Art & Science of Music Therapy

A Handbook

Tony Wigram, Bruce Saperston, Robert West, Tony Wigram, Bruce Saperston, Robert West

• Publisher: Routledge
• Year: 2013
• eBook ISBN: 9781134362691
• Edition: 1
• Topic: Media & Performing Arts
• Subtopic: Performing Arts

The fascinating and exciting evidence in this book has tremendous appeal. For students of Music Therapy, and others training in medical and paramedical disciplines, it can be considered an essential text for study, and required reading to gain an overview of the field. This book provides a landmark in the literature of Music Therapy. For the scientist, chapters on the biological and medical effects of music give a wealth of research evidence on the value of music in therapy and music in medicine. For readers from paramedical, educational and other clinical fields, there are eighteen chapters detailing music therapy techniques and approaches in psychiatry, pediatrics, learning difficulties, elderly and sensory handicap. Diagnosis and assessment are covered in considerable detail and the general effect of music is reviewed in many of the contributions. For all qualified music therapists and students.

Section 1: The Biological and Medical Effects of Music

1

Music as a Therapeutic Intervention in Medical and Dental Treatment: Research and Clinical Applications

Jayne Standley

Introduction

If given an option, would most pregnant women elect to reduce the length of labour by an average of two hours? Would the patient in the surgical recovery room choose to awaken from the anaesthesia sooner, with fewer side effects and less pain? Would persons with chronic pain prefer to use less analgesic medication, thereby reducing possible side effects? Would those undergoing consequential medical treatment opt for reduced anxiety during its course? Research shows that music provides the above medical benefits and more, and that most people perceive their preferred music to be relaxing and beneficial to their recovery.

Despite the volume of research demonstrating the value of music in a variety of medical and dental treatments, there is little consensus on which techniques or procedures are most effective. Further, the profession of music therapy is still evolving as a viable component in the array of medical treatments. As medical music therapy develops, its methodology will have to conform to the specifications of the medical model, i.e. a priori treatment protocols dictated by specific diagnoses and proven options, predictable outcomes for a known frequency and duration of applications, and systematic documentation procedures to readily identify positive or negative health consequences. A formal summary of the research literature which provides a quantitative synthesis of the available data could assist the evolution of accountable music therapy techniques in applied health practices.

A meta-analysis is a procedure which provides quantitative synthesis of research data through formal statistical techniques. Specifically, it is the application of a variety of formulae to the results of a body of homogeneous research to compute effect sizes, i.e. quantitative summaries of the properties and findings of individual studies. Effect sizes can then be compared and contrasted across multiple variables (Glass, et al., 1984) and these overall results, to some extent, generalised.

The purposes of this chapter are to use the results of a meta-analysis of existing research in music and medicine to identify and authenticate effective music therapy techniques and to develop these techniques into clinical procedures which meet the criteria of standard medical protocols.

While empirical studies on the effects of music in medical treatment continue to accumulate, by the mid-1980s there existed a sufficient quantity for reasonable and relevant analysis. An initial study screened over 98 references on this topic and identified 30 empirical studies which were amenable to a comprehensive meta-analysis of characteristics and results (Standley, 1986). Recently, additional references published since 1986 were reviewed and analysed, resulting in a pooled meta-analysis of 55 studies utilising 129 dependent variables (Standley, 1992).

Procedures and Results

Studies qualified for inclusion in the two meta-analyses by containing empirical data; by utilising actual, not simulated pain stimuli; by utilising music as an independent variable; by utilising subjects who were actual patients with medical or dental diagnoses; and by reporting results in a format amenable to data analysis. The procedures followed the three basic steps outlined by Getsie, Langer and Glass (1985): 1) a complete literature search was conducted to find all possible members of the defined population of studies whether published or unpublished; 2) the characteristics and findings of the collected studies were identified, described, and categorised; and 3) the composite findings were statistically analysed and standardised effect sizes computed.

Table 1 shows that the resulting estimated effect sizes ranged from 3.28 to.59, meaning that the music condition was sometimes more than three standard deviations greater in desired effect from the control condition without music. Only 4 of the 129 variables had a negative value, indicating that for those dependent measures the music condition was less beneficial than the non music one. (It should be noted that several of these negative results were from studies where other dependent measures showed a positive reaction to music.) The overall mean effect size for all 129 dependent measures was .88. Therefore the average therapeutic effect of music in medical treatment was almost one standard deviation greater than that without music.

Table 1. Mean music effect size for each dependent variable analysed

Reference	Dependent variable	Effect size
Bob	Podiatric Pain	>3.28
Ammon	Paediatric Respiration	3.15
Oyama et al.	Pulse-Dental Patients	3.00
Monsey	Use of Analgesia-Dental	2.49
Martin	EMG-35 Min. of Music	2.38
Gardner & Licklider	Use of Analgesia-Dental Pts.	2.36
Oyama et al.	Blood Pressure-Dental Pts.	2.25
Rider	Plain-(Debussy)	2.11
Siegel	Medication-Paediatric Surgery	2.11
Martin	EMG-26-30 Min. of Music	2.10
Schuster	Distraction-Hemodialysis	2.08
Rider	EMG-(Entrainment)	2.03
Chetta	Observed Paediatric Anxiety	1.97
Cofrancesco	Grasp Strength-Stroke Pts.	1.94
Rider	EMG-(Metheny)	1.90
Tanioka et al.	Cortisol-Surgical Recovery	1.80
Bonny	Perceived Anxiety-Cardiac Pts.	1.77
Budzynski et al.	EMG-Tension Headache	1.76
Budzynski et al.	Pain Intensity-Headache	1.76
Rider	EMG-(Crystal)	1.56
Rider	Pain-(Reich)	1.55
Rider	EMG-No Music	1.52
Ward	Pain-Debridement of Burns	1.52
Rider	Pain-(Entrainment)	1.51
Locsin	Post-operative Pain	1.49
McDowell	Attitude Toward Music	1.34
Tanioka et al.	Adrenalin-Surgery	1.33
Winokur	Relaxation-Obstetrical	1.32
Siegel	Pulse-Paediatric	1.28
Tanioka et al.	Anxiety-Surgery	1.28
Schieffelin	Crying-Debridement	1.23
Bonny	Pulse-Cardiac	1.22
Martin	EMG-18-25 Min. of Music	1.22
Roberts	Intracranial Pressure - preferred vs sedative music	1.21
Jacobson	Perceived Pain-Dental	1.19
Rider	Pain-(Metheny)	1.16
Bonny	Perceived Pain-Cardiac
	1.15
Spintge & Droh	Choice of Epidural Anaesthesia-Surgery	1.12
Sanderson	Preoperative Anxiety	1.02
Epstein et al.	Migraine Headache	1.00
Winokur	Length of Labour-Childbirth	.99
Goloff	Perceived Satisfaction	.98
Levine-Gross & Swartz	State-Trait Anxiety	.98
Winokur	Use of Medication-Obstetrical	.98
Froelich	Verbalizations	.97
Rider	Pain-(Crystal)	.96
Rider	Pain-(No Music)	.96
Shapiro & Cohen	Pain-Abortion	.96
Gfelleret al.	Helplessness-Dental Pts.	.94
Staum	Walking Speed-Stroke Pts.	.94
Staum	Gait Improvement-Stroke	.94
Rider	EMG-(Preferred Music)	.91
Hanser et al.	Observed Childbirth Pain	.90
Sanderson	Pain Relief-Surgical	.89
Crago	Relaxation-Open Heart Surgery	.88
Crago	Pain-Open Heart Surgery	.87
Scartelli	EMG of Spasticity	.85
Behrens	Exhalation Strength	.83
Hoffman	Blood Pressure-Hypertension	.83
Locsin	Blood Pressure-Surgical	.82
Kamin et al.	Cortisol-20 Min. after Extubation	.80
Tanioka et al.	Cortisol-1 hr. of Surgery	.75
Brook	Pulse-Obstetrical	.73
Brook	Neonate Apgar Score	.73
Lininger	Neonate Crying	.72
Shapiro & Cohen	Pain-Abortion	.71
Caine	Neonate Weight Gain	.71
Schneider	Pain-Paediatric Burn Pts.	.70
Curtis	Contentment-Cancer Pts.	.67
Kamin et al.	Cortisol at Anaesthesia	.67
Roberts	Intracranial Pressure - preferred music vs silence	.67
Burt & Korn	Perceived Effect-Obstetrical	.66
Chapman	Neonate Hospitalization	.65
Curtis	Perceived Cancer Pain	.63
Frank	Anxiety-Chemotherapy	.63
Codding	Perceived Childbirth Pain	.59
Epstein et al.	Pain Intensity-Headache	.59
Rider	Pain-(Preferred Music)	.59
Sanderson	Pain Verbalization-Surgical	.58
Caine	Neonate Hospitalization	.56
Locsin	Pulse-Surgical	.56
Sanderson	Blood Pressure-Surgical	.55
Brook	Cervical Dilation Time	.52
Goloff	Physical Comfort	.51
Rider	EMG-(Reich)	.50
Sanderson	Analgesics-Surgical	.50
Ward	Pulse-Burn Pts.	.50
Roberts	Blood Pressure - preferred music vs silence	.49
Ward	Perceived Pain-Debridement	.48
Corah et al.	Autonomic Sensations-Dental	.47
Frank	Emesis Intensity-Chemotherapy	.47
Crago	Music Listening-Open Heart	.45
Kamin et al.	Cortisol-15 Min. after Incision	.44
Sammons	Music Choice	.44
Bonny	Blood Pressure-Cardiac	.42
Crago	Sleep-Open Heart Surgery	.42
Kamin et al.	Cortisol-10 Min. Before Anaesthesia	.42
Spintge	Epidural Anesthesia	.42
Crago	Anxiety-Open Heart Surgery	.41
Burt & Korn	Use of Analgesia-Obstetrical	.39
Metzler & Berman	Pulse-Bronchoscopy	.39
Frank	Nausea Length-Chemotherapy	.36
Burt & Korn	Amount of Analgesic-Obstetrical	.35
Bailey	Perceived Anxiety-Cancer	.34
Clark et al.	Perceived Anxiety-Obstetrical	.34
Clark et al.	Perceived Pain-Obstetrical	.33
Frank	Emesis Length-Chemotherapy	.33
Rider	EMG-(Debussy)	.33
Crago	Analgesic-Open Heart Surgery	.30
Roter	Perceived Benefit-Patients	.28
Lininger	Neonate Crying - instrumental vs no music	.26
Roter	Perceived Benefit-Families	.26
Livingood et al.	Perceived Anxiety-Families	.23
Owens	Neonate Movement	.19
Lininger	Neonate Crying - vocal vs instrumental music	.15
Chapman	Neonate Movement	.14
Clark et al.	Perceived Length of Labour	.14
Clark et al.	Childbirth Attitude	.10
Schuster	Blood Pressure-Dialysis	.10
Owens	Neonate Crying	.06
Caine	Neonate Relaxation	.05
Roberts	Blood Pressure - preferred vs sedative music	.03
Owens	Neonate Weight	.02
Siegel	Respiration-Paediatric	.01
Frank	Nausea Intensity-Chemotherapy	.00
Tanioka et al.	ACTH Level-Surgery	-.17
Corah et al.	Anxiety-Dental	-.39
Crago	Hospitalization-Open Heart	-.51
Caine	Neonate Formula Intake	-.59

N= 129 Overall mean effect size of music = .88

After each study was evaluated and categorised according to its unique characteristics and a value on a linear scale of effect was calculated for each dependent variable incorporated, then multiple comparisons were made, i.e. subjects’ diagnosis, age or sex; type of experimental design or sample size; and independent or dependent variables.

Since a primary concern of a meta-analysis is the acceptability of generalised results based on the soundness or inherent bias of research procedures as judged by peer review, studies were compared on this issue. The analysed variables proved to be primarily from published (N=77) vs. unpublished (N=52) sources. It was found that published sources which were not refereed yielded the same effect size (1.0) as published refereed studies. Unpublished, refereed studies, such as theses and dissertations undergoing stringent faculty review, were few in number and yielded the smallest effects (.69). It was concluded that music results included in the meta-analysis were neither biased by the publication/referee process nor inflated by the lack thereof.

A secondary concern about the viability of the research included for analysis was the impact that design variables might have had on reported results. Studies which used a research design with experimental and control groups were in the majority and yie...

Table of contents

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Contents
• Acknowledgements
• Foreword
• Preface
• List of Contributors
• Section 1 The Biological and Medical Effects of Music
• Section 2 Music Therapy in Psychiatry
• Section 3 Music Therapy with Children
• Section 4 Music Therapy with the Mentally Handicapped
• Section 5 Music Therapy with the Elderly
• Section 6 Specialised Areas of Work in Music Therapy
• References
• Index