Meet Tess!

Hi! My name is Tess Vreeland, and I am one of the new Therabeat, Inc. music therapy interns. Although I am originally from Georgia, I have been residing in Tallahassee, Florida for the past 4 years working on my Bachelors of Music in Music Therapy coursework at Florida State University. My primary instrument is voice, but I have also loved learning and improving  my skills on guitar, piano, and ukulele over the past few years. I am so grateful to be back in my home state with the opportunity to work alongside so many intelligent and talented music therapists for the next 6 months! Alongside my musical hobbies, I enjoy hiking all over North Georgia, finding the best local coffee shops with friends, and hanging out with my dog, Teddy.

Although my life-long passion for music pushed me in the direction of finding a musical career, my love for helping and serving others was what led me towards the music therapy profession. Having the chance to serve a wide variety of clients, meet their needs, and help them explore their abilities and strengths through the therapeutic medium of music is so fulfilling. I have always found all forms of therapy fascinating, so having the opportunity to be in a facility where co-treatment and collaboration with physical, speech, and occupational therapists is really a dream come true.

My first week of observations and helping with summer camp was so exciting, welcoming, and helpful. I am really looking forward to creating connections with the clients and therapists here at Therabeat, Inc. in the coming months. Music therapy is an inspiring field, and I am excited for the opportunity to grow my creativity, clinical skills, musicianship, and more throughout this internship!

-Tess Vreeland

Music Therapy with Teens with EBD

Emotional behavioral disorder (EBD) in teens is an emotional or behavioral reaction that negatively affects the youth’s performance in social environments (DiCroce, Et al., 2015). Although there are many types of emotional behavioral disorders, the most common are Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, Conduct Disorder, Bipolar Disorder, Anxiety, and Depression (Ogundele, 2018). Adolescents who have a diagnosis of EBD are less likely to obtain future success in educational and social settings (DiCroce, Et al., 2015). According to DiCroce, early identification and treatment for EBD have been shown to drastically improve future life success. If left untreated, EBD can continue with the adolescent into adulthood putting strain on their family, occupation, and general quality of life (DiCroce Et al., 2015).

Finding strategies to cope can play a crucial role in a young person’s well-being. Music is a key resource to cope with psychological distress in teenagers. Although research has shown that music is one of the most commonly used methods for adolescents to deal with hardships, it is important to note that while music listening can be adaptive, it can also be maladaptive. For example, teens with depression can sometimes use music in processes of rumination leading to negative outcomes. This research suggests that even if intentions are good, teens might not be aware of the effect of their music choices, or how to use music properly for coping (Garrido, Toit, & Meade, 2022).

            Due to music being one of the top strategies for coping in teens, music therapy is an excellent treatment option for teens dealing with EBD. Music therapy is a non-pharmacological method that can be used to aid teens with EBD in providing a healthy outlet to socialize, as well as providing them with beneficial coping strategies to deal with distress. Teenagers spend a minimum of 2 and a half hours a day listening to music (McFerran, 2010), and music listening is also considered to be a crucial role in areas such as identity formation and resilience in teens (McFerran, 2010). According to McFerran, teenagers use music preference to express personal values, opinions, behavioral self-management, as a communicative outlet, and build interpersonal relationships (2010). Working with structured music interventions can be extremely important to teens who struggle with their emotions and behaviors because they often have difficulty in building or maintaining interpersonal relationships (DiCroce et al., 2015). A board-certified music therapist who uses music as a tool to reach non-musical goals can aid a teen with EBD in many evidence-based interventions. Some of the most common goals for a music therapist when working with teens with EBD are to foster understanding and acceptance. (McFerran, 2010).

            While many interventions are used with teens in music therapy, two of the most common are lyric analysis and improvisation. During a lyric analysis, a song is used to provide inspiration for a therapeutic framework. Within music therapy, the MT would ask the client to find a song relevant to their current feelings, and verbally explore these feelings using music as a medium. When using a lyric analysis intervention, a music therapist is fostering understanding, leading to an increase in self-awareness. This can aid a teen with EBD in becoming more aware and connected to their emotions, leading to a possible reduction of maladaptive behavior (McFerran, 2010). Another music therapy intervention that might be used for teens with EBD is free improvisation. Improvisation interventions used by a music therapist can provide a feeling of acceptance and encouragement of participation leading to an increase in self-confidence and socialization in adolescents with EBD (Porter et al., 2017).

  Due to music playing such an important role in a teen’s life, as well as scientific research pointing to music therapy having positive effects on teens with EBD, music therapy is a viable option to consider when finding treatment. While there needs to be further research to determine what type of interventions and approaches will work best for a specific diagnosis of EBD, research suggests that music therapy can have effects on clinically relevant outcomes (Porter Et al., 2017).

References

DiCroce, M., Preyde, M., Flaherty, S., Waverly, K., Karki-Niejadlik, N., & Kuczynski, L. (2016). Therapeutic engagement of adolescents with emotional and behavioral disorders. Child & Adolescent Social Work Journal, 33(3), 259–271. https://doi.org/10.1007/s10560-015-0419-z

Garrido, S., du Toit, M., & Meade, T. (2022). Music listening and emotion regulation: Young people’s perspectives on strategies, outcomes, and intervening factors. Psychomusicology: Music, mind, and brain. https://doi.org/10.1037/pmu0000285

McFerran, K. (2010). Adolescents, music and music therapy : Methods and techniques for clinicians, educators and students. Jessica Kingsley Publishers.

Ogundele, M. O. (2018, February 8). Behavioral and emotional disorders in childhood: A brief overview for pediatricians. World Journal of Clinical Pediatrics. Retrieved April 11, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803568/

Porter, S., McConnell, T., McLaughlin, K., Lynn, F., Cardwell, C., Braiden, H., Boylan, J., Holmes, V., Rogan, S., Clinician, L., Diamond, K., Allen, J., Reilly, C., Davidson, F., McDowell, C., Boyd, R., Oldfield, A., Mullowney, M., Downes, C., & Jack, K. (2017). Music therapy for children and adolescents with behavioral and emotional problems: A randomized controlled trial. Journal of Child Psychology & Psychiatry, 58(5), 586–594. https://doi.org/10.1111/jcpp.12656

Family-centered Music Therapy

Music therapy is an evidence-based creative arts therapeutic approach that aims to use music to meet nonmusical goals such as social, emotional, cognitive, communication, and physical goals. It can be used for groups or individuals of all ages and abilities (AMTA, 2022). There are many different approaches to music therapy including an approach called family-centered music therapy, or FCMT. Family systems theory states that events that impact the family affect all family members, including the child. A family systems therapist views the client within the family system to better make sense of the varying factors that might be impacting the individual (Thompson, 2012). Abad and Williams (2007) wrote that “the quality of family life is fundamental to the well being of children” (p.52), meaning that the family relationships provide a foundation for the overall development of the child. This same view has shaped FCMT as it prioritizes the parent-child relationship–especially during music making–due to the belief that relationships within the family significantly impact the individual (Fuller & McLeod, 2019). 

Family-centered music therapy can look different depending on the age, goals, and setting. In the NICU it can look like a music therapist working with the parents to create lullabies for the infant to hear a parental voice when the parents cannot be present (Standley & Gutierrez, 2020). In homes or at clinics it can look like singing or playing instruments with the music therapist encouraging and supporting the parents to participate and learn the songs so they can continue to practice the skills at home (Thompson, 2012). In other settings it can look like the parent and child engaging in musical activities with each other with encouragement from the music therapist to highlight strengths and build self-esteem (Thompson, 2012). It can look like a mommy and me music therapy class or other group music therapy classes to focus on social skills (Houde & Narendran, 2018). Houde and Narendran (2018) state that no matter the situation, the family-centered music therapist aims to address both the child and the parents’ needs during sessions.

Recent studies show that FCMT is associated with increased confidence, self-esteem, and self-efficacy beliefs in parents which in turn positively impacts the child too (Thompson, 2012). Williams et al. (2012) found that music therapy has been associated with higher parent satisfaction rates, higher parent engagement and positive interactions, improved parent-child relationships, parenting behaviors, child outcomes, and increased parenting skills among other things. When incorporating parents in the therapeutic process, music therapy has also shown to be helpful in reducing parental stress, improving attachments, and teaching about over-stimulation while providing the parent more resources, support, and information to continue music-centered work at home (Standley & Gutierrez, 2020). Because music therapy in general is a strength-focused approach, Thompson (2012) stated that there were results from some studies that parents were better at identifying strengths in their children after attending music therapy services.

Part of the influx of research studies being done on FCMT is due to the fact that the risk of bad parenting behaviors and unhealthy attachments in parent-child relationships is higher when parental depression, single parenting status, young parenting, or lower socioeconomic status is present (Abad & Williams, 2007). Similarly, families with a child with a disability are at higher risk for parental stress, lower socioeconomic status, and unhealthy attachments (Williams et al., 2012). When these higher risk situations occur, it is even more crucial to seek services that might decrease those risks. By incorporating the family in the therapeutic experience, many goals can be addressed within the family system that cannot otherwise be addressed if seeing someone individually. Though family-centered music therapy, or music therapy in general, may not be the best therapeutic approach for everyone, it can be an impactful method for many–especially for families with fewer resources available to them. 

References

Abad, V., & Williams, L. E. (2007). Early intervention music therapy: Reporting on a 3-year project to address needs with at-risk families. Music Therapy Perspectives, 25(1), 52-58.

American Music Therapy Association (AMTA), (2022). American Music Therapy Association. About Music Therapy and AMTA | American Music Therapy Association. Retrieved April 24, 2022, from https://www.musictherapy.org/about/ 

Fuller, A. H., and McLeod, R. G. (2019). The connected music therapy teleintervention approach (CoMTTA) and its application to family-centered programs for young children with hearing loss. Australian Journal of Music Therapy 30, 13-30.

Houde, M., and Narendran, N. (2018). A literature review of the influence of early childhood music education and music therapy on child development. Canadian Journal of Music Therapy, 24, 27-39.

Standley, J. M., and Gutierrez, C. (2020). Benefits of a comprehensive evidence-based NICU-MT program: Family-centered, neurodevelopmental music therapy for premature infants. Pediatric Nursing, 46(1), p. 40-46.

Thompson, G. (2012). Family-centered music therapy in the home environment: Promoting interpersonal engagement between children with autism spectrum disorder and their parents. Music Therapy Perspectives, 30(2), 109-116.

Williams, L. E., Berthelsen, D., Nicholson, J. M., Walker, S., & Abad, V. (2012). The effectiveness of a short-term group music therapy intervention for parents who have a child with a disability. Journal of Music Therapy, 49(1), 23-44.

Music Therapy & ASD

The month of April is Autism Awareness month, so it is the perfect time to bring awareness of the impact music therapy can have on individuals with autism spectrum disorder (ASD). The Center for Disease Control reported in 2021 that 1 in every 44 children is diagnosed with ASD in the United States (Autism Speaks Inc., 2022). ASD is a developmental disorder that affects the nervous system and is based on impairments mainly in social interaction, communication, and repetitive behaviors (Thompson, 2012). Symptoms vary widely and can include developmental, behavioral, cognitive, psychological, and mental health symptoms. Music therapy has been identified as an effective treatment approach for social interaction, verbal communication, and socioemotional reciprocity (LaGasse, 2017). 

One of the main reasons that music therapy has been so effective as a treatment approach for individuals with ASD is because music is naturally present in many homes and often involves social settings whether intended or not (Thompson, 2012). For example: music may already be present in the home through a parent singing a lullaby to their child, music being played over a speaker, or family members playing live music through instruments and voice. Even when it is not as present in the home, it is often viewed as a fun, safe, and structured way to help individuals feel more secure in social engagements (LaGasse, 2017). There have been many studies that noted that people with ASD also have a unique attraction to musical stimuli and often have a more enhanced musical ability even without much musical training (LaGasse, 2017). 

Not only is music fun and naturally present, but it can activate neural networks in the brain to help synchronize neural firings, especially between similar functions such as singing and speaking, making it easier to generalize to a nonmusical context (LaGasse, 2017). Many individuals with ASD have the neural firings but lack the organization and structure leading to incongruent sensory information (LaGrasse, 2017). The rhythmic structure of music can function as a cue to help organize the neural firings to better predict and respond in social settings. Similarly the neural organization can aid in cueing things like turn taking or impulse control (LaGrasse, 2017). Something as simple as singing a consistent hello song can help aid an individual in pragmatic reciprocal communication to engage in greetings such as saying “hello,” “goodbye,” and asking or answering questions like “How are you feeling today?” 

Another huge benefit of music therapy for individuals with ASD is that it is individualized to the person, which means that the therapist can address all levels of ASD, focusing on specific areas of need (LaGrasse, 2017). Though many therapeutic approaches are individualized to some degree, music therapy is highly individualized. Music therapists are trained to create treatment plans based on thorough assessments that are adapted to the individual needs with interventions that use client preferred music. They can be used with people of all socioeconomic backgrounds, cultures, and ages and can be used in schools, homes, clinics, or medical settings (LaGrasse, 2017). According to Thompson, the more natural the therapeutic environment, such as a school or a home, the more effective the therapy is for kids with ASD which is more attainable for music therapists than most other types of therapists (2012). Fuller and McLeod went a step further in their research and discovered that there were higher levels of engagement and socialization from clients with ASD when they were using telehealth as the therapeutic modality (2019). It is also believed that better learning takes place in daily routines such as those that take place in a home or natural setting (Thompson, 2012).

Music therapy can have positive effects on social skills by increasing the ability to engage in greetings, joint attention, social interactions, as well as cognitive social skills (LaGrasse, 2017). Music therapy is not the only effective therapeutic approach to help people with ASD increase social skills and communication, but it is certainly one that can be fun, in a natural setting, and broadly generalized to nonmusical contexts. It can also incorporate the parents or family by taking place in those natural environments, such as the home, building the attachment bond with family members which ultimately increases support and confidence in safe and familiar relationships (Thompson, 2012).

-Charlotte Reeder, Music Therapy Intern

References

Autism Speaks Inc. (2022). Autism statistics and facts. Autism Speaks. Retrieved April 25, 2022, from https://www.autismspeaks.org/autism-statistics-asd

Fuller, A. H., and McLeod, R. G. (2019). The connected music therapy teleintervention approach (CoMTTA) and its application to family-centered programs for young children with hearing loss. Australian Journal of Music Therapy 30, 13-30. 

LaGasse, A. B., (2017). Social outcomes in children with autism spectrum disorder: A review of music therapy outcomes. Patient Related Outcome Measures, 8, 23-32.

Thompson, G. (2012). Family-centered music therapy in the home environment: Promoting interpersonal engagement between children with autism spectrum disorder and their parents. Music Therapy Perspectives, 30(2), 109-116.

the effects of music therapy on Pediatric Patients with Preoperative Anxiety

Preoperative anxiety is a common experience in patients who are receiving a surgical procedure.  Preoperative anxiety is a feeling of intense uneasiness due to a lack of understanding, control, inability to communicate feelings, as well as past negative medical experiences (Gooding & Millett, 2017). This can lead to many adverse effects psychologically as well as physically. While preoperative anxiety is experienced by all ages, 75% of children are especially susceptible to these feelings of distress before an operation (Billick & Fronk, 2020). Young children typically reveal their anxiety differently from adults with behaviors such as trembling, restlessness, crying, or being silent due to the inability to verbalize their concerns or communicate effectively because they are distressed (Getahun et al., 2020). These adverse effects can lead to complications during procedures, as well as have negative long-term effects on the child. Children who experience high levels of preoperative anxiety have a greater risk of injuring themselves by trying to take control, such as accidently ripping out an IV. In addition, preoperative anxiety has also been linked to negative long-term effects such as separation anxiety, tantrums, nightmares, and bedwetting up to 12 months after a surgical procedure (Gooding & Millet, 2017).

There are multiple methods in aiding a child who is experiencing preoperative anxiety, which can be broken down into pharmacological and non-pharmacological methods (Gooding & Millet, 2017). Sedatives are a commonly used pharmacological method to ease preoperative anxiety. One of the most popular medications used for preoperative anxiety is the benzodiazepine midazolam because of its fast-acting effects and its significant reduction of nausea in patients. However, midazolam has also been linked to negative post-operative effects on behavior, cognition, and mental state (Billick & Fronk, 2020). Along with pharmacological methods being linked with adverse effects post-operation, pharmacological methods tend to be costly (Gooding & Millet, 2017). 

Music therapy is a non-pharmacological method that has been proven to be an excellent alternative to medication (Montgomery, 2016). Research has indicated that music can help individuals process emotions, and positively increase their emotional wellbeing (Montgomery, 2016). Scientific research has verified that music releases chemicals and hormones such as dopamine and endorphins within the brain. Dopamine is linked to an individual’s reward system and gives a sense of pleasure, while hormones such as endorphins also release a feeling of euphoria as well as being a known pain reliever. The release of these hormones has been shown to reduce feelings of anxiety in most individuals (Montgomery 2016). Additionally, music can also impact a person’s physical state. Scientific evidence shows that music can manipulate a person’s heart rate as well as blood pressure (Montgomery 2016). The ability to slow heart rate and lower blood pressure can lead to a calming effect on pediatric patients experiencing high levels of distress. 

Due to music’s power over the brain and body, a board-certified music therapist who has been trained to use music to manipulate these factors can greatly impact the level of preoperative anxiety experienced before surgery. According to Gooding & Millet, their research found that music therapy reduced preoperative anxiety in pediatric patients as well as their caregiver (2020). The researchers also found that none of the participants within the study showed negative post-operative outcomes unlike studies using pharmacological means (Gooding & Millet, 2020). Although there needs to be further research about music therapy and its direct effects on preoperative anxiety, research points to it being a viable alternative to medications. 

References

Fronk, E., & Billick, S. B. (2020). Pre-operative anxiety in pediatric surgery patients: Multiple case study analysis with literature review. Psychiatric Quarterly, 91(4), 1439–1451. https://doi.org/10.1007/s11126-020-09780-z

Getahun, A. B., Endalew, N. S., Mersha, A. T., & Admass, B. A. (2020). Magnitude and factors associated with preoperative anxiety among pediatric patients: Cross-sectional study. Pediatric health, medicine and therapeutics, 11, 485–494. https://doi.org/10.2147/PHMT.S288077

Millett, C. R., & Gooding, L. F. (2017). Comparing active and passive distraction-based music therapy interventions on preoperative anxiety in pediatric patients and their caregivers. Journal of Music Therapy, 54(4), 460–478. https://doi.org/10.1093/jmt/thx014 

Montgomery, E. (2016, November 1). The Science of Music therapy. Peterson Family Foundation. Retrieved February 6, 2022, from https://petersonfamilyfoundation.org/music-therapy/science-music-therapy/