Since ancient times, music has been used by humans in different ways, including therapeutically. Today, music is being used to reduce stress, enhance health, and distract the patient from bad symptoms. Despite the fact that different people prefer different music, music is known to cause a direct effect via autonomous nervous system. In addition music is known to cause an indirect effect through modifying caregiver.
Music has proven to be very effective in improving mood for both surgical and medical patient as well as patients undergoing particular procedures or those in intensive care unit and also aid in anxiety reduction. Furthermore, music therapy can be used on infants, children, adolescent or adults. Since music is a low cost intervention it can be used most often to accompany procedures or surgery with the aim of reducing chronic or acute pain. Music does not have a positive effect on patient only, but also to caregivers. Provision of music to caretaker enhances compassion, empathy and improved relationship without compromising important technical aspect of care while reducing errors. This paper will review therapeutic use of music by evaluating the effects of music on patients of various groups (infants, children etc.) and the way music is used in therapy.
Since ancient days, music has been used to reduce suffering, pain and ultimately enhance the wellbeing of people. Music therapy can be defined as the intentional use of music to attain therapeutic goal by a credited professional who has successfully finished music program that is approved.
Music is a common denominator in all human race and cultures. It is listened to by people of all ages, ethnic background and as well as color. There are different kinds of music and each class appeal differently to different people at different occasion. For instance, songs for soothing children to sleep, nursery school rhyme etc. Listening to the same music repeatedly can become irritating. Music has been applied in different ways by different categories of people. For example, music with high tempo is being used to increase the performance of athletes; baroque music is normally used after a stressful event such as examination for relaxing purposes. On the other hand jazz music has been used most frequently for the purpose of socializing. Of late, there has been an increased marketing of music with Mozart effect for enhancing pediatric development, contemporary therapies e.g. message and addressing cognitive problems. Typically, music has been used for a long time as an alternative healing and other illnesses.
Music therapy is internationally recognized as a health profession which is established and that it uses music to enhance therapeutic process. These people who deliver this services i.e. music therapist, are musician who have been trained to use music and therapists self to realize therapeutic aim; the maintenance, restoration, and improvement of physical and mental health. Music therapist can work in different areas other than in a health care setup. They can be used in hospitals, schools, clinics, hospices, day care centers, correctional facilities, rehabilitation centers and also in private practice.
Music can have different effect depending on the listener’s characteristics such as, culture, age, medical conditions, experience and music aptitude. There are other factors which affect the influence of music: element of music e.g. pitch, tempo, harmony, rhythm and melody, setting i.e. group or alone, passive verses active participation and means of delivery e.g. speakers, headphones, recorded vs. live, open air etc.
Effect music on patients
Music therapy and music may have direct benefit on the patient who may include social, emotional, and psychological. Also music can affect the patient indirectly through its effect on behavior and care give attitudes. In reference to the direct physiological effect, music is known to change neuron activity in animals. This occurs because when listening to music the rhythm, the cortal area and lateral temporal lobe which is committed movement become entertained. Steady rhythm also influences respiratory rhythm. Classical musical has been shown to increase the variability of heart rate, which is a measure of cardiac autonomic balance, increase high level is an indicator of less stress. On the other hand, rock music or noise is known to reduce heart rate variability. The reduced levels signify greater stress. Studies have shown that, students who are exposed to stressful work while listening to music have low salivary control level as compared to those who don’t listen to music. Music can also affect morphine – 6 –glucoronide, mu-opiate receptor expression, and in healthy individual, interleukin – 6 –levels.
Music and infant
In premature infant, music such as lullabies or classical music are known to decrease distressed behavior, decreased incidence of oxygen desaturation, increase in non-nutritive sucking and increases weight gain. All these can reduce the period of time in hospitals. Studies have shown that, exposing premature infants to harp music result in significant reduction in the levels of salivary cortical as well as low rate of respiration. As infant listen to music, they become quite and then sleep. As such, there is reduced energy expenditure resulting in increases weight thus hastening discharge from hospital. The effect of other music such as jazz and pop on premature babies, infant as compared to classical has not been determined.
Music therapy and children
Music therapy can be conducted using one of the two approaches available in children; in group setting or one-on-one settings. As a preliminary to either session, music therapist together with the child set goal which they should accomplish at the tail end of the session. Music therapy is known to aid children in behavioral problems, attention, and motivation and with communication. Rooms which these sessions are carried out, should be beautifully colored, and should be have a wide range of musical instrument. The music therapist can then play one instrument in rhythm. Children can be allowed to touch or play an instrument of their choice. All these features facilitate smooth outcome of music therapy.
It has been documented that 8-10 adolescence out of 100,000 commits suicide due to mood disorders. The most common mood disorders include bipolar disorder and clinical depression. Music therapy has both therapeutic and non-therapeutic benefit. Before undertaking music therapy for therapeutic purpose, there is a need for diagnosis by a therapist or a doctor.
As stated earlier, before commencement of the therapy, there is a need to set goal to be actualized by the end of the process. Basically, assessment includes cognitive, psychological, physiological function of the patient social and communicative needs of the patients etc.
There are many music therapies assessment which can be used, but of importance to adolescence treatment is music therapy for emotionally distressed children. The term emotionally distressed children encompasses, condition such as schizophrenia, behavioral disorders, attachment disorders, autism, anxiety and mood disorders. This tool consist seven areas: first and foremost, the patients is interviewed about him/ herself and their family’s background as it relates to music. This is followed by assessment of how appropriate will the patient develop socially and emotionally. Functionally while in music therapy, followed by assessing how the patient is able to organize his/her music experience. An important aspect of the assessment is following musical behavior changes exhibited by the patient during the session and try to find interpreter to those changes. In so doing the music therapist should take into account the current behavior problem, family history, the patient current diagnosis and affective development levels. Lastly, the music therapist should determine the musical response characteristic to a particular pathology by the patient.
The Beech Brook Music Therapy Assessment is another kind of assessment tool which could also be used for adolescents. It measures the patients, social and behavioral functioning, language and communication skills, emotional responsiveness and musical skills. This kind of system adopts a quantitative numbered scoring sys were total score reflects the overall trend in terms of behavior of the patient.
Techniques used in treatment
There are many techniques used in music therapy. It is important to print out that music therapy is founded on various theories which include behavioral, humanistic and psychodynamic approaches. These techniques can further be classified as structural vs., improvisational and receptive vs. active. For the adolescent, the most used techniques is improvisation where there is use of receptive music listening, pre-composed music, creative media out and discussion about the song. Studies have shown that use of discipline specific music therapy technique e.g. improvisation is very effective on adolescent.
Basically, music therapists work with the adolescent to increase cognitive and emotional stability, initiating change to eliminate distress and identifying factor that give rise to the current distress. In addition, music therapy is geared to building self-esteem, confidence sense of worth and improving life quality. Assessment to identify improvement can be done by using several tests namely; quantitative questionnaire e.g. backs depression inventory, relationship change scale and state and trait anxiety inventory. Change is awareness of emotion and mood, body language and the patient’s demeanor reflect effects of music.
One-on-one session and group meeting are the two main music therapy methods. Group methods are based on group discussion on emotion, moods, music improvisation and song writing. The Group method puts emphasis on recognition and awareness of mood (in case of an adolescent), improvement of self-esteem and group cohesion. However, this method is not the best for patient. One-on-one method of therapy has been shown to be effective. This method provides non judgments, noninvasive environment. It encourages patient to explore their capacities that they might have hidden in group discussion.
The provision of music in hospital ward, or waiting paces creates a positive atmosphere for staff, patients and families. Creation of this environment can have a remarkable effect on the mood of a patient in terms of perceived stress, depression and anxiety. In addition, changes in stress level and anxiety are accompanied by decrease in serum cortisol levels and increased level of salivary immunoglobulin. These are a reflection of a positive physiological change. Studies have shown that music is critical in reducing anxiety in hospitalized patients e.g. music can reduce anxiety and improve mood in surgical patients. For instance, in study to determine the effect of listening music pre-operative anxiety on men undergoing surgery indicated that those patients who listened to music had low levels of anxiety unlike those who did not listen to music.
Music is also known to improve mood of cancer patients e.g. during radiotherapy. It helps in reduction of tension, and activating a relaxed soothing feeling. Music can be used in intensive care units with aim of reducing the patients’ depression and anxiety. It has been shown that music helps in reducing anxiety in a patient supported by mechanical ventilators. Furthermore, music has been shown to alleviate anxiety that is associated with certain procedures e.g. colposcopy, colonoscopy and bronchoscopy.
Pain and music
Music is a powerful therapeutic tool. It can be employed to help reduce pain because it low costly and it is appealing to the patient, during after surgery. In addition to sedative and analgestic administered to the patient, music can be played to help reduce pain. For instance a study done by observing thoracic surgery patient who listened to live, harp music showed that after the session, thee was remarkable decrease in pain. Music has been effective in alleviating pain associated with several procedure e.g. laceration repair, dental procedure, lumbar puncture, immunization, burn debriment and insertion of intravenous lines. Music can be used to decrease patient response and perceptions to pain during labor and patient who experience chronic pain. For instance, women in labor listening to soft music are reported to experience les distress due to pain.
End of life and music
Music therapy can be used to make the last moments patients easier. Music therapy can be used to foster support between the patient and loved ones. It also enable the patients express his/her feeling in a way that is not threatening. Music can also be used in the therapy of other conditions such as stroke, heart disease and epilepsy.
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