A mastectomy is surgery to remove all breast tissue from a breast as a way to treat or prevent breast cancer.
For those with early-stage breast cancer, a mastectomy may be one treatment option. Breast-conserving surgery (lumpectomy), in which only the tumor is removed from the breast, may be another option.
Deciding between a mastectomy and lumpectomy can be difficult. Both procedures are equally effective for preventing a recurrence of breast cancer. But a lumpectomy isn’t an option for everyone with breast cancer, and others prefer to undergo a mastectomy.
Both mastectomy and lumpectomy are referred to as “local therapies” for breast cancer, targeting the area of the tumor, as opposed to systemic therapies, such as chemotherapy, hormonal therapy, or immunotherapy.
Traditionally, in the case of breast cancer, the whole breast was removed. Currently, the decision to do the mastectomy is based on various factors, including breast size, the number of lesions, biologic aggressiveness of a breast cancer, the availability of adjuvant radiation, and the willingness of the patient to accept higher rates of tumor recurrences after lumpectomy and radiation. Outcome studies comparing mastectomy to lumpectomy with radiation have suggested that routine radical mastectomy surgeries will not always prevent later distant secondary tumors arising from micro-metastases prior to discovery, diagnosis, and operation.
Newer mastectomy techniques can preserve breast skin and allow for a more natural breast appearance following the procedure. This is also known as skin-sparing mastectomy.
Surgery to restore shape to your breast — called breast reconstruction— may be done at the same time as your mastectomy or during a second operation at a later date.
Currently, there are several surgical approaches to mastectomy, and the type that a person decides to undergo (or whether she or he will decide instead to have a lumpectomy) depends on factors such as the size, location, and behavior of the tumor (if one is present), whether or not the surgery is prophylactic, and whether the person intends to undergo reconstructive surgery.
* Simple mastectomy (or “total mastectomy”):In this procedure, the entire breast tissue is removed, but axillary contents are undisturbed. Sometimes the “sentinel lymph node”—that is, the first axillary lymph node that the metastasizing cancer cells would be expected to drain into—is removed.
* Modified radical mastectomy:The entire breast tissue is removed along with the axillary contents (fatty tissue and lymph nodes). In contrast to a radical mastectomy, the pectoral muscles are spared. This type of mastectomy is used to examine the lymph nodes because this helps to identify whether the cancer cells have spread beyond the breasts.
* Radical mastectomy (or “Halsted mastectomy”): First performed in 1882, this procedure involves removing the entire breast, the axillary lymph nodes, and the pectoralis major and minor muscles behind the breast.
* Skin-sparing mastectomy: In this surgery, the breast tissue is removed through a conservative incision made around the areola (the dark part surrounding the nipple).
* Nipple-sparing/subcutaneous mastectomy: Breast tissue is removed, but the nipple-areola complex is preserved. This procedure was historically done only prophylactically or with mastectomy for the benign disease over the fear of increased cancer development in retained areolar ductal tissue. Recent series suggest that it may be an oncologically sound procedure for tumors not in the subareolar position.
* Extended Radical Mastectomy: Radical mastectomy with intrapleural en bloc resection of internal mammary lymph node by sternal splitting.
* Prophylactic mastectomy: This procedure is used as a preventative measure against breast cancer. The surgery is aimed to remove all breast tissue that could potentially develop into breast cancer.
Risks of a mastectomy include:
* Swelling (lymphedema) in your arm if you have an axillary node dissection
* Formation of hard scar tissue at the surgical site
* Shoulder pain and stiffness
* Numbness, particularly under your arm, from lymph node removal
Buildup of blood in the surgical site (hematoma)
Before the operation, everyone will meet with the surgeon a few days before the surgery or even the day before, however, a much longer period is very beneficial since it allows the patient for a more objective weighing of the options. Although there is some urgency in timing the surgery, the patient needs some time after the initial shock of hearing the cancer verdict; otherwise, she may later regret her decision. The extent and specific details regarding the mastectomy will be discussed along with the person’s medical history.
Of extreme importance will be the woman’s decision whether the entire breast is to be removed, or only a part of it – and that is usually much more a personal choice than a medical assessment. The medical viewpoint stresses the statistical fact of much stronger chances for cure and survival when the breast is removed completely, even when the size of the cancer is small. From the personal viewpoint, the perspective of not having the breast is very painful and difficult to accept. At this point the support of the family and of good friends can make the difference between life and death, since it is easier for friends to present the after-the-surgery future in the “matter of fact” way, thus facilitating the reasonable decision. The dilemma of the vital importance will be weighing the aesthetics and pride, against the chances of curing and surviving, which are much better when the breast is removed 100% completely. During these considerations, very painful indeed, one needs to realize that a woman’s flat chest without breasts, even without nipples, does not look bad at all, nothing to feel embarrassed of, or to be ashamed by; it looks just neutral – much better than a partly removed, disfigured breast. Since the surgery is unavoidable, for people open to see the problem in this way, the choice becomes easier.
Before the surgery the person will have time to ask any questions regarding the procedure at this time and after everything is addressed a consent form is signed. Information about not eating or drinking anything beforehand will be gone over as well. The person will also meet with the anesthesiologist or the health professional who is going to be giving the anesthesia the day of the operation.
Recent research has indicated that mammograms should not be done with any increased frequency than normal procedure in people undergoing breast surgery, including breast augmentation, mastopexy, and breast reduction.
The day of the operation the person will have an IV line started, which will be used to give medicine. Since this is an extensive procedure the person will be hooked up to an EKG machine and also have a blood pressure cuff to monitor vitals and the heart rhythm throughout the whole surgery. The anesthesia will be given, which will result in the person going to sleep. The timing of the surgery all depends on the extent and what type of mastectomy the person will be having.
When the procedure is complete the patient will be taken to a recovery room where they are monitored until they wake up and their vital signs remain stable. It is normal for people that have mastectomies to remain in the hospitals for 1 to 2 nights and they are released to go home if they are doing well. The decision for discharge should be made by the doctor based on the person’s overall health at the time. The person is dressed with a bandage over the surgery site that is wrapped around the chest snugly. It is common to have drains coming from the incision site to help remove blood and lymph to initiate the healing process. Patients may have to be taught to empty, care, and measure the fluid from the drains. Measuring the fluids will help identify any problems the doctors need to be aware of. Patients should be taught the effects of the surgery, such as regular activity may be altered. There is a possibility that pain, numbness, or tingling in the chest and arm could continue long after the surgery has been done. It is recommended that patients see their surgeon 7–14 days after the surgery, during this time the doctor will explain the results and talk about further treatment if needed such as radiation and chemotherapy. The doctor might refer the patient to a plastic surgeon if she showed interest in breast reconstruction surgery.
Enhanced external counterpulsation (EECP) is a mechanical form of treatment for angina. While several clinical studies appear to show that this treatment can be helpful in reducing symptoms of angina in patients with coronary artery disease (CAD), EECP has yet to be accepted by most cardiologists, and has not entered the mainstream of cardiology practice.
What is EECP?
EECP is a mechanical procedure in which long inflatable cuffs (like blood pressure cuffs) are wrapped around both of the patient’s legs. While the patient lies on a bed, the leg cuffs are inflated and deflated synchronously with each heartbeat. The inflation and deflation are controlled by a computer, which uses the patient’s ECG to trigger inflation early in diastole (when the heart relaxes and is filled with blood), and deflation just as systole (heart contraction) begins. The inflation of the cuffs occurs sequentially, from the lower part of the legs to the upper, so that the blood in the legs is “milked” upwards, toward the heart.
EECP has at least two potentially beneficial actions on the heart. First, the milking action of the leg cuffs increases the blood flow to the coronary arteries during diastole. (The coronary arteries, unlike other arteries in the body, receive their blood flow in between heartbeats, instead of during each heartbeat.) Second, by its deflating action just as the heart begins to beat, EECP creates something like a sudden vacuum in the arteries, which reduces the work the heart muscle has to perform in pumping blood. It is also speculated that EECP may help reduce endothelial dysfunction.
EECP is administered as a series of outpatient treatments. Patients receive 5 one-hour sessions per week, for 7 weeks (for a total of 35 sessions). The 35 one-hour sessions are aimed at provoking long lasting beneficial changes in the circulatory system.
How Effective Is EECP?
Several studies suggest that EECP can be quite effective in treating chronic stable angina. A small randomized trial showed that EECP significantly improved both the symptoms of angina (a subjective measurement) and exercise tolerance (a more objective measurement) in patients with CAD. EECP also significantly improved “quality of life” measures, as compared to placebo therapy. Other studies have shown that the improvement in symptoms following a course of EECP seems to persist for up to five years (though 1 in 5 patients may require another course of EECP to maintain their improvement).
How Does EECP Work?
The mechanism for the apparent sustained benefits seen with EECP is unknown. There is some evidence suggesting that EECP can help induce the formation of collateral vessels in the coronary artery tree, by stimulating the release of nitric oxide and other growth factors in within the coronary arteries. There is also evidence that EECP may act as a form of “passive” exercise, leading to the same sorts of persistent beneficial changes in the autonomic nervous system that are seen with real exercise.
Can EECP Be Harmful?
EECP can be somewhat uncomfortable, but is generally not painful. In studies, the large majority of patients have tolerated the procedure quite well.
But not everyone can have EECP. People probably should not have EECP if they have aortic insufficiency, or if they have had a recent cardiac catheterization, an irregular heart rhythm such as atrial fibrillation, severe hypertension, peripheral artery disease involving the legs, or a history of deep venous thrombosis. For anyone else, however, the procedure appears to be safe.
When Is EECP Recommended?
Based on what we know today, EECP should be considered in anybody who still has angina despite maximal medical therapy, and in whom stents or bypass surgery are deemed not to be good options. Medicare has approved coverage for EECP for patients with angina who have exhausted all their other choices.
In 2014, several professional organizations (the American College of Cardiology, American Heart Association, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons) finally agreed in a focused update that EECP ought to be considered for patients with angina refractory to other treatments.
Why Isn’t EECP Used More Often?
In general, the cardiology community has largely chosen to ignore such an outlandish form of therapy, and many cardiologists fail to to even consider offering EECP as a therapeutic option. Consequently, most patients who have angina never hear about it.
Indeed, EECP is a little outlandish. It certainly does not look like cardiology. Nobody can really explain how it works. And, from a cardiologist/s viewpoint, when you compare the relative effort and relative reimbursement of EECP to something like inserting a stent (35 sessions over 7 weeks vs. a 30-minute procedure) there is no contest. To expect cardiologists to embrace EECP with any enthusiasm simply ignores human nature.
Still, when a noninvasive treatment for angina exists that is safe and well tolerated, when available evidence (as imperfect as it may be) strongly suggests the treatment is quite effective in many patients, and when the patient being treated will be able to tell pretty definitively whether or not the treatment has helped in their own individual case (by the presence or absence of a substantial reduction in angina symptoms), it does not seem unreasonable to allow patients with stable angina to opt for a trial of that noninvasive therapy, perhaps even before they are pushed into invasive therapy.
If you are being treated for stable angina and still have symptoms despite therapy, it is entirely reasonable for you to bring up the possibility of trying EECP. Your doctor should be quite willing to discuss this possibility with you, objectively and without prejudice.
PUVA is an acronym. The P stands for psoralen,(Psoralen is a photosensitizing agent found in plants ) the U for ultra, the V for violet, and the A for that portion of the solar spectrum between 320 and 400 nanometers in wavelength. Psoralens are chemicals found in certain plants that have the ability to absorb ultraviolet light in these wavelengths. Once the light energy is absorbed, these chemicals are energized to interact with DNA, ultimately inhibiting cell multiplication, which is their presumed mode of action.
Certain skin diseases are characterized by cells that are rapidly multiplying. Inhibiting this unrestrained multiplication can be useful in treating these diseases. So PUVA is a combination of an oral drug and subsequent ultraviolet light exposure. The treatment may affect certain blood cells and skin cells so that the skin disease improves.
It is a treatment for eczema, psoriasis, graft-versus-host disease, vitiligo, mycosis fungoides, large-plaque parapsoriasis and cutaneous T-cell lymphoma using the sensitizing effects of the drug psoralen. The psoralen is applied or taken orally to sensitize the skin, then the skin is exposed to UVA.
Photodynamic therapy is the general use of nontoxic light-sensitive compounds that are exposed selectively to light, whereupon they become toxic to targeted malignant and other diseased cells. Still, PUVA therapy is often classified as a separate technique from photodynamic therapy.
Types of PUVA therapy:
The most common form of therapy combines 8-methoxypsoralen taken by mouth followed 45-60 minutes later by exposure of the skin to UVA. Less commonly the drug is applied topically (the medication is occasionally diluted in bathtub water in which the patient is immersed) and then after a few minutes the ultraviolet exposure occurs.
Psoralens are taken systemically or can be applied directly to the skin. The psoralens allow a relatively lower dose of UVA to be used. When they are combined with exposure to UVA in PUVA, they are highly effective at clearing psoriasis and vitiligo. Like UVB light treatments, the reason remains unclear, though investigators speculate there may be similar effects on cell turnover and the skin’s immune response.
Choosing the proper dose for PUVA is similar to the procedure followed with UVB. The physician can choose a dose based on the patient’s skin type. The dose will increase in every treatment until the skin starts to respond.
Some clinics test the skin before the treatments, by exposing a small area of the patient’s skin to UVA, after ingestion of psoralen. The dose of UVA that produces uniform redness 72 hours later, called the minimum phototoxic dose (MPD), becomes the starting dose for treatment.
At the very least for vitiligo, narrowband ultraviolet B (UVB) phototherapy is now used more commonly than PUVA since it does not require the use of the Psoralen. As with PUVA, treatment is carried out twice weekly in a clinic or every day at home, and there is no need to use psoralen.
Narrowband UVB does not cure the legs and hands, compared to the face and neck. To the hands and legs PUVA may be more effective. The reason can be because UVA penetrates deeper in the skin, and the melanocytes in the skin of the hands and legs is deeper in the skin. The Narrowband UVB does not reach the melanocytes.
How maney PUVA therapy is required:
There ought to be a significant improvement in the patient’s skin disease after about 15 treatments. Treatments are given no sooner than 48 hours apart because the burn induced by PUVA is often delayed for as long as two days (unlike ordinary sunburns). Unless there is a problem, the amount of energy administered to the patient is increased appropriately at each visit depending on the patient’s coloration. After about 30 treatments, a decision is made as to whether to continue treatments. PUVA is not always effective. If there is no improvement after these treatments, it is probably unlikely that continuing this form of treatment is worthwhile. On the other hand, if significant clearing has occurred, it is probably prudent to decrease the frequency of treatments in order to maintain the improvement. Since there is a relationship between the amount of light energy administered and the degree of photo-aging and the induction of skin cancers, it is wise to limit the light exposures as appropriate.
The major advantage to PUVA is that it is an effective therapy that becomes active only at the site of the disease, the skin. It can be used to treat large areas of skin, and the fact that the drug is only activated in the presence of UV light implies that it may be less toxic than other therapies that require systemic administration and whose effects are not localized to just the skin.
PUVA must be administered in a physician’s office under the control of a medical professional so it requires repeated visits to the office. PUVA may not cure psoriasis permanently so treatment can be required indefinitely.
Side effects and complications:
Some patients experience nausea and itching after ingesting the psoralen compound. For these patients PUVA bath therapy may be a good option.
Long term use of PUVA therapy has been associated with higher rates of skin cancer.
The most significant complication of PUVA therapy for psoriasis is squamous cell skin cancer. Two carcinogenic components of the therapy include the nonionizing radiation of UVA light as well as the psoralen intercalation with DNA. Both processes negatively contribute to genome instability. History : Psoralens have been known since ancient Egypt but have only been available in a chemically synthesized form since the 1970s.
Cognitive behavior therapy (CBT) is a type of psychotherapeutic treatment that helps patients understand the thoughts and feelings that influence behaviors. CBT is commonly used to treat a wide range of disorders including phobias, addictions, depression, and anxiety.
Cognitive behavioral therapy (CBT) is a short-term psychotherapy originally designed to treat depression, but is now used for a number of mental illnesses. It works to solve current problems and change unhelpful thinking and behavior. The name refers to behavior therapy, cognitive therapy, and therapy based upon a combination of basic behavioral and cognitive principles. Most therapists working with patients dealing with anxiety and depression use a blend of cognitive and behavioral therapy. This technique acknowledges that there may be behaviors that cannot be controlled through rational thought, but rather emerge based on prior conditioning from the environment and other external and/or internal stimuli. CBT is “problem focused” (undertaken for specific problems) and “action oriented” (therapist tries to assist the client in selecting specific strategies to help address those problems), or directive in its therapeutic approach.
CBT has been demonstrated to be effective for the treatment of a variety of conditions, including mood, anxiety, personality, eating, substance abuse, tic, and psychotic disorders. Many CBT treatment programs for specific disorders have been evaluated for efficacy; the health-care trend of evidence-based treatment, where specific treatments for symptom-based diagnoses are recommended, has favored CBT over other approaches such as psychodynamic treatments. However, other researchers have questioned the validity of such claims to superiority over other treatments.
Mainstream cognitive behavioral therapy assumes that changing maladaptive thinking leads to change in affect and behavior, but recent variants emphasize changes in one’s relationship to maladaptive thinking rather than changes in thinking itself. Therapists or computer-based programs use CBT techniques to help individuals challenge their patterns and beliefs and replace “errors in thinking such as overgeneralizing, magnifying negatives, minimizing positives and catastrophizing” with “more realistic and effective thoughts, thus decreasing emotional distress and self-defeating behavior.” These errors in thinking are known as cognitive distortions. Cognitive distortions can be either a pseudo- discrimination belief or an over-generalization of something. CBT techniques may also be used to help individuals take a more open, mindful, and aware posture toward them so as to diminish their impact. Mainstream CBT helps individuals replace “maladaptive… coping skills, cognitions, emotions and behaviors with more adaptive ones”, by challenging an individual’s way of thinking and the way that they react to certain habits or behaviors, but there is still controversy about the degree to which these traditional cognitive elements account for the effects seen with CBT over and above the earlier behavioral elements such as exposure and skills training.
Modern forms of CBT include a number of diverse but related techniques such as exposure therapy, stress inoculation training, cognitive processing therapy, cognitive therapy, relaxation training, dialectical behavior therapy, and acceptance and commitment therapy. Some practitioners promote a form of mindful cognitive therapy which includes a greater emphasis on self-awareness as part of the therapeutic process.
CBT has six phases:
1.Assessment or psychological assessment;
4.Skills consolidation and application training;
5.Generalization and maintenance;
6.Post-treatment assessment follow-up.
The reconceptualization phase makes up much of the “cognitive” portion of CBT. A summary of modern CBT approaches is given by Hofmann.
There are different protocols for delivering cognitive behavioral therapy, with important similarities among them. Use of the term CBT may refer to different interventions, including “self-instructions (e.g. distraction, imagery, motivational self-talk), relaxation and/or biofeedback, development of adaptive coping strategies (e.g. minimizing negative or self-defeating thoughts), changing maladaptive beliefs about pain, and goal setting”. Treatment is sometimes manualized, with brief, direct, and time-limited treatments for individual psychological disorders that are specific technique-driven. CBT is used in both individual and group settings, and the techniques are often adapted for self-help applications. Some clinicians and researchers are cognitively oriented (e.g. cognitive restructuring), while others are more behaviorally oriented (e.g. in vivo exposure therapy). Interventions such as imaginal exposure therapy combine both approaches.
Types of Cognitive Behavior Therapy:
There are a number of different approaches to CBT that are regularly used by mental health professionals. These types include:
•Rational Emotive Behavior Therapy (REBT)
Cochrane reviews have found no evidence that CBT is effective for tinnitus, although there appears to be an effect on management of associated depression and quality of life in this condition. Other recent Cochrane Reviews found no convincing evidence that CBT training helps foster care providers manage difficult behaviors in the youth under their care, nor was it helpful in treating men who abuse their intimate partners.
According to a 2004 review by INSERM of three methods, cognitive behavioral therapy was either “proven” or “presumed” to be an effective therapy on several specific mental disorders. According to the study, CBT was effective at treating schizophrenia, depression, bipolar disorder, panic disorder, post-traumatic stress, anxiety disorders, bulimia, anorexia, personality disorders and alcohol dependency.
Some meta-analyses find CBT more effective than psychodynamic therapy and equal to other therapies in treating anxiety and depression. However, psychodynamic therapy may provide better long-term outcomes.
Computerized CBT (CCBT) has been proven to be effective by randomized controlled and other trials in treating depression and anxiety disorders, including children, as well as insomnia. Some research has found similar effectiveness to an intervention of informational websites and weekly telephone calls. CCBT was found to be equally effective as face-to-face CBT in adolescent anxiety and insomnia.
Criticism of CBT sometimes focuses on implementations (such as the UK IAPT) which may result initially in low quality therapy being offered by poorly trained practitioners. However evidence supports the effectiveness of CBT for anxiety and depression.
Mounting evidence suggests that the addition of hypnotherapy as an adjunct to CBT improves treatment efficacy for a variety of clinical issues.
CBT has been applied in both clinical and non-clinical environments to treat disorders such as personality conditions and behavioral problems. A systematic review of CBT in depression and anxiety disorders concluded that “CBT delivered in primary care, especially including computer- or Internet-based self-help programs, is potentially more effective than usual care and could be delivered effectively by primary care therapists.”
Emerging evidence suggests a possible role for CBT in the treatment of attention deficit hyperactivity disorder (ADHD); hypochondriasis; coping with the impact of multiple sclerosis; sleep disturbances related to aging; dysmenorrhea; and bipolar disorder, but more study is needed and results should be interpreted with caution. CBT has been studied as an aid in the treatment of anxiety associated with stuttering. Initial studies have shown CBT to be effective in reducing social anxiety in adults who stutter, but not in reducing stuttering frequency.
Martinez-Devesa et al. (2010) found no evidence that CBT is effective for tinnitus, although there appears to be an effect on management of associated depression and quality of life in this condition. Turner et al. (2007) found no convincing evidence that CBT training helps foster care providers manage difficult behaviors in the youth under their care, and Smedslund et al. (2007) found that it was not helpful in treating men who abuse their intimate partners.
In the case of metastatic breast cancer, Edwards et al. (2008) maintained that the current body of evidence is not sufficient to rule out the possibility that psychological interventions may cause harm to women with this advanced neoplasm.
In adults, CBT has been shown to have a role in the treatment plans for anxiety disorders; depression; eating disorders; chronic low back pain; personality disorders; psychosis; schizophrenia; substance use disorders; in the adjustment, depression, and anxiety associated with fibromyalgia; and with post-spinal cord injuries. There is some evidence that CBT is superior in the long-term to benzodiazepines and the nonbenzodiazepines in the treatment and management of insomnia. CBT has been shown to be moderately effective for treating chronic fatigue syndrome.
In children or adolescents, CBT is an effective part of treatment plans for anxiety disorders; body dysmorphic disorder; depression and suicidality; eating disorders and obesity; obsessive–compulsive disorder; and posttraumatic stress disorder; as well as tic disorders, trichotillomania, and other repetitive behavior disorders. CBT-SP, an adaptation of CBT for suicide prevention (SP), was specifically designed for treating youth who are severely depressed and who have recently attempted suicide within the past 90 days, and was found to be effective, feasible, and acceptable. Sparx is a video game to help young persons, using the CBT method to teach them how to resolve their own issues. That’s a new way of therapy, which is quite effective for child and teenager. CBT has also been shown to be effective for posttraumatic stress disorder in very young children (3 to 6 years of age). Cognitive Behavior Therapy has also been applied to a variety of childhood disorders, including depressive disorders and various anxiety disorders.
In the United Kingdom, the National Institute for Health and Care Excellence (NICE) recommends CBT in the treatment plans for a number of mental health difficulties, including posttraumatic stress disorder, obsessive–compulsive disorder (OCD), bulimia nervosa, and clinical depression
Use of CBT in other different ways: With older adults:
CBT is used to help people of all ages, but the therapy should be adjusted based on the age of the patient with whom the therapist is dealing. Older individuals in particular have certain characteristics that need to be acknowledged and the therapy altered to account for these differences thanks to age. Some of the challenges to CBT because of age include the following:
The Cohort effect The times that each generation lives through partially shape its thought processes as well as values, so a 70-year-old may react to the therapy very differently from a 30-year-old, because of the different culture in which they were brought up. A tie-in to this effect is that each generation has to interact with one another, and the differing values clashing with one another may make the therapy more difficult. Established role By the time one reaches old age, the person has a definitive idea of her or his role in life and is invested in that role. This social role can dominate who the person thinks he or she is and may make it difficult to adapt to the changes required in CBT. Mentality toward aging If the older individual sees aging itself as a negative this can exacerbate whatever malady the therapy is trying to help (depression and anxiety for example). Negative stereotypes and prejudice against the elderly cause depression as the stereotypes become self-relevant.Processing speed decreasesAs we age, we take longer to learn new information, and as a result may take more time to learn and retain the cognitive therapy. Therefore, therapists should slow down the pacing of the therapy and use any tools both written and verbal that will improve the retention of the cognitive behavioral therapy.
Prevention of mental illness:
For anxiety disorders, use of CBT with people at risk has significantly reduced the number of episodes of generalized anxiety disorder and other anxiety symptoms, and also given significant improvements in explanatory style, hopelessness, and dysfunctional attitudes. In another study, 3% of the group receiving the CBT intervention developed generalized anxiety disorder by 12 months post intervention compared with 14% in the control group. Subthreshold panic disorder sufferers were found to significantly benefit from use of CBT. Use of CBT was found to significantly reduce social anxiety prevalence.
For depressive disorders, a stepped-care intervention (watchful waiting, CBT and medication if appropriate) achieved a 50% lower incidence rate in a patient group aged 75 or older. Another depression study found a neutral effect compared to personal, social, and health education, and usual school provision, and included a comment on potential for increased depression scores from people who have received CBT due to greater self recognition and acknowledgement of existing symptoms of depression and negative thinking styles. A further study also saw a neutral result. A meta-study of the Coping with Depression course, a cognitive behavioural intervention delivered by a psychoeducational method, saw a 38% reduction in risk of major depression.
For schizophrenia, one study of preventative CBT showed a positive effect and another showed neutral effect.
Criticisms of Cognitive Behavior Therapy:
The research conducted for CBT has been a topic of sustained controversy. While some researchers write that CBT is more effective than other treatments, many other researchers and practitioners have questioned the validity of such claims. For example, one study determined CBT to be superior to other treatments in treating anxiety and depression. However, researchers responding directly to that study conducted a re-analysis and found no evidence of CBT being superior to other bona fide treatments, and conducted an analysis of thirteen other CBT clinical trials and determined that they failed to provide evidence of CBT superiority.
Furthermore, other researchers write that CBT studies have high drop-out rates compared to other treatments. At times, the CBT drop-out rates can be more than five times higher than other treatments groups. For example, the researchers provided statistics of 28 participants in a group receiving CBT therapy dropping out, compared to 5 participants in a group receiving problem-solving therapy dropping out, or 11 participants in a group receiving psychodynamic therapy dropping out.
Other researchers conducting an analysis of treatments for youth who self-injure found similar drop-out rates in CBT and DBT groups. In this study, the researchers analyzed several clinical trials that measured the efficacy of CBT administered to youth who self-injure. The researchers concluded that none of them were found to be efficacious. These conclusions were made using the APA Division 12 Task Force on the Promotion and Dissemination of Psychological Procedures to determine intervention potency.
However, the research methods employed in CBT research have not been the only criticisms identified. Others have called CBT theory and therapy into question. For example, Fancher writes the CBT has failed to provide a framework for clear and correct thinking. He states that it is strange for CBT theorists to develop a framework for determining distorted thinking without ever developing a framework for “cognitive clarity” or what would count as “healthy, normal thinking.” Additionally, he writes that irrational thinking cannot be a source of mental and emotional distress when there is no evidence of rational thinking causing psychological well-being. Or, that social psychology has proven the normal cognitive processes of the average person to be irrational, even those who are psychologically well. Fancher also says that the theory of CBT is inconsistent with basic principles and research of rationality, and even ignores many rules of logic. He argues that CBT makes something of thinking that is far less exciting and true than thinking probably is. Among his other arguments are the maintaining of the status quo promoted in CBT, the self-deception encouraged within clients and patients engaged in CBT, how poorly the research is conducted, and some of its basic tenets and norms: “The basic norm of cognitive therapy is this: except for how the patient thinks, everything is ok”.
Meanwhile, Slife and Williams write that one of the hidden assumptions in CBT is that of determinism, or the absence of free will. They argue that CBT invokes a type of cause-and-effect relationship with cognition. They state that CBT holds that external stimuli from the environment enter the mind, causing different thoughts that cause emotional states. Nowhere in CBT theory is agency, or free will, accounted for. At its most basic foundational assumptions, CBT holds that human beings have no free will and are just determined by the cognitive processes invoked by external stimuli.
Another criticism of CBT theory, especially as applied to Major Depressive Disorder (MDD), is that it confounds the symptoms of the disorder with its causes.
A major criticism has been that clinical studies of CBT efficacy (or any psychotherapy) are not double-blind (i.e., neither subjects nor therapists in psychotherapy studies are blind to the type of treatment). They may be single-blinded, i.e. the rater may not know the treatment the patient received, but neither the patients nor the therapists are blinded to the type of therapy given (two out of three of the persons involved in the trial, i.e., all of the persons involved in the treatment, are unblinded). The patient is an active participant in correcting negative distorted thoughts, thus quite aware of the treatment group they are in.
The importance of double-blinding was shown in a meta-analysis that examined the effectiveness of CBT when placebo control and blindedness were factored in. Pooled data from published trials of CBT in schizophrenia, MDD, and bipolar disorder that used controls for non-specific effects of intervention were analyzed. This study concluded that CBT is no better than non-specific control interventions in the treatment of schizophrenia and does not reduce relapse rates, treatment effects are small in treatment studies of MDD, and it is not an effective treatment strategy for prevention of relapse in bipolar disorder. For MDD, the authors note that the pooled effect size was very low. Nevertheless, the methodological processes used to select the studies in the previously mentioned meta-analysis and the worth of its findings have been called into question.
Definition: 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.
Music therapy is the use of interventions to accomplish individual goals within a therapeutic relationship by a professional who has completed an approved music therapy program. Music therapy is an allied health profession and one of the expressive therapies, consisting of a process in which a music therapist uses music and all of its facets—physical, emotional, mental, social, aesthetic, and spiritual—to help clients improve their physical and mental health. Music therapists primarily help clients improve their health in several domains, such as cognitive functioning, motor skills, emotional development, social skills, and quality of life, by using music experiences such as free improvisation, singing, and listening to, discussing, and moving to music to achieve treatment goals. It has a wide qualitative and quantitative research literature base and incorporates clinical therapy, psychotherapy, biomusicology, musical acoustics, music theory, psychoacoustics, embodied music cognition, aesthetics of music, sensory integration, and comparative musicology. Referrals to music therapy services may be made by other health care professionals such as physicians, psychologists, physical therapists, and occupational therapists. Clients can also choose to pursue music therapy services without a referral (i.e., self-referral).
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. Music therapy is also used in some medical hospitals, cancer centers, schools, alcohol and drug recovery programs, psychiatric hospitals, and correctional facilities. History:
Music has been used as a healing implement for centuries. Apollo is the ancient Greek god of music and of medicine. Aesculapius was said to cure diseases of the mind by using song and music, and music therapy was used in Egyptian temples. Plato said that music affected the emotions and could influence the character of an individual. Aristotle taught that music affects the soul and described music as a force that purified the emotions. Aulus Cornelius Celsus advocated the sound of cymbals and running water for the treatment of mental disorders. Music therapy was practiced in biblical times, when David played the harp to rid King Saul of a bad spirit. As early as 400 B.C., Hippocrates played music for mental patients. In the thirteenth century, Arab hospitals contained music-rooms for the benefit of the patients. In the United States, Native American medicine men often employed chants and dances as a method of healing patients. 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, in which he discussed the therapeutic effects of music on the soul. 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. Music therapy as we know it began in the aftermath of World Wars I and II, when, particularly in the United Kingdom, musicians would travel to hospitals and play music for soldiers suffering from war-related emotional and physical trauma.
Music therapists may work 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.
One therapy model based on neuroscience, called “neurological music therapy” (NMT), is “based on a neuroscience model of music perception and production, and the influence of music on functional changes in non-musical brain and behavior functions. 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 affect the client non-musically. As one researcher, Dr. Thaut, said: “The brain that engages in music is changed by engaging in music.” NMT trains motor responses (i.e. tapping foot or fingers, head movement, etc.) to better help clients develop motor skills that help “entrain the timing of muscle activation patterns.
Music therapy approaches used with Children: Paul Nordoff, a Juilliard School graduate and Professor of Music, was a gifted pianist and composer who, upon seeing disabled children respond so positively to music, gave up his academic career to further investigate the possibility of music as a means for therapy. Dr. Clive Robbins, a special educator, partnered with Nordoff for over 17 years in the exploration and research of music’s effects on disabled children- first in the United Kingdom, and then in the USA in the 1950s and 60s. Their pilot projects included placements at care units for autistic children and child psychiatry departments, where they put programs in place for children with mental disorders, emotional disturbances, developmental delays, and other handicaps. Their success at establishing a means of communication and relationship with autistic children at the University of Pennsylvania gave rise to the National Institutes of Health’s first grant given of this nature, and the 5-year study “Music Therapy Project for Psychotic Children Under Seven at the Day Care Unit” involved research, publication, training and treatment. Several publications, including Therapy in Music for Handicapped Children, Creative Music Therapy, Music Therapy in Special Education, as well as instrumental and song books for children, were released during this time. Nordoff and Robbins’s success became known globally in the mental health community, and they were invited to share their findings and offer training on an international tour that lasted several years. Funds were granted to support the founding of the Nordoff Robbins Music Therapy Centre in Great Britain in 1974, where a one-year Graduate program for students was implemented. In the early eighties, a center was opened in Australia, and various programs and institutes for Music Therapy were founded in Germany and other countries. In the United States, the Nordoff-Robbins Center for Music Therapy was established at New York University in 1989.
The Nordoff-Robbins approach, based on the belief that everyone is capable of finding meaning in and benefitting from musical experience, is now practiced by hundreds of therapists internationally. It focuses on treatment through the creation of music by both therapist and client together. Various techniques are used to accommodate all capabilities so that even the most low functioning individuals are able to participate actively.
Assessment and interventions :
As with any type of therapy, the practice of Music Therapy with children must uphold standards of conduct and ethics, agreed upon by national and provincial associations such as the Canadian Association for Music Therapy. In part with this, formal assessment is crucial for understanding the child – their background, limitations and needs, as well as to create appropriate goals for the process and select the means of achieving them. This serves as the starting point from which to measure the client’s progression throughout the therapeutic process and to make adjustments later, if necessary. Similarly to how assessments are conducted with adults, the music therapist obtains extensive data on the client including their full medical history, musical (ability to duplicate a melody or identify changes in rhythm, etc.) and nonmusical functioning (social, physical/motor, emotional, etc.). The assessment process is then carried out in formal, informal, and standardized ways.
The following are the most common methods of assessment:
*Interviews with Clients and/or Family Members
*Structured or Unstructured Observation
*Reviewing of Client Records
*Standardized Assessment Tests
Information gathered at the music therapy assessment is then used to determine if music therapy is indicated for the child. The therapist then formulates a music therapy treatment plan, which includes specific short-term objectives, long-term goals, and an expected timeline for therapy.
Music therapy interventions used with children can fall into two categories. The first, Supportive active therapy, is product- oriented and can included rhythm activities such as body percussion (stomping feet, clapping hands, etc.), singing songs which re-inforce nonmusical skills, awareness and expression, or movement to music (as simple as marching to the beat, as complex as structured dances). The second area is called Insight music therapy which is process-oriented. Activities could include song-writing, active listening and reacting, or auditory discrimination activities for sensory skill development. Music therapy for children is conducted either in a one-on-one session or in a group session. The therapist typically plays either a piano or a guitar, which allows for a wide variety of musical styles to suit the client’s preferences. The child is usually encouraged to play an instrument adapted to his or her unique abilities and needs. These elements are designed to improve the experience and outcome of the therapy.
DIFFERENT BENEFITS OF MUSIC THERAPY:
Prenatal music therapy:
Music Therapy can play an important role during pregnancy. At just 16 weeks, a fetus is able to hear their mother’s speech as well as singing. Through technologies, such as ultrasound, health care professionals are able to observe the movements of the unborn child responding to musical stimuli. Through these fetal observations, we see that the baby is capable of expressing its needs, preferences, and interests through movements in the womb. At the beginning of the second trimester, the ear structure is fully matured. By this time, the fetus will begin to hear not only maternal sounds, but also vibrations of instruments…..CLICK & SEE :
Prenatal music therapy has three main bennefits:
1.Prenatal Stress Relief: Pregnant women may experience high levels of stress which can negatively affect the baby. This will cause the body will release Norepinephrine and Cortisol hormones which will increase blood pressure and weaken the immune system of both mother and child. High levels of cortisol exposure in early development can increase the likelihood of the child later having anxiety, mental retardation, autism, and depression. Music therapists use music to elevate the stress threshold of an expectant mother which helps her to maintain a relaxed state during labour and birthing process. During a music therapy session, the mother is guided to listen to her internal rhythms, as well as listing to the movements and reactions of the fetus in response to her voice and music. This technique is useful in helping reduce the mother’s level of stress, and prepare her for the birth of her child.
2.Maternal-Fetal Bonding: Communication between the mother and fetus is essential during pregnancy. One way of strengthening the bond between the two is through music therapy. Music stimulation helps to develop the fetus’s nervous system, structurally and functionally. The unborn child especially prefers the voice of their mother. The most effective way to enhance communication is through singing. Lullabies are the most popular songs sung by mothers. Singing lullabies is a wonderful way for mothers to express their love and have the baby become familiarized with their mother’s melodies and intonations which will provide them a sense of security when they are born, because it will feel just like how they were in the womb. Electronic voice phenomena studies have shown that the father’s voice engages the fetus from feet to the abdomen – which will lead the baby to start walking at a younger age. The mother’s voice engages the fetus from waist to head which will strengthen the baby’s neck and upper limbs. Not only does prenatal singing benefit the fetus, it also help produce endorphins that automatically reduce the perception of pain and help relax breathing. A fetus can show preference for music; observations have shown the fetus’s movements are gentle when listening to soothing music, and comparatively, where there are dissonances included in the music, their movements are bigger and much more rhythmic, such as rolling. The fetus would be comforted by hearing slow-pace passages of Baroque music (Vivaldi and Handel) and lullabies sung by their mother.
3.Prenatal Language Development: Music is said to be the unborn child’s beginning of language learning. It can be consider as a pre-linguistic language that prepares the Auditory Sensory System to listen, combine, and produce language sounds. The fetus learns through the voice of their mother, not only from speech but songs. The sound is received by the baby through bone conduction when the mother speaks. The singing voice is said to have a wider range of frequencies than speech. Prenatal sounds are important during the prenatal period because it forms the basis of future learning and behaviour.
Music therapy for premature infants:
Music therapy has been shown to be very beneficial in stimulating growth and development in premature infants. Premature infants are those born at 37 weeks or less gestational stage. They are subject to numerous struggles, such as abnormal breathing patterns, decreased body fat and muscle tissue, as well as feeding issues. The coordination for sucking and breathing is often not fully developed, making feeding a challenge. The improved developmental activity and behavioural status of premature infants when they are discharged from the NICU, is directly related to the stimulation programs and interventions they benefited from during hospitalization, such as music therapy.
Music is typically conducted by a musical therapist in Neonatal Intensive Care (NICU), with five main techniques designed to benefit premature infants;
1.Live or Recorded Music: Live or recorded music has been effective in promoting respiratory regularity and oxygen saturation levels, as well as decreasing signs of neonatal distress. Since premature infants have sensitive and immature sensory modalities, music is often performed in a gentle and control environment, either in the form of audio recordings or live vocalization, although live singing has been shown to have a greater affect. Live music also reduces the physiological responses in parents. Studies have shown that by combining live music, such as harp music, with the Kangaroo Care, maternal anxiety is reduced. This allows for parents, especially mothers to spend important time bonding with their premature infants. Female singing voices are also more affective at soothing premature infants. Despite being born premature, infants show a preference for the sound of a female singing voice, making it more beneficial than instrumental music.
2.Promote Healthy Sucking Reflex: By using a Pacifier-Actived Lullaby Device, music therapists can help promote stronger sucking reflexes, while also reducing pain perception for the infant. The Gato Box is a small rectangular instrument that stimulates a prenatal heartbeat sound in a soft and rhythmic manner that has also been effective in aiding sucking behaviours. The music therapist uses their fingers to tap on the drum, rather than using a mallet. The rhythm supports movement when feeding and promotes healthy sucking patterns. By increasing sucking patterns, babies are able to coordinate the important dual mechanisms of breathing, sucking and swallowing needed to feed, thus promoting growth and weight gain. When this treatment proves effective, infants are able to leave the hospital earlier.
3.Multimodal Stimulation and Music: By combining music, such as lullabies, and multimodal stimulation, premature infants were discharged from the NICU sooner, than those infants who did not receive therapy. Multimodal stimulation includes the applications of auditory, tactile, vestibular, and visual stimulation that helps aid in premature infant development. The combination of music and MMS helps premature infants sleep and conserve vital energy required to gain weight more rapidly. Studies have shown that girls respond more positively than boys during multimodal stimulation.[ While the voice is a popular choice for parents looking to bond with their premature infants, other effective instruments include the Remo Ocean Disk and the Gato Box. Both are used to stimulate the sounds of the womb. The Remo Ocean Disk, a round musical instrument that mimics the fluid sounds of the womb, has been shown to benefit decreased heart rate after therapeutic uses, as well as promoting healthy sleep patterns, lower respiratory rates and improve sucking behavior.
4.Infant Stimulation: This type of intervention uses musical stimulation to compensate for the lack of normal environmental sensory stimulation found in the NICU. The sound environment the NICU provides can be disruptive; however, music therapy can mask unwanted auditory stimuli and promote a calm environment that reduces the complications for high-risk or failure-to-thrive infants. Parent-infant bonding can also be affected by the noise of the NICU, which in turn can delay the interactions between parents and their premature infants. But music therapy creates a relaxed and peaceful environment for parents to speak and spend time with their babies while incubated.
5.Parent-Infant Bonding: Therapists work with parents so they may perform infant-directed singing techniques, as well as home care. Singing lullabies therapeutically can promote relaxation and decrease heart rate in premature infants. By calming premature babies, it allows for them to preserve their energy, which creates a stable environment for growth. Lullabies, such as “Twinkle Twinkle Little Star”, or other culturally relevant lullabies, have been shown to greatly soothe babies. These techniques can also improve overall sleep quality, caloric intake and feeding behaviours, which aids in development of the baby while they are still in the NICU. Singing has also shown greater results on oxygen saturation levels for infants while incubated, more than mothers speech alone. This technique promoted high levels of oxygen for longer periods of time.
Music therapy in child rehabilitation:
Music therapy has multiple benefits which contribute to the maintenance of health and the drive toward rehabilitation for children. Advanced technology that can monitor cortical activity offers a look at how music engages and produces changes in the brain during the perception and production of musical stimuli. Music therapy, when used with other rehabilitation methods, has increased the success rate of sensorimotor, cognitive, and communication rehabilitation. Music therapy intervention programs can include an average of 18 sessions of treatment. The achievement of a physical rehabilitation goal relies on the child’s existing motivation and feelings towards music and their commitment to engage in meaningful, rewarding efforts. Regaining full functioning also confides in the prognosis of recovery, the condition of the client, and the environmental resources available. Sessions may consist of either active techniques, where the client creates music, or receptive techniques, where the client listens to, analyze, move and respond to music. Both techniques use systematic processes where the therapists assist the client by using musical experiences and connections that collaborate as a dynamic force of change toward rehabilitation. The music is at times chosen by the client, or by the music therapist based on the clients reciprocation to the music.
Music has many calming and soothing properties that can be used as a sedative in rehabilitation. For example, a patient with chronic pain may decrease the physiological result of stress, and draw attention away from the pain by focusing on music. Music has the ability to associate physiological changes in the body and elicit physiological responses such as pulse rate, respiration rate, blood pressure, and muscle tension. Music may also stimulate a calming effect of the cardiovascular system.
Music therapy used in child rehabilitation has had a substantial emphasis on sensorimotor development including; balance and position, locomotion, agility, mobility, range of motion, strength, laterality and directionality. By using music during senorimotor rehabilitation, it allows clients to express themselves and motivates them to learn the active joint range of motion and motor coordination in which they are aiming to acquire. For example, clients with a brain injury may lack the ability to initiate movement. The intensely captivating and attention enhancing quality of music motivates clients to participate in physical activity or exercise by easing the discomfort and strenuousness of the physical rehabilitation and helps the client persevere without being conscious of the difficulty. Music can be an element of distraction, allowing the client to transcend into a positive, aesthetically-pleasing state that is beneficial to achieving their goals. Research suggests a strong connection between motor activation and the cueing of musical rhythm. Rhythmic stimuli has been found to help balance training for those with a brain injury. Repetition of proficient rhythmic qualities will stimulate participants so that the abrasive beats will synchronize with neural activity during a rhythmic motor task. For example, clients with hemiplegia gain improvement of posture stability, and consistency of symmetrical strides and regularity in step lengths when listening to music with strong rhythmic beats.
Music therapy rehabilitation sessions that incorporate active techniques involve the client producing the music themselves. This may include the client making a musical composition, or performing by singing or chanting, playing instruments, or musically improvising. Singing is a form of rehabilitation for neurological impairments. Neurological impairments following a brain injury can be in the form of apraxia – loss to perform purposeful movements, dysarthria –muscle control disturbances due to damage of the central nervous system), aphasia (defect in expression causing distorted speech), or language comprehension. Singing training has been found to improve lung, speech clarity, and coordination of speech muscles, thus, accelerating rehabilitation of such neurological impairments. For example, melodic intonation therapy is the practice of communicating with others by singing to enhance speech or increase speech production by promoting socialization, and emotional expression.
When having the child actively participate with an instrument, it is especially important for the therapist to provide them with an instrument that they can readily and easily use. Clients with limited physical abilities may express frustration when they are not able to control their environment. The ability to employ and operate a musical instrument provides them a sense of relaxation and accomplishment. Instruments must be selected to provide immediately successful experiences. Certain adaptions of the instruments may be required in order for the people to manipulate them. For example, a drumstick’s handle should be manipulated to be more prominent for those clients that may have a weak grip. Electric music-making devices have been adapted to fit the clients limited but existing movements, strength, and abilities. Electronic devices, such as the Sound Beam and the Wave Rider- read a variety of small movements made by the clients and converts the movements into electronic musical information. The devices are programmed to create easy, yet pleasing notes and sounds in coordination to the participants’ movements. It is also crucial for the client to be aware that music making is simply a modality for rehabilitation and that their wellness is not dependent on their existing musical skills. It provides children with an outlet of expression that they may have lacked in the past or due to present circumstances. By accomplishing the production of musical sounds despite their weaknesses and disabilities, it encourages the client and relieves their anxiety that they may acquire at the thought of playing musical instrument without experience. By using such adaptive music devices, it grants client’s the ability to create sounds that are originally expressive and allows them to experience affirmation –a feeling of capability to control ones own environment- an ability they may not be familiar with.
Music therapy and children with autism:
Music therapy can be a particularly useful when working with children with autism due to the nonverbal, non-threatening nature of the medium. Studies have shown that children with autism have difficulty with joint attention, symbolic communication and sharing of positive affect. Use of music therapy has demonstrated improvements of socially acceptable behaviors. Wan, Demaine, Zipse, Norton, & Schlaug (2010) found singing and music making may engage areas of the brain related to language abilities, and that music facilitated the language, social, and motor skills. Successful therapy involves long-term individual intervention tailored to each child’s needs. Passing and sharing instruments, music and movement games, learning to listen and singing greetings and improvised stories are just a few ways music therapy can improve a child’s social interaction. For example passing a ball back and forth to percussive music or playing sticks and cymbals with another person might help foster the child’s ability to follow directions when passing the ball and learn to share the cymbals and sticks. In addition to improved social behaviors music therapy has been shown to also increase communication attempts, increase focus and attention, reduce anxiety, and improve body awareness and coordination.
Since up to 30 per cent of children with autism are nonverbal and many have difficulty understanding verbal commands music therapy becomes very useful as it has been found that music can improve the mapping of sounds to actions. So by pairing music with actions, and with many hours of training the neural pathways for speech can be improved. Child-appropriate action songs would be like playing the game “peek-ka-boo” or “eeny meeny miney mo” with a musical accompaniment, usually a piano or guitar.
Children with autism are also prone to more bouts of anxiety than the average child. Short sessions (15 – 20 mins) of listening to percussive music or classical music with a steady rhythm have been shown to alleviate symptoms of anxiety and temporarily decrease anxiety-related behaviour. Music with a steady 4/4 beat is thought to work best due to the predictability of the beat.
Target behaviours such as restlessness, aggression and noisiness can also be affected by the use of music therapy. Weekly sessions ranging for ½ hour to 1 hour during which a therapist plays child-preferred melodies such as Twinkle Twinkle Little Star and engages the child in quiet singing increases socially acceptable behaviour such as using an appropriate volume when speaking. Studies also suggest that playing one of the child’s favorite songs while the child and therapist both play the piano or strum chords on a guitar can increase a child’s ability to hold eye contact and share in an experience due to their enjoyment of the therapy.
Musical improvisation during a one on one session has also been shown to be highly effective with increasing joint attention. Some noted improvisation techniques are using a welcome song that includes the child’s name, which allows the child to get used to their surroundings; an adult-led song followed by a child led song and then conclude with a goodbye song. During such sessions the child would most likely sit across from the therapist on the floor or beside the therapist on the piano bench. Composing original music that incorporates the child’s day-to-day life with actions and words is also a part of improvisation. The shared music making experience allows for spontaneous interpersonal responses from the child and may motivate the child to increase positive social behaviour and initiate further interaction with the therapist.
Some common instruments in music therapy for children are:
Upright piano, Guitar, Xylophone, Small guiro, Paddle drums, Egg shakers, Finger cymbals, Birdcalls, Whistles, & Toy hand bells.
Music therapy has also been recognized as a method for children with autism. Music therapy helps stabilize moods, increase frustration tolerance, identify a range of emotions, and improve self-expression along with much more. The visual and auditory sensory system is responsible for interpreting sounds and images. With autistic children, if a sound or image is unpleasant the child may not have the ability to express itself, which makes it difficult for a therapist, parent, etc. to interpret. Music engages the brain in both sub-coritcal and neo-cortical levels, which means it is not critical to ‘think’ while listening to music when hearing the notes and sounds. Music therapy, in the topic of austism’s sensory interpretation, provides repetitive stimuli which aim to “teach” the brain other possible ways to respond that might be more useful as they grow olde. Music therapy for Adolescents:
According to the Mayo Health Clinic, two to three thousand out of every 100,000 adolescents will have mood disorders, and out of those two to three thousand, eight to ten will commit suicide. Two prevalent mood disorders in the adolescent population are clinical depression and bipolar disorder.
On average, American adolescents listen to approximately 4.5 hours of music per day and are responsible for 70% of pop music sales. Now, with the invention of new technologies such as the iPod and digital downloads, access to music has become easier than ever. As children make the transition into adolescence they become less likely to sit and watch TV, an activity associated with family, and spend more of their leisure time listening to music, an activity associated with friends.
Adolescents obtain many benefits from listening to music, including emotional, social, and daily life benefits, along with help in forming their identity. Music can provide a sense of independence and individuality, which in turn contributes to an adolescent’s self-discovery and sense of identity. Music also offers adolescents relatable messages that allow them to take comfort in knowing that others feel the same way they do. It can also serve as a creative outlet to release or control emotions and find ways of coping with difficult situations. Music can improve an adolescent’s mood by reducing stress and lowering anxiety levels, which can help counteract or prevent depression. Music education programs provide adolescents with a safe place to express themselves and learn life skills such as self-discipline, diligence, and patience. These programs also promote confidence and self-esteem. Ethnomusicologist Alan Merriam (1964) once stated that music is a universal behavior – it is something with which everyone can identify. Among adolescents, music is a unifying force, bringing people of different backgrounds, age groups, and social groups together.
Referrals and assessments;
While many adolescents may listen to music for its therapeutic qualities, it does not mean every adolescent needs music therapy. Many adolescents go through a period of teenage angst characterized by intense feelings of strife that are caused by the development of their brains and bodies. Some adolescents develop more serious mood disorders such as major clinical depression and bipolar disorder. Adolescents diagnosed with a mood disorder may be referred to a music therapist by a physician, therapist, or school counselor/teacher. When a music therapist gets a referral, he or she must first assess the patient and then create goals and objectives before beginning the actual therapy. According to the American Music Therapy Association Standards of Clinical Practice assessments should include the “general categories of psychological, cognitive, communicative, social, and physiological functioning focusing on the client’s needs and strengths…and will also determine the client’s response to music, music skills, and musical preferences” The result of the assessment is used to create an individualized music therapy intervention plan.
There are many different music therapy techniques used with adolescents. The music therapy model is based on various theoretical backgrounds such as psychodynamic, behavioral, and humanistic approaches. Techniques can be classified as active vs. receptive and improvisational vs. structured. The most common techniques in use with adolescents are musical improvisation, the use of precomposed songs or music, receptive listening to music, verbal discussion about the music, and incorporating creative media outlets into the therapy. Research also showed that improvisation and the use of other media were the two techniques most often used by the music therapists. The overall research showed that adolescents in music therapy “change more when discipline-specific music therapy techniques, such as improvisation and verbal reflection of the music, are used.” The results of this study showed that music therapists should put careful thought into their choice of technique with each individual client. In the end, those choices can affect the outcome of the treatment.
To those unfamiliar with music therapy the idea may seem a little strange, but music therapy has been found to be as effective as traditional forms of therapy. In a meta-analysis of the effects of music therapy for children and adolescents with psychopathology, Gold, Voracek, and Wigram (2004) looked at ten studies conducted between 1970 and 1998 to examine the overall efficacy of music therapy on children and adolescents with behavioral, emotional, and developmental disorders. The results of the meta-analysis found that “music therapy with these clients has a highly significant, medium to large effect on clinically relevant outcomes.” More specifically, music therapy was most effective on subjects with mixed diagnoses. Another important result was that “the effects of music therapy are more enduring when more sessions are provided.”
One example of clinical work is that done by music therapists who work with adolescents to increase their emotional and cognitive stability, identify factors contributing to distress and initiate changes to alleviate that distress. Music therapy may also focus on improving quality of life and building self-esteem, a sense self-worth, and confidence. Improvements in these areas can be measured by a number of tests, including qualitative questionnaires like Beck’s Depression Inventory, State and Trait Anxiety Inventory, and Relationship Change Scale. Effects of music therapy can also be observed in the patient’s demeanor, body language, and changes in awareness of mood.
Two main methods for music therapy are group meetings and one-one sessions. Group music therapy can include group discussions concerning moods and emotions in or toward music, songwriting, and musical improvisation. Groups emphasizing mood recognition and awareness, group cohesion, and improvement in self-esteem can be effective in working with adolescents. Group therapy, however, is not always the best choice for the client. Ongoing one-on-one music therapy has also been shown to be effective. One-on-one music therapy provides a non-invasive, non-judgmental environment, encouraging clients to show capacities that may be hidden in group situations.
Music Therapy in which clients play musical instruments directly, show very promising results. Specifically, playing wind instruments strengthens oral and respiratory muscles, sound vocalization, articulation, and improves breath support. Symbolic Communication Training Through Musicis also an important technique in playing instruments in music therapy, because this makes communication (verbally and non verbally) improved in social situations. Most importantly, is that music provides a time cue for the body to remain regulated. Making music is also important for people of all ages because it causes motivation, increases “psychomotor” activity, causes an individual to identify with a group (in group music), regulates breathing, improves organizational skills, and increases coordination.
Though more research needs to be done to ascertain the effect of music therapy on adolescents with mood disorders, most research has shown positive effects. Music therapy for Medical disorders:
According to a 2009 Cochrane review some music may reduce heart rate, respiratory rate, and blood pressure in those with coronary heart disease. Music does not appear to have much effect on psychological distress. “The quality of the evidence is not strong and the clinical significance unclear”.
The use of music therapy in treating mental and neurological disorders is on the rise. Music therapy has showed effectiveness in treating symptoms of many disorders, including schizophrenia, amnesia, dementia and Alzheimer’s, Parkinson’s disease, mood disorders such as depression, aphasia and similar speech disorders, and Tourette’s syndrome, among others.
While music therapy has been used for many years, up until the mid-1980s little empirical research had been done to support the efficacy of the treatment. Since then, more research has focused on determining both the effectiveness and the underlying physiological mechanisms leading to symptom improvement. For example, one meta-study covering 177 patients (over 9 studies) showed a significant effect on many negative symptoms of psychopathologies, particularly in developmental and behavioral disorders. Music therapy was especially effective in improving focus and attention, and in decreasing negative symptoms like anxiety and isolation.
The following sections will discuss the uses and effectiveness of music therapy in the treatment of specific pathologies.
Stroke:…click & see
Music has been shown to affect portions of the brain. One reason for the effectiveness of music therapy for stroke victims is the capacity 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. 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. 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.
More recent research suggests that music can increase a patient’s motivation and positive emotions. Current research also suggests that when music therapy is used in conjunction with traditional therapy it improves success rates significantly. Therefore, it is hypothesized that music therapy helps a victim of stroke recover faster and with more success by increasing the patient’s positive emotions and motivation, allowing him or her to be more successful and feel more driven to participate in traditional therapies.
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. In another study, Nayak et al. found that rehabilitation staff rated participants in the music therapy group more actively involved and cooperative in therapy than those in the control group. 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.
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. A study by Jeong & Kim examined the impact of music therapy when combined with traditional stroke therapy in a community-based rehabilitation program. 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 sought and received traditional therapy. The results of this study showed that participants in the experimental group gained not only more flexibility and wider range of motion, but an increased frequency and quality of social interactions and positive mood.
Music has proven useful in the 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. 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.
Schneider et al. also studied the effects of combining music therapy with standard motor rehabilitation methods. 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 movement 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. Wilson, Parsons, & Reutens looked at the effect of melodic intonation therapy (MIT) on speech production in a male singer with severe Broca’s aphasia. 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. 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. Nayak et al. 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.
Dementia:...click & see
Alzheimer’s disease and other types of dementia are among the disorders most commonly treated with music therapy. Like many of the other disorders mentioned, some of the most common significant effects are seen in social behaviors, leading to improvements in interaction, conversation, and other such skills. A meta-study of over 330 subjects showed music therapy produces highly significant improvements to social behaviors, overt behaviors like wandering and restlessness, reductions in agitated behaviors, and improvements to cognitive defects, measured with reality orientation and face recognition tests. As with many studies of MT’s effectiveness, these positive effects on Alzheimer’s and other dementias are not homogeneous among all studies. The effectiveness of the treatment seems to be strongly dependent on the patient, the quality and length of treatment, and other similar factors.
Another meta-study examined the proposed neurological mechanisms behind music therapy’s effects on these patients. Many authors suspect that music has a soothing effect on the patient by affecting how noise is perceived: music renders noise familiar, or buffers the patient from overwhelming or extraneous noise in their environment. Others suggest that music serves as a sort of mediator for social interactions, providing a vessel through which to interact with others without requiring much cognitive load.
Amnesia:….click & see
Some symptoms of amnesia have been shown to be alleviated through various interactions with music, including playing and listening. One such case is that of Clive Wearing, whose severe retrograde and anterograde amnesia have been detailed in the documentaries Prisoner of Consciousness and The Man with the 7 Second Memory. Though unable to recall past memories or form new ones, Wearing is still able to play, conduct, and sing along with music learned prior to the onset of his amnesia, and even add improvisations and flourishes.
Wearing’s case reinforces the theory that episodic memory fundamentally differs from procedural or semantic memory. Sacks suggests that while Wearing is completely unable to recall events or episodes, musical performance (and the muscle memory involved) are a form of procedural memory that is not typically hindered in amnesia cases [Sacks]. Indeed, there is evidence that while episodic memory is reliant on the hippocampal formation, amnesiacs with damage to this area can show a loss of episodic memory accompanied by (partially) intact semantic memory.
Aphasia:….click & see
Melodic intonation therapy (MIT) is a commonly used method of treating aphasias, particularly those involving speech deficits (as opposed to reading or writing). MIT is a multi-stage treatment that involves committing words and speech rhythm to memory by incorporating them into song. The musical and rhythmic aspects are then separated from the speech and phased out, until the patient can speak normally. This method has slight variations between adult patients and child patients, but both follow the same basic structure.
While MIT is a commonly used therapy, research supporting its effectiveness is lacking. Some recent research suggests that the therapy’s efficacy may stem more from the rhythmic components of the treatment rather than the melodic aspects. Music Therapy for Psychiatric disorders:
Schizophrenia:…click & see
Music therapy is used with schizophrenic patients to ameliorate many of the symptoms of the disorder. Individual studies of patients undergoing music therapy showed diminished negative symptoms such as flattened affect, speech issues, and anhedonia and improved social symptoms such as increased conversation ability, reduced social isolation, and increased interest in external events.
Meta-studies have confirmed many of these results, showing that music therapy in conjunction with standard care to be superior to standard care alone. Improvements were seen in negative symptoms, general mental state, depression, anxiety, and even cognitive functioning. These meta-studies have also shown, however, that these results can be inconsistent and that they depend heavily on both the quality and number of therapy sessions.
Depression:...click & see
Music therapy has been found to have numerous significant outcomes for patients with major depressive disorder. A systematic review of five randomized trials found that people with depression generally accepted music therapy and was found to produce improvements in mood when compared to standard therapy. Another study showed that MDD patients were better able to express their emotional states while listening to sad music than while listening to no music or to happy, angry, or scary music. The authors found that this therapy helped patients overcome verbal barriers to expressing emotion, which can assist therapists in successfully guiding treatment.
Other studies have provided insight into the physiological interactions between music therapy and depression. Music has been shown to decrease significantly the levels of the stress hormone cortisol, leading to improved affect, mood and cognitive functioning. A study also found that music led to a shift in frontal lobe activity (as measured by EEG) in depressed adolescents. Music was shown to shift activity from the right frontal lobe to the left, a phenomenon associated with positive affect and mood. Use of Music Therapy Region wise:
Research has shown that in many parts of Africa during male and female circumcision, bone setting, or traditional surgery and bloodletting, lyrical music related to endurance has been used to reduce anticipated pain, therapeutically. In 1999, the first program for music therapy in Africa opened in Pretoria, South Africa. Research has shown that in Tanzania patients can receive palliative care for life-threatening illnesses directly after the diagnosis of these illnesses. This is different from many Western countries, because they reserve palliative care for patients who have an incurable illness. Music is also viewed differently between Africa and Western countries. In Western countries and a majority of other countries throughout the world, music is traditionally seen as entertainment whereas in many African cultures, music is used in recounting stories, celebrating life events, or sending messages
In Australia in 1949, music therapy (not clinical music therapy as understood today) was started through concerts organized by the Australian Red Cross along with a Red Cross Music Therapy Committee. The key Australian body, AMTA, the Australian Music Therapy Association, was founded in 1975.
Norway is widely recognised as an important country for music therapy research. Its two major research centres are the Center for Music and Health with the Norwegian Academy of Music in Oslo, and the Grieg Academy Centre for Music Therapy (GAMUT), at University of Bergen. The former was mostly developed by professor Even Ruud, while professor Brynjulf Stige is largely responsible for cultivating the latter. The centre in Bergen includes 3 professors and 2 associate professors, as well as lecturers and PhD students. The centre in Bergen has 18 staff, including 2 professors and 4 associate professors, as well as lecturers and PhD students. Two of the field’s major international research journals are based in Bergen: Nordic Journal for Music Therapy and Voices: A World Forum for Music Therapy. Norway’s main contribution to the field is mostly in the area of “community music therapy”, which tends to be as much oriented toward social work as individual psychotherapy, and music therapy research from this country uses a wide variety of methods to examine diverse methods in across an array of social contexts, including community centres, medical clinics, retirement homes, and prisons. United States:
Music therapy has existed in its current form in the United States since 1944 when the first undergraduate degree program in the world was begun at Michigan State University and the first graduate degree program was established 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 Association for Music and Imagery. Music therapists use ideas from different disciplines such as speech and language, physical therapy, medicine, nursing, and education.
A music therapy degree candidate can earn an undergraduate, master’s or doctoral degree in music therapy. Many AMTA approved programs offer equivalency and certificate degrees in music therapy for students that have completed a degree in a related field. Some practicing music therapists have held PhDs in fields other than, but usually related to, music therapy. Recently, Temple University established a PhD program in music therapy. A music therapist typically incorporates music therapy techniques with broader clinical practices such as psychotherapy, rehabilitation, and other practices depending on client needs. Music therapy services rendered within the context of a social service, educational, or health care agency are often reimbursable by insurance and sources of funding for individuals with certain needs. Music therapy services have been identified as reimbursable under Medicaid, Medicare, private insurance plans and federal and state government programs.
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. A music therapist may hold the designations CMT (Certified Music Therapist), ACMT (Advanced Certified Music Therapist), or RMT (Registered Music Therapist) – credentials previously conferred by the former national organizations AAMT and NAMT ; these credentials remain in force through 2020 and have not been available since 1998. The current credential available is MT-BC. To become board certified, a music therapist must complete a music therapy degree from an accredited AMTA program at a college or university, successfully complete a music therapy internship, and pass the Board Certification Examination in Music Therapy, administered through The Certification Board for Music Therapists. To maintain the credential, either 100 units of continuing education must be completed every five years, or the board exam must be retaken near the end of the five-year cycle. The units claimed for credit fall under the purview of The Certification Board for Music Therapists. North Dakota, Nevada and Georgia have established licenses for music therapists. In the State of New York, the License for Creative Arts Therapies (LCAT) incorporates the music therapy credentials within their licensure.
Live music was used in hospitals after both World Wars as part of the treatment program for recovering soldiers. Clinical music therapy in Britain as it is understood today was pioneered in the 1960s and 1970s 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, created “analytical music therapy”. The Nordoff-Robbins approach to music therapy developed from the work of Paul Nordoff and Clive Robbins in the 1950/60s.
Practitioners are registered with the Health Professions Council and, starting from 2007, new registrants must normally hold a master’s degree in music therapy. There are master’s level programs in music therapy in Manchester, Bristol, Cambridge, South Wales, Edinburgh and London, and there are therapists throughout the UK. The professional body in the UK is the British Association for Music Therapy In 2002, the World Congress of Music Therapy, coordinated and promoted by the World Federation of Music Therapy, was held in Oxford on the theme of Dialogue and Debate. In November 2006, Dr. Michael J. Crawford and his colleagues again found that music therapy helped the outcomes of schizophrenic patients.
The roots of musical therapy in India, can be traced back to ancient Hindu mythology, Vedic texts, and local folk traditions. It is very possible that music therapy has been used for hundreds of years in the Indian culture.
Suvarna Nalapat has studied music therapy in the Indian context. Her books Nadalayasindhu-Ragachikilsamrutam (2008), Music Therapy in Management Education and Administration (2008) and Ragachikitsa (2008) are accepted textbooks on music therapy and Indian arts.
The “Music Therapy Trust of India” is yet another venture in the country. It was started by Margaret Lobo. Source: http://en.wikipedia.org/wiki/Music_therapy