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.

Description

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.

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

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.

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.

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 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, 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.

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.

— Judith Turner

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/.

[Article by: Judith Turner; Rebecca J. Frey, PhD]

The use of music to cure, alleviate or stimulate. It is familiar from ancient mythology and has been used increasingly in the treatment of physical as well as mental handicaps and emotional disturbance, although there is little theoretical work to explain its effectiveness. Of the elements of music, it is rhythm that is acknowledged to be the vital therapeutic factor by virtue of its power to focus energy and to bring structure into the perception of temporal order; music has stimulated the passive or withdrawn patient into more alert response. It has served to make an emotionally ill patient more accessible, while for physical disabilities it can be used to organize the scale and sequence of small goals in acquiring muscular skill and control, and for mental retardation it can assist in the acquisition of elementary concepts. Mentally retarded and autistic children often respond to music where all else has failed. Music is an expressive vehicle for relief of emotional tension, bypassing difficulties of speech and language. Music therapy has been used to improve motor coordination in cerebral palsy and muscular dystrophy; it is also used to teach breath and diction control when there is speech impairment.

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Music therapy is an interpersonal process in which a trained music therapist uses music and all of its facets—physical, emotional, mental, social, aesthetic, and spiritual—to help clients to improve or maintain their health. In some instances, the client's needs are addressed directly through music; in others they are addressed through the relationships that develop between the client and therapist. Music therapy is used with individuals of all ages and with a variety of conditions, including: psychiatric disorders, medical problems, physical handicaps, sensory impairments, developmental disabilities, substance abuse, communication disorders, interpersonal problems, and aging. It is also used to: improve learning, build self-esteem, reduce stress, support physical exercise, and facilitate a host of other health-related activities.

For many people with certain mental illnesses, mental retardation, and autism, various forms of music can be a very healing and therapeutic art. Kids who are considered ‘special education’ students can have difficulty expressing themselves in school. They may not understand traditional academic concepts, yet music therapy can be used as an escape. Playing music, listening to it on a CD, hearing it live, or singing can give students the opportunity to release energy in a positive way.

Music therapists are found in nearly every area of the helping professions. 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.

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, where he discussed the therapeutic effects of music on the soul.^[1] 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.^[2][3][4]

It is considered one of the expressive therapies.

Contents 1 Forms of Music Therapy 2 Music therapy in the United States 3 Music therapy in the United Kingdom 4 Music Therapy as Stroke Therapy 5 Music Therapy in Heart Disease 6 Music Therapy in Epilepsy 7 Notable music therapists and authors 8 See also 9 Notes 10 Further reading 11 External links 11.1 Journals 11.2 Associations 11.3 Projects 11.4 General 11.5 Sampling of university programs in Music Therapy

Forms of Music Therapy

There are a few different philosophies of thought regarding the foundations of Music Therapy. One is based on education and two are based on music therapy itself, both of which will only be briefly covered here. In addition, there are philosophies based on psychology, and one based on neuroscience.

Different approaches from education are Orff-Schulwerk (Orff), Dalcroze Eurhythmics, and Kodaly. The two philosophies that developed directly out of music therapy are Nordoff-Robbins and the Bonny Method of Guided Imagery and Music. ^[5]

Music therapists work many times with individuals who have behavioral-emotional disorders. 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.^[6]

The therapy model based on neuroscience is called Neurological Music Therapy (NMT). A definition of NMT is "NMT is based on a neuroscience model of music perception and production, and the influence of music on functional changes in nonmusical brain and behavior functions."^[7] 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 effect the client non-musically. As internationally known professor and researcher Dr. Thaut said, "The brain that engages in music is changed by engaging in music."^[8]

Music therapy in the United States

Music therapy has existed in its common current form in the United States since around 1944, when the first undergraduate degree program in the world was founded at Michigan State University and the first graduate degree program 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 Bonny Foundation. In the United States, a music therapist is most commonly designated by MT-BC (Music Therapist-Board Certified). A music therapist may use ideas or concepts from different disciplines such as speech/language, physical therapy, medicine, nursing, education, and so forth. A music therapist may have different credentials or professional licenses and may also have a master's degree in music therapy or in another clinical field (social work, mental health counseling, or the like). New York State requires that people holding the title music therapist be licensed as a creative arts therapist by holding a master's degree or higher in the field. Other masters degree holders may also take a test administered by the state of New York. Some practicing music therapists have held Ph.D.s in non-music-therapy (but related) areas, but more recently Temple University and Lesley University have founded a true music therapy Ph.D. program. A music therapist will typically practice in a manner that incorporates music therapy techniques with broader clinical practices such as assessment, diagnosis, psychotherapy, rehabilitation, and other practices depending on population. Music therapy services rendered within the context of a social service, educational, or health care agency are reimbursable by insurance and sources of funding for individuals with certain needs, under the title of Activity Therapy. Music therapy services have been identified as reimbursable under Medicaid, Medicare, Private insurance plans and other services such as state departments and government programs.

A U.S. music therapist may also hold the designation of CMT, ACMT, or RMT—initials which were previously conferred by the now-defunct AAMT and NAMT. More current music therapists hold the designation, MT-BC, music therapist-board certified, given by the Certification Board of Music Therapists.

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.

To become board-certified in the United States, a music therapist must complete course work at an accredited ATMA program at a college or university, successfully complete a 1040 hour Music Therapy internship, and pass the Certifying Board examination.

Board Certified Music Therapists are required to maintain their education through continuing education courses, called Continuing Music Therapy Education courses, or CMTEs. These classes fall under the purview of the Certification Board for Music Therapists to assure quality and applicability. They are offered at the state, regional, and national level.

Music therapy in the United Kingdom

Live music was used in hospitals after both of the World Wars, as part of the regime for some recovering soldiers. Clinical Music therapy in Britain as it is understood today was pioneered in the 60s and 70s 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 came to discover/create Analytical Music Therapy. Analytical Music Therapy is a form of Music Therapy which together with the Nordoff-Robbins school of Music Therapy, form the two central forms of Music Therapy used today. Mary Priestley's books: Music Therapy in Action, first published by Constable and company 1975 (ISBN 0 09 459900 9) and Essays on Analytical Music Therapy, Barcelona Publishers ©1994.(ISBN 0-9624080-2-6) Form part of the core course work for students of Analytical Music Therapy all over the world.

The Nordoff-Robbins approach to music therapy developed from the work of Paul Nordoff and Clive Robbins in the 1950/60s. It is grounded in the belief that everyone can respond to music, no matter how ill or disabled. The unique qualities of music as therapy can enhance communication, support change, and enable people to live more resourcefully and creatively. Nordoff-Robbins now run music therapy sessions throughout the UK, US, South Africa, Australia and Germany. Its head quarters are in London where it also provides training and further education programmes, including the only PHD course in music therapy available in the UK. Music therapists, many of whom work with an improvisatory model (see clinical improvisation), are active particularly in the fields of child and adult learning disability, but also in psychiatry and forensic psychiatry, geriatrics, palliative care and other areas. Practitioners are registered with the Health Professions Council [3] and from 2007 new regisrants must normally hold a masters degree in music therapy. There are masters level programmes in music therapy in Bristol, Cambridge, Cardiff, Edinburgh and London, and there are therapists throughout the United Kingdom. The professional body in the UK is the Association of Professional Music Therapists [4] while the British Society for Music Therapy [5] is a charity providing information about music therapy.

In 2002, the World Congress of Music Therapy was held in Oxford, on the theme of Dialogue and Debate. ^[9]

In November 2006, Dr. Michael J. Crawford ^[10] and his colleagues again found that music therapy helped the outcomes of Schizophrenic patients. ^[11][12] In 2009, he and his team were researching the usefulness of improvisational music in helping patients with agitation and also those with Dementia.

Music Therapy as Stroke Therapy

Music has been shown to affect portions of the brain. Part of this therapy is the ability 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^[13]. 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 ^[14]. 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.^[13]

More recent research suggests that music can increase patient’s motivation and positive emotions. ^[13][15][16] Current research also suggests that when music therapy is used in conjunction with traditional therapy it improves success rates significantly.^[17][18][19] Therefore, it is hypothesized that music therapy helps stroke victims recover faster and with more success by increasing the patient’s positive emotions and motivation, allowing them to be more successful and driven to participate in traditional therapies.

Research has shown the ability of music therapy to increase positive social interactions, positive emotions, and motivation in stroke patients. Wheeler et al. found that group music therapy sessions increased the ease at which stroke patients responded to social interaction and increased positive attitude reports from patient families, while individual sessions helped to motivate patients for treatment^[16]. Another study examined the effect of music therapy on mood of stroke patients and found similar results that showed decreased anxiety, fatigue, and hostile mood states ^[15]. Additionally, Nayak et al. found improved social interaction (more actively involved and cooperative) when music therapy was used in stroke recovery programs^[13].

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.^[17] In another study, Nayak et al. found that rehabilitation staff rated participants in the music therapy group were more actively involved and cooperative in therapy than those in the control group.^[13] 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.

Although positive changes have been associated with music therapy, some considerations must be taken into account. While scientists have determined that a variety of physiological and psychological changes occur when listening to music, broad conclusions cannot yet be made concerning the relationship and the direction of the relationship between music and emotion.^[20] Additionally, there may be mediating factors which affect the success of music therapy. For example, Nayak et al. found the more impaired an individual’s social behavior was at the outset of treatment, the more likely he or she was to benefit from music therapy.^[13] Additionally, they noted the effectiveness of music therapy may be moderated by the time frame of the treatment. It is possible that music therapy has a more pronounced effect on mood the closer to injury it is applied.

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. ^{[13][17][18][19][21][22]} A study by Jeong & Kim examined the impact of music therapy when combined with traditional stroke therapy in a community-based rehabilitation program. ^[21] 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 received referral information for traditional therapy (and were assumed to have sought traditional therapy). The results of this study showed that participants in the experimental group gained more flexibility, wider range of motion, more positive moods, and increased frequency and quality of social interactions.^[21]

Music has also been used in 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.^[18] 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.^[18]

Schneider et al. also studied the effects of combining music therapy with standard motor rehabilitation methods^[19]. 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 fine 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 movements 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 ^[19]. Wilson, Parsons, & Reutens looked at the effect of melodic intonation therapy (MIT) on speech production in a male singer with severe Broca’s aphasia^[22]. 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 ^[17]. 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 ^[17]. Nayak et al. ^[13] examined the combination of music therapy with traditional stroke rehabilitation and also found 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.

Music Therapy in Heart Disease

Some music may reduce heart rate, respiratory rate, and blood pressure in patients with coronary heart disease, according to a 2009 Cochrane review of 23 clinical trials [6]. Benefits included a decrease in blood pressure, heart rate, and levels of anxiety in heart patients. However, the effect was not consistent across studies, according to Joke Bradt, Ph.D., and Cheryl Dileo, Ph.D., both of Temple University in Philadelphia. Music did not appear to have much effect on patients' psychological distress. "The quality of the evidence is not strong and the clinical significance unclear," the reviewers cautioned. In 11 studies patients were having cardiac surgery and procedures, in nine they were MI patients, and in three cardiac rehabilitation patients. The 1,461 participants were largely white (average 85%) and male (67%). In most studies, patients listened to one 30-minute music session. Only two used a trained music therapist instead of prerecorded music.

Music Therapy in Epilepsy

Research suggests that listening to Mozart´s piano sonata K448 can reduce the number of seizures in people with epilepsy.^[23] This has been called the "Mozart effect".

Notable music therapists and authors

• Al-Farabi
• Juliette Alvin
• Helen Bonny
• John Carmichael
• E. Thayer Gaston
• Pandit Chandrakant Sardeshmukh
• Rajasree Mukherjee
• Kaithapram Damodaran Namboothiri
• Paul Nordoff and Clive Robbins of Nordoff-Robbins
• Mary Priestley
• Michael Thaut
• Concetta M. Tomaino

See also

• Biomusicology
• Chronobiology
• Melodic intonation therapy
• Music cognition
• Music Therapy in Canada
• Music psychology
• Psychoacoustics
• Psychoneuroimmunology

Notes

1. ^ Amber Haque (2004), "Psychology from Islamic Perspective: Contributions of Early Muslim Scholars and Challenges to Contemporary Muslim Psychologists", Journal of Religion and Health 43 (4): 357-377 [363].
2. ^ cf. The Anatomy of Melancholy, Robert Burton, subsection 3, on and after line 3480, "Music a Remedy":

   But to leave all declamatory speeches in praise [3481] of divine music, I will confine myself to my proper subject: besides that excellent power it hath to expel many other diseases, it is a sovereign remedy against [3482] despair and melancholy, and will drive away the devil himself. Canus, a Rhodian fiddler, in [3483] Philostratus, when Apollonius was inquisitive to know what he could do with his pipe, told him, "That he would make a melancholy man merry, and him that was merry much merrier than before, a lover more enamoured, a religious man more devout." Ismenias the Theban, [3484] Chiron the centaur, is said to have cured this and many other diseases by music alone: as now they do those, saith [3485] Bodine, that are troubled with St. Vitus's Bedlam dance. [1]

3. ^ "Humanities are the Hormones: A Tarantella Comes to Newfoundland. What should we do about it?" by Dr. John Crellin, MUNMED, newsletter of the Faculty of Medicine, Memorial University of Newfoundland, 1996.
4. ^ Aung, Steven K.H., Lee, Mathew H.M., "Music, Sounds, Medicine, and Meditation: An Integrative Approach to the Healing Arts", Alternative & Complementary Therapies, Oct 2004, Vol. 10, No. 5: 266-270. [2]
5. ^ Davis, Gfeller, Thaut, (2008). An Introduction to Music Therapy Theory and Practice-Third Edition: The Music Therapy Treatment Process. Silver Spring, Maryland. pg. 460-468
6. ^ Davis, Gfeller, Thaut, (2008). An Introduction to Music Therapy Theory and Practice-Third Edition: The Music Therapy Treatment Process. Silver Spring, Maryland. pg. 469-473.
7. ^ Davis, Gfeller, Thaut, (2008). An Introduction to Music Therapy Theory and Practice-Third Edition: The Music Therapy Treatment Process. Silver Spring, Maryland. pg. 475.
8. ^ Davis, Gfeller, Thaut, (2008). An Introduction to Music Therapy Theory and Practice-Third Edition: The Music Therapy Treatment Process. Silver Spring, Maryland. pg. 475.
9. ^ "Proceedings from the WFMT World Conference in Oxford, UK, 23-28 July 2002"
10. ^ Dr. Michael J. Crawford page at Imperial College London, Faculty of Medicine, Department of Psychological Medicine.
11. ^ Crawford, Mike J.; Talwar, Nakul, et al. (November 2006). "Music therapy for in-patients with schizophrenia: Exploratory randomised controlled trial". The British Journal of Psychiatry (2006) 189: 405–409. doi:10.1192/bjp.bp.105.015073. PMID 17077429. http://bjp.rcpsych.org/cgi/content/abstract/189/5/405. 
12. ^ "Music therapy may improve schizophrenia symptoms", Faculty of Medicine News, Imperial College, London.
13. ^ ^{a b c d e f g h} >Nayak, S. et al. (2000). Effect of music therapy on mood and social interaction among individuals with acute traumatic brain injury and stroke. Rehabilitation Psychology 45(3) 274-283.
14. ^ Hanser SB, Thompson LW (November 1994). "Effects of a music therapy strategy on depressed older adults". J Gerontol 49 (6): P265–9. PMID 7963281. 
15. ^ ^{a b} Magee, W.L. & Davidson, J.W. (2002). The effect of music therapy on mood states in neurological patients: A pilot study. Journal of Music Therapy 39(1) 20-29.
16. ^ ^{a b} Wheeler, B.L. et al. (2003). Effects of Number of Sessions and Group or Individual Music Therapy on the Mood and Behavior of People Who Have Had Strokes or Traumatic Brain Injuries. Nordic Journal of Music Therapy. 12(2) 139-151.
17. ^ ^{a b c d e} Kim, S. J. (2005). The Effects of Music on Pain Perception of Stroke Patients During Upper Extremity Joint Exercises. Journal of Music Therapy. 42(1) 81-92.
18. ^ ^{a b c d} Schauer M, Mauritz KH (November 2003). "Musical motor feedback (MMF) in walking hemiparetic stroke patients: randomized trials of gait improvement". Clin Rehabil 17 (7): 713–22. doi:10.1191/0269215503cr668oa. PMID 14606736. 
19. ^ ^{a b c d} Schneider S, Schönle PW, Altenmüller E, Münte TF (October 2007). "Using musical instruments to improve motor skill recovery following a stroke". J. Neurol. 254 (10): 1339–46. doi:10.1007/s00415-006-0523-2. PMID 17260171. 
20. ^ Vink, A. (2001). Music and emotion: Living apart together: A relationship between music psychology and music therapy. Nordic Journal of Music Therapy. 10(2) 144-158.
21. ^ ^{a b c} Jeong S, Kim MT (August 2007). "Effects of a theory-driven music and movement program for stroke survivors in a community setting". Appl Nurs Res 20 (3): 125–31. doi:10.1016/j.apnr.2007.04.005. PMID 17693215. 
22. ^ ^{a b} Wilson, S.; Parsons, K.; & Reutens, D. (2006). Preserved Singing in Aphasia: A Case Study of the Efficacy of Melodic Intonation Therapy. Music Perception. 42(1) 23-36.
23. ^ Hughes, J., Daaboul Y., Fino, J., Shaw, G. (1998). The Mozart effect on epileptiform activity. Clin Electroencephalogr,29 (3), 109-19. Retrieved December 3, 2007, from Pubmed Database.

Further reading

• Aldridge, David, Music Therapy in Dementia Care, London : Jessica Kingsley Publishers, November 2000. ISBN 1853027766
• Boso M, Politi P, Barale F, Enzo E (2006). "Neurophysiology and neurobiology of the musical experience". Funct Neurol 21 (4): 187–91. PMID 17367577. 
• 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.
• Hart, Hugh. (March 23, 2008) New York Times A Season of Song, Dance and Autism. Section: AR; Page 20.
• 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
• Whipple, Jennifer. (July 2004) Music in Intervention for Children and Adolescents with Autism: A Meta-Analysis., Journal of Music Therapy, Volume 41, Issue 2, pp. 90–106.
• Wigram, Tony. (July 2000) A Method of Music Therapy Assessment for the Diagnosis of Autism and Communication Disorders in Children., Music Therapy Perspectives, Volume 18, Issue 1, pp. 13–22.
• Bruscia, Kenneth E. “Frequently Asked Questions About Music Therapy”. Boyer College of Music and Dance, Music Therapy Program, Temple University, 1993. July 6 2009.
• Marcello Sorce Keller, "Some Ethnomusicological Considerations about Magic and the Therapeutic Uses of Music", International Journal of Music Education, 8/2(1986), 13- 16.

External links

Journals

• Nordic Journal of Music Therapy

Music Therapy whit old people Alzheimer Dementia Parkinson

Associations

• World Federation of Music Therapy
• The American Music Therapy Association
• Canadian Association for Music Therapy
• Music Therapy Association of British Columbia
• British Society for Music Therapy
• Association of Professional Music Therapists (United Kingdom)
• Latvian Association for Music Therapy

Projects

• MIT Media Lab
  • "Music, Mind and Health Project"
  • "Music, Mind, and Machine Group"

General

• Certification Board for Music Therapists
• Temple University Music Therapy Faq

Sampling of university programs in Music Therapy

• Music Therapy Program - Concordia University, Montreal, Quebec, Canada
• http://www.wlu.ca/page.php?grp_id=29&p=259 Wilfrid Laurier University Music Therapy Program, Waterloo, Ontario, Canada
• http://ww3.fredonia.edu/academicaffairs/AcademicPrograms/Music/BSMusicTherapy/tabid/582/Default.aspx Music Therapy Program] - SUNY Fredonia
• Music Therapy Program - Capilano University, North Vancouver, BC Canada
• Music Therapy Program - Acadia University, Wolfville, NS. Canada
• Music and Mental Health Program - Lesley University, Cambridge, Massachusetts
• Music Therapy Program - Duquesne University, Pittsburgh, Pennsylvania
• Music Therapy Program - Baldwin Wallace College, Berea, Ohio
• Music Therapy Program - Temple University, Philadelphia, PA
• Music Therapy Program - Western Michigan University, Kalamazoo, MI
• Music Therapy Program - Utah State University, Logan, UT

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