Autism, Routines, and COVID-19

The month of April is Autism Awareness Month. Within the United States, the prevalence of autism spectrum disorders (ASD) has increased from affecting 1 in 125 children in 2010 to affecting 1 in every 59 children in 2020 (Autism Society, 2020, para. 3). Markers of autism include verbal and non-verbal communication deficits, social skill deficits, and restricted and/or repetitive behaviors (The Autism Community in Action [TACA], 2019, para. 1). In this blog post, the third marker– repetitive behaviors–will be addressed in response to COVID-19. 

Repetitive behaviors include an insistence on sameness and an inflexible adherence to routines (Applied Behavior Analysis Edu., n.d., para. 1). Changes in routines such as eating new foods, having visitors in the house, or cancelling activities can incite anxiety-induced or problem behaviors from individuals on the autism spectrum.. With the outbreak of COVID-19, day-to-day routines have been uprooted with school closures, shelter-in-place orders, and social distancing policies. The current situation can be difficult to navigate for families with special needs individuals. Listed below are a few different techniques and supports that are used within a music therapy session that can be used to help individuals with ASD and their caregivers and parents as well. 

1. Visual Schedule: In music therapy sessions, visual schedules are used with many clients to provide structure on what the individual can expect and what will happen next. These are shown to reduce anxiety, reduce frustration, and decrease problem behaviors (Autism Speaks, 2018, para. 6). In a music therapy setting, visuals might include song choices or instruments. To build a visual schedule for learning purposes, Autism Speaks recommends starting with the first subject that an individual would normally begin with at school and then follow the same order of subjects and activities they would normally do (Autism Speaks, 2020, para. 4). For younger individuals, a visual schedule with just 2 items shown in a “first, then” manner may be more appropriate. A free visual schedule template and icons can be found HERE as well as an First/Then schedule template can be found HERE. A preview of the two can be seen below: 

2. Positive Reinforcement: One of the guiding principles of Applied Behavior Analysis –ABA therapy– is positive reinforcement. When a desired action or behavior is completed by an individual, positive reinforcement or a reward is given (Autism Speaks, n.d., para. 5). This can be verbal praise, toy, food, a phone call to a relative, or anything meaningful to the individual. This increases the likelihood of the behavior in the future. In music therapy, a favorite song or instrument may be played or sung upon completion of another intervention. A popular non-musical reward is bubble blowing. Verbal praise is given frequently as well. Finding rewards for individuals with ASD can help them complete desired tasks when they understand that they will gain something upon completion. 

3. Movement: Movement to music is an essential part of every music therapy session, regardless of diagnosis. For some individuals, movement acts as a reward for a completion of a task. For others, movement acts as a break between different interventions. GoNoodle provides movement-based videos for various ages. Video times range between short 3-minute videos and longer compilations up to 20 minutes. Non-screen options can include playing recorded music and having individuals mirror movements of another individual or using movement visuals to direct movements. 

4. Breaks: While individuals with ASD may find comfort in routine, certain tasks may still pose a challenge. This is true within the music therapy setting as well. Taking breaks in between tasks or even during tasks can be beneficial to the individual. Setting a timer for a break can aid in providing structure as well, with the expectation that once the timer is done, work resumes (Raising Children Network, 2017, para. 7 ). For those individuals who are non-verbal, a free printable break visual can be found HERE. 

5. (Indirect) Contact: Therapists and teachers alike are still eager to help in whatever capacity they can during these uncertain times. At this time, Therabeat music therapists are not only providing virtual music therapy but can provide home health videos and audio recordings as well. These videos/recordings can be movement–based or transition songs or songs based on academic concepts.  Please do not hesitate to reach out if you are feeling overwhelmed by your child’s schoolwork or behaviors. Many of the techniques and supports listed above are very familiar to educators and therapists who can help guide implementation. Additional (non-affiliated) resources with more information about supporting your child with autism during this time have been included below:

• Autism Speaks: How to cope with disrupted family routines during COVID-19 

• Autism Speaks: Visual Supports and Autism Spectrum Disorders

• Raising Children Network: Changing Routines: Children and Teenagers with Autism Spectrum Disorders

• The Autism Community in Action (TACA): Coronavirus and Students with Autism

-Sarah Deal, Music Therapy Intern

References:

Applied Behavior Analysis Edu. Why Is Routine So Important to People with ASD?. Retrieved April 4, 2020, from https://www.appliedbehavioranalysisedu.org/why-is-routine-so-important-to-people-with-asd/ 

Autism Society (2020). National Autism Awareness Month. Retrieved April 4, 2020, from https://www.autism-society.org/get-involved/national-autism-awareness-month/ 

Autism Speaks (n.d). Applied Behavior Analysis (ABA). Retrieved April 4, 2020, from https://www.autismspeaks.org/applied-behavior-analysis-aba-0 

Autism Speaks (2020). How to cope with disrupted family routines during COVID-19. Retrieved April 4, 2020, from https://www.autismspeaks.org/news/how-cope-disrupted-family-routines-during-covid-19 

Autism Speaks (2018). Visual Supports and Autism Spectrum Disorders. Retrieved April 4, 2020, from http://www.autismspeaks.org/sites/default/files/2018-08/Visual%20Supports%20Tool%20Kit.pdf 

Raising Children Network (2017). Changing Routines: Children and Teenagers with Autism Spectrum Disorder. Retrieved April 4, 2020, from https://raisingchildren.net.au/autism/behaviour/understanding-behaviour/changing-routines-asd 

The Autism Community in Action [TACA] (2019). What Is Autism?. Retrieved April 4, 2020, from https://tacanow.org/about-autism/

The Month of Music

Not only is March Music Therapy Awareness month but it is also Music In Our Schools month! This post seeks to bring awareness to both fields by addressing misconceptions, providing ways the two fields can collaborate, as well as emphasizing the importance of music therapy and why it works within the school setting for special needs populations.

Music education is a type of learning wherein students gain musical skills to develop artistic and aesthetic activities and attitudes to create music (Duerksen, 1967, pg. 95). In many school systems, students start out in a general music class through their K-5 education and continue into either band, chorus, or orchestra in grades 6-12. During this period, students learn about the elements of music (rhythm, melody, harmony, dynamics, tone color, texture, form) in order to become musicians that read, write, and perform music. 

In contrast, music therapy seeks to “use music therapeutically to address physical, psychological, cognitive and/or social functioning” (American Music Therapy Association [AMTA], 2006, para. 1). While a board-certified music therapist uses musical interventions to help an individual, the emphasis is not on a musical performance but the individual’s progress towards meeting a goal using music as a medium. Oftentimes, a client or patient can achieve their goal without needing a high level of musicianship, which is why music therapy is effective for children with exceptionalities or special needs (Duerksen, 1967, pg. 95). 

One misconception is that music therapy for children is similar to early childhood music programs such as Kindermusik or Musikgarten or Music Together. While many of the songs may overlap or be similar, the difference lies in instruction and implementation. For each of the three early childhood music programs, no formal degree in music or in teaching is required of instructors. Instructors are trained by the company and are given licenses to teach after the workshop is concluded. In terms of implementation, the programs’ pedagogy is education-based in teaching musical concepts that aid in development. 

This contrasts with a music therapy session in which music interventions– such as therapeutic singing, instrument play, movement to music– are implemented to help an individual achieve physical, psychological, cognitive, or social functioning goals. A music therapist holds such knowledge through obtaining a bachelor’s degree or higher in music therapy from one of 80 American Music Therapy Association’s accredited music therapy programs (AMTA, 2014, para. 17). Music therapists are board-certified once they have passed their national board certification exam. Music therapy is considered to be an allied health profession, similar to the fields of occupational therapy and physical therapy. Through their extensive coursework, music therapists are trained musicians in addition to being well-informed about childhood development through their degree program. 

While a licensed music educator with a music education degree may go through a degree program experience comparable to a music therapist (practicum experience and student teaching), their expertise lies in teaching music to neurotypical students. Since the passing of the Individuals with Disabilities Education Act in 1990, an increasing amount of students with special needs are being included into education classes with typically-developing peers (Jellison, 1995, pg. 229). This includes special areas such as art and music. Music educators are still responsible for modifying curriculum and making accommodations for those students that have an Individualized Education Program (IEP) or 504 plan. Because of their lack of experience with special education students, music educators may consult with a music therapist to help them modify their lessons or make the necessary accommodations for specific students that are mainstreamed into their classes (AMTA, 2006, para. 6). Additionally, a music therapist may aid a music educator in using specific techniques to work in self-contained music class. However, it is important to note that music therapy services can only be delivered by a board-certified music therapist. 

The most direct service a music therapist can provide within a school is music therapy sessions to special education classes. In a 1995 case study, Jellison & Gainer observed a singular child with special needs that was in both school music education class as well as a weekly music therapy session. This child exhibited mild intellectual disabilities but did not have any physical or sensory impairments. She was included in a music education class with typical peers every 3rd day and participated in group music therapy sessions with her special education peers every other day (Jellison & Gainer, 1995, pg. 231). Over an eight-month period, the participant engaged in more on-task behaviors than off-task behaviors in each setting. However, the participant exhibited twice the amount of on-task behaviors in the music therapy session than the music education class (Jellison & Gainer, 1995, pg. 228). From the study, researchers concluded that a smaller class size and  greater therapeutic practices contributed to increased participation of the individual during music therapy sessions (Jellison & Gainer, 1995, pg. 237). Additionally, Jellison & Gainer conclude that music therapists can also aid music educators in helping students with special needs transition into their mainstreamed classroom through teaching specific skills that a student would need to be successful in the music education setting (Jellison & Gainer, 1995, pg. 238).

During this time of an international pandemic, people turn to music to stay connected. The power of music transcends words, space, and time. Music teachers and music therapists have continued to provide music to their students and clients however they possibly can, knowing how essential it is to so many of us. However, there are distinct differences between the two disciplines. Knowing the differences can help students, clients, teachers, and music therapists alike. 

-Sarah Deal, Music Therapy Intern

References:

Duerksen, G.L. (1974). Some Current Trends in Music Education: Implications for Music Therapy. Journal of Music Therapy, 11 (2), 65-67. https://doi.org/10.1093/jmt/11.2.65

Jellison, J.A. & Gainer, E.W. (1995). Into the Mainstream: A Case-Study of a Child’s Participation in Music Education and Music Therapy. Journal of Music Therapy, 32(4), 228-247. https://doi.org/10.1093/jmt/32.4.228

American Music Therapy Association (2006). Music Therapy and Music Education: Meeting the Needs of Children with Disabilities. Retrieved March 10, 2020, from https://www.musictherapy.org/assets/1/7/MT_Music_Ed_2006.pdf  

American Music Therapy Association (2014). How AMTA and Music Therapy Relate to the Documentary Film "Alive Inside" and the Organization "Music and Memory". Retrieved March 10, 2020, from https://www.musictherapy.org/music_therapy_and_the_film_alive_inside/

Telehealth and Music Therapy

COVID-19, also known as Coronavirus disease, has affected our society in many ways that were previously unimaginable. Social distancing, a tactic that is being implemented to decrease the spread of this illness, has resulted in many public spaces being closed. Entire school districts have been closed for the next two weeks at least. Many businesses have limited their access to the public. Ultimately, this affects the extent to which we can all interact with each other. Luckily, there is a way to ensure that music therapy sessions are still provided to pre- existing clients as well as new clients in order to meet individualized therapeutic needs.

         Telehealth, also referred to as telemedicine or e-health, is the application of online technology to provide health intervention services for clients with specific health issues or developmental focus areas (Fuller & McLeod, 2019, p. 14). This form of treatment has been implemented when face-to-face treatment is not a viable option. Although research involving telehealth is limited, this form of treatment has been in existence for over twenty years (Crowe & Rio, 2004). With each technological innovation, telehealth has evolved to become an effective method of care. Telehealth has been successfully implemented by general practitioners and surgeons, psychiatrists, occupational therapists, physiotherapists, and speech pathologists to address clinical goals among varying populations (Krout & Baker, 2009, p. 4).

 Telehealth in music therapy, or telemusictherapy, is a viable option to provide music therapy services when an in-person session may not be feasible. Even though the session will take place via computer, the music therapist will continue to address individualized, therapeutic goals and objectives for the client. Telehealth sessions implement music therapy techniques that are typically used in face-to-face sessions. These techniques can include songwriting, active music playing, improvisation, music-assisted relaxation, and more (Krout, Baker, & Ralf, 2010, p. 80). Telehealth music therapy sessions model the traditional in-person sessions and follow a similar structure. Each session begins with a greeting song, followed by music therapy interventions normally utilized to promote progress towards individualized goals, and end with a goodbye song.

Music therapy interventions can be used to address a client’s needs over various domains, including social needs, academic needs, and emotional needs. Krout and Baker (2009) implemented a telehealth music therapy program for an adolescent client with Asperger’s syndrome. These sessions mainly focused on songwriting in order to enhance the client’s social skills. The songwriting interventions focused on encouraging eye contact, engaging in dialogue, developing self-confidence, and providing opportunities for decision making (Krout & Baker, 2009, p. 4). Even though these sessions took place through a computer screen, the client’s engagement levels were the same as when he was in a face-to-face session. In fact, conducting the sessions in a technological setting allowed the client to be more comfortable engaging in discussions that were more difficult in regular, individualized sessions (Krout & Baker, 2009, p. 4).

Telehealth sessions can also provide opportunities for family involvement. Individualized music therapy sessions usually take place in a 1:1 setting. In the clinic setting, the client’s behaviors can be positively or negatively reinforced by the music therapist, depending on the client’s needs. However, in a telehealth session, it may be difficult for the music therapist to redirect a client’s behaviors or promote engagement. Luckily, family members or caregivers can become involved in order to ensure the client’s success. Telehealth sessions can allow for parents and caregivers to take leadership and facilitate the therapeutic interventions (Fuller & McLeod, 2019, p. 15).

         Family-centered music therapy telehealth sessions can prove beneficial for both the client and the client’s respective family members. Fuller and McLeod (2019) conducted telehealth sessions for families in which a child had a hearing loss. The family members worked in conjunction with a music therapist and a language specialist in order to ensure the client made substantial progress towards his/her pre-defined therapeutic goals.  Because the client was present with his/her family members but in a different location from the practitioners, the family members were able to assume a more prominent leadership role that may not have been possible during traditional individualized sessions. The family members facilitated the music therapy interventions with assistance from the music therapist. In this way, the interactions between the family members and clients were prioritized (Fuller & McLeod, 2019, p. 16).

         Telehealth sessions allow for the provision of music therapy services that would otherwise be inaccessible for various reasons (Krout & Baker, 2009, p. 4). Telehealth sessions have been found to not affect the client’s overall satisfaction of therapies delivered (Fuller & McLeod, p. 14).  Telehealth sessions may increase the level of comfort and engagement for clients in comparison to traditional, in-person sessions (Fuller & McLeod, 2019, p. 13). Additionally, these online services provide an opportunity for increased familial participation that may occur in traditional settings.

         A final important benefit of telehealth services is that it increases the accessibility of music therapy services for clients. Geographical distance may be a deterrent at times in pursuing music therapy treatment. The option to receive music therapy services from home offers a way for these clients to receive services to address their specific needs that may not have been possible before. COVID-19 has impacted our day-to-day lives. However, it does not have to interfere with receiving quality music therapy services.

As we as a nation navigate the unforeseeable future, it is important that we maintain our connections to each other. Team Therabeat has already started implementing telehealth music therapy sessions over this past week. These sessions have been received well, both by our clients as well as their parents. Additionally, parents and caregivers have become more engaged in their child’s treatment by participating alongside the client. The therapeutic benefits of music therapy are important as ever during this pandemic. The universal language of music can help us all make it through this challenging time. 

• Jasmine Bailey, Music Therapy Intern

References

Crowe, B.J., & Rio, R. (2004). Implications of technology in music therapy practice and research for music therapy education: A review of literature. Journal of Music Therapy, 41(4), 282-320.

Deal, S. (2020). Telehealth: Music Therapy [flyer].

Fuller, A.M., & McLeod, R.G. (2019). The connected music therapy tele intervention approach (CoMMTA) and its application to family-centred programs for young children with hearing loss. Australian Journal of Music Therapy, 30, 12-30.

Krout, R., & Baker, F. (2009). Songwriting via skype: An online music therapy intervention to enhance social skills in an adolescent diagnosed with Asperger’s Syndrome. British Journal of Music Therapy, 23(2), 3-14.

Krout, R., Baker, F., & Ralf, M. (2010). Designing, piloting, and evaluating an on-line collaborative songwriting environment and protocol using skype telecommunication technology: Perceptions of music therapy student participants. Music Therapy Perspectives, 28(1), 79-85.

Eliciting Speech in Non-verbal Children with Autism

Autism spectrum disorder (ASD) is a neurodevelopmental condition that is characterized by pronounced difficulties in social communication and relational interactions, limited areas of interest, and repetitive and/or stereotypical behaviors (Salomon-Gimmon & Elefant, 2019, p. 174). Autism is considered a spectrum disorder because it affects individuals differently and in varying degrees (Adamek et al., 2008, p. 117). However, common characteristics include communication deficits such as lack of expressive speech, lack of social skills, sensory processing issues, and behavioral issues (Oldfield, 2013, p. 24). Infants may show signs of autism spectrum disorder as early as 12 months but are not typically diagnosed until around the age of 3 (Adamek et al., 2008, p. 117). Autism has become more prevalent throughout the years and currently affects 1 in every 110 American children (Lim, 2011, p. 20). 

Autism spectrum disorder affects the ways in which information is processed in the brain. A child on the autism spectrum may have difficulty processing receptive language and/or using expressive language to convey thoughts and needs. A common communicative symptom exhibited among this population is echolalic language, in which the individual repeats words or phrases heard without any intent to interpret meaning (Adamek et al., 2008, p. 117). A child with autism may have a language acquisition delay in comparison to non-diagnosed peers, and some individuals may remain non-verbal into their adult lives (Vaiouli & Andreou, 2018, p. 323). 

A prominent characteristic displayed in individuals with autism spectrum disorder is a deficit in social skills. The development of social skills is essential in early childhood in order to be successful in the classroom setting and in the community. This importance of social skills continues throughout adolescence and adult life in order to participate in activities of daily living. Core deficits found among individuals with autism are difficulty starting social interactions, difficulty maintaining interactions, and difficulty comprehending nonverbal social cues given by others (Adamek et al., 2008, p. 123). 

Researchers have shown strong similarities between language processing and music interpretation in the brain. Music and speech have been found to share the same processing pathways within the brain (Lim, 2011, p. 18). Both music and speech have been found to elicit reactions in the Broca’s area, Wernicke’s area, and auditory cortex among other sites in the brain (Flaherty, 2017, para. 2).

A 2004 study investigated whether prior music training influenced speech and music processing in the brain (Schon et al., 2004). Participants were supplied with recordings of sentences that contained a wrong word and musical excerpts that contained a wrong note. Brain imaging results found that participants with a musical background were able to accurately decipher inaccuracies in speech and melody as compared to the participants with no prior musical knowledge. Additionally, those participants with musical knowledge were able to decipher these inconsistencies at a faster rate than their counterparts. This study is one of many that shows music and speech being processed in the same brain areas along similar neural pathways.

Music therapy is an effective method for assisting in the acquisition of communication skills among children with autism spectrum disorder (Lim, 2011, p. 17). Music therapy has been shown to provide more unique and novel experiences in which a child may become more engaged when working towards goals (Carpente, 2017, p. 161). Additionally, studies have indicated that children with autism may have a stronger attraction to music when compared to normal-aged peers (Carpente, 2017, p. 161).  In this treatment, communication and speech goals can be addressed in a non-threatening and fun environment. Using music as a therapeutic medium provides a structure that allows for reciprocal interactions and flexibility (Carpente, 2017, p. 161).

Several researchers in the music therapy field have studied the effects of music therapy interventions on the communication skills of children with autism. Carpente (2017) found that using child-lead musical improvisations led to an increase in the child’s engagement, purposeful communication, problem solving, and behavioral organization. A 2013 study compared the effectiveness of traditional speech therapy against music therapy in eliciting speech sounds in nonverbal children with autism (Sandiford et al., 2013). Researchers found that the participants enrolled in the music therapy treatment showed a greater speech production at a faster rate than participants in speech therapy (Sandiford et al., 2013). 

A popular music therapy intervention that has been used to elicit verbal speech in children is therapeutic singing using the client’s preferred music. This intervention involves pausing periodically while singing to prompt the client to respond with the correct word of phrase that will follow. For example, if a client’s preferred musical choice is “Twinkle Twinkle Little Star,” the music therapist could insert a musical pause before singing “star” in order to prompt the client to sing the last word. This intervention allows for the client’s brain to process the patterns and predictability of the music in order to finish the ends of phrases. 

Autism spectrum disorder (ASD) affects a child’s receptive and expressive language to varying degrees. It is currently estimated that as many as 40% of children with autism are nonverbal. Music therapy has been shown to encourage verbal responses from these individuals. Music therapy can be used as a springboard to ultimately elicit purposeful communication and social skill development. 

-Jasmine Bailey, Music Therapy Intern 

References 

Adamek, M.S., Thaut, M.H, & Furman, A.G. (2008). Individuals with autism  and autism spectrum disorders. In D. Williams, K. Gfeller & M. Thaut (Eds), An introduction to music therapy: Theory and practice, 3rd edn. American Music Therapy Association.

Carpente, J.A. (2017). Investigating the effectiveness of a developmental, individual difference, relationship-based (DIR) improvisational music therapy program on social communication for children with autism spectrum disorder. Music Therapy Perspectives, 35(2), 160-174. http://dx.doi.org.gcsu.idm.oclc.org/10.1093/mtp/miw013

Lim, H.A. (2011). Developmental speech-language training through music for children with autism spectrum disorders: Theory and clinical application. Jessica Kingsley.

Flaherty, S. (2017, August 30). Music and language. Music Therapy Center of California. https://themusictherapycenter.wordpress.com/2017/08/30/music-and-language/

Oldfield, A. (2013). Music, language, and autism: Exceptional strategies for exceptional minds. Jessica Kingsley. 

Salomon-Gimmon, M., & Elefant, C. (2019). Development of vocal communication in children with autism spectrum disorder during improvisational music therapy. Nordic Journal of Music Therapy, 28(3), 174-192. 

Sandiford, G., Mainers, K, & Daher, N. (2013). A pilot study on the efficacy of melodic-based communication therapy for eliciting speech in nonverbal children with autism. Journal of Autism and Developmental Disorders, 43(6), 1298-1307.  http://dx.doi.org.gcsu.idm.oclc.org/10.1007/s10803-01201672-z

Schön, D., Magne, C., & Besson, M. (2004). The music of speech: Music training facilitates pitch processing in both music and language. Psychophysiology, 41(3), 341-349.

Vaiouli, P., & Andreou, G. (2018). Communication and language development of young children with autism: A review of research in music. Communication Disorders Quarterly, 39(2), 323-329. http://dx.doi.org.gcs.idm.oclc.org/10.1177/1525740117705117

Music Therapy and Pain Perception in Adults with Chronic Pain

(Walworth, D., Rumana, C. S., Nguyen, J., & Jarred, J., 2008, p. 355)

50 million Americans suffer chronic pain spending over $100 billion a year on pain management.  Chronic pain is the most common reason individuals pursue medical treatments and 88% of doctors felt that their medical training did not prepare them for treating this pain.   Pain is a growing problem that is becoming even harder to treat (Schim, 2004, p. 4).

         There are many causes and traits of chronic pain.  Pain can be caused by many diseases, disorders, injuries, or have no known cause.  However, chronic pain is defined as pain that lasts for six or more months and is not a warning sign or telling of some other health concern.  This pain could be caused by the back, rheumatoid arthritis, osteoarthritis, angina, the head, or by injury to any body part (Schim, 2004, p.5-6).

 Two mechanisms that are important in the cause and perpetuation of pain are inflammation and neuropathy.  This damage or defect of tissue and the nerves and nervous system play a significant role in pain. Sensitization also plays a role in chronic pain, causing increased activity in neurons, decreased pain thresholds, and a strong response to stimuli.  Many patients suffering chronic pain have a poor quality of life, decreased physical ability, and lower overall health scores. Not only do individuals have lousy physical health, their mental health is affected, with heightened anxiety, little self-control or endurance, and approximately 50% suffering depression (Schim, 2004, p.5-6).  Patients begin to feel like the victim of their pain, which begins a vicious cycle of feeling consumed and controlled by pain. This cycle can lead to lowered overall functioning, ability to work, emotional distress, and poor social life (Davis, 2008, p. 310-312 ).

         Dr. Lenore Schvankovsky and Peter Guthrie developed a list of the ten essentials of a patient. This applies not only to a hospitalized patient, but a patient with any condition.  An individual needs to understand their illness and limitations, maintain a social life, prevent putting things off due to illness, exercise, and continue living life. They also believed it to be extremely important to adapt to the medical setting with their family while learning and using coping methods which reduce anxiety or fear of illness.  Music therapy brings a sense of warmth and familiarity to an unfamiliar setting like the hospital environment and helps meet these needs by giving social, emotional, and motor reinforcement (Davis, 2008, p. 319).

            It is difficult to establish goals when working with chronic pain because of the variety in diagnosis and symptomology. Treatments and therapies for pain differ greatly amongst individuals based on their condition. Common treatments include medication, physical or occupational therapy, acupuncture, or other alternative therapies. Treatments focus on treating pain related symptoms because the pain itself is so difficult to treat (Schim, 2004, p.8-10).

         Like the treatment and therapies used to treat chronic pain, there are not standard therapeutic goals, but specific goals that are targeted to each individual and their condition.  Creating realistic goals is an important step in treating and managing chronic pain. Mayo Clinic has developed a system called SMART goals, which is an acronym for specific, measurable, attainable, realistic, and timely. Some generalized goals that could be applied to any illness or condition are to exercise, focus on maintaining good overall health, reduce medications, manage emotions, and find balance (Bruce, 2014, n.p.).  The most common goals among pain management include better comfort, well-being, control, and involvement in treatment (Bailey, 1985, p.26). It is also important to lower tension, pain perception, anxiety, and stress (Music Therapy with Specific Populations, 2010, p. 4).

         Music therapy is used among patients suffering chronic pain to try and achieve these goals.  For most effective treatment, a patient’s musical background or preferences are always considered in order to come up with the best plan.  Familiar, patient-preferred music has been known to reach patients who are distant or isolated and may help build relationships and increase communication (Bailey, 1985, p.26). Music therapy when used as a distraction from pain, helps lessen pain perception, anxiety, and stress. Not only does music therapy help improve quality of life, it has been shown to improve respiration, blood pressure, cardiac output, relax tension, and shorten hospital stays (Music Therapy with Specific Populations, 2010, p. 4).  Combined with other therapies, music therapy helps to increase patient’s endurance. Music can lessen the patient’s attention to unpleasant parts of therapy, such as repetition or pain and lead to improved results (Davis, 2008, p. 319).

         Anxiety, fear, and tension not only add to the awareness of pain, but also increase muscle tension that interferes with breathing and increases overall pain perception (Davis, 2008, p. 319).  Common goals of music therapy with this population are to distract from anxiety and stress, to elevate mood, and achieve better overall thoughts and feelings. Music helps provide a steady tempo for rhythmic breathing and structure for release of tension (Music Therapy with Specific Populations, 2010, p. 4). The feeling of pain can become less when it is no longer the focal point, and the mind focuses on a positive stimulus such as music (Davis, 2008, p. 321).

         Music therapy has been shown to affect biologic and physical factors such as a stronger immune system, higher oxygen saturation, and significantly lower counts of salivary cortisol, a stress hormone (Bailey, 1985, p.27). Interventions such as singing, dancing, playing instruments, guided listening, lyric analysis, and songwriting are commonly used (Walworth, 2008, p. 356-357). Music  is often used in rehab facilities to help divert the patient’s attention from the pain and lessen overall pain perception (Lim, 2011, p. 125). Music therapy can trigger the release of endorphins, which work as the body’s natural pain killers and improves overall well-being. With the use of music therapy patients have experienced improved effects from pain killers and anesthetics, and have not required as much medication (Davis, 2008, p. 324). 

         As chronic pain has become the most common ailment in America, the importance for understanding and adequate research has risen. Since chronic pain affects so many aspects of the mind and body, it is crucial to address and manage the struggles that suffering causes along with learning to live a functional life.  By creating realistic goals and treatment plans to improve quality of life an individual can begin to understand their condition. Though there are many causes and conditions creating chronic pain, understanding a condition becomes the foundation of a strong treatment plan and the ability to manage pain.

-Rachel Buchheit, Music Therapy Intern

References

Bailey, L. M. (1986). Music therapy in pain management. Journal of Pain and Symptom  Management, 1, 25-28. Retrieved August 12, 2019, from https://www-sciencedirect-  com.bunchproxy.idm.oclc.org/science/article/abs/pii/S0885392486800240

Bruce, B., & Harrison, T. (2014) Mayo Clinic Guide to Pain Relief (2nd ed.).  Google Books.  https://books.google.com/books?id=sO4aDAAAQBAJ&printsec=frontcover&dq=Mayo+        Clinic+Guide+to+Pain+Relief&hl=en&newbks=1&newbks_redir=0&sa=X&ved=2ahUK EwiotoKYuoPnAhURSN8KHbASBxgQuwUwAHoECAYQCA#v=onepage&q=Mayo% 20Clinic%20Guide%20to%20Pain%20Relief&f=false

Davis, William B., Kate E. Gfeller, and Michael Thaut. (2008). Chapter 11: Music Therapy,    Medicine, and Well-Being. In The American Music Therapy Association,  An    Introduction to Music Therapy: Theory and Practice (pp. 305-41). Silver Springs,         Maryland. The American Music Therapy Association.

Lim, H., Miller, K., & Fabian, C. (2011). The Effects Of Therapeutic Instrumental Music         Performance On Endurance Level, Self-Perceived Fatigue Level, And Self-Perceived        Exertion Of Inpatients In Physical Rehabilitation. Journal Of Music Therapy, 48.2, 124-   148.  

American Music Therapy Association. (2010). Music Therapy with Specific Populations: Fact Sheets, Resources & Bibliographies: Music Therapy and Pain Management.  American Music Therapy Association. https://www.musictherapy.org/assets/1/7/MT_Pain_2010.pdf

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