Music Exam

music therapy

• the discipline in which credentialed professionals (MTA) use music purposefully within therapeutic relationships to support development, health, and well-being

• the MT uses music safely to address human needs within cognitive, communicative, emotional, musical, physical, social, and spiritual domains

• it is individualized and personalized

How to become a certified music therapist (MTA)

• get university training in music therapy or a related field

• be skilled as a musician → proficiency at guitar, piano, and signing

• complete a 1000 hour supervised clinical internship

• complete certification board of music therapists exam

• statement of adherence to the CAMT code of ethics and standards of practice

• gain continuing education credits

areas that music therapists work in

• music therapists work with numerous clients of all ages across many contexts

• MT’s often have fluctuating careers

• mental health is an overarching theme amongst the fields they work within

• MT is collaborative → they may work with physiotherapists, speech therapists, psychologists, etc

what are the two types of music therapy interventions?

• active music therapy

• passive music therapy

hospital settings often favour ____ interventions because they are more feasible

passive

types of music therapy interventions → active music therapy

• when the client is actively engaged in the music therapy

• ex: improvisation, singing, songwriting

types of music therapy interventions → passive music therapy

• when individuals passively participate in the music therapy

• ex: listening, pre-composed music

Why do we need research on music therapy?

• To gain credibility in the medical world

• To provide evidence for funding

• To increase access to music therapy services

• To prove something (an intervention) works

components of research papers

1. a clear statement of purpose and what is to be investigated

2. clear described and justified methodology

3. a report of the results

4. conclusions that are subsequently related to existing knowledge

research

a systematic, self-monitored inquiry which leads to a discovery or new insight, which, when documented and disseminated, contributes to or modifies existing knowledge or practice

types of data

• quantitative

• qualitative

• mixed-method

types of data → quantitative

• primarily relies on objective forms of data, and most

  often requires quantification and statistical analysis

• ex: cortisol levels, survey responses

• takes an objectivist approach

types of data → qualitative

• relies on subjective data, such as verbal, musical, and artistic materials or qualities

• ex: interviews, observations, etc

• takes an interpretivist approach

• there there are three types

  • phenomenological → how a person feels

  • meaning focused → how a person makes meaning

  • case approached → one individuals experience

mixed methods data

• research that involves both qualitative and quantitative methods

• Very common in music therapy!

  • using both qualitative and quantitative methods ate important for understanding/furthering music therapy

what outcomes can we obtain through music therapy research?

• physiological effects

  • ex: cortisol levels, adrenaline, heart rate patterns, breathing patterns, EEG, etc

• psychological effects

  • ex: mood changes, use of coping strategies, changes in mental health outcomes

what are the two types of research?

• basic

• applied

basic research

• researching basic knowledge and observable information about a phenomena

• there are no specific applications toward processes or products in mind

• done more often in disciplines other than music therapy

applied research

expanding basic research to provide a real world application

what type of research is done most common in music therapy?

applied research, as music therapy aims to help people

Evidence based practice

• Clinician observed, patient reported, and research derived evidence

• Helps us make the best decisions for patients and ensures safety

What factor strengthens research validity?

• larger sample sizes

• control groups

• standardized measures

what are some common dependent variables in music therapy research studies?

• self reports → for stress anxiety, depression, etc

• observations from staff or children’s parents

• physiological measures

What is a barrier/obstacle for research in music therapy?

Many variables are involved (music, interventions used, therapists, patients’ individual differences)

What is neurologic music therapy (NMT)?

• Using musical experiences, the elements of music or music-based tasks to reach non-musical goals

• there are several standardized clinical techniques (20+) that can be paired to address the following domains:

  • (MAINLY) sensorimotor function

  • cognitive function

  • speech and language

  • psychosocial function

• the focus is on brain function and rehabilitation

• it promotes neuroplastic changes in the brain

what is the most common NMT technique for improving sensorimotor function?

rhythmic audiotory stimulation

rhythmic auditory stimulation

• The most researched, evidence based example of sensorimotor rehabilitation

• Based on the principle of rhythmic entrainment and involves rhythmic cueing

• In Parkinson’s patients, an 8-week RAS program with music improved gait, increased sensorimotor activation, and reduced fall risk, illustrating “use it or lose it”

• named as a “best practice” by the Canadian Stroke Association

rhymthic entrainment

• the synchronization of motor neurons in response to a regular, pulsating sound

• rhythmic structure gives the brain a predictable pattern and structure to move to - the brain responds in the silence between beats

what is a common tool used for rhythmic entrainment?

a metronome

what is the most common NMT technique for improving speech and language?

melodic and intonation therapy

Aphasia

• damage to the language sections of the brain, which can result in impaired production or comprehension of written and spoken words

• SAM aphasia group in hamilton helps individuals with aphasia meet and work on speech

• people may sing better than they speak (ex: politician from Arizona)

Melodic Intonation Therapy (MIT)

• uses melody/rhythm to improve speech

• language rehabilitation can be supported by engaging both brain hemispheres, helping “rewire” speech areas

• therapy involves singing meaningful phrases with simple melodies, tapping the left hand, and gradually fading musical support to transition from singing to natural speech

music and the brain

• music activates all areas of the brain

  • ex: the corpus callosum, the sensory cortex, the visual cortex, the nucleus acumens, and the amygdala

• it also increases the release of several important neurotransmitters → dopamine, endorphins, acetylcholine, glutamate, GABA neurons

common symptoms associated with neurologic conditions

• weakened muscles

• loss of coordination

• seizures

• confusion

• pain

• altered speech patterns

who can take neurologic music therapy training?

• Music therapists

• Speech and language pathologists

• Occupational therapists

• Recreation therapists

• Physiotherapists

• but, only MTA’s can use the NMT credentials

NMT Pilot study: long-known music exposure effects on brain imaging and cognition in early stage cognitive decline

• Individuals with  early stage dementia where assigned to 3 weeks of daily listening to songs they knew; they where also given cognitive assessments

• Individuals who where musicians previously had greater improvements in cognition + memory

• This shows music may be helpful for improving cognitive function and memory, especially if individuals are musicians

in the context of NMT, why does music help?

• Rhythm drives speech

• Repetition

• Memory support

• Whole-brain activatio

trauma

• Challenging emotional consequences from living through distressing events (ex: abuse, neglect in early life, car accidents, brain injury, war, etc)

• Can be divided into little T (accumulation of stressors over time) and big T trauma (big life events)

Impacts of trauma

• having a constant sense of danger

• disrupted memories → repressed memories, flashbacks

• stress becomes stored in the body

• difficulty calming doen

• expecting the worst

What are the two parts of the nervous system?

• the parasympathetic nervous system

  • rest and digest

  • includes the vagus nerve → ventral = calm and dorsal = stress

• the sympathetic nervous system

  • helps us deal with emergencies (increases adrenaline, perspiration, heart rate)

  • people with trauma may have increased or persistent activity in the sympathetic NS

glimmers

• Small moments of joy or peacefulness that calm the nervous system

• They add up and help you rewire the brain to notice more positive things

trauma responses

the ways our body and mind respond to a traumatic event

What are the 4 different types of trauma responses?

• fight → anger/aggression

• flight → anxiety/restlessness

• freeze → being numb or disconnected

• fawn → people pleasing

Value of humming

• Activates the vagus nerve and the parasympathetic nervous system

• Helps us regulate emotions

• Lowers stress and heart rate

general stages for treating trauma

1. safety → establish secure environment + build therapeutic trust

2. remembrance → process an express trauma

3. reconnection → rebuild one’s identity and regain empowerment

TRAUMA paper 1: Heroines’ Journey‑ Emerging story by refugee women during group analytic music therapy

• a qualitative interpretivist study featuring 6 refugee women new to Canada

• all the participants completed 8 weekly therapy sessions featuring improvisation art, guided imagery and music

• they found that the group co-regulation and storytelling led to increased social support, decreased isolation/shame, and an overall shift from victim to survivor narrative

• limitations → small sample, limited generalizability, short duration

Guided Imagery and Music (GIM)

a MT technique where the therapist guides a person into an altered state of conciousness using specially selected (often classical) music

TRAUMA paper 2: in search of the self - the use of vocal holding techniques with adults traumatized as children

• Diane Austin implemented vocal holding and free associative singing in a study featuring a sample of traumatized clients with broken identities

• One’s voice was thought to be a psychological and physical anchor

• Traumatized individuals may survive by forfeiting their own voice→ this helps them get it back

• in the case of vicky, she was able to heal her mind-body split

What where the two vocal psychotherapy techinques created by Diane Austin?

• Vocal holding → the therapist is holding the space for the client to allow them to explore their feelings in a safe space; usually consists of 2 chords

• Free associative singing → sing whatever comes to mind so it can be processed and analyzed later

Parkinson’s disease

• A progressive neurodegenerative disorder characterized by several motor and non-motor symptoms

• Involves a lack of dopamine production which impacts the Basal Ganglia (responsible for initiating movement)

• Significantly impacts quality of life and speech

• Currently there is no cure, but it can be treated pharmacologically with Levodopa (stimulates dopamine release)

Issues with speech in Parkinson’s

• Occurs in 80% of people with Parkinson's

• Quieter speech and a monotone voice

• Frequent voice arrests

• Lower phonotational range

• Speech therapy most effective treatment for speech impairments resulting from PD BUT less than 5% of PD access it

Parkinson’s Community groups

• Community groups have been shown to help individuals with Parkinson’s improve their functioning (post therapy)

• Examples:

  • McMaster and Hamilton City Ballet's Dance for Parkinson's

  • Hamilton Parkinson's Chorus started by Zachary Levine

Beat inception

at 5 months old, infants can perceive rhythms + beats; it is intrinsic and helps us learn language

PARKINSON’S Paper 1: Music Therapy in Parkinson’s disease

• this was a literature review focused on analyzing the scientific use of MT for treating PD

• Results for motor symptoms → 4 of the studies saw no improvement or worse performance when music was present

• Results for non-motor symptoms → singing interventions helped with speech longitudinally; attention, memory, dysarthria, and swallowing improved

• Results for QoL: most significant improvements for mood and QOL when interventions included both singing and rhythm

• Overall, longer treatment = better patient outcomes , but music may not be effective for all people with PD due to the increased cognitive load

The Ronnie Gardiner Method

• A multisensory exercise method designed to help people with diseases/injuries of the brain and CNS

• Uses rhythm and movement to stimulate neuro-plasticity

PARKINSON’S Paper 2: the effects of participation in a group music therapy voice protocol on the speech of individuals with Parkinson's disease

• Wanted to test the efficacy of the applied group music therapy voice protocol for PD

• They adapted Lee Silverman Voice Treatment principles (loud voice, effortful phonation, intensity) into group singing/speaking exercises with warmups, breathing, scales, and preferred-song singing

• Overall, they saw improved vocal intensity, maintained vocal ranges, and benefits due to the social support

• Limitations: small n, more men than women in the sample, no control group

Aging and voice production

• Affects men and women differently

• Women's fundamental frequency get lower and men's get higher

• Men tend to have a more significant decrease in their vocal range and this happens earlier on (and is more profound)

  • Specifically, 70ya men range is lower then 60ya men

Palliative care

• An approach that improves quality of life for patients (and their families) who have life-threatening illness by preventing and relieving suffering through early identification, assessment, and treatment of physical, psychological, and spiritual problems

• Provided at the same time as other treatments while trying to cure the illness or combat symptoms

• MT in palliative care involves receptive, improvisational, and compositional techniques

Palliative care → validation therapy

Accepting a person where they're at; listening to the person as they approach the end of life; help them process this time

Hospice care

• Hospice care is provided when someone has less than 6 months left to live and treatment to cure illness has stopped

• embraces whole person care

Whole person care

Care that seeks to integrate the physical aspect of personhood along with the psychosocial and existential/spiritual ones, and to better understand how to respond to suffering experienced by the whole person

Catharsis

 the process of releasing, and thereby providing relief from, strong or repressed emotions

What is the most common symptom experienced by individuals in palliative care?

pain

Music and pain perception

• In hospice/pain care, music can reduce perceived pain, anxiety, and improve mood

  • studies showing decreased cortisol and higher pain tolerance in comparison to white noise/relaxation

• Effects are strongest when the music is personally chosen, though overall findings are mixed

Audioanalgesia

the use of music (more effective) or white noise to reduce pain and anxiety

PALLIATIVE CARE Paper 1: outcomes of music therapy interventions on symptom management in palliative medicine patients

• this was a large retrospective review of palliative care music therapy (5,970 sessions; 547 patients analyzed)

• they wanted to identify common music therapy goals, interventions and their effects

• they found that palliative care led to a significant improvement in pain, anxiety, depression, shortness of breath, mood, facial expression, and vocalization

• overall, there was a 96% positive response rate to music therapy

PALLIATIVE CARE Paper 2: a pilot study on the effectiveness of MT in hospice in Japan

• this was a pilot study on MT in Japanese Hospice care

  • previous to this, there was limited use of MT in palliative settings despite a large amount of certified therapists

• they had participants complete weekly group MT (~40min) and pre/post measures of mood and salivary cortisol

• positive mood and refreshment, alertness, and excitement increased and anxiety and depression decreased in 6/10 patients

• MT shows promise for reducing stress/anxiety and improving quality of life in end-of-life care

Acquired brain injury (ABI)

• Damage to the brain occurring after birth

• Can be caused by:

  • Tumors

  • Aneurism

  • Infections

  • Alcohol + toxins

  • etc…

• Many people’s entire way of life is disrupted, so the healing process usually involves a reintegration of the self

Common symptoms of ABI

• memory loss

• impaired reasoning skills

• emotional and personality change s

• physical disabilities

• speech problems

• headaches or seizures

Psychosocial impacts associated with ABI

• Loss of role and self-identity

• Difficulties with maintaining relationships

• Struggles with family, communication, and social skills

• Increased isolation

• Higher risk of unemployment

• Poorer financial circumstances

Case studies in music therapy research

• quite common

• pros → provides rich and detailed information about individuals, accessible to readers, multiple research methods can be used

• cons → low generalizabilty, requires large amount of time

ABI paper: exploring self-concept, wellbeing and distress in therapeutic songwriting participants following acquired brain injury

• this was a case study featuring 5 male participants with ABI (stemming from different sources) who where tasked with writing 3 songs over 3 weeks

• data collection was extensive and self-report; it took place pre-, mid, and post-intervention

• Key themes extracted from the songs: finding new life meaning; importance of relationships + family; post-traumatic growth

• Limitations → small time frame, heterogeneous sample

Post-traumatic growth

Making meaning from an experience and re-evaluating future goals and priorities

Autism spectrum disorder

• a neurodevelopmental disorder characterized by impaired social interactions, challenges with verbal and nonverbal communication, narrow interests, and repetitive behaviours

• people experience unique functional difficulties in communication, learning, and playing → no two people are the same

• has high co-morbidity with other illnesses

Prevalence of ASD

• About 1 in 50 people or in 2% of Canadian children and youth

• Men are 4x more likely to be diagnosed

• Most children (53%) are diagnosed between ages 0-4; very few people are diagnosed in adolescence

ASD comorbidity

• ASD high co-morbidity with other mental illnesses, such as ADD/ADHD, learning disabilities, and anxiety

• 68.7% of autistic children have another long-term health condition compared to 21.9% of children without ASD

What are the criteria for being diagnosed with ASD?

• Social communication and social interaction deficits

• Restrictive or repetitive behaviors, interests, or activities

Early signs and symptoms of ASD → 6-12 months

• limited smiles or other joyful expressions directed at people

• limited or NO eye contact

• limited reciprocal sharing of sounds, smiles, or facial expressions

• diminished, atypical, or no babbling/gesturing

• limited response to ones name

Early signs and symptoms of ASD → 9-12 months

• emerging repetitive behaviours

• unusual play (ex: intense visual or tactile exploration of toys)

Early signs and symptoms of ASD → 12-18 months

• no single words

• an absencse of compensatory gestures llike poinying

• a lack of pretend play

• limited joint attention

when are most individuals diagnosed with autism?

early in life, between the ages of 0-4

the autism wheel

• A tool that does a great job visually representing how autism may appear in different people → it shows their strengths and weaknesses (not just weaknesses!)

• Provides a more in-depth way to understand people's unique complexities at the individual level

  • i.e, the spectrum (ranging from low functioning to high functioning) simplifies the autistic experience

How to read the autism wheel

• more filled in areas = closer to neurotypical functioning

• more empty areas = more intense autistic trait

Advocacy work and ASD

• We are seeing an expansion of the neurodiversity movement

  • ex: sensory friendly concerts

• In addition, we are seeing greater recognition of identity first language → autistic individual, not individual with autism

Neurodiversity

the concept that neurological differences are natural variations in human brain development rather than deficits to be cured

Music therapy for ASD

• music therapy is a relief for individuals with ASD to help them address their emotional, physical, cognitive, and social needs

• the music intervention may involve singing, dancing, listening, or creating

• the music therapist works with the individual and meets them where they’re at → they tailor the intervention specifically to them

• ultimately, it gives the individual the ability to express themselves

Echolalia (in ASD)

the uncontrolled repetition of words heard in the environment

Musicophilia by Oliver Sacks

• This book discusses how music affects the brain and how it can help people with different neurological conditions, including autism

• Music can be a helpful therapy for people with autism because their brains often process music and sound very well, making it easier to connect, communicate, and express emotions

Early MT + Autism research

• only 3 RCT on Autistic individuals came out betwee 1950 and 1989

• majority of the research that came out was case studies that had small sample sizes

Early MT + Autism research → 1953 Paper

autistic individuals had…

• an unusual interest in music

• a tendency to sing differently from the average child

• an oftentimes unusual ability to reproduce familiar pieces with extrodinary accuracy

Early MT + Autism research → 1964 paper

Amongst autistic individuals, music promoted communication, emotional expression, and social engagement

Early MT + Autism research → 1969 case study

music fostered social connection and communication for people with ASD

Which celebrity visited the Nordoff-Robbins MT centre?

Paul McCartney

How does music have an important role in the lives of autistic individuals?

• They frequently demonstrate strong musical skills and abilities

• Autistic traits may be associated with the musical genius of notable artists

ASD paper 1: finding our voices - examining how QoL domains manifested in a singing group for autistic adults → purpose

• See how music can improve quality of life for people with ASD

• There is increased support needed for such individuals

• They wanted to see how music acted as a tool for self-expression and as an alternative to verbal communication

• There is currently a limited scope of publications on MT for autistic adults

ASD paper 1: finding our voices - examining how QoL domains manifested in a singing group for autistic adults → methods

• n = 8 high functioning autistic adults

• they used a mixed method design

  • qualitative data → collected throughout the research process

  • quantitative data → self-report measures where taken before and after the intervention

• all participants completed 12 group singing sessions (1.5h long) in a university research centre

ASD paper 1: finding our voices - examining how QoL domains manifested in a singing group for autistic adults → definition and coding of QoL

• health and well-being reflect a holistic psychosocial perspective that encompasses body, mind, spirit, society, culture, and environment

  • all of these factors come together to affect one’s QoL

• to code QoL, they used three subdomains:

  • being - expressing who one is

  • belonging - connection

  • becoming - ways of achieving one’s personal goals, hopes, and aspirations

ASD paper 1: finding our voices - examining how QoL domains manifested in a singing group for autistic adults → results

• They saw significant personal growth amongst the participants where they became more comfortable using their voices, they made trustworthy friendships, learned new coping skills, and improved mood regulation

• Participants rated their perceived level of anxiety as significantly lower during the group compared to their perceived level of anxiety in their daily lives

• The CD they created and personal solos where incredibly meaningful

ASD paper 1: finding our voices - examining how QoL domains manifested in a singing group for autistic adults → discussion

• Group singing appeared to have multiple benefits for the participants in this study → it was empowering, safe, and an understanding environment

• this has implications for training programs for MT’s

• This study included participants who where verbal and highly capable; thus, the results may not extend to Autistic individuals who are differently abled

 

ASD Paper 2: music improves social communication and auditory motor-connectivity in children with autism → purpose

• This was an RCT too see the benefits of a music based intervention on language and social communication in school aged children with ASD

• Music has the potential to produce changes in the brain, and research suggest ASD is related to over connectivity in sensory networks and under connectivity in fronto-temporal networks

brain connectivity in autism

ASD is related to over connectivity in sensory networks and under connectivity in fronto-temporal networks