Music Therapy

By: Group Ripple: Ashley Bridges, Rita Daniels, Holly Ehrke, and Mallory Olson

Does music therapy influence health outcomes in patients who have chronic health conditions?

Please click on sound icon of each slide to hear narrationOur group, Ashley Bridges, Rita Daniels, Holly Ehrke, and Mallory Olson, will be presenting the question Does music therapy influence health outcomes in patients who have chronic health conditions? Please click on the sound icon located on the lower, left corner of each slide to hear the narrative. This presentation will be narrated by Rita Daniels.

1Why Music Therapy?It may sound cheesy, but for me, music reaches into the soul. I think most people can relate to it, whether its the words of a song, playing music themselves, or just listening to it openly. It can change a mood, which might just change your day. Ashley BridgesMusic lets you relax, touches your heart, lifts your mood, helps you relate. Holly EhrkeMusic can be used to change an environment, it can be used as distraction, and help relieve tension and pain. Mallory OlsonMusic takes a person outside of themselves and transports them to another place. Rita Daniels

Narration: Group Ripple chose Music Therapy because music is important to each of us in a different way. Each of us feels that music can change the experience a patient is having and help to improve their health outcomes.2Introduction to Music Therapy: Practice EnvironmentMusic began its use as a healing instrument following World War II when the veterans hospitals were visited by community musicians who played to veterans suffering from both physical and emotional trauma (AMTA, 2011a).

Narration: The use of music as a healing intervention began following World War II. During this time the Veterans hospitals were being visited by community musicians who played to veterans that were suffering from both physical and emotional trauma.

Reference: AMTA. (2011a). History of music therapy. Retrieved from http://www.musictherapy.org/about/history/

3Introduction to Music Therapy: Practice EnvironmentIn the 1800s, we would first see a music therapy intervention recorded as well as medical dissertations referencing musics therapeutic value (AMTA, 2011a).In the 1940s, music therapy became an organized clinical profession and the first academic program in music therapy was created (AMTA, 2011a). 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 (AMTA, 2011b, para. 1).

Narration: Musics therapeutic value was first documented in the 1800s, along with music therapy as an intervention. In the 1940s music therapy became an organized clinical profession and the first academic program in music therapy was created. 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.

References: AMTA. (2011a). History of music therapy. Retrieved from http://www.musictherapy.org/about/history/ AMTA. (2011b). What is music therapy. Retrieved from http://www.musictherapy.org/about/musictherapy/

4Introduction to Music Therapy: Practice EnvironmentResearch in music therapy supports its effectiveness in many areas such as: overall physical rehabilitation and facilitating movement, increasing peoples motivation to become engaged in their treatment, providing emotional support for clients and their families, and providing an outlet for expression of feelings (AMTA, 2011b, para. 2).

Narration: Research in the area of music therapy has shown that music therapy is effective in many areas. These areas include physical rehabilitation and facilitation movement, increasing peoples motivation to become engaged in their treatment, providing emotional support for clients and their families, and providing an outlet for expression of feelings.

Reference: AMTA. (2011b). What is music therapy. Retrieved from http://www.musictherapy.org/about/musictherapy/

5Introduction to Music Therapy: Practice EnvironmentMichael Mayne, Dean Emeritus of Westminster, gave a lecture titled Music, Spirituality, and Healing at the 10th World Congress of Music Therapy. According to Dorit Amir, Mayne talked about the connection between spirituality, music, sickness, suffering, and being human. He perceives music as religion and believes that music defines us, human beings. It brings chaos, harmony to the soul and healing to spiritual pain. Michael Mayne defined spirituality as a sense of the beyond that gives meaning and value to our lives. He urges us to open ourselves to the hidden qualities in music and words, to go to the beyond, to discover the hidden depth of the human spirit (Amir, 2002, para. 7).

Narration: A lecture that took place at the 10th World Congress of Music Therapy talked about the connection between spirituality, music, sickness, suffering, and being human. The lecturer, Michael Mayne, perceives music as religion and believes that music defines human beings. He explained that music brings harmony to the soul and healing to spiritual pain. He defined spirituality as a sense of the beyond that gives meaning and value to our lives.

Reference: Amir, D. (2002). Spiritual music therapy: Opening ourselves to the mysterious qualities of music therapy. Retrieved from http://voices.no/?q=fortnightly-columns/2002-spiritual-music-therapy-opening-ourselves-mysterious-qualities-music-therap

6Method of ResearchArticles selected were found using:Ferris State University LibraryInternet SearchesDatabases:PubMedCINAHL

The most relevant nursing online database is CINAHL, which contains citations of nursing literature, published commonly starting in the 1980s, but some versions may have information back to the 1930s (Burns & Grove, 2011, p. 211).

7How the research was gatheredAll articles were retrieved from nursing and health care journals.All the articles were current, with the least current article from 2008.Studies included:Mixed-methods study (small randomized pilot & qualitative interview)Exploratory study with grounded theoryCluster analysis studyTheory synthesis using database reviewQuantitative & Qualitative peer-review studies.

8Nursing ImplicationsPromising objectives for physical rehabilitation, Alzheimers disease, and psychoneuroimmunologyHealth promotion and rehabilitation programs will assist communities in becoming healthierInvolvement of pediatric cancer patients in Creative Arts, such as music therapy, to assisting in the healing of cancer treatmentsThe directed use of music and music therapy is highly effective in developing coping strategies, including understanding and expressing feelings of anxiety and helplessness, supporting feelings of self-confidence and security, and providing a safe or neutral environment for relaxation (Degmecic, Pozgain, Filakovic, 2005, p. 298).

Nursing Implications ContinuedWhy use music therapy?

Low cost, ease of implementation, minimal-to-low risk of harmful side effects, and potential to improve patient satisfaction

Improved health outcomes for patients with chronic illnesses

Improved health outcomes with the initiation of music therapy to promote physical activity in various community, assisted living, nursing homes and acute care settings

So why should music therapy be used? It is a low cost, non-invasive nursing intervention that assists in improving not only the lives of chronically ill patients, but the health of communities. Future implications for nursing practice show promising goals for community settings, rehabilitation units, health promotion programs, and pediatric cancer centers.Music therapy is a nursing intervention that we all can initiate if your patient is willing to accept this form of intervention as a treatment modality. It can be provided to all patients as a relaxation technique. Remember, the music selection should be patient preference when applicable to maximize its benefits.10Our own Implications for PracticeHolly Ehrke: If the timing & atmosphere is right for the family of a deceased patient, I will play soft, back-ground music as the family congregates to say their good-byes in the Emergency Room.In the School-Based Health Center, I play hip-hop, fast-moving music, as in the Cupid Shuffle, to educate students on obesity & nutrition.Ashley Bridges: Music therapy is a challenge to implement in ER nursing because of the short amount of time available with patients. Encouraging patients to use the relaxation channel or use their MP3 players helps to reduce anxiety regarding unfamiliar procedures and waiting times for results. Mallory Olson: I use music to help calm patients struggling with pain or anxiety. Our hospital has a channel on the television that displays nature pictures while playing calming music and this seems to be helpful to many patients.Rita Daniels: I would encourage music therapy to my home health care-based population as an excellent adjunct for exercise and reminiscence.11Theoretical PerspectivesPsychological relationship between music and painCognitive coping strategiesSpinal Mechanisms involved in modulation of pain aka Gate control theoryEndorphins as natural opiatesResearch Limitations Small sample sizes Selective populations Studies often theoretical in nature Controlled studies only recently

Narration: The first theory recognizes cortical processes influence intensity and quality of pain experienced through memories, experiences, culture, competing stimuli, anxiety, suggestions, and expectations. Music can be used as a distraction, to reduce anxiety, aide in relaxation, or as a vehicle for supportive psychotherapy. The Cognitive coping strategies theory suggests attention is finite and introducing music impedes on amount of attention available for processing painful stimuli-thus reducing pain perceived. A third theory suggests that it is possible music can stimulate brain stem centers either directly via the auditory pathway or by indirect cortical mechanisms (memories, experiences, competing stimuli, etc.). This activates descending inhibitory pathways releasing neurotransmitters to reduce transmission of painful stimuli. A study performed by Goldstein found that those patients who get thrills or little shudders in response to their favorites music actually have a decrease in that response after receiving narcan-suggesting that for some, music truly works on the opiate receptors naturally.

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Who benefits from music therapy for chronic health conditions?

Patients with chronic health conditionsDevelopmental and learning disabilitiesAlzheimers patientsSubstance abuse problemsBrain injuriesAcute and chronic painLaboring mothersCancer patientsPatients with anxiety

Patients of all ages can benefit from music therapy including patients with chronic health conditions. Studies have shown that Alzheimers patients are less agitated when provided music therapy. It has proven that patients with substance abuse problems have less episodes of relapse when music therapy is implemented. Patients suffering from traumatic brain injuries, strokes, & Parkinsons disease show improved gait and balance. Music therapy reduces pain in minimally invasive procedures, decrease opiate use, provides distraction, and reduces pain for laboring mothers. Music therapy has shown to be beneficial for cancer patients. It reduces emotional strain and anxiety, decreases nausea with chemotherapy, and decreases perception time of chemotherapy administration. Music therapy also increases motivation, well-being, physical comfort, & exercise endurance with bone marrow recipients. Pediatric cancer patients that participate in music therapy show improved IgA levels in saliva.

13During a cluster-analysis study, patients who were more likely to benefit from the intervention of music therapy were older, female patients with less education (Chan, M.F., Chung, Y.F.L., Chung, S.W.A., & Lee, O.K., 2008).In a mixed method study, including a randomized pilot and a descriptive study, future nursing implementation of creative arts may aid in the therapeutic healing process of pediatric cancer patients (Madden, J.R., Mowry, P., Gao, D., Cullen, P.M., & Foreman, N.K., 2010). Engagement with creative activities has the potential to contribute toward reduction of stress and depression and can serve as a vehicle for alleviating the burden of chronic disease (p. 254). This evidence was found through research analysis of both qualitative and quantitative, peer-reviewed studies already performed related to art and music therapy.(Stuckey, H. L., & Nobel, J., 2010). Who benefits from music therapy for chronic health conditions?Benefits of Music TherapyPsychological Benefits

Connect and express feelingsPromotes interaction between loved onesHelps restore emotional balancePromotes relaxationDecreases pain sensationReduces anxietyIncreases sense of control

Physical Benefits

Lowers respiratory and heart ratesIncreases peripheral temperatureDecreases cortisol levelsDecreases myocardial oxygen demandCalms neural activity in brainMay help restore effective immune system functioning via actions of amygdala and hypothalamus

Narration: The benefits of music therapy are numerous and highly individualized. Some include increased ability to connect and express feelings, promoting interaction between loved ones, restoring emotional balance, reducing anxiety and pain sensation, increasing sense of control. Physical benefits of music therapy found in several studies include improved vital signs, decreased cortisol or stress hormone levels, even correlation between musics effects on improvement of immune functioning.

15ConsiderationsPatients should choose when possible

Assess familiar versus non-familiar preferences

Trial, monitor responses, and assess volume preferences

Chose appropriate to patients attention span and energy level

Observe for adverse effects

Narration: It is important to note that some people may not respond well to music therapy and may actually find it painful or increase their stress. Therefore whenever possible, allowing the patient to chose the type of music they want to hear or play is crucial. Sometimes familiar songs can actually worsen depression or pain symptoms and should be avoided. Other times, it helps promote reminiscence. Assessing volume levels, trialing music, and monitoring responses closely are essential for effective music therapy. Some very rare adverse effects to watch for include musicogenic epilepsy, catastrophic reactions (when dementia patients express extreme distress), and those with right temporal brain lesions which may find music painful even though they once enjoyed it.

16ConclusionsHow does music therapy work?Promotes activity which helps to alleviate pain, fatigues and troubles

Modifies a persons internal and external environment to improve health outcomes

What benefits does music therapy provide?Improves health outcomesPromotes healthy behaviors in spite of illnessIncreases self-awareness of well-beingPromotes positive effects for the mind and positive influences on healthPractice Areas that may benefit from music therapyLong term hospital stays, patients with cancer, terminally ill, patients undergoing laceration repair in the emergency department, patients undergoing surgery, patients undergoing colonoscopy, patients with Alzheimers disease

Music therapy provides many benefits to its recipients. It has shown to improve health outcomes by providing a positive effect with increased activity which directly improves obesity rates, lowers blood pressure and blood sugars and decreases cardiovascular effects which leads to an improved quality of life. In spite of illness, music therapy promotes healthy behaviors. Music makes people to want to get up and move. This movement assists patients with chronic illness to have less fatigue and pain. It provides an outlet for grief and anger. Music therapy provides a mood-altering experience that provides positive effects for the mind and influences positive behaviors.

17ReferencesAmerican Music Therapy Association (AMTA). (2011a). History of music therapy. Retrieved from http://www.musictherapy.org/about/history/ Batt-Rawden, K., Tellnes, G. (2010). How music may promote healthy behavior. Journal of Public Health, 39(2), 113-120. Retrieved from: http://sjp.sagepub.com/content/39/2/113. doi: 10.1177/1400494810494555Burns, N., & Grove, S. (2011). Understanding Nursing Research. Maryland Heights, MD: Elsevier Saunders.

ReferencesChan, M.F., Chung, Y.F.L., Chung, S.W.A., Lee, O.K. (2008). Investigating the physiological response of patients listing to music in the intensive care unit. Journal of Clinical Nursing, 18, 1250-1257. doi: 10.111/j.1365-2702.2008.02491.xDegmecic, D., Pozgain, I., Filakovic, P. (2005). Music as therapy. International Review of the Aesthetics and Sociology of Music. 36(2), 287300. Retrieved from: http://www.jstor.org/stable/30032173Richards, T., Johnson, J., Sparks, A., Emerson, H. (2007). The effects of music therapy on patients perception and manifestation of pain, anxiety, and patient satisfaction. Medsurg Nursing, 16(1), 7-14.19ReferencesMadden, J.R., Mowry, P., Gao, D, Cullen, P.M., Foreman, N.K. (2010). Creative arts therapy improves the quality of life for pediatric brain tumor patients receiving outpatient chemotherapy. Journal of Pediatric Oncology Nursing, 27(3), 144-145. Retrieved from: http://jopon.sage.com. doi: 10.1177/104Murrdock, C.J., Higgins, P.A. (2009). The theory of music, mood and movement to improve health outcomes. Journal of Advanced Nursing, 65(10. 2249-2257. doi: 10.1111/j.1365-2648.2009.05108xStuckey, H. L., & Nobel, J. (2010). The connection between art, healing, and public health: A review of current literature. American Journal of Public Health, 100(2), p. 254-263.