A Music and Art Program to Promote Emotional Health in Elementary School Children: A Review

While music therapy is considered to be an allied health profession, it is also a creative art therapy as well. Other creative art therapies include dance-movement therapy, drama therapy, and art therapy. Music therapy and art therapy often coincide, especially when helping those individuals who have endured some type of trauma (Payne II et. al, 2018, para. 1). Common benefits to music and art therapy include stress management, improving communication, increasing expression, and aiding physical rehabilitation (Payne II et. al, 2018, para. 2). 

This article review seeks to highlight the importance of creative art therapies, specifically music therapy and art therapy. While In-Harmony does not provide art therapy, crafting incorporates many of the motor skills and cognitive skills addressed in other therapies such as OT, PT, ST, and MT. For this reason, a crafting section has been incorporated in each day’s activities during Therabeat’s Virtual Summer Camp. More information about online summer camp and material kits can be found HERE.

Giles et. al’s  1991 study of the role of music and art programs in school examined the effects on how music and art could help the emotional health of elementary school children. The subjects were 255 first and second grade students from northern Virginia schools (Giles, 1991, pg. 138). There were 11 classes from 5 schools. At the beginning of the day, children would select either a happy face or sad face to color (baseline emotion). After recess–when researchers believed students would be at their peak energetic or agitated state–  the students would come into their homeroom and then listen to 3 excerpts (classical, Walt Disney soundtrack, and new age) totaling 5 minutes (Giles, 1991, pg. 138&139).  After the listening, students would select a new happy or sad face to color. This process continued for 11 days, with 9 days of treatment and 2 days of no treatment (control). Art therapists were consulted to analyze the drawings for signs of distress, anxiety, anger, aggression, and depression. 

       A significant difference was found between the before/after of the treatment each day. Additionally, art therapists discovered through the baseline happy/sad data that 44 children were sad at least 8/11 times in the beginning, which equates to roughly 73% of the time (Giles et. al, 1991, pg. 139). They considered this to be excessive and alarming. Coincidentally, these children were less responsive to the music treatment. The researchers remarked that these children “may require more positive reinforcement more often and for longer periods of time” to help alter mood (Giles et. al, 1991, pg. 146). 

     The researchers concluded the following from their study (Giles et. al, 1991, pg. 147): 

Children who may be at risk for emotional or behavioral disorder may need more exposure to such a program of music and art for longer periods of time, since the study showed that they were more resistant to mood change….It is incumbent upon the schools to find models to help children cope with their stresses, build self-esteem, and foster emotional health. 

The researchers also note that both music and art are “trusted allies” to children (Giles et. al, 1991, pg. 147), allowing therapeutic relationships to exist more organically. Giles et. al also mention that both activities are frequently woven into day-to-day schedules for primary school children, yet many states and districts undergo yearly budget cuts  that often lead to the discontinuing of fine arts and performing arts. During a time when childhood depression and anxiety is increasing, providing as many positive creative outlets as possible to children is essential.  

References:

Giles, M. M., Cogan, D., & Cox, C. (1991). A Music and Art Program to Promote Emotional Health in Elementary School Children. Journal of Music Therapy, 28(3), 135-148.

Music Therapy Benefits for Clients with Depression

Depression is one of the most common mental disorders in the U.S. with more than 3 million cases per year (National Institute of Mental Health, 2018). Depression is defined as a mood disorder that affects virtually every facet of an individual’s life. Depression affects the way in which a person thinks, feels, and executes daily activities of living, such as sleeping, eating, and working (National Institute of Mental Health, 2018). It is normal to feel depressed due to various life circumstances. However, if these symptoms continue for a prolonged period of time, the depressive episode may be diagnosed as a depressive disorder. Depressive disorders refer to the amount of time that symptoms have been present in an individual’s life. An individual is typically diagnosed with clinical depression when they have experienced symptoms continually for at least two weeks (National Institute of Mental Health, 2018).

The most well known symptom of depression is a feeling of overwhelming sadness. However, depression includes many other symptoms that affect an individual’s ability to function. An individual with depression may show a decreased energy level and loss of interest or pleasure in activities that they previously found intriguing. An individual with depression may also show signs of irritability, restlessness, and difficulty concentrating on a task. Depression may also manifest itself in an individual’s sleep schedule and changes in appetite. Finally, depression may lead to thoughts of death and suicide, and may potentially lead to suicide attempts (National Institute of Mental Health, 2018).

Major risk factors for depression include major life changes, trauma, or stress (National Institute of Mental Health, 2018). For the majority of this year, COVID-19 has altered life as we know it. Schools have closed and transitioned to online learning. Businesses have also been affected, resulting in job loss among many individuals. Social distancing has affected the ways in which people can congregate and fellowship. These major life changes may lead to feelings of isolation and depression. 

Music therapy has been shown to be effective in addressing emotional, social, and cognitive needs. Music therapy provides a non-threatening environment for the client to express themselves in a healthy way. Music therapists work to enhance the client’s self-awareness and environmental awareness, address problem solving skills, and increase the client’s attention span. Music therapists assist the clients in developing individualized coping skills, problem solving skills, and decision making skills. Additionally, music therapy sessions support healthy feelings and behavior (American Music Therapy Association, 2006). 

Receptive music therapy has the ability to modulate a client’s mood through music relaxation (Eyre, 2013, p. 342). Music relaxation interventions involve listening to music for the purpose of effecting a relaxed response. Music relaxation interventions may include guided imagery accompanied with relaxing music as well as progressive muscle relaxation. The overarching goals of music relaxation interventions are to release physical tension and increase a sense of well-being (Eyre, 2013, p. 343). In an ideal music relaxation intervention, the client’s preferred music will be utilized to facilitate a relaxed state, as evidenced by a slowing breathing rate, a slowing heart rate, and an adjusted mood (Eyre, 2013, 344). 

Improvisational music therapy involves the spontaneous creation of musical dialogue in music therapy sessions. One study evaluated the effects of short-term improvisational music therapy sessions on the severity of depressive symptoms (Aalbers, Spreek, Bosveld-van Haandel, & Bogaerts, 2017). The music therapy researchers administered a questionnaire before and after music therapy treatment to measure if this form of treatment was effective for clients experiencing depression. Improvisation interventions utilized during music therapy treatment assisted clients to express their feelings, thoughts, and actions in daily life. Over the course of music therapy sessions, the music therapist gradually related improvisation experiences to stimulate healthy thoughts and behaviors through active music playing and discussion (Aalbers, Spreek, Bosvel-van Haandel, & Bogaerts, 2017, p. 262). Results of this study showed an overall reduction in identified depressive symptoms and a significant benefit from music therapy sessions (Aalbers, Spreek, Bosvel-van Haandel, & Bogaerts, 2017, p. 262).

Songwriting in music therapy sessions provides clients with opportunities for self-expression and self-awareness. Songwriting interventions focus on the dialogue created in the creation of the song as well as the final product of the intervention (Silverman, 2013, p. 134). In addition to emotional benefits, songwriting in group settings can allow clients to foster and develop social skills. Silverman (2013) examined the effects of group songwriting among clients with depression and other mental health concerns. Group songwriting, combined with psychoeducational discussion, allowed the clients the freedom to express themselves and interact with others in an appropriate manner. Topics addressed during the songwriting interventions, such as coping skills and support systems. Results of the study found that the group songwriting interventions benefited the participating clients in the social and emotional domains (Silverman, 2013, p. 141). 

It is normal to experience depression in response to severe, unexpected life changes. COVID-19 has altered the way many of our lives in ways that were previously unimaginable. It is essential during this uncertain time to take care of both our physical health and our mental health. Music therapy has been shown to be effective in facilitating relaxation, improving mood, and fostering coping skills. 

-Jasmine Bailey, Music Therapy Intern

References 

Aalbers, S., Spreek, M., Bosveld-van Haandel, L., & Bogaerts, S. (2017). Evaluation of client progress in music therapy: An illustration of an N-of-1 design in individual short-term improvisational music therapy with clients with depression. Nordic Journal of Music Therapy, 26(3), 256-271. 

American Music Therapy Association (2006). Music therapy and mental health. Retrieved May 18, 2020 from http://www.musictherapy.org/assets/1/7/MT_Mental_Health_2006.pdf

Eyre, L. (2013). Guidelines for Music Therapy Practice in Mental Health. Barcelona Publishers.

National Institute of Mental Health (2018). Depression. Retrieved May 18, 2020 from https://www.nimh.nih.gov/health/topics/depression/index.shtml

Silverman, M. (2013). Effects of group songwriting on depression and quality of life in acute psychiatric inpatients: A randomized three group effectiveness study. Nordic Journal of Music Therapy, 22(2), 131-148.

#HowAreYouReally: Mental Health in Caregivers and Parents

May has come to be known as the Month of Mental Health. On May 15 the Mental Health Coalition started a new online campaign using the hashtag “How are you, really?”. Its purpose? To be more transparent about everyday mental health struggles and open up a dialogue about honest and real feelings. 

While a large concentration has been on maintaining and supporting children’s mental health during this crisis, acknowledging the strains of caregivers’ and parents’ mental health is equally important, especially if there is a child with special needs involved. The Mental Health Coalition estimates that 1 in every 4 people will experience some type of mental health condition at some point in their lives (The Case for Mental Health, para. 1). With this in mind, knowing how to best give or recommend support to caregivers and parents of children with special needs is crucial.

With school and business closures, online work has been a hallmark of COVID-19. Parents and caregivers have become full-time teachers overnight, therapy facilitators, and entertainers in addition to job responsibilities. Despite the World Health Organization and American Academy of Pediatrics recommendations that children ages 6-10 only receive 1-1.5 hours of screen time a day with that limit increased to 2 hours for children 11-13 (EyePromise, 2019, para. 3 &4), an increased amount of screen time for everyone–children and parents alike– has become inevitable. In a 2018 study, researchers found that an increased amount of screen time in children correlated with lower psychological well-being and less emotional stability, as well as increased anxiety and depression (Twenge, 2018, pg. 272). Additionally, a 2017 study found that the amount of TV watching and computer use can predict the depression level among adults (Madhav et. al, 2017, pg. 68). To combat these effects,  Amy Kelly– Devereux Advanced Behavioral Health National Director of Family Engagement– recommends “unplugging” from screens for set periods of time for the entire family (Kelly, para. 10). 

Juggling various responsibilities can be overwhelming. Having times dedicated to engaging in realistic self-care practices can help alleviate feelings of anxiety and stress. While yoga and mindful meditation are effective strategies, it can be difficult to block out set amounts of time. Seattle Children’s “Realistic Ways for Parents to Manage Stress” article suggests going on a short walk outside or 5-minute stretching or single-song dance party as a quick self-care practice (Ibarra, 2020, para. 23). Taking 5 deep breaths periodically as well as bringing awareness to water intake and posture are additional easy self-care practices as well (Ibarra, 2020, para. 24 &25).

For those families who desire for self-care practices to be inclusive of all family members, board-certified music therapist  Stephanie Leavell’s “Yoga Song” is intentionally written for children and is family-friendly. Stephanie’s song is based on 11 different yoga poses that are easy for beginners and children. During the song, she slowly counts to 10 before transitioning to the next pose. At the end of the song, she focuses on breathing before gently ending. Her song is part of her album “Move It, Move It!” and can be found on Spotify and iTunes music, as well as YouTube (with visuals of the poses). The song can help decrease heart rate, increase oxygen, and encourage mindfulness for all parties participating. 

Seattle Children’s also recommends 5 steps for caregivers and parents to take during times of frustration (Take 5 When You’re Overwhelmed or Frustrated, 2020): 

1. Stop and step away

2. Take a short break to breathe

3. Remind yourself “I can do this” or “It’s important to stay calm.”

4. Ask yourself, “How can I handle this situation in a way that I will feel good about?”

5. If possible, ask for support from a partner or family member. Call or text a friend or neighbor. It’s ok to ask for help. 

Per step 5, speech-language pathologist Jim Mancini from Seattle Children’s recommends to “practice physical distancing, not social distancing” (Ibarra, 2020, para. 38). He points out that regularly talking–via phone call, via video chat, or text message– can help all individuals regulate during this time of quarantine and isolation. Affirming feelings and checking in by asking “How are you, really?” can let others know that they are not alone. 

-Sarah Deal, Music Therapy Intern 

References: 

Eyepromise (2019). Screen Time Guidelines by Age. Retrieved May 16, 2020 from https://www.eyepromise.com/wp-content/uploads/2019/05/Screentime-Recommendation-Chart-Final_AAP-WHO.pdf 

Ibarra, R. (2020). Don’t Have an Hour for Yoga? Realistic Ways for Parents to Manage Stress. Retrieved May 16, 2020 from https://pulse.seattlechildrens.org/dont-have-an-hour-for-yoga-realistic-ways-for-parents-to-manage-stress/ 

Kelly, A. (2020). COVID-19: Helping families with special needs during a public health crisis. Retrieved May 16, 2020 from https://www.devereux.org/site/SPageServer/?pagename=helping_families 

Madhav, K. C., Sherchand, S. P., & Sherchan, S. (2017). Association between screen time and depression among US adults. Preventive Medicine Reports, 8, 67–71. 

The Mental Health Coalition (2020). The Case for Mental Health. Retrieved May 16, 2020 from https://thementalhealthcoalition.org/cases/ 

Twenge, J.M. & Campbell, W.K. (2018). Associations between screen time and lower psychological well-being among children and adolescents: Evidence from a population-based study. Preventative Medicine Reports, 12, 271-283.

Behavioral Strategies in Music Therapy for Children with an Emotional-Behavioral Disorder

Emotional-behavioral disorders (EBD) is an umbrella term that encompasses a vast range of diagnoses. In the educational setting, this term is used to describe a child or adolescent whose behavior is viewed as disruptive and whose actions inhibit the individual’s academic performance (Jacob, 2018). The emotional component of EBD is that the child/adolescent is unable to effectively control their emotions. Examples of emotional disorders include anxiety disorders and depression. The behavioral component is thus the manifestation of emotional dysregulation. Behavioral disorders include oppositional defiant disorder (ODD), conduct disorder (CD), and obsessive-compulsive disorder (OCD). Symptoms displayed can be categorized into externalizing behaviors and internalizing behaviors. Externalizing behaviors include acting out, fighting, using inappropriate language, destruction of property, and other deleterious behaviors. Internalizing behaviors are focused inward and may include being withdrawn, exhibiting nervousness, physical symptoms such as headaches and stomachaches, changes in sleeping patterns, and changes in eating patterns (Jacob, 2018).

         Since each individual is different and thus displays symptoms differently, it may be difficult to pinpoint which disorder a child or adolescent may suffer from. This may be why EBD is used as an umbrella term to describe multiple diagnoses (Jacob, 2018). Although there are common behaviors displayed, each child/adolescent requires individualized attention and care in regards to treatment.

An emotional-behavioral disorder affects virtually every facet of a child/adolescent’s life, including school, family, and community functioning and performance (Bakken, Obiakor, & Rotatori, 2012). A common thread amongst children/adolescents diagnosed with EBD is their lack of social skills. They are unable to form and maintain interpersonal relationships with both school-aged peers and adults. This incapability can present a major challenge in social development and emotional wellbeing.

Behavioral theories suggest that human behavior is shaped through conditioning and observational learning (Gfeller & Thaut, 2008, p. 225). A main premise of behavioral theories is that an individual is more likely to display a certain behavior if it is consistently rewarded or reinforced. A child or adolescent may be inclined to display a disruptive behavior if it is constantly acknowledged by their teacher or caregiver. Positive Behavioral Support (PBS) is a range of preventive and positive interventions designed to create a supportive and successful environment for individuals who demonstrate behavioral issues (Adamek & Darrow, 2018, p. 196). The ultimate goal of PBS is to improve the daily lives of individuals in all settings, such as school, home, and community (Adamek & Darrow, 2018, p.196).

Positive Behavioral Support (PBS) utilizes three features: a behavioral assessment, comprehensive intervention, and lifestyle enhancement (Adamek & Darrow, 2018, p. 196). Similar to music therapy treatment, the assessment stage of PBS involves tracking the child or adolescent’s problem behaviors by observing the frequency and factors leading up to them. A comprehensive PBS plan involves altering the individual’s environment in order to remove triggering stimuli, teaching new skills to replace problem behaviors, and minimize natural reinforcements for inappropriate behavior (Adamek & Darrow, 2018, p. 196). 

 Behavioral techniques can be used in the music therapy setting to promote appropriate, desired behavior among children and adolescents with an emotional or behavioral disorder. Utilizing behavioral strategies in music therapy sessions allow for the client to make progress towards more appropriate behavior in unique, engaging ways. Participating in music-based interventions serves as a distraction from displaying inappropriate behaviors. For example, providing a child or adolescent with an instrument to play may counteract their ability to interact negatively with peers. Secondly, learning to play an instrument or read an instrument requires the child or adolescent to remain focused and engaged. By learning a musical concept, the child or adolescent exhibits appropriate behavior such as remaining seated, holding an instrument, and/or reading music. Finally, music can serve as a contingency for displaying appropriate behavior for a specific length of time. Once the specific time length of desired behavior is reached, the music therapist could reward the client by incorporating the client’s prefered music into the session or allowing the client to play their prefered instrument choice.

Music therapy sessions implementing behavioral strategies would involve structure and expectations set by the music therapist. The music therapist can set the expectation for the session by creating the session’s schedule at the beginning of the session and implementing a reward chart. If the client completes a set amount of interventions during the session, they will be rewarded with a prefered music activity. For example, if the client’s goals measure fine motor skills and remaining on-task, the client would be rewarded after sitting at the piano for a determined time length and isolating their fingers to play piano scales or a piano piece. If the client completes this intervention, the client could be rewarded for their positive and appropriate behavior by being given their prefered instrument. For example, if the client’s prefered instrument is the drum, the client and music therapist could engage in an improvisational intervention that provides the client with an opportunity for self-expression and autonomy by assuming the lead role in an intervention that they favor.

-Jasmine Bailey, Music Therapy Intern 

References

Adamek, M., & Darrow, A. (2018). Students with behavior disorders. In M. Adamek & A. Darrow (Eds.), Music in special education. The American Music Therapy Association.

Brigham, F.J., Bakken, J.P., & Rotatori, A.F. (2012). Families and students with emotional and behavioral disorders. In J. Bakken, F. Obiakor, & A. Rotatori (Eds.), Behavioral disorders: practice concerns and students with EBD (pp. 207-231). Emerald Group Publishing Limited.

Gfeller, K., & Thaut, M. (2008). Music therapy in the treatment of behavioral-emotional disorders. In W. Davis, K. Gfeller, & M. Thaut (Eds.), An introduction to music therapy: Theory and practice. American Music Therapy Association. 

Jacob, L.M. (2018). Emotional and behavioral disorders. Salem Press Encyclopedia of Health. Retrieved from http://eds.a.ebscohost.com/eds/detail/detail?vid=1&sid=feb9e3e5-0cf8-435f-b0ec-7c7493b6d4b2%40sdc-v-sessmgr01&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=93787442&db=ers

Effect of Music and Movement in Older Adults

Exercise is essential for all populations but may be most imperative for older adults. The World Health Organization [WHO] recommends that adults aged 65 and older should get at least 150 minutes of moderate aerobic activity per week (World Health Organization [WHO], para. 1). However, a 2014 study by the CDC reported that 26.9% of adults aged 65-74 and 35.3% of adults >75 had no physical activity outside of work or daily living in the previous month (Watson et. al.,, 2014, 954). The benefits of physical activity are practically endless, reducing the risk for cardiovascular complications, recurrent falls, ADL limitations and cognitive decline, dementia, and depression. Overall, an increased quality life and improved cognitive functioning are the greatest outcomes (Cunningham, 2020, para. 1). 

In a 2001 music therapy case study, results indicated that there was a significant difference in the adherence to six of 14 various exercises presented with and without music during a physical therapy rehabilitation session for older adults (Johnson et. al, 91). The researchers credit the presence of music and the element of rhythm for increased fluidity and increased range of motion. Without music, the researchers noted that some patients had an increased number of repetitions per movement but some exercises required slower movements to gain maximum benefits (Johnson et. al, 2001, 92). Overall, unsolicited comments recorded during the session by the patients indicated a preference for music in the sessions (Johnson et. al, 2001, 82). 

Neurologic Music Therapy pioneer Dr. Michael Thaut gives further insight as to how rhythm aids in motor processes: “Rhythm provides temporal structure through metrical organization, predictability, and patterning….Rhythmic entrainment provides immediate time regulation but can be accessed to enhance long-term training effects” (Thaut, 2005, pg. 83). The temporal lobes are located on either side of the brain located near the ears. While their most prominent function is auditory processing and encoding memory, the right temporal lobe is involved in learning and remembering non-verbal information. This aids in visuo-spatial material as well as processing the structures of music (Queensland Government, 2017, para. 2). The rhythm of music allows auditory processing and the motor system to work in tandem through rhythmic entrainment, priming of the auditory-motor pathway, and cuing of the movement period (Thaut, 2005, 141). While the rhythmic structure of music can help individuals in real-time–in terms of the 2001 case study, while the individuals were exercising– rhythm can also be used to cue long-term memory recall, aiding in movement. 

While research is limited on examining individual’s music preference and effect on movement, a 2016 study revealed that key features of music preferred by older adults included “duple meter, consistent rhythm, major key, rounded melodic shape, legato articulation, predictable harmonies, variable volume, and episodes of tension with delayed resolution” (Clark, 2016, 364). An outline of songs from the 2001 Johnson et. al study that fit these characteristics and their respective implementation can be found below: 

Overall, fitness and movement is essential for all populations but can greatly increase the quality of life of older adults. Having input from a board-certified music to pair appropriate music selections with fitness routines can help maximize the intended effects of the exercises.

-Sarah Deal, Music Therapy Intern

References: 

Clark, I.N., Baker, F.A., & Taylor, N.F. (2016). Older Adults’ Music Listening Preferences to Support Physical Activity Following Cardiac Rehabilitation. Journal of Music Therapy, 53(4), 364-397. 

Cunningham, C., O’Sullivan, R., Caserotti, P., & Tully, M.A. (2020). Consequences of physical inactivity in older adults: A systematic review of reviews and meta‐analyses. Scandinavian Journal of Medicine & Science in Sports, 30(5), 816-827. 

Johnson, G., Otto, D., & Clair, A.A. (2001). The Effect of Instrumental and Vocal Music on Adherence to a Physical Rehabilitation Exercise Program with Persons who are Elderly. Journal of Music Therapy, 38(2), 82-96.

Thaut, M.H. (2005). Rhythm, Music, and the Brain. Routledge. 

Watson, K.B., Carlson, S.A., Gunn, J.P., Galuska, D.A., O’Connor, A., Greenlund, K.J., & Fulton, J.E. (2014). Physical Inactivity Among Adults Aged 50 Years and Older. Morbidity and Mortality Weekly Report, 65(36), 954-958. 

Queensland Government (2017). Brain Map: Temporal Lobes. Retrieved April 25, 2020 from   https://www.health.qld.gov.au/abios/asp/btemporal_lobes 

World Health Organization [WHO] (n.d). Physical Activity and Older Adults. Retrieved April 25, 2020 from https://www.who.int/dietphysicalactivity/factsheet_olderadults/en/