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Music therapy

Music therapy is the use of interventions to accomplish individual goals


within a therapeutic relationship by a professional who has completed an
approved music therapy program. Music therapy is an allied health profession
and one of the expressive therapies, consisting of a process in which a music
therapist uses music and all of its facetsphysical, emotional, mental, social,
aesthetic, and spiritualto help clients improve their physical and mental health.
Music therapists primarily help clients improve their health in several domains,
such as cognitive functioning, motor skills, emotional development, social skills,
and quality of life, by using music experiences such as free improvisation,
singing, and listening to, discussing, and moving to music to achieve treatment
goals. It has a wide qualitative and quantitative research literature base and
incorporates clinical therapy, psychotherapy, biomusicology, musical acoustics,
music theory, psychoacoustics, embodied music cognition, aesthetics of music,
sensory integration, and comparative musicology. Referrals to music therapy
services may be made by other health care professionals such as physicians,
psychologists, physical therapists, and occupational therapists. Clients can also
choose to pursue music therapy services without a referral (i.e., selfreferral).
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, song writing and listening in
reminiscence/orientation work with the elderly, processing and relaxation work,
and rhythmic entrainment for physical rehabilitation in stroke victims. Music
therapy is also used in some medical hospitals, cancer centers, schools, alcohol
and drug recovery programs, psychiatric hospitals, and correctional facilities.

History
Music has been used as a healing implement for centuries. Apollo is the
ancient Greek god of music and of medicine. Aesculapius was said to cure
diseases of the mind by using song and music, and music therapy was used in
Egyptian temples. Plato said that music affected the emotions and could
influence the character of an individual. Aristotle taught that music affects the
soul and described music as a force that purified the emotions. Aulus Cornelius
Celsus advocated the sound of cymbals and running water for the treatment of
mental disorders. Music therapy was practiced in biblical times, when David
played the harp to rid King Saul of a bad spirit. As early as 400 B.C., Hippocrates
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played music for mental patients. In the thirteenth century, Arab hospitals
contained music rooms for the benefit of the patients. In the United States, Native
American medicine men often employed chants and dances as a method of
healing patients. The Turco-Persian psychologist and music theorist al-Farabi
(872950), known as Alpharabius in Europe, dealt with music therapy in his
treatise Meanings of the Intellect, in which he discussed the therapeutic effects of
music on the soul. 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. Music therapy as we know it began in the
aftermath of World Wars I and II, when, particularly in the United Kingdom,
musicians would travel to hospitals and play music for soldiers suffering from
war-related emotional and physical trauma.

Music therapy and children with autism


Music therapy can be a particularly useful when working with children with
autism due to the nonverbal, nonthreatening nature of the medium. Studies have
shown that children with autism have difficulty with joint attention, symbolic
communication and sharing of positive affect. Use of music therapy has
demonstrated improvements of socially acceptable behaviors. Wan, Demaine,
Zipse, Norton, & Schlaug (2010) found singing and music making may engage
areas of the brain related to language abilities, and that music facilitated the
language, social, and motor skills. Successful therapy involves long-term
individual intervention tailored to each childs needs. Passing and sharing
instruments, music and movement games, learning to listen and singing
greetings and improvised stories are just a few ways music therapy can improve
a childs social interaction. For example passing a ball back and forth to
percussive music or playing sticks and cymbals with another person might help
foster the childs ability to follow directions when passing the ball and learn to
share the cymbals and sticks. In addition to improved social behaviors music
therapy has been shown to also increase communication attempts, increase
focus and attention, reduce anxiety, and improve body awareness and
coordination.
Since up to 30 per cent of children with autism are nonverbal and many
have difficulty understanding verbal commands music therapy becomes very
useful as it has been found that music can improve the mapping of sounds to
actions. So by pairing music with actions, and with many hours of training the
neural pathways for speech can be improved. Child-appropriate action songs

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would be like playing the game peek-ka-boo or eeny meeny miney mo with a
musical accompaniment, usually a piano or guitar.
Children with autism are also prone to more bouts of anxiety than the
average child. Short sessions (15 20 mins) of listening to percussive music or
classical music with a steady rhythm have been shown to alleviate symptoms of
anxiety and temporarily decrease anxiety-related behaviour. Music with a steady
4/4 beat is thought to work best due to the predictability of the beat. Target
behaviours such as restlessness, aggression and noisiness can also be affected
by the use of music therapy. Weekly sessions ranging for hour to 1 hour during
which a therapist plays child-preferred melodies such as Twinkle Twinkle Little
Star and engages the child in quiet singing increases socially acceptable
behaviour such as using an appropriate volume when speaking. Studies also
suggest that playing one of the childs favorite songs while the child and therapist
both play the piano or strum chords on a guitar can increase a childs ability to
hold eye contact and share in an experience due to their enjoyment of the
therapy.
Musical improvisation during a one on one session has also been shown
to be highly effective with increasing joint attention. Some noted improvisation
techniques are using a welcome song that includes the childs name, which
allows the child to get used to their surroundings; an adult-led song followed by a
child led song and then conclude with a goodbye song. During such sessions the
child would most likely sit across from the therapist on the floor or beside the
therapist on the piano bench. Composing original music that incorporates the
childs day-to-day life with actions and words is also a part of improvisation. The
shared music making experience allows for spontaneous interpersonal
responses from the child and may motivate the child to increase positive social
behaviour and initiate further interaction with the therapist.

Some common instruments in music therapy for children are:

Upright piano, Guitar, Xylophone, Small guiro, Paddle drums, Egg


shakers, Finger cymbals, Birdcalls, Whistles, & Toy hand bells.

Music therapy has also been recognized as a method for children with
autism. Music therapy helps stabilize moods, increase frustration tolerance,
identify a range of emotions, and improve self-expression along with much more.
The visual and auditory sensory system is responsible for interpreting sounds
and images. With autistic children, if a sound or image is unpleasant the child
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may not have the ability to express itself, which makes it difficult for a therapist,
parent, etc. to interpret. Music engages the brain in both sub-coritcal and neocortical levels, which means it is not critical to think while listening to music
when hearing the notes and sounds. Music therapy, in the topic of austisms
sensory interpretation, provides repetitive stimuli which aim to teach the brain
other possible ways to respond that might be more useful as they grow older.

Adolescents
Mood disorders
According to the Mayo Health Clinic, two to three thousand out of every
100,000 adolescents will have mood disorders, and out of those two to three
thousand, eight to ten will commit suicide. Two prevalent mood disorders in the
adolescent population are clinical depression and bipolar disorder.
On average, American adolescents listen to approximately 4.5 hours of
music per day and are responsible for 70% of pop music sales. Now, with the
invention of new technologies such as the iPod and digital downloads, access to
music has become easier than ever. As children make the transition into
adolescence they become less likely to sit and watch TV, an activity associated
with family, and spend more of their leisure time listening to music, an activity
associated with friends.
Adolescents obtain many benefits from listening to music, including
emotional, social, and daily life benefits, along with help in forming their identity.
Music can provide a sense of independence and individuality, which in turn
contributes to an adolescent's self-discovery and sense of identity. Music also
offers adolescents relatable messages that allow them to take comfort in knowing
that others feel the same way they do. It can also serve as a creative outlet to
release or control emotions and find ways of coping with difficult situations. Music
can improve an adolescent's mood by reducing stress and lowering anxiety
levels, which can help counteract or prevent depression. Music education
programs provide adolescents with a safe place to express themselves and learn
life skills such as self-discipline, diligence, and patience. These programs also
promote confidence and self-esteem. Ethnomusicologist Alan Merriam (1964)
once stated that music is a universal behavior it is something with which
everyone can identify. Among adolescents, music is a unifying force, bringing
people of different backgrounds, age groups, and social groups together

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Referrals and assessments


While many adolescents may listen to music for its therapeutic qualities, it
does not mean every adolescent needs music therapy. Many adolescents go
through a period of teenage angst characterized by intense feelings of strife that
are caused by the development of their brains and bodies. Some adolescents
develop more serious mood disorders such as major clinical depression and
bipolar disorder. Adolescents diagnosed with a mood disorder may be referred to
a music therapist by a physician, therapist, or school counselor/teacher. When a
music therapist gets a referral, he or she must first assess the patient and then
create goals and objectives before beginning the actual therapy. According to the
American Music Therapy Association Standards of Clinical Practice assessments
should include the general categories of psychological, cognitive,
communicative, social, and physiological functioning focusing on the clients
needs and strengthsand will also determine the clients response to music,
music skills, and musical preferences The result of the assessment is used to
create an individualized music therapy intervention plan.

Treatment techniques
There are many different music therapy techniques used with adolescents.
The music therapy model is based on various theoretical backgrounds such as
psychodynamic, behavioral, and humanistic approaches. Techniques can be
classified as active vs. receptive and improvisational vs. structured. The most
common techniques in use with adolescents are musical improvisation, the use
of precomposed songs or music, receptive listening to music, verbal discussion
about the music, and incorporating creative media outlets into the therapy.
Research also showed that improvisation and the use of other media were the
two techniques most often used by the music therapists. The overall research
showed that adolescents in music therapy change more when discipline-specific
music therapy techniques, such as improvisation and verbal reflection of the
music, are used. The results of this study showed that music therapists should
put careful thought into their choice of technique with each individual client. In the
end, those choices can affect the outcome of the treatment.
To those unfamiliar with music therapy the idea may seem a little strange,
but music therapy has been found to be as effective as traditional forms of
therapy. In a meta-analysis of the effects of music therapy for children and
adolescents with psychopathology, Gold, Voracek, and Wigram (2004) looked at
ten studies conducted between 1970 and 1998 to examine the overall efficacy of
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music therapy on children and adolescents with behavioral, emotional, and


developmental disorders. The results of the meta-analysis found that music
therapy with these clients has a highly significant, medium to large effect on
clinically relevant outcomes. More specifically, music therapy was most effective
on subjects with mixed diagnoses. Another important result was that the effects
of music therapy are more enduring when more sessions are provided.
One example of clinical work is that done by music therapists who work
with adolescents to increase their emotional and cognitive stability, identify
factors contributing to distress and initiate changes to alleviate that distress.
Music therapy may also focus on improving quality of life and building selfesteem, a sense self-worth, and confidence. Improvements in these areas can
be measured by a number of tests, including qualitative questionnaires like
Becks Depression Inventory, State and Trait Anxiety Inventory, and Relationship
Change Scale. Effects of music therapy can also be observed in the patients
demeanor, body language, and changes in awareness of mood.
Two main methods for music therapy are group meetings and one-one
sessions. Group music therapy can include group discussions concerning moods
and emotions in or toward music, songwriting, and musical improvisation. Groups
emphasizing mood recognition and awareness, group cohesion, and
improvement in self-esteem can be effective in working with adolescents. Group
therapy, however, is not always the best choice for the client. Ongoing one-onone music therapy has also been shown to be effective. One-on-one music
therapy provides a non-invasive, non-judgmental environment, encouraging
clients to show capacities that may be hidden in group situations.
Music Therapy in which clients play musical instruments directly, show
very promising results. Specifically, playing wind instruments strengthens oral
and respiratory muscles, sound vocalization, articulation, and improves breath
support. Symbolic Communication Training Through Musicis also an important
technique in playing instruments in music therapy, because this makes
communication (verbally and non verbally) improved in social situations. Most
importantly, is that music provides a time cue for the body to remain regulated.
Making music is also important for people of all ages because it causes
motivation, increases "psychomotor" activity, causes an individual to identify with
a group (in group music), regulates breathing, improves organizational skills, and
increases coordination. Though more research needs to be done to ascertain the
effect of music therapy on adolescents with mood disorders, most research has
shown positive effects.

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Psychiatric disorders

Schizophrenia
Music therapy is used with schizophrenic patients to ameliorate many of
the symptoms of the disorder. Individual studies of patients undergoing music
therapy showed diminished negative symptoms such as flattened affect, speech
issues, and anhedonia and improved social symptoms such as increased
conversation ability, reduced social isolation, and increased interest in external
events. Meta-studies have confirmed many of these results, showing that music
therapy in conjunction with standard care to be superior to standard care alone.
Improvements were seen in negative symptoms, general mental state,
depression, anxiety, and even cognitive functioning. These meta-studies have
also shown, however, that these results can be inconsistent and that they depend
heavily on both the quality and number of therapy sessions.

Depression
Music therapy has been found to have numerous significant outcomes for
patients with major depressive disorder. A systematic review of five randomized
trials found that people with depression generally accepted music therapy and
was found to produce improvements in mood when compared to standard
therapy. Another study showed that MDD patients were better able to express
their emotional states while listening to sad music than while listening to no
music or to happy, angry, or scary music. The authors found that this therapy
helped patients overcome verbal barriers to expressing emotion, which can
assist therapists in successfully guiding treatment.Other studies have provided
insight into the physiological interactions between music therapy and depression.
Music has been shown to decrease significantly the levels of the stress hormone
cortisol, leading to improved affect, mood and cognitive functioning. A study also
found that music led to a shift in frontal lobe activity (as measured by EEG) in
depressed adolescents. Music was shown to shift activity from the right frontal
lobe to the left, a phenomenon associated with positive affect and mood.

Music as stress reliever


One of the great benefits of music as a stress reliever is that it can be
used while you conduct your regular activities so that it really doesnt take time
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away from your busy schedule. Music provides a wonderful backdrop for your life
so that you can find increased enjoyment from what youre doing and also reduce
stress from your day. The following are some of the ways you can use music to
enhance your regular activities:

Getting Ready in the Morning:


You can wake yourself up with music, and start your day feeling
great, setting the tone for a lower-stress day.

During a Commute:
Put an end to road rage by playing your favorite music in the
car. It can relieve some of the tension you feel from the commute
itself and the day so far, and help you feel less like youre wasting
time in traffic, and more like youre having some nice time to
yourself. It can also take your mind off of all that you need to get
done once you reach your destination, so youll arrive less stressed
and more prepared to take on what awaits you.

Cooking:
Good nutrition is an important part of a healthy lifestyle, and
it can actually keep your stress level down . Eating at home is a
great way to ensure healthy meals and less expense, but many
people find themselves too tired to cook once they get home. If you
put on some smooth jazz or other genre of music that you enjoy,
cooking becomes a fun activity rather than a chore, and youll likely
find yourself relaxed and in a better frame of mind once dinner
starts, which can enable you to savor your dinner and your
company as you eat.

While Eating:
As youre eating your meal, music can also be a helper.
Soothing music can trigger the relaxation response , which can
lower cortisol levels, making it easier to digest food. Also, studies
have shown that classical music in particular can help you eat less,
digest better, and enjoy your food more.

Cleaning:

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Keeping a simple, organized home can really help to cut


down on your stress level , but cleaning itself is a chore that many
busy people dont have the energy to face after a long day.
However, if you throw on some energetic music, hip-hop or pop, for
example, you can raise your energy level and have fun as you
clean. If you tell yourself that you only need to clean for a certain
amount of songs and then you can be done, you may work more
efficiently, and even come to look forward to doing the job.

When Paying Bills:


We all need to pay bills, but the job doesnt always take a
high degree of concentration. Playing music while you write your
checks can help take your mind off of financial stress you may be
feeling, and make the task more enjoyable.

Before Bed:
Getting enough sleep is important for proper functioning, and
getting enough sleep can help you handle stress better.
Unfortunately, stress can also interfere with sleep in several ways.
Playing music as you drift off is one way to counteract the effects of
stress by taking your mind off of whats stressing you, slowing down
your breathing, and soothing your mind.

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