National experts have recommended that children with life-limiting illnesses receive integrated palliative and medical care. These programs offer a variety of services, including music therapy. Using survey data from parents whose were enrolled in Florida's Partners in Care: Together for Kids (PIC:TFK) program, this study investigates parents' experiences with music therapy. About 44% of children with life-limiting illnesses and 17% of their siblings used music therapy. For children who used music therapy, multivariate results suggest that their parents were 23 times as likely to report satisfaction with the overall PIC:TFK program (P < .05) versus parents whose children did not use music therapy. Pediatric palliative care programs should include music therapy, although recruiting licensed music therapists may be challenging.

Am J Hosp Palliat Care. 2009 Aug 7. Knapp C, Madden V, Wang H, Curtis C, Sloyer P, Shenkman E. University of Florida.

Full Title: Music therapy to relieve anxiety in pregnant women on bedrest: a randomized, controlled trial

PURPOSE: To explore the effect of music therapy on anxiety alleviation for antepartal women on bedrest in China. DESIGN AND METHODS: One hundred and twenty patients recruited from one tertiary hospital in Changsha city, China were enrolled in a randomized controlled trial. Women in the experimental group received music therapy for 30 minutes on 3 consecutive days. Usual care participants had a 30-minute rest on 3 consecutive days. Variables included anxiety (State-Trait Anxiety Inventory), and physiological responses (vital signs, fetal heart rate). Descriptive statistics, t tests, chi tests, Wilcoxon rank sum tests, and Pearson correlation analyses were used to analyze the data. RESULTS: Anxiety levels decreased and physiological responses improved significantly in the intervention group, which was provided with music therapy while on bedrest. CLINICAL IMPLICATIONS: Carefully selected music that incorporates a patient's own preferences may offer an inexpensive and effective method to reduce anxiety for antepartal women with high risk pregnancies who are on bedrest.

MCN Am J Matern Child Nurs. 2009 Sep-Oct;34(5):316-23. Yang M, Li L, Zhu H, Alexander IM, Liu S, Zhou W, Ren X. The Mental Health Institute, the Second Xiangya Hospital of Central South University, Changsha Hunan, China. yangmin426@yahoo.com.cn

This article describes the experience of a nurse who used music therapy as the intervention to reduce a patient's pain during wound care after orthopedic surgery. The intervention was applied between April 8th and April 29th 2008. The nurse applied Roy's adaptation model as the assessment tool. The major and primary health problem identified was acute pain accelerated by wound care. The pain of this client not only triggered negative feelings, but also affected negatively on his daily life and feelings of self-belongingness. Through an individual-tailored music therapy, the client's pain during wound care was greatly reduced and even completely disappeared. The ultimate outcome of decrease in pain included reductions in negative feelings and increased positive spiritual strength. It is recommended that nurses who are responsible for wound care use this simple and economical music intervention to reduce acute postoperative pain.

Hu Li Za Zhi. 2009 Aug;56(4):105-10. Hsiao TY, Hsieh HF. School of Nursing, Fooyin University, ROC. ns128@mail.fy.edu.tw.

Full Title: Emotional, motivational and interpersonal responsiveness of children with autism in improvisational music therapy

Through behavioural analysis, this study investigated the social-motivational aspects of musical interaction between the child and the therapist in improvisational music therapy by measuring emotional, motivational and interpersonal responsiveness in children with autism during joint engagement episodes. The randomized controlled study (n = 10) employed a single subject comparison design in two different conditions, improvisational music therapy and toy play sessions, and DVD analysis of sessions. Improvisational music therapy produced markedly more and longer events of 'joy', 'emotional synchronicity' and 'initiation of engagement' behaviours in the children than toy play sessions. In response to the therapist's interpersonal demands, 'compliant (positive) responses' were observed more in music therapy than in toy play sessions, and 'no responses' were twice as frequent in toy play sessions as in music therapy. The results of this exploratory study found significant evidence supporting the value of music therapy in promoting social, emotional and motivational development in children with autism.

Autism. 2009 Jul;13(4):389-409. Kim J, Wigram T, Gold C. Department of Arts Therapy, College of Alternative Medicine, Jeonju University, Korea. jinahkim@jj.ac.kr

Earlier studies have demonstrated that music interventions can lessen symptoms of depression. Depression and burnout are closely related. We hypothesized that specially designed receptive music therapy programs and protocols might reduce the symptoms of burnout. In a four-arm randomized, placebo- and waiting-list-controlled double-blind study, including 150 participants, two specific music programs significantly reduced burnout symptoms after 5 weeks. The effects were maintained over a long time period. This newly developed method of receptive music therapy was also evaluated for the treatment of depression and dysthymia, with significant outcomes.

Ann N Y Acad Sci. 2009 Jul;1169:422-5. Brandes V, Terris DD, Fischer C, Schuessler MN, Ottowitz G, Titscher G, Fischer JE, Thayer JF. Research Program MusicMedicine, Paracelsus Medical University, Salzburg, Austria. vera.brandes@pmu.ac.at

Full Title: The effect of group music therapy on quality of life for participants living with a severe and enduring mental illness

A 10-week group music therapy project was designed to determine whether music therapy influenced quality of life and social anxiety for people with a severe and enduring mental illness living in the community. Ten one-hour weekly sessions including song singing, song writing and improvisation, culminated in each group recording original song/s in a professional studio. The principal outcome measure was the WHOQOLBREF Quality of Life (QoL) Scale; other instruments used were the Social Interaction Anxiety Scale (SIAS) and the Brief Symptom Inventory (BSI). Qualitative data were gathered through focus group interviews and an analysis of lyric themes. Statistically significant improvement was found on five items of the QoL Scale. There were no changes on the BSI indicating that QoL improvement was not mediated by symptomatic change. Themes from the focus groups were: music therapy gave joy and pleasure, working as a team was beneficial, participants were pleasantly surprised at their creativity, and they took pride in their song. An analysis of song lyrics resulted in 6 themes: a concern for the world, peace and the environment; living with mental illness is difficult; coping with mental illness requires strength; religion and spirituality are sources of support; living in the present is healing; and working as a team is enjoyable.

J Music Ther. 2009 Summer;46(2):90-104. Grocke D, Bloch S, Castle D. The University of Melbourne, St Vincent's Hospital.

This study aims at determining the effectiveness of music therapy in a hospice setting. We employed the salivary cortisol level, which is widely used to measure stress level, as an objective and physical indicator and the Mood Inventory, which measures mood change, as the subjective and psychological indicators. Though many preceding studies have demonstrated that listening to music lowers cortisol levels and reduces stress, no study seems to have included hospice patients. This study measured, with the consent of 10 hospice inpatients, their salivary cortisol levels. Individual interviews, according to the Mood Inventory, were conducted before and after a small-group session. Since all the participants had terminal cancer, the 40-minute live session of songs of seasons and the participants' requests was given in a mostly passive manner considering their physical strength. Results showed significant lowering of salivary cortisol levels after the therapy session. As for the parameters of mood, refreshment was significantly increased. Though fatigue remained unchanged, anxiety and depression decreased while the score for excitement tended to increase. Thus, it was indicated that music therapy in a hospice setting reduces the stress level of patients and thereby plays a positive role in improving patients' quality of life.

J Music Ther. 2009 Summer;46(2):160-72. Nakayama H, Kikuta F, Takeda H. Sapporo Otani College.

Full Title: The effect of expressive and instrumental touch on the behavior states of older adults with late-stage dementia of the Alzheimer's type and on music therapist's perceived rapport

The purpose of this study was to examine the effect of music therapy interventions utilizing two types of touch, expressive touch and instrumental touch, on the behavior states of older adults who have late-stage dementia of the Alzheimer's type. A secondary purpose of this study was to examine the perceived effectiveness of the music therapist when expressive and instrumental touch was employed during music therapy sessions. A within-subject design was used with 9 participants receiving 3 sessions in each of the experimental conditions: no touch, expressive touch, and instrumental touch. Results of a one-way ANOVA revealed that expressive touch was significantly more effective during the initial session in eliciting and maintaining alert behavior states than the instrumental and control conditions; however, there were no significant differences between the experimental and control conditions during the first and second session repetitions. Rapport ratings revealed that the therapist's client rapport was perceived to be significantly higher during both the expressive touch and instrumental touch conditions than during the control condition. These findings have important implications for music therapy practice and the effective use of nonverbal communication.

J Music Ther. 2009 Summer;46(2):132-46. Belgrave M. The Florida State University, FL, USA.

This contribution focuses on the definition of music therapy as a specific applicative context to be seen as distinct from the generic use of music in a variety of pathologies. Music therapy is presented as a discipline grounded both upon relationship and upon the theoretical-methodological principles peculiar to each applicative model. The therapeutic nature proper to music therapy is highlighted with specific reference to the domain of the dementias. Music therapy facilitates expression, communication and relationship in the non-verbal context. Such an opportunity allows persons with dementia to establish contact, to express, and even contrive an organisation/regulation of their emotions, through the sonorous-musical relationship with the music therapist. On the basis of a brief analysis of the relevant literature, attention is drawn to the importance of both evidence-based clinical practice and music therapy evaluations, aimed at proving the effectiveness of music therapy, while promoting its correct application.

Curr Alzheimer Res. 2009 Jun;6(3):293-301. Raglio A, Gianelli MV. Sospiro Foundation and INTERDEM Group (Psycho-Social Interventions in Dementia), Cremona, Italy. raglioa@tin.it

AIMS: To determine whether definable subtypes exist within a cohort of patients listening to music with regard to their physiological patterns and to compare whether associated factors vary between subjects in groups with different profiles. BACKGROUND: The intensive care unit (ICU) is one of the most stressful environments for patients among various clinical settings in a hospital. ICU patients are not only compromised by illness but also faced with a wide range of stressors. DESIGN: A repeated-measures design was conducted with one music group. METHOD: One hundred and one patients were recruited in three intensive care units in Hong Kong. There were two main outcome variables: demographic characteristics and physiological outcomes. RESULTS: A cluster analysis yielded two clusters. Patients in cluster 1 typically experienced relatively low therapeutic effects from listening to music. There were more males, of a younger age but more educated and employed than patients in cluster 2, and they represented 41.6% of the total respondents. Cluster 2 comprised almost 58.4% of this study sample and they reported high therapeutic effects of music. There were more females in this group as well as more older people and they mainly used a ventilator in the intensive care unit. CONCLUSION: Our study shows that music may have a more positive effect on groups of patients whose profile is similar to that of the patients in cluster 2, than for patients such as those in cluster 1. A clear profile may help health professionals to design appropriate care therapy to target a specific group of patients to improve their physiological outcomes. RELEVANCE TO CLINICAL PRACTICE: The implication of this study is that music therapy should be provided to patients as a relaxation technique if they are willing to accept it, and the selection of music should be based on their preferences. Information should be given to patients so that they can understand how music therapy works and they should be encouraged to focus their attention on listening to the music to maximise its benefits.

J Clin Nurs. 2009 May;18(9):1250-7. Epub 2008 Sep 4. Chan MF, Chung YF, Chung SW, Lee OK. Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore. nurcmf@nus.edu.sg

The purpose of this study was to determine the effect of music on peer awareness in preschool age children with developmental disabilities. Specifically, this study sought to find which combinations of musical and play elements produced the longest durations of sustained attention towards peers and the highest frequency of alternating attention from peer to peer. Nine children between the ages of 2 and 6 who had been diagnosed with a developmental disability participated in the study. Each participant completed 4 small group sessions with the researcher and 2 other research participants. During each session, the children participated in activities targeting peer awareness that incorporated musical and play elements. Behavioral data were recorded representing the children's sustained and alternating attention towards peers. Results indicated that children sustained attention towards peers for the longest durations and alternated attention from peer to peer at the highest frequencies during activities that utilized a musical object within a nonmusical or play-based context.

J Music Ther. 2009 Spring;46(1):53-68. Sussman JE. University of Missouri-Kansas City, USA.

The purpose of this study was to examine the effect of background music and song texts to teach emotional understanding to children with autism. Participants were 12 students (mean age 11.5 years) with a primary diagnosis of autism who were attending schools in Japan. Each participant was taught four emotions to decode and encode: happiness, sadness, anger, and fear by the counterbalanced treatment-order. The treatment consisted of the four conditions: (a) no contact control (NCC)--no purposeful teaching of the selected emotion, (b) contact control (CC)--teaching the selected emotion using verbal instructions alone, (c) background music (BM)--teaching the selected emotion by verbal instructions with background music representing the emotion, and singing songs (SS)--teaching the selected emotion by singing specially composed songs about the emotion. Participants were given a pretest and a posttest and received 8 individual sessions between these tests. The results indicated that all participants improved significantly in their understanding of the four selected emotions. Background music was significantly more effective than the other three conditions in improving participants' emotional understanding. The findings suggest that background music can be an effective tool to increase emotional understanding in children with autism, which is crucial to their social interactions.

J Music Ther. 2009 Spring;46(1):15-31. Katagiri J. The Florida State University, USA.

Full Title: Effects of listening to music on auditory hallucination and psychiatric symptoms in people with schizophrenia

PURPOSE: The purpose of this study was to explore the effects of listening to music in inpatients diagnosed with schizophrenia, on their auditory hallucinations, and positive and negative symptoms. METHODS: A quasi-experimental research design with 2x2 cross-over trial and convenience sample was used. Eleven patients (Group AB) listened to music followed by a wash out period and then a usual care period, and 12 patients (Group BA) had a usual care period followed by a wash out period and then listened to music. For one week those who were in the experimental period listened to individualized music using an MP3 player whenever they heard hallucinations. RESULTS: There was a statistically significant decrease in the frequency of auditory hallucinations after listening to the music. There was a decrease in the mean scores for positive symptoms, negative symptoms, and general psychopathology after listening to music, but only negative symptoms showed a statistically significant decrease. The treatment effects on scores for positive symptoms, negative symptoms, and general psychopathology were greater in Group BA than Group AB. CONCLUSION: These findings suggest that listening to music may be useful for managing auditory hallucinations in schizophrenia inpatients.

J Korean Acad Nurs. 2009 Feb;39(1):62-71. Na HJ, Yang S. College of Nursing, The Catholic University of Korea, Seoul, Korea.

Average age of residents living in National sanatorium Hoshizuka-Keiaien where people have past history of Hansen disease is around 80 years old at present, and many of them spend their whole days in watching TV or sleeping almost alone in their rooms. Therefore music therapy was introduced in order to improve their daily activities in our sanatorium. Singing, listening to music, playing the musical instruments, and dancing were performed, either in a group or individually. Reactivation of their brain function such as recollection, sense of unity and relaxation were expected. Improvement of cardiopulmonary function was also expected. Solidarity and relaxed state were observed by being with the other participants in the group therapy. For example, when using musical instruments, some participants with hesitation tried to use their instruments, and had good performance. They seemed to be satisfied and became confident with the musical instruments. Then their confidence and satisfaction activated the group. After the sessions, mutual conversation increased. These processes obtained a synergy effect, which means that a group affects of individuals at first and next alteration of individual behavior influences the group. We could observe a better effect in their motivation and activity in their daily life in the individual therapy. The music therapy was applied to the senior participants by the music therapist in this study. The participants could easily reinforce their mind and body through this therapy. Music therapy will be continued for the improvement of quality of life of residents in the sanatorium.

Nihon Hansenbyo Gakkai Zasshi. 2009 Feb;78(1):35-9. Fukamizu Y, En J, Kano T, Arikawa I. National Sanatorium Hoshizuka-Keiaien, 4204 Hoshizuka-cho, Kanoya City, Kagoshima 893-8502, Japan. reha-ot@hoshizuka.hosp.go.jp

Full Title: Effect of music therapy on anxiety and depression in patients with Alzheimer's type dementia: randomised, controlled study

BACKGROUND/AIMS: Numerous studies have indicated the value of music therapy in the management of patients with Alzheimer's disease. A recent pilot study demonstrated the feasibility and usefulness of a new music therapy technique. The aim of this controlled, randomised study was to assess the effects of this new music therapy technique on anxiety and depression in patients with mild to moderate Alzheimer-type dementia. METHODS: This was a single-centre, comparative, controlled, randomised study, with blinded assessment of its results. The duration of follow-up was 24 weeks. The treated group (n = 15) participated in weekly sessions of individual, receptive music therapy. The musical style of the session was chosen by the patient. The validated 'U' technique was employed. The control group (n = 15) participated under the same conditions in reading sessions. The principal endpoint, measured at weeks 1, 4, 8, 16 and 24, was the level of anxiety (Hamilton Scale). Changes in the depression score (Geriatric Depression Scale) were also analyzed as a secondary endpoint. RESULTS: Significant improvements in anxiety (p < 0.01) and depression (p < 0.01) were observed in the music therapy group as from week 4 and until week 16. The effect of music therapy was sustained for up to 8 weeks after the discontinuation of sessions between weeks 16 and 24 (p < 0.01). CONCLUSION: These results confirm the valuable effect of music therapy on anxiety and depression in patients with mild to moderate Alzheimer's disease. This new music therapy technique is simple to implement and can easily be integrated in a multidisciplinary programme for the management of Alzheimer's disease. Copyright 2009 S. Karger AG, Basel.

Dement Geriatr Cogn Disord. 2009;28(1):36-46. Epub 2009 Jul 23. Guétin S, Portet F, Picot MC, Pommié C, Messaoudi M, Djabelkir L, Olsen AL, Cano MM, Lecourt E, Touchon J. Service de Neurologie, Centre Mémoire de Ressources et de Recherches (CMRR), Inserm U888, CHRU Montpellier, Montpellier, France. stephane.guetin@yahoo.fr

PURPOSE: Music has been utilized as a therapeutic tool during colonoscopy, but various randomized controlled trials (RCTs) have been inconsistent. We conducted a meta-analysis to analyze the effect of music on patients undergoing colonoscopy. PATIENTS AND METHODS: Multiple medical databases were searched (12/06). Only RCTs on adult subjects that compared music versus no music during colonoscopy were included. Meta-analysis was analyzed for total procedure time, dose of sedative medications (midazolam and mepiridine), and patients' pain scores, experience, and willingness to repeat the same procedure in the future. RESULTS: Eight studies (N = 712) met the inclusion criteria. Patients' overall experience scores (P < 0.01) were significantly improved with music. No significant differences were noted for patients' pain scores (P = 0.09), mean doses of midazolam (P = 0.10), mean doses of meperidine (P = 0.23), procedure times (P = 0.06), and willingness to repeat the same procedure in future (P = 0.10). CONCLUSIONS: Music improves patients' overall experience with colonoscopy.

Dig Dis Sci. 2009 Jan;54(1):19-24. Epub 2008 May 16. Bechtold ML, Puli SR, Othman MO, Bartalos CR, Marshall JB, Roy PK. Division of Gastroenterology, University of Missouri School of Medicine, One Hospital Drive, Columbia, MO 65212, USA.

The aim of this study was to determine the effect of music alone, aromatherapy alone, and music in addition to aromatherapy on anxiety levels of adults accompanying children to a pediatricemergency department waiting area. METHODS: The study was conducted over 28 consecutive days, assigned to 1 of 4 groups: no intervention, music, aromatherapy, and both music and aromatherapy. Adults accompanying children to the emergency department of an urban pediatric tertiary care referral center were given a survey including a Spielberger state anxiety inventory with additional questions about whether they noticed an aroma or music and if so their response to it. The music was classic ingenre with a tempo of 60 to 70 beats per minute. The aromatherapyused the essential oil Neroli dispersed using 2 aromatherapydiffusers placed in strategic airflow ends of the emergency department. RESULTS: The 1104 surveys were completed. There was a statistically significant decrease in anxietylevel on those days when music was playing (36.3 vs. 39.2; P = 0.017). There was no difference in anxiety levels on those days when aromatherapy was present compared with the nonaromatherapy days (37.3 vs. 38.0; P = 0.347). CONCLUSIONS: Music is an easy and useful way to decrease the anxiety of visitors in an emergency department waiting area. Although no difference was detected for the aromatherapy group, this could be because of environmental conditions or imprecise application of the aromatherapy; further study is needed to either prove or disprove its effectiveness in this setting.

Pediatr Emerg Care. 2008 Dec;24(12):836-8. Holm L, Fitzmaurice L. Department of Pediatrics, Division of Emergency Medical Services, Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA. Holml2@ihs.org

The purpose of this study was to assess the effect of lento music on examination anxiety among nursing students. A randomized crossover classroom-based trial was conducted. Thirty-eight students with a mean age of 19.4 years (SD = .54) were randomly assigned to either a music/silence or a silence/music group sequence. The students in the music group were given a 40-min group-based music intervention in a classroom, whereas the students in the silence group received the regular test without music. Using paired t-tests, there were no significant different in pretest scores for state anxiety, examination anxiety, finger temperature and pulse rate between the two conditions. Nonetheless, the findings indicated that music intervention did effectively decrease examination anxiety and state anxiety as well as reducing pulse rate and increasing higher finger temperature (p = 0.05 to 0.001). In addition, significant differences were detected between the pretest and posttest measures for silence (p = 0.001). The results suggest that lento music is effective at anxiety reduction. This study provides evidence for nursing faculty and clinical educators to foster nursing students' mastering over the anxiety of examination by using lento music.

Nurse Educ Today. 2008 Nov;28(8):909-16. Epub 2008 Jul 1. Lai HL, Chen PW, Chen CJ, Chang HK, Peng TC, Chang FM. Department of Nursing, Tzu Chi University, Taiwan, ROC. snowjade@mail.tcu.edu.tw

Full Title: The effects of improvisational music therapy on joint attention behaviors in autistic children: a randomized controlled study

The purpose of this study was to investigate the effects of improvisational music therapy on joint attention behaviors in pre-school children with autism. It was a randomized controlled study employing a single subject comparison design in two different conditions, improvisational music therapy and play sessions with toys, and using standardized tools and DVD analysis of sessions to evaluate behavioral changes in children with autism. The overall results indicated that improvisational music therapy was more effective at facilitating joint attention behaviors and non-verbal social communication skills in children than play. Session analysis showed significantly more and lengthier events of eye contact and turn-taking in improvisational music therapy than play sessions. The implications of these findings are discussed further.

J Autism Dev Disord. 2008 Oct;38(9):1758-66. Epub 2008 Jul 1. Kim J, Wigram T, Gold C. Aalborg University, Aalborg, Denmark. jinahkim@jj.ac.kr

by Tim Brunson, PhD

The words harmonize and harmony are used to describe the adaptation process. Pattern encoding involves intensity and timing, much like that experienced with sound and music. Wayne Perry, a sound therapist in California, (2007), adds insight as he expands this concept into that of rhythm and sound. He sums up these natural tendencies by saying:

Every form of life has its own unique rhythms and cycles that determine its habits and characteristics. For example, insects such as bees, hornets, and locusts fly in swarms; schools of fish swim together, almost as one; geese fly together, locked in a V-formation. In the past, scientists thought this was due to a leader with more intelligence or experience. Now we know these habits are directed by entrainment. (Perry, 2007, p. 204)

[More]

The purose of this study was to investigate bereaved parents' experiences of music therapy with their terminally ill child. In-depth interviews were conducted with 7 bereaved parents who were recruited through a community-based palliative care program. The parent participants' experiences varied as their children who received music therapy ranged in ages from 5 months to 12 years old. The interview transcripts were analyzed using phenomenological strategies. Five global themes emerged from the analysis. These included (a) music therapy was valued as a means of altering the child's and family's perception of their situation in the midst of adversity, (b) music therapy was a significant component of remembrance, (c) music therapy was a multifaceted experience for the child and family, (d) music therapy enhanced communication and expression, and (e) parents shared perceptions of and recommendations for improving music therapy services. These emergent themes yield knowledge into the relevance of music therapy within pediatric palliative care.

J Music Ther. 2008 Fall;45(3):330-48. Lindenfelser KJ, Grocke D, McFerran K. University of Melbourne.

Full Title: The effect of group music therapy on quality of life for participants living with a severe and enduring mental illness.

A 10-week group music therapy project was designed to determine whether music therapy influenced quality of life and social anxiety for people with a severe and enduring mental illness living in the community. Ten one-hour weekly sessions including song singing, song writing and improvisation, culminated in each group recording original song/s in a professional studio. The principal outcome measure was the WHOQOLBREF Quality of Life (QoL) Scale; other instruments used were the Social Interaction Anxiety Scale (SIAS) and the Brief Symptom Inventory (BSI). Qualitative data were gathered through focus group interviews and an analysis of lyric themes. Statistically significant improvement was found on five items of the QoL Scale. There were no changes on the BSI indicating that QoL improvement was not mediated by symptomatic change. Themes from the focus groups were: music therapy gave joy and pleasure, working as a team was beneficial, participants were pleasantly surprised at their creativity, and they took pride in their song. An analysis of song lyrics resulted in 6 themes: a concern for the world, peace and the environment; living with mental illness is difficult; coping with mental illness requires strength; religion and spirituality are sources of support; living in the present is healing; and working as a team is enjoyable.

J Music Ther. 2009 Summer;46(2):90-104. Grocke D, Bloch S, Castle D.

This study aims at determining the effectiveness of music therapy in a hospice setting. We employed the salivary cortisol level, which is widely used to measure stress level, as an objective and physical indicator and the Mood Inventory, which measures mood change, as the subjective and psychological indicators. Though many preceding studies have demonstrated that listening to music lowers cortisol levels and reduces stress, no study seems to have included hospice patients. This study measured, with the consent of 10 hospice inpatients, their salivary cortisol levels. Individual interviews, according to the Mood Inventory, were conducted before and after a small-group session. Since all the participants had terminal cancer, the 40-minute live session of songs of seasons and the participants' requests was given in a mostly passive manner considering their physical strength. Results showed significant lowering of salivary cortisol levels after the therapy session. As for the parameters of mood, refreshment was significantly increased. Though fatigue remained unchanged, anxiety and depression decreased while the score for excitement tended to increase. Thus, it was indicated that music therapy in a hospice setting reduces the stress level of patients and thereby plays a positive role in improving patients' quality of life.

J Music Ther. 2009 Summer;46(2):160-72. Nakayama H, Kikuta F, Takeda H.

Full Title: The effect of single-session psychoeducational music therapy on verbalizations and perceptions in psychiatric patients.

The purpose of this study was to compare group-based psychoeducational music therapy to psychoeducation in measures of satisfaction with life, knowledge of illness, treatment perceptions, and response frequency and type in acute psychiatric inpatients during a randomized and controlled clinical trial. Participants (N = 105) took part in a scripted single session controlled by a treatment manual and facilitated by a Board-Certified Music Therapist. No significant differences were found between groups in measures of helpfulness, enjoyment, satisfaction with life, or psychoeducational knowledge. However, although not significant, the music therapy group tended to have slightly higher mean scores in all aforementioned variables, suggesting music therapy can be as effective as psychoeducation in these measures. There were no significant differences between groups for the number of therapist questions and validations as measured by a trained behavioral observer, although during the music therapy condition the therapist was able to ask a mean of almost 11 additional questions than during the psychoeducational control condition. Although not significant, there were almost 20 more participant mean verbalizations per session during the music therapy conditions. Additionally, many of these verbalizations were categorized as self and cognitive insight statements, indicating participants in the music therapy condition were talking more about themselves and their unique situations. Congruent with this finding, during the music therapy condition, the ratios of participant self statements to therapist questions and participant cognitive insights to therapist questions were higher than in the control condition. There was a significant correlation between participant total verbal participation and perception of helpfulness, enjoyment, and comfort for the control condition. This correlation was not significant for the experimental condition, indicating that the music therapy group did not have to verbally participate to perceive the session as helpful, enjoyable, and comfortable. Implications for psychoeducational music therapy and suggestions for future research are provided.

J Music Ther. 2009 Summer;46(2):105-31. Silverman MJ.

AIMS: To determine whether definable subtypes exist within a cohort of patients listening to music with regard to their physiological patterns and to compare whether associated factors vary between subjects in groups with different profiles. BACKGROUND: The intensive care unit (ICU) is one of the most stressful environments for patients among various clinical settings in a hospital. ICU patients are not only compromised by illness but also faced with a wide range of stressors. DESIGN: A repeated-measures design was conducted with one music group. METHOD: One hundred and one patients were recruited in three intensive care units in Hong Kong. There were two main outcome variables: demographic characteristics and physiological outcomes. RESULTS: A cluster analysis yielded two clusters. Patients in cluster 1 typically experienced relatively low therapeutic effects from listening to music. There were more males, of a younger age but more educated and employed than patients in cluster 2, and they represented 41.6% of the total respondents. Cluster 2 comprised almost 58.4% of this study sample and they reported high therapeutic effects of music. There were more females in this group as well as more older people and they mainly used a ventilator in the intensive care unit. CONCLUSION: Our study shows that music may have a more positive effect on groups of patients whose profile is similar to that of the patients in cluster 2, than for patients such as those in cluster 1. A clear profile may help health professionals to design appropriate care therapy to target a specific group of patients to improve their physiological outcomes. RELEVANCE TO CLINICAL PRACTICE: The implication of this study is that music therapy should be provided to patients as a relaxation technique if they are willing to accept it, and the selection of music should be based on their preferences. Information should be given to patients so that they can understand how music therapy works and they should be encouraged to focus their attention on listening to the music to maximise its benefits.

J Clin Nurs. 2009 May;18(9):1250-7. Chan MF, Chung YF, Chung SW, Lee OK. Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore. nurcmf@nus.edu.sg

Full Title: The meaning of the music: the role of music in palliative care music therapy as perceived by bereaved caregivers of advanced cancer patients.

In an earlier qualitative research study exploring the meaning of preloss music therapy to bereaved caregivers who participated in sessions through a home-based hospice program, various narrative accounts revealed the significance of music in music therapy sessions. In this study, the role of music in palliative care music therapy is examined and representatively summarized, followed by a review of strategies provided by this author to home hospice patients and their caregivers. The reported perceptions of the meaning of music to 7 bereaved caregivers are presented, including a review of themes and associated narrations that illustrated its significance. The caregivers described these aspects of music in sessions to have memorable and lasting effects as follows: "music is a conduit,'' "music gets inside us,'' "live music makes a difference,'' and "music is love.'' Findings support the benefits of preloss music therapy for bereaved caregivers.

Am J Hosp Palliat Care. 2009 Feb-Mar;26(1):33-9. Magill L. University of Windsor, 1671 Victoria Avenue, Windsor, Ontario, Canada. lucannem@uwindsor.ca

BACKGROUND: Individuals with coronary heart disease (CHD) often suffer from severe distress putting them at greater risk for complications. Music interventions have been used to reduce anxiety and distress and improve physiological functioning in medical patients, however its efficacy for CHD patients needs to be evaluated. OBJECTIVES: To examine the effects of music interventions with standard care versus standard care alone on psychological and physiological responses in persons with CHD. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL, EMBASE, PSYCINFO, LILACS, Science Citation Index, www.musictherapyworld.net, CAIRSS for Music, Proquest Digital Dissertations, ClinicalTrials.gov, Current Controlled Trials, and the National Research Register (all to May 2008). We handsearched music therapy journals and reference lists, and contacted relevant experts to identify unpublished manuscripts. There was no language restriction. SELECTION CRITERIA: We included all randomized controlled trials that compared music interventions and standard care with standard care alone for persons with CHD. DATA COLLECTION AND ANALYSIS: Data were extracted, and methodological quality was assessed, independently by the two reviewers. Additional information was sought from the trial researchers when necessary. Results are presented using weighted mean differences for outcomes measured by the same scale and standardized mean differences for outcomes measured by different scales. Posttest scores were used. In cases of significant baseline difference, we used change scores. MAIN RESULTS: Twenty-three trials (1461 participants) were included. Music listening was the main intervention used, and 21 of the studies did not include a trained music therapist.Results indicated that music listening has a moderate effect on anxiety in patients with CHD, however results were inconsistent across studies. This review did not find strong evidence for reduction of psychological distress. Findings indicated that listening to music reduces heart rate, respiratory rate and blood pressure. Studies that included two or more music sessions led to a small and consistent pain-reducing effect.No strong evidence was found for peripheral skin temperature. None of the studies considered hormone levels and only one study considered quality of life as an outcome variable. AUTHORS' CONCLUSIONS: Music listening may have a beneficial effect on blood pressure, heart rate, respiratory rate, anxiety, and pain in persons with CHD. However, the quality of the evidence is not strong and the clinical significance unclear.Most studies examined the effects of listening to pre-recorded music. More research is needed on the effects of music offered by a trained music therapist.

Cochrane Database Syst Rev. 2009 Apr 15;(2):CD006577. Bradt J, Dileo C. Arts and Quality of Life Research Center, Boyer College of Music and Dance, Temple University, Presser Hall, 2001 North 13 Street, Philadelphia, USA. jbradt@temple.edu

INTRODUCTION: A previous study (carried out in 2003-2004) had included 34 patients with traumatic brain injury in order to study the feasibility and usefulness of music therapy in patients with this type of injury. OBJECTIVE: To evaluate the effect of music therapy on mood, anxiety and depression in institutionalised patients with traumatic brain injury. STUDY METHODOLOGY: A prospective, observational study. MATERIALS AND METHODS: Thirteen patients with traumatic brain injury were included in the present study and took part in individual, weekly, 1-hour music therapy sessions over a period of 20 weeks. Each session was divided into two 30-minute periods - one devoted to listening to music (receptive music therapy) and the other to playing an instrument (active music therapy). The assessment criteria (measured at weeks 1, 5, 10, 15 and 20) were mood (on the face scale) and anxiety-depression (on the Hospital Anxiety and Depression [HAD] Scale). Mood was assessed immediately before and after the first music therapy session and every fifth session. RESULTS: Music therapy enabled a significant improvement in mood, from the first session onwards. This short-term effect was confirmed by the immediate changes in the scores after music therapy sessions (from 4.6+/-3.2 to 2.6+/-2; p<0.01). Music therapy also led to a significant reduction in anxiety-depression (p<0.05) from week 10 onwards and up until the end of the study (week 20). CONCLUSION: These results confirm the usefulness of music therapy in the treatment of anxiety-depression and mood in patients with traumatic brain injury. Music therapy could usefully form an integral part of the management programme for these patients.

Ann Phys Rehabil Med. 2009 Feb;52(1):30-40. Guétin S, Soua B, Voiriot G, Picot MC, Hérisson C. Service de neurologie, centre Mémoire de ressources et de recherches (CMRR), Inserm U888, CHRU Montpellier, 34295 Montpellier, France. stephane.guetin@yahoo.fr

Serious mental disorders have considerable individual and societal impact, and traditional treatments may show limited effects. Music therapy may be beneficial in psychosis and depression, including treatment-resistant cases. The aim of this review was to examine the benefits of music therapy for people with serious mental disorders. All existing prospective studies were combined using mixed-effects meta-analysis models, allowing to examine the influence of study design (RCT vs. CCT vs. pre-post study), type of disorder (psychotic vs. non-psychotic), and number of sessions. Results showed that music therapy, when added to standard care, has strong and significant effects on global state, general symptoms, negative symptoms, depression, anxiety, functioning, and musical engagement. Significant dose-effect relationships were identified for general, negative, and depressive symptoms, as well as functioning, with explained variance ranging from 73% to 78%. Small effect sizes for these outcomes are achieved after 3 to 10, large effects after 16 to 51 sessions. The findings suggest that music therapy is an effective treatment which helps people with psychotic and non-psychotic severe mental disorders to improve global state, symptoms, and functioning. Slight improvements can be seen with a few therapy sessions, but longer courses or more frequent sessions are needed to achieve more substantial benefits.

Clin Psychol Rev. 2009 Apr;29(3):193-207. Gold C, Solli HP, Krüger V, Lie SA. Unifob Health, Bergen, Norway. christian.gold@grieg.uib.no

Full Title: Impact of music therapy on anxiety and depression for patients with Alzheimer's disease and on the burden felt by the main caregiver (feasibility study).

INTRODUCTION: The impact of music therapy on dementia care for patients with Alzheimer's disease (AD) is well-recognized. Music alters the different components of the disease through sensory, cognitive, emotional, behavioral and social impacts. The academic aspect of music therapy in this area was based on the fact that music can alter the various components of the overall evolution of this disease. We found around 10 case studies presenting various results from receptive music therapy sessions on patients with Alzheimer's disease.

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Full Title: Effects of developmental music groups for parents and premature or typical infants under two years on parental responsiveness and infant social development.

The purpose of this study was to examine the effect of music therapy intervention on premature infants' and full term infants' developmental responses and parents' responsiveness. Subjects (n=56) were parent-infant dyads who attended developmental music groups or a control condition assessing responsiveness during toy play. All subjects were matched according to developmental age and were also matched by group for socioeconomic status and for maternal depression. Types of infant play and parent responsiveness were measured using observation of a standardized toy play for parent-infant dyads. Observations were coded with the number of seconds spent in each behavior using the SCRIBE observation program. Parents completed a questionnaire on the perception of their infant's general development, interpretations of their child's needs, the purpose of using music with their child, and their child's response to music. The infants attending the developmental music groups with their parents demonstrated significantly more social toy play (p < .05) during the standardized parent-infant toy play than infants who did not attend the music groups. While not significant, graphic analysis of parent responsiveness showed parents who attended the developmental music groups engaged in more positive and less negative play behaviors with their infants than parents who did not attend the music groups. This study demonstrates the first findings of positive effects of developmental music groups on social behaviors for both premature and full term infants under 2 years old.

J Music Ther. 2009 Spring;46(1):32-52. Walworth DD. The Florida State University, USA.

Full Title: Effects of music therapy on autonomic nervous system activity, incidence of heart failure events, and plasma cytokine and catecholamine levels in elderly patients with cerebrovascular disease and dementia.

Music therapy (MT) has been used in geriatric nursing hospitals, but there has been no extensive research into whether it actually has beneficial effects on elderly patients with cerebrovascular disease (CVD) and dementia. We investigated the effects of MT on the autonomic nervous system and plasma cytokine and catecholamine levels in elderly patients with CVD and dementia, since these are related to aging and chronic geriatric disease. We also investigated the effects of MT on congestive heart failure (CHF) events.Eighty-seven patients with pre-existing CVD were enrolled in the study. We assigned patients into an MT group (n = 55) and non-MT group (n = 32). The MT group received MT at least once per week for 45 minutes over 10 times. Cardiac autonomic activity was assessed by heart rate variability (HRV). We measured plasma cytokine and catecholamine levels in both the MT group and non-MT group. We compared the incidence of CHF events between these two groups. In the MT group, rMSSD, pNN50, and HF were significantly increased by MT, whereas LF/HF was slightly decreased. In the non-MT group, there were no significant changes in any HRV parameters. Among cytokines, plasma interleukin-6 (IL-6) in the MT group was significantly lower than those in the non-MT group. Plasma adrenaline and noradrenaline levels were significantly lower in the MT group than in the non-MT group. CHF events were less frequent in the MT group than in the non-MT group (P < 0.05). These findings suggest that MT enhanced parasympathetic activities and decreased CHF by reducing plasma cytokine and catecholamine levels.

Int Heart J. 2009 Jan;50(1):95-110. Okada K, Kurita A, Takase B, Otsuka T, Kodani E, Kusama Y, Atarashi H, Mizuno K. Department of Internal Medicine and Cardiology, Nippon Medical School, Tokyo, Japan.

The healing power of music has been recognized since ancient times. The use of music has been documented in diverse cultures worldwide, for ailments ranging from pain and cancer to depression and posttraumati stress disorder. The various models of music therapy are based on different theoretical traditions, including behaviorist, humanist, and psychodynamic approache This article describes the music therapy approach known as the Bonny Method of Guided Imagery and Music (GIM) therapy, reviews its research base, and presents a first-person account of the experience of GIM treatment.

J Psychosoc Nurs Ment Health Serv. 2009 Jan;47(1):29-33. Beebe LH, Wyatt TH. University of Tennessee College of Nursing, Knoxville, Tennessee 37996, USA. lbeebe1@utk.edu

by Diáne Mandle

Sound healing is fast becoming internationally respected as an effective modality in the healing process for many physical, emotional and spiritual conditions and maladies. This article seeks to offer some background on the Himalayan (often referred to as Tibetan) bowls and their role in the healing process for cancer patients.

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In palliative care between 13.9 and 25 percent of all patients suffering from cancer show signs of anxiety disorders. Up to 75 percent of these patients suffer from non-pathologic anxiety, which has a negative impact on the patients' quality of life. Therefore it is important to provide interventions that are able to reduce anxiety of cancer patients. Massage and music therapy are effective interventions for minimizing anxiety of cancer patients in palliative care. An empathic attitude of the nurse increases the effect of the mentioned interventions. While there is evidence of the interventions mentioned it is yet necessary to further explore these in additional clinical trials to consolidate the already existing results.

Pflege Z. 2009 Mar;62(3):164-9. Mantovan F, Rauter E, Müller I. Landesfachhochschule für Gesundheitsberufe "Claudiana", Uni Verona, Bruneck. franco.mantovan@claudiana.bz.it

Patients suffering from dementia are nevertheless still able to render exceptional musical performances. For example, they can recognize music from childhood and reproduce lyrics and melodies of songs with four verses. Furthermore, behavioural symptoms such as psycho- motor agitation and crying, but also aggressive behaviour can be positively influenced by music and motivation and positive emotions can be increased. A variety of physiological and psychological changes occur when patients are listening to music. Previous research could show that music activated different parts of the brain especially in the temporal cortex, but also motoric areas in the frontal cortex, thalamus and cerebellum were essential for rhythm, melody and harmony perception and processing. Music therapy is an interpersonal process in which music is used within a therapeutic relationship to address physical, emotional, cognitive, and social needs of individuals with various psychiatric or medical conditions. However, until now only little research has been directed towards non-pharmacological treatments like music therapy in dementia patients. Further research is warranted to investigate the long term influence of music therapy on patients suffering from dementia.

Neuropsychiatr. 2009;23(1):4-14. Kerer M, Marksteiner J, Hinterhuber H, Mazzola G, Steinberg R, Weiss EM. Abteilung für Allgemeine Psychiatrie, Medizinische Universität Innsbruck. manuela@kerer.bz

The three Ds of disease, disability, and discomfort negatively affect hospice patient's energy, intelligence, and organization. Music therapy is a studied, learned, credentialed behavioral intervention. It is specific, prescribed, and delivered therapeutically. At a time when trust and belief are compromised by the three Ds, the utilization of the complementary alternative medical intervention of music therapy, with its positive effect on social relationships, may enhance weakened trust and belief abilities. The research to date regarding music therapy presents positive results from studies and surveys of nurses, music therapists, families, and patients. Recommendations for using music therapy and music therapists will establish the use of this intervention, giving increased numbers to sample sizes for further study.

Nurs Econ. 2009 Jan-Feb;27(1):26-33, 60. Gifford EJ. Pathways Hospice, Oakland, CA, USA.

INTRODUCTION: Interfacility ground critical care transport (CCT) of patients by ambulance may be stressful. This study evaluated whether playing music during CCT reduces patient anxiety and whether objective evidence is manifested by a change in vital signs. SETTING: Urban teaching hospital. METHODS: In this prospective cohort study, music was played for eligible adult patients during CCT while recording vital signs. A questionnaire was subsequently mailed to patients to rate whether the ambulance transport was stressful, the impact music had on transport, whether music changed their anxiety, whether music made them comfortable and relaxed, and whether they would prefer music to be played on future transports. Vital signs were compared between respondents who perceived transport as stressful and those who did not. RESULTS: One hundred two patients were enrolled; 23 respondents (22.5%) constituted the study group. Four patients (17.4%) reported CCT as stressful (average response, 4.75). Nineteen (82.6%) rated CCT as not stressful (average response, 1.63). Subjectively, patients reported a positive impact of music on transport, with improved comfort and relaxation but only a minimal decrease in anxiety. No statistically significant change in vital signs was observed between cohorts; too few patients were enrolled to generate power to detect any difference. CONCLUSIONS: Music therapy is a simple adjunct for use during CCT that may increase patient comfort and alleviate anxiety. The small number of patients in this preliminary report limits the strength of any conclusions. Larger studies are needed

Air Med J. 2009 Mar-Apr;28(2):88-91. Stuhlmiller DF, Lamba S, Rooney M, Chait S, Dolan B. New York Medical College, Valhalla, NY 10595, USA. stuhlmillerd@emamd.com

GOALS OF WORK: Scant attention focuses on supporting parent-child communication during the parents' cancer hospitalizations. Parents may struggle to remain emotionally available. Caregiver absences may threaten secure attachment relationships with infants and elicit problems amongst older children. Music therapists help many parents with cancer to compose songs for their children. Their lyric analysis may provide insight into song writing's communicative and therapeutic potential. MATERIALS AND METHODS: Two song lyric groups were comparatively analyzed (based on grounded theory). One group included 19 songs written by 12 patients with the first author. Another included 16 songs written by 15 patients with three music therapists (including two authors), which were previously published or recorded for the public. Songs were composed by 20 mothers and seven fathers for at least 46 offspring. All parents had hematological or metastatic diseases. Qualitative inter-rater reliability was integrated. MAIN RESULTS: Comparable lyrical ideas in the two parent song groups included: love; memories; yearning for children; metaphysical presence (now and afterlife); loss and grief; the meaning and helpfulness of the children in their lives; hopes for and compliments about their children; encouragement; requests; personal reflections; existential beliefs; and suggestions about to whom the children can turn. CONCLUSIONS: Parents' song lyric messages may support their children during the parents' illnesses and through the children's developmental transitions and possible bereavement. Some parents use song writing for catharsis and to encourage their children's continuing attachment with them after death. Through promoting parent-child connectedness and emotional expression, therapeutic song writing can be a valuable oncologic supportive care modality.

Support Care Cancer. 2008 Dec 17. O'Callaghan C, O'Brien E, Magill L, Ballinger E. Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Melbourne, VIC, 8006, Australia, clare.ocallaghan@petermac.org.

OBJECTIVE: The role of music therapy in psychiatric care in Australia is briefly traced from the early 1990s to the present. With the shift to community-based care, contemporary music therapy practice for the severely mentally ill is reappraised alongside the principles of the recovery model. CONCLUSIONS: Music therapy is a viable option within the creative arts therapies for enhancing quality of life in people with severe and enduring mental illness.

Australas Psychiatry. 2008 Dec;16(6):442-5. Grocke D, Bloch S, Castle D. National Music Therapy Research Unit, Faculty of Music, University of Melbourne, VIC, Australia. d.grocke@unimelb.edu.au