Music Therapy and Mental Health: PTSD Edition

Music Therapy and Mental Health: PTSD Edition

For individuals diagnosed with Posttraumatic Stress Disorder, every day may consist of fear, uneasiness, flashbacks, difficulty completing day to day activities, or even emotional numbness. Along with most mental illnesses, there are no cures for PTSD. There are many different treatment options to provide coping skills for those with PTSD — one of those options is Music Therapy. There are therapeutic settings and interventions that are designed to help those with PTSD better adjust to difficult aspects of their everyday lives. By setting goals to decrease a negative behavior or increase a positive with Music Therapy, living with PTSD can become more bearable.

The American Psychiatric Association (2019) defines Posttraumatic Stress Disorder as a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault. This type of trauma creates dissonance. Dissonance is created between the magnitude of the threat and the individual’s resources for coping with the rest (Felsenstein, 2013, p. 1). Symptoms of PTSD can be mental, physical, and emotional. Some symptoms of PTSD can include re-experiencing the event, intrusive memories of the event, prolonged emotional distress and psychological reactivity after exposure to trauma-related stimuli, avoidance of trauma-related thoughts and external reminders, negative alterations in mood and cognition, and alterations in arousal and reactivity (Landis-Shack, Heinz, & Bonn-Miller, 2017, p. 2) 

(Oglethorpe Inc., 2020)

There is a three-stage therapeutic process to help those experiencing PTSD stop using unhealthy coping behaviors: sense of safety, building a narrative, and engaging with the community (Story & Beck, 2017, p. 94). Treatment of PTSD can be difficult because it surfaces itself differently in everyone because everyone is different, and everyone experiences different trauma. Many different forms of treatment are being researched and will continue to be researched.

As Ahonen says, “music touches our emotions and triggers our memories on the deepest level. There is something in music that is transformative, making a difference in people’s lives” (2018, p. 26). Music Therapy has many benefits for individuals with PTSD. One benefit of Music Therapy is that music engages people in a universal environment that feels safe and more enjoyable than other verbal processing therapies (Carr, d’Ardenne, Priebe, Scott, & Wang, 2011, p. 180). Music Therapy interventions are used to help a person distinguish the present moment from past traumatic events, an important part of re-experiencing the trauma and staying grounded. Music can elicit traumatic associations, which can be both positive and negative for the individual, and it is important for the individual to understand that they are in a safe space so they can gain that first step of needing a sense of safety (Carr  et al., 2011, p. 196).

One population where PTSD is common is military personnel. Over 15% of people in the military are women and they are the fastest growing demographic among veterans (Story & Beck, 2017, p. 1). Soldiers returning from deployments or active duty status have to readjust to civilian life, which can be very stressful due to what they experienced overseas. Common posttraumatic symptoms that females most commonly identify with in the military stem from combat, sexual trauma or harassment within the military, and family and support separation (Story & Beck, 2017, p. 1).

When it comes to Music Therapy techniques, guided imagery is commonly used with people in the military or veterans. The images used are supposed to be expressions of the inner world of the client (Story & Beck, 2017, p. 3). These images are called resource images and can help the individual face their conflict. Music is the basis of the guided imagery process to help clients deepen their relationship with the music so they are able to connect music to their positive inner resources (Story & Beck, 2017, p. 3). The goals most commonly worked on using guided imagery are resource mobilization, narrative reconstruction, and coping skills. Hyperarousal is also a focus when looking into physical, cognitive, and emotional domains. One example of a goal dealing with hyperarousal is “Poor concentration is addressed through requiring patients to attend to their own sounds and those made by others” (Carr, et al. 2011, p. 181). This will help the group or individual concentrate on the present stimuli instead of the past. An example of an emotional domain would be emotional expression mirrored by instruments. Improvisation is a Music Therapy technique that includes all three domains because it enables arousal regulation by promoting relaxation (Carr, et al. 2011, p. 181).

There are many other Music Therapy techniques that benefit those who have PTSD. One Music Therapy technique is relaxation music listening. Relaxation music listening can be music listening alone, or music listening along with imagery or muscle relaxation (Jespersen & Vuust, 2012, p. 208). Another important difference in techniques is individual versus group work. Individual work with children is most prominent when it comes to Music Therapy and PTSD. On the other hand, most adults work in a group setting. Group Music Therapy is often focused on social aspects and addressing the avoidant behavior of those with PTSD (Carr, et al. 2011, p.189). It is not always easy in the beginning to be social with new peers after traumatic events, but it gets easier over time as engagement increases.

Another technique using guided imagery and music is called the Bonny Method. The Bonny Method typically consists of individualized 90-120 minute Music Therapy sessions where the therapist picks classical music, specifically western art music, to evoke sensory and emotional responses in the listener (Story & Beck, 2017, p. 94). A controlled environment study conducted in 2017 focused on planning effective interventions for women in the military who have experienced sexual trauma (Story & Beck, 2017, p. 96). Overall, the Bonny Method helped the individuals in the study be able to confront the past. One individual said, “it’s just putting it in a positive way, and this has helped associate music with positivity” (Story & Beck, 2017, p. 98).

In conclusion, there are many different Music Therapy interventions that are beneficial to people who have gone through trauma or have been diagnosed with PTSD. Every day is different for individuals who have PTSD. One day could be easy and the next day could consist of fear and then numbness. Although there is no cure for PTSD, different treatments and techniques are available. Music Therapy has such a wide variety of approaches to assist individuals with adjusting to everyday life and increasing positive behaviors or decreasing negative ones. 

-Amanda Brennen, Music Therapy Intern

References

Ahonen, H. (2018). Music medicine’s influence on music psychotherapy practice with traumatized individuals. Music & Medicine, 10(1), 26-38.

Beck, B., Messel, C., Meyer, S., Cordtz, T., Sogaard, U., Simonsen, E., & Moe, T. (2018). Feasibility of trauma-focused guided imagery and music with adult refugees diagnosed with PTSD: A pilot study. Nordic Journal of Music Therapy, 27(1), 67-86. doi: http://dx.doi.org/10.1080/08098131.2017.1286368

Carr, C., d’Ardenne, P., Priebe, S., Scott, C., Sloboda, A., & Wang, D. (2011). Group music therapy for patients with persistent post-traumatic stress disorder-An exploratory randomized controlled trial with mixed methods evaluation. Psychology and Psychotherapy, 85(2), 179-202. doi: 10.1111/j.2044-8341.2011.02026.x

Felsenstein, R. (2013). From uprooting to replanting: on post-trauma group music therapy for pre-school children. Nordic Journal of Music Therapy, 22(1), 69-85. doi: 10.1080/08098131.2012.667824

Jespersen, K., & Vuust, P. (2012). The effect of relaxation music listening on sleep quality in traumatized refugees: A pilot study. Journal of Music Therapy, 49, 205-229. doi: 10.1093/jmt/49.2.205

Landis-Shack, N., Heinz, A., & Bonn-Miller, M. (2017). Music therapy for posttraumatic stress in adults: A theoretical review. Psychomusicology, 27(4), 335-342. doi: 10.1037/pmu0000192

Story, K., & Beck, B. (2017). Guided imagery and music with female military veterans: An intervention development study. The Arts in Psychotherapy, 55, 93-102. doi: 10.1016/j.aip.2017.05.003

Jasmine's Final Blog Post

It’s so hard to believe that my time as a music therapy intern at Therabeat Inc. has come to an end. Time really does fly when you’re having fun! This internship has challenged me in ways that I never knew were possible. However, it has rewarded me in ways that I couldn’t have imagined. I started this internship feeling like a deer caught in the headlights. I’m leaving this internship as a new professional with the skill set to serve as an excellent music therapist.

I have learned so many skills, interventions, and songs throughout my internship experience. However, the most beneficial skill I learned was the ability to be flexible. COVID-19 affected my internship in ways that I couldn’t even have imagined beforehand. A lot of in-person sessions were moved to telehealth sessions, which challenged my session planning abilities. Even though this wasn’t a smooth transition, I believed that these months of telehealth sessions caused me to grow tremendously in so many ways. 

I’m so glad to be wrapping up my internship with the resuming of in-person sessions. Although I am grateful for learning how to navigate music therapy through telehealth options, it truly makes me happy to have the opportunity to see clients in person and continue to address their individualized goals. I’m also grateful for music therapy groups that have resumed at the clinic, such as Little Beats and Harmony Tots. Each individual client and group that I have had the opportunity to make connections with has impacted me for the better. I truly believe that these experiences have caused me to become even more invested in the field of music therapy and caused me to flourish and become a better music therapist.

I cannot thank Therabeat enough for this amazing, surreal internship experience. I plan to spend the next few weeks preparing to take my board certification exam so that I have the opportunity to affect my future clients as my supervisors affect theirs. I am so ready to start my journey as a music therapist and I am excited for what lies ahead!

Yours Truly, 

Jasmine Bailey, Music Therapy Intern

Meet Ms. Amanda

My name is Amanda Brennen and I am so excited to be interning at Therabeat! Serving the community and music have always been two very big passions of mine. Having grown up in Roswell, GA, I’ve been lucky enough to see the positive impact that Music Therapy has made on my hometown. My primary instruments are voice and piano, but I also love to play guitar and ukulele. Sometimes I will even pick up an accordion or keytar and play around! I will be graduating in December 2020 from Georgia College & State University. Go Bobcats! I was very involved on campus, and I loved connecting with so many people and making a difference in Milledgeville.

GCSU provided me with the opportunity to work with many different populations in different settings. One of my favorite experiences was working in a Pre-K class with 20 children between the ages of 3 and 5. Working with this classroom for an entire school year was a treat, and it was so exciting to look at the progress that was made during that time. I was even able to go on a few field trips with them! Another great experience I had was working in a nursing home with a woman who had her own poetry book. Through music therapy interventions, we transformed her beautiful compositions into music! This process was very rewarding. I also was given the opportunity to be a guest lecturer at GCSU and present my research about music therapy and PTSD. GSCU and the Milledgeville community will always have a special place in my heart. My biggest takeaway from my collegiate experience is that we are all “More alike than different”.

My first visit to Therabeat was when the Woodstock location opened and I was very drawn to the welcoming environment. Therabeat is unique because the therapists are able to co-treat with the physical therapists, speech and language pathologists, and occupational therapists. This appeals to me because one day in the future, I would like to open up my own private practice and possibly integrate co-treating. Therabeat also gives me the opportunity to work in different settings with different populations. Therabeat is a place I know I will grow into a well-equipped professional. I am so excited to learn from such a talented group of music therapists.

Sometimes change can be scary, and my first week at Therabeat was definitely not what I expected – it was bigger and better than what I could have imagined! The music therapists are so helpful with any and all questions that pop up. They even come to the rescue when you accidentally set off the building’s alarm! The entire team wants you to succeed, and will make sure you are being pushed to become the best music therapist you can be. This week I helped with summer camp and was able to observe many different sessions. Week one also reminded me that as a music therapist, you have to be very “go with the flow” because things can and do change very often. I know I am going to learn and grow both professionally and personally so much over the next few months. I am so excited for the adventure ahead!

-Be kind to one another. Until next time!

Amanda Brennen, Music Therapy Intern

Meet Ms. Sara

Hello, My name is Sara Demlow! I am one of the newest music therapy interns here at Therabeat, inc. In college, my primary instrument was voice, but I have also played clarinet since middle school and enjoy playing guitar, ukulele, and piano. My favorite music to listen to is musical theatre and this is largely due to the influence my brother had on me as a kid, and even still now. Since I was young, he has been giving me new cast albums to listen to and we have been able to connect with each other through them. This was one of the many things that sparked my love of music that still grows and grows every single day.

I discovered the music therapy profession in high school and since then, I have known that this is what I want to do for the rest of my life. My parents helped me search for colleges in the state that offered the degree and when I researched Georgia College, I knew that it was the school I wanted to go to. With my parents' support and encouragement, I made it to GCSU, and now I finally am working on the last puzzle piece to finish my degree.

Within my first week here at InHarmony, I can already tell how much of an amazing place it is and how much of an impact this facility has on the clients they serve. Not only will I get the opportunity to learn from the fantastic music therapists on staff, but I will also get to learn from the other therapists at the clinic (PT, OT, ST) and see how this facility works together to create the best possible plan of care for each of their clients. I am so excited to continue my journey of learning and look forward to the rest of my time here.

Making Social Connections among Adults with Disabilities

Humans have an innate need for social connections with other individuals. According to Maslow’s hierarchy of needs, humans prioritize feelings of love and belongingness immediately after satisfying physiological needs and safety (McLeod, S.A., 2020, para. 2). Social groups provide us with an important part of our identity, and assist us in relating to our peers (McLeod, S.A., 2020, para. 1). Adequate social connections also benefit our health and quality of life. Social relationships have been found to boost mental health by reducing levels of stress, improving self-worth, and improving perceived confidence (McLeod, S.A., 2020, para. 2). 

Individuals with intellectual and developmental disabilities often struggle with forming personal relationships with others due to their environment and how they are viewed in society. These individuals may feel frustrated due to lack of social interactions and personal connections, as well the inability to express themselves and be understood. Additionally, lack of meaningful connections may lead to a negative self-image and a further decline in social and communicative skills. 

Music therapy group sessions provide clients with opportunities to make meaningful connections with each other and develop prosocial behaviors, such as initiating conversations, participating in reciprocal dialogues, and expressing emotions (Baumgarten & Wheeler, 2016, p. 120). Music therapy interventions can facilitate motivation, communication skills, and social interactions in a non-judgemental, non-threatening environment (Baumgarten & Wheeler, 2016, p.119).  A 2016 study measured the ability of group music therapy sessions to increase initiation of conversations, reciprocal turn taking, and the ability to express an increased range of emotions among adult clients with various intellectual and developmental disabilities (Baumgarten & Wheeler, 2016, p. 120). Music therapy methods used in this study included listening to music, music assisted relaxation, improvisational music therapy activities, and re-creative music therapy activities such as songwriting and musical song-games (Baumgarten & Wheeler, 2016, p. 121). Results of this study showed that the clients were able to form trusting relationships with other group members. This contributed to an enhancement of prosocial behaviors, such as engaging in conversations, turn taking, and supporting emotional expression. Additionally, the clients displayed a reduction in antisocial behaviors, such as starting fights, teasing other group members, and being disruptive during the music therapy sessions (Baumgarten & Wheeler, 2016, p. 125). 

Current government guidelines set in place to prevent the spread of COVID-19 have altered how we as a society interact with each other. A lot of organizations and individuals in the community understand the need to continue social interactions during this trying time. Before the practice of social distancing was established and enforced, music therapists at Therabeat Inc. partnered with Empower Cherokee to provide in-person opportunities for adult clients with disabilities to interact with each other and express themselves in a non-threatening environment. Luckily, these clients are still able to meet and engage with each other during online music therapy sessions via zoom. 

A popular intervention used in virtual music therapy with clients from Empower is songwriting. This intervention has been used in sessions to address the current changes in daily life and the development of social skills. Additionally, this intervention provides opportunities for the clients to get to know each other better by relating to the personal responses of others. In the picture shown, the music therapy intern and clients worked together to write a song discussing things that make them happy using the tune “A Wonderful World” by Louis Armstrong. This intervention allowed the clients to express their individual preferences as well as learning what their peers like as well. 

Maintaining meaningful social connections is more important now than ever. With the uncertainty of society today, it is essential to have opportunities to engage with others and express ourselves. Individuals with intellectual and social disabilities need the opportunity to continue to develop their social skills and manage their emotions by engaging with their peers. As Empower states on their website, “physical distance, not social isolation.” (no author, 2020).

References

Baumgarten, H.R., & Wheeler, B.L. (2016). The influence of music therapy on prosocial behavior of adults with disabilities. Music & Medicine, 8(3), 118-127. 

McLeod, S.A. (2020). Maslow’s hierarchy of needs. Retrieved May 28, 2020, from https://www.simplypsychology.org/maslow.html

No author (2020). The importance of social connection. Retrieved May 28, 2020, from https://www.mindwise.org/blog/uncategorized/the-importance-of-social-connection/

No author (2020). Empower cherokee. Retrieved May 28, 2020, from https://www.empowercherokee.org/

Pavlicevic, M., O’Neil, N., Powell, H., Jones, O., & Sampathianaki, E. (2014). Making music, making friends: Long-term music therapy with young adults with severe learning disabilities. Journal of Intellectual Disabilities, 18(1), 5-19.