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Music therapy is both an allied health profession and a field of scientific

research which studies correlations between the process of clinical therapy


and biomusicology, musical acoustics, music theory, psychoacoustics and
comparative musicology. It is an interpersonal process in which a trained
music therapist uses music and all of its facets—physical, emotional,
mental, social, aesthetic, and spiritual—to help clients to improve or
maintain their health. Music therapists primarily help clients improve their
observable level of functioning and self-reported quality of life in various
domains (e.g., cognitive functioning, motor skills, emotional and affective
development, behavior and social skills) by using music experiences (e.g.,
singing, songwriting, listening to and discussing music, moving to music) to
achieve measurable treatment goals and objectives. Referrals to music
therapy services may be made by a treating physician or an interdisciplinary
team consisting of clinicians such as physicians, psychologists, physical
therapists, and occupational therapists.

Music therapists are found in nearly every area of the helping professions.
Some commonly found practices include developmental work
(communication, motor skills, etc.) with individuals with special needs,
songwriting and listening in reminiscence/orientation work with the elderly,
processing and relaxation work, and rhythmic entrainment for physical
rehabilitation in stroke victims.

The Turco-Persian psychologist and music theorist al-Farabi (872–950),


known as "Alpharabius" in Europe, dealt with music therapy in his treatise
Meanings of the Intellect, where he discussed the therapeutic effects of
music on the soul.[1] Robert Burton wrote in the 17th century in his classic
work, The Anatomy of Melancholy, that music and dance were critical in
treating mental illness, especially melancholia.[2][3][4]

It is considered one of the expressive therapies.

Forms

There are a few different philosophies of thought regarding the foundations


of music therapy. One is based on education and two are based on music
therapy itself, both of which will only be briefly covered here. In addition,
there are philosophies based on psychology, and one based on
neuroscience.

Different approaches from education are Orff-Schulwerk (Orff), Dalcroze


Eurhythmics, and Kodaly. The two philosophies that developed directly out
of music therapy are Nordoff-Robbins and the Bonny Method of Guided
Imagery and Music.[5]

Music therapists work many times with individuals who have behavioral-
emotional disorders. To meet the needs of this population, music therapists
have taken current psychological theories and used them as a basis for
different types of music therapy. Different models include behavioral
therapy, cognitive behavioral therapy, and psychodynamic therapy.[6]
The therapy model based on neuroscience is called "neurological music
therapy" (NMT). A definition of NMT is "NMT is based on a neuroscience
model of music perception and production, and the influence of music on
functional changes in nonmusical brain and behavior functions."[7] In other
words, NMT studies how the brain is without music, how the brain is with
music, measures the differences, and uses these differences to cause
changes in the brain through music that will eventually effect the client non-
musically. As internationally known professor and researcher Dr. Thaut said,
"The brain that engages in music is changed by engaging in music."[8]

In the United States

Music therapy has existed in its common current form in the United States
since around 1944, when the first undergraduate degree program in the
world was founded at Michigan State University and the first graduate
degree program at the University of Kansas. The American Music Therapy
Association (AMTA) was founded in 1998 as a merger between the National
Association for Music Therapy (NAMT, founded in 1950) and the American
Association for Music Therapy (AAMT, founded in 1971). Numerous other
national organizations exist, such as the Institute for Music and Neurologic
Function, Nordoff-Robbins Center For Music Therapy, and The Bonny
Foundation. In the US, a music therapist is most commonly designated by
MT-BC (Music Therapist-Board Certified). A music therapist may use ideas or
concepts from different disciplines such as speech/language, physical
therapy, medicine, nursing, education, etc.

A music therapist may have different credentials or professional licenses


and may also have a master's degree in music therapy or in another clinical
field (social work, mental health counseling, etc.). New York State requires
that people holding the title music therapist be licensed as a creative arts
therapist by holding a master's degree or higher in the field. Other master's
degree holders may also take a test administered by the state of New York.
Some practicing music therapists have held PhDs in non-music-therapy (but
related) areas, but more recently Temple University and Lesley University
have founded a true music therapy PhD program. A music therapist will
typically practice in a manner that incorporates music therapy techniques
with broader clinical practices such as assessment, diagnosis,
psychotherapy, rehabilitation, and other practices depending on population.
Music therapy services rendered within the context of a social service,
educational, or health care agency are reimbursable by insurance and
sources of funding for individuals with certain needs, under the title of
Activity Therapy. Music therapy services have been identified as
reimbursable under Medicaid, Medicare, private insurance plans and other
services such as state departments and government programs.

A US music therapist may also hold the designation of CMT, ACMT, or RMT—
initials which were previously conferred by the now-defunct AAMT and
NAMT. More current music therapists hold the designation, MT-BC, music
therapist-board certified, given by the Certification Board of Music
Therapists. A degree in music therapy requires proficiency in guitar, piano,
voice, music theory, music history, reading music, improvisation, as well as
varying levels of skill in assessment, documentation, and other counseling
and health care skills depending on the focus of the particular university's
program.
To become board-certified in the US, a music therapist must complete
course work at an accredited ATMA program at a college or university,
successfully complete a 1040 hour Music Therapy internship, and pass the
Certifying Board examination. Board Certified Music Therapists are required
to maintain their education through continuing education courses, called
Continuing Music Therapy Education courses, or CMTEs. These classes fall
under the purview of the Certification Board for Music Therapists to assure
quality and applicability. They are offered at the state, regional, and
national level.

In the United Kingdom

Live music was used in hospitals after both of the World Wars, as part of the
regime for some recovering soldiers. Clinical music therapy in Britain as it is
understood today was pioneered in the 60s and 70s by French cellist Juliette
Alvin, whose influence on the current generation of British music therapy
lecturers remains strong. Mary Priestley, one of Juliette Alvin's students,
came to discover/create "analytical music therapy". Analytical music
therapy is a form of music therapy which together with the Nordoff-Robbins
School of Music Therapy, form the two central forms of music therapy used
today. Mary Priestley's books Music Therapy in Action, first published by
Constable and company ©1975 (ISBN 0-09-459900-9) and Essays on
Analytical Music Therapy, Barcelona Publishers ©1994 (ISBN 0-9624080-2-
6) form part of the core course work for students of analytical music therapy
all over the world.

The Nordoff-Robbins approach to music therapy developed from the work of


Paul Nordoff and Clive Robbins in the 1950/60s. It is grounded in the belief
that everyone can respond to music, no matter how ill or disabled. The
unique qualities of music as therapy can enhance communication, support
change, and enable people to live more resourcefully and creatively.
Nordoff-Robbins now run music therapy sessions throughout the UK, US,
South Africa, Australia and Germany. Its headquarters are in London where
it also provides training and further education programs, including the only
PhD course in music therapy available in the UK. Music therapists, many of
whom work with an improvisatory model (see Clinical improvisation), are
active particularly in the fields of child and adult learning disability, but also
in psychiatry and forensic psychiatry, geriatrics, palliative care and other
areas.

Practitioners are registered with the Health Professions Council[9] and from
2007 new registrants must normally hold a master's degree in music
therapy. There are masters level programs in music therapy in Bristol,
Cambridge, Cardiff, Edinburgh and London, and there are therapists
throughout the UK. The professional body in the UK is the Association of
Professional Music Therapists[10] while the British Society for Music
Therapy[11] is a charity providing information about music therapy.

In 2002, the World Congress of Music Therapy was held in Oxford, on the
theme of Dialogue and Debate.[12] In November 2006, Dr. Michael J.
Crawford[13] and his colleagues again found that music therapy helped the
outcomes of schizophrenic patients.[14][15] In 2009, he and his team were
researching the usefulness of improvisational music in helping patients with
agitation and also those with dementia.
As stroke therapy

Music has been shown to affect portions of the brain. Part of this therapy is
the ability of music to affect emotions and social interactions. Research by
Nayak et. al. showed that music therapy is associated with a decrease in
depression, improved mood, and a reduction in state anxiety.[16] Both
descriptive and experimental studies have documented effects of music on
quality of life, involvement with the environment, expression of feelings,
awareness and responsiveness, positive associations, and socialization.[17]
Additionally, Nayak et. al. found that music therapy had a positive effect on
social and behavioral outcomes and showed some encouraging trends with
respect to mood.[16]

More recent research suggests that music can increase patient's motivation
and positive emotions.[16][18][19] Current research also suggests that when
music therapy is used in conjunction with traditional therapy it improves
success rates significantly.[20][21][22] Therefore, it is hypothesized that music
therapy helps stroke victims recover faster and with more success by
increasing the patient's positive emotions and motivation, allowing them to
be more successful and driven to participate in traditional therapies.

Research has shown the ability of music therapy to increase positive social
interactions, positive emotions, and motivation in stroke patients. Wheeler
et. al. found that group music therapy sessions increased the ease at which
stroke patients responded to social interaction and increased positive
attitude reports from patient families, while individual sessions helped to
motivate patients for treatment.[19] Another study examined the effect of
music therapy on mood of stroke patients and found similar results that
showed decreased anxiety, fatigue, and hostile mood states.[18] Additionally,
Nayak et. al. found improved social interaction (more actively involved and
cooperative) when music therapy was used in stroke recovery programs.[16]

Recent studies have examined the effect of music therapy on stroke


patients, when combined with traditional therapy. One study found the
incorporation of music with therapeutic upper extremity exercises gave
patients more positive emotional effects than exercise alone.[20] In another
study, Nayak et. al. found that rehabilitation staff rated participants in the
music therapy group were more actively involved and cooperative in
therapy than those in the control group.[16] Their findings gave preliminary
support to the efficacy of music therapy as a complementary therapy for
social functioning and participation in rehabilitation with a trend toward
improvement in mood during acute rehabilitation.

Although positive changes have been associated with music therapy, some
considerations must be taken into account. While scientists have
determined that a variety of physiological and psychological changes occur
when listening to music, broad conclusions cannot yet be made concerning
the relationship and the direction of the relationship between music and
emotion.[23] Additionally, there may be mediating factors which affect the
success of music therapy. For example, Nayak et. al. found the more
impaired an individual's social behavior was at the outset of treatment, the
more likely he or she was to benefit from music therapy.[16] Additionally,
they noted the effectiveness of music therapy may be moderated by the
time frame of the treatment. It is possible that music therapy has a more
pronounced effect on mood the closer to injury it is applied.

Current research shows that when music therapy is used in conjunction with
traditional therapy, it improves rates of recovery, and emotional and social
deficits resulting from stroke.[16][20][21][22][24][25] A study by Jeong & Kim
examined the impact of music therapy when combined with traditional
stroke therapy in a community-based rehabilitation program.[24] Thirty-three
stroke survivors were randomized into one of two groups: the experimental
group, which combined rhythmic music and specialized rehabilitation
movement for eight weeks; and a control group, that received referral
information for traditional therapy (and were assumed to have sought
traditional therapy). The results of this study showed that participants in the
experimental group gained more flexibility, wider range of motion, more
positive moods, and increased frequency and quality of social interactions.
[24]

Music has also been used in recovery of motor skills. Rhythmical auditory
stimulation in a musical context in combination with traditional gait therapy
improved the ability of stroke patients to walk.[21] The study consisted of two
treatment conditions, one which received traditional gait therapy and
another which received the gait therapy in combination with the rhythmical
auditory stimulation. During the rhythmical auditory stimulation, stimulation
was played back measure by measure, and was initiated by the patient's
heel-strikes. Each condition received fifteen sessions of therapy. The results
revealed that the rhythmical auditory stimulation group showed more
improvement in stride length, symmetry deviation, walking speed and
rollover path length (all indicators for improved walking gait) than the group
that received traditional therapy alone.[21]

Schneider et. al. also studied the effects of combining music therapy with
standard motor rehabilitation methods.[22] In this experiment, researchers
recruited stroke patients without prior musical experience and trained half
of them in an intensive step by step training program that occurred fifteen
times over three weeks, in addition to traditional treatment. These
participants were trained to use both fine and gross motor movements by
learning how to use the piano and drums. The other half of the patients
received only traditional treatment over the course of the three weeks.
Three-dimensional movement analysis and clinical motor tests showed
participants who received the additional music therapy had significantly
better speed, precision, and smoothness of movements as compared to the
control subjects. Participants who received music therapy also showed a
significant improvement in every-day motor activities as compared to the
control group.[22] Wilson, Parsons, & Reutens looked at the effect of melodic
intonation therapy (MIT) on speech production in a male singer with severe
Broca's aphasia[25]. In this study, thirty novel phrases were taught in three
conditions: unrehearsed, rehearsed verbal production (repetition), or
rehearsed verbal production with melody (MIT). Results showed that phrases
taught in the MIT condition had superior production, and that compared to
rehearsal, effects of MIT lasted longer.

Another study examined the incorporation of music with therapeutic upper


extremity exercises on pain perception in stroke victims.[20] Over the course
of eight weeks, stroke victims participated in upper extremity exercises (of
the hand, wrist, and shoulder joints) in conjunction with one of the three
conditions: song, karaoke accompaniment, and no music. Patients
participated in each condition once, according to a randomized order, and
rated their perceived pain immediately after the session. Results showed
that although there was no significant difference in pain rating across the
conditions, video observations revealed more positive affect and verbal
responses while performing upper extremity exercises with both music and
karaoke accompaniment.[20] Nayak et. al.[16] examined the combination of
music therapy with traditional stroke rehabilitation and also found that the
addition of music therapy improved mood and social interaction.
Participants who had suffered traumatic brain injury or stroke were placed in
one of two conditions: standard rehabilitation or standard rehabilitation
along with music therapy. Participants received three treatments per week
for up to ten treatments. Therapists found that participants who received
music therapy in conjunction with traditional methods had improved social
interaction and mood.

In heart disease

Some music may reduce heart rate, respiratory rate, and blood pressure in
patients with coronary heart disease, according to a 2009 Cochrane review
of 23 clinical trials.[26] Benefits included a decrease in blood pressure, heart
rate, and levels of anxiety in heart patients. However, the effect was not
consistent across studies, according to Joke Bradt, PhD, and Cheryl Dileo,
PhD, both of Temple University in Philadelphia. Music did not appear to have
much effect on patients' psychological distress. "The quality of the evidence
is not strong and the clinical significance unclear", the reviewers cautioned.
In 11 studies patients were having cardiac surgery and procedures, in nine
they were MI patients, and in three cardiac rehabilitation patients. The 1,461
participants were largely white (average 85%) and male (67%). In most
studies, patients listened to one 30-minute music session. Only two used a
trained music therapist instead of prerecorded music.

In epilepsy

Research suggests that listening to Mozart's piano sonata K448 can reduce
the number of seizures in people with epilepsy.[27] This has been called the
"Mozart effect".