The Effects of Music Therapy on Pediatrics with Preoperative Anxiety

Preoperative anxiety is a common obstacle for individuals of all ages before surgery. This causes uncomfortable and painful reactions because of the mental fears about the procedure. Preoperative anxiety is commonly experienced in children specifically. This anxiety can cause negative outcomes of an operation because of the behavioral responses it causes. These behaviors that inhibit the production of the operation are coping mechanisms children use in an attempt to control their current situation, including behaviors such as crying, screaming, avoidance, or physical resistance (Millet & Goodding, 2017, p. 462). Often, these behaviors can cause surgical complications that can spiral into further health complications. 

According to Giordano et al., pediatric patients who previously had negative surgical experiences have an increased likelihood of preoperative anxiety for future procedures (2020, p. 2). In order to eliminate the complications of preoperative anxiety, removing stress and fear behaviors, pharmacological analgesia, and sedation are often used. However, pharmacological techniques can also cause negative side effects and potential risks such as nausea and vomiting, itching, respiratory depression, constipation, etc (Giordano et al., 2020, p. 1). 

To avoid pharmacological side effects and risks, multidisciplinary and multimodal prevention techniques are becoming the preferred anxiety prevention method. Music therapy is an evidence-based multidisciplinary and multimodal prevention approach to treat preoperative anxiety (Giordano et. al, 2020, p. 3). Music therapy “involves the systematic use of musical experiences aimed at achieving therapeutic goals by a trained music therapist and implies the establishment of a relationship between patient, music and music therapist” (Giordano et al., 2020, p. 1). There are so many benefits that music therapy provides that outweigh the possible negative effects of pharmacological implementation. Music therapy eliminates pharmaceutical risk factors, is more cost effective, and treats more needs than just preoperative anxiety coping skills. Music therapy provides family support, physical and emotional benefits, and goals that enhance relaxation, self-expression, and communication (Giordano et. al, 2020, p. 1). 

Music naturally stimulates bodily sensations, feelings, emotions, and thoughts (Giordano et al., 2020, p. 2). Because this is music’s nature, music therapy is able to effectively calm the nervous system of preoperative patients. Treatment for a session in this setting may vary based on the patient’s demographic information and nature of the operation. However, music therapists use client-preferred music to stimulate the mind to distract from negative emotions that may arise and inhibit pre-procedural processes. Music therapists plan their session in close accordance with operational schedules, proactively beginning their sessions before anxious coping skills arise, instead of after. Depending on the length of the preoperational process, the session may last one intervention, or several. However, the music therapist should be prepared to treat until the patient has achieved a normal resting state and the procedure has been completed.

-Hanlee McCart, Music Therapy Intern

References

Charles, K. (2015, December 27). Daily Checkup: Music therapy shows dramatic results; patients with range of different diseases taking note. NY Daily News. https://www.nydailynews.com/life-style/health/daily-checkup-music-therapy-power-article-1.2469024

Giordano, F., Zanchi, B., De Leonardis, F., Rutigliano, C., Esposito, F., Brienza, N., & Santoro, N. (2020). The Influence of Music Therapy on Preoperative Anxiety in Pediatric Oncology Patients Undergoing Invasive Procedures. The Arts in Psychotherapy, 68, 101649. https://doi.org/10.1016/j.aip.2020.101649

Millett, C. R., & Gooding, L. F. (2017). Comparing active and passive distraction-based music therapy interventions on preoperative anxiety in pediatric patients and their caregivers. Journal of Music Therapy, 54(4), 460–478. https://doi.org/10.1093/jmt/thx014

Schizophrenia and Music Therapy

Schizophrenia-- a very real and serious mental illness that has no cure, but does have treatment available. The Treatment Advocacy Center states, “Schizophrenia is a chronic and severe brain disorder that interferes with a person’s ability to think clearly, manage emotions, make decisions and relate to others” (Treatment Advocacy Center, para. 1). Managing symptoms of schizophrenia can be a difficult task, but with treatment combined with music therapy there is a way to reduce the negative symptoms. A randomized controlled trial administered by Ulrich et al. (2007) was designed to “examine the effectiveness of music therapy in increasing interpersonal contact, reducing negative symptoms and enhancing QOL of schizophrenic acute care in-patients” (p. 363). This is important information for Music Therapists to assist in helping manage these symptoms or similar ones within this or any population they work with. 

With schizophrenia being “one of the most serious mental disorders,” treatment is necessary, which is why both groups involved in the study--experimental and control-- continued their standard treatments (Ulrich et al., 2007, p. 362). Throughout the study the experimental group received their standard treatments along with music therapy. One of the main focuses during the music therapy sessions was to have the patients working together in a cohesive group. Activities in the sessions included instrument play together on rhythm instruments, singing preferred music, as well as, group discussions. Rhythm instruments were utilized due to the nature of the instrument stopping any sound whenever the player immediately stops playing it, therefore allowing the patients to be in control of their music making. The music therapist utilized an eclectic approach with some behavioristic approaches during the sessions. Data was collected before and after each music therapy session by questionnaires completed by the nurses and patients. 

The three hypothesis’ that were tested included: patients interacting positively with others, music therapy decreasing negative symptoms, and music therapy improving quality of life (Ulrich et al., 2007, pp. 364-367). The results showed for the first hypothesis that there was no difference between groups as assessed by the nurses, but patients in the experimental group indicated that their interaction amongst others had improved, therefore this hypothesis was accepted (Ulrich et al., 2007, p. 365). The results showed for the second hypothesis that there was a decrease of negative symptoms amongst the experimental group, therefore this hypothesis was also accepted (Ulrich et al., 2007, pp. 365-367). Lastly, the results showed for the third hypothesis that there was no difference between the two groups, therefore this hypothesis was rejected. The last hypothesis being rejected could be due to the control group engaging in another activity while the experimental group received music therapy, therefore quality of life was not decreasing for either group. Therefore, this study showed that music therapy can assist with patients interacting with others in a positive way, as well as decrease negative symptoms for schizophrenic patients.  

All in all, music therapy can have a positive effect on psychiatric in-patients’ social interactions and decrease negative symptoms within their daily lives. This study sample included only 37 patients, but still resulted in positive findings. More research of larger samples could open many opportunities for this population. Music therapy has “no negative side effects and costs only moderately” and has shown to be “effective for primary schizophrenic patients for whom negative symptoms are central” (Ulrich et al., 2007, p. 369). Allowing this population to engage in positive treatment such as music therapy, “could increase the patient's abilities to adapt to the social environment in the community after their discharge from the hospital” which would be a very positive outcome for a patient diagnosed with schizophrenia (Ulrich et al., 2007, p. 369).

 -Kennedi Walz, Music Therapy Intern

References

Long Beach Post Partner. (2013, September 12). Mental Health Programs at Community Hospital Long Beach Leave Positive Impact, Fill Void in Community. https://lbpost.com/news/health/mental-health-programs-at-community-hospital-long-beach-leave-positive-impact-fill-void-in-community  (image) 

Treatment Advocacy Center. (n.d.). Schizophrenia – Fact Sheet. www.treatmentadvocacycenter.org/evidence-and-research/learn-more-about/25-schizophrenia-fact-sheet?gclid=Cj0KCQjwwLKFBhDPARIsAPzPi-KYxKmsJfyRtgcUAQCMM_I5kUfvw225OiZlniWk9xfP8W1XwmzAg5saAoUBEALw_wcB. 

Ulrich, G., Houtmans, T., Gold, C. (2007). The additional therapeutic effect of group music therapy for schizophrenic patients: A randomized study. Acta Psychiatr Scand., 116(5), 362-70. doi: 10.1111/j.1600-0447.2007.01073.x. 

Welcome, Kathryn!

Hello! My name is Kathryn Trujillo and I have just completed my first two weeks as one of the summer music therapy interns here at Therabeat. Though I am not a Georgia native, I have already grown to love the people I’ve met and the places I’ve explored thus far. My husband, 7-month old puppy, and I, drove across the country, from California, just to be here. We are looking forward to continued exploration of the state and I am excited for the new experiences I’ll have while interning here with the music therapy team.

Ever since I was 7-years old, I was told that I was musical. We all are actually. I studied classical piano, played cello in school and youth orchestras, attended band camps, sang and led worship services at many churches in the Bay Area, and formed meaningful connections with those around me through music. It was not until I was searching for colleges that I learned about Music Therapy. I attended Seattle Pacific University, where I studied under Dr. Carlene Brown for a year, but after realizing that this California girl missed the California sun, I returned to the Bay Area and attended Saint Mary’s College of CA. Here, I met my husband through the Intervarsity Christian Fellowship worship team, and completed studies in Kinesiology: Health & Human Performance with a minor in music. After graduating, I nannied for many local Bay Area families and began teaching private piano lessons at a studio called Music ‘N Beyond. 

As I was teaching one-on-one lessons, I encountered students who, I believed, would have benefited more from music therapy or adaptive lessons, than traditional classical piano lessons. I found myself wanting to connect more deeply with my students and wanting to support them through music. I enrolled in the equivalency masters program at University of the Pacific in San Francisco to pursue Music Therapy once again. Words cannot express how wonderful the music therapy community has been or how grateful I am to have found a career I have come to love. I am excited to learn from and work with the In Harmony Pediatric team. I can honestly say that during these first two weeks, I have already experienced how these wonderful therapists amplify the lives of children, adolescents, and the families who walk through the welcoming doors of Therabeat.  

-Kathryn Trujillo, Music Therapy Intern

Welcome, Hanlee!

Hello! My name is Hanlee McCart, and I am so blessed to say I am interning with Therabeat Inc. this year! Music therapy is a passion that I have had for many years and have seen it touch the lives of people in the most beautiful and unexpected ways. I spent my first four years studying music therapy at Georgia College & State University where my experience in the field was only the beginning. I am now close to getting my Bachelor’s in Music Therapy once I complete my internship with Therabeat this year! 

My primary instrument is cello, and I also love playing piano and the guitar. I absolutely love people and am passionate about using music to create deeper connections with people to serve their needs and advance their strengths. I have always had a passion for working with children specifically, of all ages and abilities! From what I have already experienced at Therabeat Inc., I am confident that this is the perfect internship for me! 

Some of my favorite things are listening to music, creating music, being with friends, meeting new people, laughing, laying in the sun, swimming in the ocean, going on runs, and spending time with my family. 

I am beyond grateful for the opportunity to serve alongside the Therabeat, Inc. team as an intern. While it is only my first week with Therabeat, I am already blown away by how I have seen so many different therapists use music therapy to connect with the many clients served here. I have already learned so much, and am so eager for all that I will learn from this team in the next 6 months! The reason why I chose Therabeat, Inc. is because I wanted to intern at a site that will develop my experiences in working with multidisciplinary and multi-diverse client family care with the support of professional music therapy supervisors. My first week with Therabeat has already proven this to be an accurate representation of what they care about. It is evident that their team of therapists prioritize the needs and desires of their clients over anything else. Being able to learn from the therapists at Therabeat, Inc. has been such a joy, and I feel beyond blessed to continue learning from them daily as I develop my skills into being a future certified music therapist!

-Hanlee McCart, Music Therapy Intern

3 Ways to Say "No" with Children with Autism

Children with autism may have a difficult time expressing and regulating their emotions --especially when being told “no” to a preferred activity or item. The National Autism Association states that, “Autism impacts the normal development of the brain in the areas of social interaction, communication skills, and cognitive function” (National Autism Association, para. 1). 1 in every 54 children is diagnosed with autism (National Autism Association, para. 2). Helping a child with autism manage emotional stress when being told “no” can seem like a daunting task to parents, teachers, and caregivers. An ABA (Applied Behavioral Analysis) case study done by Mace et al. (2011) may help to provide alternate strategies. Mace et al. (2011) “evaluate[d] the relative effects of three different methods of saying ‘‘no’’ to requests to engage in a preferred activity on the occurrence and escalation of oppositional, disruptive, and aggressive behavior” (p. 85-86). This is also pertinent information for Music Therapists in regards to managing behaviors and keeping a safe environment within a session.

At the beginning of the study, target behaviors --negative behaviors that occur after “no”-- of the participant with high-functioning autism were recorded. These behaviors included: oppositional vocalizations, loud vocalizations, disruption, aggression and/or threat of aggression (Mace et al., 2011, p. 86). Many of these behaviors are commonly seen amongst people with autism, specifically when told “no.” Mace et al. (2011) studied three different methods of saying “no” to a requested activity “to prevent occurrences of escalating behavior” (p. 91). The three methods include: 

1. “[saying] no and then offering an explanation for the refusal 

2. denying access to the requested activity but offering an opportunity to engage in a preferred alternative activity

3. denying immediate access to the requested activity, but permitting delayed access contingent on the completion of a low-preference demand” (Mace et al., 2011, p. 91).

Of the three methods, the last two alternative methods rarely caused the target behaviors. 

The first method did not include the child receiving anything in return other than “no,” which escalated all target behaviors. The last two methods included the child receiving “no,” but was offered the opportunity to engage in an alternative activity instead, such as playing baseball. The other strategy presented required a non-preferred activity where he had to engage in that activity first, then was able to receive the requested activity. The second alternative method was proven to extinguish most of the presented problem behaviors. 

In conclusion, the alternative methods of saying "no" are the best practice for dealing with problem behaviors. This case study had one participant, therefore further research is needed for generalization of this population. Autism Spectrum Disorder is on a "spectrum," therefore one method may not work for all children with autism. Parents may use this article and others to use creative ideas of alternate methods of dealing with inappropriate or unsafe activities other than the simple word, “no.”

Below is an example of a chart a Music Therapist may utilize with a patient with autism to remember how to sit at the piano. It is a great visual reminder that can sit at the piano while practicing music. When the patient is able to follow all three steps they are rewarded with a sticker on their music for the day, but if they struggle to follow the three steps they are unable to receive a sticker. Not receiving a sticker can provoke problem behaviors, but the Music Therapist can utilize “no” with an explanation to work harder next week so they can get a sticker. Again, every child is different and with some patients having a goal to work towards for next week is very motivating so they can transition fine without extreme problem behaviors out of the session. 

-Kennedi Walz, Music Therapy Intern

References

Mace, F., Pratt, J., Prager, K., & Pritchard, D. (2011). AN EVALUATION OF THREE METHODS OF SAYING “NO” TO AVOID AN ESCALATING RESPONSE CLASS HIERARCHY. Journal of Applied Behavior Analysis, 44(1), 83–94. https://doi.org/10.1901/jaba.2011.44-83. 

Autism Fact Sheet. National Autism Association. (n.d.). https://nationalautismassociation.org/resources/autism-fact-sheet/.