So Long, Farewell

With my internship at Therabeat finally coming to a close, I have been reflecting on all of the amazing experiences and memories that I have made along this journey. Therabeat has taught me so much about improving my therapeutic technique, professionalism, and musical interventions. It also taught me about maintaining patience, communication, choosing joy, and showing love to others.

During my internship, I have had the opportunity to work with a variety of individuals all with different ages, diagnoses, and backgrounds. Each of them has incredible talent and a love for music. I have loved experiencing thirty minutes to an hour with each of my friends and I am beyond grateful for the lessons they taught me along the way. I have learned patience for when the session takes a turn and does not go my way. I have learned how to communicate, and be open-minded to the way that others communicate as well. I have learned about how to be flexible when there are sudden changes or when something unexpected happens.

My incredible supervisors during this internship, as well as the other women in the clinic, (and Matt), have taught me how to be punctual. How to take extra steps to remain prepared and organized. How to communicate effectively with my peers. I have learned so much about how to shift from a student mindset to becoming the therapist in the room. I have also learned how to have compassion for others and how to show love through careful listening and consideration for others. I have learned how to be an encourager and how to be a good friend.

One year ago, I could not have even imagined getting to this point of completing my internship and graduating from college. It flies by so quickly. This experience is truly what you make of it along the way. I will never forget my experiences here and the friends that I have made along the way. I am so blessed to have had this opportunity, and I will miss it just a little too much.

Thank you, Therabeat. Until we meet again!

-Mallory McDonald, Music Therapy Intern

The Effects of Music on Insomnia

Insomnia is a sleep disorder that can cause mental disorders, a reduced quality of life, and health issues. Around 30% of the population experiences insomnia symptoms, and about 6-20% experience symptoms from an insomnia disorder (Jesperson, 2019). Sleep is a basic physiological need that must be met to maintain good physical and mental health. (Dos Santos, 2022). Music therapy and music therapy interventions have been shown to improve sleep quality and reduce the effects of insomnia (Kavurmaci, 2020; Dos Santos, 2022). Music can be used to calm the mind for sleep, but how can it treat insomnia and its effects?

Sleep is a basic human need that people spend around a third of their lives fulfilling, and the body needs to function properly. When the body does not receive enough sleep, it will have “physical, cognitive, and affective depression” (Kavurmaci, 2020). Other symptoms include fatigue, attention deficit, sensitivity towards pain, irritability, nonlogical thoughts, hallucinations, and a lack of appetite. Disordered sleeping occurs when there are changes in sleeping patterns that negatively affect health (Kavurmaci, 2020). In a recent study, researchers suggested that insomnia has become extremely prevalent in college students due to their poor sleep routines and negative emotions such as depression and anxiety (Dos Santos, 2022).

The DSM-5 criteria for diagnosis include a dissatisfaction with the quantity or quality of sleep and one or more symptoms such as difficulty initiating sleep, maintaining sleep, and/or early-morning awakening. The two types of insomnia include short-term insomnia and chronic insomnia. Short-term insomnia may occur for just a few weeks at a time, while chronic insomnia can last for three months or longer. Insomnia can cause or be diagnosed along with mental health disorders such as Post-Traumatic Stress Disorder (PTSD), Anxiety Disorders, Autism Spectrum Disorder, and Depression (Dos Santos, 2022).

Music has been used to aid sleeplessness in many recent studies and has been hypothesized to alleviate anxieties and contribute to psychological and physiological effects on the body (Shaw, 2016). Many different aspects of music that can be utilized to get our minds and bodies to rest. One study offered that “music intervention uses the regular frequency changes of music to act on the cerebral cortex and has an effect on the hypothalamus and limbic system to regulate hormone secretion, thereby changing college students’ emotional experience and physical function state” (Dos Santos, 2022, p. 4). By regulating these parts of the brain, people with disordered sleep can see a reduction in sleeplessness and its symptoms. Several studies have suggested that utilizing music that is calming, slow, classical, and instrumental is the best type of music for promoting sleep (Lund, 2020). Music has the ability to promote sleep by calming the Autonomic Nervous System and lowering noradrenaline in the bloodstream (Amalsi et. al., 2022). This can lead to a decrease in rate of breath, reduced blood pressure, and a lower heart rate. Research also suggests that people who listen to music to promote sleep have shown reduced maladaptive sleep behaviors (Oxtoby, 2013).

Music interventions such as music listening and music therapy have been utilized to treat participants with diagnosed sleeping disorders. One study suggests that music should be “60 to 80 beats per minute, with no dramatic changes in volume and rhythm, and played at a volume of 30 to 40 decibels. In another study that utilized relaxing music listening interventions, the music was instrumental and was similarly characterized by “a slow tempo of 50-80 bpm, stable dynamics, and simple structure” (Jesperson, 2019, p. 4). Slow tempos are important for sleep-promoting music because they will assist in slowing down breath and heart rate. Preferences for the music played may be a more important  and most statistically relevant factor than specific characteristics of the music (Shaw, 2016). In most of these studies, the interventions all begin at night or bedtime, and they utilize calm, slow, simple, and instrumental music.

Researchers were able to provide some statistically significant evidence that music is able to calm the mind and improve sleep quality for several groups. These studies provide evidence that music is able to assist the brain in the sleeping process and aid symptoms or the effects from a lack of sleep. Symptoms such as anxiety, negatively toned cognitive arousal, fast heart rate, and fast breathing rate have been greatly reduced in these studies and have helped participants get to sleep. Due to new research suggesting that the effects of music increase over time, some studies had limitations because the length of the study only averaged around two weeks in duration. Overall, there are not enough studies that focus completely on the effects of long-term music therapy on individuals diagnosed with insomnia, but there is significant evidence that demonstrates the positive impacts of the therapeutic functions of music on treating symptoms of insomnia. 

-Lila Finke, Music Therapy Intern

References

Amalsi, M., Chehri, A., Fakoori, F., & Khazaie, A. (2022). The effectiveness of music therapy on sleep quality and insomnia in middle-aged people. Scandinavia Journal of Sleep Medicine, 2(1).

Dos Santos, L. M. (2022). Study on the intervention effect of music on insomnia of college students. Journal of Healthcare Engineering, 1–5. https://doi.org/10.1155/2022/4037240

Jespersen, K. V., Otto, M., Kringelbach, M., Van Someren, E., & Vuust, P. (2019). A randomized controlled trial of bedtime music for insomnia disorder. Journal of Sleep Research, 28(4), 1–11. https://doi.org/10.1111/jsr.12817

Kavurmaci, M., Dayapoğlu, N., & Tan, M. (2020). Effect of music therapy on sleep quality. Alternative Therapies in Health & Medicine, 26(4), 22–26.

Lund, H., Pedersen, I., Johnsen, S., Heymann-Szlachcinska, A. M., Tuszewska, M., Bizik, G., Larsen, J. I., Kulhay, E., Larsen, A., Grønbech, B., Østermark, H., Borup, H., Valentin, J. B., & Mainz, J. (2020). Music to improve sleep quality in adults with depression-related insomnia (MUSTAFI): Study protocol for a randomized controlled trial. Trials, 21(1), 1–10. https://doi.org/10.1186/s13063-020-04247-9

Oxtoby, J., Sacre, S., & Lurie-Beck, J. (2013). The impact of relaxing music on insomnia-related thoughts and behaviours. Australian Journal of Music Therapy, 24, 67–86.

Shaw, R. (2016). Using music to promote sleep for hospitalized adults. American Journal of Critical Care, 25(2), 181–184. https://doi.org/10.4037/ajcc201663

Neurological Music Therapy

Neurologic music therapy (NMT) is used by licensed music therapists with a certification specifically for individuals suffering from diseases in the nervous system. Oral Motor and Respiratory Exercises (OMREX) are used to assist individuals who are suffering from neurological disorders with functions such as breathing, speech, and articulation, among other things. People who can benefit from OMREX and NMT consist of individuals who have suffered a traumatic brain injury (TBI), stroke victims, and individuals with a diagnosis of dysarthria, Huntington's disease, and Parkinson's disease, among other forms of neurological disorders.

NMT utilizes certain techniques used by speech therapists to achieve goals in the areas of speech and breathing. Breathing and respiratory problems have been found linked to speech impairment, and the use of instruments such as the harmonica and the recorder, as well as singing, have been found to improve respiratory issues. In a study completed by Bonilha in 2009,  the researcher found that individuals who suffer from respiratory issues who took singing lessons had greater improvement in their breathing and respiratory systems than individuals who did not receive the lessons.

The use of specific songs, vowel sounds, and instruments can be very vital to individuals improving breathing, articulation, and speech. For example, using the harmonica to work on fast and slow breathing, or sustaining breath, is just one way that the instrument can be utilized to improve speech and breathing. The recorder can be used to help clients find a round shape with their lips as well as sustain airflow. Singing songs with a lot of one consonant or vowel can allow the client to practice shaping and phrasing certain words or phrases.

Examples of particular interventions that can be used in NMT sessions include vocal exercises, such as having the client sing “ah” then rounding the lips and singing “oh”, then lips closed singing “mm”... and so on. This is to practice and prepare the transitions to new vowels and words when forming sentences. Playing music and participating with instruments or voice is also extremely motivating and is known for pushing clients to overcome particular obstacles in breathing, speech, and motor skills as well.

-Mallory McDonald, Music Therapy Intern

References

Alexander, J. L., & Wagner, C. L. (2012). Is harmonica playing an effective adjunct therapy to pulmonary rehabilitation? Rehabilitation Nursing : The Official Journal of the Association of Rehabilitation Nurses, 37(4), 207–212. https://doi.org/10.1002/rnj.33

Bonilha AG, Onofre F, Vieira ML, Prado MY, Martinez JA. Effects of singing classes on pulmonary function and quality of life of COPD patients. Int J Chron Obstruct Pulmon Dis. 2009;4:1-8. Epub 2009 Apr 15. PMID: 19436683; PMCID: PMC2672787.

Geist, K., McCarthy, J., Rodgers-Smith, A., & Porter, J. (2008). Integrating Music Therapy Services and Speech-Language Therapy Services for Children with Severe Communication Impairments: A Co-Treatment Model. Journal of Instructional Psychology, 35(4), 311–316.

Music Therapy and Early Intervention: Promoting Healthy Development Through Music Experiences

Do you know that it's possible to start tracking a child's development around the second month of life? Developmental milestones include things that most children should be able to do by a certain age. Parents can use the milestones highlighted by the Center for Disease Control and Prevention (CDC) to determine where their child falls developmentally. Developmental delay refers to a child's physical, cognitive, emotional, or social development not meeting typical milestones. Early identification and intervention help mitigate the impact of these delays and support the child's overall growth.

Early intervention (EI) refers to services that help babies and young children reach milestones and improve their abilities. There can be EI programs, such as Babies Can’t Wait, which is a program specific to the state of Georgia. Individuals must be eligible and apply to get access to these kinds of programs. Music therapy interventions are tailored to address the unique needs of children with developmental delays, fostering development in the crucial early years. Here are some needs that music therapists can treat for EI:

1. Sensory Integration:

Sensory processing can be a common need for a child with developmental delay. Stimulating the senses helps develop the brain. Music therapy can provide a structured environment for sensory exploration with auditory, tactile, and visual stimuli. Interventions like music listening, instrument play, or engaging in rhythmic activities can enhance sensory integration. The use of different musical elements such as dynamics, pitch, and tempo can be used to stimulate auditory senses.

2. Speech and Communication:

The rhythmic and melodic elements of music can serve as a scaffold for speech development, making it an engaging and effective approach for children with speech delays. Singing reinforces language development, especially when therapists utilize a simple melodic structure and repetition when trying to get a baby or young child to babble or speak. Music therapy can help reinforce verbal and nonverbal communication because music is a motivating structure for working on different sounds, words, gestures, and signs. A recent literature review states, “When nursery rhymes are incorporated into social routines, children are provided experiences that strengthen their early communicative skills. Listening or chanting songs or rhymes together allows for joint attention (the use of gestures or gaze to alert another to an object)” (Houde, et. al, 2018, pg. 6).

3. Motor Skills Development:

Movement-based activities in music therapy contribute to the improvement of gross and fine motor skills. Dancing, drumming, or playing instruments helps enhance coordination and motor planning in children with developmental delays. Body awareness is another area that children can work on in music. Movement interventions that utilize different parts of the body or allow the child to explore the room allow them to gain more spatial awareness. A child may be motivated by the sounds coming from a piano when they’re working on a skill such as isolating their fingers or coordinating movement of both hands.

4. Emotional Regulation:

  Music has a profound impact on emotional regulation. Music therapy interventions, through the use of calming or uplifting music, provide a non-verbal outlet for emotional expression. This can be particularly beneficial for children who are dysregulated. Children can also learn how to appropriately express emotions, recognize the emotions of others, and understand their own emotions through music therapy interventions. Music can provide a relaxed environment for a child to be calm and regulate themselves. Therapists can also use music to facilitate breathing exercises and other interventions to activate the parasympathetic nervous system.

5. Social Interaction:

Engaging in music interventions can increase social skills, turn-taking, joint attention, cooperation, eye contact, and more. Working on social interaction skills in early intervention is important because these skills only grow to be more important throughout one’s life. At this stage, this could just be getting a child to accept interaction from a music therapist. Music works as a mediator to promote interaction, participation, and communication from a child. Improvisation with sounds and instruments is a good way to assist a child in their responsivity, creative expression, self-awareness, and enhances their communication (Hanser, 2018).

Music therapists rely on evidence-based practices, and there have been many studies that provide evidence of the benefits of music therapy and early intervention. A study from the Canadian Journal of Music Therapy found that music therapy interventions improved communication and social skills in children with developmental delays (Houde, 2018). Another study demonstrated that rhythmic auditory stimulation, a neurologic music therapy intervention, positively influenced motor skills and coordination in children with developmental coordination disorder (Thaut, 2014).

Early intervention music therapy can address the diverse needs of children with developmental delays. As research continues to highlight the profound impact of music on various aspects of development, the integration of music therapy into early intervention programs becomes not just an option, but a harmonious necessity. Through this therapeutic medium, we can continue to promote development and provide children with the tools they need to reach their full potential.

-Lila Finke, Music Therapy Intern

References 

Centers for Disease Control and Prevention. (n.d.). Developmental Milestones. https://www.cdc.gov/ncbddd/actearly/milestones/index.html

Hanser, S. B. (2018). The new music therapist's handbook (3rd ed.). Berklee Press.

Houde, M., & Narendran, N. (2018). A literature review of the influence of early childhood music education and music therapy on child development. Canadian Journal of Music Therapy, 24, 27–39.

Thaut, M. H., & Hoemberg, V. (2014). Neurobiological foundations of neurologic music therapy: Rhythmic entrainment and the motor system. Frontiers in Psychology, 5, 1185. https://doi.org/10.3389/fpsyg.2014.01185

Music & Infants

Did you know that humans are first exposed to music while they are still in the womb? It's fascinating to think that even before we are born, we are already experiencing the rhythms and melodies that will become such an important part of our lives. Babies are exposed to rhythm from the mother’s heartbeat and footsteps. In the second trimester, babies will begin to hear melodies. We are exposed to music from the very beginning, and it has proven to have incredibly beneficial side effects that stimulate portions of our brain, which is so important for little ones who are rapidly developing and soaking in their environment.

Music therapy can be an excellent tool in areas such as parent-infant bonding, physical development, emotional development, and intellectual development. Therapeutic functions of music including rhythm, tempo, melody, dynamics, pitch, timbre, lyricism, etc. can each be used to promote growth for babies whose minds are rapidly developing and soaking up knowledge. For example, using rhythm and tempo to stimulate the cerebellum can promote movements such as foot tapping, clapping, or patting. Using different keys in songs can promote emotional awareness by using major versus minor keys to associate certain sounds with certain moods through the amygdala. Playing instruments can promote motor skills such as bilateral coordination or cross-body motions. Lyricism is an excellent tool for working on memorization, receptive language, speaking, or even dual language learning through the auditory cortex.

Music therapy is also beneficial for infants in the NICU or parent bonding in hospitals. According to a study completed in 2020 by Palazzi, et al, music therapy has been a beneficial tool in regulating preterm babies’ physiological responses as well as maternal mental health while their child remains in the NICU. The researchers sought out 33 mothers with infants each in the NICU for this particular study. Each of the mothers completed a survey prior to receiving music therapy services, called the State-Trait Anxiety Inventory as well as a postnatal depression scale.

The mother and child pairings would go on to participate in six music therapy sessions completed in the NICU. The music therapists conducting the study made sure to use soft sounds with rhythms matching maternal heart rates to promote comfort within sessions. Following the six sessions within the study, mothers filled out their assessment forms once again. The end of the study resulted in lower anxiety/depression levels for mothers, as well as musical techniques to work with their child on. There was a significant increase in infant weight gain and a slight reduction in how many days the infant spent in the NICU.

Music used to educate and grow babies can be so beneficial for parental mental health as well. Music is used often to develop and grow young children’s brains. When infants listen to music parts of their brain are stimulated to have natural responses that are necessary for growth. Infancy is such a magical and fast-paced growing period. Music can be a tool to guide parents and infants through these changes.

-Mallory McDonald, Music Therapy Intern

References

Baby Music: The soundtrack to your child’s development. UNICEF Parenting. (n.d.). https://www.unicef.org/parenting/child-development/baby-music-soundtrack-to-development

Palazzi, A., Meschini, R., & Piccinini, C. A. (2021). NICU music therapy effects on maternal mental health and preterm infant’s emotional arousal. Infant Mental Health Journal, 42(5), 672–689. https://doi.org/10.1002/imhj.21938

Stern, M. J. (2014, August 13). Why are we so nostalgic for music we loved as teenagers?. Slate Magazine. https://slate.com/technology/2014/08/musical-nostalgia-the-psychology-and-neuroscience-for-song-preference-and-the-reminiscence-bump.html