Music Therapy

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Music therapy

Common Names

  • Music listening
  • Experiential music
  • Singing therapy
  • Movement music therapy
  • Rhythmic drumming
  • Music reminiscence
  • Guided song-writing
  • Music-assisted relaxation
  • Lyric analysis
  • Guided imagery with music

For Patients & Caregivers

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What Is It

Cross-cultural beliefs have long held that music has healing effects on mind and body. Music therapy emerged as a formal discipline in the 1940s, and there are now about 8,000 trained therapists in the US alone, with thousands more worldwide.

Music can promote relaxation and distract from pain associated with many illnesses. Cancer guidelines recommend music therapy for anxiety, stress reduction, depression, and mood disorders.

Passive forms of therapy may be used to reduce stress before procedures or ease transition from sedation. More active forms are used for rehabilitation, enrichment, and simple enjoyment.

Patients may listen to, play, and even write their own music with guidance from a professionally trained music therapist. This process can evolve to give meaning and voice to complex emotions. It can also strengthen and enhance connections and support from loved ones.

Most NCI-designated cancer centers now offer music therapy as part of their supportive care programs. Music therapists also work with other populations, such as special needs and mental health patients.

How It Works

Music therapy helps improve social, emotional, and quality of life aspects in

  • Patients with cancer, heart disease, Alzheimer’s disease, and dementia
  • Hospitalized children
  • Patients undergoing difficult treatments
  • Patients in rehabilitation
  • Individuals with terminal illnesses

It does this by improving symptoms of

  • Anxiety
  • Depression
  • Stress and distress
  • Fatigue
  • Pain

Other studies suggest it can also

  • Reduce blood pressure
  • Help improve coordination, mobility, and endurance
  • Benefit the nervous system and immune function

By selecting appropriate music and method of participation, music therapy sessions can

  • Invite calmness or stimulation
  • Increase feel-good chemicals in the brain
  • Offer a welcome distraction or shift perception
  • Spark positive associations and memories
  • Provide meaning and pleasure
  • Improve movement coordination and breathing
  • Help process and communicate difficult emotions
  • Reduce the stress of loved ones and caregivers

In addition, music can improve the experience of exercise, making it an important option in health-challenged populations.

Purported uses and benefits
  • Anxiety
    Several clinical trials show that music therapy reduces anxiety including distress related to surgery and other procedures. Current cancer guidelines recommend music therapy for anxiety.
  • Depression
    Several studies have shown that music can help reduce depression. Current cancer guidelines recommend music therapy for depression and mood disorders.
  • Fatigue
    In a large study, active music therapy produced greater reductions in cancer-related fatigue and increased reporting of positive affect/emotions than passive music therapy.
  • Pain
    In several clinical trials, music therapy helped reduce pain or pain perception, and possibly pain medication use.
  • Stress
    Clinical trials support this use and cancer guidelines recommend music therapy for stress reduction.
  • Cancer-related symptoms
    Cancer guidelines and a number of studies support the use of music therapy to reduce anxiety, depression, and mood disturbances.
  • Family and caregiver support
    Music therapy can help reduce stress and enhance communications for loved ones and caregivers.
  • Improving exercise adherence
    Studies show that carefully selected music is integral to improving exercise adherence in health-challenged populations and in rehabilitation regimens.
Is It Safe
  • Music therapy is safe, but should be provided by a qualified therapist.
  • Because music therapy is noninvasive, free of side effects, and has shown effectiveness, it is a part of standard supportive care in major cancer hospitals and other institutions.
  • Music therapy is also recommended in cancer supportive care guidelines.
Who Can Provide this Service
  • Professional music therapists hold a degree in music therapy from a college or university program approved by the American Music Therapy Association (AMTA). Graduates may then apply for the national credential of Music Therapist – Board Certified (MT-BC).
  • There are about 8,000 board-certified therapists in the US.
  • Some may also have post-graduate specialty certifications like
    – Hospice and Palliative Music Therapy (HPMT)
    – Neurologic Music Therapy (NMT)
    – Nordoff-Robbins Music Therapy (NRMT)
  • Music therapists who include psychotherapy in their practice may need additional licensure.
  • Qualified therapists are listed in the AMTA’s National Music Therapy Registry.
  • International organizations include
    – World Federation of Music Therapy
    – International Society for Music Education
Where Can I Get Treatment
  • The Integrative Medicine Service at MSK offers music therapy and other mind-body modalities in our online program, Integrative Medicine at Home, to help support the recovery and well-being of cancer patients everywhere.
  • Many major hospitals offer some form of music therapy for rehabilitation and supportive care.
  • Most NCI-designated cancer centers offer music therapy as part of their supportive care programs. Therapists are skilled at employing evidence-based techniques for symptom management in clinical, intensive care, and hospice settings. 
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For Healthcare Professionals

Clinical Summary

Cross-cultural beliefs have long held that music has a healing effect on mind and body. Music can promote relaxation, distract from pain, and relieve distress.

Music therapy emerged as a formal discipline in the 1940s, as methods of increased effectiveness became clearer. Close to 8,000 trained music therapists work in clinical settings in the US alone, with thousands more worldwide.

Patients passively or actively listen to music, or engage in playing or even writing their own music, with guidance from a professionally trained therapist.

Considerations that may direct therapy include

  • Patient demeanor
  • Cultural backgrounds
  • Physical surroundings
  • Instrument availability
  • Desire to self-select or write music

Goals of therapy can include

  • Reducing stress before procedures
  • Easing transition from sedation
  • Reducing feelings of isolation
  • Bringing pleasure into what can often be a sterile setting

The process of music therapy may also

  • Improve emotion regulation and coping mechanisms
  • Reduce fatigue
  • Improve sleep quality
  • Give meaning and voice to complex emotions that might otherwise be difficult to articulate
  • Strengthen and enrich communications and support from loved ones

Music therapy in clinical settings
Studies show that appropriate use of music can reduce perioperative anxiety, pain, and stress (1) (2) (3) (4) (5) (6) (77), and a meta-analysis indicates it can help reduce opioid and sedative medication requirements (10). Both active and passive distraction-based music therapy were effective for pediatric patients undergoing procedures and their caregivers (7) (64). Music was superior to standard care for anxiety among intensive care unit patients receiving acute ventilatory support (8). In addition, it enhanced pulmonary rehabilitation (9) and improved respiratory function in patients with asthma (10). In hemodialysis patients, self-selected music was effective for fistula puncture-related pain (11). Other preliminary data suggest benefits of vocal music therapy in managing chronic pain (65). Music therapy also decreased pain and anxiety during colonoscopy (66).

In cancer settings
Data suggest music therapy helps reduce breathing problems, improve quality of life, and facilitate psychospiritual integration in terminal cancer patients (23) (24) (25) (78). It can also lower anxiety, distress, and/or pain in those receiving chemotherapy (38) (69) (79), radiation therapy (39) or simulation RT (26), women undergoing colposcopy (36) (37), and in pediatric (32) (33) (80), breast (34) (35), and lung cancer patients (79).

In autologous stem cell transplantation (ASCT) recipients, music therapy reduced narcotic medication use (27) and pain perception (28), and improved mood, coping, and social integration (29) (30). Another study among ASCT patients found acute rather than long-term benefits (31).

In studies comparing music and massage therapy, music therapy was associated with greater reductions in depression (76), and light massage therapy appeared to be more helpful for reducing pain (81).

Among patients with different cancer types, active music therapy was associated with greater reductions in cancer-related fatigue and increased positive affect/emotions compared to passive music therapy (63). Active music therapy was also stimulating, and provided opportunities for joyous social interaction not centered on diagnosis, while passive recipients experienced calming therapeutic effects (72).

Current oncology societies recommend music therapy for anxiety, stress reduction, depression and mood disorders (50) (51). Because it is noninvasive, free of side effects, and has shown effectiveness, music therapy is integrated into standard supportive care at major cancer hospitals.

To enhance exercise, immune function
Music also enhances the effects of exercise (42) (43) and may enhance cellular immunity (44). For specific health-challenged populations, careful music selection rather than just exercise performance is an important consideration to improve recovery and long-term adherence to lifestyle changes and physical activity guidelines (43) (45) (46) (47) (48) (49).

In other patient populations
Improvisational music therapy did not reduce symptoms in children with autism spectrum disorder (21) (22). However, music helps improve social and emotional aspects in patients with Alzheimer’s disease (12) (13) (14) and quality of life in patients with dementia (15) (67), stroke (16), and schizophrenia (68). Positive effects of group music therapy were experienced by elderly individuals with mild to moderate dementia (17). Music interventions also reduced anxiety among older adults in an urban emergency department (18), in full-term pregnant women (19), and in women with fibromyalgia (20). A meta-analysis also indicates music therapy can help reduce depressive symptoms in patients with various conditions (71).

In online settings
Virtual mind-body programs that include music therapy help patients access supportive care that enhances coping, motivation, social connections, and adherence to health behaviors (73) (74) (75). The Integrative Medicine Service at MSK offers music therapy and other mind-body modalities in our online program, Integrative Medicine at Home, to help support the recovery and well-being of cancer patients everywhere.

Mechanism of Action

Therapeutic framework
The therapeutic framework and interaction offers patients opportunities for new aesthetic, physical, and relational experiences (52). This can be particularly important as patients who are hospitalized or undergoing treatment may experience increased isolation and limited communication.

Music selection and delivery method are important considerations in periprocedural settings to induce relaxation and decrease anxiety. For example, slow-rhythm music for women undergoing colposcopy reduced anxiety and pain perception (36) (37).

Patient-centered
The intimate nature of music that is written or offered translates to a deeply personal and transporting experience. Listening to preferential music shifts the autonomic balance towards parasympathetic activity (53). Background, experiences, and traditions that have meaning to the patient as well as cherished songs or intriguing sounds can engage the brain’s reward circuitry (54), and guide therapy to energize someone who feels lethargic, evoke pleasant sensations and autobiographical memory (55), or calm agitation and distressed mood.

Entrainment
The principle of entrainment, a method used with live music, is effective in agitated patients (56). It musically emulates an existing pattern of body processes to meet a person where they are and offer a bridge by which one can organically move into a less distressed state.

Neuroplasticity
Neurobiological and cognitive effects of singing therapy used in rehabilitation include neuroplastic reorganization, mirror neuron system activation, and multimodal integration as well as the shared and distinct features fundamental to music and language (57).

Breathing and movement patterns
Among studies of singing lessons for lung conditions, Parkinson’s disease, and multiple sclerosis, participants had improved breathing, breath control, physical functioning, and mood, and also described it as fun and good exercise (58). Rhythmic movements with a percussion intervention was shown to activate the prefrontal cortex in older adults with mild cognitive impairment (59).

During high-intensity exercise, music promotes ergogenic and psychological benefits but may not reduce perceptions of exertion beyond the anaerobic threshold (42).

Immune function
Animal studies suggest music exposure enhances lymphocyte function in the brain to reverse stress-induced immune suppression (60). In humans, drumming has also been shown to enhance cellular immunity by increasing lymphocyte activated natural killer cell activity (44).

Adverse Reactions
  • Music therapy is safe, but should be provided by a qualified therapist.
  • Because music therapy is noninvasive, free of side effects, and has shown effectiveness, it is a part of standard supportive care in major cancer hospitals and other institutions.
  • Music therapy is also recommended in cancer supportive care guidelines.
Practitioners and Treatments
  • Music therapy practitioners employ evidence-based techniques for symptom management in clinical, intensive care, and hospice settings. Music therapists also work with other populations, such as specials needs and mental health patients.
  • A skilled music therapist is integral to
    – Offer and assess options for engagement
    – Encourage patient confidence in expression
  • For example, a therapist may help a patient write their own music to
    – Enjoy experimentation and discovery
    – Take them to a place of understanding about themselves
    – Provide a way to more easily communicate with loved ones and caregivers
  • Professional music therapists hold a degree in music therapy from a college or university program approved by the American Music Therapy Association (AMTA). Graduates may then apply for the national credential of Music Therapist – Board Certified (MT-BC).
  • There are about 8,000 board-certified therapists in the US.
  • Some may also have post-graduate specialty certifications like
    – Hospice and Palliative Music Therapy (HPMT)
    – Neurologic Music Therapy (NMT)
    – Nordoff-Robbins Music Therapy (NRMT)
  • Music therapists who include psychotherapy in their practice may need additional licensure.
  • Qualified therapists are listed in the AMTA’s National Music Therapy Registry.
  • International organizations include
    – World Federation of Music Therapy
    – International Society for Music Education
  • Many major hospitals and most NCI-designated cancer centers now offer some form of music therapy as part of their supportive care and rehabilitation programs.

The Integrative Medicine Service at MSK offers music therapy and other mind-body modalities in a new online program, Integrative Medicine at Home, to help support the recovery and well-being of cancer patients everywhere.

References
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  2. van der Heijden MJ, Oliai Araghi S, van Dijk M, et al. The Effects of Perioperative Music Interventions in Pediatric Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS One. 2015;10(8):e0133608.
  3. Good M, Anderson GC, Stanton-Hicks M, et al. Relaxation and music reduce pain after gynecologic surgery. Pain Manag Nurs. Jun 2002;3(2):61-70.
  4. Bradt J, Dileo C, Shim M. Music interventions for preoperative anxiety. Cochrane Database Syst Rev. Jun 6 2013(6):Cd006908.
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  7. Millett CR, Gooding LF. Comparing Active and Passive Distraction-Based Music Therapy Interventions on Preoperative Anxiety in Pediatric Patients and Their Caregivers. J Music Ther. Jan 13 2018;54(4):460-478.
  8. Chlan LL, Weinert CR, Heiderscheit A, et al. Effects of patient-directed music intervention on anxiety and sedative exposure in critically ill patients receiving mechanical ventilatory support: a randomized clinical trial. JAMA. Jun 12 2013;309(22):2335-2344.
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