Music Therapy

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Music Therapy
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OUTLINE
Music Therapy

• Mediation with Music
• Introduction
• History of Music Therapy
• What IS Music Therapy?
• The Brain and Music Therapy
• NMT Neurologic Music Therapy
• Children, Adolescents and Music Therapy
• Autism and Music Therapy
• Depression and Music Therapy
• Palliative Care and Music Therapy

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History
Music Therapy

• Ancient history
• 1849 Report of the Commissioners, Beauport
  Asylum, Quebec (music and dance)
• World War II (1945)
• Musicians went to Veterans hospitals
• Patients physical and emotional responses
• Columbia University offered the first music
  therapy course
• 1941 a National Foundation for Music Therapy was
  established in the USA

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History
Music Therapy

• New training courses at Michigan State Uni. in
  1944
• Kansas University in 1946
• National Association of Music Therapy (US)
• Related activities in UK
• E.G. Sydney Mitchells orchestra of patients
• Role of recorded music on patients
• Live music in research on alcoholic and neurotic
  patients
• 1950s the society for Music Therapy and Remedial
  Music, later replaced by the British Association
  for Music Therapy in 2011

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History
Music Therapy

• Difficult for MT to become recognized as an
  effective treatment
• More than using as a recreational activity
• The National Association for Music Therapy (NAMT)
  was founded in 1950
• Programs (1950s)
• Winter Veterans Administration Hospital in Kansas
• Other programs for children with disabilities
  mental illness
• Different organizations merged in 1998 and the
  result was American Music Therapy Association
  (AMTA)

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History
Music Therapy

• In England British Society of Music Therapy,
  founded in 1958 as the Society for Music Therapy
  and Remedial Music, collaborated with the GSM to
  develop a one-year post-graduate program
• In Canada Alfred Rosé first pilot projects
  (1952-61) at Westminster Hospital in London, Ont
• 1950s three prominent music therapists
  established programs
• Norma Sharpe (St Thomas Psychiatric Hospital)
• Fran Herman (Bloorview Hospital)
• Thérèse Pageau (Hôpital Louis-Hippolyte
  Lafontaine)

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History
Music Therapy

• 1974 Conference at St Thomas Psychiatric Hospital
• Canadian Music Therapy Association
• 1974 Sharpe and Burnett published Canadian Music
  Therapy Bulletin
• the CAMT Newsletter the first official
  publication
• 1979 the first 17 music therapists accredited by
  CAMT
• 1991 the number of Music Therapists Accredited
  (MTA) by the CAMT was 78

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History
Music Therapy

• Until the mid 70s most accredited music
  therapists were training in England or USA.
• 1976 - 1st MT training program in Canada founded
  at Capilano College, North Vancouver
• Nancy McMaster Carolyn Kenny
• two-year diploma program
• 1990 - Changed in to a 3 year undergraduate
• Graduates undergo supervised clinical internship
  of 1000 hours
• MTA

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Wilfrid Laurier University Curriculum
Music Therapy
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Music therapy training in Canada
Music Therapy

• Wilfrid Laurier University - Ontario
• University of Windsor - Ontario
• Acadia University - Nova Scotia
• Capilano University - British Columbia
• Canadian Mennonite University - Manitoba
• Concordia University Québec

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What Is Music Therapy
Music Therapy

• music therapy is a systematic process of
  intervention wherein the therapist helps the
  client to achieve health, using musical
  experiences and the relationships that develop
  through them as dynamic forces of change
  (Bruscia 1995).

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Music Therapy
What Is Music Therapy

• Not about teaching/developing musical skills
• Concept of change
• Social and Humanistic psychological roots
• Areas of change
• -communication, cognition, physical, social,
  emotional, and neurological functioning
• All ages, groups, individual

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What is Music Therapy
Music Therapy

• Diverse settings
• specialized hospitals/treatment centers,
  pre-schools, schools, hospitals, residential
  homes, centers for visual/hearing impairments,
  hospices, probations/prison services, private
  practice

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What is Music Therapy
Music Therapy

• WFMT (World federation of music therapy)
  definition
• Use of music and musical elements by a qualified
  music therapist with a client or group, in a
  process designed to facilitate and promote
  communication, expression etc. and other
  therapeutic objectives in order to meet physical,
  emotional, mental, social and cognitive needs.
• MT aims to develop potentials or restore
  functions
• Two applications of music therapy
• music for its inherent healing qualities
• mean for self expression, interaction within a
  therapeutic relationship.

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What is Music Therapy
Music Therapy

• Use of music for its inherent healing qualities
• Focus on the physical properties of music as
  healing. Client-therapist relationship is
  secondary
• E.G. Vibroacoustic therapy or Music Bath
• Use of recorded music as therapy supplementary to
  the cure of physical illness
• Surgery rooms
• Clients on kidney dialysis
• Cancer
• premature or sick infants

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What is Music Therapy
Music Therapy

• Using music as a means for self expression,
  interaction within a therapeutic relationship
• Community music therapy
• Guided imagery and Music (GIM)
• Improvisational Music Therapy

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What is Music TherapyAnother definition
Music Therapy
Music therapy is the use of sound and music
within an evolving relationship between client
and therapist to support and encourage physical,
mental and emotional well-being
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Role of the Therapist
Music Therapy

• Changes depending on the type of music therapy
  used and needs of client
• Therapist is using music to bring about change in
  clients behaviour or emotional state
• Therapist must be open, and willing to listen
• Encourage client

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Intervention Techniques
Music Therapy

• Singing
• Playing
• Rhythmic
• Improvising
• Composing / Songwriting
• Imagery
• Listening

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Goals of Music Therapy
Music Therapy

• Music as a means to an end
• Maintain and develop physical skills, cognitive
  potential, motivation, speech, language,
  non-verbal expression, social skills
• Bring about individual changes in mood, releasing
  tension, expression of feelings, social
  interaction, development of self-esteem

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Clips sex drug rock
Music Therapy

• Levitin 1st clip

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The power of music
Music Therapy

• Is there a biological basis for the experiences
  that people talk about?
• heart rate increases, breathing deepens their
  muscle tension increases
• Human body fall into synchronism with a rhythmic
  phenomenon
• What about hormones
• adrenaline, cortisol, and ACTH
• Study surgery, cortisol level and musics impact

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The power of music
Music Therapy

• Sex, drugs and rock and roll right there in the
  brain?
• Listening to music releases neurochemicals such
  as
• Prolactin
• Oxytocin
• Dopamine
• But why are music and sex and drug act so
  similar?
• Study by Robert Zattore

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The power of music
Music Therapy

• Specific parts of the brain are involved in
  perceiving different musical elements.
• Pitch, harmony, melody, loudness, rhythm
• E.G. specific neurons in the auditory cortex are
  tuned to perceive specific pitches
• Some of the areas involved auditory cortex,
  motor cortex prefrontal cortex, sensory cortex,
  the visual cortex, nucleus accumbens and
  amygdala, hippocampus and so on.

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What happens in the brain?
Music Therapy

• Hearing music
• auditory cortex
• Core pitch and volume
• Surrounding timbre, melody and rhythm
• Imagining music
• Auditory cortex to a lesser magnitude
• Inferior frontal gyrus (retrieving memories)
• Dorsolateral frontal cortex (working memory)

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What happens in the brain?
Music Therapy

• Playing music
• auditory cortex (feedback system)
• visual cortex (reading a score)
• parietal lobe ( e.g. computation of finger
  position)
• motor cortex
• sensory cortex
• frontal lobe
• cerebellum

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What happens in the brain?
Music Therapy

• Emotional reaction to music
• Reward structures such as ventral tegmental area
  (when you get chills!)
• Same areas that get activated while
• Eating
• Sex
• Using drugs
• Pleasing song ? Inhibition of amygdala

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Oliver Sacks
Music Therapy

• Clip 2 How brain reacts to music
• ?

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Neurologic Music Therapy
Music Therapy

• Center for Biomedical Research in Music at
  Colorado State University
• Brain imaging, brain wave analysis, kinematic
  motion analysis, technological shift early 90s
• Finding central nervous system involved in
  creating, perceiving, understanding, producing
• Improvement in 3 areas sensorimotor functioning,
  speech and language functioning, cognitive
  functioning

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Rhythmic Auditory Stimulation (RAS) for
sensorimotor functioning
Music Therapy

• Who uses RAS?
• Stroke patients, Parkinsons patients showed
  improvements
• Spinal cord injured patients, traumatic brain
  injured patients

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Rhythmic Auditory Stimulation (RAS) for
sensorimotor functioning
Music Therapy

• Applies auditory sounds to movement (walking,
  stepping) 2/2, 2/4
• Therapist gradually increases to form a pattern
• Rhythmic entrainment, priming of auditory-motor
  pathway, cueing of movement
• Rhythm has physiological function to stimulate
  movement

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(RAS)
Music Therapy

• Auditory system detects patterns
• No large effort required
• Stimuli activates motor neurons via
  reticulospinal pathways priming of the
  auditory-motor pathway
• Rhythm offers cues for movement when to place
  foot down, creating a pattern
• Limit cycle optimal movement frequency

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Vocal Intonation Therapy (VIT) or Melodic
Intonation Therapy (MIT)
Music Therapy

• Structured singing and voice exercises pitch,
  timber, breath control, volume, phonation,
  resonance, intonation
• Technique relaxing head, neck, upper body,
  warming up the diaphragm breath using scales and
  singing
• Therapist may resemble a voice coach, yet they
  customize the therapy to patients needs Speech
  therapist or Music Therapists

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(VIT)(MIT)
Music Therapy

• Helps for pitch disorder, hoarseness,
  respiratory control, trouble with phonation,
  emphysema, dysarthria (communication disorder
  Parkinson's patients develop dysarthria), aphasia
  
• Technique posture/breath exercises, vocal
  warming up, echo singing
• Improvements speech intelligibility, voice
  control, vocal intensity

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(VIT)(MIT)
Music Therapy

• Works closely with language therapy
• many different levels and techniques - music
• Therapist modifies to meet clients needs

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MT Neurological disorders
Music Therapy

• Melodic Intonation Therapy
• Aphasia
• Rhythm in disguise why singing may not hold the
  key to recovery from aphasia

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Musical Neglect Training (MNT) or Patterned
Sensory Enhancement (PSE)
Music Therapy

• Patients play musical instruments in spatial
  configuration (left-right, right-left)
• Temporal, spatial cues
• focus attention on area of brain that is damaged,
  visual neglect due to injury, stroke (hemispheric
  lesions)
• How music can activate neurons!

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Goals of NMT
Music Therapy

• CASE STUDY Mrs. S
• MT helps the individual as a whole
• Being in MT helps verbal/non-verbal
  communication, social-interaction, motor
  functioning, cognitive functioning, helps
  psychological and emotional adjustment to
  disability
• Environment becomes more relaxed music has
  emotional and physiological effects

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Goals
Music Therapy

• COMMUNICATION!
• Patients may not have language MT can help to
  asses and help provide info
• MT a medium for interaction
• Music abilities may be preserved when language is
  not (TBI)
• MT can asses (non verbal) imitation,
  development, turn-taking, eye contact, non-verbal
  gestures

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Goals
Music Therapy

• Help patients foster a rewarding and enjoyable
  environment
• COGNITION!
• Playing instruments and singing initiation,
  attention, concentration, short/long-term memory,
  motor planning, sequencing, switching between
  tasks, behavioural control motivation, fluency in
  thinking

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Goals
Music Therapy

• MT a vehicle for brain responses pulse, rhythm,
  tempo, melody, phrasing, melodic contour,
  harmonic direction
• Therapists can use music and customize activities
  to what patients cognitive disabilities are

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Goals
Music Therapy

• PHYSICAL FUNCTIONING!
• Being part of MT requires patients to be
  physically active playing an instrument
• Uni/bilateral hand grasps, arm extension, trunk
  alignment, leg stretching
• Wind instrument breath control and coordination,
  face muscles, voice production
• Improves walking gait
• relaxation

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Goals
Music Therapy

• EMOTIONAL FUNCTIONING!
• TBI patients dealing with trauma, loss of
  independence, fatigue, relationship change,
  anxiety
• MT allows an outlet for emotions to be expressed
  when verbal expression is unavailable
• Shared musical interactions allow can help self
  esteem, well being, confidence
• Challenge their abilities through creative means
• From grief to joy
• Reduce anxiety

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Goals
Music Therapy

• SOCIAL FUNCTIONING!
• Music for social gathering, celebrations
• Patients with TBI may benefit from interaction
  with others
• Enhance relationships, relate to each other,
  express together,
• Decreasing anger, agression

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Group Jam Session
Music Therapy
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Children Music therapy Bonding and attachment
in traumatized kids
Music Therapy

• Building a secure relationship Music therapists
  have resources for supporting this
• Early trauma affects right-hemisphere brain
  development
• Parent-Infant MT using musical and music-like
  interactions for developing a relationship with a
  caregiver/dyad
• E.G. vocal improvisation and lullabies to help
  mutual co-regulation
• practised in groups

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Music Therapy for children (0-3)
Music Therapy

• The musical parent
• Infant has the capacity to recognize the
  emotional intention of vocal timbres
• infant-directed communication
• Not present in depressed mothers
• Finding the pulse
• Exposure to crisis ? children display distress
• Repeated negative experience builds mistrust
  Music therapy as an environment to explore
  positive and creative connections
• Words may be experienced as threatening by some
  adopted children

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Music Therapy for children (0-3)
Music Therapy

• The role of music therapy in supporting
  parentchild bonding
• Parentinfant communication is intrinsically
  musical
• MT may permit regression to early, infantile
  modes of feeling, thinking and meaning
• Relearn how to engage in social exchanges

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Music Therapy for children (0-3)
Music Therapy

• The challenge of separation Sam and May
• Sam adopted by Richard and May, appeared
  well-bonded to adopted parents
• After 6 months, became very clingy with May
• Also stopped crying
• Attended MT for security and self-confidence
• In his first MT session Sam remained physically
  attached to May
• Gradually began to explore some of the
  instruments

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Music Therapy for children (0-3)
Music Therapy

• The challenge of separation Sam and May (Contd)
• fascinated by drum first significant separation
• Little by little he waited longer before jumping
• Lack of toleration for Mays absence
• Music indicated that something still existed
  rather than Sam being left with the void created
  by silence
• Appearance of smile as her mom reappeared
  reappearance from behind a drum

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Music Therapy for children (0-3)The challenge of
separation Sam and May (Contd)
Music Therapy

• Session 7 introduced the idea of mother being
  absent from the music therapy room
• His little smile on being found began to
  reassure the presence
• Sam became able to stay in the room for whole
  sessions without May present May always joined
  us for the Goodbye song
• May described Sam as chatty

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Clip Children and music therapy
Music Therapy
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Music Therapy and Children
Music Therapy

• Emotional, motivational and interpersonal
  responsiveness of children with autism

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MT and Emotional Behavioural Disorders (EBD)
children
Music Therapy

• WHO? Physical, sexual verbal assault victims,
  accident victims, death of family, loss of limbs,
  spinal cord injuries, paralysis, trauma
• Children are limited in ways they can express
  themselves and emotions behaviour is affected,
  pressure from parents, teachers peers
• Stress and anxiety can lead to withdrawal from
  peers, low academic performance, enjoyment levels
  decrease, risky behaviours, irritability,
  depression, suicide
• talk-therapy can intimidate with figures of
  authority forced into by parents

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MT and EBD
Music Therapy

• Breakdown in MT assessment
• Interviews with family about musical history
• Assessment tools Natural response choice,
  Musical Preference, Musical responsiveness,
  Verbal Associations, Non-verbal reactions and
  Client/Therapist Interaction
• Music used as tool to build trusting relationship
  between therapist and child/adolescent
• Case Studies

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Clip Dr. Levitin on emotions
Music Therapy
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Music Therapy and Emotion
Music Therapy

• Depression
• The effectiveness of music listening in reducing
  depressive symptoms
• Effects of music therapy on depression compared
  with psychotherapy

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3 clips of music and emotional responses
Music Therapy

• Clip 1
• Clip 2
• Clip 3

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MT and Palliative Care
Music Therapy

• Palliative care has grown so has MT in palliative
  centres
• Therapists may use song writing, musical
  improvisation
• Oncology, HIV/Aids, multiple sclerosis, cystic
  fibrosis, other degenerative diseases
• In home MT or institutions
• All members of hospital staff may refer patients
  to MT
• Adult family members may refer child

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..MT and Palliative Care
Music Therapy

• Patients may also self-refer themselves, includes
  adults, adolescents and children
• Depending on the diagnosis, the music therapist
  creates and implements programs for longer term
  or acute care
• MT Palliative GOALS and OUTCOMES
• helps with coping, pain management, reduction of
  anxiety, enhance relationships, provide
  self-expression, feelings of support and
  validation, improves self-worth and dignity,
  allows for interaction in non-patient way,
  feelings of choice and control, hospital
  environment becomes more pleasurable, assist with
  grieving

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...MT and Palliative Care
Music Therapy

• Study done with Health professionals
• Art therapist, Chaplain, Clinical Nurse,
  Day-Care Nurse, Medical Director, Occupational
  Therapist, Physiotherapist, Social Workers
• 1) General Attitudes towards Music Therapy?
• - Nurses too intrusive? affect the wrong
  spots?
• 2) Perceived Scope of Music Therapy?
• - emotional, physical, social, environmental,
  spiritual

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Study MT in Palliative Care
Music Therapy

• 3) Holism and Music therapy
• 4) Integration of Music therapy and palliative
  care

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Music therapy and dementia
Music Therapy

• Study Music therapy-induced changes in
  behavioral evaluations, and saliva chromogranin A
  and immunoglobulin A concentrations in elderly
  patients with senile dementia
• Aim to clarify music therapy-induced changes in
  behavioral evaluations, and saliva chromogranin A
  and immunoglobulin A concentrations in elderly
  patients with dementia.

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Music therapy and dementia
Music Therapy

• Methods
• 8 patients with dementia
• 25 1h sessions of MT twice weekly for 3 months
• Scales GottfriesBraneSteen Scale (GBS) and
  Behavioral Pathology in Alzheimers Disease
  Rating Scale
• Saliva chromogranin A and immunoglobulin A
  measured

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Music therapy and dementia
Music Therapy

• Evaluation
• Mini-Mental State (MMSE)
• GottfriesBraneSteen Scale (GBS)
• Behavior Pathology in Alzheimers Disease Rating
  Scale (BEHAVE-AD)
• Salivary chromogranin A
• Secretory immunoglobulin A
• Results
• Improvement on MMSE after 1 month showed
  significant improvement (MT group)

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Music therapy and dementia
Music Therapy

• Results (Condd)
• In the MT group, significant improvement on a GBS
  subscale (symptoms common in dementia)
  disappeared after 1 month
• On the paranoid/delusional ideation subscale
  the MT group significantly improved more
  significant after 1 month
• motor-function inability to control bladder
  and bowel MT demonstrated significant
  improvement
• level of salivary CgA was significantly decreased
  after the last therapy session impact
  disappeared after 1 month

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Music therapy approaches
Music Therapy

• Analytically oriented music therapy (AOM)
• Mary Priestly
• roots in psychoanalysis
• Example a person might be frustrated by her
  intruding mother
• Title for improvisation in order to access the
  unconscious
• Real case example rape victim

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Music therapy approaches
Music Therapy

• Nordoff-Robbins Music Therapy
• Philosophy every human being has an innate
  responsiveness to music
• Power of music enables self expression and
  communication
• Requires a skilled musician as the therapist,
  trained to improvise music
• making is the primary focus of the sessions
• The therapist provides a musical frame
• Nordoff and Robbinss account of the therapy
  session
• Also to work with adults in areas of neurology,
  psychiatry and terminal illness

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END?