Rock-a-bye Horsey...

There was an interesting new study presented at the Australasian Equine Symposium about horses being weaned while listening to sedative music.  Yes, I said horses!  I was impressed by the researchers out of The University of Queensland who tried to define and use sedative music in the study.  While I am not sure that I agree that it was truly sedative or calming in nature, they found some positive results from a cross-over, quasi-experimental design. 

Twelve weanlings were stabled for 10 days with and without exposure to calming music (Alan Silvestri's main theme music to the movie Forest Gump).  The horses had significantly lower heart rate variability during the music condition and were observed to be more relaxed, spent more time eating and less time walking in the stable.  Also of note, the weanlings had a lower peak heart rate and a decreased duration of peak heart rate while in the music condition when they were exposed to the stress of being near two stallions.  

Many questions can be raised about this study, but I found it fascinating nonetheless.  I am not sure exactly which portions of the movie theme music they used, but when I listened to the opening theme to Forest Gump, it was not as predictable and constant in tempo, dynamics, instrumentation, theme and rhythm as would be best for true sedative music.  I also think the horses must not be very selective about their music preference if they can listen to the same 8-10 minutes music selection over and over for 6 hours every day for five days! Perhaps they were less stressed because they were bored silly!  

I don't know how loud they played the music, but it is possible that the music served as a masking agent for environmental sounds.  Was the music the key to the weanling's positive responses?  There is evidence that heart rate variability responds to music intervention as reported by the emWave biofeedback monitor and the creators of the Heart Math program. Can we make any transfers from this research to an effect of music on humans?  Does this study point to a more physiological, nuero-muscular and autonomic response to music rather than a cognitive response?  

I still have more questions than answers, but please take a look for yourself at the details and let me know what you think!

Wilson, M. E., Phillips, C. J., Lisle, A. T., Anderson, S. T., Bryden, W. L., & Cawdell-Smith, A. J. (2012).  Stress responses in young, stabled horses can be modified by music.  Proceedings of Australian Equine Science Symposium, 4, 45.

More Evidence that Depression = Heart Problems

The Daily Muse     


Welcome to the Daily Muse feature of Music Makes Sense!  This daily update brings you up to the minute news about music and music therapy as it relates to our professions, events and individual lives.  You can follow the daily entries by subscribing to Music Makes Sense on Twitter or by "Liking" the Facebook page for Music Makes Sense.  Enjoy, and thanks for reading!

Gordon, J. L., Ditto, B., La Voie, K. L., Pelleteir, R., Campbell, T. S., Arsenault, A., & Bacon, S. L. (2011). The effect of major depression on postexercise cardiovascular recovery.  Psychophysiology, 48(11), 1604-1609.  

Research has already started to show a direct link between depression and a greater chance for heart attack. New research has taken this a step further by linking depression with a slower cardiovascular recovery time after exercise. Specifically, they found a slower recovery in the heart rate after exercise in participants with major depression.  The abstract is here.   

These findings emphasize the importance of more research using music to influence mood state. Music can effectively be used in a lifestyle change to improve mood and avoid some of the dire effects of heart disease and poor cardiovascular health!

Here are just a few of the links to find out more about music therapy and heart health:

What Stress Can Do For You!

Music To Help With Lifestyle Change

And don't forget to show your support of using music to help with heart health by sporting some of the cool gear from the Music for the Heart story at CafePress!  

What's with all this drumming anyway?

Here is a short reference list for some articles and books that support the idea of drumming for therapeutic benefit. These documents form the core of knowledge regarding using drumming in therapy. Much of the research for using drumming protocols for stress reduction or wellness has been conducted by Dr. Barry Bittman. I have also listed several books that talk about drum circles, drum circle facilitation and other ways to use drumming for different types of groups. Christine Steven's and Bill Matney's books provide the most information about adaptations related to music therapy. I have placed links to source materials where possible.

Bittman, B., Bruhn, K. T., Stevens, C., Westengard, J., & Umbach, P. O. (2003). Recreational music-making: A cost-effective group interdisciplinary strategy for reducing burnout and improving mood states in long-term care workers. Advances, 19, 3/4.

Bittman, B., Snyder, C., Bruhn, K., Liebfreid, F., Stevens, C. K., & Westengard, B. S. (2004). Recreational music-making: An integrative group intervention for reducing burnout and improving mood states in first year associate degree nursing students: Insight and economic impact. International Journal of Nursing Education Scholarship, 1,

Bittman, M. D., Berk, L. S., Felten, D. L., Westengard, J., Simonton, O. D., Peppas, J., & Ninehouse, M. (2001). Composite effects of group drumming music therapy on modulation of neuroendocrine-immune parameters in normal subjects. Alternative Therapy Health Medicine, 7, 38-47.

Bittman, B., Berk, L., Shannon, M., Sharaf, M., Westengard, J, Guegler, K., & Ruff, D. (2005). Recreational music-making modulates the human stress response: A preliminary individualized gene expression strategy. Medical Science Monitor, 11, 31-41.

Friedman, R. L. (2000). The Healing Power of the Drum
Reno, NV: White Cliffs Media.

Kalani (2004). Together in Rhythm: A Facilitator's Guide to Drum Circle Music (Book & DVD)
Los Angeles, CA: Alfred Publishing.

Matney, B. B. (2007). Tataku: The Use of Percussion in Music Therapy
Denton, TX: Sarsen Publishing.

Stevens, C. (2003). The Art and Heart of Drum Circles Book+CD Package
Milwaukee, WI: Hal Leonard.

What's the Protocol? An Example for Therapeutic Drumming

Protocol: The plan for carrying out a scientific study or a patient's treatment regimen.

Protocols are often established in the medical setting for standard treatments of common diagnosis. I often use protocols to outline a series of music therapy activities or a treatment plan for a music therapy session with a client. Although there are common traits and behaviors associated with certain disabilities or medical conditions, there are certainly differences between any two clients with the same conditions. A protocol used in a music therapy session is just a set of guidelines similar to a session plan, but it can and must be adapted almost every time to meet the needs of the client. Protocols are often developed for use in research about the effects of music on changing behavior or outcomes. A protocol for research, however, must be adhered to in order to maintain the validity of the results.

One example of a research protocol using music was a study conducted by Dr. Barry Bittman using active music-making in the form of hand drumming. This research study used a protocol of music activities that included singing, drumming and group discussion that became the basis for Remo's HealthRhythms program. The protocol developed for this program enabled the researchers to use the same set of activities multiple times over a number of days and weeks. They took some measurements from the participants before and after the program and compared the differences. The adherence to the music protocol allowed the researchers to conclude with some confidence that there was a significant effect in improving the immune system caused in some way by the participation in the HealthRhythms program.

Research is often different than clinical practice because therapists alter the treatment to meet the needs of the client. I do think, however, that clients can benefit from having a plan that is familiar and that can be used in some ways when the therapist is not present. With this idea in mind, I developed a protocol for cardiac patients who want to change their lifestyle by managing stress and developing more leisure skills.

My protocol for this type of workshop/training program contains the following steps:






1. Ice Breaker activity: Call and echo on hand drums. I use Remo tubanos, paddle drums, frame drums or buffalo drums. The basic premise is to introduce simple drumming on hand drums by the therapist playing a two beat rhythm and the group playing it back. There are many types of ice breaker activities, but for people who have probably never touched a hand drum, simple can still be fun and even a little challenging. An ice breaker activity also allows for the therapist to assess the musical skill level of the group. If they are able, then more advanced drumming such as playing on word syllables (e.g., names) may be introduced. Sometimes I have also used a fun "shaker pass" activity to encourage group interaction. There are dozens of chants that can work for this (e.g., Take and shake and shake and pass!), but the basic idea is to take an egg shaker from the person next to you, shake it, and then pass it to the other person next to you around in a circle. Everyone starts with an egg and the therapist gradually speeds up the tempo until everyone drops their eggs or one person ends up with most of them. This is a fun activity and usually gets people laughing and eager to try new things.

2. Presentation of Key Ideas: I have included three parts to this stage of my protocol for workshops. I quickly teach some basic hand drumming technique so that the participants are comfortable playing the instruments. This includes the idea of the "hot" drum so that players bounce their hands off the drum head instead of playing like they are trying to swat a fly. I also teach about the low, medium and high tones that you can play. The next step is to prime them for learning by explaining the way drumming can facilitate focus through the principle of entrainment. After this, I briefly talk about some of the current research regarding drumming and wellness.

3. The Beat of the Heart: The "iso-principle" is important for participants to understand. Entrainment will work best if a person tries to match their current level of activity/emotion/mental state with a drumming beat and then gradually move in a desired direction. I like to practice some rhythmic drumming in this stage that helps the participants connect with their breathing, heart beat, and even walking bodily rhythms. Don't be afraid to use some recorded music at this stage as an aid to the experience! Christine Stevens has some good drumming tracks just for this purpose. (Note: You can find her products on the "store" tab at the top of the page or just by searching for Christine Stevens in the Google search box at the upper right.)

4. Create a Healing Transfer: I teach that music builds a relationship with relaxation. Music becomes a conditioned stimulus that can activate relaxation responses. Music also helps to maintain a relaxed condition by increasing focus and eliminating distractions. This stage of the protocol is important because the therapist can start to connect drumming to the goals and desires of each client. The drumming becomes personal so that as each person drums they are drumming positive self-statements.

5. Guided Drumming with Imagery to Enhance Relaxation: Now the stage is set for an experience in drumming and relaxation. Participants are encouraged to have a frame drum on their lap or Tubano accessible in front of them. If you have assistants, then you can use them as "rhythm allies" to play ambient instruments (i.e., ocean drum, thunder tube, rainstick) at appropriate times to compliment the imagery. I sometimes begin the relaxation experience with deep breathing and stretching accompanied by soft recorded music. Kevin Kern is a great artist to try out. (Note: Sample relaxation scripts and guidelines will be discussed in a separate post.)

6. Sharing the Experience: The relaxation session usually leads to some discussion and sharing of thoughts and feelings. This is an important step in convincing participants of the power of the music and drumming so that they will try it at home. Go over the education materials they will be taking home with them, so that they understand how to recreate their positive experience.

I hope you will experiment with your own set of activities and see what works for you and your clients! If you are able to set up a protocol of activities that you can repeat over several sessions, try taking some measurments before and after and compare the results. And as always, please feel free to share your experiences and thoughts about the subject!

What Stress Can Do For You!

Stress. It really can cause heart attacks researchers say!

There is mounting evidence of the role of stress and the increased risk of heart attack. A new research study in the European Heart Journal links elevated salivary cortisol levels as a result of mental stress to increased coronary artery calcification, a risk factor for coronary heart disease (CHD). This study is important because it used subjects who were not already diagnosed with CHD. The research is also emphasizes how important it is for everyone, not just people who already have heart problems, to recognize and address stress in their lives.

I have written several posts about using music as an aid for relaxation and stress management. I think music continues to offer a powerful tool as part of a lifestyle that includes managing stress. One of the comments on the webpage that introduced the story was from Tony in Essex who quite correctly stated, "Let's get it straight, how the h--- does anyone avoid being stressed constantly in this insane society?"

This past week in my drumming in therapy class we have started each class with a facilitated drum circle. After the drum circle I asked the participants what they had been thinking about while they were drumming. I found it interesting that everybody seemed to have had a clear mind. They had not been thinking about their "to-do" lists or where they needed to go after class, or any number of different mental stressors that clutter up our everyday lives. Christine Stevens, a pioneer in community drum circles, often talks about the power drumming has on our mind, body and soul. I have heard her mention the fact that drumming is powerful because while you are engaged in a group drumming event your mind is more at peace and temporarily free of many of the mental stressors that usually take up our thought space. (For more information about Christine see my post here.)

Stress is a problem for all of us in the modern world. It obviously becomes more serious after a heart attack or diagnosis of Coronary Artery Disease, but it looks like any of us could end up in those situations if the new research holds true. Finding some time to relax and listen to some favorite music or scheduling a few times a week to play a musical instrument as a leisure skill are some healthy suggestions in developing a good way to cope with modern life. Music makes sense!

The abstract to the original research in the European Heart Journal can be found here.

Music for the Heart: Changing the Course of Depression and Heart Failure

FOXNews.com - Depression Raises Heart Failure Risks, Study Finds - Health News | Current Health News | Medical News

Posted using ShareThis

The research, based out of Intermountain Medical Center in Utah, studied a large population of 14,000 heart patients. This new research contributes to a growing body of evidence that indicates how heart patients should change their lifestyle after having a heart attack. Previous research has already linked depressed mood and depression to increasing the risk of a recurring heart attack. Stress-induced anxiety can be a major cause of depression and negative mood so it is very important to find stress-management techniques after having a heart attack. One of the most interesting findings in this new research study is that patients taking antidepressants did not reduce their risk of heart failure. This finding emphasizes the need for alternative ways to manage stress and elevate mood.

Music can be an important component of a full rehabilitation program after a patient has heart trouble. Music as an aid to relaxation is a powerful tool in developing a routine of daily relaxation. Most people listen to some kind of music, even if it is just in the car. I have found that most people are able to implement more successful and more consistent relaxation times into their busy schedules when they use music as an aid. A person's preferred music makes the time pass faster and allows the person trying to relax to take their mind off of stress-related thoughts or in getting too caught up in the process of trying to relax a tense body. Careful selection of music as an aid in relaxation can also provide musical cues that help the body gradually relax.

Music is also invaluable in effecting mood. Mood is the state or feeling you have at a particular time. We often use music to reflect our mood state. Music may reflect mood through the tempo, style and genre as well as through the lyrics. In my experience, most people automatically match their music to their current mood without thinking about it. Sometimes it is simply the lack of music that may indicate a more depressed mood if music is normally played during a happier or more relaxed state of mind. People who need to change their mood for health reasons can use music to influence their state of mind. As they examine how they have personally used music in their lives, they may discover certain times that they use music in relation to their mood . With some cognitive effort, it is then possible to match music to a current mood and then gradually change it in the direction you want your mood to follow.

Music as an aid to relaxation and as an influence on mood are two very powerful tools for helping people after a heart attack or other heart problems. Since drug therapy is not always successful in combating depression or at least decreasing the risk of recurrent heart failure, it is becoming more important that we look for alternative ways to help in rehabilitation. The following articles contain related information about music and relaxation and music for a healthy heart:



Patient Resource Page: Music Strategies for Relaxation and Wellness

Nuts and Bolts: How Music Works for Relaxation

American Heart Month: Music for the Heart

American heart month is sponsored every year in February by the American Heart Association. In order to highlight their efforts I wanted to promote the Music for the Heart website. I developed this web resource for people looking for specific connections to music and how it can benefit heart health. My personal experience is with helping people manage stress and anxiety before surgery and as well as using music to build a new heart healthy lifestyle after experiencing heart problems. I have included many of my ideas and suggestions on the website, but also have links to much more. In addition to a section about recent research studies regarding music therapy and heart health, there are links to stories in the news and reference materials like books and music. One of the most effective ways for people to improve their cardiovascular system and heart muscle is to learn how to relax. I have provided many suggestions about how to use music more effectively as an aid to relaxation.

Please consider helping support the American Heart Association by purchasing "Music for the Heart" logo merchandise. Not only does 5% of all royalties go to the American Heart Association, but we can all promote the connection between music and the heart by spreading the message!

Thank you!

Stayin' Alive: Sing it for CPR!

This is a great story about how music makes sense!

The American Heart Association has been using the original 1977 song from the Bee Gees as an aid people learning CPR. It turns out that the song has 103 beats per minute. The AHA recommends that chest compressions for CPR be given at 100 times per minute.

I usually have to maintain my CPR certification in order to work with certain populations. I have often wondered if I would be able to remember the instructions if the time ever came that I had to perform the life saving procedures. This song is the perfect combination of lyrics and rhythm being key factors for the therapeutic use of music. The AHA even tested their theory about the song by having a small group of medical professionals do CPR while listening to the song. They were reported to do the chest compressions at almost the perfect rate. This same group was then tested to see how they would do without the recorded music, but still singing the song in their heads as they did the chest compressions for CPR. Amazingly, they were able to maintain very similar rates of compression without the recorded music!

The story is here at Fox News.

...Somebody help me, yeah. Stayin' alive!

Patient Resource Page: Music Strategies for Relaxation and Wellness

*This page is actively updated*

Music Therapy:

• American Music Therapy Association - The official site for music therapy as a profession. This site includes a very informative FAQ section describing music therapy and its applications.
• Music as Part of Rehab - How music as therapy fits into the lifestyle changes that must happen after a major cardiac event or surgery. Improving your mood and reducing stress are key elements in maintaining a healthy future.
• How Music Works to Help Relaxation - Breaking down the elements of music to find out why music can be so powerful as an aid to relaxation.
  
• Abstract: The Effect of Preferred Sedative Music on Anxiety - The purpose of this study was to examine the effect of patient preferred, sedative music on the state anxiety level of patients undergoing heart catheterization or pacemaker implant.

Music Strategies:

• Using Music Effectively to Manage Pain - Theories and strategies for pain management and distraction from pain.
  
• Relaxation Strategies for Pre-Operative Settings - Three suggestions about how to relax before surgery.
• A Guide to Sedative Music - Tips for choosing the right kinds of music to aid in relaxation.
  
• Self-Guided Relaxation to Music - A relaxation script and guide for relaxing on your own.
  

Tools on the Web:

• Music for the Heart - A website that will present strategies to address the specific stress-inducing events that surround cardiovascular health problems. Recent research has emphasized the need for a holistic approach to health after heart attacks and cardiovascular surgery. This site will present tools and guidance to help patients elevate their mood, learn to relax and introduce music as a leisure-time tool to help them make the post-cardiac event lifestyle change.
• The Mind-Body Wellness Center - This center features cutting edge research about wellness by Dr. Barry Bittman.
  
• Music Makes Sense store at Amazon - A collection of books, music and instruments that I use in music therapy.
  

Pain - Forget About It! Using Music Effectively to Manage Pain.

Everyone dreads the dentist chair when they know they have a cavity. Sometimes even a sound that reminds you of a dentist's drill can cause perceived pain! I have worked with clients at the doctor's office, in hospital rooms, and at home to help them with pain management. These patients have been dealing with everything from needle sticks to chronic pain from disease and in many cases using music to help them relax and ignore the pain has been very effective.

The main theory behind using music to help with pain management is centered around the "Gate Control Theory of Pain." This theory establishes that a person cannot actively think about two different information streams at the same time. Pain is a perceived idea in our cognitive thought process. Without cognitively focusing on the pain, the sensation can be greatly diminished. The Gate Control Theory is useful in that it promotes using focus of attention to distract from pain. Active music listening or music used for relaxation are very effective ways to focus attention.

Music provides a preferred and pleasant stimulus for focus of attention. The sound of music can mask unwanted environmental sounds such as medical staff talking about procedures or the clanking of surgical equipment. Music may also act as a trigger for positive memories and associations. The choice of music, therefore, is key to successfully utilizing it as a tool for distraction from pain. In order to further enhance the success of using music to distract from pain, a person may also choose whether they want to use upbeat and highly preferred music or sedative music to use for pain management.

Upbeat or stylized music may be a better choice for masking environmental sounds and promoting active listening. Familiar lyrics and memories associated with favorite songs may more easily hold active thought patterns and form "trains of thought" to other memories. Sedative music may be recommended for highly stressful situations where anxiety and tension are contributors to pain. In most cases, muscle tension will increase pain sensations by heightening physical awareness and pulling the thought pattern towards thinking about environmental sensations. Tightening the muscle fibers can also cause more painful procedures such as needle sticks or shots into the muscle tissue. Music facilitated relaxation provides a distraction as well as helping to relax the muscles.

I suggest using music listening during dental procedures, blood draws and before surgery to help with a variety of issues, including pain management. All of these settings easily accommodate headphones and family, friends or a therapist who can be there to help.

The Importance of Using Music as Part of the Lifestyle Change After a Heart Attack or Serious Cardiac Event

Research has recently begun catching up with the conventional wisdom that mental stress after having a heart attack can greatly increase the chances for future cardiovascular problems and incidents. The emotional strain and life altering consequences after having a heart attack or cardiac related surgery are only the first challenges. Daily events produce additional physical, emotional and mental stressors that are documented to lengthen recovery times.

I have developed a workshop called, Music for the Heart, that seeks to address the specific stress-inducing events that surround cardiovascular health problems. Recent research has emphasized the need for a holistic approach to health after heart attacks and cardiovascular surgery. I present tools and guidance in the workshop to help patients elevate their mood, learn to relax and introduce music as a leisure-time tool to help them make the post-cardiac event lifestyle change. Dr. Barry Bittman, MD, and the developer of the Health Rhythms program said, “Recreational music-making provides an extraordinary opportunity for people to regain a sense of balance and wholeness conducive to improved well-being.” (San Francisco Chronicle, September 28, 2001, Rhythm of Life: Pleasant Hill drum circle participants say monthly playing is therapeutic.)

I have had the opportunity to present the Music for the Heart program to several cardiologists and surgeons. There are several recent research studies that I point to in my discussions with the doctors about the potential for using music to facilitate the lifestyle changes for their patients. John C. Barefoot, PhD and Marianne Schroll, MD, DMSc conducted a study, "Symptoms of Depression, Acute Myocardial Infarction, and Total Mortality in a Community Sample," which concluded that high levels of depression are associated with greater chances for heart attack and mortality. This study was conducted over twenty-seven years with a large sample size of over seven hundred participants. Depression and negative mood are often the result of mental stress.

Two other studies have indicated that mental stress indicates a greater chance for myocardial ischemia and mortality after someone has already had a heart attack. One of these studies is, "Mental Stress-Induced Myocardial Ischemia and Cardiac Events." In this study more than one hundred patients with coronary artery disease were followed for up to five years. The researchers concluded that the presence of mental-stress induced ischemia is associated with significantly higher rates of later fatal and non-fatal cardiac events. Another study, "Mental Stress-Induced Ischemia and All-Cause Mortality in Patients With Coronary Artery Disease," found that patients with ischemia had a greater risk of dying when they were having mental-induced stress.

The evidence is clear that a patient's lifestyle is extremely important after a cardiac event. Cardiac rehabilitation programs encourage lifestyle changes that include stress-management strategies. I believe that music facilitated relaxation is a powerful tool to help people with managing stress. Music of some type is enjoyed by almost everyone and is an easy and appropriate way to help manage stress and elevate mood states. Related articles for using music in relaxation may be found in the Most Popular Posts links and in the following articles:

A Guide for Home Relaxation
Kevin Kern Relaxation CD
Suggestions for Relaxation Music

FAQ: Suggestions for Sedative Relaxation Music

I am frequently asked about how to use music for relaxation. One of the most effective types of music for relaxation is classified as sedative. Sedative music is defined in part by having a fairly slow underlying tempo or pulse, around or below 80 beats per minute. The melody should be free of sudden jumps in pitch and without extreme high or low notes. The overall effect of the song should not be distracting, but still have aesthetic value.

Sedative music can be difficult to find on one album or in a single collection of songs. The proliferation of digital music, however, has made it much easier to separate sedative music from a collection and place it with other music for the purpose of relaxing. I have compiled a list of some music that can be considered sedative. The music can be used in any order and it is important that any music that will be used for relaxation be something related to personal preference. This list is not all inclusive and is limited in genre. There is much music available that can be effectively used for relaxation and the following examples may prove helpful.

Classical:

1. Nicamer Zabaleta: Concerto for the Harp and Orchestra in G major
2. Mozart: Adagio, Sonata in E-flat
3. Henry Purcell: Adagio from the Fairy Queen
4. Mozart: Andante K. 525
5. JS Bach: Air on a G String
6. Mozart: Concerto for Clarinet and Orchestra in A
7. Brahms: Lullaby, Cradle Song, Opus 49
8. JS Bach: Arioso in F
9. JS Bach: Concerto in D minor, Siciliano
10. Schumann: Scenes from Childhood, Foreign Lands and People

New Age:

1. Seasons: Sisters of Paradise, Guitar and Chamber Nouveau, Steven Pasero
2. Seasons: Silhouettes of Dawn
3. Rocky Mountain High: John Denver, Winter – Spring
4. Watermark: Enya, Watermark
5. Picture This: Jim Brickman, Sweet Dreams
6. Forest: George Winston, Walking on Air
7. Winter Solstice: Snow in the Prairies
8. Red River Crossing: Marshall Styler, Red River Crossing
9. Red River Crossing: Marshall Styler, Ballad of Brenham Road
10. Reflections of Passion: Yanni, A Word in Private
    

Relaxation Strategies for Pre-operative Settings

Surgery pre-op. Blank walls, metal and tubes. Bright lights and cold air. People come and go with the urgency of holiday shopping, providing cursory nods and perfunctory statements to the people on beds blocking their way. Certainly it is not always like this, but in general, the pre-surgery holding area is very lonely, with different professionals visiting you intermittently to take vital signs, blood or signatures. The environment is well formed for nurturing anxiety.

The prospect of surgery usually presents patients with an array of feelings and worries. These anxieties are counterproductive to maintaining the calm and positive state of mind that is beneficial for successful recovery after an operation. I have had the opportunity to assist patients in several different pre-operative settings to help them cope with the stress of their situation. Through these experiences, I have discovered some simple strategies that can be used by patients and their caregivers to help them relax directly before surgery.

1. Pre-op partner - Obtain permission for someone to stay with you in the pre-op area and, if possible, all the way into the operating room. This partner can offer silent companionship or conversation depending on how you feel. In my experience, some people become very talkative as they are nervous while there are others who just wish for me to hold their hand. A pre-op partner can be very helpful in distracting you from the sights and sounds of the pre-op area and focusing your attention on other subjects. A partner can also be helpful in facilitating deep breathing or relaxation routines. If the partner is allowed to go into the operating room, he or she can be responsible for collecting music recordings or personal effects that were helpful during relaxing in the pre-op area. On many occasions I have been able to stay with a patient until they are fully under anesthesia in the operating room. Family members are usually not allowed in pre-op after a certain time. Suggested candidates for a pre-op partner are a music therapist, clergy or patient services representative that work at the medical facility. The best way to obtain permission for someone to be with you is to ask the surgeon. The surgeons usually have authority over the operating room procedures and can smooth the way for you to talk with nursing staff about the possibilities.

2. Music - Bring an MP3 or CD player and your favorite music. Music may be used to distract you from the activity in the pre-op room. The music will serve to mask environmental noises and help you focus your attention on something other than needle sticks and blood pressure monitors. Consider using your preferred music, whether you are trying to facilitate relaxation or provide distraction. Preferred music will hold your attention better than trying to use music that you have never heard or that is unappealing. The advantage to using an MP3 player is that you can bring both sedative and preferred upbeat music. I have found that many people cannot start out with sedative music right away. It takes time to adjust your mood and stress level. I recommend that you start with preferred music with a moderate beat and intensity and then gradually change to more relaxing music. In this way you will be able to help yourself move in the preferred direction to a less anxious state.

3. Relaxation methods - Use breathing to induce a more relaxed state. Close your eyes and allow yourself to breathe normally, focusing on breathing in through your nose and out through your mouth. After your breathing has fallen into a natural rhythm, begin elongating the cycle by counting slowly to four on each inhale and exhale. Gradually count to higher numbers so that you have a deep breath happening on eight counts in and eight counts out. Once your breathing has slowed, begin relaxing muscle groups from your head to your feet by tensing and releasing one by one. Begin with your facial muscles by scrunching them up, holding for a moment, and then releasing. Feel the tension melt away and notice the difference in feeling between tense and relaxed states. As you work your way through a progressive muscle relaxation, be sure to drop your jaw so that it hangs loose and your tongue feels heavy and relaxed. If you are able to have a music therapist with you as a pre-op partner, then consider allowing the therapist to facilitate guided imagery to your music listening. Even without a music therapist you can imagine a peaceful place with pleasant scents and attractive sights and sounds.

Nuts and Bolts: How Music Works for Relaxation

Most people intuitively understand that music can play a powerful role in helping set the mood or reflecting our current state of feeling. Understanding some of the ways music accomplishes this will enable us to use music as a tool. Music as a tool to facilitate relaxation is effective for several definable reasons. I would like to outline some of these basic properties and functions of music as it is used to aid in relaxation.

In our fast-paced world finding time for relaxing has become a major priority. Sometimes we only have a small window of opportunity to try and wind down or take a short break. Music can help by facilitating induction to relaxation. Just as our attention is immediately turned towards finding the flag when we hear the National Anthem being played, selected music can shift our attention of focus away from the hustle and bustle and towards the purpose of relaxing. As our focus changes to listen to the music, the rhythm of the music begins to establish parameters for our breathing. Breathing is a major component for any relaxation protocol and one of the first things that we can control in trying to begin relaxing. Music may also begin to effect changes in the autonomic body systems including heart rate and blood pressure. Over time and practice, selected music can become a cue for relaxation, a conditioned stimulus that sets the mind and body onto a course for relaxation.

Once the direction has been established in inducing relaxation, music has an important role in maintaining the setting for relaxation to continue. The music holds the focus of attention and may mask unwanted environmental sounds. Appropriate music selections will assist in slowing breathing and taking deep breaths. The rhythm and constant underlying pulse of sedative music selections are mental guidelines for breathing and progressively relaxing each part of the body. Heart rate and other indicators should remain steady and at a reduced count, especially as repeated practice with the same or similar music has established a conditioned response. The music, especially a well chosen melody, may also lead to positive emotional associations and allow for feelings of self-worth and affirmations.

Music to help in relaxation is best used when combined with other relaxation methods and protocols. As previously outlined, music is a good cue for relaxation and framework for maintaining a relaxed state for a defined period of time. Techniques such as progressive muscle relaxation, deep breathing, circular breathing, imagery or biofeedback are extremely effective when used in conjunction with music. Experiment with different tempos, rhythms and melodies to gain the full advantage of using music to help structure the relaxation experience. An ascending and then descending melodic scale may lend itself to deep breathing, for example. Some melodies and instrumental arrangements can help set the stage for painting a mental picture of a beautiful nature scene where worries and stress can melt away.

Practice makes perfect!

Rock-a-bye Baby...A Guide to Sedative Music

Confusion abounds about what kind of music to use to aid in relaxation! I generally suggest using your preferred, sedative music. Finding your preferred music is not difficult, but finding sedative music that you like and music that is truly sedative will take some consideration. Relaxation will be much easier with a combination of sedative music that you enjoy.

Truly sedative music can be found by examining the rhythm, tempo, melody and dynamics in a given selection. Although these elements may change throughout a musical piece, the overall impression of each element should be similar, without abrupt changes or dramatic differences across the whole song. The tempo for sedative music is generally agreed upon to be between 60 to 80 beats per minute. The underlying rhythm and pulse at this tempo should be constant, without speeding up or slowing down. A repeating melodic pattern over this foundation is another key element. The melody can vary some for beauty and taste, but it should not contain unusually high or low notes and sudden changes in articulation, syncopation or untraditional leaps in pitch. The dynamics throughout the musical selection should be gently rising and falling, without dramatic swells or significantly soft or loud passages.

Beautiful music does exist within these parameters. Although music with these characteristics is usually a smaller section of a larger work or perhaps one song from an album of other selections that do not fit the requirements to be sedative music. The advent of Windows Media and other music file players has made things much easier in collecting an appropriate assortment of sedative music selections to use effectively in facilitating relaxation. While an entire symphony may not be a good choice, it is now possible to extract an appropriate Adagio section from a symphony and pair it with other sedative music selections in preparation for relaxing. Special care should be taken when using Adagio sections from symphonies since they are often written in minor keys with a melancholy mood. I suggest that the sedative music be chosen for its ability to uplift the spirit and create a sense of light and beauty. Two Adagio sections that work well are from Mozart's Sonata in E-flat and Henry Purcell's Adagio from the Fairy Queen. New Age artists such as Enya, Jim Brickman, George Winston and Yanni also have a variety of songs that fit into the category of sedative music.

So, find some sedative music that you like, turn off the phone, find a comfortable place to recline and take a deep breath...exhale slowly...

Music for the Heart: Instructions for self-guided relaxation

I have developed a program that I call, Music for the Heart. This program is centered around helping people who have had heart trouble or other cardiac related problems. The participants learn to use music as one of the tools to change their lifestyle in order to avoid future medical problems.

There is much new research about the role of mood and stress as it relates to recurrent heart attacks. Music is one tool that may help heart patients to manage stress and elevate their mood. I use a very simple set of instructions that I send home with clients after practicing relaxation techniques. There are many ways to use music to facilitate relaxation and this is just one example:

1. Find a place free of distraction from family, phones, etc.

2. Lie in bed or sit in a comfortable chair

3. Dim the lights and turn off the television

4. Turn on your preferred, soothing music

As you lie or sit quietly, begin to focus on your breathing. Naturally, your breath will slow down as you begin to focus on your exhales. As your breath slows down, let the weight of your body sink into the chair or bed. As you begin to feel more relaxed, imagine that you are riding down an escalator. At the bottom of the escalator is one of your favorite places in nature.

Imagine that you are walking around in this favorite place and notice all of the colors, sounds, and smells of your surroundings. Enjoy this place and the feelings of relaxation it brings you. You are moving freely and breathing easy in this place. Continue to relax and enjoy the music for a time. It is okay if you fall asleep. In fact, you may use this technique to help you fall asleep. When you are ready to return from this imagined place, slowly move your fingers and toes and return to an upright position.

Research: Title Page: The Effect of Preferred Sedative Music on the Anxiety of Patients During Pacemaker Implant Surgery and Heart Catheterization

The Effect of Preferred Sedative Music on the Anxiety of Patients During Pacemaker Implant Surgery and Heart Catheterization

by

Daniel B. Tague

B. A., Texas Tech University, 1994

Submitted to the Department of Music and Dance

and the Faculty of the Graduate School

of the University of Kansas

in partial fulfillment of the requirements for the degree of Master of Music Education (Music Therapy)

Thesis Committee:

_________________________

Chair

_________________________

_________________________

May, 2000

Date Defended

Research: Appendix: The Effect of Preferred Sedative Music on the Anxiety of Patients During Pacemaker Implant Surgery and Heart Catheterization

References

American Heart Association (1998). Medical procedures, facilities and costs [on-line]. Available: http://www.americanheart.org/Scientific/HSstats98/09medicl.html.

Augustin, P., & Haines, A. A. (1996). Effect of music on ambulatory surgery patient’s preoperative anxiety. AORN Journal, 63, 750-758.

Bolwerk, C. A. (1990). Effects of relaxing music on state anxiety in myocardial infarction patients. Critical Care Nursing Quarterly, 13, (2), 63-72.

Cheitlin, G. G., Epstein, C. A., Ferguson, F. C., Freedman, Hlatky, Naccarelli, Schlant, S. S., & Silka (1998). Journal of American College of Cardiology, 31, 1175-1209.

Chetta, H. D. (1981). The effect of music and desensitization on preoperative anxiety in children. Journal of Music Therapy, 28, 74-87.

Corah, N. L., Gale, E. N., Pace, L. F., & Seyrek, S. K. (1981). Relaxation and musical programming as means of reducing psychological stress during dental procedures. JADA, 103, 232-234.

Davis, C. A. (1992). The effects of music and basic relaxation instruction on pain and anxiety of women undergoing in-office gynecological procedures. Journal of Music Therapy, 29, 202-216.

Hanser, S. B. (1985). Music therapy and stress reduction research. Journal of Music Therapy, 22, 193-206.

Jiang, W., Babyak, M., Krantz, D. S., Waugh, R. A., Coleman, R. E., Hanson, M. M., Frid, D. J., McNulty, S., Morris, J. J., O’Connor, C. M., & Blumenthal, J. A. (1996). Mental stress induced myocardial ischemia and cardiac events. Journal of the American Medical Association, 275, 1651-1656.

Kaempf, G., & Amodei, M. E. (1989). The effect of music on anxiety. AORN Journal, 50, 112-118.

MacClelland, D. (1979). Music in the operating room. AORN Journal, 29, 252-260.

Metzler, R. K., & Berman, T. (1991). Selected effects of sedative music on the anxiety of bronchoscopy patients. In C. D. Maranto (Ed.), Applications of music in medicine (pp. 163-178). Silver Spring, MD: The National Association for Music Therapy.

Patel, C. (1993). Yoga-based therapy. In P. M. Lehrer & R. L. Woolfolk (Eds.), Principles and practice of stress management (2^nd ed.) (pp. 89-137). New York: Guilford Press.

Peretti, P. O., & Swenson, K. (1974). Effects of music on anxiety as determined by physiological skin responses. Journal of Research in Music Education, 22, 278-283.

Robb, S. L., Nichols, R. J., Rutan, R. L., Bishop, B. L., & Parker, J. C. (1995). The effects of music assisted relaxation on preoperative anxiety. Journal of Music Therapy, 32, 2-21.

Spielberger, C. D. (1983). Manual for the state-trait anxiety inventory. Palo Alto, CA: Consulting Psychologists Press.

Standley, J. M. (1996). Music research in medical/dental treatment: An update of a prior meta-analysis. In C. E. Furman (Ed.), Effectiveness of music therapy procedures: Documentation of research and clinical practice (2^nd ed.) (pp. 1-60). Silver Spring, MD: The National Association for Music Therapy.

Stein, A. M. (1991). Music to reduce anxiety during cesarean births. In C. D. Maranto (Ed.), Applications of music in medicine (pp. 163-178). Silver Spring, MD: The National Association for Music Therapy.

St. Jude Medical (1998a). Background information [on-line]. Available: http://www.sjm.com/stjude/patients/

htm/back.htm.

St. Jude Medical (1998b). Market analysis (9805020.DOC). Minneapolis, MN: Paul Levine.

St. Jude Medical (1998c). Pre-operative [on-line]. Available: http://www.sjm.com/stjude/patients/htm/

pre.htm.

Table 1

Mean Anxiety Scores Before and After Surgery for Pacemaker and Heart Catheterization Patients

_________________________________________________________

_________________________________________________________

Heart Catheterization M Control: n: 7 Pre: 29.71 Post: 31.29 Experimental: n: 8 Pre: 31.75 Post: 25.87

Pacemaker M Control: n:2 Pre: 40.00 Post: 34.00 Experimental: n:1 Pre: 51.00 Post: 30.00

_________________________________________________________

Note. The higher the score is, the greater the anxiety.

Appendix A

Consent Form

The Effect of Preferred Sedative Music on the Anxiety of Patients During Pacemaker Implant Surgery and Heart Catheterization

The Department of Art, Music Education and Music Therapy at the University of Kansas supports the practice of protection for human subjects participating in research. The following information is provided for you to decide whether you wish to participate in the present study. You should be aware that even if you agree to participate, you are free to withdraw at any time without penalty.

The purpose of this research is to attempt to decrease anxiety in patients undergoing pacemaker implant or heart catheterization surgery by providing them with preferred music to focus on during the procedure.

You will be asked to answer a set of questions directly before and after your surgery. This will take approximately ten minutes per set of questions. You may also be asked to choose a group of music selections which you will listen to during the surgery.

There are not documented risks to listening to music while undergoing surgery. Therefore, there are no foreseeable risks to you if you participate in this study. There are also no direct benefits to you for participating in this study.

Your participation is solicited although strictly voluntary. The records of this study will be kept private. Records will be kept in a secured file. Only researchers will have access to the records.

The researcher conducting this study is Daniel B. Tague. You may ask any questions you have now. If you would like additional information concerning this study before or after it is complete, please feel free to contact me by phone or mail.

Sincerely,

Daniel B. Tague Alicia Ann Clair, Ph. D.

Principle Investigator Faculty Supervisor

2435 Alabama St. AMEMT Dept.

Lawrence, KS 66046 311 Bailey Hall

(785) 331-3188 Lawrence, KS, 66045

(913) 864-4784

________________________________________

Signature of subject agreeing to participate

With my signature I affirm that I am at least 18 years of age and have received a copy of the consent form to keep.

Appendix B

Self-Evaluation Questionnaire

Directions: Answer each statement to indicate how you feel right now, that is, at this moment. There are no right or wrong answers. Give the answer which seems to describe your present feelings best.

Not at all = 1

Somewhat = 2

Moderately so = 3

Very much so = 4

1. I feel calm ........................ 1 2 3 4

2. I feel secure ...................... 1 2 3 4

3. I am tense ......................... 1 2 3 4

4. I feel strained .................... 1 2 3 4

5. I feel at ease ..................... 1 2 3 4

6. I feel upset ....................... 1 2 3 4

7. I am presently worrying over possible misfortunes

..............……………………………1 2 3 4

8. I feel satisfied ................... 1 2 3 4

9. I feel frightened .................. 1 2 3 4

10. I feel comfortable ................. 1 2 3 4

11. I feel self-confident .............. 1 2 3 4

12. I feel nervous ..................... 1 2 3 4

13. I am jittery ....................... 1 2 3 4

14. I feel indecisive .................. 1 2 3 4

15. I am relaxed ....................... 1 2 3 4

16. I feel content ..................... 1 2 3 4

17. I am worried ....................... 1 2 3 4

18. I feel confused .................... 1 2 3 4

19. I feel steady ...................... 1 2 3 4

20. I feel pleasant .................... 1 2 3 4

Appendix C

Music

Tape 1: New Age

1. Seasons: Sisters of Paradise, Guitar and Chamber Nouveau, Steven Pasero

2. Heart of Midnight (Original Soundtrack), Yanni, Carol’s Theme

3. Seasons: Silhouettes of Dawn

4. Rocky Mountain High: John Denver, Winter-Spring

5. Watermark: Enya, Watermark

6. Picture This: Jim Brickman, Sweet Dreams

7. Forest: George Winston, Walking on Air

8. Winter Solstice: Snow in the Prairies

9. Babies First Lullabies, Dance to Your Daddy

10. Red River Crossing: Marshall Styler, Red River Crossing

11. Red River Crossing: Marshall Styler, Ballad of Brenham Road

12. Meet Joe Black (Original Soundtrack): Meet Joe Black

13. Reflections of Passion: Yannie, A Word in Private

Tape 2: Easy Listening

1. Swinging on a Star: Bing Crosby, Moonlight Becomes You

2. Swinging on a Star: Bing Crosby, The Day After Forever

3. For Sentimental Reasons: Linda Ronstadt, You Go to My Head

4. Unforgettable Natalie Cole: You Go to My Head

5. Unforgettable Natalie Cole: Our Love is Here to Stay

6. Til Their Eyes Shine: Emmy Lou Harris, Child of Mine

7. Colors of the Day: Judy Collins, Since You Asked

8. Colors of the Day: Judy Collins, Who Knows Where the Time Goes

9. Colors of the Day: Judy Collins, In My Life

10. Come On Over: Shania Twain, You’ve Got a Way

Tape 3: Classical

1. The Harmonious Harp: Nicamer Zabaleta, Concerto for Harp and Orchestra in G major

2. Mozart Piano Sonatas: Adagio, Sonata in E-flat (partial)

3. Early Music: Henry Purcell, Adagio from the Fairy Queen

4. Eine Kleine Nachtmusik: Mozart, Andante K. 525

5. JS Bach: Air on a G String

6. Mozart Piano Sonatas: Andante Graziozo

7. Mozart Piano Sonatas: Sonata in E-flat, Adagio

8. Out of Africa: Mozart, Concerto for Clarinet and Orchestra in A

9. Out of Africa: Alone on the Farm

10. 101 Famous Classical Pieces: Brahms Lullaby, Cradle Song, Opus 49

11. JS Bach: Arioso in F

12. 101 Famous Classical Pieces; Sadie, Gymnopedie

13. Baby Sleep: Schumann, Scenes from childhood, Foreign Lands and People

14. JS Bach: Concerto in D minor, Siciliano

15. Meet Joe Black (Original Soundtrack): Track 3

16. Meet Joe Black (Original Soundtrack): Track 8