Music Therapy with Generalized Anxiety Disorder

     Anxiety related disorders are being diagnosed at higher rates than ever before. 18.1% of adults in the United States are diagnosed with Generalized Anxiety Disorder making it the most common mental illness in the U.S. Unfortunately; only 36.9% of those suffering are receiving treatment. (Anxiety and Depression Association of America) 

    In 2015, Gutierrez and Camarena completed a study on using music therapy with generalized anxiety disorder. They took a slightly different approach than previous studies by including active and receptive music therapy interventions. The receptive interventions meant the participants weren’t involved in the music making. During the active interventions they used their voices, bodies, or musical instruments to participate in the creation of the music.

     The study utilized receptive MT first and focused on stimulating patients to identify their problematic symptoms. The music therapy then shifted to active while the participants engaged in emotional expression exercises.  Lastly, the music therapy was used to address issues such as self-esteem and assertiveness before final processing and conclusions.

    This study found that those participating in music therapy alongside their conventional pharmacological treatment had significant positive effects. Their anxiety significantly decreased on two different assessments used by the researchers.

     This study is unique in that it specifies how music therapy was used throughout the progression of the sessions. Music therapists can use this information to inform their clinical choices and better serve their patients.

-Lauren Booke, Music Therapy Intern

Gutierrez, Octavio Flores, & Camarena, Victor Andres Teran. (2015). Music therapy in generalized anxiety disorder. The Arts in Psychotherapy 44, 19-24.

Songwriting in Music Therapy

            When people think of Music Therapy, writing songs with deep emotions is the first thing that comes to mind. Expressing deep emotions through the practice of songwriting is a technique that is used in a Music Therapy session.  However, there are many ways to use songwriting in a session with a variety of diagnosis. In the podcast, “Music therapy and neuroplasticity: Rewiring the brain through therapeutic songwriting”, they discuss three different scenarios where songwriting was used in a music therapy session.

            The first scenario was a client with a traumatic brain injury. The client had aphasia, the loss of the ability to understand and express speech, and dysphasia, the inability to correctly form words. The client was able to communicate with a picture book but felt it made her diagnosis obvious. The client was able to sing because that portion of the brain was not damaged. The music therapist took phrases the client would need in everyday life and put it to a melody line. The client would learn the phrase, practice the phrase, and then test it out in the appropriate setting.

            The second scenario was a teenage girl who also had a traumatic brain injury. After the injury the client communicated with one word answers and would not reciprocate conversation; her parents wanted her to ease back into high school. The music therapist had the client write a song about a topic most teenage girls wish to talk about: boys. The music therapist ask the questions: who, what, when, where, why, and how; these helped facilitate the songwriting process. Once the song was completed the client then had points to talk about in conversation with other girls her age.

            The final scenario was a group setting of high school students who did not have particular friend group or a club they were a member of. These students went through a group songwriting process lead by a music therapist. At the end of the process the students recorded a music video and performed two flash mobs; one flash mob took place in police office. After the students danced with the police officers and sang their original song one student stated that the police have never had a good memory of the police and now that had been changed.

            These are all various scenarios that use songwriting as a therapeutic technique to help achieve a variety of therapeutic goals.

        -Dana LaValley, Music Therapy Intern

Music therapy and neuroplasticity: Rewiring the brain through therapeutic songwriting. (March 25,

         2017). Collective Music Therapy. Retrieved from: 

         https://m.soundcloud.com/collectivemusictherapy/cmt-podcast-ep15

The Dangers of Unreliable Sources

When I typed in “Music Therapy” to Google, one of the first articles that came up talked about the “dangers of overestimating music therapy.” This immediately caught my attention and I was curious to see what context this article had been written under. The article discusses the “Alive Inside” documentary from the “Music and Memory” program. This raised some red flags for me for a couple of different reasons.

The biggest thing is that “Alive Inside” is not clinical music therapy. It is pre-recorded playlists administered by a nursing home employee through headphones and an iPod. There is a lot of confusion about this because music therapists and renowned supporters of music therapy appear in the documentary. The American Music Therapy Association created a fact sheet outlining the differences between the music and memory program and clinical music therapy. They spell out the differences in how music is experienced, what training is required, how outcomes are reached and advantages to both programs. They conclude that, “Music and Memory and Music Therapy are complimentary. Both Music Therapy and Music and Memory serve to maximize the amazing power of music to reach deeply into the lives, minds and hearts of those who often cannot be reached in any other way.” So, while music and memory is not music therapy, they don’t completely oppose it. The key is knowing the difference and being able to advocate for clinical music therapy when others are using the term inappropriately.

It also was surprising to me because the author of this article must have not done a lot of research before writing this article. If he would have gone on the AMTA website, he could have quickly learned that clinical music therapy is done by board certified professionals. He calls it music therapy, which is deceiving to people reading the article that also aren’t aware of the music therapy profession and board certification required to practice. As music therapists, we must advocate for our profession and have to educate others that have received incorrect information. This article, like many others, unfortunately pushes our advocacy efforts back and makes our uphill climb even harder.

Lastly, it makes me worried that this is one of the first exposures to “music therapy” someone may have when looking to learn more by going to the Internet. Many people will never have a first hand experience with music therapy and are forced to rely on online sources. While there are a lot of reliable sources out there, there are also always going to be unreliable sources as well. All we can do is educate others and advocate every chance we get for the amazing profession of music therapy.

All of this to say, be careful about your sources of information and never stop advocating for the field of music therapy!

-Lauren Booke, Music Therapy Intern

Article: “The Dangers of Overestimating Music Therapy” Steve Swayne

 theatlantic.com

How can we adapt for Cortical Visual Impairments?

What is CVI?

    Cortical visual impairment (CVI) is caused by a lack of oxygen which disrupts the posterior visual pathways and/or the occipital lobes to the brain. Lack of oxygen also causes neuromotor disorders such as Cerebral Palsy (CP). This explains the correlation between CP and CVI. However, CVI is the most common form of visual impairment and can affect other patients diagnosed with seizure disorders, autism, neurodegenerative conditions, and brain injury.

Posterior Visual Pathways include:

• Lateral geniculate nucleus
• Optic radiation
• Primary visual cortex
• Occipital Lobes:

Image from: https://www.reviewofoptometry.com/ce/understanding-cerebral-vision-loss

Image from:https://www.health.qld.gov.au/abios/asp/boccipital

          The visual system is divided into two sections: the ventral stream and the dorsal stream.  The ventral stream allows for recognition and the dorsal stream subconsciously analyzed the scene at the moment and guides movement. CVI has shown to have effects on both of these pathways. Damage to the ventral stream can lead to the inability to recognize faces and objects. Any damage to the dorsal stream can lead to difficulty in spatial processing.  

Image from: https://visionhelp.wordpress.com/2012/08/11/the-three-as-autism-aspergers-and-automobiles-part-5-visual-spatial/ventral-dorsal-stream/

Common Characteristics

    The vision of a client with CVI changes day by day; some days may be better than others. The peripheral vision is not impacted by CVI therefore most clientren with CVI use peripheral vision to see.; the color portion of vision is also not affected by CVI. The best way to understand what CVI appears as is to describe that it is like looking through a piece of Swiss Cheese. As stated before the dorsal stream may be impacted causing issues with depth perception. Vision may also appear better when the client is moving.

Adaptations

    There are special ways to adapt daily living and therapeutic sessions that will result in a better quality of life for clients with CVI.

• Give break times throughout the session. There is a great amount of energy needed to focus on visual task and breaks are needed to refocus.

• If seeing is the main task at hand the client needs to be comfortable to allow for full focus.

• Provide head support as needed so the visual field is not being shifted.

• If the task requires fine motor coordination and visual coordination, focus on one task at a time. Once both are mastered then combine the task.

• Keep the items used in the session simple and the environment uncluttered.

• When it comes to choosing items for a session familiar and real objects will provide the best results.

• Repetition is key.

• Find items, songs, or interventions that motivate the client.

• Vision is stimulated when paired with other sensory systems.

• Use bright colors such as: red, yellow, pink, and orange. Mylar tissue evokes a visual response and partners with the auditory response of the paper.

• Locate the light source in various locations to find the ideal location for the client.

• Try different visual fields to find the ideal one for the client.

• Allow for a good bit of time for the client to respond to what is being seen.

References

Cortical visual impairment pediatric visual diagnosis fact sheet. (1998). See Hear, 3(4). Retrieved  

      from: http://www.tsbvi.edu/seehear/fall98/cortical.htm

Macintyre-Beon et al. (2012). My voice heard: the journey of a young man with a cerebral visual

        impairment. Journal of Visual Impairment & Blindness 106(3) 166-176.

Philip, S. (2017). Setting up of a cerebral visual impairment clinic for children: challenges and

      future developments. Journal of Ophthalmology. Doi: 10.4103/0301-4738.202303

-Dana LaValley, Music Therapy Intern

Music Therapy and the Grieving Process

         Since the beginning of time music has shown its soothing effects. Take a look at David playing the harp for the King to help sooth his soul. Music can help heal a person who is grieving if the music is used in a structured therapeutic way.

         Grief has six stages that a person passes through. It is important to note that the stages may not go in the exact order as listed. Stage one is always denial. “Denial buys time needed to blunt the initial impact of the shattered dream.” (Moses, 2004) Most times a person is grieving the loss of a dream, whether it is the loss of a dream that you will have more time with the one you love or the loss of a dream you once had for yourself or someone you love. The next stage is anxiety; once a dream has been lost the person has to make a major life change. In today’s world the society makes anxiety an inappropriate response; however anxiety is an appropriate reaction to a major life change.  The next stage is fear; “fear is a warning that alarms the person to seriousness of the internal changes that are demanded.” (Moses, 2004) Fear is a common stage that comes along with anxiety; after feeling anxiety, fear of the unknown comes. Guilt is another state of grief. It is a normal feeling to feel guilty about the life you have. Guilt can be expressed because people believe that good things happen to good people and bad things happen to bad people. (Moses, 2004) The next stage is depression “characterized by profound and painful sobbing”. (Moses, 2004) The final stage is anger; the question “why me” is often asked during this state. This stage is typically directed toward one person.

Music therapy sessions can have structure while remaining open to the emotions and vulnerability of the person experiencing the grief. The music therapist can used many techniques as tools to help with the grieving process. Improvisation is a music therapy technique that has a small amount of structure but allows for a large amount of emotional expression. Songwriting is another music therapy technique; this technique can vary in structure. The therapist can take a song that already has a tune and replace the words with some that the client wants or the therapist can write an original song with the client. The therapist uses the existing relationship the client has with music, preferred music or favorite genres.

These techniques can help with anyone who is going through the grieving process such as: someone who lost a loved one, someone who lost the ability of a body part, or someone who has had a close family member receive a serious diagnosis. All of these scenarios have someone who has lost an idea of how their life would look and are going through the stages of grief. Music therapy can uses the stages of grief paired with music to help work through the stages in a non-threatening environment.  

                             -Dana LaValley, Music Therapy Intern

McFerran, K. (2011). Music Therapy with Bereaved Youth: Expressing Grief and Feeling  

       Better. Prevention Researcher, 18(3), 17-20.

Moses, K. (2004). Impact of childhood disability: the parents struggle. Pent Forum. Retrieved

       from: http://www.pent.ca.gov/beh/dis/parentstruggle_DK.pdf