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Why does Music Therapy work?

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Music Therapy—such an obscure term for many—but for others it is an avenue for socializing, recovery, self-expression, communicating, alleviating stress and so much more. The American Music Therapy Association defines Music Therapy as “the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program” (AMTA, 2021). What sets music therapy apart from other therapies is that music therapists utilize music interventions to drive the change related to therapeutic goals individualized for each person. Evidence suggests that engaging in music has a significant impact on the human brain, making it an effective tool for therapy. In 2014, researcher Stegemöller explored the principles of neuroplasticity and how it can be applied within the clinical practice of music therapy. 

Music therapy is often tested on progress based on observable behaviors and actions that are witnessed during a session, but understanding how the music is actually affecting the brain can lead to much more information as to why music therapy is working. Neuroplasticity is the ability for the brain to reorganize or remap connections in the brain to learn in a new way. Neuroplasticity indicates the ability of the brain to continuously change its form and functioning. Stegemöller (2014) states, “. . . in neuroplasticity the connectivity and non connectivity of neurons, networks, and regions . . . determines the perception and response to stimuli in the world around us (p. 212). Understanding neuroplasticity is the first step to understanding the way the brain can change due to stimuli and how music therapy can affect the way the brain functions. 

Experiences are what build up the brain. In short, the synapse is the space between two neurons where signals are passed back and forth and with constant use, the neurons become larger and long-lasting. The neurons that are not in constant use become weakened. This phenomenon is described as “synaptic plasticity” (p. 213). “Long- term potentiation (LTP)” was discovered when a brief high frequency stimulation occurred and “enhanced the synaptic activity between neurons” (p. 213). Specific receptors were found to trigger the LTP response which in return admits learning and memory to occur (p. 213). Stegemöller (2014) explains this occurrence gives researchers an understanding of “how the brain retains specific properties of an encoded memory, as well as how the brain associates one experience with another” (p. 213). “Long- term depression (LTD)” was discovered when a long period of low rate stimulation occurred and decreased synaptic activity (p. 214). LTP and LTD processes suggest that utilizing music therapy as the stimulation could have the ability to change the strengths of an entire network of neurons. 

Learning and memory are two very important targets in music therapy, but “restoring lost behaviors or finding alternative behaviors'' (p. 214) are also very important aspects targeted within music therapy. Cortical remapping is one of the largest components in understanding how the brain changes in response to music. “In sensory areas of the brain . . . the arrangement of receptive fields (i.e., areas of the brain that respond to a specified stimulus) can change in response to altered circumstances'' (Jenkins, as cited in Stegemöller, 2014, p. 214). For example, someone who has experienced a stroke no longer has the same motor abilities as before, but with receiving therapy and remapping occurring in their motor functioning, they are soon to recover close to or completely back to normal. Therefore, music therapy can be utilized to create new pathways and rewire, as well as restore and alternate old and new behaviors by altering circumstances and remapping the brain. 

The brain is understood to be always changing whether positively or negatively. From birth to ages 2 to 3, new connections of neurons are continually increasing, which is considered the critical period (p. 215). It is defined as the “critical period” due to this being the time children are learning about the world, and it is important to ensure these children are being exposed to positive stimuli. “These experiences set the neuronal structure for future plasticity”—meaning this time is critical in learning basic social interactions and engaging in stimulations with ease until it becomes more difficult later on in life (p. 215). From ages 3 to 6, new connections are increasing as well as pruning, which is when the brain is removing synapses that are no longer seen as needed due to the neurons not being utilized (p. 215). The saying “Use it or lose it” pertains to this time in development. By the time of adolescents the brain is creating new connections and pruning about the same amount, until the early 20s where the brain is completely developed (p. 215-216). Neuroplasticity spans the entire lifetime of one person, so even though the brain is developed by the early 20s, positive changes can be made within the brain throughout the entire lifespan. Music therapy can be utilized in remapping neurons that were pruned and assisting in regaining knowledge and abilities. 

One signal that neurons pass back and forth is dopamine—which has been shown to be released during positive stimuli occurring. Research has shown that music plays a role in the production of dopamine which proposes the idea of music being a driving force of the idea of reinforcement learning and reward. “Most importantly, research has shown that the response of dopamine neurons is transferred to stimuli during learning” (Romo & Schultz, as cited in Stegemöller, 2014, p. 216). For example, when a bell sounds and candy is then rewarded due to homework being turned in, dopamine is firing due to the candy. The bell becomes a signal of dopamine firing predicting future rewarded occurrences. It is assumed that dopamine has much to do with the occurrence of neuroplasticity and cortical remapping. So based on research, music therapists have the capability to utilize music as a reward, produce dopamine, which then promotes the motivation to achieve therapeutic goals. All in all, once dopamine has been fired, due to a nonmusical task, the synapse “may be strengthened by LTP, which is mediated by dopamine, ultimately leading to the learning of a new task/behavior from which the music reward (i.e., music therapy) can be faded” (p. 217). 

Noise, on the other hand, has been proven to negatively affect neuroplasticity and increase stress, while music has had the opposite of effects (p. 218). High levels of stress restrain the occurrence of LTP which in turn has negative effects on memory, cognition, and emotion.  On the contrary, exposure to music has strengthened learning and promotes the occurrence of neuroplasticity. “Research has suggested that the acoustic signal of song is more consonant than that of speech and that professional musicians have less “noise” in both their spoken and sung signals” (p. 219). Therefore, it is proven that music therapists have the ability to promote the occurrence of neuroplasticity by calming the noise. 

In conclusion, music has the ability to stimulate neuroplasticity, produce dopamine, remap the brain wiring, and quiet the noise. Music is a unique tool music therapists pair with therapeutic goals to achieve them. The brain is ever changing and so is music. “Like the sculptor who meticulously adds and cuts away until a final masterpiece is revealed, music therapists are the artists that use music to prune and create new neural connections resulting in a beautifully crafted masterpiece” (p. 220). This study is just one part of the extensive research on the positive impacts of music therapy on the brain. It is important for continued research to educate people on the effectiveness of music therapy. 

-Kennedi Walz, Music Therapy Intern


References

American Music Therapy Association. (2021, February 12). What is Music Therapy. https://www.musictherapy.org/ 

Choy, L. (2018). Neuroplasticity and Mental Wellness: Our Path Forward. Thrive Global. https://medium.com/thrive-global/neuroplasticity-mental-wellness-our-path-forward-4c03a632868 (image) 

Stegemöller, E. (2014). Exploring a Neuroplasticity Model of Music Therapy. Journal of Music Therapy, 51, 211-227. https://doi-org.proxy.lib.utc.edu/10.1093/jmt/thu023

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Welcome, Intern Macie!

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My name is Macie Skinner and I am so excited to be a part of the Therabeat team as a music therapy intern! I am from Alpharetta, Georgia, and I am so happy to be back home working in a field that I am so passionate about! Growing up, I was on a competition dance team at RISPA, a performing arts studio in Milton, GA. I moved back home at the beginning of the pandemic, and by this past fall I was able to begin teaching classes at my old studio again! I have always loved working with kids and teens, and Therabeat has already proven to be a perfect fit for me in more ways than one!

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I began my music therapy journey at Florida State University in 2016, where my primary instrument was voice, but I also spent a ton of time studying instruments like the guitar and piano! I earned a certificate degree in Music in Special Education my senior year, and I was one of a few music students lucky enough to be able to extensively study American Sign Language through a specialization program! ASL quickly became a passion of mine, and I was even able to become a TA for a nonverbal communication class for undergraduate music therapy students! One day, I hope to open my own co-operative private practice that serves individuals with hearing impairments! Outside of the classroom, I served as co-captain of LEVEL Dance Company, a student-run dance team, and performed at various campus events including: Dance Marathon, Relay for Life, FSU’s annual Homecoming Parades, and Pow-Wow Pep Rallies!

I absolutely love all things tie dye, vintage, and anything with sunflowers on it! I am a coffee fanatic, and I’m constantly listening to and learning new music. Some of my biggest musical influences include: Elton John, Jake Scott, Ben Platt, and Sara Bareilles! When I’m not working, I enjoy spending time with my friends and family, and babysitting my sweet nieces and nephew!

My first week as an intern at Therabeat has shown me that this experience is going to be everything I could’ve asked for in an internship and more! The team of therapists have been so welcoming and helpful with any and all questions we’ve had (and there’s been a LOT)! I love coming to work every morning, there’s nothing like walking into such a positive atmosphere full of joy and celebrations for little victories! I’ve already learned so much from everyone here, and I can’t wait to continue learning and growing with such incredible people! 


‘Til next time!

-Macie Skinner, Music Therapy Intern

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Welcome, Intern Kennedi!

Hello everyone! My name is Kennedi Walz. I am extremely excited to be doing my internship at Therabeat! I was uncertain of what my internship would look like during these trying times, but I am very thankful I was welcomed at Therabeat. I am originally from Manchester, TN, but have called Chattanooga, TN my home for the past four and a half years. I love to be outside and enjoy warm weather! I love to hike and travel. I am a huge animal lover with a dog named Kupcake and four guinea pigs (that’s a whole other story)! I am a huge Disney fan! Growing up, my family trips would either be to Disney or the beach, probably a huge reason behind what I love now. Family time is always something I have cherished and I believe I always will. They have each made impacts in my life that have molded me into the person that I am today, which has guided me to where I am now. 

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I was introduced to music therapy whenever I was a senior in high school. I researched it and instantly knew that it was something I was very interested in. Music therapy combines my two passions: music and helping others. I have always been passionate about the two my whole life. I had many encounters and experiences on my journey on figuring out my life purpose, and quickly realized music therapy was it. I began college at Chattanooga State Community College where I received my Associates of Fine Arts in Music. I then transferred to the University of Tennessee at Chattanooga where I will graduate in Summer 2021! I will be the first student to graduate from the university with a degree in music therapy. I am beyond thankful for my time at UTC and the experience and knowledge I gained from being there. 

My primary instrument is voice, but I also play the guitar, ukulele, and piano. I have had the pleasure of working with older adults with Parkinson’s Disease, children affected by cancer, adolescents with various special needs, and adults with IDD during my time in college. I also found a love of volunteering with the Miracle League of Chattanooga assisting children and adults with various special needs with playing baseball. Miracle League will forever hold a special place in my heart. No matter the day I am having, being able to help someone and “amplify [their] life” will always make my day brighter. 

Starting at Therabeat was life changing for me. Moving somewhere where I know no one is very different for me and transitioning from a student in a classroom to an intern constantly moving has definitely been an adjustment. I have loved every minute of being at Therabeat. The atmosphere is extremely welcoming and it feels like I’ve been there for so much longer than a week. I have already experienced and learned so many new things! I love that I am able to learn from each music therapist, and that they are so helpful. Being adaptable and flexible is something I have been told all throughout my time as a music therapy student and, to all the MT students out there, I lived it my first week! The fast moving pace at the clinic is so much fun though and I love seeing all the smiling faces I pass daily; makes each day brighter. I know I will grow to be the best music therapist I can be here and I am excited for this adventure! Here’s to the next six months! 

Love the life you live! 

Best wishes, Kennedi Walz, Music Therapy Intern



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Music Therapy & Behavioral Disorders

Research has shown that music therapy can be an effective tool for helping patients who have emotional behavioral disorders. Music can be used to help students with social skills, self-esteem, and academic support (Roley, 2017). The IDEA (individuals with disabilities education act) gives five characteristics that describe a child with a severe emotional disturbance:


  1. An inability to learn which cannot be explained by intellectual, sensory, and health factors

  2. An inability to build or maintain satisfactory relationships with peers and teachers

  3. Inappropriate types of behavior or feelings under normal circumstances

  4. A general pervasive mood of unhappiness or depression

  5. A tendency to develop physical symptoms or fears associated with personal or school problems (6).


This diagnosis makes up only about 1% of student populations due to this population being underidentified, underserved, and there not being a clearer understanding of what a severe emotional disturbance means (6). There are many risk factors that make it more likely that a child will develop this disorder and those include: socioeconomic status or demographics, unsafe home and school environment, environmental or psychosocial events (divorce, death, etc), and psychological make-up (7-8). There are many ways that music therapy can not only help students with behavioral and emotional disturbances but also be a tool for managing inappropriate behavior. 

Music interventions can help students express emotion, create group association, integrate social organization, symbolize representative beliefs and ideas, and support educational purposes (Parker, 2018). Some different music therapy techniques and approaches that could be useful with this population are the Behavioral Music Therapy Theory, The Bonnie Method of Imagery and Music, Nordoff Robbins Music Therapy, Psychodynamic Music Therapy, and Cognitive Behavioral Music Therapy (17-20). 

Specific interventions that could be used to help work on these students' goals could include “playing an instrument for on task behavior, using a small group setting to allow for interpersonal interactions, teaching turn taking, and sharing space while playing instruments to aid in impulse control” (Roley, 2017). One study by Sausser & Waller worked on 8 different goals: create a structured and safe musical experience for students, establish group cohesion, provide planned sessions to focus on group needs and individuals Individualized Education Plans (IEP’s), Music therapy and Emotional behavioral disorders, 13 facilitate group movement to enhance motor coordination and overall physical fitness, and allow for students to explore personal musical interests (12-13). 

Roley states that music therapy can “positively affect social skills in adolescents labeled EBD” (27). The literature showed that group music therapy proved to be most effective as well as improvisational techniques. Roley says that “The final theme re-occurred throughout the literature, which stated the lack of research within the effectiveness of music therapy, within all settings and among all populations. The existing research shows positive effects music therapy can have on patients with mental health needs, especially in children and adolescents with autism” (29). The research points us in the direction of music therapy being an effective tool for the students. However, to continue to advocate for this field and to be able to validate the reasoning behind music therapy with this population, more research needs to be done. 

-Sara Demlow, Music Therapy Intern


Roley, A. (2017). Music Therapy in the Treatment of Adolescents with Emotional and Behavioral Disorder: A Systematic Review. 1-34.


Parker, F., III. (2018). Music Therapy as a Behavior Modification for Students with Severe   Behavior. 1-20.



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Music Therapy and Hearing Impairments

The concept of providing music therapy for those who have hearing impairments or use a cochlear implant seems like a far-off and impractical concept to many people. This is a big misconception because most people believe that a large percentage of individuals with hearing impairments can not hear at all, which is not true. Although having a hearing impairment is a far greater communication and sensory handicap that hearing people realize, there are still many challenges that can be overcome. Alice Ann Darrow (1989, p. 61) writes that “blindness” is ‘an environmental handicap’ while deafness is a social disorder that keeps one from people”. This post is going to cue in on how individuals with cochlear implants are able to enjoy music and what methods of music therapy work best when working with these individuals.

Cochlear implants (CI) focus on transmitting only sounds that are essential to speech recognition. This means that most aspects of music are not transmitted, making it difficult for individuals with CIs to percieve timber and pitch (Hidalgo, Pesnot, Marquis, Roman, & Schön, 2019). The one aspect of music that is transmitted the best is rhythm (Gfeller & Knutson, 2003). Rap music is a common preference of teenagers with implants and line dancing music is a common preference of adults with implants because both rap and line dancing music usually have strong, steady beats (Gfeller & Knutson, 2003). Rap music also typically has rhythmically spoken lyrics over the steady beat. This is important to note because the rhythmicity of the words make the songs more easily recognizable. Individuals with cochlear implants have an easier time identifying songs with lyrics and a harder time identifying instrumental songs.

(http://www.vancouversun.com/health/should+cochlear+implant/7502865/story.html)

(http://www.vancouversun.com/health/should+cochlear+implant/7502865/story.html)

Since cochlear implants focus mainly on speech, individuals with cochlear implants can also have a hard time discriminating timber of instruments, tone quality, and pitches. These difficulties can vary based on relative health of the auditory nerve, the cause of deafness, whether a full insert of the implant was possible, whether all the implant channels are active, the age at implantation, cognitive and perceptive abilities, etc. For implant users, it is easier to compare the timbre of instruments to each other rather than listening to an instrument alone. The skill of instrument identification could possibly strengthen after listening practice (Gfeller & Knutson, 2003). Some people with cochlear implants say that the tone quality of most instruments sound “unnatural or tinny” (Gfeller & Knutson, 2003). Differentiating pitches, when listening or singing, is perceived to be one of the most difficult aspects of music listening for implant recipients. Studies show that adults with CIs are more self-conscious than children about singing in public and that they find it very difficult to sing along with an external pitch (Gfeller & Knutson, 2003). 

Listening to music and having repeated exposure to music stimuli can play a major role in how music can affect someone’s life (Gfeller & Knutson, 2003). With repeated exporesure, music would be able to be used in daily life and be more easily enjoyed by individuals with CIs. There is already emerging evidence that specific music training is able to improve music perception for people who use CIs (Jiam, Deroche, Jiradejvong, & Limb, 2019). The existing studies have used in-person training models and have not tapped into online resources yet (Jiam, Deroche, Jiradejvong, & Limb, 2019).

Music therapy can be extremely beneficial for those utilizing cochlear implants. One thing music therapists’ have to be very specific about when doing music therapy with individuals with CIs is the environment. Unlike when recording an acapella piece or singing with a choir, a music therapist would not want a very acoustic room. The room should be filled with many things that will absorb sounds and echoes. Without things like carpets and curtains, the sound will bounce around and cause distortion (Gfeller & Knutson, 2003). It is also important for therapists to dive into their patient musical preference. Just like individuals without CIs, individuals with CIs all like listening to different types of music. Music therapists’ want the patients to enjoy what they are listening to, not be turned away from it.

The four basic types of music therapy interventions used for patients with CIs are listening to music, moving to music, singing, and playing instruments (Gfeller & Knutson, 2003). Listening to music can be functional in many ways, such as providing opportunities for social interaction or even working on speech recognition. Moving to music also is a great avenue for increasing social interaction in a group setting. Singing can target many different essential areas, like socialization, articulation, and exploring one’s voice. Joining a choir can be a very social experience. Singing or saying rhythmic chants like “Going on a Bear Hunt” or “5 Little Ducks” can focus on the range of their speaking voice and articulation of speech. Using vocal exercises or therapeutic singing, music therapists can assess vocal intonation, vocal quality, range, awareness of nasal quality, volume of speech and singing voice, pitch matching, melody imitation, free vocalization, and can also exercise the diaphragm (Darrow, 1989, p. 64). Playing musical instruments is a fun way to work on understanding the sounds you are listening to and specifically focusing on those musical elements like instruments, tone quality, and pitches.

Music therapy can benefit those with hearing impairments in so many ways, especially when it comes to speech, language, and socialization. It is crucial as a music therapist when working with someone with a cochlear implant to understand how the implant works, what other factors in their life could affect therapy, and what objectives are most realistic for the patient to try and achieve.

-Amanda Brennen, MT Intern








References

Darrow, A. A. (1989). Music therapy in the treatment of the hearing-impaired. Music Therapy Perspectives, 6, 61–70.

Gfeller, K., & Knutson, J. F. (2003). Music to the Impaired or Implanted Ear.

Hidalgo, C., Pesnot-Lerousseau, J., Marquis, P., Roman, S., & Schön, D. (2019). Rhythmic Training Improves Temporal Anticipation and Adaptation Abilities in Children with Hearing Loss during Verbal Interaction. Journal of Speech, Language, and Hearing Research, 62(9), 3234–3247

Jiam, N. T., Deroche, M. L., Jiradejvong, P., & Limb, C. J. (2019). A Randomized Controlled Crossover Study of the Impact of Online Music Training on Pitch and Timbre Perception in Cochlear Implant Users. Journal of the Association for Research in Otolaryngology : JARO, 20(3), 247–262.

http://www.vancouversun.com/health/should+cochlear+implant/7502865/story.html (image)

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