MUSIC THERAPY SERVICES

Music Therapy is 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.

Music Therapy is an established health profession in which music is used within a therapeutic relationship to address physical, emotional, cognitive, and social needs of individuals. After assessing the strengths and needs of each client, the qualified music therapist provides the indicated treatment including creating, singing, moving to, and/or listening to music. Through musical involvement in the therapeutic context, clients’ abilities are strengthened and transferred to other areas of their lives. Music therapy also provides avenues for communication that can be helpful to those who find it difficult to express themselves in words. Research in music therapy supports its effectiveness in many areas such as: overall physical rehabilitation and facilitating movement, increasing people’s motivation to become engaged in their treatment, providing emotional support for clients and their families, and providing an outlet for expression of feelings. – American Music Therapy Association

INQUIRE ABOUT CREATIVE ARTS THERAPIES

Individual music therapy sessions with a CNNH Music Therapist are available throughout the year. No special skills in music necessary!

Group music therapy sessions with a CNNH Music Therapist are available throughout the year according to the Fall, Winter, Spring and Summer schedules. No special skills in music necessary!

Fall Season Schedule 2017 | Week of Sept 11th through Week of Nov 13th

Ages 3-5 – Voorhees – Mondays, 4:30pm

This group is designed to encourage age-appropriate social skills, increased communication, and sustained attention through therapist-guided instrument-playing, singing, and movement. Participants will have the opportunity to connect with peers, express their creativity, and utilize their unique strengths.

Fall Season Schedule 2017 | Week of Sept 11th through Week of Nov 13th

Ages 13-17 – Voorhees – Tuesdays, 6:00pm

This group utilizes interactive music-making to encourage healthy social interaction. Participants will have the opportunity to play guitar, drums, keyboard, and vocals while engaging in collaborative compositions and song re-creations. This band-like experience will support the process of building trust, using effective communication, and forming healthy peer relationships.

Fall Season Schedule 2017 | Week of Sept 11th through Week of Nov 13th

I: Ages 6-8 – Voorhees – Thursdays, 5:00pm
II: Ages 6-8 – Voorhees – Wednesdays, 7:00pm
*No Music Mates II on 9/27, final session 11/29

This structured, strengths-based  environment utilizes instrument playing, singing, and movement to promote expressive communication and appropriate social skills. Members will work together through therapist-guided music-making to respond to peers, follow musical cues, and express their creativity.

Trends regarding evidence-based review and recommendations regarding assessment and referral criteria based on current research and clinical evidence are emerging. Music therapy is a particularly important intervention for children with autism spectrum disorders to engage and foster their capacity for flexibility, creativity, variability and tolerance of change, in order to balance the more structured and behaviorally driven education required in school settings. One review protocol published in the Cochrane Collaborative of Systematic Reviews concluded music therapy was superior to ‘placebo’ therapy with respect to verbal and gestural communicative skills (verbal: 2 RCTs, n = 20, SMD 0.36 CI 0.15 to 0.57; gestural: 2 RCTs, n = 20, SMD 0.50 CI 0.22 to 0.79). The addition of music therapy intervention to a child’s treatment program can have positive outcomes and may be an effective method for increasing joint attention skills in some children with autism.
 Gold, C. & Wigram, T. (2006). Music therapy for autistic spectrum disorder. Cochrane Database of Systematic Reviews. Issue 1
 Reitman, M.R. (2005) Effectiveness of music therapy interventions on joint attention in children diagnosed with autism: a pilot study. Psy.D. 169 p.
 Wigram, T. (2002). Indications in music therapy. British Journal of Music Therapy, 16(1):11-28.

An overall positive direction is noted in meta-analytic reviews of the literature on the subject of music therapy and autism in terms of an array of outcomes related to both therapeutic and specific educational goals. Variations for effect size occur within the broad category of the autism spectrum disorders and tend to reflect the idiosyncratic nature of the disorders between individuals. This is typical across disciplines.
 Whipple, J. (2004). Music in intervention for children and adolescents with autism: a meta-analysis. Journal of Music Therapy. 41(2):90-106. (Listed as accepted in Database
of Abstracts of Reviews of Effects Centre for Reviews and Dissemination, 2007.)
 Standley, J.M. (1996). A meta-analysis on the effects of music as reinforcement for education/therapy objectives. Journal of Research in Music Education. 44(2), 105-133.

Survey research indicates goal areas typically addressed by music therapists among persons with autism include language/communication, behavioral/psychosocial, cognitive, and musical, to perceptual/motor. Goal attainment was found to be high within one year; and, parents and caregivers surveyed indicated subjects generalized skills/responses acquired in music therapy to non-music therapy environments.
 Kaplan, R.S., & Steele, A.L. (2005). An analysis of music therapy program goals and outcomes for clients with diagnoses on the autism spectrum. Journal of Music Therapy.
42(1):2-19.

Survey research examining therapy trends of inpatient and habilitation care of autistic children revealed the most common therapies were physical therapy, speech, occupational and music therapy. One hundred and seventy-eight subjects out of 187 showed some improvement on the Childhood Autism Rating Scale (CARS). All modes American Music Therapy Association 2010 of therapy were found to be useful. Active music therapy sessions aids in improving autistic symptoms, as well as personal musical skills in young adults with severe autism.
 Kielinen, M., Linna, S.L., Moilanen, I. (2002). Some aspects of treatment and habilitation of children and adolescents with autistic disorder in Northern-Finland. International
Journal of Circumpolar Health. 61 Suppl 2:69-79.
 Boso, M., Emanuele, E., Minazzi, V., Abbamonte, M., Politi P. (2007). Effect of longterm interactive music therapy on behavior profile and musical skills in young adults with
severe autism. Journal of Alternative and Complementary Medicine. 13(7), 709-712.

Observational study of the effect of music therapy on communication skills revealed significant gains in autistic childrens’ communication behaviors as measured by Checklist of Communicative Responses/Acts Score Sheet (CRASS). Commensurate decreases in scores were noted when music therapy intervention was removed.
 Edgerton, C. (1994). The effect of improvisational music therapy on the communicative behaviors of autistic children. Journal of Music Therapy. 21(1):31-62.

Preschool children in an early intervention music therapy program show high on-task behavior during sessions and a high success rate in language development, social skills, cognitive concepts, motor skills, and music knowledge.
 Standley, J.M., & J.E. Hughes (1996). Documenting developmentally appropriate objectives and benefits of a music therapy program for early intervention: A behavioral
analysis. Music Therapy Perspectives. 14 (2), 87-94.

Research demonstrates the efficacy of music used in the curriculum to enhance literacy skills. Musical cueing is effective to improve word recognition, logo identification, print concepts and prewriting skills of children in early intervention programs. Shared reading paired with song rehearsal of text facilitates greater text accuracy than spoken rehearsal with kindergarten students.
 Register, D. (2001). The effects of an early intervention music curriculum on pre-reading/ writing. Journal of Music Therapy. 38(3), 239-248.
 Standley, J., & Hughes, J. (1997). Evaluation of an early intervention music curriculum for enhancing pre-reading/writing skills. Music Therapy Perspectives. 15, 79-86.
 Colwell, CM. (1994). Therapeutic applications of music in the whole language kindergarten. Journal of Music Therapy. 31(4), 238-247.

Selected verbal language and speech skills are enhanced through music activities in special education populations. Musical presentation of new vocabulary words results in an increased number of words learned and transferred in elementary school-age children. Music is effective as a prompt and reinforcer to increase verbal response in
preschool-age children with limited verbal communication.
 Braithwaite, M. & J. Sigafoos (1998). Effects of social versus musical antecedents on communication responsiveness in five children with developmental disabilities. Journal
of Music Therapy. 35(2), 88-104. American Music Therapy Association 2010
 Buday, E.M. (1995). The effects of signed and spoken words taught with music on sign and speech imitation by children with autism. Journal of Music Therapy. 32(3), 189-202.

Research supports the use of music to structure and organize information in order to increase learning and retention of number concepts. Sequential verbal information, such as telephone numbers and multiplication tables, set to melodic and rhythmic patterns are more effectively memorized and recalled than through non-music presentation.
 Claussen, D., & Thaut, M. (1997). Music as a mnemonic device for children with learning disabilities. Canadian Journal of Music Therapy. 5, 55-66.
 Wolfe, D., & Hom, C. (1993). Use of melodies as structural prompts for learning and retention of sequential verbal information by preschool students. Journal of Music Therapy. 30(2), 100-118.

Music-facilitated interactions and structured instrument playing are effective to improve social skills in school-age populations. Social problem solving skills in 5-year old students are increased on a long-term basis through creative musical activities. Positive affect induced by music helps to improve social problem solving skills in middle school students. Songs assisted children with ASD in entering the classroom, greeting the teacher and/or peers, and engaging in play.
 Ulfarsdottir, L., & Erwin, P. (1999). The influence of music on social cognitive skills. The Arts in Psychotherapy. 26(2), 81-84.
 Bryan, T., Sullivan-Burstein, K., & Mathur, S. (1998). The influence of affect on social information processing. Journal of Learning Disabilities. 31(5), 418-426.
 Kern, Petra. Wolery, Mark. Aldridge, David. (2007). Use of Songs to Promote Independence in Morning Greeting Routines for Young Children with Autism. Journal of Autism and Developmental Disorders. 37(7), 1264-1271.

The SCERTS model is a newer, comprehensive curriculum designed to assess and identify treatment goals and objectives within a multidisciplinary team of clinicians and educators for children with Autism Spectrum Disorders (ASD). A national survey of music therapists working with clients at risk or diagnosed with ASD was conducted to: (a) identify the areas of SCERTS assessment model that music therapists are currently addressing within their written goals for clients with ASD, (b) identify current music therapy activities that address various SCERTS goals and objectives, and (c) provide demographic information about settings, length, and tools used in music therapy interventions for clients with ASD.
 Walworth, D.D. (2007). The use of music therapy within the SCERTS model for children with Autism Spectrum Disorder. Journal of Music Therapy. 44(1):2-22.

MUSIC THERAPY WITH ADOLESCENTS AND CHILDREN

Field, T., Martinez, A., Nawrocki, T., Pickens, J., Fox, N. A., & Schanberg, S. (1998). Music shifts frontal EEG in depressed adolescents. Adolescence, 33(129), 109–116.
Conclusions: Depressed adolescents listening to music experienced a significant decrease in stress hormone (cortisol) levels, and most adolescents shifted toward left frontal EEG activation (associated with positive affect).

Montello, L. M., & Coons, E. E. (1998). Effect of active versus passive group music therapy on preadolescents with emotional, learning, and behavioral disorders. Journal of Music Therapy, 35, 49–67.
Conclusions: Music therapy clients significantly improved on the Aggression/Hostility scale of Achenbach’s Teacher’s Report Form, suggesting that group music therapy can facilitate self-expression and provide a channel for transforming frustration, anger, and aggression into the experience of creativity and self-mastery.

MUSIC THERAPY WITH ADULTS

Bodner, E., Iancu, J., Gilboa, A., Sarel, A., Mazor, A., & Amir, D. (2007). Finding words for emotions: The reactions of patients with major depressive disorder towards various musical excerpts. Arts in Psychotherapy, 34(2):142-50.
Objective: This study aims to show that the specific use of sad music in patients with major depressive disorder can circumvent the verbal barrier they typically experience when asked to express their emotions.
Method: We examined the effect of four emotionally distinctive types of music (i.e. happiness, fear, anger, and sadness) on 14 hospitalized patients with major depressive disorder (MDD group) and 31 healthy controls (HC group). Participants were asked to choose emotional descriptors that expressed the feelings that were induced in them by each excerpt. We hypothesized that in the specific case of sad music, patients with MDD
would describe the music more vividly than HC participants.
Conclusions: Patients with MDD chose fewer emotional labels than controls in response to angry, scary, and happy excerpts. Patients with MDD and controls chose similar emotional labels in response to sad music, but patients with MDD chose more labels in response to sad music than to any other excerpt, while controls demonstrated the exact opposite pattern. These findings are in line with clinical descriptions of patients with
MDD as demonstrating difficulties in verbalizing their emotions. Their intensified response to sad music is in accordance with their focus on sad cues. The use of sad music in psychotherapy is thus recommended as means of bypassing the verbal barrier experienced by patients with MDD.

Leardi, S., Pietroletti, R., Angeloni, G., Necozione, S., Ranalletta, G., & Del Gusto B. (2007). Randomized clinical trial examining the effect of music therapy in stress response to day surgery. British Journal of Surgery. 94(8):943-7.
Objective: Music therapy could reduce stress and the stress response. The aim of this study was to investigate the role of music therapy in alleviating stress during day surgery.
Methods: Sixty patients undergoing day surgery were randomized to one of three groups, each containing 20 patients. Before and during surgery, patients in group 1 listened to new age music and those in group 2 listened to a choice of music from one of four styles. Patients in group 3 (control group) heard the normal sounds of the operating theatre. Plasma levels of cortisol and subpopulations of lymphocytes were evaluated before, during
and after operation. Results: Plasma cortisol levels decreased during operation in both groups of patients who listened to music, but increased in the control group. Postoperative cortisol levels were significantly higher in group 1 than in group 2 (mean(s.d.) 14.21(6.96) versus 8.63(2.72) ng/dl respectively; P < 0.050). Levels of natural killer lymphocytes decreased during surgery in groups 1 and 2, but increased in controls. Intraoperative levels of natural killer cells were significantly lower in group 1 than in group 3 (mean(s.d.) 212.2(89.3) versus
329.1(167.8) cells/microl; P < 0.050).
Conclusion: Perioperative music therapy changed the neurohormonal and immune stress
response to day surgery, especially when the type of music was selected by the patient.

Pellitier, C. L. ( 2004). The effect of music on decreasing arousal due to stress: A meta-analysis. Journal of Music Therapy, 42, 192-214.
Objective: To conduct a meta-analytic review of research articles using music to decrease arousal due to stress.
Results: 22 quantitative studies were included in the analysis. Results demonstrated that music alone and music assisted relaxation techniques significantly decreased arousal (d = +.67). Further analysis of each study revealed that the amount of stress reduction was significantly different when considering age, type of stress, music assisted relaxation technique, musical preference, previous music experience, and type of intervention.
Implications and suggestions for future research are discussed.

Silverman, M.J. (2006). Psychiatric patients’ perception of music therapy and other psychoeducational programming. Journal of Music Therapy, 43(2):111-22.

Objective: The purpose of this study was to quantitatively evaluate psychiatric patients’ perception of their psychoeducational programming.
Method: Participants (N = 73) completed a survey rating on each class/therapy in which they were enrolled and its helpfulness. Participants answered questions concerning which class/therapy addressed specific psychiatric deficit areas most effectively.
Results: Results indicated that participants rated music therapy as significantly more helpful than all other programming (p < .05). Further analyses indicated that participants admitted to a psychiatric institution only once rated their classes as more helpful when compared to participants who had been admitted multiple times. Additionally, participants who were minorities rated programming as more helpful than participants who were Caucasian. Participants consistently rated music therapy as more effective than other programming in addressing specific psychiatric deficit areas. Additionally, 57% of participants noted that music therapy was their favorite class/therapy. Reasons for these discrepancies are discussed and suggestions for future research are made.

Weber, S. (1996). The effects of relaxation exercises on anxiety levels in psychiatric inpatients. Journal of Holistic Nursing, 14(3), 196–205.
Conclusions: The anxiety level of psychiatric inpatients was significantly reduced using progressive muscle relaxation, meditative breathing, guided imagery and soft music to promote relaxation.

SCHIZOPHRENIA AND PSYCHOPATHOLOGY
Gold, C. (2007). Music therapy improves symptoms in adults hospitalised with schizophrenia.
Evidence-Based Mental Health. 10(3): 77
Objective: Does music therapy improve symptoms in people hospitalised with schizophrenia?
Method: RCT with concealed allocation and single blind (assessors blinded). Follow-up period was three months (treatment period only). Setting included four London hospitals, among eighty one adult inpatients (>/= 18 years old) with a primary diagnosis of schizophrenia or schizophrenia-like psychosis. Exclusions: secondary diagnoses of dementia or organic psychosis. Intervention: Music therapy (access to a range of musical instruments and encouragement to express themselves accompanied by a trained music therapist during weekly individual sessions of up to 45 min) plus standard care (access to occupational, social and other activities and nursing care) versus standard care alone for up to 12 weeks. Outcomes: Primary outcome measure: symptoms, total score on the Positive and Negative Syndrome Scale (PANSS); secondary outcome measures: satisfaction with care, Client Satisfaction Questionnaire (CSQ); global function, Global Assessment of Functioning Scale (GAF). Patient follow-up: 85%.
Results: In people hospitalised with schizophrenia, adding music therapy to standard care lead to greater improvement in symptoms compared with standard care alone at 12 weeks (change in PANSS total score from baseline: -9.00 with music therapy plus standard care vs -2.96 with standard care alone; p = 0.045). There was no significant difference in patient satisfaction with care and global function between groups (change in CSQ score from baseline: +1.82 with music therapy plus standard care vs +0.33 with standard care alone; reported as non-significant; change in GAF score from baseline: +4.74 with music therapy plus standard care vs +4.60 with standard care; reported as non-significant).
Gold, C., Heldal, T. O., Dahle, T., & Wigram, T. (2005). Music therapy for schizophrenia or schizophrenia-like illnesses. Cochrane Database of Systematic Reviews, 3.
Objectives: To review the effects of music therapy, or music therapy added to standard care, compared to placebo, standard care or no treatment for people with serious mental illnesses such as schizophrenia.
Search strategy: The Cochrane Schizophrenia Group’s Register (July 2002) was searched. This was supplemented by hand searching of music therapy journals, manual searches of reference lists, and contacting relevant authors.
Selection criteria: All randomized controlled trials that compared music therapy with standard care or other psychosocial interventions for schizophrenia.
Data collection and analysis: Studies were reliably selected, quality assessed and data extracted. Data were excluded where more than 30% of participants in any group were lost to follow up. Non-skewed continuous endpoint data from valid scales were synthesized using a standardized mean difference (SMD). If statistical heterogeneity was found, treatment ‘dosage’ and treatment approach were examined as possible sources of heterogeneity.
Results: Four studies were included. These examined the effects of music therapy over the short to medium term (1 to 3 months), with treatment ‘dosage’ varying from 7 to 78 sessions. Music therapy added to standard care was superior to standard care alone for global state (medium term, 1 RCT, n = 72, RR 0.10 CI 0.03 to 0.31, NNT 2 CI 1.2 to 2.2). Continuous data suggested some positive effects on general mental state (1 RCT, n=69, SMD average endpoint PANSS -0.36 CI -0.85 to 0.12; 1 RCT, n=70, SMD average endpoint BPRS -1.25 CI -1.77 to -0.73),on negative symptoms (3 RCTs, n=180, SMD average endpoint SANS -0.86 CI -1.17 to -0.55) and social functioning (1 RCT, n=70, SMD average endpoint SDSI score -0.78 CI -1.27 to -0.28). However these latter effects were inconsistent across studies and depended on the number of music therapy sessions. All results were for the 1-3 month follow up.
Conclusions: Music therapy as an addition to standard care helps people with schizophrenia to improve their global state and may also improve mental state and functioning if a sufficient number of music therapy sessions are provided.

Pavlicevic, M., Trevarthen, C., & Duncan, J. (1994). Improvisational music therapy and the
rehabilitation of persons suffering from chronic schizophrenia. Journal of Music Therapy, 31(2),
86–104.
Conclusions: Patients with schizophrenia at the end of 10 music therapy sessions showed significant improvement of the Brief Psychiatric Rating Scale and increased their level of musical interaction with the therapist.

Silverman, M. J. (2003). The influence of music on the symptoms of psychosis: A meta-analysis.
Journal of Music Therapy, 40(1), 27–40.
Objective: The purpose of this study was to analyze the existing quantitative research evaluating the influence of music upon the symptoms of psychosis.
Method: A meta-analysis was conducted on 19 studies.
Conclusions: Results indicated that music has proven to be significantly effective in suppressing and combating the symptoms of psychosis.

Tang, W., Yao, X., & Zheng, Z. (1994). Rehabilitative effect of music therapy for residual
schizophrenia: A one-month randomised controlled trial in Shanghai. British Journal of
Psychiatry, 165(Suppl. 24), 38–44.
Seventy-six in-patients who had the residual subtype of schizophrenia were randomly assigned to a treatment group or a control group. Both groups received standard medication as prescribed by their treating physicians, but the treatment group also received a one-month course of music therapy that included both passive listening to music and active participation in the singing of popular songs with other patients. Outcome was evaluated by four nurses using Chinese versions of the Scale for Assessment of Negative Symptoms and the in-patient version of the World Health Organization’s Disability Assessment Scale.
Conclusions: Music therapy significantly diminished patients’ negative symptoms, increased their ability to converse with others, reduced their social isolation, and increased their level of interest in external events. As music therapy has no side-effects and is relatively inexpensive, it merits further evaluation and wider application.

Thaut, M. H. (1989). The influence of music therapy interventions on self-rated changes in
relaxation, affect, and thought in psychiatric prisoner-patients. Journal of Music Therapy, 26,
155–166.
Objective: To evaluate self-perceived changes in states of relaxation, mood/emotion, and thought/insight in psychiatric prisoner-patients pre- and post- music therapy.
Methods: Three were scales derived from a survey of 130 subjects regarding perceived therapeutic benefit of music therapy. The study was condicted over a 3-month period with eight different groups of patients (N = 50); with each group participating in three different treatment modalities: group music therapy, instrumental group improvisation, and music and relaxation.
Results: There was a significant (p < .05) change in self-perceived ratings across all scales before versus after music therapy. The magnitude of change differed significantly (p < .05) between scales. All eight groups showed similar responses, and the different treatment modalities did not significantly influence the results.

Ulrich, G., Houtmans, T., & Gold C. (2007). The additional therapeutic effect of group music
therapy for schizophrenic patients: a randomized study. Acta Psychiatrica Scandinavica.
116(5):362-70.
Objective: Schizophrenia is one of the most serious mental disorders. Music therapy has only recently been introduced as a form of treatment. The aim of this study was to examine the effect of music therapy for schizophrenic in-patients needing acute care.
Method: Thirty-seven patients with psychotic disorders were randomly assigned to an experimental group and a control group. Both groups received medication and treatment indicated for their disorder. Additionally, the experimental group (n = 21) underwent group music therapy.
Results: Significant effects of music therapy are found in patients’ self-evaluation of their psychosocial orientation and for negative symptoms. No differences were found in the quality of life. CONCLUSION: Musical activity diminishes negative symptoms and improves interpersonal contact. These positive effects of music therapy could increase the patient’s abilities to adapt to the social environment in the community after discharge from the hospital.

You, Z. Y., & Wang, J. Z. (2002, December). Zhongguo yi xue ke xue yuan xue bao. [Metaanalysis
of assisted music therapy for chronic schizophrenia], 24(6), 564–567. Institute of
Evidence-Based Medicine, Shandong University, Jinan 250012, China.
Objective: To evaluate the effect of assisted music therapy for chronic schizophrenia.
Methods: 11 articles including 603 chronic schizophrenia patients were meta-analyzed using fixed effect model or random effect model.
Results: 6 randomized controlled trials were synthesized, showing that the difference was significant in statistics between experimental group (patients with music and drugs therapy) and control group (patients with drugs therapy only). Both the scores of SANS and BPRS for the control group were higher than those for the experimental group (SANS, d = 0.68; 95%CI: 0.46-0.90 and BPRS, d = 0.44; 95%CI: 0.06-0.82). In addition,
the scores of both SANS and BPRS for the pre-test were higher than those for the posttest (SANS, d = 1.17; 95%CI: 0.02-2.32 and BPRS, d = 2.05; 95%CI: 0.28-3.82).
Conclusions: The short-term effect of assisted music therapy is positive for chronic
schizophrenia, but the long-term effect is still to be further studied.

OTHER REFERENCES
Bruscia, K. (ed.) (1998). The dynamics of music psychotherapy. Gilsum, NH: Barcelona
Publishers.
Crowe, B. J., & Colwell, C. (Eds.). (2007). Effective clinical practice in music therapy: Music
therapy for children, adolescents, and adults with mental disorders. Silver Spring, MD:
American Music Therapy Association.
Scovel, M., & Gardstrom, S. (2002). Music therapy within the context of psychotherapeutic
models. In R.F. Unkefer & M.H. Thaut (Eds.), Music therapy in the treatment of adults with
mental disorders: Theoretical bases and clinical interventions (2nd ed.) (pp. 117-132). St. Louis,
MO: MMB Music.

OVERVIEW OF RESEARCH

Habilitation: to enable, or make able. Habilitation services are designed to develop, maintain
and/or maximize the individual’s independent functioning.

Given a definition of habilitation this document lists additional music therapy research and
includes international studies that address questions of habilitation. The listing, below, is far
from comprehensive and is intended as a sampling of studies.

Topics include autism/pervasive development disorders, quality of life, palliative care, medical, developmental disabilities, and motor disorders. Finally, an example of cost implications is provided to demonstrate the potential service and cost efficiencies gained from music therapy in habilitation (and rehabilitation).

AUTISM/PERVASIVE DEVELOPMENT DISORDERS
Kielinen, M., Linna, S. L., & Moilanen. I. (2002). Some aspects of treatment and habilitation
of children and adolescents with autistic disorder in Northern-Finland. International Journal of
Circumpolar Health, 61(Suppl. 2), 69–79.
Abstract: Hospital records and data on the treatment/habilitation status of 187 children
with autism aged 3-18 years were gathered from Northern Finland. The treatment
programs and therapies varied, depending on the trained staff available. One-hundred and
fifty-two (82.9%) children and adolescents with autism received more than one
therapeutic intervention or specific training program. The most common therapies were
physiotherapy as well as speech, occupational and music therapy. 43.9% of the children
and adolescents with autism received specific training according to TEACCH (Treatment
and Education of Autistic and related Communication-Handicapped Children), 10.2%
according to Lovaas and 30.5% according to the Portage program. Antiepileptic
medication had been prescribed to 23.9% and psychopharmacological interventions to
14.9% of the individuals with autistic disorder (AD). One hundred and seventy-eight
subjects out of 187 showed some improvement on the Childhood Autism Rating Scale
(CARS), even if no statistically significant difference was found between the outcome of
the available habilitation methods.

QUALITY OF LIFE
Hilliard, R. E. (2003). The effects of music therapy on the quality and length of life of
people diagnosed with terminal cancer. Journal of Music Therapy, 40(2), 113–137.
Abstract: The purpose of this study was to evaluate the effects of music therapy on
quality of life, length of life in care, physical status, and relationship of death occurrence
to the final music therapy interventions of hospice patients diagnosed with terminal
cancer. Subjects were adults who were living in their homes, receiving hospice care, and
were diagnosed with terminal cancer. A total of 80 subjects participated in the study and
were randomly assigned to one of two groups: experimental (routine hospice services and
clinical music therapy) and control (routine hospice services only). Groups were matched
on the basis of gender and age. Quality of life was measured by the Hospice Quality of
Life Index-Revised (HQOLI-R), a self-report measure given every visit. Functional status
of the subjects was assessed by the hospice nurse during every visit using the Palliative
Performance Scale. All subjects received at least two visits and quality of life and
physical status assessments. A repeated measures ANOVA revealed a significant
difference between groups on self-report quality of life scores for visits one and two.
Quality of life was higher for those subjects receiving music therapy, and their quality of
life increased over time as they received more music therapy sessions. Subjects in the
control group, however, experienced a lower quality of life than those in the experimental
group, and without music, their quality of life decreased over time. There were no
significant differences in results by age or gender of subjects in either condition.
Furthermore, there were no significant differences between groups on physical
functioning, length of life, or time of death in relation to the last scheduled visit by the
music therapist or counselor. This study provides an overview of hospice/palliative care,
explains the role of music therapy in providing care, and establishes clinical guidelines
grounded in research for the use of music therapy in improving the quality of life among
the terminally ill.

Kemper, K. J., & Danhauer, S. C. (2005). Music as therapy. Southern Medical Journal, 98(3),
282–288.
Abstract: Music is widely used to enhance well-being, reduce stress, and distract patients
from unpleasant symptoms. Although there are wide variations in individual preferences,
music appears to exert direct physiologic effects through the autonomic nervous system.
It also has indirect effects by modifying caregiver behavior. Music effectively reduces
anxiety and improves mood for medical and surgical patients, for patients in intensive
care units and patients undergoing procedures, and for children as well as adults. Music is
a low-cost intervention that often reduces surgical, procedural, acute, and chronic pain.
Music also improves the quality of life for patients receiving palliative care, enhancing a
sense of comfort and relaxation. Providing music to caregivers may be a cost-effective
and enjoyable strategy to improve empathy, compassion, and relationship-centered care
while not increasing errors or interfering with technical aspects of care. [References: 84]

Myskja, A. (2005). Therapeutic use of music in nursing homes. Tidsskrift for Den Norske
Laegeforening, 125(11), 1497–1499.
Abstract: BACKGROUND: There is growing interest in the therapeutic use of music in
nursing homes. The difficulties inherent in medical treatment of this population warrant
further studies of music as a therapeutic modality. MATERIAL AND METHODS: This
is a review of articles on the use of music and music therapy in geriatrics. Findings from
a nursing home project, “Music in the late stages of life”, have been compared with those
reported in the literature, particularly from meta-analyses and systematic reviews. The
distinction between music therapy, music medicine and individualised music has been
taken into account. RESULTS AND INTERPRETATION: The evidence base for using
music therapeutically in nursing homes is still insufficient. There is a lack of consensus
about criteria for the use of different types of music therapy, and most studies have
methodological limitations or are insufficiently defined. Approaches to measurement and
evaluation vary. Meta-analyses have tried to overcome this problem by emphasizing
effect size. A widely shared conclusion is that music can supplement medical treatment.
The cost is low, there are few side effects, and music gives a high level of patient
satisfaction. Clinical experience and analyses of effect size indicate that music has a
specific potential in nursing homes. It can enhance well-being and alleviate symptoms
like agitation, anxiety, depression, and sensomotor symptoms in neurodegenerative
diseases; it may also contribute in palliative care at the end-of-life stage. [References: 30]

PALLIATIVE CARE
Clements-Cortes, A. (2004). The use of music in facilitating emotional expression in the
terminally ill. American Journal of Hospice & Palliative Care, 21(4), 255–260.
Abstract: The expression and discussion of feelings of loss and grief can be very difficult
for terminally ill patients. Expressing their emotions can help these patients experience a
more relaxed and comfortable state. This paper discusses the role of music therapy in
palliative care and the function music plays in accessing emotion. It also describes
techniques used in assisting clients to express their thoughts and feelings. Case examples
of three in-patient palliative care clients at Baycrest Centre for Geriatric Care are
presented. The goals set for these patients were to decrease depressive symptoms and
social isolation, increase communication and self-expression, stimulate reminiscence and
life review, and enhance relaxation. The clients were all successful in reaching their
individual goals.

MEDICAL
Abdi, S., Khalessi, M. H., Khorsandi, M., & Gholami, B. (2001). Introducing music as a
means of habilitation for children with cochlear implants. International Journal of Pediatric
Otorhinolaryngology, 59(2), 105–113.
Abstract: OBJECTIVE: To investigate the feasibility, methods and the primary results of
utilizing music as a means of habilitation of children with cochlear implant. STUDY
DESIGN: A habilitation program based on music training is developed. The results are
presented as a case-series. METHODS: Music Training Program is introduced as a new
habilitation program. Methods of training (based on Orff method) and measuring the
outcomes are introduced in this paper. Effects of this program on other habilitation
programs and overall hearing related skills of children were also investigated by open
questioning of the parents and the habilitation staff. RESULTS: Twenty-three children,
(age: 2.5-12.5 years) were selected. All children showed appreciable progress in playing
a musical instrument. The effects on other habilitation processes were significant and all
parents expressed their satisfaction with the program, as they perceived its benefits.
DISCUSSION: The necessity of adding Music Training Program to the routine
habilitation may be summarized as follows: Music is a feature of sound, which should be
mastered. The psychological effects of being able to accomplish a hearing-related task
can add to the self-esteem of children and help prevent and reduce anxiety. Music is a
habilitation method: Introducing new concepts of sound, like temporal and frequencyrelated
characteristics, is a crucial part of the habilitation of a child with cochlear implant.
Practising new concepts needs motivation, too. We emphasize on using all means of
rehabilitation and encourage teaching music to cochlear implant children between 4 and 5
years of age having approximately 4 months of experience with cochlear implant.
Baker, F., & Wigram, T. (2004). The immediate and long-term effects of singing on the mood
states of people with traumatic brain injury. British Journal of Music Therapy, 18(2), 55–64.
Abstract: Mood changes in four male participants with traumatic brain injury (TBI) were
observed following their participation in a 15-session song-singing programme. An
analysis of the song material was undertaken to categorise the songs according to the
predominant mood they portrayed. Results showed significant differences between
participants for all moods (p<0.001). Immediate effects were reversed where participants
experienced increases in sadness, anger, fear and fatigue. Long-term effects were
significant for some participants who reported increased feelings of happiness and
decreased feelings of sadness, fear, confusion, tension and fatigue. Characteristics of the
songs chosen for therapy were typically representative of feelings of sadness. Findings
suggest that immediate effects of song-singing intensify and provide cathartic
experiences for people with TBI who may not have any other space for which to express
negative emotions. Long-term effects on song singing have a positive effect on mood
state.
Baker, F., Wigram, T., & Gold, C. (2005). The effects of a song-singing programme on the
affective speaking intonation of people with traumatic brain injury. Brain Injury, 19(7), 519–528.
Abstract: Objective- To examine changes in the relationship between intonation, voice
range and mood following music therapy programmes in people with traumatic brain
injury. Research design: Data from four case studies were pooled and effect size,
ANOVA and correlation calculations were performed to evaluate the effectiveness of
treatment. Methods and procedures: Subjects sang three self-selected songs for 15
sessions. Speaking fundamental frequency, fundamental frequency variability, slope,
voice range and mood were analysed pre- and post-session. Results: Immediate treatment
effects were not found. Long-term improvements in affective intonation were found in
three subjects, especially in fundamental frequency. Voice range improved over time and
was positively correlated with the three intonation components. Mood scale data showed
that immediate effects were in the negative direction whereas there were increases in
positive mood state in the longer-term. Conclusions: Findings suggest that, in the longterm,
song singing can improve vocal range and mood and enhance the affective
intonation styles of people with TBI.

Hardcastle, J. (1999). A single session of music therapy decreased anxiety and improved
relaxation in adults who required mechanical ventilation [commentary on Chlan L. Effectiveness
of a music therapy intervention on relaxation and anxiety for patients receiving ventilatory
assistance]. Heart & Lung: Journal of Acute & Critical Care, 27(3), 169–176.
Abstract: Question – Does a single session of music therapy increase relaxation and
reduce anxiety in adults who receive mechanical ventilation: Design: Randomised
controlled trial. Setting: 4 intensive care units of 3 urban university teaching hospitals in
midwestern USA. Patients: 54 adults (age range 18-89 v, mean age 57 v, 92% white, 59%
women) who were in the intensive care unit and needed mechanical ventilation. Inclusion
criteria were being alert and mentally competent, having adequate hearing, speaking
English as the primary language, and not receiving continuous intravenous sedation.
Follow up was 91%. Intervention: All patients were provided with a restful atmosphere
for 30 minutes: blinds were closed, lights were dimmed, a “do not disturb” sign was put
on the door of each patient’s room, and patients were told to relax and to think of
something pleasant. 27 patients were allocated to receive 30 minutes of music therapy
using cassette tape players and headphones. Music contained no lyrics, was designed to
be relaxing, and had 60-80 beats/minute. Patients chose from classical, New Age, country
and western, religious, and easy listening music. 27 patients received no music (rest alone
group). Main outcome measures: Self reported state anxiety (feelings of tension,
apprehension, nervousness, and worry) was measured using the Spielberger State-Trait
Anxiety Inventory at baseline and after treatment. Physiological relaxation was assessed
using heart and respiratory rate changes over time. Main results: Patients chose classical
(56%), country and western (28%), easy listening (12%), and New Age (4%) music.
Patients in the music group had a lower mean score for state anxiety than patients in the
rest alone group (10.1 v 16.2, p < 0.001), and also had a greater reduction over time in
heart and respiratory rate (p < 0.001 for both). Conclusion: A single 30 minute music
session reduced anxiety and increased relaxation (reduced heart and respiratory rate) for
adults in the intensive care unit who required mechanical ventilation.

Nayak, S., Wheeler, B. L., Shiflett, S. C., & Agostinelli, S. (2000). Effect of music therapy on
mood and social interaction among individuals with acute traumatic brain injury and stroke.
Rehabilitation Psychology, 45(3), 274–283.
Abstract: Objective: To investigate the efficacy of music therapy techniques as an aid in
improving mood and social interaction after traumatic brain injury or stroke. Design:
Eighteen individuals with traumatic brain injury or stroke were assigned either standard
rehabilitation alone or standard rehabilitation along with music therapy (3 treatments per
week for up to 10 treatments). Measures: Pretreatment and posttreatment assessments of
participant self-rating of mood, family ratings of mood and social interaction, and
therapist rating of mood and participation in therapy. Results: There was a significant
improvement in family members’ assessment of participants’ social interaction in the
music therapy group relative to the control group. The staff rated participants in the music
therapy group as more actively involved and cooperative in therapy than those in the
control group. There was a trend suggesting that self-ratings and family ratings of mood
showed greater improvement in the music group than in the control group. Conclusions:
Results lend 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.

DEVELOPMENTAL DISABILITIES

Aldridge D., Gustroff G., & Neugebauer L. (1995). A pilot study of music therapy in the
treatment of children with developmental delay. Complementary Therapies in Medicine, 3(4),
197–205.
Abstract: In a crossover study of music therapy for children who are developmentally
delayed, the children in the initial treatment group change more than the children on the
waiting list. When the waiting list group are treated and then tested, the newly treated
children catch up in their development. Such changes can be demonstrated at a level of
clinical significance. There is a continuing improvement in hearing and speech, hand-eye
co-ordination, and personal-social interaction. Music therapy seems to have an effect on
personal relationship, emphasising the positive benefits of active listening and
performing, and this in turn sets the context for developmental change. A further
investigation of the data revealed the importance of hand-eye co-ordination for
developmental changes. The active element of musical playing, which demands the skill
of hand-eye co-ordination, appears to play a significant role in developmental changes as
they occur in the therapeutic musical relationship.

MOTOR DISORDERS

Pacchetti, C., Mancini, F., Aglieri, R., Fundaro, C., Martignoni, E., & Nappi, G. (2000). Active
music therapy in Parkinson’s Disease: An integrative method for motor and emotional
rehabilitation. Psychomotic Medicine, 62, 386–393.
Abstract: Explored the efficacy of active music therapy (MT) on motor and emotional
functions in patients with Parkinson’s Disease (PD). The study lasted 3 months and
consisted of weekly sessions of MT and physical therapy (PT). 32 patients with PD, all
stable responders to levodopa and in Hoehn and Yahr stage 2 or 3, were randomly
assigned to 2 groups; 16 Ss (mean age 62.5 yrs) received MT and PT, and 16 (mean age
63.2 yrs) received PT alone. Severity of PD was assessed with the Unified Parkinson’s
Disease Rating Scale, emotional functions with the Happiness Measure, and quality of
life using the Parkinson’s Disease Quality of Life Questionnaire. MT sessions consisted
of choral singing, voice exercise, rhythmic and free body movements, and active music
involving collective invention. PT sessions included a series of passive stretching
exercises, specific motor tasks, and strategies to improve balance and gait. Results show
that MT had a significant overall effect on bradykinesia. Post-MT session findings were
consistent with motor improvement, especially in bradykinesia items. Changes on the
Happiness Measure confirmed a beneficial effect of MT on emotional functions.
Improvements in activities of daily living and in quality of life were also documented in
the MT group. PT improved rigidity.

COST-EFFECTIVENESS
Walworth, D. D. (2005). Procedural support music therapy in the healthcare setting: A
cost-effective analysis. Journal of Pediatric Nursing, 20(4), 276–284.
Abstract: This comparative analysis examined the cost-effectiveness of music therapy as
a procedural support in the pediatric healthcare setting. Many healthcare organizations
are actively attempting to reduce the amount of sedation for pediatric patients undergoing
various procedures. Patients receiving music therapy-assisted computerized tomography
scans (n = 57), echocardiograms (n = 92), and other procedures (n = 17) were included in
the analysis. Results of music therapy-assisted procedures indicate successful elimination
of patient sedation, reduction in procedural times, and decrease in the number of staff
members present for procedures. Implications for nurses and music therapists in the
healthcare setting are discussed.

Research Highlights
-Music therapy reduces depression among older adults.
-Music experiences can be structured to enhance social/emotional skills, to assist in recall and language skills and to decrease problem behaviors.
-Music tasks can be used to assess cognitive ability in people with Alzheimer’s Disease.
-Music is effective in decreasing the frequency of agitated and aggressive behaviors for individuals diagnosed with Alzheimer’s Disease and related dementias.
-Individuals in the late stages of dementia respond to and interact with music.

Selected References
Brotons, M. & Kroger, S.M. (2000). The impact of music therapy on language functioning in
dementia. Journal of Music Therapy, 37(3), 183-95.
Brotons M. & Marti, P. (2003). Music therapy with Alzheimer’s patients and their family
caregivers: a pilot project. Journal of Music Therapy 40(2), 138-150.
Cevasco, A.M. & Grant, R.E. (2003). Comparison of different methods for eliciting exerciseto-music
for clients with Alzheimer’s Disease. Journal of Music Therapy 40(1), 41-56.
Clair, A.A. (1996). The effect of singing on alert responses in persons with late stage dementia.
Journal of Music Therapy, 33(4), 234-247.
Clark, M.E., Lipe, A.W., & Bilbrey, M. (1998). Use of music to decrease aggressive behaviors
in people with dementia. Journal of Gerontological Nursing, 24(7), 10-17.
Gerdner, L.A. (2000). Effects of individualized versus classical “relaxation” music on the
frequency of agitation in elderly persons with Alzheimer’s disease and related disorders. International
Psychogeriatrics, 12(1), 49-65.
Gorman, C. (2005, November 14). Music and the mind. Time, 166(20).
Gregory, D. (2002). Music listening for maintaining attention of older adults with cognitive
impairments. Journal of Music Therapy, 39(4), 244-264.
Hanser, S.B., & Thompson, L.W. (1994). Effects of a music therapy strategy on depressed
older adults. Journal of Gerontology, 49(6), P265-9.
Johnson, G., Otto, D., & Clair, A.A. (2001). The effect of instrumental and vocal music on
adherence to a physical rehabilitation exercise program with persons who are elderly. Journal of Music
Therapy, 38(2), 82-96.
Kroger, S.M., Chapin, K., & Brotons, M. (1999). Is Music Therapy an Effective Intervention
for Dementia? A Meta-Analytic Review of Literature. Journal of Music Therapy, 36(1), 2-15.

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