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Active Participation in Music Therapy Sessions for Mental Health

A recent survey found that 1 in 5 adults have experienced a mental health issue at some point in their life. The term mental health refers to a person’s emotional, psychological, and social well-being. Mental health influences the way a person thinks, feels, acts, and relates to others. Mental health disorders are common and can be caused by a variety of factors including biological factors, life experiences, and family history. The most common mental health diagnoses are anxiety and depression. Other common mental health disorders include eating disorders, obsessive-compulsive disorder, substance use disorder, mood disorder, personality disorder, psychotic disorder, and post-traumatic stress disorder.  (U.S. Department of Health and Human Services, 2019, para. 2-4).

         In a mental health context, music therapy interventions are used for communication and expression. Group music therapy sessions address relationships and create healthy boundaries among clients in the session generalize to everyday life.. Common goals include exploring thoughts and feelings, addressing self-esteem, gaining personal insight, developing healthy coping skills, conflict resolution, social interaction, and giving the client an opportunity to be successful (AMTA Strategic Priority Group, 2006, p1-2). Mental health conditions are commonly a life-long battle, so treatment is not about short-term healing, but learning skills to manage and effectively cope in the future.

         Educational music therapy groups are increasingly common in acute mental health care facilities. These groups use music as a tool to start conversations and reinforce concepts that are addressed in other therapies (Silverman, 2016, 390). The educational model is based on the psychoeducational approach that teaches people to “understand, be aware of, and manage their mental health conditions based on their personalized goals and values” (Silverman, 2019, 627). The educational music therapy model is a highly structured and group based approach that teaches “management of skills to promote recovery” (Silverman, 2019, 625).  In a 2016 study, nurses at an acute care psychiatric facility stated that patients verbally participated more during music therapy groups than other group programming. Music therapy groups were well attended and highly motivating to patients (Silverman, 393). This information raises the question, why is it important that a music therapist facilitates the group, and what is the difference between a live music therapy session and someone playing recorded music for patients.

         A 2012 study measured attendance, participation, and outcomes of active music therapy sessions versus passive music listening groups. Both groups were led by a board-certified music therapist who used a set session plan for the duration of the study. Both groups focused on communication and healthy coping or leisure skills. The study found that on average, more patients attended live music therapy sessions and participated for a longer portion of the session. Patients who attended live music therapy sessions also had a higher treatment perception rating than those who attended the group using recorded music. This study found that music therapy sessions not only improved quality of life, but also treatment outcomes. Participants were able to state what they had done in the session and how it applied to their treatment (Silverman & Leonard, 2012, 391-392).

         A similar study evaluated the use of different music therapy interventions versus a control group that was discussion based. The goal of the group was not elimination of mental health problems or related symptoms, but “reclamation of a meaningful, purposeful, and valued life” despite mental illness (Silverman, 2019, 624). Patients who attended music therapy sessions participated in either a songwriting or lyric analysis intervention. In the music therapy sessions, live music was used to facilitate and guide the discussion. For example, a music therapist prepares lyric sheets and instructs patients to listen and follow along while marking any lines or phrases that stand out. After the music therapist plays and sings the song, the therapist asks patients if there was a lyric that stood out to them, why the lyric stood out, and how it related to their situation and recovery. In the control group, the therapist facilitated conversation based on prepared discussion prompts and what participants offered. The study found a higher level of participation in the music therapy sessions and patients who attended music therapy had a slightly higher recovery mean scores than those who attended the control group (Silverman, 2019, 626). An AMTA meta-analysis found live music therapy sessions in acute psychiatric facilities led to reduced muscle tension, improved self-image, increased self-esteem, decreased anxiety, decreased agitation, increased verbalization, enhanced interpersonal relationships, improved group cohesiveness, increased motivation, and successful and safe emotional release (AMTA Strategic Priority Group, 2006, p. 1-2).

These findings support the use of the educational music therapy model and the importance of a music therapist facilitating live sessions in acute psychiatric care facilities. By using the educational music therapy model, clients are encouraged to actively participate in establishing goals and managing illness.  Music therapy groups based on this model teach healthy coping skills while building relationships and increasing quality of life. 

-Rachel Buchheit, Music Therapy Intern

Read the following lyrics and circle a word or phrase that stood out to you. What does this phrase mean to you? How does this phrase make you feel? How does this phrase relate to your recovery process?

Read the following lyrics and circle a word or phrase that stood out to you. What does this phrase mean to you? How does this phrase make you feel? How does this phrase relate to your recovery process?

Resources

 

AMTA Strategic Priority Group. (2006). Fact sheet: music therapy and mental health. American Music Therapy Association. Retrieved from https://www.musictherapy.org/assets/1/7/MT_Mental_Health_2006.pdf 


Silverman, M.J. (2019). Comparing Educational Music Therapy Interventions via Stages of Recovery with Adults in an Acute Care Mental Health Setting: A Cluster-Randomized Pilot Effectiveness Study. Community Mental Health Journal, 55(4), 624-630.

  

Silverman, M.J. (2016). Effects of Educational Music Therapy on State Hope for Recovery in Acute Care Mental Health Inpatients: A Cluster-Randomized Effectiveness Study. Frontiers in Psychology, 7.

 

Silverman, M.J. & Leonard, J. (2012). Effects of active music therapy interventions on attendance in people with severe mental illnesses: Two pilot studies. The Arts in Psychotherapy, 39(5), 390-396.

 

U.S. Department of Health and Human Services (2019). MentalHealth.gov: What is mental health. Retrieved July 25, 2019, from https://www.mentalhealth.gov/basics/what-is-mental-health



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Mental Health & Community Music Therapy

According to the Nation Alliance on Mental Health, 1 in 5 adults experience a mental health illness. Current statistics show an increase in those diagnosed with a mental health illness receiving treatment, whether it be through therapy, medication, or a combination of both. While mental health illnesses are becoming prevalent around the world, the health care coverage system continues to make inpatient treatment sessions shorter, but more frequent. Mental health and music therapy, more specifically the Community Music Therapy Model, allows for inclusivity of making music and building relationships with individuals in mental health settings. 

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The use of music within the mental health setting not only creates an environment of inclusion, it also affects the neurobiological responses a body produces. Some mental health illnesses can be caused by an imbalance of neurotransmitters or hormones within the brain. One example of music affecting the brain is when calm or relaxing music is played, the body will decrease cortisol levels, creating the response of minimizing stress (Legge, 2015, pg. 128). Music has influenced the release of hormones associated with “social affiliation and trust” (Legge, 2015, pg. 135). This release of neurobiological responses allows for individuals diagnosed with mental health illness to be successful in an environment where Community Music Therapy Model is used. 

The Community Music Therapy Model, also called CoMT, “emphasizes human connectedness, well-being and social change in and through music” (Baker, Jeanneret, & Kelaher, 2017, pg. 158). This value based perspective gives each member of the community a voice in which he/she can express and connect to those around them. This model allows for individuals who may not have access to meaningful music making experiences, the ability to highlight strengths and gain resources for growing relationships and outlets for expression in a community setting. 

CoMT uses interventions, such as lyric analysis, improvisatory music making, or songwriting, to gain perspectives, time for reflection, and processing of emotions with a professional who can direct the responses in a therapeutic and comprehensive way. (Warren, 2016, para 4-7). 

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For those in a mental health setting, lyric analysis “introduces a novel and less-threatening approach to process emotions, thoughts, and experiences” (Warren, 2016, para 4). A lyric analysis uses either live or recorded music to allow each client the ability underline or discuss specific lyrics within the song and relate them to experiences they have encountered. 

While playing with various instruments, improvisatory music making creates an environment where socialization and themes can be used for non-verbal communication between individuals attending music therapy (Warren, 2016, para. 5). Music therapists use themes, such as creating an ocean scene, to display tension and release through instrument play. Following the improvisation, a music therapist can lead a discussion about how each person felt during the experience or allow for correlation between instrument playing and life experiences. 

Songwriting, can either be through filling in the blanks to a familiar song or creating a new song from the beginning. The use of songwriting can be “validating, and can aid in building self-worth. This intervention can also instill a sense of pride, as someone listens to their own creation” (Warren, 2016, para 7 ). During the songwriting experience, the music therapist provides a direction for musical and lyrical suggestions. 

The use of a music therapist facilitating a CoMT environment is crucial, instead of someone who works at the facility, as the “success of the facilitation suggest transformation of relationships at different ecological levels, with the facilitator/music therapist creating the conditions and environment for this to occur” (Baker, Jeanneret, & Kelaher, 2017, pg. 159). The CoMT space is most successful when individuals are willing to participate and create music. The participation of those attending music therapy sessions create a safe environment for self-exploration and empowerment through music. 

In conclusion, the Community Music Therapy Model is indicated to be used continue to be used in the mental health setting, as it allows for self expression and relationship building through interventions that increase creativity and group participation. Music therapy and mental health will continue to expand creating environments for more positive growth and experiences. 


-Michaela Shockcor, Music Therapy Intern



References 



Baker, F. A., Jeanneret, N., & Kelaher, M. (2017). Musomagic: Artist-led personal development programmes for youth as viewed through a Community Music Therapy lens. International Journal of Community Music, 10(2), 157-169. doi:10.1386/ijcm.10.2.157_1.



Legge, A. W. (2015). On the neural mechanisms of music therapy in mental health care: Literature review and clinical implications. Music Therapy Perspectives, 33(2), 128-141. Doi: 10.1093/mtp/miv025.



NAMI. (n.d.). Retrieved from https://www.nami.org/learn-more/mental-health-by-the-numbers.



Warren, M. (2016, December 19). NAMI. Retrieved from https://www.nami.org/Blogs/NAMI-Blog/December-2016/The-Impact-of-Music-Therapy-on-Mental-Health.



West, T. (2018, December 04). Wrt1050. Retrieved from https://writingandrhetoricatoaklanduniversity.wordpress.com/author/wrt1050/




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Older Adults & Therapeutic Singing

We all experience aging, and according to the World Health Organization, “people everywhere are living longer” (World Health Statistics, paragraph 1). Currently, the older adult population has increased life expectancy by about 20 years (World Health Statistics, paragraph 2).  Older Adults may present with a variety of diagnoses, such as those with progressive neurodegenerative disorders, Parkinson’s or Alzheimer’s disease, and respiratory diseases, such as Chronic Obstructive Pulmonary Disease (COPD). However music therapists can use therapeutic techniques, like therapeutic singing, to address any health concerns, open communication, and improve overall well being with those diagnosed.

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According to Dassa and Amir, music therapy and group singing creates new ways to increase communication, as therapeutic singing evokes memories, self-expression, and sense of comfort (2014). Groups, such as choir and other musical ensembles, provide an outlet where people can gather and discuss life experiences or struggles that others may encounter.  “Group singing sessions that focused on singing and reminiscing have been found to be significantly helpful in reducing symptoms of depression…” (Dassa & Amir, 2014, pg. 134) and can promote activities of daily living, such as swallowing and respiratory control (Stegmoller, 2017, pg. 408). 

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Therapeutic singing displays the most benefits when it occurs in a large space that is familiar to those attending. The intervention of singing begins with breathing exercises, and is followed by “3 to 5 songs selected from a list of participant- chosen music selections” ( Elefant, 2012, pg. 285) Due to the educational training and certification a music therapist must receive to provide appropriate services, items such as client preferred music, tempo, therapeutic techniques for discussion,and musical cues for breathing become more effective, than someone who might sing recreationally to increase socialization between older adults.  

Group singing led by a music therapist, creates an environment where memories can be evoked through music familiar to each individual attending. Client preferred music, such as music from adolescence or early twenties, promotes “well-being and sense of self” (Dassa & Amir, 2014, pg. 145). Not only does listening and conversing about preferred music increase reminiscence, vocal warm ups allow for concentration to be placed on articulation and oral muscle movement. Vocal warm ups before singing, “target specific therapeutic needs of the Parkinson’s disease population” (Stegmoller, 2017, pg. 411).

  The repetition of familiar songs generates an “increase in participation and promotes security” (Lesta & Petocz, 2006, pg. 9), as well as “imitation and modeling to support” (pg. 9) responses provided in a group setting. Specifically singing has the ability to connect and provide power to those with Alzheimer’s and Parkinson’s disease. Singing familiar songs administers a group dynamic, even with those diagnosed in the middle stages of their progressive disorder (pg. 6) The ability to be within a group of individuals experiencing similar interactions, acknowledges the understanding of social support and connections through peer interactions (pg. 7)

Music therapists have used therapeutic singing with songs like “She'll Be Coming Around the Mountain” with older adults to create an environment where isolation dissipates. During this intervention, the music therapist may ask one client to name a place that they have visited and then the new lyrics will be filled into the song. Once the song has been sung, the music therapist will ask if anyone in the group has visited the place and items they remembered while visiting there. This technique of asking others attending the group, allows for a connection between patients to begin and conversations to continue following music therapy. 

In conclusion, group singing creates an environment that allows for music therapy techniques of reminiscence and self-expression to be evoked in most individuals through client preferred music. Music therapy and group singing allows for older adults to feel connected to the people around them.



-Michaela Shockcor, Music Therapy Intern

Resources



Alzheimer’s Association. (n.d.). What is Alzheimer’s? Retrieved from 

https://www.alz.org/alzheimers-dementia/what-is-alzheimers

COPD: Everything you need to know about chronic obstructive pulmonary disease: Everyday health. (2019, July 01). Retrieved from https://www.everydayhealth.com/copd/guide/

Dassa, A., & Amir, D. (2014). The role of singing familiar songs in encouraging conversation among people with middle to late stage alzheimer’s disease. Journal of Music Therapy, 51(2), 131-153. Doi: 10.1093/jmt/thu007

Elefant, C., Baker, F. A., Lotan, M., Lagesen, S. K., & Skeie, G. O. (2012). The effect of group music therapy on mood, speech, and singing in individuals with Parkinson’s disease- A feasibility study. Journal of Music Therapy, 49(3), 278-302. doi: 10.1093/jmt/49.3.278

Heyn, S. N.,& Davis, C. P. (n.d.). Parkinson’s Disease Early and Later Symptoms, 5 Stages, and Prognosis. Retrieved from https://www.medicinenet.com/parkinsons_disease/article.htm

Lesta, B., & Petocz, P. (2006). Familiar group singing: Addressing mood and social behavior of residents with dementia displaying sundowning. Australia Journal of Music Therapy, 17, 2-17. 

Stegmoller, E. L., Hurt, T. R., O’Connor, M. C., Camp, R. D., Green, C. W., Pattee, J. C., & Williams, E. K. (2017). Experiences of persons with parkinson’s disease engaged in group therapeutic singing. Journal of Music Therapy, 54(4), 405-431. Doi: 10. 1093/jmt/thx012

World Health Statistics 2014. (2014, May 15). Retrieved from https://www.who.int/mediacentre/news/releases/2014/world-health-statistics-2014/en/




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social stories

The term Autism Spectrum Disorder “refers to a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication” that affects approximately 1 in 59 children in the United States (Autism Speaks, n.d.). Signs of the disorder begin to appear around the age of 3 but may be present as early as 18 months.  As a spectrum disorder, Autism presents itself in many ways. The two most common symptoms of Autism are: 1. interpersonal challenges such as difficulty recognizing/interpreting emotions and eye contact and 2. restricted and repetitive behaviors like hand flapping and rocking (Autism Speaks, n.d.). The cause of Autism is unknown. Environmental factors such as birth related complications may increase risk but research shows that there are both genetic and environmental components that factor into the Autism diagnosis. (Autism Speaks, n.d.). 

In 2015, the National Autism Center named music therapy as an “emerging intervention” for Autism treatment (AMTA Strategic Priority Group). Common goals include improvement of language/communication, behavioral/psychosocial, cognitive, perceptual, and motor skills (Autism Spectrum Disorders, 2010). Music therapy goals are based on an assessment that measures a client’s strengths, weaknesses, and preferences while considering the family’s priorities. The assessment is used to measure a client’s baseline through musical interventions and then develop a treatment plan (AMTA Strategic Priority Group, 2015). 

Music interventions like instrument play help to improve social skills and interpersonal interactions. Other common interventions include songwriting and lyric analysis. These interventions help with idea development and creativity (Autism Spectrum Disorders, 2010). Research shows that music therapy helps improve communication, attention span, fine and gross motor skills, interpersonal skills, responsibility, emotional expression, and play.

Musical social stories can also help change behaviors and teach new skills (AMTA Strategic Priority Group, 2015). A social story is a short story that plainly states the steps of an activity or a target behavior. It may also tell relevant information such as who, what, when, or where an activity takes place (Brownell, 2002, p.121). Social stories may be a task analysis of a specific activity like brushing teeth or an activity schedule that goes through the steps of a morning routine (Schwartzberg & Silverman 2013, p. 331). The first step to creating a social story is identifying a goal or target behavior and measuring the baseline. Once a goal is established and data has been collected, a story can be written using “descriptive, directive, perspective, and control” sentences (Brownell, 2002, p. 122). Social stories can then be implemented in music therapy sessions to address target behaviors.

The following is an example of a musical social story:

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Music therapy is able to use social stories and can “lead to improved comprehension and generalization of targeted social skills (Schwartzberg & Silverman, 2013, p. 334).When a story is presented to a client it is best to have between one and three sentences on each page with a picture. As the story is read to the client, demonstrate the appropriate behaviors and prompt the client to follow along (Brownell, 2002, p.123). Social stories can be read like a book or sung like a song. When creating a new social story, the lyrics and tune can be original or they can be written “piggyback” style where the therapist selects a familiar, memorable tune and creates new words. Brownell’s research found that when read, social stories increased target behaviors such as appropriate greetings and parallel play and decreased undesirable behaviors such as aggression. This research found that when sung, social stories increased target behaviors at an even higher rate (2002, p.121). Schwartzberg and Silverman’s study found anecdotal evidence that music based social stories were “enjoyable,” “catchy,” and transferable to daily life (2013, p. 334). 

In closing, music therapy uses social stories to address goals such as communication, behavior, and cognitive skills. Social stories teach behaviors or new skills that can be used at home or school to prompt desired behaviors. Musical social stories are set to an easily singable tune. This musical quality makes the social story memorable and transferable to other settings which helps the client be successful in and out of music therapy.


-Rachel Buchheit, Music Therapy Intern

References


AMTA Strategic Priority Group. (2015, August 26). Fact sheet: music therapy and Autism Spectrum Disorder (ASD). American Music Therapy Association. Retrieved from https://www.musictherapy.org/assets/1/7/Fact_Sheet_ASD_and_MT__8-26-15.pdf


Autism Speaks. (n.d.).What is Autism? Retrieved June 26, 2019, from https://www.autismspeaks.org/


Autism Spectrum Disorders: Music therapy research and evidence based practice support. (2010). American Music Therapy Association. Retrieved from

https://www.musictherapy.org/assets/1/7/bib_autism10.pdf


Brownell, M. (2002). Musically Adapted Social Stories to Modify Behaviors in Students with Autism: Four Case Studies. Journal of Music Therapy, 39(2), 117-144.


Schwartzberg, & Silverman. (2013). Effects of music-based social stories on comprehension and generalization of social skills in children with autism spectrum disorders: A randomized effectiveness study. The Arts in Psychotherapy,40(3), 331-337.

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Meet Ms. Michaela!

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Hello! My name is Michaela Shockcor and I am thrilled to be joining the Therabeat team as a music therapy intern. I am from Columbus, OH and recently finished my academic course work at Ohio University. Some of you may be wondering why a new college graduate packed up and moved her life 10 hours away, and here’s the reason why. While at Ohio University, I worked with multiple populations, but always felt my heart belonged working with children and adolescents. For the past few summers, I have been a teacher's aid to a transition classroom and enjoyed every minute of my experience there. When an intensive search began for various music therapy internships, a professor recommended that I contact the Therabeat team. So, I did and thoroughly enjoyed everything this program had to offer. From advocacy to music recitals, Therabeat will allow me to form my personal music therapy style and voice, as well as become a well rounded individual with all of the lessons I will learn

Amid my first week here, I have felt welcomed by everyone I have met and it’s just the beginning! From observing occupational, physical, and speech therapy to meeting everyone during music therapy, I am forming new relationships and learning so much. The various teaching styles each therapist bring to their sessions has allowed for new techniques and a greater understanding of why we do what we do. To learn from a teacher is wonderful, but to learn things from a child is even better. During internship, I hope to gain a greater love for music and working with children and adolescents, as well as immense growth in my music therapy skills and techniques. I am someone who is always willing to push myself in new opportunities, in order to become better than I was before.

I can tell that Therabeat and In Harmony Pediatric Therapy will keep my on my toes with new adventures and opportunities each and every day!

-Michaela Shockcor, Music Therapy Intern



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