-1-84905-576-5.
• Marcello Sorce Keller, "Some Ethnomusicological Considerations about Magic and the Therapeutic Uses of Music", International Journal of Music Education, 8/2(1986), 13–16.
• Pellizzari, Patricia y colaboradores: Flavia Kinisberg, Germán Tuñon, Candela Brusco, Diego Patles, Vanesa Menendez, Julieta Villegas, y Emmanuel Barrenechea. "Crear Salud", aportes de la Musicoterapia preventiva-comunitaria. Patricia Pellizzari Ediciones. Buenos Aires, 2011.
• Owens, Melissa (December 2014). "Remembering through Music: Music Therapy and Dementia". Age in Action. 29 (3): 1–5. 
• Tuet, R.W.K.; Lam, L.C.W. (September 2006) "A preliminary study of the effects of music therapy on agitation in Chinese patients with dementia", Hong Kong Journal of Psychiatry, Volume 16, Number 3
• Wheeler, Barbara L. (2015). Music Therapy Research: Quantitative And Qualitative Perspectives. Barcelona: Barcelona Publishers(NH). ISBN 1891278266. 
• Whipple, Jennifer (July 2004). "Music in Intervention for Children and Adolescents with Autism: a Meta-Analysis". Journal of Music Therapy. 41 (2): 90–106. doi:10.1093/jmt/41.2.90. PMID 15307805. 
• Wigram, Tony (2000). "A Method of Music Therapy Assessment for the Diagnosis of Autism and Communication Disorders in Children". Music Therapy Perspectives. 18 (1): 13–22. doi:10.1093/mtp/18.1.13. 
• Vladimir Simosko. Is Rock Music Harmful? Winnipeg: The Author, 1987.
• Vladimir Simosko. Jung, Music, and Music Therapy: Prepared on the Occasion of the "C.G. Jung and the Humanities" Colloquium, 1987 . Winnipeg: The Author, 1987.
• Vomberg, Elizabeth. Music for the Physically Disabled Child: a Bibliography. Toronto: The Author, 1978.

External links

• Video (04:44): Music – Medical Benefits on YouTube

Library resources about Music therapy

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