Tim Brunson DCH

Welcome to The International Hypnosis Research Institute Web site. Our intention is to support and promote the further worldwide integration of comprehensive evidence-based research and clinical hypnotherapy with mainstream mental health, medicine, and coaching. We do so by disseminating, supporting, and conducting research, providing professional level education, advocating increased level of practitioner competency, and supporting the viability and success of clinical practitioners. Although currently over 80% of our membership is comprised of mental health practitioners, we fully recognize the role, support, involvement, and needs of those in the medical and coaching fields. This site is not intended as a source of medical or psychological advice. Tim Brunson, PhD

Dementia and music



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

Patients can't wait, and why should they?



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.

Music reduces patient anxiety during interfacility ground critical care transport.



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

Resounding attachment: cancer inpatients' song lyrics for their children in music therapy.



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.

Is there a role for music therapy in the care of the severely mentally ill?



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

The impact of music on hypermetabolism in critical illness.



PURPOSE OF REVIEW: Although the literature on complementary therapy, including music, is vast, there are few studies conducted in a scientific fashion exploring physiologic mechanisms. This review summarizes recent evidence on the effects of music on the hypermetabolic response of critical illness. RECENT FINDINGS: Music may restore some of the distorted homeostasis observed in ICU patients, as well as reducing pain and the need for sedation. Music likely reduces alterations in the hypothalamic-anterior pituitary-peripheral hormone axes that produce cortisol and growth hormone. Music may also increase growth hormone levels, which can induce decreased production of cytokines such as IL-6 by white blood cells. Further, ovarian steroid secretion may paradoxically protect women by increasing baseline circulating stress hormones, providing an opportunity for music therapy to intervene effectively. Dopaminergic neurotransmission has been implicated as a means by which music can modulate the central nervous system. SUMMARY: Music may play an important role as an adjunct therapy in critical care. However, further studies are necessary to elucidate how music can be further integrated clinically and the precise underlying mechanisms of its beneficial effects.

Curr Opin Clin Nutr Metab Care. 2008 Nov;11(6):790-4. Nelson A, Hartl W, Jauch KW, Fricchione GL, Benson H, Warshaw AL, Conrad C. Tufts University, School of Medicine, Boston, Massachusetts, USA.

Music facilitates the neurogenesis, regeneration and repair of neurons.



Experience has shown that therapy using music for therapeutic purposes has certain effects on neuropsychiatric disorders (both functional and organic disorders). However, the mechanisms of action underlying music therapy remain unknown, and scientific clarification has not advanced. While that study disproved the Mozart effect, the effects of music on the human body and mind were not disproved. In fact, more scientific studies on music have been conducted in recent years, mainly in the field of neuroscience, and the level of interest among researchers is increasing. The results of past studies have clarified that music influences and affects cranial nerves in humans from fetus to adult. The effects of music at a cellular level have not been clarified, and the mechanisms of action for the effects of music on the brain have not been elucidated. We propose that listening to music facilitates the neurogenesis, the regeneration and repair of cerebral nerves by adjusting the secretion of steroid hormones, ultimately leading to cerebral plasticity. Music affects levels of such steroids as cortisol (C), testosterone (T) and estrogen (E), and we believe that music also affects the receptor genes related to these substances, and related proteins. In the prevention of Alzheimer's disease and dementia, hormone replacement therapy has been shown to be effective, but at the same time, side effects have been documented, and the clinical application of hormone replacement therapy is facing a serious challenge. Conversely, music is noninvasive, and its existence is universal and mundane. Thus, if music can be used in medical care, the application of such a safe and inexpensive therapeutic option is limitless.

Med Hypotheses. 2008 Nov;71(5):765-9. Fukui H, Toyoshima K. Department of Education, Nara University of Education, Takabatake, Nara 630 8528, Japan. fukuih@nara-edu.ac.jp

The effect of music therapy on mood and anxiety-depression.



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.

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Effect of the music-therapy under spinal anesthesia



BACKGROUND: Since no pre-medication has been widely accepted especially in spinal anesthesia, anesthesiologists should manage the control of patient's anxiety during surgery. Instead of sedatives, we have been using music-therapy during spinal anesthesia. Bispectral index monitoring (BIS) is used as one of the sedation indices in spinal anesthesia. The aim of this study was to assess the music-therapy on reducing anxiety of patients under spinal anesthesia using BIS and interview type psychology test, State Trait Anxiety Inventory (STAI). METHODS: Fifty-eight ASA physical status I-II patients scheduled for spinal anesthesia, were randomly allocated into M group (music group, n=29) or C group (control, n=29). BIS, EMG, and SQI of both groups were obtained continuously with computer system. Patients in M group listened to music by head phone and those in C group were left free under ordinary operating theater environment. Trait Anxiety Inventory (STAI-TA) score was obtained preoperatively for property-based anxiety and the State Anxiety Inventory (STAI-SA) score was obtained postoperatively for condition-based anxiety. Time averaged BIS scores (pre-surgery, during-surgery and post-surgery period)were obtained during operation. RESULTS: Time averaged BIS values of M and C group in pre-surgery period, during-surgery period, and post-surgery period were 95.3+/-0.4 vs 95.8+/-0.4 (NS), 87.6+/-7.5 vs 95.1+/-2.8 (P<0.01) and 96.0+/-0.4 vs. 96.2+/-0.4 (NS), respectively. Post-surgery STAI-SA was 29.7+/-7.2 in M group vs 38.8+/-10.3 in C group (P<0.01) while pre-surgery STAI-SA scores of both groups were not different. CONCLUSIONS: Music-therapy reduced BIS value and was effective to reduce patient's anxiety during spinal anesthesia.

Masui. 2009 Jun;58(6):684-91. Maeyama A, Kodaka M, Miyao H. Department of Anesthesiology, Saitama Medical Center Saitama Medical University, Kawagoe.

Music acupuncture stimulation method.



Harmonic Medicine is the model using the theory that the body rhythms synchronize to an outer rhythm applied for therapeutic purpose, can restores the energy balance in acupuncture channels and organs and the condition of well-being. The purpose of this scientific work was to demonstrate the role played by harmonic sounds in the stimulation of the Lung (LU) Meridian (Shoutaiyin Feijing) and of the Kidney (KI) Meridian (Zushaoyin Shenjing).

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The effect of music therapy on anxiety in patients who are terminally ill.



BACKGROUND: The literature supporting the use of music therapy in palliative care is growing. However, the number of quantitative research studies investigating the use of music therapy in palliative care, and specifically anxiety, is limited. OBJECTIVE: The aim of this research project was to examine the effectiveness of a single music therapy session in reducing anxiety for terminally ill patients. DESIGN: A randomized-controlled design was implemented and the following hypotheses tested. There will be a significant difference between the experimental and control groups on anxiety levels as demonstrated by the anxiety measurement of the Edmonton Symptom Assessment System (ESAS), and heart rate. The experimental group received a single music therapy intervention and the control group received a volunteer visit. SETTING/SUBJECTS: Twenty-five participants with end-stage terminal disease receiving inpatient hospice services were recruited. RESULTS: The first hypothesis was supported. Results demonstrated a significant reduction in anxiety for the experimental group on the anxiety measurement of the ESAS (p = 0.005). A post hoc analysis found significant reductions in other measurements on the ESAS in the experimental group, specifically pain (p = 0.019), tiredness (p = 0.024) and drowsiness (p = 0.018). The second hypothesis was not supported. CONCLUSIONS: The study supports the use of music therapy to manage anxiety in terminally ill patients. Further studies are required to examine the effect of music therapy over a longer time period, as well as addressing other symptom issues.

Horne-Thompson A, Grocke D. Calvary Health Care Bethlehem, Melbourne, Victoria, Australia. thompson_anne@optusnet.com.au J Palliat Med. 2008 May;11(4):582-90.

Foundations of sound therapy.



In the practice of music therapy, the use of the sounds of a live naturally singing voice appears to be the most effective; in some cases, results are obtained whereas there are no results using musical sounds, and generally results are obtained in a much shorter time. Sounds and singing in just intonation are particularly efficient. This practice introduces to a deep understanding of sound therapy. Sketched here are the vocal soundbody relationship and the vocal sound consciousness relationship, which are relevant in this therapy. Finally clinical examples are given (coma states, loss of speech, old persons, states close to death, mind handicapped persons, depression, etc.). Bibliography I. Reznikoff: On Primitive Elements of Musical Meaning, www.musicandmeaning.net, Journal of Music and Meaning 3 (Invited papers), 2005.

Reznikoff I. Université de Paris X, Département de Philosophie, 92001 Nanterre, France, dominiqueleconte@yahoo.fr. J Acoust Soc Am. 2008 May;123(5):3798.

The effect of music therapy on anxiety in patients who are terminally ill.



BACKGROUND: The literature supporting the use of music therapy in palliative care is growing. However, the number of quantitative research studies investigating the use of music therapy in palliative care, and specifically anxiety, is limited. OBJECTIVE: The aim of this research project was to examine the effectiveness of a single music therapy session in reducing anxiety for terminally ill patients. DESIGN: A randomized-controlled design was implemented and the following hypotheses tested. There will be a significant difference between the experimental and control groups on anxiety levels as demonstrated by the anxiety measurement of the Edmonton Symptom Assessment System (ESAS), and heart rate. The experimental group received a single music therapy intervention and the control group received a volunteer visit. SETTING/SUBJECTS: Twenty-five participants with end-stage terminal disease receiving inpatient hospice services were recruited. RESULTS: The first hypothesis was supported. Results demonstrated a significant reduction in anxiety for the experimental group on the anxiety measurement of the ESAS (p = 0.005). A post hoc analysis found significant reductions in other measurements on the ESAS in the experimental group, specifically pain (p = 0.019), tiredness (p = 0.024) and drowsiness (p = 0.018). The second hypothesis was not supported. CONCLUSIONS: The study supports the use of music therapy to manage anxiety in terminally ill patients. Further studies are required to examine the effect of music therapy over a longer time period, as well as addressing other symptom issues.

J Palliat Med. 2008 May;11(4) Horne-Thompson A, Grocke D. Calvary Health Care Bethlehem, Melbourne, Victoria, Australia. thompson_anne@optusnet.com.au

Foundations of sound therapy.



In the practice of music therapy, the use of the sounds of a live naturally singing voice appears to be the most effective; in some cases, results are obtained whereas there are no results using musical sounds, and generally results are obtained in a much shorter time. Sounds and singing in just intonation are particularly efficient. This practice introduces to a deep understanding of sound therapy. Sketched here are the vocal soundbody relationship and the vocal sound consciousness relationship, which are relevant in this therapy. Finally clinical examples are given (coma states, loss of speech, old persons, states close to death, mind handicapped persons, depression, etc.). Bibliography I. Reznikoff: On Primitive Elements of Musical Meaning, www.musicandmeaning.net, Journal of Music and Meaning 3 (Invited papers), 2005.

J Acoust Soc Am. 2008 May;123(5) Reznikoff I. Université de Paris X, Département de Philosophie, 92001 Nanterre, France, dominiqueleconte@yahoo.fr.

Professional music therapy supervision: a survey.



Clinical supervision is regularly given to music therapy students and interns, but the need for professional music therapy supervision has largely not been discussed or explored. In order to better understand prevailing thoughts about professional music therapy supervision, music therapists were surveyed and asked if they participate in supervision and how important they think supervision is for professionals. The results indicated that almost two thirds of professional music therapists do not participate in supervision. Differences in participation and importance ratings were found between several demographic groupings including years of practice and level of education. Two-tailed t tests revealed a significant difference in importance rating between those who participate in supervision and those who do not, with those who participate giving a higher importance rating. However, the majority of all respondents indicated that they felt professional supervision is at least moderately important. These results are explored and discussed, and recommendations are given.

J Music Ther. 2008 Summer;45(2) Jackson NA.

The effect of improvisation-assisted desensitization, and music-assisted muscle relaxation.



The purpose of this study was to investigate the effects of two music therapy approaches, improvisation-assisted desensitization, and music-assisted progressive muscle relaxation and imagery on ameliorating the symptoms of music performance anxiety (MPA) among student pianists. Thirty female college pianists (N = 30) were randomly assigned to one of two conditions: (a) improvised music-assisted desensitization group (n = 15), or (b) music-assisted progressive muscle relaxation (PMR) and imagery group (n = 15). All participants received 6 weekly music therapy sessions according to their assigned group. Two lab performances were provided; one before and one after the 6 music therapy sessions, as the performance stimuli for MPA. All participants completed pretest and posttest measures that included four types of visual analogue scales (MPA, stress, tension, and comfort), the state portion of Spielberger's State-Trait Anxiety Inventory (STAI), and the Music Performance Anxiety Questionnaire (MPAQ) developed by Lehrer, Goldman, and Strommen (1990). Participants' finger temperatures were also measured. When results of the music-assisted PMR and imagery condition were compared from pretest to posttest, statistically significant differences occurred in 6 out of the 7 measures-MPA, tension, comfort, STAI, MPAQ, and finger temperature, indicating that the music-assisted PMR and imagery treatment was very successful in reducing MPA. For the improvisation-assisted desensitization condition, the statistically significant decreases in tension and STAI, with increases in finger temperature indicated that this approach was effective in managing MPA to some extent. When the difference scores for the two approaches were compared, there was no statistically significant difference between the two approaches for any of the seven measures. Therefore, no one treatment condition appeared more effective than the other. Although statistically significant differences were not found between the two groups, a visual analysis of mean difference scores revealed that the music-assisted PMR and imagery condition resulted in greater mean differences from pretest to posttest than the improvisation-assisted desensitization condition across all seven measures. This result may be due to the fact that all participants in the music-assisted PMR and imagery condition followed the procedure easily, while two of the 15 participants in the improvisation-assisted desensitization group had difficulty improvising.

J Music Ther. 2008 Summer;45(2) Kim Y.

The anxiety- and pain-reducing effects of music interventions: a systematic review.



Musical interventions have been used in health care settings to reduce patient pain, anxiety, and stress, although the exact mechanism of these therapies is not well understood. This article provides a systematic review of 42 randomized controlled trials of the effects of music interventions in perioperative settings. Music intervention had positive effects on reducing patients' anxiety and pain in approximately half of the reviewed studies. Further research into music therapy is warranted in light of the low cost of implementation and the potential ability of music to reduce perioperative patient distress. (c) AORN, Inc, 2008.

AORN J. 2008 Apr;87(4):780-807 Nilsson U. Centre for Health Care Sciences and Department of Anesthesiology and Intensive Care, Orebro University Hospital, Orebro, Sweden.

Hospitalized children's mood differences during play and music therapy.



Paediatric hospitals are concerned with both the physical and social well-being of their young patients. These institutions often provide play and music therapy to enhance the child's sense of normality. The purpose of this study was to test whether children in a hospital were happier during music rather than play therapy. METHODS: Sixty children were observed either during play or music therapy. Happiness was operationally defined as the frequency of smiles during a 3 minute period. RESULTS: The results showed that music therapy (M = 12.43, SD = 4.83) led to significantly more smiles than did play therapy (M = 5.83, SD = 3.10). CONCLUSIONS: Increasing the amount of time hospitals provide music therapy for child patients may be a way to increase positive effect and ultimately to increase mental and physical well-being in hospitalized children.

Child Care Health Dev. 2008 Mar;34(2):141-4. Hendon C, Bohon LM. Department of Psychology, California State University, Sacramento, CA 95819, USA. catherinerose08@yahoo.com

Can music therapy engage patients in group cognitive behaviour therapy for substance abuse Tx?



Despite the availability of effective treatments for substance use disorders, engaging people in treatment remains a challenge. This clinical study describes a 7-week trial of music therapy as an adjunct to group cognitive behaviour therapy with the aim of increasing patient engagement in a private hospital open group programme. DESIGN AND METHODS: Patient attendance rates and perceptions of the music therapy were collected at the end of each music therapy session by means of an anonymous survey, and only data from each patient's first survey were used in the analysis. Twenty-four surveys were analysed, representing feedback from 10 men and 14 women, aged between 17 and 52 years. RESULTS: The average attendance rate over the 7-week trial was 75%. The results indicated that enjoyment and motivation to participate during the sessions was uniformly high (mean ratings of 4.3 and 4.0 out of 5, respectively). The majority (83%) of participants reported that they would attend another music therapy session, and almost half (46%) endorsed that '(music therapy) would help them to feel more a part of the group'. Additional analyses revealed that music therapy was able to engage patients regardless of their age group (25 years and under vs. over-25 years) or substance (alcohol only vs. other drugs). DISCUSSION AND CONCLUSIONS: Music therapy is a promising approach to improving engagement in substance abuse treatment groups.

Drug Alcohol Rev. 2008 Mar;27(2):190-6. Dingle GA, Gleadhill L, Baker FA. School of Psychology, University of Queensland and Rubicon Drug and Alcohol Program, QLD, Australia.

Emotional responses to music: towards scientific perspectives on music therapy.



Neurocognitive research has the potential to identify the relevant effects of music therapy. In this study, we examined the effect of music mode (major vs. minor) on stress reduction using optical topography and an endocrinological stress marker. In salivary cortisol levels, we observed that stressful conditions such as mental fatigue (thinking and creating a response) was reduced more by major mode music than by minor mode music. We suggest that music specifically induces an emotional response similar to a pleasant experience or happiness. Moreover, we demonstrated the typical asymmetrical pattern of stress responses in upper temporal cortex areas, and suggested that happiness/sadness emotional processing might be related to stress reduction by music.

Neuroreport. 2008 Jan 8;19(1):75-8. Suda M, Morimoto K, Obata A, Koizumi H, Maki A. Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. miyuki@envi.med.osaka-u.ac.jp

Effects of music therapy on psychological health of women during pregnancy.



Aims and objectives. The purpose of this study was to examine the effects of music therapy on stress, anxiety and depression in Taiwanese pregnant women. Background. The value of music therapy is slowly being realized by nurses in various clinical areas, including obstetrics. Previous studies have demonstrated a high prevalence of psychological stress during pregnancy. Few studies have examined the effects of music therapy on reducing psychological stress during pregnancy. Design. A randomized experimental study design was developed and implemented. Methods. Two hundred and thirty-six pregnant women were randomly assigned to music therapy (n = 116) and control (n = 120) groups. The music therapy group received two weeks of music intervention. The control group received only general prenatal care. Psychological health was assessed using three self-report measures: Perceived Stress Scale (PSS), State Scale of the State-Trait Anxiety Inventory (S-STAI) and Edinburgh Postnatal Depression Scale (EPDS). Results. In a paired t-test, the music therapy group showed significant decrease in PSS, S-STAI and EPDS after two weeks. The control group only showed a significant decrease in PSS after two weeks. This decrease was not as substantial as in the experimental group. An ancova test with the pretest scores as the control revealed that the changes in PSS, S-STAI and EPDS after two weeks were significantly decreased in the experimental group compared with the control group. Conclusions. This controlled trial provides preliminary evidence that two-week music therapy during pregnancy provides quantifiable psychological benefits. Relevance to clinical practice. The findings can be used to encourage pregnant women to use this cost-effective method of music in their daily life to reduce their stress, anxiety and depression. Further research is needed to test the long-term benefits.

J Clin Nurs. 2008 Feb 19 Chang MY, Chen CH, Huang KF. National Tainan Institute of Nursing, Taiwan, and College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.

Music for pain and anxiety in children undergoing medical procedures.



The aim of this study was to conduct a systematic review of the efficacy of music therapy (MT) on pain and anxiety in children undergoing clinical procedures. METHODS: We searched 16 electronic databases of published and unpublished studies, subject bibliographies, reference lists of relevant articles, and trials registries. Two reviewers independently screened 4559 citations and reviewed the full manuscript of 393 studies. Nineteen studies met the inclusion criteria: randomized controlled trial, children aged 1 month to 18 years were examined, music was used as an intervention, and the study measured pain or anxiety. Music therapy was considered active if a music therapist was involved and music was used as a medium for interactive communication. Passive music therapy was defined as listening to music without the involvement of a music therapist. RESULTS: The 19 included trials involved 1513 subjects. The methodological quality of the studies was generally poor. Overall, MT showed a significant reduction in pain and anxiety (standardized mean difference [SMD] -0.35; 95% confidence interval [CI], -0.55 to -0.14; 9 studies; N = 704; I(2) = 42%). When analyzed by outcome, MT significantly reduced anxiety (SMD -0.39; 95% CI, -0.76 to -0.03; 5 studies; n = 284; I(2) = 52.4%) and pain (SMD -0.39; 95% CI, -0.66 to -0.11; 5 studies; N = 465; I(2) = 49.7%). There was no evidence of publication bias. CONCLUSIONS: Music is effective in reducing anxiety and pain in children undergoing medical and dental procedures. Music can be considered an adjunctive therapy in clinical situations that produce pain or anxiety.

Ambul Pediatr. 2008 Mar-Apr;8(2):117-28. Klassen JA, Liang Y, Tjosvold L, Klassen TP, Hartling L. From the Alberta Research Center for Child Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Canada.

Experiencing music therapy cancer support.



I portray health-related research outcomes in an arts-informed representation that disrupts the traditional discursive-scholarly format of journal writing to privilege better the participants' accounts and communicate these experientially. The representation uncovers meaning through alternative ways of communicating and conveys the ineffable quality of music in a manner that may be understood through and beyond words. This expands the convention of health-related research outcomes, including ways of knowing, what can be known and how this can be represented. I elaborate my intentions for this experiential report, discuss theoretical underpinnings of this methodology and describe a music therapy support group model.

J Health Psychol. 2008 Mar;13(2):190-200. Rykov MH. PO Box 142, Station C, Toronto, Ontario, M6J 3M9, Canada. info@musictherapyservices.org.

Butterbur root extract and music therapy in the prevention of childhood migraine.



Migraine is very common in school-aged children, but despite a number of pharmacological and non-pharmacological options for prophylaxis, randomized controlled evidence in children is small. Evidence-based prophylactic drugs may have considerable side effects. OBJECTIVE: This study was to assess efficacy of a butterbur root extract (Petadolex) and music therapy in primary school children with migraine. DESIGN: Prospective, randomized, partly double-blind, placebo-controlled, parallel-group trial. METHODS: Following a 8-week baseline patients were randomized and received either butterbur root extract (n=19), music therapy (n=20) or placebo (n=19) over 12 weeks. All participants received additionally headache education ("treatment as usual") from the baseline onwards. Reduction of headache frequency after treatment (8-week post-treatment) as well as 6 months later (8-week follow-up) was the efficacy variable. RESULTS: Data analysis of subjects completing the respective study phase showed that during post-treatment, only music therapy was superior to placebo (p=0.005), whereas in the follow-up period both music therapy and butterbur root extract were superior to placebo (p=0.018 and p=0.044, respectively). All groups showed a substantial reduction of attack frequency already during baseline. CONCLUSION: Butterbur root extract and music therapy might be superior to placebo and may represent promising treatment approaches in the prophylaxis of paediatric migraine.

Eur J Pain. 2008 Apr;12(3):301-13. Epub 2007 Jul 30. Oelkers-Ax R, Leins A, Parzer P, Hillecke T, Bolay HV, Fischer J, Bender S, Hermanns U, Resch F. Department of Child and Adolescent Psychiatry, University of Heidelberg, Blumenstrasse 8, D-69115 Heidelberg, Germany. rieke_oelkers@med.uni-heidelberg.de

Music therapy for depression.



Depression is a highly prevalent disorder associated with reduced social functioning, impaired quality of life, and increased mortality. Music therapy has been used in the treatment of a variety of mental disorders, but its impact on those with depression is unclear. OBJECTIVES: To examine the efficacy of music therapy with standard care compared to standard care alone among people with depression and to compare the effects of music therapy for people with depression against other psychological or pharmacological therapies. SEARCH STRATEGY: CCDANCTR-Studies and CCDANCTR-References were searched on 7/11/2007, MEDLINE, PsycINFO, EMBASE, PsycLit, PSYindex, and other relevant sites were searched in November 2006. Reference lists of retrieved articles were hand searched, as well as specialist music and arts therapies journals. SELECTION CRITERIA: All randomised controlled trials comparing music therapy with standard care or other interventions for depression. DATA COLLECTION AND ANALYSIS: Data on participants, interventions and outcomes were extracted and entered onto a database independently by two review authors. The methodological quality of each study was also assessed independently by two review authors. The primary outcome was reduction in symptoms of depression, based on a continuous scale. MAIN RESULTS: Five studies met the inclusion criteria of the review. Marked variations in the interventions offered and the populations studied meant that meta-analysis was not appropriate. Four of the five studies individually reported greater reduction in symptoms of depression among those randomised to music therapy than to those in standard care conditions. The fifth study, in which music therapy was used as an active control treatment, reported no significant change in mental state for music therapy compared with standard care. Dropout rates from music therapy conditions appeared to be low in all studies. AUTHORS' CONCLUSIONS: Findings from individual randomised trials suggest that music therapy is accepted by people with depression and is associated with improvements in mood. However, the small number and low methodological quality of studies mean that it is not possible to be confident about its effectiveness. High quality trials evaluating the effects of music therapy on depression are required.

Maratos AS, Gold C, Wang X, Crawford MJ. Central and Northwest London Foundation NHS Trust, Arts Therapies, Greater London House, Hampstead Road, London, UK, NW1 7QY. anna.maratos@nhs.net

Music therapy and neuropsychology.



In the last decade, a considerable number of studies have been made on the cognitive processing of music. A patient with pure amusia due to the infarction of anterior portion of bilateral temporal lobes revealed the disturbance of the discrimination of chords. Using positron emission tomography, these regions were activated when musically naive normal subjects listened to the harmony compared to the rhythm of identical music. So, we concluded that anterior temporal portion might participate in the recognition of chords. Several articles reported that the musician's brain was different from nonmusicians' functionally and anatomically. This difference was considered to be caused by the musical training for a long time. Recent studies clarified that the reorganization might occur by musical training for a few months. Melodic intonation therapy (MIT) is a method aimed to improve speech output of aphasic patients, using short melodic phrase with a word. The literatures of mental processing of music suggested that right hemisphere might participate in the expression of music, namely singing and playing instrumentals. So, it was supposed that MIT utilized the compensational function of right hemisphere for damaged left hemisphere. We also reported that mental singing improved the gait disturbance of patients with Parkinson's disease. Music therapy is changing from a social science model based on the individual experiences to a neuroscience-guided model based on brain function and cognitive processing of the perception and expression of music.

Rinsho Shinkeigaku. 2007 Nov;47(11):868-70. Satoh M, Takeda K, Kuzuhara S. Mie St. Cross Hospital.

Music and cancer pain management.



PROBLEM: When coupled with the often debilitating side-effects of pharmacological interventions, chronic cancer pain may elicit feelings of anxiety and depression and therefore adversely affect patient well-being and quality of life. PURPOSE: This review article is a systematic assessment of the published literature related to music and cancer pain management. METHOD: A comprehensive systematic evaluation of the data based literature was undertaken and analyzed using matrix analysis. RESULTS: As an adjunctive form of pain management, music therapy has been shown to address some of these hardships by providing patients with an alternative effective means by which to reduce their subjective experiences of pain. Studies investigating the efficacy of music therapy during invasive cancer procedures and chemotherapy demonstrated the role that attention states play in distracting patients from, and therefore minimizing their experience of, the pain associated with such treatments. Other studies examining diverse outpatient populations revealed similar findings, illustrating well the cognitive-affective dimensions of pain perception. Although these findings fail to adequately address the ambiguity surrounding music therapy's role in cancer pain management, music therapy has nonetheless been shown to significantly reduce anxiety and, in so doing, indirectly lessen the intensity of pain while improving patient quality of life.

Hawaii Med J. 2007 Nov;66(11):292-5. Igawa-Silva W, Wu S, Harrigan R. Stanford University, USA.

Practice guidelines for music interventions with hospitalized pediatric patients.



Music therapy is an effective complementary approach that can achieve specific therapeutic outcomes in the clinical management of pediatric patients. Growing research on music interventions has generated scientific knowledge about how this modality benefits patients and has formed the basis for effective protocols that can be used in practice. Although it can be challenging to translate research-based protocols into routine clinical care at the bedside, it is essential that music therapy interventions be aligned with evidence-based information and that accepted standards be established by the music therapy discipline to achieve the greatest benefit. The importance of partnerships between nurses and music therapists is emphasized to enhance the success of music-based treatments. This discussion synthesizes research findings that can be used to design pediatric practice guidelines in the application of music therapy.

J Pediatr Nurs. 2007 Dec;22(6):448-56. Stouffer JW, Shirk BJ, Polomano RC. Department of Orthopedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, PA 19104, USA.

The additional therapeutic effect of group music therapy for schizophrenic patients.



Schizophrenia is one of the most serious mental disorders. Music therapy has only recently been introduced as a form of treatment. The aim of this study was to examine the effect of music therapy for schizophrenic in-patients needing acute care. METHOD: Thirty-seven patients with psychotic disorders were randomly assigned to an experimental group and a control group. Both groups received medication and treatment indicated for their disorder. Additionally, the experimental group (n = 21) underwent group music therapy. RESULTS: Significant effects of music therapy are found in patients' self-evaluation of their psychosocial orientation and for negative symptoms. No differences were found in the quality of life. CONCLUSION: Musical activity diminishes negative symptoms and improves interpersonal contact. These positive effects of music therapy could increase the patient's abilities to adapt to the social environment in the community after discharge from the hospital.

Acta Psychiatr Scand. 2007 Nov;116(5):362-70. lrich G, Houtmans T, Gold C. Rhenish Clinic Bedburg-Hau, Bedburg-Hau, Germany. gunnarulrich@tiscali.nl

Predictors of change in music therapy with children and adolescents.



Music therapy has been shown to be efficacious in experimental studies. However, there is little empirical research knowledge about what elements of music therapy influence its effectiveness in clinical practice. Children and adolescents with psychopathology (N=75) were assessed before and after participating in individual music therapy with 1 out of 15 music therapists in the Vienna region. Relationships between outcomes (as evaluated by parents) and therapy contents (as reported by therapists) were examined using general linear modelling. Results indicated that clients' symptoms and burdens on their social environment showed greater improvement when music therapy was limited to discipline-specific music therapy techniques and did not include other media such as play therapy elements. The findings indicate the importance of being aware of a therapy method's specific strengths and limitations. More research on the indicated specific ingredients of music therapy intervention is needed.

Psychol Psychother. 2007 Dec;80(Pt 4):577-89. Gold C, Wigram T, Voracek M. University of Bergen, Unifob Health, Bergen, Norway. christian.gold@grieg.uib.no

Evaluation on the effects of relaxing music on the recovery from aerobic exercise-induced fatigue.



There are few researches on the effects of music therapy on the recovery from exercise-induced fatigue worldwide. The aim of this study was to evaluate the effects of relaxing music on aerobic exercise-induced fatigue. The authors' hypothesis is that relaxing music can effectively eliminate aerobic exercise-induced fatigue. METHODS: Thirty healthy male college students were randomly assigned to either no-music group or music group. All the subjects maintained the pedal cadence of 50 revmin-1 on a cycle ergometer until fatigue. Then subjects in music group listened to relaxing music for 15 minutes, while subjects in no-music group had a 15-minute rest without music. Heart rates, jump height, blood glucose, blood lactic acid, urinary protein, simple reaction time and ratings of perceived exertion (RPE) were determined before and after the 15-minute treatment for each group. RESULTS: The results showed that heart rates, urinary protein and RPE decreased significantly after the application of relaxing music (P<0.01), and these decreases were greater than those without music. CONCLUSION: The results suggest that relaxing music has better effects on the rehabilitation of cardiovascular, central, musculoskeletal and psychological fatigue and the promotion of the regulatory capability of the kidneys.

J Sports Med Phys Fitness. 2008 Mar;48(1):102-6. Jing L, Xudong W. Department of Human Sports Science, Nanjing Institute of Physicial Education, Nanjing, Republic of China lijing197512@163.com.

When the brain plays music:



Music performance is both a natural human activity, present in all societies, and one of the most complex and demanding cognitive challenges that the human mind can undertake. Unlike most other sensory-motor activities, music performance requires precise timing of several hierarchically organized actions, as well as precise control over pitch interval production, implemented through diverse effectors according to the instrument involved. We review the cognitive neuroscience literature of both motor and auditory domains, highlighting the value of studying interactions between these systems in a musical context, and propose some ideas concerning the role of the premotor cortex in integration of higher order features of music with appropriately timed and organized actions.

Nat Rev Neurosci. 2007 Jul;8(7):547-58. Zatorre RJ, Chen JL, Penhune VB. Montreal Neurological Institute, McGill University, 3801 University Street, Montreal, Quebec, Canada. robert.zatorre@mcgill.ca

Overture for growth hormone: requiem for interleukin-6?



Music has been used for therapeutic purposes since the beginning of cultural history. However, despite numerous descriptions of beneficial effects, the precise mechanisms by which music may improve human well-being remain unclear. METHODS: We conducted a randomized study in ten critically ill patients to identify mechanisms of music-induced relaxation using a special selection of slow movements of Mozart's piano sonatas. These sonatas were analyzed for compositional elements of relaxation. We measured circulatory variables, brain electrical activity, serum levels of stress hormones and cytokines, requirements for sedative drugs, and level of sedation before and at the end of a 1-hr therapeutic session. RESULTS: Compared with controls, we found that music application significantly reduced the amount of sedative drugs needed to achieve a comparable degree of sedation. Simultaneously, among those receiving the music intervention, plasma concentrations of growth hormone increased, whereas those of interleukin-6 and epinephrine decreased. The reduction in systemic stress hormone levels was associated with a significantly lower blood pressure and heart rate. CONCLUSION: Based on the effects of slow movements of Mozart's piano sonatas, we propose a neurohumoral pathway by which music might exert its sedative action. This model includes an interaction of the hypothalamic-pituitary axis with the adrenal medulla via mediators of the unspecific immune system

Crit Care Med. 2007 Dec;35(12):2709-13. Comment in: Crit Care Med. 2007 Dec;35(12):2858-9. Conrad C, Niess H, Jauch KW, Bruns CJ, Hartl W, Welker L. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. cconrad1@partners.org

Relationships between musical structure and psychophysiological measures of emotion.



Psychophysiological studies with music have not examined what exactly in the music might be responsible for the observed physiological phenomena. The authors explored the relationships between 11 structural features of 16 musical excerpts and both self-reports of felt pleasantness and arousal and different physiological measures (respiration, skin conductance, heart rate). Overall, the relationships between musical features and experienced emotions corresponded well with those known between musical structure and perceived emotions. This suggests that the internal structure of the music played a primary role in the induction of the emotions in comparison to extramusical factors. Mode, harmonic complexity, and rhythmic articulation best differentiated between negative and positive valence, whereas tempo, accentuation, and rhythmic articulation best discriminated high arousal from low arousal. Tempo, accentuation, and rhythmic articulation were the features that most strongly correlated with physiological measures. Music that induced faster breathing and higher minute ventilation, skin conductance, and heart rate was fast, accentuated, and staccato. This finding corroborates the contention that rhythmic aspects are the major determinants of physiological responses to music.

Emotion. 2007 May;7(2):377-87. Gomez P, Danuser B. Institut Universtitaire Romand de Sante au Travail, Lausanne, Switzerland. patrick.gomez@hospvd.ch

Double dissociation between rules and memory in music



Language and music share a number of characteristics. Crucially, both domains depend on both rules and memorized representations. Double dissociations between the neurocognition of rule-governed and memory-based knowledge have been found in language but not music. Here, the neural bases of both of these aspects of music were examined with an event-related potential (ERP) study of note violations in melodies. Rule-only violations consisted of out-of-key deviant notes that violated tonal harmony rules in novel (unfamiliar) melodies. Memory-only violations consisted of in-key deviant notes in familiar well-known melodies; these notes followed musical rules but deviated from the actual melodies. Finally, out-of-key notes in familiar well-known melodies constituted violations of both rules and memory. All three conditions were presented, within-subjects, to healthy young adults, half musicians and half non-musicians. The results revealed a double dissociation, independent of musical training, between rules and memory: both rule violation conditions, but not the memory-only violations, elicited an early, somewhat right-lateralized anterior-central negativity (ERAN), consistent with previous studies of rule violations in music, and analogous to the early left-lateralized anterior negativities elicited by rule violations in language. In contrast, both memory violation conditions, but not the rule-only violation, elicited a posterior negativity that might be characterized as an N400, an ERP component that depends, at least in part, on the processing of representations stored in long-term memory, both in language and in other domains. The results suggest that the neurocognitive rule/memory dissociation extends from language to music, further strengthening the similarities between the two domains.

Neuroimage. 2007 Nov 1;38(2):331-45. Miranda RA, Ullman MT. Brain and Language Laboratory, Department of Neuroscience, Georgetown University, New Research Building, 3970 Reservoir Road, NW, Washington, DC 20057, USA; Interdisciplinary Program in Neuroscience, Georgetown University, USA.

Musical intervals in speech.



Throughout history and across cultures, humans have created music using pitch intervals that divide octaves into the 12 tones of the chromatic scale. Why these specific intervals in music are preferred, however, is not known. In the present study, we analyzed a database of individually spoken English vowel phones to examine the hypothesis that musical intervals arise from the relationships of the formants in speech spectra that determine the perceptions of distinct vowels. Expressed as ratios, the frequency relationships of the first two formants in vowel phones represent all 12 intervals of the chromatic scale. Were the formants to fall outside the ranges found in the human voice, their relationships would generate either a less complete or a more dilute representation of these specific intervals. These results imply that human preference for the intervals of the chromatic scale arises from experience with the way speech formants modulate laryngeal harmonics to create different phonemes.

Proc Natl Acad Sci U S A. 2007 Jun 5;104(23):9852-7. Ross D, Choi J, Purves D. Center for Cognitive Neuroscience and Department of Neurobiology, Duke University, Durham, NC 27708, USA.

The influence of music on the symptoms of psychosis: a meta-analysis.



The purpose of this study was to analyze the existing quantitative research evaluating the influence of music upon the symptoms of psychosis. A meta-analysis was conducted on 19 studies. Results indicated that music has proven to be significantly effective in suppressing and combating the symptoms of psychosis (d = +0.71). However, there were no differing effects between live versus recorded music and between structured music therapy groups versus passive listening. Nor were there differing effects between preferred versus therapist-selected music. Additionally, classical music did not prove as effective as nonclassical music in reducing psychotic symptoms. This supports the therapeutic potential of popular music while dispelling the theory that classical music provides the form and structure that can contribute to mental health and well-being. Further quantitative research is recommended and strongly warranted to refine unique aspects of music therapy interventions effective for those with psychotic symptoms.

J Music Ther. 2003 Spring;40(1):27-40. Silverman MJ. The Florida State University, USA.

The effect of live music on decreasing anxiety in patients undergoing chemotherapy treatment.



The purpose of this study was to investigate the effects of familiar live music on the anxiety levels of patients undergoing chemotherapy treatment. Randomly selected patients were assigned to experimental (n = 25) and control (n = 25) conditions. Pre and posttests consisted of questionnaires and the recording of the patient's heart rate and blood pressures. Subjects in the experimental group received 20 minutes of familiar live music during their chemotherapy treatment. Subjects in the control group received standard chemotherapy. It was assumed that those patients receiving music intervention would: (a) lower their anxiety levels; (b) experience a decrease in heart rate and blood pressure; (c) improve their levels of negative reactions including fatigue, worry, and fear; and (d) improve their levels of positive reactions including comfort and relaxation. Results of the study showed statistically significant improvement for the experimental group on the measures of anxiety, fear, fatigue, relaxation, and diastolic blood pressure. No significant differences between groups were found for heart rate and systolic blood pressure. Descriptive values indicated that, on average, the experimental group was influenced positively by the music intervention, and participants improved their quality of life while undergoing chemotherapy treatment.

J Music Ther. 2007 Fall;44(3):242-55. Ferrer AJ. The Florida State University, Tallahassee Memorial HealthCare, USA.

Ambient music in the emergency services: the professionals' perception.



Due to the assistant characteristic of the emergency service, the health professional experiences countless situations that generate anxiety. This study aimed to learn the professionals' perception about the presence of classical music in the working environment. The sample was composed of 49 professionals of the adult emergency department of a medium sized private hospital. The data were collected through a questionnaire to evaluate the professional's perception. The results showed that 78% of the professionals noticed alteration in the atmosphere when the music was present, 41% believed that the music altered their personal performance; 85% believed it altered their performance in a positive way and 15% in a negative way. Regarding the musical repertoire, 61% of the individuals affirmed they enjoyed the selection, 96% believed that the ambient music should be kept, while 76% of the interviewees suggested other musical genres.

Rev Lat Am Enfermagem. 2007 May-Jun;15(3):377-83. Gatti MF, da Silva MJ. Adult Emergency Medical Services, Hospital Samaritano, and University of São Paulo, College of Nursing, Brazil. maria.gatti@samaritano.com.br

Commodity specific rates of temporal discounting



Discounting rates vary as a function of commodity type. Previous studies suggest five potential characteristics of the commodity that could explain these differences: type of reinforcer (primary or secondary), if the commodity is perishable, if the commodity is satiable, if the commodity can be directly consumed, and immediacy of consumption. This paper suggests that these characteristics may best be viewed as related to a more fundamental characteristic: metabolic processing. In order to explore the possibility that metabolic processing underlies changes in discount rates, the difference in discounting between food, money, music CDs, DVDs, and books are compared. Music CDs, DVDs, and books share many characteristics in common with food, including gaining value through a physiological process, but are not directly metabolized. Results are consistent with previous findings of commodity specific discount rates and show that metabolic function plays a role in determining discount rates with those commodities that are metabolized being discounted at a higher rate. These results are interpreted as evidence that the discount rate for different commodities lies along a continuum with those that serve an exchange function rather than a direct function (money) anchoring the low end and those that serve a direct metabolic function capping the high end (food, alcohol, drugs).

Behav Processes. 2007 Aug 30 Charlton SR, Fantino E. University of California, San Diego, United States.

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