Role of Music Therapy in Dementia

Dementia:

Dementia is a progressive neurologic disorder that changes behavior, diminishes cognition, and deteriorates memory due to a disease or injury. Some causes of dementia which may or may not be reversible are brain injury, use of certain medications, hypoglycemia, hypothyroidism, immune disorders, vitamin B12 deficiency, excessive alcohol intake, and smoking. The common types of dementia are Alzheimer’s disease, Lewy body dementia, and vascular dementia.

The most pronounced effects of dementia are on memory and visual-spatial. Some psychological and behavioral expressions that can manifest are aggression, agitation, depression, wandering, restlessness, and trouble eating or swallowing. During the late stages of disease, difficulty in swallowing can result in breathing food into the lungs that may lead to aspiration pneumonia.

Treatment:

The symptoms associated with behavior and psychology affect patients and their caregivers. Available pharmacologic treatments used to treat behavior have little benefit and significant risks. Due to increased risk of mortality associated with these drugs, FDA has issued warnings against their use especially in elderly patients. The Dementia Action Alliance encourages integrated approach to focus on a person’s behavioral and psychological expressions rather than following general practices.

In a holistic approach patient-specific behavior is identified and modified to eliminate conditions which contribute to a specific behavior. A targeted approach provides patient activity program and builds skills that simplify communication and tasks. Various therapies that have been used to support a person living with dementia are music therapy, art therapy, reality orientation, aromatherapy, and cognitive behavioral therapy.

Music therapy:

It is a health profession in which music is used as a therapy to improve mental, physical, and social wellbeing of an individual. It helps to balance spiritual and emotional needs of an individual to improve quality of life.

The qualified music therapist provides treatment based on individual patient’s needs and may include playing musical instruments or video games, singing, dancing, song drawing, listening to music, and/ or multisensory stimulation. It can be provided as individual or group therapy, however studies have shown more positive results with group therapy. Active therapy engages patient with direct participation while passive therapy allows patient to listen to music or engage in another activity. Active therapy has been found to be more helpful in improving physical functions of the patient like grasping an object.

Credentialing of music therapist:

Music therapy is a health profession based on evidence. The therapist must earn at least a bachelor’s degree, complete 1200 hours of internship and obtain MT-BC credential issued by the Certification Board for Music Therapists to become a certified music therapist.

The therapist may hold different designations like Certified Music Therapist, Advanced Certified Music Therapist, or Registered Music Therapist. He must obtain continuing education credits and hold licensure in states that require board-certification to safeguard competent practice.

Impact of music therapy:

When we listen to music different parts of brain become stimulated. For instance, music stimulates amygdala which is involved in processing of emotions. Dancing and playing an instrument involves motor cortex which controls movement. Musical experiences excite hippocampus which is responsible for memory and spatial navigation. It increases blood flow in the brain, strengthens executive functions, supports heart, improves communication, and reduces stress.

Studies have shown the positive effect of music therapy on psychological and behavioral symptoms of dementia. A study by Ozdemir L et al., 2009[1] improved cognition and reduced depression and anxiety with continued effect for three weeks following the completion of study in mild dementia. Another study by Li CH et al., 2015[2] showed that cognition in music therapy group was reduced less as compared to the control group and change of abstraction domain in the music therapy group was better.

Numerous other studies have been done using different assessment instruments like Mini-Mental State Examination, Geriatric Depression Scale, Beck Anxiety Scale, Hamilton Anxiety Rating Scale, Clinical Dementia Rating, Cognitive Abilities Screening Instrument, and Neuropsychiatric Inventory. Several studies have shown promising results in the form of decreased anxiety, positive emotional states, and increased relaxation.

It has the potential effect to enhance the quality of life, improve neuropsychiatric symptoms, and reduce symptoms like cognitive decline and depression. It benefits patients who have difficulty communicating or expressing themselves in words. This, in turn, strengthens patients’ abilities and transfer it to other areas of their lives.

Conclusion:

A clinician can play a role in facilitating collaboration with specialists and other healthcare professionals to implement music therapy. Researchers have demonstrated that music therapy can protect cognition, executive function, psychomotor speed, and autobiographical and episodic memories and can yield high levels of patient and caregiver satisfaction. Additional clinical trials will add evidence to support the positive effect of music therapy. Multisensory stimulation with dance, art, video game, and physical exercise seems an exciting and promising approach.

References:

1. Ozdemir, L, and N Akdemir. “Effects of Multisensory Stimulation on Cognition, Depression and Anxiety Levels of Mildly-Affected Alzheimer’s Patients.” Journal of the Neurological Sciences., U.S. National Library of Medicine, 15 Aug. 2009, www.ncbi.nlm.nih.gov/pubmed/19289242/.

2. Fang, Rong, et al. “Music Therapy Is a Potential Intervention for Cognition of Alzheimer’s Disease: a Mini-Review.” Translational Neurodegeneration, BioMed Central, 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5267457/.

How Music Therapy Helps Children With Autism

Several researches have proven, time and again, that music therapy can benefit individuals of all abilities and ages. Such therapy has been used to support cognitive, social and emotional development in people across races, countries and communities. It can also help promote wellness by enhancing memory, improving communication skills and managing stress. Researchers have also shown that children and teenagers, who have been suffering from autism, can benefit a lot with music therapy. It helps improve their social behavior, better their communication attempts in terms of gestures, verbalizations, vocabulary and vocalizations, reduce their anxiety, increase their attention and focus, and even improve their body coordination and awareness. A few studies even show that both adults and children with autism spectrum disorders or ASD respond very well to music. This is why music is considered to be a potential therapeutic tool for treating autism.

Here’s how it can help children with autism:

· Music encourages social interaction- Kids, who suffer from autism, show more social engagement and emotional expression during music therapy sessions, as compared to the play sessions, without music. They also respond to the requests of the therapist if there is music in the session. Moreover, a trained and experienced therapist can use music to improve the social skills and increase the social interaction of these kids. Playing different types of movement and music games, passing and sharing instruments, learning to listen, singing greetings songs and gathering around a central instrument are some of the ways that a therapist can use to increase such interactions.

· Music helps improve communication – Almost thirty percent of kids with autism are non-verbal. Again, there are many kids who can’t follow verbal commands or understand body languages. Studies have proven that music improves the mapping of sounds to actions. This is done by connecting the motor and auditory sections of the brain. This helps improve the understanding of verbal commands. With the help of repetitive training and by pairing music with actions, the speaking skills of these children can be improved.

· Music helps improve one’s behavior – With some studies conducted over a span of ten months, it has been proven that weekly music therapy sessions improve overall behavior of kids with autism, especially when it comes to dealing with inattentive behavior. In a particular study, children were exposed to hour-long sessions of music therapy, once in a week, and their conduct was tracked against a checklist of certain behaviors. The results showed significant improvement in their observable behavior.

Surely, music therapy can be very useful and rewarding for children with autism.

How Does Music Therapy Relate to Bipolar Disorder?

“A mental disorder is a classified as a clinically significant behavioral or psychological syndrome that occurs and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.” (Peters, 2000). Although mental disorders may have a variety of manifestations and degrees of severity, they all are characterized by persistent, abnormal patterns of problem behaviors. These clients are sometimes described as having behavior disorders or behavioral disorders. Mental illnesses and disorders traditionally have been classified into two broad categories of neuroses and psychoses. A neurosis is a mental disorder primarily characterized by anxiety. This anxiety may be experienced directly and be the main manifestation of the disorder or it may be unconsciously controlled or modified to produce other distressing symptoms. A psychosis is a more severe mental disorder that is primarily characterized by loss of contact with reality. Individuals who have psychoses have delusions, hallucinations and an impaired ability to test reality. For many, a mental disorder can hinder a person from keeping a job, family, relationships and sanity. The psychiatric problems that occur in adults are more likely to be associated with the stresses of everyday adaptation or a more chronic reaction resulting from distress over a longer period of time. What many people don’t know is that someone can in fact live a relatively normal life with the help of many therapies, such as music therapy to be specific.

“Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks.” (2008). Symptoms of bipolar disorder are severe. They are different from the normal ups and downs that everyone goes through from time to time. Bipolar disorder symptoms can result in damaged relationships, poor job or school performance and even suicide. But bipolar disorder can be treated and people with this illness can lead full and productive lives. Bipolar disorder often develops in a person’s late teens or early adult years. At least half of all cases start before age 25. “In the acute phases of their illness, adults who have mental or behavioral disorders often display behaviors of intense confusion, agitation, excitability, fearfulness or withdrawal. They have a need to learn and develop positive coping mechanisms to deal with the stresses and responsibility of daily life.” (Peters, 2000). Some people have their first symptoms during childhood, while others may develop symptoms late in life. For example, Maria is a seventeen year old who has been suffering with bipolar disorder for two years. Her ups and down cycle average from two to three months. For the first couple of months, she is in a hypo maniac state where she goes out everyday, shops, spends excessive amounts of money, wears make up and loses a large amount of weight. The next couple of months she locks herself in her room, binge eats, gains weight, cries and completely cuts her connections with the outside world. Due to this unstable cycle, she has dropped regular school and had tried to take up homeschooling, lost all friends, unable to work for an allowance and feels worthless and hateful toward herself most of the time. Her battle with bipolar disorder has made it impossible for her to continue therapy for longer than a month at a time.

“During a depressive episode, the person has a persistent depressed mood (most of the day and nearly everyday) and several other symptoms such as diminished interest in activities that are generally enjoyable, changes in appetite or weight, changes in sleep patterns, agitation or lack of energy, feelings of worthlessness, difficulty concentrating, and thinking clearly and thoughts of suicide. Symptoms may develop at a time of personal crisis but people can also feel depressed for no apparent reason.” (Davis, 1999). Most of the time, the symptoms can be nothing mysterious and can have a minimal effect on a person’s life. But, overtime, the episodes can get increasingly worse for longer periods of time. In a severe state, a person can become psychotic and the episode can last for up to six months if it is left untreated.

“During a manic episode, people may have decreased need for sleep, their thoughts may race and they may be extremely talkative. They may engage in wild spending sprees or take on unrealistic tasks.” (Davis, 1999). For the most part, a manic episode can be just as hurtful to a person as a depressive episode, if not more. During these times of feeling up and energized, it may seem that a person does not need their medication and that can lead to many more issues to a person with bipolar disorder. While treating these times, it can also help the person from not making poor decisions and having to deal with the repercussions later on during a depressive episode. Many of these symptoms are also present in a hypo manic episode. A hypo manic episode is similar to a manic episode, but the symptoms may be experienced to a lesser extent and do not normally affect a person in their daily life.

“Music therapy is defined as a planned, goal-directed process of interaction and evaluation of individual client’s specific needs, strengths, and weaknesses, in which music or music-based experiences are specifically prescribed to be used by specifically trained personnel to influence positive changes in an individual’s condition, skills, thoughts, feelings, or behaviors.” (Peters, 2000). It is a process that takes place over time and involves growth, change, and development. The process of music therapy may include various musical, creative, artistic, therapeutic, developmental, educational, interpersonal, behavioral and scientific components as music therapist and client interact over time in both musical and non-musical areas. Under the direction of a trained music therapist, the music based experiences become potent therapeutic tools that can predictably and effectively influence positive changes in an individual’s condition, skills, thoughts, feelings or behaviors. Once a client has been assessed, evaluated, and individual therapeutic goals have been formulated, the music therapist designs a series of specific music and rhythm-based experiences that will help the client reach these goals and objectives. Music therapists often work directly with other professionals on medical or educational treatment teams. When they work in teams, these specialists meet together and decide how to coordinate their services in a way that will best help the client meet certain therapeutic goals. Treatment for psychiatric disorders often involves a combination of approaches and interventions including a structured environment, a regime of medication, a variety of psychotherapeutic interventions and a program of activity therapies. It is important to remember that individuals with mental disorders are unique and no one treatment or combination of treatments will be right for every person in therapy. Therapists who follow a humanistic approach give unconditional acceptance to the client with genuine caring, acceptance, understanding, and respect. The therapist helps the client move beyond defenses and mental or emotional blocks to confront the basic questions of life, find meaning and move to a higher level of functioning. Therapeutic techniques are experimental, oriented to building a trusting relationship, and are designed to help the client make choices, build an internal frame of reference and take personal responsibility to find purpose and meaning in life.

There are many songs that can be beneficial for people with bipolar disorder to listen to when going through a difficult time in their life. When choosing songs in a therapy environment, it is important to look at the lyrics to see if they are sending the right message to the clients. Some songs that would be beneficial for a therapist to use in a session are Keep Breathing, Empty Bottle, and A Birds Song by Ingrid Michaelson, It’s Only Life by Kate Voegel, If No One Will Listen by Keri Noble, Angel by Sarah McLaughlin, Amazing Grace, Beauty From Pain and Stand in the Rain by Superchick, Hope and Joy, On I Fight by Joy Ike, Give it Time by Jon McLaughlin, Keep Holding On by Avril Lavine, Lean on Me by Bill Withers, and Quiet Your Mind by Zac Brown Band. Each of these songs has inspiring lyrics to keep therapy enjoyable and encouraging. For relaxation purposes the songs Keep Breathing, Amazing Grace, and Angel are an excelled choice because of their simple melodies and graceful accompaniment that will enable you to focus on what is going on with you and will also enable you to do simple movement exercises. The songs Beauty From Pain, A Birds Song, Keep Holding On, On I Fight, Give It Time, If No One Will Listen, Quiet Your Mind, and It’s Only Life are a good choice for encouraging clients because of the lyrics saying how things will get better and how you have to keep pushing through all of the hard times that are in a clients way. The remainder of the songs is just good to have in therapy because of the messages that they give through the lyrics.

In conclusion, bipolar disorder can have crippling effects on people’s lives, but with music therapy, there can be hope. The field of adult psychiatry deals with preventing and treating mental, emotional and behavioral disorders in adults. Although psychiatric illnesses and disorders may vary greatly in severity and exact type of symptoms manifested, they all are characterized by persistent, abnormal, patterns of behavior. Music therapy is a non-invasive way to make connections with a therapist and communicate without being in an environment where it can be intimidating. With the right interventions and a good relationship with a therapist, the road of therapy can be very successful.

The Benefits of Music Therapy Using Binaural Beats

Music therapy or binaural beats have been around for a long time, over 170 years.  These beats use two different frequencies, one in each ear that helps stimulate the brain to help you relax.  The beats are set into soft relaxing music often with sounds of nature such as birds chirping or waterfalls etc.  

The benefits from the different frequencies, and the positive effects it has on the mind and body is good.  There are four different frequency waves that are used in music therapy, and they are, Delta, Theta, Alpha, and Beta, and each one has it’s own benefit.

Delta waves which is 1-3 Hz, and the benefits are, if you are having trouble sleeping, it is also good for lucid dreaming, which can help you if you have constant nightmares, and it also helps increase immune functions.

Theta waves which is 4-7 Hz, and the benefits are, it’s good for deep relaxation or meditation, hypnosis, also to increase memory, and to help you focus better.

Alpha waves which is 8-13 Hz, and the benefits are, that it will help you with light relaxation (while awake), also helps with learning, and positive thinking.

Beta waves which is 13-25 Hz, and the benefits are, that it will help with normal state of alertness, busy or anxious thinking, active concentration, and relieves stress, and anxiety.

The biggest benefit is that you don’t have to go to a therapist to get this treatment, you can do it in the comfort of your own home.  So many people have never heard of music therapy, or sound therapy, because of the fact that you had to go see a doctor, and get referred to a therapist who deals with these kinds of problems.  Like always doctors don’t want people to know about these kinds of treatments that you can do at home, because they will lose money.  You know how it works, they want you to see a therapist that they recommend so they get a commission, then once you see a therapist they want you to go and see them two or three times a week for a month, this can be very expensive, and inconvenient.

In conclusion, there is no reason that you can’t do this in the comfort of your own home.  When you see a therapist they put you in a room by yourself with headphones and they make you listen to the music for a certain amount of time, and that’s it, and make you go back several more times.  You can do the same thing at home, find a quiet place and put on some headphones, and just relax and listen to the music, and save yourself some money, it’s the same thing!  If you would like more information on music therapy or binaural beats see link bellow.