Music Therapy & Pediatric Oncology

The term pediatric oncology is not often a positive topic of conversation. There is grief, pain, anxiety, stress and many more feelings that encompass this topic. Fortunately, music therapy has been proven to help make lives and families experiencing pediatric oncology a more positive experience. Every child with cancer has their own perception of the hospital and treatment, most associate them with pain and anxiety, however, research shows that Music Therapy services have a positive impact on a child’s ability to regulate those experiences. Two articles show very similar concepts of music therapy being integrated into the hospital and the positive outcomes it accomplishes. 

Within the multidisciplinary team at a children’s hospital, music therapy is often included. The one difference between music therapy and other disciplines is the prescription of medicine. Tucquet and Leung (2014) described music therapy as addressing “a nonpharmacological approach to symptom management” within the hospital setting (p. 327). Common goals that are addressed within this population consist of increasing emotional support, pain management, parent/child bonding, rehabilitation, anxiety management, procedural support, and self expression (Tucquet & Leung, 2014, p. 330). Music is seen to be a positive avenue for children to actively engage themselves and begin regulating their bodies. Since every child is different, music therapy must be practiced by a trained and certified music therapist that can establish individualized and therapeutic goals for each specific child.

Approaches that music therapists utilize to achieve these goals can look very different. Some interventions include instrument play, song-writing, free improvisation, singing, creating playlists, (Giordano et al., 2020, p. 2) active music engagement, and music relaxation and imagery (2014, p. 328-29). For children receiving radiation, “a personalized music therapy CD” was created (2014, p. 328). Many of these interventions elicit opportunities for self-expression, connecting to the outside world, utilizing coping skills, increasing positive affect and quality of life. Music therapy has been shown to positively engage children inside the hospital, which in turn, has been shown to reduce stress amongst parents. Loewy, as cited in Giordano et al. (2020) stated, “these processes not only refocus the patient’s attention, but also distract from the procedure itself or from the waiting time beforehand and help the child acquire a sense of security and calm for future proceedings” (p. 3). Allowing these children to be a part of something positive is an important component of happiness for the child and their families. 

Receiving treatment can be a scary time for children. With the use of music therapy before, during and after invasive procedures, positive outcomes were discovered. In both studies, children were split between a music group and a control group. The findings all positively reinforce the use of music therapy. The children within the music group reported pain and anxiety levels to be lower before and after the procedure (2014, p. 328). Researchers also found that heart and respiratory rates were lower during the procedure, and respiratory rates were lower after the procedure (2014, p. 328). These results show that a response to music therapy can be self-reported as well as measured by physiological changes of the body. Giordano et al. (2020) stated, “None of the interviewees reported a negative opinion on the presence of MT” (p. 3). As the results show, music therapy positively affected these children, but it also provided positive experiences for the parents as well. “Parents reported music therapy also provided an opportunity for family bonding in the midst of an unpredictable and challenging journey . . .  and their gratitude toward the program and therapists was highlighted” (2014, p. 332). During the difficult times for these families, having a space for bonding and positive interactions is something hopeful and a time everyone cherishes. 

Finally, music therapy is also seen as a way for families to save money and it is beneficial for hospitals as well. It is possible that with the use of music therapy, procedural support time could be reduced which saves time, money and equipment (DeLoach, as cited in Giordano et al., 2020, p. 2). Eventually, children could progressively become more comfortable with procedures and entering the operating room which saves an abundance of time. Giordano (2020) stated “the anesthesiologists in this study observed that the absence of the MT called for a larger amount of anxiolytic drugs, with an increase in the residual effects of anesthesia” (p. 3). Music therapy, alternatively, is much more cost effective than sedation (2020, p. 2). When a child could get to a point to not have to become sedated for a procedure, that would be positive for everyone involved. That is just one other benefit of music therapy. 

In conclusion, there can be a light in the middle of the darkest times. Music therapy can provide a child with cancer and their family with peace of mind, comfort, and an avenue for bonding. It is proven, by setting individualized goals and utilizing supportive interventions, music therapy can have positive effects on one's mind and body. It can also be a positive alternative other than methods utilized in pharmaceuticals. Continuing research on this topic is important to education people on the effectiveness of music therapy in pediatric oncology.  

References 

Giordano, F., Zanchi, B., De Leonardis, F., Rutigliano, C., Esposito, F., Brienza, N., & Santoro, N. (2020). The Influence of Music Therapy on Preoperative Anxiety in Pediatric Oncology Patients Undergoing Invasive Procedures. The Arts in Psychotherapy, 68, 101649–. https://doi.org/10.1016/j.aip.2020.101649

Music Therapy Program - Center for Cancer and Blood Disorders: Children's National Hospital. (2021, March 28). Center for Cancer and Blood Disorders | Children's National Hospital. childrensnational.org/departments/center-for-cancer-and-blood-disorders/programs-and-services/music-therapy  (image) 

Tucquet, B., & Leung, M. (2014). Music Therapy Services in Pediatric Oncology: A National Clinical Practice Review. Journal of Pediatric Oncology Nursing, 31(6), 327–338. https://doi.org/10.1177/1043454214533424

Why does Music Therapy work?

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

Welcome, Intern Macie!

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!

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

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. 

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

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.